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OBJECTIVE--To investigate the hypothesis that the magnitude of the life saving effect of aspirin in the second international study of infarct survival (ISIS-2) trial cannot be explained solely by prevention of late reocclusion of the infarct related artery. The aim of this study was to discover whether or not aspirin in combination with streptokinase had an adjuvant thrombolytic effect. DESIGN--Aspirin (150 mg) or placebo was given at the start of streptokinase infusion to 200 patients seen within six hours of the start of prolonged ischaemic cardiac pain and ST segment elevation. All patients received active aspirin at three hours. Patency of the infarct related artery was assessed non-invasively by the normalised rise of creatine kinase activity at three hours after starting streptokinase in these 200 patients and in a further 52 patients who had already taken aspirin within one week of the start of infarction. MAIN OUTCOME MEASURE--Rise in creatine kinase activity from baseline to > or = 20% or < 20% of the peak rise of activity in blood taken at three hours after starting infusion of streptokinase. This correlates with patency or occlusion of the infarct related coronary artery at about 2.5 hours after starting streptokinase. RESULTS--Assessed in this way, patency of the infarct related artery was 60% in patients given aspirin, 63% in those given placebo, and 62% in patients who had already taken aspirin within one week of infarction. CONCLUSION--The magnitude of the life saving effect of aspirin remains unexplained. Further investigation is needed into the mechanism of action of antiplatelet treatment in relation to thrombolytic treatment. [ABSTRACT FROM PUBLISHER]

Acromegaly is associated with an increased cardiac morbidity and mortality, but it is not clear whether this is the result of increased incidence of hypertension and coronary heart disease or of a specific disease of heart muscle. Thirty four acromegalic patients were studied by non-invasive techniques. Seven of these patients had raised plasma concentrations of growth hormone at the time of study; three were newly diagnosed and had not received any treatment. Hypertension was present in nine (26%) but only three (9%) had electrocardiographic left ventricular hypertrophy. Echocardiography showed ventricular hypertrophy in 12 (48%) and increased left ventricular mass in 17 (68%) patients. Holter monitoring detected important ventricular arrhythmias in 14 patients. Thallium-201 scanning showed evidence for coronary heart disease in eight patients. Systolic time intervals were normal except when there was coexistent ischaemic heart disease. A comparison between 19 acromegalic patients with no other detectable cause of heart disease and 22 age matched controls showed appreciably abnormal left ventricular diastolic function in the group with acromegaly. The abnormalities shown did not correlate with left ventricular mass or wall thickness. There was no difference in diastolic function between patients with active acromegaly and those with treated acromegaly. Hypertensive acromegalic patients had worse diastolic function than hypertensive controls, suggesting that hypertension may further impair the left ventricular diastolic abnormality in acromegaly. This is the first study to find evidence of subclinical cardiac diastolic dysfunction in acromegaly and it supports the suggestion that there is a specific disease of heart muscle in acromegaly. [ABSTRACT FROM PUBLISHER]

Three measurements of diastolic filling were compared in 29 patients with essential hypertension and 27 age matched normotensive controls. Systolic function was normal in all but one of the patients. The mean (1SD) first one third filling fraction (a measurement of early diastolic filling) was significantly lower in the hypertensive groups (0.27 (0.24] than in the control group (0.45 (0.16)). The hypertensive group was subdivided into those with electrocardiographic abnormalities and those without. In the subgroup with a normal electrocardiogram the mean (1SD) first one third filling fraction measurement (0.28 (0.16)) was significantly lower than in the control group. In the subgroup with an abnormal electrocardiogram, the first one third filling fraction was even lower (0.24 (0.9)). In addition, the time to peak filling rate (213 (56) ms) was significantly longer in the subgroup with the abnormal electrocardiogram than in the control group (164 (45) ms). However, the interobserver reproducibility of the time to peak filling measurement was poor. The peak filling rate was low in the subgroup with an abnormal electrocardiogram, but not significantly different from the normal controls. The discriminatory value of the three diastolic measurements did not improve with exercise. These results showed an early diastolic filling abnormality in essential hypertension that did not appear to be caused by disease of the large coronary vessels as it was present in patients with normal wall motion and a normal exercise electrocardiogram. The occurrence of diastolic abnormalities when systolic function is still normal may mark an early stage in the development of hypertensive heart failure, at a time when the process is still potentially reversible. [ABSTRACT FROM PUBLISHER]

