Cancer Projections
Incidence 2004–08 to 2014–18
Ministry of Health. 2010. Cancer Projections: Incidence 2004–08 to 2014–18.
Wellington: Ministry of Health.
Published in January 2010 by the
Ministry of Health
PO Box 5013, Wellington, New Zealand
ISBN 978-0-478-33996-3 (online)
HP 5029
This document is available on the Ministry of Health’s website:
http://www.moh.govt.nz
Contents
Authorship and Acknowledgements
v
Executive Summary
vi
Introduction
1
Background
Method
Reporting
1
1
5
Updated Projections: Summary of Key Findings
Projections of total cancer registrations
How similar are the updated and the earlier projections?
6
9
9
Updated Projections by Site
10
References
36
Appendix: Prostate Cancer Incidence
37
List of Tables
Table 1:
Table 2:
Table 3:
Table 4:
Projected percentage change in incidence, by site and sex, 2004–2008 to 2014–18
Cancer sites for which ‘major’ change in incidence ASR is projected from 2006 to 2016
Key incidence projection results for selected sites, 2006 to 2016
Updated projected total cancer count,* annualised average, 2016
6
7
8
9
List of Figures
Figure 1:
Figure 2:
Figure 2a:
Figure 3:
Figure 4:
Figure 5:
Figure 6:
Figure 7:
Figure 8:
Figure 9:
Figure 10:
Figure 11:
All adult cancer
Childhood cancer
Childhood leukaemia
Bladder cancer
Bone and connective tissue cancer
Brain cancer
Colorectal cancer
Gallbladder cancer
Hodgkin’s disease
Kidney cancer
Laryngeal cancer
Leukaemia
Cancer Projections: Incidence 2004–08 to 2014–18
10
11
12
13
14
15
16
17
18
19
20
21
iii
Figure 12:
Figure 13:
Figure 14:
Figure 15:
Figure 16:
Figure 17:
Figure 18:
Figure 19:
Figure 20:
Figure 21:
Figure 22:
Figure 23:
Figure 24:
Figure 25:
Figure 26:
Figure 26a:
iv
Lip, mouth and pharynx cancer
Liver cancer
Lung cancer
Melanoma
Myeloma
Non-Hodgkin’s lymphoma
Oesophageal cancer
Pancreatic cancer
Stomach cancer
Thyroid cancer
Male cancers
Female cancers I
Female cancers II
Cancer of all other sites
Prostate cancer registrations: estimates and projections by age
Prostate cancer registrations (estimates and projections), by individual five-year age
group
Cancer Projections: Incidence 2004–08 to 2014–18
22
23
24
25
26
27
28
29
30
31
32
33
34
35
38
39
Authorship and Acknowledgements
The modelling was done and the report written by Robert Templeton, Martin Tobias and
Anna Davies (Health and Disability Intelligence, Health and Disability System Strategy
Directorate, Ministry of Health). The authors would like to acknowledge constructive
input from the peer reviewers: John Childs, Tony Blakely, Simon Bidwell, Deborah
Woodley, Susan Hanna, Simon Ross and Helen Jones.
Cancer Projections: Incidence 2004–08 to 2014–18
v
Executive Summary
This report updates the cancer incidence projections produced by the Ministry in 2001
(Ministry of Health 2002) and first updated in 2006 (Ministry of Health 2007), using
newly available data for the 2004–2006 period. The main projection method has not
been changed.
For a more complete view of the projected burden of cancer, both previous reports
should be consulted, together with reports on the projected mortality from cancer
(Ministry of Health 2002, 2008, 2009).
Overall, the risk of cancer is projected to stabilise over the coming decade (2006–2016)
for males and actually decline, by about 11%, for females. Nevertheless, the burden of
incident cancers will still increase, by about 29% for males and 12% for females, as a
result of demographic trends (increasing size and older age structure of the New
Zealand population).
This projected stabilisation or decline in the risk of cancer represents a notable public
health success story, coming as it does after half a century (or more) of steadily
increasing incidence rates. Substantial risk reductions are projected for tobacco-related
cancers in males with stabilisation or lesser reduction in females. Among non-tobacco
related cancers, substantial risk reductions are projected for colorectal cancer in both
sexes (even without an organised screening programme), stomach cancer (both sexes)
and cervical and ovarian cancers in females.
By contrast, continuing increases in risk are projected for thyroid cancer (both sexes),
primary liver cancer (both sexes), and lymphomas and prostate cancer in males (the
latter even excluding the impact of PSA testing).
Importantly, breast cancer risk is projected to stabilise, while the risk of melanoma is
projected to stabilise in males and may actually decline slightly in females.
vi
Cancer Projections: Incidence 2004–08 to 2014–18
Introduction
Background
Projections of cancer incidence (and mortality and survival) are useful for making
investment decisions in cancer treatment facilities and in planning for the oncology
workforce, and can also contribute to the formulation and evaluation of cancer control
policy (Black and Stockton 2001; McDermid 2005; Moller et al 2002).
In 2001 the Ministry of Health prepared incidence and mortality projections for 26 types
of cancer, forecasting from 1994–98 or 1995–99 (as the most recent five-year period
for which cancer registration or mortality data were then available) out to 2009–13 or
2010-14 respectively (Ministry of Health 2002). This work was undertaken on behalf of
the Cancer Control Taskforce to inform the development of the Cancer Control Strategy
(Ministry of Health 2003).
A further five years’ registration data became available in 2007 (covering 1999–2003),
allowing the incidence projections to be updated to 2009–13 (Ministry of Health 2007).
Rather than waiting another five years before carrying out the next update, we have
introduced a dual projection method. This allows us to carry out a short-term projection
(two years) given an additional three years of data, so deriving estimates for the next
five-year period. We then use this new data to derive a long-term projection for the
next decade, exactly as before. As we now have cancer incidence data for 2004–06,
we used the short-term projection methodology to give us new data for the five-year
period 2004–08, and then applied our long-term projection methodology to produce
projections out to 2014–18. Using this dual approach, we will be able to update the
cancer incidence projections three- rather than five-yearly in future.
A similar approach has been adopted to enable the cancer mortality projections to be
updated (reported separately). Both the updated incidence and mortality projections
should be used in tandem, along with estimates and projections of cancer survival (also
reported separately) to obtain the full picture of the projected cancer burden. For
example, the updated projections can be used for modelling future capacity
requirements for oncology services, along with work currently being done by the
Ministry in relation to oncology workforce projections. The updated cancer incidence
projections will also feed in to a cancer burden of disease study being undertaken
jointly by the Ministry and the University of Otago. This study will provide the
epidemiological input into a tool (currently under development) for evaluating the cost
effectiveness of cancer-related interventions.
Method
In updating the projections we have been careful to avoid ‘method drift’ so as to ensure
comparability with our earlier projections. We have, however, incorporated revisions
made by the New Zealand Cancer Registry to the incidence data for some cancers (in
particular bladder cancer), and have used updated population projections (based on the
2006 rather than the 2001 Census) provided by Statistics New Zealand.
