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Cancer control is one of the key National Health Priority areas in Australia (Australian Bureau of Statistics, 2018). Cancer is a group of diseases in which cells of the body divide and develop uncontrollably, with the ability to infiltrate and infect nearby cells (World Health Organization, 2018a; Yabroff, 2019).
Cancer is the result of various alterations in the processes that guide and control cell proliferation, spread and invasion (WHO, 2018a). This leads to downstream changes that alter the sequencing and working of the cell. Key risk factors for cancer include age, smoking habit, alcohol use, high body mass, sun exposure and genetic composition also coded as family history, among others.
This briefing paper examines the current burden occasioned by cancer on society, the impact of social health determinants on various cancer control outcomes, the role of the Australian government in cancer control as well as evidence-based recommendations for further action.
Problem Description
According to Mahumud, Alam, Dunn and Gow (2019) along with Cheng et al. (2019) cancer is ranked as the largest killer disease worldwide, including in Australia. WHO (2018a) notes that cancer was responsible for 9.6 million deaths worldwide in 2018, with one in every six deaths around the globe attributed to cancer. The economic impact of cancer is large and growing, with an estimated US$ 1.6 trillion spent on cancer in the year 2010. WHO (2018b) indicates that the global cancer burden rose by 18.1 million cases in 2018 (AIHW, 2019). Mahumud et al. (2019) conducted a survey of disease prevalence and impacts on the Australian population between 1982 and 2014 in one of the most extensive long-running studies yet. The results of the study indicated that the annual percentage change over this period increased by 1.27% AAPC. Cancer-related mortality during this period increased by 0.76% AAPC, the burden of the disease increased by 0.84% AAPC and hospitalization resulting from cancer grew by 1.19% AAPC.
Mahumud et al. (2019) indicate that cancer is expected to rank as the largest killer throughout the 21st century consistently. The authors did forecast more than 145,000 new cancer cases to be diagnosed in 2019 in Australia. At least 35% of these diagnosed cases were expected to die within five years of the initial diagnosis. Cancer accounts for the largest disease burden on the Australian population at 18%.
In the year 2018, 138,321 new cancer cases were discovered, this being rise from the previous 134,174 cases reported in 2017 (Chen et al., 2018). Australia posts one of the highest age-standardized incident rates of cancer, standing at 323 for every 100,000 persons. The leading types of cancer within Australia are female breast cancer, prostate cancer, colorectal cancer melanoma and lung cancer.
Cheng et al. (2018) indicates that underlying cancer illnesses, or cancer-related caused 48,586 deaths recorded in the year 2018. This averages at 131 daily deaths from cancer. The mortality rate is also significantly higher at 1.9 times that recorded in 1982 (Cheng et al., 2018). Moreover, as of the year 2018, the risk of dying from cancer in Australia by the age of eighty-five years was estimated at 1 in 4 for males and 1 in 6 for females. The authors further estimate that the total disability-adjusted life years lost due to cancer in Australia was 833,250, representing at least 19% of all the DALYs lost. Moreover, most of cancer in Australia was reported to be fatal at 94%, with only 6% regarded as non-fatal.
Social Determinants of Health on Cancer Control
The Australian Institute of Health and Welfare (AIHW) (2016) defines social health determinants of health as the conditions into which individuals are born, raised, as well as those in which they work, live and age. Moreover, these determinants also include the systems of health put into place to deal with health and illnesses. Social health determinants are noted to have the strongest and subliminal impacts on health outcomes, including cancer control (Braveman & Gottlieb, 2014).
One of the key SDH is the social-economic position of the individual, signalled mainly by the education level, income level, health literacy and occupation. AIHW (2016) debates that in general, people from lower socio-economic positions post poor health outcomes, have higher illness rates, live shorter times and have higher disability rates.
Merletti, Galasi and Spades (2011) in their work do hold that 56% of cancer cases and 63% of cancer-related deaths occur in less developed countries. In extension, the authors do debate that these are regions of the world with less developed diagnostic and treatment capabilities, and where economic resources are restricted, including information on cancer. 85% of cervical cancer cases are indicated to occur in the less developed regions of the world (LaVigne, Triedman, Randall, Trimble & Vishwanathan, 2017). Moreover, the authors point out that massive social inequalities in both incidence and mortality rates in cancer do exist within developed countries as well.
