Download Cancer in the Northern Region of New Zealand Health Needs

Cancer in the Northern Region of New Zealand
Health Needs Assessment - 2009
August 2009
Dr Geeta Gala
Public Health Physician
Northern Cancer Network
Disclaimer
Information within the report may be freely used provided the source is acknowledged.
Every effort has been made to ensure that the information in this report is correct.
Northern Cancer Network and the author will not accept any responsibility for
information which is incorrect and where action has been taken as a result of the
information in this report.
Published in August 2009
By Northern Cancer Network
Level 2, 650 Great South Road,
Penrose
Auckland
New Zealand
ISBN 978-0-473-15694-7
Suggested citation: Gala G. Cancer in the Northern Region of New Zealand: Health
Needs Assessment-2009. Northern Cancer Network; August 2009.
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Northern Cancer Network’s Health Needs Assessment - 2009
Executive summary
This needs assessment will provide an overview of the cancer burden in the Northern
Cancer Network (NCN) region and inform the network’s strategic plan. Results from
this report may be used to support the strategic, service planning, and research
activities of cancer care stakeholders.
Data for this report was collated from the National Cancer Registry, National Minimum
Dataset, National Mortality Collection Dataset, and Census 2006. Additional data on
cancer screening, survival rates, and treatment was sourced from the Ministry of
Health. A summary of key points is provided in each chapter of this report.
Population demography
The Northern Region comprises a population of 1.54 million, representing 37% of the
New Zealand population. Waitemata is the largest and Northland, the smallest District
Health Board (DHB) in the region. Counties Manukau and Northland DHBs have a
higher proportion of children, Maori, and the most deprived population, where as
Waitemata DHB has a higher proportion of elderly and the least deprived population.
The projected population growth over the next 20 years is highest for the Northern
Region (32%), compared to the other regions of New Zealand. The Auckland DHBs in
the Northern Region are very ethnically diverse and have a high proportion of New
Zealand’s Pacific and Asian populations.
Cancer incidence
There were 6,028 new registrations of cancer in the Northern Region in 2006. The
cancer incidence increased approximately 15% over the ten year period 1996-2006.
The age-standardised rate (ASR) for all cancer for the period 2003-2006 was 351 per
100,000 for ‘Other’ ethnicity, 378 per 100,000 for Maori, 333 per 100,000 for Pacific
and 200 per 100,000 for Asian ethnicity in the Northern Region; similar to national
rates. Cancer incidence increases with age. Less than 1% of total cancer cases were in
children less than 15 years. Cancer incidence increases more than seven fold between
15-44 years and 45-64 years age groups, and by three fold between 45-64 years and
65+ years.
The leading five female cancer registrations were breast, colorectal, melanoma, lung
and uterine cancers in the Northern Region and nationally for the period 2003-2006,
accounting for approximately 65% of all female cancers. The leading five male cancer
registrations for the same period were prostate, colorectal, melanoma, lung and nonHodgkin’s lymphoma in the Northern Region and nationally, accounting for
approximately 65% of all male cancers.
Cancer mortality
There were 2,378 cancer deaths in the Northern Region in 2005. Cancer deaths have
increased approximately 6% over the ten year period 1995-2005. The ASR for all
cancer mortality for the period 2003-2006 was 129 per 100,000 for ‘Other’ ethnicity,
219 per 100,000 for Maori, 172 per 100,000 for Pacific and 81 per 100,000 for Asian
ethnicity in the Northern Region, almost similar to national rates. Cancer mortality
increases with age. Less than 1% of total cancer deaths were in children less than 15
years. Cancer mortality increases more than ten fold between 15-44 years and 45-64
years age groups, and by six fold between 45-64 years and 65+ years.
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Northern Cancer Network’s Health Needs Assessment - 2009
The leading five fatal female cancers in the Northern Region and nationally for the
period 2003-2006 were cancers of the breast, lung, colorectal, ovary and pancreas,
accounting for approximately 58% of all cancer deaths. The leading five fatal cancers
for men for the same period were cancers of the lung, prostate, colorectal, stomach
and non-Hodgkin’s lymphoma in the Northern Region, accounting for approximately
55% of all cancer deaths. The fifth most common male cancer nationally was
pancreatic cancer instead of non-Hodgkin’s lymphoma.
The leading mortality cancers are a reflection of the incidence and survival of each
specific cancer. Although breast cancer was the leading female cancer for both
incidence and mortality, the mortality contribution of 17% was significantly lower than
the incidence contribution of 28% due to its higher survival rate. In comparison, the
proportion of fatal female cancers from lung cancer was 17% compared to 9% for
incidence reflecting the low survival rate for this cancer. Melanoma and uterine cancer
ranked in the top five cancers for incidence but did not feature in the top five female
fatal cancers reflecting high survival rates.
The proportion of deaths from prostate cancer for all males in the Northern Region
(13%) was lower than the incidence proportion (28%), reflecting high survival rates for
this cancer. Lung cancer was the leading cause of cancer deaths (20%), higher than
the incidence proportion (10%), reflecting low survival rates for this cancer. The
proportion of deaths and incidence for colorectal cancer were similar reflecting a mid
level survival rate.
Cancer Survival
The one and five year relative survival rate (RSR) for all cancer for the period 20022006 were significantly higher for the Northern Region compared to that nationally and
the other regions. In fact, cancer survival in the Northern Region was comparable to
that in Victoria (Australia) for most major cancers. Among the major cancers, prostate
cancer had the highest one and five year RSR followed by cancers of the breast,
cervix, colorectal and lung.
The five year RSR for lung and prostate cancer was significantly higher for the
Northern Region than all other regions and New Zealand for the period 2002-2006. The
five year RSR for cervical cancer was significantly lower in the Northern Region when
compared to the Southern Region.
Cancer treatment
The main methods of treatment for cancer are surgery, chemotherapy and
radiotherapy. The estimated radiotherapy intervention rate for the Northern Region had
increased progressively over the last few years and was approximately 36% in
2006/07, similar to that nationally. However, this was lower than the recommended
46% radiotherapy intervention rate. The radiotherapy waiting time target of less than
eight weeks between the first specialist assessment and the start of radiation treatment
was generally met in the Northern Region with less than 10% fluctuations. In future, the
Network with its tumour stream work could provide more meaningful data on
chemotherapy, surgery and other key performance indicators in regards to cancer
treatment in future.
Cancer screening
The national target for breast screening coverage of 70% and cervical screening
coverage of 75% is currently not met by any of the Northern Region DHBs.
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Northern Cancer Network’s Health Needs Assessment - 2009
Ethnic inequalities
Ethnic inequalities exist within the Northern Region for cancer screening, cancer
incidence, cancer mortality and cancer survival. Maori, Pacific and Asian women had
lower rates of screening coverage than ‘Other’ ethnicity for cervical and breast
screening. The ranking for and the contribution proportion of the leading five common
cancers, for both incidence and mortality varied in the different ethnic groupings.
However, the ranking within the ethnic groups was similar for the Northern Region and
New Zealand.
The ASR for cancer incidence and mortality (all sites) was higher for Maori and lower
for Asian people than ‘Other’ ethnicity in the Northern Region, for the period 20022006. While Maori had 12% higher cancer incidence rates compared to non-Maori, the
cancer mortality rates were 83% higher than that of non-Maori. Maori had significantly
higher incidence rates for cancers of the lung, cervix, stomach, liver, pancreas, testes
and multiple myeloma than the non-Maori population. Maori had significantly higher
death rates for cancers of the lung, prostate, testes, cervix, ovary, uterus, stomach,
liver and pancreas than the non-Maori population.
Lung cancer was more prevalent in Maori men and women. Uterine cancer was more
prevalent in Pacific women. Cervical cancer was among the leading five female
cancers in Maori, Pacific and Asian women in the Northern Region but not so for the
‘Other’ ethnicity. Stomach and liver cancer were more common among Maori, Pacific
and Asian men than ‘Other’ ethnicity. Melanoma of the skin featured in the top five
cancers for both genders in the ‘Other’ ethnicity but not in the other ethnic groups.
While lung cancer was the leading fatal cancer in Maori women, colorectal cancer was
the leading fatal cancer for ‘Other’ ethnicity, and breast cancer was the leading fatal
cancer in Pacific and Asian women. Colorectal cancer deaths were more prominent in
men of ‘Other’ ethnicity and liver cancer deaths in Pacific and Asian men. Deaths from
melanoma of the skin ranked in the leading five fatal cancers for men of ‘Other’
ethnicity but this was not the case for other ethnic groups.
Nationally, Maori had significantly lower five year RSR than those of Pacific and ‘Other’
ethnicity for cancers of the lung, bowel, and prostate; lower RSR than those of ‘Other’
ethnicity for cancers of breast, cervix and uterus. The five year RSR for ovarian and
cervical cancer was lowest in Pacific women, when compared with other ethnicities.
Northern Region DHB inequalities
Regional inequalities exist between Northern Region DHBs for cancer screening,
cancer incidence, cancer outcomes and treatment. Auckland and Counties Manukau
had the lower breast and cervical screening coverage when compared to Waitemata
and Northland DHB. The cervical screening coverage for Asian women was
significantly lower in Auckland DHB compared to other Northern Region DHBs.
Northland Maori had higher age-standardised incidence rate for all cancer than that for
Maori in other Northern Region DHBs. The age-standardised incidence rate for all
cancer was higher in Maori than non-Maori in Counties Manukau and Northland, but
not so in Auckland and Waitemata DHBs. Inequalities in lung cancer and testicular
cancer incidence were higher (three times) between Maori and non-Maori in Northland
and Counties Manukau DHBs.
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Northern Cancer Network’s Health Needs Assessment - 2009
The age-standardised cancer mortality rates for Maori and total population were
significantly higher for Northland and Counties Manukau DHB. Northland had higher
age-specific death rates in all age groups for all cancer, compared to other Northern
Region DHBs. The age-standardised cancer mortality for all cancer was almost two
times higher in Maori than non-Maori in Northland and Counties Manukau but
approximately 1.5 times higher in Waitemata and Auckland DHBs. The inequalities in
cancer mortality from cancers of the lung, prostate, cervix, uterus and stomach were
significantly higher in Northland than in other Northern Region DHBs.
Although not statistically significant, Northland and to some extent Counties Manukau
had lower five year RSR for most major cancers. Waitemata DHB had significantly
lower five year RSR for ovarian cancer, when compared to the Auckland DHB. Some of
the inequalities in Northland could be related to the lower radiotherapy intervention
rates. Northland has an approximately 27% radiotherapy intervention rate for the year
2006/07 compared to 37% for the other Northern Region DHBs.
Summary
In regards to cancer, the Northern Region by comparison is similar or slightly better
than the national picture. The Northern Region has similar ASR for cancer incidence
and deaths as national rates. The relative survival rates for all cancer and major
cancers are higher in the Northern Region compared to national rates and are
comparable to survival rates in Australia.
There are concerns regarding screening coverage, ethnic and regional inequalities.
Maori do worse; Pacific people have intermediate cancer incidence, mortality and
survival rates compared to ‘Other’ ethnicity. Northland has significant inequalities in
regards to cancer prevalence, treatment and outcomes. The regional inequalities in fact
may reflect the ethnic inequalities, which are related to the ethnic distribution of
population.
The Northern Region population is projected to grow significantly in the next 20 years,
particularly the elderly population. This has significant implications for cancer service
planning. Priority actions for cancer services in the Northern Region over the next 3-5
years are to increase the screening coverage and to reduce ethnic inequalities.
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Northern Cancer Network’s Health Needs Assessment - 2009
Table of Contents
Executive summary ........................................................................................................ 3
List of Figures ................................................................................................................. 9
List of Tables................................................................................................................. 12
Acknowledgments......................................................................................................... 14
Abbreviations ................................................................................................................ 14
1. Chapter One: Introduction and Aims ................................................................ 15
1.1.
Introduction .................................................................................................... 15
1.2.
Aims ............................................................................................................... 15
1.3.
Scope .............................................................................................................. 15
1.4.
Methods .......................................................................................................... 15
2. Chapter Two: Population demography.............................................................. 17
2.1.
Overall population distribution – 2006........................................................... 17
2.2.
Age distribution .............................................................................................. 17
2.3.
Gender distribution ......................................................................................... 18
2.4.
Ethnicity distribution ...................................................................................... 18
2.5.
Deprivation distribution.................................................................................. 19
2.6.
Rural/urban distribution.................................................................................. 20
2.7.
Population projections .................................................................................... 20
2.8.
Key points....................................................................................................... 23
3. Chapter Three: Cancer screening....................................................................... 25
3.1.
Overview ........................................................................................................ 25
3.2.
Breast cancer screening coverage................................................................... 25
3.3.
Cervical cancer screening coverage ............................................................... 27
3.4.
Key points....................................................................................................... 30
4. Chapter Four: Cancer incidence......................................................................... 31
4.1.
Overview ........................................................................................................ 31
4.2.
Cancer incidence by ethnicity ........................................................................ 32
4.3.
Cancer incidence by age and gender .............................................................. 33
4.4.
Leading cancers .............................................................................................. 34
4.5.
Inequalities in cancer incidence...................................................................... 43
4.6.
Key points....................................................................................................... 47
5. Chapter Five: Cancer mortality.......................................................................... 49
5.1.
Overview ........................................................................................................ 49
5.2.
Cancer mortality by ethnicity ......................................................................... 50
5.3.
Cancer mortality by age.................................................................................. 51
5.4.
Leading fatal cancers ...................................................................................... 52
5.5.
Inequalities in cancer mortality ...................................................................... 60
5.6.
Key points....................................................................................................... 64
6. Chapter Six: Cancer survival .............................................................................. 67
6.1.
Overview ........................................................................................................ 67
6.2.
Relative survival rates for all cancer .............................................................. 67
6.3.
Relative survival rates by cancer type ............................................................ 68
6.4.
Relative survival rate of common cancers by ethnicity.................................. 75
6.5.
International comparison of survival of common cancers.............................. 76
6.6.
Key points....................................................................................................... 76
7. Chapter Seven: Cancer treatment ...................................................................... 78
7.1.
Overview ........................................................................................................ 78
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Northern Cancer Network’s Health Needs Assessment - 2009
7.2.
Radiotherapy................................................................................................... 78
7.3.
Radiotherapy waiting times ............................................................................ 79
7.4.
Key points....................................................................................................... 80
8. Chapter Eight: Conclusions................................................................................. 80
9. Chapter Nine: References .................................................................................... 81
10.
Appendices ........................................................................................................ 83
10.1.
World Health Organisation Standard Population ....................................... 83
10.2.
ICD -10 AM codes ..................................................................................... 83
10.3.
Calculation of radiotherapy intervention rate............................................. 84
10.4.
