Ministry of Health



Cancer Projections

Incidence 2004–08 to 2014–18

Ministry of Health. 2010. Cancer Projections: Incidence 2004–08 to 2014–18. Wellington: Ministry of Health.

Published in January 2010 by the

Ministry of Health

PO Box 5013, Wellington, New Zealand

ISBN 978-0-478-33996-3 (online)

HP 5029

This document is available on the Ministry of Health’s website:



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Contents

Authorship and Acknowledgements v

Executive Summary vi

Introduction 1

Background 1

Method 1

Reporting 5

Updated Projections: Summary of Key Findings 6

Projections of total cancer registrations 9

How similar are the updated and the earlier projections? 9

Updated Projections by Site 10

References 36

Appendix: Prostate Cancer Incidence 37

List of Tables

Table 1: Projected percentage change in incidence, by site and sex, 2004–2008 to 2014–18 6

Table 2: Cancer sites for which ‘major’ change in incidence ASR is projected from 2006 to 2016 7

Table 3: Key incidence projection results for selected sites, 2006 to 2016 8

Table 4: Updated projected total cancer count,* annualised average, 2016 9

List of Figures

Figure 1: All adult cancer 10

Figure 2: Childhood cancer 11

Figure 2a: Childhood leukaemia 12

Figure 3: Bladder cancer 13

Figure 4: Bone and connective tissue cancer 14

Figure 5: Brain cancer 15

Figure 6: Colorectal cancer 16

Figure 7: Gallbladder cancer 17

Figure 8: Hodgkin’s disease 18

Figure 9: Kidney cancer 19

Figure 10: Laryngeal cancer 20

Figure 11: Leukaemia 21

Figure 12: Lip, mouth and pharynx cancer 22

Figure 13: Liver cancer 23

Figure 14: Lung cancer 24

Figure 15: Melanoma 25

Figure 16: Myeloma 26

Figure 17: Non-Hodgkin’s lymphoma 27

Figure 18: Oesophageal cancer 28

Figure 19: Pancreatic cancer 29

Figure 20: Stomach cancer 30

Figure 21: Thyroid cancer 31

Figure 22: Male cancers 32

Figure 23: Female cancers I 33

Figure 24: Female cancers II 34

Figure 25: Cancer of all other sites 35

Figure 26: Prostate cancer registrations: estimates and projections by age 38

Figure 26a: Prostate cancer registrations (estimates and projections), by individual five-year age group 39

Authorship and Acknowledgements

The modelling was done and the report written by Robert Templeton, Martin Tobias and Anna Davies (Health and Disability Intelligence, Health and Disability System Strategy Directorate, Ministry of Health). The authors would like to acknowledge constructive input from the peer reviewers: John Childs, Tony Blakely, Simon Bidwell, Deborah Woodley, Susan Hanna, Simon Ross and Helen Jones.

Executive Summary

This report updates the cancer incidence projections produced by the Ministry in 2001 (Ministry of Health 2002) and first updated in 2006 (Ministry of Health 2007), using newly available data for the 2004–2006 period. The main projection method has not been changed.

For a more complete view of the projected burden of cancer, both previous reports should be consulted, together with reports on the projected mortality from cancer (Ministry of Health 2002, 2008, 2009).

Overall, the risk of cancer is projected to stabilise over the coming decade (2006–2016) for males and actually decline, by about 11%, for females. Nevertheless, the burden of incident cancers will still increase, by about 29% for males and 12% for females, as a result of demographic trends (increasing size and older age structure of the New Zealand population).

This projected stabilisation or decline in the risk of cancer represents a notable public health success story, coming as it does after half a century (or more) of steadily increasing incidence rates. Substantial risk reductions are projected for tobacco-related cancers in males with stabilisation or lesser reduction in females. Among non-tobacco related cancers, substantial risk reductions are projected for colorectal cancer in both sexes (even without an organised screening programme), stomach cancer (both sexes) and cervical and ovarian cancers in females.

By contrast, continuing increases in risk are projected for thyroid cancer (both sexes), primary liver cancer (both sexes), and lymphomas and prostate cancer in males (the latter even excluding the impact of PSA testing).

Importantly, breast cancer risk is projected to stabilise, while the risk of melanoma is projected to stabilise in males and may actually decline slightly in females.

Introduction

Background

Projections of cancer incidence (and mortality and survival) are useful for making investment decisions in cancer treatment facilities and in planning for the oncology workforce, and can also contribute to the formulation and evaluation of cancer control policy (Black and Stockton 2001; McDermid 2005; Moller et al 2002).

In 2001 the Ministry of Health prepared incidence and mortality projections for 26 types of cancer, forecasting from 1994–98 or 1995–99 (as the most recent five-year period for which cancer registration or mortality data were then available) out to 2009–13 or 2010-14 respectively (Ministry of Health 2002). This work was undertaken on behalf of the Cancer Control Taskforce to inform the development of the Cancer Control Strategy (Ministry of Health 2003).

A further five years’ registration data became available in 2007 (covering 1999–2003), allowing the incidence projections to be updated to 2009–13 (Ministry of Health 2007). Rather than waiting another five years before carrying out the next update, we have introduced a dual projection method. This allows us to carry out a short-term projection (two years) given an additional three years of data, so deriving estimates for the next five-year period. We then use this new data to derive a long-term projection for the next decade, exactly as before. As we now have cancer incidence data for 2004–06, we used the short-term projection methodology to give us new data for the five-year period 2004–08, and then applied our long-term projection methodology to produce projections out to 2014–18. Using this dual approach, we will be able to update the cancer incidence projections three- rather than five-yearly in future.

A similar approach has been adopted to enable the cancer mortality projections to be updated (reported separately). Both the updated incidence and mortality projections should be used in tandem, along with estimates and projections of cancer survival (also reported separately) to obtain the full picture of the projected cancer burden. For example, the updated projections can be used for modelling future capacity requirements for oncology services, along with work currently being done by the Ministry in relation to oncology workforce projections. The updated cancer incidence projections will also feed in to a cancer burden of disease study being undertaken jointly by the Ministry and the University of Otago. This study will provide the epidemiological input into a tool (currently under development) for evaluating the cost effectiveness of cancer-related interventions.

Method

In updating the projections we have been careful to avoid ‘method drift’ so as to ensure comparability with our earlier projections. We have, however, incorporated revisions made by the New Zealand Cancer Registry to the incidence data for some cancers (in particular bladder cancer), and have used updated population projections (based on the 2006 rather than the 2001 Census) provided by Statistics New Zealand.

