3303.0 - Causes of Death, Australia, 2016  
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Cancer deaths in younger Australians - changes over 20 years

Just under half (49.4%) of all deaths in younger Australians (defined here as those aged under 40 years) occur due to external causes of death, most notably suicide and transport accidents. The remaining half (50.6%) are due to natural causes. In Australia, cancer is the largest cause of natural disease deaths in younger Australians, and accounted for 12.8% of deaths in this age group in 2016 (760 deaths). Although cancer deaths in this demographic account for a small proportion of all cancer deaths (1.7%), the social, emotional and economic toll of death in this younger age group is large. This article will examine cancer deaths in younger Australians, with consideration to how cancer mortality has changed over the last 20 years.


What is cancer?

Cancer is a term applied to a large group of diseases which can occur in any part of the body. Other terms used to describe cancer are 'malignant neoplasms' and 'malignant tumours'. One identifying feature of cancer is the rapid growth and multiplication of abnormal cells, which can then spread to surrounding body parts and organs (Endnotes 5 and 9). The majority of cancers originate in a particular organ. This is known as the primary site. When cancer cells spread from this site to other parts of the body to form secondary tumours, this is known as metastasis.


Cancer deaths in younger Australians

In 2016, the five leading types of cancer to cause death in younger Australians were brain cancer, cancer of the lymphoid, haematopoietic and related tissues (which includes leukaemia), colorectal cancer, breast cancer and skin cancer. These were the same cancer types as those in 1997, although their rank ordering has changed (see table, below). Cancers of the lymphoid, haematopoietic and related tissues recorded the greatest reduction in mortality over this 20 year period, moving from the leading to second leading cause of cancer deaths.


Most common cancers to cause death in younger Australians (0-39 years), 1997 and 2016(a)(b)(c)

1997
2016
Type of cancer (ICD-10 code)
Rank
No. deaths
ASDR(d)
% of total cancers
Rank
No. deaths
ASDR(d)
% of total cancers

Brain cancer (C71)
2
134
1.2
13.9
1
133
1.0
17.5
Malignant neoplasms of lymphoid, haematopoietic and related tissue (C81-C96)
1
233
2.1
24.2
2
112
0.9
14.7
Leukaemia (C91-C95)
149
1.4
15.5
83
0.6
10.9
Colorectal cancer (C18-C20, C26.0)
5
55
0.5
5.7
3
94
0.7
12.4
Breast cancer (C50)(e)
3
128
2.4(e)
13.3
4
89
1.4(e)
11.7
Skin cancer (C43-C44)
4
74
0.7
7.7
5
39
0.3
5.1
Melanoma (C43)
73
0.7
7.6
37
0.3
4.9
Total cancers (C00-C97, D45, D46, D47.1, D47.3-D47.5)
962
8.9
100.0
760
5.9
100.0
Total deaths
8,272
76.1
na
5,918
45.6
na

na Not Applicable

(a) Causes listed are the top 5 types of cancers, based on the WHO recommended tabulation of leading causes. See Explanatory Notes 35-37 in this publication for further information.
(b) The data presented for Malignant neoplasm of the colon, sigmoid, rectum and anus (C18-C21) that appear in this table now also includes deaths due to Malignant neoplasm of the intestinal tract, part unspecified (C26.0). This differs to how these cancers have been grouped in leading cause data for previous Causes of Death, Australia publications. See Explanatory note 37 in this publication for further details.
(c) All causes of death data from 2006 onward are subject to a revisions process - once data for a reference year are 'final', they are no longer revised. Causes of death data for 2016 are preliminary and subject to revisions. See Explanatory Notes 55-58 and A More Timely Annual Collection: Changes to ABS Processes (Technical Note) Causes of Death, Australia, 2015 (cat. no. 3303.0).
(d) Age-specific death rates reflect deaths per 100,000 of the Estimated Resident Population (ERP) for a specific age group, as at 30 June. See the Glossary in this publication for further information.
(e) Age-specific death rates for breast cancer have been expressed per 100,000 females. All other cancers are expressed per 100.000 persons. No younger males died from breast cancer in 1997 or 2016.
(f) Deaths registered on Norfolk Island from 1 July 2016 are included in this publication for the first time. See Explanatory Notes 12-15 for further information.
    The graph below presents age-specific death rates for younger Australians for the top five cancers over the 20 years to 2016, in five-year groupings. The graph highlights the strong reductions in mortality rates for cancers of the lymphoid, haematopoietic and related tissue, and breast cancer. Death rates from colorectal cancers and skin cancers have remained relatively stable over the 20 year period. Combined, these five cancers accounted for 59.5% of all cancer deaths in younger Australians in 2012-2016, and 63.3% in 1997-2001.

