Cancer survival, incidence and mortality by Area Health ... · Yu XQ, O’Connell DL, Gibberd RW,...

Cancer survival, incidence and mortality by Area Health Service in NSW 1994 to 2000 Xue Q Yu Dianne O’Connell Robert Gibberd David Smith Bruce Armstrong Cancer Epidemiology Research Unit Cancer Research and Registers Division The Cancer Council NSW May 2003

Acknowledgments The authors would like to thank Professor John Beard, Dr Michael Coory and Dr Hanna Noworytko for reviewing an ealier draft of this report and providing constructive advice. The Cancer Epidemiology Research Unit is a unit of and is directly funded by The Cancer Council NSW. The NSW Central Cancer Registry is managed and operated by The Cancer Council NSW under contract to NSW Health. National Library of Australia Cataloguing-in-Publication data:

Cancer survival, incidence and mortality by Area Health Service in NSW 1994 to 2000.

ISBN 1 86507 073 4 Key words: Cancer survival, Relative survival, Cancer incidence, Cancer mortality, Regional variation, Empirical Bayes, New South Wales, Australia Suggested citation: Yu XQ, O’Connell DL, Gibberd RW, Smith DP, Armstrong BK. Cancer survival, incidence and mortality by Area Health Service in NSW 1994 to 2000. Sydney: The Cancer Council NSW, 2003. Published by The Cancer Council New South Wales, May 2003

Also in this series: • Breast Cancer Survival in NSW in 1973 to 1995 (1998) • Geographic distribution of cancer in New South Wales in 1991 to 1995 by Local

Government Area (1999) • Survival from Cancer in New South Wales in 1980 to 1995 (1999) • Remoteness and cancer incidence, mortality and survival in New South Wales 1992 to

1996 (2002)

Cancer Epidemiology Research Unit Cancer Research and Registers Division Cancer Council NSW Locked Mail Bag 1 KINGS CROSS NSW 1340 Telephone: (02) 9334 1902 Facsimile: (02) 9334 1778 Email: [email protected] Internet: www.cancercouncil.com.au

Contents

Summary ............................................................................................................1 Cancer survival ....................................................................................................................................... 1 Lives potentially savable ......................................................................................................................... 1 Cancer incidence..................................................................................................................................... 1 Cancer mortality..................................................................................................................................... 1

Introduction .....................................................................................................6

Methods..............................................................................................................8 Data sources ............................................................................................................................................ 8 Incidence data ......................................................................................................................................... 8 Mortality data ......................................................................................................................................... 8 Survival data ........................................................................................................................................... 8 Population data ....................................................................................................................................... 8 Spread of disease at diagnosis................................................................................................................. 9 Area Health Service of residence............................................................................................................ 9 Indirect age standardisation ..................................................................................................................10 Excess number of new cases or deaths and confidence intervals ..........................................................10 Five-year relative survival .....................................................................................................................10 Adjusted relative risk of excess death and confidence intervals ...........................................................11 Excess deaths due to cancer...................................................................................................................11 Empirical Bayes method ........................................................................................................................12 Potential lives savable ............................................................................................................................12 Guide to interpretation of results ..........................................................................................................13

Results ..............................................................................................................14 All cancers..............................................................................................................................................14 Head and neck cancer............................................................................................................................16 Cancer of the oesophagus ......................................................................................................................18 Stomach cancer ......................................................................................................................................20 Colon cancer ..........................................................................................................................................22 Rectal cancer..........................................................................................................................................24 Liver cancer ...........................................................................................................................................26 Gallbladder cancer.................................................................................................................................28 Cancer of the pancreas ..........................................................................................................................30 Lung cancer............................................................................................................................................32 Mesothelioma .........................................................................................................................................34 Female breast cancer .............................................................................................................................36 Melanoma of the skin.............................................................................................................................38 Cervical cancer ......................................................................................................................................40 Uterine cancer........................................................................................................................................42 Ovarian cancer.......................................................................................................................................44 Prostate cancer.......................................................................................................................................46 Testis cancer...........................................................................................................................................48 Bladder cancer .......................................................................................................................................50 Kidney cancer ........................................................................................................................................52 Brain cancer...........................................................................................................................................54 Thyroid cancer.......................................................................................................................................56 Non-Hodgkin lymphoma........................................................................................................................58 Hodgkin’s disease...................................................................................................................................60 Multiple myeloma ..................................................................................................................................62 Leukaemia..............................................................................................................................................64

Implications ...................................................................................................66 References .....................................................................................................67 Appendixes.....................................................................................................68

Appendix one .........................................................................................................................................68 Appendix two .........................................................................................................................................69 Appendix three.......................................................................................................................................71 Appendix four ........................................................................................................................................74

Cancer survival, incidence and mortality in NSW 1994–2000 Summary

The Cancer Council NSW 1

Summary Five-year relative survival by Area Health Service in New South Wales (NSW) during 1994 to 2000 was calculated for 25 major cancers. Multiple regression models of relative survival were used to estimate the effect of place of residence (grouped into Area Health Services) at the time of diagnosis on patients’ survival while adjusting for potential confounders. The relative risk of excess death was estimated for each Area Health Service using the State average risk as the reference. Relative survival compares the actual survival in the cancer patients with that of people in the general population of the same age, sex and place of residence. To support the survival statistics, information about incidence and mortality during 1994–1998 was included. The analysis took into account sampling error for individual Area Health Services through Empirical Bayes methods and an overall statistical test for regional variation in survival was conducted to determine whether there were significant differences between areas.

Cancer survival Significant variation in relative survival was found for nine of the 25 cancer sites analysed: cancers of the colon, liver, lung, breast, ovary and prostate; melanoma of the skin; and multiple myeloma and leukaemia. The Area Health Services that differed significantly from the State average are shown in Table 1. While there was significant regional variation in relative survival for multiple myeloma, no single Area Health Service was significantly different from the State average. For all cancers combined, patients from four rural areas and Western Sydney and Wentworth experienced higher risk of excess death than the State as a whole, while Central, Northern and South Eastern Sydney, and Northern Rivers had less excess deaths than expected from the State average in this period.

Lives potentially savable The number of lives potentially savable provides an estimate of how many additional cancer patients would survive for at least five years after diagnosis if the relative risks of excess death were decreased across areas. It reflects both area variation in relative survival and the size of the burden of the cancer in the population. It is a theoretical estimate only and does not imply that all of these deaths would be postponed by applying current methods for preventing and treating cancer. As shown in Table 2, a total of 2,903 additional people with one of the 25 major cancers (6.4% of excess deaths due to cancer) could be expected to survive five years if cancer survival was improved. The three cancers with the largest potential gains are cancers of the lung, colon and prostate.

Cancer incidence Table 3 shows a summary of the variation in cancer incidence across Area Health Services. Area Health Services with small populations were generally not significantly different from the State average whereas differences were suggested for some of the larger metropolitan areas.

Cancer mortality Table 4 shows a summary of the variation in cancer mortality across Area Health Services. Due to smaller numbers of deaths, there was less regional variation with the main differences being observed for the metropolitan Area Health Services.

Summary Cancer survival, incidence and mortality in NSW 1994–2000

2 The Cancer Council NSW

Table 1: Summary of comparisons across Area Health Services for the adjusted

relative risk of excess death* by cancer site in NSW 1994–2000

Cancer site

Central Sydney

Northern Sydney

Western Sydney

Wentworth

S/Western Sydney

Central Coast

Hunter

Illawarra

S/Eastern Sydney

Northern Rivers

Mid North Coast

New England

Macquarie

Mid Western

Far West

Greater Murray

Southern

Head and neck Oesophagus Stomach Colon Rectum Liver Gallbladder Pancreas Lung Mesothelioma Breast (female) Melanoma of the skin Cervix Body of uterus Ovary Prostate Testis Bladder Kidney Brain Thyroid Non-Hodgkin lymphoma Hodgkin’s disease Multiple myeloma Leukaemia All cancers#

More excess deaths Fewer excess deaths No significant difference in number of excess deaths

* Empirical Bayes estimates adjusted for age, sex (if appropriate), spread of disease at diagnosis, follow-up year and interaction terms as required. # Includes all 25 sites except for testis cancer.



Table 2: Summary of comparisons across Area Health Services for the number of lives

potentially savable over the first five years after diagnosis by cancer site in NSW 1994–2000

New South Wales

Cancer site

Central Sydney

Northern Sydney

Western Sydney

Wentworth

S/Western Sydney

Central Coast

Hunter

Illawarra

S/Eastern Sydney

Northern Rivers

Mid North Coast

New England

Macquarie

Mid Western

Far West

Greater Murray

Southern

n %†Head and neck 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0.1Oesophagus 7 10 7 3 7 6 8 6 12 5 5 3 1 3 1 5 3 92 7.8Stomach 7 8 7 3 10 5 7 5 11 4 4 2 1 2 1 3 2 82 3.7Colon 21 38 24 9 25 17 30 17 37 14 16 10 4 11 3 12 10 296 6.9Rectum 5 8 5 2 6 4 6 4 9 3 3 2 1 2 1 3 3 66 2.7Liver 14 11 13 3 19 7 9 6 18 3 5 1 1 1 1 3 2 119 14.7Gallbladder 2 2 2 1 2 1 2 2 2 1 1 0 0 0 0 1 1 22 2.9Pancreas 12 21 13 5 14 9 14 9 19 6 7 4 3 4 1 6 5 152 6.2Lung 67 80 70 27 79 48 73 53 89 37 45 22 14 20 8 33 24 791 7.4Mesothelioma* 2 4 4 1 4 3 3 2 5 1 2 0 0 1 0 1 1 36 5.8Breast (female) 7 12 7 4 10 7 9 6 12 6 6 3 1 3 1 4 4 101 9.2Melanoma of the skin 9 13 11 5 12 6 8 7 12 4 5 3 2 3 1 4 3 110 4.4Cervix 2 4 2 2 3 2 4 2 3 1 1 1 1 1 1 2 1 34 7.6Body of uterus 1 1 1 1 1 1 1 1 2 1 1 0 0 0 0 1 0 14 3.5Ovary 8 18 9 4 11 6 12 7 15 3 7 4 2 4 1 5 3 119 11.1Prostate 14 27 17 10 21 11 18 14 26 14 14 9 6 7 2 10 8 228 8.9Testis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.0Bladder 3 5 4 2 5 4 5 3 6 3 3 1 1 2 0 2 1 52 4.0Kidney 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0.1Brain 3 6 4 2 4 2 4 3 6 2 2 1 1 1 0 2 1 44 2.9Thyroid 2 6 4 1 3 0 3 2 7 2 3 1 0 0 0 2 3 39 38.6Non-Hodgkin lymphoma 13 20 14 5 13 8 15 10 25 7 8 4 3 4 1 5 5 159 7.1Hodgkin’s disease 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.2Multiple myeloma 7 13 8 3 8 6 9 7 14 5 5 3 2 2 0 3 3 97 9.6Leukaemia 21 34 22 7 23 13 21 15 32 12 11 9 3 6 1 12 7 249 12.8Total‡ 228 341 247 100 281 164 262 180 362 134 154 85 49 79 24 119 92 2903 6.4

* Based on two-year relative survival. † Percentage of total excess cancer deaths. ‡ Sum of all 25 sites.

Summary Cancer survival, incidence and mortality in NSW 1994–2000


Table 3: Summary of comparisons across Area Health Services for age-standardised incidence by cancer site and sex in NSW 1994–98

Cancer site

Males

Central Sydney

Northern Sydney

Western Sydney

Wentworth

S/Western Sydney

Central Coast

Hunter

Illawarra

S/Eastern Sydney

Northern Rivers

Mid North Coast

New England

Macquarie

Mid Western

Far West

Greater Murray

Southern

Head and neck Oesophagus Stomach Colon Rectum Liver Gallbladder Pancreas Lung Mesothelioma Melanoma of the skin Prostate Testis Bladder Kidney Brain Thyroid Non-Hodgkin lymphoma Hodgkin’s disease Multiple myeloma Leukaemia All cancers

Females Head and neck Oesophagus Stomach Colon Rectum Liver Gallbladder Pancreas Lung Mesothelioma Breast Melanoma of the skin Cervix Body of uterus Ovary Bladder Kidney Brain Thyroid Non-Hodgkin lymphoma Hodgkin’s disease Multiple myeloma Leukaemia All cancers

More new cases than expected. Fewer new cases than expected. No significant difference in number of new cases.



Table 4: Summary of comparisons across Area Health Services for age-standardised

mortality by cancer site and sex in NSW 1994–98

Cancer site

Males

Central Sydney

Northern Sydney

Western Sydney

Wentworth

S/Western Sydney

Central Coast

Hunter

Illawarra

S/Eastern Sydney

Northern Rivers

Mid North Coast

New England

Macquarie

Mid Western

Far West

Greater Murray

Southern

Head and neck Oesophagus Stomach Colon Rectum Liver Gallbladder Pancreas Lung Mesothelioma Melanoma of the skin Prostate Testis Bladder Kidney Brain Thyroid Non-Hodgkin lymphoma Hodgkin’s disease Multiple myeloma Leukaemia All cancers

Females Head and neck Oesophagus Stomach Colon Rectum Liver Gallbladder Pancreas Lung Mesothelioma Breast Melanoma of the skin Cervix Body of uterus Ovary Bladder Kidney Brain Thyroid Non-Hodgkin lymphoma Hodgkin’s disease Multiple myeloma Leukaemia All cancers

More deaths than expected. Fewer deaths than expected. No significant difference in number of deaths.

Introduction Cancer survival, incidence and mortality in NSW 1994–2000


Introduction Patient survival is an indicator of the quality of cancer management including early diagnosis and use of effective treatments. Relative survival at five years after diagnosis is the measure of cancer survival most often used which compares survival in cancer patients with that for a comparable group in the general population. An analysis of cancer survival across regions is useful to highlight possible differences. Further work is then required to seek possible explanations for any differences observed including differences in patient mix (in terms of age, sex and socio-economic factors) and differences across Area Health Services in methods of diagnosis and treatment. It can be used to identify areas where cancer control efforts may need to be more concentrated. Regional variation in cancer survival has been reported in the US (Farrow et al. 1996, Goodwin 2002), Canada (The Canadian Institute for Health Information 2002), England (Cartman et al. 2002), Scotland (Twelves et al. 2001, Campbell et al. 2000), Italy (Gatta et al. 1997) and Denmark (Madsen et al. 2002). Place of residence was found to be an important determinant of survival in women with breast cancer in both Canada and Scotland (The Canadian Institute for Health Information 2002, Twelves et al. 2001). Using population-based registry data, studies in England and Denmark found that survival from lung cancer was dependent on place of residence (Gatta et al. 1997, Madsen et al. 2002). Data for 1983–91 from the Surveillance, Epidemiology and End Results (SEER) Program in the US, suggested significant regional variation in survival for cancers of the colon, rectum, breast, uterus and prostate across SEER areas (Farrow et al. 1996). However, a number of factors make it difficult to interpret the results of such analyses. These factors include an individual’s ability to access primary diagnostic care, and the availability of diagnostic and treatment facilities in different areas. In addition, differences in cancer survival may be due to differences in treatment, or they may be due simply to the addition of ‘lead time’ through earlier detection and diagnosis of cancers. Survival may be increased due to more effective treatment. A good example is the dramatic improvement in survival of childhood leukaemia since the late 1970s, which is entirely the result of improved treatment. Thus, different treatment protocols across areas could result in regional variation in survival rates. When a screening test advances the time of diagnosis without changing the time of death, the measured survival will be increased dramatically. For example, consider a man diagnosed with prostate cancer in 1996 who then died in 1998. If this man received a prostate-specific antigen (PSA) test that led to a prostate cancer diagnosis in 1994, but he still died in 1998, then the survival time would be increased from two years to four years despite no real change in disease outcome. Thus, differences in screening rates across areas could affect the comparison of survival rates between regions. If early treatment is effective and more people with early-stage cancer are detected by screening programs, then there will be a real increase in the survival rate. Good examples of cancers characterised by better response when treated at an early stage are colorectal and breast cancer. If both the treatment regimen and screening coverage are different between areas then regional variation in cancer survival will result. When survival rates are calculated for areas with small populations, the estimates may be affected by sampling error and the estimates for individual areas may lack precision. Also,

Cancer survival, incidence and mortality in NSW 1994–2000 Introduction


sampling error in the observed survival for areas with small populations can mask true regional variation in cancer survival. Consequently, use of these estimates may introduce errors in decision making for health service planning. To control for the effects of sampling error, Empirical Bayes (EB) techniques can be used to estimate the systematic variation across regions and provide more precise estimates for individual areas (Greenland and Robins 1991, Rothman and Greenland 1998). Basically this approach assumes that the excess risk of death after a diagnosis of cancer for a particular area is similar to that for other areas under comparison. The area-specific risk is then combined with those of other areas to produce an estimate that is less affected by sampling error (a ‘shrunken’ estimator). In this way, each area can ‘borrow strength’ from other areas in estimating its area-specific risk. The resulting area-specific estimates are more precise due to the use of additional information from other areas. Little is known about how place of residence affects people’s survival after diagnosis of cancer in Australia. In this report, we address this issue by using the most recent available data from the New South Wales Central Cancer Registry (CCR) and EB techniques to estimate regional variation in cancer survival across NSW Area Health Services. In addition, the number of potential lives that could be extended beyond five years after diagnosis of cancer were estimated to indicate where the greatest gains could be achieved. These were estimated by shifting the mean of the distribution of the relative risk of excess death down to the 20th centile. We also present data on the regional variation in cancer incidence and mortality as background information. The purpose of the report is to present the information on variation in cancer survival, incidence and mortality across Area Health Services as obtained from an analysis of the data from the NSW CCR. As information recorded about patients is limited and information on investigations of treatments provided is not collected, any discussion of the reasons for the observed variation would be speculative. Therefore, we have kept discussion and interpretation of the findings to a minimum. The results should be considered as hypothesis-generating rather than hypothesis-testing. Any significant differences found across Area Health Services should be investigated through other means to identify the possible explanations for the differences.

Methods Cancer survival, incidence and mortality in NSW 1994–2000


Methods Data sources Cancer data for this report were obtained from the NSW Central Cancer Registry (CCR). The Registry is a population-based register of all cancers diagnosed in NSW residents and has been operating since 1972. Notification is mandatory from public and private hospitals, departments of radiation oncology, nursing homes, pathology laboratories, outpatient departments, day procedure centres and the Registrar of Births, Deaths and Marriages. The Cancer Council NSW manages the Registry, which is funded by the NSW Department of Health1.

Incidence data People included in the summaries of cancer incidence were those diagnosed with at least one cancer in the 25 major sites and who were resident in NSW at the time of diagnosis between 1 January 1994 and 31 December 1998. Data for only the first invasive cancer diagnosed in a person during this time period were included.

Mortality data Mortality data were compiled from notifications to the NSW CCR mainly from the Principal Registrar, Births, Deaths and Marriages (NSW). The mortality data were based on place of residence at the time of diagnosis, rather than at the time of death from the cancer, and may therefore differ slightly from analyses of mortality data published by the Australian Bureau of Statistics (ABS). The mortality data for the cancer sites reported here were based on the deaths that occurred during 1994 to 1998.

Survival data Deaths from any causes in people with cancer were compiled by passive follow-up. All people with cancer who were not known to be dead were matched against death records up to 31 December 2000 from the Principal Registrar, Births, Deaths and Marriages (NSW). Matching was also undertaken between cancer cases and all deaths registered in Australia up to 31 December 2000 and recorded on the National Death Index compiled by the Australian Institute of Health and Welfare. Probabilistic matching was used with a multi-pass INTEGRITY algorithm (Vality Technology Incorporated 2000). Equivocal matches were investigated by individual examination of the details available and by active follow-up where necessary. However, no direct contact was made with people with cancer or their families. In the survival analyses reported here, it was assumed that those cases not known to be dead were alive.

Population data Population data for 1994 to 1998 were derived from ABS population estimations. The ABS provides annual estimates of the resident population (ERP) at 30 June by five-year age groups, sex, calendar year and Statistical Local Area (SLA). Area Health Service populations were derived by aggregating the appropriate SLA-level ERPs, except in the cases of Central Sydney and South Eastern Sydney Area Health Services, the border between which transects two SLAs. ERPs for these SLAs were apportioned according to the proportions derived from the 1 For more information about the NSW Central Cancer Registry see Cancer in New South Wales. Incidence and Mortality 2000 (Tracey & Supramaniam 2002).

Cancer survival, incidence and mortality in NSW 1994–2000 Methods


1996 Census usual resident counts at the Collection District level and aggregated with the whole SLAs in each of the two Areas. Population data for this report were obtained from the Health Outcomes Information and Statistical Toolkit (HOIST). HOIST2 contains many data sources commonly used for population health surveillance in NSW.

Spread of disease at diagnosis The NSW CCR requests information for all notifications on the spread of cancer at diagnosis according to a simple classification. Data on degree of spread for most tumours were recorded from notifiers as: localised to tissue of origin (localised), invasion of adjacent organs or regional lymph nodes (regional) and distant metastases (distant). In a number of cases, the degree of spread at diagnosis could not be ascertained and was coded as unknown.

This staging is not as detailed as the standard TNM staging system3 based on the extent of the primary tumour (T), regional lymph nodes (N) and distant metastases (M). Spread of disease is not relevant for lymphomas, multiple myeloma and leukemia. Therefore it was not included in the analyses for these cancers. It was also omitted from the analysis of brain cancers as almost all were localised to the brain.

Area Health Service of residence The geographical variation in cancer survival, incidence, and mortality in NSW in 1994–98 is described across the 17 Area Health Services in NSW. Nine cover the major urban areas with larger populations ranging from 270,000 to 750,000 and eight rural Area Health Services with populations ranging from 50,000 to 250,000. Assignment of cases and deaths to Area Health Services was based on the Local Government Area (LGA) of the place of residence at the time of the diagnosis of cancer. The Area Health Service boundaries defined by the NSW Department of Health in 1996 were used. The following two maps show the current boundaries of the NSW Area Health Services. Each is made up of a number of LGAs, which are listed in Appendix 2.

Figure 1: Map of NSW Area Health Services

2 HOIST is a SAS-based ‘data warehouse’ operated by Centre for Epidemiology and Research of the NSW Department of Health. 3 Condensed TNM for Coding the Extent of Disease recommended by the European Network of Cancer Registries, April 2002.



Indirect age standardisation Age standardisation of incidence and mortality rates was performed using the indirect method. The observed numbers of new cases or deaths represent all new cancers diagnosed or cancer deaths occurring in a specified Area Health Service between 1994 and 1998. The expected numbers of new cases or deaths were calculated using the age-specific rates for NSW multiplied by the age-specific population of the Area Health Service of interest to generate the expected number of events for each age group. These age-specific expected numbers were summed across age groups to get the total expected number for each Area Health Service. The column of expected numbers of new cases or deaths may not add to the total shown as numbers were rounded.

Excess number of new cases or deaths and confidence intervals The excess number of new cases or deaths is the difference between the corresponding observed and expected numbers. A positive excess number indicates that the Area Health Service had more events than expected and a negative number indicates that the Area Health Service had fewer events than expected. The excess numbers of new cases or deaths were ‘shrunk’ using the Empirical Bayes method described below to obtain better area-specific estimates that were less affected by sampling error. The excess was considered to be statistically significantly more or less than expected if its 95% confidence interval did not include zero. The 95% confidence interval is an interval (or range of values) which we can be 95% certain contains the true excess number of new cases or deaths. Confidence intervals provide an indication of the level of statistical uncertainty in the true excess number. A modification of the method described by Ulm was used (Ulm 1990). The confidence limits for the observed number of events were calculated using the Poisson distribution and then the expected number of events (which was treated as a constant) was subtracted from these limits.

Five-year relative survival This report describes five-year relative survival of people in each Area Health Service in NSW (Estėve et al. 1994). Relative survival is the ratio of the observed survival rate experienced by cancer patients over a specified interval of time after diagnosis to the expected survival rate in a comparable group of people (in terms of age and sex) from the general population. The life table for the corresponding Area Health Service was used to calculate the expected survival. A relative survival of 100% in a particular group indicates that the cancer has had no effect on the survival of that group. A relative survival of 80% in a particular group indicates that 20% more people diagnosed with cancer had died during the five years than in a comparable group of people from the general population. If the survival analysis was restricted to patients diagnosed between 1994 and 1998, five-year survival would have been available only for the 1994 and 1995 patient cohorts because follow-up was carried out only to the end of 2000. Therefore, to supplement the information from the patients diagnosed between 1994 and 1998, we used the later survival experience of patients diagnosed between 1991 and 1993. This method of analysis, called period analysis, reflects the most recent survival experience based on the deaths in the period 1994 to 2000 (Brenner and Gefeller 1996). Patients diagnosed in 1994–1998 contributed to the first two years of survival after diagnosis, those diagnosed 1993–1997 contributed to the third year, those diagnosed 1992–1996 contributed to the fourth year and those diagnosed 1991–1995 provided five-year survival (Brenner and Hakulinen 2002). The years of diagnosis and years of follow-up used in



the analysis of relative survival are illustrated in Figure 2 showing that the survival experience refers to the years between 1994 and 2000. Figure 2: Patients included in the estimation of relative survival using the period method

Follow-up interval (year) Year of diagnosis/Year of follow-up

1 1994/1995 1995/1996 1996/1997 1997/1998 1998/19992 1994/1996 1995/1997 1996/1998 1997/1999 1998/20003 1993/1996 1994/1997 1995/1998 1996/1999 1997/20004 1992/1996 1993/1997 1994/1998 1995/1999 1996/20005 1991/1996 1992/1997 1993/1998 1994/1999 1995/2000

The survival analysis was limited to people under 90 years of age at diagnosis to avoid misclassification of vital status that can occur in very elderly people. People who were notified to the cancer registry by death certificate only or who were diagnosed post mortem were excluded, as survival time for these cases was effectively zero.

