Published 26 Apr, 2018

Introduction:

This measure presents, for the first time, national stage at diagnosis data for the top five incidence cancers (breast (female), colorectal, lung, melanoma, and prostate) in Australia. Stage at diagnosis indicates the extent to which a cancer has spread when first diagnosed and is an important prognostic factor for an individual’s cancer outcomes. It also provides contextual information for interpreting cancer survival and recurrence, and treatment patterns at the population level. The collection of quality national cancer incidence data accompanied by stage at diagnosis enhances our ability to:

  • Understand the respective contributions of stage as compared with other factors (e.g. treatment) to variations in survival; and
  • Help identify and inform where further research and targeted cancer control strategies may impact on tumour types and population groups where cancers may commonly be diagnosed at an advanced stage.

Using data sources that are routinely accessible to all cancer registries, the following analysis presents the proportion of incident cancer cases in 2011 in each category of Registry-Derived stage at diagnosis (RD-Stage), henceforth referred to as ‘stage’. For this measure, the proportion of incident cancer cases in each stage category is also referred to as “stage distribution”. The “distribution of cancer stage” is one of two measures reported on the NCCI website that are related to adult cancer stage at diagnosis. The second measure is the “capture of stage data”. More information about data sources, methods for collection, and guidance for interpreting the data can be found in the ‘About the Data’ tab.

Charts
  • Notes
    • Data are sourced from the Australian Institute of Health and Welfare. More information about data sources can be found in the ‘About the Data’ tab.
    • This analysis presents unadjusted crude proportions of cancer cases for which stage data are available.
    Table caption
    Stage distribution by cancer type and sex, 2011
  • Notes
    • Data are sourced from the Australian Institute of Health and Welfare. More information about data sources can be found in the ‘About the Data’ tab.
    • This analysis presents unadjusted crude proportions of cancer cases for which stage data are available.
    • Data for age-groups 0-39 years were combined due to small numbers.
    • Data for some stage categories that do not appear in the chart have been deliberately suppressed due to small numbers. Caution should be applied in interpreting these proportions, particularly for melanoma and prostate cancer.


    Table caption
    Stage distribution by age and sex, 2011
  • Notes
    • Data are sourced from the Australian Institute of Health and Welfare. More information about data sources can be found in the ‘About the Data’ tab.
    • This analysis presents unadjusted crude proportions of cancer cases for which stage data are available.
    • Analyses by Indigenous status are only available in this report for New South Wales, Victoria, Queensland, Western Australia and Northern Territory, where higher completeness of reporting Indigenous status has been determined by the AIHW in past analyses.
    • Data for some stage categories that do not appear in the chart have been deliberately suppressed due to small numbers. Caution should be applied in interpreting these proportions, particularly for melanoma and prostate cancer.
    Table caption
    Stage distribution by Indigenous status and sex, 2011
  • Notes
    • Data are sourced from the Australian Institute of Health and Welfare. More information about data sources can be found in the ‘About the Data’ tab.
    • This analysis presents unadjusted crude proportions of cancer cases for which stage data are available.
    • Remoteness area of the patient's usual place of residence was defined using the ABS Australian Statistical Geography Standard (ASGS) remoteness structure classification, 2011.
    • Data for some stage categories that do not appear in the chart have been deliberately suppressed due to small numbers. Caution should be applied in interpreting these proportions, particularly for melanoma and prostate cancer.


    Table caption
    Stage distribution by remoteness and sex, 2011
  • Notes
    • Data are sourced from the Australian Institute of Health and Welfare. More information about data sources can be found in the ‘About the Data’ tab.
    • This analysis presents unadjusted crude proportions of cancer cases for which stage data are available.
    • Sex comparisons could not be made for breast and prostate cancer as these cancers only applied to females (in this report) and males, respectively.
    • Socioeconomic group of the patient's usual place of residence defined using the ABS SEIFA Index of Relative Socioeconomic Disadvantage, 2011.
    Table caption
    Stage distribution by SES and sex, 2011
  • Notes
    • Australian data are sourced from the Australian Institute of Health and Welfare. More information about the Australian, Canadian and English data sources can be found in the ‘About the Data’ tab.
    • This analysis presents unadjusted crude proportions of cancer cases for which stage data are available.
    • Data for Australia and England are available at the national level. For Canada, data are not available for Quebec.
    • For Canada, stage at diagnosis data for melanoma are not available.
    • The Canadian data are presented in greater detail than the Australian and English data. For ease of comparison, changes have been made to the publicly available Canadian data as outlined in the 'About the data' tab.
    Table caption
    Stage distribution comparisons - selected countries, 2011-2013

