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Simple Summary: Reports of a significant increase in young-onset cancers in South Australia (SA) with a higher-than-average incidence in the Northern Territory (NT) in the last 3 decades. Cancer incidence significantly decreased over time amongst non-Indigenous children but remained unchanged amongst Indigenous children (NT). Overall survival improved in SA, but unchanged in the NT. In the NT, overall survival of Indigenous children was significantly lower than non-Indigenous children, but survival rates in the former have improved. Ongoing targeted public health response is needed to reduce disparities in cancer health care outcomes for Indigenous Australians as outlined within the Australian and the Aboriginal and Torres Strait Islander Cancer Plans. Background & Aims: Reports of a rise in childhood cancer incidence in Australia and globally prompted the investigation of cancer incidence and survival in South Australia (SA) and the Northern Territory (NT) over a 28-year period, with emphasis on Indigenous peoples. Methods: This cross-sectional analysis of two prospective longitudinal databases, the SA and NT Cancer Registries (1990–2017), included all reported cases of childhood cancers. Poisson regression provided estimates of incidence rate ratios and survival was modelled using Cox proportional hazard models for children aged <5 and ≥5 years. Results: A total of 895 patients across SA (N = 753) and the NT (N = 142) were ascertained. Overall and in the NT, childhood cancer incidence was higher in males compared with females (IRR 1.19 [1.04–1.35] and 1.43 [1.02–2.01], respectively). Lymphocytic leukemia was the most reported cancer type across all locations. With reference to the 1990–1999 era (181.67/100,000), cancer incidence remained unchanged across subsequent eras in the combined cohort (SA and NT) (2000–2009: 190.55/100,000; 1.06 [0.91–1.25]; 2010–2017: 210.00/100,000; 1.15 [0.98–1.35]); similar outcomes were reflected in SA and NT cohorts. Cancer incidence amongst non-Indigenous children significantly decreased from the 1990–1999 era (278.32/100,000) to the 2000–2009 era (162.92/100,000; 0.58 [0.35–0.97]). Amongst 39 Indigenous children in the NT, incidence rates remained unchanged across eras (p > 0.05). With reference to the 1990–1999 era, overall survival improved in subsequent eras in SA (2000–2009: HR 0.53 [0.38–0.73]; 2010–2017: 0.44 [0.28–0.68]); however, remained unchanged in the NT (2000–2009: 0.78 [0.40–1.51]; 2010–2017: 0.50 [0.24–1.05]). In the NT, overall survival of Indigenous patients was significantly lower compared with the non-Indigenous cohort (3.42 [1.92–6.10]). While the survival of Indigenous children with cancer significantly improved in the last two eras (p < 0.05), compared to the 1990–1999 era, no change was noted amongst non-Indigenous children in the NT (p > 0.05). Conclusions: The incidence of childhood cancers has remained unchanged over 28-years in SA and the NT. Encouragingly, improved survival rates over time were observed in SA and amongst Indigenous children of the NT. Nevertheless, survival rates in Indigenous children remain lower than non-Indigenous children. [ABSTRACT FROM AUTHOR]

Purpose: Increased risk of second primary cancers is an unwanted consequence of cancer survivorship. While the epidemiology of second cancers is well-documented for children and older people, less is known about second cancers among adolescent and young adult (AYA) cancer survivors. Methods: Unit record data were obtained from the Queensland Cancer Register. The study cohort comprised Queensland residents aged 15 to 39 years who were diagnosed with a first primary invasive cancer between 1982 and 2013. Follow-up on second cancers was available for a minimum of 5 years to the end of 2018. Standardized incidence ratios (SIRs) were used to approximate the risk of a second primary cancer relative to the general population. Results: In total, 3086 second primary cancers were observed among 34,431 eligible AYA patients (9%), equating to an overall SIR of 1.59 (95% confidence interval [CI] 1.53–1.64). Melanoma (n = 853, 28%) and female breast cancer (n = 594, 19%) were the most common types of second primary cancer in the study cohort. Relative risk of all second primary cancers combined among AYA patients was inversely associated with age and was highest within the period immediately after first diagnosis irrespective of age group; for example, patients aged 15–24 at first diagnosis recorded more than four times as many second primary cancers than expected within 2 years of their first cancer (SIR = 4.40, 95% CI 2.83–6.82). Conclusions: Detailed data on second primary cancers among AYA cancer survivors are important in promoting increased awareness and to inform the development of targeted prevention and surveillance strategies. [ABSTRACT FROM AUTHOR]

Simple Summary: Earlier diagnosis is often advocated to prevent advanced cancer morbidity and death. Compelling evidence exists where this occurs. A major conundrum is the lack of supportive evidence for some cancers where more sensitive screening and early detection may not translate into reduced morbidity and mortality. Some early cancers do not advance to metastases and death, and thus may not endanger the patient during life, nor require treatment. Biological variants that are non-metastatic and non-lethal may exist. Distinguishing potentially 'fatal' cancers from 'non-fatal' cancers is fundamental for screening to selectively benefit, while avoiding unnecessary treatment. Immune control of cancer has evidential support, and may explain why some cancers progress, while others stay quiescent. The extent of immune system modulation of malignant behaviour could decisively influence cancer outcomes, including lethality. We advance an evidence-based, immune model, worthy of further research, potentially explaining cancer "overdiagnosis" and the susceptibility to recurrence, regression, and lethality. Even though clinically small 'early' cancers represent many millions of cells biologically, when removed surgically, these often never recur or regrow, nor reduce the individual's lifespan. However, some early cancers remain quiescent and indolent; while others grow and metastasize, threatening life. Distinguishing between these different clinical behaviours using clinical/pathological criteria is currently problematic. It is reported that many suspicious lesions and early cancers are being removed surgically that would not threaten the patient's life. This has been termed 'overdiagnosis', especially in the sphere of cancer screening. Although a controversial and emotive topic, it poses clinical and public health policy challenges. The diagnostic differentiation between 'non-lethal' and 'lethal' tumor forms is generally impossible. One perspective gathering evidential support is that a dynamic balance exists between the immune response and malignant processes governing 'lethality', where many more cancers are produced than become clinically significant due to the immune system preventing their progression. Higher medical screening "diagnosis" rates may reflect lead-time effects, with more 'non-progressing' cancers detected when an early immune-cancer interaction is occurring. We present a model for this immune-cancer interaction and review 'excess' or 'overdiagnosis' claims that accompany increasingly sensitive diagnostic and screening technologies. We consider that immune tools should be incorporated into future research, with potential for immune system modulation for some early cancers. [ABSTRACT FROM AUTHOR]

