Cancer in Tasmania Incidence and Mortality 2004

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1 Cancer in Tasmania Incidence and Mortality 2004 Tasmanian Cancer Registry University of Tasmania Menzies Research Institute 52 Bathurst Street Hobart Tasmania Australia 7000 Postal address: Private Bag 23 Hobart Tasmania Australia 7001 Telephone (03) Facsimile (03) URL: Editors: Dalton M, Venn A, Albion T, Bhowmik J, Blizzard L Publication date: August 2007

2 Acknowledgements The Tasmanian Cancer Registry is funded by the Tasmanian Department of Health and Human Services (DHHS), through its Population Health subdivision, and by the Menzies Research Institute. Additional funds are raised from the community and research funding bodies. The work of collecting and collating cancer registry data would not be possible without the continuing assistance and support of a number of people. These include staff members of: Private and public pathology laboratories The Registry of Births, and Marriages Medical Records Departments of all Tasmanian hospitals WP Holman Clinics in Launceston and Hobart Medical practitioners in specialist and general practices The Australian Bureau of Statistics Other State and Territory cancer registries The assistance provided by the Registry s Advisory Committee is greatly appreciated. The administrative staff and volunteers of the Registry are commended for their commitment and efforts towards achieving the high level of accuracy and completeness of data upon which this report is based. We also thank other Menzies Research Institute staff for their assistance with statistical, computing, administrative, financial, media and editorial matters. Citation The following citation is suggested in referring to this report: Dalton M, Venn A, Albion T, Bhowmik J, Blizzard L. Cancer in Tasmania: Incidence and Mortality Menzies Research Institute, Hobart, Tasmanian Cancer Registry

3 Tasmanian Cancer Registry Staff Dr A Venn Director Ms M Dalton Manager (from January 2007) Ms L Newman Manager (until December 2006) Mrs K Jackman Administrative Officer Ms J Luck Administrative Officer Mrs P Whelan Administration Assistant Dr L Blizzard Biostatistician, Menzies Research Institute Mr T Albion IT Systems Manager, Menzies Research Institute Dr J Bhowmik Biostatistician, Menzies Research Institute (until January 2007) Members of the Advisory Committee 2006 Mr K Churchill Dr R Brodribb Ms G Raw Professor P Stanton Dr R Taylor Australian Bureau of Statistics, Tasmania The Cancer Council Tasmania, Tasmania Department of Health and Human Services, Tasmania School of Medicine, Department of Surgery, University of Tasmania, Tasmania Director of Public Health and Director of Population Health, Department of Health and Human Services, Tasmania Tasmanian Cancer Registry 3

4 4 Tasmanian Cancer Registry

5 Contents Coding changes in registration & reporting... 7 The Tasmanian Cancer Registry... 8 Introduction... 8 Sources of data... 8 Data handling, collection and coding practices... 8 Data control and quality assurance... 9 Publication of reports... 9 All Cancers Incidence and mortality of all cancers Trends for all cancers Common Cancers Common cancers diagnosed in males Common cancer-related deaths in males Common cancers diagnosed in females Common cancer-related deaths in females Regional Distribution of Cancers Female breast cancer Tumour size Lymph node involvement Cancer incidence and mortality table Differences in reporting due to coding changes Appendices Appendix A: Cancer site codes and combinations Appendix B: Statistical methods Appendix C: Population data Appendix D: Indices of data quality Appendix E: Use of Tasmanian Cancer Registry Data Appendix F: Incidence and mortality summary tables Tasmanian Cancer Registry 5

