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BACKGROUND: Worldwide, the incidence of thick melanoma has not declined, and the nodular melanoma (NM) subtype accounts for nearly 40% of newly diagnosed thick melanoma. To assess differences between patients with thin (≤2.00 mm) and thick (≥2.01 mm) nodular melanoma, the authors evaluated factors such as demographics, melanoma detection patterns, tumor visibility, and physician screening for NM alone and compared clinical presentation and anatomic location of NM with superficial spreading melanoma (SSM). METHODS: The authors used data from a large population-based study of Queensland (Australia) residents diagnosed with melanoma. Queensland residents aged 20 to 75 years with histologically confirmed first primary invasive cutaneous melanoma were eligible for the study, and all questionnaires were conducted by telephone (response rate, 77.9%). RESULTS: During this 4-year period, 369 patients with nodular melanoma were interviewed, of whom 56.7% were diagnosed with tumors ≤2.00 mm. Men, older individuals, and those who had not been screened by a physician in the past 3 years were more likely to have nodular tumors of greater thickness. Thickest nodular melanoma (4 mm+) was also most common in persons who had not been screened by a physician within the past 3 years (odds ratio, 3.75; 95% confidence interval, 1.47-9.59). Forty-six percent of patients with thin nodular melanoma (≤2.00 mm) reported a change in color, compared with 64% of patients with thin SSM and 26% of patients with thick nodular melanoma (>2.00 mm). CONCLUSIONS: Awareness of factors related to earlier detection of potentially fatal nodular melanomas, including the benefits of a physician examination, should be useful in enhancing public and professional education strategies. Particular awareness of clinical warning signs associated with thin nodular melanoma should allow for more prompt diagnosis and treatment of this subtype. Cancer 2009. © 2009 American Cancer Society.

This review outlines current international patterns in prostate cancer incidence and mortality rates and survival, including recent trends and a discussion of the possible impact of prostate-specific antigen (PSA) testing on the observed data. Internationally, prostate cancer is the second most common cancer diagnosed among men (behind lung cancer), and is the sixth most common cause of cancer death among men. Prostate cancer is particularly prevalent in developed countries such as the United States and the Scandinavian countries, with about a six-fold difference between high-incidence and low-incidence countries. Interpretation of trends in incidence and survival are complicated by the increasing impact of PSA testing, particularly in more developed countries. As Western influences become more pronounced in less developed countries, prostate cancer incidence rates in those countries are tending to increase, even though the prevalence of PSA testing is relatively low. Larger proportions of younger men are being diagnosed with prostate cancer and living longer following diagnosis of prostate cancer, which has many implications for health systems. Decreasing mortality rates are becoming widespread among more developed countries, although it is not clear whether this is due to earlier diagnosis (PSA testing), improved treatment, or some combination of these or other factors.

Objective To assess physician, patient, and skin lesion characteristics that affect the number of benign skin lesions excised by primary care physicians for each skin cancer. Design Prospective study collecting clinical, patient, and histopathologic details of excisions or biopsies of skin lesions by random samples of primary care physicians. Setting Southeast Queensland involving traditional family medicine physicians (n = 104; response rate, 53.9%) and family medicine physicians working in 27 primary care skin cancer clinics (n = 50; response rate, 75.0%). Participants Of 28 755 skin examinations recorded during the study, 11 403 skin lesions were excised or biopsied; 97.5% of the excised lesions had clinical and histologic diagnoses recorded. Main Outcome Measures Number of lesions needed to excise or biopsy (NNE) for 1 melanoma (pigmented lesions only) and NNE for 1 nonmelanoma skin cancer (nonpigmented lesions only). Results The NNE for nonpigmented lesions (n = 8139) was 1.5 (95% confidence interval, 1.4-1.6) and for pigmented lesions (n = 2977) was 19.6 (16.2-22.9). The NNE estimates were up to 8 times lower if the physician thought the lesion was likely to be malignant and up to 2.5 times higher if there was strong patient pressure to excise. The NNE estimates varied by other physician-, patient-, and lesion-related variables. Conclusions Clinical impressions of excised skin lesions were strongly associated with NNE estimates. By focusing on pigmented skin lesions and by addressing the physician- and patient-specific factors identified, the effectiveness of future training for primary care physicians in the clinical management of skin cancer could be improved.