Research undertaken over the last two decades has provided firm evidence that lung cancer is directly related to the adult socio-economic position of the individual (Merletti, Galasi, & Spadea, 2011). This has further been linked with inequalities in smoking risks and behaviors, as well as occupational exposures. The authors report that two previous studies noted that smoking a counted for between 50 and 65% of lung cancer risk, with occupational exposures a counting for 14% (Merletti, Galasi, & Spadea, 2011).
Merletti, Galasi and Spadea (2011) note that cancer mortality depends largely on access to adequate healthcare, of which groups in the lower socio-economic status may have limited access. Moreover, cancer survivability is closely linked with socio-economic abilities, with disadvantaged groups noted to have significantly lower five-year survivability levels.
Lower education has been found to have a high relationship with stomach, liver, rectal, bladder and throat cancers (Merletti, Galasi, & Spadea, 2011). This is partly explained by the delay or inability of the less educated to promptly seek medication for probable cancer at first sight of symptoms.
People living in remote regions have been indicated to have poorer outcomes in relation to cancer incidents as well as survivability, partly explained by their limited access to high-end diagnostic and treatment. Provision of a national health care system that aims to reduce inequalities also needs to take care of these fundamental differences in access.
The Role of the Government
Cancer control in Australia has been one of the most successful around the world (Cheng et al., 2018). Lung cancer has been a particular success, with the government’s austere laws and regulations on tobacco smoking being effective in stemming the incidence and prevalence levels of lung cancer. The low prevalence of smoking results from multifaceted efforts that include incredibly high taxes, stringent controls on marketing, advertisement, promotion and display of tobacco products, control on points of sale and discouragement of smoking. Other control measures launched by the government have included publicly funded immunization for human papillomavirus introduced in 2007. Thirdly, public campaigns promoting sunscreen protection which has been in place since the 1980s.
Early detection screening programs have been a vital area for cancer control (Cheng et al., 2018). The Australian government runs three different types of screening programs across the country. The three are The National Bowel Cancer screening program (starting in 2006), the BreastScreen Australia program and the National Cervical Screening program (both started in 1991). Given early detection and prognosis is decisive in the successful control of cancer, these programs have been vital in detecting cancer among the population and making rapid referrals for specifically targeted intervention programs.
Cheng et al. (2018) also notes that the national government has implemented and maintained a registry for all cancer cases detected and diagnosed in Australia. These registered have been in operation since 1982 and are mandated by law. Given the complexity of cancer research and treatment, the databases provide an important one-stop-shop for researchers, population-level surveillance programs and inform policy and strategy development, implementation and evaluation.
The universal health care program implemented by the national government in Australia has been substantially effective in eliminating economic inequalities in access to care and treatment for patients, including cancer patients (Cheng et al., 2018). Even though the program has not entirely eliminated these inequalities, it has significantly reduced economic barriers towards medical and healthcare access and improved survivability as well.
Recommendations
Socio-economic factors are significant determinants of health care outcomes and continue to have massive impacts on cancer control (Markwick et al. 2014). In this respect, remoteness has been cited as a significant mediating factor, as well as social isolation and loneliness. Improvement of these factors will likely help play a role in improving outcomes. The government thus needs to ensure better policies to help bridge these inequalities.
MacDonald et al. (2018) observes that awareness of cancer risks and symptoms is especially dire in population, who ironically face the highest risk of cancer as they age. Also, food habits are also responsible for cancer to a significant extent. One research held that 1.4% of all cancer cases in 2010 in Australia were due to inadequate intake of fruits and non-starchy vegetables (Cancer Council Australia, 2018). There is thus need for the government to ensure specific, targeted and tailored information programs that will ensure the elderly are adequately informed of potential indicators. One example could be promoting the message of healthy diet and physical activity. Also, regular screening and health checkup could also be effective. This would help facilitate early detection and diagnosis, and by consequence, improve health outcomes.