The lack of high quality national cancer staging data is an identified gap in our data knowledge in Australia. As part of the Stage, Treatment and Recurrence (STaR) project, Cancer Australia has worked with population-based cancer registries (PBCRs) and the Australasian Association of Cancer Registries (AACR) to develop nationally-standardised methodologies for collecting stage at diagnosis data. This work has initially focussed on the top five incident cancers (breast (female), colorectal, lung, prostate cancer, and melanoma), for population-level reporting purposes.

Cancer Australia supported the Cancer Council Victoria (CCV) in developing Business Rules for the collection of national cancer stage at diagnosis for invasive tumours based on the Tumour, Node, and Metastases (TNM) staging system as developed and maintained by the American Joint Committee on Cancer (AJCC) in collaboration with the International Union for Cancer Control (UICC). The TNM Staging System is based on the extent of the tumour (T), the extent of spread to the lymph nodes (N), and the presence of metastasis (M). As each cancer type has its own classification system, letters and numbers do not always mean the same thing for every kind of cancer. Once the T, N, and M are determined, they are combined, and an overall stage of 0, I, II, III, IV is assigned1.

Using these Business Rules, all Australian PBCRs have derived cancer stage at diagnosis (RD-Stage) using data sources that are routinely accessible to all cancer registries. RD-Stage at diagnosis is defined as the best estimate of summary TNM stage at diagnosis that can be derived nationally by Australian cancer registries from the data sources available to them. Its purpose will be for population-based analyses, not clinical applications.

RD-Stage has the following values:

  • Stage 1 (equivalent to TNM stage I; Early stage)
  • Stage 2 (equivalent to TNM stage II; Early stage)
  • Stage 3 (equivalent to TNM stage III; Locally advanced)
  • Stage 4 (equivalent to TNM stage IV; Metastatic)
  • Stage unknown
  • Stage not applicable (including tumours with morphologies not eligible for TNM and tumours with no histological confirmation) – These have been excluded for the purpose of this analysis.

This measure presents, for the first time, national stage at diagnosis data for the top five incidence cancers (breast (female), colorectal, lung, melanoma, and prostate) in Australia using data sources that are routinely accessible to all cancer registries. To date, RD-Stage has been collected only for an index year (2011) as this represents the most up-to date cancer incidence data for which 5-year relative survival by stage could be reported in Australia (up to 2016 – data forthcoming). In collaboration with Cancer Australia, the PBCRs and AACR, the Australian Institute of Health and Welfare (AIHW) has combined newly collected information on RD-Stage with information on cancer incidence from the Australian Cancer Database (ACD).

 

Upcoming releases for stage at diagnosis data:

Cancer Australia, the PBCRs, the AACR and the AIHW are also working together to combine incidence by stage at diagnosis with mortality data from the National Death Index (NDI). Once complete, these data will allow for the reporting of national 5-year relative survival rates by stage at diagnosis collected by registries for the first time in Australia. Currently, the only international data for relative survival (1-year) by cancer stage of which we are aware is published by the National Cancer Registration and Analysis Service (NCRAS) in England – These data can be accessed through the ‘References’ tab.

It is anticipated that Australian national 5-year relative survival data by cancer type and stage at diagnosis for the top five incidence cancers will be released on the NCCI website later in 2018. This will be an important opportunity to benchmark survival by cancer stage at diagnosis across comparable populations.

Cancer Australia is also supporting the development of a set of complementary Business Rules for deriving cancer stage at diagnosis for 16 paediatric (childhood) cancer types as well as scoping the development and testing of new business rules for additional cancer types.

