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Cancer Institute NSW Monograph
Pancreatic cancer in New South Wales
March 2010
Nicola Creighton, Deborah Baker, James F Bishop
00
Bowel Cancer in New South Wales
Cancer Institute NSW catalogue number: EM-2010-01
National Library of Australia cataloguing-in-publication data:
Pancreatic cancer in New South Wales
SHPN (CI) 100018
ISBN 978-1-74187-481-5
Key words: Pancreatic cancer, New South Wales, Australia
Suggested citation:
Creighton N, Baker D, Bishop J. Pancreatic cancer in New South
Wales. Sydney: Cancer Institute NSW, March 2010.
Published by the Cancer Institute NSW, March 2010.
Cancer Institute NSW
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Suite 101
1 Central Avenue
Eveleigh NSW 2015
PO Box 41
Alexandria NSW 1435
Telephone (02) 8374 5600
Facsimile (02) 8374 5700
E–mail [email protected]
Homepage www.cancerinstitute.org.au
Publications www.cancerinstitute.org.au/publications
Copyright © Cancer Institute NSW March 2010.
This work is copyright. It may be reproduced in whole or
part for study or training purposes subject to the inclusion of
acknowledgement of the source. It may not be reproduced
for commercial usage or sale. Reproduction for purposes
other than those indicated above requires written permission
from the Cancer Institute NSW.
Cover image: Pancreatic cancer cell, coloured SEM.
1
Contents
Tables 3
Figures 5
Acknowledgements 6
Executive Summary 7
1 Introduction 8
2 Identifi cation and management 9
2.1 Anatomy and physiology of the pancreas 9
2.2 Pathology 11
2.3 Symptoms 12
2.4 Diagnosis and staging 12
2.5 Management of pancreatic cancer 14
3 Epidemiology of pancreatic cancer 15
3.1 Age 15
3.2 Gender 15
3.3 Lifestyle – smoking, alcohol, weight and diet 15
3.4 Pancreatic diseases 16
3.5 Genetics and family history 16
4 Methods 17
4.1 Cases 17
4.2 Population estimates 18
4.3 Age-standardised rates 18
4.4 Survival 18
4.5 Prevalence and projections 18
4.6 Data interpretation 19
5 Incidence and Mortality 20
5.1 Number of cases and deaths from
pancreatic cancer 20
5.2 Crude incidence and mortality rates of
pancreatic cancer 21
5.3 Age-standardised incidence and mortality
rates of pancreatic cancer 21
5.4 Age-specifi c incidence and mortality
rates of pancreatic cancer 23
5.5 Median age at diagnosis and death 26
5.6 Incidence of pancreatic cancer by
histology type and tumour location 26
6 Trends in degree of spread and survival 28
6.1 Degree of spread at diagnosis 28
6.2 Survival of pancreatic cancer 29
7 Geographic patterns of pancreatic cancer 32
7.1 Incidence and mortality of pancreatic
cancer by accessibility and remoteness 32
7.2 Incidence and mortality of pancreatic
cancer by Area Health Service 32
7.3 Incidence and mortality of pancreatic
cancer in Australian states and territories 33
7.4 Global incidence and mortality of
pancreatic cancer 34
7.5 National and international survival of
pancreatic cancer 37
2
Pancreatic Cancer in New South Wales
8 Pancreatic cancer in sub-populations 38
8.1 Incidence and mortality of pancreatic
cancer by socioeconomic status 38
8.2 Incidence and mortality of pancreatic
cancer by country of birth 38
9 Prevalence and projections 40
9.1 Prevalence of pancreatic cancer 40
9.2 Projections for pancreatic cancer 40
10 Conclusions 42
11 Appendix 43
12 Glossary 44
13 Data tables 47
References 62
3
Tables
Tables
Table 1
Staging for exocrine pancreatic cancer 13
Table 2
New cases of pancreatic cancer in NSW,
persons, 1972–2006 47
Table 3
New cases of pancreatic cancer in NSW,
males, 1972–2006 48
Table 4
New cases of pancreatic cancer in NSW,
females, 1972–2006 49
Table 5
Deaths from pancreatic cancer in NSW,
persons, 1972–2006. 50
Table 6
Deaths from pancreatic cancer in NSW,
males, 1972–2006 51
Table 7
Deaths from pancreatic cancer in NSW,
females, 1972–2006 52
Table 8
Age-specifi c and age-standardised (ASR) incidence
rate (per 100,000) of pancreatic cancer in
persons, NSW, 1972–2006 53
Table 9
Age-specifi c and age-standardised (ASR) incidence
rate (per 100,000) of pancreatic cancer in
males, NSW, 1972–2006 54
Table 10
Age-specifi c and age-standardised (ASR) incidence
rate (per 100,000) of pancreatic cancer in
females, NSW, 1972–2006 55
Table 11
Age-specifi c and age-standardised (ASR) mortality
rate (per 100,000) of pancreatic cancer in
persons, NSW, 1972–2006 56
Table 12
Age-specifi c and age-standardised (ASR) mortality
rate (per 100,000) of pancreatic cancer in
males, NSW, 1972–2006 57
Table 13
Age-specifi c and age-standardised (ASR) mortality
rate (per 100,000) of pancreatic cancer in
females, NSW, 1972–2006 58
Table 14
Cases of pancreatic cancers by histological type
and age group,1972-2006, and the annual
age-standardised (ASR) incidence rate (per 100,000),
NSW, 2002–2006 59
Table 15
Incidence of pancreatic cancer by accessibility and
remoteness (ARIA+ category), NSW, 2002–2006 59
Table 16
Mortality from pancreatic cancer by accessibility and
remoteness (ARIA+ category), NSW, 2002–2006 60
Table 17
Incidence of pancreatic cancer by Area Health Service,
NSW, 2002–2006 60
Table 18
Mortality from pancreatic cancer by Area Health
Service, NSW, 2002–2006. 61
Table A1
ICD-O-3 coding for tumour topography
in the pancreas 43
Table A2
Histology groups by ICD-O-3 morphology codes 43
4
Pancreatic Cancer in New South Wales
Figures
Figures
Figure 1
Anatomy of the pancreas and surrounding organs 9
Figure 2
New cases of pancreatic cancer, NSW, 1972–2006 20
Figure 3
Number of deaths from pancreatic cancer, NSW,
1972–2006 20
Figure 4
Crude incidence rate of pancreatic cancer, NSW,
1972–2006 21
Figure 5
Crude mortality rate of pancreatic cancer, NSW,
1972–2006 21
Figure 6
Age-standardised incidence and mortality rates for
pancreatic cancer, males, NSW, 1972–2006 22
Figure 7
Age-standardised incidence and mortality rates for
pancreatic cancer, females, NSW, 1972–2006 22
Figure 8
Age-standardised incidence and mortality rates for
pancreatic cancer, persons, NSW, 1972–2006 22
Figure 9
Number of new cases of pancreatic cancer
by age group, males and females, NSW, 1972–2006 23
Figure 10
Age-specifi c incidence rates of pancreatic cancer,
males and females, NSW, 2002–2006 24
Figure 11
Age-specifi c mortality rates of pancreatic cancer,
males and females, NSW, 2002–2006 24
Figure 12
Trends in age-specifi c incidence (solid line) and
mortality (dashed line) rates of pancreatic cancer
by fi ve-year periods, males, NSW 25
Figure 13
Trends in age-specifi c incidence (solid line) and
mortality (dashed line) rates of pancreatic cancer
by fi ve-year periods, females, NSW 25
Figure 14
Age-specifi c incidence rates of pancreatic cancer
by birth cohort, males, NSW 25
Figure 15
Age-specifi c incidence rates of pancreatic cancer
by birth cohort, females, NSW 25
Figure 16
Median age at diagnosis and death for pancreatic
cancer cases, males and females, NSW, 1972–2006 26
Figure 17
Tumour location in the pancreas, NSW, 2002–2006 27
Figure 18
Degree of spread of pancreatic cancer at diagnosis,
NSW, 1972–2006 28
Figure 19
Degree of spread at diagnosis, males and females,
NSW, 2002–2006 28
Figure 20
Five-year relative survival of pancreatic cancer by
gender, NSW, 1999–2003 29
Figure 21
Five-year relative survival of pancreatic cancer by
degree of spread at diagnosis, NSW, 1999–2003 29
Figure 22
Five-year relative survival of pancreatic cancer
by age at diagnosis, NSW, 1999–2003 30
Figure 23
Five-year relative survival of pancreatic cancer by
histology group, NSW, 1999–2003 30
Figure 24
Five-year relative survival of pancreatic cancer by
period of diagnosis, NSW, 1980–2003 31
5
Figure 25
Age-standardised incidence and mortality rates
(± 95% CI) of pancreatic cancer by accessibility and
remoteness (ARIA+ category), NSW, 2002–2006 32
Figure 26
Age-standardised incidence and mortality rates
(± 95% CI) of pancreatic cancer by Area Health
Service, NSW, 2002–2006 33
Figure 27
Age-standardised incidence rates of pancreatic
cancer by state and territory, males and females,
2001–2005 34
Figure 28
Age-standardised mortality rates of pancreatic
cancer by state and territory, males and females, 1997–2001
34
Figure 29
Age-standardised incidence rates of pancreatic cancer,
males, worldwide, 2002 35
Figure 30
Age-standardised incidence rates of pancreatic cancer,
females, worldwide, 2002 35
Figure 31
Age-standardised mortality rates of pancreatic cancer,
males, worldwide, 2002 36
Figure 32
Age-standardised mortality rates of pancreatic cancer,
females, worldwide, 2002 36
Figure 33
National and international fi ve-year relative survival
(± 95% CI) of pancreatic cancer 37
Figure 34
Age-standardised incidence and mortality rates
(± 95% CI) of pancreatic cancer by socioeconomic
disadvantage, NSW, 2002–2006 38
Figure 35
Age-standardised incidence and mortality rates
(± 95% CI) of pancreatic cancer by country of birth,
NSW, 2002–2006 38
Figure 36
Age-standardised incidence and mortality rates
(± 95% CI) of pancreatic cancer by region of birth,
NSW, 2002–2006 39
Figure 37
Actual and projected cases of pancreatic cancer,
NSW, 1995–2012 40
Figure 38
Actual and projected deaths from pancreatic cancer,
NSW, 1995–2012 40
Figure 39
Population pyramid for NSW in 2006 and 2020 41
Figure 40
Actual and projected age-standardised incidence and
mortality rates for pancreatic cancer, males and
females, NSW, 1995–2012 41
Figure 41
Area Health Service boundaries in 2005 45
6
Pancreatic Cancer in New South Wales
Acknowledgements
This report was made possible through the collaboration of many people within the Cancer Institute NSW and the NSW
Department of Health. We would particularly like to thank the NSW Central Cancer Registry (NSW CCR) staff for their hard
work in processing and coding the data as well as taking the time to explain the processes for coding cancer data. We appreciate
the cooperation of statutory notifi ers in the supply of notifi cations and the assistance of medical records personnel, clinicians and
pathologists in meeting requests for supplementary information. The NSW CCR is funded by the NSW Department of Health
and is managed by the Cancer Institute NSW under an agreement. The authors would like to thank Professor Andrew Biankin for
reviewing this report.
Mortality details are provided by the Registrar of Births, Deaths and Marriages (NSW). Population and demographic data, and
coded cause of death data are provided by the Australian Bureau of Statistics. Population and demographic data used in this report
were accessed via the Health Outcomes and Information Statistical Toolkit (HOIST). HOIST is a facility that enables data access,
analysis and reporting and was established and is operated by the Centre for Epidemiology and Research, Division of Population
Health, NSW Department of Health.
7
Executive Summary
In 2006, only 16.8 per cent of cases were diagnosed with cancer localised to the pancreas.
Over the past three decades the number of cases of pancreatic
cancer in New South Wales has approximately doubled
for males and nearly tripled for females. A similar pattern is
observed for deaths from pancreatic cancer. In 2006, pancreatic
cancer accounted for 2.2 per cent of all new cases of cancer.
Pancreatic cancer accounted for 5.4 per cent of all cancer deaths
and was the sixth most common cause of cancer mortality in
New South Wales in 2006.
Until 2000, the age-standardised incidence rate of pancreatic
cancer was declining in males but increasing by 0.7 per cent per annum in females. However since 2000, rates have increased by 1.8
per cent per annum in males and continued to increase at 0.7 per cent per annum in females.
The major risk factor for pancreatic cancer is age and, as with many cancers, the risk of developing pancreatic cancer increases
with age. Pancreatic cancer is uncommon in people under 50 years old. Age-specifi c incidence rates in 80–85-year-olds are 9.8 and
15.0 times higher in males and females respectively compared to 50–54-year-olds. There is very little variation in pancreatic cancer
incidence by demographic variables such as geographic location, socioeconomic status or country of birth.
Consistently, most cases of pancreatic cancer have been diagnosed at a distant degree of spread. In 2006, only 16.8 per cent of
cases were diagnosed with cancer localised to the pancreas. The majority (43.7% of cases) were diagnosed with distant spread or
secondary metastases and 13.4 per cent had regional spread outside the pancreas. Just over one quarter of cases (26.1%) were of
an unknown degree of spread.
Pancreatic cancer has a poor prognosis with very low survival. Most cases (75%) do not survive past one year, and the fi ve-year
relative survival for the 1999–2003 period was 7.2 per cent. Five-year relative survival has not improved signifi cantly since 1980.
There has been a slight but signifi cant increase in one-year survival from 19.3 per cent in the 1980–1983 period, to 24.6 per cent
in the 1999–2003 period. Even pancreatic cancers diagnosed with localised disease have a poor fi ve-year survival of 11.2 per cent.
Therefore, earlier detection of pancreatic cancers will have limited benefi t in improving the overall survival from pancreatic cancer.
The best hope lies with the development of new diagnostic methods to detect the pre-cursor cells to invasive cancer, and new
treatments for pancreatic cancer.
8
Pancreatic Cancer in New South Wales
1 Introduction
This report identifi es trends in the incidence and mortality of pancreatic cancer over the past three decades in NSW.
Despite advances in treating many cancers, the outcome for
pancreatic cancer remains poor. Pancreatic cancer is the fi fth
most common cause of cancer death in Australia for males
and females and the eighth most common worldwide.1-2 It has
the worst survival of all the main cancer sites with a fi ve-year
relative survival of 4.6 per cent.1
The poor outcome of pancreatic cancer is primarily due to the
presentation of the disease at an advanced stage, aggressive
tumour biology and the lack of effective treatments especially
for localised disease. Symptoms for pancreatic cancer generally present when the tumour has invaded surrounding structures and
has metastasised. Less than 20 per cent of patients present with resectable pancreatic cancer.3 Even with surgery recurrence is
common and fi ve-year survival of resected patients is around 30 per cent or less.3-4 Adjuvant therapies may prolong survival but are
not curative.5-6 Standard adjuvant therapy regimes have not been established and are currently the subject of large clinical trials. To
make substantial improvements in the outcomes of pancreatic cancer patients a number of areas of research are being targeted.
These include molecular methods for the early detection of pancreatic cancer and more effective systemic therapies.7
In Australia, around 2200 cases of pancreatic cancer are diagnosed each year making it the 11th most common cancer.1 There is the
potential to reduce the incidence of pancreatic cancer as there are several modifi able risk factors. In particular, smoking increases
the risk of pancreatic cancer and is responsible for around 20–25 per cent of pancreatic cancers.1, 8 The evidence about the impact
of alcohol and diet on risk is less unequivocal. However, the greatest risk factor for pancreatic cancer is ageing. The incidence rate
of pancreatic cancer is around nine times higher in people aged 80–84 years compared to 50–54 years and less than 10 per cent of
cases occur in people under 50 years old.9-10 A family history of pancreatic cancer can also increase the risk of pancreatic cancer. A
hereditary component is present in around 5–10 per cent of pancreatic cancer cases.11-12
Progress has been made in understanding the mechanisms and events that lead to the initiation and progression of cancer in
pancreatic cells.13 Understanding the molecular mechanisms of pancreatic carcinogenesis will help to develop diagnostic biomarkers
and novel therapeutic agents. It will also help to identify the genetic and environmental interactions that increase the risk of
pancreatic cancer in individuals.
This report identifi es trends in the incidence and mortality of pancreatic cancer over the past three decades in New South Wales.
It also investigates variations in the incidence and mortality by age, geographic areas, socioeconomic status and country of birth.
Comparisons are made to the incidence and mortality in other Australian states and territories, and internationally. The survival of
pancreatic cancer by tumour characteristics is also examined. It is envisaged that this information will assist with the planning and
provision of services to better diagnose, treat and support people with pancreatic cancer in New South Wales.
9
2 Identifi cation and management
of pancreatic cancer2.1 Anatomy and physiology of the pancreas
2.1.1 Anatomy of the pancreas
The pancreas is located in the centre of the upper abdomen behind the peritoneum. It is surrounded by many important organs
and structures (Figure 1). It is typically 15–20 cm long, weighs 100–120 g and has a volume of 60-85 ml in an adult.14 The pancreas
can be divided into three sections – the head, body and tail. The head of the pancreas lies in the curve of the duodenum. Part of
the head, known as the uncinate process, wraps around the right side of the portal vein. The body of the pancreas is situated in
front of the abdominal aorta, portal vein and left kidney. The tail extends obliquely to under the hilum of the spleen.
The main pancreatic duct runs the length of the pancreas and is 2-3 mm in diameter. The main pancreatic duct merges at the
head of the pancreas with the common bile duct. The common bile duct runs in a deep groove along the head of the pancreas
before passing through the pancreatic tissue and draining into the duodenum. An accessory pancreatic duct drains the head of the
pancreas and enters the duodenum above the common bile duct.
Figure 1Anatomy of the pancreas and surrounding organs
Source: National Cancer Institute (www.visualsonline.cancer.gov)
10
Pancreatic Cancer in New South Wales
The pancreas has a rich supply of blood. The head of the pancreas and the duodenum have a common blood supply from
pancreaticoduodenal arteries that originate from the trunk of the celiac artery. The body and tail of the pancreas are supplied with
blood by pancreatic arteries that emerge from the splenic and superior mesenteric arteries.15 The venous system of the pancreas
corresponds closely with the arterial system and drains into the portal, superior mesenteric and splenic veins.
The pancreas is drained by a large and diffuse network of lymph vessels and nodes.15 The pancreatic lymphatic system connects
with lymph nodes associated with the spleen and parts of the small and large intestine. Sympathetic and parasympathetic nerves
from branches of the vagal and splanchic nerves innervate cells in the pancreas. The pancreas also has a rich supply of afferent
nerves, responsible for carrying stimuli to the central nervous system.
The pancreas has a dual role as an organ of the digestive and the endocrine systems. The pancreatic juices that drain into the
duodenum are exocrine secretions whereas the hormones secreted into the blood are endocrine secretions. The exocrine and
endocrine functions of the pancreas take place in different types of cells in the pancreas.
2.1.2 The exocrine pancreas
Exocrine pancreatic cells make up approximately 85 per cent of the weight of the pancreas.15 They are grouped into clusters called
acini which are drained by a system of branching ducts that fl ow into the main pancreatic duct. Pancreatic juice contains digestive
enzymes and bicarbonate ions. The digestive enzymes are produced by acinar cells. The acinar cells release most enzymes into the
ducts in an inactive form. In a healthy pancreas, the inactive enzymes are only activated once they reach the small intestine which
prevents autodigestion of the pancreas. The enzymes break down proteins, fats and carbohydrates.
The acini are drained by short intercalated ducts which connect to collecting ducts. The intercalated ducts are lined by epithelial
cells which release bicarbonate ions into the pancreatic juice making it alkaline. The alkaline pancreatic juice neutralises acid from
the stomach, creating an optimum pH in the small intestine for the digestive enzymes to function. The exocrine pancreatic cells
are stimulated to increase the production of pancreatic juices in response to a meal through nerve and hormonal action.16 The
pancreas secretes about 500–800ml of pancreatic juice per day.15
2.1.3 The endocrine pancreas
Endocrine cells are embedded throughout the pancreas in groups called Islets of Langerhans. They are only about 2 per cent of the
volume of the pancreas and are highly vascularised.17 The main function of the endocrine pancreas is the homeostasis of glucose
through the secretion of the hormones insulin and glucagon. Approximately 75 per cent of the endocrine cells produce insulin
and are called beta cells. Glucagon is produced by alpha cells which are about 20 per cent of the endocrine cells. The remaining
endocrine cells produce somatostatin and pancreatic polypeptide which have generalised inhibitory effects on the pancreas and
gastrointestinal system.17
Insulin and glucagon have complementary roles in glucose homeostasis. The maintenance of optimal blood glucose concentration
and the supply of glucose to cells are controlled by the ratio of insulin to glucagon. The production of insulin is stimulated primarily
by elevated blood glucose. Elevated blood glucose typically occurs after a meal due to the digestion of carbohydrates. Hormones,
neurotransmitters and amino acids also have a role in stimulating insulin production.17 The uptake and storage of glucose by skeletal
muscle and adipose tissues is dependent on insulin. The binding of insulin to insulin-receptors on the cell membrane mobilises
glucose transporters which move glucose into the cells. Insulin mediates approximately 40 per cent of the glucose disposal in the
body.17 Insulin also regulates glucose metabolism in the liver. Liver cells take up glucose that is absorbed by the small intestine but
this uptake is not mediated by insulin. However, insulin promotes the storage of glucose as glycogen in the liver and also inhibits
the breakdown of glycogen into glucose. Insulin also has an important role in the metabolism of fatty acids and amino acids by
promoting their uptake and storage in muscle, liver and adipose tissues.
11
The role of glucagon in glucose homeostasis is to increase blood glucose concentration. Glucagon production by the pancreas is
stimulated by low blood glucose. The main site of action of glucagon is in the liver. Glugacon stimulates the breakdown of glycogen
into glucose and the production of glucose from non-carbohydrate sources (gluconeogenesis) by liver cells. Glucagon also promotes
the release of fatty acids from adipose tissues which can then be used as a fuel.