Adjusted relative risk of excess death and confidence intervals Adjusted relative risks of excess death due to a diagnosis of cancer are presented for each Area Health Service. Relative risk indicates the risk of excess death within five years after diagnosis compared to that of the reference category which, in this analysis, was the State average. The higher the relative risk of excess death, the lower the chance of surviving the first five years after a diagnosis of cancer. The relative risk of excess death was calculated from the regression coefficients of a generalised linear model. As relative risk may be influenced by factors such as age, sex, year of follow-up and spread of disease at diagnosis, the model was fitted with these variables as covariates to produce adjusted relative risks for each Area Health Service. To test the assumption of proportional excess hazards over age or spread of disease, interaction terms involving these variables and year of follow-up were fitted in the model together with the main effects when convergence of the model was achieved. For most cancer sites age was divided into four groups: 15–44 years, 45–59 years, 60–74 years and 75–89 years. Age groups used for the analysis of specific cancers are described in Appendix 3. The follow-up period was stratified into 12-month intervals. Point estimates and 95% confidence intervals for the relative risks were calculated from the estimated coefficients for each Area Health Service and are presented in the tables in this report. Confidence intervals indicate the uncertainty about the true relative risk of excess death in the population. Wide confidence intervals reflect small numbers of observed cases and small populations at risk and hence increased uncertainty about the true value. Confidence intervals that did not include one (1) were taken to indicate that the relative risk of excess death was statistically significantly higher or lower than expected from the State average. These results are included in Appendix 4.

Excess deaths due to cancer The death rates of cancer patients are usually higher than those of the general population. The number of excess deaths provides a measure of the burden of mortality from cancer within five years of diagnosis. It provides an estimate of the difference between the actual number of



additional deaths occurring within five years of a cancer diagnosis in each Area Health Service and the number that would be expected based on the State average risk.

Empirical Bayes method The estimated relative risk of excess death was highly uncertain for some rare cancers especially in Area Health Services with small populations (such as the Far West Area Health Service). The Empirical Bayes (EB) method was used to ‘shrink’ the relative risk and to reduce the uncertainty of estimates in areas with small populations. The EB method combines the information about the individual area-specific risk with information about risk from all other areas in the study. The resulting relative risk takes the form of a weighted average of the observed risk for an individual area and the mean relative risk across areas. On applying this approach, formerly unstable estimates became less extreme and more precise, whereas moderate, stable estimates remained much the same. For cancers with large numbers of events, such as lung and colon cancer, the EB estimates from areas with large populations were similar to the estimates from the standard approach. On the other hand, the EB estimates were ‘shrunk’ towards the State average (which is set to 1) for rare cancers such as thyroid and liver cancer for areas with small populations. The method is described in greater detail in Appendix 3. The estimated ‘unshrunken’ relative risks of excess death for each cancer site by Area Health Service are shown in Appendix 4. For some cancer sites, because area variation was so small, the ‘shrunken’ estimates of the adjusted relative risk of excess death or the excess number of new cases or deaths were all equal to the null values of 1 or 0 (respectively). Also the 95% confidence limits were very close to 1 or 0. In this situation, it has been indicated in the corresponding columns of the table that there was no area variation. In other situations the results for each Area Health Service are shown even though there was no statistically significant regional variation. A p-value less than 0.05 corresponding to the statistical test for regional variation was taken to indicate significant differences across Area Health Services. Only differences across Area Health Services that reached statistical significance are reported and discussed in the text.

Potential lives savable The number of lives savable was calculated by shifting the mean relative risk of excess death after a diagnosis of cancer to the 20th centile of the distribution. This represents the additional number of cancer patients that would survive five years after diagnosis if cancer survival was improved across the State. It reflects both area variation in relative survival and the size of the burden of the cancer in the population. While there may be significant regional variation for some cancer sites, the overall potential gains may not be sufficient to expend resources in improving survival for that cancer. However, for some of the cancer sites with large numbers of patients, there may be considerable gains to be made through small improvements. While the choice of the 20th centile is somewhat arbitrary, it was a recommended reporting format considered to be a more realistic and achievable target for improvement in quality of care (Gibberd et al. 2000). The column totals shown for the number of lives savable may vary from the sum of the individual entries due to rounding of numbers for each Area Health Service.



Guide to interpretation of results The quantities presented in the tables for survival, incidence and mortality are explained in the order in which they occur across the columns. Five-year relative survival is the ratio of the observed survival rate experienced by cancer patients over five years to the expected survival rate in a comparable group of people (in terms of age, sex and Area Health Service (AHS) of residence) from the general population. Relative risk of excess death provides a measure for comparing risk of excess death after a diagnosis of cancer across AHSs while adjusting for other factors that may affect survival. The State average risk was used as the reference and set to a value of 1. The higher the relative risk the lower the chance of surviving five years, and the lower the relative risk the higher the chance of surviving five years. For example, area A with a relative risk of 1.5 indicates that patients from that area experienced a 50% higher risk of excess death than those in the State as a whole. For area B with a relative risk of 0.5, the risk of excess death was 50% lower than the State average. Excess number of cancer deaths is the difference in the observed number of excess deaths in a given area due to a diagnosis of cancer and the number that would be expected if the risk of excess death in that area was the same as the State average. A positive excess number indicates that the AHS had more deaths in cancer patients within five years of diagnosis than expected from the State average and a negative number indicates that the AHS had fewer excess deaths within five years than expected. The number of potential lives savable represents the additional number of cancer patients who would survive up to five years after diagnosis. These could be used to identify cancer sites in which improvement in cancer care could result in large gains in survival. Number of observed new cases is the number of new cases diagnosed in each AHS during 1994–1998 and notified to the registry. Expected number of new cases (or deaths) was calculated using indirect age standardisation and the rates for the whole of NSW as the standard. It represents the number of events that would have been reported in each AHS if its rate was the same as that of NSW. Excess number of new cases (or deaths) is the difference between the observed and expected numbers of new cases or deaths. The estimates were ‘shrunk’ to the mean of the distribution using the EB method and represent the magnitude of the difference between the area-specific and State average incidence (or mortality) rates. Percent of new cases aged 65 years or over at diagnosis is the number of new cases aged 65 years or over divided by the total number of new cases and multiplied by 100. This allows a comparison to be made of the age-structure of the cancer patients across AHSs. Percent of new cases diagnosed as non-localised is the number of new cases that were non-localised (regional or distant spread) at diagnosis as a proportion of the total number of new cases, excluding cases with unknown stage of disease at diagnosis. It is an indicator of the severity of cancer at diagnosis in each of the AHSs. Number of observed deaths is the number of cancer deaths that occurred in each AHS during 1994–1998 and identified by the registry.

All cancers Cancer survival, incidence and mortality in NSW 1994–2000


Results All cancers

• This category includes all cancers in this report except testis cancer • The five-year relative survival from all these cancers in NSW between 1994 and 2000 was

61.0% • The adjusted relative risks of excess death after shrinking were higher than expected in

Western Sydney (6%, 203 excess deaths), Wentworth (11%, 155 excess deaths), New England (7%, 90 excess deaths), Macquarie (9%, 65 excess deaths), Mid Western (12%, 131 excess deaths) and Southern (6%, 75 excess deaths); and lower than expected in Central Sydney (4%, 130 fewer deaths), Northern Sydney (12%, 700 fewer deaths), South Eastern Sydney (9%, 542 fewer deaths) and Northern Rivers (5%, 111 fewer deaths)

• If the State average risk of excess death was shifted to the 20th centile of the distribution, an additional 2,088 cancer patients would be expected to survive to five years after diagnosis – the largest numbers being in South Eastern Sydney and Northern Sydney

• There were 124,369 new cases of all cancers in NSW in 1994 to 1998 (68,586 males and 55,783 females) and 52,278 deaths (29,921 males and 22,357 females)

• There were more new cases of cancer than expected in Northern Sydney (294 in females), Central Coast (303 in males, 126 in females), Illawarra (161 in males), South Eastern Sydney (247 in females) and Greater Murray (160 in males); and fewer than expected in Northern Sydney (286 in males), Western Sydney (166 in females), South Western Sydney (167 in males, 226 in females), Northern Rivers (83 in females) and New England (95 in males)

• There were more deaths from all cancers than expected after shrinking in Central Sydney (103 in females), Hunter (119 in males), Illawarra (82 in males) and New England (42 in females); and fewer than expected in Northern Sydney (482 in males), Northern Rivers (93 in males, 109 in females) and Mid North Coast (78 in females)

Table 5a: Five-year relative survival, relative risk of excess death due to

cancer and excess cancer deaths after shrinking with 95% confidence intervals and potential lives savable by Area Health Services in NSW 1994–2000. All cancers

Five-year relative Relative risk of excess Excess number of Potential Area Health Service survival (%) death (95% CI) cancer deaths (95% CI) lives savable

Central Sydney 57.9 0.96 (0.93-1.00) -130 (-244,-17) 163 Northern Sydney 66.7 0.88 (0.86-0.91) -700 (-839,-560) 241 Western Sydney 59.6 1.06 (1.02-1.09) 203 (86,320) 176 Wentworth 60.5 1.11 (1.06-1.16) 155 (83,228) 74 South Western Sydney 58.2 1.01 (0.98-1.04) 29 (-97,155) 202 Central Coast 60.4 0.99 (0.95-1.03) -26 (-122,71) 122 Hunter 60.3 0.98 (0.95-1.01) -67 (-190,56) 190 Illawarra 59.7 1.00 (0.97-1.04) 9 (-91,109) 130 South Eastern Sydney 63.0 0.91 (0.89-0.94) -542 (-687,-397) 260 Northern Rivers 62.0 0.95 (0.91-0.99) -111 (-197,-25) 97 Mid North Coast 61.7 1.00 (0.97-1.04) 12 (-80,103) 110 New England 58.6 1.07 (1.02-1.13) 90 (25,155) 61 Macquarie 56.2 1.09 (1.02-1.16) 65 (17,113) 36 Mid Western 56.4 1.12 (1.06-1.18) 131 (68,194) 58 Far West 54.0 1.04 (0.95-1.12) 14 (-17,44) 18 Greater Murray 61.9 1.01 (0.97-1.06) 23 (-57,103) 86 Southern 59.4 1.06 (1.01-1.11) 75 (7,143) 66 New South Wales† 61.0 1.00 2088

Note: Relative risk of excess death compares observed relative survival with that expected from a Poisson model including terms for age, sex, follow-up year, site and spread of disease at diagnosis, and site and spread of disease by follow-up year interaction terms, with the NSW average rates as the reference. † All sites except testis cancer combined as one group.

Cancer survival, incidence and mortality in NSW 1994–2000 All cancers


Table 5b: Observed and expected number of new cases and deaths, excess new cases

and deaths with 95% confidence intervals, percent of cases aged 65 years or over and with non-localised spread of disease at diagnosis by Area Health Services in NSW 1994–98. All cancers

Males

Number of new cases % diagnosed % diagnosed Number of deaths Area Health Service

observed expected excess* (95% CI) 65+ yrs as non-localised observed expected excess* (95% CI)

Central Sydney 5066 5177 -97 (-228,33) 65.1 51.5 2311 2260 45 (-43,133) Northern Sydney 8349 8659 -286 (-458,-114) 65.8 40.1 3326 3849 -482 (-591,-373) Western Sydney 5516 5668 -134 (-271,3) 57.1 42.2 2437 2370 59 (-32,150) Wentworth 2275 2353 -60 (-141,22) 55.8 43.0 998 988 7 (-46,61) South Western Sydney 6153 6340 -167 (-313,-21) 59.4 48.6 2760 2656 93 (-4,190) Central Coast 4126 3762 303 (189,417) 73.3 42.4 1790 1706 71 (-5,147) Hunter 6250 6090 142 (-4,288) 65.9 45.3 2806 2673 119 (21,217) Illawarra 4267 4076 161 (44,278) 66.7 51.2 1860 1763 82 (4,159) South Eastern Sydney 8574 8556 17 (-157,191) 65.8 45.9 3801 3781 19 (-97,134) Northern Rivers 3420 3389 25 (-78,129) 69.4 44.3 1402 1515 -93 (-160,-26) Mid North Coast 3848 3752 80 (-31,191) 68.1 45.2 1618 1677 -50 (-122,23) New England 1887 2018 -95 (-169,-22) 63.7 46.7 876 881 -4 (-53,46) Macquarie 1129 1139 -6 (-57,45) 64.4 49.0 540 492 29 (-6,63) Mid Western 1807 1857 -35 (-106,35) 64.0 48.6 848 810 27 (-21,75) Far West 565 588 -10 (-41,21) 61.1 61.4 284 252 14 (-7,35) Greater Murray 3118 2917 160 (63,257) 65.0 42.9 1330 1275 44 (-20,107) Southern 2236 2244 -6 (-86,74) 65.3 45.5 934 973 -29 (-81,23) New South Wales 68586 68586 64.8 45.3 29921 29921 Females



Central Sydney 4192 4219 -22 (-137,93) 53.2 49.2 1827 1703 103 (27,178) Northern Sydney 7978 7647 294 (130,459) 54.5 44.4 3093 3184 -82 (-185,22) Western Sydney 4738 4936 -166 (-290,-42) 45.5 44.3 1897 1853 37 (-41,115) Wentworth 2054 2089 -24 (-98,50) 43.2 42.7 784 765 13 (-32,58) South Western Sydney 5102 5368 -226 (-356,-97) 44.3 49.7 1961 1994 -28 (-108,52) Central Coast 3074 2907 126 (32,220) 57.7 44.9 1212 1230 -14 (-74,46) Hunter 4967 4885 68 (-58,194) 52.9 46.0 2084 1989 81 (-1,163) Illawarra 3216 3112 80 (-17,177) 50.7 47.5 1237 1238 -1 (-62,60) South Eastern Sydney 7356 7075 247 (90,405) 53.9 48.0 2968 2898 62 (-38,163) Northern Rivers 2385 2500 -83 (-165,-1) 57.3 41.5 881 1028 -109 (-160,-58) Mid North Coast 2655 2687 -24 (-111,63) 54.5 43.9 1008 1112 -78 (-133,-24) New England 1589 1612 -14 (-77,48) 49.1 46.6 714 649 42 (0,83) Macquarie 861 892 -15 (-55,26) 52.8 44.2 379 355 12 (-15,38) Mid Western 1416 1489 -44 (-103,14) 53.8 46.6 622 605 11 (-28,49) Far West 390 430 -13 (-35,10) 52.4 53.0 194 173 7 (-8,22) Greater Murray 2220 2275 -39 (-117,39) 51.3 42.5 864 922 -41 (-91,8) Southern 1590 1660 -45 (-107,18) 51.0 45.9 632 660 -18 (-58,22) New South Wales 55783 55783 51.7 46.0 22357 22357

* Excess number after shrinking.

Head and neck Cancer survival, incidence and mortality in NSW 1994–2000


Head and neck cancer

• This category includes cancers of the tongue, mouth (excluding lip), salivary glands, pharynx, larynx and nasal passages, middle ear and accessory sinuses

• The five-year relative survival from head and neck cancer in NSW between 1994 and 2000 was 55.2%

• There was no area variation in the adjusted relative risk of excess death after shrinking due to head and neck cancer

• There were 4,270 new cases of head and neck cancer in NSW in 1994 to 1998 (3,127 males and 1,143 females) and 1,768 deaths (1,334 males and 434 females)

• There were more new cases of head and neck cancer than expected after shrinking in Central Sydney (38 in males) and South Eastern Sydney (48 in males), and fewer than expected in Northern Sydney (104 in males)

• There were 21 more deaths from head and neck cancer than expected after shrinking in males in Central Sydney and 40 fewer than expected in males in Northern Sydney

• There was no area variation in the excess number of deaths in females

Table 6a: Five-year relative survival, relative risk of excess death due to cancer and excess cancer deaths after shrinking with 95% confidence intervals and potential lives savable by Area Health Services in NSW 1994–2000. Head and neck cancer


Central Sydney 55.8 Northern Sydney 57.4 Western Sydney 59.0 Wentworth 57.3 South Western Sydney 56.7 Central Coast 52.6 Hunter 52.3 Illawarra 55.0 South Eastern Sydney 57.9 Northern Rivers 56.1

There was no area variation in the adjusted relative risks of excess death due to head and neck cancer after shrinking

Mid North Coast 56.2 New England 46.6 Macquarie 46.2 Mid Western 60.7 Far West 32.6 Greater Murray 51.1 Southern 55.9 New South Wales† 55.2

Note: Relative risk of excess death compares observed relative survival with that expected from a Poisson model including terms for age, sex, follow-up year, and spread of disease at diagnosis and age by follow-up year interaction term, with the NSW average rates as the reference.

Cancer survival, incidence and mortality in NSW 1994–2000 Head and neck



and deaths with 95% confidence intervals, percent of cases aged 65 years or over and with non-localised spread of disease at diagnosis by Area Health Services in NSW 1994–98. Head and neck cancer

Males



Central Sydney 284 236 38 (9,67) 47.5 66.7 130 100 21 (3,39)

Northern Sydney 270 391 -104 (-134,-73) 50.0 60.9 117 167 -40 (-60,-20)

Western Sydney 275 274 1 (-29,30) 40.0 42.9 101 112 -8 (-25,9)

Wentworth 93 114 -13 (-29,3) 35.5 55.7 32 46 -7 (-16,2)

South Western Sydney 292 303 -9 (-40,21) 47.3 61.2 143 124 14 (-6,34)

Central Coast 182 160 15 (-6,37) 58.2 68.2 70 71 -1 (-14,12)

Hunter 281 274 6 (-24,35) 61.9 50.6 136 118 13 (-6,33)

Illawarra 181 185 -3 (-26,20) 53.0 62.0 69 80 -7 (-20,7)

South Eastern Sydney 440 384 48 (10,86) 49.1 58.2 176 165 9 (-14,32)

Northern Rivers 148 148 0 (-20,20) 56.8 54.5 55 65 -6 (-18,6)

Mid North Coast 158 164 -4 (-25,17) 51.9 60.9 69 72 -2 (-15,11)

New England 88 93 -3 (-17,11) 44.3 73.7 38 40 -1 (-9,8)

Macquarie 68 53 7 (-3,17) 47.1 58.5 31 22 3 (-3,9)

Mid Western 89 85 2 (-12,16) 49.4 51.6 36 36 0 (-8,8)

Far West 39 28 3 (-3,9) 43.6 65.4 21 12 2 (-1,5)

Greater Murray 137 133 3 (-16,21) 50.4 66.7 68 57 6 (-5,18)

Southern 102 103 0 (-16,15) 55.9 57.6 40 44 -2 (-11,7)

New South Wales 3127 3127 50.1 58.6 1334 1334

Females



Central Sydney 112 86 14 (-1,28) 46.4 46.0 41 33

Northern Sydney 168 157 7 (-13,28) 58.3 49.2 65 63

Western Sydney 98 99 -1 (-16,14) 50.0 45.8 45 36

Wentworth 33 42 -3 (-10,4) 42.4 52.0 13 15

South Western Sydney 98 108 -6 (-21,9) 54.1 58.3 32 38

Central Coast 81 61 9 (-2,20) 71.6 53.0 27 24

Hunter 91 101 -6 (-20,9) 68.1 64.2 39 39

Illawarra 52 64 -6 (-16,5) 55.8 57.6 20 24

South Eastern Sydney 166 146 13 (-7,34) 56.6 46.0 61 57

Northern Rivers 47 52 -2 (-11,7) 70.2 57.1 17 20

Mid North Coast 47 56 -4 (-13,5) 57.4 64.0 19 22

There was no area variation in excess number of deaths

New England 24 33 -3 (-9,3) 50.0 65.0 12 13

Macquarie 18 18 0 (-4,4) 38.9 50.0 4 7

Mid Western 24 31 -2 (-8,4) 58.3 50.0 5 12

Far West 9 9 0 (-2,2) 44.4 60.0 2 3

Greater Murray 40 47 -3 (-11,5) 55.0 51.7 19 18

Southern 35 34 0 (-6,7) 45.7 43.5 13 13

New South Wales 1143 1143 56.3 51.9 434 434


Oesophagus Cancer survival, incidence and mortality in NSW 1994–2000


Cancer of the oesophagus

• The five-year relative survival from oesophageal cancer in NSW between 1994 and 2000 was 16.3%

• No Area Health Service was different from the State average in the adjusted relative risk of excess death after shrinking

• An additional 92 patients would be expected to survive to five years after diagnosis in NSW if the State average risk was shifted to the 20th centile of the distribution

• There were 1,554 new cases of oesophageal cancer in NSW in 1994 to 1998 (961 males and 593 females) and 1,214 deaths (762 males and 452 females)

• There were more new cases of oesophageal cancer than expected in Mid Western (seven in males) and Southern (nine in males)

• There were no Area Health Services in which the number of deaths from oesophageal cancer was different from expected in males, although significant area variation in the excess number of deaths was detected (p = 0.01)

• There was no area variation in the excess number of deaths after shrinking in females

Table 7a: Five-year relative survival, relative risk of excess death due to cancer and excess cancer deaths after shrinking with 95% confidence intervals and potential lives savable by Area Health Services in NSW 1994–2000. Cancer of the oesophagus


Central Sydney 15.2 1.01 (0.89-1.13) 1 (-9,11) 7 Northern Sydney 19.1 1.00 (0.89-1.11) 0 (-15,15) 10 Western Sydney 16.4 1.04 (0.91-1.16) 3 (-6,12) 7 Wentworth 13.4 1.00 (0.87-1.14) 0 (-5,6) 3 South Western Sydney 23.1 0.96 (0.84-1.07) -4 (-16,7) 7 Central Coast 13.0 1.05 (0.93-1.18) 3 (-4,11) 6 Hunter 18.4 0.98 (0.86-1.09) -3 (-15,10) 8 Illawarra 14.5 1.02 (0.89-1.14) 1 (-8,10) 6 South Eastern Sydney 9.2 1.07 (0.95-1.18) 9 (-6,24) 12 Northern Rivers 17.6 0.94 (0.82-1.05) -5 (-15,5) 5 Mid North Coast 19.0 0.95 (0.83-1.07) -4 (-12,5) 5 New England 16.2 0.98 (0.86-1.11) -1 (-7,5) 3 Macquarie 27.4 0.96 (0.83-1.10) -1 (-4,2) 1 Mid Western 9.7 1.04 (0.91-1.17) 1 (-3,6) 3 Far West N/A 1.04 (0.89-1.18) 0 (-1,1) 1 Greater Murray 18.8 1.00 (0.88-1.13) 0 (-7,7) 5 Southern 18.2 0.96 (0.84-1.09) -2 (-9,5) 3 New South Wales† 16.3 1.00 92

Note: Relative risk of excess death compares observed relative survival with that expected from a Poisson model including terms for age, sex, follow-up year, and spread of disease at diagnosis and age by follow-up year interaction term, with the NSW average rates as the reference. N/A: No cases alive after the 4th year of follow-up.