Radiotherapy treatment booking priorities ................................................. 85
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Northern Cancer Network’s Health Needs Assessment - 2009
List of Figures
Figure 1: Population distribution by DHB in 2006 ....................................................................... 17
Figure 2: Population distribution by DHB and ethnicity in 2006 .................................................. 19
Figure 3: Population distribution by DHB and NZDep06............................................................. 19
Figure 4: Projected population growth to 2026 by Northern Region DHBs and New Zealand ... 21
Figure 5: Breast Screen Aotearoa (BSA) coverage of Total women aged 45-69 years by
Northern Region DHBs for the 24 months ending June 2008..................................................... 25
Figure 6: Breast Screen Aotearoa (BSA) coverage of Maori women aged 45-69 years by
Northern Region DHBs for the 24 months ending June 2008..................................................... 26
Figure 7: Breast Screen Aotearoa (BSA) coverage of Pacific women aged 45-69 years by
Northern Region DHBs for the 24 months ending June 2008..................................................... 26
Figure 8: Breast Screen Aotearoa (BSA) coverage of European/Other women aged 45-69 years
by Northern Region DHBs for the 24 months ending June 2008................................................ 27
Figure 9: National Cervical Screening Programme (NCSP) coverage of Total women aged 2069 years by DHB for the 36 months ending June 2008 .............................................................. 27
Figure 10: National Cervical Screening Programme (NCSP) coverage of Maori women aged 2069 years by DHB for the 36 months ending June 2008 .............................................................. 28
Figure 11: National Cervical Screening Programme (NCSP) coverage of Pacific women aged
20-69 years by DHB for the 36 months ending June 2008 ......................................................... 28
Figure 12: National Cervical Screening Programme (NCSP) coverage of Asian women aged 2069 years by DHB for the 36 months ending June 2008 .............................................................. 29
Figure 13: National Cervical Screening Programme (NCSP) coverage of European/Other
women aged 20-69 years by DHB for the 36 months ending June 2008 ................................... 29
Figure 14: Number of cancer registrations for all cancer, both sexes by DHBs and Northern
Cancer Network Region, 1996-2006 ........................................................................................... 31
Figure 15: Age-specific rates for all cancer registrations, both sexes by DHB, NCN and NZ,
2003-2006 ................................................................................................................................... 34
Figure 16: Distribution of cancer registrations in Northern Region by site for females, all age and
ethnic groups combined, 2003-2006 ........................................................................................... 35
Figure 17: Distribution of cancer registrations in New Zealand by site for females, all age and
ethnic groups combined, 2003-2006 ........................................................................................... 35
Figure 18: Distribution of cancer registrations in Northern Region by site for males, all age and
ethnic groups combined, 2003-2006 ........................................................................................... 36
Figure 19: Distribution of cancer registrations in New Zealand by site for males, all age and
ethnic groups combined, 2003-2006 ........................................................................................... 37
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Northern Cancer Network’s Health Needs Assessment - 2009
Figure 20: Most common cancers in Northern Region in less than 15 years, 2003-2006 .......... 38
Figure 21: Most common cancers in Northern Region in 15-44 years, 2003-2006 .................... 38
Figure 22: Most common cancers in Northern Region in 45-64 years, 2003-2006 .................... 39
Figure 23: Most common cancers in Northern Region in 65+ years, 2003-2006 ....................... 39
Figure 24: Cancer deaths from all cancer. Both sexes by DHBs and NCN Region, 1995-2005 49
Figure 25: Age-specific rates for all cancer mortality, both sexes by DHB, NCN and NZ, 20032006............................................................................................................................................. 51
Figure 26: Age-specific rates by ethnicity for all cancer mortality, both sexes, for the Northern
Region, 2003-2006 ...................................................................................................................... 52
Figure 27: Distribution of cancer deaths in Northern Region by site for females, all age and
ethnic groups combined, 2003-2006 ........................................................................................... 53
Figure 28: Distribution of cancer deaths in New Zealand by site for females, all age and ethnic
groups combined, 2003-2006...................................................................................................... 53
Figure 29: Distribution of cancer deaths in Northern Region by site for males, all age and ethnic
groups combined, 2003-2006...................................................................................................... 54
Figure 30: Distribution of cancer deaths in New Zealand by site for males, all age and ethnic
groups combined, 2003-2006...................................................................................................... 55
Figure 31: Most common fatal cancers in the Northern Region in less than 15 years, 2003-2006
..................................................................................................................................................... 56
Figure 32: Most common fatal cancers in the Northern Region in 15-44 years, 2003-2006 ...... 56
Figure 33: Most common fatal cancers in the Northern Region in 45-64 years, 2003-2006 ...... 57
Figure 34: Most common fatal cancers in the Northern Region in 65+ years, 2003-2006 ......... 57
Figure 35: Relative survival rates (1 and 5 years) by Regions and New Zealand, 2002-2006... 68
Figure 36: Relative survival rates (1 and 5 years) by cancer site, Northern Region, 2002-2006 68
Figure 37: Five year relative survival rates for breast cancer by Regions and New Zealand,
2002-2006 ................................................................................................................................... 69
Figure 38: Five year relative survival rates for breast cancer by Northern Region DHBs, 20022006............................................................................................................................................. 69
Figure 39: Five year relative survival rates for lung cancer by Regions and New Zealand, 20022006............................................................................................................................................. 70
Figure 40: Five year relative survival rates for lung cancer by Northern Region DHBs, 20022006............................................................................................................................................. 70
Figure 41: Five year relative survival rates for colorectal cancer by Regions and New Zealand,
2002-2006 ................................................................................................................................... 71
Figure 42: Five year relative survival rates for colorectal cancer by Northern Region DHBs,
2002-2006 ................................................................................................................................... 71
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Northern Cancer Network’s Health Needs Assessment - 2009
Figure 43: Five year relative survival rates for prostate cancer by Regions and New Zealand,
2002-2006 ................................................................................................................................... 72
Figure 44: Five year relative survival rates for prostate cancer by Northern Region DHBs, 20022006............................................................................................................................................. 72
Figure 45: Five year relative survival rates for cervical cancer by Regions and New Zealand,
2002-2006 ................................................................................................................................... 73
Figure 46: Five year relative survival rates for cervical cancer by Northern Region DHBs, 20022006............................................................................................................................................. 73
Figure 47: Five year relative survival rates for uterine cancer by Northern Region DHBs, 20022006............................................................................................................................................. 74
Figure 48: Five year relative survival rates for ovarian cancer by Northern Region DHBs, 20022006............................................................................................................................................. 74
Figure 49: Five year relative survival rates for lung, bowel and prostate cancer by ethnicity, New
Zealand, 2002-2006 .................................................................................................................... 75
Figure 50: Five year survival rates of cancers of the ovary, uterus, cervix and breast by ethnicity,
New Zealand, 2002-2006 ............................................................................................................ 75
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Northern Cancer Network’s Health Needs Assessment - 2009
List of Tables
Table 1: Population distribution by DHB and age in 2006 .......................................................... 17
Table 2: Population distribution by DHB and gender in 2006 ..................................................... 18
Table 3: Population distribution by DHB and ethnicity in 2006 ................................................... 18
Table 4 : Rural/urban population distribution by DHB in 2006 .................................................... 20
Table 5: Projected total population growth for Northern Region DHBs and New Zealand ......... 20
Table 6: Projected population to 2026 by ethnicity for Northern Region..................................... 21
Table 7: Projected population to 2026 by ethnicity for New Zealand.......................................... 22
Table 8: Projected population to 2026 by ethnicity for ADHB ..................................................... 22
Table 9: Projected population to 2026 by ethnicity for CMDHB.................................................. 22
Table 10: Projected population to 2026 by ethnicity for NDHB................................................... 23
Table 11: Projected population to 2026 by ethnicity for WDHB .................................................. 23
Table 12: Number of cancer registrations for all cancer, both sexes by NCN Region and New
Zealand, 1996-2006 .................................................................................................................... 31
Table 13: All cancer registrations, all ages, both sexes by DHB, NCN and NZ, 2003-2006 ...... 32
Table 14: Age-standardised rates for all cancer registrations, all ages, both sexes by DHB, NCN
and NZ, 2003-2006, per 100,000 population .............................................................................. 32
Table 15: All cancer registrations, by age groups, both sexes by DHB, NCN and NZ, 2003-2006
..................................................................................................................................................... 33
Table 16: Leading female cancers by ethnicity for Northern Region, 2003-2006...................... 40
Table 17: Leading female cancers by ethnicity for New Zealand, 2003-2006 ........................... 40
Table 18: Leading male cancers by ethnicity for Northern Region, 2003-2006......................... 41
Table 19: Leading male cancers by ethnicity for New Zealand, 2003-2006 .............................. 41
Table 20: Maori and non-Maori inequalities in cancer registrations by tumour site, 2003- 2006,
Northern Region .......................................................................................................................... 43
Table 21: Maori and non-Maori inequalities in cancer registrations by tumour site, 2003-2006,
ADHB........................................................................................................................................... 44
Table 22: Maori and non-Maori inequalities in cancer registrations by tumour site, 2003-2006,
CMDHB ....................................................................................................................................... 45
Table 23: Maori and non-Maori inequalities in cancer registrations by tumour site, 2003-2006,
NDHB .......................................................................................................................................... 46
Table 24: Maori and non-Maori inequalities in cancer registrations by tumour site, 2003-2006,
WDHB.......................................................................................................................................... 47
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Northern Cancer Network’s Health Needs Assessment - 2009
Table 25: All cancer mortality, all ages, both sexes by DHB, NCN and NZ, by ethnicity, 20032006............................................................................................................................................. 50
Table 26: Age-standardised rates for all cancer deaths by ethnicity, by DHB, NCN Region and
NZ, 2003-2006, per 100,000 population ..................................................................................... 50
Table 27: Leading female fatal cancers by ethnicity for Northern Region, 2003-2006 .............. 58
Table 28: Leading fatal female cancers by ethnicity for New Zealand, 2003-2006 .................... 58
Table 29: Leading fatal male cancers by ethnicity for Northern Region, 2003-2006 .................. 59
Table 30: Leading fatal male cancers by ethnicity for New Zealand, 2003-2006 ....................... 59
Table 31: Maori and non-Maori inequalities in cancer mortality by tumour site, 2003-2006,
Northern Region .......................................................................................................................... 60
Table 32: Maori and non-Maori inequalities in cancer mortality by tumour site, 2003-2006,
ADHB........................................................................................................................................... 61
Table 33: Maori and non-Maori inequalities in cancer mortality by tumour site, 2003-2006,
CMDHB ....................................................................................................................................... 62
Table 34: Maori and non-Maori inequalities in cancer mortality by tumour site, 2003-2006,
NDHB .......................................................................................................................................... 63
Table 35: Maori and non-Maori inequalities in cancer mortality by tumour site, 2003-2006,
WDHB.......................................................................................................................................... 64
Table 36: Five year relative survival rate (%) for major cancers by Northern Region, New
Zealand, Australia (Victoria) and USA ........................................................................................ 76
Table 37: Estimated radiotherapy treatment intervention rates by Northern Region DHBs and
New Zealand, 2004/05 – 2006/07 ............................................................................................... 78
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Northern Cancer Network’s Health Needs Assessment - 2009
Acknowledgments
The report was prepared for Northern Cancer Network and the author would like to
acknowledge the invaluable assistance of the following people.
Dean Papa, Anrie Weidemann and Keming Wang for providing statistical and analytical
support.
Simon Bidwell, Vladimir Stevanovic and Amanda Borich from the Ministry of Health for
providing various datasets.
Dr Gary Jackson for peer reviewing the draft copy of this report.
Annette Mortensen and my team for all their support.
Abbreviations
ADHB
Auckland District Health Board
ASR
Age Standardised Rate
BSA
Breast Screen Aotearoa
CMDHB
Counties Manukau District Health Board
HNA
Health Needs Assessment
ICD-10-AM
ICD-O
International Classification of Diseases, tenth revision, Australian
Modification
International Classification of Diseases for Oncology
NCN
Northern Cancer Network
NCSP
National Cervical Screening Programme
NDHB
Northland District Health Board
NZCR
New Zealand Cancer Registry
NZDep06
New Zealand Deprivation Score 2006
RSR
Relative Survival Rate
WDHB
Waitemata District Health Board
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Northern Cancer Network’s Health Needs Assessment - 2009
1.
Chapter One: Introduction and Aims
1.1. Introduction
The Northern Cancer Network (NCN) is one of four regional cancer networks in New
Zealand established to implement the New Zealand Cancer Control Strategy Action
Plan 2005-2010.[1] The NCN works across the cancer continuum, providing leadership,
facilitation and coordination with cancer control stakeholders to achieve the goals of the
Cancer Control Strategy. The NCN region comprises four District Health Boards
(DHBs): Auckland, Counties Manukau, Northland and Waitemata.
The Health Needs Assessment (HNA) in respect to cancer for the Northern Region is
undertaken to inform the Northern Cancer Network Strategic Plan. The report will also
assist cancer care stakeholders to identify priorities for their districts or areas, in turn
informing their district annual and strategic planning.
1.2. Aims
o To inform the NCN Strategic Plan 2009-14
o To provide evidence to make decisions about the priorities in respect to cancer
care and control
o To provide an interpretation of key results in order to support strategic, service
planning and research activities in the Northern Region
1.3. Scope
The focus of this report is to inform the strategic plan of the NCN. It is recognised that
this HNA does not cover all the data across the cancer continuum. From the Network
point of view, the emphasis is on early cancer diagnosis and treatment. Hence the
focus has been on the analyses and interpretation of the key findings in cancer
diagnosis and treatment. However, this has been limited by the data available. It is
recognised that many other analyses would be useful, including cancer prevention,
rehabilitation and palliative care. It is hoped that future work will build on the findings of
this report. Further, the work of the Networks, the Ministry of Health, and that of the
other cancer control stakeholders will improve the availability of data.
1.4. Methods
The key data sets used in this HNA are from the New Zealand Cancer Registry, the
National Minimum Dataset and the National Mortality Collection Dataset. Population
demography information is from the Census 2006. The population projections from
2007 were obtained from Statistics New Zealand and Ministry of Health. The
deprivation index is from NZDep06, where 1 represents the least deprived area and 10
the most deprived area.[2] Additional data on cancer screening, survival rates, and
treatment are sourced from the Ministry of Health.
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Northern Cancer Network’s Health Needs Assessment - 2009
The New Zealand Cancer Registry uses the International Statistical Classification of
Diseases, Tenth Revision, Australian Modification (ICD-10-AM) Third Edition [3] to
classify the site or topography. The International Classification of Diseases for
Oncology (ICD-O) Third Edition is used to classify the morphology (histology type and
behaviour) of tumours.
It is important to note that there were changes to the coding of cancers since 1 January
2003. For some tumour types, particularly haematological, ovarian and bladder
cancers, these changes may affect incidence reporting. Polycythaemia vera,
myelodysplastic syndromes and chronic myeloproliferative disorders (D45 -D47) are
now considered to be malignant and are included in all cancer coding.
The cancer incidence and mortality analysis in this HNA includes codes C00 to C96
and D45-D47, excluding non-melanocytic skin cancer (ICD -10 code C44). For the ICD10 codes for specific cancers, refer to Appendix 10.2. Depending upon the codes used
and whether changes in code definitions were included, there may be slight variations
when data in this report is compared to other reports.
The ethnicity data is collected and classified according to the Ministry of Health
ethnicity data protocols for the health and disability sector [4] by New Zealand Cancer
Registry. In this report, the ethnicity data is based on prioritised ethnicity classification.
Each individual is assigned to a single ethnic group using the priority system, in the
following order: Maori, Pacific, Asian, European/Other group.
Age-standardised rates are calculated using direct standardisation to the WHO
standard population in most analyses and expressed as rates per 100,000 populations
(Appendix 10.1). The data is often categorised into four age groups for ease of
interpretation: 0-14 years, 15-44 years, 45-64 years and 65+ years. The age structure
of the population has an important implication for service provision in any given area.
Cancer incidence increases with age and older populations generally have a greater
demand for services.
Data presentation
The data in this HNA is presented for the Northern Region and their respective DHBs
where possible, and comparisons are made with all New Zealand cancer data. The
cancer incidence and mortality data including leading cancers and Maori/non-Maori
inequality data is aggregated for 4 years (2003-2006) to increase the numbers and the
reliability. Cancer survival data consists of relative survival rates based on period
analysis from 2002-2006. Radiotherapy intervention rates are for a three year period
from 2004/05 to 2006/07. The breast and cervical screening data are for two and three
years respectively ending June 2008. More details are given in the specific chapters.
16
Northern Cancer Network’s Health Needs Assessment - 2009
2.
Chapter Two: Population demography
2.1. Overall population distribution – 2006
The 2006 census population for the region is estimated to be 1.54 million (estimated
resident population), representing 37% of New Zealand’s population. Waitemata is the
largest DHB in the region with a population of 504,710; the smallest DHB is Northland
with a population of 152,650. Auckland and Counties Manukau have a population of
428,280 and 454,790 respectively. This population is distributed as follows:
Figure 1: Population distribution by DHB in 2006
Population distribution by DHB in 2006
27.8%
32.8%
ADHB
CMDHB
NDHB
WDHB
9.9%
29.5%
Source: Ministry of Health projections, Statistics New Zealand. The 2006 census population is “estimated usually
resident” census population count which is adjusted for undercounts.
2.2. Age distribution
Table 1: Population distribution by DHB and age in 2006
DHB
0-14
15-24
25-44
45-64
65+
ADHB
78,950
(18.4%)
71,820
(16.8%)
145,400
(33.9%)
91,690
(21.4%)
40,420
(9.4%)
Total (%
Northern
Region)
428,280
(27.8%)
CMDHB
115,500
(25.4%)
70,220
(15.4%)
130,700
(28.7%)
98,530
(21.7%)
39,840
(8.8%)
454,790
(29.5%)
NDHB
35,330
(23.1%)
18,360
(12.0%)
36,450
(23.9%)
40,410
(26.5%)
22,100
(14.5%)
152,650
(9.9%)
WDHB
107,500
(21.3%)
72,460
(14.4%)
150,360
(29.8%)
119,290
(23.6%)
55,100
(10.9%)
NCN
337,280
(21.9%)
232,860
(15.1%)
462,910
(30.1%)
349,920
(22.7%)
157,460
(10.2%)
504,710
(32.8%)
1,540,430
(36.8% of
NZ)
NZ
888,170
(21.2%)
604,740
(14.5%)
1,181,270
(28.2%)
998,335
(23.9%)
511,580
(12.2%)
4,184,095
Source: Ministry of Health projections, Statistics New Zealand. The 2006 census population is “estimated usually
resident” census population count which is adjusted for undercounts.
17
Northern Cancer Network’s Health Needs Assessment - 2009
Age distribution in the Northern Region is very similar to age distribution in New
Zealand but there are some variations by DHB. Counties Manukau and Northland have
higher proportions of children less than 15 years; Auckland DHB has proportionally
more people aged 15-44 years; and Northland has the highest proportion of older
people aged 65+ (14.5%). The proportion of older people aged 65+ in the Northern
Region is 10.2%. However, Waitemata DHB has the largest number of older people
65+ (approximately 55,000).
2.3. Gender distribution
The Northern Region has slightly more females than males (51.0% and 49.0%
respectively). Similar distribution is seen in the Northern Region DHBs and New
Zealand.
Table 2: Population distribution by DHB and gender in 2006
ADHB
CMDHB
NDHB
WDHB
NCN
NZ
Female
Percentage
218,680
(51.1%)
232,350
(51.1%)
77,580
(50.8%)
257,740
(51.1%)
786,350
(51.0%)
2,136,125
(51.1%)
Male
Percentage
209,600
(48.9%)
222,440
(48.9%)
75,070
(49.2%)
246,970
(48.9%)
754,080
(49.0%)
2,047,970
(48.9%)
Source: Ministry of Health projections, Statistics New Zealand. The 2006 census population is “estimated usually
resident” census population count which is adjusted for undercounts.
2.4. Ethnicity distribution
The Northern Region has higher proportions of Pacific (11.9%) and Asian (15.7%)
people when compared to New Zealand.
Table 3: Population distribution by DHB and ethnicity in 2006
DHB
ADHB
CMDHB
NDHB
WDHB
NCN
NZ
Maori
Pacific
Asian
European/Other
34,930
(8.2%)
76,060
(16.7%)
48,040
(31.5%)
48,860
(9.7%)
207,890
(13.5%)
624,280
(14.9%)
51,330
(12.0%)
95,420
(21.0%)
2,270
(1.5%)
34,320
(6.8%)
183,340
(11.9%)
256,865
(6.1%)
97,182
(22.7%)
73,299
(16.1%)
2,031
(1.3%)
69,611
(13.8%)
242,122
(15.7%)
356,066
(8.5%)
244,838
(57.2%)
210,011
(46.2%)
100,309
(65.7%)
351,919
(69.7%)
907,078
(58.9%)
2,946,884
(70.4%)
Total (%
Northern
Region)
428,280
454,790
152,650
504,710
1,540,430
4,184,095
Source: Ministry of Health projections, Statistics New Zealand. The 2006 census population is “estimated usually
resident” census population count which is adjusted for undercounts.
18
Northern Cancer Network’s Health Needs Assessment - 2009
Counties Manukau DHB has the largest number of Maori living in the region (76,060)
while Northland has the highest proportion of Maori (31.5%). Counties Manukau has
both the largest number of and the largest proportion of Pacific peoples. Northland has
the lowest number of and the lowest proportion of Asian and Pacific peoples. The four
DHBs have diverse ethnic distributions as shown in the figure below:
Figure 2: Population distribution by DHB and ethnicity in 2006
Population distribution by DHB & ethnicity in 2006
NZ
NCN
WDHB
NDHB
CMDHB
ADHB
0
10
20
30
40
Maori
Pacific
50
Asian
60
70
80
90
100
European/other
2.5. Deprivation distribution
Figure 3: Population distribution by DHB and NZDep06
Population distribution by DHB and NZDep06 decile 9 & 10
160000
40%
140000
Total 9&10
35%
120000
9 & 10%
30%
100000
25%
80000
20%
60000
15%
40000
10%
20000
5%
0
0%
ADHB
CMDHB
NDHB
WDHB
There are marked differences in population distribution by deprivation across the
Northern Region. The deprivation indexes are further grouped into deciles where decile
1 refers to the least deprived area while decile 10 refers to the most deprived areas.
Counties Manukau and Northland have the largest proportion of people living in the
most deprived areas (34% and 33% in decile 9 & 10). Waitemata has the least
proportion of people living in the most deprived areas (8%).
19
Northern Cancer Network’s Health Needs Assessment - 2009
2.6. Rural/urban distribution
Approximately 9.2% of the Northern Region population live in rural areas while 90.8%
of the population live in urban areas. Except for Northland, the Northern Region is
highly urbanised like New Zealand. Northland has a high proportion of people living in
rural areas (49%). Auckland has the least proportion of people living in rural areas
(0.2%).
Table 4 : Rural/urban population distribution by DHB in 2006
ADHB
CMDHB
NDHB
WDHB
NCN
NZ
Rural
Percentage
1,005
(0.2%)
31,212
(7.2%)
72,717
(49.0%)
30,498
(6.3%)
135,432
(9.2%)
565,509
(14.0%)
Urban
Percentage
403,551
(99.8%)
401,841
(92.8%)
75,687
(51.0%)
451,206
(93.7%)
1,332,285
(90.8%)
3,462,636
(86.0%)
Source: Statistics New Zealand Area Concordance data 2006 Census. The 2006 census population is “usually resident”
census population count which is not adjusted for undercounts.
2.7. Population projections
Table 5: Projected total population growth for Northern Region DHBs and New
Zealand
DHB
2006
2011
2016
2021
2026
% increase
2006-26
ADHB
428,280
464,260
500,980
538,170
574,660
34%
CMDHB
454,790
499,590
541,310
583,510
625,930
38%
NDHB
152,650
158,620
163,530
167,690
170,960
12%
WDHB
504,710
544,600
583,000
621,200
658,940
31%
NCN
1,540,430
1,667,070
1,788,820
1,910,570
2,030,490
32%
NZ
4,184,095
4,401,460
4,591,035
4,771,395
4,939,850
18%
Source: Ministry of Health projections, Statistics New Zealand. The 2006 census population is “estimated usually
resident” census population count which is adjusted for undercounts. 2007-2026 growth extrapolated from MoH (2007)
medium projection.