The effects of insulin are far-reaching. As well as the role of insulin in nutrient metabolism, insulin mediates vasodilation by
stimulating the release of nitric oxide in vascular endothelium. This increases glucose uptake in skeletal muscle. Insulin also
stimulates the production of vasoconstrictors. Insulin has an important role in cardiovascular physiology.18
2.2 Pathology
Most (>95%) pancreatic cancers originate in the exocrine pancreas. Around 90 per cent of all pancreatic cancers are ductal
adenocarcinomas which are thought to arise from pancreatic duct epithelia.6,19 Ductal adenocarcinomas have poor survival with
an overall fi ve-year survival of around 5 per cent.20 Less frequently occurring exocrine pancreatic cancer types include acinar cell
carcinomas and cystadenocarcinomas. Recognition of these different histological types of tumours is important since some have a
better prognosis than ductal adenocarcinomas. For example, cystadenocarcinomas and acinar cell carcinomas, which are less than 2
per cent of exocrine pancreatic cancers, have a fi ve-year survival of 47 per cent and 28 per cent respectively.20
There are currently three recognised types of non-invasive precursor lesions of invasive pancreatic cancer. Evidence for a disease
progression model for ductal adenocarcinomas is increasing.22-23 Normal duct epithelia progresses through three grades of
pancreatic intraepithelial neoplasia (PanIN) to invasive cancer. The three grades of PanIN have distinguishing hyperplastic and
dysplastic changes that are associated with characteristic genetic alterations. Early in the progression at PanIN-1, alterations in the
K-ras gene are common. Late in the progression at PanIN-3, the lesions have typically accumulated changes in the p53, BRCA2, p16,
mucin genes and various others.24 Currently, PanIN is only detectable microscopically. The other recognised precursors to invasive
pancreatic cancers are mucinous cystic neoplasms (MCNs) and intraductal papillary neoplasms (IPMNs). MCNs and IPMNs can be
detected macroscopically. Non-invasive MCNs can develop into invasive MCNs. IPMNs can develop into invasive ductal/tubular
adenocarcinomas or colloidal carcinomas.25 The early detection and treatment of these non-invasive lesions may prevent the
progression to invasive pancreatic cancer.25-26
Recent evidence suggests that pancreatic adenocarcinoma tumours contain a small percentage of cells known as cancer stem cells.27
It is believed that the cancer stem cells are responsible for tumour initiation, metastasis and resistance to current chemotherapy
and radiotherapy treatments. Understanding the mechanisms underlying their behaviour may lead to the development of new and
effective therapies for pancreatic cancer.27
Endocrine pancreatic cancers, also known as islet cell carcinomas, neuroendocrine carcinomas and carcinoid tumours, are rare
and make up less than 3 per cent of all pancreatic cancers.28-29 Endocrine pancreatic cancers can be functional, that is they produce
pancreatic hormones, or they are non-functional. The most common functional endocrine pancreatic cancers are insulinomas,
which are insulin producing tumours of beta cells. Most (85–90%) insulinomas are benign.29 Other pancreatic endocrine cancers
include glucagonomas, somatostatinomas and gastrinomas which produce glucagon, somatostatin and gastrin respectively. Around
40 per cent of endocrine pancreatic tumours are non-functional.30 Non-functional tumours have a high malignancy rate (90%).31
Patients with endocrine pancreatic cancers generally have better survival than patients with exocrine cancers with an overall fi ve-
year survival of around 40–60 per cent.20,32
Most pancreatic cancers are located in the head of the pancreas.19-20 Tumours occurring in the head of the pancreas are more likely
to obstruct the common bile duct and cause jaundice, which can lead to earlier detection.33 Tumours in the head of the pancreas
have a better one-year survival compared to tumours in the body and tail of the pancreas, although the survival advantage is not
present fi ve years after diagnosis.20
12
Pancreatic Cancer in New South Wales
2.3 Symptoms
Pancreatic cancer usually presents clinical symptoms late in the course of the disease when the tumour is already advanced or has
spread beyond the pancreas. The main symptoms of pancreatic cancer are upper abdominal and back pain, jaundice, unexplained
weight loss, nausea, vomiting, steatorrhoea and malaise.6,33 Back pain is often severe and is generally an indication that the cancer
has invaded the retroperitoneum.6 Jaundice may be caused by the tumour obstructing the bile duct but may also indicate that the
cancer has metastatised to the liver.6 The duration of symptoms prior to diagnosis is generally around two–four months but ranges
from 0–36 months.33-35
The onset of diabetes often precedes a diagnosis of pancreatic cancer and is likely to be caused by the cancer. Approximately 40
per cent of pancreatic cancer patients have diabetes with more than half of these being diagnosed with diabetes in the two years
preceding the pancreatic cancer diagnosis.35 Pancreatic cancer can also cause an attack of acute pancreatitis.6,36
Functional endocrine pancreatic cancers can cause symptoms associated with the abnormally high levels of hormones. High levels
of insulin caused by insulinomas can cause hypoglycaemia and its associated problems including hunger, sweating, palpitations,
irritability and confusion.37 High glucagon levels caused by glucagonomas can cause diabetes, dermatitis, weight loss and anaemia.
The other types of functional endocrine cancers can also cause problems associated with the excessive secretion of its
particular hormone.
2.4 Diagnosis and staging
After the presentation of clinical symptoms suggesting pancreatic cancer, various imagining techniques may be used to identify
pancreatic tumours, to determine the extent of the tumour and to detect the presence of metastases. Computerised tomography
(CT) and magnetic resonance imaging (MRI) provide information on tumour extent, organ and vascular involvement, lymph node
metastases and hepatic metastases. CT and MRI can predict suitability for resection for large tumours but are less sensitive for
small tumours.6 CT is the primary method for evaluating resectability.38 Endoscopic ultrasound (EUS) is sensitive in detecting small
tumours and in determining the tumour spread. Laparoscopy may also be used to determine the extent of the tumour and the
presence of metastases. In some cases, endoscopic retrograde cholangiography (ERCP) may be used to visualise the ducts. The
information on the size, invasion of surrounding structures and the presence of metastases is used in staging the disease and in
determining if the patient is a candidate for surgical resection.
Tumour tissue samples can be taken at the time of diagnostic EUS, ERCP or laparoscopy, using fi ne needle aspiration or brush
cytology of the ducts. Biopsies may also be taken percutaneously under the guidance of CT or ultrasound, although this is not
generally recommended for patients with potentially resectable tumours.6,39 In patients with unresectable disease, tissue biopsies
can determine if the patient has a tumour type that has a better prognosis than ductal adenocarcinoma.6
There are no tumour-specifi c blood tests for pancreatic cancers,6 although biochemical tumour markers, in particular cancer
antigen 19-9 (Ca19-9), can be used in symptomatic patients to assist in distinguishing between benign and malignant tumours and
in determining suitability for tumour resection.40-41 However, due to the limited sensitivity and specifi city of Ca19-9 it must be used
alongside other diagnostic techniques in the diagnosis of pancreatic cancer.40,42
The American Joint Committee on Cancer (AJCC) has developed a classifi cation system for the staging of exocrine pancreatic
cancer.43 The TNM staging system describes the extent of the primary tumour (T), the extent of spread to lymph nodes (N) and
the presence of metastasis (M). The staging system is used to assess the resectability of pancreatic cancers, to provide information
on prognosis and to assign patients to clinical trials.
13
The T, N and M categories for exocrine pancreatic cancer are:
T0: No evidence of primary tumour
TX: Primary tumour cannot be assessed
Tis: Carcinoma in situ
T1: Tumour limited to the pancreas, greatest dimension 2cm or less
T2: Tumour limited to the pancreas, greatest dimension more than 2cm
T3: Tumour extends beyond pancreas but no involvement of the celiac axis or superior mesenteric artery
T4: Tumour extends beyond the pancreas and involves the celiac axis or superior mesenteric artery (unresectable primary tumour)
N0: No regional lymph node metastasis
N1: Regional lymph node metastasis
NX: Regional nodes cannot be assessed
M0: No distant metastasis
M1: Distant metastasis
MX: Distant metastasis cannot be assessed
The T, N and M categories are used to assign the following stages for exocrine pancreatic cancer (Table 1).
Table 1Staging for exocrine pancreatic cancer43
Stage Description Primary tumour Lymph nodes Distant metastases 5-year survival (%)*
Stage 0 Localised within the pancreas Tis N0 M0 –
Stage I A Localised within the pancreas T1 N0 M0 14
Stage I B Localised within the pancreas T2 N0 M0 12
Stage II A Locally invasive (resectable) T3 N0 M0 7
Stage II B Locally invasive (resectable) T1-3 N1 M0 5
Stage III Locally advanced (unresectable) T4 Any N M0 3
Stage IV Distant metastases Any T Any N M1 <1
*Survival is for resected and un-resected patients from Bilimoria et al. 2007.3
Borderline resectable pancreatic cancer is also a recognised stage in a clinical setting.26,44 Pancreatic cancer patients generally have
advanced disease at diagnosis. For patients on the National Cancer Database of the United States, the stage at diagnosis was 55 per
cent at stage IV, 13 per cent at stage III, 22 per cent at stage II and 10 per cent at Stage I.3
The European Neuroendocrine Tumour Society (ENETS) has proposed a similar TNM staging system for endocrine pancreatic
cancers that also incorporates the World Health Organization’s histological grading system.45 This staging system has yet to be
widely accepted and validated.32
14
Pancreatic Cancer in New South Wales
2.5 Management of pancreatic cancer
Surgery is currently the only potential cure for pancreatic cancer.46 For patients with stage I pancreatic ductal adenocarcinoma, the
fi ve-year survival for resected patients is 25–30 per cent compared to <5 per cent for unresected patients.3,47 Pancreatic resection
also improves the survival of patients with endocrine pancreatic cancers. Median survival time for endocrine pancreatic cancer
increases from 21 to 97 months for patients who undergo resection.48 Generally less than 20 per cent of pancreatic cancer patients
undergo pancreatic resection. This is mainly due to the late presentation of the disease but may also be due to the advanced
age of most people diagnosed with pancreatic cancer and due to comorbidities.3,6,47 There is also overseas evidence that surgical
resection is under used in patients that could potentially benefi t.47 Historically, pancreatic resection had high perioperative mortality
and morbidity.46 However, specialist centres with a high volume of pancreatic resection cases can have low surgical mortality and
morbidity.49-51 Under use of pancreatic resection may refl ect a ‘nihilistic’ attitude towards pancreatic cancer.26,47
A commonly used surgical resection method is the pancreaticoduodenectomy, also known as the Whipple procedure. In this
procedure the head of the pancreas, the duodenum, part of the jejunum, the gall bladder and the distal half and the pylorus of
the stomach are removed. An alternative procedure is the pylorus-preserving pancreaticoduodenectomy in which no part of the
stomach is removed. The results from randomised clinical trials of these two surgical methods have not demonstrated a clear
advantage for one method compared to another.52 A less frequently performed surgery is the total pancreaticoduodenectomy,
which is similar to the pancreaticoduodenectomy but the whole pancreas and the spleen are also removed. Total
pancreaticoduodenectomy does not improve survival compared to the other procedures and can have serious nutritional and
metabolic complications.6,53
Survival for resectable pancreatic cancer can be improved with adjuvant chemotherapy or chemoradiotherapy. There is currently
no widely accepted standard adjuvant therapy as clinical trials have generally been small and the results mixed.4,6,38 Additional large
and high quality clinical trials are needed to determine the optimal adjuvant therapy. Neoadjuvant therapy for pancreatic cancer
is commonly used but has insuffi cient high level evidence and is therefore at an investigational stage.6,38 It is recommended that
adjuvant and neoadjuvant therapy be given as part of a clinical trial.6,38
The treatment of non-resectable and metastatic pancreatic cancer aims to relieve symptoms and prolong survival. Systemic therapy
may offer a modest improvement in survival. Gemcitabine has been accepted as the standard front-line therapy for patients with
metastatic disease.6,38 Obstructive jaundice is a common symptom in advanced pancreatic cancer that may be improved by stenting
or bypass surgery.4,6 Jaundice may be a major obstacle to the delivery of effective palliative chemotherapy. Advanced pancreatic
cancer is often associated with intense pain. A celiac nerve block can be performed to relieve pain if systemic analgesics are
inadequate. Patients may also experience malabsorption of nutrients due to insuffi cient pancreatic enzymes. These symptoms can
be relieved by the administration of pancreatic enzyme supplements. The poor survival outcomes provide an incentive to re-
double research efforts into better therapies for this cancer.
15
3 Epidemiology of pancreatic cancer
3.1 Age
The risk of pancreatic cancer increases with ageing. The risk of a 40 year old developing pancreatic cancer before turning 50 is one
in 2500. The risk of an 80 year old developing cancer before turning 90 is nearly 16 times higher at one in 161.10 Pancreatic cancer is
uncommon in people aged under 50 years with less than 10 per cent of cases diagnosed in people aged under 50 years.9
3.2 Gender
Males have an approximately 30 per cent higher incidence rate of pancreatic cancer after adjusting for differences in age.1,10 The
lifetime (0–74 years) risk of being diagnosed with pancreatic cancer in Australia is one in 125 for males and one in 184 for females.1
The higher rate of pancreatic cancer in males is most likely due to the higher proportion of smokers and ex-smokers in males.
There is no strong evidence that hormonal and reproductive factors infl uence the risk of pancreatic cancer in females.54-56
3.3 Lifestyle – smoking, alcohol, weight and diet
Apart from age, smoking is the strongest risk factor for pancreatic cancer. Smoking increases the risk of pancreatic cancer by
around 74 per cent.8 Ex-smokers have an increased risk of pancreatic cancer for at least 10 years after stopping.8 Approximately
20–25 per cent of pancreatic cancers are attributable to cigarette smoking.1,8
Alcohol consumption has been found to have an inconsistent effect on the risk of pancreatic cancer. Some studies have not
found an association between alcohol consumption and risk of pancreatic cancer.57-58 Other studies have found that heavy alcohol
consumption causes a modest increase in the risk of pancreatic cancer.12,59-60 However, since smoking rates are generally higher
amongst people with high alcohol consumption, smoking can be a confounding effect in studies examining the effect of alcohol on
the risk of pancreatic cancer. Also, heavy consumption of alcohol increases the risk of chronic pancreatitis and diabetes which are
also linked to an increased risk of pancreatic cancer (see 3.4).61-62
There is evidence that excess body mass increases the risk of pancreatic cancer. Studies have found around a 20–70 per cent
increased risk of pancreatic cancer for obese people (Body Mass Index >30).63-66 Some studies have not found an effect
of obesity.67-69
The evidence for the effect of diet on pancreatic cancer risk is mixed. High consumption of red meat has been shown to increase
risk in some studies, particularly for men, 70–71 but not in another.72 High vegetable, fruit and whole grain consumption has been
found to be protective in some studies21,73 but not others.72,74 There is evidence that dietary folate reduces the risk of pancreatic
cancer.75-76
The World Cancer Research Fund and the American Institute for Cancer Research have recently evaluated the evidence for the
effect of diet, body mass and physical activity on the risk of pancreatic cancer.77 They consider that there is convincing evidence
that higher body fatness increases the risk of pancreatic cancer and that there is limited but suggestive evidence that red meat is
associated with increased pancreatic cancer risk. They also conclude that there is probable evidence that foods containing folate
decrease the risk of pancreatic cancer and that there is limited but suggestive evidence that fruits and physical activity decrease the
risk. The limited availability of evidence meant that they did not make a conclusion on the effect of other dietary components such
as vegetables, cereals and alcohol on the risk of pancreatic cancer.77 They suggested that low to moderate alcohol consumption was
unlikely to affect risk, but they could not exclude heavy alcohol consumption as a risk factor for pancreatic cancer.
16
Pancreatic Cancer in New South Wales
3.4 Pancreatic diseases
Diagnosis with acute, recurrent or chronic pancreatitis is a risk factor for pancreatic cancer. The risk of being diagnosed with
pancreatic cancer is highest in the one–four years after the diagnosis of pancreatitis but diminishes over time.12,78-79 Diagnosis
with chronic pancreatitis has a greater risk of pancreatic cancer than acute pancreatitis. Patients diagnosed with acute or chronic
pancreatitis are around two and 22 times respectively more likely to develop pancreatic cancer in the one–four years after
diagnosis of pancreatitis.79 In general, patients with chronic pancreatitis are more likely to be heavy smokers and heavy drinkers
which may account for the increased risk.12,79 However, 10–24 years after pancreatitis diagnosis there is no statistically signifi cant
increased risk of pancreatic cancer.79 The incidence of acute pancreatitis in Western countries is between 10–40 cases per 100,000
people per year.80 The annual incidence of chronic pancreatitis is estimated to be around six cases per 100,000 people in
European countries.36
Diagnosis with diabetes is also a risk factor for pancreatic cancer. Diabetes diagnosis is usually in the two years preceding pancreatic
cancer diagnosis.12,35,81 In most pancreatic cancer patients with new-onset diabetes, the diabetes is likely to be caused by the
tumour. The risk of being diagnosed with pancreatic cancer is four times higher in the year following diabetes diagnosis.12 The risk
of pancreatic cancer diagnosis declines in the years following diabetes diagnosis. However, 10 years after a diagnosis of diabetes
the risk of pancreatic cancer remains elevated which suggests that diabetes is an independent risk factor for pancreatic cancer.12,82
Approximately 700,000 Australians, 3.6 per cent of the population, were estimated to have diabetes in 2004–05 which is more
than double the proportion in 1989–90.83
3.5 Genetics and family history
There are a number of recognised hereditary syndromes or diseases that are associated with pancreatic cancer (ductal
adenocarcinomas). They are responsible for around 5–10 per cent of all pancreatic cancers.11-12 They include:11, 84
• Peutz-Jeghers syndrome
• Familial atypical multiple mole melanoma (FAMMM)
• Cystic fi brosis
• Hereditary pancreatitis
• Hereditary non-polyposis colorectal cancer
• Familial breast cancer (BRCA1 and BRCA2 genes)
• Familial adenomatous polyposis
• Ataxia telangiectasia
• Li-Fraumeni syndrome
Familial pancreatic cancer (FPC) is also recognised as a distinct hereditary syndrome but the genetic defect responsible has not
been identifi ed.11 People with FAMMM, Peutz-Jeghers syndrome, hereditary pancreatitis and FPC have a risk of pancreatic cancer
more than 10 times higher than the general population.84
People with multiple endocrine neoplasia type 1 (MEN1) and von Hippel-Lindau syndrome are at increased risk of endocrine
pancreatic cancers.85-87
For people with a family history of pancreatic cancer, smoking further increases the risk of pancreatic cancer.12,88-89
17
4 Methods
4.1 Cases
Cases were selected from the New South Wales Central Cancer Registry (NSW CCR) based on the International Classifi cation
of Diseases for Oncology, 3rd edition (ICD-O-3) topography code for tumours of the pancreas C25 (See Appendix). Notifi cation
of invasive cancer cases to the NSW CCR by public and private hospitals, pathology laboratories, radiation oncology departments,
outpatient departments, day procedure centres and nursing homes has been a statutory requirement in New South Wales since
1972. Data in this report were extracted from the NSW CCR as of September 2008 and contain cases diagnosed to the end of
2006. Some changes may occur in the data between extraction dates from the NSW CCR due to changes in coding, addition of
further information or delayed registration of cases.
4.1.1 Cancer Incidence
Cancer incidence refers to new cases diagnosed in a given population during a specifi ed period. The incidence data in this report
are based on cancer cases diagnosed from 1972 to 2006 in New South Wales residents.
4.1.2 Cancer Mortality
Cancer mortality refers to deaths from cancer in a given population occurring in a specifi ed period. These cancers may have
been diagnosed during or before the period. The mortality data in this report are based on persons who were diagnosed with
pancreatic cancer while residing in New South Wales and died of that cancer between 1972 and 2006. Cases that died from
pancreatic cancer after migrating to other Australian states and territories are included in this report. Cases that died overseas are
lost to follow-up.
4.1.3 Degree of spread
Degree of spread was based on the spread at fi rst presentation and indicates the maximum extent of the cancer within four
months of the date of diagnosis. It is derived by the NSW CCR from the maximum extent of disease from all reports and
notifi cations dated within four months of the date of diagnosis. Degree of spread reported here follows the international
coding guidelines for summary stage adopted by several international groups including the World Health Organization and
the International Association of Cancer Registries.90 Extent is classifi ed as local, regional, distant and unknown. Local cases are
predominantly Stage I and some Stage II, regional are predominantly Stage II and some Stage III and distant are some Stage III but
predominantly Stage IV (See 2.4).
4.1.4 Area Health Service and accessibility and remoteness
Cases were allocated to the 2006 Australian Standard Geographical Classifi cation (ASGC) Statistical Local Areas (SLAs)91 and the
2005 Area Health Services (AHS) based on residential address at the time of diagnosis. Individuals may not necessarily be treated
in the AHS to which they are allocated.
This report uses the Accessibility/Remoteness Index for Australia (ARIA+) which is endorsed by the Australian Bureau of Statistics
(ABS) as a standard measure of remoteness.92 The ARIA+ values were assigned to the case and death data using a population
weighted concordance for the SLAs produced by the ABS based on the 2006 census. Cases and deaths were categorised as being
from ‘Major Cities’, ‘Inner Regional’, ‘Outer Regional’, ‘Remote’ and ‘Very Remote’ areas using the standard ARIA+ cut-off values
used by the ABS (see Glossary). The ‘Remote’ and ‘Very Remote’ areas were combined due to the small number of cases and
deaths in these areas. Analyses in this report use case and death data from the period 2002–2006.
18
Pancreatic Cancer in New South Wales
4.1.5 Socioeconomic status
Socioeconomic status was estimated using the Index of Relative Socio-Economic Disadvantage (IRSD), one of four Socio-Economic
Indexes for Areas (SEIFA) created by the ABS (see Glossary).93 The IRSD index for each SLA was assigned to each case and death
using the census undertaken closest to the time of diagnosis or death. The IRSD index for each SLA is categorised into population-
weighted quintiles. Analyses in this report use case and death data from the period 2002-2006.
