Cancer mortality in Aboriginal people in New South Wales, Australia, 1994-2002

Objective: To describe, for the first time, mortality from cancer for Aboriginal residents of New South Wales (NSW). Methods: These are the results of a descriptive study of cancer deaths from the NSW Central Cancer Registry for 1994 to 2002. Standardised mortality ratios were calculated with Poisson confidence intervals to compare the relative rates in the Indigenous and non‐Indigenous populations. Results: The overall standardised mortality rates were 66% higher for males and 59% higher for females for Aboriginal people compared with non‐Indigenous people. Mortality from lung cancer was 50% and 100% higher than for NSW non‐Indigenous males and females respectively. The high mortality rate from cervical cancer in Aboriginal females is contrary to the trends in the general population since the introduction of free population‐based screening. Conclusions: For the first time, data are available for cancer mortality for Aboriginal people in NSW. Mortality for all cancers combined was higher than that of the non‐Indigenous population. This suggests that a combination of later diagnoses and perhaps poorer treatment outcomes as well as being diagnosed with poorer prognosis cancers is occurring in Aboriginal people of NSW. Implications: It was possible to increase the rate of identification in a population register using routinely collected data, but the completeness and accuracy of Indigenous status should, and can, be improved in all notifying data collections. Public health planners in NSW can now begin to address the issues of prevention, treatment and palliation of cancer in Aboriginal people with local, rather than imputed, evidence

Cancer in Indigenous people in New South Wales, 1994-2002 : a growing problem

Background: Indigenous Australians have significantly lower life expectancies than the peoples of developing nations including India, Thailand and Bangladesh. Indigenous peoples of Australia also have a much lower life expectancy than the Indigenous peoples of Canada, New Zealand and the United States of America. Cancer is the second highest killer of Indigenous Australians. The most common cancer causes of death in Indigenous people perhaps reflect lifestyle factors such as tobacco use,alcohol use and poor diet. However, until now, very little was known about cancer incidence in Indigenous Australians due to previous low rates of Indigenous identification on hospital and disease registers. Methods: We vastly improved the rate of Indigenous identification on the New South Wales Central Cancer Registry using information from death certificates. Using indirect standardisation we then compared the Indigenous people’s cancer incidence and mortality to that of the non-Indigenous New South Wales population. Results: Both Indigenous males and females had a 20% lower incidence of all cancers combined, although rates for lung cancer were significantly higher in both sexes. However, standardised mortality ratios for all cancers combined were 66% and 59% higher for males and females respectively. Both incidence and mortality from lung cancer for both sexes was more than 50% higher than the NSW population .The incidence of other tobacco related cancers such as tongue was more than twice (the Standardised Incidence Ratio was 2.5, 95% Confidence Interval 1.1-4.4) that of the non-Indigenous male population. Indigenous males also had a 96% (1.1-3.1) higher incidence rate of oesophageal cancer. Cervical cancer incidence in Indigenous women was 59% (1.1-2.2) higher than in non-Indigenous and mortality was more than three-times (Standardised Mortality Ratio 3.7,95% CI 1.9-6.2) the rate of non-Indigenous women. Conclusions: Cancer is an important, but often overlooked, disease and cause of death in Indigenous peoples in New South Wales and Australia. Lung cancer in particular is a lifestyle disease where Indigenous Australians are over-represented in its incidence and mortality. Issues such as improving the access to, and the suitability of Pap-test screening has been identified by others as a way to reduce the incidence and mortality of cervical cancer in Indigenous women

Increasing rates of surgical treatment and preventing comorbidities may increase breast cancer survival for Aboriginal women

Background: Lower breast cancer survival has been reported for Australian Aboriginal women compared to non-Aboriginal women, however the reasons for this disparity have not been fully explored. We compared the surgical treatment and survival of Aboriginal and non-Aboriginal women diagnosed with breast cancer in New South Wales (NSW), Australia. Methods: We analysed NSW cancer registry records of breast cancers diagnosed in 2001–2007, linked to hospital inpatient episodes and deaths. We used unconditional logistic regression to compare the odds of Aboriginal and non-Aboriginal women receiving surgical treatment. Breast cancer-specific survival was examined using cumulative mortality curves and Cox proportional hazards regression models. Results: Of the 27 850 eligible women, 288 (1.03%) identified as Aboriginal. The Aboriginal women were younger and more likely to have advanced spread of disease when diagnosed than non-Aboriginal women. Aboriginal women were less likely than non-Aboriginal women to receive surgical treatment (odds ratio 0.59, 95% confidence interval (CI) 0.42-0.86). The five-year crude breast cancer-specific mortality was 6.1% higher for Aboriginal women (17.7%, 95% CI 12.9-23.2) compared with non-Aboriginal women (11.6%, 95% CI 11.2-12.0). After accounting for differences in age at diagnosis, year of diagnosis, spread of disease and surgical treatment received the risk of death from breast cancer was 39% higher in Aboriginal women (HR 1.39, 95% CI 1.01-1.86). Finally after also accounting for differences in comorbidities, socioeconomic disadvantage and place of residence the hazard ratio was reduced to 1.30 (95% CI 0.94-1.75). Conclusion: Preventing comorbidities and increasing rates of surgical treatment may increase breast cancer survival for NSW Aboriginal women