The distribution of cancer stage at diagnosis provides an indication of whether a particular cancer type is diagnosed earlier or later. Using data sources that are routinely accessible to all cancer registries, Business Rules were developed to assign cancer stage at diagnosis (as stage 1, stage 2, stage 3, stage 4) for the top five incidence cancers (breast (female), colorectal, lung, melanoma, and prostate cancer). To assist in interpretation, some of the following findings are grouped into early stage cancers (stage 1 and stage 2), locally advanced (stage 3) and metastatic cancers (stage 4).

 

National stage distribution of incident cancer cases diagnosed in Australia in 2011

The distribution pattern of cancer stage at diagnosis varied by cancer type. At least 75% of cancers were diagnosed as early stage (stage 1 or stage 2) for breast (female) and prostate cancer, and melanoma. Colorectal and lung cancer had higher proportions of locally advanced (stage 3) and metastatic cancers (stage 4). Specifically:

  • For breast (female) cancer, over three quarters (77%) of incident cancer cases were diagnosed at an early stage (stage 1, 43%; stage 2, 35%). Locally advanced cancers (stage 3) represented 12%, and metastatic cancers (stage 4) represented 5% of incident cases.
  • For colorectal cancer, almost half (46%) of incident cancer cases were diagnosed at an early stage (stage 1, 22%; stage 2, 24%). Locally advanced cancers (stage 3) represented 24%, and metastatic cancers (stage 4) represented 18% of incident cases.
  • For lung cancer, around one in five (18%) of incident cancer cases were diagnosed at an early stage (stage 1, 12%; stage 2, 7%). Locally advanced cancers (stage 3) represented 11%, and metastatic cancers (stage 4) represented 42% of incident cases. A high proportion of incident lung cancers were not able to be staged (29%)
  • For melanoma, almost all (92%) incident cases were diagnosed at an early stage (stage 1, 78%; stage 2, 14%). Locally advanced cancers (stage 3) represented 3% of incident cases and metastatic cancers (stage 4) represented 2% of cases.
  • For prostate cancer, around four in five (82%) incident cancer cases were diagnosed at an early stage (stage 1, 36%; stage 2, 46%). Locally advanced cancers (stage 3) represented 11% and metastatic cancers (stage 4) represented 4% of cases.

 

National RD-stage distribution by sex and age in 2011

For melanoma, the stage distribution pattern varied by sex with the proportion of stage 1 cancers slightly higher for females than males (81% compared with 76%). For colorectal and lung cancer, there was a similar distribution of stage at diagnosis for both sexes.

The stage distribution pattern varied by age for each cancer type:

