Pancreatic Cancer in NSW · ICD-O-3 coding for tumour topography in the pancreas 43 Table A2...

Cancer Institute NSW Monograph

Pancreatic cancer in New South Wales

March 2010

Nicola Creighton, Deborah Baker, James F Bishop

00

Bowel Cancer in New South Wales

Cancer Institute NSW catalogue number: EM-2010-01

National Library of Australia cataloguing-in-publication data:

Pancreatic cancer in New South Wales

SHPN (CI) 100018

ISBN 978-1-74187-481-5

Key words: Pancreatic cancer, New South Wales, Australia

Suggested citation:

Creighton N, Baker D, Bishop J. Pancreatic cancer in New South

Wales. Sydney: Cancer Institute NSW, March 2010.

Published by the Cancer Institute NSW, March 2010.

Cancer Institute NSW

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Copyright © Cancer Institute NSW March 2010.

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other than those indicated above requires written permission

from the Cancer Institute NSW.

Cover image: Pancreatic cancer cell, coloured SEM.

1

Contents

Tables 3

Figures 5

Acknowledgements 6

Executive Summary 7

1 Introduction 8

2 Identifi cation and management 9

2.1 Anatomy and physiology of the pancreas 9

2.2 Pathology 11

2.3 Symptoms 12

2.4 Diagnosis and staging 12

2.5 Management of pancreatic cancer 14

3 Epidemiology of pancreatic cancer 15

3.1 Age 15

3.2 Gender 15

3.3 Lifestyle – smoking, alcohol, weight and diet 15

3.4 Pancreatic diseases 16

3.5 Genetics and family history 16

4 Methods 17

4.1 Cases 17

4.2 Population estimates 18

4.3 Age-standardised rates 18

4.4 Survival 18

4.5 Prevalence and projections 18

4.6 Data interpretation 19

5 Incidence and Mortality 20

5.1 Number of cases and deaths from

pancreatic cancer 20

5.2 Crude incidence and mortality rates of


5.3 Age-standardised incidence and mortality

rates of pancreatic cancer 21

5.4 Age-specifi c incidence and mortality

rates of pancreatic cancer 23

5.5 Median age at diagnosis and death 26

5.6 Incidence of pancreatic cancer by

histology type and tumour location 26

6 Trends in degree of spread and survival 28

6.1 Degree of spread at diagnosis 28

6.2 Survival of pancreatic cancer 29

7 Geographic patterns of pancreatic cancer 32

7.1 Incidence and mortality of pancreatic

cancer by accessibility and remoteness 32


cancer by Area Health Service 32


cancer in Australian states and territories 33

7.4 Global incidence and mortality of


7.5 National and international survival of


2

Pancreatic Cancer in New South Wales

8 Pancreatic cancer in sub-populations 38


cancer by socioeconomic status 38


cancer by country of birth 38

9 Prevalence and projections 40

9.1 Prevalence of pancreatic cancer 40

9.2 Projections for pancreatic cancer 40

10 Conclusions 42

11 Appendix 43

12 Glossary 44

13 Data tables 47

References 62

3

Tables

Tables

Table 1

Staging for exocrine pancreatic cancer 13

Table 2

New cases of pancreatic cancer in NSW,

persons, 1972–2006 47

Table 3


males, 1972–2006 48

Table 4


females, 1972–2006 49

Table 5

Deaths from pancreatic cancer in NSW,

persons, 1972–2006. 50

Table 6


males, 1972–2006 51

Table 7


females, 1972–2006 52

Table 8

Age-specifi c and age-standardised (ASR) incidence

rate (per 100,000) of pancreatic cancer in

persons, NSW, 1972–2006 53

Table 9



males, NSW, 1972–2006 54

Table 10



females, NSW, 1972–2006 55

Table 11

Age-specifi c and age-standardised (ASR) mortality


persons, NSW, 1972–2006 56

Table 12



males, NSW, 1972–2006 57

Table 13



females, NSW, 1972–2006 58

Table 14

Cases of pancreatic cancers by histological type

and age group,1972-2006, and the annual

age-standardised (ASR) incidence rate (per 100,000),

NSW, 2002–2006 59

Table 15

Incidence of pancreatic cancer by accessibility and

remoteness (ARIA+ category), NSW, 2002–2006 59

Table 16

Mortality from pancreatic cancer by accessibility and


Table 17

Incidence of pancreatic cancer by Area Health Service,

NSW, 2002–2006 60

Table 18

Mortality from pancreatic cancer by Area Health

Service, NSW, 2002–2006. 61

Table A1

ICD-O-3 coding for tumour topography

in the pancreas 43

Table A2

Histology groups by ICD-O-3 morphology codes 43

4


Figures

Figures

Figure 1

Anatomy of the pancreas and surrounding organs 9

Figure 2

New cases of pancreatic cancer, NSW, 1972–2006 20

Figure 3

Number of deaths from pancreatic cancer, NSW,

1972–2006 20

Figure 4

Crude incidence rate of pancreatic cancer, NSW,

1972–2006 21

Figure 5

Crude mortality rate of pancreatic cancer, NSW,

1972–2006 21

Figure 6

Age-standardised incidence and mortality rates for

pancreatic cancer, males, NSW, 1972–2006 22

Figure 7


pancreatic cancer, females, NSW, 1972–2006 22

Figure 8


pancreatic cancer, persons, NSW, 1972–2006 22

Figure 9

Number of new cases of pancreatic cancer

by age group, males and females, NSW, 1972–2006 23

Figure 10

Age-specifi c incidence rates of pancreatic cancer,

males and females, NSW, 2002–2006 24

Figure 11

Age-specifi c mortality rates of pancreatic cancer,

males and females, NSW, 2002–2006 24

Figure 12

Trends in age-specifi c incidence (solid line) and

mortality (dashed line) rates of pancreatic cancer

by fi ve-year periods, males, NSW 25

Figure 13

Trends in age-specifi c incidence (solid line) and

mortality (dashed line) rates of pancreatic cancer

by fi ve-year periods, females, NSW 25

Figure 14

Age-specifi c incidence rates of pancreatic cancer

by birth cohort, males, NSW 25

Figure 15

Age-specifi c incidence rates of pancreatic cancer

by birth cohort, females, NSW 25

Figure 16

Median age at diagnosis and death for pancreatic

cancer cases, males and females, NSW, 1972–2006 26

Figure 17

Tumour location in the pancreas, NSW, 2002–2006 27

Figure 18

Degree of spread of pancreatic cancer at diagnosis,

NSW, 1972–2006 28

Figure 19

Degree of spread at diagnosis, males and females,

NSW, 2002–2006 28

Figure 20

Five-year relative survival of pancreatic cancer by

gender, NSW, 1999–2003 29

Figure 21


degree of spread at diagnosis, NSW, 1999–2003 29

Figure 22

Five-year relative survival of pancreatic cancer

by age at diagnosis, NSW, 1999–2003 30

Figure 23


histology group, NSW, 1999–2003 30

Figure 24


period of diagnosis, NSW, 1980–2003 31

5

Figure 25

Age-standardised incidence and mortality rates

(± 95% CI) of pancreatic cancer by accessibility and


Figure 26


(± 95% CI) of pancreatic cancer by Area Health

Service, NSW, 2002–2006 33

Figure 27

Age-standardised incidence rates of pancreatic

cancer by state and territory, males and females,

2001–2005 34

Figure 28

Age-standardised mortality rates of pancreatic

cancer by state and territory, males and females, 1997–2001

34

Figure 29

Age-standardised incidence rates of pancreatic cancer,

males, worldwide, 2002 35

Figure 30

Age-standardised incidence rates of pancreatic cancer,

females, worldwide, 2002 35

Figure 31

Age-standardised mortality rates of pancreatic cancer,

males, worldwide, 2002 36

Figure 32

Age-standardised mortality rates of pancreatic cancer,

females, worldwide, 2002 36

Figure 33

National and international fi ve-year relative survival

(± 95% CI) of pancreatic cancer 37

Figure 34


(± 95% CI) of pancreatic cancer by socioeconomic

disadvantage, NSW, 2002–2006 38

Figure 35


(± 95% CI) of pancreatic cancer by country of birth,

NSW, 2002–2006 38

Figure 36


(± 95% CI) of pancreatic cancer by region of birth,

NSW, 2002–2006 39

Figure 37

Actual and projected cases of pancreatic cancer,

NSW, 1995–2012 40

Figure 38

Actual and projected deaths from pancreatic cancer,

NSW, 1995–2012 40

Figure 39

Population pyramid for NSW in 2006 and 2020 41

Figure 40

Actual and projected age-standardised incidence and

mortality rates for pancreatic cancer, males and

females, NSW, 1995–2012 41

Figure 41

Area Health Service boundaries in 2005 45

6


Acknowledgements

This report was made possible through the collaboration of many people within the Cancer Institute NSW and the NSW

Department of Health. We would particularly like to thank the NSW Central Cancer Registry (NSW CCR) staff for their hard

work in processing and coding the data as well as taking the time to explain the processes for coding cancer data. We appreciate

the cooperation of statutory notifi ers in the supply of notifi cations and the assistance of medical records personnel, clinicians and

pathologists in meeting requests for supplementary information. The NSW CCR is funded by the NSW Department of Health

and is managed by the Cancer Institute NSW under an agreement. The authors would like to thank Professor Andrew Biankin for

reviewing this report.

Mortality details are provided by the Registrar of Births, Deaths and Marriages (NSW). Population and demographic data, and

coded cause of death data are provided by the Australian Bureau of Statistics. Population and demographic data used in this report

were accessed via the Health Outcomes and Information Statistical Toolkit (HOIST). HOIST is a facility that enables data access,

analysis and reporting and was established and is operated by the Centre for Epidemiology and Research, Division of Population

Health, NSW Department of Health.

7

Executive Summary

In 2006, only 16.8 per cent of cases were diagnosed with cancer localised to the pancreas.

Over the past three decades the number of cases of pancreatic

cancer in New South Wales has approximately doubled

for males and nearly tripled for females. A similar pattern is

observed for deaths from pancreatic cancer. In 2006, pancreatic

cancer accounted for 2.2 per cent of all new cases of cancer.

Pancreatic cancer accounted for 5.4 per cent of all cancer deaths

and was the sixth most common cause of cancer mortality in

New South Wales in 2006.

Until 2000, the age-standardised incidence rate of pancreatic

cancer was declining in males but increasing by 0.7 per cent per annum in females. However since 2000, rates have increased by 1.8

per cent per annum in males and continued to increase at 0.7 per cent per annum in females.

The major risk factor for pancreatic cancer is age and, as with many cancers, the risk of developing pancreatic cancer increases

with age. Pancreatic cancer is uncommon in people under 50 years old. Age-specifi c incidence rates in 80–85-year-olds are 9.8 and

15.0 times higher in males and females respectively compared to 50–54-year-olds. There is very little variation in pancreatic cancer

incidence by demographic variables such as geographic location, socioeconomic status or country of birth.

Consistently, most cases of pancreatic cancer have been diagnosed at a distant degree of spread. In 2006, only 16.8 per cent of

cases were diagnosed with cancer localised to the pancreas. The majority (43.7% of cases) were diagnosed with distant spread or

secondary metastases and 13.4 per cent had regional spread outside the pancreas. Just over one quarter of cases (26.1%) were of

an unknown degree of spread.

Pancreatic cancer has a poor prognosis with very low survival. Most cases (75%) do not survive past one year, and the fi ve-year

relative survival for the 1999–2003 period was 7.2 per cent. Five-year relative survival has not improved signifi cantly since 1980.

There has been a slight but signifi cant increase in one-year survival from 19.3 per cent in the 1980–1983 period, to 24.6 per cent

in the 1999–2003 period. Even pancreatic cancers diagnosed with localised disease have a poor fi ve-year survival of 11.2 per cent.

Therefore, earlier detection of pancreatic cancers will have limited benefi t in improving the overall survival from pancreatic cancer.

The best hope lies with the development of new diagnostic methods to detect the pre-cursor cells to invasive cancer, and new

treatments for pancreatic cancer.

8


1 Introduction

This report identifi es trends in the incidence and mortality of pancreatic cancer over the past three decades in NSW.

Despite advances in treating many cancers, the outcome for

pancreatic cancer remains poor. Pancreatic cancer is the fi fth

most common cause of cancer death in Australia for males

and females and the eighth most common worldwide.1-2 It has

the worst survival of all the main cancer sites with a fi ve-year

relative survival of 4.6 per cent.1

The poor outcome of pancreatic cancer is primarily due to the

presentation of the disease at an advanced stage, aggressive

tumour biology and the lack of effective treatments especially

for localised disease. Symptoms for pancreatic cancer generally present when the tumour has invaded surrounding structures and

has metastasised. Less than 20 per cent of patients present with resectable pancreatic cancer.3 Even with surgery recurrence is

common and fi ve-year survival of resected patients is around 30 per cent or less.3-4 Adjuvant therapies may prolong survival but are

not curative.5-6 Standard adjuvant therapy regimes have not been established and are currently the subject of large clinical trials. To

make substantial improvements in the outcomes of pancreatic cancer patients a number of areas of research are being targeted.

These include molecular methods for the early detection of pancreatic cancer and more effective systemic therapies.7

In Australia, around 2200 cases of pancreatic cancer are diagnosed each year making it the 11th most common cancer.1 There is the

potential to reduce the incidence of pancreatic cancer as there are several modifi able risk factors. In particular, smoking increases

the risk of pancreatic cancer and is responsible for around 20–25 per cent of pancreatic cancers.1, 8 The evidence about the impact

of alcohol and diet on risk is less unequivocal. However, the greatest risk factor for pancreatic cancer is ageing. The incidence rate

of pancreatic cancer is around nine times higher in people aged 80–84 years compared to 50–54 years and less than 10 per cent of

cases occur in people under 50 years old.9-10 A family history of pancreatic cancer can also increase the risk of pancreatic cancer. A

hereditary component is present in around 5–10 per cent of pancreatic cancer cases.11-12

Progress has been made in understanding the mechanisms and events that lead to the initiation and progression of cancer in

pancreatic cells.13 Understanding the molecular mechanisms of pancreatic carcinogenesis will help to develop diagnostic biomarkers

and novel therapeutic agents. It will also help to identify the genetic and environmental interactions that increase the risk of

pancreatic cancer in individuals.

This report identifi es trends in the incidence and mortality of pancreatic cancer over the past three decades in New South Wales.

It also investigates variations in the incidence and mortality by age, geographic areas, socioeconomic status and country of birth.

Comparisons are made to the incidence and mortality in other Australian states and territories, and internationally. The survival of

pancreatic cancer by tumour characteristics is also examined. It is envisaged that this information will assist with the planning and

provision of services to better diagnose, treat and support people with pancreatic cancer in New South Wales.

9

2 Identifi cation and management

of pancreatic cancer2.1 Anatomy and physiology of the pancreas

2.1.1 Anatomy of the pancreas

The pancreas is located in the centre of the upper abdomen behind the peritoneum. It is surrounded by many important organs

and structures (Figure 1). It is typically 15–20 cm long, weighs 100–120 g and has a volume of 60-85 ml in an adult.14 The pancreas

can be divided into three sections – the head, body and tail. The head of the pancreas lies in the curve of the duodenum. Part of

the head, known as the uncinate process, wraps around the right side of the portal vein. The body of the pancreas is situated in

front of the abdominal aorta, portal vein and left kidney. The tail extends obliquely to under the hilum of the spleen.

The main pancreatic duct runs the length of the pancreas and is 2-3 mm in diameter. The main pancreatic duct merges at the

head of the pancreas with the common bile duct. The common bile duct runs in a deep groove along the head of the pancreas

before passing through the pancreatic tissue and draining into the duodenum. An accessory pancreatic duct drains the head of the

pancreas and enters the duodenum above the common bile duct.

Figure 1Anatomy of the pancreas and surrounding organs

Source: National Cancer Institute (www.visualsonline.cancer.gov)

10


The pancreas has a rich supply of blood. The head of the pancreas and the duodenum have a common blood supply from

pancreaticoduodenal arteries that originate from the trunk of the celiac artery. The body and tail of the pancreas are supplied with

blood by pancreatic arteries that emerge from the splenic and superior mesenteric arteries.15 The venous system of the pancreas

corresponds closely with the arterial system and drains into the portal, superior mesenteric and splenic veins.

The pancreas is drained by a large and diffuse network of lymph vessels and nodes.15 The pancreatic lymphatic system connects

with lymph nodes associated with the spleen and parts of the small and large intestine. Sympathetic and parasympathetic nerves

from branches of the vagal and splanchic nerves innervate cells in the pancreas. The pancreas also has a rich supply of afferent

nerves, responsible for carrying stimuli to the central nervous system.

The pancreas has a dual role as an organ of the digestive and the endocrine systems. The pancreatic juices that drain into the

duodenum are exocrine secretions whereas the hormones secreted into the blood are endocrine secretions. The exocrine and

endocrine functions of the pancreas take place in different types of cells in the pancreas.

2.1.2 The exocrine pancreas

Exocrine pancreatic cells make up approximately 85 per cent of the weight of the pancreas.15 They are grouped into clusters called

acini which are drained by a system of branching ducts that fl ow into the main pancreatic duct. Pancreatic juice contains digestive

enzymes and bicarbonate ions. The digestive enzymes are produced by acinar cells. The acinar cells release most enzymes into the

ducts in an inactive form. In a healthy pancreas, the inactive enzymes are only activated once they reach the small intestine which

prevents autodigestion of the pancreas. The enzymes break down proteins, fats and carbohydrates.

The acini are drained by short intercalated ducts which connect to collecting ducts. The intercalated ducts are lined by epithelial

cells which release bicarbonate ions into the pancreatic juice making it alkaline. The alkaline pancreatic juice neutralises acid from

the stomach, creating an optimum pH in the small intestine for the digestive enzymes to function. The exocrine pancreatic cells

are stimulated to increase the production of pancreatic juices in response to a meal through nerve and hormonal action.16 The

pancreas secretes about 500–800ml of pancreatic juice per day.15

2.1.3 The endocrine pancreas

Endocrine cells are embedded throughout the pancreas in groups called Islets of Langerhans. They are only about 2 per cent of the

volume of the pancreas and are highly vascularised.17 The main function of the endocrine pancreas is the homeostasis of glucose

through the secretion of the hormones insulin and glucagon. Approximately 75 per cent of the endocrine cells produce insulin

and are called beta cells. Glucagon is produced by alpha cells which are about 20 per cent of the endocrine cells. The remaining

endocrine cells produce somatostatin and pancreatic polypeptide which have generalised inhibitory effects on the pancreas and

gastrointestinal system.17

Insulin and glucagon have complementary roles in glucose homeostasis. The maintenance of optimal blood glucose concentration

and the supply of glucose to cells are controlled by the ratio of insulin to glucagon. The production of insulin is stimulated primarily

by elevated blood glucose. Elevated blood glucose typically occurs after a meal due to the digestion of carbohydrates. Hormones,

neurotransmitters and amino acids also have a role in stimulating insulin production.17 The uptake and storage of glucose by skeletal

muscle and adipose tissues is dependent on insulin. The binding of insulin to insulin-receptors on the cell membrane mobilises

glucose transporters which move glucose into the cells. Insulin mediates approximately 40 per cent of the glucose disposal in the

body.17 Insulin also regulates glucose metabolism in the liver. Liver cells take up glucose that is absorbed by the small intestine but

this uptake is not mediated by insulin. However, insulin promotes the storage of glucose as glycogen in the liver and also inhibits

the breakdown of glycogen into glucose. Insulin also has an important role in the metabolism of fatty acids and amino acids by

promoting their uptake and storage in muscle, liver and adipose tissues.

11

The role of glucagon in glucose homeostasis is to increase blood glucose concentration. Glucagon production by the pancreas is

stimulated by low blood glucose. The main site of action of glucagon is in the liver. Glugacon stimulates the breakdown of glycogen

into glucose and the production of glucose from non-carbohydrate sources (gluconeogenesis) by liver cells. Glucagon also promotes

the release of fatty acids from adipose tissues which can then be used as a fuel.

