Lamees Alafeishat

Lamees Alafeishat
Outline:

 Background and Rationale
 My Study
 Aims and Objectives
 Methods
 Results
 Conclusion
 Questions time
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….
Cancer Incidence in 5
Continents

 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
Fast-forward in time…

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
Key Points to Remember:

 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)
Bringing it back to New Zealand
and Australia

 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
Study Objectives

 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)
Research Questions:

 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 Characteristics:

 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)
Methods:

 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
Data analysis:

 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
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.
Conclusion:

 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
Future Research

 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.
Limitations

 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
Questions?