  • For breast cancer, the proportion of:
    • Early stage cancers (stage 1 and 2) accounted for around 80% of cancers for females from 45-69 years of age. The highest proportion of early stage cancers were in females aged 60-64 years (83%). For females aged 70 years and older the proportion of early stage cancers decreased with age from 79% to 49%.
    • Locally advanced cancers (stage 3) generally decreased with age to 60-64 years (from 19% to 10%) and remained around 10% for females aged 65 years and over (9% to 12%).
    • Metastatic cancers (stage 4) accounted for 3% to 5% of cancers for females aged up to 69 years. For females 70 years and older the proportion of metastatic cancers ranged between 6% and 8%.
  • For colorectal cancer, the proportion of:
    • Early stage cancer (stage 1 and stage 2) accounted for between 40% and 50% of cancers for persons aged 45 years and older. Slightly lower proportions of early stage cancers were found in persons aged 40-44 years (39%) and under 40 years (36%).
    • Locally advanced cancers (stage 3) accounted for between 26% and 28% of cancers for persons aged less than 60 years of age. For persons aged 60-84 years the proportion of locally advanced cancers was slightly lower ranging between 22% and 25%, and for persons 85 years and over the proportion was 18%.
    • Metastatic (stage 4) cancers accounted for between 23% and 28% for persons less than 50 years of age. For those over 50 years of age the proportion ranged between 15% and 20%.
  • For lung cancer, the proportion of:
    • Early stage cancers (stage 1 and stage 2) generally increased with age from 15% to 23% of cancers for persons aged 50-54 years to 70-74 years. For persons aged 75 years and over, the proportion of early stage cancers decreased with age to 9% for persons aged over 85 years.
    • Locally advanced cancers (stage 3) accounted for between 11% and 15% for persons aged 45-79. For persons aged over 80 years the proportion of cancers was less than 10% (5% to 9%).
    • Metastatic (stage 4) cancers generally decreased with age from 56% to 37% for persons aged 50-54 years to 75-79 years.
    • Lung cancers had a relatively high proportion of cancers where RD-Stage could not be derived. The proportion of cancers with unknown stage at diagnosis generally increased with age from 16% to 45% for persons aged 50-54 years to 85 years and over.
  • For melanoma, the proportion of:
    • Early stage cancers (stage 1 and stage 2) accounted for a high proportion of cancers (91% to 93%) across all age groups. However, the proportion of stage 1 cancers generally decreased with increasing age excepting the 55-59 year old group (83%), and stage 2 cancers increased with increasing age ranging from 5% to 38%.
    • Locally advanced cancers (stage 3) and metastatic cancers (stage 4) each represented less than 4% of cancer cases for each age group.
  • For prostate cancer, the proportion of:
    • Early stage cancers (stage 1 and stage 2) accounted for between 81% and 87% of cancers for 40-84 years of age. However, the proportion of early stage cancers was lower (65%) for males aged 85 years and older.  
    • Locally advanced cancers (stage 3) accounted for between 10% and 15% of cancers for males aged 40-75 years, and decreased from 5% to 2% for males aged 75 years and over.   
    • Metastatic (stage 4) cancers accounted for between 2% and 5% of cancers for males aged  45-80 years. For males 80-84 years of age the proportion of stage 4 cancers was 8%, increasing to 17% for males aged 85 years and over.

For breast and colorectal cancers the stage distribution showed that for those aged 50 years and over, stage 1 cancers generally represented a higher proportion of cases than stage 2 cancers when compared with the younger age-group (less than 50 years) as follows:

  • Breast (female) cancer: 45% of incident cases were stage 1 for females aged 50 years and over compared with 37% for females under 50 years. For females aged 50 years and over 33% were stage 2 cancers compared to 40% for females under 50 years.
  • Colorectal cancer: 22% of incident cases were stage 1 in persons aged 50 years and over compared with 20% for persons under 50 years. For persons aged 50 years and over 25% were stage 2 cancers, compared to 19% for persons under 50 years. There was a similar pattern among males and females when comparing the proportion stage 1 and 2 cancers for those aged under 50 years to those 50 years and over.

 

National RD-stage distribution for Aboriginal and Torres Strait Islander peoples in 2011

Due to the small number of incident cancer cases in a single year (2011), results of analysis by Aboriginal and Torres Strait Islander (henceforth referred to as Indigenous) status should be interpreted with caution. Indigenous status data are only available for cancer incidence data in this report for New South Wales, Victoria, Queensland, Western Australia and the Northern Territory, as these jurisdictions have a higher completeness of Indigenous status recording.

  • There were differences in the distribution pattern of cancer stage at diagnosis for Indigenous and non-Indigenous persons. Indigenous persons tended to have lower proportions stage 1 cancers, and higher proportions of locally advanced and metastatic cancers than non-Indigenous persons, for some cancer types.
    • For breast (female) cancer, Indigenous females had a lower proportion of stage 1 (30% compared to 43%) and a higher proportion of stage 3 (24% compared to 13%) cancers than non-Indigenous females. There were no notable differences in the proportion of stage 2 cancers (36% for both) and metastatic cancers (stage 4; 4% for both) for Indigenous and non-Indigenous females.
    • For colorectal cancer, Indigenous persons had a lower proportion of early stage cancers than non-Indigenous persons (stage 1, 15% compared to 22%; stage 2, 21% compared to 24%). Indigenous persons had a higher proportion of locally advanced cancers (stage 3; 31%) than non-Indigenous persons (24%). Similar patterns were apparent in both sexes when comparing the stage distribution by Indigenous status.
    • For melanoma, Indigenous persons had a lower proportion of stage 1 cancers (55%) than non-Indigenous persons (69%). The proportion of stage 2, locally advanced (stage 3) and metastatic (stage 4) cancers are not examined in detail for melanoma due to small numbers for Indigenous persons. 
    • For prostate cancer, Indigenous males had a lower proportion of stage 1 (27% compared to 33%) and a higher proportion of stage 2 (60% compared to 48%) cancers than non-Indigenous males. Indigenous males also had a lower proportion of locally advanced cancers (stage 3, 7%) than non-Indigenous males (stage 3, 12%). The proportion of metastatic (stage 4) cancers is not examined in detail for melanoma due to small numbers for Indigenous persons.