Cancer Projections: Incidence 2004–08 to 2014–18
1
Bladder cancer rates have been revised to reflect a change in cancer registration
practice from 2005, whereby superficial (non-invasive) bladder cancers are no longer
included. That is, rates prior to 2005 have been adjusted (downwards) to reflect the
ratio of non-invasive to invasive cancers reported to the New Zealand Cancer Registry
in the 2005–06 period. This adjustment assumes that this ratio has remained stable
over time.
In addition to projecting ‘all childhood cancers’, projections of childhood leukaemia
(acute lymphoblastic leukaemia, ALL) have been added. ALL comprises approximately
one-third of all childhood cancers; even so, counts for boys and girls had to be pooled
to generate stable rates.
Projections of prostate cancer incidence could not be updated (although they have
been extended), as these are based only on data up to 1984–88. This constraint has
been imposed in order to avoid the discontinuity resulting from the widespread use of
prostate specific antigen (PSA) testing since the late 1980s and early 1990s. ‘All adult
cancer’ for males therefore also excludes the ‘PSA effect’. Once prostate cancer
incidence returns to its ‘pre PSA’ level or thereabout (see Appendix), updating will
become possible once again.
Note that ‘all adult cancer’, ‘childhood cancer’ and ‘adult cancer of all other sites’ are
very heterogeneous categories. Trends in the incidence of these sites should therefore
be interpreted cautiously as they may reflect divergent trends in the mix of specific
cancers included in the respective category.
We have not extended the new projections out beyond two five-year periods, that is,
2014–18 (henceforward ‘2016’) as our earlier experience revealed that a projection
horizon of more than 10 years yields estimates that are too uncertain to be useful for
planning.
For technical information relating to the cancer incidence and population data, the
selection of cancer sites, and the age/period/cohort modelling methodology used for the
long-term projections, please see our earlier report (Ministry of Health 2002). A brief
summary of the regression modelling approach is provided here (Box 1), and the shortterm projection methodology is outlined in Box 2.
2
Cancer Projections: Incidence 2004–08 to 2014–18
Box 1: Long-term projection methodology
Cancer incidence rates can be thought of as realisations of three time dimensions: age
(at diagnosis), period (calendar year of diagnosis) and cohort (year of birth). Given a
sufficiently long historical time series of cancer incidence data, statistical models can be
constructed to project incidence based on the historical pattern of age, period and cohort
effects.
Model identification
The approach adopted was to fit the data by five year period from 1952-56 to 2004-08 for
each cancer by five-year age group (the method requires data aggregated by five year
period and age group, so generating ten year overlapping cohorts) to four different
models: generalised linear models (the classical age/period/cohort or APC models); nonparametric generalised additive models (GAM models); non-linear models developed by
Dyba and Hakulinen (so-called DH models); and Bayesian versions of APC models using
second differences as autoregressive priors for the parameters, fitted using markov chain
monte carlo (MCMC) methods (Bayesian Age-period-cohort Modelling and Prediction or
BAMP models).
Model selection
For each cancer, all four models were fitted and then tested using measures of goodness
of fit and ex-post tests. Those models that failed either or both statistical tests were
eliminated. Note that the number and type of models finally used thus differed depending
on the particular cancer.
Model averaging
Final fitted values (for each cancer) were calculated as the mean of the modelled number
of cases, for each age-period combination, of the models finally selected and fitted for
each cancer.
Projection
Once the final set of models for each cancer had been determined, the models were then
fitted again using all available data together with the short-term projected data for 2007
and 2008 (see Box 2 below).
For the BAMP, GAM and DH models, projections are ‘automatically’ obtained by
extending the modelled risk surface to future time periods using the fitted parameters.
To project the classical APC models, however, an assumption had to be made that the
age effects would remain stable (which is usually accepted as a reasonable assumption),
so that the fitted age parameters could be used for projection. Future period and cohort
effect parameters were estimated by fitting a linear regression model to the three most
recent period or cohort parameters and then extrapolating the next two. This assumes
that the recent observed period and cohort trends will continue unchanged into the future,
which is a strong assumption and somewhat limits the usefulness of APC models for
projection.
Cancer Projections: Incidence 2004–08 to 2014–18
3
Uncertainty estimation
A BAMP 90% credible interval was obtained during the model fitting process. This
includes both uncertainty associated with the Bayesian model and random fluctuations in
the data. Such credible intervals are generally acknowledged to be wide, thereby
providing a conservative estimate of uncertainty for the projection obtained through the
model averaging process.
Note that the credible interval is not centred about the average projection (for each
cancer) but about the BAMP projection. Hence we show both the 90% credible interval
(purple coloured area in figures 1-25) and the highest and lowest rates obtained from the
individual models selected for each cancer (broken red lines in figures 1-25).
Box 2: Short-term projection methodology
Our projection method is based on data aggregated into five-year periods (see Box 1).
For cancer incidence, the most recent five-year period is 2004–08, but the two most
recent years of data (2007, 2008) are not available yet. In order to make sure all the
latest registration data (that is, all years up to and including 2006) is used to help make
the best projections, we estimate the number of cancer registrations for 2007 and 2008.
This then gives us a new five-year period, 2004–08 (henceforth ‘2006’), to use in our
long-term projections (so enabling the long-term projection horizon to extend out to
2014–18 (henceforth ‘2016’).
To carry out the short-term projection (that is, in this case, to derive estimates for cancer
incidence in 2007 and 2008) we use the forecasts for the ‘missing years’ 2007 and 2008
from the previous round of long-term projections, for which data up to 2003 was available,
as the starting point. We then adjust these earlier projections to account for the observed
forecast errors from the years 2004, 2005 and 2006.
Suppose X t fi  the original forecast number of cancer registrations for year = t+i and
X t  j  the observed number of cancer registrations for year = t-j, then the estimated
number of cancer registrations for year t+i is
Xˆ t i  R  X t fi
 2
  X t j
 j 0
 2
  X t f j
 j 0



f
  X t i


So for the most recent five-year period the number of cancer registrations is
2006
2008
i  2004
i  2007
 Xi 
4
 Xˆ
i
Cancer Projections: Incidence 2004–08 to 2014–18
Reporting
The updated projections from 2006 to 2016 are presented in summarised form in the
body of the report (in alphabetical order, except for some sex-specific cancers and ‘all
other sites’). Full results are available from the authors. Box 3 provides a guide to
interpreting the tables and charts.
We also present a brief summary of the key findings (page 6).
The appendix (page 37) provides a more detailed analysis of prostate cancer incidence
estimates and projections.
Box 3: Interpreting Figures 1–25 and associated tables
Except for sex-specific sites, projections for males are shown on the left and females on
the right.
