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

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. 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. AUSTRALIA’S RANKING AMONG
OECD COUNTRIES 1987-2006
Source: AIHW Australia’s Health 2010

4. SELF-ASSESSED PHYSICAL &
MENTAL HEALTH, 2007
Source: AIHW Australia’s Health 2010

5. BROAD CAUSE MORTALITY
TRENDS AUSTRALIA
Source: AIHW

6. Source: AIHW Australia’s Health 2010
AGED ADJUSTED DEATH RATES
From CVD, 1907 - 2006

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. Changes in Deaths rates in
Males using Joinpoint Analysis
Source: Tracey et al – Cancer Institute NSW

9. Changes in Deaths Rates in
Females Using Joinpoint Analysis
Source: Tracey et al – Cancer Institute NSW

10. BREAST CANCER
MORTALITY
NEJM 2005
Source: NEJM 2005

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. 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. Projected YLLs – Three scenarios,
Australia – 1980 to 2016
Source: Bishop et al – Cancer Institute NSW

14. PROJECTED BURDEN of
MAJOR DISEASE GROUPS, 2010
Source: AIHW Australia’s Health 2010

15. TRENDS IN LEADING CAUSES
OF DISEASE BURDEN 2003-2023
Source: AIHW Australia’s Health 2010

16. Changes in Incidence Rates for all Cancer
in
Males using Joinpoint Analysis
Source: Tracey et al – Cancer Institute NSW

17. Changes in Incidence Rates in
Females using Joinpoint Analysis
Source: Tracey et al – Cancer Institute NSW

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. 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. AUSTRALIA’S RANKING AMONG
OECD COUNTRIES 1987-2006
Source: AIHW Australia’s Health 2010

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. 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. Cost Effectiveness of Smoking Cessation
pharmacotherapies in MALES
Source: Cancer Institute NSW

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. OBESTITY INCREASING
FOR ALL
Source: AIHW: Australia’s Health 2008

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. NSW Population Age Distributions,
Males (1977-2036)
Source: Cancer Institute NSW

28. Total Cancer Cases and Deaths
per year (1972 to 2036)
Source: Cancer Institute NSW

29. NSW Cancer Deaths, Major
Cancer Types (2007-2036)
Source: Cancer Institute NSW

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. 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. 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. NON-COMMERCIAL CANCER
RESEARCH EXPENDITURE, 2004
(A$ per CAPITAL)
Source: Eckhouse et al (2007), ABS

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. 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. Commonwealth Government Health and
Hospital expenditure under the NHHN
Source: Commonwealth Budget Papers, DoHA and PM&C Analysis

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. AUSTRALIAN GOVERNMENT’S
INITIATIVES IN CANCER CONTROL
 Preventative Health Agency
 Australian health Survey
 Tobacco Control initiatives
 Cancer funding $2 billion 09/10

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.  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.  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