Bladder cancer rates have been revised to reflect a change in cancer registration practice from 2005, whereby superficial (non-invasive) bladder cancers are no longer included. That is, rates prior to 2005 have been adjusted (downwards) to reflect the ratio of non-invasive to invasive cancers reported to the New Zealand Cancer Registry in the 2005–06 period. This adjustment assumes that this ratio has remained stable over time.

In addition to projecting ‘all childhood cancers’, projections of childhood leukaemia (acute lymphoblastic leukaemia, ALL) have been added. ALL comprises approximately one-third of all childhood cancers; even so, counts for boys and girls had to be pooled to generate stable rates.

Projections of prostate cancer incidence could not be updated (although they have been extended), as these are based only on data up to 1984–88. This constraint has been imposed in order to avoid the discontinuity resulting from the widespread use of prostate specific antigen (PSA) testing since the late 1980s and early 1990s. ‘All adult cancer’ for males therefore also excludes the ‘PSA effect’. Once prostate cancer incidence returns to its ‘pre PSA’ level or thereabout (see Appendix), updating will become possible once again.

Note that ‘all adult cancer’, ‘childhood cancer’ and ‘adult cancer of all other sites’ are very heterogeneous categories. Trends in the incidence of these sites should therefore be interpreted cautiously as they may reflect divergent trends in the mix of specific cancers included in the respective category.

We have not extended the new projections out beyond two five-year periods, that is, 2014–18 (henceforward ‘2016’) as our earlier experience revealed that a projection horizon of more than 10 years yields estimates that are too uncertain to be useful for planning.

For technical information relating to the cancer incidence and population data, the selection of cancer sites, and the age/period/cohort modelling methodology used for the long-term projections, please see our earlier report (Ministry of Health 2002). A brief summary of the regression modelling approach is provided here (Box 1), and the short-term projection methodology is outlined in Box 2.

Box 1: Long-term projection methodology

Cancer incidence rates can be thought of as realisations of three time dimensions: age (at diagnosis), period (calendar year of diagnosis) and cohort (year of birth). Given a sufficiently long historical time series of cancer incidence data, statistical models can be constructed to project incidence based on the historical pattern of age, period and cohort effects.

Model identification

The approach adopted was to fit the data by five year period from 1952-56 to 2004-08 for each cancer by five-year age group (the method requires data aggregated by five year period and age group, so generating ten year overlapping cohorts) to four different models: generalised linear models (the classical age/period/cohort or APC models); non-parametric generalised additive models (GAM models); non-linear models developed by Dyba and Hakulinen (so-called DH models); and Bayesian versions of APC models using second differences as autoregressive priors for the parameters, fitted using markov chain monte carlo (MCMC) methods (Bayesian Age-period-cohort Modelling and Prediction or BAMP models).

Model selection

For each cancer, all four models were fitted and then tested using measures of goodness of fit and ex-post tests. Those models that failed either or both statistical tests were eliminated. Note that the number and type of models finally used thus differed depending on the particular cancer.

Model averaging

Final fitted values (for each cancer) were calculated as the mean of the modelled number of cases, for each age-period combination, of the models finally selected and fitted for each cancer.

Projection

Once the final set of models for each cancer had been determined, the models were then fitted again using all available data together with the short-term projected data for 2007 and 2008 (see Box 2 below).

For the BAMP, GAM and DH models, projections are ‘automatically’ obtained by extending the modelled risk surface to future time periods using the fitted parameters.

To project the classical APC models, however, an assumption had to be made that the age effects would remain stable (which is usually accepted as a reasonable assumption), so that the fitted age parameters could be used for projection. Future period and cohort effect parameters were estimated by fitting a linear regression model to the three most recent period or cohort parameters and then extrapolating the next two. This assumes that the recent observed period and cohort trends will continue unchanged into the future, which is a strong assumption and somewhat limits the usefulness of APC models for projection.

Uncertainty estimation

A BAMP 90% credible interval was obtained during the model fitting process. This includes both uncertainty associated with the Bayesian model and random fluctuations in the data. Such credible intervals are generally acknowledged to be wide, thereby providing a conservative estimate of uncertainty for the projection obtained through the model averaging process.

Note that the credible interval is not centred about the average projection (for each cancer) but about the BAMP projection. Hence we show both the 90% credible interval (purple coloured area in figures 1-25) and the highest and lowest rates obtained from the individual models selected for each cancer (broken red lines in figures 1-25).

Box 2: Short-term projection methodology

Our projection method is based on data aggregated into five-year periods (see Box 1). For cancer incidence, the most recent five-year period is 2004–08, but the two most recent years of data (2007, 2008) are not available yet. In order to make sure all the latest registration data (that is, all years up to and including 2006) is used to help make the best projections, we estimate the number of cancer registrations for 2007 and 2008. This then gives us a new five-year period, 2004–08 (henceforth ‘2006’), to use in our long-term projections (so enabling the long-term projection horizon to extend out to

2014–18 (henceforth ‘2016’).

To carry out the short-term projection (that is, in this case, to derive estimates for cancer incidence in 2007 and 2008) we use the forecasts for the ‘missing years’ 2007 and 2008 from the previous round of long-term projections, for which data up to 2003 was available, as the starting point. We then adjust these earlier projections to account for the observed forecast errors from the years 2004, 2005 and 2006.

Suppose [pic] the original forecast number of cancer registrations for year = t+i and [pic] the observed number of cancer registrations for year = t-j, then the estimated number of cancer registrations for year t+i is

[pic]

So for the most recent five-year period the number of cancer registrations is

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Reporting

The updated projections from 2006 to 2016 are presented in summarised form in the body of the report (in alphabetical order, except for some sex-specific cancers and ‘all other sites’). Full results are available from the authors. Box 3 provides a guide to interpreting the tables and charts.

We also present a brief summary of the key findings (page 6).

The appendix (page 37) provides a more detailed analysis of prostate cancer incidence estimates and projections.

Box 3: Interpreting Figures 1–25 and associated tables

Except for sex-specific sites, projections for males are shown on the left and females on the right.

The upper charts show empirical data points and fitted and projected models for incidence rates by age group. (All rates are per 100,000.)

The lower charts show empirical data points and the fitted and projected models for age standardised incidence rates (standardised by the direct method to the World Health Organization [WHO] World Standard Population).

The solid red line is the updated projection.