6 6 Tasmanian Cancer Registry

7 Coding changes in registration & reporting This report provides a summary of cancer incidence and mortality statistics for Tasmania in It includes all cancers notified to the Tasmanian Cancer Registry that were first diagnosed in Tasmanian residents between 1 January 2004 and 31 December In this report, the primary site and morphology for cancers diagnosed in Tasmania in 2004 were coded using the International Classification of Diseases for Oncology, Third Edition (ICD-O3 1 ). In reports prior to 2003, the primary sites of cancers diagnosed in Tasmania were coded using the International Classification of Diseases for Oncology, Ninth Edition (ICD-9) and the morphologies were coded using the Systematized Nomenclature of Medicine and Modifications (SNOMED) and the International Classification of Diseases for Oncology, Second Edition (ICD-O2) 2. The Cancer in Tasmania 2003 report was produced using codes from ICD-03. In this report, cancers have been tabulated according to ICD codes (refer to Appendix A on page 58), but coded using ICD-O3. This allows comparisons to be made with national cancer incidence and mortality. Cancers were also tabulated in ICD-10 in the 2001 and 2002 annual reports, but were coded using ICD-9 and SNOMED/ICD-O2 codes. In earlier annual reports, cancers were tabulated in ICD-9, and coded using ICD-9 and SNOMED/ICD-O2 codes. Cancer types and groups are mostly comparable across reports. An explanation of differences in the reporting of cancers due to coding changes in this report compared to the annual reports prior to 2003 is provided below and on page 55. although no cases having this morphology were registered in In line with all other Australian state and territory cancer registries, the Tasmanian Cancer Registry now routinely codes all melanomas of unknown site to ICD-03 C44 (skin), and these are reported as ICD-10 C43 Melanoma of Skin. This is consistent with reporting practices in the 2003 report. Melanoma morphology codes occurring at other sites are coded to the site in which they occurred. Cancers reported as C44 skin cancer include all malignant cancers of the skin, but exclude basal cell carcinoma, squamous cell carcinoma, melanoma (reported as ICD-10 C43), some Kaposi sarcomas (reported as ICD-10 C46), and some types of lymphomas (ICD- 10 C81-C85). The reporting of some chronic myeloproliferative (CMD) and myelodysplastic syndromes previously coded as leukaemia might have resulted in a decrease in reported leukaemia rates. However, this has not been seen since the coding change occurred in A change in the site coding of transitional cell carcinomas of the kidney (C649) to renal pelvis (C659) will have resulted in some cancers previously recorded as kidney (site heading C64) now being recorded as renal pelvis etc (site heading C65,C66,C68) in this and future annual reports. Lymphoid granulomatosis, which was previously considered of uncertain behaviour (morphology code 9766/1) is now deemed to be invasive (9766/3) and will thus be reported in the table C85 Other and unspecified types of NHL. This may affect incidence and mortality trends in this and future reports, 1 Fritz A, Percy C, Jack A et al eds. International Classification of Diseases for Oncology, Third edition 2 Percy C, Van Holten V, Muir C eds. International Classification of Diseases for Oncology, Second edition 3 The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) Tasmanian Cancer Registry 7

8 The Tasmanian Cancer Registry Introduction The Tasmanian Cancer Registry was established in 1977 as a population-based registry covering the whole of Tasmania. The Registry was established to provide the State Government with accurate cancer incidence and mortality statistics and to monitor cancer trends. In July 1988 the operation of the Cancer Registry was moved from the Department of Health Services to the Menzies Research Institute. Cancer was proclaimed a notifiable disease in December 1992 and cancer registration since then has had a legislative basis. Registry staff includes a Director, Manager, two Administrative Officers and an Administration Assistant. Volunteers also assist with the paper data handling. The Registry has access to a biostatistician and a computer consultant. An Advisory Committee assists the Registry. The Tasmanian Cancer Registry is a full member of the Australasian Association of Cancer Registries (AACR) and the International Association of Cancer Registries (IACR). Sources of data All pathology laboratories in the State provide the Registry with copies of histopathological and cytology reports of cancer and cell marker reports. Cancer notification forms are supplied by the two radiation oncology clinics. Private and public hospitals notify diagnoses of cancer to the Registry upon discharge of patients or provide a computerised listing of cancer cases periodically. Death notifications of Tasmanian people are reviewed for mention of cancer as a cause of death. Since 1994 breast and cervical cancer screening programs have been undertaken in Tasmania and listings from these sources are available to check against Registry records. Interstate registries supply data to the Tasmanian Cancer Registry on Tasmanian residents who seek treatment interstate or who move interstate at some time after cancer diagnosis were registered on an ACCESS database developed in house for the Tasmanian Cancer Registry. This database was developed to enable: the registration of cancers using International Classification of Diseases for Oncology, Third Edition (ICD-O3) codes; the electronic transfer and processing of cancer incidence and death notifications; the collection of the minimum dataset defined by the Australasian Association of Cancer Registries members; and improved access and manipulation of registry data for data requests and reporting. Information collected by the Registry includes demographic and clinical data for the cancer patient in accordance with the minimum data defined in the Cancer Registries Data Dictionary. Additional tumour data are collected for melanomas, lymphomas, unknown primaries, and breast and bladder cancers. The Tasmanian Cancer Registry collects and registers nonmelanoma skin cancers (NMSC) on a register established in 2001 for this purpose. Currently NMSC registrations are complete from 1978 to NMSC notifications are registered only when additional funding sources are obtained. Resource considerations prevent the routine registration of these cancers and the pathology reports are stored until additional funds become available. Both the primary site and morphology of cancers diagnosed in Tasmania in 2004 were coded to the International Classification of Diseases for Oncology, Third Edition (ICD- O3 1 ). This report presents data for invasive cancers only (behaviour = 3, site C000 C809). In situ cancers and second primary cancers with the same three-digit topography code and related morphologies are not included in this report. Coding practices specific to the Tasmanian Cancer Registry are detailed in Appendix A on page 58. Data handling, collection and coding practices Paper copies of all information are retained. Paper records for persons deceased are archived two years after death. Data for cancers diagnosed between 1 January 2004 and 31 December In this report, incidence refers to the number of new primary tumours that are diagnosed in the Tasmanian population in any year, rather than the number of people with cancer. While the Tasmanian Cancer Registry registers multiple primary cancers diagnosed in a person, not all primary tumours are reported in incidence rates according to the rules for incidence reporting 8 Tasmanian Cancer Registry