Conclusion
Age is regarded as a major risk factor for cancer, with 75% of those diagnosed being above sixty years of age. Other major risk factors include high body mass, exposure to harmful radiations and other chemicals, lack of adequate physical exercise and family history. Early prognosis and treatment is the defining factor in the treatment and control of cancer. As a result, prompt and equitable access to modern health care and treatment is vital to control the same. Australia’s considerable success in dealing with cancer control is down to strict tobacco smoking control, publicly funded immunization programs for certain cancers, early detection and screening programs, universal health care program and a cancer registry that enables research and population-level surveillance. Going forward, programs that reduce the impact of socio health Determinants will be valuable in further constraining the impact of the disease.
References
- AIHW (2016). Australia’s Health 2016: 4.1 Social Determinants of Health. Retrieved from https://www.aihw.gov.au/getmedia/11ada76c-0572-4d01-93f4-d96ac6008a95/ah16-4-1-social-determinants-health.pdf.aspx
- AIHW (2019). Cancer in Australia 2019. Retrieved from https://www.aihw.gov.au/reports/cancer/cancer-in-australia-2019/contents/summary
- Australian Bureau of Statistics (2018). National Health Priority Areas. Retrieved from https://www.abs.gov.au/ausstats/abs@.nsf/Products/5317BAD6B8EEE19ACA25757C001EED30?opendocument
- Cancer Council Australia (2018). Links Between Cancer and Weight, Nutrition and Physical Activity. Retrieved from https://wiki.cancer.org.au/policy/Obesity/Links_between_cancer_and_weight,_nutrition_and_physical_activity
- Cheng, E. S., Weber, M., Feletto, E., Smith, M. A., & Yu, X. Q. (2018). Cancer Burden and Control in Australia: Lessons Learnt and Challenges Remaining. Analysis of Cancer Epidemiology, 2, doi: 10.21037/ace.2018.08.03
- Braveman, P. & Gottlieb, L. (2014). The Social Determinants of Health: Its Time to Consider the Causes of the Causes. Public Health Rep, 129(supp.2), 19-31.
- LaVigne, A. W., Triedman, S. A., Randall, T. C., Trimble, E. L. & Vishwanathan, A. N. (2017). Cervical Cancer in Low- and Middle-Income Countries: Addressing Barriers to Radiotherapy Delivery. Gynecol Oncol Rep. 22(1), 16-20.
- MacDonald, S., Cunningham, Y., Patterson, C., Robb, K., MacLeod, U., Anker, T., & Hilton, S. (2018). Mass Media and Risk Factors for Cancer: The Under-Representation of Age, BMC Public Health, 18(490) https://doi.org/10.1186/s12889-018-5341-9
- Mahumud, R. A., Alam, K., Dunn, J., & Gow, J. (2019). Emerging Cancer Incidence, Mortality, Hospitalisation and Associated Burden Among Australian Cancer Patients, 1982 2014: An Incidence-Based Approach in Terms of Trends, Determinants and Inequality. BMJ Open 9:e031874. doi:10.1136/ bmjopen-2019-031874
- Markwick, A., Anzari, Z., Sullivan, M., Parsons, L., & McNeil, J. (2014). Inequalities in the Social Determinants of Health of Aboriginal and Torres Strait Islander People: A Cross-Sectional Population-Based Study in the Australian State of Victoria. International Journal for Equity in Health, 13(91).
- Merletti, F., Galasi, C., & Spadea, T. (2011). The Socio-Economic Determinants of Cancer, Environmental Health, 10(S7).
- WHO (2014). World Cancer Report 2014. Retrieved from https://www.who.int/cancer/publications/WRC_2014/en/
- WHO (2018). Cancer, Retrieved from https://www.who.int/news-room/fact-sheets/detail/cancer
- WHO (2018b). Latest Global Cancer Data: Press Release No. 263. Retrieved from https://www.iarc.fr/wp-content/uploads/2018/09/pr263_E.pdf
- Yabroff, Y. R., Handler, T., Wender, R. C., Cullen, K. J., & Brawley, O. W. (2019). Minimising the Burden of Cancer in the United States: Goals for a High-Performing Health Care System. Cancer Journal for Clinicians, 69(3), 166-183.
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