4.1.6 Country of birth
Country of birth was aggregated into the main English speaking countries (New Zealand, the United Kingdom, the Republic of
Ireland, the United States of America, Canada and South Africa), non-English speaking countries and Australia. Region of birth was
also analysed by grouping countries using the Standard Australian Classifi cation of Countries (SACC).94 While country of birth is
routinely collected in the NSW CCR, under ascertainment of migrant status is possible, particularly for notifi cations by pathology
laboratories. Analyses in this report use case and death data from the period 2002-2006. During this period, 2.4 per cent of cases
(n=90) and 1.6 per cent of deaths (n=52) had an unknown country of birth.
4.2 Population estimates
Estimated residential populations for New South Wales, Area Health Services, Statistical Local Areas, as well as on the basis
of accessibility and remoteness (ARIA+), socioeconomic status (IRSD) and country of birth were obtained from the ABS via
the Health Outcomes and Information Statistical Toolkit (HOIST) maintained by the NSW Department of Health. Population
estimates used 2006 census data and were mid-year population estimates.
4.3 Age-standardised rates
Directly age-standardised rates were calculated using fi ve-year age groups and standardised using the Australian 2001 Standard
Population produced by the ABS. Rates were also standardised to the World Health Organization (WHO) 2000 World Standard
Population for comparison with global rates of pancreatic cancer (see 7.4). Age-standardisation eliminates the effect that a changing
population age structure has on rates. Where rates are calculated for fi ve-year periods (e.g. 2002–2006), the reported rate is the
rate per 100,000 person-years at risk. Trends over time in the age-standardised incidence and mortality rates of pancreatic cancer
were analysed using a joinpoint model in the Joinpoint Regression Program version 3.3.95-96
4.4 Survival
The fi ve-year relative survival of pancreatic cancer patients was estimated using the multiple-year cohort method.97-98 Cases
that had not been matched to a death record in the National Death Index (maintained by the Australian Institute of Health and
Welfare) were censored at the end of 2004. Cases that had been notifi ed by death certifi cate only were excluded from analysis.
Estimates of the population survival rates were from the New South Wales Life Tables for 2002–2004 produced by the ABS.99
Five-year relative survival by gender, age at diagnosis, stage at diagnosis and histology was estimated using cases diagnosed between
1999 and 2003 with follow-up to the end of 2004. Changes in relative survival over time were calculated using cases diagnosed
between 1980 and 2003.98
4.5 Prevalence and projections
The 25-year limited duration prevalence was defi ned as the number of people alive at 31 December 2004 who had been
diagnosed with pancreatic cancer between 1980 and 2004. The age-standardised fi ve-year prevalence estimates used cases
19
diagnosed in the 5 years prior to 31 December 2004 and is standardised to the Australian 2001 Standard Population. The
prevalence estimates in this report are taken from Tracey et al. 2007.100 Prevalence estimates include persons that migrated out of
New South Wales after diagnosis.
The projected number of pancreatic cancer cases and deaths for 2007–2012 were estimated using Nordpred, which is an age-
period-cohort model for the prediction of cancer incidence and mortality.101 This method assumes that historical trends in
incidence and mortality will continue in the future.
4.6 Data interpretation
Although all care was taken in the calculations for this report, the numbers of cases are subject to change due to revisions made
by the NSW CCR. This is due to routine data cleaning and quality assurance, as well as adjustments with the availability of new
information. As a result, fi gures in this report may differ slightly to those in other reports. Estimated populations are updated, which
means that rates may differ slightly from values in other reports.
20
Pancreatic Cancer in New South Wales
5 Incidence and Mortality
5.1 Number of cases and deaths from pancreatic cancer
The total number of pancreatic cancer cases from 1972 to 2006 was 17,975 (Table 2). There were 9,336 cases in males and 8,639
cases in females (Tables 3 and 4). The annual number of cases of pancreatic cancer has approximately doubled for males and nearly
tripled for females between 1972 and 2006 (Figure 2).
In 2006, there were 762 cases of pancreatic cancer diagnosed in New South Wales residents. Of these, 49.7 per cent of cases were
male and 50.3 per cent of cases were female. Pancreatic cancer represented 2.2 per cent of all new cancers diagnosed and the 10th
most common cancer overall in New South Wales in 2006.102 In males, pancreatic cancer was 1.9 per cent of all cancers diagnosed
and the 11th most common cancer. In females, pancreatic cancer was 2.5 per cent of all cancers diagnosed and the 10th most
common cancer.
The total number of pancreatic cancer deaths from 1972 to 2006 was 16,321 (Table 5). There were 8,435 male deaths and 7,886
female deaths (Tables 6 and 7). The annual number of deaths from pancreatic cancer has approximately doubled for males and
nearly tripled for females between 1972 and 2006 (Figure 3).
In 2006, there were 706 deaths from pancreatic cancer in people that were diagnosed while residing in New South Wales. Of
these, 48.9 per cent of deaths were male and 51.1 per cent of deaths were female. Deaths from pancreatic cancer were 5.4 per
cent of all cancer deaths and the sixth most common cause of cancer mortality in New South Wales in 2006. In males, pancreatic
cancer was 4.7 per cent of all cancer deaths and the fi fth most common cause of cancer mortality. In females, pancreatic cancer
was 6.2 per cent of all cancer deaths and the fi fth most common cause of cancer mortality.
0
100
200
300
400
500
600
700
800
900
FemalesMalesPersons
20052000199519901985198019751970
Num
ber
of n
ew c
ases
Year
Figure 2New cases of pancreatic cancer, NSW, 1972–2006
Figure 3Number of deaths from pancreatic cancer, NSW, 1972–2006
0
100
200
300
400
500
600
700
800
FemalesMalesPersons
20052000199519901985198019751970
Year
Num
ber
of d
eath
s
21
5.2 Crude incidence and mortality rates of pancreatic cancer
The crude incidence rate of pancreatic cancer has steadily increased since 1972 for both males and females, with a greater increase
in the female rate (Figure 4, Tables 8–10). The female crude incidence rate was approximately 25 per cent lower than the male rate
in the early 1970s, but since the 1990s the male and female rates have followed a similar pattern. In 2006, the crude incidence rate
of pancreatic cancer was 11.2 new cases per 100,000 persons, which is an increase of at least 50 per cent since the early 1970s.
Changes in the crude incidence rates refl ect changes in population characteristics such as the ageing of the New South Wales
population as well as changes in exposure to pancreatic cancer risk factors such as smoking.
The crude mortality rates from pancreatic cancer follow a similar pattern to the crude incidence rates of pancreatic cancer due to
the poor survival from this cancer (Figure 5, Tables 11–13). There has been a greater increase in the female crude mortality rate
compared to the male rate between 1972 and 2006. In 2006, there were 10.4 deaths per 100,000 people.
Figure 4Crude incidence rate of pancreatic cancer, NSW, 1972–2006
Figure 5Crude mortality rate of pancreatic cancer, NSW, 1972–2006
0
2
4
6
8
10
12
14
FemalesMalesPersons
20052000199519901985198019751970
Year
Inci
denc
e ra
te (
per
100,
000)
0
2
4
6
8
10
12
FemalesMalesPersons
20052000199519901985198019751970
Years
Mor
talit
y ra
te (
per
100,
000)
5.3 Age-standardised incidence and mortality rates of pancreatic cancer
The age-standardised incidence rate of pancreatic cancer in males decreased signifi cantly (p<0.001) by 0.7 per cent (95% CI 0.4–
1.0) per year between 1972 and around 2000. Since 2000, the incidence rate in males has increased signifi cantly (p<0.05) by 1.8
per cent per year (95% CI 0.01–3.5) (Figure 6, Table 9). For females, the age-standardised incidence rate has increased signifi cantly
(p<0.001) since 1972 by 0.7 per cent per year (95% CI 0.4–1.0) (Figure 7, Table 10). Overall, the age-standardised incidence rate in
persons increased between 1972 and 2006 but this increase is not statistically signifi cant (p=0.1) (Figure 8, Table 8).
Between 2002 and 2006, there was a signifi cant increase in the male and female age-standardised pancreatic cancer incidence rate.
For this period, the average annual percentage change (AAPC) was 1.8 per cent (95% 0.1–3.5) for males and 0.7 per cent (95% CI
0.4–1.0) for females. In 2006, the age-standardised incidence rate (per 100,000) of pancreatic cancer was 11.4 (95% CI 10.3–12.6)
for males and 9.2 (95% CI 8.3–10.2) for females. The age-standardised incidence rate for persons was 10.2 (95% CI 9.5–11.0) cases
per 100,000.
After adjusting for differences in age, males are more likely to be diagnosed with pancreatic cancer. Between 2002 and 2006, the
incidence rate of pancreatic cancer was 20–35 per cent higher in males compared to females.
22
Pancreatic Cancer in New South Wales
The trends in age-standardised pancreatic cancer incidence are
likely to refl ect the changes in tobacco smoking in New South
Wales. Although without data on smoking status for pancreatic
cancer cases this is not certain. The trends in pancreatic cancer
follow a similar pattern to the trends observed in lung cancer
incidence rates. The age-standardised incidence rate of lung
cancer has decreased in males and increased in females over
the last 35 years.102 In New South Wales, smoking rates in males
have been decreasing since the mid 1940s, whereas smoking
rates in females were increasing until the mid 1970s and have
since been decreasing.103 Due to the lag between tobacco
exposure and cancer incidence, the effect of the decreased
risk of cancer due to decreased smoking prevalence in the
female population is not yet apparent in cancers that are in part
attributable to cigarette smoking. The reason for the increase
in pancreatic cancer in males since 2000 is unknown, but may
be related to changes in other risk factors for pancreatic cancer
(see section 3). As the prevalence of smoking continues to
decline, the effect of other risk factors on the epidemiology of pancreatic cancer in New South Wales will become
increasingly important.
The age-standardised mortality rate of pancreatic cancer in males decreased signifi cantly (p<0.001) between 1972 to around 2001
by 1.1 per cent per year (95% CI 0.7–1.4). Since 2001, the rate has increased by 2.1 per cent per year (95% CI -1.0–5.3) although
this increase is not statistically signifi cant (p=0.2) (Figure 6, Table 12). For females, the age-standardised mortality rate of pancreatic
cancer increased signifi cantly (p<0.05) by 0.4 per cent per year (95% CI 0.03–0.7) since 1972 (Figure 7, Table 13). Overall, the age-
standardised mortality rate in persons decreased signifi cantly (p<0.01) by 0.4 per cent per year (95% CI 0.1–0.7) between 1972
Figure 6Age-standardised incidence and mortality rates of pancreatic cancer, males,
NSW, 1972–2006
Figure 7Age-standardised incidence and mortality rates of pancreatic cancer, females,
NSW, 1972–2006
0
2
4
6
8
10
12
14
16
MortalityIncidence
20052000199519901985198019751970
Year
Rat
e (p
er 1
00,0
00 p
opul
atio
n)
0
2
4
6
8
10
12
MortalityIncidence
20052000199519901985198019751970
Year
Rat
e (p
er 1
00,0
00 p
opul
atio
n)
Figure 8Age-standardised incidence and mortality rates of pancreatic cancer, persons,
NSW, 1972–2006
0
2
4
6
8
10
12
MortalityIncidence
20052000199519901985198019751970
Year
Rat
e (p
er 1
00,0
00 p
opul
atio
n)
23
and around 2003 (Figure 8, Table 11). There was a large (4.7%) increase in the mortality rate in persons between 2003 and 2006
although this increase is not statistically signifi cant (p=0.2).
Between 2002 and 2006, the AAPC in the age-standardised mortality rates of pancreatic cancer was 2.1 per cent (95% CI
-0.9–5.1) in males, 0.4 per cent (95% CI 0.04–0.7) in females and 3.4 per cent (95% CI -1.3–8.3) in persons. In 2006, the age-
standardised mortality rate (per 100,000) of pancreatic cancer was 10.5 (95% CI 9.4–11.6) for males and 8.6 (95% CI 7.8–9.6) for
females. The age-standardised mortality rate for persons was 9.4 (95% CI 8.8–10.2) deaths per 100,000.
After adjusting for differences in age, males are more likely to die from pancreatic cancer. Between 2002 and 2006, the mortality
rate of pancreatic cancer was 15–40 per cent higher in males compared to females.
The similarity between the incidence and mortality rates is an indication of the poor survival of pancreatic cancer. However, the
mortality to incidence ratio has decreased since 1972, which suggests that survival has improved slightly over the past 30 years.
5.4 Age-specifi c incidence and mortality rates of pancreatic cancer
5.4.1 Age-specifi c incidence and mortality rates, 2002–2006
Pancreatic cancer is uncommon in people under 50 years old. For males, 5.7 per cent of cases were in men under 50 years and
38.5 per cent in men over 75 years. For females, 4.4 per cent of cases were in women under 50 years and 54.0 per cent were in
women over 75 years. There are approximately double the number of females 85 years or older that are diagnosed with pancreatic
cancer compared to males (Figure 9). However, males have a higher incidence rate than females due to the larger population of
older females.
The risk of pancreatic cancer increases with age (Figure 10). The age-specifi c incidence rate for the 80–84 year age group
compared to the 50–54 year age group is 9.8 and 15.0 times higher for males and females respectively. The lifetime risk (0–74
years) of being diagnosed with pancreatic cancer is one in 123 for males and one in 169 for females based on the age-specifi c rates
for the 2002–2006 period. The lifetime risk (0–84 years) of
being diagnosed with pancreatic cancer is one in 63 for males
and one in 77 for females. The age-specifi c mortality rates
follow a similar pattern to the incidence rates (Figure 11).
Between 2002 and 2006, the age-specifi c mortality rate for the
80–84 year age group compared to the 50–54 year age group
was approximately 10.9 and 17.3 times higher for males and
females respectively.
The lifetime risk (0–74 years) of dying from pancreatic cancer
is one in 149 for males and one in 207 for females based on
the age-specifi c rates for the 2002–06 period. The lifetime risk
(0–84 years) of dying from pancreatic cancer is one in 72 for
males and one in 87 for females.
0
50
100
150
200
250
300
350
400
FemalesMales
85+
80
-84
75-7
9
70
-74
65-6
9
60
-64
55-5
9
50
-54
45-4
9
40
-44
35-3
9
30
-34
25-2
9
20
-24
15-1
9
10-1
4
5-9
0-4
Age group (years)
Num
ber
of c
ases
Figure 9Number of new cases of pancreatic cancer by age group, males and females,
NSW, 1972–2006
24
Pancreatic Cancer in New South Wales
Figure 10Age-specifi c incidence rates of pancreatic cancer, males and females,
NSW, 2002–2006
Figure 11Age-specifi c mortality rates of pancreatic cancer, males and females,
NSW, 2002–2006
0
20
40
60
80
100
120
140
FemalesMales
85+
80
-84
75-7
9
70
-74
65-6
9
60
-64
55-5
9
50
-54
45-4
9
40
-44
35-3
9
30
-34
25-2
9
20
-24
15-1
9
10-1
4
5-9
0-4
Age group (years)
Inci
denc
e ra
te (
per
100,
000)
0
20
40
60
80
100
120
FemalesMales
85+
80
-84
75-7
9
70
-74
65-6
9
60
-64
55-5
9
50
-54
45-4
9
40
-44
35-3
9
30
-34
25-2
9
20
-24
15-1
9
10-1
4
5-9
0-4
Age group (years)
Mor
talit
y ra
te (
per
100,
000)
5.4.2 Age-specifi c incidence and mortality rates by period
The age-specifi c incidence and mortality rates of pancreatic cancer by fi ve-year age groups and fi ve-year periods are shown in
Figures 12 and 13. The decline in the male age-standardised incidence and mortality rates from 1972 to around 2000 (section 5.3)
appears to be due to a decline in the rates for men aged 50–74 years. The incidence and mortality rates decreased by around
20–30 per cent and 30–40 per cent respectively in males aged 50–74 years between 1972 and 2001. The mortality rate for males
75–79 years old also decreased but incidence has fl uctuated. There is no clear trend for the incidence and mortality rates for males
80 years and older between 1972 and 2006.
The increase in the female age-standardised incidence and mortality rates (section 5.3) appears to be due largely to the increase in
the rates in women aged 75 and older. Between 1972 and 2006, the age-specifi c incidence and mortality rates for females 85 years
and over have increased by around 60 per cent. The incidence and mortality rates for females aged 75–79 years increased by at
least 20 per cent. The incidence rate for 70–74 year old females increased by around 20 per cent but the mortality fl uctuated. The
incidence and mortality rates for females 65–69 years old have increased slightly and for females 50–64 years old have remained
relatively stable between 1972 and 2006.
5.4.3 Age-specifi c pancreatic cancer incidence rates by birth cohort
The age-specifi c incidence rates of pancreatic cancer by fi ve-year age groups and fi ve-year birth cohorts were calculated for males
and females (Figure 14 and 15). For males, the longitudinal incidence rates follow a similar pattern for each cohort. For females,
there is a trend for later cohorts to have a greater risk of pancreatic cancer in older age groups, particularly from 75 years of age
and onwards.
25
Figure 12Trends in age-specifi c incidence (solid line) and mortality (dashed line) rates of
pancreatic cancer by fi ve-year periods, males, NSW
Figure 13Trends in age-specifi c incidence (solid line) and mortality (dashed line) rates of
pancreatic cancer by fi ve-year periods, females, NSW
0
10
20
30
40
50
60
70
80
90
100
2002-
2006
1997-
2001
1992-
1996
1987-
1991
1982-
1986
1977-
1981
1972-
1976
Period
Rat
e (p
er 1
00,0
00)
85+
80–84
75–79
70–74
65–69
60–64
55–59
50–54
0
20
40
60
80
100
120
140
2002-
2006
1997-
2001
1992-
1996
1987-
1991
1982-
1986
1977-
1981
1972-
1976
Period
Rat
e (p
er 1
00,0
00)
85+
80–84
75–79
70–74
65–69
60–64
55–59
50–54
Figure 14Age-specifi c incidence rates of pancreatic cancer by birth cohort, males, NSW
Figure 15Age-specifi c incidence rates of pancreatic cancer by birth cohort, females, NSW
1
10
100
1,000
40–44 45–49 50–54 55–59 60–64 65–69 70–74 75–79 80–84 85+
Inci
denc
e ra
te (
per
100,
000)
Age group
1885 –18891890 –18941895 –18991900 –19041905 –19091910 –19141915 –19191920 –19241925 –19291930 –19341935 –19391940 –19441945 –19491950 –19541955 –19591960 –1964
1
10
100
40–44 45–49 50–54 55–59 60–64 65–69 70–74 75–79 80–84 85+
Inci
denc
e ra
te (
per
100,
000)
Age group
1885 –1889
1890 –1894
1895 –1899
1900 –1904
1905 –1909
1910 –1914
1915 –1919
1920 –1924
1925 –1929
1930 –1934
1935 –1939
1940 –1944
1945 –1949
1950 –1954
1955 –1959
1960 –1964
26
Pancreatic Cancer in New South Wales
5.5 Median age at diagnosis and death
The median age at diagnosis and death for pancreatic cancer has
increased for both males and females between 1972 and 2006
(Figure 16). The median age at death is within two years of the
median age of diagnosis for males and females. The similarity
between median age at diagnosis and death indicates that
survival from pancreatic cancer is very poor.
The median age at diagnosis for males was 66 years in the early
1970s and has increased to 71 years in 2006. The median age
at diagnosis for females was around 70 in the early 1970s and
was 76 in 2006. The increase in the median age of diagnosis and
death refl ects the ageing of the New South Wales population.
The percentage of the population over 70 years old has
doubled between 1972 and 2006.
5.6 Incidence of pancreatic cancer by histology type and tumour location
5.6.1 Histological types of pancreatic cancers
Adenocarcinomas and carcinoma/malignant neoplasms were 42.2 per cent and 48.4 per cent respectively of all pancreatic cancers
diagnosed in New South Wales between 1972 and 2006 (Table 14). There are a large number of pancreatic cancers assigned to
the non-specifi c group of carcinoma/malignant neoplasm as these were mostly diagnosed clinically. Histological examination was not
conducted for 45 per cent of all pancreatic cancer cases. See Appendix for details on histology groups.
Mucinous adenocarcinomas and undifferentiated carcinomas were 2.5 per cent and 3.0 per cent of all cases respectively between
1972 and 2006. Cancers of the endocrine pancreas were 1.6 per cent of all pancreatic cancers diagnosed between 1972 and 2006.
Under ascertainment of the rarer tumour types is likely since not all tumours have histopathology performed and due to non-
specifi c pathology reports particularly prior to electronic notifi cations to the NSW CCR.
Endocrine pancreas and papillary tumours are more common in younger people, with 29 per cent and 23 per cent respectively
occurring in people under 50 years of age. Only 7.1 per cent and 2.4 per cent of adenocarcinomas and carcinoma/malignant
neoplasms respectively were diagnosed in people under 50 years.
The annual age-standardised incidence rate between 2002 and 2006 of adenocarcinomas and carcinoma/malignant neoplasms was
4.6 and 4.9 per 100,000 persons respectively (Table 14). The incidence rates of the rare histological groups of pancreatic cancers
were 0.2 per 100,000 persons or lower.
60
62
64
66
68
70
72
74
76
78
80
Death - males
Diagnosis - males
Death - females
Diagnosis - females
20052000199519901985198019751970
Year
Med
ian
age
(yea
rs)
Figure 16Median age at diagnosis and death for pancreatic cancer cases, males and
females, NSW, 1972–2006
27
0
5
10
15
20
25
30
35
40
45
50
Not
otherwise
specified
Over-
lapping
lesion
Other
specified
parts
Islets of
Langer-
hans
Pacreatic
duct
TailBodyHead
Location of tumour
Perc
enta
ge
5.6.2 Location of tumours in the pancreas
Pancreatic cancers were most commonly located in the head of the pancreas (45%) in cases diagnosed between 2002 and 2006,
although 41 per cent of tumours did not have a specifi ed location (Figure 17). Of pancreatic tumours, 6 per cent and 4 per
cent were in the tail and body respectively. The remaining 4 per cent of tumours were located in the pancreatic ducts, Islets of
Langerhans, other specifi ed parts or were overlapping lesions.