The broken lines show the highest and lowest rates obtained for the individual models that were averaged to obtain the final updated projection (the red line) for each cancer site.

The purple coloured space shows the 90% Bayesian credible interval, used to represent the ‘prediction interval’ or uncertainty around the updated projection (ie, uncertainty around the red line).

The tables below the charts show rates (upper tables) and counts (lower tables) by age group, for 2004–2008 (‘2006’, most recent data available) and for 2014–2018 (‘2016’, the projection horizon), and the percentage change between these two dates (that is, over the next decade).

Note that the 2004–2008 estimates shown are not the empirical (observed) data for these years, but rather the estimate for this period obtained from the fitted model. This approach is taken to reduce the stochastic noise inherent in the observed data. As a consequence, the percentage change shown in the table will be slightly different from that obtained by simply comparing the observed data for 2004–2008 with the projection for 2014–2018.

Also note that the data for 2007 and 2008 are not in fact observed (empirical) data, but are short-term forecasts derived as explained in Box 2 above.

Finally, note that the age standardised rates for adult cancers reported here are for the age group 15+ years. These rates differ from the age standardised cancer registration rates published in Cancer: New registrations and deaths 2006 (Ministry of Health 2010), which include all ages (0+ years).

Updated Projections: Summary of Key Findings

Updated projections by cancer site (largely in alphabetical order) are provided in Figures 1–25 and their associated tables. Key results are summarised in four tables below.

Table 1: Projected percentage change in incidence, by site and sex, 2004–2008 to 2014–18

|Site |Male (%) |Female (%) |

| |ASR |Total count |ASR |Total count |

|All adult |-3 |29 |-11 |12 |

|Childhood |-11 |-9 |6 |9 |

|Bladder |-11 |24 |-12 |15 |

|Bone and CT |-8 |15 |-11 |8 |

|Brain |0 |24 |-10 |8 |

|Breast | | |-1 |23 |

|Cervix | | |-28 |-21 |

|Colorectal |-17 |15 |-12 |19 |

|Gallbladder |-14 |17 |-4 |24 |

|Hodgkins |28 |46 |21 |29 |

|Kidney |9 |41 |3 |32 |

|Laryngeal |-33 |-10 |-8 |18 |

|Leukemia |-1 |32 |-1 |28 |

|Lip, mouth |-6 |20 |-3 |21 |

|Liver |23 |61 |16 |47 |

|Lung |-26 |-1 |-3 |27 |

|Melanoma |1 |32 |-7 |18 |

|Myeloma |-6 |27 |-15 |11 |

|NHL |11 |44 |0 |28 |

|Oesophageal |1 |36 |-9 |20 |

|Ovary | | |-14 |6 |

|Endometrium | | |8 |38 |

|Pancreatic |-13 |18 |-2 |27 |

|Prostate |23 |71 | | |

|Testis |2 |10 | | |

|Stomach |-19 |6 |-15 |7 |

|Thyroid |22 |45 |31 |51 |

|All Other |-22 |7 |-29 |-9 |

Percentage change estimated from fitted (smoothed) estimates, not empirical estimates, for 2000–2004.

ASR = age standardised rate per 100,000 (directly standardised to the WHO World Population).

All adult cancer for males excludes prostate cancers diagnosed solely by PSA testing (the ‘PSA effect’).

Table 1 shows that the overall risk of being diagnosed with cancer is projected to reduce slowly in females, reducing by approximately 11% over the decade. Among males, the overall risk of cancer – excluding the ‘PSA effect’ – is projected to remain stable (or decline very slightly). At the same time the burden (count) of new cancer patients is projected to increase by about 12% in females and a more substantial 29% in males, reflecting the offsetting effect of demographic trends (the expected increase in size and structural ageing of the New Zealand population).

Cancer sites projected to show ‘major’ changes in incidence risk (ASR) or burden (total count) over the next decade (2006–2016) are summarised in Table 2 below.

Table 2: Cancer sites for which ‘major’ change in incidence ASR is projected from 2006 to 2016

| |Male |Female |

|>10% increase in risk* |Hodgkins |Hodgkins |

| |Liver |Liver |

| |NHL |Thyroid |

| |Prostate | |

| |Thyroid | |

|>40% increase in burden** |Hodgkins |Liver |

| |Kidney |Thyroid |

| |Liver | |

| |NHL | |

| |Prostate | |

| |Thyroid | |

|>10% decrease in risk* |Colorectal |Bone |

| |Gallbladder |Cervix |

| |Larynx |Colorectal |

| |Lung |Myeloma |

| |Pancreas |Ovary |

| |Stomach |Stomach |

|>10% decrease in burden** | |Cervix |

Childhood cancer, all adult cancer and adult cancer in ‘all other sites’ are excluded from this table as these are heterogenous categories.

* Risk = age standardised rate.

** Burden = total count.

Several cancers are projected to reduce by >10% in risk over the decade, including colorectal cancer in both sexes (even in the absence of an organised screening programme), cervical cancer in females (as a result of screening, not immunisation against HPV), and lung cancer in males (reflecting the differential phasing of the tobacco epidemics between the sexes). Because of demographic trends, however, no cancer actually decreases substantively in burden (count of new cases per year) except for cervical cancer.

By contrast, several cancers are projected to buck the overall trend and continue to increase in incidence. These include primary liver cancer and thyroid cancer in both sexes and lymphomas and prostate cancer in males (the latter even after ‘correction’ for the ‘PSA effect’). Although relatively rare, primary liver cancer and thyroid cancer have been steadily increasing in both sexes for at least half a century. While the former may be related mainly to persistent infection with hepatitis B virus, the cause of the latter is unknown. The sharp rise in NHL noted in previous reports is projected to continue in males, while risk of NHL is projected to increase more slowly in future in females. Again the reason for this trend, or the projected sex difference in the trend, is unknown.

Table 3 below summarises the key incidence projection results for the major cancer sites and those of special policy interest.