Cancer survival, incidence and mortality in NSW 1994–2000 Oesophagus



and deaths with 95% confidence intervals, percent of cases aged 65 years or over and with non-localised spread of disease at diagnosis by Area Health Services in NSW 1994–98. Cancer of the oesophagus

Males



Central Sydney 63 72 -6 (-19,7) 63.5 75.7 51 57 -4 (-15,7)

Northern Sydney 103 122 -14 (-32,3) 63.1 63.6 77 97 -14 (-29,1)

Western Sydney 66 79 -9 (-22,5) 51.5 52.6 51 62 -7 (-18,5)

Wentworth 36 33 2 (-6,9) 69.4 70.4 34 26 3 (-3,10)

South Western Sydney 84 88 -3 (-18,12) 60.7 61.7 67 69 -1 (-14,11)

Central Coast 46 53 -4 (-15,6) 65.2 68.8 39 42 -2 (-10,7)

Hunter 76 85 -7 (-21,8) 69.7 60.9 61 68 -4 (-16,8)

Illawarra 60 57 2 (-10,13) 76.7 65.4 44 45 -1 (-10,9)

South Eastern Sydney 116 120 -3 (-21,16) 64.1 73.1 99 95 3 (-14,19)

Northern Rivers 54 48 4 (-7,14) 66.7 52.2 36 38 -1 (-9,7)

Mid North Coast 44 53 -5 (-16,5) 56.8 75.0 35 42 -4 (-12,5)

New England 41 28 5 (-2,13) 65.9 71.4 33 23 4 (-2,9)

Macquarie 14 16 -1 (-5,4) 57.1 88.9 11 13 0 (-4,3)

Mid Western 44 26 7 (0,15) 68.2 53.6 38 21 6 (0,11)

Far West 9 8 0 (-2,3) 55.6 33.3 8 7 0 (-2,2)

Greater Murray 54 41 7 (-3,17) 72.2 62.5 44 33 5 (-3,13)

Southern 51 32 9 (0,17) 70.6 62.5 34 25 3 (-3,10)

New South Wales 961 961 65.0 64.8 762 762

Females



Central Sydney 49 46 0 (-2,2) 89.8 50.0 33 35

Northern Sydney 81 87 0 (-4,4) 85.2 39.3 70 68

Western Sydney 41 47 0 (-2,2) 80.5 44.8 34 35

Wentworth 14 19 0 (-1,1) 92.9 50.0 12 14

South Western Sydney 41 50 0 (-3,2) 78.0 53.6 24 36

Central Coast 44 34 0 (-1,2) 72.7 43.3 36 26

Hunter 57 53 0 (-2,3) 84.2 53.6 47 41

Illawarra 37 32 0 (-1,2) 83.8 63.6 27 24


Northern Rivers 37 28 0 (-1,1) 81.1 45.5 29 21

Mid North Coast 35 30 0 (-1,1) 74.3 27.8 19 23


New England 14 17 0 (-1,1) 85.7 66.7 12 13

Macquarie 9 9 0 (0,0) 66.7 100.0 7 7

Mid Western 13 16 0 (-1,1) 84.6 42.9 10 12

Far West 7 5 0 (0,0) 85.7 100.0 5 3

Greater Murray 32 25 0 (-1,1) 68.8 52.6 20 19

Southern 11 17 0 (-1,1) 81.8 33.3 9 13

New South Wales 593 593 81.5 47.5 452 452


Stomach Cancer survival, incidence and mortality in NSW 1994–2000


Stomach cancer

• The five-year relative survival from stomach cancer in NSW between 1994 and 2000 was 25.3%


• An additional 82 patients would be expected to survive five years after diagnosis in NSW if the State average risk was shifted to the 20th centile of the distribution

• There were 3,208 new cases of stomach cancer in NSW in 1994 to 1998 (2,091 males and 1,117 females) and 2,300 deaths (1,525 males and 775 females)

• There were more new cases of stomach cancer than expected in South Western Sydney (43 in males and 19 in females) and Central Sydney (19 in females), and fewer than expected in Northern Sydney (44 in males) and Northern Rivers (10 in females)

• There were more deaths from stomach cancer than expected in South Western Sydney (31 in males), and fewer than expected in Northern Sydney (33 in males)

Table 8a: Five-year relative survival, relative risk of excess death due to cancer and excess cancer deaths after shrinking with 95% confidence intervals and potential lives savable by Area Health Services in NSW 1994–2000. Stomach cancer


Central Sydney 28.7 0.98 (0.90-1.07) -3 (-21,14) 7

Northern Sydney 32.2 0.92 (0.84-1.00) -21 (-41,0) 8

Western Sydney 25.2 1.00 (0.91-1.09) -1 (-17,16) 7

Wentworth 20.8 1.04 (0.93-1.14) 2 (-4,9) 3

South Western Sydney 22.9 1.01 (0.93-1.10) 4 (-18,25) 10

Central Coast 14.5 1.04 (0.94-1.14) 4 (-7,15) 5

Hunter 27.2 0.96 (0.88-1.05) -8 (-26,10) 7

Illawarra 26.4 1.03 (0.94-1.13) 4 (-8,17) 5

South Eastern Sydney 27.0 0.98 (0.90-1.06) -7 (-32,18) 11

Northern Rivers 20.8 1.00 (0.90-1.10) 0 (-10,10) 4

Mid North Coast 25.6 1.02 (0.92-1.12) 2 (-8,12) 4

New England 20.1 1.04 (0.93-1.14) 2 (-3,7) 2

Macquarie 25.3 0.99 (0.89-1.10) 0 (-5,4) 1

Mid Western 23.3 1.03 (0.92-1.14) 1 (-3,6) 2

Far West 12.0 1.02 (0.91-1.13) 0 (-2,2) 1

Greater Murray 29.3 1.00 (0.89-1.10) 0 (-8,7) 3

Southern 22.4 1.02 (0.91-1.12) 1 (-5,6) 2

New South Wales 25.3 1.00 82


Cancer survival, incidence and mortality in NSW 1994–2000 Stomach



and deaths with 95% confidence intervals, percent of cases aged 65 years or over and with non-localised spread of disease at diagnosis by Area Health Services in NSW 1994–98. Stomach cancer

Males



Central Sydney 177 158 12 (-8,33) 71.2 74.8 119 115 2 (-14,19)

Northern Sydney 209 268 -44 (-70,-19) 67.5 71.3 153 197 -33 (-54,-11)

Western Sydney 175 170 3 (-18,24) 57.1 78.8 136 122 9 (-9,27)

Wentworth 72 71 0 (-11,12) 56.9 84.9 52 51 0 (-9,10)

South Western Sydney 252 190 43 (18,68) 56.7 81.0 183 136 31 (11,52)

Central Coast 110 116 -4 (-19,12) 73.6 82.4 84 87 -1 (-15,12)

Hunter 191 186 3 (-19,26) 71.2 75.0 145 136 6 (-13,25)

Illawarra 135 123 7 (-10,24) 65.9 83.5 105 89 9 (-6,23)

South Eastern Sydney 268 263 4 (-24,32) 70.5 78.5 183 193 -7 (-30,16)

Northern Rivers 101 104 -2 (-16,13) 79.2 84.8 74 77 -2 (-14,11)

Mid North Coast 102 115 -7 (-23,8) 81.4 91.9 76 85 -5 (-18,8)

New England 59 61 -1 (-11,9) 61.0 85.4 45 45 0 (-8,8)

Macquarie 37 34 1 (-5,7) 83.8 88.2 26 25 0 (-5,5)

Mid Western 53 56 -1 (-11,8) 60.4 82.9 37 41 -2 (-9,6)

Far West 20 18 0 (-3,4) 55.0 100.0 18 13 1 (-2,4)

Greater Murray 75 89 -7 (-20,6) 66.7 92.3 50 65 -7 (-17,3)

Southern 55 68 -6 (-16,5) 65.5 66.7 39 49 -4 (-13,4)

New South Wales 2091 2091 67.2 80.0 1525 1525

Females



Central Sydney 113 86 19 (2,35) 68.1 74.4 81 60 10 (-1,21)

Northern Sydney 140 161 -17 (-38,4) 74.3 72.1 94 115 -13 (-29,2)

Western Sydney 100 91 6 (-10,22) 71.0 72.8 66 62 2 (-9,13)

Wentworth 34 38 -2 (-10,6) 76.5 52.4 25 25 0 (-5,5)

South Western Sydney 124 98 19 (1,37) 64.5 79.5 84 65 9 (-3,21)

Central Coast 61 62 -1 (-13,11) 82.0 67.6 41 44 -1 (-9,7)

Hunter 90 99 -7 (-23,9) 77.8 81.0 60 69 -5 (-16,7)

Illawarra 68 61 4 (-8,17) 76.5 75.6 46 42 2 (-6,10)

South Eastern Sydney 173 146 21 (-1,44) 68.2 79.2 115 103 7 (-8,23)

Northern Rivers 34 51 -10 (-19,0) 76.5 84.0 27 36 -3 (-10,4)

Mid North Coast 48 55 -4 (-15,6) 75.0 65.6 31 38 -3 (-10,4)

New England 24 32 -4 (-11,3) 91.7 71.4 22 23 0 (-5,4)

Macquarie 20 18 1 (-4,5) 65.0 57.1 14 12 0 (-2,3)

Mid Western 20 30 -4 (-11,2) 85.0 91.7 15 21 -1 (-6,3)

Far West 6 9 0 (-3,2) 100.0 66.7 6 6 0 (-1,1)

Greater Murray 37 46 -5 (-14,4) 75.7 75.0 29 32 -1 (-7,5)

Southern 25 33 -3 (-11,4) 80.0 94.4 19 22 -1 (-5,4)

New South Wales 1117 1117 73.1 75.2 775 775


Colon Cancer survival, incidence and mortality in NSW 1994–2000


Colon cancer

• The five-year relative survival from colon cancer in NSW between 1994 and 2000 was 60.4%

• The adjusted relative risks of excess death after shrinking were higher in Western Sydney (14%, 40 excess deaths) and Mid Western (19%, 22 excess deaths), and lower in Northern Sydney (11%, 67 fewer deaths)

• If the State average risk of excess death was shifted to the 20th centile of the distribution, an additional 296 patients with colon cancer would be expected to survive to five years after diagnosis in NSW – the largest numbers being in Northern Sydney and South Eastern Sydney

• There were 11,936 new cases of colon cancer in NSW in 1994 to 1998 (6,181 males and 5,755 females) and 5,034 deaths (2,556 males and 2,478 females)

• There were more new cases of colon cancer than expected in Hunter (39 in males and 52 in females) and Central Coast (30 in females), and fewer than expected in Western Sydney (46 in males and 38 in females), Central Sydney (43 in females) and South Western Sydney (51 in females)

• There were 27 more deaths after shrinking from colon cancer in females than expected in Hunter, and there was no Area Health Service in which the number of deaths from colon cancer was different from expected in males

Table 9a: Five-year relative survival, relative risk of excess death due to cancer and excess cancer deaths after shrinking with 95% confidence intervals and potential lives savable by Area Health Services in NSW 1994–2000. Colon cancer


Central Sydney 58.2 1.07 (0.96-1.17) 19 (-10,48) 21

Northern Sydney 64.1 0.89 (0.82-0.96) -67 (-110,-24) 38

Western Sydney 56.6 1.14 (1.03-1.24) 40 (9,71) 24

Wentworth 60.1 1.05 (0.91-1.18) 6 (-10,23) 9

South Western Sydney 59.6 0.93 (0.85-1.01) -28 (-62,6) 25

Central Coast 63.1 0.94 (0.85-1.04) -15 (-42,12) 17

Hunter 60.4 1.02 (0.93-1.10) 7 (-29,44) 30

Illawarra 62.0 0.94 (0.84-1.04) -16 (-43,11) 17


Northern Rivers 66.5 0.97 (0.86-1.08) -7 (-30,16) 14

Mid North Coast 63.8 1.00 (0.89-1.11) 0 (-25,25) 16

New England 53.7 1.12 (0.98-1.26) 13 (-3,30) 10

Macquarie 64.6 1.03 (0.87-1.19) 2 (-7,11) 4

Mid Western 51.5 1.19 (1.04-1.34) 22 (5,39) 11

Far West 61.0 1.01 (0.84-1.18) 0 (-6,6) 3

Greater Murray 59.5 1.04 (0.92-1.16) 7 (-14,28) 12

Southern 56.2 1.12 (0.98-1.26) 15 (-2,31) 10



Cancer survival, incidence and mortality in NSW 1994–2000 Colon



and deaths with 95% confidence intervals, percent of cases aged 65 years or over and with non-localised spread of disease at diagnosis by Area Health Services in NSW 1994–98. Colon cancer

Males



Central Sydney 440 466 -16 (-49,17) 73.2 69.9 198 193 2 (-16,20)

Northern Sydney 795 785 7 (-40,54) 66.0 73.9 299 330 -18 (-44,9)

Western Sydney 435 507 -46 (-79,-12) 58.9 67.7 192 203 -5 (-23,14)

Wentworth 182 209 -11 (-29,6) 57.1 74.2 82 84 -1 (-10,9)

South Western Sydney 523 565 -28 (-65,9) 56.6 75.0 188 226 -18 (-38,1)

Central Coast 371 340 17 (-10,44) 76.6 69.9 171 145 10 (-5,25)

Hunter 608 549 39 (0,77) 63.3 76.8 261 228 16 (-5,37)

Illawarra 393 367 15 (-14,43) 66.4 76.4 164 150 5 (-10,20)


Northern Rivers 333 306 14 (-11,39) 68.8 68.8 113 129 -6 (-18,7)

Mid North Coast 365 340 13 (-14,40) 65.5 74.6 153 143 4 (-11,18)

New England 164 183 -7 (-23,9) 61.6 71.4 73 76 -1 (-9,8)

Macquarie 107 103 1 (-9,11) 66.4 66.7 39 42 0 (-5,4)

Mid Western 176 168 3 (-13,18) 61.9 77.6 71 70 0 (-7,8)

Far West 62 53 1 (-4,7) 61.3 82.0 24 22 0 (-2,3)

Greater Murray 253 263 -5 (-27,17) 65.6 71.0 115 109 2 (-10,13)

Southern 196 203 -3 (-21,15) 64.3 70.0 76 83 -2 (-11,7)

New South Wales 6181 6181 65.2 72.9 2556 2556

Females



Central Sydney 377 436 -43 (-76,-10) 72.4 75.0 179 191 -6 (-26,13)

Northern Sydney 860 814 38 (-14,90) 74.5 73.2 360 362 -1 (-32,30)

Western Sydney 423 475 -38 (-74,-3) 69.0 73.7 194 200 -3 (-23,17)

Wentworth 179 194 -8 (-28,11) 64.2 67.9 77 81 -1 (-11,9)

South Western Sydney 445 512 -51 (-88,-14) 61.3 78.7 179 213 -19 (-40,1)

Central Coast 365 319 30 (1,60) 74.2 72.3 152 137 7 (-9,22)

Hunter 582 513 52 (11,93) 64.3 74.7 268 221 27 (3,50)

Illawarra 316 322 -4 (-33,24) 67.1 81.0 135 136 0 (-16,15)


Northern Rivers 289 266 14 (-12,40) 74.7 76.2 100 114 -6 (-19,7)

Mid North Coast 319 290 19 (-9,46) 72.4 76.1 126 124 1 (-13,15)

New England 163 167 -2 (-20,16) 67.5 79.4 88 73 5 (-5,14)

Macquarie 81 92 -4 (-15,7) 72.8 72.3 40 39 0 (-5,6)

Mid Western 172 156 8 (-10,25) 68.0 76.5 86 68 5 (-4,14)

Far West 46 45 0 (-6,6) 73.9 67.5 22 19 0 (-2,3)

Greater Murray 230 238 -5 (-28,18) 65.2 69.9 86 103 -6 (-18,5)

Southern 158 171 -7 (-25,11) 64.6 72.8 70 73 -1 (-10,8)

New South Wales 5755 5755 70.0 74.8 2478 2478


Rectum Cancer survival, incidence and mortality in NSW 1994–2000


Rectal cancer

• The five-year relative survival from rectal cancer in NSW between 1994 and 2000 was 60.2%

• No Area Health Service was significantly different from the State average in the adjusted relative risk of excess death after shrinking


• There were 6,727 new cases of rectal cancer in NSW in 1994 to 1998 (4,046 males and 2,681 females) and 2,880 deaths (1,738 males and 1,142 females)

• There were more new cases of rectal cancer than expected in Illawarra (28 in males) and Greater Murray (22 in males), and fewer than expected in Northern Sydney (46 in males) and South Western Sydney (27 in females)

• There were 35 fewer deaths from rectal cancer in males than expected in Northern Sydney. There were 21 more deaths from rectal cancer in females than expected in Central Sydney and 14 fewer than expected in Northern Rivers

Table 10a: Five-year relative survival, relative risk of excess death due to cancer and excess cancer deaths after shrinking with 95% confidence intervals and potential lives savable by Area Health Services in NSW 1994–2000. Rectal cancer


Central Sydney 59.4 1.00 (0.95-1.05) 0 (-10,10) 5 Northern Sydney 62.8 0.99 (0.94-1.04) -3 (-18,12) 8 Western Sydney 60.8 1.01 (0.96-1.06) 2 (-8,12) 5 Wentworth 61.2 1.01 (0.96-1.07) 1 (-3,5) 2 South Western Sydney 58.3 1.01 (0.96-1.06) 2 (-9,13) 6 Central Coast 59.9 0.98 (0.93-1.04) -2 (-11,6) 4 Hunter 58.6 1.01 (0.96-1.06) 2 (-10,14) 6 Illawarra 60.7 1.00 (0.94-1.05) -1 (-10,8) 4 South Eastern Sydney 61.5 0.98 (0.93-1.03) -7 (-26,11) 9 Northern Rivers 64.2 0.99 (0.94-1.05) -1 (-7,5) 3 Mid North Coast 64.4 1.00 (0.95-1.06) 0 (-6,7) 3 New England 58.4 1.01 (0.95-1.06) 0 (-3,4) 2 Macquarie 49.7 1.01 (0.95-1.07) 0 (-1,2) 1 Mid Western 55.6 1.00 (0.95-1.06) 0 (-3,4) 2 Far West 52.2 1.01 (0.95-1.06) 0 (-1,1) 1 Greater Murray 62.8 0.99 (0.94-1.05) -1 (-7,6) 3 Southern 58.3 1.01 (0.95-1.07) 1 (-4,6) 3 New South Wales 60.2 1.00 66


Cancer survival, incidence and mortality in NSW 1994–2000 Rectum


Table 10b: Observed and expected number of new cases and deaths, excess new cases and deaths with 95% confidence intervals, percent of cases aged 65 years or over and with non-localised spread of disease at diagnosis by Area Health Services in NSW 1994–98. Rectal cancer

Males



Central Sydney 274 305 -21 (-49,6) 61.7 63.4 117 131 -8 (-25,8)

Northern Sydney 452 511 -46 (-84,-9) 62.6 61.6 173 222 -35 (-57,-12)

Western Sydney 323 339 -12 (-41,18) 56.0 63.8 128 140 -7 (-25,10)

Wentworth 127 140 -6 (-22,10) 48.0 56.2 49 58 -3 (-12,6)


Central Coast 231 218 8 (-15,31) 68.8 64.0 100 97 2 (-12,15)

Hunter 355 358 -2 (-34,29) 57.7 70.3 169 155 9 (-11,29)

Illawarra 284 241 28 (2,53) 60.2 72.9 125 103 12 (-4,27)


Northern Rivers 192 198 -4 (-25,17) 68.8 61.8 76 87 -5 (-18,7)

Mid North Coast 242 220 14 (-10,37) 65.3 58.4 95 97 -1 (-15,13)

New England 101 120 -9 (-23,5) 69.3 72.3 49 52 -1 (-9,7)

Macquarie 52 68 -5 (-14,4) 57.7 60.0 24 29 -1 (-6,4)

Mid Western 106 110 -2 (-15,12) 61.3 67.4 43 47 -1 (-9,6)

Far West 37 35 0 (-5,6) 59.5 70.8 17 15 0 (-3,3)

Greater Murray 212 172 22 (2,43) 60.4 60.5 95 74 9 (-3,21)

Southern 152 133 9 (-7,26) 62.5 65.6 68 57 4 (-5,14)

New South Wales 4046 4046 60.9 65.1 1738 1738

Females



Central Sydney 233 202 18 (-4,41) 65.7 62.6 119 88 21 (4,38)

Northern Sydney 362 374 -9 (-41,23) 68.5 56.3 149 166 -14 (-35,8)

Western Sydney 226 227 -1 (-24,23) 58.0 57.8 93 93 0 (-15,16)

Wentworth 88 94 -2 (-14,10) 46.6 59.5 39 38 1 (-8,9)


Central Coast 123 146 -12 (-28,5) 66.7 66.7 56 63 -4 (-16,7)

Hunter 250 238 8 (-17,32) 63.6 61.3 101 102 -1 (-17,16)

Illawarra 156 151 3 (-15,20) 59.0 65.6 64 63 1 (-11,13)


Northern Rivers 102 123 -10 (-24,4) 72.5 54.8 28 53 -14 (-23,-5)

Mid North Coast 121 134 -6 (-22,9) 64.5 60.2 43 57 -8 (-19,2)

New England 79 78 0 (-10,11) 55.7 56.5 40 33 3 (-5,11)

Macquarie 39 43 -1 (-7,5) 59.0 72.4 18 18 0 (-5,5)

Mid Western 75 72 1 (-9,11) 62.7 77.2 44 31 6 (-2,13)

Far West 15 21 -1 (-4,2) 66.7 72.7 8 9 0 (-3,2)

Greater Murray 124 110 6 (-8,20) 58.9 64.9 53 47 3 (-7,13)

Southern 99 80 7 (-4,18) 64.6 56.8 43 34 4 (-4,12)

New South Wales 2681 2681 63.3 62.4 1142 1142


Liver Cancer survival, incidence and mortality in NSW 1994–2000


Liver cancer

• The five-year relative survival from liver cancer in NSW between 1994 and 2000 was 12.6%

• The adjusted relative risks of excess death after shrinking were higher in Mid North Coast (33%, seven excess deaths), and lower in South Eastern Sydney (21%, 34 fewer deaths)

• If the State average risk of excess death was shifted to the 20th centile of the distribution, an additional 119 people with liver cancer in NSW would be expected to survive to five years after diagnosis

• There were 1,016 new cases of liver cancer in NSW in 1994 to 1998 (749 males and 267 females) and 774 deaths (567 males and 207 females)

• There were more new cases of liver cancer than expected in Central Sydney (38 in males), Western Sydney (18 in males), South Western Sydney (34 in males and 20 in females) and South Eastern Sydney (22 in males); and fewer than expected in Northern Sydney (17 in males and 13 in females), Illawarra (12 in males), Northern Rivers (13 in males), Mid North Coast (12 in males), New England (nine in males and four in females), Macquarie (six in males), Mid Western (nine in males), Greater Murray (nine in males) and Southern (eight in males)

• There were more deaths than expected in Central Sydney (24 in males), South Western Sydney (30 in males and 13 in females) and Western Sydney (nine in females); and fewer than expected in Northern Sydney (19 in males), Illawarra (13 in males), Northern Rivers (12 in males), Macquarie (five in males), Southern (seven in males) and New England (three in females)


cancer and excess cancer deaths after shrinking with 95% confidence intervals and potential lives savable by Area Health Services in NSW 1994–2000. Liver cancer


Central Sydney 14.9 0.85 (0.70-1.00) -18 (-35,0) 14 Northern Sydney 8.7 1.00 (0.80-1.20) 0 (-14,15) 11 Western Sydney 15.2 1.00 (0.82-1.18) 0 (-16,16) 13 Wentworth 9.2 1.00 (0.72-1.28) 0 (-6,6) 3 South Western Sydney 10.1 1.12 (0.95-1.30) 14 (-6,34) 19 Central Coast 5.4 1.20 (0.92-1.47) 7 (-3,17) 7 Hunter 5.2 1.25 (0.99-1.51) 11 (0,23) 9 Illawarra 7.6 1.04 (0.79-1.29) 1 (-8,11) 6 South Eastern Sydney 20.5 0.79 (0.66-0.92) -34 (-54,-13) 18 Northern Rivers 22.3 0.79 (0.56-1.02) -7 (-14,1) 3 Mid North Coast 4.0 1.33 (1.00-1.67) 7 (0,14) 5 New England N/A 0.99 (0.65-1.32) 0 (-3,3) 1 Macquarie 36.3 0.95 (0.61-1.29) 0 (-2,2) 1 Mid Western 17.8 1.06 (0.71-1.41) 0 (-2,3) 1 Far West 9.7 1.13 (0.76-1.50) 1 (-1,3) 1 Greater Murray 9.6 1.11 (0.80-1.42) 2 (-4,8) 3 Southern 13.8 0.95 (0.66-1.24) -1 (-6,4) 2 New South Wales 12.6 1.00 119


Cancer survival, incidence and mortality in NSW 1994–2000 Liver



and deaths with 95% confidence intervals, percent of cases aged 65 years or over and with non-localised spread of disease at diagnosis by Area Health Services in NSW 1994–98. Liver cancer

Males



Central Sydney 99 56 38 (20,57) 59.6 39.5 70 43 24 (9,39)

Northern Sydney 75 93 -17 (-33,0) 54.7 42.9 50 71 -19 (-32,-5)

Western Sydney 84 64 18 (1,35) 44.0 40.0 63 47 14 (-1,28)

Wentworth 25 27 -1 (-10,8) 48.0 72.7 21 20 1 (-7,9)


Central Coast 41 40 1 (-11,13) 68.3 69.2 35 31 3 (-7,14)

Hunter 54 66 -11 (-25,3) 59.3 66.7 46 50 -4 (-17,9)

Illawarra 31 45 -12 (-23,-2) 51.6 62.5 19 34 -13 (-21,-4)


Northern Rivers 21 36 -13 (-22,-4) 76.2 71.4 13 28 -12 (-19,-5)

Mid North Coast 26 40 -12 (-22,-3) 69.2 25.0 21 31 -8 (-17,0)

New England 10 22 -9 (-16,-3) 50.0 50.0 11 17 -4 (-10,2)

Macquarie 4 13 -6 (-10,-2) 75.0 50.0 2 9 -5 (-8,-1)

Mid Western 9 20 -9 (-15,-3) 55.6 40.0 8 15 -5 (-10,0)

