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Wednesday, 27 May 1987
Page: 3453

(Question No. 4965)

Mr Milton asked the Minister for Health, upon notice, on 27 November 1986:

Will he establish a national register of deaths from cancer in Australia which would include information on the past occupations, lifestyles and place of residence of the deceased; if not, why not.

Dr Blewett —The answer to the honourable member's question is as follows:

I share the honourable member's concern. As he is no doubt aware, cancer is the second most important cause of death in the Australian population and is the only major cause of death which is still increasing in our country. Cancer registries already exist in each of the States and the Northern Territory (Australian Capital Territory events are recorded by the New South Wales registry), and a National Cancer Statistics Clearing House is currently being established at the Australian Institute of Health in Canberra, as a co-operative venture between the Institute and the Australasian Association of Cancer Registries.

The Clearing House will receive from the registries reports of initial diagnoses of, and deaths from, malignant tumours that occur in usual residents of Australia, commencing with reports from 1982. The reports include usual residence at the time of onset or death, but do not include past occupation or lifestyle factors; current occupation is recorded by four of the registries.

The Clearing House will fill an important national monitoring function, including:

(1) computation and analysis of cancer statistics on a national basis;

(2) tracking of interstate movements of cancer patients; and

(3) facilitating the conduct of follow-up studies to determine the outcome of cancer cases.

However, the Clearing House is not a particularly suitable vehicle for establishing the role of environmental, behavioural and lifestyle factors in the aetiology of cancers.

The time between exposure to risk factors, and mani- festation of cancer is often in the order of 15-30 years. Patients only come to the attention of the registries when a cancer is diagnosed, so in order to establish a connection, information would have to be collected retrospectively on the supposed risk factors in operation 15-30 years earlier. It would be impractical to do this for each case, as more than fifty thousand cancers occur every year. The Clearing House will, however, subject to ethical clearance and the agreement of the registries, be able to provide researchers with details of cases of particular tumours. The registries already provide this facility on a State basis.

As part of the proposal to establish a National Register of Births, Deaths and Marriages under the Australia Card legislation, the Institute will establish a National Death Index, which will provide the means to determine whether a given person has died, and if so, the cause of death.

The Index will include details of occupation as reported at the time of death, but that of course may not be particularly informative, especially if occupation is given as pensioner, retired etc. There have been proposals, for instance, to record `main lifetime occupation', or even a detailed occupational history, but again this would not be practicable for every death that occurs, or even for every cancer death that occurs.

I would, however, point out to the honourable member that there is another, more appropriate method for investigating the link between occupation, lifestyle and residence, and cancer, which the Institute of Health is also pursuing. This involves the follow-up of persons known to have been exposed to possible risk factors, rather than the retrospective reconstruction of risk factors for people who manifest a disease.

Experience in the UK, USA and Canada has shown that in conjunction with lists of people exposed to possible risk factors (eg residents of particular areas at particular times, employees of particular companies, and members of particular occupational groups), a death index of the kind that the Institute of Health will be establishing can provide a very powerful tool for investigating the contribution of environmental, behavioural or lifestyle factors to the causation of cancer.