Table 3: Key incidence projection results for selected sites, 2006 to 2016

|Selected site |Comment |

|Colorectal |Rates are projected to decline in all age groups except 75+ for both sexes, falling overall by approximately |

| |one-quarter in the 45–74 age group. This occurs without an organised screening programme. |

| |Burden still increases, however (by about 15%), because of offsetting demographic effects. |

|Lung |Rates continue their steady long-term decline in males (all ages), falling by one-quarter over the decade. As a |

| |result, overall burden remains stable. |

| |Trends in incidence rates vary by age group among females, most notably increasing substantively (~15%) in young |

| |adults, but the overall outcome is stability. However, female and male rates most probably will not cross over by |

| |the projection horizon. |

| |Given stable rates, burden must increase for females – an increase of one-quarter is projected over the decade. |

|Melanoma |Trends in rates are projected to vary by age among males, decreasing in younger and increasing in older age groups |

| |(most probably reflecting cohort effects), such that the overall rate remains stable and the total burden increases|

| |by one-third. Note, however, that the credible interval around these projections is exceptionally wide (reflecting|

| |the very divergent trends by age group). |

| |Female rates are projected to decline in all age groups except the oldest, so the overall rate falls slightly. The|

| |burden increases by about one-sixth overall. |

|Breast |Rates are projected to fall among women younger than 45 years of age, remain stable in those aged 45–74 year olds |

| |and increase slightly in those aged >75 years, with the result that the overall rate remains stable. This reflects|

| |the complex interaction of underlying epidemiological trends with the impact of screening. |

| |Total burden nevertheless increases by about one-fifth, reflecting the impact of demographic trends. |

|Cervix |Both rates and counts are projected to continue to fall sharply, although exact estimates are imprecise because of |

| |relatively small numbers. |

| |This is entirely due to the ongoing effect of the screening programme (insufficient time has elapsed for HPV |

| |immunisation to have had a measurable impact on incidence). |

| |The steady decline in cervical cancer incidence (since the introduction of the National Cervical Screening |

| |Programme) is a notable public health success story. |

|Prostate |Rates are projected to increase slowly, even after correcting for the impact of opportunistic PSA screening, with |

| |the result that the burden of new cases is expected to increase by approximately 70% (and would more than double if|

| |cases detected solely by PSA screening were included). |

| |The steep increase in burden reflects the impact of population ageing in particular, as this cancer has a |

| |particularly right-shifted age distribution. |

| |See the appendix to this report for more details. |

Projections of total cancer registrations

Table 4 summarises the updated projections for the total cancer count (all sites combined) in 2016, derived independently by two methods:

1. using the ‘all adult cancers’ model (that is, treating all cancers as a single ‘site’)

2. summing the total counts projected for each separate site (that is, sum of all sites other than ‘childhood cancers’).

Table 4: Updated projected total cancer count,* annualised average, 2016

| |Male* |Female |Total |

|Derived from ‘all adult cancer’ model |11,893 |10,049 |21,942 |

|Derived by summing across all individual cancer sites |11,655 |10,388 |22,043 |

|Difference (%) |238 (2%) |-339 (-3%) |-101 (0%) |

* Excludes ‘PSA effect’.

As Table 4 shows, the two counts agree closely (within 3% by sex and within 1% overall), which provides a valuable test as to the internal consistency of the models.

How similar are the updated and the earlier projections?

The updated (2009) projections can be compared with those produced in 2006 with respect to their respective forecasts for 2011, the projection horizon for the earlier set.

In brief, both sets of projections agree closely, except for six sites where the updated projection (age standardised rate) lies below the 90% credible interval of the corresponding earlier projection. These sites are ovary, adult leukaemia, kidney and non-Hodgkins lymphoma in females, and adult leukaemia and childhood cancers in males. Changes in ICD classification or coding may explain these findings, at least for ovarian cancer and adult leukaemia.

Updated Projections by Site

Figure 1: All adult cancer (excluding ‘PSA effect’)

[pic]

|All adult |Age |Male |Female |

|sites | | | |

| | |Observed 2006 |Projected 2016 |Projected % |Observed 2006 |Projected 2016 |Projected % |

| | | | |change | | |change |

|Rates |15–24 |29 |24 (12,36) |-15 |24 |18 (10,26) |-27 |

| |25–44 |94 |90 (67,94) |-5 |158 |138 (100,158) |-13 |

| |45–64 |511 |519 (428,604) |2 |648 |579 (425,664) |-11 |

| |65–74 |1,919 |1,798 (1430,2097) |-6 |1,351 |1,210 (871,1399) |-10 |

| |75+ |3,669 |3,726 (2840,4016) |2 |1,928 |1,837 (1312,2065) |-5 |

| |Total |463 |448 (360,489) |-3 |408 |364 (268,408) |-11 |

|Counts |15–24 |87 |77 (37,117) |-12 |71 |53 (30,75) |-26 |

| |25–44 |535 |519 (384,542) |-3 |968 |837 (604,958) |-14 |

| |45–64 |2,508 |2,955 (2436,3437) |18 |3,288 |3,521 (2586,4036) |7 |

| |65–74 |2,554 |3,440 (2737,4014) |35 |1,930 |2,476 (1783,2863) |28 |

| |75+ |3,510 |4,902 (3737,5284) |40 |2,696 |3,162 (2258,3554) |17 |

| |Total |9,195 |11,893 (9550,12997) |29 |8,953 |10,049 (7378,11246) |12 |

Figure 2: Childhood cancer

[pic]

|Childhood |Age |Male |Female |

| | |Observed 2006 |Projected 2016 |Projected % |Observed 2006 |Projected 2016 |Projected % |

| | | | |change | | |change |

|Rates |0–4 |

| |Age |Observed 2006 |Projected 2016 |Projected % change |

|Rates |0–4 |8 |8 (6,11) |-2 |

| |5–9 |4 |5 (4,7) |15 |

| |10–14 |3 |3 (2,4) |8 |

| |Total |5 |6 (4,7) |5 |

|Counts |0–4 |24 |24 (18,33) |2 |

| |5–9 |13 |16 (12,21) |22 |

| |10–14 |10 |10 (7,13) |4 |

| |Total |47 |50 (39,63) |8 |

Figure 3: Bladder cancer

[pic]

|Bladder |Age |Male |Female |

| | |Observed 2006 |Projected 2016 |Projected % |Observed 2006 |Projected 2016 |Projected % |

| | | | |change | | |change |

|Rates |25–44 |1 |0 (0,1) |-32 |0 |0 (0,0) |-42 |

| |45–64 |9 |8 (8,12) |-8 |3 |3 (2,4) |8 |

| |65–74 |56 |47 (41,63) |-16 |14 |11 (11,18) |-22 |

| |75+ |134 |130 (110,165) |-3 |36 |34 (29,47) |-7 |

| |Total |12 |11 (10,14) |-11 |3 |3 (3,4) |-12 |

|Counts |25–44 |3 |2 (2,4) |-31 |2 |1 (1,2) |-42 |

| |45–64 |45 |48 (43,68) |6 |13 |17 (15,26) |29 |

| |65–74 |74 |90 (79,120) |21 |20 |22 (22,36) |11 |

| |75+ |129 |172 (145,217) |33 |51 |58 (51,82) |14 |

| |Total |251 |311 (276,401) |24 |85 |98 (91,141) |15 |

Note: Counts for 1956–2004 have been adjusted to reflect the ratio of non-invasive to invasive cases in 2005–06. This adjustment introduces an additional source of uncertainty into the projections (not reflected in the credible interval).