Far West 10 7 2 (-2,6) 70.0 33.3 8 5 1 (-2,5)

Greater Murray 21 32 -9 (-18,-1) 57.1 40.0 20 24 -3 (-11,5)

Southern 15 25 -8 (-15,-1) 60.0 16.7 9 19 -7 (-13,-2)

New South Wales 749 749 58.1 45.8 567 567

Females



Central Sydney 28 20 6 (-3,15) 67.9 27.3 16 16 0 (-6,7)

Northern Sydney 22 37 -13 (-22,-4) 68.2 40.0 21 29 -7 (-15,2)

Western Sydney 30 23 6 (-4,15) 56.7 35.7 30 17 9 (1,18)

Wentworth 6 9 -2 (-6,2) 83.3 100.0 5 7 -1 (-4,2)


Central Coast 13 15 -1 (-7,5) 69.2 50.0 13 12 1 (-5,6)

Hunter 18 24 -5 (-12,3) 88.9 50.0 15 18 -3 (-9,4)

Illawarra 13 15 -1 (-8,5) 84.6 100.0 9 12 -2 (-7,3)


Northern Rivers 6 12 -4 (-9,0) 83.3 100.0 6 10 -2 (-6,2)

Mid North Coast 13 13 0 (-6,6) 53.8 50.0 10 10 0 (-5,5)

New England 0 8 -4 (-7,-2) 0.0 0.0 0 6 -3 (-5,0)

Macquarie 5 4 0 (-2,3) 60.0 25.0 3 3 0 (-2,2)

Mid Western 5 7 -1 (-5,2) 80.0 33.3 4 6 -1 (-4,2)

Far West 3 2 0 (-1,2) 66.7 66.7 3 2 0 (-1,1)

Greater Murray 7 11 -3 (-7,2) 28.6 66.7 3 9 -3 (-7,0)

Southern 4 8 -2 (-6,1) 75.0 100.0 3 6 -1 (-4,1)

New South Wales 267 267 65.2 47.5 207 207


Gallbladder Cancer survival, incidence and mortality in NSW 1994–2000


Gallbladder cancer

• The five-year relative survival from gallbladder cancer in NSW between 1994 and 2000 was 18.8%

• No Area Health Service was significantly different from the State average in the adjusted relative risk of excess death after shrinking

• An additional 22 patients would be expected to survive to five years after diagnosis in NSW if the State average risk of excess death was shifted to the 20th centile of the distribution

• There were 1,031 new cases of gallbladder cancer in NSW in 1994 to 1998 (440 males and 591 females) and 762 deaths (316 males and 446 females)

• There were more new cases and more deaths in females from gallbladder cancer than expected in Central Sydney (17 cases and 13 deaths) and fewer than expected in females in Northern Sydney (16 cases and 13 deaths)

• There were no Area Health Services in which the number of new cases or deaths from gallbladder cancer was significantly different from that expected in males

Table 12a: Five-year relative survival, relative risk of excess death due to cancer and excess cancer deaths after shrinking with 95% confidence intervals and potential lives savable by Area Health Services in NSW 1994–2000. Gallbladder cancer


Central Sydney 19.4 1.01 (0.91-1.12) 1 (-6,7) 2 Northern Sydney 14.4 1.01 (0.91-1.11) 1 (-7,9) 2 Western Sydney 22.9 1.01 (0.90-1.11) 0 (-5,6) 2 Wentworth 25.6 0.99 (0.88-1.10) 0 (-4,3) 1 South Western Sydney 19.9 0.99 (0.89-1.09) -1 (-9,8) 2 Central Coast 7.1 1.01 (0.91-1.12) 1 (-4,5) 1 Hunter 21.5 0.95 (0.85-1.04) -5 (-15,4) 2 Illawarra 18.3 1.02 (0.91-1.12) 1 (-4,6) 2 South Eastern Sydney 25.2 0.97 (0.87-1.07) -3 (-12,6) 2 Northern Rivers 15.3 1.01 (0.90-1.12) 0 (-3,4) 1 Mid North Coast 9.9 1.02 (0.91-1.13) 1 (-2,4) 1 New England 27.6 0.99 (0.88-1.10) 0 (-2,2) 0 Macquarie N/A 1.00 (0.89-1.11) 0 (-1,1) 0 Mid Western 27.2 1.00 (0.89-1.11) 0 (-2,2) 0 Far West N/A 1.00 (0.88-1.11) 0 (0,0) 0 Greater Murray 19.4 1.02 (0.91-1.13) 1 (-2,3) 1 Southern 7.0 1.03 (0.92-1.14) 0 (-1,2) 1 New South Wales 18.8 1.00 22

Note: Relative risk of excess death compares observed relative survival with that expected from a Poisson model including terms for age, sex, follow-up year, and spread of disease at diagnosis and age by follow-up year interaction term, with the NSW average rates as the reference. N/A: Only one case alive after the 4th year of follow-up.

Cancer survival, incidence and mortality in NSW 1994–2000 Gallbladder


Table 12b: Observed and expected number of new cases and deaths, excess new cases and deaths with 95% confidence intervals, percent of cases aged 65 years or over and with non-localised spread of disease at diagnosis by Area Health Services in NSW 1994–98. Gallbladder cancer

Males



Central Sydney 32 33 0 (-2,2) 68.8 78.3 21 24 0 (-3,3)

Northern Sydney 50 56 0 (-4,3) 84.0 74.3 31 40 -1 (-6,3)

Western Sydney 33 35 0 (-2,2) 57.6 66.7 31 25 1 (-2,4)

Wentworth 13 15 0 (-1,1) 69.2 44.4 8 10 0 (-1,1)

South Western Sydney 47 40 0 (-2,3) 68.1 75.8 31 28 0 (-3,4)

Central Coast 26 25 0 (-2,2) 92.3 76.9 21 18 0 (-2,2)

Hunter 54 39 1 (-2,3) 75.9 92.6 37 28 1 (-3,4)

Illawarra 27 26 0 (-2,2) 88.9 84.6 21 19 0 (-2,2)


Northern Rivers 21 22 0 (-1,1) 71.4 80.0 14 16 0 (-2,2)

Mid North Coast 16 25 0 (-2,1) 62.5 92.3 10 18 -1 (-3,2)

New England 10 13 0 (-1,1) 90.0 100.0 9 9 0 (-1,1)

Macquarie 8 7 0 (0,0) 37.5 75.0 8 5 0 (-1,1)

Mid Western 8 12 0 (-1,1) 62.5 80.0 5 9 0 (-1,1)

Far West 1 4 0 (0,0) 0.0 100.0 0 3 0 (0,0)

Greater Murray 18 19 0 (-1,1) 72.2 75.0 13 13 0 (-2,2)

Southern 15 14 0 (-1,1) 66.7 75.0 13 10 0 (-1,1)

New South Wales 440 440 72.3 77.1 316 316

Females



Central Sydney 70 45 17 (4,29) 72.9 76.5 57 34 13 (3,24)

Northern Sydney 64 85 -16 (-31,-2) 81.3 78.3 47 65 -13 (-25,-1)

Western Sydney 48 48 0 (-11,11) 64.6 64.9 28 35 -4 (-13,4)

Wentworth 28 20 4 (-3,10) 75.0 85.7 18 14 1 (-3,6)


Central Coast 31 33 -1 (-10,7) 77.4 100.0 27 25 1 (-6,8)

Hunter 62 53 6 (-6,19) 74.2 82.9 42 40 1 (-9,11)

Illawarra 44 33 7 (-3,16) 86.4 77.8 36 25 6 (-2,13)

South Eastern Sydney 62 77 -12 (-26,2) 75.8 72.3 43 59 -11 (-22,0)

Northern Rivers 22 27 -3 (-10,4) 86.4 92.3 19 21 -1 (-7,5)

Mid North Coast 25 30 -3 (-10,5) 76.0 89.5 17 22 -3 (-9,3)

New England 14 17 -1 (-6,4) 78.6 88.9 16 13 1 (-3,5)

Macquarie 4 9 -2 (-5,1) 100.0 100.0 5 7 0 (-3,2)

Mid Western 13 16 -1 (-6,4) 84.6 100.0 13 12 0 (-4,4)

Far West 1 5 -1 (-2,1) 100.0 100.0 2 3 0 (-1,1)

Greater Murray 23 24 -1 (-8,6) 65.2 82.4 17 18 -1 (-6,5)

Southern 13 17 -2 (-7,3) 92.3 66.7 13 13 0 (-4,4)

New South Wales 591 591 75.8 78.9 446 446


Pancreas Cancer survival, incidence and mortality in NSW 1994–2000


Cancer of the pancreas

• The five-year relative survival from pancreatic cancer in NSW between 1994 and 2000 was 5.4%

• There was no significant area variation in the adjusted relative risk of excess death after shrinking


• There were 2,839 new cases of pancreatic cancer in NSW in 1994 to 1998 (1,411 males and 1,428 females) and 2,543 deaths (1,223 males and 1,320 females)

• There were no Area Health Services in which the number of new cases or deaths from pancreatic cancer was different from expected in females

• There was no area variation in the excess numbers of new cases or deaths in males

Table 13a: Five-year relative survival, relative risk of excess death due to cancer and excess cancer deaths after shrinking with 95% confidence intervals and potential lives savable by Area Health Services in NSW 1994–2000. Cancer of the pancreas


Central Sydney 6.6 0.96 (0.86-1.05) -9 (-29,10) 12

Northern Sydney 4.1 0.92 (0.84-1.00) -31 (-61,-2) 21

Western Sydney 6.4 1.01 (0.92-1.11) 2 (-17,22) 13

Wentworth 2.5 1.05 (0.93-1.17) 3 (-5,11) 5


Central Coast 2.4 1.03 (0.93-1.14) 4 (-9,18) 9

Hunter 5.0 1.02 (0.92-1.12) 4 (-16,25) 14

Illawarra 3.4 1.04 (0.94-1.15) 6 (-8,19) 9


Northern Rivers 11.0 0.97 (0.86-1.08) -3 (-15,9) 6

Mid North Coast 5.2 1.00 (0.89-1.11) 0 (-12,12) 7

New England 3.6 1.07 (0.94-1.19) 3 (-3,9) 4

Macquarie 6.6 0.99 (0.87-1.11) -1 (-7,6) 3

Mid Western 5.3 1.04 (0.92-1.16) 2 (-4,9) 4

Far West N/A 1.00 (0.87-1.13) 0 (-2,2) 1

Greater Murray 3.7 1.05 (0.94-1.17) 5 (-5,14) 6

Southern 7.5 1.02 (0.90-1.14) 1 (-7,10) 5



Cancer survival, incidence and mortality in NSW 1994–2000 Pancreas


Table 13b: Observed and expected number of new cases and deaths, excess new cases and deaths with 95% confidence intervals, percent of cases aged 65 years or over and with non-localised spread of disease at diagnosis by Area Health Services in NSW 1994–98. Cancer of the pancreas

Males



Central Sydney 128 106 65.6 94.4 108 92

Northern Sydney 160 181 76.9 89.6 141 157

Western Sydney 116 113 58.6 78.5 94 97

Wentworth 38 47 57.9 73.1 34 40

South Western Sydney 137 127 56.2 84.2 115 109

Central Coast 81 80 80.2 95.6 76 69

Hunter 122 126 72.1 90.9 113 109

Illawarra 79 83 74.7 85.7 70 72

South Eastern Sydney 176 178 76.1 89.0 146 154

Northern Rivers 67 71 79.1 88.2 49 62

Mid North Coast 74 79

There was no area variation in excess number of new cases 78.4 86.4 56 69


New England 39 42 69.2 79.2 39 36

Macquarie 33 23 75.8 81.0 28 20

Mid Western 40 38 62.5 94.4 37 33

Far West 10 12 70.0 100.0 13 10

Greater Murray 64 60 76.6 80.5 57 52

Southern 47 46 74.5 83.3 47 40

New South Wales 1411 1411 70.8 86.9 1223 1223

Females



Central Sydney 103 109 -1 (-7,6) 83.5 92.8 99 101 -1 (-12,11)

Northern Sydney 226 207 4 (-9,16) 84.5 80.7 204 192 6 (-14,26)

Western Sydney 128 114 2 (-6,9) 74.2 84.0 120 104 6 (-7,18)

Wentworth 55 46 0 (-3,3) 78.2 82.1 49 42 1 (-4,7)


Central Coast 72 81 -1 (-6,4) 76.4 89.7 69 76 -2 (-11,7)

Hunter 136 128 1 (-7,9) 78.7 86.7 120 119 1 (-13,14)

Illawarra 79 79 0 (-5,5) 78.5 93.8 66 73 -2 (-11,7)


Northern Rivers 60 67 0 (-5,4) 81.7 82.9 52 62 -2 (-10,5)

Mid North Coast 53 72 -1 (-6,3) 75.5 78.3 43 67 -6 (-14,2)

New England 37 41 0 (-3,2) 86.5 100.0 36 38 0 (-5,5)

Macquarie 25 23 0 (-1,2) 72.0 68.4 28 21 1 (-2,4)

Mid Western 40 39 0 (-2,3) 75.0 83.3 41 36 1 (-4,6)

Far West 10 11 0 (-1,1) 100.0 100.0 9 10 0 (-1,1)

Greater Murray 50 59 -1 (-4,3) 76.0 86.7 50 55 -1 (-8,6)

Southern 45 42 0 (-3,3) 60.0 90.3 49 39 2 (-3,7)

New South Wales 1428 1428 78.8 85.5 1320 1320


Lung Cancer survival, incidence and mortality in NSW 1994–2000


Lung cancer

• The five-year relative survival from lung cancer in NSW between 1994 and 2000 was 13.2%

• The adjusted relative risks of excess death due to lung cancer after shrinking were higher in the Hunter (9%, 81 excess deaths); and lower in Northern Sydney (8%, 92 fewer deaths), South Eastern Sydney (9%, 115 fewer deaths) and Northern Rivers (7%, 39 fewer deaths)

• An additional 791 patients with lung cancer would be expected to survive to five years after diagnosis in NSW if the State average risk was shifted to the 20th centile of the distribution – the largest numbers being in South Eastern Sydney and Northern Sydney

• There were 13,230 new cases of lung cancer in NSW in 1994 to 1998 (9,052 males and 4,178 females) and 10,959 deaths (7,624 males and 3,335 females)

• For males, there were more new cases and more deaths from lung cancer than expected in Central Sydney (119 cases and 102 deaths), Western Sydney (83 cases and 80 deaths) and South Western Sydney (98 cases and 97 deaths); and fewer than expected in Northern Sydney (271 cases and 246 deaths) and South Eastern Sydney (123 cases and 110 deaths)

• For females, there were no Area Health Services in which the numbers of new cases or deaths from lung cancer were different from expected, although significant area variation in the excess number of new cases was detected (p=0.04)


cancer and excess cancer deaths after shrinking with 95% confidence intervals and potential lives savable by Area Health Services in NSW 1994–2000. Lung cancer


Central Sydney 13.4 0.99 (0.93-1.04) -12 (-65,42) 67

Northern Sydney 16.2 0.92 (0.87-0.97) -92 (-151,-32) 80

Western Sydney 14.2 1.04 (0.98-1.10) 35 (-19,89) 70

Wentworth 16.5 1.04 (0.95-1.12) 13 (-16,42) 27


Central Coast 12.8 1.05 (0.98-1.12) 32 (-10,75) 48

Hunter 9.9 1.09 (1.03-1.15) 81 (26,136) 73

Illawarra 10.9 1.01 (0.95-1.08) 9 (-37,54) 53

South Eastern Sydney 14.2 0.91 (0.87-0.96) -115 (-178,-51) 89

Northern Rivers 15.2 0.93 (0.86-1.00) -39 (-77,-1) 37

Mid North Coast 10.7 1.05 (0.98-1.12) 28 (-13,69) 45

New England 10.0 1.00 (0.92-1.09) 1 (-25,26) 22

Macquarie 10.5 1.06 (0.96-1.17) 11 (-6,28) 14

Mid Western 8.9 1.03 (0.94-1.12) 8 (-15,32) 20

Far West 10.4 1.01 (0.90-1.12) 1 (-11,13) 8

Greater Murray 13.3 1.06 (0.98-1.14) 24 (-8,57) 33

Southern 10.7 1.09 (1.00-1.18) 25 (-1,51) 24


Note: Relative risk of excess death compares observed relative survival with that expected from a Poisson model including terms for age, sex, follow-up years, and spread of disease at diagnosis, and age and spread of disease by follow-up year interaction terms, with the NSW average rates as the reference.

Cancer survival, incidence and mortality in NSW 1994–2000 Lung



and deaths with 95% confidence intervals, percent of cases aged 65 years or over and with non-localised spread of disease at diagnosis by Area Health Services in NSW 1994–98. Lung cancer

Males



Central Sydney 813 679 119 (67,171) 68.0 79.4 687 572 102 (54,150)

Northern Sydney 850 1140 -271 (-326,-215) 76.8 75.4 701 966 -246 (-297,-196)

Western Sydney 820 728 83 (30,135) 66.5 65.6 694 604 80 (32,129)

Wentworth 300 298 2 (-28,32) 61.0 68.2 254 248 5 (-23,32)


Central Coast 517 509 6 (-35,48) 78.1 80.0 447 435 10 (-28,48)

Hunter 850 810 36 (-18,91) 72.9 70.7 708 684 22 (-28,71)

Illawarra 594 546 41 (-3,86) 71.4 82.8 492 459 29 (-11,69)

South Eastern Sydney 996 1128 -123 (-183,-63) 73.2 73.8 836 954 -110 (-165,-55)

Northern Rivers 477 457 17 (-23,56) 76.5 76.3 389 389 0 (-35,36)

Mid North Coast 505 511 -5 (-46,36) 73.7 79.3 419 434 -13 (-50,25)

New England 255 267 -9 (-36,19) 74.9 85.0 200 224 -18 (-43,6)

Macquarie 168 151 11 (-9,31) 62.5 68.8 146 126 13 (-6,31)

Mid Western 240 245 -4 (-30,22) 70.8 84.2 219 206 9 (-15,34)

Far West 97 78 9 (-3,22) 66.0 83.0 77 65 6 (-6,17)

Greater Murray 370 387 -14 (-48,20) 68.6 74.9 331 326 4 (-28,37)

Southern 275 300 -19 (-48,10) 67.6 69.4 236 252 -12 (-39,15)

New South Wales 9052 9052 71.1 75.2 7624 7624

Females



Central Sydney 322 311 6 (-20,33) 69.6 76.0 256 249 2 (-16,20)

Northern Sydney 532 573 -30 (-68,9) 74.1 70.5 418 463 -22 (-50,7)

Western Sydney 377 351 16 (-13,46) 65.3 70.5 278 276 1 (-19,20)

Wentworth 167 144 9 (-6,24) 63.5 74.6 131 113 3 (-6,12)


Central Coast 269 233 19 (-4,41) 68.4 82.5 200 188 3 (-11,17)

Hunter 332 373 -26 (-55,3) 64.2 78.6 303 299 2 (-19,22)

Illawarra 255 239 8 (-14,31) 63.1 82.5 207 190 5 (-10,19)


Northern Rivers 173 195 -10 (-29,8) 67.6 81.6 126 156 -7 (-19,5)

Mid North Coast 218 213 2 (-18,23) 65.1 75.6 172 170 0 (-12,13)

New England 112 120 -3 (-16,10) 65.2 85.5 95 96 0 (-8,8)

Macquarie 67 66 0 (-8,8) 70.1 73.2 61 53 1 (-4,5)

Mid Western 86 112 -9 (-21,3) 66.3 65.3 78 90 -2 (-9,5)

Far West 42 32 1 (-3,5) 54.8 66.7 37 26 1 (-2,3)

Greater Murray 168 172 -2 (-19,15) 69.0 69.3 133 137 -1 (-12,10)

Southern 123 126 -1 (-14,12) 67.5 66.7 101 100 0 (-8,8)

New South Wales 4178 4178 67.7 74.9 3335 3335


Mesothelioma Cancer survival, incidence and mortality in NSW 1994–2000


Mesothelioma

• Due to the small number of new cases of mesothelioma and its high fatality, two-year relative survival was estimated

• The two-year relative survival from mesothelioma in NSW between 1994 and 2000 was 15.1%


• An additional 36 patients would be expected to survive to two years after diagnosis in NSW if the State average risk was shifted to the 20th centile of the distribution

• There were 765 new cases of mesothelioma in NSW in 1994 to 1998 (663 males and 102 females) and 684 deaths (594 males and 90 females)

• There were 13 more new cases of mesothelioma than expected in males in Central Coast, and six fewer than expected in males in New England

• For males, there were more deaths from mesothelioma than expected in South Western Sydney (17) and Central Coast (15); and fewer than expected in Northern Rivers (10), New England (seven) and Greater Murray (seven)

• For females, there were no Area Health Services in which the number of new cases or deaths from mesothelioma was different from expected

Table 15a: Two-year relative survival, relative risk of excess death due to

cancer and excess cancer deaths after shrinking with 95% confidence intervals and potential lives savable by Area Health Services in NSW 1994–2000. Mesothelioma

Two-year relative Relative risk of excess Excess number of Potential Area Health Service survival (%) death (95% CI) cancer deaths (95% CI) lives savable

Central Sydney 8.7 1.03 (0.91-1.15) 1 (-3,5) 2

Northern Sydney 18.8 0.98 (0.87-1.09) -2 (-10,7) 4

Western Sydney 12.8 1.01 (0.90-1.13) 1 (-6,8) 4

Wentworth 23.4 0.99 (0.87-1.11) 0 (-3,3) 1


Central Coast 10.1 1.03 (0.91-1.15) 1 (-4,7) 3

Hunter 17.6 0.97 (0.86-1.08) -2 (-8,5) 3

Illawarra 23.2 0.98 (0.86-1.09) -1 (-6,4) 2

South Eastern Sydney 13.2 1.00 (0.89-1.11) 0 (-9,9) 5

Northern Rivers 12.2 0.98 (0.86-1.10) 0 (-4,3) 1

Mid North Coast 22.5 0.97 (0.85-1.08) -1 (-6,4) 2

New England 13.0 1.00 (0.88-1.13) 0 (-1,1) 0

Macquarie N/A 0

Mid Western 18.9 0.99 (0.87-1.12) 0 (-2,2) 1

Far West N/A 0

Greater Murray 12.9 1.00 (0.88-1.12) 0 (-2,3) 1

Southern 11.6 1.01 (0.88-1.13) 0 (-2,2) 1


Note: Relative risk of excess death compares observed relative survival with that expected from a Poisson model including terms for age, sex, follow-up year, and spread of disease at diagnosis and age by follow-up year interaction term, with the NSW average rates as the reference. N/A: No cases alive beyond the 1st year of follow-up.

