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1.08 Cancer

Why is it important?

Cancer was responsible for 8% of the total disease burden for Aboriginal and Torres Strait Islander peoples in 2003 (Vos et al. 2007). Cancer is a group of diseases in which abnormal cells proliferate and spread. These cells can form a malignant tumour that can invade and damage the area around it and spread to other parts of the body through the bloodstream or the lymphatic system. If the spread of these tumours is not controlled, they may result in death. The effectiveness of treatment and survival rates can vary between different cancers and patients.

Risk factors for high fatality cancers remain prevalent in the Aboriginal and Torres Strait Islander population, including smoking, risky drinking and poor diet (Condon et al. 2003). Indigenous Australians have a higher incidence of fatal, screen-detectable and preventable cancers and are diagnosed at more advanced stages, and often with more complex comorbidities (Cunningham et al. 2008). Compared with non-Indigenous Australians diagnosed with the same cancer, Indigenous Australians are doubly disadvantaged because they are usually diagnosed later with more advanced disease, are less likely to have treatment, and often have to wait longer for surgery than non-Indigenous patients (Hall et al. 2004; Valery et al. 2006).

Findings

Over the period 2005–09, in the four jurisdictions with data of adequate quality (NSW, Qld, WA and the NT combined), cancer incidence was slightly lower for Aboriginal and Torres Strait Islander peoples (408 per 100,000) than for non-Indigenous Australians (440 per 100,000). Cancer incidence among Aboriginal and Torres Strait Islander peoples varied by cancer type. Compared with non-Indigenous Australians, rates for lung cancer and cervical cancer were higher and rates for bowel cancer and breast cancer were lower. Based on cancers diagnosed in 1999–2007, the mean age of diagnosis was lower for Indigenous males and females compared with non-Indigenous males and females for all cancer types examined. Followed to the end of 2010, the crude cancer survival rate for Indigenous Australians over this period was lower for both Indigenous males (34%) and females (46%) compared with non-Indigenous males (48%) and females (56%). A study of cancer registry data in NSW found a large number of cases with missing Indigenous status. Once these cases were imputed, an additional 12–13% of cancer cases were identified for Indigenous Australians (Morrell et al. 2012).

Cancer was the second leading cause of death among Indigenous Australians, accounting for 20% of deaths, during the period 2008–2012, in NSW, Qld, WA, SA and the NT combined. Over this period, cancers of the digestive organs (including bowel) and respiratory organs (including lung) were the most common causes of cancer death among Indigenous Australians (29% and 26% respectively). In 2008–12, after adjusting for differing population age structures, Indigenous Australians were 1.3 times as likely to die from cancer as non-Indigenous Australians. Cancer was the third leading cause of the gap in death rates between Indigenous and non-Indigenous Australians (12% of the gap). The largest gaps between the two populations were in cancers of the respiratory organs, particularly bronchus and lung cancer, followed by cancers of the digestive organs. Over the period 2006 to 2012, there has been a significant increase in cancer death rates for Indigenous Australians (11%) and a significant decline for non-Indigenous Australians (5%); therefore the gap in cancer deaths between the two populations widened.

Research suggests that survival rates among non-Indigenous patients are up to 50% greater than those for Aboriginal and Torres Strait Islander patients within the first 12 months of diagnosis, dropping to a similar survival rate 2 years after diagnosis. There was no evidence that the rate of five year survival varied by remoteness or socio-economic status for Indigenous Australians (Cramb et al. 2012). Analysis of 1991–2006 data found that Indigenous women had, after adjusting for diagnostic period and socio-demographic factors, a risk of death from breast cancer 68% higher than other women with breast cancer (Cancer Australia 2012). A study on cancer survival in children found that Indigenous children were 1.6 times as likely to die within 5 years of diagnosis as other children and this remained significant following adjustment for place of residence, socio-economic disadvantage and cancer group. Stage of diagnosis was similar for both groups of children (Valery et al. 2011).

After adjusting for differences in the age structure of the two populations, GP survey data collected from April 2008 to March 2013 suggest that Indigenous Australians were less likely to have cancer managed as a problem by GPs compared with other Australians (17 per 1,000 encounters compared with 26 per 1,000 encounters). Data from the 2012–13 Health Survey suggests that around 5,600 Indigenous Australians (1%) had cancer.

Implications

The lower survival rate for Indigenous Australians from some cancers may be partly explained by factors such as lower likelihood of receiving treatment, later diagnoses, comorbidities, and greater likelihood of being diagnosed with cancers where the prospect of successful treatment and survival is poorer (Cunningham et al. 2008; Supramaniam et al. 2011).