Figure 17Tumour location in the pancreas, NSW, 2002–2006
28
Pancreatic Cancer in New South Wales
6 Trends in degree of spread and survival
6.1 Degree of spread at diagnosis
6.1.1 Trends in degree of spread at diagnosis
Since 1972, most cases of pancreatic cancer have been diagnosed at a distant degree of spread (Figure 18). Between 1993 and 1998
there is an artefact in the reporting of the degree of spread at diagnosis due to the introduction of electronic notifi cations of cancer
cases to the NSW CCR. This affects the percentage of cases classifi ed as local and unknown spread during this period.104 Apart
from the period affected by the artefact, the percentage of cases diagnosed with local degree of spread has remained relatively
stable since 1972. Since 1986, the percentage of cases diagnosed at a regional and unknown degree of spread has remained
relatively stable (apart from the artefact period).
In 2006, 43.7 per cent of cases were diagnosed with distant spread, 13.4 per cent with regional spread, 16.8 per cent with local and
26.1 per cent with unknown spread.
6.1.2 Degree of spread at diagnosis by gender
Between 2002 and 2006, the percentage of pancreatic cancers with local spread at diagnosis was slightly higher in females (19%)
than males (16%) (Figure 19). Males had a higher percentage of pancreatic cancer cases with distant spread (43%) compared
to females (36%). However, females had more cases with an unknown degree of spread (29%) compared to males (24%). The
percentage of pancreatic cancer cases diagnosed at a regional degree of spread was similar for males (16%) and females (15%).
Figure 18Degree of spread of pancreatic cancer at diagnosis, NSW, 1972–2006
0
5
10
15
20
25
30
35
40
45
50
Unknown
Distant
Regional
Local
20052000199519901985198019751970
Year
Perc
enta
ge
0
5
10
15
20
25
30
35
40
45
50
FemalesMales
UnknownDistantRegionalLocal
Degree of spread at diagnosis
Perc
enta
ge
Figure 19Degree of spread at diagnosis, males and females, NSW, 2002–2006
29
6.2 Survival of pancreatic cancer
6.2.1 Relative survival by gender
Survival from pancreatic cancer is very poor. Overall, between 1999 and 2003 around 75 per cent of people did not survive
beyond one year after diagnosis (Figure 20). The fi ve-year survival for this period was 7.2 per cent (95% CI 5.9–8.4). Survival from
pancreatic cancer was not signifi cantly different for males and females. The fi ve-year relative survival for males was 6.4 per cent
(95% CI 4.7–8.2) and for females was 7.9 per cent (95% CI 6.1–9.6).
6.2.2 Relative survival by degree of spread at diagnosis
Five-year relative survival from pancreatic cancer is affected by the degree of spread at diagnosis (Figure 21). Pancreatic cancer
cases diagnosed between 1999 and 2003 with a distant degree of spread had signifi cantly worse survival compared to cases with
local, regional and unknown degree of spread at diagnosis.
The fi ve-year relative survival from pancreatic cancer with distant spread was 2.7 per cent (95% CI 1.5–3.9). There was no
statistically signifi cant difference in survival of cases diagnosed with local, regional or unknown degree of spread. The fi ve-year
relative survival was 11.2 per cent (95% CI 7.7–14.8), 9.6 per cent (95% CI 6.3–13.0) and 9.0 per cent (95% CI 6.2–11.8) for local,
regional and unknown degree of spread at diagnosis respectively.
Years since diagnosis
Rel
ativ
e su
rviv
al (
%)
FemaleMale
0 1 2 3 4 50
10
20
30
40
50
60
70
80
90
100
Figure 20i
Five-year relative survival of pancreatic cancer by gender,
NSW, 1999–2003
Years since diagnosis
Rel
ativ
e su
rviv
al (
%)
UnknownDistant
RegionalLocal
0 1 2 3 4 50
10
20
30
40
50
60
70
80
90
100
Figure 21i
Five-year relative survival of pancreatic cancer by degree of spread at diagnosis,
NSW, 1999–2003
i. Source: Tracey et al. 2007.98
30
Pancreatic Cancer in New South Wales
6.2.3 Relative survival by age at diagnosis
Survival from pancreatic cancer decreases with increasing age (Figure 22), particularly in the fi rst two years after diagnosis. People
diagnosed with pancreatic cancer at 80 years and older have signifi cantly worse one-year relative survival of 13.7 per cent (95% CI
11.2–16.3) compared to all younger age groups. The one-year relative survival for the 15–49, 50–59, 60–69 and 70–79 age groups
is 41.6 (95% CI 33.9–49.3), 36.5 per cent (95% CI 31.5–41.6), 29.4 per cent (95% CI 26.1–32.8) and 22.8 per cent (95% CI 20.3–
25.4) respectively.
People diagnosed with pancreatic cancer in the youngest age group (15–49 years) have a fi ve-year relative survival of 20.3 per cent
(95% CI 13.3–27.3), which is signifi cantly better than all older age groups. The fi ve-year relative survival of the older age groups is
not statistically signifi cantly different to each other. The fi ve-year relative survival of people in the 50–59, 60–69, 70–79 and 80+
age groups is 8.2 per cent (95% CI 4.8–11.7), 6.8 per cent (95% CI 4.4–9.2), 6.2 per cent (95% CI 4.3–8.1) and 5.9 per cent (95% CI
2.9–9.0) respectively.
6.2.4 Relative survival by histology type
The histological type of the pancreatic cancer signifi cantly affects survival (Figure 23). The fi ve-year relative survival from endocrine
tumours was 39.5 per cent (95% CI 25.3–53.6) for cases diagnosed between 1999 and 2003. Exocrine pancreatic cancers had
signifi cantly worse survival than endocrine cancers of the pancreas. Adenocarcinomas had a fi ve-year survival of 4.5 per cent (95%
CI 3.0–6.1). Carcinoma/malignant neoplasms had a fi ve-year survival of 6.1 per cent (95% CI 4.4–7.8).
Cancers with all other histology types had signifi cantly better survival compared to other exocrine pancreatic cancers with a fi ve-
year relative survival of 22.4 per cent (95% CI 15.0–29.7). See Appendix for details on histology groups.
In this analysis (which excludes cases notifi ed at death), 91.1 per cent of cases were adenocarcinomas and carcinoma/malignant
neoplasms. Endocrine tumours were 2.3 per cent of the cases and 6.6 per cent were other histology types.
80+ years70-79 years
60-69 years50-59 years15-49 years
Years since diagnosis
Rel
ativ
e su
rviv
al (
%)
0 1 2 3 4 50
10
20
30
40
50
60
70
80
90
100
Figure 22Five-year relative survival of pancreatic cancer by age at diagnosis,
NSW, 1999–2003
Figure 23Five-year relative survival of pancreatic cancer by histology group,
NSW, 1999–2003
Carcinoma/malignant neoplasmAdenocarcinoma
All other histologyEndocrine tumour
Years since diagnosis
Rel
ativ
e su
rviv
al (
%)
0 1 2 3 4 50
10
20
30
40
50
60
70
80
90
100
31
6.2.5 Relative survival by period of diagnosis
Overall, fi ve-year relative survival of pancreatic cancers by period of diagnosis has not improved signifi cantly between 1980 and
2003 (Figure 24).98 Five-year relative survival was 6.2 per cent (95% CI 4.8–7.6) in the 1980–1983 period and 7.2 per cent (95%
CI 5.9–8.4) in the 1999–2003 period. One-year relative survival from pancreatic cancer has improved slightly. One-year relative
survival was 24.6 per cent (95% CI 23.0–26.1) in the 1999–2003 period, which is statistically signifi cantly greater than 19.3 per cent
(95% CI 17.3–21.4) in the 1980–1983 period.
Figure 24i
Five-year relative survival of pancreatic cancer by period of diagnosis, NSW, 1980–2003
i. Source: Tracey et al. 2007.98
1999-20031994-1998
1989-19931984-19881980-1983
Years since diagnosis
Rel
ativ
e su
rviv
al (
%)
0 1 2 3 4 50
10
20
30
40
50
60
70
80
90
100
32
Pancreatic Cancer in New South Wales
7 Geographic patterns of pancreatic cancer
Here, geographic patterns of pancreatic cancer are measured by the Accessibility/Remoteness Index for Areas (ARIA+) and in
Area Health Services (AHS), states and territories and internationally. It is important to measure the patterns of cancer in different
geographic areas, as there may be disparities in access to services, screening programs and prevention initiatives.
7.1 Incidence and mortality of pancreatic cancer by accessibility and remoteness
After adjusting for differences in age, the
incidence rate of pancreatic cancer in New
South Wales did not vary signifi cantly by
accessibility and remoteness (Figure 25, Table
15). The age-standardised incidence rates of
pancreatic cancer in persons living in major
cities, inner regional, outer regional and
remote/very remote areas were 10.4 (95% CI:
10.0–10.9), 9.8 (95% CI 9.2–10.5), 10.3 (95% CI
9.1–11.5) and 13.2 (95% CI 8.5–19.6) cases per
100,000 respectively. There were less than 30
cases of pancreatic cancer in people residing in
remote and very remote areas of New South
Wales between 2002 and 2006.
After adjusting for differences in age, the mortality rate from pancreatic cancer in New South Wales did not vary signifi cantly by
accessibility and remoteness (Figure 25, Table 16). The age-standardised mortality rates of pancreatic cancer in persons living in
major cities, inner regional, outer regional and remote/very remote areas were 9.0 (95% CI 8.6–9.4), 8.8 (95% CI 8.2–9.5), 8.8 (95%
CI 7.8–10.0) and 11.8 (95% CI 7.4–17.8) deaths per 100,000 respectively.
7.2 Incidence and mortality of pancreatic cancer by Area Health Service
After adjusting for differences in age, incidence rates of pancreatic cancer for males, females and persons did not vary signifi cantly
by Area Health Service (Figure 26, Table 17). For males, the age-standardised incidence rate ranged from 10.1 (95% CI 8.4–12.0)
cases per 100,000 in the Greater Southern AHS to 13.1 (95% CI 11.6–14.6) cases per 100,000 in the Sydney South West AHS. For
females, the age-standardised incidence rate ranged from 7.8 (95% CI 6.6–9.2) cases per 100,000 in the North Coast AHS to 9.9
(95% CI 8.4–11.7 and 8.7–11.3) cases per 100,000 in the Greater Southern and Sydney West AHS respectively.
After adjusting for differences in age, mortality rates from pancreatic cancer did not vary signifi cantly by Area Health Service
(Figure 26, Table 18). The mortality rates follow a similar pattern to the incidence rates. For males, the age-standardised mortality
rate ranged from 9.0 (95% CI 7.4–10.9) deaths per 100,000 in the Greater Southern AHS to 11.1 (95% CI 9.8–12.5) deaths per
100,000 in the Sydney South West AHS. For females, the age-standardised mortality rate ranged from 6.9 (95% CI 5.7–8.2) deaths
per 100,000 in the North Coast AHS to 9.1 (95% CI 7.6–10.8) deaths per 100,000 in the Greater Southern AHS.
0
4
8
12
16
20
MortalityIncidence
Remote and
Very Remote
Outer
Regional
Inner
Regional
Major
Cities
NSW
Rat
e (p
er 1
00,0
00)
Figure 25Age-standardised incidence and mortality rates (± 95% CI) of pancreatic cancer by accessibility and
remoteness (ARIA+ category), NSW, 2002–2006
33
0 2 4 6 8 10 12 14
MortalityIncidence
Greater Western
Greater Southern
North Coast
Hunter & New England
Nothern Sydney & Central Coast
Sydney West
South Eastern Sydney & Illawarra
Sydney South West
NSW
Rate (per 100,000)
Figure 26Age-standardised incidence and mortality rates (± 95% CI) of pancreatic cancer by Area Health Service, NSW, 2002–2006
7.3 Incidence and mortality of pancreatic cancer in Australian states and territories
Between 2001 and 2005, the age-standardised incidence rate of pancreatic cancer was lower in females than males in all states
and territories (Figure 27). In this period, the incidence of pancreatic cancer in New South Wales was similar to the incidence for
Australia. The age-standardised incidence rate in males was 11.4 and 11.2 cases per 100,000 in New South Wales and Australia
respectively. The incidence rate ranged from 8.4 per 100,000 in the ACT to 11.6 per 100,000 in Victoria.
In females, the age-standardised incidence rate was 8.8 cases per 100,000 in New South Wales and Australia. The incidence rate
ranged from 6.1 per 100,000 in the Northern Territory to 9.1 per 100,000 in Victoria and Western Australia.
Between 1997 and 2001, the mortality rates from pancreatic cancer in New South Wales were similar to most other states
and territories in Australia (Figure 28).9 The mortality rate of pancreatic cancer was lower in females than males in all states and
territories except for the Northern Territory. The female mortality rate in the Northern Territory is substantially higher than
both the male and female rates in the other states and territories. However, the average annual number of female deaths from
pancreatic cancer in the Northern Territory between 1997 and 2001 is less than fi ve.9 Therefore this result should be interpreted
with caution.
For males, the age-standardised mortality rate ranged from 9.0 deaths per 100,000 in the Northern Territory to 11.1 deaths per
100,000 in Victoria. For females, the age-standardised mortality rate ranged from 7.7 deaths per 100,000 in South Australia to 15.7
deaths per 100,000 in the Northern Territory.
34
Pancreatic Cancer in New South Wales
Figure 27ii
Age-standardised incidence rates of pancreatic cancer by state and territory, males and females, 2001–2005
0
2
4
6
8
10
12
14
FemalesMales
AustNTACTTasSAWAQldVicNSW
State/Territory
Inci
denc
e ra
te (
per
100,
000)
ii. Source: AIHW 2008.1
iii. Source: AIHW 2004.9
Figure 28iii
Age-standardised mortality rates of pancreatic cancer by state and territory, males and females, 1997–2001
0
2
4
6
8
10
12
14
16
FemalesMales
NTACTTasSAWAQldVicNSW
State/Territory
Mor
talit
y ra
te (
per
100,
000)
7.4 Global incidence and mortality of pancreatic cancer
Between 2002 and 2006, the incidence rate of pancreatic cancer in New South Wales standardised to the WHO 2000 World
Standard Population was 7.8 (95% CI 7.6–8.3) and 6.1 (95% CI 5.8–6.4) cases per 100,000 for males and females respectively. The
incidence of pancreatic cancer in New South Wales was similar to the rates in North America and Europe for males and females
(Figure 29 and 30).
Between 2002 and 2006, the mortality rate of pancreatic cancer in New South Wales standardised to the WHO 2000 World
Standard Population was 6.8 (95% CI 6.4–7.1) and 5.2 (95% CI 5.0–5.5) deaths per 100,000 for males and females respectively.
Worldwide, mortality from pancreatic cancer (Figure 31 and 32) follows a similar pattern to incidence.
35
Figure 29iv
Age-standardised incidence rates of pancreatic cancer, males, worldwide, 2002
iv. Source: Ferlay et al. 2004.106
During this period the incidence rates in New South Wales and Australia were higher than in most developing countries. This may
be due to the under-reporting of cancers in the developing world,105 as well as due to differences in exposure to risk factors for
pancreatic cancer.
Figure 30iv
Age-standardised incidence rates of pancreatic cancer, females, worldwide, 2002
36
Pancreatic Cancer in New South Wales
v. Ferlay et al. 2004.106
Figure 31v
Age-standardised mortality rates of pancreatic cancer, males, worldwide, 2002
Figure 32v
Age-standardised mortality rates of pancreatic cancer, females, worldwide, 2002
37
7.5 National and international survival of pancreatic cancer
The survival of pancreatic cancer is universally poor (Figure 33). The fi ve-year relative survival estimates use different periods of
diagnosis, follow-up times and slightly different analytical methods. This means that comparisons between the values are indicative
only. The results suggest that survival of pancreatic cancer in New South Wales is good relative to other countries and Australia.
However, with less than 10 per cent of people surviving fi ve years after diagnosis of pancreatic cancer throughout the world, there
is a great need to make substantial improvements in the outcomes of this cancer.
Figure 33National and international fi ve-year relative survival (± 95% CI) of pancreatic cancer
0 2 4 6 8 10 12
Denmark
Finland
Netherlands
UK - Northern Ireland
Sweden
UK - Scotland
UK - England
Switzerland
Norway
Australia
Australia - South Australia
Austraila - Victoria
USA - SEER
Poland
Spain
New Zealand
UK - Wales
Germany
Canada
Italy
Australia - Queensland
Japan
Ireland
Austria
Australia - New South Wales
France
Czech Republic
Portugal
Belgium
Relative Survival (%)
Sources: European countries: Sant et al. 2009.107 USA: Ries et al. 2008.10 Canada: Canadian Cancer Society’s Steering Committee 2009.108 Japan: Tsukuma et al. 2006.109 New
Zealand: New Zealand Health Information Service 2006.110 Australia: AIHW and AACR 2008.1 Queensland: Youlden, Bade and Coory 2005.111 Victoria: English et al. 2007.112
South Australia: South Australian Cancer Registry 2007.113
38
Pancreatic Cancer in New South Wales
8 Pancreatic cancer in sub-populations
8.1 Incidence and mortality of pancreatic cancer by socio- economic status
Between 2002 and 2006, the incidence of
pancreatic cancer did not vary signifi cantly by
level of socioeconomic disadvantage (Figure
34). However, there was a trend for people
in the most disadvantaged quintile to have
a higher incidence rate than people in the
least disadvantaged quintile with an age-
standardised incidence rate of 11.3 (95% CI
10.5–12.1) and 9.9 (95% CI 9.2–10.6) cases per
100,000 respectively.
Between 2002 and 2006, the mortality
rate from pancreatic cancer did not vary
signifi cantly by level of socioeconomic
disadvantage (Figure 34). Similar to the
incidence rates, there was a trend for people
in the most disadvantaged quintile to have a
higher mortality rate than people in the least disadvantaged quintile. The age-standardised mortality rate in people from the most
and least disadvantaged quintiles was 9.7 (95% CI 8.9–10.5) and 8.5 (95% CI 7.8–9.2) deaths per 100,000 respectively.
8.2 Incidence and mortality of pancreatic cancer by country of birth
8.2.1 Incidence and mortality by language
Between 2002 and 2006, the age-standardised
incidence of pancreatic cancer in people from
non-English speaking countries of birth was
10.8 cases per 100,000 (95% CI 10.1–11.6)
which is slightly but not signifi cantly (p>0.05)
higher than the incidence rate in people born
in Australia at 9.8 cases per 100,000 (95% CI
9.4–10.2) (Figure 35).
Similar to incidence, people born in non-
English speaking countries had slightly but not
signifi cantly (p>0.05) higher mortality from
pancreatic cancer after adjusting for differences
Figure 34Age-standardised incidence and mortality rates (± 95% CI) of pancreatic cancer by socioeconomic
disadvantage, NSW, 2002–2006
0
2
4
6
8
10
12
14
MortalityIncidence
Most
disadvantaged
quintile
4th
Quintile
3rd
Quintile
2nd
Quintile
Least
disadvantaged
quintile
NSW
Socioeconomic disadvantage
Rat
e (p
er 1
00,0
00)
Figure 35Age-standardised incidence and mortality rates (± 95% CI) of pancreatic cancer by country of
birth, NSW, 2002–2006
0
2
4
6
8
10
12
MortalityIncidence
Non-English speakingEnglish speakingAustraliaAll countries
Main language of country of birth
Rat
e (p
er 1
00,0
00)
39
in age and sex (Figure 35). The age-standardised mortality rate of pancreatic cancer in people from non-English speaking countries
of birth and those born in Australia was 9.2 deaths per 100,000 (95% CI 8.5–9.9) and 8.6 deaths per 100,000 (95% CI 8.3–9.0)
respectively.
8.2.2 Incidence and mortality of pancreatic cancer by region of birth
Between 2002 and 2006, the age-standardised incidence rate of pancreatic cancer was signifi cantly higher amongst people born
in South Eastern and Eastern Europe and the Americas compared to the rate in Australian born people (Figure 36). The age-
standardised incidence rate amongst people born in Australia was 9.8 (95% CI 9.4–10.2) cases per 100,000 and was 12.7 (95% CI
11.2–14.4) and 14.4 (95% CI 10.3–19.4) cases per 100,000 in people born in South Eastern and Eastern Europe and the Americas
respectively. The incidence rates in people born in other regions did not vary signifi cantly from those born in Australia.
The age-standardised mortality rates from pancreatic cancer by region of birth followed a similar pattern to the incidence rates.
Persons born in South Eastern and Eastern Europe had signifi cantly higher mortality compared to people born in Australia (Figure
36). The age-standardised mortality rate for persons born in Australia was 8.6 (95% CI 8.3–9.0) deaths per 100,000 and 11.4 (95%
CI 9.9–13.0) deaths per 100,000 amongst those born in South Eastern and Eastern Europe. Mortality rates for people born in
other regions did not vary signifi cantly from those born in Australia.
The reason for the higher incidence and mortality rates of pancreatic cancer in people from South Eastern and Eastern Europe is
unknown. People from this region do not have a signifi cantly higher rate of lung cancer compared to people born in Australia,114
which suggests that the higher rate of pancreatic cancer is not due to higher smoking rates, which is a risk factor for both pancreas
and lung cancer.