Cancer survival, incidence and mortality in NSW 1994–2000 Mesothelioma


Table 15b: Observed and expected number of new cases and deaths, excess new cases and deaths with 95% confidence intervals, percent of cases aged 65 years or over and with non-localised spread of disease at diagnosis by Area Health Services in NSW 1994–98. Mesothelioma

Males



Central Sydney 42 50 -6 (-17,6) 71.4 88.2 37 45 -6 (-17,5)

Northern Sydney 84 84 0 (-16,16) 65.5 45.5 72 75 -3 (-18,13)

Western Sydney 63 54 7 (-6,20) 68.3 39.4 62 48 12 (-2,25)

Wentworth 22 22 0 (-7,7) 54.5 44.4 22 20 2 (-6,9)

South Western Sydney 73 60 10 (-5,24) 63.0 48.1 74 53 17 (2,32)

Central Coast 57 37 13 (2,25) 80.7 70.0 53 34 15 (3,26)

Hunter 60 59 1 (-13,14) 70.0 75.0 59 53 5 (-9,18)

Illawarra 44 40 3 (-8,13) 68.2 60.0 35 36 -1 (-11,10)


Northern Rivers 26 33 -5 (-13,4) 76.9 66.7 17 30 -10 (-17,-2)

Mid North Coast 40 37 2 (-8,12) 65.0 71.4 31 34 -2 (-12,8)

New England 7 20 -6 (-11,-1) 42.9 66.7 6 17 -7 (-12,-2)

Macquarie 4 11 -3 (-6,1) 75.0 33.3 4 10 -3 (-6,1)

Mid Western 15 18 -1 (-7,4) 66.7 66.7 12 16 -2 (-8,3)

Far West 0 6 -1 (-3,1) 0.0 0.0 1 5 -1 (-3,1)

Greater Murray 19 28 -6 (-13,2) 73.7 80.0 15 25 -7 (-14,0)

Southern 17 22 -3 (-9,4) 82.4 77.8 14 20 -4 (-10,3)

New South Wales 663 663 69.4 59.8 594 594

Females



Central Sydney 8 8 0 (-3,3) 62.5 100.0 7 7 0 (-2,2)

Northern Sydney 12 14 -1 (-6,4) 75.0 42.9 15 12 1 (-3,4)

Western Sydney 13 9 2 (-2,5) 61.5 50.0 9 7 0 (-2,3)

Wentworth 6 4 0 (-1,2) 33.3 33.3 2 3 0 (-1,1)


Central Coast 9 6 1 (-2,4) 77.8 80.0 10 5 1 (-1,2)

Hunter 2 9 -3 (-6,0) 0.0 100.0 4 8 -1 (-3,2)

Illawarra 6 6 0 (-2,3) 50.0 100.0 5 5 0 (-2,2)


Northern Rivers 1 5 -1 (-3,1) 0.0 100.0 1 4 0 (-2,1)

Mid North Coast 8 5 1 (-2,3) 37.5 100.0 9 5 1 (-1,2)

New England 1 3 0 (-2,1) 100.0 0.0 1 3 0 (-1,1)

Macquarie 0 2 0 (-1,1) 0.0 0.0 0 1 0 (-1,0)

Mid Western 2 3 0 (-1,1) 50.0 100.0 0 2 0 (-1,1)

Far West 1 1 0 (0,0) 100.0 0.0 0 1 0 (0,0)

Greater Murray 7 4 1 (-1,3) 71.4 25.0 5 4 0 (-1,1)

Southern 3 3 0 (-1,1) 33.3 100.0 3 3 0 (-1,1)

New South Wales 102 102 63.7 64.4 90 90


Breast (female) Cancer survival, incidence and mortality in NSW 1994–2000


Female breast cancer

• The five-year relative survival from female breast cancer in NSW between 1994 and 2000 was 84.9%

• The adjusted relative risks of excess death after shrinking were lower in Northern Sydney (17%, 62 fewer deaths) and South Eastern Sydney (13%, 42 fewer deaths)

• An additional 110 patients with breast cancer would be expected to survive to five years after diagnosis in NSW if the State average risk was shifted to the 20th centile of the distribution

• There were 17,441 new cases of female breast cancer in NSW in 1994 to 1998 and 4,409 deaths

• There were more new cases of breast cancer than expected in Northern Sydney (240) and South Eastern Sydney (109); and fewer than expected in South Western Sydney (100), Hunter (123) and Northern Rivers (50)

• There were 49 more deaths from breast cancer than expected in South Eastern Sydney, and 28 fewer than expected in Mid North Coast

Table 16a: Five-year relative survival, relative risk of excess death due to cancer and excess cancer deaths after shrinking with 95% confidence intervals and potential lives savable by Area Health Services in NSW 1994–2000. Female breast cancer


Central Sydney 84.1 1.03 (0.91-1.14) 5 (-17,27) 9

Northern Sydney 88.3 0.83 (0.75-0.92) -62 (-93,-31) 13

Western Sydney 83.8 1.07 (0.96-1.19) 16 (-8,41) 11

Wentworth 84.8 1.06 (0.92-1.21) 6 (-8,19) 5


Central Coast 83.5 1.00 (0.87-1.12) -1 (-18,17) 6

Hunter 85.2 0.96 (0.85-1.07) -8 (-30,14) 8

Illawarra 84.1 1.01 (0.89-1.14) 2 (-17,20) 7

South Eastern Sydney 87.4 0.87 (0.79-0.96) -42 (-72,-13) 12

Northern Rivers 85.0 1.05 (0.90-1.19) 4 (-9,18) 4

Mid North Coast 84.9 1.05 (0.91-1.19) 5 (-9,20) 5

New England 85.3 0.98 (0.83-1.13) -1 (-12,9) 3

Macquarie 79.6 1.12 (0.94-1.29) 4 (-2,11) 2

Mid Western 82.3 1.06 (0.90-1.22) 4 (-6,13) 3

Far West 80.6 1.05 (0.87-1.24) 1 (-2,4) 1

Greater Murray 85.1 1.05 (0.91-1.20) 5 (-8,17) 4

Southern 84.8 0.98 (0.83-1.12) -2 (-13,10) 3


Note: Relative risk of excess death compares observed relative survival with that expected from a Poisson model including terms for age, follow-up year, and spread of disease at diagnosis, and age and spread of disease by follow-up year interaction terms, with the NSW average rates as the reference.

Cancer survival, incidence and mortality in s NSW 1994–2000 Breast (female)



and deaths with 95% confidence intervals, percent of cases aged 65 years or over and with non-localised spread of disease at diagnosis by Area Health Services in NSW 1994–98. Female breast cancer

Number of new cases % diagnosed % diagnosed Number of deaths

Area Health Service observed expected excess* (95% CI) 65+ yrs as non-localised observed expected excess* (95% CI)

Central Sydney 1315 1302 10 (-53,74) 41.2 41.2 376 333 31 (-1,63)

Northern Sydney 2631 2356 240 (147,334) 40.9 35.1 635 616 16 (-29,61)

Western Sydney 1534 1606 -59 (-129,11) 31.4 38.3 419 384 27 (-8,61)

Wentworth 729 686 29 (-14,72) 31.6 37.7 177 161 9 (-10,28)


Central Coast 897 871 19 (-31,68) 46.1 37.3 205 231 -17 (-40,6)

Hunter 1361 1512 -123 (-190,-57) 41.7 38.7 363 387 -18 (-51,14)

Illawarra 1003 975 21 (-33,74) 38.1 40.1 218 245 -18 (-42,6)

South Eastern Sydney 2300 2174 109 (22,196) 39.9 40.8 621 562 49 (5,92)

Northern Rivers 699 771 -50 (-94,-6) 46.8 30.8 176 199 -14 (-35,7)

Mid North Coast 786 828 -30 (-76,17) 44.0 37.4 170 214 -28 (-49,-7)

New England 518 506 7 (-27,42) 35.5 41.2 144 128 8 (-8,24)

Macquarie 282 281 1 (-22,23) 46.1 35.3 81 71 4 (-6,14)

Mid Western 433 463 -17 (-49,14) 45.4 39.6 128 118 5 (-11,20)

Far West 123 134 -3 (-15,9) 40.7 46.7 44 34 2 (-3,8)

Greater Murray 690 707 -12 (-54,31) 39.1 35.7 163 181 -10 (-30,9)

Southern 516 525 -5 (-40,30) 43.2 40.7 111 131 -10 (-26,5)

New South Wales 17441 17441 39.3 38.7 4409 4409


Melanoma Cancer survival, incidence and mortality in NSW 1994–2000


Melanoma of the skin

• The five-year relative survival from melanoma of the skin in NSW between 1994 and 2000 was 91.0%

• The adjusted relative risks of excess death after shrinking were higher in Central Sydney (35%, 16 excess deaths) and South Western Sydney (30%, 23 excess deaths)

• An additional 101 patients with melanoma would be expected to survive to five years after diagnosis in NSW if the State average risk was shifted to the 20th centile of the distribution

• There were 12,700 new cases of melanoma of the skin in NSW in 1994 to 1998 (7,391 males and 5,309 females) and 1,773 deaths (1,211 males and 562 females)

• There were more new cases of melanoma of the skin than expected in coastal Area Health Services: Northern Sydney (111 in males), Central Coast (94 in males and 99 in females), Hunter (141 in males and 134 in females), Northern Rivers (151 in males and 80 in females), Mid North Coast (174 in males and 101 in females) and Illawarra (44 in females)

• Some urban and the inland Area Health Services had fewer new cases than expected: Central Sydney (200 in males and 140 in females), Western Sydney (159 in males and 145 in females), South Western Sydney (162 in males and 148 in females), Macquarie (26 in males), Far West (18 in males and 10 in females) and Greater Murray (54 in males)

• There were 14 fewer deaths from melanoma of the skin than expected in Central Sydney in males, and there was no area variation in the excess number of deaths from melanoma of the skin in females


cancer and excess cancer deaths after shrinking with 95% confidence intervals and potential lives savable by Area Health Services in NSW 1994–2000. Melanoma of the skin


Central Sydney 87.7 1.35 (1.09-1.61) 16 (4,28) 7 Northern Sydney 92.4 0.93 (0.78-1.07) -10 (-31,10) 12 Western Sydney 90.9 0.99 (0.80-1.17) -1 (-15,13) 7 Wentworth 90.2 1.13 (0.87-1.38) 5 (-5,14) 4 South Western Sydney 88.1 1.30 (1.08-1.51) 23 (6,39) 10 Central Coast 90.1 1.05 (0.85-1.25) 4 (-10,18) 7 Hunter 92.9 0.92 (0.76-1.07) -9 (-26,8) 9 Illawarra 90.9 1.10 (0.88-1.32) 5 (-7,18) 6 South Eastern Sydney 91.4 0.99 (0.84-1.14) -2 (-22,19) 12 Northern Rivers 92.1 0.92 (0.73-1.10) -6 (-19,7) 6 Mid North Coast 92.8 0.93 (0.74-1.11) -5 (-18,8) 6 New England 90.6 1.11 (0.84-1.37) 3 (-4,11) 3 Macquarie 91.3 0.96 (0.68-1.23) -1 (-5,4) 1 Mid Western 90.1 1.18 (0.89-1.46) 4 (-3,11) 3 Far West 90.9 1.00 (0.69-1.32) 0 (-2,2) 1 Greater Murray 91.4 0.97 (0.75-1.20) -1 (-10,8) 4 Southern 86.8 1.26 (0.98-1.54) 7 (-1,15) 4 New South Wales 91.0 1.00 101


Cancer survival, incidence and mortality in NSW 1994–2000 Melanoma



and deaths with 95% confidence intervals, percent of cases aged 65 years or over and with non-localised spread of disease at diagnosis by Area Health Services in NSW 1994–98. Melanoma of the skin

Males



Central Sydney 363 569 -200 (-237,-163) 47.7 9.7 65 92 -14 (-26,-2)

Northern Sydney 1045 932 111 (48,173) 47.6 7.6 173 155 12 (-9,32)

Western Sydney 498 661 -159 (-203,-116) 38.0 13.6 86 100 -7 (-21,6)

Wentworth 258 283 -23 (-54,7) 33.3 8.6 49 43 2 (-5,10)


Central Coast 470 372 94 (53,135) 55.1 9.8 75 66 4 (-7,15)

Hunter 787 642 141 (87,195) 47.3 7.5 118 106 6 (-9,22)

Illawarra 434 424 9 (-31,50) 48.2 8.2 60 70 -4 (-15,6)


Northern Rivers 499 341 151 (108,193) 48.5 7.5 74 59 6 (-4,16)

Mid North Coast 550 368 174 (130,219) 50.4 7.6 79 64 6 (-4,17)

New England 237 216 20 (-9,49) 38.0 6.3 32 35 -1 (-7,5)

Macquarie 92 122 -26 (-44,-8) 37.0 12.4 18 20 0 (-4,3)

Mid Western 186 198 -11 (-37,14) 37.1 9.6 26 32 -2 (-7,4)

Far West 41 63 -18 (-29,-6) 36.6 7.7 10 10 0 (-2,2)

Greater Murray 252 309 -54 (-85,-24) 35.3 11.3 48 51 -1 (-9,7)

Southern 216 235 -18 (-46,10) 45.8 12.7 34 39 -1 (-8,5)

New South Wales 7391 7391 45.8 8.8 1211 1211

Females



Central Sydney 266 412 -140 (-172,-108) 36.8 8.6 38 43

Northern Sydney 710 713 -3 (-55,49) 40.6 7.4 84 80

Western Sydney 348 498 -145 (-181,-109) 35.1 6.3 51 48

Wentworth 198 218 -18 (-45,8) 18.7 7.8 22 20

South Western Sydney 392 545 -148 (-187,-110) 30.4 6.0 46 52

Central Coast 364 259 99 (63,135) 41.9 5.7 27 30

Hunter 594 455 134 (87,181) 34.0 7.2 45 49

Illawarra 337 291 44 (9,79) 32.9 5.9 33 31

South Eastern Sydney 652 670 -17 (-67,32) 37.7 7.6 74 73

Northern Rivers 313 227 80 (47,113) 40.6 7.6 30 25

Mid North Coast 347 239 101 (66,136) 43.2 4.5 28 27


New England 169 151 16 (-8,40) 33.7 3.7 22 16

Macquarie 69 84 -13 (-28,2) 46.4 6.0 7 9

Mid Western 160 139 19 (-4,42) 28.1 3.8 13 15

Far West 27 41 -10 (-19,0) 29.6 20.0 7 4

Greater Murray 215 213 2 (-26,29) 40.5 5.8 21 23

Southern 148 155 -6 (-29,16) 34.5 3.5 14 16

New South Wales 5309 5309 36.3 6.6 562 562


Cervix Cancer survival, incidence and mortality in NSW 1994–2000


Cervical cancer

• The five-year relative survival from cervical cancer in NSW between 1994 and 2000 was 72.6%

• No Area Health Service differed from the State average in the adjusted relative risk of excess death after shrinking


• There were 1,596 new cases of cervical cancer in NSW in 1994 to 1998 and 538 deaths

• There were 17 more new cases and 16 more deaths from cervical cancer than expected in Hunter

Table 18a: Five-year relative survival, relative risk of excess death due to cancer and excess cancer deaths after shrinking with 95% confidence intervals and potential lives savable by Area Health Services in NSW 1994–2000. Cervical cancer


Central Sydney 76.6 0.97 (0.81-1.13) -1 (-7,5) 2 Northern Sydney 71.7 0.99 (0.84-1.15) 0 (-9,8) 4 Western Sydney 77.6 0.96 (0.80-1.12) -1 (-7,5) 2 Wentworth 67.0 1.08 (0.89-1.26) 1 (-1,3) 2 South Western Sydney 76.2 1.00 (0.85-1.16) 0 (-7,7) 3 Central Coast 67.6 1.00 (0.83-1.17) 0 (-4,4) 2 Hunter 70.7 1.03 (0.87-1.19) 1 (-6,9) 4 Illawarra 70.8 1.02 (0.85-1.19) 0 (-4,5) 2 South Eastern Sydney 78.8 0.90 (0.76-1.05) -6 (-14,3) 3 Northern Rivers 69.4 1.02 (0.84-1.19) 0 (-2,3) 1 Mid North Coast 72.0 1.00 (0.82-1.17) 0 (-3,3) 1 New England 72.5 1.02 (0.84-1.20) 0 (-2,2) 1 Macquarie 62.5 1.04 (0.85-1.22) 0 (-1,1) 1 Mid Western 75.9 0.96 (0.78-1.13) -1 (-3,2) 1 Far West 40.9 1.03 (0.85-1.22) 0 (-1,1) 1 Greater Murray 68.1 1.05 (0.87-1.22) 1 (-2,4) 2 Southern 66.0 1.04 (0.86-1.22) 1 (-2,3) 1 New South Wales 72.6 1.00 34

Note: Relative risk of excess death compares observed relative survival with that expected from a Poisson model including terms for age, follow-up year, and spread of disease at diagnosis and age by follow-up year interaction term, with the NSW average rates as the reference.

Cancer survival, incidence and mortality in NSW 1994–2000 Cervix



and deaths with 95% confidence intervals, percent of cases aged 65 years or over and with non-localised spread of disease at diagnosis by Area Health Services in NSW 1994–98. Cervical cancer



Central Sydney 129 125 2 (-13,17) 30.2 33.7 41 41 0 (-9,9)

Northern Sydney 187 211 -14 (-35,7) 32.6 41.7 62 74 -8 (-21,5)

Western Sydney 137 154 -9 (-25,8) 24.1 28.8 44 48 -2 (-12,7)

Wentworth 62 69 -2 (-11,7) 27.4 26.4 24 21 1 (-4,6)


Central Coast 76 75 0 (-9,10) 30.3 35.2 22 28 -2 (-9,4)

Hunter 172 135 17 (1,34) 27.9 38.0 76 47 16 (4,27)

Illawarra 96 86 3 (-8,15) 28.1 45.0 31 30 1 (-6,8)


Northern Rivers 52 67 -5 (-13,4) 30.8 39.4 16 24 -3 (-8,3)

Mid North Coast 56 70 -4 (-13,5) 23.2 30.8 23 26 -1 (-7,5)

New England 43 45 0 (-7,6) 20.9 34.5 16 16 0 (-4,4)

Macquarie 28 25 0 (-3,4) 17.9 37.5 11 9 0 (-2,3)

Mid Western 41 41 0 (-6,6) 29.3 41.9 14 14 0 (-4,4)

Far West 16 12 0 (-2,2) 31.3 63.6 10 4 1 (-1,2)

Greater Murray 69 63 2 (-7,10) 24.6 31.4 23 22 0 (-5,6)

Southern 51 47 1 (-5,8) 19.6 25.0 15 16 0 (-4,4)

New South Wales 1596 1596 26.8 34.8 538 538


Body of uterus Cancer survival, incidence and mortality in NSW 1994–2000


Uterine cancer

• The five-year relative survival from uterine cancer in NSW between 1994 and 2000 was 79.8%



• There were 2,179 new cases of uterine cancer in NSW in 1994 to 1998 and 469 deaths

• There were no Area Health Services in which the number of new cases of uterine cancer was different from expected, and there was no area variation in the excess number of deaths from uterine cancer

Table 19a: Five-year relative survival, relative risk of excess death due to cancer and excess cancer deaths after shrinking with 95% confidence intervals and potential lives savable by Area Health Services in NSW 1994–2000. Uterine cancer


Central Sydney 78.1 1.01 (0.81-1.21) 0 (-7,7) 1 Northern Sydney 86.2 0.86 (0.69-1.02) -8 (-18,1) 1 Western Sydney 75.7 1.12 (0.91-1.34) 4 (-3,10) 1 Wentworth 78.3 1.07 (0.84-1.31) 1 (-2,4) 1 South Western Sydney 77.9 1.05 (0.84-1.25) 2 (-5,9) 1 Central Coast 78.6 0.98 (0.77-1.20) 0 (-5,4) 1 Hunter 85.6 0.88 (0.70-1.06) -5 (-13,2) 1 Illawarra 81.6 0.98 (0.77-1.19) 0 (-6,5) 1 South Eastern Sydney 77.1 1.04 (0.85-1.22) 2 (-8,12) 2 Northern Rivers 81.2 0.99 (0.77-1.21) 0 (-4,4) 1 Mid North Coast 74.2 1.08 (0.84-1.31) 1 (-2,5) 1 New England 74.3 1.04 (0.80-1.28) 0 (-2,3) 0 Macquarie 82.1 1.00 (0.76-1.24) 0 (-1,1) 0 Mid Western 81.4 1.00 (0.77-1.23) 0 (-2,2) 0 Far West 82.3 1.00 (0.76-1.25) 0 (0,0) 0 Greater Murray 83.2 1.00 (0.77-1.22) 0 (-4,4) 1 Southern 74.3 1.05 (0.81-1.29) 1 (-2,3) 0 New South Wales 79.8 1.00 14


Cancer survival, incidence and mortality in NSW 1994–2000 Body of uterus



and deaths with 95% confidence intervals, percent of cases aged 65 years or over and with non-localised spread of disease at diagnosis by Area Health Services in NSW 1994–98. Uterine cancer



Central Sydney 156 162 -1 (-13,10) 50.6 29.7 45 36

Northern Sydney 306 296 3 (-16,23) 54.9 31.5 58 67

Western Sydney 186 190 -1 (-15,12) 43.0 25.2 42 38

Wentworth 90 79 1 (-5,7) 51.1 26.7 21 15


Central Coast 107 115 -1 (-10,7) 62.6 28.1 26 27

Hunter 228 192 9 (-5,23) 61.4 30.8 43 42

Illawarra 126 125 0 (-9,9) 52.4 23.9 20 26


Northern Rivers 98 99 0 (-8,7) 51.0 21.4 14 22

Mid North Coast 86 108 -4 (-12,4) 62.8 25.8 21 24


New England 51 63 -1 (-6,4) 45.1 24.3 12 14

Macquarie 40 35 0 (-3,3) 45.0 32.4 5 7

Mid Western 61 59 0 (-4,5) 57.4 26.1 13 13

Far West 10 17 0 (-2,1) 40.0 11.1 2 4

Greater Murray 99 89 1 (-6,8) 51.5 25.6 23 19

Southern 64 66 0 (-5,5) 48.4 36.7 19 14

New South Wales 2179 2179 52.7 28.6 469 469


Ovary Cancer survival, incidence and mortality in NSW 1994–2000


Ovarian cancer

• The five-year relative survival from ovarian cancer in NSW between 1994 and 2000 was 39.5%

• The adjusted relative risk of excess death due to ovarian cancer after shrinking was lower in South Eastern Sydney by 17%, resulting in 29 fewer deaths


• There were 1,852 new cases of ovarian cancer in NSW in 1994 to 1998 and 1,176 deaths

• There were no Area Health Services in which the number of new cases of ovarian cancer was different from expected, and there was no area variation in the excess number of deaths from ovarian cancer

Table 20a: Five-year relative survival, relative risk of excess death due to cancer and excess cancer deaths after shrinking with 95% confidence intervals and potential lives savable by Area Health Services in NSW 1994–2000. Ovarian cancer


Central Sydney 41.6 1.05 (0.86-1.23) 3 (-10,16) 8 Northern Sydney 41.1 0.99 (0.86-1.13) -1 (-23,20) 18 Western Sydney 47.1 0.99 (0.82-1.16) -1 (-14,13) 9 Wentworth 36.0 1.09 (0.85-1.33) 2 (-4,9) 4 South Western Sydney 40.3 0.99 (0.83-1.15) -1 (-17,15) 11 Central Coast 43.8 0.91 (0.73-1.10) -5 (-16,6) 6 Hunter 33.9 1.07 (0.90-1.23) 7 (-10,24) 12 Illawarra 33.1 1.05 (0.86-1.24) 3 (-9,15) 7 South Eastern Sydney 43.7 0.83 (0.71-0.96) -29 (-49,-8) 15 Northern Rivers 57.6 0.82 (0.64-1.01) -8 (-16,0) 3 Mid North Coast 30.9 1.15 (0.94-1.37) 7 (-3,17) 7 New England 34.6 1.08 (0.86-1.31) 3 (-5,10) 4 Macquarie 23.7 1.12 (0.85-1.40) 1 (-2,4) 2 Mid Western 20.9 1.22 (0.96-1.49) 4 (-1,9) 4 Far West 42.0 0.97 (0.72-1.23) 0 (-3,2) 1 Greater Murray 29.9 1.06 (0.84-1.27) 2 (-6,11) 5 Southern 40.8 0.92 (0.72-1.13) -3 (-10,5) 3 New South Wales 39.5 1.00 119


Cancer survival, incidence and mortality in NSW 1994–2000 Ovary



and deaths with 95% confidence intervals, percent of cases aged 65 years or over and with non-localised spread of disease at diagnosis by Area Health Services in NSW 1994–98. Ovarian cancer



Central Sydney 137 140 -1 (-11,10) 51.8 78.3 88 88

Northern Sydney 283 253 9 (-8,26) 50.2 77.7 174 164

Western Sydney 150 165 -3 (-15,8) 42.7 73.0 101 100

Wentworth 53 69 -2 (-7,3) 50.9 83.8 34 41


Central Coast 93 96 0 (-8,7) 58.1 83.1 54 64

Hunter 174 162 3 (-9,14) 50.0 80.5 110 104

Illawarra 105 104 0 (-7,8) 53.3 89.0 66 66


Northern Rivers 71 83 -1 (-8,5) 54.9 78.2 42 54

Mid North Coast 91 89 0 (-6,7) 50.5 81.6 70 59


New England 63 54 1 (-3,5) 50.8 83.0 39 34

Macquarie 23 30 0 (-3,2) 56.5 85.7 19 19

Mid Western 45 49 0 (-4,3) 64.4 89.5 39 32

Far West 15 14 0 (-1,1) 33.3 90.9 7 9

Greater Murray 69 75 -1 (-6,5) 59.4 83.0 55 48

Southern 58 55 0 (-4,4) 44.8 83.3 28 35

New South Wales 1852 1852 50.2 80.7 1176 1176


Prostate Cancer survival, incidence and mortality in NSW 1994–2000


Prostate cancer

• The five-year relative survival from prostate cancer in NSW between 1994 and 2000 was 85.2%

• The adjusted relative risks of excess death after shrinkage were higher in Wentworth (43%, 29 excess deaths), South Western Sydney (20% , 38 excess deaths), Northern Rivers (21%, 26 excess deaths) and Macquarie (32%, 14 excess deaths); and lower in Central Coast (15%, 23 fewer deaths)

• An additional 228 patients with prostate cancer would be expected to survive to five years after diagnosis in NSW if the State average risk was shifted to the 20th centile – the largest numbers being in Northern Sydney and South Eastern Sydney

• There were 19,553 new cases of prostate cancer in NSW in 1994 to 1998 and 4,397 deaths

• There were more new cases of prostate cancer than expected in Northern Sydney (192), Central Coast (82) and Greater Murray (223); and fewer than expected in Central Sydney (104), South Western Sydney (134), Hunter (107) and Northern Rivers (113)

• There were 29 more deaths from prostate cancer than expected in New England, and 58 and 38 fewer than expected respectively in Central Sydney and South Western Sydney


cancer and excess cancer deaths after shrinking with 95% confidence intervals and potential lives savable by Area Health Services in NSW 1994–2000. Prostate cancer


Central Sydney 86.4 0.91 (0.78-1.04) -16 (-39,7) 14

Northern Sydney 87.6 0.96 (0.85-1.06) -13 (-46,19) 27

Western Sydney 85.0 1.08 (0.93-1.22) 13 (-12,38) 17

Wentworth 78.9 1.43 (1.19-1.67) 29 (13,45) 10

South Western Sydney 82.4 1.20 (1.06-1.35) 38 (11,66) 21

Central Coast 88.6 0.85 (0.72-0.99) -23 (-43,-2) 11

Hunter 86.5 0.89 (0.78-1.00) -25 (-52,1) 18

Illawarra 85.6 0.94 (0.80-1.07) -10 (-33,12) 14


Northern Rivers 80.4 1.21 (1.04-1.38) 26 (4,47) 14

Mid North Coast 83.5 1.04 (0.90-1.19) 7 (-16,29) 14

New England 79.7 1.17 (0.97-1.36) 14 (-3,30) 9

Macquarie 76.0 1.32 (1.06-1.57) 14 (3,25) 6

Mid Western 81.7 1.19 (0.97-1.41) 12 (-2,25) 7

Far West 80.7 1.11 (0.81-1.40) 2 (-3,7) 2

Greater Murray 88.4 0.96 (0.80-1.12) -5 (-24,14) 10

Southern 85.0 1.05 (0.86-1.24) 4 (-12,20) 8


Note: Relative risk of excess death compares observed relative survival with that expected from a Poisson model including terms for age, follow-up year, and spread of disease at diagnosis, and age and spread of disease by follow-up year interaction terms, with the NSW average rates as the reference.

