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4102.0 - Australian Social Trends, 1995  
Previous ISSUE Released at 11:30 AM (CANBERRA TIME) 20/06/1995   
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Contents >> Health >> Causes of Death: Cancer trends

Mortality and Morbidity: Cancer trends

As the population ages, there is a greater likelihood that people will die from cancer and other age-related diseases. The cancer death rate has increased by 4% over the past two decades.

In 1993, 32,691 people died of cancer, 18,479 males and 14,212 females. This accounted for around 1 in 4 of all deaths. Four types of cancer caused 45% of all cancer deaths; lung cancer (6,380 deaths), colon cancer (3,308 deaths), breast cancer (2,641 deaths) and prostate cancer (2,544 deaths). Lung cancer was the most common cause of cancer death among men while for women it was breast cancer.

The ageing of the population, exposure to both carcinogenic and anti-carcinogenic agents, and causes of morbidity and deaths other than cancer affect cancer death rates1. Since many cancers at advanced stages remain incurable, preventative measures, such as early screening programs and changes in lifestyle, are the most effective ways to reduce cancer deaths.


Cancer deaths

Cancer (malignant neoplasm) is a term that refers to several diseases which result when the process of cell division, by which tissues normally grow and renew themselves, becomes uncontrolled and leads to the development of malignant cells1. These cancer cells multiply in an uncoordinated way to form a tumour. If left untreated most malignant tumours will eventually result in death. Cancers are classified according to where they initially develop in the body.

Cancer deaths are deaths where the primary cause, as indicated on the death certificate, is cancer.

The age-specific death rate is the number of deaths in a particular age-sex group per 100,000 people in the same group. Age-specific death rates allow comparisons between age groups over time.

The standardised death rate allows comparisons to be made between populations which have different age structures. To calculate the standardised death rate the age-specific death rates are applied to a standard population. The standard population used in this review is the 1991 Australian population.


Cancer deaths 1973-93
In 1993, the standardised death rate in Australia was lower than in 1973. This was mainly due to advances in medical technology, and the leading of healthier lifestyles through better diets, regular exercise, and reduction in tobacco and alcohol consumption. The result of these changes is that people were more likely to die from cancer in 1993 because they were not dying from other causes of death at earlier ages.

In 1993, cancers were the leading cause of death, exceeding heart attacks by almost 3,000 deaths. Of the major causes of death in 1993 (including cancers, heart attacks and strokes) only the death rate from cancer had increased since 1973. The cancer death rate increased from 173 deaths per 100,000 population in 1973 to 180 deaths per 100,000 population in 1993. In comparison the death rate from heart attacks in 1993 was almost half the rate recorded in 1973. Both male and female cancer death rates rose between 1973 and 1993. The rate for males rose more rapidly than the rate for females.

Males are more likely to die from cancer than females. In 1993 the cancer death rate for males was 236 per 100,000 population, while for women it was 141. In the past men were more likely than women to smoke, consume alcohol and experience other health risk factors such as occupational stress. These factors have contributed to the higher cancer death rates for men compared to women.

Of the leading cancer death rates, only those for stomach cancer declined significantly between 1973 and 1993. This decline, and the lower death rate from heart disease, could reflect changes in people's diets.

Between 1973 and 1993, age-specific cancer death rates decreased for both males and females in all age groups except for those aged 65 and over. Men had higher age-specific cancer death rates than women after the age of 50. In 1993, the age-specific cancer death rate for men aged 65 and over was nearly twice the rate observed in women. The higher cancer death rate of older men reflects the higher risk men have of developing cancer later in life than women. Men die of prostate cancer later in life, while women die of breast cancer at younger ages.

LEADING CANCER DEATHS, 1993

Males
Females
Persons
Cancer type
no.
no.
no.

Lung
4,552
1,828
6,380
Colon
1,706
1,602
3,308
Breast (female)
. .
2,641
2,641
Prostate
2,544
. .
2,544
Pancreas
771
705
1,476
Lymphoid
681
594
1,275
Stomach
791
447
1,238
Rectum
653
477
1,130
Brain
546
387
933
Melanoma
575
279
854
All cancers
18,479
14,212
32,691

Source: Causes of Death

STANDARDISED CANCER DEATH RATE(a)

Males
Females


1973
1993
1973
1993
Cancer type
rate
rate
rate
rate

Lung
61
57
9
19
Colon
20
22
20
15
Breast (female)
. .
. .
26
27
Prostate
28
35
. .
. .
Pancreas
12
10
7
7
Lymphoid
n.a.
8
n.a.
6
Stomach
20
10
10
4
Rectum(b)
9
8
6
5
Brain
4
6
3
4
Melanoma
4
7
3
3
All cancers
224
236
138
141

(a) Standardised death rate per 100,000 population.
(b) Caution should be used in comparing these cancers due to minor classification changes between 1973 and 1993.

Source: Causes of Death

AGE-SPECIFIC CANCER DEATH RATES

1973
1993


Age group (years)
Male
Female
Male
Female
rate
rate
rate
rate

0-14
7
5
4
4
15-24
8
6
4
5
25-44
28
30
24
28
45-64
275
229
264
205
65 & over
1,300
726
1,456
833

Source: Causes of Death


Lung cancer
In 1993, 4,552 males and 1,828 females died of lung cancer. This accounted for 25% of all male cancer deaths and 13% of all female cancer deaths. The lung cancer death rate for men was over twice the rate for women. Lung cancer is often preventable and has been linked to lifestyle patterns such as smoking. The differences between men's and women's lung cancer death rates can be linked to differences in smoking behaviours (see Australian Social Trends 1994, Tobacco use).