Objective: To investigate the reliability of collecting colorectal stage information from pathology reports and general practitioners in Queensland, Australia.Methods: A longitudinal study of colorectal cancer survivors conducted in 2003 and 2004 (n=1966, response rate=57%) obtained stage information from clinical specialists (n=1334), general practitioners (GP) (n=1417) and by extracting stage from pathology reports (n=1484). Reliability of stage information was determined by comparing stage from GPs and pathology reports with that reported by the clinical specialists, using a weighted kappa.Results: GPs and pathology reports each had a similar level of agreement with clinical specialists, with kappa scores of 0.77 (0.75-0.80) (n=1042) and 0.78 (0.75-0.81) (n=1152), respectively. Results were similar when restricting to records staged by all three methods (n=847). GPs had similar levels of agreement with clinical specialists within each stage, although pathology reports tended to under-stage patients in Stage D (0.37). Collapsing stage into two categories (A or B, C or D) increased the reliability estimates from the pathology reports to 0.91 (0.88-0.93), but there was little change in GP estimates 0.79 (0.75-0.83).Conclusions: Extractions from pathology reports are a valid source of broad stage information for colorectal cancer.Implications: In the absence of clinical stage data, access to pathology records by population-based cancer registries enables a more accurate assessment of survival inequalities in colorectal cancer survival.

To describe the incidence of second primary invasive melanoma. Data describing 52,997 subjects with melanoma notified to The Queensland Cancer Registry between 1982 and 2003. We calculated incidence rates of second primary invasive melanoma (per 1,000 person-years) by sex, age, and characteristics of the first primary. The rate of second primary invasive melanoma was relatively constant over 20 years of follow-up at 6.01 per 1,000 person-years indicating a high, constant lifetime risk of second primary invasive melanoma. Rates were 62% higher in males than in females and increased with age at first diagnosis with the rate in older patients (80+ years) more than double the rate observed in younger patients (40–49 years). Rates in patients with melanomas thicker than 2 mm were over 50% higher than in patients with thinner melanomas. Melanoma patients are at high risk of a second primary invasive melanoma. This risk does not diminish with time and does not differ significantly between patients first diagnosed with lentigo maligna, in situ melanoma or invasive melanoma. These results indicate that all melanoma patients require lifetime surveillance. Current treatment guidelines should be modified to reflect this.

To better understand the clinical diagnostic process for invasive melanoma in Queensland. Descriptive population-based study of Queensland residents (n=3772) aged 20-75 years diagnosed with invasive melanoma between January 2000 and December 2003. Information was obtained via telephone interview combined with pathology data from the Queensland Cancer Registry. About 85% of melanoma patients diagnosed in Queensland saw a general practitioner at least once during the process, most of these for the initial consultation. Almost one-fifth of patients (18.1%) saw a skin clinic doctor sometime through the diagnosis pathway; this proportion increased significantly over the study period (P

