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Objectives To evaluate the effectiveness of a population-based, statewide public health intervention designed to improve women's awareness and knowledge of the link between alcohol and cancer. Design Cross-sectional tracking surveys conducted pre-intervention and post-intervention (waves I and III of campaign). Setting Western Australia. Participants Cross-sectional samples of Western Australian women aged 25–54 years before the campaign (n=136) and immediately after wave I (n=206) and wave III (n=155) of the campaign. Intervention The ‘Alcohol and Cancer’ mass media campaign ran from May 2010 to May 2011 and consisted of three waves of paid television advertising with supporting print advertisements. Main outcome measures Campaign awareness; knowledge of drinking guidelines and the link between alcohol and cancer; intentions towards drinking. Results Prompted recognition of the campaign increased from 67% following wave I to 81% following wave III (adjusted OR (adj OR)=2.31, 95% CI 1.33 to 4.00, p=0.003). Improvements in women's knowledge that drinking alcohol on a regular basis increases cancer risk were found following wave I (adj OR=2.60, 95% CI 1.57 to 4.30, p

Introduction While overall survival for most common cancers in Australia is improving, the rural–urban differential has been widening, with significant excess deaths due to lung, colorectal, breast and prostate cancer in regional Australia. Internationally a major focus on understanding variations in cancer outcomes has been later presentation to healthcare and later diagnosis. Approaches to reducing time to diagnosis of symptomatic cancer include public symptom awareness campaigns and interventions in primary care to improve early cancer detection. This paper reports the protocol of a factorial cluster-randomised trial of community and general practice (GP) level interventions to reduce the time to diagnosis of cancer in rural Western Australia (WA). Methods and analysis The community intervention is a symptom awareness campaign tailored for rural Australians delivered through a community engagement model. The GP intervention includes a resource card with symptom risk assessment charts and local referral pathways implemented through multiple academic detailing visits and case studies. Participants are eligible if recently diagnosed with breast, colorectal, lung or prostate cancer who reside in specific regions of rural WA with a planned sample size of 1350. The primary outcome is the Total Diagnostic Interval, defined as the duration from first symptom (or date of cancer screening test) to cancer diagnosis. Secondary outcomes include cancer stage, healthcare utilisation, disease-free status, survival at 2 and 5 years and cost-effectiveness. Ethics and dissemination Ethics approval has been granted by the University of Western Australia and from all relevant hospital recruitment sites in WA. Results Results of this trial will be reported in peer-reviewed publications and in conference presentations. Trial registration number Australian New Zealand Clinical Trials Registry (ANZCTR). ACTRN12610000872033.

Objectives We investigated hypotheses for the association between shiftwork and breast cancer based on our a priori theoretical framework of five biological mechanisms which might be operational in shiftwork: light at night; phase shift (when central cycles have adjusted to night work, but peripheral cycles have not); sleep disruption; lifestyle factors (diet, physical activity and alcohol intake) and low vitamin D. Methods We conducted a population-based case-control study with 1205 breast cancer cases, identified from 2009 to 2011 identified through the Western Australian Cancer Registry, and 1789 age-matched controls from the Western Australian electoral roll. An occupational history was collected by self-completed questionnaire for every job a woman had held for at least six months (job title, main tasks, year started, duration, hours per week and weeks per year worked, and whether the job involved night work, shift work, or work at unusual hours). Using the web application OccIDEAS, we obtained further details about the shiftwork by telephone interview. Automatic assessments with manual reviews were used to assess occupational exposure to the hypothesized factors. Results We found a 22% increase in breast cancer risk (OR 1·22, 95% CI 1·01–1·47) for phase shift with a statistically significant dose response relationship (p = 0.04). For the other hypothesized mechanisms, risks were marginally elevated and not statistically significant. No association was significant in Bayesian analyses. Conclusions We suggest that future studies use similar biologically-based exposure assessments in order for us to be sure what advice we should give to the millions of women around the world who work at night.