9 recommended by the International Agency for Research on Cancer. Applying these rules to incidence reporting improves the comparability of Tasmanian cancer data with national and international cancer data. subsequent revisions to the data and may not exactly correspond to the figures in this report. Data control and quality assurance The quality of information provided by the Registry depends on the quality of data received. The indices used to measure the quality of the 2004 data are provided in Appendix D on page 62. To help achieve high data quality and case ascertainment, data are obtained from multiple sources such as pathology laboratories, hospitals and the Registrar of Births, and Marriages. Most registered cases include data from both a pathology laboratory and a hospital service (inpatient or radiation oncology clinic). Where insufficient information is received to enable complete registration, active follow-up is undertaken by contacting treating doctors, pathology laboratories and hospital medical record departments. The quality also depends on the accuracy of data processing by the Registry. The new information system is able to detect a number of errors when data entry is performed. Data matching programs enable the identification and amendment of duplicate entries by identifying incorrect spellings, name changes and date of birth inconsistencies. In addition, the National Cancer Statistics Clearing House (NCSCH) collates all state and territory data and checks for duplicate registrations across two or more states. On average, the Registry receives cancer notifications once or twice a week from pathology laboratories, half yearly and ad hoc from hospitals, and monthly from the Registrar of Births, and Marriages. The cases are usually registered within six months of notification and resolution of incomplete information can take up to 18 months. Publication of reports The incidence and mortality data in this report are based on cancer registrations for 2004 and for for trend analysis. Despite intensive efforts to ensure the completeness of incidence data, the database is continually updated with previously unregistered cases and new information for registered cases. The data in this report were complete as of 31 st January This improves the quality of data but future publications and responses to requests for data will reflect any Tasmanian Cancer Registry 9

10 All Cancers Incidence and mortality of all cancers 2004 There were 2,472 new cases of cancer (excluding non-melanoma skin cancers) diagnosed among Tasmanian residents during 2004 (1,379 males and 1,093 females). The overall age standardised incidence was per 100,000 for males and per 100,000 for females 2. The risk of developing any cancer by age 75 years was 1 in 3 for males and 1 in 4 for females. The risk estimate does not include the risk of developing non-melanoma skin cancer. Cancer incidence generally increased with age (Figure 1). Male rates exceeded female rates for Tasmanians aged 55 years and over. Prostate, lung and bladder cancers were responsible for the greater male cancer incidence at these ages. Breast cancer accounted for the slightly higher female rates among younger adults. There is no obvious explanation for the decrease in male incidence and female mortality rates seen in the age bracket. There were 1,092 (615 male and 477 female) cancer-related deaths among Tasmanian residents in The overall age standardised mortality rate was per 100,000 for males and 92.4 per 100,000 for females. The person years life lost to age 75 years was 4,238 for males and 3,645 for females. Figure 1: Age specific incidence and mortality for all cancers (excluding non-melanoma skin cancers) Male Incidence Female Incidence Male Mortality Female Mortality Age-specific rates per 100, Age (years) 2 Age standardised incidence was calculated using the World Standard Population (1960) 10 Tasmanian Cancer Registry