In comparison to the 18% growth projected for New Zealand in the next 20 years from
2006, the Northern Region’s population is projected to grow by 32% - the largest
projected increase of any of the regions in New Zealand. Within the Northern Region,
the Auckland Region DHBs are expected to have a growth increase of approximately
31-38% while Northland is expected to have a growth increase of 12%.
20
Northern Cancer Network’s Health Needs Assessment - 2009
Figure 4: Projected population growth to 2026 by Northern Region DHBs and
New Zealand
% of projected population growth 2006-26
Projected population grow th By Northern Region DHBs & New
Zealand
140
0-14
120
15-64
65+
100
80
60
40
20
0
-20
ADHB
CMDHB
NDHB
WDHB
NCN
NZ
Projections to 2026 by age group indicate that there are increases in population growth
in all age groups in the Northern Region DHBs except Northland. By 2026, a decline of
8% is projected for the younger population in Northland. The proportion of the aging
population (65+ years) is expected to grow more rapidly than the rest of the population.
Counties Manukau is projected to have the largest growth (130%) in the 65+ age
population.
Population projection by ethnicity
The ethnic composition of the Northern Region is likely to become more diverse by
2026 with the increasing proportion of Maori, Pacific and Asian peoples. Similar growth
is projected in New Zealand but to a lesser extent than in the Northern Region. Further,
the Asian population is projected to increase by 22% in the Northern Region, compared
to an increase of 11% for New Zealand. See Table 6 and 7.
Table 6: Projected population to 2026 by ethnicity for Northern Region
DHB
NCN
21
Ethnicity
%
increase
2006-26
2006
2011
2016
2021
2026
Maori
207,890
225,110
241,620
258,410
275,820
33%
Pacific
183,340
204,840
225,790
247,320
269,840
47%
Asian
242,122
258,071
271,631
283,782
294,758
22%
Other
907,078
979,049
1,049,779
1,121,058
1,190,072
31%
Northern Cancer Network’s Health Needs Assessment - 2009
Table 7: Projected population to 2026 by ethnicity for New Zealand
DHB
New
Zealand
Ethnicity
%
increase
2006-26
2006
2011
2016
2021
2026
Maori
624,280
672,220
717,800
763,780
810,730
30%
Pacific
256,865
284,310
311,165
338,525
367,100
43%
Asian
356,066
372,815
384,944
394,786
403,153
13%
Other
2,946,884
3,072,115
3,177,126
3,274,304
3,358,867
14%
All the Northern Region DHBs are projected to have an increase in Maori, Pacific and
European/other populations. With the exception of Northland, the other Northern
Region DHBs are projected to have increases in the Asian population by 2026.
CMDHB and NDHB have the highest projected increase in the Maori population, 37%
and 26% respectively. Waitemata and CMDHB have a high projected increase in the
Pacific population, approximately 63% and 58% respectively. In ADHB the Asian
population is projected to increase by 29%, compared to a decrease of 22% in NDHB.
See Table 8-11.
Table 8: Projected population to 2026 by ethnicity for ADHB
DHB
ADHB
Ethnicity
%
increase
2006-26
2006
2011
2016
2021
2026
Maori
34,746
36,900
38,470
39,800
40,960
18%
Pacific
51,330
53,880
56,200
58,450
60,730
18%
Asian
97,182
104,837
111,927
118,677
124,888
29%
Other
244,838
268,643
294,383
321,243
348,082
42%
Table 9: Projected population to 2026 by ethnicity for CMDHB
DHB
CMDHB
22
Ethnicity
%
increase
2006-26
2006
2011
2016
2021
2026
Maori
76,060
83,200
90,000
97,030
104,530
37%
Pacific
95,420
108,930
122,230
135,980
150,430
58%
Asian
73,299
77,681
81,288
84,475
87,219
19%
Other
210,011
229,779
247,792
266,025
283,751
35%
Northern Cancer Network’s Health Needs Assessment - 2009
Table 10: Projected population to 2026 by ethnicity for NDHB
DHB
NDHB
Ethnicity
%
increase
2006-26
2006
2011
2016
2021
2026
Maori
48,040
51,140
54,250
57,450
60,720
26%
Pacific
2,270
2,370
2,460
2,550
2,660
17%
Asian
2,031
1,944
1,825
1,703
1,584
-22%
Other
100,309
103,166
104,995
105,987
105,996
6%
Table 11: Projected population to 2026 by ethnicity for WDHB
DHB
WDHB
Ethnicity
%
increase
2006-26
2006
2011
2016
2021
2026
Maori
48,860
53,870
58,900
64,130
69,610
42%
Pacific
34,320
39,660
44,900
50,340
56,020
63%
Asian
69,611
73,609
76,591
78,927
81,067
16%
Other
351,919
377,461
402,609
427,803
452,243
29%
2.8. Key points
o
The Northern Region represents 37% of New Zealand’s population. Waitemata
is the largest DHB in the region and nationally,
o
Counties Manukau has a higher proportion of children, the most deprived
population and the largest number of Maori,
o
Northland has a high proportion of children, elderly aged 65+, Maori, and the
most deprived population but the numbers are higher in other Northern DHBs,
o
Waitemata has the lowest proportion of the most deprived population, and the
largest number of elderly 65+ population,
o
Except for Northland, the Northern Region is highly urbanised,
o The Northern Region’s population is projected to grow in the next 20 years by
32% - the largest projected increase of any of the regions in New Zealand,
o The Auckland DHBs are expected to have 31-38% growth increase, compared
to 12% for Northland,
o The Northern Region DHBs have positive population growth projections for all
ages except for a decline in younger populations (8%) in Northland by 2026.
The elderly 65+ population is projected to grow more rapidly than the rest of the
population,
o
23
The Northern Region is going to be more diverse by 2026 with increasing
proportion of Maori, Pacific and Asian populations,
Northern Cancer Network’s Health Needs Assessment - 2009
o Waitemata and Counties Manukau DHB will have an increase of 63% and 58%
in their Pacific populations,
o In Auckland DHB the Asian population is projected to increase by 29%,
compared to a decrease of 22% in NDHB,
o
24
In the Northern Region the projected increase in the Asian population by 2026
is double than that projected for the New Zealand overall.
Northern Cancer Network’s Health Needs Assessment - 2009
3.
Chapter Three: Cancer screening
3.1. Overview
New Zealand currently has national screening programmes for breast cancer and
cervical cancer. Planning for bowel cancer screening is in its early stages. The second
goal of the New Zealand Cancer Control Strategy is ‘to ensure effective screening and
early detection to reduce cancer incidence and mortality’. [5]
Breast Screen Aotearoa (BSA) was established nationally in 1998 to provide free
mammograms and follow-up for asymptomatic women aged 50-64 years. In July 2004,
the eligible age for publicly funded breast screening was extended to 45-69 years. The
current coverage target is two-yearly screening of 70% of eligible women. The
programme is delivered throughout the country by lead providers, their sub-contracted
providers, and by mobile units that deliver services to rural and some urban
communities.
The National Cervical Screening programme (NCSP) in New Zealand was established
in 1990. The NCSP encourages women between 20 and 70 years of age to have three
yearly cervical smear tests. The current coverage target is to screen 75% of eligible
women.
3.2. Breast cancer screening coverage
The BSA 24-month or 2 year coverage is the number of BSA screened women aged
45-69 years during the 24-month period as a proportion of all eligible women in New
Zealand aged 45-69 years (as derived from the 2001 Census population projections for
that screening period).
The breast screening coverage in Northland for total women (65.4%) exceeded the
national average (61.9%) and that for Waitemata DHB (59.4%) was close to the
national average. The breast screening coverage for Auckland (49.3%) and Counties
Manukau (50.3%) were significantly lower compared to the national average. The
national target for breast screening coverage of 70% had not been met by any of the
Northern Region DHBs.
Figure 5: Breast Screen Aotearoa (BSA) coverage of Total women aged 45-69
years by Northern Region DHBs for the 24 months ending June 2008
Northern DHBs & National
Target (70%)
80%
Coverage rate
70%
60%
50%
40%
30%
20%
10%
0%
Auckland
25
Counties
Manukau
Northland
Waitemata
National
Northern Cancer Network’s Health Needs Assessment - 2009
Figure 6: Breast Screen Aotearoa (BSA) coverage of Maori women aged 45-69
years by Northern Region DHBs for the 24 months ending June 2008
Northern DHBs & National
Target (70%)
80%
Coverage rate
70%
60%
50%
40%
30%
20%
10%
0%
Auckland
Counties
Manukau
Northland
Waitemata
National
Maori women had significantly lower BSA screening rates compared to
European/Other women. While the coverage for ‘Other’ women was between 50-60%,
the coverage for Maori women was 40-50% in the Northern Region. The breast
screening coverage for Maori women in the Northern Region was comparable to the
national average but significantly lower than the national target of 70% coverage.
Auckland and Counties Manukau DHB had lower rates of coverage when compared to
Northland and Waitemata DHBs.
Figure 7: Breast Screen Aotearoa (BSA) coverage of Pacific women aged 45-69
years by Northern Region DHBs for the 24 months ending June 2008
Northern DHBs & National
Target (70%)
80%
Coverage rate
70%
60%
50%
40%
30%
20%
10%
0%
Auckland
Counties
Manukau
Northland
Waitemata
National
The breast screening coverage for Pacific women in the Northern Region was
comparable to the national average but generally lower than ‘Other’ women. The high
coverage in Northland may be due to skewed results because of the small numbers of
Pacific women in the region.
26
Northern Cancer Network’s Health Needs Assessment - 2009
Figure 8: Breast Screen Aotearoa (BSA) coverage of European/Other women
aged 45-69 years by Northern Region DHBs for the 24 months ending June 2008
Northern DHBs & National
Target (70%)
80%
Coverage rate
70%
60%
50%
40%
30%
20%
10%
0%
Auckland
Counties
Manukau
Northland
Waitemata
National
There were many inequalities in the breast screening coverage of European/Other
women in the Northern Region. The breast screening coverage of 69.2% for Northland
was very close to the target of 70% coverage. Waitemata had coverage of 60.3% but
the coverage rates for Auckland (49.1%) and for Counties Manukau DHBs (51.7%)
were significantly lower than the national average of 64.1%.
3.3. Cervical cancer screening coverage
The NCSP 36-month or 3 year coverage is the number of NCSP screened women
aged 20-69 years during the 36-month period as a proportion of all eligible women in
New Zealand aged 20-69 years (as derived from the 2001 Census population
projections for that screening period). All NCSP coverage rates are hysterectomyadjusted.
Coverage rate
Figure 9: National Cervical Screening Programme (NCSP) coverage of Total
women aged 20-69 years by DHB for the 36 months ending June 2008
80%
75%
70%
65%
60%
55%
50%
45%
40%
35%
30%
Auckland
Counties
Manukau
Northland
Northern DHBs & National
27
Waitemata
National
Target (75%)
Northern Cancer Network’s Health Needs Assessment - 2009
The national target for cervical cancer screening coverage of 75% was not being met
by any of the Northern Region DHBs. All the Northern Region DHBs had cervical
screening coverage rates that were lower than the national average (72.1%). Auckland
(65.5%) and Counties Manukau (66.1%) had significantly lower coverage rates.
Coverage rate
Figure 10: National Cervical Screening Programme (NCSP) coverage of Maori
women aged 20-69 years by DHB for the 36 months ending June 2008
80%
75%
70%
65%
60%
55%
50%
45%
40%
35%
30%
Auckland
Counties
Manukau
Northland
Northern DHBs & National
Waitemata
National
Target (75%)
The Cervical screening coverage in Maori women was significantly lower than that of
the European/Other ethnicity. While the coverage for Maori women in the Northern
Region ranged between 40-50%, the coverage for ‘Other’ women was between 8087% coverage. Cervical screening coverage for Maori women in Auckland and
Waitemata DHB was lower than the national average of 49.7% coverage.
Coverage rate
Figure 11: National Cervical Screening Programme (NCSP) coverage of Pacific
women aged 20-69 years by DHB for the 36 months ending June 2008
80%
75%
70%
65%
60%
55%
50%
45%
40%
35%
30%
Auckland
Counties
Manukau
Northland
Northern DHBs & National
Waitemata
National
Target (75%)
The cervical screening coverage for Pacific women was similar to that of Maori women
but significantly lower than of the ‘Other’ ethnicity. All Northern DHBs, except Counties
28
Northern Cancer Network’s Health Needs Assessment - 2009
Manukau DHB had cervical screening coverage rates lower than the national average
for Pacific women.
Coverage rate
Figure 12: National Cervical Screening Programme (NCSP) coverage of Asian
women aged 20-69 years by DHB for the 36 months ending June 2008
80%
75%
70%
65%
60%
55%
50%
45%
40%
35%
30%
Auckland
Counties
Manukau
Northland
Northern DHBs & National
Waitemata
National
Target (75%)
The Cervical screening coverage for Asian women, similar to that for Maori and Pacific
women in the Northern Region, was significantly lower than that of ‘Other’ ethnicity.
Auckland DHB had significantly lower cervical screening coverage rates for Asian
women (38.9%) when compared with other Northern Region DHBs.
Figure 13: National Cervical Screening Programme (NCSP) coverage of
European/Other women aged 20-69 years by DHB for the 36 months ending June
2008
100%
Coverage rate
90%
80%
70%
60%
50%
40%
30%
Auckland
Counties
Manukau
Northland
Northern DHBs & National
Waitemata
National
Target (75%)
The cervical screening coverage rates for European/Other women in the Northern
Region were significantly higher than the other ethnic groups and reach the national
target of 75% coverage.
29
Northern Cancer Network’s Health Needs Assessment - 2009
3.4. Key points
30
o
There were significant disparities in breast and cervical screening coverage
between different ethnic groups in the Northern Region,
o
The national target for breast screening coverage of 70% and cervical
screening coverage of 75% was not met for total women by any of the Northern
Region DHBs,
o
Auckland and Counties Manukau had significantly lower breast and cervical
screening rates when compared to Waitemata and Northland DHBs,
o
Maori and Pacific women in the Northern Region had lower breast screening
coverage rates compared to those of ‘Other’ ethnicity,
o
Maori, Pacific and Asian women in the Northern Region had lower cervical
screening rates when compared to that of ‘Other’ ethnicity,
o
The cervical screening coverage for European/Other women in all Northern
Region DHBs was significantly higher and reached the national target of 75%,
o
The cervical screening coverage for Asian women in Auckland DHB was
significantly lower (38.9%), compared to other Northern DHBs and nationally.
Northern Cancer Network’s Health Needs Assessment - 2009
4.
Chapter Four: Cancer incidence
4.1. Overview
Cancer registrations are used as a measure of cancer incidence. There were 6,028
new registrations of cancer (malignant cancers, C00-C96 & D45-D47) in the Northern
Region compared to 19,534 in New Zealand in 2006. The cancer registrations peaked
in 2004, slightly decreased in 2005 but showed an upward trend in 2006 across the
Northern Region. It should be noted that from 1 January 2005 superficial transitional
cell carcinoma of the bladder was no longer coded as invasive cancer [6] and this may
account for the decline in cancer registrations in 2005.
Figure 14: Number of cancer registrations for all cancer, both sexes by DHBs
and Northern Cancer Network Region, 1996-2006
ADHB
CMDHB
NDHB
WDHB
NCN
8000
7000
2500
6000
2000
5000
4000
1500
3000
1000
2000
500
noof registrations(NCN)
Number of registrations(DHB)
3000
1000
0
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Calendar Year
The cancer incidence in the Northern Region has increased approximately 15% over
the ten year period from 1996-2006, compared to a 20% increase nationally. However,
there were variations among the Northern Region DHBs. While CMDHB and NDHB
showed an increase of 24 and 23% respectively, WDHB had an increase of 17% and
ADHB had the smallest increase of 3.6%.
Table 12: Number of cancer registrations for all cancer, both sexes by NCN
Region and New Zealand, 1996-2006
Region
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
199606
ADHB
1,628
1,593
1,568
1,591
1,775
1,666
1,633
1,640
1,748
1,686
1,686
3.6%
CMDHB
1,247
1,234
1,307
1,336
1,513
1,444
1,469
1,518
1,662
1,605
1,548
24.1%
NDHB
665
712
753
767
787
809
823
813
907
769
817
22.9%
WDHB
1,840
1,689
1,732
1,822
1,968
2,049
2,060
2,114
2,177
2,035
2,157
17.2%
NCN
5,380
5,228
5,360
5,516
6,043
5,968
5,985
6,085
6,494
6,095
6,208
15.4%
16,332
16,263
16,815
17,362
18,319
18,448
18,476
19,183
19,876
19,435
19,534
19.6%
NZ
31
Northern Cancer Network’s Health Needs Assessment - 2009
4.2. Cancer incidence by ethnicity
The Northern Region had approximately a third of all cancers in New Zealand,
proportionate to the population. The following table shows the number of all cancers for
different ethnic groups by Northern Region DHBs and New Zealand for a four year
period 2003-2006.
Table 13: All cancer registrations, all ages, both sexes by DHB, NCN and NZ,
2003-2006
DHB
Maori
Pacific
European/
Other
Asian
Total
ADHB
306
552
508
5,139
6,505
CMDHB
604
781
391
4,347
6,123
NDHB
587
14
14
2,568
3,183
WDHB
343
281
352
7,206
8,182
NCN
region
1,840
1,628
1,265
19,260
23,993
NZ
5,724
2,147
1,858
65,168
74,897
All cancer age-standardised rates (ASR) across the Northern Region were generally
similar to the national rates for the all ethnic groups during the period 2004-2006. The
ASR for all cancer for the Maori population was higher than the Other/European
population both in the Northern Region and nationally. In contrast, the ASR rates for all
cancer for the Asian population were significantly lower than the other ethnic groups
both in the Northern Region and nationally.
Table 14: Age-standardised rates for all cancer registrations, all ages, both sexes
by DHB, NCN and NZ, 2003-2006, per 100,000 population
DHB
Maori
Pacific
European/
Other
Asian
Total
ADHB
346
360
195
369
341
CMDHB
378
341
191
343
328
NDHB
403
*
*
352
356
WDHB
346
345
191
348
334
NCN region
375
345
194
353
337
NZ
378
333
200
351
344
• Rates not represented for groups with small numbers. Age-standardised to the WHO standard population.
32
Northern Cancer Network’s Health Needs Assessment - 2009
The ASR for all cancer for Maori was similar in the Northern Region and nationally.
However, the ASR for Maori for all cancer was highest in Northland, approximately 403
per 100,000 population.
4.3. Cancer incidence by age and gender
Cancer risk increases with age. During the time period 2003-2006, there were 192
cancers diagnosed in children (under 15 years), less than 1% of total cancer cases in
the Northern Region. The numbers of cancer registrations for people aged 15-44 years
were 2,563 (11%), for 45-64 years were 8,602 (36%) and 65+ years were 12,636
(53%) respectively.
In general, males had a greater incidence of cancer compared to females, but the
difference between genders in the Northern Region for total cancer during the time
period 2003-2006 was much less. The cancer incidence was significantly higher in
females aged 15-44 years than in males across the Northern Region and nationally. In
contrast, males aged 65+ years had significantly higher rates than females.
