Cancer Control in Australia
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CANCER CONTROL in
AUSTRALIA
Institute of Cancer Research –
12 July 2010
Professor Jim Bishop AO
Chief Medical Officer
Australian Government Department of Health and Ageing
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Health Expenditure per capita, public and private expenditure, OECD countries, 2008 ($US PPP)
7538
5004
4627
42104079 4063 3970
3793 3737 3696 36773540 3470
3359 33533129 3060 3008 2902 2870
2729 2687 2683
2151
1801 1781 1737
14371213
999852 767
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
1. Refers to insured population rather than resident population. 2. Current expenditure. 3. 2006. 4. 2007. Source: OECD, OECD Health Data, June 2010
Public expenditure on health Private expenditure on health
OECD HEALTH DATA 2010How Does AUSTRALIA Compare
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AUSTRALIA’S RANKING AMONGOECD COUNTRIES 1987-2006
Source: AIHW Australia’s Health 2010
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SELF-ASSESSED PHYSICAL &MENTAL HEALTH, 2007
Source: AIHW Australia’s Health 2010
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BROAD CAUSE MORTALITY TRENDS AUSTRALIA
Source: AIHW
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Source: AIHW Australia’s Health 2010
AGED ADJUSTED DEATH RATESFrom CVD, 1907 -
2006
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All Cancer-
Mortality/Incidence ratios for selected countries -
2008
Source: IARC 2010.
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
Kenya
Nigeria
Egypt
Viet N
amTurk
eyInd
iaChinaRuss
iaSou
th Afric
aGreec
eBraz
ilJa
pan
Czech
Rep
ublic
Italy
United King
domCana
daGerm
any
Sweden
New Zealan
dUSA
Austra
liaM
orta
lity-
to-in
cide
nce
ratio
MalesFemales
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Changes in Deaths rates in Males using Joinpoint
Analysis
Source: Tracey et al –
Cancer Institute NSW
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Changes in Deaths Rates in Females Using Joinpoint
Analysis
Source: Tracey et al –
Cancer Institute NSW
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BREAST CANCER MORTALITY
NEJM 2005Source: NEJM 2005
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Cancers with reducing death rates 1997 to 2006 –
all ages
Lung, -18.5Colon, -19.6 Prostate, -19.7
Leukaemia, -23.7
Stomach, -29.4
Head and Neck, -23.7
Bladder, -18.5
Testicular, -42.2
Breast, -13.8
Cervix, -38.3
NHL, -25.1
Unknown, -24.8
Rectum, -19.9
Bowel, -19.7
All cancers, -13.8
, -24.3
-18.5
Kidney, -24.1
, -15.2
-31.9
, -21.1
-19.0-19.0
, -18.9
-7.9
-45
-40
-35
-30
-25
-20
-15
-10
-5
0
Male FemaleSource: Tracey et al, Cancer Institute NSW
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5 YEAR SURVIVAL RATES 2004
NSW
SEER
Non small cell lung 13% 14%
Colon 65% 67%
Rectum 66% 69%
Breast Cancer 89% 90%
Lymphoma (DL)
53% 53%
Source: Tracey et al –
Cancer Institute NSW
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Projected YLLs
–
Three scenarios, Australia –
1980 to 2016
Source: Bishop et al –
Cancer Institute NSW
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PROJECTED BURDEN of MAJOR DISEASE GROUPS, 2010
Source: AIHW Australia’s Health 2010
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TRENDS IN LEADING CAUSESOF DISEASE BURDEN 2003-2023
Source: AIHW Australia’s Health 2010
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Changes in Incidence Rates for all Cancer in
Males using Joinpoint
Analysis
Source: Tracey et al –
Cancer Institute NSW
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Changes in Incidence Rates in Females using Joinpoint
Analysis
Source: Tracey et al –
Cancer Institute NSW
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TRENDS IN CANCER INCIDENCE/DEATHS
1986
1996 2006All Cancers 53,888 79,169 104,592
Prostate
4,310 10,304 17,444CRC
8,018 10,871 13,591Breast
6,079 9,745 12,614Melanoma
4,710 7,819 10,326Lung
6,460 7,799 9,563
Incidence Rates* 394.7 461.6 480.4Death Rates* 209.2 202.1 179.1
* per 100,000
Source: AIHW: Australia’s Health 2010
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THE KEYS TO PREVENTION
0.0 2.0 4.0 6.0 8.0
Tobacco
Blood pressure
Overweight/obesity
Physical inactivity
Blood cholesterol
Alcohol
Fruit/vegetables
Illicit drugs
Air pollution
Unsafe sex
% DALYs
Total of 32%
Source: Table 4.1 AIHW Australia’s Health 2008
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AUSTRALIA’S RANKING AMONGOECD COUNTRIES 1987-2006
Source: AIHW Australia’s Health 2010
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SMOKING IN AUSTRALIA
SMOKINGSTATUS
NSW VIC QLD WA SA TAS ACT NT AUS
Daily 16.4 16.5 17.2 14.8 16.5 22.7 14.7 25.3 16.6
Weekly 1.2 1.5 1.4 1.2 1.5 0.6 0.9 1.2 1.3
Less than Weekly
1.4 1.7 1.3 1.4 1.8 1.6 1.6 1.3 1.5
Ex-smoker 24.7 24.4 25.7 28.3 24.1 26.5 24.8 22.4 25.1
Never smoked
56.3 55.9 54.5 54.3 56.2 48.6 57.9 49.8 55.4
National
Drug Strategy Household Survey 2007Source: 2007 Household Survey, Australian Government
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AUSTRALIA’S INITIATIVES IN
TOBACCO CONTROL
Advertising Bans
Under the counter at retail sites
Banning smoking in restaurants, pubs and cars
Graphic warnings on cigarette packets
Anti-tobacco campaigns
Increase in tobacco excise