The effects of insulin are far-reaching. As well as the role of insulin in nutrient metabolism, insulin mediates vasodilation by

stimulating the release of nitric oxide in vascular endothelium. This increases glucose uptake in skeletal muscle. Insulin also

stimulates the production of vasoconstrictors. Insulin has an important role in cardiovascular physiology.18

2.2 Pathology

Most (>95%) pancreatic cancers originate in the exocrine pancreas. Around 90 per cent of all pancreatic cancers are ductal

adenocarcinomas which are thought to arise from pancreatic duct epithelia.6,19 Ductal adenocarcinomas have poor survival with

an overall fi ve-year survival of around 5 per cent.20 Less frequently occurring exocrine pancreatic cancer types include acinar cell

carcinomas and cystadenocarcinomas. Recognition of these different histological types of tumours is important since some have a

better prognosis than ductal adenocarcinomas. For example, cystadenocarcinomas and acinar cell carcinomas, which are less than 2

per cent of exocrine pancreatic cancers, have a fi ve-year survival of 47 per cent and 28 per cent respectively.20

There are currently three recognised types of non-invasive precursor lesions of invasive pancreatic cancer. Evidence for a disease

progression model for ductal adenocarcinomas is increasing.22-23 Normal duct epithelia progresses through three grades of

pancreatic intraepithelial neoplasia (PanIN) to invasive cancer. The three grades of PanIN have distinguishing hyperplastic and

dysplastic changes that are associated with characteristic genetic alterations. Early in the progression at PanIN-1, alterations in the

K-ras gene are common. Late in the progression at PanIN-3, the lesions have typically accumulated changes in the p53, BRCA2, p16,

mucin genes and various others.24 Currently, PanIN is only detectable microscopically. The other recognised precursors to invasive

pancreatic cancers are mucinous cystic neoplasms (MCNs) and intraductal papillary neoplasms (IPMNs). MCNs and IPMNs can be

detected macroscopically. Non-invasive MCNs can develop into invasive MCNs. IPMNs can develop into invasive ductal/tubular

adenocarcinomas or colloidal carcinomas.25 The early detection and treatment of these non-invasive lesions may prevent the

progression to invasive pancreatic cancer.25-26

Recent evidence suggests that pancreatic adenocarcinoma tumours contain a small percentage of cells known as cancer stem cells.27

It is believed that the cancer stem cells are responsible for tumour initiation, metastasis and resistance to current chemotherapy

and radiotherapy treatments. Understanding the mechanisms underlying their behaviour may lead to the development of new and

effective therapies for pancreatic cancer.27

Endocrine pancreatic cancers, also known as islet cell carcinomas, neuroendocrine carcinomas and carcinoid tumours, are rare

and make up less than 3 per cent of all pancreatic cancers.28-29 Endocrine pancreatic cancers can be functional, that is they produce

pancreatic hormones, or they are non-functional. The most common functional endocrine pancreatic cancers are insulinomas,

which are insulin producing tumours of beta cells. Most (85–90%) insulinomas are benign.29 Other pancreatic endocrine cancers

include glucagonomas, somatostatinomas and gastrinomas which produce glucagon, somatostatin and gastrin respectively. Around

40 per cent of endocrine pancreatic tumours are non-functional.30 Non-functional tumours have a high malignancy rate (90%).31

Patients with endocrine pancreatic cancers generally have better survival than patients with exocrine cancers with an overall fi ve-

year survival of around 40–60 per cent.20,32

Most pancreatic cancers are located in the head of the pancreas.19-20 Tumours occurring in the head of the pancreas are more likely

to obstruct the common bile duct and cause jaundice, which can lead to earlier detection.33 Tumours in the head of the pancreas

have a better one-year survival compared to tumours in the body and tail of the pancreas, although the survival advantage is not

present fi ve years after diagnosis.20

12


2.3 Symptoms

Pancreatic cancer usually presents clinical symptoms late in the course of the disease when the tumour is already advanced or has

spread beyond the pancreas. The main symptoms of pancreatic cancer are upper abdominal and back pain, jaundice, unexplained

weight loss, nausea, vomiting, steatorrhoea and malaise.6,33 Back pain is often severe and is generally an indication that the cancer

has invaded the retroperitoneum.6 Jaundice may be caused by the tumour obstructing the bile duct but may also indicate that the

cancer has metastatised to the liver.6 The duration of symptoms prior to diagnosis is generally around two–four months but ranges

from 0–36 months.33-35

The onset of diabetes often precedes a diagnosis of pancreatic cancer and is likely to be caused by the cancer. Approximately 40

per cent of pancreatic cancer patients have diabetes with more than half of these being diagnosed with diabetes in the two years

preceding the pancreatic cancer diagnosis.35 Pancreatic cancer can also cause an attack of acute pancreatitis.6,36

Functional endocrine pancreatic cancers can cause symptoms associated with the abnormally high levels of hormones. High levels

of insulin caused by insulinomas can cause hypoglycaemia and its associated problems including hunger, sweating, palpitations,

irritability and confusion.37 High glucagon levels caused by glucagonomas can cause diabetes, dermatitis, weight loss and anaemia.

The other types of functional endocrine cancers can also cause problems associated with the excessive secretion of its

particular hormone.

2.4 Diagnosis and staging

After the presentation of clinical symptoms suggesting pancreatic cancer, various imagining techniques may be used to identify

pancreatic tumours, to determine the extent of the tumour and to detect the presence of metastases. Computerised tomography

(CT) and magnetic resonance imaging (MRI) provide information on tumour extent, organ and vascular involvement, lymph node

metastases and hepatic metastases. CT and MRI can predict suitability for resection for large tumours but are less sensitive for

small tumours.6 CT is the primary method for evaluating resectability.38 Endoscopic ultrasound (EUS) is sensitive in detecting small

tumours and in determining the tumour spread. Laparoscopy may also be used to determine the extent of the tumour and the

presence of metastases. In some cases, endoscopic retrograde cholangiography (ERCP) may be used to visualise the ducts. The

information on the size, invasion of surrounding structures and the presence of metastases is used in staging the disease and in

determining if the patient is a candidate for surgical resection.

Tumour tissue samples can be taken at the time of diagnostic EUS, ERCP or laparoscopy, using fi ne needle aspiration or brush

cytology of the ducts. Biopsies may also be taken percutaneously under the guidance of CT or ultrasound, although this is not

generally recommended for patients with potentially resectable tumours.6,39 In patients with unresectable disease, tissue biopsies

can determine if the patient has a tumour type that has a better prognosis than ductal adenocarcinoma.6

There are no tumour-specifi c blood tests for pancreatic cancers,6 although biochemical tumour markers, in particular cancer

antigen 19-9 (Ca19-9), can be used in symptomatic patients to assist in distinguishing between benign and malignant tumours and

in determining suitability for tumour resection.40-41 However, due to the limited sensitivity and specifi city of Ca19-9 it must be used

alongside other diagnostic techniques in the diagnosis of pancreatic cancer.40,42

The American Joint Committee on Cancer (AJCC) has developed a classifi cation system for the staging of exocrine pancreatic

cancer.43 The TNM staging system describes the extent of the primary tumour (T), the extent of spread to lymph nodes (N) and

the presence of metastasis (M). The staging system is used to assess the resectability of pancreatic cancers, to provide information

on prognosis and to assign patients to clinical trials.

13

The T, N and M categories for exocrine pancreatic cancer are:

T0: No evidence of primary tumour

TX: Primary tumour cannot be assessed

Tis: Carcinoma in situ

T1: Tumour limited to the pancreas, greatest dimension 2cm or less

T2: Tumour limited to the pancreas, greatest dimension more than 2cm

T3: Tumour extends beyond pancreas but no involvement of the celiac axis or superior mesenteric artery

T4: Tumour extends beyond the pancreas and involves the celiac axis or superior mesenteric artery (unresectable primary tumour)

N0: No regional lymph node metastasis

N1: Regional lymph node metastasis

NX: Regional nodes cannot be assessed

M0: No distant metastasis

M1: Distant metastasis

MX: Distant metastasis cannot be assessed

The T, N and M categories are used to assign the following stages for exocrine pancreatic cancer (Table 1).

Table 1Staging for exocrine pancreatic cancer43

Stage Description Primary tumour Lymph nodes Distant metastases 5-year survival (%)*

Stage 0 Localised within the pancreas Tis N0 M0 –

Stage I A Localised within the pancreas T1 N0 M0 14

Stage I B Localised within the pancreas T2 N0 M0 12

Stage II A Locally invasive (resectable) T3 N0 M0 7

Stage II B Locally invasive (resectable) T1-3 N1 M0 5

Stage III Locally advanced (unresectable) T4 Any N M0 3

Stage IV Distant metastases Any T Any N M1 <1

*Survival is for resected and un-resected patients from Bilimoria et al. 2007.3

Borderline resectable pancreatic cancer is also a recognised stage in a clinical setting.26,44 Pancreatic cancer patients generally have

advanced disease at diagnosis. For patients on the National Cancer Database of the United States, the stage at diagnosis was 55 per

cent at stage IV, 13 per cent at stage III, 22 per cent at stage II and 10 per cent at Stage I.3

The European Neuroendocrine Tumour Society (ENETS) has proposed a similar TNM staging system for endocrine pancreatic

cancers that also incorporates the World Health Organization’s histological grading system.45 This staging system has yet to be

widely accepted and validated.32

14


2.5 Management of pancreatic cancer

Surgery is currently the only potential cure for pancreatic cancer.46 For patients with stage I pancreatic ductal adenocarcinoma, the

fi ve-year survival for resected patients is 25–30 per cent compared to <5 per cent for unresected patients.3,47 Pancreatic resection

also improves the survival of patients with endocrine pancreatic cancers. Median survival time for endocrine pancreatic cancer

increases from 21 to 97 months for patients who undergo resection.48 Generally less than 20 per cent of pancreatic cancer patients

undergo pancreatic resection. This is mainly due to the late presentation of the disease but may also be due to the advanced

age of most people diagnosed with pancreatic cancer and due to comorbidities.3,6,47 There is also overseas evidence that surgical

resection is under used in patients that could potentially benefi t.47 Historically, pancreatic resection had high perioperative mortality

and morbidity.46 However, specialist centres with a high volume of pancreatic resection cases can have low surgical mortality and

morbidity.49-51 Under use of pancreatic resection may refl ect a ‘nihilistic’ attitude towards pancreatic cancer.26,47

A commonly used surgical resection method is the pancreaticoduodenectomy, also known as the Whipple procedure. In this

procedure the head of the pancreas, the duodenum, part of the jejunum, the gall bladder and the distal half and the pylorus of

the stomach are removed. An alternative procedure is the pylorus-preserving pancreaticoduodenectomy in which no part of the

stomach is removed. The results from randomised clinical trials of these two surgical methods have not demonstrated a clear

advantage for one method compared to another.52 A less frequently performed surgery is the total pancreaticoduodenectomy,

which is similar to the pancreaticoduodenectomy but the whole pancreas and the spleen are also removed. Total

pancreaticoduodenectomy does not improve survival compared to the other procedures and can have serious nutritional and

metabolic complications.6,53

Survival for resectable pancreatic cancer can be improved with adjuvant chemotherapy or chemoradiotherapy. There is currently

no widely accepted standard adjuvant therapy as clinical trials have generally been small and the results mixed.4,6,38 Additional large

and high quality clinical trials are needed to determine the optimal adjuvant therapy. Neoadjuvant therapy for pancreatic cancer

is commonly used but has insuffi cient high level evidence and is therefore at an investigational stage.6,38 It is recommended that

adjuvant and neoadjuvant therapy be given as part of a clinical trial.6,38

The treatment of non-resectable and metastatic pancreatic cancer aims to relieve symptoms and prolong survival. Systemic therapy

may offer a modest improvement in survival. Gemcitabine has been accepted as the standard front-line therapy for patients with

metastatic disease.6,38 Obstructive jaundice is a common symptom in advanced pancreatic cancer that may be improved by stenting

or bypass surgery.4,6 Jaundice may be a major obstacle to the delivery of effective palliative chemotherapy. Advanced pancreatic

cancer is often associated with intense pain. A celiac nerve block can be performed to relieve pain if systemic analgesics are

inadequate. Patients may also experience malabsorption of nutrients due to insuffi cient pancreatic enzymes. These symptoms can

be relieved by the administration of pancreatic enzyme supplements. The poor survival outcomes provide an incentive to re-

double research efforts into better therapies for this cancer.

15

3 Epidemiology of pancreatic cancer

3.1 Age

The risk of pancreatic cancer increases with ageing. The risk of a 40 year old developing pancreatic cancer before turning 50 is one

in 2500. The risk of an 80 year old developing cancer before turning 90 is nearly 16 times higher at one in 161.10 Pancreatic cancer is

uncommon in people aged under 50 years with less than 10 per cent of cases diagnosed in people aged under 50 years.9

3.2 Gender

Males have an approximately 30 per cent higher incidence rate of pancreatic cancer after adjusting for differences in age.1,10 The

lifetime (0–74 years) risk of being diagnosed with pancreatic cancer in Australia is one in 125 for males and one in 184 for females.1

The higher rate of pancreatic cancer in males is most likely due to the higher proportion of smokers and ex-smokers in males.

There is no strong evidence that hormonal and reproductive factors infl uence the risk of pancreatic cancer in females.54-56

3.3 Lifestyle – smoking, alcohol, weight and diet

Apart from age, smoking is the strongest risk factor for pancreatic cancer. Smoking increases the risk of pancreatic cancer by

around 74 per cent.8 Ex-smokers have an increased risk of pancreatic cancer for at least 10 years after stopping.8 Approximately

20–25 per cent of pancreatic cancers are attributable to cigarette smoking.1,8

Alcohol consumption has been found to have an inconsistent effect on the risk of pancreatic cancer. Some studies have not

found an association between alcohol consumption and risk of pancreatic cancer.57-58 Other studies have found that heavy alcohol

consumption causes a modest increase in the risk of pancreatic cancer.12,59-60 However, since smoking rates are generally higher

amongst people with high alcohol consumption, smoking can be a confounding effect in studies examining the effect of alcohol on

the risk of pancreatic cancer. Also, heavy consumption of alcohol increases the risk of chronic pancreatitis and diabetes which are

also linked to an increased risk of pancreatic cancer (see 3.4).61-62

There is evidence that excess body mass increases the risk of pancreatic cancer. Studies have found around a 20–70 per cent

increased risk of pancreatic cancer for obese people (Body Mass Index >30).63-66 Some studies have not found an effect

of obesity.67-69

The evidence for the effect of diet on pancreatic cancer risk is mixed. High consumption of red meat has been shown to increase

risk in some studies, particularly for men, 70–71 but not in another.72 High vegetable, fruit and whole grain consumption has been

found to be protective in some studies21,73 but not others.72,74 There is evidence that dietary folate reduces the risk of pancreatic

cancer.75-76

The World Cancer Research Fund and the American Institute for Cancer Research have recently evaluated the evidence for the

effect of diet, body mass and physical activity on the risk of pancreatic cancer.77 They consider that there is convincing evidence

that higher body fatness increases the risk of pancreatic cancer and that there is limited but suggestive evidence that red meat is

associated with increased pancreatic cancer risk. They also conclude that there is probable evidence that foods containing folate

decrease the risk of pancreatic cancer and that there is limited but suggestive evidence that fruits and physical activity decrease the

risk. The limited availability of evidence meant that they did not make a conclusion on the effect of other dietary components such

as vegetables, cereals and alcohol on the risk of pancreatic cancer.77 They suggested that low to moderate alcohol consumption was

unlikely to affect risk, but they could not exclude heavy alcohol consumption as a risk factor for pancreatic cancer.

16


3.4 Pancreatic diseases

Diagnosis with acute, recurrent or chronic pancreatitis is a risk factor for pancreatic cancer. The risk of being diagnosed with

pancreatic cancer is highest in the one–four years after the diagnosis of pancreatitis but diminishes over time.12,78-79 Diagnosis

with chronic pancreatitis has a greater risk of pancreatic cancer than acute pancreatitis. Patients diagnosed with acute or chronic

pancreatitis are around two and 22 times respectively more likely to develop pancreatic cancer in the one–four years after

diagnosis of pancreatitis.79 In general, patients with chronic pancreatitis are more likely to be heavy smokers and heavy drinkers

which may account for the increased risk.12,79 However, 10–24 years after pancreatitis diagnosis there is no statistically signifi cant

increased risk of pancreatic cancer.79 The incidence of acute pancreatitis in Western countries is between 10–40 cases per 100,000

people per year.80 The annual incidence of chronic pancreatitis is estimated to be around six cases per 100,000 people in

European countries.36

Diagnosis with diabetes is also a risk factor for pancreatic cancer. Diabetes diagnosis is usually in the two years preceding pancreatic

cancer diagnosis.12,35,81 In most pancreatic cancer patients with new-onset diabetes, the diabetes is likely to be caused by the

tumour. The risk of being diagnosed with pancreatic cancer is four times higher in the year following diabetes diagnosis.12 The risk

of pancreatic cancer diagnosis declines in the years following diabetes diagnosis. However, 10 years after a diagnosis of diabetes

the risk of pancreatic cancer remains elevated which suggests that diabetes is an independent risk factor for pancreatic cancer.12,82

Approximately 700,000 Australians, 3.6 per cent of the population, were estimated to have diabetes in 2004–05 which is more

than double the proportion in 1989–90.83

3.5 Genetics and family history

There are a number of recognised hereditary syndromes or diseases that are associated with pancreatic cancer (ductal

adenocarcinomas). They are responsible for around 5–10 per cent of all pancreatic cancers.11-12 They include:11, 84

• Peutz-Jeghers syndrome

• Familial atypical multiple mole melanoma (FAMMM)

• Cystic fi brosis

• Hereditary pancreatitis

• Hereditary non-polyposis colorectal cancer

• Familial breast cancer (BRCA1 and BRCA2 genes)

• Familial adenomatous polyposis

• Ataxia telangiectasia

• Li-Fraumeni syndrome

Familial pancreatic cancer (FPC) is also recognised as a distinct hereditary syndrome but the genetic defect responsible has not

been identifi ed.11 People with FAMMM, Peutz-Jeghers syndrome, hereditary pancreatitis and FPC have a risk of pancreatic cancer

more than 10 times higher than the general population.84

People with multiple endocrine neoplasia type 1 (MEN1) and von Hippel-Lindau syndrome are at increased risk of endocrine

pancreatic cancers.85-87

For people with a family history of pancreatic cancer, smoking further increases the risk of pancreatic cancer.12,88-89

17

4 Methods

4.1 Cases

Cases were selected from the New South Wales Central Cancer Registry (NSW CCR) based on the International Classifi cation

of Diseases for Oncology, 3rd edition (ICD-O-3) topography code for tumours of the pancreas C25 (See Appendix). Notifi cation

of invasive cancer cases to the NSW CCR by public and private hospitals, pathology laboratories, radiation oncology departments,

outpatient departments, day procedure centres and nursing homes has been a statutory requirement in New South Wales since

1972. Data in this report were extracted from the NSW CCR as of September 2008 and contain cases diagnosed to the end of

2006. Some changes may occur in the data between extraction dates from the NSW CCR due to changes in coding, addition of

further information or delayed registration of cases.

4.1.1 Cancer Incidence

Cancer incidence refers to new cases diagnosed in a given population during a specifi ed period. The incidence data in this report

are based on cancer cases diagnosed from 1972 to 2006 in New South Wales residents.

4.1.2 Cancer Mortality

Cancer mortality refers to deaths from cancer in a given population occurring in a specifi ed period. These cancers may have

been diagnosed during or before the period. The mortality data in this report are based on persons who were diagnosed with

pancreatic cancer while residing in New South Wales and died of that cancer between 1972 and 2006. Cases that died from

pancreatic cancer after migrating to other Australian states and territories are included in this report. Cases that died overseas are

lost to follow-up.

4.1.3 Degree of spread

Degree of spread was based on the spread at fi rst presentation and indicates the maximum extent of the cancer within four

months of the date of diagnosis. It is derived by the NSW CCR from the maximum extent of disease from all reports and

notifi cations dated within four months of the date of diagnosis. Degree of spread reported here follows the international

coding guidelines for summary stage adopted by several international groups including the World Health Organization and

the International Association of Cancer Registries.90 Extent is classifi ed as local, regional, distant and unknown. Local cases are

predominantly Stage I and some Stage II, regional are predominantly Stage II and some Stage III and distant are some Stage III but

predominantly Stage IV (See 2.4).

4.1.4 Area Health Service and accessibility and remoteness

Cases were allocated to the 2006 Australian Standard Geographical Classifi cation (ASGC) Statistical Local Areas (SLAs)91 and the

2005 Area Health Services (AHS) based on residential address at the time of diagnosis. Individuals may not necessarily be treated

in the AHS to which they are allocated.

This report uses the Accessibility/Remoteness Index for Australia (ARIA+) which is endorsed by the Australian Bureau of Statistics

(ABS) as a standard measure of remoteness.92 The ARIA+ values were assigned to the case and death data using a population

weighted concordance for the SLAs produced by the ABS based on the 2006 census. Cases and deaths were categorised as being

from ‘Major Cities’, ‘Inner Regional’, ‘Outer Regional’, ‘Remote’ and ‘Very Remote’ areas using the standard ARIA+ cut-off values

used by the ABS (see Glossary). The ‘Remote’ and ‘Very Remote’ areas were combined due to the small number of cases and

deaths in these areas. Analyses in this report use case and death data from the period 2002–2006.

18


4.1.5 Socioeconomic status

Socioeconomic status was estimated using the Index of Relative Socio-Economic Disadvantage (IRSD), one of four Socio-Economic

Indexes for Areas (SEIFA) created by the ABS (see Glossary).93 The IRSD index for each SLA was assigned to each case and death

using the census undertaken closest to the time of diagnosis or death. The IRSD index for each SLA is categorised into population-

weighted quintiles. Analyses in this report use case and death data from the period 2002-2006.

4.1.6 Country of birth

Country of birth was aggregated into the main English speaking countries (New Zealand, the United Kingdom, the Republic of

Ireland, the United States of America, Canada and South Africa), non-English speaking countries and Australia. Region of birth was

also analysed by grouping countries using the Standard Australian Classifi cation of Countries (SACC).94 While country of birth is

routinely collected in the NSW CCR, under ascertainment of migrant status is possible, particularly for notifi cations by pathology

laboratories. Analyses in this report use case and death data from the period 2002-2006. During this period, 2.4 per cent of cases

(n=90) and 1.6 per cent of deaths (n=52) had an unknown country of birth.

4.2 Population estimates

Estimated residential populations for New South Wales, Area Health Services, Statistical Local Areas, as well as on the basis

of accessibility and remoteness (ARIA+), socioeconomic status (IRSD) and country of birth were obtained from the ABS via

the Health Outcomes and Information Statistical Toolkit (HOIST) maintained by the NSW Department of Health. Population

estimates used 2006 census data and were mid-year population estimates.

