The ACT has the highest rate of female cancer deaths in Australia, according to Australian Bureau of Statistics figures issued last week.
The percentage of cancer deaths among females in the ACT is significantly higher than in the rest of Australia.
The statistics show that through all age groups, the ACT has a significantly higher percentage of female cancer deaths than the rest of Australia. They show that the male rate, on the other hand is about the same, except of the 25-44 group. Shown the figures, a leading ACT oncologist, Dr Richard Pembrey, said the figures warranted investigation. He called for a compulsory ACT cancer registry.
Overall, cancer causes 33 per cent of female deaths in the ACT. Nationwide it causes 25 percent of deaths. Throughout all age groups the ACT percentage is higher than the national one.
It could be explained by saying that other causes of death are lower in the ACT, bearing in mind that the ACT has a generally lower death rate than the rest of Australia. However, the Australian Bureau of Statistics provided some additional figures. These revealed that the ACT rate as a percentage of deaths was been higher than every state and territory in 1990 and 1991 and was second highest to Western Australia in 1989.
Further, the age-by-age crude death rates reveal a higher trend than the national one. The worst example is in the 55-64 age group. In that group there were 434 female cancer deaths per 100,000 in 1991 compared with an Australia-wide figure of 321. In other age groups the ACT figure for female cancer deaths was equal to or worse than the Australian figure in a general environment of far lower ACT death rates than the national average.
Statistics about the ACT generally have to be treated with caution because of the ACT’s different age profile and because of low samples. However, the cancer figures are true across all the main age groups and the sampling has been consistent for several years.
The figures show that in the ACT 66 per cent of deaths in the 55-64-year-old age group are due to cancer. Nationwide that figure is 50 per cent, a difference of 16 per cent. The difference in the other critical age groups is 10 per cent among 25-44 year olds, 7 per cent in the 45-to-54 age group and 5 per cent in the 65-to-74 age group. The trend is not the same among males. In general the male cancer death rate in the ACT is similar to the national trend.
Past analysis of ACT statistics have often revealed aberrations which could often be put down n to the different age and income profile, or in the case of divorce statistics to the fact that the ACT Family Court Registry draws in many out-of-ACT applicants. So these figures have been treated with caution and pitted against an exploration of all other obvious factors. However, weighted against the experience of other states and Australia-wide age-by-cause tables, there is a disturbing and obvious conclusion that cancer deaths among females in the ACT is alarmingly high compared to the rest of Australia.
Moreover, it seems that statisticians and health authorities are not especially aware of it. Dr Pembrey, called for changes to ACT law and practice in the reporting of cancer cases. He thought that the ACT should have a compulsory cancer registry, like NSW. At present there was only a voluntary scheme. His experience was that patients, in general, did not object to wider statistical reporting, but doctors thought statutory protection was necessary to improve reporting of details. There were problems of confidentially when cancer patients often moved, so it was necessary to record patients by name.
“”There was a need for a proper cancer registry in the ACT,” he said.
Dr Pembrey said the data required further study.
He thought there were two possible explanations. One was the uncomfortable one that the ACT was not treating its patients as well as elsewhere, but this was not very likely because the ACT was up with the latest Australian and world practice. None the less, it warranted study. More likely was the probability that the ACT was leading Australia in a worldwide trend. That trend was that, as treatments for other causes of death became more successful, cancer deaths stood out as a higher proportion of death s. Already in parts of the US and Singapore cancer was the leading cause of death. Within 10 or 20 years this would be the case in Australia, he said.
Depending on classification, cancer is already the leading cause of death in Australia. If circulatory disease is split into heart attacks and strokes (brain circulation) cancer is the leading cause. If the two circulatory causes are added it is not.
Dr Pembrey said that even with the two circulatory diseases added, on present trends cancer would be the leading cause of death within 10 or 20 years.
“”We are not winning the war against cancer,” he said.
The figures showed the need for more money for cancer research, he said.
The Bureau of Statistics figures did not record AIDS deaths as a separate category in the ACT figures. The bureau will not record categories where the number is so few as to breach privacy. Nationally, 24 women died of AIDS in 1991 compared with 14,000 female cancer deaths.
Linda Reaby, of Page, in a Letter to the Editor last week asked, “”When does a disease become a political issue? When it is contagious, incurable and kills those who are still vigorous enough to mount a campaign to grab public interest and funding? Yet, because breast cancer is nota contagious or a predictably incurable disease and because women have not yet defined it as a “”women’s issue”, what should be seen as a major social and political problem is regarded as a tragic and somehow biologically fated part of a woman’s lot.”
The ACT high female cancer figures are despite what appears to be the most directed government services in the area of any state or territory in Australia. The ACT has had separate women’s budgets with targeted health projects, especially concentrating on breast and cervical cancer, for the past four years.
The 1992-93 ACT Women’s Budget statement on the women’s community-health program said: “”The program aims to provide a comprehensive approach to breast and cervical cancer screening. It aims to decrease the morbidity and mortality attributable to breast and cervical cancer by introducing a population screening program that will detect cancers in early stages.” However, the only statistics in the women’s budget are breakdowns of male-to-female staffing of various employment agencies. There are no breakdowns of expenditure of different areas of women’s health.
At present cancer patients are not routinely surveyed for medical research. Only about 2 per cent of patients are surveyed in detail to determine success rates of various treatments. Medical researchers say that for research to be valid it requires random selection of a control group and a treatment group. That in turn requires an agreement to follow the treatment prescribed without choice, and few patients are prepared to agree to this.
In the ACT there is no general surveying of all cancer patients involving lifestyle, family history, residence history and the myriad of other detail that could point to possible causes or risk factors.