Objectives: To examine population changes in 5‐year survival for people in South Australia diagnosed with acute leukaemia during 1980–2016, by socio‐demographic characteristics. Design, setting: Retrospective analysis of South Australian Cancer Registry data for the period 1980–2016. Participants: All South Australian residents diagnosed with primary acute lymphoblastic leukaemia (ALL) or acute myeloid leukaemia (AML) during 1980–2016. Main outcome measures: 5‐year disease‐specific survival and disease‐specific mortality. Results: Crude 5‐year disease‐specific survival was 58% (95% CI, 54–61%) for the 1035 people diagnosed with ALL during 1980–2016, and 18% (95% CI, 17–20%) for the 2814 people diagnosed with AML. Survival improved steadily across the study period: from 44% (95% CI, 35–52%) for people with ALL diagnosed during 1980–1984 to 69% (95% CI, 63–75%) for those diagnosed during 2010–2016; and from 9% (95% CI, 5–15%) to 23% (95% CI, 20–26%) for people diagnosed with AML. Disease‐specific mortality increased with age, but was not influenced by socio‐economic status or remoteness of residence. After adjusting for other factors, rates of change in risk of leukaemia‐related death were greater for younger than older patients with ALL (for interaction: P = 0.004) or AML (P = 0.005), but were not significantly influenced by socio‐economic status or remoteness. Conclusion: Five‐year survival for people with acute leukaemia in South Australia continuously improved during 1980–2016, and socio‐economic status and remoteness did not influence survival. It improved markedly for younger patients (under 50 years of age). However, survival is still relatively poor, especially for people over 50 years with AML. [ABSTRACT FROM AUTHOR]

Objective: To examine the screening–treatment–mortality pathway among women with invasive breast cancer in 2006–2014 using linked data. Methods: BreastScreen histories of South Australian women diagnosed with breast cancer (n = 8453) were investigated. Treatments recorded within 12 months from diagnosis were obtained from linked registry and administrative data. Associations of screening history with treatment were investigated using logistic regression and with cancer mortality outcomes using competing risk analyses, adjusting for socio‐demographic, cancer and comorbidity characteristics. Results and conclusion: For screening ages of 50–69 years, 70% had participated in BreastScreen SA ≤ 5 years and 53% ≤ 2 years of diagnosis. Five‐year disease‐specific survival post‐diagnosis was 90%. Compared with those not screened ≤5 years, women screened ≤2 years had higher odds, adjusted for socio‐demographic, cancer and comorbidity characteristics, and diagnostic period, of breast‐conserving surgery (aOR 2.5, 95% CI 1.9–3.2) and radiotherapy (aOR 1.2, 95% CI 1.1–1.3). These women had a lower unadjusted risk of post‐diagnostic cancer mortality (SHR 0.33, 95% CI 0.27–0.41), partly mediated by stage (aSHR 0.65, 95% CI 0.51–0.81), and less breast surgery (aSHR 0.78, 95% CI 0.62–0.99). Screening ≤2 years and conserving surgery appeared to have a greater than additive association with lower post‐diagnostic mortality (interaction term SHR 0.42, 95% CI 0.23–0.78). The screening–treatment–mortality pathway was investigated using linked data. [ABSTRACT FROM AUTHOR]

Objectives: To investigate causes of death of people with cancer alive five years after diagnosis, and to compare mortality rates for this group with those of the general population. Design, setting, participants: Retrospective cohort study; analysis of South Australian Cancer Registry data for all people diagnosed with cancer during 1990–1999 and alive five years after diagnosis, with follow‐up to 31 December 2016. Main outcome measures: All‐cause and cancer cause‐specific mortality, by cancer diagnosis; standardised mortality ratios (study group v SA general population) by sex, age at diagnosis, follow‐up period, and index cancer. Results: Of 32 646 people with cancer alive five years after diagnosis, 30 309 were of European background (93%) and 16 400 were males (50%); the mean age at diagnosis was 60.3 years (SD, 15.7 years). The median follow‐up time was 17 years (IQR, 11–21 years); 17 268 deaths were recorded (53% of patients; mean age, 80.6 years; SD, 11.4 years): 7845 attributed to cancer (45% of deaths) and 9423 attributed to non‐cancer causes (55%). Ischaemic heart disease was the leading cause of death (2393 deaths), followed by prostate cancer (1424), cerebrovascular disease (1175), and breast cancer (1118). The overall standardised mortality ratio (adjusted for age, sex, and year of diagnosis) was 1.24 (95% CI, 1.22–1.25). The cumulative number of cardiovascular deaths exceeded that of cancer cause‐specific deaths from 13 years after cancer diagnosis. Conclusions: Mortality among people with cancer who are alive at least five years after diagnosis was higher than for the general population, particularly cardiovascular disease‐related mortality. Survivorship care should include early recognition and management of risk factors for cardiovascular disease. [ABSTRACT FROM AUTHOR]

