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A comprehensive evaluation of bladder cancer epidemiology and outcomes in Australia

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To review bladder cancer statistics and management in Australia and identify gaps for future work here. Evidence was reviewed from GLOBOCAN 2008v2.0, Pubmed, and conference presentations. We also use data from reports from Cancer Council Australia, State Cancer Councils, and Australian Institute of Health and Welfare. The incidence and mortality rates of bladder cancer in Australia closely parallel those of other developed countries. Bladder cancer was the 8th most common cause of cancer in men, and the 17th most common cause of cancer in women. Bladder cancer was the 13th most common cause of cancer death in men, and the 17th most common cause of cancer death in women. We briefly review the evidence regarding causality, including nutritional, occupational, and environmental factors. We compare Australian incidence and mortality rates internationally, by state/territory, by socioeconomic strata, and by geographical regions. Importantly, we review evidence on the quality of bladder cancer management in Australia. The geographical, regional, and socioeconomic differences in Australian bladder cancer statistics may be associated with different patterns of diagnosis and treatment. The quality of bladder cancer surveillance and cystectomies in Australia requires improvement to conform to global standards and to improve decreasing survival rates.
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UROLOGY – REVIEW
A comprehensive evaluation of bladder cancer epidemiology
and outcomes in Australia
Rajkumar Cheluvappa David P. Smith
Sabina Cerimagic Manish I. Patel
Received: 8 November 2013 / Accepted: 8 January 2014 / Published online: 1 February 2014
ÓSpringer Science+Business Media Dordrecht 2014
Abstract
Objective To review bladder cancer statistics and man-
agement in Australia and identify gaps for future work
here.
Methods Evidence was reviewed from GLOBOCAN
2008v2.0, Pubmed, and conference presentations. We also
use data from reports from Cancer Council Australia, State
Cancer Councils, and Australian Institute of Health and
Welfare.
Results The incidence and mortality rates of bladder
cancer in Australia closely parallel those of other devel-
oped countries. Bladder cancer was the 8th most common
cause of cancer in men, and the 17th most common cause
of cancer in women. Bladder cancer was the 13th most
common cause of cancer death in men, and the 17th most
common cause of cancer death in women. We briefly
review the evidence regarding causality, including nutri-
tional, occupational, and environmental factors. We com-
pare Australian incidence and mortality rates
internationally, by state/territory, by socioeconomic strata,
and by geographical regions. Importantly, we review evi-
dence on the quality of bladder cancer management in
Australia.
Conclusions The geographical, regional, and socioeco-
nomic differences in Australian bladder cancer statistics
may be associated with different patterns of diagnosis and
treatment.
Implications The quality of bladder cancer surveillance
and cystectomies in Australia requires improvement to
conform to global standards and to improve decreasing
survival rates.
Keywords Bladder cancer Australia Incidence and
mortality Survival Management Cystectomy
Abbreviations
ACT Australian Capital Territory
ARIA Accessibility/Remoteness Index for
Australia
ASR
(ASR1960W)
Age-Standardised Rate according to
1960 Standard World Population
ASR
(ASR2001Aus)
Age-Standardised Rate according to
2001 Standard Australian Population
IR Inner Regional Australia
MC Major Cities of Australia
NSW New South Wales
NT Northern Territory
OR Outer Regional Australia
R Remote Australia
SA South Australia
SEIFA Socio-economic Indexes for Areas
TAS Tasmania
VR Very Remote Australia
Vs. Versus
WA Western Australia
R. Cheluvappa S. Cerimagic M. I. Patel (&)
The Urological Cancer Outcomes Centre, Department of
Surgery, Western Clinical School, University of Sydney, Suite
10, 16-18 Mons Road, Westmead, Sydney, NSW 2145, Australia
e-mail: manish.patel@sydney.edu.au
R. Cheluvappa
e-mail: rajkumarchel@gmail.com
D. P. Smith
Cancer Research Division, Cancer Council NSW, Kings Cross,
NSW 1340, Australia
D. P. Smith
Griffith Health Institute, Griffith University, Brisbane,
QLD 4222, Australia
123
Int Urol Nephrol (2014) 46:1351–1360
DOI 10.1007/s11255-014-0643-z
Introduction
In 2008, bladder cancer was the 9th most common cancer
diagnosed worldwide and the 13th most common cancer
cause of death [1]. Internationally, the incidence of bladder
cancer is consistently 3–4 times higher in males than
females. Bladder cancer is associated with advancing age,
over 90 % of new diagnoses occur in individuals 55 years
or more [2]. Developed countries generally have higher
incidence rates than non-developed countries (Table 1), but
better survival rates.
In this study, we use data from GLOBOCAN 2008 v2.0
and from seven different official reports from Cancer
Council Australia, State Cancer Councils, and the Austra-
lian Institute of Health and Welfare. The data from these
reports have been chronologically and statistically equili-
brated. We also review evidence from Pubmed, and con-
ference presentations, where we inductively collate data
based on their relevance to bladder cancer epidemiology,
management, and surveillance; within the Australian
context.