Table 15: All cancer registrations, by age groups, both sexes by DHB, NCN and
NZ, 2003-2006
Age & gender
0-14 yrs
15-44 yrs
45-64 yrs
65+ yrs
Total
ADHB
CMDHB
NDHB
WDHB
NCN
NZ
F
24
24
8
26
82
251
M
25
40
13
32
110
249
T
49
64
21
58
192
500
F
528
413
152
540
1,633
4,162
M
275
257
94
304
930
2,502
T
803
670
246
844
2,563
6,664
F
1,154
1,177
538
1,474
4,343
12,869
M
1,155
1,139
557
1,408
4,259
12,396
T
2,309
2,316
1,095
2,882
8,602
25,265
F
1,509
1,312
733
1,910
5,464
18,381
M
1,835
1,761
1,088
2,488
7,172
24,087
T
3,344
3,073
1,821
4,398
12,636
42,468
F
3,215
2,926
1,431
3,950
11,522
35,663
M
3,290
3,197
1,752
4,232
12,471
39,234
T
6,505
6,123
3,183
8,182
23,993
74,897
During the period 2003-2006, age-specific rates for all cancer in the Northern region
was 15 per 100,000 for the less than 15 years age group, 98 per 100,000 for the 15-44
years age group, 680 per 100,000 for the 45-64 years age group and 2,144 per
100,000 for the 65+ years age group.
The age-specific rates for all cancer increased approximately seven fold between the
15-44 years and 45-64 years age group, and three fold between the 45-64 years and
33
Northern Cancer Network’s Health Needs Assessment - 2009
65+ years age group. A similar trend was seen across the Northern Region DHBs and
nationally as shown in the Figure 15.
Figure 15: Age-specific rates for all cancer registrations, both sexes by DHB,
NCN and NZ, 2003-2006
ADHB
CMDHB
NDHB
WDHB
NCN
NZ
Age specific rate per 100,000
2,500
2,000
1,500
1,000
500
0
0-14yrs
15-44yrs
45-64yrs
65+yrs
Age group
4.4. Leading cancers
The following section outlines the leading types of cancer in the Northern Region and
nationally. Common cancers are discussed for different age groups and ethnicities for
the combined period 2003-2006. The results are presented for both genders and
comparisons are made between the Northern Region and New Zealand.
There were a total of 11,522 female cancer registrations during the period 2003-2006.
The most common cancer was breast cancer (3,210 cases), which made up
approximately 28% of all cancers and had almost double the number of cases of the
second most common cancer, colorectal cancer (1,564 cases, 14%). The next three
most common cancers were melanoma of the skin (1,170 cases), lung cancer (1,015
cases) and uterine cancer (505 cases). The top five cancers accounted for over 65% of
all cancers.
There were a total of 35,663 female cancer registrations nationally during the period
2003-2006. Breast cancer (9,679 cases, 27%), colorectal cancer (5,411 cases, 15%),
melanoma of skin (3,674 cases, 10%), lung cancer (3,027 cases, 9%) and uterine
cancer (1,416 cases, 4%) were the five most common cancers in females nationally,
similar to that in the Northern Region.
Figures 16 and 17 show rankings of cancers in females for the Northern Region and
New Zealand during the period 2003-2006:
34
Northern Cancer Network’s Health Needs Assessment - 2009
Figure 16: Distribution of cancer registrations in Northern Region by site for
females, all age and ethnic groups combined, 2003-2006
Northern Re gion, Cancer Re gistrations
Females 2003-2006
Breast
Lung
Colorectal
Unknown Site
Ovary
Pancreas
Other
Stomach
Non-Hodgkins Lymphomas
Leukaemia
Liver, biliary tract
Melanoma
Eye, Brain, CNS
Uterus
Myeloma
Oesophagus
Cervix
Bladder
Myeloproliferate
Kidney
Lip & Oral
Thyroid & Endocrine
Small Intestine
Hodgkins
0
100
200
300
400
500
600
700
800
900
Figure 17: Distribution of cancer registrations in New Zealand by site for females,
all age and ethnic groups combined, 2003-2006
National, Cancer Registrations
Females 2003-2006
Breast
Colorectal
Melanoma
Lung
Uterus
Non-Hodgkins Lymphomas
Other
Leukaemia
Ovary
Unknown Site
Myeloproliferate
Pancreas
Cervix
Thyroid & Endocrine
Stomach
Kidney
Eye, Brain, CNS
Liver, biliary tract
Bladder
Myeloma
Lip & Oral
Oesophagus
Hodgkins
Small Intestine
0
35
2000
4000
6000
8000
10000
Northern Cancer Network’s Health Needs Assessment - 2009
12000
There were a total of 12,471 male cancer registrations in the Northern Region during
the period 2003-2006 (See Figure 18). The most common cancer was prostate cancer
(3,344 cases), which made up approximately 27% of all cancers and more than double
the number of cases of the second most common cancer, colorectal cancer (1,566
cases, 13%). The next three most common cancers were melanoma of the skin (1,385
cases), lung cancer (1,253 cases) and non-Hodgkin’s lymphoma (498 cases). The top
five cancers accounted for approximately 65% of all cancers. The following figure
shows the ranking of other cancers according to the number of cases.
Figure 18: Distribution of cancer registrations in Northern Region by site for
males, all age and ethnic groups combined, 2003-2006
Northern Region, Cancer Registrations
Males 2003-2006
Lung
Prostate
Colorectal
Other
Unknown Site
Stomach
Non-Hodgkins Lymphomas
Liver, biliary tract
Eye, Brain, CNS
Leukaemia
Melanoma
Pancreas
Bladder
Oesophagus
Lip & Oral
Kidney
Myeloma
Myeloproliferate
Small Intestine
Testis
Thyroid & Endocrine
Hodgkins
0
200
400
600
800
1000
1200
There were a total of 39,234 male cancer registrations nationally during the period
2003-2006 (See Figure 19). Prostate cancer (10,356 cases, 26%), colorectal cancer
(5,548 cases, 14%), melanoma of skin (4,062 cases, 11%), lung cancer (3,994 cases,
10%) and non-Hodgkin’s cancer (1,469 cases, 4%) were the five most common
cancers in males nationally, similar to that of the Northern Region. The following figure
shows rankings of other cancers according to the number of cases.
36
Northern Cancer Network’s Health Needs Assessment - 2009
Figure 19: Distribution of cancer registrations in New Zealand by site for males,
all age and ethnic groups combined, 2003-2006
National, Cancer Registrations
Males 2003-2006
Prostate
Colorectal
Melanoma
Lung
Other
Non-Hodgkins Lymphomas
Leukaemia
Bladder
Myeloproliferate
Kidney
Unknown Site
Stomach
Lip & Oral
Eye, Brain, CNS
Pancreas
Liver, biliary tract
Oesophagus
Testis
Myeloma
Thyroid & Endocrine
Hodgkins
Small Intestine
0
37
2000
4000
6000
8000
10000
Northern Cancer Network’s Health Needs Assessment - 2009
12000
Common cancers by age and gender
The following figures show the ranking of cancer sites according to the numbers of new
cases by age and gender during the period 2003-2006.
Figure 20: Most common cancers in Northern Region in less than 15 years, 20032006
Fem ales 0-14 years
Males 0-14 years
Leukaemia
Leukaemia
CNS
CNS
Kidney
Non Hodgkins
Lymphoma
Bone
Bone
Non Hodgkins
Lymphoma
Kidney
0
5
10
15
20
25
30
0
10
Number of cases
•
20
Number of cases
30
40
Leukaemia, cancers of the central nervous system, kidney, bone and nonHodgkin’s lymphoma were the most common malignancies in children aged 014 years.
Figure 21: Most common cancers in Northern Region in 15-44 years, 2003-2006
Females 15-44 years
Males 15-44 years
Melanoma
Breast
Testis
Melanoma
Cervix
Non Hodgkins
Lymphoma
Throid
Colrectal
Colorectal
CNS
0
38
100
200
300
400
Number of cases
500
600
0
50
100
150
200
Number of cases
•
Breast, melanoma of the skin, cervical, thyroid and colorectal cancers were the
most common cancers in females aged 15-44 years,
•
Melanoma of the skin, followed by testicular cancer, non-Hodgkin’s lymphoma,
colorectal and central nervous system cancers were the most common cancers
in males aged 15-44 years.
Northern Cancer Network’s Health Needs Assessment - 2009
Figure 22: Most common cancers in Northern Region in 45-64 years, 2003-2006
Males 45-64 years
Females 45-64 years
Breast
Prostate
Melanoma
Melanoma
Colorectal
Colorectal
Lung
Lung
Uterine
Non Hodgkins
Lymohoma
0
500
1000
1500
2000
0
200
Number of cases
400
600
800
1000
1200
1400
Number of cases
•
Breast, melanoma of the skin, colorectal, lung and uterine cancers were the
most common cancers in females aged 45-64 years,
•
Prostate, melanoma of the skin, colorectal, lung cancers and non-Hodgkin’s
lymphoma were the most common malignancies in males aged 45-64 years.
Figure 23: Most common cancers in Northern Region in 65+ years, 2003-2006
Males 65+ years
Females 65+ years
Colorectal
Prostate
Breast
Colorectal
Lung
Lung
Melanoma
Melanoma
Non Hodgkins
Lymphoma
Bladder
0
200
400
600
800
Number of cases
39
1000
1200
0
500
1000
1500
Number of cases
2000
2500
•
Colorectal, breast, lung cancers, melanoma of skin and non-Hodgkin’s
lymphoma were the five most common cancers in females aged 65+ years,
•
Prostate, colorectal, lung cancers, melanoma of skin and bladder cancers were
the most common cancers in males aged 65+ years.
Northern Cancer Network’s Health Needs Assessment - 2009
Common cancers by ethnicity
Females
The following tables (Tables 16 and 17) present the five most common cancers by
ethnicity for females during the period 2003-2006 for the Northern Region and New
Zealand. Although the analysis is combined for four years, the numbers of cancers are
small when ethnic groups are compared and a few additional cancers can change the
ranking order, particularly for the fourth and fifth most common cancers.
Table 16: Leading female cancers by ethnicity for Northern Region, 2003-2006
Maori
Cancer
Breast
Lung
Colorectal
Uterus
Cervix
No.
287
215
53
49
38
%
28
21
5
5
4
Pacific
Cancer
Breast
Uterus
Lung
Colorectal
Cervix
No.
240
106
77
50
37
%
29
13
9
6
5
Asian
Cancer
Breast
Colorectal
Thyroid
Cervix
Lung
No.
245
66
51
49
44
%
34
9
7
7
6
Other/European
Cancer
No.
Breast
2,438
Colorectal 1,395
Melanoma 1,146
Lung
679
Uterus
309
%
27
16
13
8
4
Table 17: Leading female cancers by ethnicity for New Zealand, 2003-2006
Maori
Cancer
Breast
Lung
Colorectal
Uterus
Stomach
No.
928
612
195
162
114
%
29
19
6
5
4
Pacific
Cancer
Breast
Uterus
Lung
Colorectal
Ovary
No.
333
131
95
73
46
%
29
12
8
7
4
Asian
Cancer
Breast
Colorectal
Cervix
Thyroid
Uterus
No.
359
105
66
62
50
%
34
10
6
6
5
Other/European
Cancer
No.
Breast
8,059
Colorectal 5,038
Melanoma 3,613
Lung
2,246
Uterus
1,073
%
27
17
12
7
4
Breast cancer was consistently the leading female cancer across all ethnicities, both for
the Northern Region and New Zealand, contributing to approximately 28% of all female
cancers. However, Asian women had a higher percentage of breast cancers (34%);
both in the Northern Region and nationally.
In the Northern Region, colorectal cancer ranked second for European/Other (16%)
and Asian ethnicity (9%), third for Maori women (5%) and fourth for Pacific women
(7%) respectively. Similar ranking and distribution was seen nationally. Lung cancer
ranked second in Maori women (19-21%); uterine cancer ranked second in Pacific
women (12-13%), both in the Northern Region and nationally. Lung cancer contributed
to a higher proportion of female Maori cancers, probably due to higher prevalence of
smoking in this group.
Melanoma of the skin ranked third for European/Other ethnicity (12-13%) both in the
Northern Region and nationally. However, it did not feature in the five most common
cancers in Maori, Pacific and Asian women, both in Northern Region and nationally.
Lung cancer ranked third in Pacific women (8-9%) in the Northern Region and
nationally.
Thyroid cancer (6-7%) and cervical cancer (6-7%) were the other common cancers for
Asian women, both in the Northern Region and nationally. In the Northern Region,
cervical cancer was the fifth most common cancer for Maori (4%) and Pacific (5%)
women. However, cervical cancer did not feature in the five most common cancers in
40
Northern Cancer Network’s Health Needs Assessment - 2009
the European/Other women. This could be related to low cervical cancer screening
rates in Maori, Pacific and Asian women; particularly in the Northern Region.[7]
Uterine cancer was the second most common cancer among Pacific women,
contributing to approximately 12-13% of all female cancers, both in the Northern
Region and nationally. However, they account for 4-5% of all cancers for
European/Other, Maori and Asian women.
The ranking of leading cancers by ethnicity for women was generally similar in the
Northern Region to that nationally with few exceptions. However, the ranking order was
different and there were some cancers more common in some ethnic groups, both in
the Northern Region and nationally. Stomach cancer features in the five most common
cancers in Maori women nationally but not in the Northern Region.
Males
The following tables (Tables 18 and 19) present the five most common cancers for men
during the period 2003-2006 by ethnicity for the Northern Region and New Zealand.
Although the analysis is combined for four years, the numbers of cancers are small
when ethnic groups are compared and a few additional cancers can change the
ranking order, particularly for the fourth and fifth most common cancers.
Table 18: Leading male cancers by ethnicity for Northern Region, 2003-2006
Maori
Cancer
Lung
Prostate
Colorectal
Stomach
Testis
No.
172
144
58
47
41
%
21
18
7
6
5
Pacific
Cancer
Prostate
Lung
Liver
Colorectal
Myeloproliferative
No.
180
146
57
49
42
%
23
18
7
6
5
Asian
Cancer
Prostate
Colorectal
Lung
Liver
Lip & Oral
No.
97
80
68
50
35
%
18
15
12
9
6
Other/European
Cancer
No.
Prostate
2,923
Colorectal 1,379
Melanoma 1,364
Lung
867
Non399
Hodgkin’s
%
28
13
13
8
4
Table 19: Leading male cancers by ethnicity for New Zealand, 2003-2006
Maori
Cancer
Lung
Prostate
Colorectal
Stomach
Liver
No.
510
463
220
138
125
%
20
18
9
5
5
Pacific
Cancer
Prostate
Lung
Liver
Colorectal
Myeloproliferative
No.
225
179
74
69
56
%
22
18
7
7
6
Asian
Cancer
Prostate
Colorectal
Lung
Liver
Lip & Oral
No.
144
110
109
66
45
%
18
14
14
8
6
Other/European
Cancer
No.
Prostate
9,524
Colorectal 5,149
Melanoma 4,016
Lung
3,196
Bladder
1,317
Prostate cancer was the leading male cancer for all ethnicities except Maori men, both
in the Northern Region and nationally. The proportion of prostate cancer in
European/Other (27-28%) was higher than the Pacific (22-23 %) and Asian men (18%),
in the Northern Region and nationally. Prostate cancer contributed to approximately
18% of all cancers in Maori men and ranked second.
Lung cancer was the leading cancer for Maori men both nationally (20%) and in the
Northern Region (21%), due to higher prevalence of smoking among Maori. Lung
cancer ranked second for Pacific men (18% both in the Northern Region and
nationally), third for Asian men (12% NCN Region, 14% nationally) and fourth for
European/Other men (8% NCN Region, 9% nationally).
41
Northern Cancer Network’s Health Needs Assessment - 2009
%
27
15
12
9
4
Melanoma of the skin ranked third for European/Other men both in the Northern
Region (13%) and nationally (12%). However, as in the case of women this cancer did
not feature in the five most common cancers in other ethnic groups both nationally and
in the Northern Region.
Colorectal cancer ranked second in European/Other and Asian men both nationally (13
and 15% respectively) and in the Northern Region (15 and 14% respectively).
However, it accounted for approximately 6-9% of all male cancers in Maori and Pacific
men, both in the Northern Region and nationally.
Stomach cancer ranked fourth for Maori men both nationally (5%) and in the Northern
Region (6%). Although not ranked in the five most common cancers, stomach cancer
accounted for 4-5% of all cancer in Pacific and Asian men both nationally and in the
Northern Region. However, it contributed to approximately 2% of all cancer in
European/Other men, both in the Northern Region and nationally.
Liver cancer ranked in the top five cancers for Maori, Pacific and Asian men (5-8%)
nationally and in Pacific and Asian men (7-9%) in the Northern Region. Liver cancer
accounted for less than 2% of all male cancer for the European/other ethnicity, both
nationally and in the Northern Region. This may relate to the high prevalence of
hepatitis B infection in Maori, Pacific and Asian populations compared to that of the
European population. [8]
Chronic myeloproliferative cancers (codes D45-D47) in Pacific men (5-6%) and lip and
oral cancer in Asian men (4%) ranked fifth, both in the Northern Region and nationally.
Testicular cancer in Maori men (5%) and Non-Hodgkin’s lymphoma in European/other
men (4%) ranked fifth in the Northern Region. Bladder cancer ranked fifth in
European/Other men (4%) nationally.
The ranking of leading cancers by ethnicity were generally similar in the Northern
Region when compared with New Zealand with some exceptions. Testicular cancer
ranked fifth in Maori men in Northern Region, compared to liver cancer nationally. NonHodgkin’s cancer ranked fifth in European/Other men in the Northern Region compared
to the bladder cancer nationally.
The small numbers of cancers in different ethnic groups should be noted when
considering the reliability of ranking of cancers by ethnicity, particularly the fourth and
fifth most common cancers.
42
Northern Cancer Network’s Health Needs Assessment - 2009
4.5. Inequalities in cancer incidence
This section provides an overview of cancer registrations for Maori and non-Maori for
the period 2003-2006. The data is sourced from the New Zealand Cancer Registry
(NZCR). Maori and non-Maori cancer incidence (from adjusted cancer registrations)
were calculated for the combined period 2003 to 2006. No adjustments were made for
the undercounting of Maori in cancer registrations.
Age-standardised rates were calculated by direct standardisation with the WHO
standard population. This can result in an under estimation of some disparities as the
Maori population is younger than the WHO world population. Further, it is recognised
that the disparities in cancer outcomes is due to delayed presentation and the
differences in the stage at diagnosis between Maori and non-Maori. [9] There is
variation in the completeness of staging information from NZCR and therefore this
analysis was not undertaken.
The data is presented according to tumour sites for the Northern Region and the
Northern Region DHBs. The NCN plans to work in collaboration with the clinical staff in
the DHBs to improve the cancer patient journey by working across different tumour
streams. The numbers of cancers are very small when the tumour site is considered at
a DHB level and hence statistics with reasonable numbers (>5) are presented.
Table 20: Maori and non-Maori inequalities in cancer registrations by tumour
site, 2003- 2006, Northern Region
Cancer site
All sites
Lung
Colorectal
Breast*
Genito-urinary
Prostate*
Testis *
Bladder
Kidney
Melanoma
Haematological
Hodgkin’s disease
Non-Hodgkin’s lymphomas
Leukaemia
Myeloma
CNS
Gynaecological
Uterine*
Ovarian*
Cervix*
Upper GI
Oesophagus
Stomach
Pancreas
Hepato-biliary
Other
Number
Maori
non-Maori
1,840
22,153
387
1,881
111
3,019
287
2,923
Registrations
Rate
Maori
non-Maori
374.6
334.5
85.7
27.6
24.5
43.7
95.8
87.7
Rate
ratio
1.12
3.11
0.56
1.09
144
41
21
39
24
3,200
148
557
408
2,531
85.6
11.5
5.4
6.7
4.1
103.3
5.7
7.8
6.3
39.2
0.83
2.01
0.69
1.06
0.11
8
60
55
29
25
108
817
741
273
402
1.1
11.8
10.7
6.8
3.6
2.0
12.5
11.4
4.0
6.6
0.57
0.94
0.94
1.68
0.55
49
31
38
456
297
245
17.0
9.8
11.2
13.6
8.6
7.8
1.25
1.14
1.43
18
81
50
59
283
241
465
422
392
2,600
4.0
16.2
11.3
13.1
55.4
3.4
6.7
5.9
5.9
38.8
1.16
2.43
1.91
2.23
1.40
• Rates are calculated per 100,000 and were age-standardised to the WHO standard population. Rates not represented
for tumour sites with small numbers. Rates are sex –specific.