Purpose: Breast cancer is the most common cancer diagnosed among adolescent and young adult (AYA) females worldwide, but epidemiological patterns unique to this group are often obscured when results are combined with older patients. This study investigates breast cancer incidence and survival among AYA females, including differences by broad stage at diagnosis. Methods: A retrospective, population-based cohort study was conducted using de-identified data for females in Queensland, Australia, aged 15–39 diagnosed with a first primary breast cancer between 1997 and 2014 with follow-up to December 31, 2016. Incidence rate trends were examined with Joinpoint analysis. Cause-specific survival was calculated for key characteristics, and 5-year adjusted hazard ratios (HRs) were estimated from a multivariable flexible parametric model. Results: The study cohort comprised 2337 patients, of whom two-thirds (n = 1565, 67%) were diagnosed with advanced disease (tumor diameter >20 mm, lymph node involvement or presence of distant metastases at diagnosis). Incidence rates of localized tumors decreased by 1.9% per year (95% confidence interval [CI] −3.5% to −0.4%) over the study period, whereas the trend for advanced breast cancers remained stable. Five-year cause-specific survival increased from 85% to 92% for 2011–2014 compared to 1997–2001 (adjusted HR = 0.43, 95% CI = 0.29–0.65). Patients who were Indigenous from disadvantaged areas or diagnosed with advanced stage experienced significantly worse survival. Conclusion: The high proportion of younger females diagnosed with advanced breast cancer should be the focus of future campaigns to improve awareness and earlier detection. While survival has increased over time, further work is required to ensure that this progress is experienced equitably by all patients. [ABSTRACT FROM AUTHOR]

Purpose: Cancer is a significant health concern for adolescents and young adults (AYAs; aged 15–24 years). Monitoring population-level changes in incidence, mortality, and survival is complicated by the lack of published data presenting statistics separately for AYAs. This study synthesizes and reviews data on AYA cancers in Australia, including trends in incidence and mortality. Methods: National data were extracted for 1980–2012, primarily from the Australian Cancer Database and Australian National Mortality Database. Incidence, mortality, and survival trends are described, and incidence and mortality projections are reported. Results: In 2000–2009, the annual all-cancer incidence was 31.7 cases per 100,000 population, and the mortality rate was 4.1 per 100,000. Incidence, mortality, and survival varied widely, indicating areas of concern. Melanoma was the most common cancer, and bone cancer had the highest mortality and poorest survival rates. All-cancer incidence rates peaked in the late 1990s, but then declined, largely due to melanoma. All-cancer mortality decreased throughout the study period, but showed no improvements for some common sites (i.e., brain, bone, soft tissue). Further reductions in all-cancer incidence and mortality are projected for the next decade, although specific cancers (colorectal cancers and lymphomas) were projected to increase in incidence. Conclusions: Observed Australian cancer trends are largely consistent with trends for other high-income populations. While overall decreases in incidence and mortality are encouraging, consistently high mortality and poor survival for some cancers remain concerning. Planned data initiatives for AYAs with cancer will aid in resolving whether trends continue and projections are realized in the future. [ABSTRACT FROM AUTHOR]

Objective: To compare how frequently selected chronic diseases developed in women with breast cancer receiving endocrine therapy, and in women without cancer.Design, Setting and Participants: Retrospective, rolling cohort study, analysing a random 10% sample of Pharmaceutical Benefits Scheme (PBS) data for the period 1 January 2003 - 31 December 2014. Women with breast cancer who first commenced endocrine therapy between January 2004 and December 2011 were identified, and age- and sex-matched (1:10) by comorbidity with control groups of women who did not have a dispensing record for antineoplastic agents during the study period or the comorbidity of interest at baseline.Main Outcome Measures: Development of any of eight pre-selected comorbidities, identified in PBS claims data with the RxRisk-V model.Results: Women with hormone-dependent breast cancer were significantly more likely than women in the control group to develop depression (overall hazard ratio [HR], 1.36; 95% CI, 1.26-1.46), pain or pain-inflammation (HR, 1.30; 95% CI, 1.23-1.38), osteoporosis (overall HR, 1.27; 95% CI, 1.17-1.39), diabetes (HR, 1.24; 95% CI, 1.10-1.41), cardiovascular disorders (overall HR, 1.22; 95% CI, 1.13-1.32), and gastric acid disorders (HR, 1.20; 95% CI, 1.13-1.28). The hazard ratios for developing cardiovascular disorders, depression and osteoporosis were highest during the first year of endocrine therapy. The risk of hyperlipidaemia was lower among women with breast cancer than in the control group (HR, 0.88; 95% CI, 0.81-0.96). There was no significant difference between the two groups in the risk of reactive airway diseases (HR, 1.05; 95% CI, 0.98-1.13).Conclusion: Comorbid conditions are more likely to develop in women who have been diagnosed with hormone-dependent breast cancer than in women without cancer. Our results further support the need to develop appropriate models of care to manage the multiple chronic disorders of breast cancer survivors. [ABSTRACT FROM AUTHOR]

