Better health and ageing for all Australians

Aboriginal and Torres Strait Islander Health Performance Framework (HPF) 2012

Tier 1—Health conditions—1.08 Cancer

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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 are not destroyed by normal metabolic processes but instead proliferate and spread. These cells can form a malignant tumour which 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). Aboriginal and Torres Strait Islander peoples have a higher incidence of fatal, screen-detectable and preventable cancers and are diagnosed at more advanced stages, and often with more complex co-morbidities (Cunningham et al. 2008a). 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).Top of page

Findings:

Over the period 2004–08, in the four jurisdictions with data of adequate quality (NSW, Qld, WA and the NT combined), cancer incidence was slightly higher for Aboriginal and Torres Strait Islander peoples (459 per 100,000) than for non-Indigenous Australians (432 per 100,000). Cancer incidence among Aboriginal and Torres Strait Islander peoples varied across the four jurisdictions and by cancer type. Compared to non-Indigenous Australians, rates for lung cancer and cervical cancer were higher and rates for bowel cancer and breast cancer were lower. The mean age of diagnosis was lower for Indigenous males and females compared to non-Indigenous males and females for all cancer types examined. The crude cancer survival rate for Indigenous Australians was lower for both Indigenous males (41%) and females (49%) compared to non-Indigenous males (52%) and females (59%). A study of cancer registry data in NSW found a large number of cases with missing Indigenous status. Once these 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 19% of deaths, during the period 2006 to 2010, in NSW, Qld, WA, SA and the NT combined. Cancers of the digestive organs (including bowel) and respiratory organs (including lung) were the most common causes of cancer death among Indigenous Australians. After adjusting for differing population age structures, Indigenous Australians were 1.4 times as likely to die from cancer as non-Indigenous Australians. 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 1997–2010 the gap increased between Indigenous and non-Indigenous cancer mortality rates due to a decline in the non-Indigenous rate and no significant change for Aboriginal and Torres Strait Islander peoples.Top of page

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 two years after diagnosis. There was no evidence that the rate of five year survival varied by remoteness or socioeconomic status for Indigenous Australians (Cramb et al. 2012). Analysis of 1991–2006 data found that Aboriginal and Torres Strait Islander 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 five years of diagnosis as other children and this remained significant following adjustment for place of residence, socioeconomic 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, BEACH survey data collected from April 2006 to March 2011 suggest that Aboriginal and Torres Strait Islander peoples were less likely to have cancer managed as a problem by GPs compared to non-Indigenous Australians (14 per 1,000 encounters compared to 25 per 1,000 encounters).

Implications:

The lower survival rate for Aboriginal and Torres Strait Islander peoples 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. 2008b; AIHW 2010e; Supramaniam et al. 2011).

The National Human Papillomavirus (HPV) Vaccination Program (established in 2007) aims to reduce the incidence of cervical cancer in Australia by preventing HPV infection that can lead to 70–80% of cervical cancers. Cervical screening remains vital as the current vaccine is not effective against all types of HPV that cause cervical cancer.

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, as the Government's national cancer control agency, works across all cancers and also focuses on populations which experience poorer outcomes, including Aboriginal and Torres Strait Islander peoples. For example, Indigenous Australians are identified as a priority target for Cancer Australia's Priority-driven Collaborative Cancer Research Scheme and the Supporting people with cancer grant initiative.Top of page
Figure 29—Deaths of Indigenous Australians from cancer, by sex, NSW, Qld, WA, SA and the NT, 2006–10
Figure 29—Deaths of Indigenous Australians from cancer, by sex, NSW, Qld, WA, SA and the NT, 2006–10
Source: ABS and AIHW analysis of ABS Mortality Database
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Figure 30—Age-standardised mortality rates, cancer, by Indigenous status
Figure 30—Age-standardised mortality rates, cancer, by Indigenous status
Source: ABS and AIHW analysis of ABS Mortality Database
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Figure 31—Age-standardised incidence of bowel and lung cancer by state and territory and Indigenous status, NSW, Qld, WA and the NT, 2004–08
Figure 31—Age-standardised incidence of bowel and lung cancer by state and territory and Indigenous status, NSW, Qld, WA and the NT, 2004–08
Source: AIHW Australian Cancer Database
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Figure 32—Age-standardised incidence of breast and cervical cancer in females by state and territory and Indigenous status, NSW, Qld, WA and the NT, 2004–08
Figure 32—Age-standardised incidence of breast and cervical cancer in females by state and territory and Indigenous status, NSW, Qld, WA and the NT, 2004–08
Source: AIHW Australian Cancer Database
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Figure 33—Mean age at diagnosis, selected cancers by Indigenous status and sex, WA, Qld, NSW and the NT, 2006–10
Figure 33—Mean age at diagnosis, selected cancers by Indigenous status and sex, WA, Qld, NSW and the NT, 2006–10
Source: AIHW Australian Cancer Database
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Figure 34—Five-year crude survival for selected cancers by Indigenous status and sex, WA, Qld, NSW and the NT, 2006–10
Figure 34—Five-year crude survival for selected cancers by Indigenous status and sex, WA, Qld, NSW and the NT, 2006–10
Source: AIHW Australian Cancer Database
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