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Preliminary results for cancers

• Highlights
• How the estimates were derived
• Health state descriptions and classifications
• Preference scores
• Impact of cancers (HALYs)
• Population attributable fraction

 Highlights

One quarter of the impact of cancer is due to lung cancer

• The combined impact of mortality and morbidity in Canada for cancers diagnosed 2001 is 905,000 health-adjusted life years.
• Tne quarter of this impact is due to lung cancer.
• Premature mortality accounts for 85% of the impact of cancers, over one quarter due to lung cancer.

data table

Morbidity for breast cancer is four times the morbidity for lung cancer

• About 15% of the total impact of cancer is due to morbidity.
• Morbidity for breast cancer is four times the morbidity for lung cancer because of earlier diagnosis and longer survival.

Source: Population Health Impact of Disease in Canada, 2001

Notes: Morbidity is measured by year-equivalents lost to reduced functioning (YERFs).
YERF for each age group = number of new cases X duration X weight for severity
YERFs are discounted at 3%.

data table

Smoking is a major risk factor for many cancers, but so are lack of fruit and vegetable consumption, physical inactivity, and obesity.

• One quarter of the impact of cancer can be attributed to smoking.
• More than one tenth can be attributed to lack of fruit and vegetable consumption.
• The major risk factors for cancer are lifestyle risk factors and thus potentially modifiable.

Source: Population Health Impact of Disease in Canada, 2001

data table

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How the estimates were derived

A series of health states related to cancer was identified and the effects of each were described using peer-reviewed literature and expert review. This information was used to create standardized classifications of functional limitations, a series of numbers that represent the level of severity for each of 11 attributes that span physical, mental, and social health. The Classification and Measurement System of Functional Health comprises 11 attributes with four or five levels each for this purpose.

The classification for each health state was then transformed into a global score using a statistical function. The function is based on observed values obtained from lay Canadians.

These preference scores were then integrated with epidemiologic information about the number of cases and duration of each health state related to a particular type of cancer. This provides an estimate of the morbidity, which was then combined with an estimate of mortality to calculate the total impact for each type of cancer.

This information was synthesized in structured workbooks that calculated health-adjusted life years lost for each type of cancer and the proportion of them that can be attributed to five different risk factors.

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Health state descriptions and classifications

The following classifications were used in the HALY and PAF estimates. Cancers with similar prognoses or similar treatments were grouped together for purposes of classification. The durations of each health state, and the number of individuals affected, were incorporated in the subsequent step of the process. These classifications are currently being peer-reviewed.

Detailed information and related products

Table 1 Classification of health states related to cancer

How to read the classification

Summary table (continued)

Preference scores

The following preference scores were developed from these classifications. A scoring function was used to transform the classification into a single number. They are used in the calculation of the HALYs and PAFs provided in the subsequent sections.

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Impact of cancer (Health-adjusted life years lost to cancers)

• Impact of cancers in Canada, 2001 (HALYs, YLLs, YERFs)
• Impact of cancers in Canada, males, 2001 (HALYs, YLLs, YERFs)
• Impact of cancers in Canada, females, 2001 (HALYs, YLLs, YERFs)
• Data sources for HALYs, YLLs, YERFs

The following tables provide summary information for 25 types of cancer. Detailed calculations are available in an interactive Excel workbook for each cancer type. Each workbook contains several worksheets that calculate and document YLLs, YERFs, and HALYs lost to the disease for the reference year 2001.

For more information about the workbooks, or to access them:

More on workbooks
View sample workbook
Download workbooks

Notes:
HALY = YLL + YERF
YLL for each age group = number of deaths X hypothetical years of life remaining
YERF for each age group = number of new cases X duration X weight for severity
Estimates are discounted at 3%.
a. Data for non-melanoma skin cancers are underestimated due to reporting problems.