Objective: To compare how frequently selected chronic diseases developed in women with breast cancer receiving endocrine therapy, and in women without cancer. Design, setting and participants: Retrospective, rolling cohort study, analysing a random 10% sample of Pharmaceutical Benefits Scheme (PBS) data for the period 1 January 2003 – 31 December 2014. Women with breast cancer who first commenced endocrine therapy between January 2004 and December 2011 were identified, and age‐ and sex‐matched (1:10) by comorbidity with control groups of women who did not have a dispensing record for antineoplastic agents during the study period or the comorbidity of interest at baseline. Main outcome measures: Development of any of eight pre‐selected comorbidities, identified in PBS claims data with the RxRisk‐V model. Results: Women with hormone‐dependent breast cancer were significantly more likely than women in the control group to develop depression (overall hazard ratio [HR], 1.36; 95% CI, 1.26–1.46), pain or pain–inflammation (HR, 1.30; 95% CI, 1.23–1.38), osteoporosis (overall HR, 1.27; 95% CI, 1.17–1.39), diabetes (HR, 1.24; 95% CI, 1.10–1.41), cardiovascular disorders (overall HR, 1.22; 95% CI, 1.13–1.32), and gastric acid disorders (HR, 1.20; 95% CI, 1.13–1.28). The hazard ratios for developing cardiovascular disorders, depression and osteoporosis were highest during the first year of endocrine therapy. The risk of hyperlipidaemia was lower among women with breast cancer than in the control group (HR, 0.88; 95% CI, 0.81–0.96). There was no significant difference between the two groups in the risk of reactive airway diseases (HR, 1.05; 95% CI, 0.98–1.13). Conclusion: Comorbid conditions are more likely to develop in women who have been diagnosed with hormone‐dependent breast cancer than in women without cancer. Our results further support the need to develop appropriate models of care to manage the multiple chronic disorders of breast cancer survivors. [ABSTRACT FROM AUTHOR]

Objective To compare clinical features, treatments and outcomes in men with non-metastatic prostate cancer ( PCa) according to whether they were referred for symptoms or elevated prostate-specific antigen ( PSA) level. Patients and Methods This study used data from the South Australia Prostate Cancer Clinical Outcomes Collaborative database; a multi-institutional clinical registry covering both the public and private sectors. We included all non-metastatic cases from 1998 to 2013 referred for urinary/prostatic symptoms or elevated PSA level. Multivariate Poisson regression was used to identify characteristics associated with symptomatic presentation and compare treatments according to reason for referral. Outcomes (i.e. overall survival, PCa-specific survival, metastasis-free survival and disease-free survival) were compared using multivariate Cox proportional hazards and competing risk regression. Results Our analytical cohort consisted of 4 841 men with localized PCa. Symptomatic men had lower-risk disease (incidence ratio [IR] 0.70, 95% confidence interval [ CI] 0.61-0.81 for high vs low risk), fewer radical prostatectomies ( IR 0.64, CI: 0.56-0.75) and less radiotherapy ( IR 0.86, CI: 0.77-0.96) than men presenting with elevated PSA level. All-cause mortality (hazard ratio [ HR] 1.31, CI: 1.16-1.47), disease-specific mortality ( HR 1.42, CI: 1.13-1.77) and risk of metastases ( HR 1.36, CI: 1.13-1.64) were higher for men presenting with symptoms, after adjustment for other clinical characteristics; however, risk of disease progression did not differ ( HR 0.90, CI: 0.74-1.07) amongst those treated curatively. Subgroup analyses indicated poorer PCa survival for symptomatic referral among men undergoing radical prostatectomy ( HR 3.4, CI: 1.3-8.8), those aged >70 years ( HR 1.4, CI: 1.0-1.8), men receiving private treatment ( HR 2.1, CI: 1.3-3.3), those diagnosed via biopsy ( HR 1.3, CI: 1.0-1.7) and those diagnosed before 2006 ( HR 1.6, CI: 1.2-2.7). Conclusion Our results suggest that symptomatic presentation may be an independent negative prognostic indicator for PCa survival. More complete assessment of disease grade and extent, more definitive treatment and increased post-treatment monitoring among symptomatic cases may improve outcomes. Further research to determine any pathophysiological basis for poor outcomes in symptomatic men is warranted. [ABSTRACT FROM AUTHOR]

Objectives: To investigate time to follow-up (clinical investigation) for Indigenous and non-Indigenous women in Queensland after a high grade abnormality (HGA) being detected by Pap smear. Design, setting, participants: Population-based retrospective cohort analysis of linked data from the Queensland Pap Smear Register (PSR), the Queensland Hospital Admitted Patient Data Collection, and the Queensland Cancer Registry. 34 980 women aged 20e68 years (including 1592 Indigenous women) with their first HGA Pap smear result recorded on the PSR (index smear) during 2000e2009 were included and followed to the end of 2010. Main outcome measures: Time from the index smear to clinical investigation (histology test or cancer diagnosis date), censored at 12 months. Results: The proportion of women who had a clinical investigation within 2 months of a HGA finding was lower for Indigenous (34.1%; 95% CI, 31.8e36.4%) than for non-Indigenous women (46.5%; 95% CI, 46.0e47.0%; unadjusted incidence rate ratio [IRR], 0.65; 95% CI, 0.60e0.71). This difference remained after adjusting for place of residence, area-level disadvantage, and age group (adjusted IRR, 0.74; 95% CI, 0.68e0.81). However, Indigenous women who had not been followed up within 2months were subsequently more likely to have a clinical investigation than non-Indigenous women (adjusted IRR for 2e4 month interval, 1.21; 95% CI, 1.08e1.36); by 6 months, a similar proportion of Indigenous (62.2%; 95% CI, 59.8e64.6%) and non-Indigenous women (62.8%; 95% CI, 62.2e63.3%) had been followed up. Conclusions: Prompt follow-up after a HGA Pap smear finding needs to improve for Indigenous women. Nevertheless, slow follow-up is a smaller contributor to their higher cervical cancer incidence and mortality than their lower participation in cervical screening. [ABSTRACT FROM AUTHOR]