43
Northern Cancer Network’s Health Needs Assessment - 2009
In the Northern Region, during the period 2003-2006, there were a total of 1,840 new
Maori cancer registrations, an average of approximately 460 Maori cancer cases each
year. For the same period, there were 22,153 new non-Maori cancer registrations,
averaging 5,538 new registrations each year. The age-standardised incidence rate for
cancer overall (all sites) in the Northern Region was 374.6 per 100,000 in Maori for the
period 2003-2006. This rate was 12% higher than for the non-Maori rate of 334.5 per
100,000.
Maori had significantly high incidence rates for cancers of the lung, cervix, multiple
myeloma, stomach, liver, pancreas and testis. Cancers of the breast, uterus, ovary,
and oesophagus were also more common among Maori than non-Maori. Maori had
significantly lower incidence rates for colorectal cancer, cancers of the central nervous
system, Hodgkin’s disease, and melanoma of the skin.
Inequalities in common cancers by Northern Region DHBs
Auckland District Health Board (ADHB)
Table 21: Maori and non-Maori inequalities in cancer registrations by tumour
site, 2003-2006, ADHB
Cancer site
Maori
All sites
Lung
Colorectal
Breast*
Genito-urinary
Prostate*
Testis*
Melanoma
Haematological
Non-Hodgkin’s lymphomas
Leukaemia
Gynaecological
Uterine*
Cervix*
Upper GI
Stomach
Pancreas
Hepato-biliary
Number
non-Maori
306
6,199
54
534
22
843
62
844
Registrations
Rate
Maori
non-Maori
345.4
340.3
66.9
29.0
25.7
44.4
119.5
91.3
Rate
ratio
1.01
2.31
0.58
1.31
19
6
*
825
55
689
67.7
8.8
*
102.1
6.4
38.0
0.66
1.37
*
16
8
227
208
17.2
9.8
12.6
11.6
1.37
0.85
8
7
131
78
14.3
12.5
14.1
8.2
1.01
1.52
11
11
13
131
117
125
10.9
14.1
17.9
6.9
5.8
7.0
1.59
2.42
2.55
• Rates are calculated per 100,000 and were age-standardised to the WHO standard population. Rates not represented
for tumour sites with small numbers. Rates are sex –specific.
44
•
There were a total of 306 new Maori and 6,199 non-Maori cancer registrations
in ADHB, during the period 2003-2006,
•
The age-standardised incidence rate for cancer overall (all sites) was similar
between Maori (345.4 per 100,000) and Non-Maori (340.3 per 100,000),
•
Maori had significantly high incidence rates for cancers of the lung, liver,
pancreas, stomach, breast, cervix and testis,
•
Lung, Stomach and pancreatic was more than twice as common in Maori
compared to non-Maori.
Northern Cancer Network’s Health Needs Assessment - 2009
Counties Manukau District Health Board (CMDHB)
Table 22: Maori and non-Maori inequalities in cancer registrations by tumour
site, 2003-2006, CMDHB
Cancer site
Maori
All sites
Lung
Colorectal
Breast*
Genito-urinary
Prostate*
Testis*
Melanoma
Haematological
Non-Hodgkin’s lymphomas
Leukaemia
Gynaecological
Uterine*
Ovary*
Cervix*
Upper GI
Oesophagus
Stomach
Pancreas
Hepato-biliary
Number
non-Maori
604
5,519
138
507
84
724
84
720
Registrations
Rate
Maori
non-Maori
378.5
322.5
94.6
29.3
44.2
42.5
81.4
81.2
Rate
ratio
1.17
3.22
1.04
1.00
36
17
9
788
34
525
58.6
14.8
4.0
98.3
4.9
30.8
0.60
3.06
0.13
18
19
196
177
17.6
12.1
11.4
10.6
1.54
1.15
12
12
15
141
87
70
17.9
10.6
12.2
16.1
9.8
8.3
1.11
1.08
1.46
7
34
12
22
66
132
95
109
4.4
22.0
6.7
15.8
3.8
7.5
5.3
6.4
1.18
2.93
1.26
2.47
• Rates are calculated per 100,000 and were age-standardised to the WHO standard population. Rates not represented
for tumour sites with small numbers. Rates are sex –specific.
45
•
There were a total of 604 new Maori and 5,519 non-Maori cancer registrations
in CMDHB, during the period 2003-2006,
•
The age-standardised incidence rate for cancer overall (all sites) was 378.5 per
100,000 in Maori and 322.5 per 100,000 in Non-Maori, a 17% higher rate in
Maori than non-Maori,
•
Maori had significantly higher incidence rates for cancers of the lung, testis,
cervix and non-Hodgkin’s lymphoma,
•
Lung and testicular cancer was more than three times more common in Maori
compared to non-Maori.
Northern Cancer Network’s Health Needs Assessment - 2009
Northland District Health Board (NDHB)
Table 23: Maori and non-Maori inequalities in cancer registrations by tumour
site, 2003-2006, NDHB
Cancer site
Maori
All sites
Lung
Colorectal
Breast*
Genito-urinary
Prostate*
Testis*
Melanoma
Haematological
Non-Hodgkin’s lymphomas
Leukaemia
Gynaecological
Uterine*
Ovary*
Cervix*
Upper GI
Stomach
Pancreas
Hepato-biliary
Number
non-Maori
587
2,596
140
210
34
377
79
297
Registrations
Rate
Maori
non-Maori
404.5
349.6
98.9
26.2
24.4
45.3
94.9
89.7
Rate
ratio
1.16
3.78
0.54
1.06
63
9
8
488
7
316
117.2
11.4
5.2
123.8
3.7
46.1
0.95
3.10
0.11
17
18
94
94
10.2
11.3
13.2
13.3
0.77
0.85
16
10
9
41
23
27
18.3
11.8
10.2
10.6
7.4
10.6
1.73
1.59
0.95
25
19
14
48
43
36
16.8
14.4
9.6
6.2
5.3
4.5
2.69
2.75
2.13
• Rates are calculated per 100,000 and were age-standardised to the WHO standard population. Rates not represented
for tumour sites with small numbers. Rates are sex –specific.
46
•
There were a total of 587 new Maori and 2,596 non-Maori cancer registrations
in NDHB, during the period 2003-2006,
•
The age-standardised incidence rate for cancer overall (all sites) was 404.5 per
100,000 in Maori and 349.6 per 100,000 in Non-Maori, a 16% higher rate in
Maori than non-Maori,
•
Maori from NDHB had the highest age-standardised rate for cancer overall
when compared with other Northern Region DHBs,
•
Maori had significantly higher incidence rates for cancers of the lung, testis,
uterus, ovary, stomach, pancreas and liver,
•
Lung and testicular cancer was more than three times more common in Maori
compared to non-Maori,
•
Stomach, pancreatic and liver cancer was more than twice common in Maori
compared to non-Maori.
Northern Cancer Network’s Health Needs Assessment - 2009
Waitemata District Health Board (WDHB)
Table 24: Maori and non-Maori inequalities in cancer registrations by tumour
site, 2003-2006, WDHB
Cancer site
Maori
All sites
Lung
Colorectal
Breast*
Genito-urinary
Prostate*
Testis*
Melanoma
Haematological
Non-Hodgkin’s lymphomas
Leukaemia
Gynaecological
Uterine*
Cervix*
Upper GI
Stomach
Pancreas
Hepato-biliary
Number
non-Maori
343
7,839
55
630
17
1,059
62
1,062
Registrations
Rate
Maori
non-Maori
343.6
334.1
63.0
25.8
19.3
43.2
103.8
90.1
Rate
ratio
1.03
2.44
0.45
1.15
26
9
7
1,099
52
1,001
76.9
9.7
5.3
100.8
6.1
44.2
0.76
1.58
0.12
9
10
300
262
6.2
9.8
12.9
11.4
0.48
0.85
13
7
143
70
20.9
8.7
12.0
6.6
1.74
1.32
11
8
10
154
167
122
12.1
8.6
12.0
6.1
6.7
5.0
1.97
1.28
2.40
• Rates are calculated per 100,000 and were age-standardised to the WHO standard population. Rates not represented
for tumour sites with small numbers. Rates are sex –specific.
•
There were a total of 343 new Maori and 7,839 non-Maori cancer registrations
in WDHB, during the period 2003-2006,
•
The age-standardised incidence rate for cancer overall (all sites) was similar
between Maori (343.6 per 100,000) and Non-Maori (334.1 per 100,000),
•
Maori had significantly higher incidence rates for cancers of the lung, testis,
uterus, cervix, stomach, pancreas and liver,
•
Cancers of the lung, stomach and liver were almost twice as common in Maori
compared to Non-Maori.
4.6. Key points
47
o
There were 6,028 new cancer registrations in the Northern Region in 2006,
approximately 30% of the cancer registrations nationally,
o
The cancer incidence increased 15% over the ten year period 1996 to 2006 in
the Northern Region, compared to a 20% increase nationally,
o
The proportion of increase over the same ten year period was 17%, 24% and
23% respectively in WDHB, NDHB and CMDHB; compared to a 3.6% increase
in the ADHB region,
Northern Cancer Network’s Health Needs Assessment - 2009
o
For the combined period 2003-2006, there were no significant differences in all
cancer ASR amongst all ethnic groups, when comparisons were made between
the Northern Region and nationally,
o
For the combined period 2003-2006, all cancer ASR was higher for Maori and
lower for Asian people than the Other/European population both in the Northern
Region and nationally,
o
Northland Maori had significantly higher all cancer ASR (403 per 100,000) than
that of Maori in other Northern Region DHBs and New Zealand,
o For the combined period 2003-2006, there were 192 cancers diagnosed in
children (under 15 years), less than 1% of all cancer cases in the Northern
Region,
o
For the same period, the number of cancer cases were 2,563 (11%) for people
aged 15-44 years, 8,602 (36%) for 45-64 years and 12,636 (53%) for 65+ years
respectively,
o
The age-specific rates for all cancer increased seven fold between the age
groups 15-44 years and 45-64 years and three fold between 45-64 years and
65+years,
o
The leading five female cancer registrations were breast, colorectal, melanoma,
lung and uterus in the Northern Region and nationally for the period 2003-2006,
accounting for approximately 65% of all female cancers,
o
The leading five male cancer registrations were cancers of the prostate,
colorectal, melanoma, lung and non-Hodgkin’s cancer in the Northern Region
and nationally for the period 2003-2006, accounting for approximately 65% of
all male cancers,
o
Uterine cancer was the second most common cancer (12%) amongst Pacific
women, both nationally and in the Northern Region,
o
Cervical cancer was among the five most common female cancers in Maori,
Pacific and Asian women but not in European/Other women in the Northern
Region. Nationally, cervical cancer was in the top five female cancers for Asian
women only,
o
Prostate cancer was the leading cancer in all ethnic groups except Maori men,
lung cancer was the leading cancer in Maori men both in the Northern Region
and nationally,
o
Melanoma of the skin featured in the top five cancers for both genders in the
European/Other ethnic group, but not for other ethnic groups,
o
Stomach cancer ranked in the top five cancers in Maori men both in the
Northern Region and nationally, but not for other ethnic groups,
o
The age-standardised incidence rate for all cancer was 12% higher in Maori
than non-Maori in the Northern Region for the period 2003-2006, this difference
was higher in NDHB and CMDHB,
o
Maori had significantly higher incidence rates for cancers of the lung, cervix,
multiple myeloma, stomach, liver, pancreas and testes; and lower rates for
cancers of the central nervous system, colorectal, Hodgkin’s diseases and
melanoma of the skin,
o The inequalities in lung and testicular cancer were three times higher between
Maori and non-Maori in NDHB and CMDHB.
48
Northern Cancer Network’s Health Needs Assessment - 2009
5.
Chapter Five: Cancer mortality
5.1. Overview
Cancer is the leading cause of death in New Zealand, accounting for almost a third of
all deaths. The cancer mortality data presented below is sourced from the New
Zealand Mortality Collections. Cancer trends are presented for 10 years from 19952005 for the Northern Region and the Northern Region DHBs. Further detailed analysis
of cancer mortality by age and ethnicity is presented for the years 2003-2006.
Analyses are based on date of death (as opposed to date of death registration) and as
a result the data is subject to change as some deaths are registered in subsequent
years. For example, deaths occurring in 2006 but registered in 2007 are not yet
available. The death data is manually processed and there is a time lag in receiving all
the coroner’s finding for a particular year.
In 2005, there were approximately 7,865 cancer deaths (30% of all deaths) nationally
[6] compared to 2,376 cancer deaths in the Northern Region. Cancer deaths decreased
in 2005 from 2004 but generally have increased by approximately 6% over a ten year
period from 1995-2005, both in the Northern Region and nationally. Cancer mortality
decreased in ADHB by 13% while it increased in the other Northern region DHBs; 9%
in CMDHB, 12% in NDHB and 19% in WDHB respectively.
Figure 24: Cancer deaths from all cancer. Both sexes by DHBs and NCN Region,
1995-2005
WDHB
ADHB
CMDHB
NDHB
NCN
900
2500
2450
700
2400
600
500
2350
400
2300
300
200
2250
100
0
2200
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Calendar Year
49
Northern Cancer Network’s Health Needs Assessment - 2009
Number of cancer deaths (NCN)
Number of cancer deaths (DHB)
800
5.2. Cancer mortality by ethnicity
Table 25 shows the number of cancer deaths by ethnicity in the Northern Region and
nationally for the period 2003-2006. Table 26 shows the age-standardised rates for all
cancer by ethnicity for the same period.
Table 25: All cancer mortality, all ages, both sexes by DHB, NCN and NZ, by
ethnicity, 2003-2006
DHB
Maori
Pacific
European/
Other
Asian
Total
ADHB
148
245
129
1,999
2,521
CMDHB
323
405
140
1,689
2,557
NDHB
364
5
6
1,057
1,432
WDHB
163
115
110
2,799
3,187
NCN
region
998
770
385
7,544
9,697
3,030
1,000
618
27,083
31,731
NZ
Table 26: Age-standardised rates for all cancer deaths by ethnicity, by DHB, NCN
Region and NZ, 2003-2006, per 100,000 population
DHB
Maori
Pacific
European/
Other
Asian
Total
ADHB
191
172
57
124
123
CMDHB
237
193
77
122
135
NDHB
258
*
*
131
152
WDHB
183
153
83
121
122
NCN
region
224
178
71
123
129
NZ
219
172
81
129
135
* Rates not represented for groups with small numbers. Age-standardised to the New Zealand population
For the period 2003-2006, the cancer mortality ASR was 129 per 100,000 population,
slightly lower than that for New Zealand (135 per 100,000). Among the Northern
Region DHBs the cancer mortality ASR was higher in Northland and Counties
50
Northern Cancer Network’s Health Needs Assessment - 2009
Manukau, compared to Auckland and Waitemata DHB. This is probably related to the
higher Maori population in these DHBs.
All cancer age-standardised mortality rates were significantly higher for Maori than
European/Other ethnicity, both nationally and in the Northern Region. The agestandardised mortality rates for Pacific people were higher and for Asian people were
lower than the European/Other ethnicity, both nationally and in the Northern Region.
Northland and Counties Manukau DHB had higher age-standardised mortality rates for
all cancer for Maori when compared to the other Northern Region DHBs. However, no
significant variability is seen in all cancer mortality rates for other ethnic groups across
the Northern Region DHBs.
5.3. Cancer mortality by age
The number of cancer deaths increases with age. For the period 2003-2006, agespecific death rates for all cancer in the Northern Region were 3 per 100,000 for less
than 15 years age, 20 per 100,000 for 15-44 years, 197 per 100,000 for 45-64 years
and 1,125 for 65+ years respectively.
The age-specific death rates for all cancer in the Northern Region increased ten fold
between the ages 15-44 years and 45-64 years, and six fold between the ages 45-64
years and 65+ years. Northland had higher age-specific death rates for all cancer
compared with the other Northern Region DHBs and nationally.
Figure 25: Age-specific rates for all cancer mortality, both sexes by DHB, NCN
and NZ, 2003-2006
ADHB
CMDHB
NDHB
WDHB
NCN
NZ
Age specific rate per 100,000
1,400
1,200
1,000
800
600
400
200
0
0-14yrs
15-44yrs
45-64yrs
65+yrs
Age group
Ethnic disparities in age-specific all cancer mortality in the Northern Region was
apparent at 45-64 years and 65+ year. Maori had the highest rates, followed by Pacific,
European/Other and Asian populations (Figure 17). Elderly Asian people (65+) had
significantly low all cancer mortality compared to other ethnic groups. This may reflect
51
Northern Cancer Network’s Health Needs Assessment - 2009
selection processes, the healthy migrant effect and can also be explained by the young
demography of this population. [10]
Figure 26: Age-specific rates by ethnicity for all cancer mortality, both sexes, for
the Northern Region, 2003-2006
Maori
Pacific
Asian
European/Other
Age specific rate per 100,000
1,600
1,400
1,200
1,000
800
600
400
200
0
0-14yrs
15-44yrs
45-64yrs
65+yrs
Age group
5.4. Leading fatal cancers
The following section outlines the leading types of fatal cancer in the Northern Region
and nationally. Common fatal cancers are discussed for different age groups and
ethnicity for the combined period 2003-2006. The results are presented for both gender
and comparisons made between the Northern Region and nationally.
There were a total of 4,616 female cancer deaths in the Northern Region during the
period 2003-2006. The most common fatal cancer was breast cancer (776 cases),
which accounted for 16.8% of all female cancer deaths. Lung cancer deaths (769) were
the second most common (16.6%) and almost the same numbers as breast cancer.
The next three most common fatal cancers were colorectal cancer (669 cases, 14.5%),
ovarian cancer (224 cases, 4.9%) and pancreatic cancer (214 cases, 4.6%). The
leading five fatal cancers accounted for 57.5% of all cancer deaths.
There were a total of 15,170 female cancer deaths nationally during the period 20032006. Breast cancer (2,539 cases, 16.7%), lung cancer (2,482 cases, 16.4%),
colorectal cancer (2,391, 15.8%), ovarian cancer (751 cases, 5%) and pancreatic
cancer (704 cases, 4.6%) were the five most common fatal cancers in women
nationally, similar to that in the Northern Region.
Figures 27 and 28 show rankings of cancer deaths in females for the Northern Region
and nationally during the period 2003-2006.