4.3 Age-standardised rates

Directly age-standardised rates were calculated using fi ve-year age groups and standardised using the Australian 2001 Standard

Population produced by the ABS. Rates were also standardised to the World Health Organization (WHO) 2000 World Standard

Population for comparison with global rates of pancreatic cancer (see 7.4). Age-standardisation eliminates the effect that a changing

population age structure has on rates. Where rates are calculated for fi ve-year periods (e.g. 2002–2006), the reported rate is the

rate per 100,000 person-years at risk. Trends over time in the age-standardised incidence and mortality rates of pancreatic cancer

were analysed using a joinpoint model in the Joinpoint Regression Program version 3.3.95-96

4.4 Survival

The fi ve-year relative survival of pancreatic cancer patients was estimated using the multiple-year cohort method.97-98 Cases

that had not been matched to a death record in the National Death Index (maintained by the Australian Institute of Health and

Welfare) were censored at the end of 2004. Cases that had been notifi ed by death certifi cate only were excluded from analysis.

Estimates of the population survival rates were from the New South Wales Life Tables for 2002–2004 produced by the ABS.99

Five-year relative survival by gender, age at diagnosis, stage at diagnosis and histology was estimated using cases diagnosed between

1999 and 2003 with follow-up to the end of 2004. Changes in relative survival over time were calculated using cases diagnosed

between 1980 and 2003.98

4.5 Prevalence and projections

The 25-year limited duration prevalence was defi ned as the number of people alive at 31 December 2004 who had been

diagnosed with pancreatic cancer between 1980 and 2004. The age-standardised fi ve-year prevalence estimates used cases

19

diagnosed in the 5 years prior to 31 December 2004 and is standardised to the Australian 2001 Standard Population. The

prevalence estimates in this report are taken from Tracey et al. 2007.100 Prevalence estimates include persons that migrated out of

New South Wales after diagnosis.

The projected number of pancreatic cancer cases and deaths for 2007–2012 were estimated using Nordpred, which is an age-

period-cohort model for the prediction of cancer incidence and mortality.101 This method assumes that historical trends in

incidence and mortality will continue in the future.

4.6 Data interpretation

Although all care was taken in the calculations for this report, the numbers of cases are subject to change due to revisions made

by the NSW CCR. This is due to routine data cleaning and quality assurance, as well as adjustments with the availability of new

information. As a result, fi gures in this report may differ slightly to those in other reports. Estimated populations are updated, which

means that rates may differ slightly from values in other reports.

20


5 Incidence and Mortality

5.1 Number of cases and deaths from pancreatic cancer

The total number of pancreatic cancer cases from 1972 to 2006 was 17,975 (Table 2). There were 9,336 cases in males and 8,639

cases in females (Tables 3 and 4). The annual number of cases of pancreatic cancer has approximately doubled for males and nearly

tripled for females between 1972 and 2006 (Figure 2).

In 2006, there were 762 cases of pancreatic cancer diagnosed in New South Wales residents. Of these, 49.7 per cent of cases were

male and 50.3 per cent of cases were female. Pancreatic cancer represented 2.2 per cent of all new cancers diagnosed and the 10th

most common cancer overall in New South Wales in 2006.102 In males, pancreatic cancer was 1.9 per cent of all cancers diagnosed

and the 11th most common cancer. In females, pancreatic cancer was 2.5 per cent of all cancers diagnosed and the 10th most

common cancer.

The total number of pancreatic cancer deaths from 1972 to 2006 was 16,321 (Table 5). There were 8,435 male deaths and 7,886

female deaths (Tables 6 and 7). The annual number of deaths from pancreatic cancer has approximately doubled for males and

nearly tripled for females between 1972 and 2006 (Figure 3).

In 2006, there were 706 deaths from pancreatic cancer in people that were diagnosed while residing in New South Wales. Of

these, 48.9 per cent of deaths were male and 51.1 per cent of deaths were female. Deaths from pancreatic cancer were 5.4 per

cent of all cancer deaths and the sixth most common cause of cancer mortality in New South Wales in 2006. In males, pancreatic

cancer was 4.7 per cent of all cancer deaths and the fi fth most common cause of cancer mortality. In females, pancreatic cancer

was 6.2 per cent of all cancer deaths and the fi fth most common cause of cancer mortality.

0

100

200

300

400

500

600

700

800

900

FemalesMalesPersons

20052000199519901985198019751970

Num

ber

of n

ew c

ases

Year

Figure 2New cases of pancreatic cancer, NSW, 1972–2006

Figure 3Number of deaths from pancreatic cancer, NSW, 1972–2006

0

100

200

300

400

500

600

700

800

FemalesMalesPersons

20052000199519901985198019751970

Year

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eath

s

21

5.2 Crude incidence and mortality rates of pancreatic cancer

The crude incidence rate of pancreatic cancer has steadily increased since 1972 for both males and females, with a greater increase

in the female rate (Figure 4, Tables 8–10). The female crude incidence rate was approximately 25 per cent lower than the male rate

in the early 1970s, but since the 1990s the male and female rates have followed a similar pattern. In 2006, the crude incidence rate

of pancreatic cancer was 11.2 new cases per 100,000 persons, which is an increase of at least 50 per cent since the early 1970s.

Changes in the crude incidence rates refl ect changes in population characteristics such as the ageing of the New South Wales

population as well as changes in exposure to pancreatic cancer risk factors such as smoking.

The crude mortality rates from pancreatic cancer follow a similar pattern to the crude incidence rates of pancreatic cancer due to

the poor survival from this cancer (Figure 5, Tables 11–13). There has been a greater increase in the female crude mortality rate

compared to the male rate between 1972 and 2006. In 2006, there were 10.4 deaths per 100,000 people.

Figure 4Crude incidence rate of pancreatic cancer, NSW, 1972–2006

Figure 5Crude mortality rate of pancreatic cancer, NSW, 1972–2006

0

2

4

6

8

10

12

14

FemalesMalesPersons

20052000199519901985198019751970

Year

Inci

denc

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te (

per

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000)

0

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4

6

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10

12

FemalesMalesPersons

20052000199519901985198019751970

Years

Mor

talit

y ra

te (

per

100,

000)

5.3 Age-standardised incidence and mortality rates of pancreatic cancer

The age-standardised incidence rate of pancreatic cancer in males decreased signifi cantly (p<0.001) by 0.7 per cent (95% CI 0.4–

1.0) per year between 1972 and around 2000. Since 2000, the incidence rate in males has increased signifi cantly (p<0.05) by 1.8

per cent per year (95% CI 0.01–3.5) (Figure 6, Table 9). For females, the age-standardised incidence rate has increased signifi cantly

(p<0.001) since 1972 by 0.7 per cent per year (95% CI 0.4–1.0) (Figure 7, Table 10). Overall, the age-standardised incidence rate in

persons increased between 1972 and 2006 but this increase is not statistically signifi cant (p=0.1) (Figure 8, Table 8).

Between 2002 and 2006, there was a signifi cant increase in the male and female age-standardised pancreatic cancer incidence rate.

For this period, the average annual percentage change (AAPC) was 1.8 per cent (95% 0.1–3.5) for males and 0.7 per cent (95% CI

0.4–1.0) for females. In 2006, the age-standardised incidence rate (per 100,000) of pancreatic cancer was 11.4 (95% CI 10.3–12.6)

for males and 9.2 (95% CI 8.3–10.2) for females. The age-standardised incidence rate for persons was 10.2 (95% CI 9.5–11.0) cases

per 100,000.

After adjusting for differences in age, males are more likely to be diagnosed with pancreatic cancer. Between 2002 and 2006, the

incidence rate of pancreatic cancer was 20–35 per cent higher in males compared to females.

22


The trends in age-standardised pancreatic cancer incidence are

likely to refl ect the changes in tobacco smoking in New South

Wales. Although without data on smoking status for pancreatic

cancer cases this is not certain. The trends in pancreatic cancer

follow a similar pattern to the trends observed in lung cancer

incidence rates. The age-standardised incidence rate of lung

cancer has decreased in males and increased in females over

the last 35 years.102 In New South Wales, smoking rates in males

have been decreasing since the mid 1940s, whereas smoking

rates in females were increasing until the mid 1970s and have

since been decreasing.103 Due to the lag between tobacco

exposure and cancer incidence, the effect of the decreased

risk of cancer due to decreased smoking prevalence in the

female population is not yet apparent in cancers that are in part

attributable to cigarette smoking. The reason for the increase

in pancreatic cancer in males since 2000 is unknown, but may

be related to changes in other risk factors for pancreatic cancer

(see section 3). As the prevalence of smoking continues to

decline, the effect of other risk factors on the epidemiology of pancreatic cancer in New South Wales will become

increasingly important.

The age-standardised mortality rate of pancreatic cancer in males decreased signifi cantly (p<0.001) between 1972 to around 2001

by 1.1 per cent per year (95% CI 0.7–1.4). Since 2001, the rate has increased by 2.1 per cent per year (95% CI -1.0–5.3) although

this increase is not statistically signifi cant (p=0.2) (Figure 6, Table 12). For females, the age-standardised mortality rate of pancreatic

cancer increased signifi cantly (p<0.05) by 0.4 per cent per year (95% CI 0.03–0.7) since 1972 (Figure 7, Table 13). Overall, the age-

standardised mortality rate in persons decreased signifi cantly (p<0.01) by 0.4 per cent per year (95% CI 0.1–0.7) between 1972

Figure 6Age-standardised incidence and mortality rates of pancreatic cancer, males,

NSW, 1972–2006

Figure 7Age-standardised incidence and mortality rates of pancreatic cancer, females,

NSW, 1972–2006

0

2

4

6

8

10

12

14

16

MortalityIncidence

20052000199519901985198019751970

Year

Rat

e (p

er 1

00,0

00 p

opul

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n)

0

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6

8

10

12

MortalityIncidence

20052000199519901985198019751970

Year

Rat

e (p

er 1

00,0

00 p

opul

atio

n)

Figure 8Age-standardised incidence and mortality rates of pancreatic cancer, persons,

NSW, 1972–2006

0

2

4

6

8

10

12

MortalityIncidence

20052000199519901985198019751970

Year

Rat

e (p

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23

and around 2003 (Figure 8, Table 11). There was a large (4.7%) increase in the mortality rate in persons between 2003 and 2006

although this increase is not statistically signifi cant (p=0.2).

Between 2002 and 2006, the AAPC in the age-standardised mortality rates of pancreatic cancer was 2.1 per cent (95% CI

-0.9–5.1) in males, 0.4 per cent (95% CI 0.04–0.7) in females and 3.4 per cent (95% CI -1.3–8.3) in persons. In 2006, the age-

standardised mortality rate (per 100,000) of pancreatic cancer was 10.5 (95% CI 9.4–11.6) for males and 8.6 (95% CI 7.8–9.6) for

females. The age-standardised mortality rate for persons was 9.4 (95% CI 8.8–10.2) deaths per 100,000.

After adjusting for differences in age, males are more likely to die from pancreatic cancer. Between 2002 and 2006, the mortality

rate of pancreatic cancer was 15–40 per cent higher in males compared to females.

The similarity between the incidence and mortality rates is an indication of the poor survival of pancreatic cancer. However, the

mortality to incidence ratio has decreased since 1972, which suggests that survival has improved slightly over the past 30 years.

5.4 Age-specifi c incidence and mortality rates of pancreatic cancer

5.4.1 Age-specifi c incidence and mortality rates, 2002–2006

Pancreatic cancer is uncommon in people under 50 years old. For males, 5.7 per cent of cases were in men under 50 years and

38.5 per cent in men over 75 years. For females, 4.4 per cent of cases were in women under 50 years and 54.0 per cent were in

women over 75 years. There are approximately double the number of females 85 years or older that are diagnosed with pancreatic

cancer compared to males (Figure 9). However, males have a higher incidence rate than females due to the larger population of

older females.

The risk of pancreatic cancer increases with age (Figure 10). The age-specifi c incidence rate for the 80–84 year age group

compared to the 50–54 year age group is 9.8 and 15.0 times higher for males and females respectively. The lifetime risk (0–74

years) of being diagnosed with pancreatic cancer is one in 123 for males and one in 169 for females based on the age-specifi c rates

for the 2002–2006 period. The lifetime risk (0–84 years) of

being diagnosed with pancreatic cancer is one in 63 for males

and one in 77 for females. The age-specifi c mortality rates

follow a similar pattern to the incidence rates (Figure 11).

Between 2002 and 2006, the age-specifi c mortality rate for the

80–84 year age group compared to the 50–54 year age group

was approximately 10.9 and 17.3 times higher for males and

females respectively.

The lifetime risk (0–74 years) of dying from pancreatic cancer

is one in 149 for males and one in 207 for females based on

the age-specifi c rates for the 2002–06 period. The lifetime risk

(0–84 years) of dying from pancreatic cancer is one in 72 for

males and one in 87 for females.

0

50

100

150

200

250

300

350

400

FemalesMales

85+

80

-84

75-7

9

70

-74

65-6

9

60

-64

55-5

9

50

-54

45-4

9

40

-44

35-3

9

30

-34

25-2

9

20

-24

15-1

9

10-1

4

5-9

0-4

Age group (years)

Num

ber

of c

ases

Figure 9Number of new cases of pancreatic cancer by age group, males and females,

NSW, 1972–2006

24


Figure 10Age-specifi c incidence rates of pancreatic cancer, males and females,

NSW, 2002–2006

Figure 11Age-specifi c mortality rates of pancreatic cancer, males and females,

NSW, 2002–2006

0

20

40

60

80

100

120

140

FemalesMales

85+

80

-84

75-7

9

70

-74

65-6

9

60

-64

55-5

9

50

-54

45-4

9

40

-44

35-3

9

30

-34

25-2

9

20

-24

15-1

9

10-1

4

5-9

0-4

Age group (years)

Inci

denc

e ra

te (

per

100,

000)

0

20

40

60

80

100

120

FemalesMales

85+

80

-84

75-7

9

70

-74

65-6

9

60

-64

55-5

9

50

-54

45-4

9

40

-44

35-3

9

30

-34

25-2

9

20

-24

15-1

9

10-1

4

5-9

0-4

Age group (years)

Mor

talit

y ra

te (

per

100,

000)

5.4.2 Age-specifi c incidence and mortality rates by period

The age-specifi c incidence and mortality rates of pancreatic cancer by fi ve-year age groups and fi ve-year periods are shown in

Figures 12 and 13. The decline in the male age-standardised incidence and mortality rates from 1972 to around 2000 (section 5.3)

appears to be due to a decline in the rates for men aged 50–74 years. The incidence and mortality rates decreased by around

20–30 per cent and 30–40 per cent respectively in males aged 50–74 years between 1972 and 2001. The mortality rate for males

75–79 years old also decreased but incidence has fl uctuated. There is no clear trend for the incidence and mortality rates for males

80 years and older between 1972 and 2006.

The increase in the female age-standardised incidence and mortality rates (section 5.3) appears to be due largely to the increase in

the rates in women aged 75 and older. Between 1972 and 2006, the age-specifi c incidence and mortality rates for females 85 years

and over have increased by around 60 per cent. The incidence and mortality rates for females aged 75–79 years increased by at

least 20 per cent. The incidence rate for 70–74 year old females increased by around 20 per cent but the mortality fl uctuated. The

incidence and mortality rates for females 65–69 years old have increased slightly and for females 50–64 years old have remained

relatively stable between 1972 and 2006.

5.4.3 Age-specifi c pancreatic cancer incidence rates by birth cohort

The age-specifi c incidence rates of pancreatic cancer by fi ve-year age groups and fi ve-year birth cohorts were calculated for males

and females (Figure 14 and 15). For males, the longitudinal incidence rates follow a similar pattern for each cohort. For females,

there is a trend for later cohorts to have a greater risk of pancreatic cancer in older age groups, particularly from 75 years of age

and onwards.

25

Figure 12Trends in age-specifi c incidence (solid line) and mortality (dashed line) rates of

pancreatic cancer by fi ve-year periods, males, NSW

Figure 13Trends in age-specifi c incidence (solid line) and mortality (dashed line) rates of

pancreatic cancer by fi ve-year periods, females, NSW

0

10

20

30

40

50

60

70

80

90

100

2002-

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1997-

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1992-

1996

1987-

1991

1982-

1986

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1981

1972-

1976

Period

Rat

e (p

er 1

00,0

00)

85+

80–84

75–79

70–74

65–69

60–64

55–59

50–54

0

20

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60

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100

120

140

2002-

2006

1997-

2001

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1996

1987-

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1982-

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1972-

1976

Period

Rat

e (p

er 1

00,0

00)

85+

80–84

75–79

70–74

65–69

60–64

55–59

50–54

Figure 14Age-specifi c incidence rates of pancreatic cancer by birth cohort, males, NSW

Figure 15Age-specifi c incidence rates of pancreatic cancer by birth cohort, females, NSW

1

10

100

1,000

40–44 45–49 50–54 55–59 60–64 65–69 70–74 75–79 80–84 85+

Inci

denc

e ra

te (

per

100,

000)

Age group

1885 –18891890 –18941895 –18991900 –19041905 –19091910 –19141915 –19191920 –19241925 –19291930 –19341935 –19391940 –19441945 –19491950 –19541955 –19591960 –1964

1

10

100

40–44 45–49 50–54 55–59 60–64 65–69 70–74 75–79 80–84 85+

Inci

denc

e ra

te (

per

100,

000)

Age group

1885 –1889

1890 –1894

1895 –1899

1900 –1904

1905 –1909

1910 –1914

1915 –1919

1920 –1924

1925 –1929

1930 –1934

1935 –1939

1940 –1944

1945 –1949

1950 –1954

1955 –1959

1960 –1964

26


5.5 Median age at diagnosis and death

The median age at diagnosis and death for pancreatic cancer has

increased for both males and females between 1972 and 2006

(Figure 16). The median age at death is within two years of the

median age of diagnosis for males and females. The similarity

between median age at diagnosis and death indicates that

survival from pancreatic cancer is very poor.

The median age at diagnosis for males was 66 years in the early

1970s and has increased to 71 years in 2006. The median age

at diagnosis for females was around 70 in the early 1970s and

was 76 in 2006. The increase in the median age of diagnosis and

death refl ects the ageing of the New South Wales population.

The percentage of the population over 70 years old has

doubled between 1972 and 2006.

5.6 Incidence of pancreatic cancer by histology type and tumour location

5.6.1 Histological types of pancreatic cancers

Adenocarcinomas and carcinoma/malignant neoplasms were 42.2 per cent and 48.4 per cent respectively of all pancreatic cancers

diagnosed in New South Wales between 1972 and 2006 (Table 14). There are a large number of pancreatic cancers assigned to

the non-specifi c group of carcinoma/malignant neoplasm as these were mostly diagnosed clinically. Histological examination was not

conducted for 45 per cent of all pancreatic cancer cases. See Appendix for details on histology groups.

Mucinous adenocarcinomas and undifferentiated carcinomas were 2.5 per cent and 3.0 per cent of all cases respectively between

1972 and 2006. Cancers of the endocrine pancreas were 1.6 per cent of all pancreatic cancers diagnosed between 1972 and 2006.

Under ascertainment of the rarer tumour types is likely since not all tumours have histopathology performed and due to non-

specifi c pathology reports particularly prior to electronic notifi cations to the NSW CCR.

Endocrine pancreas and papillary tumours are more common in younger people, with 29 per cent and 23 per cent respectively

occurring in people under 50 years of age. Only 7.1 per cent and 2.4 per cent of adenocarcinomas and carcinoma/malignant

neoplasms respectively were diagnosed in people under 50 years.

The annual age-standardised incidence rate between 2002 and 2006 of adenocarcinomas and carcinoma/malignant neoplasms was

4.6 and 4.9 per 100,000 persons respectively (Table 14). The incidence rates of the rare histological groups of pancreatic cancers

were 0.2 per 100,000 persons or lower.

60

62

64

66

68

70

72

74

76

78

80

Death - males

Diagnosis - males

Death - females

Diagnosis - females

20052000199519901985198019751970

Year

Med

ian

age

(yea

rs)

Figure 16Median age at diagnosis and death for pancreatic cancer cases, males and

females, NSW, 1972–2006

27

0

5

10

15

20

25

30

35

40

45

50

Not

otherwise

specified

Over-

lapping

lesion

Other

specified

parts

Islets of

Langer-

hans

Pacreatic

duct

TailBodyHead

Location of tumour

Perc

enta

ge

5.6.2 Location of tumours in the pancreas

Pancreatic cancers were most commonly located in the head of the pancreas (45%) in cases diagnosed between 2002 and 2006,

although 41 per cent of tumours did not have a specifi ed location (Figure 17). Of pancreatic tumours, 6 per cent and 4 per

cent were in the tail and body respectively. The remaining 4 per cent of tumours were located in the pancreatic ducts, Islets of

Langerhans, other specifi ed parts or were overlapping lesions.

Figure 17Tumour location in the pancreas, NSW, 2002–2006

28


6 Trends in degree of spread and survival

6.1 Degree of spread at diagnosis

6.1.1 Trends in degree of spread at diagnosis

Since 1972, most cases of pancreatic cancer have been diagnosed at a distant degree of spread (Figure 18). Between 1993 and 1998

there is an artefact in the reporting of the degree of spread at diagnosis due to the introduction of electronic notifi cations of cancer

cases to the NSW CCR. This affects the percentage of cases classifi ed as local and unknown spread during this period.104 Apart

from the period affected by the artefact, the percentage of cases diagnosed with local degree of spread has remained relatively

stable since 1972. Since 1986, the percentage of cases diagnosed at a regional and unknown degree of spread has remained

relatively stable (apart from the artefact period).

