Cancer has been infamously named the leading cause of death -worldwide- by the World Health Organization (WHO, 2019). According to the World Health Organization, the global rates of cancer incidence and cancer mortality2 are not improving either, but are rather continuing to increase (WHO, 2019). Currently, cancer is said to be responsible for one in every six deaths worldwide (WHO, 2019). Lung cancer, in specific, is the most commonly diagnosed cancer and is said to be the leading cause of cancer death worldwide (WHO, 2019).
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Australia is drastically affected by lung cancer. According to the World Health Organization's International Agency for Research on Cancer, Australia is known to have both the highest rates of cancer incidence and mortality compared to any other country (International Agency for Research on Cancer, 2018). While currently in Australia, more men are diagnosed with lung cancer than women, it is estimated that women's incidence rate of lung cancer will surpass men's incidence rate within the next decade (Yu, X., Kahn, C., Luo, Q., Sitas, F., & O'connell, D., 2015). Furtehr on, there has been a significant increase in disparity across socioeconomic areas for lung cancer (Yu, X., Luo, Q., Kahn, C., Cahill, C., Weber, M., Grogan, P., … O'Connell, D., 2017) in Australia.
In addition to Australia, lung cancer in the United States of America is said to be the number one killer cancer for both men and women (American Lung Association Scientific and Medical Editorial Review Panel, 2019). Although currently in America, men are more likely to be diagnosed with lung cancer than women, the already small incidence gap between the two sexes is decreasing (Donington, J., & Colson, Y, 2011). In America, a low socioeconomic status has also been associated with an increased risk for Lung Cancer (Hovanec, J., Siemiatycki, J., Conway, D., Olsson, A., Stucker, I., Guida, F., … Behrens, T. 2018).
The high rates of lung cancer incidence and mortality for both countries may be contributed to smoking tobacco, second-hand smoke, genetic susceptibility, poor diet, occupational exposures, and air pollution (Malhotra, J., Malvezzi, M., Negri, E., La Vecchia, C., Boffetta, P., & Malhotra, J, 2016). Further on, cultural views and stigma may be an important cause of lung cancer mortality (Crane, M., Scott, N., O'Hara, B., Aranda, S., Lafontaine, M., Stacey, I., … Currow, D, 2016). Some of lung cancer's effects include high mortality rates, high healthcare expenditures, tobacco control initiatives, and other governmental interventions.
The following paper will consist of a body which will further explain the role that gender plays in lung cancer, the causes of lung cancer, the role that socioeconomic status plays in lung cancer, and the effects of lung cancer in Australia. Additionally, the paper will consist of an analysis that will critically examine and analyze the literatures mentioned in the body and compare the lung cancer's causes, effects, gender roles, and socioeconomic roles in Australia to America. Lastly, the paper will include a conclusion to wrap up the paper's main points and explain what research should be further examines for lung cancer in Australia.
Role of Gender in Lung Cancer in Australia
In Australia there is an estimated 10,000 lung cancers diagnosis per year -in which 5,950 are in men and 3,755 are in females (Australian Institute of Health and Welfare, 2019). Further on, there is an estimated lung cancer mortality of 4,715 males and 2,910 females (Australian Institute of Health and Welfare, 2019). This makes lung cancer the second cause of death for all males and the fourth cause of death for females in Australia (Australian Institute of Health and Welfare, 2019). However, over the past several years, the mortality rate from lung cancer for males has decreased by 41%, while the mortality rate for females has increased by 56% (Australian Institute of Health and Welfare, 2019). This is a huge disparity gap between both genders. This different pattern of incidence and mortality rates in males and females is said to reflect recent changed in attitude and smoking behavior. Currently men smoke more tobacco than women, but women have started smoking tobacco much more than before, whereas men have stopped smoking tobacco as much as before. This can be due to changing cultural views, in which smoking tobacco is no longer perceived a "male" activity- making women more inclined to smoke. At the same time, there has been many tobacco control initiatives targeted to the male population, which may be the cause of why the male population has decreased their smoking rates (Australian Institute of Health and Welfare, 2019).
Causes of Lung Cancer in Australia
As a chronic disease, lung cancer has many risk factors that may accumulate over time to initiate the disease. Such risk factors include smoking tobacco, inhaling second-hand smoke, genetic susceptibility, poor diet, occupational exposures, and air pollution (Malhotra, J., Malvezzi, M., Negri, E., La Vecchia, C., Boffetta, P., & Malhotra, J, 2016).