Cancer survival, incidence and mortality in NSW 1994–2000 Prostate


Table 21b: Observed and expected number of new cases and deaths, excess new cases and deaths with 95% confidence intervals, percent of cases aged 65 years or over and with non-localised spread of disease at diagnosis by Area Health Services in NSW 1994–98. Prostate cancer



Central Sydney 1354 1467 -104 (-173,-34) 79.3 22.4 262 334 -58 (-87,-29)

Northern Sydney 2670 2468 192 (93,290) 75.0 17.3 604 590 12 (-33,57)

Western Sydney 1507 1531 -22 (-95,51) 69.6 17.8 304 314 -8 (-38,23)

Wentworth 613 623 -8 (-53,36) 73.9 17.1 145 133 7 (-11,26)

South Western Sydney 1585 1729 -134 (-209,-58) 73.6 20.4 307 354 -38 (-70,-7)

Central Coast 1219 1128 82 (17,146) 84.5 17.2 271 273 -1 (-30,27)

Hunter 1644 1759 -107 (-184,-30) 78.4 22.1 413 398 13 (-24,49)

Illawarra 1247 1187 54 (-11,120) 78.9 24.9 279 252 20 (-8,48)


Northern Rivers 878 1005 -113 (-168,-58) 81.9 28.4 210 234 -18 (-43,7)

Mid North Coast 1077 1127 -44 (-106,17) 80.3 25.1 257 258 -1 (-29,26)

New England 538 575 -30 (-72,11) 77.3 25.9 176 129 29 (10,48)

Macquarie 337 324 9 (-21,40) 79.2 30.8 91 70 10 (-2,22)

Mid Western 524 530 -5 (-45,35) 80.3 17.3 143 119 14 (-3,32)

Far West 148 167 -11 (-29,8) 74.3 36.8 45 35 3 (-4,10)

Greater Murray 1095 838 223 (163,282) 75.3 16.7 203 188 11 (-12,34)

Southern 694 649 38 (-9,85) 77.2 23.6 131 140 -6 (-24,13)

New South Wales 19553 19553 77.2 20.3 4397 4397


Testis Cancer survival, incidence and mortality in NSW 1994–2000


Testis cancer

• The five-year relative survival from testis cancer in NSW between 1994 and 2000 was 95.6%

• There was no area variation in the adjusted relative risks of excess death due to testis cancer after shrinking

• There were 935 new cases of testis cancer in NSW in 1994 to 1998 and 53 deaths • There were no Area Health Services in which the number of deaths from testis cancer

was different from expected, and there was no area variation in the excess number of new cases of testis cancer

Table 22a: Five-year relative survival, relative risk of excess deaths due to cancer and excess cancer deaths after shrinking with 95% confidence intervals and potential lives savable by Area Health Services in NSW 1994–2000. Testis cancer

Five-year relative Relative risk of excess Excess number of Potential Area Health Service

survival (%) death (95% CI) cancer deaths (95% CI) lives savable

Central Sydney 95.3 Northern Sydney 97.1 Western Sydney 93.5 Wentworth 92.2 South Western Sydney 95.0 Central Coast 98.6 Hunter 94.9 Illawarra 99.3 South Eastern Sydney 98.1 Northern Rivers 96.4

There was no area variation in the adjusted relative risks of excess death due to testis cancer after shrinking

Mid North Coast 89.3 New England 102.0 Macquarie 95.2 Mid Western 93.9 Far West 84.3 Greater Murray 93.1 Southern 92.5 New South Wales† 95.6

Note: Relative risk of excess death compares observed relative survival with that expected from a Poisson model including terms for age, follow-up year, and spread of disease at diagnosis, with the NSW average rates as the reference.

Cancer survival, incidence and mortality in NSW 1994–2000 Testis



and deaths with 95% confidence intervals, percent of cases aged 65 years or over and with non-localised spread of disease at diagnosis by Area Health Services in NSW 1994–98. Testis cancer



Central Sydney 67 82 0.0 33.3 2 4 0 (-1,1)

Northern Sydney 109 115 4.5 26.2 5 6 0 (-1,1)

Western Sydney 90 100 2.2 32.9 10 5 0 (-1,1)

Wentworth 40 46 5.0 26.5 4 2 0 (0,0)

South Western Sydney 121 112 1.7 21.2 7 6 0 (-1,1)

Central Coast 43 36 2.3 37.0 1 2 0 (0,0)

Hunter 73 76 0.0 25.0 4 4 0 (-1,1)

Illawarra 44 48 2.2 17.1 2 3 0 (0,0)

South Eastern Sydney 128 123 0.8 23.4 5 7 0 (-1,1)

Northern Rivers 39 33 2.6 31.3 0 2 0 (0,0)


There was no area variation in excess number of new cases 5.7 36.7 4 2 0 (0,0)

New England 34 25 5.9 25.0 0 1 0 (0,0)

Macquarie 13 14 7.7 8.3 1 1 0 (0,0)

Mid Western 30 23 10.0 31.6 3 1 0 (0,0)

Far West 6 8 0.0 25.0 0 0 0 (0,0)

Greater Murray 32 37 6.3 28.6 3 2 0 (0,0)

Southern 32 26 3.1 52.0 2 1 0 (0,0)

New South Wales 935 935 2.2 27.5 53 53


Bladder Cancer survival, incidence and mortality in NSW 1994–2000


Bladder cancer

• The five-year relative survival from bladder cancer in NSW between 1994 and 2000 was 62.0%



• There were 3,784 new cases of bladder cancer in NSW in 1994 to 1998 (2,769 males and 1,015 females) and 1,353 deaths (965 males and 388 females)

• There were 29 more new cases of bladder cancer in males than expected in Central Coast and 33 fewer than expected in Northern Sydney

• There were no Area Health Services in which the number of new cases of bladder cancer was different from expected in females

• There were no Area Health Services in which the number of deaths from bladder cancer was different from expected in males, and there was no area variation in the excess number of deaths in females

Table 23a: Five-year relative survival, relative risk of excess death due to cancer and excess cancer deaths after shrinking with 95% confidence intervals and potential lives savable by Area Health Services in NSW 1994–2000. Bladder cancer


Central Sydney 64.4 1.00 (0.88-1.12) 0 (-10,10) 3

Northern Sydney 68.0 0.91 (0.81-1.02) -13 (-29,3) 5

Western Sydney 65.3 0.99 (0.88-1.11) -1 (-13,11) 4

Wentworth 62.4 1.03 (0.90-1.17) 1 (-4,7) 2


Central Coast 60.6 0.98 (0.87-1.10) -2 (-13,10) 4

Hunter 59.6 1.00 (0.89-1.11) 0 (-14,15) 5

Illawarra 64.6 1.01 (0.88-1.14) 1 (-8,9) 3


Northern Rivers 52.6 1.07 (0.94-1.21) 4 (-3,11) 3

Mid North Coast 55.4 1.07 (0.94-1.20) 5 (-4,14) 3

New England 61.8 1.01 (0.87-1.15) 0 (-4,5) 1

Macquarie 57.9 1.04 (0.90-1.18) 1 (-2,4) 1

Mid Western 52.1 1.03 (0.89-1.17) 1 (-3,5) 2

Far West 69.5 1.00 (0.86-1.14) 0 (-1,1) 0

Greater Murray 64.6 0.98 (0.85-1.10) -1 (-9,6) 2

Southern 63.3 0.97 (0.84-1.10) -1 (-6,4) 1



Cancer survival, incidence and mortality in NSW 1994–2000 Bladder



and deaths with 95% confidence intervals, percent of cases aged 65 years or over and with non-localised spread of disease at diagnosis by Area Health Services in NSW 1994–98. Bladder cancer

Males



Central Sydney 196 209 -9 (-32,14) 71.9 25.0 65 73 -2 (-11,6)

Northern Sydney 314 355 -33 (-64,-2) 77.7 24.6 101 128 -11 (-24,3)

Western Sydney 246 218 20 (-6,45) 66.3 27.4 83 71 3 (-6,12)

Wentworth 116 90 13 (-1,27) 70.7 24.3 39 30 1 (-3,5)


Central Coast 204 159 29 (7,50) 81.4 26.7 68 58 2 (-5,9)

Hunter 257 248 7 (-20,33) 74.8 33.8 92 87 2 (-9,12)

Illawarra 149 164 -10 (-29,10) 73.8 29.5 53 56 -1 (-7,6)


Northern Rivers 125 141 -10 (-27,8) 84.8 21.2 46 51 -1 (-7,5)

Mid North Coast 173 157 10 (-10,31) 82.1 25.0 66 56 2 (-5,9)

New England 76 81 -3 (-14,9) 68.4 20.0 22 28 -1 (-4,3)

Macquarie 48 45 1 (-7,9) 79.2 36.7 22 16 0 (-2,3)

Mid Western 64 75 -5 (-16,6) 68.8 42.3 26 26 0 (-3,3)

Far West 24 23 0 (-4,4) 75.0 23.1 8 8 0 (-1,1)

Greater Murray 141 118 13 (-4,30) 73.0 25.6 41 41 0 (-5,5)

Southern 74 90 -8 (-21,4) 74.3 32.8 32 31 0 (-4,4)

New South Wales 2769 2769 74.8 26.2 965 965

Females



Central Sydney 66 77 0 (-2,2) 83.3 23.5 24 30

Northern Sydney 136 145 0 (-4,3) 86.0 26.1 51 59

Western Sydney 86 81 0 (-2,2) 69.8 22.2 24 29

Wentworth 32 33 0 (-1,1) 65.6 22.7 12 12


Central Coast 67 58 0 (-1,2) 82.1 29.4 26 22

Hunter 99 91 0 (-2,2) 70.7 33.3 35 35

Illawarra 56 57 0 (-1,1) 76.8 21.2 22 21


Northern Rivers 38 48 0 (-1,1) 92.1 15.4 18 18

Mid North Coast 46 52 0 (-1,1) 76.1 22.2 17 20


New England 24 29 0 (-1,1) 70.8 18.2 10 11

Macquarie 23 16 0 (0,0) 60.9 20.0 6 6

Mid Western 25 28 0 (-1,1) 84.0 36.4 11 11

Far West 7 8 0 (0,0) 100.0 20.0 4 3

Greater Murray 46 42 0 (-1,1) 80.4 26.1 16 16

Southern 26 30 0 (-1,1) 69.2 30.0 13 11

New South Wales 1015 1015 78.6 25.9 388 388


Kidney Cancer survival, incidence and mortality in NSW 1994–2000


Kidney cancer

• The five-year relative survival from kidney cancer in NSW between 1994 and 2000 was 58.4%

• There was no area variation in the adjusted relative risk of excess death due to kidney cancer after shrinking

• There were 3,665 new cases of kidney cancer in NSW in 1994 to 1998 (2,165 males and 1,500 females) and 1,472 deaths (785 males and 687 females)

• There were 15 more new cases of kidney cancer than expected in males in Central Coast; there was no area variation in the excess number of new cases in females

• There was no area variation in the excess number of deaths from kidney cancer in either males or females

Table 24a: Five-year relative survival, relative risk of excess death due to cancer and excess cancer deaths after shrinking with 95% confidence intervals and potential lives savable by Area Health Services in NSW 1994–2000. Kidney cancer


Central Sydney 62.1

Northern Sydney 57.8

Western Sydney 66.8

Wentworth 54.1

South Western Sydney 60.2

Central Coast 55.0

Hunter 58.7

Illawarra 57.6

South Eastern Sydney 58.2

Northern Rivers 53.2

There was no area variation in the adjusted relative risks of excess death due to kidney cancer after shrinking

Mid North Coast 60.1 New England 48.9 Macquarie 69.5 Mid Western 50.1 Far West 57.1 Greater Murray 62.6 Southern 48.6 New South Wales 58.4


Cancer survival, incidence and mortality in NSW 1994–2000 Kidney



and deaths with 95% confidence intervals, percent of cases aged 65 years or over and with non-localised spread of disease at diagnosis by Area Health Services in NSW 1994–98. Kidney cancer

Males



Central Sydney 164 163 0 (-16,17) 53.7 43.3 56 59

Northern Sydney 242 272 -17 (-41,6) 58.7 36.3 85 100

Western Sydney 190 185 2 (-16,21) 46.3 32.5 62 64

Wentworth 68 77 -3 (-12,6) 45.6 40.7 22 26


Central Coast 157 115 15 (2,29) 59.9 42.1 52 44

Hunter 200 191 4 (-15,24) 58.5 45.5 78 70

Illawarra 140 128 5 (-9,19) 62.1 44.2 56 46

South Eastern Sydney 258 268 -6 (-30,18) 58.9 42.0 102 99

Northern Rivers 105 105 0 (-12,12) 70.5 39.7 36 39

Mid North Coast 102 115 -5 (-17,8) 60.8 44.7 36 43


New England 59 64 -1 (-9,6) 55.9 46.5 29 23

Macquarie 35 36 0 (-5,4) 48.6 40.0 12 13

Mid Western 69 59 2 (-5,10) 56.5 65.3 28 21

Far West 14 19 0 (-3,2) 57.1 66.7 8 7

Greater Murray 98 92 2 (-9,13) 54.1 35.8 31 34

Southern 63 71 -2 (-10,6) 55.6 42.6 24 26

New South Wales 2165 2165 56.4 41.7 785 785

Females



Central Sydney 120 112 62.5 45.2 52 52

Northern Sydney 188 206 71.8 49.4 93 99

Western Sydney 114 127 61.4 33.0 42 55

Wentworth 59 53 57.6 44.4 19 22

South Western Sydney 153 139 56.9 47.7 58 59

Central Coast 86 83 59.3 41.1 37 39

Hunter 146 134 74.0 43.0 74 62

Illawarra 94 85 66.0 40.8 44 38

South Eastern Sydney 192 191 68.2 46.5 91 90

Northern Rivers 68 69 58.8 41.3 32 32


There was no area variation in excess number of new cases 60.0 46.2 33 35


New England 40 43 65.0 48.4 28 20

Macquarie 27 24 77.8 53.8 19 11

Mid Western 39 40 64.1 53.6 19 19

Far West 8 12 50.0 57.1 5 5

Greater Murray 69 62 63.8 32.6 28 28

Southern 27 45 66.7 55.0 13 20

New South Wales 1500 1500 64.9 44.7 687 687


Brain Cancer survival, incidence and mortality in NSW 1994–2000


Brain cancer

• The five-year relative survival from brain cancer in NSW between 1994 and 2000 was 18.4%



• There were 2,073 new cases of brain cancer in NSW in 1994 to 1998 (1,198 males and 875 females) and 1,637 deaths (950 males and 687 females)

• There were no Area Health Services in which the number of new cases or deaths from brain cancer was different from expected in males

• There was no area variation in the excess number of new cases or deaths in females

Table 25a: Five-year relative survival, relative risk of excess death due to cancer and excess cancer deaths after shrinking with 95% confidence intervals and potential lives savable by Area Health Services in NSW 1994–2000. Brain cancer


Central Sydney 22.8 1.01 (0.92-1.11) 1 (-7,10) 3 Northern Sydney 20.8 0.94 (0.86-1.02) -14 (-32,5) 6 Western Sydney 21.3 1.02 (0.92-1.11) 2 (-9,13) 4 Wentworth 14.5 1.03 (0.93-1.14) 2 (-4,8) 2 South Western Sydney 20.1 0.99 (0.90-1.08) -2 (-15,11) 4 Central Coast 19.2 0.99 (0.89-1.08) -1 (-9,7) 2 Hunter 13.6 1.04 (0.95-1.13) 5 (-7,16) 4 Illawarra 17.9 1.00 (0.90-1.09) 0 (-9,8) 3 South Eastern Sydney 16.9 0.99 (0.90-1.07) -3 (-21,15) 6 Northern Rivers 12.0 1.05 (0.95-1.15) 3 (-3,8) 2 Mid North Coast 12.4 0.99 (0.89-1.08) -1 (-9,7) 2 New England 16.8 1.01 (0.91-1.12) 1 (-3,4) 1 Macquarie 17.0 1.01 (0.90-1.11) 0 (-2,2) 1 Mid Western 20.1 0.99 (0.89-1.09) 0 (-5,4) 1 Far West 26.4 0.99 (0.88-1.09) 0 (-2,1) 0 Greater Murray 20.5 0.99 (0.90-1.09) 0 (-7,7) 2 Southern 21.0 0.99 (0.89-1.09) 0 (-5,4) 1 New South Wales 18.4 1.00 44

Note: Relative risk of excess death compares observed relative survival with that expected from a Poisson model including terms for age, sex, follow-up year, and age by follow-up year interaction term, with the NSW average rates as the reference.

Cancer survival, incidence and mortality in NSW 1994–2000 Brain


Table 25b: Observed and expected number of new cases and deaths, excess

new cases and deaths with 95% confidence intervals, percent of cases aged 65 years or over by Area Health Services in NSW 1994–98. Brain cancer

Males

Number of new cases % diagnosed Number of deaths Area Health Service

observed expected excess* (95% CI) 65+ yrs observed expected excess* (95% CI)

Central Sydney 74 90 -2 (-9,4) 33.8 56 72 -6 (-16,4)

Northern Sydney 148 148 0 (-10,10) 36.5 120 119 1 (-14,16)

Western Sydney 103 111 -1 (-9,7) 21.4 74 84 -4 (-16,7)

Wentworth 56 49 1 (-3,4) 31.6 47 36 3 (-3,8)

South Western Sydney 108 124 -3 (-12,6) 38.0 81 94 -6 (-18,7)

Central Coast 58 59 0 (-4,4) 44.8 41 49 -2 (-9,5)

Hunter 104 104 0 (-8,8) 47.1 87 83 2 (-10,13)

Illawarra 76 69 1 (-4,6) 34.2 53 55 -1 (-9,7)

South Eastern Sydney 170 146 5 (-6,15) 42.9 146 117 14 (-1,30)

Northern Rivers 60 54 0 (-4,5) 45.0 42 44 -1 (-7,6)

Mid North Coast 58 58 0 (-4,4) 37.9 51 48 1 (-7,8)

New England 31 35 0 (-3,2) 35.5 30 28 0 (-4,5)

Macquarie 19 20 0 (-2,2) 31.6 15 16 0 (-3,3)

Mid Western 28 33 0 (-3,2) 39.3 20 26 -1 (-5,3)

Far West 9 10 0 (-1,1) 33.3 7 8 0 (-2,1)

Greater Murray 60 51 1 (-3,5) 48.3 51 40 3 (-4,9)

Southern 36 38 0 (-3,3) 52.8 31 31 0 (-5,5)

New South Wales 1198 1198 38.5 950 950

Females



Central Sydney 64 66 40.6 53 51

Northern Sydney 114 115 44.7 77 92

Western Sydney 76 81 43.4 57 61

Wentworth 39 35 48.7 28 26

South Western Sydney 103 90 37.9 70 68

Central Coast 49 44 51.0 44 36

Hunter 78 76 42.3 62 60

Illawarra 44 49 50.0 40 39

South Eastern Sydney 103 108 39.8 85 86

Northern Rivers 38 38 47.4 37 31


There was no area variation in excess number of new cases 47.6 34 33


New England 24 25 41.7 18 20

Macquarie 12 14 25.0 10 11

Mid Western 27 23 44.4 25 18

Far West 5 7 40.0 5 5

Greater Murray 36 36 55.6 24 28

Southern 21 26 33.3 18 21

New South Wales 875 875 43.5 687 687


Thyroid Cancer survival, incidence and mortality in NSW 1994–2000


Thyroid cancer

• The five-year relative survival from thyroid cancer in NSW between 1994 and 2000 was 94.0%

• There was no significant area variation in the adjusted relative risk of excess death due to thyroid cancer after shrinking


• There were 1,708 new cases of thyroid cancer in NSW in 1994 to 1998 (456 males and 1,252 females) and 126 deaths (69 males and 57 females)

• There were more new cases of thyroid cancer than expected in Central Sydney (19 in males), Northern Sydney (28 in females), Western Sydney (15 in males and 49 in females), South Eastern Sydney (37 in females); and fewer than expected in Wentworth (19 in females), Central Coast (eight in males), Hunter (13 in males and 44 in females), Northern Rivers (seven in males and 19 in females), Mid North Coast (14 in females), Macquarie (three in males), Greater Murray (six in males and 18 in females) and Southern (13 in females)

• There were no Area Health Services in which the number of deaths from thyroid cancer was different from expected in females, and there was no area variation in the excess number of deaths in males


cancer and excess cancer deaths after shrinking with 95% confidence intervals and potential lives savable by Area Health Services in NSW 1994–2000. Thyroid cancer


Central Sydney 96.6 0.70 (0.30-1.10) -3 (-8,1) 2

Northern Sydney 93.6 1.00 (0.57-1.43) 0 (-6,6) 6

Western Sydney 95.3 1.12 (0.57-1.67) 1 (-4,6) 4

Wentworth 97.2 1.01 (0.30-1.72) 0 (-1,1) 1

South Western Sydney 96.5 0.62 (0.28-0.96) -6 (-11,-1) 3

Central Coast 101.0 0.61 (0.11-1.11) -1 (-3,0) 0

Hunter 91.0 1.38 (0.62-2.14) 1 (-1,4) 3

Illawarra 94.6 0.81 (0.35-1.28) -2 (-6,2) 2

South Eastern Sydney 92.6 1.46 (0.88-2.04) 5 (-1,12) 7

Northern Rivers 84.5 1.14 (0.49-1.79) 1 (-2,4) 2

Mid North Coast 83.6 1.41 (0.63-2.19) 1 (-1,4) 3

New England 91.9 1.31 (0.44-2.19) 0 (-1,1) 1

Macquarie 104.4 0.86 (0.15-1.57) 0 (-1,1) 0

Mid Western 96.0 0.80 (0.19-1.40) -1 (-2,1) 0

Far West 107.1 0.85 (0.15-1.54) 0 (-1,1) 0

Greater Murray 89.8 1.23 (0.46-2.00) 1 (-1,2) 2

Southern 76.2 1.28 (0.58-1.99) 1 (-2,4) 3



Cancer survival, incidence and mortality in NSW 1994–2000 Thyroid



and deaths with 95% confidence intervals, percent of cases aged 65 years or over and with non-localised spread of disease at diagnosis by Area Health Services in NSW 1994–98. Thyroid cancer

Males



Central Sydney 59 36 19 (5,32) 36.7 41.3 11 5

Northern Sydney 48 57 -8 (-21,5) 33.3 54.5 8 9

Western Sydney 61 44 15 (1,28) 19.4 24.5 6 6

Wentworth 24 19 3 (-4,11) 8.3 42.9 4 2


Central Coast 10 21 -8 (-14,-2) 40.0 50.0 1 4

Hunter 23 39 -13 (-22,-4) 13.0 42.1 3 6

Illawarra 32 25 5 (-4,15) 34.4 50.0 4 4


Northern Rivers 10 19 -7 (-13,-1) 40.0 71.4 3 3

Mid North Coast 13 20 -5 (-12,1) 46.2 58.3 4 4


New England 9 13 -3 (-8,2) 11.1 16.7 0 2

Macquarie 1 7 -3 (-6,0) 0.0 0.0 2 1

Mid Western 11 12 -1 (-6,4) 9.1 55.6 1 2

Far West 3 4 0 (-2,2) 33.3 100.0 0 1

Greater Murray 10 19 -6 (-12,0) 40.0 57.1 2 3

Southern 15 14 1 (-5,7) 26.7 66.7 3 2

New South Wales 456 456 27.2 42.4 69 69

Females



Central Sydney 123 101 20 (0,41) 16.0 27.4 3 4 0 (-2,1)