In 2006, 43.7 per cent of cases were diagnosed with distant spread, 13.4 per cent with regional spread, 16.8 per cent with local and

26.1 per cent with unknown spread.

6.1.2 Degree of spread at diagnosis by gender

Between 2002 and 2006, the percentage of pancreatic cancers with local spread at diagnosis was slightly higher in females (19%)

than males (16%) (Figure 19). Males had a higher percentage of pancreatic cancer cases with distant spread (43%) compared

to females (36%). However, females had more cases with an unknown degree of spread (29%) compared to males (24%). The

percentage of pancreatic cancer cases diagnosed at a regional degree of spread was similar for males (16%) and females (15%).

Figure 18Degree of spread of pancreatic cancer at diagnosis, NSW, 1972–2006

0

5

10

15

20

25

30

35

40

45

50

Unknown

Distant

Regional

Local

20052000199519901985198019751970

Year

Perc

enta

ge

0

5

10

15

20

25

30

35

40

45

50

FemalesMales

UnknownDistantRegionalLocal

Degree of spread at diagnosis

Perc

enta

ge

Figure 19Degree of spread at diagnosis, males and females, NSW, 2002–2006

29

6.2 Survival of pancreatic cancer

6.2.1 Relative survival by gender

Survival from pancreatic cancer is very poor. Overall, between 1999 and 2003 around 75 per cent of people did not survive

beyond one year after diagnosis (Figure 20). The fi ve-year survival for this period was 7.2 per cent (95% CI 5.9–8.4). Survival from

pancreatic cancer was not signifi cantly different for males and females. The fi ve-year relative survival for males was 6.4 per cent

(95% CI 4.7–8.2) and for females was 7.9 per cent (95% CI 6.1–9.6).

6.2.2 Relative survival by degree of spread at diagnosis

Five-year relative survival from pancreatic cancer is affected by the degree of spread at diagnosis (Figure 21). Pancreatic cancer

cases diagnosed between 1999 and 2003 with a distant degree of spread had signifi cantly worse survival compared to cases with

local, regional and unknown degree of spread at diagnosis.

The fi ve-year relative survival from pancreatic cancer with distant spread was 2.7 per cent (95% CI 1.5–3.9). There was no

statistically signifi cant difference in survival of cases diagnosed with local, regional or unknown degree of spread. The fi ve-year

relative survival was 11.2 per cent (95% CI 7.7–14.8), 9.6 per cent (95% CI 6.3–13.0) and 9.0 per cent (95% CI 6.2–11.8) for local,

regional and unknown degree of spread at diagnosis respectively.

Years since diagnosis

Rel

ativ

e su

rviv

al (

%)

FemaleMale

0 1 2 3 4 50

10

20

30

40

50

60

70

80

90

100

Figure 20i

Five-year relative survival of pancreatic cancer by gender,

NSW, 1999–2003


Rel

ativ

e su

rviv

al (

%)

UnknownDistant

RegionalLocal

0 1 2 3 4 50

10

20

30

40

50

60

70

80

90

100

Figure 21i

Five-year relative survival of pancreatic cancer by degree of spread at diagnosis,

NSW, 1999–2003

i. Source: Tracey et al. 2007.98

30


6.2.3 Relative survival by age at diagnosis

Survival from pancreatic cancer decreases with increasing age (Figure 22), particularly in the fi rst two years after diagnosis. People

diagnosed with pancreatic cancer at 80 years and older have signifi cantly worse one-year relative survival of 13.7 per cent (95% CI

11.2–16.3) compared to all younger age groups. The one-year relative survival for the 15–49, 50–59, 60–69 and 70–79 age groups

is 41.6 (95% CI 33.9–49.3), 36.5 per cent (95% CI 31.5–41.6), 29.4 per cent (95% CI 26.1–32.8) and 22.8 per cent (95% CI 20.3–

25.4) respectively.

People diagnosed with pancreatic cancer in the youngest age group (15–49 years) have a fi ve-year relative survival of 20.3 per cent

(95% CI 13.3–27.3), which is signifi cantly better than all older age groups. The fi ve-year relative survival of the older age groups is

not statistically signifi cantly different to each other. The fi ve-year relative survival of people in the 50–59, 60–69, 70–79 and 80+

age groups is 8.2 per cent (95% CI 4.8–11.7), 6.8 per cent (95% CI 4.4–9.2), 6.2 per cent (95% CI 4.3–8.1) and 5.9 per cent (95% CI

2.9–9.0) respectively.

6.2.4 Relative survival by histology type

The histological type of the pancreatic cancer signifi cantly affects survival (Figure 23). The fi ve-year relative survival from endocrine

tumours was 39.5 per cent (95% CI 25.3–53.6) for cases diagnosed between 1999 and 2003. Exocrine pancreatic cancers had

signifi cantly worse survival than endocrine cancers of the pancreas. Adenocarcinomas had a fi ve-year survival of 4.5 per cent (95%

CI 3.0–6.1). Carcinoma/malignant neoplasms had a fi ve-year survival of 6.1 per cent (95% CI 4.4–7.8).

Cancers with all other histology types had signifi cantly better survival compared to other exocrine pancreatic cancers with a fi ve-

year relative survival of 22.4 per cent (95% CI 15.0–29.7). See Appendix for details on histology groups.

In this analysis (which excludes cases notifi ed at death), 91.1 per cent of cases were adenocarcinomas and carcinoma/malignant

neoplasms. Endocrine tumours were 2.3 per cent of the cases and 6.6 per cent were other histology types.

80+ years70-79 years

60-69 years50-59 years15-49 years


Rel

ativ

e su

rviv

al (

%)

0 1 2 3 4 50

10

20

30

40

50

60

70

80

90

100

Figure 22Five-year relative survival of pancreatic cancer by age at diagnosis,

NSW, 1999–2003

Figure 23Five-year relative survival of pancreatic cancer by histology group,

NSW, 1999–2003

Carcinoma/malignant neoplasmAdenocarcinoma

All other histologyEndocrine tumour


Rel

ativ

e su

rviv

al (

%)

0 1 2 3 4 50

10

20

30

40

50

60

70

80

90

100

31

6.2.5 Relative survival by period of diagnosis

Overall, fi ve-year relative survival of pancreatic cancers by period of diagnosis has not improved signifi cantly between 1980 and

2003 (Figure 24).98 Five-year relative survival was 6.2 per cent (95% CI 4.8–7.6) in the 1980–1983 period and 7.2 per cent (95%

CI 5.9–8.4) in the 1999–2003 period. One-year relative survival from pancreatic cancer has improved slightly. One-year relative

survival was 24.6 per cent (95% CI 23.0–26.1) in the 1999–2003 period, which is statistically signifi cantly greater than 19.3 per cent

(95% CI 17.3–21.4) in the 1980–1983 period.

Figure 24i

Five-year relative survival of pancreatic cancer by period of diagnosis, NSW, 1980–2003

i. Source: Tracey et al. 2007.98

1999-20031994-1998

1989-19931984-19881980-1983


Rel

ativ

e su

rviv

al (

%)

0 1 2 3 4 50

10

20

30

40

50

60

70

80

90

100

32


7 Geographic patterns of pancreatic cancer

Here, geographic patterns of pancreatic cancer are measured by the Accessibility/Remoteness Index for Areas (ARIA+) and in

Area Health Services (AHS), states and territories and internationally. It is important to measure the patterns of cancer in different

geographic areas, as there may be disparities in access to services, screening programs and prevention initiatives.

7.1 Incidence and mortality of pancreatic cancer by accessibility and remoteness

After adjusting for differences in age, the

incidence rate of pancreatic cancer in New

South Wales did not vary signifi cantly by

accessibility and remoteness (Figure 25, Table

15). The age-standardised incidence rates of

pancreatic cancer in persons living in major

cities, inner regional, outer regional and

remote/very remote areas were 10.4 (95% CI:

10.0–10.9), 9.8 (95% CI 9.2–10.5), 10.3 (95% CI

9.1–11.5) and 13.2 (95% CI 8.5–19.6) cases per

100,000 respectively. There were less than 30

cases of pancreatic cancer in people residing in

remote and very remote areas of New South

Wales between 2002 and 2006.

After adjusting for differences in age, the mortality rate from pancreatic cancer in New South Wales did not vary signifi cantly by

accessibility and remoteness (Figure 25, Table 16). The age-standardised mortality rates of pancreatic cancer in persons living in

major cities, inner regional, outer regional and remote/very remote areas were 9.0 (95% CI 8.6–9.4), 8.8 (95% CI 8.2–9.5), 8.8 (95%

CI 7.8–10.0) and 11.8 (95% CI 7.4–17.8) deaths per 100,000 respectively.

7.2 Incidence and mortality of pancreatic cancer by Area Health Service

After adjusting for differences in age, incidence rates of pancreatic cancer for males, females and persons did not vary signifi cantly

by Area Health Service (Figure 26, Table 17). For males, the age-standardised incidence rate ranged from 10.1 (95% CI 8.4–12.0)

cases per 100,000 in the Greater Southern AHS to 13.1 (95% CI 11.6–14.6) cases per 100,000 in the Sydney South West AHS. For

females, the age-standardised incidence rate ranged from 7.8 (95% CI 6.6–9.2) cases per 100,000 in the North Coast AHS to 9.9

(95% CI 8.4–11.7 and 8.7–11.3) cases per 100,000 in the Greater Southern and Sydney West AHS respectively.

After adjusting for differences in age, mortality rates from pancreatic cancer did not vary signifi cantly by Area Health Service

(Figure 26, Table 18). The mortality rates follow a similar pattern to the incidence rates. For males, the age-standardised mortality

rate ranged from 9.0 (95% CI 7.4–10.9) deaths per 100,000 in the Greater Southern AHS to 11.1 (95% CI 9.8–12.5) deaths per

100,000 in the Sydney South West AHS. For females, the age-standardised mortality rate ranged from 6.9 (95% CI 5.7–8.2) deaths

per 100,000 in the North Coast AHS to 9.1 (95% CI 7.6–10.8) deaths per 100,000 in the Greater Southern AHS.

0

4

8

12

16

20

MortalityIncidence

Remote and

Very Remote

Outer

Regional

Inner

Regional

Major

Cities

NSW

Rat

e (p

er 1

00,0

00)

Figure 25Age-standardised incidence and mortality rates (± 95% CI) of pancreatic cancer by accessibility and

remoteness (ARIA+ category), NSW, 2002–2006

33

0 2 4 6 8 10 12 14

MortalityIncidence

Greater Western

Greater Southern

North Coast

Hunter & New England

Nothern Sydney & Central Coast

Sydney West

South Eastern Sydney & Illawarra

Sydney South West

NSW

Rate (per 100,000)

Figure 26Age-standardised incidence and mortality rates (± 95% CI) of pancreatic cancer by Area Health Service, NSW, 2002–2006

7.3 Incidence and mortality of pancreatic cancer in Australian states and territories

Between 2001 and 2005, the age-standardised incidence rate of pancreatic cancer was lower in females than males in all states

and territories (Figure 27). In this period, the incidence of pancreatic cancer in New South Wales was similar to the incidence for

Australia. The age-standardised incidence rate in males was 11.4 and 11.2 cases per 100,000 in New South Wales and Australia

respectively. The incidence rate ranged from 8.4 per 100,000 in the ACT to 11.6 per 100,000 in Victoria.

In females, the age-standardised incidence rate was 8.8 cases per 100,000 in New South Wales and Australia. The incidence rate

ranged from 6.1 per 100,000 in the Northern Territory to 9.1 per 100,000 in Victoria and Western Australia.

Between 1997 and 2001, the mortality rates from pancreatic cancer in New South Wales were similar to most other states

and territories in Australia (Figure 28).9 The mortality rate of pancreatic cancer was lower in females than males in all states and

territories except for the Northern Territory. The female mortality rate in the Northern Territory is substantially higher than

both the male and female rates in the other states and territories. However, the average annual number of female deaths from

pancreatic cancer in the Northern Territory between 1997 and 2001 is less than fi ve.9 Therefore this result should be interpreted

with caution.

For males, the age-standardised mortality rate ranged from 9.0 deaths per 100,000 in the Northern Territory to 11.1 deaths per

100,000 in Victoria. For females, the age-standardised mortality rate ranged from 7.7 deaths per 100,000 in South Australia to 15.7

deaths per 100,000 in the Northern Territory.

34


Figure 27ii

Age-standardised incidence rates of pancreatic cancer by state and territory, males and females, 2001–2005

0

2

4

6

8

10

12

14

FemalesMales

AustNTACTTasSAWAQldVicNSW

State/Territory

Inci

denc

e ra

te (

per

100,

000)

ii. Source: AIHW 2008.1

iii. Source: AIHW 2004.9

Figure 28iii

Age-standardised mortality rates of pancreatic cancer by state and territory, males and females, 1997–2001

0

2

4

6

8

10

12

14

16

FemalesMales

NTACTTasSAWAQldVicNSW

State/Territory

Mor

talit

y ra

te (

per

100,

000)

7.4 Global incidence and mortality of pancreatic cancer

Between 2002 and 2006, the incidence rate of pancreatic cancer in New South Wales standardised to the WHO 2000 World

Standard Population was 7.8 (95% CI 7.6–8.3) and 6.1 (95% CI 5.8–6.4) cases per 100,000 for males and females respectively. The

incidence of pancreatic cancer in New South Wales was similar to the rates in North America and Europe for males and females

(Figure 29 and 30).

Between 2002 and 2006, the mortality rate of pancreatic cancer in New South Wales standardised to the WHO 2000 World

Standard Population was 6.8 (95% CI 6.4–7.1) and 5.2 (95% CI 5.0–5.5) deaths per 100,000 for males and females respectively.

Worldwide, mortality from pancreatic cancer (Figure 31 and 32) follows a similar pattern to incidence.

35

Figure 29iv

Age-standardised incidence rates of pancreatic cancer, males, worldwide, 2002

iv. Source: Ferlay et al. 2004.106

During this period the incidence rates in New South Wales and Australia were higher than in most developing countries. This may

be due to the under-reporting of cancers in the developing world,105 as well as due to differences in exposure to risk factors for

pancreatic cancer.

Figure 30iv

Age-standardised incidence rates of pancreatic cancer, females, worldwide, 2002

36


v. Ferlay et al. 2004.106

Figure 31v

Age-standardised mortality rates of pancreatic cancer, males, worldwide, 2002

Figure 32v

Age-standardised mortality rates of pancreatic cancer, females, worldwide, 2002

37

7.5 National and international survival of pancreatic cancer

The survival of pancreatic cancer is universally poor (Figure 33). The fi ve-year relative survival estimates use different periods of

diagnosis, follow-up times and slightly different analytical methods. This means that comparisons between the values are indicative

only. The results suggest that survival of pancreatic cancer in New South Wales is good relative to other countries and Australia.

However, with less than 10 per cent of people surviving fi ve years after diagnosis of pancreatic cancer throughout the world, there

is a great need to make substantial improvements in the outcomes of this cancer.

Figure 33National and international fi ve-year relative survival (± 95% CI) of pancreatic cancer

0 2 4 6 8 10 12

Denmark

Finland

Netherlands

UK - Northern Ireland

Sweden

UK - Scotland

UK - England

Switzerland

Norway

Australia

Australia - South Australia

Austraila - Victoria

USA - SEER

Poland

Spain

New Zealand

UK - Wales

Germany

Canada

Italy

Australia - Queensland

Japan

Ireland

Austria

Australia - New South Wales

France

Czech Republic

Portugal

Belgium

Relative Survival (%)

Sources: European countries: Sant et al. 2009.107 USA: Ries et al. 2008.10 Canada: Canadian Cancer Society’s Steering Committee 2009.108 Japan: Tsukuma et al. 2006.109 New

Zealand: New Zealand Health Information Service 2006.110 Australia: AIHW and AACR 2008.1 Queensland: Youlden, Bade and Coory 2005.111 Victoria: English et al. 2007.112

South Australia: South Australian Cancer Registry 2007.113

38


8 Pancreatic cancer in sub-populations

8.1 Incidence and mortality of pancreatic cancer by socioeconomic status

Between 2002 and 2006, the incidence of

pancreatic cancer did not vary signifi cantly by

level of socioeconomic disadvantage (Figure

34). However, there was a trend for people

in the most disadvantaged quintile to have

a higher incidence rate than people in the

least disadvantaged quintile with an age-

standardised incidence rate of 11.3 (95% CI

10.5–12.1) and 9.9 (95% CI 9.2–10.6) cases per

100,000 respectively.

Between 2002 and 2006, the mortality

rate from pancreatic cancer did not vary

signifi cantly by level of socioeconomic

disadvantage (Figure 34). Similar to the

incidence rates, there was a trend for people

in the most disadvantaged quintile to have a

higher mortality rate than people in the least disadvantaged quintile. The age-standardised mortality rate in people from the most

and least disadvantaged quintiles was 9.7 (95% CI 8.9–10.5) and 8.5 (95% CI 7.8–9.2) deaths per 100,000 respectively.

8.2 Incidence and mortality of pancreatic cancer by country of birth

8.2.1 Incidence and mortality by language

Between 2002 and 2006, the age-standardised

incidence of pancreatic cancer in people from

non-English speaking countries of birth was

10.8 cases per 100,000 (95% CI 10.1–11.6)

which is slightly but not signifi cantly (p>0.05)

higher than the incidence rate in people born

in Australia at 9.8 cases per 100,000 (95% CI

9.4–10.2) (Figure 35).

Similar to incidence, people born in non-

English speaking countries had slightly but not

signifi cantly (p>0.05) higher mortality from

pancreatic cancer after adjusting for differences

Figure 34Age-standardised incidence and mortality rates (± 95% CI) of pancreatic cancer by socioeconomic

disadvantage, NSW, 2002–2006

0

2

4

6

8

10

12

14

MortalityIncidence

Most

disadvantaged

quintile

4th

Quintile

3rd

Quintile

2nd

Quintile

Least

disadvantaged

quintile

NSW

Socioeconomic disadvantage

Rat

e (p

er 1

00,0

00)

Figure 35Age-standardised incidence and mortality rates (± 95% CI) of pancreatic cancer by country of

birth, NSW, 2002–2006

0

2

4

6

8

10

12

MortalityIncidence

Non-English speakingEnglish speakingAustraliaAll countries

Main language of country of birth

Rat

e (p

er 1

00,0

00)

39

in age and sex (Figure 35). The age-standardised mortality rate of pancreatic cancer in people from non-English speaking countries

of birth and those born in Australia was 9.2 deaths per 100,000 (95% CI 8.5–9.9) and 8.6 deaths per 100,000 (95% CI 8.3–9.0)

respectively.

8.2.2 Incidence and mortality of pancreatic cancer by region of birth

Between 2002 and 2006, the age-standardised incidence rate of pancreatic cancer was signifi cantly higher amongst people born

in South Eastern and Eastern Europe and the Americas compared to the rate in Australian born people (Figure 36). The age-

standardised incidence rate amongst people born in Australia was 9.8 (95% CI 9.4–10.2) cases per 100,000 and was 12.7 (95% CI

11.2–14.4) and 14.4 (95% CI 10.3–19.4) cases per 100,000 in people born in South Eastern and Eastern Europe and the Americas

respectively. The incidence rates in people born in other regions did not vary signifi cantly from those born in Australia.

The age-standardised mortality rates from pancreatic cancer by region of birth followed a similar pattern to the incidence rates.

Persons born in South Eastern and Eastern Europe had signifi cantly higher mortality compared to people born in Australia (Figure

36). The age-standardised mortality rate for persons born in Australia was 8.6 (95% CI 8.3–9.0) deaths per 100,000 and 11.4 (95%

CI 9.9–13.0) deaths per 100,000 amongst those born in South Eastern and Eastern Europe. Mortality rates for people born in

other regions did not vary signifi cantly from those born in Australia.

The reason for the higher incidence and mortality rates of pancreatic cancer in people from South Eastern and Eastern Europe is

unknown. People from this region do not have a signifi cantly higher rate of lung cancer compared to people born in Australia,114

which suggests that the higher rate of pancreatic cancer is not due to higher smoking rates, which is a risk factor for both pancreas

and lung cancer.

0 5 10 15 20

MortalityIncidence

UK & Ireland

Southern Europe

South Eastern & Easter Europe

North-West Europe

New Zealand & Oceania

Asia

Americas

Africa & the Middle East

Australia

All countries

Rate (per 100,000)

Figure 36Age-standardised incidence and mortality rates (± 95% CI) of pancreatic cancer by region of birth, NSW, 2002–2006

40


9 Prevalence and projections

9.1 Prevalence of pancreatic cancer

At the end of 2004, there were 270 males and 274 females living with pancreatic cancer who were diagnosed between 1980 and

2004.100 Of the 25-year prevalence, there were 315 people (158 males, 157 females) living with pancreatic cancer within the fi ve

years prior to December 2004.100 The age-standardised fi ve-year prevalence is fi ve per 100,000 in males and four per 100,000

in females.100

9.2 Projections for pancreatic cancer

The number of cases of pancreatic cancer in

New South Wales is projected to increase in

males and females (Figure 37). The projected

number of cases in 2012 is 513 (95% CI 434–

587) and 447 (95% CI 422–474) in males and

females respectively. Between 2008 and 2012,

the annual number of cases is predicted to

increase by 16 per cent in males and 10 per cent

in females.

If survival from pancreatic cancer remains poor,

the number of deaths from pancreatic cancer

will closely follow the projected number of cases

(Figure 38). The predicted number of deaths in

2012 is 437 (95% CI 364–508) and 390 (95% CI

356–452) for males and females respectively.

