Cancer Control in Australia

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A presentation by Australia's Chief Medical Officer, Professor Jim Bishop AO, on Cancer Control in Australia - Institute of Cancer Research 12 July 2010

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Cancer Control in Australia

  1. 1. 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
  2. 2. Health Expenditure per capita, public and private expenditure, OECD countries, 2008 ($US PPP) 7538 5004 4627 4210 4079 4063 3970 3793 3737 3696 3677 3540 3470 3359 3353 3129 3060 3008 2902 2870 2729 2687 2683 2151 1801 1781 1737 1437 1213 999 852 767 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 2010 How Does AUSTRALIA Compare
  3. 3. AUSTRALIA’S RANKING AMONG OECD COUNTRIES 1987-2006 Source: AIHW Australia’s Health 2010
  4. 4. SELF-ASSESSED PHYSICAL & MENTAL HEALTH, 2007 Source: AIHW Australia’s Health 2010
  5. 5. BROAD CAUSE MORTALITY TRENDS AUSTRALIA Source: AIHW
  6. 6. Source: AIHW Australia’s Health 2010 AGED ADJUSTED DEATH RATES From CVD, 1907 - 2006
  7. 7. 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 EgyptVietNam Turkey India China Russia South Africa G reece Brazil Japan Czech Republic Italy United Kingdom CanadaG erm anySweden New Zealand USAAustralia Mortality-to-incidenceratio Males Females
  8. 8. Changes in Deaths rates in Males using Joinpoint Analysis Source: Tracey et al – Cancer Institute NSW
  9. 9. Changes in Deaths Rates in Females Using Joinpoint Analysis Source: Tracey et al – Cancer Institute NSW
  10. 10. BREAST CANCER MORTALITY NEJM 2005 Source: NEJM 2005
  11. 11. Cancers with reducing death rates 1997 to 2006 – all ages Lung, -18.5 Colon, -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 Female Source: Tracey et al, Cancer Institute NSW
  12. 12. 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
  13. 13. Projected YLLs – Three scenarios, Australia – 1980 to 2016 Source: Bishop et al – Cancer Institute NSW
  14. 14. PROJECTED BURDEN of MAJOR DISEASE GROUPS, 2010 Source: AIHW Australia’s Health 2010
  15. 15. TRENDS IN LEADING CAUSES OF DISEASE BURDEN 2003-2023 Source: AIHW Australia’s Health 2010
  16. 16. Changes in Incidence Rates for all Cancer in Males using Joinpoint Analysis Source: Tracey et al – Cancer Institute NSW
  17. 17. Changes in Incidence Rates in Females using Joinpoint Analysis Source: Tracey et al – Cancer Institute NSW
  18. 18. TRENDS IN CANCER INCIDENCE/DEATHS 1986 1996 2006 All Cancers 53,888 79,169 104,592 Prostate 4,310 10,304 17,444 CRC 8,018 10,871 13,591 Breast 6,079 9,745 12,614 Melanoma 4,710 7,819 10,326 Lung 6,460 7,799 9,563 Incidence Rates* 394.7 461.6 480.4 Death Rates* 209.2 202.1 179.1 * per 100,000 Source: AIHW: Australia’s Health 2010
  19. 19. 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
  20. 20. AUSTRALIA’S RANKING AMONG OECD COUNTRIES 1987-2006 Source: AIHW Australia’s Health 2010
  21. 21. SMOKING IN AUSTRALIA SMOKING STATUS 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
  22. 22. 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
  23. 23. Cost Effectiveness of Smoking Cessation pharmacotherapies in MALES Source: Cancer Institute NSW
  24. 24. 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 $7,200/LYG  Resection of Stage I costs 37% less than treating advanced disease Molecular targeted molecular in advanced NSCLC  Many not yet cost effective Source: Cancer Institute NSW
  25. 25. OBESTITY INCREASING FOR ALL Source: AIHW: Australia’s Health 2008
  26. 26. Increased Risk Body Fatness Oesophagus Pancreas Colorectal Breast (PM) Endometrum Abnormal Fatness Colorectal Reduced Risk Physical exercise Colon World Cancer Research Fund: Food, nutrition, physical activity and prevention of cancer, 2007 OBESITY and CANCER
  27. 27. NSW Population Age Distributions, Males (1977-2036) Source: Cancer Institute NSW
  28. 28. Total Cancer Cases and Deaths per year (1972 to 2036) Source: Cancer Institute NSW
  29. 29. NSW Cancer Deaths, Major Cancer Types (2007-2036) Source: Cancer Institute NSW
  30. 30. Modelling - Cumulative Cancer Deaths from 2006 in NSW 2007 2016 2026 2036 All Cancer 13,456 145,659 310,959 497,122 Prostate 1,004 12,217 27,142 44,529 Colorectal 1,626 18,287 40,931 69,310 Breast 1,109 12,226 25,637 40,285 Lung 2.569 26.918 55.570 85.220 Melanoma 689 7,976 17,775 29,367 Source: Cancer Institute NSW
  31. 31. The DIFFERENCE between localised & regional extent of disease at diagnosis 1% 10% 1% 11% 14% 6% 23% 23% 26% 21% 38% 28% 24% 28% 22% 23% 29% 20% 21% 21% 40% 26% 33% 9% 12% 5% 0% 20% 40% 60% 80% 100% 120% Pancreatic Liver Oesophageal Lung Gallbladder Unknown Stomach Tongue Mouth Head and Neck Bladder Larynx Small intestine Connective tissue All cancer Cervix Ovary Large bowel Colon Rectal Kidney Uterine Melanoma Prostate Breast Thyroid Regional Localised Source: Tracey et al – Cancer Institute NSW
  32. 32. Milestones in Cancer Control  Public health measures in smoking reduction , screening breast, cervix, bowel, literacy  Adjuvant treatment of breast, lung and bowel cancer  New anti-cancer and symptom control drugs  Enhancement of cancer research  Data linkage and analysis
  33. 33. NON-COMMERCIAL CANCER RESEARCH EXPENDITURE, 2004 (A$ per CAPITAL) Source: Eckhouse et al (2007), ABS
  34. 34. CANCER PUBLICATIONS Australia Growth* World Australian Share 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
  35. 35. 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)
  36. 36. Commonwealth Government Health and Hospital expenditure under the NHHN Source: Commonwealth Budget Papers, DoHA and PM&C Analysis
  37. 37. HEALTH REFORM KEY NEW STRUCTURES  National Health Performance Agency  National Pricing Authority  Expanded Australian Commission of Safety and Quality in Health Care (ACSQHC)
  38. 38. AUSTRALIAN GOVERNMENT’S INITIATIVES IN CANCER CONTROL  Preventative Health Agency  Australian health Survey  Tobacco Control initiatives  Cancer funding $2 billion 09/10
  39. 39.  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
  40. 40.  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
  41. 41.  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

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