Objective: To examine differences in the proportions of people diagnosed with pancreatic cancer who underwent pancreatectomy, post-operative outcomes and 5-year survival in different New South Wales administrative health regions of residence.Design, Setting and Participants: Retrospective analysis of NSW data on pancreatic cancer incidence and surgery, 2005-2013.Main Outcome Measures: The proportion of newly diagnosed patients with pancreatic cancer who were resected in each region; 90-day post-operative mortality; one-year post-operative survival; 5-year post-diagnosis survival.Results: 14% of people diagnosed with pancreatic cancer during 2010-2013 (431 of 3064) underwent pancreatectomy, an average of 108 resections per year. After adjusting for age, sex and comorbidities, the proportion that underwent resection varied significantly between regions, ranging between 8% and 21% (P<0.001). Higher resection rates were not associated with higher post-operative 90-day mortality or lower one-year survival (unadjusted and risk-adjusted analyses). Higher resection rates were associated with higher 5-year post-diagnosis survival: the mean survival in regions with resection rates below 10% was 3.4%, compared with 7.2% in regions with rates greater than 15% (unadjusted and adjusted survival analyses; P<0.001). There was a positive association between regional resection rate and the pancreatectomy volume of hospitals during 2005-2009. An additional 32 people would be resected annually if resection rates in low rate regions were increased to the 80th percentile regional resection rate (18%).Conclusion: There is significant geographic variation in the proportion of people with pancreatic cancer undergoing pancreatectomy, and the 5-year survival rate is higher in regions where this proportion is higher. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Stratification of women with screen-detected ductal carcinoma in situ (DCIS) by risk of subsequent invasive breast cancer (IBC) could assist treatment planning and selection of surveillance protocols that accord with risk. We assessed the utility of routinely collected administrative data for stratifying by IBC risk following DCIS detection in a population-based screening programme to inform ongoing surveillance protocols. Methods A retrospective cohort design was used, employing linked data from the South Australian breast screening programme and cancer registry. Women entered the study at screening commencement and were followed until IBC diagnosis, death or end of the study period (1 December 2010), whichever came first. Routinely collected administrative data were analyzed to identify predictors of invasive breast cancer. Results Proportional hazards regression confirmed that the DCIS cohort had an elevated risk of IBC after adjustment for relevant confounders (HR = 4.0 (95% CL 3.4, 4.8)), which accorded with previous study results. Within the DCIS cohort, conservative breast surgery and earlier year of screening commencement were both predictive of an elevated invasive breast cancer risk. Conclusions These linked cancer registry and administrative data gave plausible estimates of IBC risk following DCIS diagnosis, but were limited in coverage of key items for further risk stratification. It is important that the research utility of administrative datasets is maximized in their design phase in collaboration with researchers. [ABSTRACT FROM AUTHOR]

Background The Quality Audit ( BQA) of Breast Surgeons of Australia and New Zealand includes a broad range of data and is the largest New Zealand (NZ) breast cancer ( BC) database outside the NZ Cancer Registry. We used BQA data to compare BC survival by ethnicity, deprivation, remoteness, clinical characteristic and case load. Methods BQA and death data were linked using the National Health Index. Disease-specific survival for invasive cases was benchmarked against Australian BQA data and NZ population-based survivals. Validity was explored by comparison with expected survival by risk factor. Results Compared with 93% for Australian audit cases, 5-year survival was 90% for NZ audit cases overall, 87% for Maori, 84% for Pacific and 91% for other. Conclusions BC survival in NZ appears lower than in Australia, with inequities by ethnicity. Differences may be due to access, timeliness and quality of health services, patient risk profiles, BQA coverage and death-record methodology. [ABSTRACT FROM AUTHOR]

Debate about the extent of breast cancer over-diagnosis due to mammography screening has continued for over a decade, without consensus. Estimates range from 0 to 54%, but many studies have been criticized for having flawed methodology. In this study we used a novel study design to estimate over-diagnosis due to organised mammography screening in South Australia (SA). To estimate breast cancer incidence at and following screening we used a population-based, age-matched case-control design involving 4,931 breast cancer cases and 22,914 controls to obtain OR for yearly time intervals since women's last screening mammogram. The level of over-diagnosis was estimated by comparing the cumulative breast cancer incidence with and without screening. The former was derived by applying ORs for each time window to incidence rates in the absence of screening, and the latter, by projecting pre-screening incidence rates. Sensitivity analyses were undertaken to assess potential biases. Over-diagnosis was estimated to be 8% (95%CI 2-14%) and 14% (95%CI 8-19%) among SA women aged 45 to 85 years from 2006-2010, for invasive breast cancer and all breast cancer respectively. These estimates were robust when applying various sensitivity analyses, except for adjustment for potential confounding assuming higher risk among screened than non-screened women, which reduced levels of over-diagnosis to 1% (95%CI 5-7%) and 8% (95%CI 2-14%) respectively when incidence rates for screening participants were adjusted by 10%. Our results indicate that the level of over-diagnosis due to mammography screening is modest and considerably lower than many previous estimates, including others for Australia. [ABSTRACT FROM AUTHOR]

The article presents a study that investigates the association of colorectal cancer (CRC) screening history and the subsequent incidence of CRC New South Wales. It provides brief overview of the method of the study that observes 196 464 subjects who completed a baseline questionnaire. It notes the result of the study which indicates that the CRC incidence is lower among individuals with a history of CRC screening.

The article examines the opportunities to lessen mortality after diagnosis of non-small cell lung cancer through surgical resection in New South Wales. Among the reasons cited for not having a resection was the lack of private health insurance, lower socioeconomic status, and older age. Adjusted 5-year death probabilities were noted to be 45% for pneumonectomy, 22% for lobectomy and 76% in absence of resection. An increased in resection was found effective in reducing mortality.

The article presents a study which compares the outcome and management of metropolitan and rural patients with metastatic colorectal cancer (mCRC) in South Australia in 2014. Equivalent rates in the administration of chemotherapy between rural and city patients across every line of treatment were noted. Patterns of surgical management and chemotherapy of rural patients with mCRC were found to be the same to their metropolitan counterparts and result to comparable overall survival.