Nicardipine 30 mg three times daily and verapamil 160 mg twice daily have been compared in 30 patients with essential hypertension using a two-period crossover clinical trial with 6 week treatment periods., Blood pressure, heart rate and radionuclide left ventricular function were measured before and after exercise on both treatments. In addition to ejection fraction and ejection time, the left ventricular pressure volume ratio (P/V ratio) and left ventricular circumferential fibre shortening (VcF) were determined from the radionuclide scans., Two patients were withdrawn from the trial during each of the treatment periods because of possible side-effects of therapy. Three patients were not analysed because of early crossover due to side-effects, leaving 23 completed studies., Both treatments resulted in similar reductions in blood pressure, which were statistically significant with respect to the placebo-treated baseline. There was a significant difference between the effect of the two treatments on heart rate; both at rest and peak exercise, verapamil produced significant falls in heart rate but nicardipine produced little change. Neither treatment altered exercise capacity., Both treatments produced similar increases in resting ejection fraction. Nicardipine resulted in a small decrease in ejection time and verapamil in a small increase ( P < 0.001 between treatments)., Neither treatment produced significant change in resting P/V ratio. However, VcF improved significantly with nicardipine but was virtually unchanged with verapamil., Nicardipine has a similar hypotensive efficacy to that of verapamil, but may be safer in the treatment of patients with depressed or compromised cardiac function. [ABSTRACT FROM AUTHOR]

This article discusses the emigration problems in Malta. Malta's interest in emigration problems is twofold: the solution of its economic difficulties and the spiritual welfare of its emigrants. Though a decline in the birthrate has been observed in the last ten years from 40.5 per 1000 in 1944 to 28.3 per 100 in 1953, still the birthrate in Malta is one of the highest in Europe. The Department of Emigration was set up in 1921 with the objective of encouraging and assisting emigration. The Department tries to place before the public the serious economic position of the Island and though it does not engage in direct propaganda, it furnishes full information to applicants regarding life and conditions in the receiving countries. The moral problems involved could not but engage the active participation of the Church. The Malta Catholic Action Emigrants Commission was formed to serve several purposes, such as studying the emigration problem from the Catholic point of view and to preparing the emigrants for the new conditions of life. The Universal scope of Catholic Action extends the vision from particular objects and parochial limitations to more universal attitude. This attitude is best training for prospective emigrants that have to carry their faith with them with a positive purpose.

This paper presents an overview of national reports on Catholic migration. South Africa would seem to offer great possibilities for large scale immigration. There has been little recruiting overseas on the part of the South African government or other public authorities and the results seem to have been not too encouraging for either side. Some progress has been made in the care for the spiritual needs of Catholic German immigrations who have settled in Johannesburg and Pretoria area by the appointment of two German speaking priests with the assistance of the German hierarchy in terms of the Encyclica Exsul Familia. The information on newly arriving families to Argentina's parishes, which is sent by the central board, has created very important work in the parishes. Some of the parish priests not only visit the immigrants and keep in touch with them but have started to organize them. Migration Sunday is observed in every Catholic church through out Australia. During the past six years Australia has received migrants to the number of about 800,000. Of these great numbers are Catholics. The assimilation of migrants into the Australian way of life is necessarily slow and had to be cautiously approached. Emigration from Ireland to Great Britain presents many problems for attention. The Irish boy or girl grows up, however, in an atmosphere in which there is rarely need to engage in controversy in defence of religious beliefs and is, in a sense, unprepared for the non-Catholic environment to be encountered in the country of immigration.