Figure 4: Bone and connective tissue cancer

[pic]

|Bone |Age |Male |Female |

| | |Observed 2006 |Projected 2016 |Projected % |Observed 2006 |Projected 2016 |Projected % |

| | | | |change | | |change |

|Rates |15–24 |3 |2 (1,3) |-19 |2 |2 (1,2) |-20 |

| |25–44 |3 |2 (2,3) |-9 |2 |2 (1,2) |-11 |

| |45–64 |6 |5 (4,7) |-5 |4 |3 (2,4) |-9 |

| |65–74 |12 |12 (8,16) |-6 |7 |7 (4,9) |-7 |

| |75+ |22 |22 (17,30) |-2 |11 |11 (8,15) |-7 |

| |Total |5 |5 (3,5) |-8 |3 |3 (2,3) |-11 |

|Counts |15–24 |8 |7 (4,8) |-15 |6 |5 (3,6) |-19 |

| |25–44 |15 |14 (9,16) |-7 |11 |10 (7,13) |-11 |

| |45–64 |28 |31 (23,40) |10 |18 |20 (14,26) |9 |

| |65–74 |16 |22 (16,30) |35 |10 |14 (9,18) |33 |

| |75+ |21 |29 (22,39) |35 |16 |18 (13,25) |15 |

| |Total |90 |104 (77,127) |15 |61 |66 (49,83) |8 |

Figure 5: Brain cancer

[pic]

|Brain |Age |Male |Female |

| | |Observed 2006 |Projected 2016 |Projected % |Observed 2006 |Projected 2016 |Projected % |

| | | | |change | | |change |

|Rates |15–24 |2 |2 (1,2) |-13 |1 |1 (1,1) |-6 |

| |25–44 |5 |5 (3,5) |-6 |3 |2 (2,3) |-15 |

| |45–64 |12 |14 (11,17) |8 |7 |7 (5,9) |-3 |

| |65–74 |24 |24 (19,32) |1 |14 |12 (8,15) |-17 |

| |75+ |28 |26 (17,28) |-5 |15 |13 (8,15) |-12 |

| |Total |8 |8 (7,10) |0 |5 |4 (3,5) |-10 |

|Counts |15–24 |6 |5 (3,5) |-9 |4 |4 (2,4) |-5 |

| |25–44 |28 |26 (19,30) |-4 |18 |15 (11,19) |-16 |

| |45–64 |61 |77 (63,96) |25 |36 |41 (33,55) |16 |

| |65–74 |32 |47 (36,60) |45 |20 |24 (17,32) |19 |

| |75+ |26 |34 (23,37) |30 |21 |23 (15,26) |8 |

| |Total |153 |190 (152,216) |24 |98 |106 (81,129) |8 |

Figure 6: Colorectal cancer

[pic]

|Colorectal |Age |Male |Female |

| | |Observed 2006 |Projected 2016 |Projected % |Observed 2006 |Projected 2016 |Projected % |

| | | | |change | | |change |

|Rates |25–44 |6 |6 (4,6) |

| | |Observed 2006 |Projected 2016 |Projected % |Observed 2006 |Projected 2016 |Projected % |

| | | | |change | | |change |

|Rates |25–44 |0 |0 (0,0) |

| | |Observed 2006 |Projected 2016 |Projected % |Observed 2006 |Projected 2016 |Projected % |

| | | | |change | | |change |

|Rates |15–24 |3 |3 (1,4) |

| | |Observed 2006 |Projected 2016 |Projected % |Observed 2006 |Projected 2016 |Projected % |

| | | | |change | | |change |

|Rates |25–44 |3 |3 (2,3) |9 |2 |1 (1,2) |-21 |

| |45–64 |23 |26 (23,32) |14 |11 |13 (11,17) |10 |

| |65–74 |63 |66 (57,83) |5 |28 |30 (26,42) |8 |

| |75+ |82 |89 (80,112) |9 |39 |40 (35,54) |2 |

| |Total |15 |16 (14,19) |9 |7 |8 (7,10) |3 |

|Counts |25–44 |18 |20 (12,19) |11 |11 |9 (7,13) |-22 |

| |45–64 |113 |150 (129,182) |32 |58 |77 (65,101) |31 |

| |65–74 |84 |127 (110,159) |50 |40 |62 (54,87) |55 |

| |75+ |78 |118 (105,148) |50 |54 |69 (59,92) |26 |

| |Total |294 |414 (370,491) |41 |164 |216 (195,279) |32 |

Figure 10: Laryngeal cancer

[pic]

|Laryngeal |Age |Male |Female |

| | |Observed 2006 |Projected 2016 |Projected % |Observed 2006 |Projected 2016 |Projected % |

| | | | |change | | |change |

|Rates |25–44 |0 |0 (0,0) |

| | |Observed 2006 |Projected 2016 |Projected % |Observed 2006 |Projected 2016 |Projected % |

| | | | |change | | |change |

|Rates |15–24 |4 |3 (1,3) |-9 |2 |2 (1,2) |-11 |

| |25–44 |4 |4 (2,5) |-2 |3 |3 (2,4) |-5 |

| |45–64 |17 |16 (9,22) |-5 |11 |11 (8,15) |0 |

| |65–74 |63 |63 (36,86) |-1 |40 |38 (25,51) |-7 |

| |75+ |131 |142 (84,196) |9 |77 |86 (55,109) |12 |

| |Total |17 |17 (10,21) |-1 |11 |11 (7,13) |-1 |

|Counts |15–24 |11 |10 (4,9) |-5 |7 |6 (3,7) |-10 |

| |25–44 |22 |22 (12,28) |-1 |19 |18 (11,22) |-6 |

| |45–64 |85 |94 (54,125) |10 |58 |70 (46,91) |20 |

| |65–74 |84 |120 (68,165) |42 |58 |77 (50,104) |33 |

| |75+ |125 |187 (111,258) |49 |107 |147 (94,188) |38 |

| |Total |328 |433 (254,557) |32 |249 |318 (211,393) |28 |

Figure 12: Lip, mouth and pharynx cancer

[pic]