Plain packaging
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Cost Effectiveness of Smoking Cessation pharmacotherapies in MALES
Source: Cancer Institute NSW
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COST BENEFIT ISSUES
Smoking cessation with drugs Cost effective <$30,000 per DALY Hazard ratios 1.5 –
2.5x “cold turkey”
Average of 5 years gained
Early detection and resection Adjuvant chemo $7,200/LYG Resection of Stage I costs 37% less than treating
advanced disease
Molecular targeted molecular in advanced NSCLC Many not yet cost effective
Source: Cancer Institute NSW
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OBESTITY INCREASING FOR ALL
Source: AIHW: Australia’s Health 2008
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Increased Risk Body Fatness OesophagusPancreasColorectalBreast (PM)Endometrum
Abnormal Fatness Colorectal
Reduced Risk Physical exercise Colon
World Cancer Research Fund: Food, nutrition, physical activity and prevention of cancer, 2007
OBESITY and CANCER
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NSW Population Age Distributions,
Males (1977-2036)
Source: Cancer Institute NSW
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Total Cancer Cases and Deaths per year (1972 to 2036)
Source: Cancer Institute NSW
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NSW Cancer Deaths, Major
Cancer Types (2007-2036)
Source: Cancer Institute NSW
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Modelling -
Cumulative Cancer Deaths from 2006 in NSW
2007 2016 2026 2036
All Cancer 13,456 145,659 310,959 497,122
Prostate 1,004 12,217 27,142 44,529
Colorectal 1,626 18,287 40,931 69,310
Breast 1,109 12,226 25,637 40,285
Lung 2.569 26.918 55.570 85.220
Melanoma 689 7,976 17,775 29,367
Source: Cancer Institute NSW
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The DIFFERENCE between localised & regional extent of disease at diagnosis
1%10%
1%11%
14%6%
23%23%26%
21%38%
28%24%
28%22%23%
29%20%21%21%
40%26%
33%9%
12%5%
0% 20% 40% 60% 80% 100% 120%
Pancreatic
Liver
Oesophageal
Lung
Gallbladder
Unknown
Stomach
Tongue
Mouth
Head and Neck
Bladder
Larynx
Small intestine
Connective tissue
All cancer
Cervix
Ovary
Large bowel
Colon
Rectal
Kidney
Uterine
Melanoma
Prostate
Breast
Thyroid
RegionalLocalised
Source: Tracey et al –
Cancer Institute NSW
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Milestones in Cancer Control
Public health measures in smoking reduction ,
screening breast, cervix, bowel, literacy
Adjuvant treatment of breast, lung and bowel cancer
New anti-cancer and symptom control drugs
Enhancement of cancer research
Data linkage and analysis
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NON-COMMERCIAL CANCER RESEARCH EXPENDITURE, 2004
(A$ per CAPITAL)
Source: Eckhouse
et al (2007), ABS
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CANCER PUBLICATIONS
Australia
Growth* World
AustralianShare
2000 1,881 5.6% 88,604 2.0%
2002 2,000 3.5% 97,035 2.1%
2004 2,514 19.0% 110.390 2.3%
2006 3,035 14.1% 125,934 2.4%__________________________________________________________________8 year period 17,917 70.4% 822,768 2.2%__________________________________________________________________* From pervious year
Source: Cancer Institute NSW 2008
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HEALTH REFORM
Increasing expenditure to $15 billion 2010/11
Additional $7.3 billion over 4 years
Local Hospital Networks (LHN) 60% Federal Funds (60% of research and teaching)
Medicare locals (100% Federal funds)
GP Superclinics
–
multi disciplinary teams (100% Federal Funds)
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Commonwealth Government Health and Hospital expenditure under the NHHN
Source: Commonwealth Budget Papers, DoHA
and PM&C Analysis
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HEALTH REFORM
KEY NEW STRUCTURES
National Health Performance Agency
National Pricing Authority
Expanded Australian Commission of Safety and Quality in Health Care (ACSQHC)
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AUSTRALIAN GOVERNMENT’S INITIATIVES IN CANCER CONTROL
Preventative Health Agency
Australian health Survey
Tobacco Control initiatives
Cancer funding $2 billion 09/10
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Four components run by ABS 2011-13
- Health Survey
-
ATSI Health Survey
-
Nutrition and Physical Activity Survey
-
Health measurement Survey
Around 50,000 participants
De-identified data available as summary statistics, tables
AUSTRALIAN HEALTH SURVEY
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Integrated Cancer Centre ($526m) –
Camperdown and Parkville
Regional Cancer Centres ($560m) –
20 sites
announced
Digitalization of breast screening services
Access to new anti-cancer drugs ($613m)
Amalgamation Cancer Australia and NBOCC Programs
AUSTRALIAN GOVERNMENT’S INITIATIVES IN CANCER CONTROL
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Cancer Control in Australia is successful by international measures with more needed
Research breakthroughs have delivered population mortality reductions
New research is needed in successful interventions for obesity, physical activity, diet and alcohol
Better methods of identifying susceptibility, early cancer and evidence-based interventions are urgently needed
CONCLUSIONS