Simulation models of smoking behaviour provide vital forecasts of exposure to inform policy targets, estimates of the burden of disease, and impacts of tobacco control interventions. A key element of useful model-based forecasts is a clear picture of uncertainty due to the data used to inform the model, however, assessment of this parameter uncertainty is incomplete in almost all tobacco control models. As a remedy, we demonstrate a Bayesian approach to model calibration that quantifies parameter uncertainty. With a model calibrated to Australian data, we observed that the smoking cessation rate in Australia has increased with calendar year since the late 20th century, and in 2016 people who smoked would quit at a rate of 4.7 quit-events per 100 person-years (90% equal-tailed interval (ETI): 4.5-4.9). We found that those who quit smoking before age 30 years switched to reporting that they never smoked at a rate of approximately 2% annually (90% ETI: 1.9-2.2%). The Bayesian approach demonstrated here can be used as a blueprint to model other population behaviours that are challenging to measure directly, and to provide a clearer picture of uncertainty to decision-makers., Competing Interests: Declaration of conflicting interestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: K.C. is co-principal investigator of an unrelated investigator-initiated trial of cervical screening in Australia (Compass; ACTRN12613001207707 and NCT02328872), which is conducted and funded by the VCS Foundation, a government-funded health promotion charity. She is also an investigator of Compass New Zealand (ACTRN12614000714684), which was conducted and funded by Diagnostic Medlab (DML), now Auckland District Health Board. The VCS Foundation received equipment and a funding contribution from Roche Molecular Systems and Ventana USA and DML received equipment and a funding contribution for Compass from Roche Molecular Systems. However, neither K.C. nor her institution on her behalf (Cancer Council New South Wales) receives direct funding from industry for this trial or any other project. The remaining authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Changing colorectal cancer (CRC) incidence rates, including recent increases for people younger than 50 y, need to be considered in planning for future cancer control and screening initiatives. Reliable estimates of the impact of changing CRC trends on the National Bowel Cancer Screening Program (NBCSP) are essential for programmatic planning in Australia. An existing microsimulation model of CRC, Policy1-Bowel , was updated to reproduce Australian CRC trends data and provide updated projections of CRC- and screening-related outcomes to inform clinical practice guidelines for the prevention of CRC., Methods: Policy1-Bowel was recalibrated to reproduce statistical age-period-cohort model trends and projections of CRC incidence for 1995-2045 in the absence of the NBCSP as well as published data on CRC incidence trends, stage distribution, and survival in 1995-2020 in Australia. The recalibrated Policy1-Bowel predictions were validated by comparison with published Australian CRC mortality trends for 1995-2015 and statistical projections to 2040. Metamodels were developed to aid the calibration process and significantly reduce the computational burden., Results: Policy1-Bowel was recalibrated, and best-fit parameter sets were identified for lesion incidence, CRC stage progression rates, detection rates, and survival rates by age, sex, bowel location, cancer stage, and birth year. The recalibrated model was validated and successfully reproduced observed CRC mortality rates for 1995-2015 and statistical projections for 2016-2030., Conclusion: The recalibrated Policy1-Bowel model captures significant additional detail on the future incidence and mortality burden of CRC in Australia. This is particularly relevant as younger cohorts with higher CRC incidence rates approach screening ages to inform decision making for these groups. The metamodeling approach allows fast recalibration and makes regular updates to incorporate new evidence feasible., Highlights: In Australia, colorectal cancer incidence rates are increasing for people younger than 50 y but decreasing for people older than 50 y, and colorectal cancer survival is improving as new treatment technologies emerge.To evaluate the future health and economic impact of screening and inform policy, modeling must include detailed trends and projections of colorectal cancer incidence, mortality, and diagnosis stage.We used novel techniques including integrative age-period cohort projections and metamodel calibration to update Policy1-Bowel , a detailed microsimulation of colorectal cancer and screening in Australia., Competing Interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Karen Canfell is co-principal investigator (PI) of an investigator-initiated trial of human papillomavirus (HPV) screening in Australia (Compass), which is conducted and funded by the Australian Centre for the Prevention of Cervical Cancer (ACPCC), a government-funded health promotion charity. The ACPCC has previously received equipment and a funding contribution for the Compass trial from Roche Molecular Systems USA. She is also co-PI on a major implementation program, “Elimination of Cervical Cancer in the Western Pacific,” which receives support from the Minderoo Foundation and equipment donations from Cepheid Inc. Michael Caruana is an investigator on an investigator-initiated trial of cytology and primary HPV screening in Australia (“Compass”) (ACTRN12613001207707 and NCT02328872), which is conducted and funded by the Australian Centre for the Prevention of Cervical Cancer, a government-funded health promotion charity. The ACPCC has received equipment and a funding contribution for the Compass trial from Roche Molecular Systems and operational support from the Australian Government. However, neither MC nor his institution on his behalf (the Daffodil Centre, a joint venture between Cancer Council NSW and The University of Sydney) receive direct or indirect funding from industry for Compass Australia. These disclosures do not constitute a conflict of interest for the present study and so the authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was performed to support the 2023 review and update of the Population Screening chapter of the Clinical Practice Guidelines for the Prevention, Early Detection and Management of Colorectal Cancer, which were auspiced by Cancer Council Australia and the Department of Health and Aged Care, Australian Government. KC and JBL report grant funding from the National Health and Medical Research Council of Australia (APP1194679 and APP1194784, respectively). JS is a recipient of a Cancer Institute NSW Career Development Fellowship (2022/CDF1154). These funding agreements ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report.

