Cancer mortality and survival

Introduction

In this section, cancer mortality is presented as the number or rate of cancer deaths in a population during a calendar year. Five-year survival is the percentage of people who are alive five years after their cancer diagnosis.

Cancer mortality and survival are commonly improved with earlier detection which is why some cancers have population-level screening programs. Improving mortality and survival also reflect advancements in cancer treatment overall.

Cancer mortality

In 2020, there were 9,840 cancer deaths reported in Queensland equivalent to an age-standardised mortality rate (ASR or standardised rate) of 156.0 deaths per 100,000 persons (Figure 1).

The number of deaths in 2020 for the selected cancers in this report were 1,953 (lung), 1,150 (bowel), 612 (breast), 659 (pancreatic), 787 (prostate), 346 (melanoma of the skin) and 55 (cervical).¹ Figure 1 provides standardised mortality rates.

Demographic differences

Cancer mortality rates increased markedly in older age groups and differences between males and females were evident for some cancers (Figure 1). For example, in 2020, mortality rates for those 80 years and older were:

• all cancers: 1.6 times higher in males than females (2,309.0 compared to 1,412.0 per 100,000, respectively)
• lung cancer: 1.7 times higher in males than females (360.9 compared to 208.0 per 100,000, respectively)
• melanoma of the skin: 2.3 times higher in males than females (104.3 compared to 45.7 per 100,000, respectively).

Remoteness and socioeconomic differences

Two measures that classify Queensland’s diversity are remoteness,² and the area-based index of relative socioeconomic advantage and disadvantage.³

Remoteness

In 2020, the standardised mortality rate in remote and very remote areas was 21.3% higher than in major cities (176.7 compared to 145.7 per 100,000 persons, respectively) (Figure 2).

Standardised mortality rates were similar for most age ranges, however, for adults 80 years and older, rates were 2,150.9 per 100,000 persons in remote and very remote areas compared to 1,691.1 per 100,000 persons in major cities.

Standardised mortality rates for specific cancers were similar for most cancer types. Lung cancer, however, was 46.2% higher in remote and very remote areas (standardised mortality rate per 100,000 persons, 40.8 in remote and very remote areas compared to 27.9 in major cities).

Socioeconomic status

In 2020, the standardised mortality rate per 100,000 persons, for all cancers was 49.9% higher in disadvantaged areas (182.9 in the most disadvantaged areas compared to 122.0 in the most advantaged areas) (Figure 2). Within age groups mortality rates also varied considerably by socioeconomic status.

Standardised mortality rates for several individual cancers varied by socioeconomic status:

• lung cancer: 85.6% higher in disadvantaged areas (40.1 per 100,000 persons in the most disadvantaged areas compared to 21.6 per 100,000 persons in the most advantaged areas)
• colorectal cancer: 68.8% higher in disadvantaged areas (21.6 per 100,000 persons in the most disadvantaged areas compared to 12.8 per 100,000 persons in the most advantaged areas).

Cancer mortality trends

National comparisons

Overall cancer mortality rates have been decreasing from 1994 (Figure 3). Trends for Queensland and Australia have been broadly similar over that period overall and for most cancers described in this section.

Marked decreases in standardised mortality rates were evident for lung and colorectal cancer since 1982, and some moderate decreases for prostate and breast cancer since 1994 (Figure 3).

Melanoma of the skin exhibited a moderate decrease in mortality, especially in males, from around 2010, potentially due to treatment advances using novel immunotherapies.⁴ Pancreatic cancer has remained largely unchanged over the period (noting that standardised mortality rates were low for this cancer) (Supplemental Figure S1 under Additional information).

Demographic differences

High level population trends can obscure underlying age and sex related trends that are relevant to public health programs. Lung cancer, colorectal cancer and melanoma of the skin had standardised cancer mortality rate profiles that differed markedly by sex or age group (Figure 4).

• For males, nationally a large decline in mortality from 1984 was evident in males 80 years and older with a lower but similar decline for males 60 to 79 years (Queensland and Australia).
• For females, national and state trends were increasing from 1984 for females 80 years and older but were stable in females 60 to 79 years from the early 2000s.

Trends in melanoma of the skin mortality rates differed by age and sex:

• For adults 80 years and older, mortality rates increased from 1984. The rate of increase was higher in males compared to females.
• For adults 60 to 79 years, mortality rates increased for males but were stable for females.

Nationally, lifetime risk of death from melanoma of the skin and by age 30 and 60 was estimated.⁵

• By age 30: risk decreased from 1-in-9,100 persons in 1982 to an estimated 1-in-62,000 persons in 2020. The risk of death from melanoma in 2020 was one-sixth the risk in 1982.
• By age 60: risk decreased consistently from 1982 (1-in-650 persons) to 2013 (1-in-850 persons). From 2013, risk has declined more sharply with risk in 2020 an estimated 1-in-1,600 persons.
• Lifetime: risk increased from 1982 (1-in-240 persons) to 2013 (1-in-110 persons) before decreasing to an estimated 1-in-140 persons in 2020. Declines from 2013 are driven by males (1-in-80 males in 2013 to 1-in-104 in 2020)
• Trends in colorectal cancer standardised mortality rates showed similar declines for males and females with a higher prevalence in males in older age groups.