0 5 10 15 20
MortalityIncidence
UK & Ireland
Southern Europe
South Eastern & Easter Europe
North-West Europe
New Zealand & Oceania
Asia
Americas
Africa & the Middle East
Australia
All countries
Rate (per 100,000)
Figure 36Age-standardised incidence and mortality rates (± 95% CI) of pancreatic cancer by region of birth, NSW, 2002–2006
40
Pancreatic Cancer in New South Wales
9 Prevalence and projections
9.1 Prevalence of pancreatic cancer
At the end of 2004, there were 270 males and 274 females living with pancreatic cancer who were diagnosed between 1980 and
2004.100 Of the 25-year prevalence, there were 315 people (158 males, 157 females) living with pancreatic cancer within the fi ve
years prior to December 2004.100 The age-standardised fi ve-year prevalence is fi ve per 100,000 in males and four per 100,000
in females.100
9.2 Projections for pancreatic cancer
The number of cases of pancreatic cancer in
New South Wales is projected to increase in
males and females (Figure 37). The projected
number of cases in 2012 is 513 (95% CI 434–
587) and 447 (95% CI 422–474) in males and
females respectively. Between 2008 and 2012,
the annual number of cases is predicted to
increase by 16 per cent in males and 10 per cent
in females.
If survival from pancreatic cancer remains poor,
the number of deaths from pancreatic cancer
will closely follow the projected number of cases
(Figure 38). The predicted number of deaths in
2012 is 437 (95% CI 364–508) and 390 (95% CI
356–452) for males and females respectively.
As well as population growth, the percentage
of the population over 60 years is predicted
to increase (Figure 39). Since age is the main
risk factor for pancreatic cancer in New South
Wales, the effect of the ageing of the New
South Wales population on the number of cases
and deaths may outweigh any reduction in the
other risk factors for pancreatic cancer, such as
lower smoking rates.
The age-standardised incidence of pancreatic
cancer is projected to increase in males and
remain steady in females (Figure 40). In 2012,
the incidence rate is predicted to be 12.9 (95%
CI 11.0–14.8) and 9.2 (95% CI 8.7–9.9) cases per
100,000 in males and females respectively. The
age-standardised mortality rate of pancreatic
cancer is projected to increase in males and remain steady in females (Figure 40). In 2012, the mortality rate is predicted to be 11.0
(95% CI 9.2–12.7) and 7.2 (95% CI 7.3–9.3) deaths per 100,000 in males and females.
0
100
200
300
400
500
600
700
800
900
1000
FemalesMalesPersons
2013201120092007200520032001199919971995
Year
Num
ber
of n
ew c
ases
Figure 37Actual and projected cases of pancreatic cancer, NSW, 1995–2012
0
100
200
300
400
500
600
700
800
900
1000
FemalesMalesPersons
2013200120092007200520032001199919971995
Year
Num
ber
of d
eath
s
Figure 38Actual and projected deaths from pancreatic cancer, NSW, 1995–2012
41
Figure 39Population pyramid for NSW in 2006 and 2020
0 50000 100000 150000 200000 250000 300000
20062020
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85+
Females
300000 250000 200000 150000 100000 50000 0
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85+
Males
Estimated resident population Estimated resident population
Figure 40Actual and projected age-standardised incidence and mortality rates of pancreatic cancer,
males and females, NSW, 1995–2012
0
2
4
6
8
10
12
14
Female mortalityFemale incidence
Male mortalityMale incidence
2013201120092007200520032001199919971995
Year
Rat
e (p
er 1
00,0
00)
42
Pancreatic Cancer in New South Wales
10 Conclusions
The number of cases of pancreatic cancer in New South
Wales is increasing due to the ageing and growth of the New
South Wales population. After adjusting for changes in the age
structure of the New South Wales population, the incidence of
pancreatic cancer in males decreased from 1972 but appears
to be increasing from 2000 onwards. For females, the age-
standardised incidence rate has been increasing since 1972,
although it may remain steady in the next fi ve years. Smoking is
the most signifi cant modifi able risk factor for pancreatic cancer.
Although there is no direct evidence, the changes in age-
standardised incidence rates of pancreatic cancer are likely to be due in part to changes in historical smoking rates in New South
Wales. The cause of the recent increase in the male age-standardised incidence rate is unknown. There is little variation in the age-
standardised incidence and mortality of pancreatic cancer across New South Wales.
Survival from pancreatic is poor with a fi ve-year relative survival of 7 per cent. Even pancreatic cancers diagnosed at a local degree
of spread have a poor fi ve-year survival of 11 per cent. Therefore, earlier detection of pancreatic cancers at a local spread will have
limited benefi t in improving the overall survival of pancreatic cancer.
The results in this report highlight the need for novel methods of diagnosis and treatment of pancreatic cancer. Methods for
detecting the pre-cursor cells to invasive pancreatic cancer will be invaluable for the early detection and prevention of pancreatic
cancers and the development of screening programmes for high risk persons. As well, the development of systemic therapies that
are effective against pancreatic cancers are much needed.
The results in this report highlight the need for novel methods of diagnosis and treatment of pancreatic cancer.
43
11 Appendix
Table A1 ICD-O-3 coding for tumour topography in the pancreas
Topography code Location
C25.0 Head of the pancreas
C25.1 Body of the pancreas
C25.2 Tail of the pancreas
C25.3 Pancreatic duct (Duct of Santorini, Duct of Wirsung)
C25.4 Islets of Langerhans
C25.7 Other specifi ed parts of the pancreas
C25.8 Overlapping lesion of pancreas
C25.9 Pancreas, not otherwise specifi ed
Table A2Histology groups by ICD-O-3 morphology codes. All are invasive cancers (behaviour = 3).
Histology group 3 or 4 digit ICD-O-3 morphology code
Acinar cell carcinoma 855
Adenocarcinomas 814, 816, 820, 821, 825, 8261, 8262, 831, 843, 849, 856, 857
Carcinoma/malignant neoplasm 800, 801
Cystadenocarcinoma 844, 845, 847
Endocrine tumours 815, 824
Infi ltrating duct carcinoma 850
Mucinous adenocarcinoma 848
Other histology 803, 804, 807, 880, 883, 889, 893, 897, 898, 912
Papillary carcinoma/adenocarcinoma 805, 813, 8260
Undifferentiated carcinoma 802, 823
Note: For the survival analysis by histology type (section 6.2.4) the ‘All other histology’ group refers to all histology groups other than Adenocarcinomas, Carcinoma/
malignant neoplasm and Endocrine tumours.
44
Pancreatic Cancer in New South Wales
12 Glossary
ABS Australian Bureau of Statistics
Accessibility/Remoteness Index of Australia (ARIA)
This report uses the ARIA+ index which has been endorsed by the ABS for remoteness
classifi cation.92 ARIA+ is based on road distance to fi ve categories of ‘service centre’, with the
smallest service centre having between 1000 and 4999 people. It is assumed that there is a
strong relationship between population size and service availability, particularly education and
health services,115 but ARIA+ does not provide specifi c information on accessibility to health
services. An ARIA+ score ranging from 0 (metropolitan) to 15 (very remote) is allocated to
each locality, interpolated to create a 1km grid across all of Australia and then aggregated
to the required geographical unit (SLA in this report). The ARIA+ values are allocated to
one of fi ve categories of remoteness using cut-off points determined by the ABS (see Table
below). The proportion of the population in an SLA in each remoteness category was used
to calculate the proportion of cases and deaths in each remoteness category.
Allocation of ARIA+ values to remoteness category
Category ARIA+ score range
Major City 0 to 0.2
Inner regional >0.2 to 2.4
Outer regional >2.4 to 5.92
Remote >5.92 to 10.53
Very remote >10.53
Source: ABS 2003.92
Age-specifi c rate A rate for a specifi ed age group. The numerator and denominator refer to the same age
group. It is usually expressed per 100,000 people in the population per year.
Age-standardised rate Age-standardisation is used to adjust for the effect of age when comparing rates in
populations with different age structures. In this report, age-standardised rates were
calculated by the direct method using the Australian 2001 Standard Population (derived by
the ABS from the mid-year population estimate in 2001) or the World Health Organization
(WHO) 2000 World Standard Population.
Area Health Service (AHS) Public sector health services in NSW are administered by eight Area Health Services.
There are four metropolitan AHS that include the major cities of Sydney, Newcastle and
Wollongong. The remaining four AHS cover the regional and rural areas of NSW. The
current AHS boundaries were established in January 2005 (Figure 41).
45
Figure 41Area Health Service boundaries in 2005
Source: Centre for Epidemiology and Research, Population Health Division.116
Cancer incidence Cancer cases diagnosed in a defi ned population during a specifi ed period. This term is often
used to denote numbers or rates.
Cancer mortality Deaths from cancer in a defi ned population during a specifi ed period. It may be used to
denote numbers or rates. It only includes deaths for which the underlying cause is attributed
to cancer. Persons with cancer that died from another cause are not included in the mortality
calculations in this report.
Cases These are individual cancers. A person may have more than one cancer giving rise to multiple
cases in the same person. Second cases in one person are only counted if they are of
different histological type or originate in a different organ.
46
Pancreatic Cancer in New South Wales
Confi dence interval (CI) The confi dence interval gives the range of values for which there is a specifi ed probability
(95% in this report) that the interval contains the true estimate of the variable (rate,
proportion, etc).
Degree of spread at diagnosis This is the maximum extent of disease within four months of the fi rst date of diagnosis. This is
a summary stage that combines information from clinical and pathological documentation on
the extent of disease.
Health Outcomes and Information Statistical Toolkit (HOIST)
HOIST is a data warehouse that stores data collections and analytical tools that are
commonly used in population health and surveillance in New South Wales. It is operated by
the Centre for Epidemiology and Research of the NSW Department of Health.
Index of Relative Socio-Economic Disadvantage (IRSD)
See Socio-Economic Index For Areas (SEIFA).
Lifetime risk The lifetime risk is an estimate of the cumulative risk an individual has of developing or dying
from cancer during a defi ned lifespan in the absence of competing causes of mortality. In this
report, it is calculated using the cumulative rate. The cumulative rate is the sum of the age-
specifi c incidence or mortality rates for 5-year age groups (multiplied by the width of the age
group). The lifetime risk assumes that throughout the defi ned lifespan the person experiences
the same age-specifi c risks as the population used to calculate the cumulative rate.
Relative survival This is the ratio of observed survival of a cohort of people diagnosed with cancer to the
expected survival of the cohort based on the New South Wales Life Tables.
Statistical Local Area (SLA) Statistical local areas are geographical areas defi ned by the ABS and are part of the Australian
Standard Geographical Classifi cation (ASGC).91 Between census years, the SLA is the smallest
spatial unit defi ned by the ABS. SLAs are based on the boundaries of local government areas
where they exist. A local government may contain one or more SLAs.
Socio-Economic Indexes For Areas (SEIFA)
These indexes are created by the ABS to rank geographic areas in terms of their
socioeconomic disadvantage.93 There are four SEIFA indexes that each measure a slightly
different aspect of socioeconomic disadvantage. The Index of Relative Socio-Economic
Disadvantage (IRSD) was chosen for this report to be consistent with other reports such as
the Chief Health Offi cer’s Report.116 The indexes use census data to measure socioeconomic
characteristics of people and households in small geographical areas called census collector
districts. They are then aggregated (on a population-weighted basis) to other geographical
levels including the statistical local area level. It is an area-based assessment and cannot be
used to label individuals within an area.
47
13 Data tables
Tabl
e 2
New
cas
es o
f pan
crea
tic
canc
er in
NSW
, per
sons
, 197
2–20
06
Year
Age
gro
up a
t di
agno
sis
(yea
rs)
Tota
l0-4
5-9
10-1
415
-19
20-2
425-2
930-3
435-3
940-4
445-4
950-5
455-5
960-6
465-6
970-7
475-7
980-8
485+
1972
00
00
00
0<
5np*
1315
2452
5160
37
1916
297
1973
00
00
00
<5
<5
716
3136
46
45
56
4334
20
341
1974
00
00
00
<5
<5
109
25
33
58
66
48
4131
24
350
1975
00
00
00
<5
5<
514
28
40
50
75
64
50
4127
397
1976
00
00
0<
5<
5<
5<
516
29
37
7157
5142
36
20
366
1977
00
00
00
<5
np
511
24
47
64
58
60
48
48
25
398
1978
00
00
0<
5<
5<
5<
58
24
33
52
47
63
49
36
19346
1979
00
00
<5
0<
5<
56
1530
47
55
77
63
50
42
24
416
1980
00
0<
5<
50
<5
<5
<5
1532
4141
65
65
52
33
29
385
1981
00
0<
50
00
<5
66
29
50
40
63
72
48
45
19383
1982
00
0<
50
0<
5<
5<
512
30
4358
85
77
65
39
26
444
1983
00
00
<5
0<
5<
57
<5
24
35
62
72
70
8137
26
424
1984
00
00
00
0<
5np
1019
36
65
75
8167
50
36
447
1985
00
00
<5
00
<5
68
2137
58
60
7466
52
40
427
1986
00
00
0<
5<
5<
511
1721
45
66
66
92
69
5344
492
1987
00
00
00
<5
np
715
30
38
5978
86
8157
39
497
1988
00
<5
00
<5
<5
<5
913
22
38
62
7498
83
60
34
499
1989
00
<5
00
<5
0<
56
825
38
52
77
100
80
5339
484
1990
00
00
<5
<5
<5
56
1025
36
68
73
73
80
58
49
488
1991
00
0<
50
0<
5<
59
1420
4368
78
86
77
64
45
511
1992
00
00
<5
0<
56
518
2145
63
84
99
79
8158
561
1993
00
00
<5
0<
55
714
2148
6195
103
103
8153
594
1994
00
0<
50
<5
<5
<5
1113
26
38
60
75
104
93
77
53557
1995
00
00
0<
5<
5<
55
1228
28
5376
97
94
93
56
548
1996
00
0<
50
<5
<5
<5
<5
1223
39
42
87
101
111
87
56
569
1997
00
00
<5
<5
0<
510
1632
3152
85
92
112
68
62
565
1998
00
<5
0<
50
<5
<5
<5
1432
28
66
79
106
109
92
77
615
1999
00
00
00
<5
np
810
25
45
69
77
137
125
82
72
657
2000
00
00
0<
5<
5<
59
1733
42
50
72
98
116
84
73
599
2001
00
00
0<
5<
510
817
34
4363
7483
124
85
82
625
2002
00
00
0<
5<
5<
59
24
3139
63
95
116
111
87
97
678
2003
00
00
0<
50
np
616
3138
73
96
117
127
111
96
717
2004
00
<5
00
0<
56
1221
30
49
77
83
108
110
107
99
705
2005
00
0<
5<
5<
5<
50
1125
35
60
8190
129
132
136
124
831
2006
00
00
00
0<
5np
2132
54
7490
110
118
137
115
762
Tota
l0
0<
5np
1321
52
135
240
484
938
1404
2094
2600
3039
2873
2296
1774
17975
* np =
Not
publis
hed t
o m
ainta
in c
onfi dential
ity.
48
Pancreatic Cancer in New South Wales
Tabl
e 3
New
cas
es o
f pan
crea
tic
canc
er in
NSW
, mal
es, 1
972–
2006
Year
Age
gro
up a
t di
agno
sis
(yea
rs)
Tota
l0-4
5-9
10-1
415
-19
20-2
425-2
930-3
435-3
940-4
445-4
950-5
455-5
960-6
465-6
970-7
475-7
980-8
485+
1972
00
00
00
0<
5np*
1011
1434
32
32
166
816
9
1973
00
00
00
<5
<5
511
2123
28
25
28
26
158
194
1974
00
00
00
0<
5np
715
22
35
40
29
2110
12200
1975
00
00
00
<5
<5
<5
1115
25
3147
38
2119
10224
1976
00
00
0<
50
<5
011
1621
4327
29
1518
619
0
1977
00
00
00
0<
5<
56
1636
42
37
3126
20
11230
1978
00
00
0<
5<
5<
5<
5<
516
20
36
29
35
26
1811
205
1979
00
00
<5
0<
5<
5<
57
1529
36
49
40
24
20
7236
1980
00
0<
5<
50
<5
<5
<5
924
28
27
39
28
28
1810
219
1981
00
0<
50
00
<5
<5
619
36
22
35
4325
18<
521
5
1982
00
0<
50
0<
5<
5<
58
20
2128
49
5135
1911
250
1983
00
00
<5
00
<5
6<
511
26
40
4140
4316
<5
233
1984
00
00
00
0<
5<
56
1125
4339
44
3122
11235
1985
00
00
<5
00
<5
57
1718
38
34
40
35
2112
232
1986
00
00
00
<5
<5
68
1126
4133
44
38
27
13253
1987
00
00
00
0<
5np
1017
25
35
47
4342
20
12259
1988
00
00
0<
5<
5<
56
1015
1931
34
50
4325
14251
1989
00
<5
00
00
<5
5<
516
22
34
47
5341
23
17266
1990
00
00
0<
50
<5
<5
720
1846
47
35
37
22
19260
1991
00
00
00
<5
0<
57
1229
37
36
46
35
27
20
254
1992
00
00
00
0<
5<
512
1124
4138
55
35
40
21283
1993
00
00
00
<5
<5
07
1121
32
48
6146
33
15279
1994
00
00
00
<5
<5
56
1530
33
36
55
37
32
20
273
1995
00
00
0<
5<
5<
5<
59
1516
3143
52
45
36
17270
1996
00
00
0<
5<
5<
50
717
2123
5357
5138
12284
1997
00
00
0<
50
<5
711
1921
24
45
54
50
27
22
282
1998
00
<5
00
0<
5<
5<
511
1715
34
48
52
52
4127
303
1999
00
00
00
<5
<5
57
1727
35
45
5953
36
27
314
2000
00
00
0<
50
<5
611
2124
28
34
46
52
34
25
285
2001
00
00
0<
5<
55
<5
1220
24
36
42
48
7143
29
334
2002
00
00
00
<5
<5
<5
1315
2138
4369
64
4138
349
2003
00
00
0<
50
<5
<5
819
25
46
48
72
64
45
27
361
2004
00
00
00
<5
np
713
25
28
46
47
60
47
4133
354
2005
00
00
0<
5<
50
<5
1517
39
54
52
68
67
47
4341
1
2006
00
00
00
0<
5<
514
20
32
45
5155
56
57
44
379
Tota
l0
0<
5<
55
1431
82
136
307
577
851
1253
1440
1642
1398
975
620
9336
* np =
Not
publis
hed t
o m
ainta
in c
onfi dential
ity.
49
Tabl
e 4
New
cas
es o
f pan
crea
tic
canc
er in
NSW
, fem
ales
, 197
2–20
06
Year
Age
gro
up a
t di
agno
sis
(yea
rs)
Tota
l0-4
5-9
10-1
415
-19
20-2
425-2
930-3
435-3
940-4
445-4
950-5
455-5
960-6
465-6
970-7
475-7
980-8
485+
1972
00
00
00
0<
5<
5<
5<
510
1819
28
2113
812
8
1973
00
00
00
<5
0<
55
1013
1820
28
1719
1214
7
1974
00
00
00
<5
<5
<5
<5
1011
23
26
1920
2112
150
1975
00
00
00
0<
50
<5
1315
1928
26
29
22
1717
3
1976
00
00
00
<5
0<
55
1316
28
30
22
27
1814
176
1977
00
00
00
<5
<5
<5
58
1122
2129
22
28
1416
8
1978
00
00
00
<5
<5
<5
58
1316
1828
23
188
141
1979
00
00
00
<5
<5
<5
815
1819
28
23
26
22
1718
0
1980
00
0<
50
00
<5
<5
68
1314
26
37
24
1519
166
1981
00
00
00
0<
5<
50
1014
1828
29
23
27
1516
8
1982
00
00
00
0<
50
<5
1022
30
36
26
30
20
1519
4
1983
00
00
00
<5
<5
<5
<5
139
22
3130
38
2122
191
1984
00
00
00
0<
5<
5<
58
1122
36
37
36
28
25
212
1985
00
00
00
00
<5
<5
<5
1920
26
34
3131
28
195
1986
00
00
0<
5<
50
59
1019
25
33
48
3126
31239
1987
00
00
00
<5
<5
<5
513
1324
3143
39
37
27
238
1988
00
<5
00
00
<5
<5
<5
719
3140
48
40
35
20
248
1989
00
00
0<
50
<5
<5
<5
916
1830
47
39
30
22
218
1990
00
00
<5
<5
<5
<5
<5
<5
518
22
26
38
4336
30
228
1991
00
0<
50
0<
5<
56
78
1431
42
40
42
37
25
257
1992
00
00
<5
0<
5<
5<
56
1021
22
46
44
44
4137
278
1993
00
00
<5
0<
5<
57
710
27
29
47
42
57
48
38
315
1994
00
0<
50
<5
0<
56
711
827
39
49
56
45
33
284
1995
00
00
0<
5<
50
<5
<5
1312
22
33
45
49
57
39
278
1996
00
0<
50
00
<5
<5
56
1819
34
44
60
49
44
285
1997
00
00
<5
00
<5
<5
513
1028
40
38
62
4140
283
1998
00
00
<5
00
<5
<5
<5
1513
32
3154
57
5150
312
1999
00
00
00
0<
5<
5<
58
1834
32
78
72
46
45
343
2000
00
00
00
<5
0<
56
1218
22
38
52
64
50
48
314
2001
00
00
00
05
65
1419
27
32
35
5342
53291
2002
00
00
0<
50
<5
511
1618
25
52
47
47
46
59329
2003
00
00
00
0<
5<
58
1213
27
48
45
63
66
69
356
2004
00
<5
00
00
<5
58
521
3136
48
63
66
66
351
2005
00
0<
5<
5<
50
07
1018
2127
38
6165
89
81420
2006
00
00
00
00
67
1222
29
39
55
62
80
71383
Tota
l0
0<
5np*
87
2153
104
177
361
553
841
1160
1397
1475
1321
1154
8639
* np =
Not
publis
hed t
o m
ainta
in c
onfi dential
ity.
50
Pancreatic Cancer in New South Wales
Tabl
e 5
Dea
ths
from
pan
crea
tic
canc
er in
NSW
, per
sons
, 197
2–20
06.