The coronavirus disease 2019 pandemic substantially impacted the delivery of cancer services and programs. Here we reviewed and synthesized the global scale and impact of pandemic-related delays and disruptions on cancer services, including diagnosis, diagnostic procedures, screening, treatment and supportive and palliative care. Based on data from 245 articles in 46 countries, we observed declines in the number of cancer screening participation (39.0%), diagnoses (23.0%), diagnostic procedures (24.0%) and treatment (28.0%), ranging from a 15.0% decline for radiotherapy to a 35.0% decline for systemic treatment during the pandemic compared to during the prepandemic period. Medium-human development index (HDI) category countries experienced greater reductions than high- and very-high-HDI countries. Missing data from low-HDI countries emphasize the need for increased investments in cancer surveillance and research in these settings. PROSPERO registration: CRD42022301816., Competing Interests: Competing interests: K.C. is co-principal investigator of an investigator-initiated trial of cervical screening, ‘Compass’, run by the VCS Foundation Australia, which is a government-funded not-for-profit charity. She is also co-principal investigator on a major implementation program ‘Elimination of Cervical Cancer in the Western Pacific’, which will receive support from the Minderoo Foundation and the Frazer Family Foundation and equipment donations from Cepheid. M.C. is an investigator on an investigator-initiated trial of cytology and primary human papillomavirus screening in Australia (Compass; ACTRN12613001207707 and NCT02328872 ), which is also conducted and funded by the VCS Foundation. The VCS Foundation has received equipment and a funding contribution for the Compass trial from Roche Molecular Systems and Ventana. However, K.C., M.C. and their institution on their behalf (the Daffodil Centre, a joint venture between Cancer Council NSW and The University of Sydney) do not receive direct funding from the industry for these or any other research project. The other authors declare no competing interests., (© 2025. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Australia's National Lung Cancer Screening Program will commence in July 2025, targeted at individuals aged 50-70 years with a 30 pack-year smoking history (equivalent to 20 cigarettes per day for 30 years), who either currently smoke or have quit within the past 10 years. We forecasted the number of screening-eligible individuals over the first 5 years of the program using data from the 2019 National Drug Strategy Household Survey and the 2022 Australian Bureau of Statistics population projections. Multiple imputation integrated with predictive modelling of future or unmeasured smoking characteristics was used to address missing data and, simultaneously, to project individuals' smoking histories to 2030. In 2025, 930 500 (95% prediction interval 852 200-1 019 000) individuals were estimated to be eligible, with the number meeting the criteria declining slightly during the years 2025-2030 in all Australian jurisdictions. Overall, 26-30% of those eligible will have quit smoking, and 70-74% will currently smoke. These estimates can be used in resource planning and as an indicative denominator to track participation rates for the program over time., Competing Interests: None declared

Objective: To compare 50-year forecasts of Australian tobacco smoking rates in relation to trends in smoking initiation and cessation and in relation to a national target of ≤5% adult daily prevalence by 2030., Methods: A compartmental model of Australian population daily smoking, calibrated to the observed smoking status of 229 523 participants aged 20-99 years in 26 surveys (1962-2016) by age, sex and birth year (1910-1996), estimated smoking prevalence to 2066 using Australian Bureau of Statistics 50-year population predictions. Prevalence forecasts were compared across scenarios in which smoking initiation and cessation trends from 2017 were continued, kept constant or reversed., Results: At the end of the observation period in 2016, model-estimated daily smoking prevalence was 13.7% (90% equal-tailed interval (EI) 13.4%-14.0%). When smoking initiation and cessation rates were held constant, daily smoking prevalence reached 5.2% (90% EI 4.9%-5.5%) after 50 years, in 2066. When initiation and cessation rates continued their trajectory downwards and upwards, respectively, daily smoking prevalence reached 5% by 2039 (90% EI 2037-2041). The greatest progress towards the 5% goal came from eliminating initiation among younger cohorts, with the target met by 2037 (90% EI 2036-2038) in the most optimistic scenario. Conversely, if initiation and cessation rates reversed to 2007 levels, estimated prevalence was 9.1% (90% EI 8.8%-9.4%) in 2066., Conclusion: A 5% adult daily smoking prevalence target cannot be achieved by the year 2030 based on current trends. Urgent investment in concerted strategies that prevent smoking initiation and facilitate cessation is necessary to achieve 5% prevalence by 2030., Competing Interests: Competing interests: Although not relevant to the current project, KC declares she receives salaray support from the National Health and Medical Research Council Australia (APP1194679). She is also co-PI of an investigator-initiated trial of cervical screening, "Compass", run by the Australian Centre for Prevention of Cervical Cancer (ACPCC), which is a government-funded not-for-profit charity. Compass receives infrastructure support from the Australian government and the ACPCC has received equipment and a funding contribution from Roche Molecular Diagnostics, USA. KC is also co-PI on a major implementation program Elimination of Cervical Cancer in the Western Pacific which has received support from the Minderoo Foundation and the Frazer Family Foundation and equipment donations from Cepheid Inc., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