Smoking tobacco is the biggest risk factor for lung cancer as it accounts for 87 percent of all lung cancer deaths (Ball, W.,1957). In Australia, smoking tobacco became common as it exponentially increased after World War Two (Adair, T., Hoy, D., Dettrick, Z., & Lopez, A., 2011). Beneficially, within the past decades' discovery of how harmful smoking tobacco is, the proportion of adults in Australia who were daily smokers decreased from 22.3% to 13.8% (Adair, T., Hoy, D., Dettrick, Z., & Lopez, A., 2011). During the more recent years, however, the daily smoking rate has remained relatively stable at 13.8% (Adair, T., Hoy, D., Dettrick, Z., & Lopez, A., 2011).
Poor diet is also one of the major risk factors for lung cancer. A diet high in red meat and low in vegetables is shown to have a strong correlation to lung cancer (Xue, X., Gao, Q., Qiao, J., Zhang, J., Xu, C., Liu, J., & Xue, X., 2014). Australians consume approximately 100kg of red meat per year- ranking Australia as the number one country with the highest red and processed meat intake per person ("FED: Snapshot of Australia's health", 2018). In addition to red and processed meat, only 68% of children and five percent of adults have a sufficient intake of vegetables ("FED: Snapshot of Australia's health", 2018). This shows that Australia's diet is extremely poor and could be why so many Australians are affected with lung cancer.
Stigma and other cultural views may also be an important cause of lung cancer mortality. When it comes to lung cancer screenings in Australia, there is a common belief in that a person should only go to the doctor if the symptoms are severe enough— since they "know their body, and would know if something was wrong" (Crane, M., Scott, N., O'Hara, B., Aranda, S., Lafontaine, M., Stacey, I., … Currow, D, 2016). Another widely held view is to not mention "mild" symptoms to the doctor since it will "go away" (Crane, M., Scott, N., O'Hara, B., Aranda, S., Lafontaine, M., Stacey, I., … Currow, D, 2016). Lastly, many smokers admitted that they would not tell their doctor if they experience symptoms of smoking because of the stigma associated with smoking (Crane, M., Scott, N., O'Hara, B., Aranda, S., Lafontaine, M., Stacey, I., … Currow, D, 2016). This is an obstacle to secondary prevention for lung cancer, which is critical for early treatments and stopping further spread of the cancer.
Roles of Socioeconomic Status in Lung Cancer in Australia
Currently in Australia, there has been a significant increase in disparity across socioeconomic areas for lung cancer (Yu, X., Luo, Q., Kahn, C., Cahill, C., Weber, M., Grogan, P., … O'Connell, D., 2017). Many studies show a strong negative correlation with one's smoking rate and one's socioeconomic status; people in the lowest socioeconomic status group are almost twice that of the highest socioeconomic class to smoke tobacco (AIHW, AIHW & AACR, 2008). As a result, people with lower socioeconomic statuses have higher lung cancer incidence and mortality rates than people from higher socioeconomic statuses (AIHW, 2010a). More specifically, the Aboriginal and Torres Strait Islander population of Australia show a relative socioeconomic disadvantage to other Australians. As a result, the age-standardized incidence rate of lung cancer are significantly higher for Indigenous than non-Indigenous Australians (AIHW, 2010a). In specific, Indigenous (Aboriginal and Torres Strait Islander) males were 1.7 times as likely to be diagnosed with lung cancer as non-Indigenous males and Indigenous females were 1.6 times as likely to be diagnosed with lung cancer as non-Indigenous females. This difference may be explained, at least in part, by the fact that Indigenous adults have a relatively low socioeconomic status (AIHW, 2010a). Being in a low socioeconomic status puts the Indigenous population at a more than twice as likely chance to be a current daily smoker and not be able to afford healthy and nutritious foods (AIHW, 2010a).
Effects of Lung Cancer in Australia
Premature mortality is the biggest effect of lung cancer in Australia. Other effects of lung cancer include high healthcare expenditures, tobacco control initiatives, and increased research for lung cancer. As previously mentioned, lung cancer has extremely high mortality rate in
Australia; the chance of surviving at least five years of lung cancer is only 17 percent (Torre, L., Siegel, R., Jemal, A., & Torre, L., 2016). Most people who die prematurely from lung cancer not only cause emotional damage on their families, but they become a lost value in their country as a whole; in Australia, the amount of premature deaths from lung cancer in 2003 resulted in 88,000 working years lost and was estimated to be a $4.2 billion economic cost for the country (Carter, H., Schofield, D., & Shrestha, R., 2016).