Year
Age
gro
up a
t de
ath
(yea
rs)
Tota
l0-4
5-9
10-1
415
-19
20-2
425-2
930-3
435-3
940-4
445-4
950-5
455-5
960-6
465-6
970-7
475-7
980-8
485+
1972
00
00
<5
00
<5
612
1731
4148
49
3124
15276
1973
00
00
00
<5
<5
815
1334
46
50
56
4334
24
326
1974
00
00
00
<5
<5
67
35
29
5364
5939
33
26
357
1975
00
00
00
0<
5<
512
25
36
5166
64
39
40
32
371
1976
00
00
00
<5
<5
<5
1225
36
67
55
52
52
37
22
363
1977
00
00
00
<5
np*
510
25
38
54
55
58
49
4328
372
1978
00
00
0<
5<
5<
56
1216
45
6158
57
45
42
23
372
1979
00
00
<5
<5
<5
5<
58
22
38
39
65
68
49
39
26
363
1980
00
00
<5
0<
5<
55
1331
36
42
67
55
56
44
24
379
1981
00
00
00
0<
5<
56
1838
3150
6146
32
30
317
1982
00
0<
50
0<
5<
5<
511
26
4152
68
75
5936
28
405
1983
00
0<
50
00
<5
<5
<5
2134
60
5975
68
37
20
383
1984
00
00
00
0<
5np
1015
3168
58
73
75
47
27
412
1985
00
00
0<
50
<5
65
1833
45
5963
64
46
43387
1986
00
00
0<
5<
5<
55
1021
36
5360
88
67
48
47
439
1987
00
00
0<
5<
5<
510
824
36
63
7182
7150
42
462
1988
00
00
00
<5
<5
816
1835
64
63
83
72
54
34
450
1989
00
00
00
06
58
2126
57
7410
192
67
45
502
1990
00
00
0<
5<
5<
55
1329
4362
64
75
7155
40
464
1991
00
00
0<
5<
5<
57
713
27
67
66
79
72
5946
449
1992
00
00
<5
0<
5<
55
1419
38
5973
86
72
7461
506
1993
00
00
00
<5
<5
512
2138
56
90
96
88
75
57
542
1994
00
00
0<
5<
5<
56
819
39
49
60
96
97
69
51499
1995
00
00
0<
5<
5<
56
1324
25
5188
8183
84
52
511
1996
00
00
<5
0<
5<
55
1122
29
32
68
83
112
8161
508
1997
00
00
0<
50
65
923
22
4178
86
94
65
61491
1998
00
00
0<
5<
5<
5<
512
2130
54
68
87
98
77
7653
2
1999
00
00
00
0np
<5
1225
30
7163
121
112
84
74600
2000
00
00
00
0<
5np
925
34
39
66
9111
476
68
533
2001
00
00
00
<5
<5
<5
1826
25
49
68
84
99
84
77
535
2002
00
00
00
<5
np
517
2137
66
7692
103
86
83
593
2003
00
00
00
0<
5np
1123
32
55
82
88
98
94
92
583
2004
00
00
00
05
611
30
40
66
7192
117
99
93
630
2005
00
00
00
0<
5np
25
27
42
67
66
110
116
121
122
703
2006
00
00
0<
5<
50
816
29
42
57
86
93
129
130
114
706
Tota
l0
00
<5
np
1532
100
184
397
788
1206
1888
2323
2759
2692
2166
1764
16321
* np =
Not
publis
hed t
o m
ainta
in c
onfi dential
ity.
51
Tabl
e 6
Dea
ths
from
pan
crea
tic
canc
er in
NSW
, mal
es, 1
972–
2006
Year
Age
gro
up a
t de
ath
(yea
rs)
Tota
l0-4
5-9
10-1
415
-19
20-2
425-2
930-3
435-3
940-4
445-4
950-5
455-5
960-6
465-6
970-7
475-7
980-8
485+
1972
00
00
<5
00
0<
58
917
26
32
25
20
77
155
1973
00
00
00
0<
5np*
911
23
27
29
32
22
147
181
1974
00
00
00
<5
<5
55
25
20
37
34
3123
1213
209
1975
00
00
00
0<
5<
58
1817
25
44
40
22
1913
212
1976
00
00
00
<5
<5
<5
810
25
4132
3115
137
185
1977
00
00
00
<5
<5
<5
<5
1732
37
34
3120
20
1421
5
1978
00
00
0<
5<
5<
5<
56
1029
4134
34
25
219
218
1979
00
00
<5
<5
<5
<5
<5
<5
1322
24
35
38
32
219
205
1980
00
00
<5
0<
5<
5<
56
23
25
30
46
26
26
186
213
1981
00
00
00
0<
5<
56
1327
23
3137
22
1211
186
1982
00
00
00
<5
<5
<5
611
23
27
34
44
32
20
1121
5
1983
00
0<
50
00
0<
5<
512
27
37
35
46
33
15<
521
3
1984
00
00
00
00
<5
np
821
46
28
46
42
189
228
1985
00
00
0<
50
<5
<5
<5
1322
32
32
28
34
1813
204
1986
00
00
0<
5<
5<
5<
56
1218
37
37
45
39
22
15238
1987
00
00
00
0<
56
<5
1524
36
38
40
33
24
8230
1988
00
00
00
<5
<5
613
1021
33
29
42
40
1913
228
1989
00
00
00
0np
<5
616
1731
39
54
42
30
18261
1990
00
00
0<
5<
5<
5<
57
20
24
4142
35
35
27
17256
1991
00
00
00
0<
5<
5<
59
1436
38
46
35
20
19226
1992
00
00
00
<5
<5
<5
910
2138
30
42
35
37
25
253
1993
00
00
00
<5
<5
<5
913
1732
45
50
4130
19259
1994
00
00
00
<5
0<
55
1323
26
3153
38
29
18240
1995
00
00
00
<5
<5
<5
714
1831
42
45
37
30
13243
1996
00
00
00
<5
<5
<5
711
1420
40
38
49
35
12232
1997
00
00
0<
50
<5
<5
514
1520
4350
47
29
19247
1998
00
00
0<
5<
5<
5<
510
1020
3136
40
46
32
31262
1999
00
00
00
0<
50
np
1518
32
37
56
5133
31285
2000
00
00
00
0<
5np
617
22
2139
42
50
32
24
263
2001
00
00
00
00
014
1612
30
40
42
5144
26
275
2002
00
00
00
<5
<5
<5
910
23
35
33
56
62
39
37
310
2003
00
00
00
0<
5<
55
1420
38
4353
50
39
26
292
2004
00
00
00
0<
5<
55
26
23
44
38
56
49
38
30
316
2005
00
00
00
0<
5<
516
1533
45
3153
56
4142
335
2006
00
00
0<
5<
50
59
1524
34
54
48
5356
45
345
Tota
l0
00
<5
<5
1021
62
104
250
488
751
1144
1285
1475
1307
914
620
843
5
* np =
Not
publis
hed t
o m
ainta
in c
onfi dential
ity.
52
Pancreatic Cancer in New South Wales
Tabl
e 7
Dea
ths
from
pan
crea
tic
canc
er in
NSW
, fem
ales
, 197
2–20
06
Year
Age
gro
up a
t de
ath
(yea
rs)
Tota
l0-4
5-9
10-1
415
-19
20-2
425-2
930-3
435-3
940-4
445-4
950-5
455-5
960-6
465-6
970-7
475-7
980-8
485+
1972
00
00
00
0<
5<
5<
58
1415
1624
1117
812
1
1973
00
00
00
<5
0<
56
<5
1119
2124
2120
1714
5
1974
00
00
00
<5
<5
<5
<5
109
1630
28
1621
1314
8
1975
00
00
00
00
0<
5np*
1926
22
24
1721
1915
9
1976
00
00
00
<5
0<
5<
515
1126
23
2137
24
1517
8
1977
00
00
00
<5
<5
<5
68
617
2127
29
23
1415
7
1978
00
00
00
<5
<5
<5
66
1620
24
23
20
2114
154
1979
00
00
00
0<
50
<5
916
1530
30
1718
1715
8
1980
00
00
00
<5
0<
57
811
1221
29
30
26
1816
6
1981
00
00
00
00
<5
0np
118
1924
24
20
1913
1
1982
00
0<
50
00
0<
55
1518
25
34
3127
1617
190
1983
00
00
00
0<
50
<5
97
23
24
29
35
22
1717
0
1984
00
00
00
0<
55
<5
710
22
30
27
33
29
1818
4
1985
00
00
00
0<
5<
5<
55
1113
27
35
30
28
30
183
1986
00
00
00
00
<5
<5
918
1623
4328
26
32
201
1987
00
00
0<
5<
5<
5<
5<
59
1227
33
42
38
26
34
232
1988
00
00
00
0<
5<
5<
58
1431
34
4132
35
21222
1989
00
00
00
0<
5<
5<
55
926
35
47
50
37
27
241
1990
00
00
0<
5<
5<
5<
56
919
2122
40
36
28
23
208
1991
00
00
0<
5<
5<
55
<5
<5
1331
28
33
37
39
27
223
1992
00
00
<5
00
<5
<5
59
1721
4344
37
37
36
253
1993
00
00
00
0<
5<
5<
58
2124
45
46
47
45
38
283
1994
00
00
0<
50
<5
<5
<5
616
23
29
4359
40
33
259
1995
00
00
0<
50
<5
<5
610
720
46
36
46
54
39
268
1996
00
00
<5
00
0<
5<
511
1512
28
45
63
46
49
276
1997
00
00
00
0<
5<
5<
59
721
35
36
47
36
42
244
1998
00
00
00
0<
5<
5<
511
1023
32
47
52
45
45
270
1999
00
00
00
0<
5<
5<
510
1239
26
65
6151
4331
5
2000
00
00
00
00
<5
<5
812
1827
49
64
44
44
270
2001
00
00
00
<5
<5
<5
<5
1013
1928
42
48
40
51260
2002
00
00
00
0<
5<
58
1114
3143
36
4147
46
283
2003
00
00
00
00
<5
np
912
1739
35
48
55
66
291
2004
00
00
00
0<
5<
56
<5
1722
33
36
68
6163
314
2005
00
00
00
0<
5<
59
129
22
35
57
60
80
80
368
2006
00
00
00
00
<5
np
1418
23
32
45
7674
69
361
Tota
l0
00
<5
<5
511
38
80
147
300
455
744
1038
1284
1385
1252
1144
7886
* np =
Not
publis
hed t
o m
ainta
in c
onfi dential
ity.
53
Tabl
e 8
Age
-spe
cifi c
and
age
-sta
ndar
dise
d (A
SR)
inci
denc
e ra
te (
per
100,
000)
of p
ancr
eati
c ca
ncer
in p
erso
ns, N
SW, 1
972–
2006
Year
Age
gro
up a
t di
agno
sis
(yea
rs)
Cru
de
rate
ASR
(a)
Low
er
95%
C
I
Upp
er
95%
C
I0
-45-9
10-1
415
-19
20
-24
25-2
930
-34
35-3
940
-44
45-4
950
-54
55-5
960
-64
65-6
970
-74
75-7
980
-84
85+
1972
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.7
2.7
4.4
5.7
10.3
26.3
33.7
53.7
49.
140.8
60.8
6.2
8.4
7.4
9.4
1973
0.0
0.0
0.0
0.0
0.0
0.0
1.3
1.1
2.4
5.4
11.4
15.4
22.6
28.8
48.9
57.
171
.672.5
7.0
9.6
8.6
10.7
1974
0.0
0.0
0.0
0.0
0.0
0.0
0.3
1.4
3.6
3.0
8.9
14.2
27.
740.9
40.5
53.8
64.2
83.2
7.2
9.6
8.5
10.7
1975
0.0
0.0
0.0
0.0
0.0
0.0
0.3
1.7
0.7
4.8
9.9
17.0
23.3
45.3
53.4
62.5
84.7
90.9
8.0
10.8
9.7
11.9
1976
0.0
0.0
0.0
0.0
0.0
0.2
0.3
1.0
0.7
5.5
10.2
15.3
32.8
33.3
41.5
50.1
72.5
64.1
7.4
9.4
8.4
10.5
1977
0.0
0.0
0.0
0.0
0.0
0.0
0.5
2.0
1.8
3.9
8.4
18.9
29.
432.8
47.
356.6
96.6
78.2
8.0
10.3
9.3
11.4
1978
0.0
0.0
0.0
0.0
0.0
0.7
1.0
1.3
1.4
2.9
8.4
12.8
23.8
25.8
48.1
56.5
71.4
57.
26.8
8.8
7.8
9.8
1979
0.0
0.0
0.0
0.0
0.2
0.0
1.0
0.6
2.1
5.5
10.5
17.7
25.3
40.8
46.5
55.9
82.5
70.1
8.1
10.2
9.2
11.3
1980
0.0
0.0
0.0
0.4
0.5
0.0
0.2
0.9
1.4
5.6
11.3
15.1
18.7
33.5
46.4
57.
162.6
80.2
7.4
9.4
8.4
10.4
1981
0.0
0.0
0.0
0.2
0.0
0.0
0.0
1.1
2.0
2.3
10.3
18.4
17.6
32.1
49.
451
.482.8
50.0
7.3
9.0
8.1
10.0
1982
0.0
0.0
0.0
0.2
0.0
0.0
0.2
1.1
1.0
4.5
10.8
15.8
24.8
42.8
50.7
66.9
68.8
67.
98.4
10.2
9.2
11.2
1983
0.0
0.0
0.0
0.0
0.2
0.0
0.2
1.0
2.2
1.5
8.9
12.8
25.6
36.2
44.5
79.
763.0
66.7
7.9
9.6
8.7
10.6
1984
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.7
1.5
3.6
7.2
13.1
25.8
37.
949.
663.1
81.6
89.
78.3
9.9
9.0
10.9
1985
0.0
0.0
0.0
0.0
0.2
0.0
0.0
0.9
1.8
2.8
8.0
13.5
22.5
29.
944.1
59.6
82.8
93.6
7.8
9.4
8.5
10.4
1986
0.0
0.0
0.0
0.0
0.0
0.2
0.9
0.7
3.1
5.7
8.0
16.6
25.3
31.6
53.8
59.4
81.2
96.8
8.9
10.4
9.5
11.4
1987
0.0
0.0
0.0
0.0
0.0
0.0
0.5
1.2
1.8
4.9
11.3
14.1
22.5
35.9
49.
467.
183.0
83.3
8.8
10.3
9.4
11.2
1988
0.0
0.0
0.2
0.0
0.0
0.2
0.2
0.7
2.2
4.2
8.1
14.4
23.5
32.8
56.1
66.3
83.8
70.6
8.7
10.0
9.1
10.9
1989
0.0
0.0
0.2
0.0
0.0
0.2
0.0
0.9
1.4
2.5
9.0
14.6
19.6
32.8
57.
361
.371
.278.0
8.4
9.5
8.7
10.4
1990
0.0
0.0
0.0
0.0
0.4
0.4
0.2
1.1
1.4
3.0
8.7
14.0
25.7
30.5
41.1
59.6
74.9
96.0
8.4
9.5
8.6
10.4
1991
0.0
0.0
0.0
0.2
0.0
0.0
0.8
0.4
2.1
4.0
6.8
16.8
25.8
32.3
46.4
55.9
78.9
83.8
8.7
9.6
8.8
10.5
1992
0.0
0.0
0.0
0.0
0.2
0.0
0.2
1.3
1.1
4.8
7.0
17.3
24.3
34.6
51.6
56.3
95.6
102.7
9.4
10.4
9.5
11.3
1993
0.0
0.0
0.0
0.0
0.2
0.0
0.4
1.1
1.6
3.5
6.9
18.1
24.0
38.8
51.7
72.8
90.9
89.
19.
910
.79.
811
.6
1994
0.0
0.0
0.0
0.2
0.0
0.2
0.4
0.6
2.5
3.2
8.2
14.0
23.9
30.6
50.0
65.9
81.9
84.8
9.2
9.8
9.0
10.7
1995
0.0
0.0
0.0
0.0
0.0
0.4
0.6
0.2
1.1
2.9
8.4
10.1
21.2
31.0
45.7
64.9
95.6
84.7
8.9
9.5
8.7
10.3
1996
0.0
0.0
0.0
0.2
0.0
0.4
0.2
0.8
0.7
2.8
6.6
13.7
16.9
35.4
46.9
73.2
87.
280.0
9.2
9.6
8.8
10.4
1997
0.0
0.0
0.0
0.0
0.2
0.2
0.0
0.6
2.2
3.7
8.6
10.6
20.5
34.7
42.3
70.1
66.4
83.5
9.0
9.3
8.5
10.0
1998
0.0
0.0
0.2
0.0
0.5
0.0
0.2
0.8
0.8
3.2
8.1
9.3
25.4
32.6
48.2
65.0
88.1
98.5
9.7
9.8
9.1
10.6
1999
0.0
0.0
0.0
0.0
0.0
0.0
0.2
1.2
1.7
2.3
6.1
14.3
25.8
32.2
61.5
71.2
77.
486.7
10.2
10.2
9.4
11.0
2000
0.0
0.0
0.0
0.0
0.0
0.2
0.2
0.6
1.8
3.8
7.8
12.8
18.2
30.3
43.8
64.3
76.1
83.0
9.2
9.1
8.4
9.9
2001
0.0
0.0
0.0
0.0
0.0
0.2
0.2
2.0
1.6
3.7
7.8
12.6
22.3
31.0
36.8
67.
472.1
88.9
9.5
9.2
8.5
10.0
2002
0.0
0.0
0.0
0.0
0.0
0.2
0.2
0.8
1.8
5.2
7.2
10.7
22.0
39.
251
.859
.870.5
100.9
10.2
9.8
9.1
10.6
2003
0.0
0.0
0.0
0.0
0.0
0.2
0.0
1.0
1.2
3.4
7.2
9.9
25.0
39.
053
.267.
586.2
97.
310
.710
.29.
511
.0
2004
0.0
0.0
0.2
0.0
0.0
0.0
0.4
1.2
2.3
4.4
6.9
12.4
25.5
33.0
49.
957.
979.
898.0
10.5
9.9
9.1
10.6
2005
0.0
0.0
0.0
0.2
0.2
0.4
0.8
0.0
2.2
5.2
8.0
14.8
25.8
35.0
60.1
69.
398.3
117.
012
.311
.410
.612
.2
2006
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.4
1.8
4.3
7.2
13.1
22.6
34.5
51.1
61.9
97.
310
3.4
11.2
10.2
9.5
11.0
(a)
Stan
dar
dis
ed t
o t
he A
ust
ralia
n 2
001
Sta
ndar
d P
opula
tio
n.
54
Pancreatic Cancer in New South Wales
Tabl
e 9
Age
-spe
cifi c
and
age
-sta
ndar
dise
d (A
SR)
inci
denc
e ra
te (
per
100,
000)
of p
ancr
eati
c ca
ncer
in m
ales
, NSW
, 197
2–20
06
Year
Age
gro
up a
t di
agno
sis
(yea
rs)
Cru
de
rate
ASR
(a)
Low
er
95%
CI
Upp
er
95%
CI
0-4
5-9
10-1
415
-19
20
-24
25-2
930
-34
35-3
940
-44
45-4
950
-54
55-5
960
-64
65-6
970
-74
75-7
980
-84
85+
1972
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.7
3.3
6.6
8.3
12.2
35.8
45.3
68.0
56.9
37.
098.7
7.0
10.8
9.1
12.7
1973
0.0
0.0
0.0
0.0
0.0
0.0
0.6
2.1
3.4
7.3
15.4
20.0
28.7
34.4
57.
793.2
92.0
95.5
8.0
12.7
10.8
14.8
1974
0.0
0.0
0.0
0.0
0.0
0.0
0.0
2.0
4.2
4.6
10.6
19.3
34.9
53.4
57.
274
.061
.513
9.9
8.2
12.7
10.8
14.8
1975
0.0
0.0
0.0
0.0
0.0
0.0
0.6
2.6
1.4
7.2
10.5
21.6
30.2
61.3
73.5
70.5
118.8
115.2
9.1
14.0
12.1
16.2
1976
0.0
0.0
0.0
0.0
0.0
0.5
0.0
1.9
0.0
7.3
11.1
17.6
41.6
34.2
54.4
47.
511
2.5
67.
47.
711
.29.
513
.1
1977
0.0
0.0
0.0
0.0
0.0
0.0
0.0
1.3
2.1
4.1
11.1
29.
440.3
45.4
56.1
80.5
124.8
124.0
9.2
13.9
12.0
16.1
1978
0.0
0.0
0.0
0.0
0.0
1.5
1.5
1.2
2.1
2.1
11.1
15.8
34.3
34.6
61.3
77.
811
0.2
122.6
8.1
12.5
10.7
14.5
1979
0.0
0.0
0.0
0.0
0.5
0.0
1.5
0.6
2.8
5.0
10.4
22.1
34.7
56.5
67.
768.9
120.9
77.
39.
313
.211
.415
.2
1980
0.0
0.0
0.0
0.4
0.9
0.0
0.5
0.6
2.0
6.6
16.7
20.9
25.8
43.6
45.9
78.2
103.7
105.8
8.5
12.4
10.7
14.4
1981
0.0
0.0
0.0
0.4
0.0
0.0
0.0
1.1
2.6
4.4
13.3
26.7
20.5
38.5
68.1
67.
499.
841
.08.2
11.4
9.8
13.2
1982
0.0
0.0
0.0
0.4
0.0
0.0
0.5
1.6
1.9
5.8
14.1
15.5
25.1
53.4
77.
490.3
100.6
111.
19.
513
.611
.815
.6
1983
0.0
0.0
0.0
0.0
0.4
0.0
0.0
1.0
3.7
2.1
7.9
19.0
34.4
44.6
58.6
106.6
80.7
40.3
8.7
11.8
10.2
13.5
1984
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.5
1.2
4.2
8.1
18.1
35.4
42.7
61.9
73.5
105.6
107.
88.7
12.2
10.5
14.0
1985
0.0
0.0
0.0
0.0
0.4
0.0
0.0
1.9
2.9
4.7
12.7
13.0
30.5
36.7
54.5
79.
197.