52
Northern Cancer Network’s Health Needs Assessment - 2009
Figure 27: Distribution of cancer deaths in Northern Region by site for females,
all age and ethnic groups combined, 2003-2006
Northern Region, Cance r Morta lity
Fe ma les 2003-2006
Breast
Lung
Colorectal
Unknown Site
Ovary
Pancreas
Other
Stomach
Non-Hodgkins Lymphomas
Leukaemia
Liver, biliary tract
Melanoma
Eye, Brain, CNS
Uterus
Myeloma
Oesophagus
Cervix
Bladder
Myeloproliferate
Kidney
Lip & Oral
Thyroid & Endocrine
Small Intestine
Hodgkins
0
100
200
300
400
500
600
700
800
900
Figure 28: Distribution of cancer deaths in New Zealand by site for females, all
age and ethnic groups combined, 2003-2006
Na tional, Cance r Morta lity
Female s 2003-2006
Breast
Lung
Colorectal
Unknown Site
Ovary
Pancreas
Other
Non-Hodgkins Lymphomas
Leukaemia
Stomach
Melanoma
Liver, biliary tract
Eye, Brain, CNS
Uterus
Oesophagus
Myeloma
Kidney
Cervix
Bladder
Myeloproliferate
Lip & Oral
Thyroid & Endocrine
Small Intestine
Hodgkins
0
53
500
1000
1500
2000
Northern Cancer Network’s Health Needs Assessment - 2009
2500
3000
There were a total of 5,081 male cancer deaths in the Northern Region during the
period 2003-2006 (See Figure 29). The most common fatal cancer was lung cancer
(1,020 cases), which accounted for 20.1% of all male cancer deaths. Prostate cancer
deaths (660) were the second most common (13%) and the next three most common
fatal cancers were colorectal cancer (646 cases, 12.7%), stomach cancer (238 cases,
4.7%) and non-Hodgkin’s lymphoma (214 cases, 4.2%). The leading five fatal cancers
accounted for 54.7% of all cancer deaths.
Figure 29: Distribution of cancer deaths in Northern Region by site for males, all
age and ethnic groups combined, 2003-2006
Northern Re gion, Ca ncer Morta lity
Males 2003-2006
Lung
Prostate
Colorectal
Other
Unknown Site
Stomach
Non-Hodgkins Lymphomas
Liver, biliary tract
Eye, Brain, CNS
Leukaemia
Melanoma
Pancreas
Bladder
Oesophagus
Lip & Oral
Kidney
Myeloma
Myeloproliferate
Small Intestine
Testis
Thyroid & Endocrine
Hodgkins
0
200
400
600
800
1000
There were a total of 16,561 male cancer deaths nationally during the period 20032006 (See Figure 30). The five most common fatal cancers nationally were lung cancer
(3,430 cases, 20.7%), colorectal cancer (2,301 cases, 13.9%), prostate cancer (2,260
cases, 13.7%), stomach cancer (695 cases, 4.2%) and pancreatic cancer (657 cases,
4%). The rankings of the five most fatal cancers in the Northern Region and nationally
were similar.
It should be noted that featuring in the leading cancer mortality were cancers from
unknown sites (5-6%). Although unknown site cancers rank in the top five leading
cancer deaths, they have not been included in the top five to highlight the top five
cancer sites. Further, the coding of cancers to this category will lesson the contribution
of specific site cancers.
54
Northern Cancer Network’s Health Needs Assessment - 2009
1200
Figure 30: Distribution of cancer deaths in New Zealand by site for males, all age
and ethnic groups combined, 2003-2006
National, Cancer Mortality
Males 2003-2006
Lung
Colorectal
Prostate
Other
Unknown Site
Stomach
Pancreas
Melanoma
Non-Hodgkins Lymphomas
Leukaemia
Eye, Brain, CNS
Liver, biliary tract
Oesophagus
Bladder
Kidney
Myeloma
Lip & Oral
Myeloproliferate
Small Intestine
Thyroid & Endocrine
Hodgkins
Testis
0
500
1000
1500
2000
2500
3000
3500
4000
Leading mortality cancers are a reflection of the incidence and survival rates for each
specific cancer. Although breast cancer was the leading female cancer for both
incidence and mortality, the mortality contribution of 17% was significantly lower than
the incidence contribution of 28% due to higher survival rates. In comparison, the
proportion of fatal female cancers from lung cancer was 17% compared to a 9%
incidence reflecting the low survival rates for this cancer. Melanoma and uterine cancer
ranked in the top five cancers for incidence but did not feature in the top five fatal
cancers reflecting high survival rates.
The proportion of deaths from prostate cancer for all males in the Northern Region
(13%) was lower than the incidence proportion (28%), reflecting high survival rates for
this cancer. Lung cancer was the leading cause of cancer deaths (20%), higher than
the incidence proportion (10%), reflecting low survival rates for this cancer. The
proportion of deaths and incidence for colorectal cancer were similar reflecting mid
level survival rates.
55
Northern Cancer Network’s Health Needs Assessment - 2009
Common fatal cancers by age and gender
The following figures show the ranking of cancer deaths by age and gender for the
period 2003-2006.
Figure 31: Most common fatal cancers in the Northern Region in less than 15
years, 2003-2006
Fem ales 0-14 years
Males 0-14 years
Leukaemia
Leukaemia
CNS
CNS
Bone
Bone
0
1
2
3
4
5
6
7
0
2
4
Number of cases
•
6
8
Number of cases
Leukaemia, cancers of the central nervous system and bone cancers were the
leading causes of cancer deaths in children aged 0-14 years.
Figure 32: Most common fatal cancers in the Northern Region in 15-44 years,
2003-2006
Males 15-44 years
Females 15-44 years
Breast
CNS
Colorectal
Non Hodgkins
Lymphoma
Lung
Leukaemia
cervix
Lung
CNS
Melanoma
0
20
40
60
Number of cases
56
80
100
0
5
10
15
20
25
30
35
Number of cases
•
Cancers of the breast, colorectal, lung, cervix and central nervous system were
the leading causes of cancer deaths in females aged 15-44 years,
•
Cancers of the central nervous system, non-Hodgkin’s lymphoma, leukaemia,
lung cancer and melanoma of the skin were the leading causes of cancer
deaths in males aged 15-44 years.
Northern Cancer Network’s Health Needs Assessment - 2009
Figure 33: Most common fatal cancers in the Northern Region in 45-64 years,
2003-2006
Fem ales 45-64 years
Males 45-64 years
Breast
Lung
Lung
Colorectal
Colorectal
CNS
Ovary
Stomach
CNS
Liver
0
50
100
150
200
250
300
0
350
50
100
150
200
250
300
Number of cases
Number of cases
•
Cancers of the breast, lung, colorectal, ovary and central nervous system were
the leading causes of cancer deaths in females aged 45-64 years,
•
Lung cancer, colorectal cancer, cancer of the central nervous system, stomach
and liver cancers were the leading causes of cancer deaths in males aged 4564 years.
Figure 34: Most common fatal cancers in the Northern Region in 65+ years, 20032006
Fem ales 65+ years
Males 65+ years
Colorectal
Lung
Lung
Prostate
Colorectal
Breast
Stomach
Pancreas
Melanoma
Ovary
0
0
57
100
200
300
400
Number of cases
500
600
200
400
600
800
Number of cases
•
Colorectal cancer, lung cancer, cancers of the breast, pancreas and ovary were
the leading causes of cancer deaths in females aged 65+ years,
•
Lung cancer, prostate cancer, colorectal cancer, stomach cancer and
melanoma of the skin were the leading causes of cancer deaths in males aged
65+ years.
Northern Cancer Network’s Health Needs Assessment - 2009
Common fatal cancers by ethnicity
Females
The following tables (Table 27 and 28) present the leading fatal cancers for females
during the period 2003-2006 by ethnicity for the Northern Region and New Zealand. It
should be noted that although the analysis is combined for four years, the absolute
cancer numbers are small when ethnic groups are compared. Few additional cancers
can change the ranking order, particularly for the fourth and fifth most common fatal
cancers.
By ethnicity, it is apparent that the ranking and contribution of fatal female cancers
differs between, Maori, Pacific, Asian, and European/Other people. Colorectal cancer
was the leading fatal cancer in Europeans/Other women, accounting for approximately
17% of all female cancer deaths, both in the Northern Region and nationally. Colorectal
cancer accounted for 6-8% of all female cancer deaths in other ethnic groups, both in
the Northern Region and nationally.
Lung cancer was the leading cause of cancer deaths in Maori women in the Northern
Region, and nationally contributing to approximately 34% of all female cancer deaths.
This finding is related to the high prevalence of smoking in Maori women compared
with other ethnicities. Breast cancer (16%), colorectal cancer (6%), stomach cancer
(5%), ovarian cancer (4%) and pancreatic cancer (4%) were the remaining leading fatal
cancers in Maori women for the Northern Region and nationally. Colorectal cancer
deaths in Maori women were notably less prominent when compared to
European/Other women both in the Northern Region and nationally.
Table 27: Leading female fatal cancers by ethnicity for Northern Region, 20032006
Maori
Cancer
Lung
Breast
Colorectal
Stomach
Ovary
No.
178
83
31
27
23
%
34
16
6
5
4
Pacific
Cancer
Breast
Lung
Colorectal
Uterus
Stomach
No.
72
60
30
29
25
%
19
16
8
8
7
Asian
Cancer
Breast
Lung
Liver
Colorectal
Ovary
No.
39
21
14
11
9
%
23
12
8
8
5
Other/European
Cancer
No.
Colorectal 594
Breast
582
Lung
510
Pancreas
179
Ovary
173
%
17
16
14
5
5
Table 28: Leading fatal female cancers by ethnicity for New Zealand, 2003-2006
Maori
Cancer
Lung
Breast
Colorectal
Stomach
Pancreas
No.
513
279
101
73
63
%
33
18
7
5
4
Pacific
Cancer
Breast
Lung
Colorectal
Uterus
Stomach
No.
97
73
40
35
32
%
20
15
8
7
7
Asian
Cancer
Breast
Lung
Colorectal
Liver
Leukaemia
No.
68
41
32
19
14
%
23
14
11
7
5
Other/European
Cancer
No.
Colorectal 2,218
Breast
2,095
Lung
1,855
Ovary
650
Pancreas
618
%
17
16
15
5
5
Breast cancer was the leading cause of female cancer deaths in both Pacific and Asian
women. Breast cancer deaths were much more prominent in Asian women (23%) both
in the Northern Region and nationally. This could relate to a higher proportion of breast
cancer registrations in Asian women. For all ethnicities there were several types of
cancer that contributed to between 4-8% of all cancer deaths and there was variability
depending upon the ethnic group.
58
Northern Cancer Network’s Health Needs Assessment - 2009
Males
The following tables (Table 29 and 30) present the leading fatal cancers for males
during the period 2003 -2006 by ethnicity for the Northern Region and New Zealand. It
should be noted that although the analysis is combined for four years, the absolute
cancer numbers are small when ethnic groups are compared. Few additional cancers
can change the ranking order, particularly for the fourth and fifth most common fatal
cancers.
In the period 2003-2006, lung cancer was the leading cause of male cancer death in all
ethnic groups, both in the Northern Region and nationally. Deaths due to lung cancer
were particularly prominent in Maori men, accounting for 31-32% of all male cancer
deaths, both in the Northern Region and nationally. Again, this is related to high
smoking rates in Maori men. Lung cancer deaths were also high in Pacific men (2829%) compared to Asian men (21-25%) and European/Other men (18-19%)
respectively.
Prostate and colorectal cancers contributed to a similar proportion (14-15%) of cancer
deaths in European/Other men, both in the Northern Region and nationally. Although
prostate cancer was the second most common cancer in Maori men, it accounted for
only 9% of all cancer deaths. Deaths from liver cancer were second most common in
Pacific and Asian men, contributing 12-16% of all cancer deaths, both in the Northern
Region and nationally.
The contribution of colorectal cancer to all cancer deaths was significantly lower in
Maori, Pacific and Asian men (6-10%) when compared to European/Other men (1415%) both in the Northern Region and nationally. Stomach cancer contributed to
approximately 7% of all cancer deaths in Maori and Pacific men (Northern Region and
nationally).
Table 29: Leading fatal male cancers by ethnicity for Northern Region, 2003-2006
Maori
Cancer
Lung
Prostate
Colorectal
Stomach
Liver
No.
153
45
34
32
25
%
32
9
7
7
5
Pacific
Cancer
Lung
Liver
Prostate
Stomach
Colorectal
No.
115
47
37
28
24
%
29
12
9
7
6
Asian
Cancer
Lung
Liver
Colorectal
Lip & Oral
Pancreas
No.
45
33
19
14
13
%
21
16
9
7
6
Other/European
Cancer
No.
Lung
707
Prostate
570
Colorectal 569
Melanoma 198
CNS
177
%
18
14
14
5
4
Table 30: Leading fatal male cancers by ethnicity for New Zealand, 2003-2006
Maori
Cancer
Lung
Prostate
Colorectal
Stomach
Liver
No.
450
131
116
111
94
%
31
9
8
8
6
Pacific
Cancer
Lung
Liver
Prostate
Stomach
Colorectal
No.
142
62
47
35
31
%
28
12
9
7
6
Asian
Cancer
Lung
Liver
Colorectal
Pancreas
Lip & Oral
No.
82
45
31
20
19
%
25
14
10
6
6
Other/European
Cancer
No.
Lung
2,755
Colorectal 2,123
Prostate
2,065
Melanoma
632
Pancreas
563
%
19
15
15
4
4
Deaths from melanoma of the skin ranked fourth in European/Other men nationally and
in the Northern Region but did not feature in the top five leading cancer deaths in other
ethnic groups. For all ethnicities there were several types of cancer that contributed to
between 4-8% of all cancer deaths and there was variability depending upon the ethnic
group.
59
Northern Cancer Network’s Health Needs Assessment - 2009
5.5. Inequalities in cancer mortality
This section provides an overview of cancer mortality for Maori and non-Maori for the
period 2003-2006. The data is sourced from New Zealand Cancer Registry and the
New Zealand Mortality Collection. The data is presented according to tumour sites for
the Northern Region and the Northern Region DHBs. The numbers of cancer deaths
are very small when the tumour site is considered at a DHB level and hence statistics
with reasonable numbers (>5) are presented.
Age-standardised rates were calculated by direct standardisation with the WHO
standard population. This can result in an under estimation of some disparities as the
Maori population is younger than the WHO world population. Further, it is recognised
that the disparities in cancer outcomes is due to delayed presentation and the
differences in the stage at diagnosis between Maori and non-Maori. [9] There is
variation in the completeness of staging information from NZCR and therefore this
analysis was not undertaken.
Table 31: Maori and non-Maori inequalities in cancer mortality by tumour site,
2003-2006, Northern Region
Mortalities
Cancer site
Maori
All sites
Lung
Colorectal
Breast*
Genito-urinary
Prostate*
Testis*
Bladder
Kidney
Melanoma
Haematological
Hodgkin’s disease
Non-Hodgkin’s lymphomas
Leukaemia
Myeloma
CNS
Gynaecological
Uterine*
Ovarian*
Cervix*
Upper GI
Oesophagus
Stomach
Pancreas
Hepato-biliary
Other
Number
non-Maori
998
8,699
331
1,458
65
1,250
83
700
Maori
Rate
non-Maori
223.5
122.3
75.2
20.9
15.0
17.2
16.9
10.4
Rate
ratio
1.83
3.60
0.87
1.63
45
7
13
11
6
615
11
200
146
332
36.3
1.9
3.5
2.2
1.4
18.7
0.4
2.6
2.1
4.8
1.94
4.59
1.36
1.08
0.29
3
31
28
13
23
346
333
173
*
6.8
6.0
2.9
0.4
4.9
4.8
2.5
*
0.94
0.94
1.68
19
315
3.1
4.9
0.64
18
23
15
92
201
67
6.8
8.6
5.0
2.5
5.3
2.0
2.70
1.61
2.56
15
59
37
42
134
197
343
375
312
1,210
3.4
12.3
9.3
9.0
29.6
2.8
4.7
5.2
4.6
16.7
1.23
2.61
1.80
1.96
1.77
• Rates are calculated per 100,000 and were age-standardised to the WHO standard population. Rates not represented
for tumour sites with small numbers. Rates are sex –specific.
In the period 2003-2006, there were a total of 998 Maori and 8,699 non-Maori cancer
deaths in the Northern Region. This averaged to 250 Maori and 2,175 non-Maori
cancer deaths each year in the Northern Region. The age-standardised mortality rate
60
Northern Cancer Network’s Health Needs Assessment - 2009
for all cancer was 223.5 per 100,000 in Maori and 122.3 per 100,000 in non-Maori.
Maori had approximately 1.83 times higher all cancer mortality rates than that of nonMaori.
Maori had significantly higher death rates for cancers of the lung, prostate, testis, liver,
pancreas, stomach, breast, cervix, ovary and uterus. Deaths from cancers of the
bladder, kidney, oesophagus and haematological cancers like leukaemia, nonHodgkin’s lymphoma and multiple myeloma were more common among Maori than
non-Maori. Maori had significantly lower mortality rates for melanoma of the skin.
Further, mortality from colorectal cancer and cancers of the central nervous system
were relatively less common among Maori, compared to non-Maori.
Inequalities in cancer mortality by Northern Region DHBs
Auckland District Health Board (ADHB)
Table 32: Maori and non-Maori inequalities in cancer mortality by tumour site,
2003-2006, ADHB
Mortalities
Cancer site
Maori
All sites
Lung
Colorectal
Breast*
Prostate*
Melanoma
Haematological
Non-Hodgkin’s lymphomas
Leukaemia
Upper GI
Stomach
Pancreas
Hepato-biliary
Number
non-Maori
148
2,373
42
400
11
340
16
211
11
825
*
73
Maori
Rate
non-Maori
190.2
119.6
55.4
20.9
13.2
16.6
31.7
21.1
67.7
102.1
*
3.7
Rate
ratio
1.59
2.65
0.80
1.50
0.66
*
8
5
89
84
10.5
5.7
4.7
4.3
2.26
1.34
6
7
7
107
98
96
6.1
10.8
8.5
5.4
4.6
5.2
1.13
2.33
1.63
• Rates are calculated per 100,000 and were age-standardised to the WHO standard population. Rates not represented
for tumour sites with small numbers. Rates are sex –specific.
61
•
There were a total of 148 Maori and 2,373 non-Maori cancer deaths in ADHB,
during the period 2003-2006,
•
The age-standardised mortality rate for all cancer was 190.2 per 100,000 in
Maori and 119.6 per 100,000 in non-Maori, a 59% higher rate in Maori than
non-Maori,
•
Maori had significantly higher mortality rates from cancers of the lung, breast,
pancreas, liver and non-Hodgkin’s lymphoma,
•
Mortality from colorectal and prostate cancer was lower in Maori than nonMaori.
Northern Cancer Network’s Health Needs Assessment - 2009
Counties Manukau District Health Board (CMDHB)
Table 33: Maori and non-Maori inequalities in cancer mortality by tumour site,
2003-2006, CMDHB
Mortalities
Cancer site
Maori
All sites
Lung
Colorectal
Breast*
Prostate*
Melanoma
Haematological
Non-Hodgkin’s lymphomas
Leukaemia
Gynaecological
Uterine*
Ovary*
Cervix*
Upper GI
Stomach
Pancreas
Hepato-biliary
Number
non-Maori
323
2,234
114
416
18
315
27
165
8
146
*
89
Maori
Rate
non-Maori
237.8
126.2
83.5
23.8
16.2
17.5
36.7
17.9
23.6
18.8
*
5.0
Rate
ratio
1.88
3.51
0.93
2.05
1.26
*
10
8
103
84
9.4
3.9
5.8
4.9
1.61
0.80
6
9
5
29
57
20
8.4
9.3
4.1
3.1
6.1
2.4
2.67
1.53
1.74
26
11
15
96
82
89
17.8
8.7
10.3
5.4
4.5
5.1
3.28
1.92
2.01
• Rates are calculated per 100,000 and were age-standardised to the WHO standard population. Rates not represented
for tumour sites with small numbers. Rates are sex –specific.