11 Trends for all cancers The age standardised incidence rates of all cancers (excluding non-melanoma skin cancers) increased by 31% for males and 24% for females during the 24-year period from 1980 to 2004 (comparing with ), but decreased by 3.6% for males and increased by 1.5% for females during the period Some of the largest increases since 1980 were observed for prostate cancer in males and breast cancer in females. The increase in incidence during the 1990s coincided with the greater use of prostate-antigen testing (PSA) for prostate cancer in men and the introduction of mammography screening for breast cancer in women. While the number of new cancer cases and cancer deaths occurring each year have generally risen since 1980, age standardised mortality rates per 100,000 population have remained relatively stable. A slight increase in the total new cancer cases in 2004 is mainly attributable to females, with the age-standardised incidence rate for all cancers in females increasing from in 2003 to in While increases were seen in the age-standardised rates for breast cancer and colorectal cancer in females (7% and 10% respectively), decreases were observed for age-standardised rates for lung and uterine cancers (16% and 23%). In males, a 19% decrease in the age-standardised rate for all lymphomas was seen, along with a 16% decrease for bladder cancer and a 10% decrease for colorectal cancer, while the ASRs for other common cancers remained similar to Age standardised rates per 100,000 (World 1960) Male Incidence Female Incidence Male Mortality Female Mortality Figure 2: Trends in age standardised incidence and mortality of all cancers (excluding non-melanoma skin cancers) * Year *Incidence and mortality for all cancers from 1980 to 2000 is reported in ICD-9 while data for 2001 to 2004 are reported in ICD Male Incidence Female Incidence Crude per 100,000 population Male Mortality Female Mortality Figure 3: Trends in crude incidence and mortality of all cancers (excluding non-melanoma skin cancers) * Year Tasmanian Cancer Registry 11

12 Common Cancers Common cancers diagnosed in males 2004 The most common cancer diagnosed in males in 2004 was prostate cancer, followed by lung cancer, colorectal cancer, melanoma skin cancer and all lymphomas. Figure 4: Common cancers diagnosed in males 2004 Prostate 417 Lung 163 Colorectal 162 Melanoma of skin 116 All lymphomas Number of cancer cases Common cancer-related deaths in males 2004 The most common causes of cancer-related deaths in male Tasmanian residents in 2004 were lung cancer, colorectal cancer, prostate cancer, cancer of the pancreas, bladder cancer, stomach cancer and all lymphomas. Figure 5: Common causes of cancer-related deaths in males 2004 Lung 127 Colorectal 88 Prostate 81 Pancreas Bladder Stomach All lymphomas Number of cancer deaths 12 Tasmanian Cancer Registry

13 Common cancers diagnosed in females 2004 The most common cancer diagnosed in females in 2004 was breast cancer, followed by colorectal cancer, melanoma skin cancer, lung cancer and all lymphomas. Figure 6: Common cancers diagnosed in females 2004 Breast 319 Colorectal 150 Melanoma of skin 100 Lung 85 All lymphomas Number of cancer cases Common cancer-related deaths in females 2004 The most common causes of cancer-related deaths in female Tasmanian residents in 2004 were, colorectal cancer, breast cancer, lung cancer, all lymphomas and cancer of the pancreas. Figure 7: Common causes of cancer-related deaths in females 2004 Colorectal 85 Breast 71 Lung 66 All lymphomas 26 Pancreas Number of cancer deaths Tasmanian Cancer Registry 13

14 Regional Distribution of Cancers The regional distribution of common cancers is shown as the number of cases and the percentage of all cases of each cancer site in each statistical division (Table 1). This information is based on recorded postcode of residence. On the basis of population numbers in each of the statistical divisions, the distribution of cancers would be expected to be 49% in the South, 28% in the North and 23% in the Mersey-Lyell division. Variation around that distribution can be expected due to chance occurrences and differences in the age distribution between the regional populations. Table 1: Regional distribution of cancer incidence for all sites with a minimum of 50 new cases 2004 ICD-10 Site Southern Northern Mersey-Lyell Total # 237,597 (49%) 136,638 (28%) 107,893 (22%) 482,128 (100%) C61 Prostate 208 (50%) 124 (30%) 85 (20%) 417 C50 Breast 167 (52%) 77 (24%) 79 (24%) 323 C18 - C21 Colorectal 158 (51%) 82 (26%) 72 (23%) 312 C33, C34 Lung 115 (46%) 80 (32%) 53 (21%) 248 C43 Melanoma of skin 100 (46%) 55 (25%) 61 (28%) 216 C81 - C85 All lymphomas 48 (48%) 25 (25%) 28 (28%) 101 C91 - C95 All leukaemia 46 (55%) 23 (28%) 14 (17%) 83 C16 Stomach 20 (34%) 24 (41%) 14 (24%) 58 C64 Kidney 31 (56%) 12 (22%) 12 (22%) 55 C67 Bladder 28 (52%) 15 (28%) 11 (20%) 54 Total new cases 921 (49%) 517 (28%) 429 (23%) 1867 *Cancer types may not add up to 100% due to rounding. # Source: Australian Bureau of Statistics (ABS), Population Estimates by Age and Sex, Tasmania 2004, Data Cube (Cat. No ). 14 Tasmanian Cancer Registry

