HSC PDHPE

Cancer

The Cancer Council NSW

Carla SaundersMedical and Scientific Policy Manager

The Cancer Council NSWcarlas@nswcc.org.au

Cancer Facts* Cancer is not one disease

* Some risk factors modifiable

* Others cannot be avoided through personal action

…..unknown risk factors

* Synergic risks

* Individual susceptibility

Extent of the Problem

http://www.aihw.gov.au/publications/index.cfm/title/10476

Extent of the Problem

http://www.cancercouncil.com.au/

Extent of the Problem

http://www.health.nsw.gov.au/research/index.html

Extent of the Problem (2006)

Incidence: 106,000 new cases Mortality: 39,200 deaths

* Australian males have a 1 in 3 chance of a cancer diagnosis before age 75 years, and a 1 in 2 chance before age 85.

* Australian females have a 1 in 4 chance of a cancer diagnosis before age 75 years, and a 1 in 3 chance before age 85.

Extent of the Problem (2006)

* The most common cancers diagnosed in males are prostate cancer, colorectal (bowel) cancer, melanoma, lung cancer and lymphoma.

* The most common cancers diagnosed in females are breast cancer, colorectal (bowel) cancer, melanoma, lung cancer and lymphoma.

Trends - Incidence (AIHW)

• The total number of cancers diagnosed in 2003 was 26% higher in 2003 than in 1993 (24% for males and 29% for females)

• Compared with a 12% increase in the Australian population during this period.

• However, the age-standardised incidence rate for ‘all cancers’ was 0.7% lower in 2003 than in 1993.

• Among the NHPA cancers the largest decrease in rate from 1993 to 2003 was for cervical cancer (41%), followed by prostate cancer (12%), lung cancer (11%) and colorectal cancer (1.5%)

• The largest increase in rate for NHPA cancers from 1993 to 2003 was for melanoma (up 14%), followed by non-Hodgkin lymphoma (7.2%) and breast cancer in females (6.1%).

Trends - Incidence (AIHW)

• The total number of deaths from cancer in 2003 was 15% higher than in 1993 (14% for males and 17% for females)

• Compared with a 9.1% increase in deaths from all causes over this time.

• However, the age-standardised death rate for ‘all cancers’ was 12% lower in 2003 than in 1993.

Trends - Mortality (AIHW)

• Among the NHPA cancers the largest decrease in death rate from 1993 to 2003 was for cervical cancer (41%), followed by colorectal cancer (25%), prostate cancer (22%), breast cancer in females (20%), non-Hodgkin lymphoma (15%) and lung cancer (14%).

• Among the NHPA cancers the only increase in death rate from 1993 to 2003 was for melanoma (up 4.4%: 3.3% in males, 9.1% in females).

Trends - Mortality (AIHW)

Cancer Incidence – why the fluctuations?• Age

• Detection rates

• Risk factor reduction

• Advances in technology and understanding of cancer development and causes

Cost of CancerThe average lifetime financial cost of cancer on a household in NSW is around 1.7 years of annual household income.

The NSW Government spends approximately $800 million each year on the prevention, management and treatment of cancer.

In addition, the Australian Government in NSW spends about $200 million on cancer through general practitioners and other services.

Cost of Cancer

Social justice and Cancer Control

Equitable allocation, or more precisely - benefits from, cancer control interventions and resources.

• Conveniently located resources may not bring equal benefit

• Positive discrimination often necessary to increase the opportunity to benefit

Annotated Bibliography on Equity in Healthhttp://www.equityhealthj.com/content/1/1/1

1. Equity

Social justice and Cancer Control2. Access

• Cancer prevention, early detection and care services are available to everyone entitled.

• Access is free of any form of discrimination irrespective of a persons location, socioeconomic status, ethnicity, race, age, religion etc

• There is equal use of services across different population groups

Social justice and Cancer Control

3. ParticipationInformation and understanding of cancer prevention, early detection and care services (and the capacity to act on such knowledge) is available to everyone who is entitled.

Social justice and Cancer Control4. Rights

• Opportunities for appropriate cancer care are available

• Information and understanding of health care rights and provisions for disadvantaged groups (and the capacity of individuals to act on such knowledge) is available to everyone who is entitled.

Poverty is the single most important determinant of poor health. 

However, poor health is far from the single most important determinant of poverty.

Applying the principles of the Ottawa Charter (in Cancer Control)

1. Build healthy public policy2. Create supportive environments3. Strengthen community action4. Develop personal skills5. Reorient health services

+ Principles of the Jakarta Declaration

Health Improvement - Ottawa Charter

Investment

partnerships

infrastructure

Contemporary health promotion rightly accords greater attention to research evidence, the social determinants of health, multiple

strategies/players and building the capacity of others

Building Healthy Public PolicyAim: To protect health across the population irrespective of SES, rurality, race ……….etc

• Regulation e.g laws preventing minors under 18 yrs purchasing alcohol and tobacco, OH&S

• Fiscal Measures e.g. Medicare reimbursement

• Taxation e.g. Tobacco, alcohol, ?junk food

• Policy e.g Vaccination / Screening programs

• Evidence Based Practice e.g. Clinical care guidelines, continuing professional development, cost effective interventions

Create Supportive EnvironmentsAim: Generate living, playing and working conditions that support health and safety

Infrastructure e.g Women's health centres, walking paths, shade structures, libraries etc

Technology e.g Accessible and reliable Internet and broadband access, specialist diagnostic etc

Services e.g Free phone quit (smoking) service, Cancer Helpline, Free cancer telegroup counselling, interpreter and sign lang. services

Training and Resources e.g Cancer education and information, OH&S information & training

“the ability of people and communities to do the work

needed in order to address the determinants of health for those

people in that place”

Bopp, GermAnn, Bopp, Baugh Littlejohns, & Smith (2000)

Community Capacity

Community Development (Information, training and learning opportunities, resources) e.g. volunteer recruitment and training, consumer advocacy training, information on community health statistics and harmful environmental substances, cancer support group resources, financial reimbursement for volunteer transport services, community consultation etc etc….

Strengthen Community ActionAim: Empowering communities to increase control over and improve health

Develop Personal SkillsAim: Empowering individuals to increase control over and improve health

Personal Development (Information, training and learning opportunities, resources) e.g. strengthen individual skills through free and readily available health information; target functional literacy skills to enable individuals to interpret written and oral information about health, conduct store tours to educate people about healthy foods, thereby enabling them to make healthier food choices etc etc….

Aim: Shift the focus towards prevention in settings focused on providing clinical and curative services.

Reorient Health Services

Health Professional e.g. Educate paediatricians and family doctors about assessing second hand smoke exposure in children and counselling in smoking cessation.

Organisational Change e.g. Training to support cross-cultural competence in health care. Allocation of adequate resources for interpreters and multilingual information.

Activities• Cancer, population statistics, human

behaviour and the determinants of health are all complex. There are a number of very difficult concepts to grasp

• Start with simple tasks and work up to the more complex. Allow reasonable time for fact gathering and understanding

• Need to stimulate thinking and problem solving but also correct misconceptions quickly

Questions? Comments?