Prostate cancer mortality outcomes and patterns of primary treatment for Aboriginal men in New South Wales, Australia

Objective: To compare prostate cancer mortality for Aboriginal and non-Aboriginal men and to describe prostate cancer treatments received by Aboriginal men. Patients and methods: We analysed cancer registry records for all men diagnosed with prostate cancer in New South Wales (NSW) in 2001–2007 linked to hospital inpatient episodes and deaths. More detailed information on androgen-deprivation therapy and radiotherapy was obtained from medical records for 87 NSW Aboriginal men diagnosed in 2000–2011. The main outcomes were primary treatment for, and death from, prostate cancer. Analysis included Cox proportional hazards regression and logistic regression. Results: There were 259 Aboriginal men among 35 214 prostate cancer cases diagnosed in 2001–2007. Age and spread of disease at diagnosis were similar for Aboriginal and non-Aboriginal men. Prostate cancer mortality 5 years after diagnosis was higher for Aboriginal men (17.5%, 95% confidence interval (CI) 12.4–23.3) than non-Aboriginal men (11.4%, 95% CI 11.0–11.8). Aboriginal men were 49% more likely to die from prostate cancer (hazard ratio 1.49, 95% CI 1.07–1.99) after adjusting for differences in demographic factors, stage at diagnosis, health access and comorbidities. Aboriginal men were less likely to have a prostatectomy for localised or regional cancer than non-Aboriginal men (adjusted odds ratio 0.60, 95% CI 0.40–0.91). Of 87 Aboriginal men with full staging and treatment information, 60% were diagnosed with localised disease. Of these, 38% had a prostatectomy (± radiotherapy), 29% had radiotherapy only and 33% had neither. Conclusion: More research is required to explain differences in treatment and mortality for Aboriginal men with prostate cancer compared with non-Aboriginal men. In the meantime, ongoing monitoring and efforts are needed to ensure Aboriginal men have equitable access to best care

Comparing colorectal cancer treatment and survival for Aboriginal and non-Aboriginal people in New South Wales

Summary Objectives: Our aim was to compare surgical treatment rates and survival rates for Aboriginal and non-Aboriginal people in New South Wales with colorectal cancer, and to describe the medical treatment received by a sample of Aboriginal people with colorectal cancer

Prostate cancer mortality outcomes and patterns of primary treatment for Aboriginal men in New South Wales, Australia

Objective To compare prostate cancer mortality for Aboriginal and non-Aboriginal men and to describe prostate cancer treatments received by Aboriginal men. Patients and methods We analysed cancer registry records for all men diagnosed with prostate cancer in New South Wales (NSW) in 2001-2007 linked to hospital inpatient episodes and deaths. More detailed information on androgen-deprivation therapy and radiotherapy was obtained from medical records for 87 NSW Aboriginal men diagnosed in 2000-2011. The main outcomes were primary treatment for, and death from, prostate cancer. Analysis included Cox proportional hazards regression and logistic regression. Results There were 259 Aboriginal men among 35 214 prostate cancer cases diagnosed in [2001][2002][2003][2004][2005][2006][2007]. Age and spread of disease at diagnosis were similar for Aboriginal and non-Aboriginal men. Prostate cancer mortality 5 years after diagnosis was higher for Aboriginal men (17.5%, 95% confidence interval (CI) 12.4-23.3) than non-Aboriginal men (11.4%, 95% CI 11.0-11.8). Aboriginal men were 49% more likely to die from prostate cancer (hazard ratio 1.49, 95% CI 1.07-1.99) after adjusting for differences in demographic factors, stage at diagnosis, health access and comorbidities. Aboriginal men were less likely to have a prostatectomy for localised or regional cancer than non-Aboriginal men (adjusted odds ratio 0.60, 95% CI 0.40-0.91). Of 87 Aboriginal men with full staging and treatment information, 60% were diagnosed with localised disease. Of these, 38% had a prostatectomy (± radiotherapy), 29% had radiotherapy only and 33% had neither. Conclusion More research is required to explain differences in treatment and mortality for Aboriginal men with prostate cancer compared with non-Aboriginal men. In the meantime, ongoing monitoring and efforts are needed to ensure Aboriginal men have equitable access to best care