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Methods: Local Health Districts
Local Health Districts (LHDs) are health administrative areas constituted under Section 17 of the NSW Health Services Act, 1997 which became effective from January 2011 and were initially called Local Health Networks.
There are 15 geographically-based LHDs (8 covering the Sydney metropolitan region and 7 rural and regional NSW) and two specialist networks focussing on Children's and Paediatric Services and Forensic Mental Health. A third network operates across the public health services provided by three Sydney facilities operated by St Vincent's Health: these include St Vincent's Hospital and the Sacred Heart Hospice at Darlinghurst and St Joseph’s at Auburn.
LHDs replaced the former Area Health Services and have their own budgets, management and accountabilities. Geographically-based LHDs are overseen by Governing Boards. Please refer to the NSW Health website for a list of Local Health Districts and the membership of Boards.
Local Health Districts are:
Metropolitan NSW: Central Coast, Illawarra Shoalhaven, Nepean Blue Mountains, Northern Sydney, South Eastern Sydney, South Western Sydney, Sydney, Western Sydney.
Rural & regional NSW: Far West, Hunter New England, Mid North Coast, Murrumbidgee, Northern NSW, Southern NSW, Western NSW
Smoothing of estimates for rare conditions analysed by Local Health District in this report
The term ‘small area’ refers to a small geographical area and a small population. Data from a small area are characterised by considerable variability. Smoothing is a general term for statistical methods used to reduce the random variability of data. Examples include rounding, moving averages, extending the period of time in which cases are counted or increasing the size of the areas. In addition, Bayesian statistical smoothing can be used to adjust raw estimates in small areas by taking into account information from adjacent areas (local or spatial variability) and from the whole state (global or non-spatial variability).
In this report, extending the period of time, in which cases in the Local Health Districts are counted, was the most frequently used smoothing technique. Results for some Local Health Districts were completely suppressed in few indicators due to very low numbers and privacy concerns. Refer to Notes under the graphs or Methods tabs for confirmation of suppression and the smoothing technique used.
NSW Health. Home page. Last updated 1 July 2011. Available at http://www.health.nsw.gov.au/services/pages/default.aspx
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Key points: Cancer
• Cancer is Australia's leading cause of disease burden. It accounts for almost one-fifth of years of healthy life lost due to premature death, disease, and injury.
• In NSW in 2008, there were 36,611 new cases of cancer (57% in males) and 13,186 deaths (57% in males). Between 1998 and 2007 the incidence rate for all cancers rose by 11% in males, but was stable in females. Death rates fell by 12.9% in males and 6.4% in females between 1998 and 2007.
• In 2008 in NSW the five leading types of new cases of cancer in descending order were:
• However in 2007 in NSW:
Lung cancer was the leading cause of cancer death.
Colorectal cancer was the second leading cause of cancer death
Prostate cancer was the third leading cause of cancer death
Breast cancer was the fourth cause of cancer death
Melanoma was the eighth leading cause of cancer death
• A bowel (colorectal) cancer screening program commenced in NSW in August 2006.
• Cervical cancer cases and deaths decreased between 1998 and 2007 and in 2008 it was the fourteenth most common female cancer. It can be prevented through the early detection of precancerous lesions by two-yearly Pap tests of women aged 20-69 years. The percentage of eligible women who had their Pap test by December 2010 was 56.4%.
• Breast cancer was the most common cancer among females and but the second most common cause of cancer death among females. BreastScreen NSW provides a two-yearly mammographic screening service to women aged 50-69 years in NSW, which aims to detect early cases of breast cancer. The percentage of eligible women who had their two-yearly mammogram by December 2010 was 52.7%.
Cancer (that is malignant neoplasm) is a diverse group of diseases in which abnormal cells proliferate and spread out of control. Cancer can develop from most types of cells in different parts of the body, each with its own pattern of growth and spread.
Some cancers are very invasive and invade adjacent organs and spread to other parts of the body (metastasise) quickly, while others may remain in the body for years without showing any clinical symptoms. Benign neoplasms never spread to distant organs.
Cancers are classified according to the organ in which they originate (primary site). Even when cancers spread to other organs (secondary cancers or metastases) it is usually possible to ascertain the origin of the malignant cells.
Burden of disease from cancer
Cancer is a major cause of mortality in Australia and contributes greatly to morbidity and disability. It accounts for 19% of the total burden of disease in Australia (Begg et al. 2007).
Cancer incidence in NSW has been increasing for a number of decades. As in other regions of developed world, this due to the aging of population and lifestyle changes. The rankings of individual cancers have also changed. In 1972, the four most common cancers in males were lung, colorectal (large bowel), prostate, and stomach; and in females were breast, colorectal, melanoma, and cervical cancers. The 2008 rank order is now prostate, colorectal, melanoma, and lung cancers in males; and breast, colorectal, melanoma, and lung cancer in females.
Most cancers have a unique set of causal factors, but many share risk factors. These include: smoking (responsible for the majority of preventable cancers); dietary influences; infectious agents; radiation (including ultraviolet radiation); and genetic factors. The most significant risk factor for developing cancer is old age.
Begg S, Vos T, Barker B. The burden of disease and injury in Australia, 2003. Cat. no. PHE 82 edition. Canberra: AIHW, 2007. Available at http://www.aihw.gov.au/publications/index.cfm/title/10317
Some cancers can be prevented though the avoidance of known risk factors. Risk of death from a number of cancers can be reduced by screening, early detection and treatment, and appropriate management and follow-up (Tracey et al. 2010).
The NSW Government established the Cancer Institute NSW in 2003, in recognition of the importance of accelerating improvements in cancer control in NSW. In 2010, the Cancer Institute NSW prepared its third plan, the NSW Cancer Plan 2011-2015, which aims to consolidate the strategic activities for cancer control in NSW including prevention, diagnosis, treatment and rehabilitation services as well as cancer information, education and research (Cancer Institute NSW 2010).
The Cancer Institute NSW is responsible for the NSW Pap Test Registry as well as the Central Cancer Registry. In July 2005, the Cancer Institute NSW assumed responsibility for the management of the breast and cervical screening programs and is supporting the staged introduction of bowel cancer screening in NSW, which began in NSW in August 2006. The success of vaccination against Human Papilloma Virus (HPV) is monitored by the Cancer Institute NSW using statistics from its Registries. The HPV vaccine is offered though the School Based Immunisation Program, run by the NSW Department of Health and educational facilities (NSW Department of Health 2011).
Cancer Institute NSW. NSW Cancer Plan 2011-2015. Lessening the impact of cancer in NSW. Sydney: Cancer Institute NSW, 2010. Available at http://www.cancerplan.cancerinstitute.org.au/default.html
NSW Department of Health. School Based Immunisation Program. NSW Department of Health. Cited on 1 April, 2011). Available at http://www.health.nsw.gov.au/PublicHealth/Immunisation/school_prog/index.asp
Tracey E, Kerr T, Dobrovic A, Currow D. Cancer In NSW: Incidence and Mortality Report 2008. Sydney: Cancer Institute NSW, 2010. Available at http://www.cancerinstitute.org.au/cancer_inst/publications/CIM2008/CIM_2008_full.pdf
For more information: Cancer
Useful websites include:
Cancer Institute NSW at http://www.cancerinstitute.org.au
Australian Bureau of Statistics at http://www.abs.gov.au
Australian Institute of Health and Welfare at http://www.aihw.gov.au
HealthInsite at http://www.healthinsite.gov.au
New South Wales Government. Public Health Act 1991 and Public Health Act 2010. Parliamentary Counsel's Office. Available at http://www.legislation.nsw.gov.au