In Australia, 1,695 men and 621 women were newly
diagnosed with bladder cancer in 2009 (the most recent
year for which national data are available)—this equates
to Age-Standardised Rates (2001Aus) of 16 per 100,000
in males and 4.6 per 100,000 in females [3]. In 2007 (the
most recent years for which mortality data are available),
630 males and 295 females died of bladder cancer—this
equates to Age-Standardised Rates (2001Aus) of 6.5 per
100,000 in males and 2.2 per 100,000 in females [3].
Figure 1and Table 1demonstrate that the incidence and
mortality rates of bladder cancer in Australia closely
resemble those in other parts of the developed world. In
2008, bladder cancer was the 14th most common cause of
cancer in Australia and the 15th most common cancer
leading to death in Australia [1]. In Australian men,
bladder cancer was the 8th most common cause of cancer
and the 13th most common cancer leading to death, the
incidence rate being more than the average world inci-
dence rate [1]. However, in Australian women, bladder
cancer was the 17th most common cause of cancer and
the 17th most common cancer leading to death [1]. In
2009, bladder cancer accounted for 2 % of all Australian
cancer cases, and 2.6 % of all Australian men with cancer
[3].
Between 1983 and 2003, the incidence of bladder cancer
in Australia dropped from 17.1 per 100,000 to 10.9 per
100,000 [4]. During the same period, mortality from
bladder cancer dropped from 5.4 to 4.0 deaths per 100,000.
Over the past couple of decades, there has been reduced
exposure to established risk factors for bladder cancer such
as smoking and aromatic arylamines (occupation) in
Australia. This is reflected in the slow, but declining
bladder cancer incidence rates. However, between the
periods 1982–1987, and 2006–2010, 5-year survival fell
from 68 to 58 % [5]. The reasons behind this phenomenon
are not clear. However, between these periods, there have
been no coding changes pertaining to cancer registry data
entry in Australia. Increases in the age of diagnosis have
been modest; and interestingly, incidence rates for patients
[79 years of age have remained more-or-less the same in
this time period [5]. The SEER registries (USA) record
in situ bladder cancer, in addition to localised, regionalised,
distant, and unknown bladder cancer [6]. Australian dat-
abases do not record in situ bladder cancer, but record the
others. However, these differences may account only for
better bladder survival rates in the USA, compared with
Australia, but not for the decreases in survival data evident
over two different time periods within Australia. The major
contributing factor therefore seems to be the deterioration
of the quality of bladder cancer management in Australia.
This is dissected out in the subsequent sections.
Risk factors for bladder cancer
Many studies [7] have investigated associations between
bladder cancer and specific occupations, the most com-
pelling evidence demonstrating higher risks in those
working in the textile industry (dye users and weavers),
aromatic amine dye manufacturing, rubber industry,
painters, aluminium workers, and truck drivers exposed
constantly to exhaust fumes (Table 2)[8]. In the USA,
bladder cancer incidence and mortality was highest in the
north-eastern part [9]. In addition to the historically higher
rates of smoking prevalent here, these high rates have been
associated with certain occupations, specifically the aro-
matic amine-using textile industry here several decades
back [10]. Interestingly, the rates are higher even in rural
parts of the north–east when compared with most urban
areas in other parts of the USA [10,11]. Diet and other
known characteristics do not appear to be responsible for
these variations [12].
There is a wealth of data on bladder cancer risk factors
and associations. It is out of scope of this study to discuss
those in more detail here. However, we have summarised
the key risk factors and associations in Table 2[8].
A few Australian studies too have investigated the
associations between bladder cancer and occupation. An
Australasian study involving 15,957 male and 1,206 female
petroleum industry employees demonstrated an increased
incidence of bladder cancer amongst employees in the
industry [13]. Micronuclei, which are important biomarkers
of malignant change, originate from chromosome frag-
ments not included in the main daughter nuclei during
1352 Int Urol Nephrol (2014) 46:1351–1360
123
nuclear division, generally due to DNA damage and mis-
repair. In a South Australian study, 12 men employed in
polyurethane manufacture, 12 bitumen road layers, and
18 control subjects provided blood and urine samples
to assess genotoxic events extrapolated from micronu-
clei formation in exfoliated cells and lymphocytes.
Micronuclei were significantly more in urothelial cells
from polyurethane industry workers and in lymphocytes
from bitumen road layers [14]. Chronic exposure to arsenic
[15] and disinfection by-products such as halomethanes,
haloacetonitriles, halopropanones, chloral hydrate, and
trichloronitromethane in drinking water has been linked to
bladder cancer.