Rationale, aims and objectives Population level data on colorectal cancer ( CRC) management in Australia are lacking. This study assessed broad level patterns of care and concordance with guidelines for CRC management at the population level using linked administrative data from both the private and public health sectors across South Australia. Disparities in CRC treatment were also explored. Method Linking information from the South Australian Cancer Registry, hospital separations, radiotherapy services and hospital-based cancer registry systems provided data on the socio-demographic, clinical and treatment characteristics for 4641 CRC patients, aged 50-79 years, diagnosed from 2003 to 2008. Factors associated with receiving site/stage-specific treatments (surgery, chemotherapy and radiotherapy) and overall concordance with treatment guidelines were identified using Poisson regression analysis. Results About 83% of colon and 56% of rectal cancer patients received recommended treatment. Provision of neo-adjuvant/adjuvant therapies may be less than optimal. Radiotherapy was less likely among older patients (prevalence ratio 0.7, 95% confidence interval 0.5-0.8). Chemotherapy was less likely among older patients (0.7, 0.6-0.8), those with severe or multiple co-morbidities (0.8, 0.7-0.9), and those from rural areas (0.9, 0.8-1.0). Overall discordance with treatment guidelines was more likely among rectal cancer patients (3.0, 2.7-3.3), older patients (1.6, 1.4-1.8), those with multiple co-morbid conditions (1.3, 1.1-1.4), and those living in rural areas (1.2, 1.0-1.3). Conclusions Greater emphasis should be given to ensure CRC patients who may benefit from neo-adjuvant/adjuvant therapies have access to these treatments. [ABSTRACT FROM AUTHOR]

Background: National cancer survival statistics are available for the total Australian population but not Indigenous Australians, although their cancer mortality rates are known to be higher than those of other Australians. We aimed to validate analysis methods and report cancer survival rates for Indigenous Australians as the basis for regular national reporting. Methods: We used national cancer registrations data to calculate all-cancer and site-specific relative survival for Indigenous Australians (compared with non-Indigenous Australians) diagnosed in 2001-2005. Because of limited availability of Indigenous life tables, we validated and used cause-specific survival (rather than relative survival) for proportional hazards regression to analyze time trends and regional variation in all-cancer survival between 1991 and 2005. Results: Survival was lower for Indigenous than non-Indigenous Australians for all cancers combined and for many cancer sites. The excess mortality of Indigenous people with cancer was restricted to the first three years after diagnosis, and greatest in the first year. Survival was lower for rural and remote than urban residents; this disparity was much greater for Indigenous people. Survival improved between 1991 and 2005 for non-Indigenous people (mortality decreased by 28%), but to a much lesser extent for Indigenous people (11%) and only for those in remote areas; cancer survival did not improve for urban Indigenous residents. Conclusions: Cancer survival is lower for Indigenous than other Australians, for all cancers combined and many individual cancer sites, although more accurate recording of Indigenous status by cancer registers is required before the extent of this disadvantage can be known with certainty. Cancer care for Indigenous Australians needs to be considerably improved; cancer diagnosis, treatment, and support services need to be redesigned specifically to be accessible and acceptable to Indigenous people. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives It is uncertain whether survival increases from melanoma recorded by some population registries include a treatment effect. The US Surveillance, Epidemiology and End Results ( SEER) programme has good data quality control, large numbers of cases enabling high statistical precision and summary stage plus thickness, which we consider to be a best-case population registry scenario to investigate potential for a treatment effect. We have investigated SEER data to indicate whether survivals increases are fully attributable to earlier diagnosis and other non-treatment factors. Methods Through relative survival regression, the effects of diagnostic period on 5-year excess mortality were investigated, adjusting for socio-demographic factors, lesion sub-site, histology, thickness and stage at diagnosis in 1990-2009 (n = 99 690 cases). Results The reduction in excess mortality (95% confidence interval) between 1990-1999 and 2000-2009 was 31 (20-41)% for localised melanoma, 18 (12-22)% for regional melanoma and 3 (-5-10)% for melanomas with distant spread. Younger age was predictive of a greater percentage reduction. Treatment benefits are inferred from the higher survivals in 2000-2009 but uncertainty remains due to incomplete data to adjust for non-treatment factors and a lack of treatment data. Conclusions Registries should use new information systems to collect more complete data on stage, other prognostic indicators, co-morbidities and treatment, to provide more definitive and detailed information on population effects of cancer control. [ABSTRACT FROM AUTHOR]

The article offers information on a study related to breast cancer risk factors in participants and non-participants of population-based mammography screening. It informs that the study also aimed to find whether the mammography screening for breast cancer leads to over diagnosis. It states that screening programs can lead to risks which effect over diagnosis for women who under go with this procedure.

Background: The study aim was to determine whether age is an independent risk factor for survival from early invasive breast cancer in contemporary Australian clinical settings. Methods: The study included 31 493 breast cancers diagnosed in 1998-2005. Risk of death from breast cancer was compared by age, without and with adjustment for clinical risk factors, using Cox proportional hazard regression. Results: Risk of breast cancer death was elevated for cancers of larger size, higher grade, positive nodal status, oestrogen receptor negative status, vascular invasion and multiple foci. Ductal lesions presented a higher risk than other lesions. Adjusting for these factors, the relative risk of breast cancer death (95% confidence limits) was lower for 40-49-year-olds at 0.80 (0.66, 0.96) than for the reference category under 40 years, but higher for 70-79-year-olds at 1.64 (1.36, 1.98) and women aged 80 years or more at 2.19 (1.79, 2.69). The risk for 50-69-year-olds and women under 40 years was similar. Risk-factor adjustment reduced the difference in risk between the reference category under 40 years and 40-49-year-olds, largely eliminated the lower relative risk for 50-69-year-olds, and increased the relative risks for women aged 70-79 years and older. Discussion: Survivals in women under 40 and over 70 years of age are poorer than for 40-69-year-olds. Research is needed into the best treatment modalities for younger women and older women with co-morbidity. [ABSTRACT FROM AUTHOR]

The article discusses a study on the incidence of non-metastatic breast cancer (MBC) in an Australian population-based cohort of women with non-metastatic breast cancer at diagnosis. The researchers conducted a population-based cohort study of all women with non-metastatic MBC registered on the New South Wales Central Cancer Register (CCR) in 2001 and 2002. The results indicate that women with node-negative disease have a low risk of developing MBC.