As well as population growth, the percentage

of the population over 60 years is predicted

to increase (Figure 39). Since age is the main

risk factor for pancreatic cancer in New South

Wales, the effect of the ageing of the New

South Wales population on the number of cases

and deaths may outweigh any reduction in the

other risk factors for pancreatic cancer, such as

lower smoking rates.

The age-standardised incidence of pancreatic

cancer is projected to increase in males and

remain steady in females (Figure 40). In 2012,

the incidence rate is predicted to be 12.9 (95%

CI 11.0–14.8) and 9.2 (95% CI 8.7–9.9) cases per

100,000 in males and females respectively. The

age-standardised mortality rate of pancreatic

cancer is projected to increase in males and remain steady in females (Figure 40). In 2012, the mortality rate is predicted to be 11.0

(95% CI 9.2–12.7) and 7.2 (95% CI 7.3–9.3) deaths per 100,000 in males and females.

0

100

200

300

400

500

600

700

800

900

1000

FemalesMalesPersons

2013201120092007200520032001199919971995

Year

Num

ber

of n

ew c

ases

Figure 37Actual and projected cases of pancreatic cancer, NSW, 1995–2012

0

100

200

300

400

500

600

700

800

900

1000

FemalesMalesPersons

2013200120092007200520032001199919971995

Year

Num

ber

of d

eath

s

Figure 38Actual and projected deaths from pancreatic cancer, NSW, 1995–2012

41

Figure 39Population pyramid for NSW in 2006 and 2020

0 50000 100000 150000 200000 250000 300000

20062020

0-4

5-9

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+

Females

300000 250000 200000 150000 100000 50000 0

0-4

5-9

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+

Males

Estimated resident population Estimated resident population

Figure 40Actual and projected age-standardised incidence and mortality rates of pancreatic cancer,

males and females, NSW, 1995–2012

0

2

4

6

8

10

12

14

Female mortalityFemale incidence

Male mortalityMale incidence

2013201120092007200520032001199919971995

Year

Rat

e (p

er 1

00,0

00)

42


10 Conclusions

The number of cases of pancreatic cancer in New South

Wales is increasing due to the ageing and growth of the New

South Wales population. After adjusting for changes in the age

structure of the New South Wales population, the incidence of

pancreatic cancer in males decreased from 1972 but appears

to be increasing from 2000 onwards. For females, the age-

standardised incidence rate has been increasing since 1972,

although it may remain steady in the next fi ve years. Smoking is

the most signifi cant modifi able risk factor for pancreatic cancer.

Although there is no direct evidence, the changes in age-

standardised incidence rates of pancreatic cancer are likely to be due in part to changes in historical smoking rates in New South

Wales. The cause of the recent increase in the male age-standardised incidence rate is unknown. There is little variation in the age-

standardised incidence and mortality of pancreatic cancer across New South Wales.

Survival from pancreatic is poor with a fi ve-year relative survival of 7 per cent. Even pancreatic cancers diagnosed at a local degree

of spread have a poor fi ve-year survival of 11 per cent. Therefore, earlier detection of pancreatic cancers at a local spread will have

limited benefi t in improving the overall survival of pancreatic cancer.

The results in this report highlight the need for novel methods of diagnosis and treatment of pancreatic cancer. Methods for

detecting the pre-cursor cells to invasive pancreatic cancer will be invaluable for the early detection and prevention of pancreatic

cancers and the development of screening programmes for high risk persons. As well, the development of systemic therapies that

are effective against pancreatic cancers are much needed.

The results in this report highlight the need for novel methods of diagnosis and treatment of pancreatic cancer.

43

11 Appendix

Table A1 ICD-O-3 coding for tumour topography in the pancreas

Topography code Location

C25.0 Head of the pancreas

C25.1 Body of the pancreas

C25.2 Tail of the pancreas

C25.3 Pancreatic duct (Duct of Santorini, Duct of Wirsung)

C25.4 Islets of Langerhans

C25.7 Other specifi ed parts of the pancreas

C25.8 Overlapping lesion of pancreas

C25.9 Pancreas, not otherwise specifi ed

Table A2Histology groups by ICD-O-3 morphology codes. All are invasive cancers (behaviour = 3).

Histology group 3 or 4 digit ICD-O-3 morphology code

Acinar cell carcinoma 855

Adenocarcinomas 814, 816, 820, 821, 825, 8261, 8262, 831, 843, 849, 856, 857

Carcinoma/malignant neoplasm 800, 801

Cystadenocarcinoma 844, 845, 847

Endocrine tumours 815, 824

Infi ltrating duct carcinoma 850

Mucinous adenocarcinoma 848

Other histology 803, 804, 807, 880, 883, 889, 893, 897, 898, 912

Papillary carcinoma/adenocarcinoma 805, 813, 8260

Undifferentiated carcinoma 802, 823

Note: For the survival analysis by histology type (section 6.2.4) the ‘All other histology’ group refers to all histology groups other than Adenocarcinomas, Carcinoma/

malignant neoplasm and Endocrine tumours.

44


12 Glossary

ABS Australian Bureau of Statistics

Accessibility/Remoteness Index of Australia (ARIA)

This report uses the ARIA+ index which has been endorsed by the ABS for remoteness

classifi cation.92 ARIA+ is based on road distance to fi ve categories of ‘service centre’, with the

smallest service centre having between 1000 and 4999 people. It is assumed that there is a

strong relationship between population size and service availability, particularly education and

health services,115 but ARIA+ does not provide specifi c information on accessibility to health

services. An ARIA+ score ranging from 0 (metropolitan) to 15 (very remote) is allocated to

each locality, interpolated to create a 1km grid across all of Australia and then aggregated

to the required geographical unit (SLA in this report). The ARIA+ values are allocated to

one of fi ve categories of remoteness using cut-off points determined by the ABS (see Table

below). The proportion of the population in an SLA in each remoteness category was used

to calculate the proportion of cases and deaths in each remoteness category.

Allocation of ARIA+ values to remoteness category

Category ARIA+ score range

Major City 0 to 0.2

Inner regional >0.2 to 2.4

Outer regional >2.4 to 5.92

Remote >5.92 to 10.53

Very remote >10.53

Source: ABS 2003.92

Age-specifi c rate A rate for a specifi ed age group. The numerator and denominator refer to the same age

group. It is usually expressed per 100,000 people in the population per year.

Age-standardised rate Age-standardisation is used to adjust for the effect of age when comparing rates in

populations with different age structures. In this report, age-standardised rates were

calculated by the direct method using the Australian 2001 Standard Population (derived by

the ABS from the mid-year population estimate in 2001) or the World Health Organization

(WHO) 2000 World Standard Population.

Area Health Service (AHS) Public sector health services in NSW are administered by eight Area Health Services.

There are four metropolitan AHS that include the major cities of Sydney, Newcastle and

Wollongong. The remaining four AHS cover the regional and rural areas of NSW. The

current AHS boundaries were established in January 2005 (Figure 41).

45

Figure 41Area Health Service boundaries in 2005

Source: Centre for Epidemiology and Research, Population Health Division.116

Cancer incidence Cancer cases diagnosed in a defi ned population during a specifi ed period. This term is often

used to denote numbers or rates.

Cancer mortality Deaths from cancer in a defi ned population during a specifi ed period. It may be used to

denote numbers or rates. It only includes deaths for which the underlying cause is attributed

to cancer. Persons with cancer that died from another cause are not included in the mortality

calculations in this report.

Cases These are individual cancers. A person may have more than one cancer giving rise to multiple

cases in the same person. Second cases in one person are only counted if they are of

different histological type or originate in a different organ.

46


Confi dence interval (CI) The confi dence interval gives the range of values for which there is a specifi ed probability

(95% in this report) that the interval contains the true estimate of the variable (rate,

proportion, etc).

Degree of spread at diagnosis This is the maximum extent of disease within four months of the fi rst date of diagnosis. This is

a summary stage that combines information from clinical and pathological documentation on

the extent of disease.

Health Outcomes and Information Statistical Toolkit (HOIST)

HOIST is a data warehouse that stores data collections and analytical tools that are

commonly used in population health and surveillance in New South Wales. It is operated by

the Centre for Epidemiology and Research of the NSW Department of Health.

Index of Relative Socio-Economic Disadvantage (IRSD)

See Socio-Economic Index For Areas (SEIFA).

Lifetime risk The lifetime risk is an estimate of the cumulative risk an individual has of developing or dying

from cancer during a defi ned lifespan in the absence of competing causes of mortality. In this

report, it is calculated using the cumulative rate. The cumulative rate is the sum of the age-

specifi c incidence or mortality rates for 5-year age groups (multiplied by the width of the age

group). The lifetime risk assumes that throughout the defi ned lifespan the person experiences

the same age-specifi c risks as the population used to calculate the cumulative rate.

Relative survival This is the ratio of observed survival of a cohort of people diagnosed with cancer to the

expected survival of the cohort based on the New South Wales Life Tables.

Statistical Local Area (SLA) Statistical local areas are geographical areas defi ned by the ABS and are part of the Australian

Standard Geographical Classifi cation (ASGC).91 Between census years, the SLA is the smallest

spatial unit defi ned by the ABS. SLAs are based on the boundaries of local government areas

where they exist. A local government may contain one or more SLAs.

Socio-Economic Indexes For Areas (SEIFA)

These indexes are created by the ABS to rank geographic areas in terms of their

socioeconomic disadvantage.93 There are four SEIFA indexes that each measure a slightly

different aspect of socioeconomic disadvantage. The Index of Relative Socio-Economic

Disadvantage (IRSD) was chosen for this report to be consistent with other reports such as

the Chief Health Offi cer’s Report.116 The indexes use census data to measure socioeconomic

characteristics of people and households in small geographical areas called census collector

districts. They are then aggregated (on a population-weighted basis) to other geographical

levels including the statistical local area level. It is an area-based assessment and cannot be

used to label individuals within an area.

47

13 Data tables

Tabl

e 2

New

cas

es o

f pan

crea

tic

canc

er in

NSW

, per

sons

, 197

2–20

06

Year

Age

gro

up a

t di

agno

sis

(yea

rs)

Tota

l0-4

5-9

10-1

415

-19

20-2

425-2

930-3

435-3

940-4

445-4

950-5

455-5

960-6

465-6

970-7

475-7

980-8

485+

1972

00

00

00

0<

5np*

1315

2452

5160

37

1916

297

1973

00

00

00

<5

<5

716

3136

46

45

56

4334

20

341

1974

00

00

00

<5

<5

109

25

33

58

66

48

4131

24

350

1975

00

00

00

<5

5<

514

28

40

50

75

64

50

4127

397

1976

00

00

0<

5<

5<

5<

516

29

37

7157

5142

36

20

366

1977

00

00

00

<5

np

511

24

47

64

58

60

48

48

25

398

1978

00

00

0<

5<

5<

5<

58

24

33

52

47

63

49

36

19346

1979

00

00

<5

0<

5<

56

1530

47

55

77

63

50

42

24

416

1980

00

0<

5<

50

<5

<5

<5

1532

4141

65

65

52

33

29

385

1981

00

0<

50

00

<5

66

29

50

40

63

72

48

45

19383

1982

00

0<

50

0<

5<

5<

512

30

4358

85

77

65

39

26

444

1983

00

00

<5

0<

5<

57

<5

24

35

62

72

70

8137

26

424

1984

00

00

00

0<

5np

1019

36

65

75

8167

50

36

447

1985

00

00

<5

00

<5

68

2137

58

60

7466

52

40

427

1986

00

00

0<

5<

5<

511

1721

45

66

66

92

69

5344

492

1987

00

00

00

<5

np

715

30

38

5978

86

8157

39

497

1988

00

<5

00

<5

<5

<5

913

22

38

62

7498

83

60

34

499

1989

00

<5

00

<5

0<

56

825

38

52

77

100

80

5339

484

1990

00

00

<5

<5

<5

56

1025

36

68

73

73

80

58

49

488

1991

00

0<

50

0<

5<

59

1420

4368

78

86

77

64

45

511

1992

00

00

<5

0<

56

518

2145

63

84

99

79

8158

561

1993

00

00

<5

0<

55

714

2148

6195

103

103

8153

594

1994

00

0<

50

<5

<5

<5

1113

26

38

60

75

104

93

77

53557

1995

00

00

0<

5<

5<

55

1228

28

5376

97

94

93

56

548

1996

00

0<

50

<5

<5

<5

<5

1223

39

42

87

101

111

87

56

569

1997

00

00

<5

<5

0<

510

1632

3152

85

92

112

68

62

565

1998

00

<5

0<

50

<5

<5

<5

1432

28

66

79

106

109

92

77

615

1999

00

00

00

<5

np

810

25

45

69

77

137

125

82

72

657

2000

00

00

0<

5<

5<

59

1733

42

50

72

98

116

84

73

599

2001

00

00

0<

5<

510

817

34

4363

7483

124

85

82

625

2002

00

00

0<

5<

5<

59

24

3139

63

95

116

111

87

97

678

2003

00

00

0<

50

np

616

3138

73

96

117

127

111

96

717

2004

00

<5

00

0<

56

1221

30

49

77

83

108

110

107

99

705

2005

00

0<

5<

5<

5<

50

1125

35

60

8190

129

132

136

124

831

2006

00

00

00

0<

5np

2132

54

7490

110

118

137

115

762

Tota

l0

0<

5np

1321

52

135

240

484

938

1404

2094

2600

3039

2873

2296

1774

17975

* np =

Not

publis

hed t

o m

ainta

in c

onfi dential

ity.

48


Tabl

e 3

New

cas

es o

f pan

crea

tic

canc

er in

NSW

, mal

es, 1

972–

2006

Year

Age

gro

up a

t di

agno

sis

(yea

rs)

Tota

l0-4

5-9

10-1

415

-19

20-2

425-2

930-3

435-3

940-4

445-4

950-5

455-5

960-6

465-6

970-7

475-7

980-8

485+

1972

00

00

00

0<

5np*

1011

1434

32

32

166

816

9

1973

00

00

00

<5

<5

511

2123

28

25

28

26

158

194

1974

00

00

00

0<

5np

715

22

35

40

29

2110

12200

1975

00

00

00

<5

<5

<5

1115

25

3147

38

2119

10224

1976

00

00

0<

50

<5

011

1621

4327

29

1518

619

0

1977

00

00

00

0<

5<

56

1636

42

37

3126

20

11230

1978

00

00

0<

5<

5<

5<

5<

516

20

36

29

35

26

1811

205

1979

00

00

<5

0<

5<

5<

57

1529

36

49

40

24

20

7236

1980

00

0<

5<

50

<5

<5

<5

924

28

27

39

28

28

1810

219

1981

00

0<

50

00

<5

<5

619

36

22

35

4325

18<

521

5

1982

00

0<

50

0<

5<

5<

58

20

2128

49

5135

1911

250

1983

00

00

<5

00

<5

6<

511

26

40

4140

4316

<5

233

1984

00

00

00

0<

5<

56

1125

4339

44

3122

11235

1985

00

00

<5

00

<5

57

1718

38

34

40

35

2112

232

1986

00

00

00

<5

<5

68

1126

4133

44

38

27

13253

1987

00

00

00

0<

5np

1017

25

35

47

4342

20

12259

1988

00

00

0<

5<

5<

56

1015

1931

34

50

4325

14251

1989

00

<5

00

00

<5

5<

516

22

34

47

5341

23

17266

1990

00

00

0<

50

<5

<5

720

1846

47

35

37

22

19260

1991

00

00

00

<5

0<

57

1229

37

36

46

35

27

20

254

1992

00

00

00

0<

5<

512

1124

4138

55

35

40

21283

1993

00

00

00

<5

<5

07

1121

32

48

6146

33

15279

1994

00

00

00

<5

<5

56

1530

33

36

55

37

32

20

273

1995

00

00

0<

5<

5<

5<

59

1516

3143

52

45

36

17270

1996

00

00

0<

5<

5<

50

717

2123

5357

5138

12284

1997

00

00

0<

50

<5

711

1921

24

45

54

50

27

22

282

1998

00

<5

00

0<

5<

5<

511

1715

34

48

52

52

4127

303

1999

00

00

00

<5

<5

57

1727

35

45

5953

36

27

314

2000

00

00

0<

50

<5

611

2124

28

34

46

52

34

25

285

2001

00

00

0<

5<

55

<5

1220

24

36

42

48

7143

29

334

2002

00

00

00

<5

<5

<5

1315

2138

4369

64

4138

349

2003

00

00

0<

50

<5

<5

819

25

46

48

72

64

45

27

361

2004

00

00

00

<5

np

713

25

28

46

47

60

47

4133

354

2005

00

00

0<

5<

50

<5

1517

39

54

52

68

67

47

4341

1

2006

00

00

00

0<

5<

514

20

32

45

5155

56

57

44

379

Tota

l0

0<

5<

55

1431

82

136

307

577

851

1253

1440

1642

1398

975

620

9336

* np =

Not

publis

hed t

o m

ainta

in c

onfi dential

ity.

49

Tabl

e 4

New

cas

es o

f pan

crea

tic

canc

er in

NSW

, fem

ales

, 197

2–20

06

Year

Age

gro

up a

t di

agno

sis

(yea

rs)

Tota

l0-4

5-9

10-1

415

-19

20-2

425-2

930-3

435-3

940-4

445-4

950-5

455-5

960-6

465-6

970-7

475-7

980-8

485+

1972

00

00

00

0<

5<

5<

5<

510

1819

28

2113

812

8

1973

00

00

00

<5

0<

55

1013

1820

28

1719

1214

7

1974

00

00

00

<5

<5

<5

<5

1011

23

26

1920

2112

150

1975

00

00

00

0<

50

<5

1315

1928

26

29

22

1717

3

1976

00

00

00

<5

0<

55

1316

28

30

22

27

1814

176

1977

00

00

00

<5

<5

<5

58

1122

2129

22

28

1416

8

1978

00

00

00

<5

<5

<5

58

1316

1828

23

188

141

1979

00

00

00

<5

<5

<5

815

1819

28

23

26

22

1718

0

1980

00

0<

50

00

<5

<5

68

1314

26

37

24

1519

166

1981

00

00

00

0<

5<

50

1014

1828

29

23

27

1516

8

1982

00

00

00

0<

50

<5

1022

30

36

26

30

20

1519

4

1983

00

00

00

<5

<5

<5

<5

139

22

3130

38

2122

191

1984

00

00

00

0<

5<

5<

58

1122

36

37

36

28

25

212

1985

00

00

00

00

<5

<5

<5

1920

26

34

3131

28

195

1986

00

00

0<

5<

50

59

1019

25

33

48

3126

31239

1987

00

00

00

<5

<5

<5

513

1324

3143

39

37

27

238

1988

00

<5

00

00

<5

<5

<5

719

3140

48

40

35

20

248

1989

00

00

0<

50

<5

<5

<5

916

1830

47

39

30

22

218

1990

00

00

<5

<5

<5

<5

<5

<5

518

22

26

38

4336

30

228

1991

00

0<

50

0<

5<

56

78

1431

42

40

42

37

25

257

1992

00

00

<5

0<

5<

5<

56

1021

22

46

44

44

4137

278

1993

00

00

<5

0<

5<

57

710

27

29

47

42

57

48

38

315

1994

00

0<

50

<5

0<

56

711

827

39

49

56

45

33

284

1995

00

00

0<

5<

50

<5

<5

1312

22

33

45

49

57

39

278

1996

00

0<

50

00

<5

<5

56

1819

34

44

60

49

44

285

1997

00

00

<5

00

<5

<5

513

1028

40

38

62

4140

283

1998

00

00

<5

00

<5

<5

<5

1513

32

3154

57

5150

312

1999

00

00

00

0<

5<

5<

58

1834

32

78

72

46

45

343

2000

00

00

00

<5

0<

56

1218

22

38

52

64

50

48

314

2001

00

00

00

05

65

1419

27

32

35

5342

53291

2002

00

00

0<

50

<5

511

1618

25

52

47

47

46

59329

2003

00

00

00

0<

5<

58

1213

27

48

45

63

66

69

356

2004

00

<5

00

00

<5

58

521

3136

48

63

66

66

351

2005

00

0<

5<

5<

50

07

1018

2127

38

6165

89

81420

2006

00

00

00

00

67

1222

29

39

55

62

80

71383

Tota

l0

0<

5np*

87

2153

104

177

361

553

841

1160

1397

1475

1321

1154

8639

* np =

Not

publis

hed t

o m

ainta

in c

onfi dential

ity.

50


Tabl

e 5

Dea

ths

from

pan

crea

tic

canc

er in

NSW

, per

sons

, 197

2–20

06.