Lung cancer in Australia also creates high healthcare expenditures. Just in 2004 alone, Australia's healthcare expenditure for lung cancer was approximated to cost $166 million (AIHW, 2010b). 79% of the health expenditure on lung cancer was for hospital admitted patient services -costing around $131 million (AIHW, 2010b). Another 18% was spent on out-ofhospital medical services -costing around $30 million, and the last 3% was spent on prescription pharmaceuticals -costing nearly $5 million (AIHW, 2010b). This is an extremely high spending as in 2004 it was found that the proportion of health-care expenditure for lung cancer was more than the healthcare expenditure for all other cancers and all diseases (AIHW, 2010b).
Additionally, the future cost for lung cancer healthcare expenditures is estimated to have a sharp increase (AIHW, 2010b).
There have also been tobacco control initiatives as a result of the high lung cancer rates in Australia. In Australia, such initiatives such as putting health warnings on tobacco packaging, making smoke-free zones, tobacco price increases, and increased anti-tobacco marketing campaigns have already been shown to avert a great number of deaths in the country, preventing roughly 400 thousand deaths from lung cancer from 1956-2015 (Dela Cruz, C., Tanoue, L., & Matthay, R., 2011).
The articles used in the body of this paper contribute to the larger body of science by bringing in comprehensive snapshots of Australia's lung cancer's latest statistics and their collective impact. This is important since one must know the collective effects, gender roles, socioeconomic roles, and causes of lung cancer for decision-making, resource allocation and the evaluation of programs and policies regarding lung cancer in Australia. All of the literatures used in the body are appropriate, as they are credible -all are peer reviewed and the experimental research papers have even been repeated multiple times by different studies in which similar results were found-, they are also relevant as they have the most recent data, and are directly related to the topic of lung cancer in Australia such as explaining genders' roles in lung cancer, causes of lung cancer, socioeconomic roles on lung cancer, and the effects of lung cancer.
When it comes to gender roles' effect on lung cancer in America compared to Australia, the gap between female and male lung cancer incidence and mortality rates is much smaller than Australia's. In America, there is an estimated 228,150 new cases of lung cancer per year -in which 116,440 are in men and 111,710 are in women (American Cancer Society, 2019). Additionally, there is an estimated 142,670 deaths from lung cancer every year -in which 76,650 are in men and 66,020 are in women (American Cancer Society, 2019). It is important to note that the number of deaths are much larger in America since the population in America is bigger than Australia's -however, Australia still has a higher mortality rate. Overall, in America the chance that a man will develop lung cancer in his lifetime is about 1 in 15, while for a woman the risk is about 1 in 17. Just like the disparity that the Aboriginal population of Australia face when it comes to lung cancer, black men and women in America also face a disparity as they are about 15% more likely to develop lung cancer than white men and women (Desantis, C., Miller, K., Goding Sauer, A., Jemal, A., & Siegel, R., 2019). In America, both black and white women have lower rates of lung cancer incidence than men, but this gap is very close to closing (American Cancer Society, 2019).
During the past 50 years there has also been a dramatic increase in the incidence of lung cancer in women in America- just like in Australia (Donington, J., & Colson, Y., 2011). There is a gap in the literatures when it comes to causes of the increase in lung cancer for women in both Australia and America. Most of the articles contribute this rise to an increase in smoking tobacco within the female population, however, approximately 1 in 5 women with lung cancer have never smoked (Donington, J., & Colson, Y., 2011). Some small studies have tried examining the significance of gender-based differences in epidemiology, genetics, hormones, and treatments of lung cancer to find what is the cause of 20 percent of the women with lung cancer, but not many studies have found significant data (Donington, J., & Colson, Y., 2011).
When it comes to the causes of lung cancer, Australia and America both struggle with the same causes. Australia's historical trends in smoking tobacco and lung cancer were very similar to America's (Adair, T., Hoy, D., Dettrick, Z., & Lopez, A., 2011). In America, the tobacco smoking rate were also extremely high after World War Two, where 42.4% of U.S. adults would smoke cigarettes (Angelicalavito, 2018). America's smoking trends recently reached a record low of 14% after a 67% decline since 1965, just like they did in Australia (Angelicalavito, 2018). Further on, when it comes to dietary trends, in America, although high rates of red meat intake persist along with low rates of vegetable intake, there has been a national decrease in red meat consumption and a national increase in vegetable consumption (Neff, R. A., Edwards, D., Palmer, A., Ramsing, R., Righter, A., & Wolfson, J., 2018). This shows that America is less likely to be affected by lung cancer because of their diet as compared to Australia. In addition, cultural views such as stigma also persists in America as many lung cancer patients fear being denied treatment and conceal their condition and their psychosocial distress (Hamann, H., Ostroff, J., Marks, E., Gerber, D., Schiller, J., & Lee, S., 2014). Not many studies are done on how to effectively reduce this stigma in both America and Australia. Such stigma and cultural views prevent many people in both Australia and America in getting primary, secondary, and tertiary prevention for lung cancer.