A few Australian studies have also investigated dietary
associations with bladder cancer. A review by Brinkman
et al. [16] demonstrates that yellow–orange vegetables
(particularly carrots), citrus fruits, cruciferous vegetables,
and selenium are associated with moderate reductions in
the risk of developing bladder cancer. Possible risk factors
are salted and barbecued meat, pork, total fat, pickled
Table 1 2008 Global and
regional patterns of bladder
cancer incidence and mortality
per 100,000 population (1960W
age-standardised) [1]
Population Incidence Mortality
Persons Males Females Persons Males Females
Australia 6.2 10.2 2.7 2.0 3.0 1.1
World 5.3 8.9 2.2 2.0 3.3 0.9
More developed regions 9.1 16.3 3.6 2.6 4.6 1.0
Less developed regions 3.3 5.4 1.4 1.6 2.6 0.7
Very high human development 9.4 16.3 3.8 2.3 4.0 1.1
High human development 5.5 10.1 2.1 2.4 4.6 0.9
Medium human development 3.2 5.2 1.3 1.6 2.6 0.7
Low human development 2.4 3.2 1.7 1.9 2.6 1.3
The following data are listed in order to incidence (persons) highest to lowest
United States of America 12.7 21.1 5.8 2.2 3.7 1.1
Northern America 12.0 20.1 5.5 2.2 3.7 1.1
Southern Europe 11.2 20.7 3.3 3.3 6.2 1.1
Western Europe 9.8 17.2 3.9 2.5 4.4 1.2
Northern Europe 8.2 13.7 3.8 2.9 4.7 1.6
Northern Africa 8.2 14.5 2.4 5.5 9.9 1.6
Middle East and Northern Africa 7.8 13.8 2.4 4.6 8.2 1.4
Western Asia 7.4 13.1 2.4 3.8 6.7 1.3
Central and Eastern Europe 7.2 14.6 2.6 3.0 6.5 0.9
New Zealand 7.1 11.8 3.0 2.2 3.5 1.1
Oceania 5.9 9.7 2.5 1.9 3.0 1.0
Polynesia 4.5 8.1 1.3 1.1 2.4 0.0
Southern Africa 4.2 7.3 2.1 2.7 4.9 1.3
Eastern Asia 3.8 6.2 1.6 1.3 2.1 0.6
South America 3.7 6.3 1.6 1.6 2.6 0.9
Caribbean 3.7 5.8 1.9 1.7 2.5 1.0
Eastern and South-Eastern Asia, and Pacific 3.7 5.9 1.6 1.4 2.2 0.6
China 3.5 5.5 1.5 1.3 2.0 0.6
South-Eastern Asia 2.7 4.5 1.3 1.5 2.4 0.7
Western Africa 2.6 3.9 1.4 2.0 3.1 1.0
Sub-Saharan Africa 2.5 3.7 1.5 1.8 2.8 1.1
Eastern Africa 2.5 3.4 1.8 1.9 2.6 1.3
Central America 2.2 3.5 1.1 0.8 1.2 0.5
South-central Asia 2.2 3.6 0.9 1.3 2.1 0.5
Micronesia 2.1 4.7 0.0 1.1 2.5 0.0
India 1.7 2.8 0.6 1.0 1.6 0.4
Melanesia 1.6 2.7 0.5 1.2 2.0 0.4
Middle Africa 0.8 1.5 0.3 0.7 1.2 0.2
Int Urol Nephrol (2014) 46:1351–1360 1353
123
vegetables, salt, soy products, spices, and artificial sweet-
eners. No clear association could be determined for beef,
eggs, processed meats, and total fluid intake [16]. Similar
findings were noted in a meta-analysis examining 6 dietary
factors—retinol, beta-carotene, fruits, vegetables, meat,
and fat [17]. A study involving 322 cases and 239 controls
Table 2 Risk factors for bladder cancer
Risk factor Association Description
Tobacco smoking ???? Exposure to aromatic amines and other carcinogens (tar,
hydrocarbons)
Occupations Aromatic amine
manufacture
???? Chemical carcinogenesis
Dyestuff manufacture ????
Rubber industry ??
Painting ?
Leather industry ?
Aluminium industry ?
Truck drivers ?? Diesel exhaust and reduced bladder voiding
Drugs Phenacetin ????
Cyclophosphamide ????
Urinary tract diseases Schistosoma infection ???? Chronic inflammation, altered metabolism
Cystitis ?
Urinary stones ?
Carcinogens in drinking
water
Arsenic ?Direct carcinogenesis
Chlorination by-products ?Reactive species and direct carcinogenesis
Decreased fluid intake ? Less dilution of carcinogens, decreased voiding frequency
Genetic polymorphisms NAT1,NAT2, and GSTM1 ? Genetic predisposition
Coffee ?
Artificial sweeteners ?
Risk factors for bladder cancer [8]. This table has been extensively modified from the original table from [8]
Fig. 1 2008 Global patterns of
bladder cancer incidence per
100,000 population (1960W
age-standardised) [1]. Bladder
cancer was the 9th most
common worldwide cancer
cause and the 13th most
common cancer leading to death
globally. Developed and
industrialised countries
generally have a higher
incidence and mortality
1354 Int Urol Nephrol (2014) 46:1351–1360
123
suggests that vitamin E, carotenoids, vitamin D, thiamin,
and niacin may be protective [18]. However, other trials
suggest the opposite [19].
Bladder cancer histology
Histologically, [90 % of bladder cancers reported in
Australia are transitional cell carcinomas (TCCs), \5%of
bladder cancers are squamous cell carcinomas (SCCs), and
\2 % are adenocarcinomas and small cell carcinomas [20,
21]. These statistics mirror world statistics. However, in a
Victorian study with data accrued from a limited cohort of
110 patients treated with radical cystectomy for high-grade
invasive bladder cancer, TCCs accounted for the majority
disease (99 %) with the remaining SCCs (1 %) [22].