511
0.5
8.5
11.9
10.3
13.7
1986
0.0
0.0
0.0
0.0
0.0
0.0
1.4
1.4
3.3
5.3
8.2
18.9
32.3
34.1
58.6
81.5
118.8
112.3
9.2
12.6
11.0
14.4
1987
0.0
0.0
0.0
0.0
0.0
0.0
0.0
1.4
2.6
6.4
12.5
18.4
27.
346.4
56.0
86.6
82.7
98.6
9.3
12.2
10.7
13.9
1988
0.0
0.0
0.0
0.0
0.0
0.4
0.4
0.9
2.9
6.2
10.8
14.2
23.9
32.2
64.9
85.1
98.6
110.3
8.8
12.0
10.5
13.7
1989
0.0
0.0
0.5
0.0
0.0
0.0
0.0
1.4
2.4
2.4
11.2
16.7
26.0
42.6
68.7
77.
586.8
126.5
9.2
12.2
10.7
13.9
1990
0.0
0.0
0.0
0.0
0.0
0.4
0.0
1.8
1.8
4.0
13.6
13.9
35.1
41.8
44.5
67.
679.
513
6.4
8.9
11.7
10.2
13.3
1991
0.0
0.0
0.0
0.0
0.0
0.0
0.8
0.0
1.4
3.9
8.0
22.5
28.4
31.4
55.8
62.0
93.0
134.6
8.7
11.4
9.9
12.9
1992
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.9
1.8
6.2
7.2
18.3
31.9
32.8
64.0
60.6
131.
313
2.5
9.5
12.3
10.9
14.0
1993
0.0
0.0
0.0
0.0
0.0
0.0
0.4
1.7
0.0
3.5
7.0
15.7
25.3
41.0
68.0
78.7
101.
889.
59.
311
.510
.113
.0
1994
0.0
0.0
0.0
0.0
0.0
0.0
0.8
0.9
2.3
2.9
9.2
22.0
26.4
30.5
58.5
63.0
93.1
112.4
9.1
11.2
9.8
12.6
1995
0.0
0.0
0.0
0.0
0.0
0.4
0.4
0.4
1.3
4.2
8.9
11.4
25.1
36.3
54.0
74.3
100.4
89.
38.9
10.7
9.4
12.1
1996
0.0
0.0
0.0
0.0
0.0
0.8
0.4
0.8
0.0
3.2
9.6
14.5
18.6
44.5
58.1
79.
610
2.5
59.3
9.2
10.7
9.5
12.1
1997
0.0
0.0
0.0
0.0
0.0
0.4
0.0
0.4
3.0
5.0
10.0
14.1
19.0
37.
854.1
73.6
70.6
101.
49.
110
.59.
311
.9
1998
0.0
0.0
0.4
0.0
0.0
0.0
0.4
0.8
0.9
5.0
8.5
9.8
26.3
40.6
51.1
72.6
104.7
116.8
9.6
11.2
9.9
12.5
1999
0.0
0.0
0.0
0.0
0.0
0.0
0.4
0.8
2.1
3.2
8.2
16.9
26.3
38.4
56.7
70.3
89.
810
9.3
9.9
11.1
9.9
12.5
2000
0.0
0.0
0.0
0.0
0.0
0.4
0.0
1.2
2.5
4.9
9.9
14.4
20.3
29.
343
.766.8
80.4
94.6
8.9
9.8
8.7
11.1
2001
0.0
0.0
0.0
0.0
0.0
0.4
0.4
2.0
0.8
5.3
9.1
13.8
25.4
35.9
45.0
88.5
94.3
103.5
10.2
11.2
10.0
12.5
2002
0.0
0.0
0.0
0.0
0.0
0.0
0.4
0.8
1.6
5.7
6.9
11.3
26.3
36.1
64.9
78.5
84.7
129.
210
.611
.510
.312
.8
2003
0.0
0.0
0.0
0.0
0.0
0.4
0.0
0.8
1.6
3.4
8.8
12.8
31.3
39.
768.7
76.7
88.2
88.8
10.9
11.5
10.3
12.7
2004
0.0
0.0
0.0
0.0
0.0
0.0
0.8
2.1
2.7
5.5
11.5
14.0
30.3
38.1
58.1
55.2
76.5
104.8
10.6
11.1
9.9
12.3
2005
0.0
0.0
0.0
0.0
0.0
0.4
1.6
0.0
1.6
6.3
7.8
19.1
34.3
41.1
66.4
77.
884.6
127.
912
.312
.611
.413
.9
2006
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.8
1.2
5.8
9.1
15.5
27.
539.
753
.464.8
99.
612
3.2
11.2
11.4
10.3
12.6
(a)
Stan
dar
dis
ed t
o t
he A
ust
ralia
n 2
001
Sta
ndar
d P
opula
tio
n.
55
Tabl
e 10
A
ge-s
peci
fi c a
nd a
ge-s
tand
ardi
sed
(ASR
) in
cide
nce
rate
(pe
r 10
0,00
0) o
f pan
crea
tic
canc
er in
fem
ales
, NSW
, 197
2–20
06
Year
Age
gro
up a
t di
agno
sis
(yea
rs)
Cru
de
rate
ASR
(a)
Low
er
95%
C
I
Upp
er
95%
C
I0
-45-9
10-1
415
-19
20
-24
25-2
930
-34
35-3
940
-44
45-4
950
-54
55-5
960
-64
65-6
970
-74
75-7
980
-84
85+
1972
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.7
2.1
2.1
3.0
8.4
17.5
23.5
43.4
44.4
42.9
44.0
5.4
6.5
5.4
7.8
1973
0.0
0.0
0.0
0.0
0.0
0.0
2.0
0.0
1.4
3.5
7.4
10.9
17.0
23.9
42.5
35.8
61.0
62.4
6.1
7.4
6.2
8.7
1974
0.0
0.0
0.0
0.0
0.0
0.0
0.6
0.7
3.0
1.4
7.2
9.3
21.0
30.1
28.0
41.8
65.5
59.2
6.1
7.3
6.2
8.6
1975
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.7
0.0
2.1
9.2
12.5
17.0
31.5
38.2
57.
867.
980.9
7.0
8.4
7.1
9.7
1976
0.0
0.0
0.0
0.0
0.0
0.0
0.6
0.0
1.5
3.6
9.2
13.0
24.7
32.6
31.7
51.6
53.5
62.8
7.1
8.1
6.9
9.4
1977
0.0
0.0
0.0
0.0
0.0
0.0
1.1
2.7
1.5
3.6
5.7
8.7
19.4
22.0
40.5
41.9
83.2
60.6
6.7
7.8
6.6
9.1
1978
0.0
0.0
0.0
0.0
0.0
0.0
0.5
1.3
0.7
3.7
5.7
10.0
14.0
18.2
37.
943
.252.8
33.0
5.6
6.3
5.3
7.5
1979
0.0
0.0
0.0
0.0
0.0
0.0
0.5
0.6
1.4
6.1
10.7
13.4
16.7
27.
530.1
47.
664.0
67.
57.
08.0
6.8
9.3
1980
0.0
0.0
0.0
0.5
0.0
0.0
0.0
1.2
0.7
4.6
5.8
9.5
12.2
24.9
46.8
43.5
42.4
71.1
6.4
7.2
6.1
8.4
1981
0.0
0.0
0.0
0.0
0.0
0.0
0.0
1.2
1.4
0.0
7.3
10.3
15.1
26.6
35.1
40.9
74.4
53.2
6.4
7.0
6.0
8.2
1982
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.5
0.0
3.1
7.4
16.1
24.5
33.7
30.2
51.3
52.9
52.8
7.3
7.8
6.7
9.0
1983
0.0
0.0
0.0
0.0
0.0
0.0
0.5
1.0
0.7
0.8
9.8
6.6
17.5
28.9
33.7
62.1
54.0
75.6
7.1
7.7
6.6
8.9
1984
0.0
0.0
0.0
0.0
0.0
0.0
0.0
1.0
1.9
2.9
6.2
8.1
16.9
33.7
40.2
56.3
69.
283.5
7.8
8.3
7.2
9.5
1985
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.6
0.7
3.1
14.0
15.0
24.2
36.1
46.6
75.1
87.
97.
17.
46.4
8.6
1986
0.0
0.0
0.0
0.0
0.0
0.4
0.5
0.0
2.9
6.3
7.8
14.2
18.6
29.
550.1
44.6
61.2
91.5
8.6
8.9
7.8
10.2
1987
0.0
0.0
0.0
0.0
0.0
0.0
0.9
0.9
1.1
3.4
10.0
9.8
17.9
26.7
44.2
54.0
83.2
77.
98.4
8.7
7.6
9.9
1988
0.0
0.0
0.5
0.0
0.0
0.0
0.0
0.5
1.5
2.0
5.2
14.5
23.1
33.3
49.
253
.575.7
56.4
8.7
8.7
7.6
9.8
1989
0.0
0.0
0.0
0.0
0.0
0.4
0.0
0.5
0.5
2.5
6.6
12.4
13.5
24.0
48.3
50.2
62.6
60.2
7.5
7.6
6.6
8.7
1990
0.0
0.0
0.0
0.0
0.9
0.4
0.4
0.5
1.0
1.8
3.6
14.1
16.5
20.5
38.4
54.1
72.4
80.9
7.8
7.8
6.8
8.9
1991
0.0
0.0
0.0
0.5
0.0
0.0
0.8
0.9
2.8
4.1
5.6
11.0
23.3
33.0
38.9
51.7
71.0
64.4
8.7
8.5
7.5
9.6
1992
0.0
0.0
0.0
0.0
0.4
0.0
0.4
1.8
0.5
3.3
6.8
16.3
16.8
36.2
41.5
53.2
75.6
91.1
9.3
9.1
8.0
10.2
1993
0.0
0.0
0.0
0.0
0.4
0.0
0.4
0.4
3.2
3.6
6.7
20.5
22.6
36.8
38.4
68.6
84.7
88.9
10.4
10.1
9.0
11.3
1994
0.0
0.0
0.0
0.5
0.0
0.4
0.0
0.4
2.7
3.5
7.1
5.9
21.4
30.7
42.9
67.
975.4
73.8
9.3
8.8
7.8
9.9
1995
0.0
0.0
0.0
0.0
0.0
0.4
0.8
0.0
0.9
1.4
8.0
8.8
17.5
26.1
38.8
58.1
92.8
82.8
9.0
8.5
7.5
9.5
1996
0.0
0.0
0.0
0.5
0.0
0.0
0.0
0.8
1.3
2.3
3.5
12.8
15.2
26.9
37.
568.5
78.2
88.3
9.1
8.5
7.5
9.5
1997
0.0
0.0
0.0
0.0
0.5
0.0
0.0
0.8
1.3
2.3
7.1
6.9
22.0
31.9
32.3
67.
463.9
76.1
9.0
8.2
7.3
9.3
1998
0.0
0.0
0.0
0.0
0.9
0.0
0.0
0.8
0.8
1.4
7.8
8.7
24.6
25.0
45.7
59.4
78.1
90.8
9.8
8.8
7.9
9.9
1999
0.0
0.0
0.0
0.0
0.0
0.0
0.0
1.6
1.2
1.4
4.0
11.6
25.4
26.2
65.7
71.9
69.
977.
210
.69.
58.5
10.6
2000
0.0
0.0
0.0
0.0
0.0
0.0
0.4
0.0
1.2
2.7
5.8
11.1
16.0
31.3
43.9
62.3
73.4
78.0
9.6
8.5
7.6
9.5
2001
0.0
0.0
0.0
0.0
0.0
0.0
0.0
2.0
2.4
2.2
6.5
11.3
19.2
26.3
29.
551
.158.1
82.5
8.8
7.7
6.8
8.6
2002
0.0
0.0
0.0
0.0
0.0
0.4
0.0
0.8
2.0
4.8
7.5
10.0
17.5
42.2
40.0
45.2
61.3
88.5
9.9
8.6
7.7
9.6
2003
0.0
0.0
0.0
0.0
0.0
0.0
0.0
1.2
0.8
3.4
5.6
6.8
18.6
38.3
39.
060.2
84.9
101.
110
.69.
08.1
10.0
2004
0.0
0.0
0.4
0.0
0.0
0.0
0.0
0.4
1.9
3.3
2.3
10.7
20.6
28.1
42.4
60.1
81.9
94.9
10.4
8.7
7.8
9.7
2005
0.0
0.0
0.0
0.5
0.4
0.4
0.0
0.0
2.7
4.1
8.2
10.4
17.2
29.
154.4
62.2
107.
611
1.9
12.3
10.2
9.3
11.3
2006
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
2.4
2.8
5.4
10.7
17.8
29.
449.
059
.695.7
94.0
11.1
9.2
8.3
10.2
(a)
Stan
dar
dis
ed t
o t
he A
ust
ralia
n 2
001
Sta
ndar
d P
opula
tio
n.
56
Pancreatic Cancer in New South Wales
Tabl
e 11
A
ge-s
peci
fi c a
nd a
ge-s
tand
ardi
sed
(ASR
) m
orta
lity
rate
(pe
r 10
0,00
0) o
f pan
crea
tic
canc
er in
per
sons
, NSW
, 197
2–20
06
Year
Age
gro
up a
t de
ath
(yea
rs)
Cru
de
rate
ASR
(a)
Low
er
95%
C
I
Upp
er
95%
C
I0
-45-9
10-1
415
-19
20
-24
25-2
930
-34
35-3
940
-44
45-4
950
-54
55-5
960
-64
65-6
970
-74
75-7
980
-84
85+
1972
0.0
0.0
0.0
0.0
0.2
0.0
0.0
0.4
2.0
4.1
6.5
13.3
20.7
31.7
43.9
41.1
51.6
57.
05.8
7.8
6.9
8.8
1973
0.0
0.0
0.0
0.0
0.0
0.0
0.6
0.4
2.8
5.1
4.8
14.5
22.6
32.0
48.9
57.
171
.687.
06.7
9.3
8.3
10.5
1974
0.0
0.0
0.0
0.0
0.0
0.0
0.6
1.4
2.1
2.4
12.5
12.5
25.3
39.
749.
851
.268.3
90.1
7.3
9.8
8.8
10.9
1975
0.0
0.0
0.0
0.0
0.0
0.0
0.0
1.0
1.1
4.1
8.8
15.3
23.8
39.
853
.448.8
82.6
107.
87.
510
.29.
111
.3
1976
0.0
0.0
0.0
0.0
0.0
0.0
0.6
0.3
0.7
4.1
8.8
14.9
30.9
32.1
42.3
62.0
74.5
70.5
7.3
9.5
8.5
10.6
1977
0.0
0.0
0.0
0.0
0.0
0.0
0.5
1.6
1.8
3.5
8.8
15.3
24.8
31.1
45.7
57.
886.5
87.
57.
49.
88.8
10.9
1978
0.0
0.0
0.0
0.0
0.0
0.5
0.5
1.0
2.2
4.3
5.6
17.5
27.
931
.843
.551
.983.3
69.
37.
49.
48.4
10.4
1979
0.0
0.0
0.0
0.0
0.2
0.2
0.2
1.5
0.4
2.9
7.7
14.3
17.9
34.5
50.2
54.8
76.6
75.9
7.1
9.1
8.2
10.1
1980
0.0
0.0
0.0
0.0
0.2
0.0
1.0
0.3
1.7
4.9
11.0
13.3
19.1
34.5
39.
361
.583.4
66.3
7.3
9.3
8.4
10.3
1981
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.3
1.3
2.3
6.4
14.0
13.7
25.5
41.8
49.
358.9
79.
06.1
7.7
6.8
8.6
1982
0.0
0.0
0.0
0.2
0.0
0.0
0.2
0.8
1.3
4.1
9.4
15.1
22.2
34.2
49.
460.7
63.5
73.1
7.6
9.4
8.5
10.3
1983
0.0
0.0
0.0
0.2
0.0
0.0
0.0
0.5
0.6
1.5
7.8
12.4
24.8
29.
647.
766.9
63.0
51.3
7.2
8.6
7.7
9.5
1984
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.2
2.1
3.6
5.6
11.3
27.
029.
344.7
70.7
76.7
67.
37.
69.
28.3
10.1
1985
0.0
0.0
0.0
0.0
0.0
0.2
0.0
0.9
1.8
1.7
6.9
12.1
17.5
29.
537.
657.
773.2
100.7
7.1
8.6
7.8
9.5
1986
0.0
0.0
0.0
0.0
0.0
0.2
0.2
0.5
1.4
3.4
8.0
13.2
20.3
28.7
51.5
57.
773.6
103.4
7.9
9.4
8.5
10.3
1987
0.0
0.0
0.0
0.0
0.0
0.2
0.2
0.7
2.6
2.6
9.0
13.4
24.0
32.7
47.
158.8
72.8
89.
78.2
9.5
8.7
10.5
1988
0.0
0.0
0.0
0.0
0.0
0.0
0.2
0.5
2.0
5.1
6.6
13.2
24.2
27.
947.
557.
575.4
70.6
7.9
9.0
8.2
9.9
1989
0.0
0.0
0.0
0.0
0.0
0.0
0.0
1.4
1.2
2.5
7.5
10.0
21.5
31.5
57.
970.4
90.0
90.0
8.7
10.0
9.1
10.9
1990
0.0
0.0
0.0
0.0
0.0
0.4
0.4
0.7
1.2
3.8
10.1
16.7
23.4
26.8
42.2
52.9
71.1
78.4
8.0
9.0
8.2
9.9
1991
0.0
0.0
0.0
0.0
0.0
0.2
0.2
0.9
1.6
2.0
4.4
10.6
25.4
27.
342.6
52.3
72.7
85.6
7.6
8.4
7.7
9.3
1992
0.0
0.0
0.0
0.0
0.2
0.0
0.2
0.7
1.1
3.7
6.3
14.6
22.7
30.0
44.8
51.3
87.
310
8.0
8.5
9.4
8.6
10.3
1993
0.0
0.0
0.0
0.0
0.0
0.0
0.2
0.6
1.1
3.0
6.9
14.3
22.0
36.7
48.2
62.2
84.2
95.8
9.0
9.8
9.0
10.6
1994
0.0
0.0
0.0
0.0
0.0
0.2
0.2
0.6
1.4
2.0
6.0
14.4
19.5
24.5
46.1
68.7
73.4
81.6
8.2
8.9
8.1
9.7
1995
0.0
0.0
0.0
0.0
0.0
0.2
0.2
0.4
1.3
3.1
7.2
9.0
20.4
35.9
38.2
57.
386.4
78.7
8.3
8.8
8.0
9.6
1996
0.0
0.0
0.0
0.0
0.2
0.0
0.4
0.2
1.1
2.5
6.4
10.2
12.9
27.
738.5
73.9
81.2
87.
18.2
8.6
7.9
9.4
1997
0.0
0.0
0.0
0.0
0.0
0.2
0.0
1.2
1.1
2.1
6.2
7.5
16.2
31.9
39.
658.8
63.5
82.2
7.8
8.0
7.3
8.8
1998
0.0
0.0
0.0
0.0
0.0
0.4
0.2
0.4
0.8
2.7
5.3
9.9
20.8
28.1
39.
558.5
73.7
97.
28.4
8.5
7.8
9.3
1999
0.0
0.0
0.0
0.0
0.0
0.0
0.0
1.0
0.6
2.7
6.1
9.5
26.6
26.3
54.3
63.8
79.
389.
19.
49.
38.6
10.1
2000
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.8
1.4
2.0
5.9
10.4
14.2
27.
840.7
63.1
68.8
77.
38.2
8.1
7.4
8.8
2001
0.0
0.0
0.0
0.0
0.0
0.0
0.2
0.4
0.4
4.0
6.0
7.3
17.4
28.5
37.
353
.871
.383.5
8.1
7.9
7.2
8.6
2002
0.0
0.0
0.0
0.0
0.0
0.0
0.2
1.2
1.0
3.7
4.9
10.1
23.0
31.4
41.1
55.5
69.
786.4
8.9
8.6
7.9
9.3
2003
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.2
1.4
2.4
5.3
8.3
18.8
33.3
40.0
52.1
73.0
93.2
8.7
8.3
7.6
9.0
2004
0.0
0.0
0.0
0.0
0.0
0.0
0.0
1.0
1.2
2.3
6.9
10.1
21.8
28.2
42.5
61.6
73.8
92.0
9.4
8.8
8.1
9.5
2005
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.4
1.0
5.2
6.2
10.4
21.3
25.7
51.3
60.9
87.
511
5.1
10.4
9.6
8.9
10.3
2006
0.0
0.0
0.0
0.0
0.0
0.2
0.2
0.0
1.6
3.3
6.5
10.2
17.4
32.9
43.2
67.
792.3
102.5
10.4
9.4
8.8
10.2
(a)
Stan
dar
dis
ed t
o t
he A
ust
ralia
n 2
001
Sta
ndar
d P
opula
tio
n.
57
Tabl
e 12
A
ge-s
peci
fi c a
nd a
ge-s
tand
ardi
sed
(ASR
) m
orta
lity
rate
(pe
r 10
0,00
0) o
f pan
crea
tic
canc
er in
mal
es, N
SW, 1
972–
2006
Year
Age
gro
up a
t de
ath
(yea
rs)
Cru
de
rate
ASR
(a)
Low
er
95%
C
I
Upp
er
95%
C
I0
-45-9
10-1
415
-19
20
-24
25-2
930
-34
35-3
940
-44
45-4
950
-54
55-5
960
-64
65-6
970
-74
75-7
980
-84
85+
1972
0.0
0.0
0.0
0.0
0.5
0.0
0.0
0.0
2.0
5.3
6.8
14.8
27.
445.3
53.1
71.2
43.2
86.4
6.4
10.1
8.4
12.0
1973
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.7
4.0
5.9
8.1
20.0
27.
639.
965.9
78.9
85.8
83.5
7.5
11.8
10.0
13.8
1974
0.0
0.0
0.0
0.0
0.0
0.0
0.6
2.0
3.5
3.3
17.7
17.5
36.9
45.4
61.2
81.1
73.8
151.