For lung cancer, Indigenous and non-Indigenous persons had a similar pattern for stage of cancer at diagnosis, but these differed when comparing by sex.

  • Indigenous females had a lower proportion of stage 1 cancers (7%) than non-Indigenous females (13%). Indigenous females had a higher proportion of metastatic cancers (stage 4, 47%) than non-Indigenous females (42%). There were no notable differences between Indigenous and non-Indigenous females for the other cancer stages.
  • Indigenous males had a slightly higher proportion of stage 1 cancers (14%) than non-Indigenous males (11%). Indigenous males had also higher proportion of locally advanced cancers (stage 3, 15%) than non-Indigenous males (11%). There were no notable differences between Indigenous and non-Indigenous males for the other cancer stages.

 

National RD-stage distribution by remoteness area of residence in 2011

There was a similar proportion of early stage, locally advanced and metastatic cancers when comparing Major Cities to Inner and Outer Regional areas. However, there was a clear pattern of Remote and Very remote areas having a smaller proportion of early stage cancers when compared to other remoteness areas.

  • For breast (female) cancer, Remote and Very Remote areas had a lower proportion of stage 1 cancers (36%) than Major Cities (43%) and Inner and Outer Regional areas (44%). There were no notable differences in the proportion of locally advanced (stage 3, between 12% and 13%) and metastatic cancers (stage 4; between 4% and 5%) across remoteness areas.
  • For colorectal cancer, Remote and Very Remote areas had a higher proportion of metastatic cancers (stage 4, 23%) than Major Cities (18%) and Inner and Outer Regional areas (16%). This corresponded with a lower proportion of locally advanced cancers (stage 3) in Remote and Very Remote areas (18%), than Major Cities (24%) and Inner and Outer Regional areas (24%). There were no notable differences in the proportion of early stage cancers (stage 1, between 21% and 23%; stage 2, between 21% and 25%) across remoteness areas.
  • For lung cancer, Remote and Very Remote areas had lower proportion of early stage cancers (stage 1, 9%; stage 2, 5%) than Major Cities (stage 1, 12%; stage 2, 7%) and Inner and Outer Regional areas (stage 1, 11%; stage 2, 6%). There were no notable differences in the proportion of locally advanced (stage 3, between 11% and 13%) and metastatic cancers (stage 4; between 41% and 43%) across remoteness areas.
  • Melanoma cannot be examined for Remote and Very Remote areas due to very small numbers for later stage (stage 3 and stage 4) and unknown stage at diagnosis. For melanoma, Major cities can only be compared to Other Remoteness areas combined. There was a similar proportion early stage cancers for Major Cities (stage 1, 78%; stage 2, 14%) and Other Remoteness areas (stage 1, 79%; stage 2, 14%). There was the same proportion of locally advanced and metastatic cancers for both Major Cities and Other Remoteness areas (stage 3, 3%; stage 4, 2%)
  • For prostate cancer, Remote and Very Remote areas had a lower proportion of stage 1 cancers (28%) than Major Cities (35%) and Inner and Outer Regional areas (38%). There were no notable differences in the proportion of locally advanced (stage 3, between 11% and 13%) and metastatic cancers (stage 4; between 4% and 7%) across remoteness areas.

 

National RD-stage distribution by socioeconomic status in 2011

Across socioeconomic status areas, there were similar stage distribution patterns for each cancer type.