Bladder cancer incidence and mortality amongst
immigrants and indigenous Australians
Migrants to Australia are at higher risk of a diagnosis of
bladder cancer than Australian-born individuals [23]. NSW
Central Cancer Registry data accrued from 2001 to 2005
shows that people born overseas, more specifically those
born in English-speaking countries, had significantly
higher bladder cancer incidence and mortality [20].
Indigenous Australians appear to have no additional risk of
developing bladder cancer compared with non-indigenous
Australians [24].
Differences in bladder cancer incidence and mortality
rates within Australia
In the USA, bladder cancer incidence and mortality was
highest in the north-eastern part (New England) [9].
Interestingly, the rates are higher even in rural parts of the
north–east when compared with most urban areas in other
parts of the USA [10,11]. In Europe, rates were high in
Denmark (females) and northern Germany (persons),
Scotland (persons), and Netherlands (persons) [25].
Between 1999 and 2003 (Fig. 2a; Table 3), Queensland
reported the highest incidence rates of bladder cancer (19.8
per 100,000) and Northern Territory (NT) the lowest (7.2
per 100,000) [4]. We could not find literature or data which
could explain the high incidence in Queensland. The low
incidence in the NT may be totally or partially attributable
to high mortality, leading to misdiagnosis and/or under-
reporting. There were minimal differences between the
other states and territory. Males had an incidence rates 3–4
times higher than females in each state and territory
(Fig. 2a; Table 3)[4].
Fig. 2 Regional and geographical differences in bladder cancer
incidence and mortality in Australia. aAustralian regional bladder
cancer incidence rates 1999–2003 (per 100,000 population; age-
standardised to 2001 Australian Population) [4]: Between 1999 and
2003, Queensland had the highest incidence rates and NT the lowest
incidence rates compared with the Australian average (p\0.05).
Incidence rates for males were higher than females in all states and
territories. NSW New South Wales, SA South Australia, WA Western
Australia, NT Northern Territory, ACT Australian Capital Territory.
bAustralian regional bladder cancer mortality rates 1997–2001 (per
100,000 population; Age-standardised to 2001 Australian Population)
[27,35]: Between 1997 and 2001, the NT and ACT had the highest
mortality rates. Mortality rates for males were higher than females in
all states and territories. NSW New South Wales, SA South Australia,
WA Western Australia, NT Northern Territory, ACT Australian
Capital Territory. cRegional differences in bladder cancer standard-
ised incidence ratios (2001–2003) based on geographical remoteness
from urban medical services [4]: between 2001 and 2003, the
standardised incidence ratios for persons and men were (statistically)
significantly more in inner regional Australia (*pvalue \0.05),
compared with Australian major cities. MC major cities of Australia,
IR inner regional Australia, OR outer regional Australia, Rremote
Australia, VR very remote Australia
Int Urol Nephrol (2014) 46:1351–1360 1355
123
A recent study using Centre for Health record linkage
(CHeReL) datasets and annual hospitalisation data from
Australian Institute of Health and Welfare (AIHW) data-
sets showed a rapid increase in Australian bladder carci-
noma in situ from 2001 to 2006 [26]. Annually, there is an
11 % increase in men and a 14 % increase in women [26].
Unfortunately, bladder carcinoma in situ is not reportable
in Australia, unlike in the USA.
The NT and Australian Capital Territory (ACT) had the
highest mortality rates (1997–2001; Fig. 2b; Table 4)
amongst all Australian states and territories. Mortality rates
were higher for males than females in all states and terri-
tories (Fig. 2b; Table 4)[27].
In Queensland males (1998–2007), there was increased
bladder cancer incidence in coastal and urban areas com-
pared with residents of interior and rural/less urban areas
[28]. In South Australia, coastal and urban areas had an
increased incidence of bladder cancer (1977–2001), com-
pared with rural and interior areas [29].
The standardised incidence ratios were statistically more
significant, overall, and in men [4]; when compared to
Australian major cities where 2/3rds of the Australian
population lives (Fig. 2c).
