Cancer Control in Australia

CANCER CONTROL in

AUSTRALIA

Institute of Cancer Research –

12 July 2010

Professor Jim Bishop AO

Chief Medical Officer

Australian Government Department of Health and Ageing

Health Expenditure per capita, public and private expenditure, OECD countries, 2008 ($US PPP)

7538

5004

4627

42104079 4063 3970

3793 3737 3696 36773540 3470

3359 33533129 3060 3008 2902 2870

2729 2687 2683

2151

1801 1781 1737

14371213

999852 767

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

1. Refers to insured population rather than resident population. 2. Current expenditure. 3. 2006. 4. 2007. Source: OECD, OECD Health Data, June 2010

Public expenditure on health Private expenditure on health

OECD HEALTH DATA 2010How Does AUSTRALIA Compare

AUSTRALIA’S RANKING AMONGOECD COUNTRIES 1987-2006

Source: AIHW Australia’s Health 2010

SELF-ASSESSED PHYSICAL &MENTAL HEALTH, 2007

Source: AIHW Australia’s Health 2010

BROAD CAUSE MORTALITY TRENDS AUSTRALIA

Source: AIHW

Source: AIHW Australia’s Health 2010

AGED ADJUSTED DEATH RATESFrom CVD, 1907 -

2006

All Cancer-

Mortality/Incidence ratios for selected countries -

2008

Source: IARC 2010.

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1.0

Kenya

Nigeria

Egypt

Viet N

amTurk

eyInd

iaChinaRuss

iaSou

th Afric

aGreec

eBraz

ilJa

pan

Czech

Rep

ublic

Italy

United King

domCana

daGerm

any

Sweden

New Zealan

dUSA

Austra

liaM

orta

lity-

to-in

cide

nce

ratio

MalesFemales

Changes in Deaths rates in Males using Joinpoint

Analysis

Source: Tracey et al –

Cancer Institute NSW

Changes in Deaths Rates in Females Using Joinpoint

Analysis

Source: Tracey et al –

Cancer Institute NSW

BREAST CANCER MORTALITY

NEJM 2005Source: NEJM 2005

Cancers with reducing death rates 1997 to 2006 –

all ages

Lung, -18.5Colon, -19.6 Prostate, -19.7

Leukaemia, -23.7

Stomach, -29.4

Head and Neck, -23.7

Bladder, -18.5

Testicular, -42.2

Breast, -13.8

Cervix, -38.3

NHL, -25.1

Unknown, -24.8

Rectum, -19.9

Bowel, -19.7

All cancers, -13.8

, -24.3

-18.5

Kidney, -24.1

, -15.2

-31.9

, -21.1

-19.0-19.0

, -18.9

-7.9

-45

-40

-35

-30

-25

-20

-15

-10

-5

0

Male FemaleSource: Tracey et al, Cancer Institute NSW

5 YEAR SURVIVAL RATES 2004

NSW

SEER

Non small cell lung 13% 14%

Colon 65% 67%

Rectum 66% 69%

Breast Cancer 89% 90%

Lymphoma (DL)

53% 53%

Source: Tracey et al –

Cancer Institute NSW

Projected YLLs

–

Three scenarios, Australia –

1980 to 2016

Source: Bishop et al –

Cancer Institute NSW

PROJECTED BURDEN of MAJOR DISEASE GROUPS, 2010

Source: AIHW Australia’s Health 2010

TRENDS IN LEADING CAUSESOF DISEASE BURDEN 2003-2023

Source: AIHW Australia’s Health 2010

Changes in Incidence Rates for all Cancer in

Males using Joinpoint

Analysis

Source: Tracey et al –

Cancer Institute NSW

Changes in Incidence Rates in Females using Joinpoint

Analysis

Source: Tracey et al –

Cancer Institute NSW

TRENDS IN CANCER INCIDENCE/DEATHS

1986

1996 2006All Cancers 53,888 79,169 104,592

Prostate

4,310 10,304 17,444CRC

8,018 10,871 13,591Breast

6,079 9,745 12,614Melanoma

4,710 7,819 10,326Lung

6,460 7,799 9,563

Incidence Rates* 394.7 461.6 480.4Death Rates* 209.2 202.1 179.1

* per 100,000

Source: AIHW: Australia’s Health 2010

THE KEYS TO PREVENTION

0.0 2.0 4.0 6.0 8.0

Tobacco

Blood pressure

Overweight/obesity

Physical inactivity

Blood cholesterol

Alcohol

Fruit/vegetables

Illicit drugs

Air pollution

Unsafe sex

% DALYs

Total of 32%

Source: Table 4.1 AIHW Australia’s Health 2008

AUSTRALIA’S RANKING AMONGOECD COUNTRIES 1987-2006

Source: AIHW Australia’s Health 2010

SMOKING IN AUSTRALIA

SMOKINGSTATUS

NSW VIC QLD WA SA TAS ACT NT AUS

Daily 16.4 16.5 17.2 14.8 16.5 22.7 14.7 25.3 16.6

Weekly 1.2 1.5 1.4 1.2 1.5 0.6 0.9 1.2 1.3

Less than Weekly

1.4 1.7 1.3 1.4 1.8 1.6 1.6 1.3 1.5

Ex-smoker 24.7 24.4 25.7 28.3 24.1 26.5 24.8 22.4 25.1

Never smoked

56.3 55.9 54.5 54.3 56.2 48.6 57.9 49.8 55.4

National

Drug Strategy Household Survey 2007Source: 2007 Household Survey, Australian Government