During the COVID-19 pandemic, countries adopted mitigation strategies to reduce disruptions to cancer services. We reviewed their implementation across health system functions and their impact on cancer diagnosis and care during the pandemic. A systematic search was performed using terms related to cancer and COVID-19. Included studies reported on individuals with cancer or cancer care services, focusing on strategies/programs aimed to reduce delays and disruptions. Extracted data were grouped into four functions (governance, financing, service delivery, and resource generation) and sub-functions of the health system performance assessment framework. We included 30 studies from 16 countries involving 192,233 patients with cancer. Multiple mitigation approaches were implemented, predominantly affecting sub-functions of service delivery to control COVID-19 infection via the suspension of non-urgent cancer care, modified treatment guidelines, and increased telemedicine use in routine cancer care delivery. Resource generation was mainly ensured through adequate workforce supply. However, less emphasis on monitoring or assessing the effectiveness and financing of these strategies was observed. Seventeen studies suggested improved service uptake after mitigation implementation, yet the resulting impact on cancer diagnosis and care has not been established. This review emphasizes the importance of developing effective mitigation strategies across all health system (sub)functions to minimize cancer care service disruptions during crises. Deficiencies were observed in health service delivery (to ensure equity), governance (to monitor and evaluate the implementation of mitigation strategies), and financing. In the wake of future emergencies, implementation research studies that include pre-prepared protocols will be essential to assess mitigation impact across cancer care services., Competing Interests: Declaration of Competing Interest Prof Karen Canfell is co-PI of an investigator-initiated trial of cervical screening, "Compass", run by the VCS Foundation Australia, which is a government-funded not-for-profit charity. She is also co-PI on a major implementation program "Elimination of Cervical Cancer in the Western Pacific" which will receive support from the Minderoo Foundation and the Frazer Family Foundation and equipment donations from Cepheid Inc. Dr Michael Caruana is an investigator on an investigator-initiated trial of cytology and primary HPV screening in Australia (‘Compass’) (ACTRN12613001207707 and NCT02328872), which is also conducted and funded by the VCS Foundation. The VCS Foundation has received equipment and a funding contribution for the Compass trial from Roche Molecular Systems and Ventana Inc USA. However, KC, MC, and their institution on their behalf (the Daffodil Centre, a joint venture between Cancer Council NSW and The University of Sydney) do not receive direct funding from the industry for these or any other research project. Dr. Ethna McFerran receives funding from Health Data Research UK and Cancer Focus Northern Ireland unrelated to this work., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Academic health centers (AHCs) have traditionally focused on 3 core missions: patient care, research, and education. The current changing health care environment requires AHCs to broaden their focus to improve the health of their communities. This study reports the opportunities and challenges for the 5 North Carolina AHCs addressing social determinants of health (SDOH)., Methods: We used a mixed methods design. We analyzed financial data from systemwide community benefits reports and the Form 990 Schedule H of the primary medical centers (when available) from the 5 AHCs, and we conducted 4 key informant (KI) interviews at each of the 5 AHCs for a total of 20 interviews., Results: Overall, AHCs spend a very small percentage of their total spending on community improvement services and community benefit operations. By far, the largest amount spent on community benefit is for treating patients eligible for charity care. Food insecurity and access to health care were the most addressed SDOH. Housing was viewed as a crisis that needed to be addressed at statewide and national levels., Limitations: Community benefits reports from North Carolina AHCs lack important details. Key informant interviews provide far more recent information on the quantity and breadth of initiatives than the latest community benefits reports that were all completed pre-pandemic. We only interviewed 4 stakeholders from each AHC in North Carolina., Conclusion: A new strategic vision must incorporate social accountability into the AHCs' core missions to remove barriers and institute and sustain change, but the AHCs face a steep challenge to incorporate social accountability at a core mission level., Competing Interests: Acknowledgments: The authors would like to acknowledge Sandra Greene, DrPH; Alexandra Zuber, DrPH; and Michael Flynn, MD, who were part of the dissertation committee for this study. Funding: The authors received no financial support for the research, authorship, and/or publication of this article. Disclosure of interests: The authors report no conflict of interest., (Copyright ©2024 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.)

