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Background: Previous research has shown that women diagnosed with melanoma have better survival than their male counterparts, but little is known about the underlying mechanisms by which sex affects melanoma survival. Aim: The aim of this study was to quantify the contribution of age at diagnosis, tumor thickness and tumor site to sex differences in 1-year and 5-year melanoma-specific survival. Methods: We conducted a population-based study using cancer registry data including 6,009 men and 5,232 women aged 15-70 years with first primary melanoma diagnosed between 2007 and 2015 in Victoria, Australia. We excluded cases notified via death certificate only. Deaths to the end of 2015 were identified through linkage to the Victorian and national death registries. We decomposed the total effect of sex on melanoma-specific survival into three possible pathways, examining the mediating role of age at diagnosis, tumor thickness and tumor site. The natural indirect effects through the mediators were assessed using weighted, sequential causal mediation analysis. Results: Compared with women, there were 60 (95% confidence interval (CI) 34 to 91) and 201 (95% CI 135 to 267) additional deaths per 10,000 in men within 1 year and 5 years following diagnosis, respectively. Within 1 year following diagnosis, the indirect effect through age at diagnosis was estimated to be 4 (95% CI -2 to 9) additional deaths per 10,000 in men compared with women, explaining 7% of the total effect of sex, while a considerable proportion of the total effect (79%) explained by melanoma thickness [47 (95% CI 32 to 66) additional deaths per 10,000 in men], excluding the potential influence of age at diagnosis on thickness. Similarly, within 5 years after diagnosis, about 13% of the total effect was estimated to be explained by age at diagnosis [26 (95% CI 15 to 38) additional deaths per 10,000 in men] and 86% by tumor thickness [174 (95% CI 142 to 207) additional death per 10,000 in men]. There was no indirect effect through tumor site within 1 year and 5 years postdiagnosis. Conclusion: The lower survival from melanoma of men relative to women appears to be explained primarily by tumor thickness rather than age at diagnosis. Our findings highlight the need for earlier detection of melanoma in men. [ABSTRACT FROM AUTHOR]

Background: Socio-economic inequalities in colon cancer survival exist in high-income countries, but the reasons are unclear. We assessed the mediating effects of stage at diagnosis, comorbidities, and treatment (surgery and intravenous chemotherapy) on survival from colon cancer., Methods: We identified 2,203 people aged 15 to 79 years with first primary colon cancer diagnosed in Victoria, Australia, between 2008 and 2011. Colon cancer cases were identified through the Victorian Cancer Registry (VCR), and clinical information was obtained from hospital records. Deaths till December 31, 2016 ( n = 807), were identified from Victorian and national death registries. Socio-economic disadvantage was based on residential address at diagnosis. For stage III disease, we decomposed its total effect into direct and indirect effects using interventional mediation analysis., Results: Socio-economic inequalities in colon cancer survival were not explained by stage and were greater for men than women. For men with stage III disease, there were 161 [95% confidence interval (CI), 67-256] additional deaths per 1,000 cases in the 5 years following diagnosis for the most disadvantaged compared with the least disadvantaged. The indirect effects through comorbidities and intravenous chemotherapy explained 6 (95% CI, -10-21) and 15 (95% CI, -14-44) per 1,000 of these additional deaths, respectively. Surgery did not explain the observed gap in survival., Conclusions: Disadvantaged men have lower survival from stage III colon cancer that is only modestly explained by having comorbidities or not receiving chemotherapy after surgery., Impact: Future studies should investigate the potential mediating role of factors occurring beyond the first year following diagnosis, such as compliance with surveillance for recurrence and supportive care services., (©2021 American Association for Cancer Research.)