Year

Age

gro

up a

t de

ath

(yea

rs)

Tota

l0-4

5-9

10-1

415

-19

20-2

425-2

930-3

435-3

940-4

445-4

950-5

455-5

960-6

465-6

970-7

475-7

980-8

485+

1972

00

00

<5

00

<5

612

1731

4148

49

3124

15276

1973

00

00

00

<5

<5

815

1334

46

50

56

4334

24

326

1974

00

00

00

<5

<5

67

35

29

5364

5939

33

26

357

1975

00

00

00

0<

5<

512

25

36

5166

64

39

40

32

371

1976

00

00

00

<5

<5

<5

1225

36

67

55

52

52

37

22

363

1977

00

00

00

<5

np*

510

25

38

54

55

58

49

4328

372

1978

00

00

0<

5<

5<

56

1216

45

6158

57

45

42

23

372

1979

00

00

<5

<5

<5

5<

58

22

38

39

65

68

49

39

26

363

1980

00

00

<5

0<

5<

55

1331

36

42

67

55

56

44

24

379

1981

00

00

00

0<

5<

56

1838

3150

6146

32

30

317

1982

00

0<

50

0<

5<

5<

511

26

4152

68

75

5936

28

405

1983

00

0<

50

00

<5

<5

<5

2134

60

5975

68

37

20

383

1984

00

00

00

0<

5np

1015

3168

58

73

75

47

27

412

1985

00

00

0<

50

<5

65

1833

45

5963

64

46

43387

1986

00

00

0<

5<

5<

55

1021

36

5360

88

67

48

47

439

1987

00

00

0<

5<

5<

510

824

36

63

7182

7150

42

462

1988

00

00

00

<5

<5

816

1835

64

63

83

72

54

34

450

1989

00

00

00

06

58

2126

57

7410

192

67

45

502

1990

00

00

0<

5<

5<

55

1329

4362

64

75

7155

40

464

1991

00

00

0<

5<

5<

57

713

27

67

66

79

72

5946

449

1992

00

00

<5

0<

5<

55

1419

38

5973

86

72

7461

506

1993

00

00

00

<5

<5

512

2138

56

90

96

88

75

57

542

1994

00

00

0<

5<

5<

56

819

39

49

60

96

97

69

51499

1995

00

00

0<

5<

5<

56

1324

25

5188

8183

84

52

511

1996

00

00

<5

0<

5<

55

1122

29

32

68

83

112

8161

508

1997

00

00

0<

50

65

923

22

4178

86

94

65

61491

1998

00

00

0<

5<

5<

5<

512

2130

54

68

87

98

77

7653

2

1999

00

00

00

0np

<5

1225

30

7163

121

112

84

74600

2000

00

00

00

0<

5np

925

34

39

66

9111

476

68

533

2001

00

00

00

<5

<5

<5

1826

25

49

68

84

99

84

77

535

2002

00

00

00

<5

np

517

2137

66

7692

103

86

83

593

2003

00

00

00

0<

5np

1123

32

55

82

88

98

94

92

583

2004

00

00

00

05

611

30

40

66

7192

117

99

93

630

2005

00

00

00

0<

5np

25

27

42

67

66

110

116

121

122

703

2006

00

00

0<

5<

50

816

29

42

57

86

93

129

130

114

706

Tota

l0

00

<5

np

1532

100

184

397

788

1206

1888

2323

2759

2692

2166

1764

16321

* np =

Not

publis

hed t

o m

ainta

in c

onfi dential

ity.

51

Tabl

e 6

Dea

ths

from

pan

crea

tic

canc

er in

NSW

, mal

es, 1

972–

2006

Year

Age

gro

up a

t de

ath

(yea

rs)

Tota

l0-4

5-9

10-1

415

-19

20-2

425-2

930-3

435-3

940-4

445-4

950-5

455-5

960-6

465-6

970-7

475-7

980-8

485+

1972

00

00

<5

00

0<

58

917

26

32

25

20

77

155

1973

00

00

00

0<

5np*

911

23

27

29

32

22

147

181

1974

00

00

00

<5

<5

55

25

20

37

34

3123

1213

209

1975

00

00

00

0<

5<

58

1817

25

44

40

22

1913

212

1976

00

00

00

<5

<5

<5

810

25

4132

3115

137

185

1977

00

00

00

<5

<5

<5

<5

1732

37

34

3120

20

1421

5

1978

00

00

0<

5<

5<

5<

56

1029

4134

34

25

219

218

1979

00

00

<5

<5

<5

<5

<5

<5

1322

24

35

38

32

219

205

1980

00

00

<5

0<

5<

5<

56

23

25

30

46

26

26

186

213

1981

00

00

00

0<

5<

56

1327

23

3137

22

1211

186

1982

00

00

00

<5

<5

<5

611

23

27

34

44

32

20

1121

5

1983

00

0<

50

00

0<

5<

512

27

37

35

46

33

15<

521

3

1984

00

00

00

00

<5

np

821

46

28

46

42

189

228

1985

00

00

0<

50

<5

<5

<5

1322

32

32

28

34

1813

204

1986

00

00

0<

5<

5<

5<

56

1218

37

37

45

39

22

15238

1987

00

00

00

0<

56

<5

1524

36

38

40

33

24

8230

1988

00

00

00

<5

<5

613

1021

33

29

42

40

1913

228

1989

00

00

00

0np

<5

616

1731

39

54

42

30

18261

1990

00

00

0<

5<

5<

5<

57

20

24

4142

35

35

27

17256

1991

00

00

00

0<

5<

5<

59

1436

38

46

35

20

19226

1992

00

00

00

<5

<5

<5

910

2138

30

42

35

37

25

253

1993

00

00

00

<5

<5

<5

913

1732

45

50

4130

19259

1994

00

00

00

<5

0<

55

1323

26

3153

38

29

18240

1995

00

00

00

<5

<5

<5

714

1831

42

45

37

30

13243

1996

00

00

00

<5

<5

<5

711

1420

40

38

49

35

12232

1997

00

00

0<

50

<5

<5

514

1520

4350

47

29

19247

1998

00

00

0<

5<

5<

5<

510

1020

3136

40

46

32

31262

1999

00

00

00

0<

50

np

1518

32

37

56

5133

31285

2000

00

00

00

0<

5np

617

22

2139

42

50

32

24

263

2001

00

00

00

00

014

1612

30

40

42

5144

26

275

2002

00

00

00

<5

<5

<5

910

23

35

33

56

62

39

37

310

2003

00

00

00

0<

5<

55

1420

38

4353

50

39

26

292

2004

00

00

00

0<

5<

55

26

23

44

38

56

49

38

30

316

2005

00

00

00

0<

5<

516

1533

45

3153

56

4142

335

2006

00

00

0<

5<

50

59

1524

34

54

48

5356

45

345

Tota

l0

00

<5

<5

1021

62

104

250

488

751

1144

1285

1475

1307

914

620

843

5

* np =

Not

publis

hed t

o m

ainta

in c

onfi dential

ity.

52


Tabl

e 7

Dea

ths

from

pan

crea

tic

canc

er in

NSW

, fem

ales

, 197

2–20

06

Year

Age

gro

up a

t de

ath

(yea

rs)

Tota

l0-4

5-9

10-1

415

-19

20-2

425-2

930-3

435-3

940-4

445-4

950-5

455-5

960-6

465-6

970-7

475-7

980-8

485+

1972

00

00

00

0<

5<

5<

58

1415

1624

1117

812

1

1973

00

00

00

<5

0<

56

<5

1119

2124

2120

1714

5

1974

00

00

00

<5

<5

<5

<5

109

1630

28

1621

1314

8

1975

00

00

00

00

0<

5np*

1926

22

24

1721

1915

9

1976

00

00

00

<5

0<

5<

515

1126

23

2137

24

1517

8

1977

00

00

00

<5

<5

<5

68

617

2127

29

23

1415

7

1978

00

00

00

<5

<5

<5

66

1620

24

23

20

2114

154

1979

00

00

00

0<

50

<5

916

1530

30

1718

1715

8

1980

00

00

00

<5

0<

57

811

1221

29

30

26

1816

6

1981

00

00

00

00

<5

0np

118

1924

24

20

1913

1

1982

00

0<

50

00

0<

55

1518

25

34

3127

1617

190

1983

00

00

00

0<

50

<5

97

23

24

29

35

22

1717

0

1984

00

00

00

0<

55

<5

710

22

30

27

33

29

1818

4

1985

00

00

00

0<

5<

5<

55

1113

27

35

30

28

30

183

1986

00

00

00

00

<5

<5

918

1623

4328

26

32

201

1987

00

00

0<

5<

5<

5<

5<

59

1227

33

42

38

26

34

232

1988

00

00

00

0<

5<

5<

58

1431

34

4132

35

21222

1989

00

00

00

0<

5<

5<

55

926

35

47

50

37

27

241

1990

00

00

0<

5<

5<

5<

56

919

2122

40

36

28

23

208

1991

00

00

0<

5<

5<

55

<5

<5

1331

28

33

37

39

27

223

1992

00

00

<5

00

<5

<5

59

1721

4344

37

37

36

253

1993

00

00

00

0<

5<

5<

58

2124

45

46

47

45

38

283

1994

00

00

0<

50

<5

<5

<5

616

23

29

4359

40

33

259

1995

00

00

0<

50

<5

<5

610

720

46

36

46

54

39

268

1996

00

00

<5

00

0<

5<

511

1512

28

45

63

46

49

276

1997

00

00

00

0<

5<

5<

59

721

35

36

47

36

42

244

1998

00

00

00

0<

5<

5<

511

1023

32

47

52

45

45

270

1999

00

00

00

0<

5<

5<

510

1239

26

65

6151

4331

5

2000

00

00

00

00

<5

<5

812

1827

49

64

44

44

270

2001

00

00

00

<5

<5

<5

<5

1013

1928

42

48

40

51260

2002

00

00

00

0<

5<

58

1114

3143

36

4147

46

283

2003

00

00

00

00

<5

np

912

1739

35

48

55

66

291

2004

00

00

00

0<

5<

56

<5

1722

33

36

68

6163

314

2005

00

00

00

0<

5<

59

129

22

35

57

60

80

80

368

2006

00

00

00

00

<5

np

1418

23

32

45

7674

69

361

Tota

l0

00

<5

<5

511

38

80

147

300

455

744

1038

1284

1385

1252

1144

7886

* np =

Not

publis

hed t

o m

ainta

in c

onfi dential

ity.

53

Tabl

e 8

Age

-spe

cifi c

and

age

-sta

ndar

dise

d (A

SR)

inci

denc

e ra

te (

per

100,

000)

of p

ancr

eati

c ca

ncer

in p

erso

ns, N

SW, 1

972–

2006

Year

Age

gro

up a

t di

agno

sis

(yea

rs)

Cru

de

rate

ASR

(a)

Low

er

95%

C

I

Upp

er

95%

C

I0

-45-9

10-1

415

-19

20

-24

25-2

930

-34

35-3

940

-44

45-4

950

-54

55-5

960

-64

65-6

970

-74

75-7

980

-84

85+

1972

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.7

2.7

4.4

5.7

10.3

26.3

33.7

53.7

49.

140.8

60.8

6.2

8.4

7.4

9.4

1973

0.0

0.0

0.0

0.0

0.0

0.0

1.3

1.1

2.4

5.4

11.4

15.4

22.6

28.8

48.9

57.

171

.672.5

7.0

9.6

8.6

10.7

1974

0.0

0.0

0.0

0.0

0.0

0.0

0.3

1.4

3.6

3.0

8.9

14.2

27.

740.9

40.5

53.8

64.2

83.2

7.2

9.6

8.5

10.7

1975

0.0

0.0

0.0

0.0

0.0

0.0

0.3

1.7

0.7

4.8

9.9

17.0

23.3

45.3

53.4

62.5

84.7

90.9

8.0

10.8

9.7

11.9

1976

0.0

0.0

0.0

0.0

0.0

0.2

0.3

1.0

0.7

5.5

10.2

15.3

32.8

33.3

41.5

50.1

72.5

64.1

7.4

9.4

8.4

10.5

1977

0.0

0.0

0.0

0.0

0.0

0.0

0.5

2.0

1.8

3.9

8.4

18.9

29.

432.8

47.

356.6

96.6

78.2

8.0

10.3

9.3

11.4

1978

0.0

0.0

0.0

0.0

0.0

0.7

1.0

1.3

1.4

2.9

8.4

12.8

23.8

25.8

48.1

56.5

71.4

57.

26.8

8.8

7.8

9.8

1979

0.0

0.0

0.0

0.0

0.2

0.0

1.0

0.6

2.1

5.5

10.5

17.7

25.3

40.8

46.5

55.9

82.5

70.1

8.1

10.2

9.2

11.3

1980

0.0

0.0

0.0

0.4

0.5

0.0

0.2

0.9

1.4

5.6

11.3

15.1

18.7

33.5

46.4

57.

162.6

80.2

7.4

9.4

8.4

10.4

1981

0.0

0.0

0.0

0.2

0.0

0.0

0.0

1.1

2.0

2.3

10.3

18.4

17.6

32.1

49.

451

.482.8

50.0

7.3

9.0

8.1

10.0

1982

0.0

0.0

0.0

0.2

0.0

0.0

0.2

1.1

1.0

4.5

10.8

15.8

24.8

42.8

50.7

66.9

68.8

67.

98.4

10.2

9.2

11.2

1983

0.0

0.0

0.0

0.0

0.2

0.0

0.2

1.0

2.2

1.5

8.9

12.8

25.6

36.2

44.5

79.

763.0

66.7

7.9

9.6

8.7

10.6

1984

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.7

1.5

3.6

7.2

13.1

25.8

37.

949.

663.1

81.6

89.

78.3

9.9

9.0

10.9

1985

0.0

0.0

0.0

0.0

0.2

0.0

0.0

0.9

1.8

2.8

8.0

13.5

22.5

29.

944.1

59.6

82.8

93.6

7.8

9.4

8.5

10.4

1986

0.0

0.0

0.0

0.0

0.0

0.2

0.9

0.7

3.1

5.7

8.0

16.6

25.3

31.6

53.8

59.4

81.2

96.8

8.9

10.4

9.5

11.4

1987

0.0

0.0

0.0

0.0

0.0

0.0

0.5

1.2

1.8

4.9

11.3

14.1

22.5

35.9

49.

467.

183.0

83.3

8.8

10.3

9.4

11.2

1988

0.0

0.0

0.2

0.0

0.0

0.2

0.2

0.7

2.2

4.2

8.1

14.4

23.5

32.8

56.1

66.3

83.8

70.6

8.7

10.0

9.1

10.9

1989

0.0

0.0

0.2

0.0

0.0

0.2

0.0

0.9

1.4

2.5

9.0

14.6

19.6

32.8

57.

361

.371

.278.0

8.4

9.5

8.7

10.4

1990

0.0

0.0

0.0

0.0

0.4

0.4

0.2

1.1

1.4

3.0

8.7

14.0

25.7

30.5

41.1

59.6

74.9

96.0

8.4

9.5

8.6

10.4

1991

0.0

0.0

0.0

0.2

0.0

0.0

0.8

0.4

2.1

4.0

6.8

16.8

25.8

32.3

46.4

55.9

78.9

83.8

8.7

9.6

8.8

10.5

1992

0.0

0.0

0.0

0.0

0.2

0.0

0.2

1.3

1.1

4.8

7.0

17.3

24.3

34.6

51.6

56.3

95.6

102.7

9.4

10.4

9.5

11.3

1993

0.0

0.0

0.0

0.0

0.2

0.0

0.4

1.1

1.6

3.5

6.9

18.1

24.0

38.8

51.7

72.8

90.9

89.

19.

910

.79.

811

.6

1994

0.0

0.0

0.0

0.2

0.0

0.2

0.4

0.6

2.5

3.2

8.2

14.0

23.9

30.6

50.0

65.9

81.9

84.8

9.2

9.8

9.0

10.7

1995

0.0

0.0

0.0

0.0

0.0

0.4

0.6

0.2

1.1

2.9

8.4

10.1

21.2

31.0

45.7

64.9

95.6

84.7

8.9

9.5

8.7

10.3

1996

0.0

0.0

0.0

0.2

0.0

0.4

0.2

0.8

0.7

2.8

6.6

13.7

16.9

35.4

46.9

73.2

87.

280.0

9.2

9.6

8.8

10.4

1997

0.0

0.0

0.0

0.0

0.2

0.2

0.0

0.6

2.2

3.7

8.6

10.6

20.5

34.7

42.3

70.1

66.4

83.5

9.0

9.3

8.5

10.0

1998

0.0

0.0

0.2

0.0

0.5

0.0

0.2

0.8

0.8

3.2

8.1

9.3

25.4

32.6

48.2

65.0

88.1

98.5

9.7

9.8

9.1

10.6

1999

0.0

0.0

0.0

0.0

0.0

0.0

0.2

1.2

1.7

2.3

6.1

14.3

25.8

32.2

61.5

71.2

77.

486.7

10.2

10.2

9.4

11.0

2000

0.0

0.0

0.0

0.0

0.0

0.2

0.2

0.6

1.8

3.8

7.8

12.8

18.2

30.3

43.8

64.3

76.1

83.0

9.2

9.1

8.4

9.9

2001

0.0

0.0

0.0

0.0

0.0

0.2

0.2

2.0

1.6

3.7

7.8

12.6

22.3

31.0

36.8

67.

472.1

88.9

9.5

9.2

8.5

10.0

2002

0.0

0.0

0.0

0.0

0.0

0.2

0.2

0.8

1.8

5.2

7.2

10.7

22.0

39.

251

.859

.870.5

100.9

10.2

9.8

9.1

10.6

2003

0.0

0.0

0.0

0.0

0.0

0.2

0.0

1.0

1.2

3.4

7.2

9.9

25.0

39.

053

.267.

586.2

97.

310

.710

.29.

511

.0

2004

0.0

0.0

0.2

0.0

0.0

0.0

0.4

1.2

2.3

4.4

6.9

12.4

25.5

33.0

49.

957.

979.

898.0

10.5

9.9

9.1

10.6

2005

0.0

0.0

0.0

0.2

0.2

0.4

0.8

0.0

2.2

5.2

8.0

14.8

25.8

35.0

60.1

69.

398.3

117.

012

.311

.410

.612

.2

2006

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.4

1.8

4.3

7.2

13.1

22.6

34.5

51.1

61.9

97.

310

3.4

11.2

10.2

9.5

11.0

(a)

Stan

dar

dis

ed t

o t

he A

ust

ralia

n 2

001

Sta

ndar

d P

opula

tio

n.

54


Tabl

e 9

Age

-spe

cifi c

and

age

-sta

ndar

dise

d (A

SR)

inci

denc

e ra

te (

per

100,

000)

of p

ancr

eati

c ca

ncer

in m

ales

, NSW

, 197

2–20

06

Year

Age

gro

up a

t di

agno

sis

(yea

rs)

Cru

de

rate

ASR

(a)

Low

er

95%

CI

Upp

er

95%

CI

0-4

5-9

10-1

415

-19

20

-24

25-2

930

-34

35-3

940

-44

45-4

950

-54

55-5

960

-64

65-6

970

-74

75-7

980

-84

85+

1972

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.7

3.3

6.6

8.3

12.2

35.8

45.3

68.0

56.9

37.

098.7

7.0

10.8

9.1

12.7

1973

0.0

0.0

0.0

0.0

0.0

0.0

0.6

2.1

3.4

7.3

15.4

20.0

28.7

34.4

57.

793.2

92.0

95.5

8.0

12.7

10.8

14.8

1974

0.0

0.0

0.0

0.0

0.0

0.0

0.0

2.0

4.2

4.6

10.6

19.3

34.9

53.4

57.

274

.061

.513

9.9

8.2

12.7

10.8

14.8

1975

0.0

0.0

0.0

0.0

0.0

0.0

0.6

2.6

1.4

7.2

10.5

21.6

30.2

61.3

73.5

70.5

118.8

115.2

9.1

14.0

12.1

16.2

1976

0.0

0.0

0.0

0.0

0.0

0.5

0.0

1.9

0.0

7.3

11.1

17.6

41.6

34.2

54.4

47.

511

2.5

67.

47.

711

.29.

513

.1

1977

0.0

0.0

0.0

0.0

0.0

0.0

0.0

1.3

2.1

4.1

11.1

29.

440.3

45.4

56.1

80.5

124.8

124.0

9.2

13.9

12.0

16.1

1978

0.0

0.0

0.0

0.0

0.0

1.5

1.5

1.2

2.1

2.1

11.1

15.8

34.3

34.6

61.3

77.

811

0.2

122.6

8.1

12.5

10.7

14.5

1979

0.0

0.0

0.0

0.0

0.5

0.0

1.5

0.6

2.8

5.0

10.4

22.1

34.7

56.5

67.

768.9

120.9

77.

39.

313

.211

.415

.2

1980

0.0

0.0

0.0

0.4

0.9

0.0

0.5

0.6

2.0

6.6

16.7

20.9

25.8

43.6

45.9

78.2

103.7

105.8

8.5

12.4

10.7

14.4

1981

0.0

0.0

0.0

0.4

0.0

0.0

0.0

1.1

2.6

4.4

13.3

26.7

20.5

38.5

68.1

67.

499.

841

.08.2

11.4

9.8

13.2

1982

0.0

0.0

0.0

0.4

0.0

0.0

0.5

1.6

1.9

5.8

14.1

15.5

25.1

53.4

77.

490.3

100.6

111.

19.

513

.611

.815

.6

1983

0.0

0.0

0.0

0.0

0.4

0.0

0.0

1.0

3.7

2.1

7.9

19.0

34.4

44.6

58.6

106.6

80.7

40.3

8.7

11.8

10.2

13.5

1984

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.5

1.2

4.2

8.1

18.1

35.4

42.7

61.9

73.5

105.6

107.

88.7

12.2

10.5

14.0

1985

0.0

0.0

0.0

0.0

0.4

0.0

0.0

1.9

2.9

4.7

12.7

13.0

30.5

36.7

54.5

79.

197.

511

0.5

8.5

11.9

10.3

13.7

1986

0.0

0.0

0.0

0.0

0.0

0.0

1.4

1.4

3.3

5.3

8.2

18.9

32.3

34.1

58.6

81.5

118.8

112.3

9.2

12.6

11.0

14.4

1987

0.0

0.0

0.0

0.0

0.0

0.0

0.0

1.4

2.6

6.4

12.5

18.4

27.