Socio-economic differences in incidence of bladder
cancer have been demonstrated in Australia. The socio-
economic classification (SEIFA—Socio-Economic Indexes
for Areas) used in Australia entails 5 quintiles: Quintile 1
(least disadvantaged), Quintile 2 (second least disadvan-
taged), Quintile 3 (middle), Quintile 4 (second most dis-
advantaged), and Quintile 5 (most disadvantaged). In
NSW, from 2001 to 2005, Quintile 4 (second most disad-
vantaged) had an incidence rate of bladder cancer signifi-
cantly higher (p\0.001) than Quintile 1 (least
disadvantaged) [20]. Similarly, those in Quintile 4 (second
most disadvantaged) had a mortality rate from bladder
cancer significantly higher (p\0.006) than Quintile 1
(least disadvantaged) [20]. This pattern, however, is not
noted in other states or territories. For males in Queensland
(1998–2007), the incidence was lowest in Quintile 5 (most
disadvantaged) and Quintile 4 (second most disadvantaged)
[28]. In South Australia (SA), bladder cancer did not show
a consistent socio-economic gradient (1977–2001), with
Table 3 Australian regional differences in incidence (1999–2003)
rates of bladder cancer per 100,000 population
Incidence rate Standard
population
Persons Males Females
World 2002 [36] 6.3 10.1 2.5 ASR (1960W)
Australia 2003
[4]
7.3 12 3.5 ASR (1960W)
Australia 2003
[4]
10.9 18.3 5.1 ASR (2001Aus)
Australia 11.8 20.1 5.4 ASR (2001Aus)
NSW 11.8 20.1 5.5 ASR (2001Aus)
Victoria 7.7 13.0 3.8 ASR (2001Aus)
Queensland 19.1 32.2 8.4 ASR (2001Aus)
WA 10.0 17.3 4.5 ASR (2001Aus)
SA 10.6 18.2 4.9 ASR (2001Aus)
Tasmania 12.5 21.4 5.7 ASR (2001Aus)
ACT 12.6 22.2 5.1 ASR (2001Aus)
NT 7.2 12.3 1.7 ASR (2001Aus)
References [37][36][36]
Queensland had the highest incidence rates, and NT the lowest inci-
dence rates, amongst all the Australian states and territories. Inci-
dence rates for males were higher than females in all states and
territories
NSW New South Wales, SA South Australia, WA Western Australia,
NT Northern Territory, ACT Australian Capital Territory, ASR
(1960W) Age-Standardised Rate according to 1960 Standard World
Population, ASR (2001Aus) Age-Standardised Rate according to 2001
Standard Australian Population
Table 4 Australian regional differences in mortality (1997–2001)
rates of bladder cancer per 100,000 population
Mortality rate Standard
population
Persons Males Females
World 2002 [36] 4 1.1 ASR (1960W)
Australia 2003
[4]
2.6 4.2 1.4 ASR (1960W)
Australia 2003
[4]
4.2 7.0 2.3 ASR (2001Aus)
Australia 4.6 7.9 2.4 ASR (2001Aus)
NSW 4.6 8.0 2.3 ASR (2001Aus)
Victoria 4.4 7.4 2.4 ASR (2001Aus)
Queensland 4.8 8.0 2.5 ASR (2001Aus)
WA 4.2 7.1 2.2 ASR (2001Aus)
SA 4.9 8.7 2.5 ASR (2001Aus)
Tasmania 5.0 8.9 2.4 ASR (2001Aus)
ACT 6.7 12.5 3.0 ASR (2001Aus)
NT 5.3 9.4 1.6 ASR (2001Aus)
References [27,
35]
[27,
35]
[27]
The NT and ACT had the highest mortality rates, amongst all the
Australian states and territories. Mortality rates for males were higher
than females in all states and territories
NSW New South Wales, SA South Australia, WA Western Australia,
NT Northern Territory, ACT Australian Capital Territory, ASR
(1960W) Age-Standardised Rate according to 1960 Standard World
Population, ASR (2001Aus) Age-Standardised Rate according to 2001
Standard Australian Population
1356 Int Urol Nephrol (2014) 46:1351–1360
123
the incidence being highest in Quintile 5 (most disadvan-
taged) [29].
Gender differences in bladder cancer survival rates
Males have higher incidence and mortality rates of bladder
cancer than females, worldwide and Australia-wide
(Table 1). However, in a study which included all New
South Wales (NSW) cases of bladder cancer diagnosed
between 1980 and 2003 (17,923 cases), the likelihood of
death was 13 % higher in females than in males (after
adjusting for age, extent of disease, socioeconomic status,
period of diagnosis, and histological type) [30]. The rea-
sons for poorer survival in women were not evident but
may include:
1. Women are more likely to have cystitis and this may
lead to ignoring early warning signs of bladder cancer
including haematuria and urge incontinence;
2. Haematuria, as a presenting symptom of bladder
cancer, may be less visible to women owing to
anatomical differences with men;
3. Haematuria from bladder cancer may be mistaken for
menstrual blood or menstrual abnormalities;
4. Gender-based histological differences may lead to
obscuration of the degree of invasiveness; and
5. Gender-based anatomical differences may result in
qualitative differences in cystectomies
We have identified 5 other reasons from our 2001–2007
NSW bladder cancer study (manuscript in preparation).
Three of them are as follows:
1. The increased incidence of SCC and adenocarcinomas
in women, compared with men;
2. Women are diagnosed at a later age than men (age-
related morbidity); and
3. More frequent and injudicious use of cystectomy in
women, compared with men.
Surveillance of bladder cancer in Australia
In a NSW study conducted using data obtained from the
Douglas Hanly Moir Pathology Database [31] involving
201 patients who had undergone cystectomies, the clinical/
pathological pattern of bladder cancer presentation at the
time of cystectomy was similar to North American/Euro-
pean cohorts.