Aims: To describe the clinical and socio-demographic data from a South Australian prostate cancer cohort (PCCOD). Methods: Clinical data for 2329 prostate cancer patients treated at three South Australian teaching hospitals between 1998 and 2007 were analyzed by place of residence, time of diagnosis and socioeconomic status (SES). χ2 tests were used to investigate differences in stage, grade and prostate-specific antigen (PSA) at diagnosis, among subgroups and over time. Logistic regression was used to examine predictors of treatment modalities. Five-year survival was assessed using Kaplan–Meier methods. Results: The distributions of age, SES and place of residence of PCCOD patients closely reflected those of the state-based prostate cancer population, with rural patients slightly underrepresented. Lower SES or rural residence was not associated with higher stage, grade, PSA level or disease-specific survival. Treatment modalities varied with SES (for radical prostatectomy), rural residence (radical prostatectomy, radiotherapy and androgen ablation), age and clinical characteristics. There was a trend over time towards a younger age at diagnosis and more favorable clinical profiles, consistent with earlier diagnosis. However, the current risk profile for this cohort is similar to that reported approximately a decade earlier in a US series. Conclusion: PCCOD patients have a broadly similar socio-demographic profile to prostate cancer patients statewide. Socioeconomic status is not associated with clinical characteristics at diagnosis, but does predict treatment type. The clinical characteristics of the cohort are consistent with a much later stage presentation than reported in current US case series. [ABSTRACT FROM AUTHOR]

Background: With the recent cervix screening national guidelines recommending against reporting of benign endometrial cells, we examined South Australian data to see what impact this would have on detecting uterine cancers. Aims: To test whether benign endometrial cells detected in cervical cytology testing confer an increased risk of uterine cancer, and to ascertain what percentage of uterine cancers will be missed in cervical screening programs if these cells are not reported. Methods: The study was a retrospective cohort design of 1585 women with shed endometrial cells, each matched with three women without shed cells. All were linked with cancer registry data to check for uterine cancer diagnosis. Cox proportional hazards regression was used to check for any increase in cancer risk with shed endometrial cells. Using the calculated relative risks for uterine cancer diagnosis, we estimated the number of uterine cancers in South Australia associated with benign endometrial cells. Results: The presence of benign endometrial cells in a cervical cytology test increases the risk of uterine cancer sixfold. However, screening women with benign cells would involve a major increase in pathology work for only an 18% increase in uterine cancers detected. Conclusions: Until cytology systems have a higher sensitivity in detecting which benign endometrial cells are associated with uterine cancer, pathology laboratories are unlikely to be required to report these cells on tests. Inability to adjust for symptomatic status may have reduced the relevance of the results in this study. [ABSTRACT FROM AUTHOR]

To reduce the potential for overdiagnosis, personalised risk-based screening has been advocated, whereby screening intensity would be adjusted according to individual cancer risk.[3] Theoretically, the full benefits of screening would be retained but the potential for overdiagnosis would be reduced. The Independent United Kingdom Panel on Breast Cancer Screening reported in 2013 that the extent of overdiagnosis was uncertain because reliable data on lifetime risk were not available.[2] This problem still applies. Overdiagnosis, whatever its prevalence, is a negative outcome, and the balance between benefits and risks could be improved by effective risk-based screening protocols.[3] The question is how they might be developed. [Extracted from the article]

The Australian Institute of Health and Welfare began collecting cancer incidence statistics at the population level during the mid-1980s, based on state and territory registry data that are now collated by the Australian Cancer Database, supplemented by mortality data from the Australian Bureau of Statistics.[1] These data inform Australian policy makers, researchers, and the general public about cancer profiles and trends.[1] Population cancer statistics are important for broad population health surveillance and for providing key information about historical and emerging trends in socio-demographic differences in cancer incidence and mortality at the global, national, and local levels. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. [Extracted from the article]

In a population survey, 2652 respondents aged 15+ years reported their preferred place of death, if dying of 'a terminal illness such as cancer or emphysema', to be home (70%), a hospital (19%), hospice (10%), or nursing home (<1%). The majority of respondents in all socio-demographic categories reported a preference for dying at home, with the greatest majorities occurring in younger age groups. After weighting to the age – sex distribution of all South Australian cancer deaths, 58% in our survey declared a preference to die at home, which is much higher than the 14% of cancer deaths that actually occurred at home in South Australia in 2000 – 2002. Multivariable analyses indicate that predictors of preferred home death include younger age, male, born in the UK/Ireland or Italy/Greece, better physical health, poorer mental health, and fewer concerns about dying at home. Predictors of preference for death in a hospice rather than hospital include older age, female, single, metropolitan residence, having higher educational and income levels, paid employment, awareness of advanced directives, and interpreting 'dying with dignity' as death without pain or suffering. Investigating the differences between preferred and actual places of death may assist service providers to meet end-of-life wishes. [ABSTRACT FROM AUTHOR]