  • For breast (female) cancer, people living in in different SES areas had similarly high proportion of early stage cancers, (stage 1, 40% to 45%; and stage 2, 33% to 37%). In each SES area, there were smaller proportions of locally advanced (stage 3; 11% to13%) and metastatic cancers (stage 4; 3% to 6%);
  • For colorectal cancer, people living in different SES areas had similar proportions of early stage cancers (stage 1, 21% to 23%; stage 2, 23% to 25%) and locally advanced cancers (stage 3; 23% to 24%), but similarly slightly lower proportions of metastatic cancers (stage 4; 16% to 19%).
  • For lung cancer, people living in different SES areas had a similarly low proportions of early stage cancers (stage 1, 11% to 14%; stage 2, 6% to 7%) and locally advanced cancers (stage 3; 11% to12%), but similarly high proportions of metastatic cancers (stage 4; 41% to 44%).
  • For melanoma, people living in different SES areas had a similarly high proportion of early stage (stage 1, 76%  to 79%; stage 2, 13% to16%) with similarly smaller proportions of locally advanced (stage 3; 2% to 4%) and metastatic cancers (stage 4; 2%).
  • For prostate cancer, people living in different SES areas had a high proportion of early stage (stage 1, 32% to 40%; stage 2, 42% to 51%) with smaller proportions of locally advanced (stage 3; 10% to 13%) and metastatic cancers (stage 4; 4% to 5%).
  • Similar distribution patterns of stage at diagnosis were apparent for both sexes when comparing the proportion of cancers staged across SES areas.

 

International benchmarks for national stage distribution

Due to differences in the scope of data collection, methodology and availability of information for staging, the distribution of international stage at diagnosis varies considerably. Differences in methodology for collecting these data will influence the overall stage distribution as this is influenced by number of cases with an unknown stage at diagnosis. They are intended to provide an international context for assessing the Australian data.

More detailed information on stage data for Canada (Canadian Partnership Against Cancer) and England (National Cancer Intelligence Network) is available the ‘References’ tab. In this section, data are presented for Canada using 2013 data, England using 2012 data, and Australia using 2011 data.

The stage distribution pattern for each cancer type varied among countries. Australia had a relatively high proportion of early stage (stage 1 and stage 2) cancers compared to Canada and England.

 

Unit of analysis:

The unadjusted crude proportion of cancer cases for which stage data are available for cases with a principal diagnosis of:

Cancer type*

ICD-10-AM codes

Breast (female)

C50

Colorectal

C18.0, C18.2–C20
  • Colon

C18**
  • Rectal

C19-C20

Lung

C34

Melanoma***

C43

Prostate

C61

*The top 5 incident cancers that were eligible for staging comprise breast (female) cancer (ICD-10 code C50), colorectal cancer excluding appendix (C18.0, C18.2–C20), lung cancer excluding trachea (C34), melanoma of the skin excluding skin of genitals (C43) and prostate cancer (C61). Certain morphology codes that were not eligible for staging are excluded, such as sarcomas, lymphomas or carcinoid tumours.

**Colon cancer (C18) excludes cancer of the appendix (C18.1)

***Excludes melanoma of “unknown primary site”

 

Numerator: Incident cancer cases for a selected RD-Stage at diagnosis value (stage 1, stage 2, stage 3, stage 4, or unknown) for a selected cancer type.

Denominator: All eligible RD-Stage records that were able to be matched to an incident cancer case in the ACD for the relevant cancer type. The denominator includes cases with an "Unknown" stage at diagnosis for which the registry did not have sufficient information to derive stage.

 

Scope:

RD-Stage

RD-Stage at diagnosis is defined as the best estimate of summary TNM stage of diagnosis as derived by cancer registries from data sources available to them. These data will be used for statistical purposes as opposed to clinical management and supporting individual patient care. Clinical requirements for prognostic precision differ from epidemiological requirements for comparability and statistical completeness.2 Specifically, the collection of RD-Stage:

  • Is intended for epidemiological population-based analyses only – in particular, this   information stage at diagnosis will assist in understanding the severity of disease across tumour types and different and sociodemographic groups as well as inform us of patterns of incidence and mortality.

The Business Rules have been tested and reviewed by all states and territories to ensure applicability across all Australian population based cancer registries. The Business Rules have also been endorsed as a national standard for the collection of stage data by the AACR.