Established European guidelines for superficial bladder
cancer management indicate that decreasing the frequency
of surveillance cystoscopies does not impact patient sur-
vival [32]. A 2005 Victorian study [32] shows that despite
the existence of accepted guidelines, there was a gener-
alised non-conformity in the frequency of surveillance
cystoscopies in superficial bladder cancer patients in
Victoria. Muscle-invasive bladder cancer in Victoria
typically occurs in elderly patients, and a notable pro-
portion of these patients do not proceed onto ‘‘definitive’
treatment. Disease stage, cystectomy, and the use of high
doses of radiation were associated with better outcomes
[21]. In a Victorian study on patients newly diagnosed
with bladder cancer (1990–1995), tumour recurrence was
observed in 390 out of 610 patients (63.9 %), of whom
56.9 % had their recurrence noted at the first-check cys-
toscopy. Forty-three patients (6.3 %) progressed to inva-
sive disease with a 5-year overall survival rate of 35 %
[32].
In a South Australian study [33] which examined
treatment consistency, surveillance strategies, and guide-
line adherence for patients (2005–2009) with non-muscle-
invasive bladder cancer found that the pattern of cysto-
scopic surveillance varied widely within each risk cate-
gory. In high-risk patients, cytology, upper tract imaging,
adjuvant therapy, and re-resection was significantly lower
(3–56 %). In this study [33], discrepancies in adherence to
standardised management guidelines seemed apparent as in
78 low-risk cancer patients. More cystoscopies than
‘would have been expected’’ [33] were undertaken in 55 %
of these patients, and in 235 patients at high or intermediate
risk, 43 % received less follow-up than that recommended
by guidelines.
Management of bladder cancer in Australia
In a NSW study of people diagnosed with bladder cancer
between 1980 and 2003 (17,923 cases), the likelihood of
death was 13 % higher in females than in males (after
adjusting for age, extent of disease, socio-economic status,
period of diagnosis, and histological type) [30]. NSW
histopathological data from the Douglas Hanly Moir
Pathology Database [31], accrued over a period of 10 years
(1998–2008), involving 184 patients who had undergone
radical cystectomies and 17 patients who had undergone
partial cystectomies, revealed that:
1. Pelvic node dissection was not performed in 55 radical
cystectomies (30 %), and 8 partial cystectomies
(47 %). Only 32 patients (17 %) had 10 or more
nodes harvested
2. The main soft tissue surgical margins were tumour
positive in 30 specimens (15 %)
3. Intra-operative frozen section was performed only in
123 patients (67 %)
4. Ureteric margins were tumour positive in 21 patients
(11.5 %)
5. Urethral margins were tumour positive in 15 patients
(7.5 %)
Int Urol Nephrol (2014) 46:1351–1360 1357
123
In the light of bladder cancer management guideline,
these data suggest that the quality of these cystectomies
could have been much better.
In a Victorian study [22] presenting data from 110
patients treated with radical cystectomy for high-grade
invasive bladder cancer, accumulated for around 10 years,
59 patients (53 %) developed recurrent disease, and 79
patients (66 %) died within 1.5 years of surgery. These
Australian data exhibit poor survival results, high recur-
rence rates, and early death in invasive bladder cancer
patients. The conclusion from this study [22] is that, in the
light of bladder cancer management guidelines, the quality
of these cystectomies could have been far better.
As mentioned earlier, between the periods 1982–1987
and 2006–2010, in the absence of coding changes, 5-year
survival fell from 68 to 58 % [5].
Discussion
We have reviewed current statistics and health services
research publications for bladder cancer in Australia. This
section highlights and discusses certain peculiarities per-
taining to bladder cancer epidemiology and management in
Australia. We have also posited a few speculative com-
ments that may or may not contribute to these peculiarities.
We intend to explore various aspects of this, with a focus
on NSW.
1. Queensland (1999–2003 data) reported the highest
incidence rates of bladder cancer (19.8) and NT, the
lowest (7.2) [4]. As smoking differences are not
significant between the states at any point of time,
regional and geographical variations in industry, work
availability, and vocation, resulting in differential
carcinogen exposure, may contribute to these signif-
icant differences. More data on these are unavailable.
2. Similar to global statistics, males have an incidence
rate 3–4 times higher than females in each state/
territory (Fig. 2a; Table 3)[4]. The increased propor-
tion of men in high-risk occupations and industry may
account partially for this. Increased awareness, avail-
ability, and utilisation of prostate cancer screening and
investigation modalities may concurrently identify
more cases of bladder cancer in men.
3. Migrants to Australia are at higher risk of a
diagnosis of bladder cancer than Australian-born
individuals [23]. This is most clearly seen in NSW
(2001–2005 data) where people born overseas, and
more specifically those born in English-speaking
countries, have a significantly higher bladder cancer
incidence and mortality than Australian-born resi-
dents [20].
4. In NSW (2001–2005 data), the second most socio-
economically disadvantaged group had bladder cancer
incidence and mortality rates significantly higher than
the least disadvantaged group [20]. A possible reason
for this could be that more people in the second most
disadvantaged group may have been employed in
specific higher risk occupations (unknown) leading to
a higher incidence rate of bladder cancer.
