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Cancer in New South Wales:
Incidence and Mortality 2007

Cancer in New South Wales: Incidence and Mortality 2007 is the most up-to-date overview of cancer published for NSW. The report provides new information on the histological, or cell type of cancer including international variation and five-year relative survival with comparisons between NSW, Victoria and the USA. Additionally, updated referenced risk factors and information on factors that may influence trends and survival by histological type are included. Projections of cancer incidence and mortality for selected major cancer sites and all cancer for 2011, 2016 and 2021 are also provided.

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Overall, cancer incidence rates have increased in men by 11 per cent with no significant change for females over the past 10 years. However, closer examination of incidence rate patterns within the 10 year period shows that there is a significant downward trend in incidence rates of cancer in women for the most recent six year period. This is the first time a downward trend in incidence has been observed in NSW and is consistent with findings in the USA. Possible reasons provided for the USA decline in incidence for females were a decrease in the use of menopausal hormone therapy and increased mammography screening. It is difficult to determine whether these reasons apply in NSW.

In NSW the most common cancers are prostate, bowel, breast, melanoma and lung, which are responsible for 63 per cent of incidence in NSW. Prostate cancer is responsible for 32 per cent of all new cases in men. In the past five years, incidence rates for prostate cancer have increased sharply and are now at higher levels than the 1992 to 1994 peak. Prostate cancer incidence rates appear related to the prevalence of prostate-specific antigen (PSA) testing in the community.

Long-term cancer projections are featured in this report and can be used for planning, research, cancer control activities and in allocating resources. It is projected that the number of new cases of cancer in NSW may increase on average by 5,000 every five years. In 2007, there were 36,043 new cases of cancer diagnosed. These numbers are projected to rise to more than 50,000 new cases in 2021.

Being careful about weight, stopping tobacco use and reducing alcohol consumption, will lead to a significant decrease in some cancers in the future.

For the first time in 2007, we analysed trends by histological, or cell type. This allowed a greater understanding of the dominant cell types and their overall impact on rates and survival by cancer site. For example, some breast cancer starts in cells that line the milk ducts of the breast, called ductal carcinoma. This was responsible for 79 per cent of breast cancer in NSW in 2007, compared to 71 per cent of all breast cancer in USA females. Five-year relative survival comparisons for USA, Victoria and NSW were similar at 88, 89 and 90 per cent respectively for women diagnosed with this type of breast cancer.

Superficial spreading melanoma grows within the outer layer of the skin and was the most common cell type of melanoma (45.9% of total cases) in NSW in 2007. Superficial spreading melanoma is increasing as a proportion of total melanoma cases and mirrors the trend of overall melanoma. This suggests that people are presenting with less invasive melanoma as a result of skin awareness campaigns. Five-year relative survival in NSW varies by melanoma subtype, with the superficial spreading melanoma responsible for 96.7 per cent survival in males and 97.7 per cent in females. We cannot be complacent about melanoma. NSW males have the third highest incidence of melanoma in the world, surpassed only by Queensland and Western Australia. NSW also has four times the incidence of selected European countries.

Different cell types are influenced by various risk factors. Adenocarcinoma of the oesophagus is thought to be due to Barrett’s oesophagus developed as a result of gastroesophageal reflux. A common risk factor is obesity. The USA and Australia are in the top six OECD countries for obesity and also have a high proportion of adenocarcinoma. Japan and Korea have low rates of obesity and adenocarcinoma.

Japan has a higher proportion of squamous cell carcinoma of the oesophagus compared to NSW and other Western countries, mainly because this cell type is most strongly related to tobacco and alcohol-related risk factors. Japanese and Korean males have high rates of smoking compared to other OECD countries.

This suggests that being careful about weight, stopping tobacco use and reducing alcohol consumption, will lead to a significant decrease in some cancers in the future.

Mortality rates from all causes of cancer death have declined in NSW since 1989 in males and 1988 in females. Mortality rates are most influenced by trends in lung cancer deaths in both males and females; followed by breast, prostate and bowel cancer deaths. The reduction in mortality rates for the majority of cancer sites are a combination of earlier detection, changes in risk factors and treatment improvement.

A concerning finding is that lung cancer deaths in women have overtaken breast cancer deaths in NSW for the first time in 2007. This is because incidence and mortality rates of lung cancer in women are increasing. Women started smoking later than men in NSW and fewer have stopped. Death rates mirror incidence rates because of the poor survival of this disease. If rates continue to rise as they have been doing, by 2021 lung cancer is projected to account for 22 per cent of female cancer deaths, whereas breast cancer will decline to just 13 per cent. This indicates that we should continue to do all we can to reduce smoking rates.