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Wednesday, 29 March 2006
Page: 50

Mr CADMAN (12:23 PM) —The Cancer Australia Bill 2006 is a terrific initiative for cancer sufferers. It brings for the first time into the government ambit a strong commitment in a way that all Australians would endorse. The carping negativity of the opposition is resented and rejected by the government. This innovation is a great improvement on the way in which this nation considers cancer. The functions of Cancer Australia, which is the body being established, are:

(a)   to provide national leadership in cancer control;

(b)   to guide scientific improvements to cancer prevention, treatment and care;

(c)   to coordinate and liaise between the wide range of groups and health care providers with an interest in cancer;

(d)   to make recommendations to the Commonwealth Government about cancer policy and priorities;

(e)   to oversee a dedicated budget for research into cancer;

(f)   to assist with the implementation of Commonwealth Government policies and programs in cancer control;

(g)   to provide financial assistance, out of money appropriated by the Parliament, for research mentioned in paragraph (e)—

that is the above paragraph in this proposed section—

   and for the implementation of policies and programs ...

   (h)   any functions that the Minister, by writing, directs Cancer Australia to perform.

The body will be established with an advisory council and a chief executive officer. I am delighted to know that the chairman of the advisory council has already been selected—Dr Bill Glasson, the former head of the Australian Medical Association. The budget has been set down in the explanatory memorandum. The total over a four-year period will be $12.6 million in a forward commitment by the government. There has been a complaint made by the previous speaker that the current financial year is coming to an end and that those funds cannot be used in the time that is left. I know of no provision that there is going to be a shortcut of funding for this election commitment by the government.

I have researched the incidence of cancer in Australia. It is interesting to note that, of all new cases of cancer in females in 2001, the most common cancers were breast, 29 per cent; colorectal, 14 per cent; melanoma, 10 per cent; and lung, seven per cent. In males, of all new cases of cancer, the most common cancers were prostate, 23 per cent; colorectal, 15 per cent—a little above women; melanoma, 11 per cent—again a little above women; and lung, 11 per cent, significantly above women at seven per cent. I trust these proposals before the House will go across the whole range of the causes of cancers, dealing with both male and female problems.

The only difficulty that I have detected over the years is that the Cancer Council of Australia has been reluctant to commit itself to a course of action for prostate cancer. I think everybody applauds the program of testing and screening for breast cancer, the initiatives that have been taken with colorectal cancer and the efforts being made to prevent lung cancer. But the one shortcoming that I detect in all of this is an impetus for prostate cancer. Part of it is because men create their own problem; they are like that. I do not believe there is a well-directed program to attack this problem. At this early stage I would like to charge Cancer Australia with the task of committing themselves to doing something more definitive about the problem of prostate cancer.

The Cancer Council of Australia has produced a statement giving their position on prostate cancer screening. I have a certain degree of disappointment with it, having dealt with proponents of prostate cancer screening and their lack of confidence in the stance of the Cancer Council of Australia on this issue. I will read out the recommendations of the Cancer Council of Australia:

  • In the absence of direct evidence showing a clear benefit of population based screening for prostate cancer, a patient centred approach for individual decisions about testing is recommended. Ideally this takes the form of an informed, shared, decision-making process between the doctor and man, discussing the benefits, risks and uncertainties of testing, and discussion about treatment options and side effects.
  • Screening discussions and decisions should always include and take into account age and other individual risk factors such as a family history of the disease.
  • Research into prostate cancer diagnosis and treatment must continue to be a high priority. In particular, the development of an accurate test to detect the potentially lethal form of prostate cancer.
  • Education and resourcing of GPs and other relevant health professionals needs to occur to enable them to adequately inform men of the benefits and risks of testing for prostate cancer and to enable men to make an informed decision as to whether or not they should be tested.

That is a pretty equivocal statement. I would like to see something far more positive from the Cancer Council of Australia. I hope Cancer Australia will adopt a far more dynamic, proactive and positive approach to the problems faced by those people who are among the 23 per cent of new cases of prostate cancer identified in 2001. The Cancer Council goes on to explain some of the difficulties in testing. The prostate specific antigen, PSA, as the test is known, can produce diverse results. Provided there is a proper lapse of time and the PSA test is supported by other testing mechanisms, I think we have a chance of achieving fairly reasonable results.

Is there a need for universal testing? On the evidence, as I see it, probably not. The high-risk age is somewhere between 45 and 60. If we narrow the field of likely sufferers of prostate cancer to that age group, we immediately reduce the population that should be considered for screening. If, together with the PSA screening test, we adopt some of the other processes, they might give us an indication of a risk of cancer. DRE is a painful test for men. They do not like it very much; it is a rectal examination. It is what I think men dread more than anything else about this testing, but it is a complementary process to the PSA test, which is a simple blood test and easily done.

If we are going to improve the health of Australians in this age group, then we need these two tests, along with any further tests, as an indicative process. It is a critical age group. They are at their maximum earning capacity and have probably got teenage kids or kids who are in their early 20s and at the point of marriage. The resources of the male in a family are called upon to provide for more than just the immediate needs of him and his spouse. Even if his spouse is working too, it can be soul destroying to a family to suddenly have all of the responsibility thrown onto the female. There is good argument for us to be seriously doing more about investigating the prospect of screening for this age group, who are most likely to be the contractors of prostate cancer.