|Lip, mouth and |Age |Male |Female |

|pharynx | | | |

| | |Observed 2006 |Projected 2016 |Projected % |Observed 2006 |Projected 2016 |Projected % |

| | | | |change | | |change |

|Rates |25–44 |4 |3 (2,4) |-18 |2 |2 (1,2) |-7 |

| |45–64 |22 |21 (12,23) |-6 |8 |8 (4,8) |0 |

| |65–74 |38 |40 (23,45) |5 |14 |15 (9,16) |6 |

| |75+ |44 |42 (26,52) |-4 |26 |24 (16,29) |-7 |

| |Total |12 |11 (7,13) |-6 |5 |5 (3,5) |-3 |

|Counts |25–44 |21 |18 (12,25) |-16 |12 |11 (6,12) |-8 |

| |45–64 |109 |119 (68,132) |9 |39 |47 (26,46) |19 |

| |65–74 |51 |77 (43,86) |51 |20 |31 (18,33) |52 |

| |75+ |42 |55 (35,69) |32 |36 |42 (27,50) |14 |

| |Total |223 |268 (162,307) |20 |108 |131 (80,137) |21 |

Figure 13: Liver cancer

[pic]

|Liver |Age |Male |Female |

| | |Observed 2006 |Projected 2016 |Projected % |Observed 2006 |Projected 2016 |Projected % |

| | | | |change | | |change |

|Rates |25–44 |2 |2 (1,3) |-17 |1 |1 (0,1) |3 |

| |45–64 |12 |16 (13,21) |31 |4 |5 (3,7) |26 |

| |65–74 |30 |36 (29,47) |20 |12 |13 (9,21) |11 |

| |75+ |40 |53 (40,62) |33 |17 |20 (14,31) |17 |

| |Total |8 |9 (8,12) |23 |3 |3 (2,5) |16 |

|Counts |25–44 |10 |9 (9,16) |-15 |4 |4 (3,7) |3 |

| |45–64 |60 |92 (76,119) |52 |20 |30 (19,42) |51 |

| |65–74 |39 |68 (55,91) |73 |17 |27 (18,42) |60 |

| |75+ |38 |69 (52,82) |83 |24 |35 (24,53) |44 |

| |Total |148 |238 (205,290) |61 |65 |96 (69,140) |47 |

Figure 14: Lung cancer

[pic]

|Lung |Age |Male |Female |

| | |Observed 2006 |Projected 2016 |Projected % |Observed 2006 |Projected 2016 |Projected % |

| | | | |change | | |change |

|Rates |25–44 |3 |2 (1,2) |-22 |4 |4 (3,5) |16 |

| |45–64 |56 |45 (37,57) |-20 |51 |49 (40,64) |-4 |

| |65–74 |243 |168 (138,211) |-31 |162 |154 (123,198) |-5 |

| |75+ |387 |295 (244,371) |-24 |182 |196 (155,247) |8 |

| |Total |49 |36 (30,44) |-26 |34 |33 (27,41) |-3 |

|Counts |25–44 |14 |11 (7,14) |-21 |23 |26 (15,29) |15 |

| |45–64 |275 |256 (213,325) |-7 |260 |299 (242,388) |15 |

| |65–74 |324 |321 (263,404) |-1 |231 |316 (251,405) |36 |

| |75+ |371 |388 (321,488) |5 |254 |337 (267,425) |32 |

| |Total |983 |977 (815,1215) |-1 |769 |978 (789,1229) |27 |

Figure 15: Melanoma

[pic]

|Melanoma |Age |Male |Female |

| | |Observed 2006 |Projected 2016 |Projected % |Observed 2006 |Projected 2016 |Projected % |

| | | | |change | | |change |

|Rates |15–24 |4 |4 (1,8) |-13 |6 |5 (3,8) |-18 |

| |25–44 |21 |17 (7,41) |-20 |30 |25 (18,34) |-18 |

| |45–64 |86 |82 (33,187) |-4 |71 |65 (46,85) |-8 |

| |65–74 |183 |206 (88,486) |13 |115 |120 (85,162) |5 |

| |75+ |278 |332 (143,799) |19 |153 |174 (123,231) |14 |

| |Total |56 |56 (24,132) |1 |46 |43 (31,56) |-7 |

|Counts |15–24 |13 |11 (4,26) |-9 |18 |15 (9,23) |-17 |

| |25–44 |121 |99 (41,234) |-19 |186 |151 (111,209) |-19 |

| |45–64 |421 |466 (190,1063) |11 |361 |396 (278,514) |10 |

| |65–74 |244 |395 (169,931) |62 |164 |246 (175,331) |50 |

| |75+ |266 |437 (188,1051) |64 |214 |300 (212,398) |40 |

| |Total |1065 |1409 (597,3299) |32 |943 |1108 (793,1448) |18 |

Note: Unusually wide credible interval for male rate is unexplained. Further work is in progress to investigate this.

Figure 16: Myeloma

[pic]

|Myeloma |Age |Male |Female |

| | |Observed 2006 |Projected 2016 |Projected % |Observed 2006 |Projected 2016 |Projected % |

| | | | |change | | |change |

|Rates |25–44 |1 |1 (0,1) |-3 |0 |0 (0,1) |-32 |

| |45–64 |8 |8 (6,11) |-5 |6 |5 (4,8) |-20 |

| |65–74 |30 |27 (22,37) |-8 |19 |17 (15,26) |-11 |

| |75+ |56 |57 (47,76) |2 |32 |29 (27,46) |-8 |

| |Total |7 |6 (5,8) |-6 |4 |4 (3,5) |-15 |

|Counts |25–44 |5 |4 (3,6) |-2 |2 |1 (1,3) |-33 |

| |45–64 |40 |44 (37,61) |10 |32 |30 (26,46) |-4 |

| |65–74 |40 |52 (43,72) |32 |27 |34 (30,52) |27 |

| |75+ |53 |75 (62,101) |40 |45 |50 (46,79) |13 |

| |Total |138 |176 (149,231) |27 |105 |117 (107,174) |11 |

Figure 17: Non-Hodgkin’s lymphoma (NHL)

