Lamees Alafeishat

Background and Rationale My Study Aims and Objectives Methods Results Conclusion Questions time

Outline:

Why is it important do international comparisons of cancer incidence and mortality?

BECAUSE: The big killers? Impact of Environment on cancer

development Enhance knowledge about aetiology Prognosis of cancer and survival Impact of Policy, control and

intervention programmes Who is in most need of urgent action

and who is doing well The impact of new medical treatments

and technology Evaluate systems performance And many more….

International Union Against Cancer (UICC) and the

World Health Organisation (WHO) First volume published 1966 (landmark in global

cancer control) Stimulated research into social, environmental and

systematic causes Since then there has been 9 publications, with the

latest version published in 2009

Cancer Incidence in 5 Continents

If mortality and incidence vary between countries, what about cancer outcomes in terms of survival, quality of life and patterns of care? Eurocare project (1995): Large international variations in

cancer survival UK Cancer Plan 2000: Appointment of a National Cancer

Director Cancer Reform Strategy 2007: Improve all areas of care

from prevention and diagnosis to treatment and aftercare Concord and high-resolution studies

Fast-forward in time…

Cancer Incidence in Five Continents set the scene for

international comparisons of cancer incidence and mortality rates.

Eurocare project as an example of a resulting research collaboration

UK Cancer Plan 2000 and Cancer Reform Strategy 2007

On going work on cancer survival to investigate international differences (Concord) and drive further research into causes (high resolution studies)

Key Points to Remember:

Similar lifestyles, cultures, dietary behaviours and

medical practices. Only one study compared the incidence and

mortality between the two. Skegg and McCredie 2002 but looked at data from 1996 and 1997

Results showed higher mortality and incidence for males and females in NZ

BUT there is potential for reducing the rates and closing the gab

Bringing it back to New Zealand and Australia

Conduct an analysis of the differences in cancer incidence

and mortality rates between NZ and Australia using more recent data from 2000-07

Fill in the current gab in knowledge about the differences

in incidence and mortality between NZ and Australia Set the way for future research into cancer survival trends

between the two countries and further investigations into causes of differences (if any)

Study Objectives

Has the rates changed since the Skegg and McCredie

study? Who is doing better and in what? What is the potential for reducing deaths from

cancer in NZ What are the areas of priority for cancer research and

public health action in NZ

Research Questions:

Descriptive Epidemiology (what, who, where) Quantitative design Secondary data Age-standardisation All-cancers combined plus 5 cancer sites (lung,

colorectal, pancreatic, female breast and prostate)

Research Characteristics:

NZ population numbers extracted from Statistics NZ

in 5-year age groups and by sex Australian incidence and mortality rates extracted

from the Australian Institute of Health and Welfare Total cancer registrations and deaths for NZ

extracted from the MOH Cancer New Registration and Deaths 2009 Report

Methods:

Rates expected in New Zealand were calculated based on

rates observed in Australian Total observed rate compared to total expected rate and

standard incidence and mortality ratios calculated for each year and by sex

Differences in number of cases calculated for each year and by sex

Standard incidence and mortality ratios calculated for the entire period

Excess/deficit numbers calculated for the entire period

Data analysis:

Results: All-cancers combined

Colorectal Cancer

Lung Cancer

Pancreatic Cancer

Prostate Cancer

Female Breast Cancer

Summary of Key Results:

There were small differences in incidence rates between Australia and NZ within the period 2000-07 for all-cancers combined, however, the mortality rates were significantly higher, for men and women, in NZ compared to Australia, suggesting poorer survival post diagnosis in NZ.

If the Australian rates had applied, there would have been 2034 less

deaths in males and 4747 less deaths in females across the period of 2000-07

Without accounting for the Australian rates, Lung cancer was the main cause of cancer deaths for men and women in New Zealand followed by Colorectal cancer, Female Breast cancer, Prostate Cancer and finally pancreatic cancer within 2000-07

Results cont.

If we account for the Australian rates, the largest difference in mortality was caused by Colorectal cancer, followed by Female Breast, Lung and Prostate cancers over the period of 2000-07 suggesting poorer survival in that order

Pancreatic cancer showed a negative mortality figure

of 257, suggesting that mortality of Pancreatic cancer in New Zealand has been lower than that of Australia within 2000-07, hence survival is better in NZ for pancreatic cancer.

The differences in trends of mortality showed by

Skegg and McCredie in 1996-97 remained in 2000-07 Although incidence of all-cancers are relatively

similar, NZ is doing significantly worse than Australia in controlling cancer mortality

Colorectal cancer is the top priority for NZ in terms

of action to control mortality followed by Female Breast cancer

Conclusion:

Investigate trends in cancer outcomes (survival and

quality of life post diagnosis)

Conduct high-resolution studies in order to understand and explain the difference in incidence and mortality rates between Australia and NZ

Investigate and explain the factors that have allowed for lower mortality rates in Australia and advice policy and intervention programmes in NZ.

Future Research

Accuracy of the results can be affected by the quality of

data obtained from cancer registries Mortality data is affected by death certification processes

and by accurate accounts of causes of death High incidence could reflect high screening and imaging

techniques rather than true disease occurrence

Limitations

Questions?