The upper charts show empirical data points and fitted and projected models for
incidence rates by age group. (All rates are per 100,000.)
The lower charts show empirical data points and the fitted and projected models for age
standardised incidence rates (standardised by the direct method to the World Health
Organization [WHO] World Standard Population).
The solid red line is the updated projection.
The broken lines show the highest and lowest rates obtained for the individual models
that were averaged to obtain the final updated projection (the red line) for each cancer
site.
The purple coloured space shows the 90% Bayesian credible interval, used to represent
the ‘prediction interval’ or uncertainty around the updated projection (ie, uncertainty
around the red line).
The tables below the charts show rates (upper tables) and counts (lower tables) by age
group, for 2004–2008 (‘2006’, most recent data available) and for 2014–2018 (‘2016’, the
projection horizon), and the percentage change between these two dates (that is, over the
next decade).
Note that the 2004–2008 estimates shown are not the empirical (observed) data for these
years, but rather the estimate for this period obtained from the fitted model. This
approach is taken to reduce the stochastic noise inherent in the observed data. As a
consequence, the percentage change shown in the table will be slightly different from that
obtained by simply comparing the observed data for 2004–2008 with the projection for
2014–2018.
Also note that the data for 2007 and 2008 are not in fact observed (empirical) data, but
are short-term forecasts derived as explained in Box 2 above.
Finally, note that the age standardised rates for adult cancers reported here are for the
age group 15+ years. These rates differ from the age standardised cancer registration
rates published in Cancer: New registrations and deaths 2006 (Ministry of Health 2010),
which include all ages (0+ years).
Cancer Projections: Incidence 2004–08 to 2014–18
5
Updated Projections: Summary of Key Findings
Updated projections by cancer site (largely in alphabetical order) are provided in
Figures 1–25 and their associated tables. Key results are summarised in four tables
below.
Table 1:
Projected percentage change in incidence, by site and sex, 2004–2008 to 2014–18
Site
Male (%)
Female (%)
ASR
Total count
ASR
Total count
-3
29
-11
12
Childhood
-11
-9
6
9
Bladder
-11
24
-12
15
-8
15
-11
8
0
24
All adult
Bone and CT
Brain
-10
8
Breast
-1
23
Cervix
-28
-21
Colorectal
-17
15
-12
19
Gallbladder
-14
17
-4
24
28
46
21
29
Hodgkins
Kidney
9
41
3
32
Laryngeal
-33
-10
-8
18
Leukemia
-1
32
-1
28
Lip, mouth
-6
20
-3
21
Liver
23
61
16
47
Lung
-26
-1
-3
27
1
32
-7
18
Myeloma
-6
27
-15
11
NHL
11
44
0
28
1
36
-9
20
-14
6
8
38
-2
27
Melanoma
Oesophageal
Ovary
Endometrium
Pancreatic
-13
18
23
71
2
10
-19
6
-15
7
Thyroid
22
45
31
51
All Other
-22
7
-29
-9
Prostate
Testis
Stomach
Percentage change estimated from fitted (smoothed) estimates, not empirical estimates, for 2000–2004.
ASR = age standardised rate per 100,000 (directly standardised to the WHO World Population).
All adult cancer for males excludes prostate cancers diagnosed solely by PSA testing (the ‘PSA effect’).
6
Cancer Projections: Incidence 2004–08 to 2014–18
Table 1 shows that the overall risk of being diagnosed with cancer is projected to
reduce slowly in females, reducing by approximately 11% over the decade. Among
males, the overall risk of cancer – excluding the ‘PSA effect’ – is projected to remain
stable (or decline very slightly). At the same time the burden (count) of new cancer
patients is projected to increase by about 12% in females and a more substantial 29%
in males, reflecting the offsetting effect of demographic trends (the expected increase in
size and structural ageing of the New Zealand population).
Cancer sites projected to show ‘major’ changes in incidence risk (ASR) or burden (total
count) over the next decade (2006–2016) are summarised in Table 2 below.
Table 2:
Cancer sites for which ‘major’ change in incidence ASR is projected from 2006 to
2016
Male
>10% increase in risk*
Female
Hodgkins
Hodgkins
Liver
Liver
NHL
Thyroid
Prostate
Thyroid
>40% increase in burden**
Hodgkins
Liver
Kidney
Thyroid
Liver
NHL
Prostate
Thyroid
>10% decrease in risk*
>10% decrease in burden**
Colorectal
Bone
Gallbladder
Cervix
Larynx
Colorectal
Lung
Myeloma
Pancreas
Ovary
Stomach
Stomach
Cervix
Childhood cancer, all adult cancer and adult cancer in ‘all other sites’ are excluded from this table as
these are heterogenous categories.
*
Risk = age standardised rate.
** Burden = total count.
Several cancers are projected to reduce by >10% in risk over the decade, including
colorectal cancer in both sexes (even in the absence of an organised screening
programme), cervical cancer in females (as a result of screening, not immunisation
against HPV), and lung cancer in males (reflecting the differential phasing of the
tobacco epidemics between the sexes). Because of demographic trends, however, no
cancer actually decreases substantively in burden (count of new cases per year) except
for cervical cancer.
Cancer Projections: Incidence 2004–08 to 2014–18
7
By contrast, several cancers are projected to buck the overall trend and continue to
increase in incidence. These include primary liver cancer and thyroid cancer in both
sexes and lymphomas and prostate cancer in males (the latter even after ‘correction’
for the ‘PSA effect’). Although relatively rare, primary liver cancer and thyroid cancer
have been steadily increasing in both sexes for at least half a century. While the former
may be related mainly to persistent infection with hepatitis B virus, the cause of the
latter is unknown. The sharp rise in NHL noted in previous reports is projected to
continue in males, while risk of NHL is projected to increase more slowly in future in
females. Again the reason for this trend, or the projected sex difference in the trend, is
unknown.
Table 3 below summarises the key incidence projection results for the major cancer
sites and those of special policy interest.
Table 3:
Key incidence projection results for selected sites, 2006 to 2016
Selected site
Comment
Colorectal
Rates are projected to decline in all age groups except 75+ for both sexes, falling
overall by approximately one-quarter in the 45–74 age group. This occurs without an
organised screening programme.
Burden still increases, however (by about 15%), because of offsetting demographic
effects.
Lung
Rates continue their steady long-term decline in males (all ages), falling by onequarter over the decade. As a result, overall burden remains stable.
Trends in incidence rates vary by age group among females, most notably increasing
substantively (~15%) in young adults, but the overall outcome is stability. However,
female and male rates most probably will not cross over by the projection horizon.
Given stable rates, burden must increase for females – an increase of one-quarter is
projected over the decade.
Melanoma
Trends in rates are projected to vary by age among males, decreasing in younger and
increasing in older age groups (most probably reflecting cohort effects), such that the
overall rate remains stable and the total burden increases by one-third. Note,
however, that the credible interval around these projections is exceptionally wide
(reflecting the very divergent trends by age group).