In 1993, 96% of people who died from lung cancer were over the age of 50. Half of all people who died from lung cancer were aged over 70.

Educating people about ways of preventing lung cancer, such as quitting smoking, will help to decrease the lung cancer death rate. however, there is a long lag period between changes in smoking behaviour and falling lung cancer death rates. Therefore, lung cancer is likely to remain a leading cause of death for many years2

LUNG CANCER DEATHS BY AGE, 1993



Source: Causes of Death


Breast cancer
In 1993, breast cancer was the most common type of cancer death in women, accounting for 2,641 deaths. Breast cancer deaths accounted for around 1 in 5 female cancer deaths. Over one-third of all breast cancer deaths in women occurred before the age of 60. 17% occurred before the age of 50.

Breast cancer is a major health concern because it is more likely than other cancers to affect women at early ages. It can also be successfully treated if detected early through examination and screening procedures. Screening is currently recommended in Australia for all women aged 50-692.

BREAST CANCER DEATHS BY AGE, 1993



Source: Causes of Death


Prostate cancer
In 1993, 2,544 men died of prostate cancer. Prostate cancer has been a leading contributor to the rise in cancer deaths in older men. In 1993, 97% of prostate cancer deaths occurred in men aged over 60. 80% of prostate cancer deaths occurred in man aged over 70.

The prostate cancer death rate increased between 1973 and 1993, mainly because fewer men are dying from other causes at younger ages. However, the increase may also reflect a generally low health awareness. Greater education on screening for prostate cancer is needed to reduce the growing number of prostate cancer deaths.

PROSTATE CANCER DEATHS BY AGE, 1993



Source: Causes of Death


Colon Cancer
In 1993, colon cancer was the third largest cause of cancer mortality for both men and women. In 1993, it accounted for 1,706 male deaths and 1,602 female deaths. Most men and women (94%) died of colon cancer after the age of 50.

COLON CANCER DEATHS BY AGE, 1993



Source: Causes of Death


International comparison
Australia has one of the lower cancer death rates among OECD countries but this would be partly related to Australia's comparatively younger age structure. In the United Kingdom the cancer death rates are high for both men and women mainly due to the high lung cancer death rate in that country. Japan has a much higher cancer death rate for men than for women. This may be linked to the high prevalence of smoking among Japanese men compared to Japanese women (see Australian Social Trends 1994, Tobacco use). Japan also has a much lower breast cancer and prostate cancer death rate than any other country.
CANCER DEATH RATES

Males
Females
Country
Year
rate
rate

Australia
1992
206.0
153.9
Canada
1991
220.5
175.5
Japan
1992
230.5
146.7
New Zealand
1991
212.8
189.9
Sweden
1990
252.6
222.8
United Kingdom
1992
300.0
262.4
United States
1990
221.3
186.0

(a) Cancer death rates per 100,000 population.

Source: World Health Organisation (1994) World Health Statistics Annual 1993

Incidence of cancer
Males have a higher cancer incidence rate than females. However, between 1982 and 1988, cancer incidence rates rose more rapidly for females than males. For males, cancer incidence rates were highest for lung cancer, melanoma, colon cancer and lung cancer. For females they were highest for breast cancer, followed by melanoma, colon cancer and lung cancer.

Between 1982 and 1988, the incidence rate for melanoma increased more rapidly than for any other type of cancer. Melanomas increased from 18 new cases diagnosed per 100,000 population for both males and females in 1982, up to 33 for males and 28 for females in 1988. This rise in incidence may be due to increased awareness, and subsequent detection, through skin cancer awareness campaigns.

The likelihood of surviving cancer can be measured by the difference between the cancer incidence rate and the cancer death rate. The difference varies between cancers. Melanomas, which rarely lead to death, have a high incidence rate and low mortality rate. In contrast, the difference for lung cancer is smaller.

Men are more likely to develop, and die from, cancer than women. In 1988, the probability of a male being diagnosed with cancer during his lifetime was 1 in 3, compared to 1 in 4 for a female. The probability of dying from cancer was 1 in 6 for males and 1 in 9 for females3. However, these probabilities do not take into account other competing causes of death.

INCIDENCE RATES OF CANCER(a)

1982
1985
1988
Type of cancer
rate
rate
rate

Males
    Lung
54.0
52.8
46.9
    Prostate
37.6
41.6
41.8
    Melanoma
18.0
24.2
33.1
    Colon
24.4
28.9
26.5
All cancers
288.7
305.1
301.6
Females
    Breast
55.6
59.2
62.3
    Melanoma
17.6
24.0
28.3
    Colon
22.0
23.6
20.8
    Lung
12.5
13.7
14.2
All cancers
217.8
232.8
235.1

(a) New cases diagnosed per 100,000 population.

Source: Australian Institute of Health & Welfare Cancer in Australia



Cancer Incidence rate

The cancer incidence rate is the number of new cancer cases in a particular age-sex group diagnosed during a calendar year, divided by the mid-year estimated resident population for that group. These age-sex incidence rates are applied to a standard population (in this case the WHO world standard population) to give an overall incidence rate.


Endnotes
1 Australian Institute of Health and Welfare and the Australasian Association of Cancer Registries (1992) Cancer in Australia, 1983-85.

2 Australian Institute of Health and Welfare (1992) Australia's Health 1992: the 3rd biennial report of the Australian Institute of Health and Welfare.

2 Australian Institute of Health and Welfare unpublished data.



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