62
•
There were a total of 323 Maori and 2,234 non-Maori cancer deaths in CMDHB,
during the period 2003-2006,
•
The age-standardised mortality rate for all cancer was 237.8 per 100,000 in
Maori and 126.2 per 100,000 in non-Maori, an 88% higher rate in Maori than
non-Maori,
•
Maori had significantly higher mortality rates from cancers of the lung, breast,
uterus, cervix, ovary, stomach, pancreas, liver and non-Hodgkin’s lymphoma,
•
Lung cancer mortality in Maori was 3.5 times that of non-Maori,
•
Cancer mortality from colorectal cancer was less common and that from
prostate cancer more common in Maori.
Northern Cancer Network’s Health Needs Assessment - 2009
Northland District Health Board (NDHB)
Table 34: Maori and non-Maori inequalities in cancer mortality by tumour site,
2003-2006, NDHB
Mortalities
Cancer site
Maori
All sites
Lung
Colorectal
Breast*
Prostate*
Melanoma
Haematological
Non-Hodgkin’s lymphomas
Leukaemia
Gynaecological
Uterine*
Ovary*
Cervix*
Upper GI
Stomach
Pancreas
Hepato-biliary
Number
non-Maori
364
1,068
125
181
22
191
24
67
20
88
*
26
Maori
Rate
non-Maori
259.4
130.5
88.8
21.6
16.1
21.7
30.6
19.6
40.6
20.1
*
7.1
Rate
ratio
1.99
4.12
0.74
1.56
2.02
*
7
11
39
48
4.4
8.2
5.0
6.4
0.86
1.29
9
7
7
12
17
6
9.9
8.8
8.1
2.9
4.2
1.6
3.44
2.13
5.18
20
16
12
35
42
29
13.6
12.6
7.9
4.4
5.3
3.5
3.10
2.38
2.24
• Rates are calculated per 100,000 and were age-standardised to the WHO standard population. Rates not represented
for tumour sites with small numbers. Rates are sex –specific.
63
•
There were a total of 364 Maori and 1,068 non-Maori cancer deaths in NDHB,
during the period 2003-2006,
•
The age-standardised mortality rate for all cancer was 259.4 per 100,000 in
Maori and 130.5 per 100,000 in non-Maori, an almost two times higher rate in
Maori than non-Maori,
•
Maori had significantly higher mortality rates from cancers of the lung, prostate,
breast, uterus, cervix, ovary, stomach, pancreas and liver,
•
The inequality in cancer mortality for lung cancer was highest in the NDHB
when compared to other Northern Region DHBs and four times higher in Maori
than non-Maori,
•
Prostate cancer mortality rates were also significantly higher for Maori in the
NDHB when compared to other Northern DHBs,
•
The cancer mortality rates for uterus, cervix and stomach were significantly
higher in Maori in NDHB, compared with other Northern DHBs. However, the
numbers of these cancer were very small and a few additional numbers can
skew the data,
•
The cancer mortality from colorectal cancer was less common in Maori in
NDHB, similar to other Northern DHBs.
Northern Cancer Network’s Health Needs Assessment - 2009
Waitemata District Health Board (WDHB)
Table 35: Maori and non-Maori inequalities in cancer mortality by tumour site,
2003-2006, WDHB
Mortalities
Cancer site
Maori
All sites
Lung
Colorectal
Breast*
Prostate*
Melanoma
Number
non-Maori
163
3,024
50
461
14
404
16
250
6
214
*
122
Maori
Rate
non-Maori
181.4
119.1
57.2
18.5
15.7
15.8
24.4
19.4
27.8
18.2
*
4.9
Rate
ratio
1.52
3.09
0.99
1.26
1.53
*
Upper GI
Stomach
Hepato-biliary
7
8
105
98
9.5
9.5
3.9
3.9
2.44
2.41
Non –Hodgkin’s
Lymphoma
6
115
5.4
4.6
1.17
• Rates are calculated per 100,000 and were age-standardised to the WHO standard population. Rates not represented
for tumour sites with small numbers. Rates are sex –specific.
•
There were a total of 163 Maori and 3,024 non-Maori cancer deaths in WDHB,
during the period 2003-2006,
•
The age-standardised mortality rate for all cancer was 181.4 per 100,000 in
Maori and 119.1 per 100,000 in non-Maori, a 52% higher rate in Maori than
non-Maori,
•
Maori had significantly higher mortality rates from cancers of the lung, stomach
and liver,
•
The lung cancer mortality in Maori was 3.5 times that of non-Maori,
•
Mortality from cancers of the breast, prostate and non-Hodgkin’s lymphoma
were more common in Maori compared to non-Maori,
•
There was no inequality in cancer mortality from colorectal cancer between
Maori and non-Maori. However, small numbers for Maori may have skewed the
data.
5.6. Key points
64
o
There were 2,376 cancer deaths in the Northern Region in 2005, approximately
30% of the cancer deaths nationally,
o
The cancer mortality increased 6% over the ten year period 1995 to 2005 in the
Northern Region and nationally,
o
The proportion of cancer mortality increase over the same ten year period was
19%, 12% and 9% respectively in WDHB, NDHB and CMDHB; compared to a
13% decrease in the ADHB region,
Northern Cancer Network’s Health Needs Assessment - 2009
o
For the combined period 2003-2006, there were no significant differences in
ASR of all cancer mortality amongst all ethnic groups when comparisons were
made between the Northern Region and New Zealand,
o
For the combined period 2003-2006, all cancer ASR was higher for Maori and
Pacific people, and lower for Asian people than the Other/European population
both in the Northern Region and nationally,
o
For the combined period 2003-2006, the cancer mortality ASR were higher for
NDHB and CMDHB, compared to WDHB and ADHB, particularly for Maori,
o For the combined period 2003-2006, there were 37 cancer deaths in children
(under 15 years), less than 1% of all cancers deaths in the Northern Region,
65
o
For the same period, the number of cancer deaths were 534 (6%) for people
aged 15-44 years, 2,495 (26%) for 45-64 years and 6,631 (68%) for 65+ years
respectively,
o
The age-specific rates for all cancer increased ten fold between the age groups
15-44 years and 45-64 years, and six fold between 45-64 years and 65+years.
Northland DHB had higher age specific all cancer death rates compared to
other Northern Region DHBs and nationally,
o
Ethnic disparities were evident in the Northern Region at 45-64 years and 65+
years. Maori had the highest all cancer mortality rate, followed by Pacific,
European/Other, and Asian people,
o
The leading five fatal cancers for females were cancers of the breast, lung,
colorectal, ovary and pancreas in the Northern Region and nationally for the
period 2003-2006, accounting for approximately 58% of all female cancer
deaths,
o
The leading five fatal cancers for men were cancers of the lung, prostate,
colorectal, stomach and non-Hodgkin’s lymphoma in the Northern Region for
the period 2003-2006, accounting for approximately 55% of all male cancers,
o
Nationally, lung, colorectal, prostate, stomach and pancreatic cancer were the
leading five fatal cancers in men for the combined period 2003-2006,
o
Colorectal cancer was the leading fatal cancer in the European/Other women
(17%) in the Northern Region and nationally, but not so in the other ethnic
groups, where it accounted for 6-8% of all female cancer deaths,
o
Lung cancer was the leading fatal cancer in Maori women, contributing to 34%
of all female can deaths, both in the Northern Region and nationally,
o
Breast cancer was the leading fatal cancer in Pacific (19-205) and Asian
women (23%), both in the Northern Region and nationally,
o
Lung cancer deaths were significantly higher in Maori men (31-32%), compared
to other ethnic groups, both in the Northern Region and nationally for the
combined period 2003-2006,
o
Liver cancer was the second most common cause of cancer death in Pacific
and Asian men, contributing 12-16% of all cancer deaths, both in the Northern
Region and nationally. By contrast, liver cancer deaths don’t feature in the five
most common cancer deaths in the European/Other men,
o
Colorectal cancer deaths in European/Other men is relatively more common
(14-15%) than in other ethnic groups (6-10%), both in the Northern Region and
nationally,
Northern Cancer Network’s Health Needs Assessment - 2009
o
Stomach cancer contributed to approximately 7% of cancer deaths in Maori and
Pacific men but not in other ethnic groups, both in the Northern Region and
nationally,
o
Deaths from melanoma of the skin ranked fourth in European/Other men, but
did not feature in the leading cancer deaths for other ethnic groups, both in the
Northern Region and nationally,
o
Breast cancer was the leading female cancer for both incidence and mortality.
However, the mortality contribution of 17% was significantly lower than the
incidence contribution of 28%, due to its relatively higher survival rate. In
contrast, lung cancer mortality in females of 17% was significantly higher than
the incidence contribution of 9%, reflecting the relatively low survival rate,
o
In men, the proportion of deaths due to prostate cancer (13%) was lower than
the incidence proportion (28%), reflecting high survival rates. By contrast the
proportion of lung cancer deaths (20%) was higher than the incidence
proportion (10%), reflecting low survival rates. The colorectal cancer death and
incidence proportion were similar, reflecting a mid survival rate,
o
Age-standardised cancer mortality rates for all cancers was 1.83 times higher in
Maori compared to non-Maori, in the Northern Region for the period 2003-2006
and this difference was highest in the NDHB,
o
Maori had significantly higher death rates for cancers of the lung, prostate,
testes, cervix, ovary, uterus, stomach, liver and pancreas and lower rates for
cancers of the central nervous system, colorectal and melanoma of the skin,
o The inequalities in cancer mortality rates resulting from lung, prostate, cervix,
uterus and stomach cancers were significantly higher in the NDHB, compared
to the other Northern DHBs.
66
Northern Cancer Network’s Health Needs Assessment - 2009
6.
Chapter Six: Cancer survival
6.1. Overview
The length of time that a person survives after a cancer diagnosis is one means of
evaluating cancer treatment effectiveness. While cancer registrations measure the
incidence of cancer, the relative survival rate is an important measure of the impact of
cancer (the incidence combined with survival determines mortality).
The relative survival analysis compares the survival of persons diagnosed with cancer
(observed survival) with the survival of the entire population of the same sex and age in
the same calendar year as the cancer cohort (expected survival). This method of
analysis does not require the cause of death. Relative survival is defined as the
observed survival divided by the expected survival and is usually given as a
proportion.[11]
Relative cancer survival rates can be calculated by the traditional cohort method or by
the newer method of period analysis. The following section presents relative survival
rates calculated by the period analysis and sourced from the Ministry of Health. This
method examines the survival experience of people who were alive at the beginning of
a particular recent calendar period and who were diagnosed with cancer before this
period. [11] Therefore, the period method might provide more up-to-date estimates of
survival, and therefore a better reflection of current cancer management.
There is evidence of ethnic inequalities in cancer survival from national and
international studies. [9,12-15] Age-standardised, five year relative survival rates were
lowest for Maori, intermediate for Pacific peoples and highest for non-Maori/non-Pacific
peoples for many cancers.[12] The stage at diagnosis explained some but not all of the
ethnic disparities in cancer survival in New Zealand. [9,13] The possible factors
responsible for ethnic inequalities might include access to specialised cancer services
and the quality of care received.
Data presented below are based on period analysis for the study period 1 January
2002 to 31 December 2006, with follow up until 31 December 2007. Results are
expressed as a ratio; with the closer a result is to one, the better the survival estimate.
For example, a relative survival rate of 0.85 indicates an 85% survival estimate for a
given time period. In this analysis, one year and five year relative survival rates are
presented. No adjustment has been made for stage at diagnosis. Survival analysis by
ethnicity is presented for the national data. Similar ethnic inequalities would be
expected in the Northern Region.
6.2. Relative survival rates for all cancer
The following graph presents one and five year relative survival rates (RSR) for all
cancer for New Zealand and the four regions for the study period 2002-2006. The one
year and five year RSR for all cancer was approximately 76% and 63% for Northern
Region, compared to 75% and 60% nationally.
The one and five year RSR for all cancer was significantly higher for the Northern
Region than for all the other regions and New Zealand (See Figure 26).
67
Northern Cancer Network’s Health Needs Assessment - 2009
Figure 35: Relative survival rates (1 and 5 years) by Regions and New Zealand,
2002-2006
1.0
0.9
Northern
Central
Midland
Southern
NZ
Relative survival rate
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0.0
1 year
5 year
Time interval
6.3. Relative survival rates by cancer type
The following graph (Figure 27) shows the one year and five year RSR for major
cancers in the Northern Region for the period 2002-2006. Among the major cancers,
prostate cancer had the highest one and five year RSR (96% and 90%) followed by
breast cancer (97% and 84%), cervix (86% and 71%), colorectal (78 and 61%) and
lung cancer (29% and 11%) respectively.
Figure 36: Relative survival rates (1 and 5 years) by cancer site, Northern Region,
2002-2006
Relative survival rate
Lung
Colorectal
Cervix
Breast
Prostate
1.2
1.1
1
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
1 year
5 year
Time interval
68
Northern Cancer Network’s Health Needs Assessment - 2009
Breast cancer
There were no significant differences in one and five year RSR for breast cancer
between all regions and New Zealand.
Figure 37: Five year relative survival rates for breast cancer by Regions and New
Zealand, 2002-2006
Northern
Central
Midland
Southern
NZ
1.0
0.9
Relative survival rate
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0.0
1 year
Time interval
5 year
Among the Northern Region DHBs, the five year RSR for breast cancer was lowest in
Northland (82%). The Auckland region DHBs had 84-85% five year RSR for breast
cancer, but this was not statistically significantly higher than Northland.
Figure 38: Five year relative survival rates for breast cancer by Northern Region
DHBs, 2002-2006
0.90
Relative survival rate
0.85
0.80
0.75
0.70
0.65
Northland
69
Waitemata
Auckland
Counties Manukau
Northern Cancer Network’s Health Needs Assessment - 2009
Lung cancer
The one year RSR for lung cancer was higher in the Northern Region compared to
other regions and with New Zealand. The one year RSR for lung cancer in the Northern
Region was significantly higher than that for Midland, while the five year RSR was
significantly higher than that for all regions and New Zealand.
Figure 39: Five year relative survival rates for lung cancer by Regions and New
Zealand, 2002-2006
0.50
0.45
Northern
Central
Midland
Southern
NZ
Relative survival rate
0.40
0.35
0.30
0.25
0.20
0.15
0.10
0.05
0.00
1 year
5 year
Time interval
The five year RSR for lung cancer was higher in the Auckland DHB (15%) and
Waitemata DHB (14%), compared to Counties Manukau (12%) and Northland DHB
(12%). However, this was not statistically significant.
Figure 40: Five year relative survival rates for lung cancer by Northern Region
DHBs, 2002-2006
0.20
0.18
Relative survival rate
0.16
0.14
0.12
0.10
0.08
0.06
0.04
0.02
0.00
Northland
70
Waitemata
Auckland
Counties Manukau
Northern Cancer Network’s Health Needs Assessment - 2009
Colorectal cancer
There were no significant differences in the one and five year RSR for colorectal
cancer between regions.
Figure 41: Five year relative survival rates for colorectal cancer by Regions and
New Zealand, 2002-2006
1.0
0.9
Northern
Central
Midland
Southern
NZ
Relative survival rate
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0.0
1 year
5 year
Time interval
The five year RSR for colorectal cancer was higher in the Waitemata and Auckland
DHB (63%) compared to Counties Manukau (58%) and Northland (57%) but this was
not statistically significant.
Figure 42: Five year relative survival rates for colorectal cancer by Northern
Region DHBs, 2002-2006
0.80
Relative survival rate
0.70
0.60
0.50
0.40
0.30
0.20
0.10
0.00
Northland
71
Waitemata
Auckland
Counties Manukau
Northern Cancer Network’s Health Needs Assessment - 2009
Prostate cancer
There were no significant differences in the one year RSR for prostate cancer between
regions. However, the five year RSR for prostate cancer in the Northern Region (90%)
was significantly higher than that for other regions and New Zealand.
Figure 43: Five year relative survival rates for prostate cancer by Regions and
New Zealand, 2002-2006
Northern
Central
Midland
Southern
NZ
1.0
0.9
Relative survival rate
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0.0
1 year
5 year
Time interval
Although the five year RSR for prostate cancer was lower in the Counties Manukau
(87%) and Northland DHBs (89%) compared to Waitemata (95%) and Auckland (93%),
this was not statistically significant.
Figure 44: Five year relative survival rates for prostate cancer by Northern
Region DHBs, 2002-2006
1.00
0.95
Relative survival rate
0.90
0.85
0.80
0.75
0.70
0.65
0.60
0.55
0.50
Northland
72
Waitemata
Auckland
Counties Manukau
Northern Cancer Network’s Health Needs Assessment - 2009
Cervical cancer
There were no significant differences in the one year RSR for cervical cancer between
regions. However, the five year RSR for cervical cancer was significantly lower in the
Northern Region (70.5%) compared to that of the Southern Region (81.1%).
Figure 45: Five year relative survival rates for cervical cancer by Regions and
New Zealand, 2002-2006
1.0
Northern
Central
Midland
Southern
NZ
0.9
Relative survival rate
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0.0
1 year
5 year
Time interval
Although not significant, Waitemata DHB had lower five year RSR for cervical cancer
(64%) compared with other Northern Region DHBs.
Figure 46: Five year relative survival rates for cervical cancer by Northern Region
DHBs, 2002-2006
1.00
0.90
Relative survival rate
0.80
0.70
0.60
0.50
0.40
0.30
0.20
0.10
0.00
Northland
73
Waitemata
Auckland
Counties Manukau
Northern Cancer Network’s Health Needs Assessment - 2009
Uterine cancer
Although not significant, Northland has lower five year RSR for uterine cancer
compared to other Northern Region DHBs and New Zealand.
Figure 47: Five year relative survival rates for uterine cancer by Northern Region
DHBs, 2002-2006
1.00
Relative survival rate
0.90
0.80
0.70
0.60
0.50
0.40
0.30
0.20
0.10
0.00
Northland
Waitemata
Auckland
Counties
Manukau
NZ
Ovarian cancer
Auckland DHB had significantly higher five year RSR for ovarian cancer (55%) than
Waitemata DHB (34%) and New Zealand (40%) respectively.
Figure 48: Five year relative survival rates for ovarian cancer by Northern Region
DHBs, 2002-2006
0.70
Relative survival rate
0.60
0.50
0.40
0.30
0.20
0.10
0.00
Northland
74
Waitemata
Auckland
Counties
Manukau
Northern Cancer Network’s Health Needs Assessment - 2009
NZ
6.4. Relative survival rate of common cancers by ethnicity
Figure 40 and 41 shows the difference in relative survival rates for major cancers by
ethnicity nationally. Data was not available for the Northern Region but ethnic
differences similar to that nationally, would be expected in the Northern Region.
Maori had lower five year RSR for lung, bowel and prostate cancer compared to
European/Other and Pacific people. The five year RSR for lung cancer was
significantly lower in Maori people (7.7%) compared to Pacific (16.9%) and
European/Other people (10.4%). The five year RSR for colorectal cancer was higher in
the European/Other people (61.5%) compared to Maori (47.8%) and Pacific people
(49.2%). The five year RSR for prostate cancer was higher in European/Other people
(91.3%) than the Maori (74.1%) and Pacific people (81.8%).