Northern Sydney 192 163 28 (1,54) 22.9 24.1 8 8 0 (-3,3)

Western Sydney 179 126 49 (24,74) 11.1 23.3 4 5 0 (-2,2)

Wentworth 35 57 -19 (-30,-8) 2.8 20.0 0 2 0 (-1,1)


Central Coast 44 56 -10 (-22,2) 15.9 37.1 1 3 0 (-1,1)

Hunter 56 104 -44 (-59,-30) 22.4 38.2 9 5 1 (-1,3)

Illawarra 73 67 5 (-10,21) 20.5 18.6 3 3 0 (-1,1)


Northern Rivers 28 50 -19 (-29,-9) 34.5 22.7 1 3 0 (-1,1)

Mid North Coast 34 51 -14 (-25,-4) 20.0 37.5 2 3 0 (-1,1)

New England 29 35 -5 (-14,5) 13.8 38.1 6 2 0 (0,1)

Macquarie 22 20 1 (-6,9) 8.7 38.9 0 1 0 (0,0)

Mid Western 25 32 -5 (-14,4) 20.0 46.7 0 2 0 (-1,0)

Far West 6 9 -2 (-6,2) 0.0 25.0 0 0 0 (0,0)

Greater Murray 28 49 -18 (-28,-8) 23.3 13.6 5 2 0 (-1,1)

Southern 19 36 -13 (-21,-5) 26.3 21.4 1 2 0 (-1,1)

New South Wales 1252 1252 16.2 27.8 57 57


Non-Hodgkin lymphoma Cancer survival, incidence and mortality in NSW 1994–2000


Non-Hodgkin lymphoma

• The five-year relative survival from non-Hodgkin lymphoma in NSW between 1994 and 2000 was 54.3%

• No Area Health Service was different from the State average in the adjusted relative risk of excess death due to non-Hodgkin lymphoma after shrinking


• There were 5,167 new cases of non-Hodgkin lymphoma in NSW in 1994 to 1998 (2,791 males and 2,376 females) and 2,612 deaths (1,361 males and 1,251 females)

• There were 49 more new cases of non-Hodgkin lymphoma than expected in males in South Eastern Sydney, and 28 fewer than expected in males in South Western Sydney

• There were 22 more deaths from non-Hodgkin lymphoma than expected in males in South Eastern Sydney

• There were no other Area Health Services in which the number of new cases or deaths from non-Hodgkin lymphoma was different from expected in either males or females

Table 27a: Five-year relative survival, relative risk of excess death due to cancer and excess cancer deaths after shrinking with 95% confidence intervals and potential lives savable by Area Health Services in NSW 1994–2000. Non-Hodgkin lymphoma


Central Sydney 54.3 0.99 (0.89-1.09) -2 (-20,16) 13 Northern Sydney 57.9 0.92 (0.84-1.00) -27 (-54,0) 20 Western Sydney 52.4 1.03 (0.93-1.13) 5 (-14,24) 14 Wentworth 55.0 1.01 (0.89-1.13) 1 (-8,9) 5 South Western Sydney 54.8 1.03 (0.93-1.13) 5 (-13,23) 13 Central Coast 56.6 0.95 (0.84-1.06) -6 (-19,7) 8 Hunter 54.9 1.00 (0.90-1.10) 0 (-20,21) 15 Illawarra 48.7 1.06 (0.95-1.18) 7 (-6,21) 10 South Eastern Sydney 51.0 1.07 (0.98-1.16) 22 (-6,50) 25 Northern Rivers 58.2 0.96 (0.85-1.07) -4 (-15,8) 7 Mid North Coast 53.9 0.97 (0.87-1.08) -3 (-16,10) 8 New England 60.2 0.97 (0.85-1.09) -2 (-9,5) 4 Macquarie 47.3 1.03 (0.90-1.16) 1 (-3,5) 3 Mid Western 45.2 1.06 (0.93-1.19) 3 (-3,9) 4 Far West 68.0 0.98 (0.85-1.11) 0 (-2,1) 1 Greater Murray 61.7 0.95 (0.84-1.06) -4 (-13,5) 5 Southern 51.2 1.01 (0.89-1.13) 1 (-8,9) 5 New South Wales 54.3 1.00 159


Cancer survival, incidence and mortality in NSW 1994–2000 Non-Hodgkin lymphoma


Table 27b: Observed and expected number of new cases and deaths, excess new cases and deaths with 95% confidence intervals, percent of cases aged 65 years or over by Area Health Services in NSW 1994–98. Non-Hodgkin lymphoma

Males



Central Sydney 223 214 6 (-17,29) 42.0 108 104 2 (-11,15)

Northern Sydney 357 352 4 (-28,36) 53.5 190 174 9 (-11,29)

Western Sydney 235 246 -7 (-32,18) 45.9 114 113 1 (-13,15)

Wentworth 107 105 1 (-13,14) 39.8 51 48 1 (-6,8)

South Western Sydney 232 273 -28 (-54,-3) 46.8 104 126 -10 (-25,4)

Central Coast 155 144 6 (-11,24) 61.2 79 75 2 (-9,12)

Hunter 267 244 15 (-10,41) 48.8 115 120 -2 (-17,12)

Illawarra 157 161 -2 (-21,16) 56.5 78 79 0 (-11,10)

South Eastern Sydney 415 348 49 (16,83) 45.5 212 172 22 (2,43)

Northern Rivers 140 131 5 (-12,21) 52.8 55 67 -4 (-13,5)

Mid North Coast 126 141 -8 (-25,8) 61.9 69 73 -1 (-11,8)

New England 62 81 -8 (-18,3) 54.4 27 40 -3 (-9,3)

Macquarie 49 46 1 (-6,8) 50.0 27 22 1 (-3,4)

Mid Western 62 75 -5 (-15,5) 47.5 31 37 -1 (-7,4)

Far West 15 24 -1 (-5,2) 30.8 7 11 0 (-2,1)

Greater Murray 95 117 -11 (-25,3) 53.2 48 57 -3 (-11,5)

Southern 94 89 2 (-10,14) 53.3 46 44 1 (-6,7)

New South Wales 2791 2791 50.1 1361 1361

Females



Central Sydney 189 180 2 (-10,13) 64.0 96 96 0 (-11,11)

Northern Sydney 369 330 11 (-8,31) 60.1 183 181 1 (-17,19)

Western Sydney 206 205 0 (-12,13) 51.8 104 101 1 (-10,12)

Wentworth 70 86 -2 (-7,4) 42.4 34 42 -1 (-6,4)


Central Coast 106 127 -3 (-11,5) 73.5 62 70 -2 (-10,6)

Hunter 219 210 2 (-11,15) 62.9 138 112 9 (-4,21)

Illawarra 125 132 -1 (-9,7) 56.9 59 69 -2 (-10,5)


Northern Rivers 102 108 -1 (-8,6) 62.5 47 58 -2 (-9,4)

Mid North Coast 115 116 0 (-8,7) 53.9 64 62 0 (-7,8)

New England 72 69 0 (-4,5) 60.6 38 36 0 (-4,5)

Macquarie 28 38 0 (-3,2) 64.0 18 20 0 (-3,2)

Mid Western 58 64 0 (-5,4) 66.0 32 34 0 (-4,4)

Far West 16 18 0 (-1,1) 62.5 11 10 0 (-1,1)

Greater Murray 87 97 -1 (-7,5) 49.3 42 52 -2 (-8,4)

Southern 73 70 0 (-4,5) 58.0 39 37 0 (-4,5)

New South Wales 2376 2376 59.5 1251 1251


Hodgkin’s disease Cancer survival, incidence and mortality in NSW 1994–2000


Hodgkin’s disease

• The five-year relative survival from Hodgkin’s disease in NSW between 1994 and 2000 was 78.0%

• There was no area variation in the adjusted relative risk of excess death due to Hodgkin’s disease after shrinking

• There were 639 new cases of Hodgkin’s disease in NSW in 1994 to 1998 (358 males and 281 females) and 161 deaths (95 males and 66 females)

• There were no Area Health Services in which the number of new cases of Hodgkin’s disease was different from expected in males, and there was no area variation in the excess number of new cases in females

• There were no Area Health Services in which the number of deaths from Hodgkin’s disease was different from expected in either males or females

Table 28a: Five-year relative survival, relative risk of excess death due to cancer and excess cancer deaths after shrinking with 95% confidence intervals and potential lives savable by Area Health Services in NSW 1994–2000. Hodgkin’s disease


Central Sydney 80.3

Northern Sydney 75.0

Western Sydney 79.3

Wentworth 73.6

South Western Sydney 85.6

Central Coast 45.8

Hunter 87.4

Illawarra 80.6

South Eastern Sydney 83.9

Northern Rivers 66.6

There was no area variation in the adjusted relative risks of excess death due to Hodgkin’s disease after shrinking

Mid North Coast 59.6 New England 67.1 Macquarie 75.2 Mid Western 59.9 Far West 67.4 Greater Murray 93.4 Southern 93.7 New South Wales 78.0

Note: Relative risk of excess death compares observed relative survival with that expected from a Poisson model including terms for age, sex, follow-up year, and age by follow-up year interaction, with the NSW average rates as the reference.

Cancer survival, incidence and mortality in NSW 1994–2000 Hodgkin’s disease



new cases and deaths with 95% confidence intervals, percent of cases aged 65 years or over by Area Health Services in NSW 1994–98. Hodgkin’s disease

Males



Central Sydney 31 28 1 (-5,7) 9.7 6 7 0 (-1,1)

Northern Sydney 38 44 -3 (-11,6) 26.3 18 12 0 (-1,2)

Western Sydney 33 36 -1 (-9,6) 18.2 7 9 0 (-1,1)

Wentworth 26 16 2 (-2,7) 11.5 4 4 0 (0,1)

South Western Sydney 42 41 1 (-8,9) 14.3 8 9 0 (-1,1)

Central Coast 14 15 0 (-4,3) 28.6 8 5 0 (-1,1)

Hunter 23 30 -3 (-9,4) 26.1 6 8 0 (-1,1)

Illawarra 24 20 1 (-3,6) 20.8 7 5 0 (-1,1)


Northern Rivers 5 14 -2 (-5,1) 20.0 6 4 0 (-1,1)

Mid North Coast 23 14 2 (-2,6) 34.8 7 5 0 (-1,1)

New England 11 10 0 (-2,3) 27.3 1 3 0 (0,0)

Macquarie 10 6 0 (-1,2) 30.0 2 2 0 (0,0)

Mid Western 6 9 -1 (-3,2) 33.3 1 3 0 (0,0)

Far West 4 3 0 (-1,1) 0.0 0 1 0 (0,0)

Greater Murray 12 15 -1 (-4,3) 25.0 5 4 0 (-1,1)

Southern 8 10 0 (-3,2) 12.5 2 3 0 (0,0)

New South Wales 358 358 19.0 95 95

Females



Central Sydney 29 23 6.9 7 5 0 (-1,2)

Northern Sydney 41 36 26.8 6 9 -1 (-3,2)

Western Sydney 35 29 20.0 6 6 0 (-2,2)

Wentworth 9 13 33.3 4 2 0 (-1,1)

South Western Sydney 37 32 21.6 5 6 0 (-2,2)

Central Coast 9 12 22.2 3 3 0 (-1,1)

Hunter 17 23 17.6 3 6 0 (-2,1)

Illawarra 12 15 16.7 2 4 0 (-1,1)

South Eastern Sydney 40 36 17.5 14 9 1 (-2,4)

Northern Rivers 10 11 20.0 5 3 0 (-1,1)


There was no area variation in excess number of new cases 11.1 1 3 0 (-1,1)

New England 8 8 25.0 2 2 0 (-1,1)

Macquarie 5 4 20.0 1 1 0 (0,0)

Mid Western 8 7 37.5 4 2 0 (0,1)

Far West 0 2 0.0 1 1 0 (0,0)

Greater Murray 9 11 22.2 0 3 0 (-1,1)

Southern 3 8 0.0 2 2 0 (-1,1)

New South Wales 281 281 19.9 66 66


Multiple myeloma Cancer survival, incidence and mortality in NSW 1994–2000


Multiple myeloma

• The five-year relative survival from multiple myeloma in NSW between 1994 and 2000 was 34.8%

• No Area Health Service was significantly different from the State average in the adjusted relative risk of excess death due to multiple myeloma after shrinking, although significant area variation was detected (p = 0.02)


• There were 1,699 new cases of multiple myeloma in NSW in 1994 to 1998 (962 males and 737 females) and 1,035 deaths (567 males and 468 females)

• There were no Area Health Services in which the number of new cases of multiple myeloma was different from expected in either males or females

• There were no Area Health Services in which the number of deaths from multiple myeloma was different from expected in males, and there was no area variation in the excess number of deaths in females

Table 29a: Five-year relative survival, relative risk of excess death due to cancer and excess cancer deaths after shrinking with 95% confidence intervals and potential lives savable by Area Health Services in NSW 1994–2000. Multiple myeloma


Central Sydney 43.0 0.87 (0.72-1.01) -13 (-27,1) 7

Northern Sydney 40.1 0.91 (0.78-1.03) -15 (-35,5) 13

Western Sydney 31.9 1.10 (0.92-1.27) 7 (-6,19) 8

Wentworth 39.9 1.01 (0.81-1.22) 0 (-5,6) 3


Central Coast 30.2 1.01 (0.83-1.19) 1 (-10,11) 6

Hunter 33.3 0.97 (0.82-1.13) -2 (-17,12) 9

Illawarra 27.3 1.15 (0.96-1.34) 8 (-2,19) 7


Northern Rivers 18.6 1.20 (0.98-1.42) 7 (-1,14) 5

Mid North Coast 28.2 1.08 (0.88-1.28) 3 (-5,12) 5

New England 39.9 1.00 (0.80-1.21) 0 (-5,6) 3

Macquarie 46.7 1.02 (0.80-1.24) 0 (-3,4) 2

Mid Western 23.6 1.06 (0.83-1.28) 1 (-3,5) 2

Far West 51.5 0.94 (0.71-1.16) 0 (-2,1) 0

Greater Murray 39.5 0.95 (0.76-1.14) -2 (-10,6) 3

Southern 45.3 0.93 (0.74-1.12) -2 (-9,4) 3



Cancer survival, incidence and mortality in NSW 1994–2000 Multiple myeloma



new cases and deaths with 95% confidence intervals, percent of cases aged 65 years or over by Area Health Services in NSW 1994–98. Multiple myeloma

Males



Central Sydney 77 73 1 (-8,11) 70.0 40 43 0 (-5,4)

Northern Sydney 141 123 8 (-7,23) 74.4 66 73 -2 (-9,6)

Western Sydney 59 78 -6 (-16,3) 53.6 43 45 0 (-5,5)

Wentworth 35 32 0 (-4,5) 63.6 15 19 0 (-2,2)


Central Coast 50 54 -1 (-8,6) 74.5 25 32 -1 (-4,3)

Hunter 84 86 -1 (-11,10) 72.7 52 50 0 (-5,6)

Illawarra 65 57 2 (-6,10) 66.1 48 33 2 (-2,6)


Northern Rivers 51 48 1 (-6,7) 72.9 31 29 0 (-3,4)

Mid North Coast 49 53 -1 (-8,6) 60.9 27 32 -1 (-4,3)

New England 27 28 0 (-4,4) 65.4 14 17 0 (-2,2)

Macquarie 17 16 0 (-2,2) 56.3 10 9 0 (-1,1)

Mid Western 11 26 -2 (-6,1) 60.0 20 15 0 (-2,2)

Far West 4 8 0 (-1,1) 100.0 6 5 0 (-1,1)

Greater Murray 38 41 -1 (-6,5) 71.4 27 24 0 (-3,3)

Southern 40 32 1 (-3,6) 56.8 20 18 0 (-2,2)

New South Wales 962 962 68.4 567 567

Females



Central Sydney 62 56 1 (-5,7) 75.0 36 36

Northern Sydney 107 105 1 (-9,10) 68.6 72 68

Western Sydney 69 60 1 (-5,7) 64.2 41 37

Wentworth 18 25 0 (-3,2) 55.6 7 15

South Western Sydney 55 65 -2 (-8,5) 75.5 38 40

Central Coast 48 42 1 (-4,5) 73.9 27 27

Hunter 72 66 1 (-6,8) 72.1 49 42

Illawarra 42 41 0 (-4,4) 71.1 26 26

South Eastern Sydney 108 96 3 (-7,12) 79.2 66 62

Northern Rivers 23 34 -1 (-5,2) 90.9 21 22

Mid North Coast 27 37 -1 (-5,3) 88.5 23 24


New England 25 21 0 (-2,2) 72.7 17 14

Macquarie 16 12 0 (-1,1) 56.3 10 7

Mid Western 18 20 0 (-2,2) 88.9 15 13

Far West 6 6 0 (-1,1) 100.0 0 4

Greater Murray 24 30 -1 (-4,3) 77.3 11 19

Southern 17 22 0 (-3,2) 70.6 9 14

New South Wales 737 737 73.5 468 468


Leukaemia Cancer survival, incidence and mortality in NSW 1994–2000


Leukaemia

• The five-year relative survival from leukaemia in NSW between 1994 and 2000 was 36.5%

• The adjusted relative risks of excess death after shrinking were lower in Northern Sydney (12%, 38 fewer deaths) and Hunter (13%, 27 fewer deaths)

• An additional 249 patients with leukaemia would be expected to survive to five years after diagnosis in NSW if the State average risk was shifted to the 20th centile of the distribution

• There were 3,609 new cases of leukaemia in NSW in 1994 to 1998 (2,094 males and 1,515 females) and 2,183 deaths (1,261 males and 922 females)

• There was no area variation in the excess number of new cases in males, and there were no Area Health Services in which the number of new cases in females was different from expected

• There were no Area Health Services in which the number of deaths from leukaemia was different from expected in either males or females

Table 30a: Five-year relative survival, relative risk of excess death due to cancer and excess cancer deaths after shrinking with 95% confidence intervals and potential lives savable by Area Health Services in NSW 1994–2000. Leukaemia


Central Sydney 31.8 1.04 (0.91-1.17) 6 (-14,26) 21 Northern Sydney 42.0 0.88 (0.78-0.97) -38 (-67,-9) 34 Western Sydney 35.0 1.04 (0.91-1.17) 7 (-14,28) 22 Wentworth 35.4 1.02 (0.85-1.20) 1 (-8,11) 7 South Western Sydney 38.1 1.01 (0.88-1.13) 1 (-21,23) 23 Central Coast 33.7 1.06 (0.91-1.22) 6 (-8,20) 13 Hunter 42.9 0.87 (0.76-0.98) -27 (-49,-5) 21 Illawarra 27.5 1.14 (0.98-1.30) 13 (-2,28) 15 South Eastern Sydney 34.7 1.03 (0.92-1.14) 7 (-20,33) 32 Northern Rivers 36.5 0.97 (0.83-1.12) -3 (-17,12) 12 Mid North Coast 32.4 1.01 (0.86-1.16) 1 (-12,14) 11 New England 31.9 1.07 (0.89-1.24) 4 (-6,14) 9 Macquarie 36.5 1.05 (0.84-1.25) 1 (-3,6) 3 Mid Western 34.2 1.07 (0.89-1.26) 3 (-5,11) 6 Far West 68.1 0.92 (0.73-1.12) -1 (-4,2) 1 Greater Murray 28.4 1.17 (0.99-1.34) 12 (-1,24) 12 Southern 45.3 0.89 (0.74-1.04) -8 (-19,3) 7 New South Wales 36.5 1.00 249


Cancer survival, incidence and mortality in NSW 1994–2000 Leukaemia



new cases and deaths with 95% confidence intervals, percent of cases aged 65 years or over by Area Health Services in NSW 1994–98. Leukaemia

Males



Central Sydney 159 157 50.3 101 95 0 (-5,6)

Northern Sydney 279 262 57.6 145 161 -2 (-10,7)

Western Sydney 184 182 48.4 105 103 0 (-5,6)

Wentworth 59 79 42.4 33 44 0 (-3,2)

South Western Sydney 220 205 41.4 115 116 0 (-6,6)

Central Coast 115 111 63.5 72 70 0 (-4,4)

Hunter 203 184 58.6 106 112 -1 (-6,5)

Illawarra 107 121 60.7 74 73 0 (-4,4)

South Eastern Sydney 247 258 56.3 181 159 3 (-6,11)

Northern Rivers 100 100 58.0 61 62 0 (-3,3)


There was no area variation in excess number of new cases 59.2 56 68 -1 (-4,3)

New England 62 62 54.8 42 37 0 (-2,2)

Macquarie 26 35 61.5 22 21 0 (-1,1)

Mid Western 62 57 51.6 45 34 0 (-2,2)

Far West 16 18 62.5 6 11 0 (-1,1)

Greater Murray 90 89 54.4 62 54 0 (-3,3)

Southern 67 67 49.3 35 40 0 (-2,2)

New South Wales 2094 2094 54.0 1261 1261

Females



Central Sydney 121 115 3 (-12,17) 62.8 80 71 2 (-6,9)

Northern Sydney 247 209 23 (0,46) 57.5 147 132 5 (-8,17)

Western Sydney 134 132 1 (-15,17) 47.8 65 76 -2 (-10,5)

Wentworth 50 57 -2 (-10,6) 50.0 31 32 0 (-4,3)

South Western Sydney 139 144 -3 (-20,14) 54.0 86 82 1 (-8,9)

Central Coast 60 81 -8 (-18,2) 66.7 47 50 -1 (-6,5)

Hunter 131 134 -1 (-17,15) 55.0 78 82 -1 (-9,7)

Illawarra 77 83 -2 (-13,9) 64.9 58 50 1 (-4,7)


Northern Rivers 74 68 2 (-7,12) 64.9 37 42 -1 (-5,4)

Mid North Coast 59 72 -5 (-14,5) 61.0 33 45 -2 (-6,3)

New England 55 44 3 (-4,9) 70.9 40 27 1 (-2,4)

Macquarie 18 24 -1 (-5,3) 55.6 12 15 0 (-2,2)

Mid Western 26 41 -4 (-9,2) 57.7 13 25 -1 (-4,2)

Far West 11 12 0 (-2,2) 63.6 4 7 0 (-1,1)

Greater Murray 61 63 -1 (-9,8) 52.5 38 38 0 (-4,4)

Southern 51 44 2 (-5,8) 58.8 27 27 0 (-3,3)

New South Wales 1515 1515 59.4 922 922


Implications Cancer survival, incidence and mortality in NSW 1994–2000


Implications We found some differences in cancer survival across the Area Heath Services in NSW during the study period. The most marked significant regional variation in survival was found for cancers of the prostate, liver and ovary and melanoma of the skin. Statistically significant differences across Area Heath Services were also found for cancers of the colon, lung and female breast, and for multiple myeloma and leukaemia. The importance of this variation in survival was expressed in terms of the number of potential lives savable or deaths avoidable. A total of 2,903 additional people with one of the 25 major cancers could be expected to survive to five years after diagnosis by shifting the State average risk to the 20th centile of the distribution of relative risks. Although the reasons for the variation are not entirely clear, an important contributing factor could be the differences in the access to, and quality of, cancer care across Area Health Services. The results indicate that there may be opportunities to improve the outcome of cancer care in some Area Health Services for some cancers, especially the common cancers with large regional variation. Possible reasons for this variation may include earlier detection (therefore a large proportion of cases with localised disease at diagnosis) and use of different treatment regimens. The results suggest that health authorities should target the sites with the largest potential gains in the number of lives savable (lung, colon and prostate cancers) and to explore what factors may be contributing to the significant differences across Area Health Services in cancer survival.

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Twelves CJ, Thomson CS, Dewar JA, Brewster DH. Variation in survival of women with breast cancer: Health Board remains a factor at 10 years. Br J Cancer 2001;85(5):637–40.

Ulm, K. A simple method to calculate the confidence interval of a standardized mortality ratio (SMR). Am J Epidemiol 1990;131(2):373–75.

Vality Technology Incorporated. The INTEGRITY Data Re-engineering EnvironmentTM User Guide (version 3.6). Boston, USA: Vality Technology Incorporated. 2000.