We present a rare case of short-segment jejunal infarction following inferior mesenteric artery embolisation for type 2 endoleak in a patient who previously underwent endovascular repair of abdominal aortic aneurysm. Potential causes for the event might include thromboembolism or traumatic thrombosis of a jejunal branch of the superior mesenteric artery (SMA) caused by a buddy guide wire used to maintain the position of the long vascular sheath in the SMA hiatus. The condition was recognised on CT and treated with resection of the infarcted segment of the small bowel followed by primary anastomosis., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Genetic and genomic testing can provide valuable information on individuals' risk of chronic diseases, presenting an opportunity for risk-tailored disease screening to improve early detection and health outcomes. The acceptability, uptake and effectiveness of such programmes is dependent on public preferences for the programme features. This study aims to conduct a systematic review of discrete choice experiments assessing preferences for genetic/genomic risk-tailored chronic disease screening., Methods: PubMed, Embase, EconLit and Cochrane Library were searched in October 2023 for discrete choice experiment studies assessing preferences for genetic or genomic risk-tailored chronic disease screening. Eligible studies were double screened, extracted and synthesised through descriptive statistics and content analysis of themes. Bias was assessed using an existing quality checklist., Results: Twelve studies were included. Most studies focused on cancer screening (n = 10) and explored preferences for testing of rare, high-risk variants (n = 10), largely within a targeted population (e.g. subgroups with family history of disease). Two studies explored preferences for the use of polygenic risk scores (PRS) at a population level. Twenty-six programme attributes were identified, with most significantly impacting preferences. Survival, test accuracy and screening impact were most frequently reported as most important. Depending on the clinical context and programme attributes and levels, estimated uptake of hypothetical programmes varied from no participation to almost full participation (97%)., Conclusion: The uptake of potential programmes would strongly depend on specific programme features and the disease context. In particular, careful communication of potential survival benefits and likely genetic/genomic test accuracy might encourage uptake of genetic and genomic risk-tailored disease screening programmes. As the majority of the literature focused on high-risk variants and cancer screening, further research is required to understand preferences specific to PRS testing at a population level and targeted genomic testing for different disease contexts., (© 2024. The Author(s).)

While previous reviews found a positive association between pre-existing cancer diagnosis and COVID-19-related death, most early studies did not distinguish long-term cancer survivors from those recently diagnosed/treated, nor adjust for important confounders including age. We aimed to consolidate higher-quality evidence on risk of COVID-19-related death for people with recent/active cancer (compared to people without) in the pre-COVID-19-vaccination period. We searched the WHO COVID-19 Global Research Database (20 December 2021), and Medline and Embase (10 May 2023). We included studies adjusting for age and sex, and providing details of cancer status. Risk-of-bias assessment was based on the Newcastle-Ottawa Scale. Pooled adjusted odds or risk ratios (aORs, aRRs) or hazard ratios (aHRs) and 95% confidence intervals (95% CIs) were calculated using generic inverse-variance random-effects models. Random-effects meta-regressions were used to assess associations between effect estimates and time since cancer diagnosis/treatment. Of 23 773 unique title/abstract records, 39 studies were eligible for inclusion (2 low, 17 moderate, 20 high risk of bias). Risk of COVID-19-related death was higher for people with active or recently diagnosed/treated cancer (general population: aOR = 1.48, 95% CI: 1.36-1.61, I 2  = 0; people with COVID-19: aOR = 1.58, 95% CI: 1.41-1.77, I 2  = 0.58; inpatients with COVID-19: aOR = 1.66, 95% CI: 1.34-2.06, I 2  = 0.98). Risks were more elevated for lung (general population: aOR = 3.4, 95% CI: 2.4-4.7) and hematological cancers (general population: aOR = 2.13, 95% CI: 1.68-2.68, I 2  = 0.43), and for metastatic cancers. Meta-regression suggested risk of COVID-19-related death decreased with time since diagnosis/treatment, for example, for any/solid cancers, fitted aOR = 1.55 (95% CI: 1.37-1.75) at 1 year and aOR = 0.98 (95% CI: 0.80-1.20) at 5 years post-cancer diagnosis/treatment. In conclusion, before COVID-19-vaccination, risk of COVID-19-related death was higher for people with recent cancer, with risk depending on cancer type and time since diagnosis/treatment., (© 2023 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.)