 

Australian Cancer Database3

Cancer incidence indicates the number of new cancers diagnosed during a specified time period (usually one year). The major source of national cancer incidence data is the ACD which contains records of all primary, malignant cancers (except basal cell and squamous cell carcinomas of the skin) diagnosed in Australia since 1982.

All Australian states and territories have legislation that makes cancer a notifiable disease. Various designated bodies, i.e., institutions such as hospitals, pathology laboratories and registries of births, deaths and marriages, are required to report cancer cases and deaths to their jurisdictional cancer registries.

Each registry supplies incidence data annually to the AIHW under an agreement between the registries and the AIHW. These data are compiled into the ACD, the only repository of national cancer incidence data.

 

Linkage of RD-Stage and the ACD

The data used for reporting this measure have been created by linkage of data from RD-Stage collection and the ACD. These data are therefore limited to records that have been matched across these two collections. For this analysis, 3.7% records in the RD-Stage collection (approximately 2,500 out of 72,200 cases) have been excluded from these analyses for the following reasons:

  • RD-stage record did not link to the ACD.
  • The RD-Stage record linked to an ACD record that was out of scope.
  • RD-Stage record was ineligible for stage (such as sarcomas, lymphomas or carcinoid tumours)
  • RD-Stage record was a duplicate

A relatively small number of records (approximately 600, less than 1%) records in the ACD were in scope but did not link to the RD-Stage collection. These records did not link because:

  • They had been altered since being submitted to the ACD and were now out of scope; or
  • Applied to melanomas of unknown primary site but not coded as such in the ACD; or
  • Had been staged at a point after diagnosis but not at diagnosis.

 

International data on stage at diagnosis – England and Canada

Data presented for the international comparisons of stage at diagnosis have been sourced from the Canadian Partnership Against Cancer (Canada) and the National Cancer Intelligence Network (England). Data for Australia and England are available at the national level. For Canada, data are not available for Quebec. Further information on the scope, and methodology for collection, and relevant caveats are available through the links under the ‘References’ tab.

The Canadian data are presented in greater detail than the Australian and English data, the following changes have been made to the publicly available Canadian data for ease of comparison:

  • Stage 0 cancers have been excluded from totals and proportions;
  • Sub-stages (e.g. Stage IA, Stage IIB) have been aggregated to Stage 1, Stage 2, Stage 3 and Stage 4, accordingly.
  • For lung cancer, small cell and non-small cell lung cancers have been grouped. Small cell lung cancers represented 13% of staged lung cancers in Canada.
  • Cases where stage data were “not available” have been combined with “Unknown” stage.

 

Data caveats

  • This analysis presents crude proportions that have not been adjusted.
  • Collection of these data has provided an insight into differences in the availability, extent and accessibility of information that is required to derive RD-Stage across Population-based Cancer Registries (PBCRs). Notably, the availability and quality of data accessible to PBCRs was found to improve during the study period.
  • Remoteness area of the patient's usual place of residence was defined using the ABS Australian Statistical Geography Standard (ASGS) remoteness structure classification, 2011. The process for calculating remoteness areas results in some records being split across areas, e.g. a record might be 0.6 Major Cities and 0.4 Inner Regional. The number of incident cases by remoteness, expressed as decimals and aggregated for split records, has been rounded to the nearest whole number. Totals may differ from other demographic breakdowns due to rounding.
  • Socioeconomic group of the patient's usual place of residence defined using the ABS SEIFA Index of Relative Socioeconomic Disadvantage, 2011.
  • Due to the small number of incident cancer cases in a single year (2011), results of analysis by Indigenous status should be interpreted with caution.
  • Analyses by Indigenous status are only available in this report for New South Wales, Victoria, Queensland, Western Australia and Northern Territory, where higher completeness of reporting Indigenous status has been determined by the AIHW in past analyses.

Activity in this area

Cancer Australia, 2008. A National Cancer Data Strategy for Australia. (https://canceraustralia.gov.au/sites/default/files/publications/ncds_final_web1_504af02093a68.pdf).

 

Cancer Australia. The Stage, Treatment, and Recurrence project. (https://canceraustralia.gov.au/research-data/cancer-data/improving-cancer-data).

 

Data

Australian Institute of Health and Welfare.