AUSTRALIA’S INITIATIVES IN

TOBACCO CONTROL

Advertising Bans

Under the counter at retail sites

Banning smoking in restaurants, pubs and cars

Graphic warnings on cigarette packets

Anti-tobacco campaigns

Increase in tobacco excise

Plain packaging

Cost Effectiveness of Smoking Cessation pharmacotherapies in MALES

Source: Cancer Institute NSW

COST BENEFIT ISSUES

Smoking cessation with drugs Cost effective <$30,000 per DALY Hazard ratios 1.5 –

2.5x “cold turkey”

Average of 5 years gained

Early detection and resection Adjuvant chemo $7,200/LYG Resection of Stage I costs 37% less than treating

advanced disease

Molecular targeted molecular in advanced NSCLC Many not yet cost effective

Source: Cancer Institute NSW

OBESTITY INCREASING FOR ALL

Source: AIHW: Australia’s Health 2008

Increased Risk Body Fatness OesophagusPancreasColorectalBreast (PM)Endometrum

Abnormal Fatness Colorectal

Reduced Risk Physical exercise Colon

World Cancer Research Fund: Food, nutrition, physical activity and prevention of cancer, 2007

OBESITY and CANCER

NSW Population Age Distributions,

Males (1977-2036)

Source: Cancer Institute NSW

Total Cancer Cases and Deaths per year (1972 to 2036)

Source: Cancer Institute NSW

NSW Cancer Deaths, Major

Cancer Types (2007-2036)

Source: Cancer Institute NSW

Modelling -

Cumulative Cancer Deaths from 2006 in NSW

2007 2016 2026 2036

All Cancer 13,456 145,659 310,959 497,122

Prostate 1,004 12,217 27,142 44,529

Colorectal 1,626 18,287 40,931 69,310

Breast 1,109 12,226 25,637 40,285

Lung 2.569 26.918 55.570 85.220

Melanoma 689 7,976 17,775 29,367

Source: Cancer Institute NSW

The DIFFERENCE between localised & regional extent of disease at diagnosis

1%10%

1%11%

14%6%

23%23%26%

21%38%

28%24%

28%22%23%

29%20%21%21%

40%26%

33%9%

12%5%

0% 20% 40% 60% 80% 100% 120%

Pancreatic

Liver

Oesophageal

Lung

Gallbladder

Unknown

Stomach

Tongue

Mouth

Head and Neck

Bladder

Larynx

Small intestine

Connective tissue

All cancer

Cervix

Ovary

Large bowel

Colon

Rectal

Kidney

Uterine

Melanoma

Prostate

Breast

Thyroid

RegionalLocalised

Source: Tracey et al –

Cancer Institute NSW

Milestones in Cancer Control

Public health measures in smoking reduction ,

screening breast, cervix, bowel, literacy

Adjuvant treatment of breast, lung and bowel cancer

New anti-cancer and symptom control drugs

Enhancement of cancer research

Data linkage and analysis

NON-COMMERCIAL CANCER RESEARCH EXPENDITURE, 2004

(A$ per CAPITAL)

Source: Eckhouse

et al (2007), ABS

CANCER PUBLICATIONS

Australia

Growth* World

AustralianShare

2000 1,881 5.6% 88,604 2.0%

2002 2,000 3.5% 97,035 2.1%

2004 2,514 19.0% 110.390 2.3%

2006 3,035 14.1% 125,934 2.4%__________________________________________________________________8 year period 17,917 70.4% 822,768 2.2%__________________________________________________________________* From pervious year

Source: Cancer Institute NSW 2008

HEALTH REFORM

Increasing expenditure to $15 billion 2010/11

Additional $7.3 billion over 4 years

Local Hospital Networks (LHN) 60% Federal Funds (60% of research and teaching)

Medicare locals (100% Federal funds)

GP Superclinics

–

multi disciplinary teams (100% Federal Funds)

Commonwealth Government Health and Hospital expenditure under the NHHN

Source: Commonwealth Budget Papers, DoHA

and PM&C Analysis

HEALTH REFORM

KEY NEW STRUCTURES

National Health Performance Agency

National Pricing Authority

Expanded Australian Commission of Safety and Quality in Health Care (ACSQHC)

AUSTRALIAN GOVERNMENT’S INITIATIVES IN CANCER CONTROL

Preventative Health Agency

Australian health Survey

Tobacco Control initiatives

Cancer funding $2 billion 09/10

Four components run by ABS 2011-13

- Health Survey

-

ATSI Health Survey

-

Nutrition and Physical Activity Survey

-

Health measurement Survey

Around 50,000 participants

De-identified data available as summary statistics, tables

AUSTRALIAN HEALTH SURVEY

Integrated Cancer Centre ($526m) –

Camperdown and Parkville

Regional Cancer Centres ($560m) –

20 sites

announced

Digitalization of breast screening services

Access to new anti-cancer drugs ($613m)

Amalgamation Cancer Australia and NBOCC Programs

AUSTRALIAN GOVERNMENT’S INITIATIVES IN CANCER CONTROL

Cancer Control in Australia is successful by international measures with more needed

Research breakthroughs have delivered population mortality reductions

New research is needed in successful interventions for obesity, physical activity, diet and alcohol

Better methods of identifying susceptibility, early cancer and evidence-based interventions are urgently needed

CONCLUSIONS