Appendix one Cancer survival, incidence and mortality in NSW 1994–2000


Appendixes

Appendix one Table 31: Standard populations

NSW population 1994–981

Age group Males Females Age group Males Females 0 222,119 211,109 45 219,088 216,836 1 224,434 213,159 46 217,897 213,727 2 225,312 213,809 47 219,320 213,412 3 226,309 214,914 48 214,247 207,318 4 226,824 215,312 49 208,036 200,325 5 226,333 215,137 50 201,378 192,995 6 225,271 214,306 51 189,555 181,718 7 223,841 213,621 52 176,392 169,385 8 222,665 212,367 53 169,225 163,021 9 221,458 211,285 54 161,299 155,448

10 221,329 211,038 55 153,629 148,441 11 221,495 211,606 56 148,903 144,576 12 222,073 211,742 57 144,682 140,858 13 221,870 211,457 58 139,944 137,114 14 220,920 209,884 59 134,453 133,594 15 219,829 208,371 60 130,526 130,300 16 217,907 207,024 61 126,642 127,195 17 216,975 206,484 62 123,292 124,995 18 216,141 206,122 63 122,709 125,465 19 218,767 209,398 64 122,579 125,541 20 222,490 214,023 65 122,238 126,212 21 228,139 220,451 66 121,313 126,746 22 235,568 228,203 67 119,429 126,562 23 242,416 236,696 68 116,164 125,457 24 243,809 240,697 69 112,233 123,629 25 242,904 242,203 70 107,799 122,078 26 239,964 240,362 71 102,797 119,466 27 234,983 236,002 72 98,035 117,176 28 230,850 231,634 73 92,760 114,120 29 231,194 231,944 74 86,961 109,547 30 234,885 234,960 75 79,156 101,834 31 240,219 239,424 76 71,428 94,832 32 246,293 244,364 77 63,963 87,826 33 251,653 249,938 78 56,943 81,239 34 254,180 252,464 79 51,071 75,709 35 252,218 251,238 80 46,589 72,443 36 249,558 249,381 81 41,755 67,736 37 245,821 245,712 82 36,714 62,646 38 241,573 241,434 83 31,894 57,306 39 237,361 237,221 84 27,246 51,822 40 234,170 234,290 85 22,487 45,063 41 230,795 230,738 86 18,377 38,984 42 226,863 226,940 87 14,750 33,023 43 224,607 224,649 88 11,718 27,636 44 222,195 221,128 89 or over 34,432 103,973

1 Population estimated at 30 June. ABS 1994–1998 estimated resident populations (HOIST). Centre for Epidemiology and Research, NSW Health Department.

Cancer survival, incidence and mortality in NSW 1994–2000 Appendix two


Appendix two

List of NSW local government areas by Area Health Service

Appendix two Cancer survival, incidence and mortality in NSW 1994–2000


Central Sydney South Eastern Sydney (cont.) Mid Western (cont.) Ashfield Sutherland Forbes Burwood Sydney East 1 Greater Lithgow Canterbury Waverley Lachlan Concord Woollahra Oberon Drummoyne Northern Rivers Orange Leichhardt Ballina Parkes Marrickville Byron Rylstone Strathfield Casino Weddin Sydney West 1 Copmanhurst Far West

Northern Sydney Grafton Balranald Hornsby Kyogle Bourke Hunters Hill Lismore Brewarrina Ku-ring-gai Maclean Broken Hill Lane Cove Nymboida Central Darling Manly Richmond River Unincorporated Far West Mosman Tweed Walgett North Sydney Ulmarra Wentworth Ryde Mid North Coast Greater Murray Warringah Bellingen Albury Willoughby Coffs Harbour Berrigan

Western Sydney Gloucester Bland Auburn Great Lakes Carrathool Baulkham Hills Greater Taree Conargo Blacktown Hastings Coolamon Holroyd Kempsey Cootamundra Parramatta Nambucca Corowa

Wentworth New England Culcairn Blue Mountains Armidale Deniliquin Hawkesbury Barraba Griffith Penrith Bingara Gundagai

South Western Sydney Dumaresq Hay Bankstown Glen Innes Holbrook Camden Gunnedah Hume Campbelltown Guyra Jerilderie Fairfield Inverell Junee Liverpool Manilla Leeton Wingecarribee Moree Plains Lockhart Wollondilly Narrabri Murray

Central Coast Nundle Murrumbidgee Gosford Parry Narrandera Wyong Quirindi Temora

Hunter Severn Tumbarumba Cessnock Tamworth Tumut Dungog Tenterfield Urana Lake Macquarie Uralla Wagga Wagga Maitland Walcha Wakool Merriwa Yallaroi Windouran Murrurundi Macquarie Southern Muswellbrook Bogan Bega Valley Newcastle Cobar Bombala Port Stephens Coolah Boorowa Scone Coonabarabran Cooma-Monaro Singleton Coonamble Crookwell

Illawarra Dubbo Eurobodalla Kiama Gilgandra Goulburn Shellharbour Mudgee Gunning Shoalhaven Narromine Harden Wollongong Warren Mulwaree

South Eastern Sydney Wellington Queanbeyan Botany Mid Western Snowy River Hurstville Bathurst Tallaganda Kogarah Blayney Yarrowlumla Lord Howe Island Cabonne Yass Randwick Cowra Young Rockdale Evans

1 The cities of Sydney and South Sydney are divided between Central and South Eastern Sydney Area Health Services. ‘Sydney West’ describes the part in Central Sydney while the remainder, in South Eastern Sydney, is designated ‘Sydney East’.

Cancer survival, incidence and mortality in NSW 1994–2000 Appendix three


Appendix three

Estimating regional variation

The usual approach to estimating regional variation involves calculating the five-year relative survival for each region. Then the relative risk of excess death is estimated for each region via a generalised linear model to adjust for potential confounders such as patient’s age, sex, severity of disease at diagnosis and time since diagnosis. However, when comparing the relative survival across geographical areas, the sizes of the populations in some of the areas under comparison may be quite different. Therefore the sampling error around the estimates for some areas may be substantial and this may ‘swamp’ any true underlying regional variation. The distribution of the observed estimates of five-year relative survival can be expressed as the sum of two distributions – the distribution of the true relative survival and the distribution of the sampling errors within areas. Extreme (large or small) estimates of five-year relative survival are likely to represent unstable observations from areas with small populations. To overcome this, the Empirical Bayes (EB) method can be used to estimate a prior distribution for the relative risk from the observed data for all regions and ‘shrink’ the estimates in each area by combining information about the area-specific risk with information about risk from all other areas under study. The key difference between the EB approach and standard methods lies in the incorporation of data-based prior beliefs into the analysis of the data. EB estimation places a prior distribution on area-specific risk, thus the resulting relative risk estimate for each area is a weighted average of the observed relative risk of excess death and the mean relative risk across all areas. In general, upon applying EB estimation, formerly extreme, unstable estimates from areas with small populations become less extreme and more precise, whereas moderate, stable estimates from areas with large populations remain much the same. Methods First, for a particular cancer site, five-year relative survival was calculated for each Area Health Service. Because cancer survival can be affected by many factors, e.g. age, sex and spread of disease at diagnosis, differences observed in relative survival may be due to the differences in these factors between areas. Therefore, the excess deaths after a diagnosis of cancer were modelled for each Area Health Service while adjusting for these other prognostic factors. Poisson regression models for five-year relative survival with main effects for age group (15–44, 45–59, 60–74, 75–89 years), years since diagnosis, sex (where applicable) and spread of disease at diagnosis (where applicable categorised as localised, regional, distant and unknown) and an interaction between age group and years since diagnosis, were fitted separately for each of the 25 cancer sites. Then these area-specific estimates were used to quantify the magnitude of systematic regional variation in cancer survival. In order to stabilise the area-specific estimates of the relative risk of excess death an EB approach was applied to get ‘shrunken’ estimators. It was assumed that the adjusted relative risk of excess death followed a Gamma distribution with mean µ and standard deviation σ. An Empirical Bayes estimator for each cancer site was calculated using the formula:

EB estimator for Relative Risk = (O + µ2/σ2) / (E + µ/σ2)

where O is the observed excess deaths after a diagnosis of cancer in an Area Health Service and E is the expected excess deaths based on the State average.

Appendix three Cancer survival, incidence and mortality in NSW 1994–2000


The mean (µ) was set to be 1 and σ was estimated using the SAS procedure PROC NLIN. If both the observed (O) and expected (E) excess deaths are large (from large population areas) then the EB estimator is close to the usual estimator, whereas if they are both small (from low-population areas), then it is ‘shrunk’ towards the average value for all areas. A formal test for significant regional variation was performed by comparing the statistic calculated as the estimate of sigma divided by its standard error (Z = σ /se(σ )) with the standard normal distribution. Model fitting strategy The Poisson regression model for five-year relative survival was first fitted with main effects only – age group, follow-up interval, sex (where applicable) and spread of disease at diagnosis (where applicable). The models for all 25 sites of cancer converged except those for cancers of the testis and thyroid. For those 23 models that converged an interaction term of age group by follow-up interval was added in the model to test the assumption of proportional excess hazards over age groups. Six more models did not converge when the interaction term was added. The data for the eight models that failed to converge was checked by tabulating age group by follow-up interval for each site. Age groups were redefined for some cancer sites to eliminate cells with zero counts. Three age groups were formed by combining the two youngest age groups. After this, the only model that did not converge was that for cancer of the testis. For this cancer site three new age groups were defined: 15–24, 25–34, 35–44 years. The model containing the main effects of interest including the three new age categories converged. As the model with the interaction term for age group by follow-up interval did not converge, estimates of the relative risk of excess death were obtained from the main effects model. Two-year relative survival was modelled for mesothelioma because too few cases survived beyond two years after diagnosis to provide reliable estimates of survival beyond this time period. The goodness-of-fit for each model was checked by looking at the deviance statistics under the ‘Criteria For Assessing Goodness-Of-Fit’ table printed by SAS. The models including main effects and age group by follow-up interaction with large p-values (>0.05) were a good fit to the data. For some cancer sites where model fit was poor, a follow-up interval by spread of disease interaction term was added to achieve better fitting models. In summary, as shown in Table 32, nine models fitted the data well with large p-values, six models fitted quite well (with p-values between 0.06 and 0.33), three models had p-values just below the 0.05 level and the remaining seven models did not fit the data well (as indicated by very small p-values).

Cancer survival, incidence and mortality in NSW 1994–2000 Appendix three


Table 32: Goodness-of-fit of models for risk of excess death Goodness-of-fit (deviance/DF) Cancer site Main effects + age group

by follow-up interval Main effects + spread of disease by follow-up interval

Main effects + both interaction terms

p-value for the ‘best’ model

Head and neck 0.94 0.97 Oesophagus* 1.07 <0.05 Stomach 1.12 Model did not converge 0.0007 Colon 1.04 0.11 Rectum 1.04 0.10 Liver* 1.41 Model did not converge 6.32E-12 Gallbladder* 1.04 0.21 Pancreas 1.26 Model did not converge 1.54E-08 Lung 1.17 1.14 1.13 0.00002 Mesothelioma# (2-yr RSR) 1.30 Model did not converge 0.0002 Melanoma of the skin 0.96 0.92 Breast 1.36 1.23 1.17 0.00002 Cervix 1.02 0.33 Body of uterus 0.83 1.00 Ovary 0.93 0.96 Prostate* 1.22 1.20 1.17 0.0002 Testis# 0.27 1.00 Bladder* 0.91 0.99 Kidney* 0.95 0.95 Brain 1.07 0.06 Thyroid* 0.43 1.00 Non-Hodgkin lymphoma 1.07 0.08 Hodgkin's disease 0.76 1.00 Multiple myeloma 1.11 0.04 Leukaemia 1.11 0.02

# For testis cancer, different age groups (15–24, 25–34, 35–44 yrs) were included in the model; for mesothelioma two-year relative survival was modelled. * Only three age groups (15–59, 60–74, 75+ yrs) were used for adjustment in the model for these sites. Model of best fit

Appendix four Cancer survival, incidence and mortality in NSW 1994–2000


Appendix four Five-year relative survival and unshrunken relative risks of excess death by Area

Health Services in NSW

Cancer survival, incidence and mortality in NSW 1994–2000 Appendix four


Table 33: Five-year relative survival, relative risk

of excess death due to cancer with 95% confidence intervals by Area Health Services in NSW 1994–2000. Head and neck cancer

Area Health Service Five-year relative survival (%)

Relative risk of excess death (95% CI)

Central Sydney 55.8 1.00 (0.87-1.19) Northern Sydney 57.4 0.94 (0.82-1.11) Western Sydney 59.0 1.05 (0.90-1.26) Wentworth 57.3 1.02 (0.77-1.35) South Western Sydney 56.7 1.01 (0.88-1.20) Central Coast 52.6 0.98 (0.83-1.20) Hunter 52.3 1.09 (0.94-1.28) Illawarra 55.0 0.92 (0.76-1.14) South Eastern Sydney 57.9 0.95 (0.85-1.10) Northern Rivers 56.1 0.98 (0.80-1.25) Mid North Coast 56.2 0.91 (0.73-1.13) New England 46.6 1.16 (0.89-1.51) Macquarie 46.2 1.17 (0.86-1.58) Mid Western 60.7 0.89 (0.65-1.23) Far West 32.6 1.63 (1.13-2.28) Greater Murray 51.1 1.05 (0.84-1.31) Southern 55.9 1.01 (0.78-1.33) New South Wales 55.2 1.00

Note: The relative risk of excess deaths has been adjusted for age, sex, follow-up years and spread of disease at diagnosis, and the reference category is the State average rates predicted from a Poisson regression model.




of excess death due to cancer with 95% confidence intervals by Area Health Services in NSW 1994–2000. Cancer of the oesophagus



Central Sydney 15.2 1.02 (0.83-1.29) Northern Sydney 19.1 1.00 (0.87-1.23) Western Sydney 16.4 1.13 (0.93-1.45) Wentworth 13.4 1.03 (0.77-1.45) South Western Sydney 23.1 0.88 (0.74-1.13) Central Coast 13.0 1.23 (0.99-1.59) Hunter 18.4 0.93 (0.78-1.17) Illawarra 14.5 1.06 (0.86-1.36) South Eastern Sydney 9.2 1.16 (1.01-1.39) Northern Rivers 17.6 0.80 (0.64-1.05) Mid North Coast 19.0 0.82 (0.65-1.10) New England 16.2 0.92 (0.68-1.27) Macquarie 27.4 0.66 (0.37-1.09) Mid Western 9.7 1.24 (0.91-1.67) Far West N/A 1.99 (1.08-3.32) Greater Murray 18.8 1.01 (0.78-1.32) Southern 18.2 0.84 (0.64-1.17) New South Wales 16.3 1.00

Note: The relative risk of excess deaths has been adjusted for age, sex, follow-up years and spread of disease at diagnosis, and the reference category is the State average rates predicted from a Poisson regression model. N/A: No cases alive after the 4th year follow-up.




of excess death due to cancer with 95% confidence intervals by Area Health Services in NSW 1994–2000. Stomach cancer



Central Sydney 28.7 0.96 (0.84-1.13) Northern Sydney 32.2 0.83 (0.74-0.98) Western Sydney 25.2 0.99 (0.87-1.17) Wentworth 20.8 1.20 (0.98-1.53) South Western Sydney 22.9 1.03 (0.93-1.18) Central Coast 14.5 1.14 (0.97-1.40) Hunter 27.2 0.91 (0.80-1.07) Illawarra 26.4 1.11 (0.95-1.33) South Eastern Sydney 27.0 0.96 (0.88-1.11) Northern Rivers 20.8 1.01 (0.84-1.26) Mid North Coast 25.6 1.07 (0.89-1.31) New England 20.1 1.26 (0.97-1.63) Macquarie 25.3 0.94 (0.67-1.29) Mid Western 23.3 1.23 (0.92-1.63) Far West 12.0 1.32 (0.83-1.97) Greater Murray 29.3 0.98 (0.77-1.24) Southern 22.4 1.10 (0.85-1.47)

New South Wales 25.3 1.00

Note: The relative risk of excess deaths has been adjusted for age, sex, follow-up years and spread of disease at diagnosis and interaction term follow-up years by age, and the reference category is the State average rates predicted from a Poisson regression model.




of excess death due to cancer with 95% confidence intervals by Area Health Services in NSW 1994–2000. Colon cancer









of excess death due to cancer with 95% confidence intervals by Area Health Services in NSW 1994–2000. Rectal cancer









of excess death due to cancer with 95% confidence intervals by Area Health Services in NSW 1994–2000. Liver cancer



Central Sydney 14.9 0.82 (0.69-1.04) Northern Sydney 8.7 1.00 (0.83-1.32) Western Sydney 15.2 1.00 (0.82-1.27) Wentworth 9.2 1.00 (0.64-1.53) South Western Sydney 10.1 1.15 (0.99-1.40) Central Coast 5.4 1.35 (1.00-1.81) Hunter 5.2 1.39 (1.10-1.82) Illawarra 7.6 1.07 (0.78-1.50) South Eastern Sydney 20.5 0.76 (0.65-0.94) Northern Rivers 22.3 0.62 (0.40-1.01) Mid North Coast 4.0 1.75 (1.27-2.51) New England N/A 0.95 (0.42-1.91) Macquarie 36.3 0.71 (0.20-1.89) Mid Western 17.8 1.25 (0.61-2.34) Far West 9.7 1.70 (0.79-3.01) Greater Murray 9.6 1.26 (0.82-1.94) Southern 13.8 0.86 (0.52-1.53)


Note: The relative risk of excess deaths has been adjusted for age, sex, follow-up years and spread of disease at diagnosis, and the reference category is the State average rates predicted from Poisson regression model. N/A: No cases alive after the 4th year of follow-up




of excess death due to cancer with 95% confidence intervals by Area Health Services in NSW 1994–2000. Gallbladder cancer



Central Sydney 19.4 1.07 (0.86-1.40) Northern Sydney 14.4 1.05 (0.86-1.33) Western Sydney 22.9 1.04 (0.83-1.42) Wentworth 25.6 0.92 (0.64-1.38) South Western Sydney 19.9 0.97 (0.81-1.26) Central Coast 7.1 1.10 (0.83-1.50) Hunter 21.5 0.79 (0.64-1.01) Illawarra 18.3 1.12 (0.85-1.47) South Eastern Sydney 25.2 0.87 (0.73-1.13) Northern Rivers 15.3 1.11 (0.79-1.60) Mid North Coast 9.9 1.26 (0.90-1.78) New England 27.6 0.77 (0.42-1.35) Macquarie N/A 0.95 (0.48-1.72) Mid Western 27.2 0.94 (0.56-1.64) Far West N/A 0.46 (0.01-2.80) Greater Murray 19.4 1.32 (0.92-1.91) Southern 7.0 1.55 (1.05-2.36)


Note: The relative risk of excess deaths has been adjusted for age, sex, follow-up years and spread of disease at diagnosis, and the reference category is the State average rates predicted from a Poisson regression model. N/A: No cases alive after the 4th year of follow-up.




of excess death due to cancer with 95% confidence intervals by Area Health Services in NSW 1994–2000. Cancer of the pancreas



Central Sydney 6.6 0.91 (0.80-1.07) Northern Sydney 4.1 0.87 (0.80-1.00) Western Sydney 6.4 1.02 (0.91-1.20) Wentworth 2.5 1.20 (0.96-1.50) South Western Sydney 6.4 1.03 (0.92-1.19) Central Coast 2.4 1.09 (0.93-1.31) Hunter 5.0 1.04 (0.91-1.20) Illawarra 3.4 1.12 (0.95-1.33) South Eastern Sydney 6.2 0.90 (0.83-1.04) Northern Rivers 11.0 0.92 (0.77-1.14) Mid North Coast 5.2 1.00 (0.83-1.23) New England 3.6 1.36 (1.06-1.73) Macquarie 6.6 0.95 (0.72-1.29) Mid Western 5.3 1.20 (0.93-1.53) Far West N/A 1.02 (0.55-1.77) Greater Murray 3.7 1.19 (0.97-1.45) Southern 7.5 1.08 (0.87-1.37)


Note: The relative risk of excess deaths has been adjusted for age, sex, follow-up years and spread of disease at diagnosis and interaction term follow-up years by age, and the reference category is the State average rates predicted from a Poisson regression model. N/A: No cases alive after the 4th year of follow-up




of excess death due to cancer with 95% confidence intervals by Area Health Services in NSW 1994–2000. Lung cancer





Note: The relative risk of excess deaths has been adjusted for age, sex, follow-up years and spread of disease at diagnosis and interaction terms of follow-up years by age and spread of disease, and the reference category is the State average rates predicted from a Poisson regression model.



Table 42: Two-year relative survival, relative risk

of excess death due to cancer with 95% confidence intervals by Area Health Services in NSW 1994–2000. Mesothelioma

Area Health Service Two-year relative survival (%)


Central Sydney 8.7 1.24 (0.90-1.67) Northern Sydney 18.8 0.92 (0.74-1.18) Western Sydney 12.8 1.07 (0.83-1.38) Wentworth 23.4 0.87 (0.54-1.36) South Western Sydney 8.8 1.33 (1.04-1.67) Central Coast 10.1 1.17 (0.89-1.54) Hunter 17.6 0.85 (0.64-1.15) Illawarra 23.2 0.86 (0.61-1.20) South Eastern Sydney 13.2 1.00 (0.80-1.26) Northern Rivers 12.2 0.83 (0.53-1.27) Mid North Coast 22.5 0.80 (0.57-1.13) New England 13.0 1.15 (0.47-2.39) Macquarie N/A 1.12 (0.23-3.27) Mid Western 18.9 0.87 (0.47-1.49) Far West N/A 0.00 (0.00-1.64) Greater Murray 12.9 1.02 (0.63-1.56) Southern 11.6 1.13 (0.63-1.86) New South Wales 15.1 1.00

Note: The relative risk of excess deaths has been adjusted for age, follow-up years and spread of disease at diagnosis, and the reference category is the State average rates predicted from a Poisson regression model. N/A: No cases alive beyond the 1st year of follow-up.




of excess death due to cancer with 95% confidence intervals by Area Health Services in NSW 1994–2000. Female breast cancer





Note: The relative risk of excess deaths has been adjusted for age, follow-up years and spread of disease at diagnosis and interaction terms of follow-up years by age and spread of disease, and the reference category is the State average rates predicted from a Poisson regression model.




of excess death due to cancer with 95% confidence intervals by Area Health Services in NSW 1994–2000. Melanoma of the skin





Note: The relative risk of excess deaths has been adjusted for age, sex, follow-up years and spread of disease at diagnosis, and the reference category is the State average rates predicted from Poisson regression model.



Table 45: Five-year relative survival, relative risk of excess death due to cancer with 95% confidence intervals by Area Health Services in NSW 1994–2000. Cervical cancer





Note: The relative risk of excess deaths has been adjusted for age, follow-up years and spread of disease at diagnosis, and the reference category is the State average rates predicted from a Poisson regression model.



Table 46: Five-year relative survival, relative risk of excess death due to cancer with 95% confidence intervals by Area Health Services in NSW 1994–2000. Uterine cancer








Table 47: Five-year relative survival, relative risk of excess death due to cancer with 95% confidence intervals by Area Health Services in NSW 1994–2000. Ovarian cancer








Table 48: Five-year relative survival, relative risk of excess death due to cancer with 95% confidence intervals by Area Health Services in NSW 1994–2000. Prostate cancer





Note: The relative risk of excess deaths has been adjusted for age, follow-up years and spread of disease at diagnosis and interaction term of follow-up years by spread of disease, and the reference category is the State average rates predicted from a Poisson regression model.




of excess death due to cancer with 95% confidence intervals by Area Health Services in NSW 1994–2000. Testis cancer



Central Sydney 95.3 0.72 (0.09-2.60) Northern Sydney 97.1 1.02 (0.28-2.60) Western Sydney 93.5 1.35 (0.37-3.47) Wentworth 92.2 2.18 (0.45-6.36) South Western Sydney 95.0 0.68 (0.14-2.00) Central Coast 98.6 0.00 (0.00-1.77) Hunter 94.9 1.54 (0.42-3.94) Illawarra 99.3 0.00 (0.00-1.81) South Eastern Sydney 98.1 0.41 (0.05-1.50) Northern Rivers 96.4 0.76 (0.02-4.23) Mid North Coast 89.3 2.45 (0.51-7.16) New England 102.0 0.00 (0.00-2.54) Macquarie 95.2 2.66 (0.07-14.80) Mid Western 93.9 2.18 (0.26-7.89) Far West 84.3 3.93 (0.10-21.88) Greater Murray 93.1 2.93 (0.60-8.57) Southern 92.5 2.45 (0.50-7.15) New South Wales 95.6 1.00

Note: The relative risk of excess deaths has been adjusted for follow-up years and spread of disease at diagnosis, and the reference category is the State average rates predicted from a Poisson regression model.




of excess death due to cancer with 95% confidence intervals by Area Health Services in NSW 1994–2000. Bladder cancer









of excess death due to cancer with 95% confidence intervals by Area Health Services in NSW 1994–2000. Kidney cancer









of excess death due to with 95% confidence intervals by Area Health Services in NSW 1994–2000. Brain cancer





Note: The relative risk of excess deaths has been adjusted for age, sex and follow-up years, and the reference category is the State average rates predicted from a Poisson regression model.




of excess death due to cancer with 95% confidence intervals by Area Health Services in NSW 1994–2000. Thyroid cancer









of excess death due to cancer with 95% confidence intervals by Area Health Services in NSW 1994–2000. Non-Hodgkin lymphoma





Note: The relative risk of excess deaths has been adjusted for age, sex, follow-up years and interaction term of follow-up years by age, and the reference category is the State average rates predicted from a Poisson regression model.




of excess death due to cancer with 95% confidence intervals by Area Health Services in NSW 1994–2000. Hodgkin’s disease









of excess death due to cancer with 95% confidence intervals by Area Health Services in NSW 1994–2000. Multiple myeloma









of excess death due to cancer with 95% confidence intervals by Area Health Services in NSW 1994–2000. Leukaemia






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