5. Between 1983 and 2003, the incidence of bladder
cancer in Australia dropped from 17.1 per 100,000 to
10.9 per 100,000 and mortality dropped from 5.4 to 4.0
deaths per 100,000 [4]. However, during the 5-year
periods 1982–1987 and 2006–2010, 5-year survival
fell from 68 to 58 % [5].
i. The earlier decrease in incidence and mortality
could have been artificial, being attributable to
bladder cancer coding changes—all low-grade
non-invasive papillary tumours that were classified
as papillomas before 1973 were reclassified by the
WHO grading system as grade 1 papillocarcinomas
(pTa); and pTaG1 lesions were reclassified in 1998
as ‘‘papillary urothelial neoplasm of low malignant
potential (PUNLMP)’’ [34]. These changes which
shifted higher-grade lesions to lower-grade ones
may have artificially decreased bladder cancer
incidence and mortality.
ii. Australian databases record localised, regiona-
lised, distant, and unknown bladder cancer. The
SEER registries (USA) record in situ bladder
cancer; in addition to these 4, hence artificially
inflating survival statistics [6]. However, these
differences cannot account for the decreases in
survival data within Australia.
iii. The recent decrease in survival rates is less likely
to be due to major coding changes in Australia
(2010 onwards), although increased life expec-
tancy and age of diagnosis could be a contribut-
ing factor. More detailed analysis of bladder
cancer surveillance and management in Australia
is necessary to determine whether quality of care
has contributed to the decline in survival rates
[22,31].
Summary
Bladder cancer is an important health issue in Australia and
internationally. Variations in the incidence and mortality
indicate inequitable risks and outcomes, with the burden
generally heavier on those born outside Australia or those
living in lower SES areas. Survival rates have fallen. The
extent to which patterns of care that may appear to differ
1358 Int Urol Nephrol (2014) 46:1351–1360
123
from internationally accepted guidelines influence these
outcomes requires further detailed analysis.
Box with thumbnail sketch
What is already known
Queensland (1999–2003 data) reported the highest incidence
rates of bladder cancer.
Similar to global statistics, males have an incidence rate 3–4
times higher than females in each state/territory
Between 1983 and 2003, the incidence of bladder cancer in
Australia dropped from 17.1 per 100,000 to 10.9 per 100,000 and
mortality dropped from 5.4 to 4.0 deaths per 100,000. However,
during the 5-year periods 1982–1987 and 2006–2010, 5-year
survival fell from 68 to 58 %
What the manuscript adds to the literature
Possible reasons to why Queensland has the highest incidence
rates of bladder cancer
Migrants to Australia are at higher risk of a diagnosis of bladder
cancer than Australian-born individuals
In NSW (2001–2005 data), people born overseas, specifically
those born in English-speaking countries, have a significantly
higher bladder cancer incidence and mortality than Australian-born
residents
Possible reasons contributing to the decreasing survival rates of
bladder cancer in Australia, especially in women
Acknowledgments We acknowledge the New South Wales Cancer
Institute for funding this study through Early Career Research
Fellowship: M.I.P.
Conflict of interest None.
References
1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM
(2010) GLOBOCAN 2008 v2.0, Cancer Incidence and Mortality
Worldwide: IARC CancerBase No. 10 [Internet]. International
Agency for Research on Cancer, Lyon. http://globocan.iarc.fr.
Accessed on 25 Oct 2012
2. Ploeg M, Aben KK, Kiemeney LA (2009) The present and future
burden of urinary bladder cancer in the world. World J Urol
27(3):289–293
3. Australian Institute of Health and Welfare AIHW (2012) ACIM
(Australian Cancer Incidence and Mortality) Books. Canberra,
AIHW
4. AIHW AACR (2007) Cancer in Australia: an overview, 2006.
AIHW, Canberra
5. AIHW (2012) Cancer survival and prevalence in Australia: per-
iod estimates from 1982 to 2010. Cancer series no 69 2012; Cat.
No. CAN 65. AIHW, Canberra
6. SEER NCI (2013) Surveillance epidemiology and end results. US
National Institutes of Health. http://seer.cancer.gov/statfacts/
html/urinb.html#survival. SEER Stat Fact Sheets, Bladder
7. IARC (1987) IARC monograph on the evaluation of the carcin-
ogenic risks to humans. Overall evaluations of carcinogenicity:
an updating of IARC monographs, vol 1–42(Suppl 7). s.n, Lyon
8. Negri E, La Vecchia C (2001) Epidemiology and prevention of
bladder cancer. Eur J Cancer Prevent Off J Eur Cancer Prevent
Org (ECP) 10(1):7–14
9. Ries LAG, Miller BA, Hankey BF, Kosary CL, Harris A,
Edwards BK (1997) SEER cancer statistics review, 1973–1997.