Female rates are projected to decline in all age groups except the oldest, so the
overall rate falls slightly. The burden increases by about one-sixth overall.
Breast
Rates are projected to fall among women younger than 45 years of age, remain stable
in those aged 45–74 year olds and increase slightly in those aged >75 years, with the
result that the overall rate remains stable. This reflects the complex interaction of
underlying epidemiological trends with the impact of screening.
Total burden nevertheless increases by about one-fifth, reflecting the impact of
demographic trends.
Cervix
Both rates and counts are projected to continue to fall sharply, although exact
estimates are imprecise because of relatively small numbers.
This is entirely due to the ongoing effect of the screening programme (insufficient time
has elapsed for HPV immunisation to have had a measurable impact on incidence).
The steady decline in cervical cancer incidence (since the introduction of the National
Cervical Screening Programme) is a notable public health success story.
8
Cancer Projections: Incidence 2004–08 to 2014–18
Selected site
Comment
Prostate
Rates are projected to increase slowly, even after correcting for the impact of
opportunistic PSA screening, with the result that the burden of new cases is expected
to increase by approximately 70% (and would more than double if cases detected
solely by PSA screening were included).
The steep increase in burden reflects the impact of population ageing in particular, as
this cancer has a particularly right-shifted age distribution.
See the appendix to this report for more details.
Projections of total cancer registrations
Table 4 summarises the updated projections for the total cancer count (all sites
combined) in 2016, derived independently by two methods:
1.
using the ‘all adult cancers’ model (that is, treating all cancers as a single ‘site’)
2.
summing the total counts projected for each separate site (that is, sum of all sites
other than ‘childhood cancers’).
Table 4:
Updated projected total cancer count,* annualised average, 2016
Male*
Female
Total
Derived from ‘all adult cancer’ model
11,893
10,049
21,942
Derived by summing across all individual cancer sites
11,655
10,388
22,043
238 (2%)
-339 (-3%)
-101 (0%)
Difference (%)
*
Excludes ‘PSA effect’.
As Table 4 shows, the two counts agree closely (within 3% by sex and within 1%
overall), which provides a valuable test as to the internal consistency of the models.
How similar are the updated and the earlier projections?
The updated (2009) projections can be compared with those produced in 2006 with
respect to their respective forecasts for 2011, the projection horizon for the earlier set.
In brief, both sets of projections agree closely, except for six sites where the updated
projection (age standardised rate) lies below the 90% credible interval of the
corresponding earlier projection. These sites are ovary, adult leukaemia, kidney and
non-Hodgkins lymphoma in females, and adult leukaemia and childhood cancers in
males. Changes in ICD classification or coding may explain these findings, at least for
ovarian cancer and adult leukaemia.
Cancer Projections: Incidence 2004–08 to 2014–18
9
Updated Projections by Site
Figure 1:
All adult
sites
All adult cancer (excluding ‘PSA effect’)
Age
Male
Observed
2006
Rates
Counts
10
Projected 2016
Female
Projected Observed
% change
2006
Projected 2016
Projected
% change
15–24
29
24 (12,36)
-15
24
18 (10,26)
-27
25–44
94
90 (67,94)
-5
158
138 (100,158)
-13
45–64
511
519 (428,604)
2
648
579 (425,664)
-11
65–74
1,919
1,798 (1430,2097)
-6
1,351
1,210 (871,1399)
-10
75+
3,669
3,726 (2840,4016)
2
1,928
1,837 (1312,2065)
-5
Total
463
448 (360,489)
-3
408
364 (268,408)
-11
15–24
87
77 (37,117)
-12
71
53 (30,75)
-26
25–44
535
519 (384,542)
-3
968
837 (604,958)
-14
45–64
2,508
2,955 (2436,3437)
18
3,288
3,521 (2586,4036)
7
65–74
2,554
3,440 (2737,4014)
35
1,930
2,476 (1783,2863)
28
75+
3,510
4,902 (3737,5284)
40
2,696
3,162 (2258,3554)
17
Total
9,195
11,893 (9550,12997)
29
8,953
10,049 (7378,11246)
12
Cancer Projections: Incidence 2004–08 to 2014–18
Figure 2:
Childhood
Rates
Counts
Childhood cancer
Age
Male
Observed
2006
Projected 2016
0–4
18
16 (12,28)
5–9
10
11 (10,21)
10–14
12
9 (8,17)
Total
14
12 (11,21)
0–4
26
5–9
16
10–14
Total
Female
Projected Observed
% change
2006
Projected 2016
Projected
% change
-12
19
19 (13,28)
2
9
12
14 (10,21)
19
-28
11
11 (8,17)
1
-11
14
15 (11,21)
6
24 (19,44)
-8
27
28 (18,40)
5
18 (15,34)
17
17
22 (15,32)
26
20
14 (12,26)
-31
17
17 (12,25)
-2
61
56 (50,96)
-9
61
66 (50,90)
9
Cancer Projections: Incidence 2004–08 to 2014–18
11
Figure 2a:
Childhood leukaemia
Childhood
leukaemia
Males and females
Age
Rates
Counts
12
Observed 2006
Projected 2016
Projected % change
0–4
8
8 (6,11)
-2
5–9
4
5 (4,7)
15
10–14
3
3 (2,4)
8
Total
5
6 (4,7)
5
0–4
24
24 (18,33)
2
5–9
13
16 (12,21)
22
10–14
10
10 (7,13)
4
Total
47
50 (39,63)
8
Cancer Projections: Incidence 2004–08 to 2014–18
Bladder cancer
Figure 3:
Bladder
Age
Male
Observed
2006
Rates
Projected 2016
Projected Observed
% change
2006
Projected 2016
Projected
% change
25–44
1
0 (0,1)
-32
0
0 (0,0)
-42
45–64
9
8 (8,12)
-8
3
3 (2,4)
8
65–74
Counts
Female
56
47 (41,63)
-16
14
11 (11,18)
-22
75+
134
130 (110,165)
-3
36
34 (29,47)
-7
Total
12
11 (10,14)
-11
3
3 (3,4)
-12
25–44
3
2 (2,4)
-31
2
1 (1,2)
-42
45–64
45
48 (43,68)
6
13
17 (15,26)
29
65–74
74
90 (79,120)
21
20
22 (22,36)
11
75+
129
172 (145,217)
33
51
58 (51,82)
14
Total
251
311 (276,401)
24
85
98 (91,141)
15
Note: Counts for 1956–2004 have been adjusted to reflect the ratio of non-invasive to invasive cases in 2005–06. This adjustment
introduces an additional source of uncertainty into the projections (not reflected in the credible interval).
