Men seem to be taking a hit in New South Wales. Cancer incidence rates have increased among them by 11 per cent, while there is a significant downward trend in the case of women, according to Cancer in New South Wales: Incidence and Mortality 2007, published by the state's Cancer Institute.
This is the first time a downward trend in incidence has been observed in the state and is consistent with findings in the USA., says Rob Sanson-Fisher, Acting Chief Cancer Officer and CEO of the Cancer Institute.
Possible reasons provided for the USA decline in incidence for females were a decrease in the use of menopausal hormone therapy and increased mammography screening. It is difficult to determine whether these reasons apply in NSW, the report says.
In NSW the most common cancers are prostate, bowel, breast, melanoma and lung, which are responsible for 63 per cent of incidence in NSW. Prostate cancer is responsible for 32 per cent of all new cases in men. In the past fi ve years, incidence rates for prostate cancer have increased sharply and are now at higher levels than the 1992 to 1994 peak. Prostate cancer incidence rates appear related to theprevalence of prostate-specifi c antigen (PSA) testing in the community.
Long-term cancer projections are featured in this report and can be used for planning, research, cancer control activities and in allocating resources. It is projected that the number of new cases of cancer in NSW may increase on average by 5,000 every five years.
In 2007, there were 36,043 new cases of cancer diagnosed. These numbers are projected to rise to more than 50,000 new cases in 2021.
For the first time in 2007, we analysed trends by histological, or cell type. This allowed a greater understanding of the dominant cell types and their overall impact on rates and survival by cancer site. For example, some breast cancer starts in cells that line the milk ducts of the breast, called ductal carcinoma. This was responsible for 79 per cent of breast cancer in NSW in 2007, compared to 71 per cent of all breast cancer in USA females. Five-year relative survival comparisons for USA, Victoria and NSW were similar at 88, 89 and 90 per cent respectively for women diagnosed with this type of breast cancer.
Superficial spreading melanoma grows within the outer layer of the skin and was the most common cell type of melanoma (45.9% of total cases) in NSW in 2007. Superfi cial spreading melanoma is increasing as a proportion of total melanoma cases and mirrors the trend of overall melanoma. This suggests that people are presenting with less invasive melanoma which may be a result of skin awareness campaigns.
Five-year relative survival in NSW varies by melanoma subtype, with the superficial spreading melanoma responsible for 96.7 per cent survival in males and 97.7 per cent in females. We cannot be complacent about melanoma. NSW males have the third highest incidence of melanoma in the world, surpassed only by Queensland and Western Australia. NSW also has four times the incidence of selected European countries.
Different cell types are infl uenced by various risk factors. Adenocarcinoma of the oesophagus is thought to be due to Barrett's oesophagus developed as a result of gastroesophageal refl ux. A common risk factor is obesity. The USA and Australia are in the top six OECD countries for obesity and also have a high proportion of adenocarcinoma. Japan and Korea have low rates of obesity and adenocarcinoma. Japan has a higher proportion of squamous cell carcinoma of the oesophagus compared to NSW and other Western countries, mainly because this cell type is most strongly related to tobacco and alcohol-related risk factors. Japanese and Korean males have high rates of smoking compared to other OECD countries. This suggests that being careful about weight, stopping tobacco use and reducing alcohol consumption, will lead to a significant decrease in some cancers in the future.
Mortality rates from all causes of cancer death have declined in NSW since 1989 in males and 1988 in females. Mortality rates are most influenced by trends in lung cancer deaths in both males and females; followed by breast, prostate and bowel cancer deaths. The reduction in mortality rates for the majority of cancer sites are a combination of earlier detection, changes in risk factors and treatment improvement. A concerning finding is that lung cancer deaths in women have overtaken breast cancer deaths in NSW for the first time in 2007. This is because incidence and mortality rates of lung cancer in women are increasing. Women started smoking later than men in NSW and fewer have stopped. Death rates mirror incidence rates because of the poor survival of this disease. If rates continue to rise as they have been doing, by 2021 lung cancer is projected to account for 22 per cent of female cancer deaths, whereas breast cancer will decline to just 13 per cent. This indicates that we should continue to do all we can to reduce smoking rates, the report concludes.