Tables and Graphs National Cancer Institute, Bethesda, MD
10. Blot WJ, Fraumeni JF Jr (1978) Geographic patterns of bladder
cancer in the United States. J Natl Cancer Inst 61(4):1017–1023
11. Brown LM, Zahm SH, Hoover RN, Fraumeni JF Jr (1995) High
bladder cancer mortality in rural New England (United States): an
etiologic study. Cancer Causes Control 6(4):361–368
12. Michaud DS, Clinton SK, Rimm EB, Willett WC, Giovannucci
E (2001) Risk of bladder cancer by geographic region in a U.S.
cohort of male health professionals. Epidemiology
12(6):719–726
13. Gun RT, Pratt NL, Griffith EC, Adams GG, Bisby JA, Robinson
KL (2004) Update of a prospective study of mortality and cancer
incidence in the Australian petroleum industry. Occup Environ
Med 61(2):150–156
14. Murray EB, Edwards JW (2005) Differential induction of
micronuclei in peripheral lymphocytes and exfoliated urothelial
cells of workers exposed to 4,40-methylenebis-(2-chloroaniline)
(MOCA) and bitumen fumes. Rev Environ Health 20(3):
163–176
15. Rahman MM, Ng JC, Naidu R (2009) Chronic exposure of
arsenic via drinking water and its adverse health impacts on
humans. Environ Geochem Health 31(Suppl 1):189–200
16. Brinkman M, Zeegers MP (2008) Nutrition, total fluid and
bladder cancer. Scand J Urol Nephrol Suppl 218:25–36
17. Steinmaus CM, Nunez S, Smith AH (2000) Diet and bladder
cancer: a meta-analysis of six dietary variables. Am J Epidemiol
151(7):693–702
18. Brinkman MT, Karagas MR, Zens MS, Schned A, Reulen RC,
Zeegers MP (2010) Minerals and vitamins and the risk of bladder
cancer: results from the New Hampshire Study. Cancer Causes
Control 21(4):609–619
19. Virtamo J, Edwards BK, Virtanen M et al (2000) Effects of
supplemental alpha-tocopherol and beta-carotene on urinary tract
cancer: incidence and mortality in a controlled trial (Finland).
Cancer Causes Control 11(10):933–939
20. Duncombe J, Stavrou E, Chen W, Baker D, Tracey E, Bishop JF
(2009) Bladder cancer in New South Wales. Cancer Institute
NSW 2009 February; Cancer Institute NSW Catalogue number:
EM-2009-06
21. Millar JL, Frydenberg M, Toner G, Syme R, Thursfield V, Giles
GG (2006) Management of muscle-invasive bladder cancer in
Victoria, 1990–1995. ANZ J Surg 76(3):113–119
22. Chen EC, McCahy P, Frydenberg M (2011) Long term outcomes
of radical cystectomy—Monash Medical Centre Experience. Asia
Pac J Clin Oncol 7(Suppl s4):117–195
23. Anikeeva O, Bi P, Hiller JE, Ryan P, Roder D, Han GS (2012)
Trends in cancer mortality rates among migrants in Australia:
1981–2007. Cancer Epidemiol 36(2):e74–e82
24. Condon JR, Armstrong BK, Barnes T, Zhao Y (2005) Cancer
incidence and survival for indigenous Australians in the Northern
Territory. Aust N Z J Public Health 29(2):123–128
25. Boyle P, Smans M (2008) IARC Scientific Publications, Number
159. Atlas of cancer mortality in the European Union and the
European Economic Area 1993–1997. International Agency for
Research on Cancer, Lyon
26. Ranasinghe WK, Attia J, Oldmeadow C et al. (2013) Bladder
carcinoma in situ (CIS) in Australia: a rising incidence for an
under-reported malignancy. BJU Int 112(Suppl 2):46–52
27. AIHW AACR (2004) Cancer in Australia, 2001. AIHW,
Canberra
Int Urol Nephrol (2014) 46:1351–1360 1359
123
28. Viertel Centre for Research in Cancer Control (2007) Bladder
cancer. Cancer Council Queensland. Atlas of Cancer in
Queensland
29. Cancer Council South Australia (2009) Statistics—bladder can-
cer. Cancer Council South Australia 2009
30. Tracey E, Roder D, Luke C, Bishop J (2009) Bladder cancer
survivals in New South Wales, Australia: Why do women have
poorer survival than men? BJU Int 104(4):498–504
31. Ahmadi N, Delprado WJ, Brooks AJ et al. (2012) A 10-year
histopathological audit of radical cystectomy in a Single
Pathology Centre in New South Wales, Australia. USANZ2012
conference 2012; Urological Society of Australia and New Zea-
land, p 076
32. Frydenberg M, Millar JL, Toner G et al (2005) Management of
superficial bladder cancer in Victoria: 1990 and 1995. ANZ J
Surg 75(5):270–274
33. Siddins MT, Wong VV, Fitzgerald JT, Bamberg LJ (2011)
Challenges in non-muscle invasive bladder cancer: lessons from a
regional review. ANZ J Surg 81(12):889–894
34. Parkin DM (2008) The global burden of urinary bladder cancer.
Scand J Urol Nephrol Suppl 218:12–20
35. Personal communication from Dr. Mark Short, Senior Data
Analyst, Cancer and Screening Unit, Australian Institute of
Health and Welfare
36. Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer
statistics, 2002. CA Cancer J Clin 55(2):74–108
37. Ferlay J, Bray F, Pisani P, Max Parkin D (2004) GLOBOCAN
2002: cancer incidence, mortality and prevalence worldwide.
IARC CancerBase 2004;No. 5. version 2.0. IARC Press, Lyon
1360 Int Urol Nephrol (2014) 46:1351–1360
123
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