    Graph Image for Age specific death rates for top five cancers in younger Australians, by five-year groupings

    Footnote(s): (a) Causes listed are the top 5 types of cancers, based on the WHO recommended tabulation of leading causes. See Explanatory Notes 35-37 in this publication for further information. (b) The data presented for Malignant neoplasm of the colon, sigmoid, rectum and anus (C18-C21) that appear in this table now also includes deaths due to Malignant neoplasm of the intestinal tract, part unspecified (C26.0). This differs to how these cancers have been grouped in leading cause data for previous Causes of Death, Australia publications. See Explanatory note 37 in this publication for further details. (c) All causes of death data from 2006 onward are subject to a revisions process - once data for a reference year are 'final', they are no longer revised. Causes of death data for 2016 are preliminary and subject to revisions. See Explanatory Notes 55-58 and A More Timely Annual Collection: Changes to ABS Processes (Technical Note) Causes of Death, Australia, 2015 (cat. no. 3303.0). (d) Age-specific death rates reflect deaths per 100,000 of the Estimated Resident Population (ERP) for a specific age group, as at 30 June. See the Glossary in this publication for further information. (e) Age-specific death rates for breast cancer have been expressed per 100,000 females. All other cancers are expressed per 100.000 persons. Very few younger males died from breast cancer over the period 1997 to 2016. (f) Deaths registered on Norfolk Island from 1 July 2016 are included in this publication for the first time. See Explanatory Notes 12-15 for further information.

    Source(s): Age specific death rates for top five cancers in younger Australians, by five-year groupings-ASDRs, top five cancers in younger Australians

    .
    Brain cancer deaths

    Brain cancer is the leading cause of cancer death in younger Australians, accounting for 17.5% of cancer deaths in this age group in 2016. Close to 1 in 10 brain cancer deaths occurred in those aged under 40 (9.2%), and brain cancer was the cause of two out of every five cancer deaths in those under the age of 10. While the incidence rate and number of deaths due to brain cancer has remained relatively stable over time (Endnote 3), the age-specific rate of death has seen a small decrease, from 1.2 deaths per 100,000 persons in 1997 to 1.0 deaths per 100,000 persons in 2016. For further information on risk factors, symptoms and treatment of brain cancer, see the Cancer Council, Australia website.

    Cancer of the lymphoid, haematopoietic and related tissues

    In 2016, leukaemia accounted for almost three-quarters of all lymphoid, haematopoietic and related tissue cancer deaths among younger Australians. Leukaemia is a cancer of the blood and bone marrow which leads to excessive production of abnormal white blood cells. Over time, leukaemia cells crowd out normal blood cells, which can starve the body of oxygen, lead to infection and cause serious bleeding (Endnote 7).

    Leukaemia was responsible for one in ten cancer deaths in younger Australians in 2016 (83 deaths), with the majority of these deaths due to acute myeloblastic leukaemia (AML) (35 deaths) and acute lymphoblastic leukaemia (ALL) (32 deaths). Over the last 20 years, the death rate of leukaemia in younger Australians has decreased from 1.4 deaths per 100,000 persons in 1997 to 0.6 per 100,000 persons in 2016. This is despite an overall increase in incidence rates in this demographic over the same period (Endnote 3). Over time, advances in treatment (which include chemotherapy and stem cell transplantation), have increased survival rates.

    Colorectal cancer deaths

    Although colorectal cancer deaths are rare in younger Australians, there has been an increase in the number of deaths recorded in this demographic over the past 20 years and there are also signs that the death rate is increasing. According to Bowel Cancer Australia (Endnote 4), from 1990 to 2010, the incidence rate of bowel cancer doubled in those aged 20-29 years, and increased by 35% in those aged 30-39 years. Similar trends have been identified in the United States, with one study finding that incidence rates of colorectal cancer increased among those aged 20-39 years, from the mid 1980s to 2013 (Endnote 8). As a result of the increase in incidence of bowel cancer in young people, Bowel Cancer Australia have initiated You're Never Too Young - a campaign to raise awareness of the disease in this younger demographic.

    Breast cancer

    Breast cancer is the leading cause of cancer deaths in young women. In 2016, 3.0% (89 deaths) of breast cancer deaths occurred before the age of 40, most of which were within the 30-39 year age group. Overall, the age-specific death rate for breast cancer in young women has decreased over time, from 2.4 deaths per 100,000 women in 1997 compared with 1.4 deaths per 100,000 in 2016.