Cancer Projections: Incidence 2004–08 to 2014–18
13
Figure 4:
Bone
Bone and connective tissue cancer
Age
Male
Observed
2006
Rates
Counts
14
Projected 2016
Female
Projected Observed
% change
2006
Projected 2016
Projected
% change
15–24
3
2 (1,3)
-19
2
2 (1,2)
-20
25–44
3
2 (2,3)
-9
2
2 (1,2)
-11
45–64
6
5 (4,7)
-5
4
3 (2,4)
-9
65–74
12
12 (8,16)
-6
7
7 (4,9)
-7
75+
22
22 (17,30)
-2
11
11 (8,15)
-7
Total
5
5 (3,5)
-8
3
3 (2,3)
-11
15–24
8
7 (4,8)
-15
6
5 (3,6)
-19
25–44
15
14 (9,16)
-7
11
10 (7,13)
-11
45–64
28
31 (23,40)
10
18
20 (14,26)
9
65–74
16
22 (16,30)
35
10
14 (9,18)
33
75+
21
29 (22,39)
35
16
18 (13,25)
15
Total
90
104 (77,127)
15
61
66 (49,83)
8
Cancer Projections: Incidence 2004–08 to 2014–18
Brain cancer
Figure 5:
Brain
Age
Male
Observed
2006
Rates
Counts
Female
Projected 2016
Projected Observed
% change
2006
Projected 2016
Projected
% change
15–24
2
2 (1,2)
-13
1
1 (1,1)
-6
25–44
5
5 (3,5)
-6
3
2 (2,3)
-15
45–64
12
14 (11,17)
8
7
7 (5,9)
-3
65–74
24
24 (19,32)
1
14
12 (8,15)
-17
75+
28
26 (17,28)
-5
15
13 (8,15)
-12
Total
8
8 (7,10)
0
5
4 (3,5)
-10
15–24
6
5 (3,5)
-9
4
4 (2,4)
-5
25–44
28
26 (19,30)
-4
18
15 (11,19)
-16
45–64
61
77 (63,96)
25
36
41 (33,55)
16
65–74
32
47 (36,60)
45
20
24 (17,32)
19
75+
26
34 (23,37)
30
21
23 (15,26)
8
Total
153
190 (152,216)
24
98
106 (81,129)
8
Cancer Projections: Incidence 2004–08 to 2014–18
15
Figure 6:
Colorectal
Colorectal cancer
Age
Male
Observed
2006
Rates
Counts
16
Projected 2016
Female
Projected Observed
% change
2006
Projected 2016
Projected
% change
25–44
6
6 (4,6)
-13
7
7 (4,6)
-10
45–64
77
57 (45,67)
-26
66
53 (42,60)
-19
65–74
362
265 (205,310)
-27
274
208 (163,240)
-24
75+
557
594 (501,744)
7
440
497 (432,624)
13
Total
71
59 (48,70)
-17
57
50 (41,58)
-12
25-–44
36
32 (21,36)
-11
45
40 (23,37)
-11
45–64
376
323 (258,383)
-14
335
325 (254,367)
-3
65–74
482
507 (393,594)
5
392
426 (334,492)
9
75+
532
782 (659,979)
47
615
856 (744,1073)
39
Total
1426
1643 (1353,1963)
15
1387
1647 (1377,1944)
19
Cancer Projections: Incidence 2004–08 to 2014–18
Figure 7:
Gallbladder
Rates
Counts
Gallbladder cancer
Age
Male
Female
Observed
2006
Projected 2016
Projected Observed
% change
2006
25–44
0
0 (0,0)
-26
45–64
2
2 (1,2)
-17
65–74
8
7 (5,9)
-12
75+
16
15 (11,18)
-7
Total
2
2 (1,2)
25–44
1
45–64
0
Projected 2016
Projected
% change
0 (0,0)
-10
3
3 (2,4)
-3
10
10 (7,12)
-4
20
20 (15,23)
0
-14
2
2 (2,3)
-4
1 (0,1)
-25
2
1 (1,2)
-10
10
10 (7,14)
-3
13
16 (12,21)
17
65–74
10
13 (10,17)
26
14
20 (15,25)
37
75+
16
20 (14,24)
27
27
34 (25,40)
23
Total
36
43 (34,53)
17
57
70 (56,85)
24
Cancer Projections: Incidence 2004–08 to 2014–18
17
Figure 8:
Hodgkins
Hodgkin’s disease
Age
Male
Observed
2006
Rates
Counts
18
Projected 2016
Female
Projected Observed
% change
2006
Projected 2016
Projected
% change
15–24
3
3 (1,4)
22
3
3 (1,4)
25
25–44
3
4 (2,6)
31
2
3 (1,4)
29
45–64
3
4 (2,6)
36
1
2 (1,2)
22
65–74
4
5 (3,8)
22
2
2 (1,3)
-17
75+
6
6 (3,10)
15
2
1 (1,2)
-15
Total
3
4 (2,6)
28
2
2 (1,3)
21
15–24
8
10 (5,14)
27
8
10 (4,13)
26
25–44
19
25 (14,37)
33
13
17 (8,24)
28
45–64
14
23 (13,34)
58
7
10 (5,15)
46
65–74
5
10 (6,16)
75
3
4 (2,6)
18
75+
5
8 (4,13)
58
2
2 (1,4)
5
Total
52
76 (43,111)
46
33
43 (20,59)
29
Cancer Projections: Incidence 2004–08 to 2014–18
Kidney cancer
Figure 9:
Kidney
Age
Male
Observed
2006
Rates
Counts
Female
Projected 2016
Projected Observed
% change
2006
Projected 2016
Projected
% change
25–44
3
3 (2,3)
9
2
1 (1,2)
-21
45–64
23
26 (23,32)
14
11
13 (11,17)
10
65–74
63
66 (57,83)
5
28
30 (26,42)
8
75+
82
89 (80,112)
9
39
40 (35,54)
2
Total
15
16 (14,19)
9
7
8 (7,10)
3
25–44
18
20 (12,19)
11
11
9 (7,13)
-22
45–64
113
150 (129,182)
32
58
77 (65,101)
31
65–74
84
127 (110,159)
50
40
62 (54,87)
55
75+
78
118 (105,148)
50
54
69 (59,92)
26
Total
294
414 (370,491)
41
164
216 (195,279)
32
Cancer Projections: Incidence 2004–08 to 2014–18
19
Figure 10:
Laryngeal
Laryngeal cancer
