Public Health Bulletin Edition 1, 2004 - SA Health - SA.Gov.au

Adelaide, north western Adelaide and far southern Adelaide
all had high incidence for lung cancer and cervix cancer,
as did the industrialised rural areas of the Iron Triangle
and the Lower South East. The far north and west of the
state with remote and low SES communities also had
high incidence for cervix cancer.
Breast cancer, melanoma and lymphoma had an
increased incidence in high SES groups; but, importantly,
there is no increased mortality among high SES groups
for any of these cancers. While an SES effect was also
evident for colon and prostate cancer incidence, there
was no clear gradient of incidence from low to high SES
groups, and the effect was not significant.
People living in remote areas had an increased
mortality from four cancers: melanoma, prostate, cervix
and leukemia. Stomach cancer incidence was reduced
in remote areas.
Discussion
This paper highlights some important trends, such
as reduced lung and cervix cancer incidence being related
to increasing SES, and increased breast cancer and
melanoma incidence being related to increasing SES. It
has also shown some new trends in relation to increasing
mortality being associated with remote location for a
number of cancers.
While the relationship between lung and cervix cancer
incidence is widely reported in the literature, it is of
interest that, in South Australia, mortality from cervix
cancer is associated with remoteness rather than with
SES. This association may be partly due to Aboriginal
women having high rates of cervix cancer mortality. Lung
cancer is the only cancer for which there is a consistent
and significant SES effect for both incidence and mortality,
confirming the importance of this cancer in low SES
groups.
The lack of an association between stomach cancer
incidence and death and SES is of interest, given the
previous reporting of such an association 7 . Rather, we
have found a declining incidence of stomach cancer with
increasing remoteness. The low population of migrants
outside the metropolitan area may explain this remoteness
effect, as migrants are a high-risk group for stomach
cancer.
The fact that mortality from four cancers is significantly
higher in remote areas than in the metropolitan area is
of concern. This increase in mortality may be due to poor
detection of cancers such as melanoma and cervix cancer,
or due to country people being less likely to undertake
complex or lengthy courses of treatment, such as those
required for prostate cancer and leukemia.
In conclusion, the mapping of cancer incidence and
mortality data provides further refinement in our
knowledge of South Australian cancer epidemiology. The
need to focus health promotion efforts for cervix cancer
on rural, low SES communities is very clear. Also the
fact that people in rural communities are dying from some
cancers at a higher rate than people in metropolitan
communities, may have implications for the provision of
treatment services for these cancers.
References
1. South Australian Cancer Registry. Epidemiology of
cancer in South Australia. Adelaide: South Australian
Cancer Registry, 2001.
2. Devesa SS, Grauman DJ, Blot WJ, Pennello G, Hoover
RN, Fraumeni JF Jr. Atlas of cancer mortality in the
United States, 1950-94. Washington, DC: US Govt Print
Off, 1999; NIH Publ No. 99-4564.
3. Australian Bureau of Statistics: 1998 Australian standard
geographical classification. Canberra: Australian Bureau
of Statistics, 1998.
4. Australian Bureau of Statistics: 2001 census of
population and housing: Socio-economic indicators for
areas. Canberra: Australian Bureau of Statistics, 2002.
5. Australian Bureau of Statistics: 2001 census of
population and housing: Australian remoteness
indicators for areas. Canberra: Australian Bureau of
Statistics, 2002.
6. StataCorp 2003 Stata Statistical Software: Release
8.0. College Station, Texas: Stata Corporation.
7. Howard G, Anderson RT, Russell G et al. Race,
socioeconomic status, and cause-specific mortality.
Ann Epidemiol. 2000; 10: 214-23.
8. Williams J, Clifford C, Hooper J et al. Socioeconomic
status and cancer mortality and incidence in Melbourne.
Eur J Cancer. 1991; 27: 917-21.
Two of the cancers that show an increased incidence
with increasing SES are breast cancer and melanoma,
cancers for which screening and medical detection are
important. This association is widely reported in the literature,
and often is found in other cancers such as colon/rectum
and prostate cancers 8 . Both those latter cancers show a
SES trend which is near significance in this study.
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