    The characteristics and risk factors for breast cancer tend to be different in younger women compared to older women. For example, according to the Australian Institute of Health and Welfare (AIHW) (Endnote 1) a higher proportion of breast cancers are of a larger tumour size in younger women, and these are, in-turn, associated with lower survival rates. Even when the cancer is small, the five-year survival rate of younger women is lower than for women aged over 40 years. However, over time, there has been an improvement in the five-year relative survival rate for younger women — from 72% in 1982-1986 to 88% in 2007-2011 (Endnote 1).

    While free mammograms are offered every two years to women aged between 50 and 74 through BreastScreen Australia, such screening is not recommended for women aged under 40. Younger women have dense breast tissue, which makes mammography less effective in correctly identifying breast cancer. Breast awareness is the most effective means of identifying breast cancer in younger women. Women who notice a change in the look or feel of their breast, including a lump, nipple discharge or pain, should consult their general practitioner (Endnote 1).

    Skin cancer

    There are three main types of skin cancer, which are named after the type of skin cell in which the cancer developed: basal cell carcinoma, squamous cell carcinoma and melanoma (from cells called melanocytes). Melanoma is the most serious type of skin cancer, and caused 37 (94.9%) of the 39 skin cancer deaths in younger Australians in 2016. Australia and New Zealand have the highest rates of melanoma in the world (Endnote 2). Although the risk of developing skin cancer increases with age, it is not uncommon for young people to be diagnosed with it. In 2014, 8.7% of new cases of melanoma were diagnosed in younger Australians (based on information provided in Australian Cancer Incidence and Mortality (ACIM) books. See Endnote 3).

    From 1997-2016, Queensland had the highest rate of skin cancer deaths in younger Australians, with 0.8 deaths per 100,000 persons. Northern Territory had the lowest rate, at 0.2 deaths per 100,000 persons. In general, the death rate for skin cancer in younger Australians has decreased over time — from 0.7 deaths per 100,000 persons in 1997 to 0.3 deaths per 100,000 in 2016. Similarly, the AIHW (Endnote 2) has reported a decrease in the incidence rate of skin cancer in younger Australians, from 13 cases per 100,000 persons in 2002 to 9.4 per 100,000 in 2016. Most skin cancers are caused by overexposure to ultraviolet (UV) radiation from the sun. Public awareness and prevention campaigns such as "Slip, Slop, Slap", which originated in Queensland in the 1980s, focused on encouraging behaviours to reduce exposure to UV rays. These campaigns have, at least in part, been credited with the observed decrease in skin cancer incidence and death rates in younger Australians (Endnote 6).


    Bibliography

    1. AIHW 2015, Breast Cancer in Young Women: Key facts about breast cancer in women in their 20s and 30s. Cancer series no. 96. Cat. no. CAN 94. Canberra: AIHW.

    2. AIHW 2016. Skin cancer in Australia. Cat. no. CAN 96. Canberra: AIHW.

    3. AIHW 2017, Australian Cancer Incidence and Mortality (ACIM) books. Viewed 15th January 2018 <https://www.aihw.gov.au/reports/cancer/acim-books/contents/acim-books>

    4. Bowel Cancer Australia 2017, You're Never Too Young - Bowel Cancer Stories. Viewed 20th December 2017 <https://www.bowelcanceraustralia.org/never-too-young-stories?gclid=CI-8y_D289YCFY6XvQodJy8Frg>

    5. Cancer Australia 2017, What is cancer? Viewed 20th December 2017 <https://canceraustralia.gov.au/affected-cancer/what-cancer>

    6. Iannacone, M.R. & Green, A.C. (2014). Towards skin cancer prevention and early detection: evolution of skin cancer awareness campaigns in Australia. Melanoma Management, Vol 1, No. 1.

    7. Leukaemia Foundation 2017, Leukaemias. Viewed 20th December 2017 <http://www.leukaemia.org.au/blood-cancers/leukaemias?gclid=EAIaIQobChMI1NSouZ6r1wIVzworCh0xZwYwEAAYASAAEgI5TPD_BwE>

    8. Siegel, R.L., Fedewa, S.A., Anderson, W.F., Miller, K.D., Ma, J., Rosenberg, P.S., Jemal, A. (2017). Colorectal Cancer Incidence Patterns in the Unites States, 1974-2013. Journal of the National Cancer Institute. Volume 109, Issue 8.

    9. World Health Organization 2017, Cancer. Viewed 20th December 2017 <http://www.who.int/mediacentre/factsheets/fs297/en/>