A study in WA (Thompson et al. 2011) made several recommendations to improve cancer outcomes for Aboriginal people. These include community education, establishment or improvement of support systems such as transport and accommodation, and changes to the health system to improve communication and care coordination.

Cancer Australia aims to reduce the impact of cancer, address disparities and improve outcomes for people affected by cancer. Cancer Australia's work is underpinned by a model for engaging Indigenous communities including: evidence translation, community engagement, collaboration and capacity building, message repetition and sustainability. Cancer Australia has a focus on raising awareness of risk factors, symptoms and the importance of early detection.

Communication activities to support the Human Papillomavirus (HPV) Vaccination Program include specific components for Aboriginal and Torres Strait Islander communities. This includes distribution of tailored resources to schools, as well as targeted public relations activities and social media engagement. The Tackling Indigenous Smoking Programme supports smoking cessation (see measure 2.15).

Figure 1.08-1 Proportion of deaths by cancer type, Indigenous Australians, by sex, NSW, Qld, WA, SA and the NT, 2008–12
chart showing Proportion of deaths by cancer type

Figure 1.08-1 shows the proportion of deaths of Aboriginal and Torres Strait Islander peoples from cancer, broken down by type of cancer, in NSW, Queensland, WA, SA and NT in 2008-12. Data is presented for males and females. Refer to the findings section of this measure for a description of key results found in this figure.

Source: ABS and AIHW analysis of ABS Mortality Database

Figure 1.08-2 Age-standardised mortality rates for cancer, by Indigenous status, NSW, Qld, WA, SA and the NT, 1998 to 2012
chart showing Age-standardised mortality rates, cancer

Figure 1.08-2 shows age-standardised mortality rates from cancer (deaths per 100,000). Data is presented for Aboriginal and Torres Strait Islander peoples in NSW, Qld, WA, SA and NT from 1998 to 2012; and non-Indigenous Australians in NSW, Qld, WA, SA and NT from 1998 to 2012. In 2008–12, after adjusting for differing population age structures, Indigenous Australians were 1.3 times as likely to die from cancer as non-Indigenous Australians.

Source: ABS and AIHW analysis of ABS Mortality Database

Figure 1.08-3 Age-standardised incidence of bowel and lung cancer by state and territory and Indigenous status, NSW, Qld, WA and the NT, 2005–09
chart showing Age-standardised incidence of bowel and lung cancer

Figure 1.08-3 shows the age-standardised incidence of bowel and lung cancer among Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians in 2005-2009 (rate per 100,000 population). Data is presented separately for bowel and lung cancer in NSW, Queensland, WA, NT, and the total of the 4 jurisdictions. Refer to the findings section of this measure for a description of key results found in this figure.

Source: AIHW Australian Cancer Database 2010

Figure 1.08-4 Age-standardised incidence of breast and cervical cancer in females by state and territory and Indigenous status, NSW, Qld, WA and the NT, 2005–09
chart showing Age-standardised incidence of breast and cervical cancer

Figure 1.08-4 shows the age-standardised incidence of breast and cervical cancer among Aboriginal and Torres Strait Islander females and non-Indigenous Australian females in 2005-2009 (rate per 100,000 population). Data is presented separately for breast and cervical cancer in NSW, Queensland, WA, NT, and the total of the 4 jurisdictions. Refer to the findings section of this measure for a description of key results found in this figure.

Source: AIHW Australian Cancer Database 2010

Figure 1.08-5 Mean age at diagnosis, selected cancers by Indigenous status and sex, WA, Qld, NSW, and the NT, 1999–2007
chart showing Mean age at diagnosis, selected cancers

Figure 1.08-5 shows the mean age at diagnosis of selected types of cancer among Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians. The mean age at diagnosis for males is presented for bowel, lung, and total cancers. The mean age at diagnosis for females is presented for bowel, lung, breast, cervical, and total cancers. Data is presented for WA, Queensland, NSW and NT in 1999-2007. Refer to the findings section of this measure for a description of key results found in this figure.

Source: AIHW Australian Cancer Database 2007

Figure 1.08-6 Five-year crude survival for selected cancers by Indigenous status and sex, WA, Qld, NSW and the NT, 1999–2007 followed to the end of 2010
chart showing Five-year crude survival for selected cancers

Figure 1.08-6 shows the five-year crude survival rate for selected types of cancer among Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians. The five-year crude survival rate for males is presented for bowel, lung, and total cancers. The five-year crude survival rate for females is presented for bowel, lung, breast, cervical, and total cancers. Data is presented for WA, Queensland, NSW and NT in 1999-2007 followed to the end of 2010. Refer to the findings section of this measure for a description of key results found in this figure.

Source: AIHW Australian Cancer Database 2007