Purpose: Cancer survival is generally lower for rural compared with urban residents, but findings have been inconsistent. We aimed to assess inequalities in cancer survival by remoteness of residence in Victoria, Australia., Methods: Incident cancer cases diagnosed in 2001-2015 with 30 cancer types (n = 331,302) were identified through the Victorian Cancer Registry and followed to the end of 2015 through death registries. Five-year net survival was estimated using the Pohar-Perme method and differences assessed by excess mortality rate ratios (EMRRs) using Poisson regression, adjusting for sex, age and year of diagnosis. EMRRs adjusted for socio-economic disadvantage were also estimated., Results: People living outside major cities had lower survival for 11 cancers: esophagus, stomach, colorectum, liver, gallbladder/biliary tract, pancreas, lung, connective/soft tissue, ovary, prostate, kidney. No differences in survival were found for cancers of uterus, small intestine and mesothelioma. After adjusting for socio-economic disadvantage, the observed differences in survival decreased for most cancers and disappeared for colorectal cancer, but they remained largely unchanged for cancers of esophagus, stomach, liver, pancreas, lung, connective/soft tissue, ovary and kidney., Conclusion: People with cancer residing outside major cities had lower survival from some cancers, which is partly due to the greater socio-economic disadvantage of rural residents.

Despite overall improvements in cancer survival due to earlier diagnosis and better treatment, socio-economically disadvantaged people have lower cancer survival than more advantaged people. We aimed to examine differences in cancer survival by area-level socio-economic disadvantage in Victoria, Australia and assess whether these inequalities varied by year of diagnosis, age at diagnosis, time since diagnosis and sex. Cases diagnosed with a first primary cancer in 2001-2015 were identified using the Victorian Cancer Registry and followed to the end of 2016. Five-year net survival and the excess risk of death due to a cancer diagnosis were estimated. People living in more disadvantaged areas had lower five-year survival than residents of less disadvantaged regions for 21 of 29 cancer types: head and neck, oesophagus, stomach, colorectum, anus/anal canal, liver, gallbladder/biliary tract, pancreas, lung, melanoma, connective/soft tissue, female breast, ovary, prostate, kidney, bladder, brain and central nervous system, unknown primary, non-Hodgkin lymphoma, multiple myeloma and leukemia. The observed lower survival in more deprived regions persisted over time, except head and neck cancer, for which the gap in survival has widened. Socio-economic inequalities in survival decreased with increasing age at diagnosis for cancers of connective/soft tissue, bladder and unknown primary. For colorectal cancer, the observed survival disadvantage in lower socio-economic regions was greater for men than for women, while for brain and central nervous system tumours, it was larger for women. Cancer survival is generally lower for residents of more socio-economically disadvantaged areas. Identifying the underlying reasons for these inequalities is important and may help to identify effective interventions to increase survival for underprivileged cancer patients., Competing Interests: The authors have declared that no competing interests exist.

Purpose: Few large-scale studies have investigated sex differences in cancer survival and little is known about their temporal and age-related patterns., Methods: We used cancer registry data for first primary cancers diagnosed between 1982 and 2015 in Victoria, Australia. Cases were followed until the end of 2015 through linkage to death registries. Differences in survival were assessed for 25 cancers using the Pohar-Perme estimator of net survival and the excess mortality rate ratio (EMRR) adjusting for age and year of diagnosis., Results: Five-year net survival for all cancers combined was lower for men (47.1%; 95% CI 46.9-47.4) than women (52.0%; 95% CI 51.7-52.3); EMRR 1.13 (95% CI 1.12-1.14; p < 0.001). A survival disadvantage for men was observed for 11 cancers: head and neck, esophagus, colorectum, pancreas, lung, bone, melanoma, mesothelioma, kidney, thyroid, and non-Hodgkin lymphoma. In contrast, women had lower survival from cancers of the bladder, renal pelvis, and ureter. For the majority of cancers with survival differences, the EMRR decreased with increasing age at diagnosis; for colorectal, esophageal, and kidney cancer, the EMRR increased with time since diagnosis., Conclusion: Identifying the underlying reasons behind sex differences in cancer survival is necessary to address inequalities, which may improve outcomes for men and women.