[pic]

|Non-Hodgkins |Age |Male |Female |

|lymphoma | | | |

| | |Observed 2006 |Projected 2016 |Projected % |Observed 2006 |Projected 2016 |Projected % |

| | | | |change | | |change |

|Rates |15–24 |2 |2 (1,2) |-6 |1 |1 (1,1) |-5 |

| |25–44 |7 |7 (5,8) |-5 |4 |4 (3,5) |-6 |

| |45–64 |30 |33 (30,44) |13 |20 |20 (17,28) |0 |

| |65–74 |74 |86 (79,118) |17 |54 |55 (47,78) |2 |

| |75+ |108 |127 (118,171) |17 |77 |82 (71,115) |6 |

| |Total |21 |23 (21,29) |11 |14 |14 (12,19) |0 |

|Counts |15–24 |6 |6 (3,6) |-1 |4 |3 (2,4) |-4 |

| |25–44 |41 |40 (30,45) |-3 |26 |24 (18,30) |-6 |

| |45–64 |146 |191 (172,249) |31 |103 |124 (105,170) |20 |

| |65–74 |98 |165 (151,225) |68 |77 |113 (97,159) |47 |

| |75+ |103 |166 (155,225) |61 |108 |141 (122,198) |30 |

| |Total |394 |568 (528,723) |44 |318 |406 (351,547) |28 |

Figure 18: Oesophageal cancer

[pic]

|Oesophagus |Age |Male |Female |

| | |Observed 2006 |Projected 2016 |Projected % |Observed 2006 |Projected 2016 |Projected % |

| | | | |change | | |change |

|Rates |25–44 |1 |0 (0,1) |-49 |0 |0 (0,0) |-19 |

| |45–64 |11 |11 (8,13) |0 |3 |3 (2,4) |-16 |

| |65–74 |38 |40 (30,47) |7 |13 |13 (10,15) |-3 |

| |75+ |65 |68 (53,82) |5 |35 |34 (27,41) |-3 |

| |Total |8 |8 (7,10) |1 |3 |3 (2,4) |-9 |

|Counts |25–44 |4 |2 (2,4) |-48 |1 |1 (1,1) |-20 |

| |45–64 |52 |60 (46,74) |16 |16 |16 (13,22) |1 |

| |65–74 |50 |77 (57,90) |54 |19 |26 (20,32) |39 |

| |75+ |62 |90 (70,108) |44 |49 |58 (46,71) |20 |

| |Total |168 |229 (182,266) |36 |84 |101 (83,122) |20 |

Figure 19: Pancreatic cancer

[pic]

|Pancreas |Age |Male |Female |

| | |Observed 2006 |Projected 2016 |Projected % |Observed 2006 |Projected 2016 |Projected % |

| | | | |change | | |change |

|Rates |25–44 |1 |1 (1,1) |-29 |1 |1 (1,1) |-9 |

| |45–64 |11 |10 (8,13) |-10 |8 |9 (7,11) |3 |

| |65–74 |42 |37 (30,46) |-13 |35 |32 (27,41) |-7 |

| |75+ |69 |64 (52,79) |-8 |76 |78 (61,91) |3 |

| |Total |9 |8 (7,10) |-13 |8 |8 (6,9) |-2 |

|Counts |25–44 |6 |4 (3,6) |-28 |5 |4 (3,6) |-9 |

| |45–64 |56 |58 (48,73) |4 |43 |53 (43,66) |24 |

| |65–74 |56 |71 (57,87) |26 |49 |66 (54,83) |34 |

| |75+ |66 |84 (68,104) |27 |106 |134 (105,156) |26 |

| |Total |184 |217 (181,265) |18 |203 |257 (213,303) |27 |

Figure 20: Stomach cancer

[pic]

|Stomach |Age |Male |Female |

| | |Observed 2006 |Projected 2016 |Projected % |Observed 2006 |Projected 2016 |Projected % |

| | | | |change | | |change |

|Rates |25–44 |2 |2 (1,2) |1 |2 |1 (1,2) |-28 |

| |45–64 |14 |12 (10,15) |-11 |8 |7 (6,9) |-6 |

| |65–74 |45 |36 (29,44) |-21 |21 |19 (15,24) |-9 |

| |75+ |84 |63 (50,76) |-24 |46 |38 (31,48) |-19 |

| |Total |11 |9 (7,11) |-19 |6 |5 (4,6) |-15 |

|Counts |25–44 |12 |13 (7,13) |2 |11 |8 (7,13) |-29 |

| |45–64 |69 |70 (57,87) |3 |39 |44 (34,54) |13 |

| |65–74 |60 |68 (55,85) |14 |29 |38 (31,49) |30 |

| |75+ |80 |84 (66,100) |4 |65 |65 (53,82) |0 |

| |Total |221 |235 (189,277) |6 |145 |155 (129,192) |7 |

Figure 21: Thyroid cancer

[pic]

|Thyroid |Age |Male |Female |

| | |Observed 2006 |Projected 2016 |Projected % |Observed 2006 |Projected 2016 |Projected % |

| | | | |change | | |change |

|Rates |15–24 |1 |1 (0,1) |0 |3 |3 (2,4) |11 |

| |25–44 |3 |3 (2,4) |17 |8 |11 (8,13) |26 |

| |45–64 |5 |6 (5,9) |30 |11 |16 (12,18) |41 |

| |65–74 |7 |8 (6,13) |19 |12 |15 (11,19) |24 |

| |75+ |7 |9 (6,13) |18 |9 |13 (10,16) |37 |

| |Total |3 |4 (3,5) |22 |8 |11 (8,12) |31 |

|Counts |15–24 |2 |3 (1,4) |5 |8 |9 (5,12) |12 |

| |25–44 |14 |17 (11,24) |19 |52 |65 (47,76) |25 |

| |45–64 |24 |36 (26,50) |51 |56 |94 (72,111) |69 |

| |65–74 |9 |16 (11,24) |71 |18 |32 (23,40) |78 |

| |75+ |7 |11 (8,17) |62 |13 |22 (17,28) |68 |

| |Total |57 |83 (65,108) |45 |147 |222 (176,251) |51 |

Figure 22: Male cancers (excluding the ‘PSA effect’)