15 Female breast cancer The Tasmanian Cancer Registry first recorded breast cancer tumour size and lymph node involvement in 1997 when funding was provided to all Australian cancer registries for this purpose. Tumour size In 2004, 96% of the 319 primary breast cancer cases (female) were histologically examined 3. Information about tumour size was available for 283 (89%) of these cases. Of these tumours, 54 (17%) were less than 10mm in diameter, 106 (33%) were between 10 and 19mm, 110 (35%) were between 20 and 49mm, and 13 (4%) were greater than 50mm in diameter. Figure 8 compares categories of tumour size from 1997 to Figure 8: Breast cancer - Size of histologically confirmed tumours Percentage of cases Tumour size mm mm mm 50+ mm Lymph node involvement Of the 319 primary breast cancer cases (female), lymph nodes were investigated in 224 (70%) of cases. Where nodal status was examined, 127 (56.7%) cases were classified as lymph node negative, 74 (33%) cases involved 1 to 3 lymph nodes, 15 (6.7%) cases involved 4 to 6 lymph nodes, and 8 (3.6%) cases involved 7 or more lymph nodes. Figure 9 compares categories of lymph node involvement from 1997 to Figure 9: Breast cancer - Lymph node involvement Percentage of cases nodes 1-3 nodes 4-6 nodes 7+ nodes Tumour size 3 Refer to Indices of Data Quality on page 63. Tasmanian Cancer Registry 15

16 16 Tasmanian Cancer Registry

17 Cancer incidence and mortality table Numbers of new cases and deaths - Age-specific incidence and mortality rates per 100,000 - Crude incidence and morality rates per 100,000 (Crude s) - ative incidence and mortality rates ( s) - Age standardised incidence and mortality rates using the Australian Standard Population (2001) and the World Standard Population (1960) Tasmanian Cancer Registry 17

18 18 Tasmanian Cancer Registry

19 C00. Lip AS s C01, C02. Tongue M F P M F P M F P M F P M F P M F P M F P M F P Tasmanian Cancer Registry 19

20 C03. Gum AS s M F P M F P M F P M F P C04. Floor of mouth M F P M F P M F P M F P Tasmanian Cancer Registry

21 C05, C06. Other mouth AS s M F P M F P M F P M F P C01 - C06. Oral Cavity M F P M F P M F P M F P Tasmanian Cancer Registry 21

22 C07, C08. Salivary glands AS s M F P M F P M F P M F P C09, C10. Oropharynx M F P M F P M F P M F P Tasmanian Cancer Registry

23 C11. Nasopharynx AS s M F P M F P M F P M F P C12, C13. Hypopharynx M F P M F P M F P M F P Tasmanian Cancer Registry 23

24 C09 - C13. Pharynx AS s C14. Other oral M F P M F P M F P M F P M F P M F P M F P M F P Tasmanian Cancer Registry

25 C01-C14,C30-C32. Head and neck AS s C15. Oesophagus M F P M F P M F P M F P M F P M F P M F P M F P Tasmanian Cancer Registry 25

26 C16. Stomach AS s M F P M F P M F P M F P C17. Small intestine M F P M F P M F P M F P Tasmanian Cancer Registry

27 C18. Colon AS s M F P M F P M F P M F P C19 - C21. Rectum M F P M F P M F P M F P Tasmanian Cancer Registry 27

28 C18 - C21. Colorectal AS s C22. Liver M F P M F P M F P M F P M F P M F P M F P M F P Tasmanian Cancer Registry

29 C23, C24. Gallbladder AS s C25. Pancreas M F P M F P M F P M F P M F P M F P M F P M F P Tasmanian Cancer Registry 29

30 C30, C31. Nasal cavities AS s C32. Larynx M F P M F P M F P M F P M F P M F P M F P M F P Tasmanian Cancer Registry

31 C33, C34. Lung AS s M F P M F P M F P M F P C37, C38. Thymus etc M F P M F P M F P M F P Tasmanian Cancer Registry 31

32 C40, C41. Bone AS s M F P M F P M F P M F P C43. Melanoma of skin M F P M F P M F P M F P Tasmanian Cancer Registry

33 C44. Skin AS s M F P M F P M F P M F P C45. Mesothelioma M F P M F P M F P M F P Tasmanian Cancer Registry 33

34 C46. Kaposi sarcoma AS s M F P M F P M F P M F P C47, C49. Connective tissue M F P M F P M F P M F P Tasmanian Cancer Registry

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