346.4

56.0

86.6

82.7

98.6

9.3

12.2

10.7

13.9

1988

0.0

0.0

0.0

0.0

0.0

0.4

0.4

0.9

2.9

6.2

10.8

14.2

23.9

32.2

64.9

85.1

98.6

110.3

8.8

12.0

10.5

13.7

1989

0.0

0.0

0.5

0.0

0.0

0.0

0.0

1.4

2.4

2.4

11.2

16.7

26.0

42.6

68.7

77.

586.8

126.5

9.2

12.2

10.7

13.9

1990

0.0

0.0

0.0

0.0

0.0

0.4

0.0

1.8

1.8

4.0

13.6

13.9

35.1

41.8

44.5

67.

679.

513

6.4

8.9

11.7

10.2

13.3

1991

0.0

0.0

0.0

0.0

0.0

0.0

0.8

0.0

1.4

3.9

8.0

22.5

28.4

31.4

55.8

62.0

93.0

134.6

8.7

11.4

9.9

12.9

1992

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.9

1.8

6.2

7.2

18.3

31.9

32.8

64.0

60.6

131.

313

2.5

9.5

12.3

10.9

14.0

1993

0.0

0.0

0.0

0.0

0.0

0.0

0.4

1.7

0.0

3.5

7.0

15.7

25.3

41.0

68.0

78.7

101.

889.

59.

311

.510

.113

.0

1994

0.0

0.0

0.0

0.0

0.0

0.0

0.8

0.9

2.3

2.9

9.2

22.0

26.4

30.5

58.5

63.0

93.1

112.4

9.1

11.2

9.8

12.6

1995

0.0

0.0

0.0

0.0

0.0

0.4

0.4

0.4

1.3

4.2

8.9

11.4

25.1

36.3

54.0

74.3

100.4

89.

38.9

10.7

9.4

12.1

1996

0.0

0.0

0.0

0.0

0.0

0.8

0.4

0.8

0.0

3.2

9.6

14.5

18.6

44.5

58.1

79.

610

2.5

59.3

9.2

10.7

9.5

12.1

1997

0.0

0.0

0.0

0.0

0.0

0.4

0.0

0.4

3.0

5.0

10.0

14.1

19.0

37.

854.1

73.6

70.6

101.

49.

110

.59.

311

.9

1998

0.0

0.0

0.4

0.0

0.0

0.0

0.4

0.8

0.9

5.0

8.5

9.8

26.3

40.6

51.1

72.6

104.7

116.8

9.6

11.2

9.9

12.5

1999

0.0

0.0

0.0

0.0

0.0

0.0

0.4

0.8

2.1

3.2

8.2

16.9

26.3

38.4

56.7

70.3

89.

810

9.3

9.9

11.1

9.9

12.5

2000

0.0

0.0

0.0

0.0

0.0

0.4

0.0

1.2

2.5

4.9

9.9

14.4

20.3

29.

343

.766.8

80.4

94.6

8.9

9.8

8.7

11.1

2001

0.0

0.0

0.0

0.0

0.0

0.4

0.4

2.0

0.8

5.3

9.1

13.8

25.4

35.9

45.0

88.5

94.3

103.5

10.2

11.2

10.0

12.5

2002

0.0

0.0

0.0

0.0

0.0

0.0

0.4

0.8

1.6

5.7

6.9

11.3

26.3

36.1

64.9

78.5

84.7

129.

210

.611

.510

.312

.8

2003

0.0

0.0

0.0

0.0

0.0

0.4

0.0

0.8

1.6

3.4

8.8

12.8

31.3

39.

768.7

76.7

88.2

88.8

10.9

11.5

10.3

12.7

2004

0.0

0.0

0.0

0.0

0.0

0.0

0.8

2.1

2.7

5.5

11.5

14.0

30.3

38.1

58.1

55.2

76.5

104.8

10.6

11.1

9.9

12.3

2005

0.0

0.0

0.0

0.0

0.0

0.4

1.6

0.0

1.6

6.3

7.8

19.1

34.3

41.1

66.4

77.

884.6

127.

912

.312

.611

.413

.9

2006

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.8

1.2

5.8

9.1

15.5

27.

539.

753

.464.8

99.

612

3.2

11.2

11.4

10.3

12.6

(a)

Stan

dar

dis

ed t

o t

he A

ust

ralia

n 2

001

Sta

ndar

d P

opula

tio

n.

55

Tabl

e 10

A

ge-s

peci

fi c a

nd a

ge-s

tand

ardi

sed

(ASR

) in

cide

nce

rate

(pe

r 10

0,00

0) o

f pan

crea

tic

canc

er in

fem

ales

, NSW

, 197

2–20

06

Year

Age

gro

up a

t di

agno

sis

(yea

rs)

Cru

de

rate

ASR

(a)

Low

er

95%

C

I

Upp

er

95%

C

I0

-45-9

10-1

415

-19

20

-24

25-2

930

-34

35-3

940

-44

45-4

950

-54

55-5

960

-64

65-6

970

-74

75-7

980

-84

85+

1972

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.7

2.1

2.1

3.0

8.4

17.5

23.5

43.4

44.4

42.9

44.0

5.4

6.5

5.4

7.8

1973

0.0

0.0

0.0

0.0

0.0

0.0

2.0

0.0

1.4

3.5

7.4

10.9

17.0

23.9

42.5

35.8

61.0

62.4

6.1

7.4

6.2

8.7

1974

0.0

0.0

0.0

0.0

0.0

0.0

0.6

0.7

3.0

1.4

7.2

9.3

21.0

30.1

28.0

41.8

65.5

59.2

6.1

7.3

6.2

8.6

1975

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.7

0.0

2.1

9.2

12.5

17.0

31.5

38.2

57.

867.

980.9

7.0

8.4

7.1

9.7

1976

0.0

0.0

0.0

0.0

0.0

0.0

0.6

0.0

1.5

3.6

9.2

13.0

24.7

32.6

31.7

51.6

53.5

62.8

7.1

8.1

6.9

9.4

1977

0.0

0.0

0.0

0.0

0.0

0.0

1.1

2.7

1.5

3.6

5.7

8.7

19.4

22.0

40.5

41.9

83.2

60.6

6.7

7.8

6.6

9.1

1978

0.0

0.0

0.0

0.0

0.0

0.0

0.5

1.3

0.7

3.7

5.7

10.0

14.0

18.2

37.

943

.252.8

33.0

5.6

6.3

5.3

7.5

1979

0.0

0.0

0.0

0.0

0.0

0.0

0.5

0.6

1.4

6.1

10.7

13.4

16.7

27.

530.1

47.

664.0

67.

57.

08.0

6.8

9.3

1980

0.0

0.0

0.0

0.5

0.0

0.0

0.0

1.2

0.7

4.6

5.8

9.5

12.2

24.9

46.8

43.5

42.4

71.1

6.4

7.2

6.1

8.4

1981

0.0

0.0

0.0

0.0

0.0

0.0

0.0

1.2

1.4

0.0

7.3

10.3

15.1

26.6

35.1

40.9

74.4

53.2

6.4

7.0

6.0

8.2

1982

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.5

0.0

3.1

7.4

16.1

24.5

33.7

30.2

51.3

52.9

52.8

7.3

7.8

6.7

9.0

1983

0.0

0.0

0.0

0.0

0.0

0.0

0.5

1.0

0.7

0.8

9.8

6.6

17.5

28.9

33.7

62.1

54.0

75.6

7.1

7.7

6.6

8.9

1984

0.0

0.0

0.0

0.0

0.0

0.0

0.0

1.0

1.9

2.9

6.2

8.1

16.9

33.7

40.2

56.3

69.

283.5

7.8

8.3

7.2

9.5

1985

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.6

0.7

3.1

14.0

15.0

24.2

36.1

46.6

75.1

87.

97.

17.

46.4

8.6

1986

0.0

0.0

0.0

0.0

0.0

0.4

0.5

0.0

2.9

6.3

7.8

14.2

18.6

29.

550.1

44.6

61.2

91.5

8.6

8.9

7.8

10.2

1987

0.0

0.0

0.0

0.0

0.0

0.0

0.9

0.9

1.1

3.4

10.0

9.8

17.9

26.7

44.2

54.0

83.2

77.

98.4

8.7

7.6

9.9

1988

0.0

0.0

0.5

0.0

0.0

0.0

0.0

0.5

1.5

2.0

5.2

14.5

23.1

33.3

49.

253

.575.7

56.4

8.7

8.7

7.6

9.8

1989

0.0

0.0

0.0

0.0

0.0

0.4

0.0

0.5

0.5

2.5

6.6

12.4

13.5

24.0

48.3

50.2

62.6

60.2

7.5

7.6

6.6

8.7

1990

0.0

0.0

0.0

0.0

0.9

0.4

0.4

0.5

1.0

1.8

3.6

14.1

16.5

20.5

38.4

54.1

72.4

80.9

7.8

7.8

6.8

8.9

1991

0.0

0.0

0.0

0.5

0.0

0.0

0.8

0.9

2.8

4.1

5.6

11.0

23.3

33.0

38.9

51.7

71.0

64.4

8.7

8.5

7.5

9.6

1992

0.0

0.0

0.0

0.0

0.4

0.0

0.4

1.8

0.5

3.3

6.8

16.3

16.8

36.2

41.5

53.2

75.6

91.1

9.3

9.1

8.0

10.2

1993

0.0

0.0

0.0

0.0

0.4

0.0

0.4

0.4

3.2

3.6

6.7

20.5

22.6

36.8

38.4

68.6

84.7

88.9

10.4

10.1

9.0

11.3

1994

0.0

0.0

0.0

0.5

0.0

0.4

0.0

0.4

2.7

3.5

7.1

5.9

21.4

30.7

42.9

67.

975.4

73.8

9.3

8.8

7.8

9.9

1995

0.0

0.0

0.0

0.0

0.0

0.4

0.8

0.0

0.9

1.4

8.0

8.8

17.5

26.1

38.8

58.1

92.8

82.8

9.0

8.5

7.5

9.5

1996

0.0

0.0

0.0

0.5

0.0

0.0

0.0

0.8

1.3

2.3

3.5

12.8

15.2

26.9

37.

568.5

78.2

88.3

9.1

8.5

7.5

9.5

1997

0.0

0.0

0.0

0.0

0.5

0.0

0.0

0.8

1.3

2.3

7.1

6.9

22.0

31.9

32.3

67.

463.9

76.1

9.0

8.2

7.3

9.3

1998

0.0

0.0

0.0

0.0

0.9

0.0

0.0

0.8

0.8

1.4

7.8

8.7

24.6

25.0

45.7

59.4

78.1

90.8

9.8

8.8

7.9

9.9

1999

0.0

0.0

0.0

0.0

0.0

0.0

0.0

1.6

1.2

1.4

4.0

11.6

25.4

26.2

65.7

71.9

69.

977.

210

.69.

58.5

10.6

2000

0.0

0.0

0.0

0.0

0.0

0.0

0.4

0.0

1.2

2.7

5.8

11.1

16.0

31.3

43.9

62.3

73.4

78.0

9.6

8.5

7.6

9.5

2001

0.0

0.0

0.0

0.0

0.0

0.0

0.0

2.0

2.4

2.2

6.5

11.3

19.2

26.3

29.

551

.158.1

82.5

8.8

7.7

6.8

8.6

2002

0.0

0.0

0.0

0.0

0.0

0.4

0.0

0.8

2.0

4.8

7.5

10.0

17.5

42.2

40.0

45.2

61.3

88.5

9.9

8.6

7.7

9.6

2003

0.0

0.0

0.0

0.0

0.0

0.0

0.0

1.2

0.8

3.4

5.6

6.8

18.6

38.3

39.

060.2

84.9

101.

110

.69.

08.1

10.0

2004

0.0

0.0

0.4

0.0

0.0

0.0

0.0

0.4

1.9

3.3

2.3

10.7

20.6

28.1

42.4

60.1

81.9

94.9

10.4

8.7

7.8

9.7

2005

0.0

0.0

0.0

0.5

0.4

0.4

0.0

0.0

2.7

4.1

8.2

10.4

17.2

29.

154.4

62.2

107.

611

1.9

12.3

10.2

9.3

11.3

2006

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

2.4

2.8

5.4

10.7

17.8

29.

449.

059

.695.7

94.0

11.1

9.2

8.3

10.2

(a)

Stan

dar

dis

ed t

o t

he A

ust

ralia

n 2

001

Sta

ndar

d P

opula

tio

n.

56


Tabl

e 11

A

ge-s

peci

fi c a

nd a

ge-s

tand

ardi

sed

(ASR

) m

orta

lity

rate

(pe

r 10

0,00

0) o

f pan

crea

tic

canc

er in

per

sons

, NSW

, 197

2–20

06

Year

Age

gro

up a

t de

ath

(yea

rs)

Cru

de

rate

ASR

(a)

Low

er

95%

C

I

Upp

er

95%

C

I0

-45-9

10-1

415

-19

20

-24

25-2

930

-34

35-3

940

-44

45-4

950

-54

55-5

960

-64

65-6

970

-74

75-7

980

-84

85+

1972

0.0

0.0

0.0

0.0

0.2

0.0

0.0

0.4

2.0

4.1

6.5

13.3

20.7

31.7

43.9

41.1

51.6

57.

05.8

7.8

6.9

8.8

1973

0.0

0.0

0.0

0.0

0.0

0.0

0.6

0.4

2.8

5.1

4.8

14.5

22.6

32.0

48.9

57.

171

.687.

06.7

9.3

8.3

10.5

1974

0.0

0.0

0.0

0.0

0.0

0.0

0.6

1.4

2.1

2.4

12.5

12.5

25.3

39.

749.

851

.268.3

90.1

7.3

9.8

8.8

10.9

1975

0.0

0.0

0.0

0.0

0.0

0.0

0.0

1.0

1.1

4.1

8.8

15.3

23.8

39.

853

.448.8

82.6

107.

87.

510

.29.

111

.3

1976

0.0

0.0

0.0

0.0

0.0

0.0

0.6

0.3

0.7

4.1

8.8

14.9

30.9

32.1

42.3

62.0

74.5

70.5

7.3

9.5

8.5

10.6

1977

0.0

0.0

0.0

0.0

0.0

0.0

0.5

1.6

1.8

3.5

8.8

15.3

24.8

31.1

45.7

57.

886.5

87.

57.

49.

88.8

10.9

1978

0.0

0.0

0.0

0.0

0.0

0.5

0.5

1.0

2.2

4.3

5.6

17.5

27.

931

.843

.551

.983.3

69.

37.

49.

48.4

10.4

1979

0.0

0.0

0.0

0.0

0.2

0.2

0.2

1.5

0.4

2.9

7.7

14.3

17.9

34.5

50.2

54.8

76.6

75.9

7.1

9.1

8.2

10.1

1980

0.0

0.0

0.0

0.0

0.2

0.0

1.0

0.3

1.7

4.9

11.0

13.3

19.1

34.5

39.

361

.583.4

66.3

7.3

9.3

8.4

10.3

1981

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.3

1.3

2.3

6.4

14.0

13.7

25.5

41.8

49.

358.9

79.

06.1

7.7

6.8

8.6

1982

0.0

0.0

0.0

0.2

0.0

0.0

0.2

0.8

1.3

4.1

9.4

15.1

22.2

34.2

49.

460.7

63.5

73.1

7.6

9.4

8.5

10.3

1983

0.0

0.0

0.0

0.2

0.0

0.0

0.0

0.5

0.6

1.5

7.8

12.4

24.8

29.

647.

766.9

63.0

51.3

7.2

8.6

7.7

9.5

1984

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.2

2.1

3.6

5.6

11.3

27.

029.

344.7

70.7

76.7

67.

37.

69.

28.3

10.1

1985

0.0

0.0

0.0

0.0

0.0

0.2

0.0

0.9

1.8

1.7

6.9

12.1

17.5

29.

537.

657.

773.2

100.7

7.1

8.6

7.8

9.5

1986

0.0

0.0

0.0

0.0

0.0

0.2

0.2

0.5

1.4

3.4

8.0

13.2

20.3

28.7

51.5

57.

773.6

103.4

7.9

9.4

8.5

10.3

1987

0.0

0.0

0.0

0.0

0.0

0.2

0.2

0.7

2.6

2.6

9.0

13.4

24.0

32.7

47.

158.8

72.8

89.

78.2

9.5

8.7

10.5

1988

0.0

0.0

0.0

0.0

0.0

0.0

0.2

0.5

2.0

5.1

6.6

13.2

24.2

27.

947.

557.

575.4

70.6

7.9

9.0

8.2

9.9

1989

0.0

0.0

0.0

0.0

0.0

0.0

0.0

1.4

1.2

2.5

7.5

10.0

21.5

31.5

57.

970.4

90.0

90.0

8.7

10.0

9.1

10.9

1990

0.0

0.0

0.0

0.0

0.0

0.4

0.4

0.7

1.2

3.8

10.1

16.7

23.4

26.8

42.2

52.9

71.1

78.4

8.0

9.0

8.2

9.9

1991

0.0

0.0

0.0

0.0

0.0

0.2

0.2

0.9

1.6

2.0

4.4

10.6

25.4

27.

342.6

52.3

72.7

85.6

7.6

8.4

7.7

9.3

1992

0.0

0.0

0.0

0.0

0.2

0.0

0.2

0.7

1.1

3.7

6.3

14.6

22.7

30.0

44.8

51.3

87.

310

8.0

8.5

9.4

8.6

10.3

1993

0.0

0.0

0.0

0.0

0.0

0.0

0.2

0.6

1.1

3.0

6.9

14.3

22.0

36.7

48.2

62.2

84.2

95.8

9.0

9.8

9.0

10.6

1994

0.0

0.0

0.0

0.0

0.0

0.2

0.2

0.6

1.4

2.0

6.0

14.4

19.5

24.5

46.1

68.7

73.4

81.6

8.2

8.9

8.1

9.7

1995

0.0

0.0

0.0

0.0

0.0

0.2

0.2

0.4

1.3

3.1

7.2

9.0

20.4

35.9

38.2

57.

386.4

78.7

8.3

8.8

8.0

9.6

1996

0.0

0.0

0.0

0.0

0.2

0.0

0.4

0.2

1.1

2.5

6.4

10.2

12.9

27.

738.5

73.9

81.2

87.

18.2

8.6

7.9

9.4

1997

0.0

0.0

0.0

0.0

0.0

0.2

0.0

1.2

1.1

2.1

6.2

7.5

16.2

31.9

39.

658.8

63.5

82.2

7.8

8.0

7.3

8.8

1998

0.0

0.0

0.0

0.0

0.0

0.4

0.2

0.4

0.8

2.7

5.3

9.9

20.8

28.1

39.

558.5

73.7

97.

28.4

8.5

7.8

9.3

1999

0.0

0.0

0.0

0.0

0.0

0.0

0.0

1.0

0.6

2.7

6.1

9.5

26.6

26.3

54.3

63.8

79.

389.

19.

49.

38.6

10.1

2000

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.8

1.4

2.0

5.9

10.4

14.2

27.

840.7

63.1

68.8

77.

38.2

8.1

7.4

8.8

2001

0.0

0.0

0.0

0.0

0.0

0.0

0.2

0.4

0.4

4.0

6.0

7.3

17.4

28.5

37.

353

.871

.383.5

8.1

7.9

7.2

8.6

2002

0.0

0.0

0.0

0.0

0.0

0.0

0.2

1.2

1.0

3.7

4.9

10.1

23.0

31.4

41.1

55.5

69.

786.4

8.9

8.6

7.9

9.3

2003

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.2

1.4

2.4

5.3

8.3

18.8

33.3

40.0

52.1

73.0

93.2

8.7

8.3

7.6

9.0

2004

0.0

0.0

0.0

0.0

0.0

0.0

0.0

1.0

1.2

2.3

6.9

10.1

21.8

28.2

42.5

61.6

73.8

92.0

9.4

8.8

8.1

9.5

2005

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.4

1.0

5.2

6.2

10.4

21.3

25.7

51.3

60.9

87.

511

5.1

10.4

9.6

8.9

10.3

2006

0.0

0.0

0.0

0.0

0.0

0.2

0.2

0.0

1.6

3.3

6.5

10.2

17.4

32.9

43.2

67.

792.3

102.5

10.4

9.4

8.8

10.2

(a)

Stan

dar

dis

ed t

o t

he A

ust

ralia

n 2

001

Sta

ndar

d P

opula

tio

n.

57

Tabl

e 12

A

ge-s

peci

fi c a

nd a

ge-s

tand

ardi

sed

(ASR

) m

orta

lity

rate

(pe

r 10

0,00

0) o

f pan

crea

tic

canc

er in

mal

es, N

SW, 1

972–

2006

Year

Age

gro

up a

t de

ath

(yea

rs)

Cru

de

rate

ASR

(a)

Low

er

95%

C

I

Upp

er

95%

C

I0

-45-9

10-1

415

-19

20

-24

25-2

930

-34

35-3

940

-44

45-4

950

-54

55-5

960

-64

65-6

970

-74

75-7

980

-84

85+

1972

0.0

0.0

0.0

0.0

0.5

0.0

0.0

0.0

2.0

5.3

6.8

14.8

27.

445.3

53.1

71.2

43.2

86.4

6.4

10.1

8.4

12.0

1973

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.7

4.0

5.9

8.1

20.0

27.

639.

965.9

78.9

85.8

83.5

7.5

11.8

10.0

13.8

1974

0.0

0.0

0.0

0.0

0.0

0.0

0.6

2.0

3.5

3.3

17.7

17.5

36.9

45.4

61.2

81.1

73.8

151.