Age
Male
Observed
2006
Rates
Counts
20
Projected 2016
Female
Projected Observed
% change
2006
Projected 2016
Projected
% change
25–44
0
0 (0,0)
-43
0
0 (0,0)
-16
45–64
5
3 (2,5)
-34
1
1 (1,1)
-7
65–74
17
11 (8,15)
-34
3
2 (2,4)
-2
75+
19
15 (11,20)
-23
3
2 (2,3)
-10
Total
3
2 (2,3)
-33
1
1 (0,1)
-8
25–44
1
1 (0,1)
-42
1
1 (0,1)
-17
45–64
25
19 (14,26)
-24
5
6 (4,9)
12
65–74
22
21 (16,28)
-5
4
5 (3,8)
41
75+
19
20 (15,26)
6
4
4 (3,6)
11
Total
66
60 (47,78)
-10
13
15 (11,21)
18
Cancer Projections: Incidence 2004–08 to 2014–18
Figure 11:
Leukaemia
Leukaemia (adult)
Age
Male
Observed
2006
Rates
Counts
Projected 2016
Female
Projected Observed
% change
2006
Projected 2016
Projected
% change
15–24
4
3 (1,3)
-9
2
2 (1,2)
-11
25–44
4
4 (2,5)
-2
3
3 (2,4)
-5
45–64
17
16 (9,22)
-5
11
11 (8,15)
0
65–74
63
63 (36,86)
-1
40
38 (25,51)
-7
75+
131
142 (84,196)
9
77
86 (55,109)
12
Total
17
17 (10,21)
-1
11
11 (7,13)
-1
15–24
11
10 (4,9)
-5
7
6 (3,7)
-10
25–44
22
22 (12,28)
-1
19
18 (11,22)
-6
45–64
85
94 (54,125)
10
58
70 (46,91)
20
65–74
84
120 (68,165)
42
58
77 (50,104)
33
75+
125
187 (111,258)
49
107
147 (94,188)
38
Total
328
433 (254,557)
32
249
318 (211,393)
28
Cancer Projections: Incidence 2004–08 to 2014–18
21
Figure 12:
Lip, mouth
and
pharynx
Rates
Counts
22
Lip, mouth and pharynx cancer
Age
Male
Observed
2006
Projected 2016
Female
Projected Observed
% change
2006
Projected 2016
Projected
% change
25–44
4
3 (2,4)
-18
2
2 (1,2)
-7
45–64
22
21 (12,23)
-6
8
8 (4,8)
0
65–74
38
40 (23,45)
5
14
15 (9,16)
6
75+
44
42 (26,52)
-4
26
24 (16,29)
-7
Total
12
11 (7,13)
-6
5
5 (3,5)
-3
25–44
21
18 (12,25)
-16
12
11 (6,12)
-8
45–64
109
119 (68,132)
9
39
47 (26,46)
19
65–74
51
77 (43,86)
51
20
31 (18,33)
52
75+
42
55 (35,69)
32
36
42 (27,50)
14
Total
223
268 (162,307)
20
108
131 (80,137)
21
Cancer Projections: Incidence 2004–08 to 2014–18
Liver cancer
Figure 13:
Liver
Age
Male
Observed
2006
Rates
Counts
Female
Projected 2016
Projected Observed
% change
2006
Projected 2016
Projected
% change
25–44
2
2 (1,3)
-17
1
1 (0,1)
3
45–64
12
16 (13,21)
31
4
5 (3,7)
26
65–74
30
36 (29,47)
20
12
13 (9,21)
11
75+
40
53 (40,62)
33
17
20 (14,31)
17
Total
8
9 (8,12)
23
3
3 (2,5)
16
25–44
10
9 (9,16)
-15
4
4 (3,7)
3
45–64
60
92 (76,119)
52
20
30 (19,42)
51
65–74
39
68 (55,91)
73
17
27 (18,42)
60
75+
38
69 (52,82)
83
24
35 (24,53)
44
Total
148
238 (205,290)
61
65
96 (69,140)
47
Cancer Projections: Incidence 2004–08 to 2014–18
23
Lung cancer
Figure 14:
Lung
Age
Male
Observed
2006
Rates
Counts
24
25–44
3
Projected 2016
Female
Projected Observed
% change
2006
2 (1,2)
-22
4
Projected 2016
Projected
% change
4 (3,5)
16
45–64
56
45 (37,57)
-20
51
49 (40,64)
-4
65–74
243
168 (138,211)
-31
162
154 (123,198)
-5
75+
387
295 (244,371)
-24
182
196 (155,247)
8
Total
49
36 (30,44)
-26
34
33 (27,41)
-3
25–44
14
11 (7,14)
-21
23
26 (15,29)
15
45–64
275
256 (213,325)
-7
260
299 (242,388)
15
65–74
324
321 (263,404)
-1
231
316 (251,405)
36
75+
371
388 (321,488)
5
254
337 (267,425)
32
Total
983
977 (815,1215)
-1
769
978 (789,1229)
27
Cancer Projections: Incidence 2004–08 to 2014–18
Figure 15:
Melanoma
Melanoma
Age
Male
Observed
2006
Rates
Counts
Projected 2016
Female
Projected Observed
% change
2006
Projected 2016
Projected
% change
15–24
4
4 (1,8)
-13
6
5 (3,8)
-18
25–44
21
17 (7,41)
-20
30
25 (18,34)
-18
45–64
86
82 (33,187)
-4
71
65 (46,85)
-8
65–74
183
206 (88,486)
13
115
120 (85,162)
5
75+
278
332 (143,799)
19
153
174 (123,231)
14
Total
56
56 (24,132)
1
46
43 (31,56)
-7
15–24
13
11 (4,26)
-9
18
15 (9,23)
-17
25–44
121
99 (41,234)
-19
186
151 (111,209)
-19
45–64
421
466 (190,1063)
11
361
396 (278,514)
10
65–74
244
395 (169,931)
62
164
246 (175,331)
50
75+
266
437 (188,1051)
64
214
300 (212,398)
40
Total
1065
1409 (597,3299)
32
943
1108 (793,1448)
18
Note: Unusually wide credible interval for male rate is unexplained. Further work is in progress to investigate this.