Figure 49: Five year relative survival rates for lung, bowel and prostate cancer by
ethnicity, New Zealand, 2002-2006
1.00
Maori
Pacific
Other
0.90
Relative survival rate
0.80
0.70
0.60
0.50
0.40
0.30
0.20
0.10
0.00
Lung
Bowel
Prostate
Figure 50: Five year survival rates of cancers of the ovary, uterus, cervix and
breast by ethnicity, New Zealand, 2002-2006
1.00
Maori
Pacific
Other
0.90
Relative survival rate
0.80
0.70
0.60
0.50
0.40
0.30
0.20
0.10
0.00
Ovary
75
Uterus
Cervix
Northern Cancer Network’s Health Needs Assessment - 2009
Breast
The five year RSR for cancers of the breast, cervix and uterus were significantly lower
for Maori compared to European/Other people. However, the five year RSR for ovarian
cancer was higher in Maori than European/Other people. The five year RSR for ovarian
and cervical cancer was lowest for Pacific people when compared to Maori and
European/Other.
6.5. International comparison of survival of common cancers
The following table compares five year survival rates for major cancers in the Northern
Region with national and international survival data. Although the time periods are
different, they use the same period analysis method and provide a good benchmark for
comparison.
Five year relative survival for the Northern Region appeared to be comparable to that in
Victoria, Australia [16] and the United States[17] for most cancers. The difference in
prostate survival may reflect the high prevalence of the Prostate-Specific Antigen
(PSA) testing in the United States with active treatment consequently undertaken on
numbers of patients who would have survived in any case without intervention.
Table 36: Five year relative survival rate (%) for major cancers by Northern
Region, New Zealand, Australia (Victoria) and USA
Cancer site
Northern Region
2002-2006
New Zealand
2002-2006
Victoria
(Australia)
2000-2004
USA SEER
1993-1998
Lung
11.1%
8.4%
11%
15.0%
Colorectal
60.5%
59.7%
63%
62.2%
Breast
84.4%
83.6%
87%
86.4%
Cervix
70.6%
72.7%
70%
70.5%
Prostate
90.2%
87.5%
84%
98.8%
The relative survival for lung, colorectal, breast and prostate cancers was higher in the
Northern Region compared to that nationally. However, cervical cancer survival was
lower in the Northern Region than that nationally. This could relate to lower cervical
screening coverage in the Northern Region, compared to nationally. Colorectal and
breast cancer relative survival rates were higher in Victoria than in the Northern
Region, while relative survival for prostate cancer was higher in New Zealand, including
the Northern Region than in Victoria.
6.6. Key points
76
o
The one and five year RSR for all cancers was significantly higher in the
Northern Region than all the other regions and New Zealand for the period
2002-2006,
o
The five year RSR for lung cancer and prostate cancer was significantly higher
for the Northern Region than all the other regions and New Zealand for the
period 2002-2006,
Northern Cancer Network’s Health Needs Assessment - 2009
o
The five year RSR for cervical cancer was significantly lower in the Northern
Region compared to the Southern Region,
o
There were no significant differences in one and five year RSR for breast and
colorectal cancer between regions,
o
Maori have lower five year RSR for lung, bowel and prostate cancer nationally
than European/Other and Pacific people,
o
Maori have lower five year RSR nationally for cancers of the breast, cervix and
uterus than European/Other people,
o
The five year RSR nationally for ovarian cancer was higher in Maori people
than the European/other people,
o
The five year RSR nationally for ovarian and cervical cancer was lowest for
Pacific people, compared to the other ethnic groups,
o The five year RSR for lung and cervical cancers in the Northern Region were
comparable to that in Victoria, Australia,
o The five year RSR for breast and colorectal cancers were slightly better and
that for prostate cancer was worse in Victoria, compared to the Northern
Region,
o
There were no significant differences in the one and five year RSR for lung,
bowel, breast, prostate, cervical and uterine cancers in the Northern Region
during the period 2002-2006,
o Auckland DHB had significantly higher five year RSR for ovarian cancer (55%)
than Waitemata DHB (34%) and New Zealand (40%).
77
Northern Cancer Network’s Health Needs Assessment - 2009
7.
Chapter Seven: Cancer treatment
7.1. Overview
The main methods of treatment for cancer are surgery, chemotherapy and
radiotherapy. In New Zealand, six regional oncology centres provide medical oncology,
radiation oncology and haematology services. These centres are in Auckland,
Hamilton, Palmerston North, Wellington, Christchurch and Dunedin. The Auckland
cancer centre serves as the regional centre for the Northern Region. Although radiation
treatment is only offered at these six centres, chemotherapy and surgical services are
offered in most hospitals.
There is lot of interface between public and private sectors in oncology treatment with
part of the journey in the private sector, particularly for the investigation phase. A
recent study of bowel cancer showed that approximately 25% of colon cancer patients
were diagnosed in private and nearly 20% had surgery in the private sector. [18]
This section provides the radiotherapy intervention rates and radiotherapy waiting time
only. Meaningful data for chemotherapy and surgery is not currently available. In future,
the Network, with its tumour stream work should be able to provide meaningful data
regarding the primary care and secondary care service interface and time lines from
the first specialist appointment to investigations, and treatment for respective tumours.
This will provide better information on the regional and ethnic disparities in cancer
treatment.
7.2. Radiotherapy
Radiotherapy is a critical component of both radical cancer treatment, where the aim is
to improve local control of the cancer, and palliative treatment, where the aim is to
provide symptom relief in the case of incurable cancer. There is an extensive literature
reporting the effectiveness of radiotherapy in improving patient outcomes. [19-21] This
is true in both definitive (isolated treatment) and adjuvant (treatment in combination
with other modalities, such as delivery after surgery) settings. Of those cured of their
cancer it is estimated that radiotherapy contributes to the cure in 40% of cases either
alone or in combination with other treatments such as surgery.
Table 37: Estimated radiotherapy treatment intervention rates by Northern
Region DHBs and New Zealand, 2004/05 – 2006/07
DHB
Northland
Waitemata
Auckland
Counties Manukau
Northern Region
New Zealand
2004/05
27.7%
36.1%
34.4%
31.2%
33.2%
Estimated intervention rate
2005/06
25.7%
34.7%
38.2%
34.5%
34.5%
2006/07
26.7%
36.7%
37.8%
37.6%
35.9%
36.4%
35.9%
35.7%
Source: Cancer Registry, Personal Health Non Case Weight (PHNCW) and Breast Screen Aotearoa (BSA)
78
Northern Cancer Network’s Health Needs Assessment - 2009
The radiotherapy treatment intervention rate is defined as the proportion of people with
cancer who receive at least one course of radiation treatment. Details regarding the
method of calculation are available in Appendix 10.3. Based on the recommendations
of the National Radiotherapy Advisory Group in England, and applying the model to
New Zealand cancer registrations, it was estimated that approximately 45-46% of
people diagnosed with cancer need radiotherapy.1
The estimated radiotherapy intervention rate in 2006/07 for the Northern Region had
slightly increased over the three years and was approximately 36%. This was similar to
the national radiotherapy intervention rate of 35.7%. Among the Northern Region
DHBs, Northland had a significantly lower radiation intervention rate (approximately
27%), when compared with the other Northern Region DHBs. All other Northern Region
DHBs had slightly higher radiotherapy intervention rates than the national rates (3738% approximately).
7.3. Radiotherapy waiting times
Radiotherapy treatment waiting times are well-established as the main indicator used
to measure system performance. Radiotherapy treatment waiting time is one of the ten
health targets set by the Ministry of Health. The health target in 2007/08 for
radiotherapy times was ‘all patients in category A (acute), B (curative) and C (palliative
and radical) wait less than eight weeks between the first specialist assessment and the
start of radiation oncology treatment’. This has changed for 2008/09 to less than 6
weeks. Category D (combined chemotherapy and radiotherapy) patients are excluded.
(Refer to Appendix 10.4 for details on definitions of prioritisation categories for radiation
treatment).
Figure: Number of patients within radiotherapy waiting time categories (priority A, B & C)
in Northern Region, 2003-2008
180
less than 4
160
4--8
>8
140
120
100
80
60
40
20
Ap
ri l
Au
gu
st
D
ec
em
be
r
Au
gu
st
D
ec
em
be
r
Ap
ri l
Au
gu
st
D
ec
em
be
r
Ap
ri l
Au
gu
st
D
ec
em
be
r
Ap
ri l
Au
gu
st
D
ec
em
be
r
-20
Ap
ri l
Ap
ri l
Au
gu
st
D
ec
em
be
r
0
Source: Ministry of Health, radiotherapy waiting time data 2003-2008
1
Northern Region Radiotherapy Strategic Plan Working Group
79
Northern Cancer Network’s Health Needs Assessment - 2009
In general, the average number of patients (priority A, B and C) waiting for more than 8
weeks for radiotherapy in the Northern Region was less than 10%. However, each year
there were monthly fluctuations.
7.4. Key points
8.
o
For the year 2006/07, the Northern Region had similar radiotherapy intervention
rates to national rates,
o
The radiotherapy intervention rates for Northland were significantly lower than
the other Northern Region DHBs,
o
The radiotherapy waiting time target of less than 8 weeks between the first
specialist assessment and the start of radiation treatment was generally met in
the Northern Region.
Chapter Eight: Conclusions
This document commences a formal assessment of the health needs analysis in
regards to cancer for the population at a regional level. Key results were presented,
interpreted and discussed. The report not only identifies the regional inequalities for the
total population but also the disparities between different ethnicities at district and
regional levels.
Findings from these analyses will inform the Northern Cancer Network Strategic Plan
2009-14. Further, the report will would assist the cancer care stakeholders to identify
priorities for their districts or areas. This report can be used as baseline data against
which improvements can be measured. It is recognised that there are many other
analyses and areas that could be covered in such a report. It is expected that future
reports will build on this one.
80
Northern Cancer Network’s Health Needs Assessment - 2009
9.
Chapter Nine: References
[1]
Cancer Control Taskforce. The New Zealand Cancer Control Strategy: Action
Plan 2005-2010Wellington: Ministry of Health; 2005.
[2]
Salmond C, Crampton P, Atkinson J. NZDep2006 Index of Deprivation.
Wellington: Department of Public Health, University of Otago; August 2007.
[3]
National Centre for Classification in Health. The International Statistical
Classification of Diseases and Related Health Problems, Tenth Revision, Australian
Modification (ICD-10-AM), Third Edition. Sydney: National Centre for Classification in
Health.; 2002.
[4]
Ministry of Health. Ethnicity Data Protocols for the Health and Disability Sector.
Wellington: Ministry of Health; 2004.
[5]
Ministry of Health. The New Zealand Cancer Control Strategy. Wellington:
Ministry of Health and the New Zealand Cancer Control Trust; 2003.
[6]
Ministry of Health. Cancer: New Registrations and Deaths 2005. Wellington:
Ministry of Health; 2008.
[7]
National Screening Unit. National Cervical Screening Programme DHB Report.
Wellington: Ministry of Health; June 2008.
[8]
Robinson T, Bullen C, Humphries W, Hornell J, Moyes C. The New Zealand
Hepatitis B Screening Programme: screening coverage and prevalence of chronic
hepatitis B infection. The New Zealand Medical Journal. March 2005; 118(1211).
[9]
Robson B, Harris R. Hauora: Maori Standards of Health IV. A study of the years
2000-2005. Wellington: Te Ropu Rangahau Hauora a Eru Pomare; November 2007.
[10]
Ministry of Health. Asian Health Chart Book 2006. Wellington: Ministry of
Health; 2006.
[11]
Australian Institute of Health and Welfare, Cancer Australia & Australasian
Association of Cancer Registries. Cancer survival and prevalence in Australia: cancers
diagnosed from 1982 to 2004. Canberra: AIHW; 2008.
[12]
Robson B, Purdie G, Cormack D. Unequal Impact: Māori and Non-Māori
Cancer Statistics 1996–2001. Wellington: Ministry of Health; 2005.
[13]
Jeffreys M, Stevanovic V, Tobias M, Lewis C, Ellison-Loschmann L, Pearce N,
et al. Ethnic Inequalities in Cancer Survival in New Zealand: Linkage Study. Am J
Public Health. 2005 May 1, 2005; 95(5):834-7.
[14]
Haynes M, Smedley B. The Unequal Burden of Cancer: An assessment of NIH
research and programs for ethnic minorities and the medically underserved.
Washington DC: National Academy Press; 1999.
[15]
Shavers V, Brown M. Racial and ethnic disparities in the receipt of cancer
treatment. Journal of the National Cancer Institute. 2002; 94:334-57.
81
Northern Cancer Network’s Health Needs Assessment - 2009
[16]
English D, Farrugia H, Thursfield V, Chang P, Giles G. Cancer Survival Victoria
2007: Estimates of survival in 2004 (and comparisons with earlier periods)
Melbourne, Victoria: Victorian Cancer Registry, Cancer Epidemiology Centre, The
Cancer Council Victoria; 2007.
[17]
Brenner H. Long-term survival rates of cancer patients achieved by the end of
the 20th century: a period analysis. Lancet. 2002; 360(9340):1131-5.
[18]
Cunningham R, Sarfati D, Hill S, Dennett E, O'Donnell A. Colon cancer
management in New Zealand: 1996-2003. New Zealand Medical Journal. 2009;
122(1294):51-60.
[19]
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effects of
radiotherapy and of differences in the extent of surgery for early breast cancer on local
recurrence and 15 year survival: an overview of the randomised trials. Lancet. 2005;
366:2087-106.
[20]
Widmark A et al. A randomised trial comparing antiandrogens with or without
radiotherapy in the treatment of locally advanced prostate cancer: survival and QOL
outcome. Int J Radiat Oncol Biol Phys. 2008; 72(1).
[21]
Swanson G et al. Update of SWOG 8794: Adjuvant Radiotherapy for pT3
prostate cancer improves metastasis free survival. Int J Radiat Oncol Biol Phys. 2008;
72(1).
82
Northern Cancer Network’s Health Needs Assessment - 2009
10. Appendices
10.1.
World Health Organisation Standard Population
Age group (years)
WHO world population*
0–4
8.86
5–9
8.69
10-14
8.60
15–19
8.47
20–24
8.22
25–29
7.93
30–34
7.61
35–39
7.15
40–44
6.59
45–49
6.04
50–54
5.37
55–59
4.55
60–64
3.72
65–69
2.96
70–74
2.21
75–79
1.52
80–84
0.91
85+
0.63
Total
100.00
• For the purposes of comparison, the WHO Standard age group 85+ is an aggregate of the age
groups 85-89, 90-94, 95-99 and 100+.
10.2.
ICD -10 AM codes
The following ICD codes are identified and used in the Northern Cancer Network HNA:
Code
C00 – C14
C15
C16
C17
C18 – C21
C22 – C24
C25
C33 – C34
C40 – C41
C43
C 44
C50
C53
83
Malignant neoplasm
Lip, oral cavity and pharynx
Oesophagus
Stomach
Small Intestine
Colorectal
Liver, biliary tract
Pancreas
Trachea. Bronchus and lung
Bone, joints and articular cartilage
Malignant melanoma of skin
Other malignant neoplasms of skin
Breast
Cervix
Code
C54 – C55
C56
C61
C62
C64
C67
C69 – C72
C73
C81
C82–C85, C96
C91 – C95
D45 – D 47
Malignant neoplasm
Uterus
Ovary
Prostate
Testes
Kidney, except renal pelvis
Bladder
Eyes, brain & other parts of CNS
Thyroid gland
Hodgkin lymphoma
Non-Hodgkin lymphoma
Leukaemia
Chronic myeloproliferative disorders
Northern Cancer Network’s Health Needs Assessment - 2009
10.3.
Calculation of radiotherapy intervention rate
The radiation treatment intervention rate is defined as the proportion of people with
cancer who receive at least one course of radiation treatment. The method used for
calculating this rate is to compare the relative size of two cohorts:
• The number of people who receive radiation treatment in a financial year (e.g.,
2004/05)
• The number of people with registered cancer in a calendar year (e.g., 2004)
We also have to take account of people who are receiving a second course of radiation
treatment. Radiation oncologists estimate the ‘re-treatment rate’ to be around 25
percent. We therefore assume that 75% of all those who receive radiation treatment in
a given financial year are receiving their first course of radiation. The ‘intervention
rate’ is therefore: The total individuals receiving treatment (in a given financial year) x
0.75 / total cancer registrations (in the previous calendar year).
‘Total individuals receiving treatment’ is defined as the number of distinct National
Health Index (NHI) numbers appearing under the radiation treatment purchase unit
(M5005) in data supplied by DHBs to the Personal Health Non Case Weight (PHNCW)
data collection process. Until the 2008/09 year, treatment services for breast cancer
patients referred through the Breast Screen Aotearoa (BSA) screening programme
have been funded separately by BSA. Because the PHNCW has been used to
calculate inter-district flow (IDF) payments between DHBs, data on BSA-funded
patients has not been provided to the Ministry of Health. Volume information on BSAfunded treatment has been obtained separately. BSA-funded patients are assumed to
have the same average number of attendances as other patients (around 17), and so
total volumes are divided by this number to calculate the number of BSA-funded
individuals receiving radiation treatment. This number is then added to the number of
NHIs found in the PHNCW data.
Total cancer registrations by DHB are available directly from the Cancer Registry for
the years up to and including 2005. Provisional registration data is not yet available for
2006. In order to obtain a denominator for the 2006/07 treatment data, average actual
registrations for the years 2003—05 have been calculated, then increased by the 10year historical growth rate of 1.6% for two years to obtain estimated average
registrations for the years 2005—07. The final column under ‘estimated intervention
rate’ is therefore more provisional and subject to modification when the 2006
registrations are available
84
Northern Cancer Network’s Health Needs Assessment - 2009
10.4.
Radiotherapy treatment booking priorities
Priority
category
A
Urgent
B
Curative
Good
practice
Maximum
acceptable
Criteria
Within 24 hours Patients with rapidly
progressive
complications of
malignancy that
require rapid
treatment to prevent
or minimise severe
morbidity or
life threat
Within 2 weeks
Examples
Spinal cord
compression
Superior vena
cava
obstruction
Cord equina
compression
Major lifethreatening
haemorrhage
not amenable to
surgical
intervention
Major upper
airways or
bronchial
obstruction with
stridor
Tumours for which Head and neck
radiation
cancer
treatment usually Bladder cancer
results in
Carcinoma
20 percent or better
oesophagus
survival
Paediatric
at five years and
cancer
there is
High grade Non
evidence that delay
Hodgkin’s
may
Lymphoma
compromise chance
Hodgkin’s
of cure
Disease
Patient fit to have
Cervix cancer
radical
Pre-operative
radiation treatment
radiation
treatment
C
Palliative
Within 4 weeks Radical or adjuvant Prostate cancer
Palliativeand
treatment
radiation
Post operative
other
within 2 weeks
treatment where
breast cancer
radical
or sooner
there is no
Post operative
according to
clear evidence that
endometrial
severity of
short
cancer
symptoms
delays are likely to
Skin cancer
affect the
Seminoma
outcome
testis (stage I)
Brain tumours
D
Combined
chemotherapy
and
radiation
treatment
85
Start date
booked
according to
treatment
schedule
Patients having
Anal cancer
combined
Oesophageal
radiation treatment
cancer
and
Bladder cancer
chemotherapy
Rectal cancer
where safe,
Paediatric
effective sequencing
cancer
of
Hodgkin’s
treatment modalities
disease
Northern Cancer Network’s Health Needs Assessment - 2009
is
Non-Hodgkin’s
required
lymphoma
Tumours treated
Patients in
according
clinical trials
to clinical trial or
documented
referenced
national/international
protocols
Note
When treatment resources do not allow priority C patients to start treatment within four
weeks, priorities for A, B and D should not change. Priority C patients should be
started as soon as possible but could expect delays longer than the accepted
maximum of 4 weeks.
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Northern Cancer Network’s Health Needs Assessment - 2009
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Northern Cancer Network’s Health Needs Assessment - 2009