In this study of the incidence of asbestos-related cancer in the Australian petroleum industry, the authors traced a cohort of 16,543 petroleum industry workers for a total of 226,989 person-years. There were 18 cases of pleural mesothelioma; 12 occurred in refinery nonoffice workers, for whom the Standardized Incidence Ratio was 3.77 (95% confidence interval = 1.95-6.59). The incidence of lung cancer was significantly lower than that in the general male population. Lung cancer incidence was higher in maintenance workers than in nonmaintenance workers, but the excess was not statistically significant, as it was based on small numbers with wide confidence intervals. Lung cancer rates in refinery workers did not increase with duration of employment; however, they did tend to be higher in workers hired in earlier decades. Excess mesothelioma incidence in refinery workers is confirmed, but it is likely that there are few if any asbestos-related lung cancers. [ABSTRACT FROM AUTHOR]

Gastric cancer mortality has declined markedly around the world. In South Australia, the reduction approximated 40% over the last 20 years. Possible reasons include: better refrigeration; reduced consumption of salted, smoked, and chemically preserved foods; increased intake of fruit and vegetables; and improved living standards and a greater use of antibiotics, which may have reduced Helicobacter pylori infection. Reductions generally have been greater for intestinal than diffuse histopathologies. Gastric cancer remains the second leading cause of cancer death worldwide, probably accounting for about 10% of newly diagnosed cancers. High rates apply to Japan, China, Central and South America, Eastern Europe, and parts of the Middle East, and low rates to North America, Australia and New Zealand, Northern Europe, and India. Rates usually are higher in lower socioeconomic groups. Five-year relative survivals of around 20% or less are frequently reported. A figure of 50% or more has been cited for Japan, where there has been radiological screening, although this exceptional figure could have been affected artificially by lead-time and related effects. Male-to-female incidence ratios generally are in the 1.5–2.5 range, with higher ratios for intestinal than diffuse cancers and higher-risk populations. In South Australia, the ratio has been 1.8 to one, although higher at 4.6 to one for cardia lesions. Recent increases in cardia cancers, especially in males in populations of European extraction, often are accompanied by increases for esophageal adenocarcinoma. It is estimated that the global burden of gastric cancer could be reduced by up to 50% by dietary changes that included an increased intake of fruit and vegetables. [ABSTRACT FROM AUTHOR]

Estimating overdiagnosis and mortality benefits Estimates of overdiagnosis within breast cancer screening programs vary widely, and this is in part due to methodological as well as programmatic differences. Cancer, Breast neoplasms, Early detection of cancer, Population health, Prevention and control, Public health, Mass screening, Mammography Keywords: Cancer; Breast neoplasms; Early detection of cancer; Population health; Prevention and control; Public health; Mass screening; Mammography EN Cancer Breast neoplasms Early detection of cancer Population health Prevention and control Public health Mass screening Mammography 455 455 1 06/08/21 20210601 NES 210601 Screen-detected breast cancer overdiagnosis occurs, but each woman has been diagnosed with cancer that cannot be ignored There are an increasing number of publications estimating the extent of cancer overdiagnosis, which for breast cancer is in the context of population cancer screening programs.1 Researchers investigating overdiagnosis point to a range of related harms, but it is important to view these in the context of screening benefits, such as reductions in risk of breast cancer death.2 Care needs to be taken not to conflate formal screening programs with informal or opportunistic approaches to early detection, such as prostate-specific antigen (PSA) testing in prostate cancer. [Extracted from the article]

There is a pressing need for a reliable, low-cost method of assessing the gingival and periodontal status of large population groups. Existing indexes, despite their value in dental public health, are still too subject to examiner variability for use by uncalibrated examiners. This study describes an evaluation of a quick, inexpensive, extraoral colorimetric test for gingival inflammation, based on a reaction between saliva and the test material. It could probably be applied by non-professional personnel. in this study, the test was applied to a population of elementary schoolchildren, dental hygiene students and faculty, and adult inmates of two correctional institutions. These populations were chosen on the assumption that they would exhibit varying intensities of gingival inflammation. Values obtained from the colorimetric test carried out by one researcher were compared with Gingival Index (GI) scores observed by a different examiner. Results suggest that the colorimetric test may be a valid, reliable means of detecting major differences in the prevalence of gingival inflammation in most adult populations, although having little, if any, useful application among children at the mixed dentition stage. [ABSTRACT FROM AUTHOR]

The article reflects on high quality data to understand inequalities in cancer outcomes for Aboriginal and Torres Strait Islander Australians.

The article presents a debate on whether the benefits of mammography screening outweigh the harms caused by overdiagnosis and unnecessary treatment in Australia. Public health adviser David Roder and Cancer Council Australia chief executive officer (CEO) Ian Olver note that the decline in breast cancer mortality is indicative of the effect of treatment and screening. Breast cancer researchers Robin Bell and Robert Burton believe otherwise, stressing that screening leads to overdiagnosis.

Yes. Public health adviser David Roder and Cancer Council Australia CEO Ian Olver believe the reduction in breast cancer mortality in Australia reflects both treatment and screening effects. [ABSTRACT FROM AUTHOR]

Quality of care from the patient's perspective is an increasingly important outcome measure for cancer services. Patients' and carers' perceptions of cancer care were assessed through structured telephone interviews, 4-10 months post-discharge, which focused on experiences during the most recent hospital admission. A total of 481 patients with a primary diagnosis of cancer (ICD-10 C codes) were recruited, along with 345 carers nominated by the patients. Perceptions of clinical care were generally positive. Less positive aspects of care included not being asked how they were coping, not being offered counselling, and not receiving written information about procedures. Results also highlighted inadequate discharge processes. Carers were more likely than patients to report negative experiences. Perceptions of care also differed by cancer type. [ABSTRACT FROM AUTHOR]