There is an age that men will reach when testing is a waste of time. Men in the last 10 years of their life may have prostate cancer but they are more than likely going to die from causes other than prostate. To stretch this testing program across all ages of men is probably unwise. Young men can also contract this problem, but as this cancer is more likely to occur within a specific age group universal screening for it may not be necessary.

The Cancer Council speaks about the processes that they advise. From a male’s point of view they seem pretty wishy-washy. They advise men to discuss it with their doctor. Men are not going to go to their doctor unless there is something seriously wrong. They are not going to go to their doctor on the chance of their having prostate cancer. They might require a PSA test at the time they are having heart or other tests done, which are more likely causes for men to go to doctors. The automatic testing for PSA in those circumstances for this age group, to me, should not be a process that is a matter for discussion or debate. To expect men to go into a deep and meaningful with their doctor about prostate cancer is, I think, pretty unlikely. They will want to get out of there as fast as they can. The attitude of most males when having a stress test or any other tests for their physical health and wellbeing is for it to be administered as quickly as possible so that they can get out of the doctor’s surgery and get on with their life. I think the Cancer Council of Australia should recommend that a PSA test be automatically conducted for that age group at risk.

The council seem to be recommending this deep and meaningful approach, with discussions about screening. It should not be a matter of discussion; it should happen automatically. Then, if a man’s PSA is up, they can be advised to come back in three months for another test to see whether or not there is a need for further testing. That is a simple thing to do at a critical point in the control of cancer.

Is this a man-woman thing? No. It is certainly not. Men have to be just as careful about their health as women do, and if they are not prepared to adopt such an approach and care for themselves then there should be put in place automatic testing points. Prognostic markers can be used and there is the screening process.

It is very interesting to read what is said about prostate cancer. The Prostate Cancer Institute, the PCI, explain what we should do about screening:

Screening, if elected for by the patient, should commence at the age of 50 years (and possibly earlier) with a digital rectal examination and a serum PSA test. A biopsy should be performed if the rectal examination is abnormal or if the PSA reading is greater than the reference range for his age.

There is increasing evidence that PSA testing beginning as early as the age of 40 years may predict the likelihood of later clinical cancer. For example, if a patient’s PSA level between the ages of 40 and 50 years is greater than 0.6 ng/mL, he is seven times more likely to develop prostate cancer than if his level is less than 0.3 ng/mL. If a patient has a family history of prostate cancer, screening should commence at 40 years of age and continue annually until his life expectancy falls below 10 years. Currently, 25% of Australian men over the age of 40 years are having regular PSA tests.

Who should we screen?

Assessing a patient’s preferences and determining the likelihood that he will benefit from screening are part of the physician’s responsibility. For example, a patient who has a life expectancy of less than 10 years is unlikely to benefit from screening and may suffer a significant reduction in his quality of life. The final decision about whether or not to screen will depend on each man’s goals, fears and willingness to accept risks.

I think that is a more practical approach and that is the one I would like to see adopted. In fact, the Prostate Cancer Institute says that the reasons are simple. The male population is ageing rapidly and the risk of prostate cancer is also on the rise rapidly. The predictions that I have indicate that prostate cancers will increase by 34 per cent from 11,892 in 2001 to 15,972 by 2011. In a 10-year period, there will be a 34 per cent increase. Part of that increase, of course, is the increased number of people in the at-risk age group. Therefore, we need to deal with this issue and Cancer Australia needs to take note of it. It must not adopt the passive line of the Cancer Council of Australia but take a more proactive interest. I cannot understand the Cancer Council’s reluctance in this area and it has been a matter of contention between the various professional groups involved with the various types of cancers.

I want to go to the institute proposal. Many younger men under the age of 60 are now being diagnosed with prostatic cancer. The chance of detecting prostatic cancer at an early and curable age has increased due to the sensitivity of the PSA blood test. Many men, especially younger men, will die from prostate cancer without early detection and effective curative intervention. Many advances have occurred recently in the treatment of prostate cancer by surgery, radiotherapy or drug therapy. A team approach to management where patients receive individual attention has been shown in other cancers to produce better health outcomes.

The incidence of prostate cancer is a little less than breast cancer. Early detection of breast cancer in women and more effective treatments have led to a steady improvement in survival and reduced mortality. Those are the goals I would like to see adopted by Cancer Australia. I would like to see Cancer Australia get active in this area. I would like to see them produce some really positive statements early in their establishment. I would like to see the new chairman of the advisory council make it clear that they are going to be aggressive and proactive on all forms of cancer and wherever possible make advances, first of all by screening and then by a team approach to treatment and care.

Cancer and heart disease are the great killer diseases of our time. Of the teenage girls alive today I am told that 30 per cent will live to be 100. That is going to produce some big changes in life expectancy. I know in the retirement villages I visit that the people who were considered old 30 years ago, when I was first elected, were the 80- or 85-year-olds. Now it is the 90- and 95-year-olds and they are as bright today at that age as the 85-year-olds were some years ago. That change in outlook, expectancy and attitude is something that is going to increase as mortality comes later. The attention to cancer by Cancer Australia is the most significant part of life improvement and life extension. I encourage them to take a balanced and universal look at this problem.