When it comes to socioeconomic status' role in lung cancer, many studies also showed a negative correlation between one's socioeconomic status and lung cancer incidence in America just as they did in Australia (Hovanec, J., Siemiatycki, J., Conway, D., Olsson, A., Stucker, I., Guida, F., … Behrens, T., 2018). This can in part be due to people in lower socioeconomic classes for both countries are less likely to be educated about the importance of their health and more likely to be targeting by tobacco ads. Further on, people in lower socioeconomic statuses for both countries are less likely to afford healthy foods and are more likely to eat processed meats from fast food store chains, which increases their chances of developing lung cancer. There is a gap in articles that talk about the disparity in lung cancer mortality rates in Australia and America due to socioeconomic class roles. Although one might assume people from lower socioeconomic classes have higher mortality rates because they might have less access to quality healthcare- since this is generally a case of higher mortality rates in least developed countries as seen in the video of Dead Mum Don't Cry (British Broadcasting Corporation, 2005) and talked about in the book "Introduction to Global Health" by Kathryn H. Jacobsen on chapters explaining infectious disease and disparities in least developed countries (Jacobsen, K. H., 2019) -however, this is not supported by scientific evidence for lung cancer. Further on, little is known about the relation between the strength of association and the level of adjustment and level of aggregation of the socioeconomic status measure for both Australia and America. One literature found "a weak positive association between individual income and lung cancer survival" however this correlation is too weak to have any significance (Finke, I., Behrens, G., Weisser, L., Brenner, H., & Jansen, L., 2018).
When it comes to the effects of lung cancer, Australia is more drastically impacted than America. For instance, the chance of surviving lung cancer after five years in Australia is only 17 percent, whereas in America that number is increased to 56 percent (American Lung Association Scientific and Medical Editorial Review Panel, 2019. Additionally, when it comes to the cost of healthcare expenditures, lung cancer in America does not have the highest healthcare expenditures out of all other cancers like it does in Australia (Yabroff, K. R., Lund, J., Kepka, D., & Mariotto, A., 2011) -even though lung cancer healthcare expenditures in America are estimated to be a whopping $12.1 billon (Yabroff, K. R., Lund, J., Kepka, D., & Mariotto, A., 2011). In addition, the same tobacco control initiatives have been used in America and have resulted in an 8% short-term relative reduction in smoking and a 12% long-term relative reduction in smoking prevalence through the greater impact on youth smoking (Levy, T., Tam, T., Kuo, T., Fong, T., & Chaloupka, T., 2018), reaching more people than the initiatives in Australia. There is a gap in articles about more efficient tobacco control initiatives in Australia that will primarily affect the minority groups such as the Aboriginal population, people in lower socioeconomic statuses, and women in Australia in order to eventually close the disparity gap. The only major area in which lung cancer is more drastically affecting America than Australia is the projected 3 million years of life that will be prematurely lost due to lung cancer -leading to about $145 billion in economic loss for the country (American Cancer Society, 2019). America is estimated to lose more money from premature deaths of lung cancer than Australia since the American population is larger, and more deaths in total mean more money lost in total. In America, it was also estimated that the cost of lung cancer healthcare expenditures will increase in the following years just like they will increase in Australia (Yabroff, K. R., Lund, J., Kepka, D., & Mariotto, A., 2011).
In reflection, lung cancer greatly impacts the population of Australia as it has both the highest incidence rate as well as the highest mortality rate out of all other cancers. Smoking tobacco, poor diet, and stigma are some of the causes of lung cancer that can be changed. Decreasing lung cancer incidence rates through primary prevention is said to be the most efficient way in dealing with lung cancer. That being said, further research should be done to find the most efficient ways to change people's behavioral attitudes towards smoking tobacco, diet, and stigma. Such research should be especially aimed at populations who are most effected by lung cancer -such as the Aboriginal population in Australia, people in lower socioeconomic classes, and women. More research done in these areas should be able to remove the disparity gap and overall lung cancer incidence rates by guiding with decision-making, resource allocation and the evaluation of programs and policies regarding lung cancer. In addition, further questions should be asked on how America has made increased their five-year lung cancer survivability rate to 56 percent whereas it is only still 17 percent in Australia. Australia can learn a lot from America's approach -as both countries have had very similar trends, causes, and effects (including the high mortality rates, high healthcare expenditures, and money spent on future tobacco prevention initiatives) of lung cancer.
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 Cancer incidence refers to the number of people being diagnosed with cancer. 2 Cancer mortality refers to the number of deaths from cancer per 100,000 people in a population.
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