68.5

13.5

11.5

15.6

1975

0.0

0.0

0.0

0.0

0.0

0.0

0.0

2.0

2.1

5.3

12.6

14.7

24.4

57.

377.

473.8

118.8

149.

78.6

13.9

11.9

16.1

1976

0.0

0.0

0.0

0.0

0.0

0.0

0.6

0.6

0.7

5.3

7.0

21.0

39.

640.5

58.1

47.

581

.278.6

7.5

10.8

9.2

12.7

1977

0.0

0.0

0.0

0.0

0.0

0.0

0.5

1.9

1.4

2.7

11.8

26.2

35.5

41.8

56.1

62.0

124.8

157.

88.6

13.4

11.4

15.5

1978

0.0

0.0

0.0

0.0

0.0

1.0

0.5

1.2

2.8

4.2

6.9

22.9

39.

140.5

59.5

74.8

128.6

100.3

8.7

13.0

11.1

15.0

1979

0.0

0.0

0.0

0.0

0.5

0.5

0.5

1.8

0.7

2.9

9.0

16.8

23.1

40.4

64.3

91.9

127.

099.

48.0

12.5

10.6

14.5

1980

0.0

0.0

0.0

0.0

0.4

0.0

1.4

0.6

1.3

4.4

16.0

18.7

28.6

51.4

42.6

72.6

103.7

63.5

8.3

11.6

10.0

13.4

1981

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.6

2.0

4.4

9.1

20.0

21.4

34.1

58.6

59.3

66.5

112.7

7.1

10.4

8.8

12.2

1982

0.0

0.0

0.0

0.0

0.0

0.0

0.5

1.6

1.9

4.4

7.8

17.0

24.2

37.

066.8

82.5

105.9

111.

18.1

12.1

10.4

13.9

1983

0.0

0.0

0.0

0.5

0.0

0.0

0.0

0.0

1.2

1.4

8.7

19.7

31.8

38.1

67.

481

.875.7

30.3

8.0

10.6

9.2

12.2

1984

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

1.2

5.6

5.9

15.2

37.

830.6

64.7

99.

686.4

88.2

8.5

11.8

10.2

13.6

1985

0.0

0.0

0.0

0.0

0.0

0.4

0.0

1.4

2.3

2.7

9.7

15.9

25.7

34.5

38.2

76.9

83.6

119.

77.

510

.69.

112

.4

1986

0.0

0.0

0.0

0.0

0.0

0.4

0.5

0.9

1.7

3.9

9.0

13.1

29.

138.2

59.9

83.7

96.8

129.

68.6

12.0

10.4

13.8

1987

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.9

3.1

2.6

11.0

17.6

28.1

37.

552.1

68.1

99.

365.8

8.2

10.8

9.3

12.3

1988

0.0

0.0

0.0

0.0

0.0

0.0

0.4

0.5

2.9

8.1

7.2

15.7

25.4

27.

454.5

79.

274

.910

2.4

8.0

10.8

9.3

12.4

1989

0.0

0.0

0.0

0.0

0.0

0.0

0.0

2.3

1.4

3.6

11.2

12.9

23.7

35.4

70.0

79.

411

3.2

134.0

9.1

12.4

10.8

14.1

1990

0.0

0.0

0.0

0.0

0.0

0.4

0.4

0.9

1.8

4.0

13.6

18.5

31.3

37.

344.5

63.9

97.

612

2.1

8.8

11.6

10.1

13.2

1991

0.0

0.0

0.0

0.0

0.0

0.0

0.0

1.3

0.9

2.2

6.0

10.9

27.

633.2

55.8

62.0

68.9

127.

87.

710

.08.7

11.5

1992

0.0

0.0

0.0

0.0

0.0

0.0

0.4

0.9

1.4

4.7

6.5

16.0

29.

625.9

48.9

60.6

121.

415

7.8

8.5

11.4

10.0

13.0

1993

0.0

0.0

0.0

0.0

0.0

0.0

0.4

0.4

0.5

4.4

8.3

12.7

25.3

38.4

55.7

70.2

92.6

113.4

8.7

10.9

9.5

12.4

1994

0.0

0.0

0.0

0.0

0.0

0.0

0.4

0.0

1.4

2.4

8.0

16.8

20.8

26.3

56.4

64.7

84.4

101.

18.0

9.9

8.7

11.3

1995

0.0

0.0

0.0

0.0

0.0

0.0

0.4

0.4

1.8

3.3

8.3

12.8

25.1

35.5

46.8

61.1

83.7

68.3

8.0

9.5

8.3

10.8

1996

0.0

0.0

0.0

0.0

0.0

0.0

0.8

0.4

1.3

3.2

6.2

9.7

16.2

33.6

38.7

76.5

94.4

59.3

7.5

8.9

7.8

10.2

1997

0.0

0.0

0.0

0.0

0.0

0.4

0.0

0.8

0.9

2.3

7.4

10.1

15.8

36.1

50.1

69.

275.9

87.

67.

99.

38.1

10.5

1998

0.0

0.0

0.0

0.0

0.0

0.8

0.4

0.4

0.9

4.6

5.0

13.1

23.9

30.4

39.

364.2

81.7

134.1

8.3

9.8

8.6

11.1

1999

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.8

0.0

4.5

7.2

11.2

24.0

31.6

53.9

67.

782.3

125.5

9.0

10.3

9.1

11.6

2000

0.0

0.0

0.0

0.0

0.0

0.0

0.0

1.6

2.5

2.7

8.0

13.2

15.2

33.6

39.

964.2

75.7

90.8

8.2

9.1

8.0

10.3

2001

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

6.2

7.3

6.9

21.2

34.2

39.

363.6

96.5

92.8

8.4

9.3

8.2

10.5

2002

0.0

0.0

0.0

0.0

0.0

0.0

0.4

1.6

0.4

3.9

4.6

12.4

24.3

27.

752.6

76.1

80.6

125.8

9.4

10.3

9.1

11.5

2003

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.4

1.2

2.1

6.5

10.3

25.9

35.6

50.6

59.9

76.5

85.5

8.8

9.3

8.3

10.5

2004

0.0

0.0

0.0

0.0

0.0

0.0

0.0

1.2

1.6

2.1

12.0

11.5

29.

030.8

54.2

57.

670.9

95.3

9.5

9.9

8.8

11.1

2005

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.4

0.8

6.7

6.9

16.2

28.6

24.5

51.8

65.1

73.8

124.9

10.0

10.3

9.3

11.5

2006

0.0

0.0

0.0

0.0

0.0

0.4

0.4

0.0

2.0

3.7

6.8

11.6

20.8

42.1

46.6

61.3

97.

812

6.0

10.2

10.4

9.4

11.6

(a)

Stan

dar

dis

ed t

o t

he A

ust

ralia

n 2

001

Sta

ndar

d P

opula

tio

n.

58


Tabl

e 13

A

ge-s

peci

fi c a

nd a

ge-s

tand

ardi

sed

(ASR

) m

orta

lity

rate

(pe

r 10

0,00

0) o

f pan

crea

tic

canc

er in

fem

ales

, NSW

, 197

2–20

06

Year

Age

gro

up a

t de

ath

(yea

rs)

Cru

de

rate

ASR

(a)

Low

er

95%

C

I

Upp

er

95%

C

I0

-45-9

10-1

415

-19

20

-24

25-2

930

-34

35-3

940

-44

45-4

950

-54

55-5

960

-64

65-6

970

-74

75-7

980

-84

85+

1972

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.7

2.1

2.8

6.1

11.8

14.6

19.8

37.

223.3

56.1

44.0

5.1

6.1

5.1

7.4

1973

0.0

0.0

0.0

0.0

0.0

0.0

1.3

0.0

1.4

4.1

1.5

9.2

17.9

25.1

36.4

44.2

64.2

88.5

6.0

7.4

6.2

8.7

1974

0.0

0.0

0.0

0.0

0.0

0.0

0.6

0.7

0.7

1.4

7.2

7.6

14.6

34.7

41.2

33.4

65.5

64.1

6.1

7.2

6.1

8.5

1975

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

2.8

5.0

15.8

23.2

24.7

35.2

33.9

64.8

90.5

6.5

7.6

6.5

8.9

1976

0.0

0.0

0.0

0.0

0.0

0.0

0.6

0.0

0.8

2.9

10.6

9.0

23.0

25.0

30.2

70.8

71.3

67.

37.

28.3

7.2

9.7

1977

0.0

0.0

0.0

0.0

0.0

0.0

0.5

1.3

2.3

4.4

5.7

4.7

15.0

22.0

37.

755.2

68.3

60.6

6.3

7.4

6.2

8.6

1978

0.0

0.0

0.0

0.0

0.0

0.0

0.5

0.7

1.5

4.5

4.3

12.3

17.5

24.3

31.1

37.

561

.657.

86.1

6.9

5.8

8.1

1979

0.0

0.0

0.0

0.0

0.0

0.0

0.0

1.3

0.0

3.0

6.4

11.9

13.2

29.

439.

331

.152.4

67.

56.2

6.9

5.8

8.1

1980

0.0

0.0

0.0

0.0

0.0

0.0

0.5

0.0

2.1

5.4

5.8

8.0

10.4

20.1

36.7

54.3

73.5

67.

46.4

7.4

6.3

8.6

1981

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.7

0.0

3.6

8.1

6.7

18.0

29.

042.7

55.1

67.

35.0

5.6

4.7

6.6

1982

0.0

0.0

0.0

0.5

0.0

0.0

0.0

0.0

0.7

3.9

11.1

13.2

20.4

31.8

36.0

46.2

42.3

59.8

7.1

7.7

6.7

8.9

1983

0.0

0.0

0.0

0.0

0.0

0.0

0.0

1.0

0.0

1.5

6.8

5.1

18.3

22.4

32.6

57.

256.5

58.4

6.3

6.8

5.8

7.9

1984

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.5

3.2

1.5

5.4

7.4

16.9

28.1

29.

351

.671

.760.2

6.8

7.2

6.2

8.3

1985

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.5

1.2

0.7

3.9

8.1

9.8

25.1

37.

145.1

67.

894.2

6.7

7.0

6.0

8.1

1986

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

1.2

2.8

7.0

13.4

11.9

20.5

44.9

40.2

61.2

94.4

7.2

7.6

6.5

8.7

1987

0.0

0.0

0.0

0.0

0.0

0.4

0.5

0.5

2.2

2.7

6.9

9.0

20.1

28.5

43.1

52.6

58.5

98.1

8.2

8.4

7.3

9.6

1988

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.5

1.0

2.0

6.0

10.7

23.1

28.3

42.0

42.8

75.7

59.3

7.8

7.8

6.8

8.9

1989

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.5

1.0

1.3

3.7

7.0

19.4

28.0

48.3

64.4

77.

273.9

8.3

8.2

7.2

9.4

1990

0.0

0.0

0.0

0.0

0.0

0.4

0.4

0.5

0.5

3.6

6.4

14.9

15.7

17.4

40.4

45.3

56.3

62.0

7.1

7.2

6.3

8.3

1991

0.0

0.0

0.0

0.0

0.0

0.4

0.4

0.4

2.3

1.7

2.8

10.2

23.3

22.0

32.1

45.5

74.8

69.

57.

57.

46.4

8.4

1992

0.0

0.0

0.0

0.0

0.4

0.0

0.0

0.4

0.9

2.7

6.1

13.2

16.0

33.8

41.5

44.8

68.2

88.6

8.4

8.2

7.2

9.3

1993

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.9

1.8

1.5

5.4

15.9

18.7

35.2

42.0

56.6

79.

488.9

9.4

9.0

8.0

10.1

1994

0.0

0.0

0.0

0.0

0.0

0.4

0.0

1.3

1.4

1.5

3.9

11.9

18.2

22.8

37.

771

.567.

073.8

8.5

8.1

7.1

9.1

1995

0.0

0.0

0.0

0.0

0.0

0.4

0.0

0.4

0.9

2.9

6.1

5.1

15.9

36.4

31.0

54.6

87.

982.8

8.7

8.1

7.1

9.1

1996

0.0

0.0

0.0

0.0

0.4

0.0

0.0

0.0

0.9

1.9

6.5

10.7

9.6

22.1

38.4

71.9

73.4

98.4

8.8

8.2

7.2

9.2

1997

0.0

0.0

0.0

0.0

0.0

0.0

0.0

1.6

1.3

1.9

4.9

4.8

16.5

27.

930.6

51.1

56.1

79.

97.

77.

06.2

8.0

1998

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.4

0.8

0.9

5.7

6.7

17.7

25.8

39.

754.2

69.

081

.78.5

7.6

6.7

8.6

1999

0.0

0.0

0.0

0.0

0.0

0.0

0.0

1.2

1.2

0.9

5.0

7.7

29.

221

.354.8

60.9

77.

573.7

9.8

8.7

7.8

9.7

2000

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.4

1.3

3.8

7.4

13.1

22.3

41.4

62.3

64.6

71.5

8.3

7.2

6.4

8.1

2001

0.0

0.0

0.0

0.0

0.0

0.0

0.4

0.8

0.8

1.8

4.6

7.7

13.5

23.0

35.4

46.2

55.4

79.

47.

96.8

6.0

7.7

2002

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.8

1.6

3.5

5.1

7.8

21.7

34.9

30.7

39.

462.6

69.

08.5

7.4

6.5

8.3

2003

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

1.6

2.6

4.2

6.3

11.7

31.1

30.4

45.8

70.7

96.7

8.7

7.2

6.4

8.1

2004

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.8

0.8

2.5

1.8

8.7

14.6

25.8

31.8

64.9

75.7

90.5

9.3

7.7

6.9

8.6

2005

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.4

1.2

3.7

5.5

4.5

14.0

26.8

50.8

57.

596.7

110.5

10.8

8.9

8.0

9.8

2006

0.0

0.0

0.0

0.0

0.0

0.0

0.0

0.0

1.2

2.8

6.3

8.7

14.1

24.1

40.1

73.0

88.5

91.3

10.5

8.6

7.8

9.6

(a)

Stan

dar

dis

ed t

o t

he A

ust

ralia

n 2

001

Sta

ndar

d P

opula

tio

n.

59

Table 14 Cases of pancreatic cancers by histological type and age group,1972-2006, and the annual age-standardised (ASR) incidence rate (per 100,000), NSW, 2002–2006

Histology type(a)

Age group at diagnosisTotal No.

of cases% of cases ASR(b)0-49 50-59 60-69 70-79 80+

No. (%) No. (%) No. (%) No. (%) No. (%)

Acinar cell carcinoma <5 7 6 6 <5 24 0.1 <0.1

Adenocarcinoma 535 (7.1) 1296 (17.1) 2446 (32.3) 2393 (31.6) 908 (12.0) 7578 42.2 4.6

Carcinoma/malignant neoplasm 210 (2.4) 683 (7.9) 1762 (20.3) 3033 (34.9) 3012 (34.6) 8700 48.4 4.9

Cystadenocarcinoma 11 (11.6) 12 (12.6) 26 (27.4) 29 (30.5) 17 (17.9) 95 0.5 0.1

Endocrine pancreas tumour 85 (29.0) 76 (25.9) 56 (19.1) 60 (20.5) 16 (5.5) 293 1.6 0.2

Infi ltrating duct carcinoma 6 (4.7) 29 (22.8) 43 (33.9) 43 (33.9) 6 (4.7) 127 0.7 0.2

Mucinous adenocarcinoma 40 (9.1) 85 (19.3) 133 (30.2) 143 (32.4) 40 (9.1) 441 2.5 0.2

Other specifi ed histology 8 (7.2) 14 (12.6) 36 (32.4) 39 (35.1) 14 (12.6) 111 0.6 0.1

Papillary tumour 15 (23.4) 9 (14.1) 9 (14.1) 22 (34.4) 9 (14.1) 64 0.4 <0.1

Undifferentiated carcinoma 44 (8.1) 131 (24.2) 177 (32.7) 144 (26.6) 46 (8.5) 542 3.0 <0.1

(a) See Appendix for details on histology groups.

(b) Standardised to the Australian 2001 Standard Population.

Table 15 Incidence of pancreatic cancer by accessibility and remoteness (ARIA+ category), NSW, 2002–2006

Major Cities Inner Regional Outer RegionalRemote &

Very Remote

Males Cases 1297 406 137 14

Crude rate (per 100,000) 10.8 12.0 12.1 13.6

Age-standardised rate(a) (per 100,000) 12.0 10.8 10.4 13.8

Lower 95% CI 11.4 9.8 8.7 7.4

Upper 95% CI 12.7 11.9 12.4 23.3

Females Cases 1274 407 147 11

Crude rate (per 100,000) 10.3 11.9 13.4 12.2

Age-standardised rate (per 100,000) 9.2 8.8 9.9 12.1

Lower 95% CI 8.7 8.0 8.3 6.1

Upper 95% CI 9.7 9.8 11.6 21.5

Persons Cases 2571 814 283 26(b)

Crude rate (per 100,000) 10.6 11.9 12.8 12.9


Lower 95% CI 10.0 9.2 9.1 8.5

Upper 95% CI 10.9 10.5 11.5 19.6

(a) Standardised to the Australian 2001 Standard Population.

(b) Due to the allocation of cases to ARIA+ category using the proportional split for each SLA, there are minor differences in the total number of cases

due to rounding.

60


Table 16 Mortality from pancreatic cancer by accessibility and remoteness (ARIA+ category), NSW, 2002–2006

Major Cities Inner Regional Outer RegionalRemote &

Very Remote

Males Deaths 1113 357 115 13

Crude rate (per 100,000) 9.2 10.5 10.3 12.2

Age-standardised rate(a) (per 100,000) 10.4 9.6 8.9 11.5

Lower 95% CI 9.8 8.6 7.3 6.0

Upper 95% CI 11.0 10.6 10.7 19.9

Females Deaths 1104 372 131 10

Crude rate (per 100,000) 9.0 10.9 11.9 11.3


Lower 95% CI 7.4 7.2 7.2 5.5

Upper 95% CI 8.3 8.9 10.3 20.4

Persons Deaths 2217 729 246 23

Crude rate (per 100,000) 9.1 10.7 11.1 11.8


Lower 95% CI 8.6 8.2 7.8 7.4

Upper 95% CI 9.4 9.5 10.0 17.8


Table 17 Incidence of pancreatic cancer by Area Health Service, NSW, 2002–2006

Sydney South West

South Eastern

Sydney & Illawarra

Sydney West

Northern Sydney &

Central Coast

Hunter & New

EnglandNorth Coast

Greater Southern

Greater Western

Males Cases 330 337 219 333 256 164 127 88

Crude rate (per 100,000) 10.1 11.6 8.2 12.5 12.4 14.2 10.8 11.6

Age-standardised rate(a) (per 100,000) 13.1 11.6 11.2 11.9 11.5 11.1 10.1 11.5

Lower 95% CI 11.6 10.4 9.7 10.6 10.1 9.5 8.4 9.2

Upper 95% CI 14.6 12.9 12.8 13.2 13.0 12.9 12.0 14.2

Females Cases 299 348 240 333 239 143 148 89

Crude rate (per 100,000) 9.1 11.8 8.9 11.8 11.4 12.0 12.8 11.9

Age-standardised rate (per 100,000) 9.4 9.6 9.9 8.7 8.7 7.8 9.9 9.6

Lower 95% CI 8.3 8.6 8.7 7.7 7.6 6.6 8.4 7.7

Upper 95% CI 10.5 10.7 11.3 9.7 9.9 9.2 11.7 11.8

Persons Cases 629 685 459 666 495 307 275 177

Crude rate (per 100,000) 9.6 11.7 8.5 12.1 11.9 13.1 11.8 11.8


Lower 95% CI 10.2 9.8 9.6 9.3 9.1 8.4 9.0 9.1

Upper 95% CI 11.9 11.4 11.5 10.9 10.8 10.6 11.5 12.3


61

Table 18 Mortality from pancreatic cancer by Area Health Service, NSW, 2002–2006.

Sydney South West

South Eastern

Sydney & Illawarra

Sydney West

Northern Sydney &

Central Coast

Hunter & New

EnglandNorth Coast

Greater Southern

Greater Western

Males Deaths 280 285 189 289 222 142 113 78

Crude rate (per 100,000) 8.6 9.8 7.0 10.8 10.7 12.3 9.6 10.3

Age-standardised rate(a) (per 100,000) 11.1 9.9 9.8 10.3 10.0 9.6 9.0 10.2

Lower 95% CI 9.8 8.7 8.4 9.2 8.7 8.1 7.4 8.0

Upper 95% CI 12.5 11.1 11.4 11.6 11.4 11.3 10.9 12.8

Females Deaths 255 312 201 292 212 128 136 81

Crude rate (per 100,000) 7.7 10.6 7.5 10.3 10.1 10.8 11.8 10.9


Lower 95% CI 7.0 7.6 7.2 6.6 6.6 5.7 7.6 6.8

Upper 95% CI 9.0 9.5 9.5 8.4 8.7 8.2 10.8 10.7

Persons Deaths 535 597 390 581 434 270 249 159

Crude rate (per 100,000) 8.2 10.2 7.3 10.6 10.4 11.5 10.7 10.6


Lower 95% CI 8.6 8.4 8.1 8.0 7.9 7.3 8.1 8.1

Upper 95% CI 10.2 9.9 9.9 9.5 9.5 9.3 10.5 11.1


62


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116. Population Health Division. The health of the people of New South Wales - report of the Chief Health Offi cer, 2008. Sydney. Available at: www.

health.nsw.gov.au/publichealth/chorep/. Accessed 30 March 2009). NSW Department of Health.

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