[pic]

| |Age |Prostate |Testicular |

| | |Observed 2006 |Projected 2016 |Projected % |Observed 2006 |Projected 2016 |Projected % |

| | | | |change | | |change |

|Rates |15–24 | | | |7 |7 (5,10) |4 |

| |25–44 |0 |0 (0,1) |17 |17 |17 (15,23) |1 |

| |45–64 |47 |82 (41,107) |76 |6 |6 (5,8) |5 |

| |65–74 |428 |483 (361,840) |13 |3 |3 (2,4) |17 |

| |75+ |1168 |1417 (1039,2253) |21 |3 |3 (2,4) |19 |

| |Total |91 |112 (79,173) |23 |10 |10 (9,13) |2 |

|Counts |15–24 | | | |22 |24 (17,31) |9 |

| |25–44 |2 |2 (1,5) |19 |95 |97 (86,130) |3 |

| |45–64 |229 |469 (236,608) |104 |29 |35 (29,44) |22 |

| |65–74 |570 |925 (691,1608) |62 |3 |6 (5,8) |68 |

| |75+ |1117 |1865 (1368,2964) |67 |2 |4 (3,6) |63 |

| |Total |1919 |3282 (2336,5100) |71 |151 |166 (145,211) |10 |

Figure 23: Female cancers I

[pic]

Note: For key see Figure 22.

| |Age |Breast |Cervical |

| | |Observed 2006 |Projected 2016 |Projected % |Observed 2006 |Projected 2016 |Projected % |

| | | | |change | | |change |

|Rates |25–44 |58 |52 (41,61) |-11 |11 |8 (5,11) |-22 |

| |45–64 |246 |236 (193,271) |-4 |12 |8 (6,13) |-32 |

| |65–74 |317 |336 (268,388) |6 |11 |7 (4,10) |-37 |

| |75+ |338 |392 (325,461) |16 |10 |5 (3,6) |-47 |

| |Total |122 |121 (100,137) |-1 |8 |6 (4,9) |-28 |

|Counts |25–44 |354 |313 (251,371) |-12 |66 |51 (30,69) |-23 |

| |45–64 |1247 |1436 (1171,1646) |15 |58 |48 (35,77) |-18 |

| |65–74 |453 |688 (548,794) |52 |15 |14 (8,20) |-10 |

| |75+ |473 |674 (559,793) |43 |14 |9 (5,11) |-34 |

| |Total |2528 |3111 (2572,3536) |23 |153 |121 (81,170) |-21 |

Figure 24: Female cancers II

[pic]

Note: For key see Figure 22.

| |Age |Ovarian |Endometrial |

| | |Observed 2006 |Projected 2016 |Projected % |Observed 2006 |Projected 2016 |Projected % |

| | | | |change | | |change |

|Rates |15–24 |2 |2 (1,2) |-12 | | | |

| |25–44 |6 |5 (4,7) |-9 |4 |4 (3,6) |10 |

| |45–64 |24 |20 (19,28) |-15 |35 |38 (30,56) |10 |

| |65–74 |45 |38 (31,47) |-16 |62 |65 (50,95) |6 |

| |75+ |57 |50 (39,58) |-13 |55 |64 (49,91) |17 |

| |Total |14 |12 (11,15) |-14 |17 |19 (15,27) |8 |

|Counts |15–24 |5 |5 (3,6) |-11 | | | |

| |25–44 |35 |32 (27,42) |-9 |23 |25 (17,35) |9 |

| |45–64 |120 |123 (115,168) |2 |176 |232 (183,341) |32 |

| |65–74 |65 |78 (64,97) |21 |88 |133 (102,195) |52 |

| |75+ |80 |86 (67,100) |7 |76 |110 (84,157) |44 |

| |Total |305 |323 (284,400) |6 |363 |500 (394,718) |38 |

Figure 25: Cancer of all other sites

[pic]

|Other sites |Age |Male |Female |

| | |Observed 2006 |Projected 2016 |Projected % |Observed 2006 |Projected 2016 |Projected % |

| | | | |change | | |change |

|Rates |15–24 |2 |1 (1,2) |-14 |1 |1 (1,2) |-31 |

| |25–44 |5 |4 (2,5) |-21 |5 |3 (2,5) |-36 |

| |45–64 |30 |23 (14,34) |-24 |24 |18 (10,24) |-27 |

| |65–74 |117 |87 (52,129) |-25 |72 |52 (29,73) |-27 |

| |75+ |246 |216 (130,314) |-12 |180 |133 (74,182) |-26 |

| |Total |29 |22 (14,32) |-22 |21 |15 (8,20) |-29 |

|Counts |15–24 |5 |5 (2,6) |-10 |3 |2 (2,5) |-31 |

| |25–44 |27 |22 (13,32) |-20 |31 |20 (11,29) |-37 |

| |45–64 |149 |132 (79,191) |-11 |124 |109 (59,145) |-12 |

| |65–74 |155 |167 (99,246) |7 |103 |107 (60,150) |4 |

| |75+ |235 |284 (171,413) |21 |252 |229 (127,313) |-9 |

| |Total |572 |610 (370,875) |7 |512 |467 (263,631) |-9 |

References

Bidwell S, Jo E. 2009. Incidence and prevalence of PSA testing in New Zealand men >50 years. Unpublished report. Wellington: Ministry of Health. (see Appendix to this report).

Black R, Stockton D. 2001. Cancer Scenarios: An aid to planning cancer services in Scotland in the next decade. Edinburgh: Scottish Executive Health Department.

McDermid I. 2005. Cancer Incidence Projections for Australia 2002 to 2011. Canberra: Australian Institute for Health and Welfare.

Ministry of Health. 2002. Cancer in New Zealand: Trends and projections. Wellington: Ministry of Health.

Ministry of Health. 2003. The New Zealand Cancer Control Strategy. Wellington: Ministry of Health.

Ministry of Health. 2007. Cancer Incidence Projections: 1999–2003 Update. Wellington: Ministry of Health.

Moller B, Fekjaer H, Hakulinen T, et al. 2002. Prediction of cancer incidence in the Nordic countries up to the year 2020. Euro J Cancer Prevention 11 (Supplement 1).

Appendix: Prostate Cancer Incidence

Figure 26 shows observed (solid lines) and projected (broken lines) registration rates for prostate cancer by single calendar year and five-year age group (from age 60 – prostate cancer incidence is very low below this age).

Unlike all other projections in this report, the prostate cancer projections begin in 1987, not 2006. This is to avoid the projections being influenced by prostate cancers detected only through PSA testing.

Opportunistic screening with PSA began in the mid 1980s, and by the early 1990s had become widespread. By 2005–07, over half of men aged 50+ were being screened at least once every three years, although rates were lower in younger age groups ( ................
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