Cancer survival

In Queensland, 5-year cancer survival for the period 2016–2020 for all cancers was 65.9% (Figure 5).¹ Nationally, for the period 2014–2018, it was 62.6%. One-year and 2-year survival for persons diagnosed with any cancer in Queensland and Australia were:

• Queensland 2016–2020:
  • 1-year survival: 83.3%
  • 2-year survival: 76.6%.
• Australia 2014–2018:
  • 1-year survival: 81.5%
  • 2-year survival: 74.1%.

While survival (1, 2 and 5-year) varied by cancer type, 5-year survival for breast, melanoma of the skin and prostate cancer were all above 80.0%, followed by cervical cancer at 78.0%. The lowest 5-year survival were for pancreatic cancer at 12.8%, followed by lung cancer, at 24.8%.

Remoteness and socioeconomic differences

Remoteness

For all cancers, 5-year survival for the period 2016–2020 was 7.2% lower in remote or very remote areas (67.0% in major cities compared to 62.2% in remote and very remote areas) (Figure 6).

There was little variability by cancer type by remoteness and most varied by 10% or less by areas. An exception was cervical cancer although the combined low incidence and population size in remote areas means that results should be viewed with caution.

Socioeconomic status

For all cancers, 5-year survival for the period 2016–2020 was 17.7% lower in disadvantaged areas (73.3% in the most advantaged areas compared to 60.3% in the most disadvantaged areas) (Figure 6).

Five-year survival for the period 2016–2020 was lower in more disadvantaged areas for several cancers (Figure 6), for example:

• lung cancer: 5-year survival for breast cancers in disadvantaged areas was 21.5% lower than in advantaged areas: 22.7% compared to 28.9%, respectively.

Cancer survival trends

From 1989 to 2018, national 5-year survival has improved by 39.1% for all cancers (45.0% for the period 1989–1993 compared to 62.6% for the period 2014–2018).

Several specific cancers showed gains over these periods, for example:

• For breast cancer, 5-year survival improved from 70.1% (1989–1993) to 85.7% (2014–2018), an increase of 22.3%.
• For prostate cancer, 5-year survival improved from 46.0% (1989–1993) to 84.2% (2014–2018), an increase of 83.0%.

Additional information

Data and statistics

Visit Cancer Alliance Queensland (CAQ) to:

• learn more about accessing cancer statistics
• explore the CAQ data dashboards.

Visit the Australian Bureau of Statistics website for:

• Cancer data in Australia
• Australia’s health cancer.

Supplemental Figure S1 presents the same results as Figure 1 but better highlights relative differences. It also includes melanoma of the skin by age and sex in a format to better view younger age groups.

Information and strategies

Visit Queensland Cancer screening for more information about cancer screening services.

Section technical notes

• Where presented, ratios were calculated using higher precision estimates than in text. Ratios calculated using estimates in text may differ.
• Prostate and cervical cancers occur only in males and females respectively. Where rates are provided for “persons” for these cancers it is for comparative purposes.
• 5-year cancer survival was calculated using the Observed method of survival calculation for both Queensland and Australia.
• Comparisons were made of incidence rates for Queensland obtained from the Queensland Cancer Register⁶ and for Australia obtained from the Australian Institute of Health and Welfare.⁷ It is acknowledged that there may be minor differences in case numbers due to data collection methods. The maximum error between sources in most recent years was estimated to be +/- 1-2% (for rates).

References

1. Queensland Health. 2023. Queensland Cancer Register: Cancer Alliance Queensland. Accessed: 1 November 2022.
2. Hugo Centre for Migration and Population Research. 2018. Accessibility/Remoteness Index of Australia (ARIA). Accessibility/Remoteness Index of Australia (ARIA). Accessed: 1 October 2022.
3. Australian Bureau of Statistics. 2018. Socio-Economic Indexes for Areas (SEIFA) 2016. 2033.0.55.001 - Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA), Australia, 2016. Accessed: 1 October 2022.
4. Wolchok J.D., Hodi F.S., Weber J.S., Allison J.P., Urba W.J., Robert C., O’Day S.J., Hoos A., Humphrey R., Berman D.M., Lonberg N. & Korman A.J. 2013. Development of ipilimumab: a novel immunotherapeutic approach for the treatment of advanced melanoma. Annals of the New York Academy of Sciences. 1291(1): 1–13. doi: 10.1111/nyas.12180.
5. Australian Institute of Health and Welfare. 2022. Risk of Melanoma of the Skin by Age and over Time. Accessed: 13 February 2022.
6. Queensland Health. 2023. Queensland Cancer Register: Cancer Alliance Queensland. Accessed: 1 November 2022.
7. Cancer Australia. 2022. Cancer in Australia Statistics.