Notes:
HALY = YLL + YERF
YLL for each age group = number of deaths X hypothetical years of life remaining
YERF for each age group = number of new cases X duration X weight for severity
Estimates are discounted at 3%.
... not applicable
a. Data for non-melanoma skin cancers are underestimated due to reporting problems.

Notes:
HALY = YLL + YERF
YLL for each age group = number of deaths X hypothetical years of life remaining
YERF for each age group = number of new cases X duration X weight for severity
Estimates are discounted at 3%.
... not applicable
a. Data for non-melanoma skin cancers are underestimated due to reporting problems.

References

1. Health Statistics Division, Statistics Canada. Vital statistics: death database. Statistics Canada Catalogue 84F0211X.
2. Statistics Canada, Population estimates 0-90+ Canada - Provinces 1971-2001 ( July 11, 2002 ).
3. Based on Mortality Hazards, Canada, 2001 Cohort, from LifePaths41, Statistics Canada. http://www.statcan.ca/english/spsd/LifePaths.htm
4. Life Tables Canada, Provinces and Territories 1995-1997, p. 10, Statistics Canada Catalogue no. 84-537
5. Gorber S, Bernier J, McIntosh CN, Berthelot J-M. Eliciting Canadian population preferences for health states (forthcoming).
6. Health Statistics Division, Statistics Canada. Canadian Cancer Registry.
7. Simunovic M, Gagliardi A, McCready D, Coates A, Levine M, DePetrillo D. A snapshot of waiting times for cancer surgery provided by surgeons affiliated with regional cancer centres in Ontario. CMAJ 2001;165(4): 421-5.
8. Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence SEER 12 Regs Public Use, Nov 2002 Sub (1973 2000), National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2003, based on the November 2002 submission. Using software: Surveillance Research Program, National Cancer Institute SEER*Stat software (www.seer.cancer.gov/seerstat) version 5.0.17.
9. Expert consultation, Dr. WK Evans, Juravinski Cancer Centre, Hamilton Health Sciences and McMaster University.

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Population attributable fraction (PAF)

Standard methods were used to attribute the health-adjusted life years lost to each type of cancer among various risk factors.

Detailed information

Note:
HALY estimates are discounted at 3%.

References

1. AIHW Burden of Disease. Risk factors. Last reviewed on 29 October 2001. http://www.aihw.gov.au/bod/bod_risk_factors/index.cfm.
2. Statistics Canada, Household, Family and Social Statistics Division. General Social Survey–Health Cycle 6, 1991. Statistics Canada Survey 3894.
3. Health Statistics Division, Statistics Canada. Canadian Community Health Survey 2000-01. Statistics Canada, Survey 3226.
4. Flanagan W, Boswell-Purdy J, Le Petit C, Berthelot J-M. Estimating summary measures of health: a structured workbook approach. Population Health Metrics 2005; 3(1):5.
5. English DR, Holman CDJ, Milne E. The quantification of drug caused morbidity and mortality in Australia, 1995 edition. Canberra: Commonwealth Department of Human Services and Health; 1995.
6. New Zealand Ministry of Health (NZMOH). The health of New Zealanders 1996/7. Wellington: NZMOH; 1999.
7. Mao Y, Pan S, Wen SW, Johnson KC; Canadian Cancer Registries Epidemiology Research Group. Physical inactivity, energy intake, obesity and the risk of rectal cancer in Canada. Int J Cancer 2003; 105(6): 831-7.
8. Pan SY, Johnson KC, Ugnat AM, Wen SW, Mao Y; Canadian Cancer Registries Epidemiology Research Group. Association of obesity and cancer risk in Canada. Am J Epidemiol 2004; 159(3): 259-68.
9. National Centre for Chronic Disease Prevention and Health Promotion, Centre for Disease Control. Smoking-Attributable Mortality, Morbidity and Economic Costs (SAMMEC). Based on CPS-II study (82-88). Page last updated March 18, 2002. http://apps.nccd.cdc.gov/sammec/show_risk_data.asp. Accessed October 1, 2003