COVID-19 disrupted cancer control worldwide, impacting preventative screening, diagnoses, and treatment services. This modelling study estimates the impact of disruptions on colorectal cancer cases and deaths in Canada and Australia, informed by data on screening, diagnosis, and treatment procedures. Modelling was used to estimate short- and long-term effects on colorectal cancer incidence and mortality, including ongoing impact of patient backlogs. A hypothetical mitigation strategy was simulated, with diagnostic and treatment capacities increased by 5% from 2022 to address backlogs. Colorectal cancer screening dropped by 40% in Canada and 6.3% in Australia in 2020. Significant decreases to diagnostic and treatment procedures were also observed in Australia and Canada, which were estimated to lead to additional patient wait times. These changes would lead to an estimated increase of 255 colorectal cancer cases and 1,820 colorectal cancer deaths in Canada and 234 cases and 1,186 deaths in Australia over 2020-2030; a 1.9% and 2.4% increase in mortality, respectively, vs a scenario with no screening disruption or diagnostic/treatment delays. Diagnostic and treatment capacity mitigation would avert 789 and 350 deaths in Canada and Australia, respectively. COVID-related disruptions had a significant impact on colorectal cancer screening, diagnostic, and treatment procedures in Canada and Australia. Modelling demonstrates that downstream effects on disease burden could be substantial. However, backlogs can be managed and deaths averted with even small increases to diagnostic and treatment capacity. Careful management of resources can improve patient outcomes after any temporary disruption, and these results can inform targeted approaches early detection of cancers., Competing Interests: KC is co-PI of an investigator-initiated trial of cervical screening, “Compass”, run by the Australian Centre for Prevention of Cervical Cancer (ACPCC), which is a government-funded not-for-profit charity. Compass receives infrastructure support from the Australian government and the ACPCC has received equipment and a funding contribution from Roche Molecular Diagnostics, USA. KC is also co-PI on a major implementation program Elimination of Cervical Cancer in the Western Pacific which has received support from the Minderoo Foundation and the Frazer Family Foundation and equipment donations from Cepheid Inc MC is an investigator on an investigator-initiated trial of cytology and primary HPV screening in Australia (‘Compass’) (ACTRN12613001207707 and NCT02328872), which is conducted and funded by the Australian Centre for the Prevention of Cervical Cancer, a government-funded health promotion charity. Australian Centre for the Prevention of Cervical Cancer has received equipment and a funding contribution for the Compass trial from Roche Molecular Systems and operational support from the Australian Government. However, neither MC nor his institution on his behalf (the Daffodil Centre, a joint venture between Cancer Council NSW and The University of Sydney) receive direct or indirect funding from industry for Compass Australia or any other project. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2024 Worthington et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Guidelines for prostate specific antigen (PSA) testing in Australia recommend that men at average risk of prostate cancer who have been informed of the benefits and harms, and who decide to undergo regular testing, should be offered testing every 2 years from 50 to 69 years. This study aimed to estimate the benefits and harms of regular testing in this context. We constructed Policy1-Prostate, a discrete event microsimulation platform of the natural history of prostate cancer and prostate cancer survival, and PSA testing patterns and subsequent management in Australia. The model was calibrated to pre-PSA (before 1985) prostate cancer incidence and mortality and validated against incidence and mortality trends from 1985 to 2011 and international trials. The model predictions were concordant with trials and Australian observed incidence and mortality data from 1985 to 2011. Out of 1000 men who choose to test according to the guidelines, 36 [21-41] men will die from prostate cancer and 126 [119-133] men will be diagnosed with prostate cancer, compared with 50 [47-54] and 94 [90-98] men who do not test, respectively. During the 20 years of active PSA testing, 32.3% [25.6%-38.8%] of all PSA-test detected cancers are overdiagnosed cases that is, 30 [21-42] out of 94 [83-107] PSA-test detected cancers. Australian men choosing to test with PSA every two years from 50 to 69 will reduce their risk of ever dying from prostate cancer and incur a risk of overdiagnosis: for every man who avoids dying from prostate cancer, two will be overdiagnosed with prostate cancer between 50 and 69 years of age. Australian men, with health professionals, can use these results to inform decision-making about PSA testing., (© 2023 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.)