Cancer Projections: Incidence 2004–08 to 2014–18
25
Figure 16:
Myeloma
Myeloma
Age
Male
Observed
2006
Rates
Counts
26
25–44
1
Projected 2016
Female
Projected Observed
% change
2006
1 (0,1)
-3
0
Projected 2016
Projected
% change
0 (0,1)
-32
45–64
8
8 (6,11)
-5
6
5 (4,8)
-20
65–74
30
27 (22,37)
-8
19
17 (15,26)
-11
75+
56
57 (47,76)
2
32
29 (27,46)
-8
Total
7
6 (5,8)
-6
4
4 (3,5)
-15
25–44
5
4 (3,6)
-2
2
1 (1,3)
-33
45–64
40
44 (37,61)
10
32
30 (26,46)
-4
65–74
40
52 (43,72)
32
27
34 (30,52)
27
75+
53
75 (62,101)
40
45
50 (46,79)
13
Total
138
176 (149,231)
27
105
117 (107,174)
11
Cancer Projections: Incidence 2004–08 to 2014–18
Figure 17:
NonHodgkins
lymphoma
Rates
Counts
Non-Hodgkin’s lymphoma (NHL)
Age
Male
Observed
2006
Projected 2016
Female
Projected Observed
% change
2006
Projected 2016
Projected
% change
15–24
2
2 (1,2)
-6
1
1 (1,1)
-5
25–44
7
7 (5,8)
-5
4
4 (3,5)
-6
45–64
30
33 (30,44)
13
20
20 (17,28)
0
65–74
74
86 (79,118)
17
54
55 (47,78)
2
75+
108
127 (118,171)
17
77
82 (71,115)
6
Total
21
23 (21,29)
11
14
14 (12,19)
0
15–24
6
6 (3,6)
-1
4
3 (2,4)
-4
25–44
41
40 (30,45)
-3
26
24 (18,30)
-6
45–64
146
191 (172,249)
31
103
124 (105,170)
20
65–74
98
165 (151,225)
68
77
113 (97,159)
47
75+
103
166 (155,225)
61
108
141 (122,198)
30
Total
394
568 (528,723)
44
318
406 (351,547)
28
Cancer Projections: Incidence 2004–08 to 2014–18
27
Figure 18:
Oesophagus
Oesophageal cancer
Age
Male
Observed
2006
Rates
Counts
28
Projected 2016
25–44
1
0 (0,1)
45–64
11
65–74
75+
Total
Female
Projected Observed
% change
2006
Projected 2016
Projected
% change
-49
0
0 (0,0)
-19
11 (8,13)
0
3
3 (2,4)
-16
38
40 (30,47)
7
13
13 (10,15)
-3
65
68 (53,82)
5
35
34 (27,41)
-3
8
8 (7,10)
1
3
3 (2,4)
-9
-20
25–44
4
2 (2,4)
-48
1
1 (1,1)
45–64
52
60 (46,74)
16
16
16 (13,22)
1
65–74
50
77 (57,90)
54
19
26 (20,32)
39
75+
62
90 (70,108)
44
49
58 (46,71)
20
Total
168
229 (182,266)
36
84
101 (83,122)
20
Cancer Projections: Incidence 2004–08 to 2014–18
Figure 19:
Pancreas
Pancreatic cancer
Age
Male
Observed
2006
Rates
Counts
Projected 2016
Female
Projected Observed
% change
2006
Projected 2016
Projected
% change
25–44
1
1 (1,1)
-29
1
1 (1,1)
-9
45–64
11
10 (8,13)
-10
8
9 (7,11)
3
65–74
42
37 (30,46)
-13
35
32 (27,41)
-7
75+
69
64 (52,79)
-8
76
78 (61,91)
3
Total
9
8 (7,10)
-13
8
8 (6,9)
-2
25–44
6
4 (3,6)
-28
5
4 (3,6)
-9
45–64
56
58 (48,73)
4
43
53 (43,66)
24
65–74
56
71 (57,87)
26
49
66 (54,83)
34
75+
66
84 (68,104)
27
106
134 (105,156)
26
Total
184
217 (181,265)
18
203
257 (213,303)
27
Cancer Projections: Incidence 2004–08 to 2014–18
29
Figure 20:
Stomach
Stomach cancer
Age
Male
Observed
2006
Rates
Counts
30
Projected 2016
25–44
2
2 (1,2)
45–64
14
65–74
75+
Female
Projected Observed
% change
2006
Projected 2016
Projected
% change
1
2
1 (1,2)
-28
12 (10,15)
-11
8
7 (6,9)
-6
45
36 (29,44)
-21
21
19 (15,24)
-9
84
63 (50,76)
-24
46
38 (31,48)
-19
Total
11
9 (7,11)
-19
6
5 (4,6)
-15
25–44
12
13 (7,13)
2
11
8 (7,13)
-29
45–64
69
70 (57,87)
3
39
44 (34,54)
13
65–74
60
68 (55,85)
14
29
38 (31,49)
30
75+
80
84 (66,100)
4
65
65 (53,82)
0
Total
221
235 (189,277)
6
145
155 (129,192)
7
Cancer Projections: Incidence 2004–08 to 2014–18
Thyroid cancer
Figure 21:
Thyroid
Age
Male
Observed
2006
Rates
Counts
Female
Projected 2016
Projected Observed
% change
2006
Projected 2016
Projected
% change
15–24
1
1 (0,1)
0
3
3 (2,4)
11
25–44
3
3 (2,4)
17
8
11 (8,13)
26
45–64
5
6 (5,9)
30
11
16 (12,18)
41
65–74
7
8 (6,13)
19
12
15 (11,19)
24
75+
7
9 (6,13)
18
9
13 (10,16)
37
Total
3
4 (3,5)
22
8
11 (8,12)
31
15–24
2
3 (1,4)
5
8
9 (5,12)
12
25–44
14
17 (11,24)
19
52
65 (47,76)
25
45–64
24
36 (26,50)
51
56
94 (72,111)
69
65–74
9
16 (11,24)
71
18
32 (23,40)
78
75+
7
11 (8,17)
62
13
22 (17,28)
68
Total
57
83 (65,108)
45
147
222 (176,251)
51
Cancer Projections: Incidence 2004–08 to 2014–18
31
Male cancers (excluding the ‘PSA effect’)
Figure 22:
Age
Prostate
Observed
2006
Rates
0
0 (0,1)
Observed
2006
Projected 2016
Projected
% change
7
7 (5,10)
4
17
17
17 (15,23)
1
45–64
47
82 (41,107)
76
6
6 (5,8)
5
65–74
428
483 (361,840)
13
3
3 (2,4)
17
1168
1417 (1039,2253)
21
3
3 (2,4)
19
10
10 (9,13)
2
75+
Total
32
Projected
% change
15–24
25–44
Counts
Projected 2016
Testicular
91
112 (79,173)
23
22
24 (17,31)
9
25–44
2
2 (1,5)
19
95
97 (86,130)
3
45–64
229
469 (236,608)
104
29
35 (29,44)
22
65–74
570
925 (691,1608)
62
3
6 (5,8)
68
75+
1117
1865 (1368,2964)
67
2
4 (3,6)
63
Total
1919
3282 (2336,5100)
71
151
15–24
Cancer Projections: Incidence 2004–08 to 2014–18
166 (145,211)
10
Female cancers I
Figure 23:
Note: For key see Figure 22.
Age
Breast
Observed
2006
Rates
Counts
Projected 2016
Cervical
Projected
% change
Observed
2006
Projected 2016
Projected
% change
25–44
58
52 (41,61)
-11
11
8 (5,11)
-22
45–64
246
236 (193,271)
-4
12
8 (6,13)
-32
65–74
317
336 (268,388)
6
11
7 (4,10)
-37
75+
338
392 (325,461)
16
10
5 (3,6)
-47
Total
122
121 (100,137)
-1
8
6 (4,9)
-28
25–44
354
313 (251,371)
-12
66
51 (30,69)
-23
45–64
1247
1436 (1171,1646)
15
58
48 (35,77)
-18
65–74
453
688 (548,794)
52
15
14 (8,20)
-10
75+
473
674 (559,793)
43
14
9 (5,11)
-34
Total
2528
3111 (2572,3536)
23
153
121 (81,170)
-21
Cancer Projections: Incidence 2004–08 to 2014–18
33
Female cancers II
Figure 24:
Note: For key see Figure 22.