68.5
13.5
11.5
15.6
1975
0.0
0.0
0.0
0.0
0.0
0.0
0.0
2.0
2.1
5.3
12.6
14.7
24.4
57.
377.
473.8
118.8
149.
78.6
13.9
11.9
16.1
1976
0.0
0.0
0.0
0.0
0.0
0.0
0.6
0.6
0.7
5.3
7.0
21.0
39.
640.5
58.1
47.
581
.278.6
7.5
10.8
9.2
12.7
1977
0.0
0.0
0.0
0.0
0.0
0.0
0.5
1.9
1.4
2.7
11.8
26.2
35.5
41.8
56.1
62.0
124.8
157.
88.6
13.4
11.4
15.5
1978
0.0
0.0
0.0
0.0
0.0
1.0
0.5
1.2
2.8
4.2
6.9
22.9
39.
140.5
59.5
74.8
128.6
100.3
8.7
13.0
11.1
15.0
1979
0.0
0.0
0.0
0.0
0.5
0.5
0.5
1.8
0.7
2.9
9.0
16.8
23.1
40.4
64.3
91.9
127.
099.
48.0
12.5
10.6
14.5
1980
0.0
0.0
0.0
0.0
0.4
0.0
1.4
0.6
1.3
4.4
16.0
18.7
28.6
51.4
42.6
72.6
103.7
63.5
8.3
11.6
10.0
13.4
1981
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.6
2.0
4.4
9.1
20.0
21.4
34.1
58.6
59.3
66.5
112.7
7.1
10.4
8.8
12.2
1982
0.0
0.0
0.0
0.0
0.0
0.0
0.5
1.6
1.9
4.4
7.8
17.0
24.2
37.
066.8
82.5
105.9
111.
18.1
12.1
10.4
13.9
1983
0.0
0.0
0.0
0.5
0.0
0.0
0.0
0.0
1.2
1.4
8.7
19.7
31.8
38.1
67.
481
.875.7
30.3
8.0
10.6
9.2
12.2
1984
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
1.2
5.6
5.9
15.2
37.
830.6
64.7
99.
686.4
88.2
8.5
11.8
10.2
13.6
1985
0.0
0.0
0.0
0.0
0.0
0.4
0.0
1.4
2.3
2.7
9.7
15.9
25.7
34.5
38.2
76.9
83.6
119.
77.
510
.69.
112
.4
1986
0.0
0.0
0.0
0.0
0.0
0.4
0.5
0.9
1.7
3.9
9.0
13.1
29.
138.2
59.9
83.7
96.8
129.
68.6
12.0
10.4
13.8
1987
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.9
3.1
2.6
11.0
17.6
28.1
37.
552.1
68.1
99.
365.8
8.2
10.8
9.3
12.3
1988
0.0
0.0
0.0
0.0
0.0
0.0
0.4
0.5
2.9
8.1
7.2
15.7
25.4
27.
454.5
79.
274
.910
2.4
8.0
10.8
9.3
12.4
1989
0.0
0.0
0.0
0.0
0.0
0.0
0.0
2.3
1.4
3.6
11.2
12.9
23.7
35.4
70.0
79.
411
3.2
134.0
9.1
12.4
10.8
14.1
1990
0.0
0.0
0.0
0.0
0.0
0.4
0.4
0.9
1.8
4.0
13.6
18.5
31.3
37.
344.5
63.9
97.
612
2.1
8.8
11.6
10.1
13.2
1991
0.0
0.0
0.0
0.0
0.0
0.0
0.0
1.3
0.9
2.2
6.0
10.9
27.
633.2
55.8
62.0
68.9
127.
87.
710
.08.7
11.5
1992
0.0
0.0
0.0
0.0
0.0
0.0
0.4
0.9
1.4
4.7
6.5
16.0
29.
625.9
48.9
60.6
121.
415
7.8
8.5
11.4
10.0
13.0
1993
0.0
0.0
0.0
0.0
0.0
0.0
0.4
0.4
0.5
4.4
8.3
12.7
25.3
38.4
55.7
70.2
92.6
113.4
8.7
10.9
9.5
12.4
1994
0.0
0.0
0.0
0.0
0.0
0.0
0.4
0.0
1.4
2.4
8.0
16.8
20.8
26.3
56.4
64.7
84.4
101.
18.0
9.9
8.7
11.3
1995
0.0
0.0
0.0
0.0
0.0
0.0
0.4
0.4
1.8
3.3
8.3
12.8
25.1
35.5
46.8
61.1
83.7
68.3
8.0
9.5
8.3
10.8
1996
0.0
0.0
0.0
0.0
0.0
0.0
0.8
0.4
1.3
3.2
6.2
9.7
16.2
33.6
38.7
76.5
94.4
59.3
7.5
8.9
7.8
10.2
1997
0.0
0.0
0.0
0.0
0.0
0.4
0.0
0.8
0.9
2.3
7.4
10.1
15.8
36.1
50.1
69.
275.9
87.
67.
99.
38.1
10.5
1998
0.0
0.0
0.0
0.0
0.0
0.8
0.4
0.4
0.9
4.6
5.0
13.1
23.9
30.4
39.
364.2
81.7
134.1
8.3
9.8
8.6
11.1
1999
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.8
0.0
4.5
7.2
11.2
24.0
31.6
53.9
67.
782.3
125.5
9.0
10.3
9.1
11.6
2000
0.0
0.0
0.0
0.0
0.0
0.0
0.0
1.6
2.5
2.7
8.0
13.2
15.2
33.6
39.
964.2
75.7
90.8
8.2
9.1
8.0
10.3
2001
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
6.2
7.3
6.9
21.2
34.2
39.
363.6
96.5
92.8
8.4
9.3
8.2
10.5
2002
0.0
0.0
0.0
0.0
0.0
0.0
0.4
1.6
0.4
3.9
4.6
12.4
24.3
27.
752.6
76.1
80.6
125.8
9.4
10.3
9.1
11.5
2003
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.4
1.2
2.1
6.5
10.3
25.9
35.6
50.6
59.9
76.5
85.5
8.8
9.3
8.3
10.5
2004
0.0
0.0
0.0
0.0
0.0
0.0
0.0
1.2
1.6
2.1
12.0
11.5
29.
030.8
54.2
57.
670.9
95.3
9.5
9.9
8.8
11.1
2005
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.4
0.8
6.7
6.9
16.2
28.6
24.5
51.8
65.1
73.8
124.9
10.0
10.3
9.3
11.5
2006
0.0
0.0
0.0
0.0
0.0
0.4
0.4
0.0
2.0
3.7
6.8
11.6
20.8
42.1
46.6
61.3
97.
812
6.0
10.2
10.4
9.4
11.6
(a)
Stan
dar
dis
ed t
o t
he A
ust
ralia
n 2
001
Sta
ndar
d P
opula
tio
n.
58
Pancreatic Cancer in New South Wales
Tabl
e 13
A
ge-s
peci
fi c a
nd a
ge-s
tand
ardi
sed
(ASR
) m
orta
lity
rate
(pe
r 10
0,00
0) o
f pan
crea
tic
canc
er in
fem
ales
, NSW
, 197
2–20
06
Year
Age
gro
up a
t de
ath
(yea
rs)
Cru
de
rate
ASR
(a)
Low
er
95%
C
I
Upp
er
95%
C
I0
-45-9
10-1
415
-19
20
-24
25-2
930
-34
35-3
940
-44
45-4
950
-54
55-5
960
-64
65-6
970
-74
75-7
980
-84
85+
1972
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.7
2.1
2.8
6.1
11.8
14.6
19.8
37.
223.3
56.1
44.0
5.1
6.1
5.1
7.4
1973
0.0
0.0
0.0
0.0
0.0
0.0
1.3
0.0
1.4
4.1
1.5
9.2
17.9
25.1
36.4
44.2
64.2
88.5
6.0
7.4
6.2
8.7
1974
0.0
0.0
0.0
0.0
0.0
0.0
0.6
0.7
0.7
1.4
7.2
7.6
14.6
34.7
41.2
33.4
65.5
64.1
6.1
7.2
6.1
8.5
1975
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
2.8
5.0
15.8
23.2
24.7
35.2
33.9
64.8
90.5
6.5
7.6
6.5
8.9
1976
0.0
0.0
0.0
0.0
0.0
0.0
0.6
0.0
0.8
2.9
10.6
9.0
23.0
25.0
30.2
70.8
71.3
67.
37.
28.3
7.2
9.7
1977
0.0
0.0
0.0
0.0
0.0
0.0
0.5
1.3
2.3
4.4
5.7
4.7
15.0
22.0
37.
755.2
68.3
60.6
6.3
7.4
6.2
8.6
1978
0.0
0.0
0.0
0.0
0.0
0.0
0.5
0.7
1.5
4.5
4.3
12.3
17.5
24.3
31.1
37.
561
.657.
86.1
6.9
5.8
8.1
1979
0.0
0.0
0.0
0.0
0.0
0.0
0.0
1.3
0.0
3.0
6.4
11.9
13.2
29.
439.
331
.152.4
67.
56.2
6.9
5.8
8.1
1980
0.0
0.0
0.0
0.0
0.0
0.0
0.5
0.0
2.1
5.4
5.8
8.0
10.4
20.1
36.7
54.3
73.5
67.
46.4
7.4
6.3
8.6
1981
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.7
0.0
3.6
8.1
6.7
18.0
29.
042.7
55.1
67.
35.0
5.6
4.7
6.6
1982
0.0
0.0
0.0
0.5
0.0
0.0
0.0
0.0
0.7
3.9
11.1
13.2
20.4
31.8
36.0
46.2
42.3
59.8
7.1
7.7
6.7
8.9
1983
0.0
0.0
0.0
0.0
0.0
0.0
0.0
1.0
0.0
1.5
6.8
5.1
18.3
22.4
32.6
57.
256.5
58.4
6.3
6.8
5.8
7.9
1984
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.5
3.2
1.5
5.4
7.4
16.9
28.1
29.
351
.671
.760.2
6.8
7.2
6.2
8.3
1985
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.5
1.2
0.7
3.9
8.1
9.8
25.1
37.
145.1
67.
894.2
6.7
7.0
6.0
8.1
1986
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
1.2
2.8
7.0
13.4
11.9
20.5
44.9
40.2
61.2
94.4
7.2
7.6
6.5
8.7
1987
0.0
0.0
0.0
0.0
0.0
0.4
0.5
0.5
2.2
2.7
6.9
9.0
20.1
28.5
43.1
52.6
58.5
98.1
8.2
8.4
7.3
9.6
1988
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.5
1.0
2.0
6.0
10.7
23.1
28.3
42.0
42.8
75.7
59.3
7.8
7.8
6.8
8.9
1989
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.5
1.0
1.3
3.7
7.0
19.4
28.0
48.3
64.4
77.
273.9
8.3
8.2
7.2
9.4
1990
0.0
0.0
0.0
0.0
0.0
0.4
0.4
0.5
0.5
3.6
6.4
14.9
15.7
17.4
40.4
45.3
56.3
62.0
7.1
7.2
6.3
8.3
1991
0.0
0.0
0.0
0.0
0.0
0.4
0.4
0.4
2.3
1.7
2.8
10.2
23.3
22.0
32.1
45.5
74.8
69.
57.
57.
46.4
8.4
1992
0.0
0.0
0.0
0.0
0.4
0.0
0.0
0.4
0.9
2.7
6.1
13.2
16.0
33.8
41.5
44.8
68.2
88.6
8.4
8.2
7.2
9.3
1993
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.9
1.8
1.5
5.4
15.9
18.7
35.2
42.0
56.6
79.
488.9
9.4
9.0
8.0
10.1
1994
0.0
0.0
0.0
0.0
0.0
0.4
0.0
1.3
1.4
1.5
3.9
11.9
18.2
22.8
37.
771
.567.
073.8
8.5
8.1
7.1
9.1
1995
0.0
0.0
0.0
0.0
0.0
0.4
0.0
0.4
0.9
2.9
6.1
5.1
15.9
36.4
31.0
54.6
87.
982.8
8.7
8.1
7.1
9.1
1996
0.0
0.0
0.0
0.0
0.4
0.0
0.0
0.0
0.9
1.9
6.5
10.7
9.6
22.1
38.4
71.9
73.4
98.4
8.8
8.2
7.2
9.2
1997
0.0
0.0
0.0
0.0
0.0
0.0
0.0
1.6
1.3
1.9
4.9
4.8
16.5
27.
930.6
51.1
56.1
79.
97.
77.
06.2
8.0
1998
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.4
0.8
0.9
5.7
6.7
17.7
25.8
39.
754.2
69.
081
.78.5
7.6
6.7
8.6
1999
0.0
0.0
0.0
0.0
0.0
0.0
0.0
1.2
1.2
0.9
5.0
7.7
29.
221
.354.8
60.9
77.
573.7
9.8
8.7
7.8
9.7
2000
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.4
1.3
3.8
7.4
13.1
22.3
41.4
62.3
64.6
71.5
8.3
7.2
6.4
8.1
2001
0.0
0.0
0.0
0.0
0.0
0.0
0.4
0.8
0.8
1.8
4.6
7.7
13.5
23.0
35.4
46.2
55.4
79.
47.
96.8
6.0
7.7
2002
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.8
1.6
3.5
5.1
7.8
21.7
34.9
30.7
39.
462.6
69.
08.5
7.4
6.5
8.3
2003
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
1.6
2.6
4.2
6.3
11.7
31.1
30.4
45.8
70.7
96.7
8.7
7.2
6.4
8.1
2004
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.8
0.8
2.5
1.8
8.7
14.6
25.8
31.8
64.9
75.7
90.5
9.3
7.7
6.9
8.6
2005
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.4
1.2
3.7
5.5
4.5
14.0
26.8
50.8
57.
596.7
110.5
10.8
8.9
8.0
9.8
2006
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
1.2
2.8
6.3
8.7
14.1
24.1
40.1
73.0
88.5
91.3
10.5
8.6
7.8
9.6
(a)
Stan
dar
dis
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Table 14 Cases of pancreatic cancers by histological type and age group,1972-2006, and the annual age-standardised (ASR) incidence rate (per 100,000), NSW, 2002–2006
Histology type(a)
Age group at diagnosisTotal No.
of cases% of cases ASR(b)0-49 50-59 60-69 70-79 80+
No. (%) No. (%) No. (%) No. (%) No. (%)
Acinar cell carcinoma <5 7 6 6 <5 24 0.1 <0.1
Adenocarcinoma 535 (7.1) 1296 (17.1) 2446 (32.3) 2393 (31.6) 908 (12.0) 7578 42.2 4.6
Carcinoma/malignant neoplasm 210 (2.4) 683 (7.9) 1762 (20.3) 3033 (34.9) 3012 (34.6) 8700 48.4 4.9
Cystadenocarcinoma 11 (11.6) 12 (12.6) 26 (27.4) 29 (30.5) 17 (17.9) 95 0.5 0.1
Endocrine pancreas tumour 85 (29.0) 76 (25.9) 56 (19.1) 60 (20.5) 16 (5.5) 293 1.6 0.2
Infi ltrating duct carcinoma 6 (4.7) 29 (22.8) 43 (33.9) 43 (33.9) 6 (4.7) 127 0.7 0.2
Mucinous adenocarcinoma 40 (9.1) 85 (19.3) 133 (30.2) 143 (32.4) 40 (9.1) 441 2.5 0.2
Other specifi ed histology 8 (7.2) 14 (12.6) 36 (32.4) 39 (35.1) 14 (12.6) 111 0.6 0.1
Papillary tumour 15 (23.4) 9 (14.1) 9 (14.1) 22 (34.4) 9 (14.1) 64 0.4 <0.1
Undifferentiated carcinoma 44 (8.1) 131 (24.2) 177 (32.7) 144 (26.6) 46 (8.5) 542 3.0 <0.1
(a) See Appendix for details on histology groups.
(b) Standardised to the Australian 2001 Standard Population.
Table 15 Incidence of pancreatic cancer by accessibility and remoteness (ARIA+ category), NSW, 2002–2006
Major Cities Inner Regional Outer RegionalRemote &
Very Remote
Males Cases 1297 406 137 14
Crude rate (per 100,000) 10.8 12.0 12.1 13.6
Age-standardised rate(a) (per 100,000) 12.0 10.8 10.4 13.8
Lower 95% CI 11.4 9.8 8.7 7.4
Upper 95% CI 12.7 11.9 12.4 23.3
Females Cases 1274 407 147 11
Crude rate (per 100,000) 10.3 11.9 13.4 12.2
Age-standardised rate (per 100,000) 9.2 8.8 9.9 12.1
Lower 95% CI 8.7 8.0 8.3 6.1
Upper 95% CI 9.7 9.8 11.6 21.5
Persons Cases 2571 814 283 26(b)
Crude rate (per 100,000) 10.6 11.9 12.8 12.9
Age-standardised rate (per 100,000) 10.4 9.8 10.3 13.2
Lower 95% CI 10.0 9.2 9.1 8.5
Upper 95% CI 10.9 10.5 11.5 19.6
(a) Standardised to the Australian 2001 Standard Population.
(b) Due to the allocation of cases to ARIA+ category using the proportional split for each SLA, there are minor differences in the total number of cases
due to rounding.
60
Pancreatic Cancer in New South Wales
Table 16 Mortality from pancreatic cancer by accessibility and remoteness (ARIA+ category), NSW, 2002–2006
Major Cities Inner Regional Outer RegionalRemote &
Very Remote
Males Deaths 1113 357 115 13
Crude rate (per 100,000) 9.2 10.5 10.3 12.2
Age-standardised rate(a) (per 100,000) 10.4 9.6 8.9 11.5
Lower 95% CI 9.8 8.6 7.3 6.0
Upper 95% CI 11.0 10.6 10.7 19.9
Females Deaths 1104 372 131 10
Crude rate (per 100,000) 9.0 10.9 11.9 11.3
Age-standardised rate (per 100,000) 7.9 8.0 8.6 11.2
Lower 95% CI 7.4 7.2 7.2 5.5
Upper 95% CI 8.3 8.9 10.3 20.4
Persons Deaths 2217 729 246 23
Crude rate (per 100,000) 9.1 10.7 11.1 11.8
Age-standardised rate (per 100,000) 9.0 8.8 8.8 11.8
Lower 95% CI 8.6 8.2 7.8 7.4
Upper 95% CI 9.4 9.5 10.0 17.8
(a) Standardised to the Australian 2001 Standard Population.
Table 17 Incidence of pancreatic cancer by Area Health Service, NSW, 2002–2006
Sydney South West
South Eastern
Sydney & Illawarra
Sydney West
Northern Sydney &
Central Coast
Hunter & New
EnglandNorth Coast
Greater Southern
Greater Western
Males Cases 330 337 219 333 256 164 127 88
Crude rate (per 100,000) 10.1 11.6 8.2 12.5 12.4 14.2 10.8 11.6
Age-standardised rate(a) (per 100,000) 13.1 11.6 11.2 11.9 11.5 11.1 10.1 11.5
Lower 95% CI 11.6 10.4 9.7 10.6 10.1 9.5 8.4 9.2
Upper 95% CI 14.6 12.9 12.8 13.2 13.0 12.9 12.0 14.2
Females Cases 299 348 240 333 239 143 148 89
Crude rate (per 100,000) 9.1 11.8 8.9 11.8 11.4 12.0 12.8 11.9
Age-standardised rate (per 100,000) 9.4 9.6 9.9 8.7 8.7 7.8 9.9 9.6
Lower 95% CI 8.3 8.6 8.7 7.7 7.6 6.6 8.4 7.7
Upper 95% CI 10.5 10.7 11.3 9.7 9.9 9.2 11.7 11.8
Persons Cases 629 685 459 666 495 307 275 177
Crude rate (per 100,000) 9.6 11.7 8.5 12.1 11.9 13.1 11.8 11.8
Age-standardised rate (per 100,000) 11.0 10.6 10.5 10.1 9.9 9.5 10.2 10.6
Lower 95% CI 10.2 9.8 9.6 9.3 9.1 8.4 9.0 9.1
Upper 95% CI 11.9 11.4 11.5 10.9 10.8 10.6 11.5 12.3
(a) Standardised to the Australian 2001 Standard Population.
61
Table 18 Mortality from pancreatic cancer by Area Health Service, NSW, 2002–2006.
Sydney South West
South Eastern
Sydney & Illawarra
Sydney West
Northern Sydney &
Central Coast
Hunter & New
EnglandNorth Coast
Greater Southern
Greater Western
Males Deaths 280 285 189 289 222 142 113 78
Crude rate (per 100,000) 8.6 9.8 7.0 10.8 10.7 12.3 9.6 10.3
Age-standardised rate(a) (per 100,000) 11.1 9.9 9.8 10.3 10.0 9.6 9.0 10.2
Lower 95% CI 9.8 8.7 8.4 9.2 8.7 8.1 7.4 8.0
Upper 95% CI 12.5 11.1 11.4 11.6 11.4 11.3 10.9 12.8
Females Deaths 255 312 201 292 212 128 136 81
Crude rate (per 100,000) 7.7 10.6 7.5 10.3 10.1 10.8 11.8 10.9
Age-standardised rate (per 100,000) 8.0 8.5 8.3 7.5 7.6 6.9 9.1 8.6
Lower 95% CI 7.0 7.6 7.2 6.6 6.6 5.7 7.6 6.8
Upper 95% CI 9.0 9.5 9.5 8.4 8.7 8.2 10.8 10.7
Persons Deaths 535 597 390 581 434 270 249 159
Crude rate (per 100,000) 8.2 10.2 7.3 10.6 10.4 11.5 10.7 10.6
Age-standardised rate (per 100,000) 9.4 9.1 9.0 8.7 8.7 8.2 9.3 9.5
Lower 95% CI 8.6 8.4 8.1 8.0 7.9 7.3 8.1 8.1
Upper 95% CI 10.2 9.9 9.9 9.5 9.5 9.3 10.5 11.1
(a) Standardised to the Australian 2001 Standard Population.
62
Pancreatic Cancer in New South Wales
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