Background: The Phase 1/2 Treat&#95;CCM randomized controlled trial for people with familial cerebral cavernous malformations (FCCMs) confirmed the safety of propranolol and suggested beneficial effects on intracerebral hemorrhage or new focal neurological deficits, but the effects on patient-reported outcome measures have not been reported., Methods: Participants completed self-reported questionnaires at baseline, 1 and 2 years. Depression was assessed with the Beck Depression Inventory-II (BDI-2); Anxiety with the State-Trait Anxiety Inventory X1 and X2 (STAI X-1 and STAI X-2); and Quality of Life with the Short Form 36 (SF-36), split into the physical and mental component scales (PCS and MCS). Differences between treatment groups and the general population were assessed. Change over time by treatment was assessed by means of mixed models., Results: In total, 71 participants (48 propranolol and 23 standard care) were enrolled, of whom 61 (73%) completed questionnaires at baseline and 2-year FU. At baseline, no differences between treatment groups for any of the questionnaires were present. Twenty (31.7%) patients were considered depressed at baseline, while this proportion was lower in the propranolol group after 2 years (28.6% vs. 55.5%, p  = 0.047). The STAI X-1 and X-2 scores were stable over time. PCS was lower in FCCM patients as compared with the general Italian population, while the MCS was similar to the general population. No effect of propranolol was found for both PCS and MCS., Conclusion: Depression is common among patients with FCCM. Patients randomized to propranolol had a lower proportion of participants with depression after 2 years. Clinical trial registration : https://clinicaltrials.gov/, identifier (NCT03589014)., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Meessen, Abete-Fornara, Zarino, Castori, Tassi, Carriero, D'Alessandris, Al-Shahi Salman, Blanda, Nicolis, Novelli, Caruana, Vasamì, Lanfranconi and Latini.)

Background: Long-term projections of premature mortality (defined as deaths age <75 years) help to inform decisions about public health priorities. This study aimed to project premature mortality rates in Australia to 2044, and to estimate numbers of deaths and potential years of life lost (PYLL) due to premature mortality overall and for 59 causes., Methods: We examined the past trends in premature mortality rates using Australian mortality data by sex, 5-year age group and 5-year calendar period up to 2019. Cigarette smoking exposure data (1945-2019) were included to project lung cancer mortality. Age-period-cohort or generalised linear models were developed and validated for each cause to project premature mortality rates to 2044., Findings: Over the 25-year period from 1990-1994 to 2015-2019, there was a 44.4% decrease in the overall age-standardised premature mortality rate. This decline is expected to continue, from 162.4 deaths/100,000 population in 2015-2019 to 141.7/100,000 in 2040-2044 (12.7% decrease). Despite declining rates, total numbers of premature deaths are projected to increase by 22.8%, rising from 272,815 deaths in 2015-2019 to 334,894 deaths in 2040-2044. This is expected to result in 1.58 million premature deaths over the 25-year period 2020-2044, accounting for 24.5 million PYLL. Of the high-level cause categories, cancer is projected to remain the most common cause of premature death in Australia by 2044, followed by cardiovascular disease, external causes (including injury, poisoning, and suicide), and respiratory diseases., Interpretation: Despite continuously declining overall premature mortality rates, the total number of premature deaths in Australia is projected to remain substantial, and cancer will continue to be the leading cause. These projections can inform the targeting of public health efforts and can serve as benchmarks against which to measure the impact of future interventions. They emphasise the ongoing importance of accelerating the prevention, early detection, and treatment of key health conditions., Funding: No funding was provided for this study., Competing Interests: KC's research is funded by the National Health and Medical Research Council (NHMRC) of Australia (Fellowship APP1194679, Centre of Research Excellence in Cervical Cancer Control 1135172). KC is co-PI and MC is an investigator of an investigator-initiated trial of cervical screening, Compass, run by the Australian Centre for Prevention of Cervical Cancer (ACPCC), which is a government-funded not-for-profit charity; the ACPCC has received equipment and a funding contribution from Roche Molecular Diagnostics, and operational support from the Australian Government. KC is also co-PI on a major investigator-initiated implementation program Elimination of Cervical Cancer in the Western Pacific (ECCWP) which will receive support from the Minderoo Foundation, the Frazer Family Foundation and equipment donations from Cepheid Inc. Neither KC and MC nor their institution on their behalf receives direct or indirect funding from industry for any project. No other conflicts of interest are declared. The remaining authors declare that they have no conflicts of interest., (© 2023 The Author(s).)