The Australian Institute of Health and Welfare have recently released a report titled Cancer in Australia: an overview, 2008.
I was a little disappointed that there was only a couple of comments, with no explanation, about the much higher incidences of cancer within our remote indigenous population. This is despite a number of studies being done. One has shown those living in the Kakadu around the Ranger Uranium Mine have a 90% higher incidence of cancer than the rest of the Northern Territory.
One paragraph in the report noted that:
Incidence rates for many types of cancer are considerably lower or higher for the Northern Territory than for other states and territories. These differences are mainly due to low or high incidence of these cancers in Aboriginal and Torres Strait Islander peoples, who comprise 29% of the Northern Territory population (d’Espaignet et al. 1996; Condon et al. 2001).
There was no discussion on why the incidence rates would be so much higher despite several studies looking at this issue.
There was some discussion about lower rates of melanoma of the skin and the indigenous population. This discussion was about a quirk in the state based statistics. The largest number of indigenous people in Australia reside in New South Wales. However they are a still a small percentage of the total population in this highly populated state. A high percentage of the people living in the Northern Territory are indigenous. You would expect those living in the warmer northern parts of Australia to have the highest incidence of melanoma.
The incidences of melanoma per state are:
Queensland (65.3 cases per 100,000 persons)
Western Australia (53.0)
New South Wales (47.8)
Australian Capital Territory (45.2)
South Australia (40.0)
Northern Territory (32.5)
We could perhaps expect that the Northern Territory would have a similar rate of skin cancer to Queensland. From the AIHW report:
8.2 Melanoma of the skin
The age-standardised rates for all forms of skin cancer are correlated with exposure to ultraviolet radiation (Jelfs et al. 1994). Therefore one would expect to see higher rates in the more northern states and territories, and lower rates in the more southern ones. However, the rates will also be affected by sun-protection behaviour and the percentage of the Indigenous population (which has a lower rate of skin cancer than the non-Indigenous population).
What about all the other cancers that indigenous people have a much higher incidence of. An article, again by Condon in the Medical Journal of Australia in 2004 (free registration required go to PubMed for abstract) explains why.
The NT Indigenous cancer mortality rate was higher than the total Australian rate for cancers of the liver, lungs, uterus, cervix and thyroid…… Differences between Indigenous and total Australian cancer mortality rates were more pronounced among those aged under 64 years for most cancers. NT Indigenous cancer mortality rates increased over the 24-year period for cancers of the oropharynx, pancreas and lung, all of which are smoking-related cancers. CONCLUSIONS: Cancer is an important and increasing health problem for Indigenous Australians. Cancers that affect Indigenous Australians to a greater extent than other Australians are largely preventable (eg, through smoking cessation, Pap smear programs and hepatitis B vaccination).
As well as cancer affecting our indigenous population earlier, the cancers that affect Indigenous Australians to a greater extent than other Australians are largely preventable (eg, through smoking cessation, Pap smear programs and hepatitis B vaccination).
Our indigenous population has smoking rates of 55% compared to the Australian average of 21% (men) 18%(women). The good news is that some money has been put aside for programs to reduce smoking rates in our indigenous people.
The cost of vaccinations on each states vaccination schedule is covered by the federal government’s Immunise Australia Program. As well as Hepatitis B, the Human papillomavirus vaccine for teenage girls is now covered, hopefully reducing the incidences of cervical cancer.
Ngaanyatjarra health has won an award for its vaccination efforts in the past. However, when a new vaccine is introduced there are no funds provided to assist in a program to vaccinate all members of a remote community.
These higher cancer rates in indigenous Australia I feel highlight our health authorities failure to make funding available to ensure this hard to reach population group, who are often moving about in very remote areas, can be followed up and vaccinated.