Australian Cancer Incidence and Mortality (ACIM) books provide incidence and mortality by cancer type and selected demographic groups. (https://www.aihw.gov.au/reports/cancer/acim-books/contents/acim-books).

 

Canadian Partnership Against Cancer.

Provides information on the capture  and distribution of stage data for selected provinces.

(http://www.systemperformance.ca/cancer-control-domain/diagnosis/capture-of-stage/).

(http://www.systemperformance.ca/cancer-control-domain/diagnosis/stage-distribution/). 

 

National Cancer Intelligence Network.

The National Cancer Registration and Analysis Service provides information on cancer survival by stage at diagnosis in England.

(http://www.ncin.org.uk/publications/survival_by_stage).

 

Thursfield V, Farrugia H. Cancer in Victoria: Statistics & Trends 2014. Cancer Council Victoria, Melbourne 2015.

Provides information on prostate cancer stage at diagnosis in Victoria.

http://www.cancervic.org.au/downloads/cec/cancer-in-vic/CCV-statistics-trends-2014.pdf

 

References

  1. American Joint Committee on Cancer. What is cancer staging? Accessed 26 March 2018; https://cancerstaging.org/references-tools/Pages/What-is-Cancer-Staging.aspx

  2. Walters S, Maringe C, Butler J et al. 2013. Comparability of stage data in cancer registries in six countries: lessons from the International Cancer Benchmarking Partnership. Int. J. Cancer: 132; 676-685.

  3. Australian Institute of Health and Welfare. METeOR: Australian Cancer Database 2014; Quality Statement. Accessed 16 February 2018; http://meteor.aihw.gov.au/content/index.phtml/itemId/687104

Summary

A high proportion of cases for breast (female) and prostate cancers and melanomas were diagnosed as early stage cancers

At least 77% of incident cancer cases were diagnosed as early stage (stage 1 or stage 2) for breast (female) and prostate cancer, and melanoma. Colorectal cancer stage at diagnosis was relatively evenly distributed across stage 1, stage 2 and locally advanced (stage 3) cancers. For lung cancer, there were lower proportions of early stage (stage 1 or stage 2) cancers (18%) and relatively high proportions of metastatic cancers (stage 4; 42%).

The distribution pattern for stage at diagnosis for each cancer type varied by age

For colorectal cancer, people aged 50 years and over had a higher proportion of early stage cancers at diagnosis (stage 1 and stage 2) than those aged less than 50 years. For breast cancer, people aged 50 years and over had a higher proportion of stage 1 cancers at diagnosis than those aged less than 50 years. For lung cancer, melanoma, and prostate cancer, persons aged less than 50 years had a higher proportion of stage 1 cancers than persons aged 50 years and over.

Proportions for locally advanced or metastatic cancers tended to be higher for Indigenous persons compared to non-Indigenous persons

Indigenous persons tended to have lower proportions of stage 1 cancers, and higher proportions of locally advanced or metastatic cancers than non-Indigenous persons for breast (female), colorectal and prostate cancer. For lung cancer, the stage distribution pattern by Indigenous status only differed when comparing by sex. These data are only available for New South Wales, Victoria, Queensland, Western Australia and Northern Territory.

The proportion of early stage cancers were lower in Remote and Very Remote areas

For breast (female), colorectal, lung and prostate cancer there were similar proportions of early stage, locally advanced and metastatic cancers when comparing Major Cities to Inner and Outer Regional areas, however Remote and Very remote areas had a lower proportion of early stage cancers. Melanoma cannot be examined for Remote and Very remote areas due to small numbers.

The distribution pattern for stage at diagnosis was similar across socioeconomic status areas for each cancer type

Across socioeconomic status areas, there were similar stage distribution patterns for each cancer type, and similar patterns were apparent across socioeconomic status areas for both sexes.

The stage distribution pattern varied among countries

Australia had a comparable or higher proportion of early stage (stage 1 and stage 2) cancers for most cancer types compared to Canada and England.

In this Measure

Topics

Stage
Stage at diagnosis

Other measures in this indicator

Capture of stage data
Distribution of childhood cancer stage

Related measures

Capture of stage data
Cancer incidence