Age
Ovarian
Observed
2006
Rates
Counts
34
15–24
2
Projected 2016
2 (1,2)
Endometrial
Projected
% change
Observed
2006
Projected 2016
Projected
% change
-12
25–44
6
5 (4,7)
-9
4
4 (3,6)
10
45–64
24
20 (19,28)
-15
35
38 (30,56)
10
65–74
45
38 (31,47)
-16
62
65 (50,95)
6
75+
57
50 (39,58)
-13
55
64 (49,91)
17
Total
14
12 (11,15)
-14
17
19 (15,27)
8
15–24
5
5 (3,6)
-11
25–44
35
32 (27,42)
-9
23
25 (17,35)
9
45–64
120
123 (115,168)
2
176
232 (183,341)
32
65–74
65
78 (64,97)
21
88
133 (102,195)
52
75+
80
86 (67,100)
7
76
110 (84,157)
44
Total
305
323 (284,400)
6
363
500 (394,718)
38
Cancer Projections: Incidence 2004–08 to 2014–18
Cancer of all other sites
Figure 25:
Other
sites
Age
Rates
15–24
2
1 (1,2)
-14
1
1 (1,2)
-31
25–44
5
4 (2,5)
-21
5
3 (2,5)
-36
45–64
30
23 (14,34)
-24
24
18 (10,24)
-27
65–74
117
87 (52,129)
-25
72
52 (29,73)
-27
75+
246
216 (130,314)
-12
180
133 (74,182)
-26
Total
29
22 (14,32)
-22
21
15 (8,20)
-29
15–24
5
5 (2,6)
-10
3
2 (2,5)
-31
Counts
Male
Observed
2006
Female
Projected 2016
Projected Observed
% change
2006
Projected 2016
Projected
% change
25–44
27
22 (13,32)
-20
31
20 (11,29)
-37
45–64
149
132 (79,191)
-11
124
109 (59,145)
-12
65–74
155
167 (99,246)
7
103
107 (60,150)
4
75+
235
284 (171,413)
21
252
229 (127,313)
-9
Total
572
610 (370,875)
7
512
467 (263,631)
-9
Cancer Projections: Incidence 2004–08 to 2014–18
35
References
Bidwell S, Jo E. 2009. Incidence and prevalence of PSA testing in New Zealand men >50
years. Unpublished report. Wellington: Ministry of Health. (see Appendix to this report).
Black R, Stockton D. 2001. Cancer Scenarios: An aid to planning cancer services in Scotland
in the next decade. Edinburgh: Scottish Executive Health Department.
McDermid I. 2005. Cancer Incidence Projections for Australia 2002 to 2011. Canberra:
Australian Institute for Health and Welfare.
Ministry of Health. 2002. Cancer in New Zealand: Trends and projections. Wellington: Ministry
of Health.
Ministry of Health. 2003. The New Zealand Cancer Control Strategy. Wellington: Ministry of
Health.
Ministry of Health. 2007. Cancer Incidence Projections: 1999–2003 Update. Wellington:
Ministry of Health.
Moller B, Fekjaer H, Hakulinen T, et al. 2002. Prediction of cancer incidence in the Nordic
countries up to the year 2020. Euro J Cancer Prevention 11 (Supplement 1).
36
Cancer Projections: Incidence 2004–08 to 2014–18
Appendix: Prostate Cancer Incidence
Figure 26 shows observed (solid lines) and projected (broken lines) registration rates
for prostate cancer by single calendar year and five-year age group (from age 60 –
prostate cancer incidence is very low below this age).
Unlike all other projections in this report, the prostate cancer projections begin in 1987,
not 2006. This is to avoid the projections being influenced by prostate cancers
detected only through PSA testing.
Opportunistic screening with PSA began in the mid 1980s, and by the early 1990s had
become widespread. By 2005–07, over half of men aged 50+ were being screened at
least once every three years, although rates were lower in younger age groups
(<70 years) and in Māori and Pacific men (Bidwell et al 2009).
This explains the findings shown in the middle and lower panels of Figure 26: a sudden
and dramatic rise in prostate cancer registrations in all 60+ age groups (but more so in
older than younger age groups, at least on an absolute scale) beginning around 1990,
far in excess of that projected in the absence of PSA testing.
However, within 10 years of this upturn, registration rates reverse direction, falling in
older age groups from the late 1990s almost as steeply as they had risen, to levels well
below those projected for the early 2000s. For the oldest age groups (80+), there is
some indication that this phase of rapid decline may now also be coming to an end,
with rates possibly beginning to level off. In younger age groups (60–64 years in
particular), the phase of declining rates has not yet begun, but there is clear evidence
that the (earlier) phase of rapid acceleration is over, with rates now essentially stable.
These changing trends by age group can be more clearly seen in Figure 26a, which
shows each five-year age group separately (in relation to its own projection, based on
data to 1986).
What explains this somewhat complex pattern? It is almost certainly the result of
widespread if opportunistic PSA screening. PSA testing leads to cancers being
diagnosed (and registered) earlier than was previously the case – so registration rates
initially rise in all age groups. But earlier diagnosis also necessarily implies younger
diagnosis – so registration rates subsequently fall in older age groups while remaining
elevated in younger age groups. That is, screening leads to a permanent shift in the
age distribution of prostate cancer incidence.1
Ultimately we would expect age-specific prostate cancer registration rates to level off
and resume the trajectory indicated by the ‘pre PSA’ projections (that is, for the
foreseeable future, a gradual increase). The levels at which these rates level off will
determine the extent of over-diagnosis induced by PSA screening (that is, the extent to
which the ‘excess’ of cases detected at younger ages exceeds the ‘deficit’ of cases at
older ages induced by screening). We will continue to monitor and report on this issue
in subsequent updates as data accumulates.
1
Phasing of screening by age (ie higher rates of PSA testing in older age groups initially) may also have
contributed to this pattern.
Cancer Projections: Incidence 2004–08 to 2014–18
37
Figure 26:
Prostate cancer registrations: estimates and projections by age
Broken line = projected rates (per 100 000) based on data to 1986 (ie excluding cancers detected by PSA
screening).
Solid line = observed rates (per 100 000) to 2006 (ie including cancers detected by PSA screening).
38
Cancer Projections: Incidence 2004–08 to 2014–18
Figure 26a: Prostate cancer registrations (estimates and projections), by five-year age
group from 60-64 to 85+
Broken line = projected rates (per 100 000) based on data to 1986 (ie excluding cancers detected by PSA
screening).
Solid line = observed rates (per 100 000) to 2006 (ie including cancers detected by PSA screening).
Cancer Projections: Incidence 2004–08 to 2014–18
39