Objective To examine the relationship between melanoma thickness and reported time from first recognition and from first physician contact to the diagnosis of invasive melanoma. Design Telephone survey of patients recently diagnosed as having melanoma, combined with relevant pathological data (including melanoma thickness and morphologic structure) from the population-based Queensland Cancer Registry. A test-retest study (n = 176) was also conducted. Setting Population-based study in Queensland. Participants Residents of Queensland (n = 3772) who had been diagnosed as having invasive melanoma between January 1, 2000, and December 31, 2003. Main Outcome Measures Prepresentation time (time between first noticing a suspicious spot and the first physician visit), postpresentation time (time between the first physician visit and diagnosis), and total time to diagnosis (time from initial detection of the melanoma to diagnosis). Results With 1 exception, we found no significant association between melanoma thickness and reported time to diagnosis for all melanomas combined, superficial spreading melanomas, or nodular melanomas. The exception was a positive association between melanoma thickness and postpresentation delay of physician-detected nodular melanomas. The reliability study gave intraclass correlation coefficients of 0.85 to 0.90 for the measures of intervals. Conclusions This large study demonstrates no clear relationship between the melanoma thickness when diagnosed and the time from first recognition of changes or from first physician examination to diagnosis. This may be because of varying biological characteristics of melanomas, as well as methodological limitations of retrospective studies when trying to measure this complex association.

Spermatocytic seminoma is a rare subtype of testicular germ cell tumor which has been reported to occur in elderly men. We report the first population based estimate of incidence, temporal trends and age distribution of this tumor.All cases of primary testicular cancer identified by cancer registries in Australia between 1982 and 2002 were available for analysis. The International Classification of Diseases for Oncology code M-9063/3 was used to identify spermatocytic seminomas. Incidence trends were modeled using Poisson regression.There were 58 cases of spermatocytic seminoma out of 9,658 cases of primary malignant testicular neoplasms identified by the cancer registries. This tumor comprised 1.1% of all seminoma and the age standardized incidence rate was 0.4 per million (95% CI 0.3-0.6). A temporal increase in incidence was found but not one reaching statistically significance. Age at diagnosis ranged from 19 to 92 years with a mean of 53.5 (SD 16.7) and a median of 54 years.Spermatocytic seminoma should be considered in the differential diagnosis for testicular germ cell tumors presenting in young adults because this tumor occurs as often in men younger than 55 years as it does in older men. Although rare, the occurrence of this tumor is not as singular as the current literature suggests.

Background: The screening behaviour and screening outcomes of men ≥ 50 years was investigated within a randomized controlled trial of a community-based intervention of screening for melanoma, consisting of a community education program, an education program for medical practitioners and the provision of dedicated skin screening clinics. Methods: Data from cross-sectional telephone surveys before (559 completed interviews); at the end (591 completed interview); and at 2 year after the intervention (445 completed interviews) were analysed. In addition, we analysed data from skin screening clinics within the intervention program (3,355 men ≥ 50 years participated). Results: During the intervention period men ≥ 50 years increased both their screening behaviour and intention to screen. Those men ≥ 50 years who reported a past history of removal of a mole as well as other risk factors for skin cancer and positive attitudes towards screening were more likely to participate in skin screening across time. Men ≥ 50 years accounted for 20.5% of all skin screening clinic attendees, 31.3% of those referred for a suspicious lesion, 48.5% of melanomas, and 45% of all Keratinocyte Carcinomas diagnosed within the screening program, respectively. Conclusions: The intervention program successfully motivated men ≥ 50 years to attend screening for skin cancer, resulting in the highest yield of skin cancer within this subgroup of the population. Messages addressing skin cancer risk factors and attitudes towards skin cancer and screening could be used to target a screening program for melanoma towards men ≥ 50 years.

Sunlight is essential for the production of vitamin D in the body. Evidence exists to suggest that vitamin D metabolites may have a role in tumor growth suppression. In this large study, involving over a million cancer patients from the United Kingdom, we have analyzed the role of season of diagnosis and sunlight exposure in cancer survival for cancers of the breast, colorectum, lung, prostate and at all sites combined. We used population-based data from the Thames Cancer Registry to analyze cancer survival in periods 0-1 and 0-5 years after diagnosis. The analysis was performed using Cox proportional regression analysis adjusting for age and period at diagnosis and including season of diagnosis and sunlight exposure in the preceding months as factors in the analysis. We found evidence of substantial seasonality in cancer survival, with diagnosis in summer and autumn associated with improved survival compared with that in winter, especially in female breast cancer patients and both male and female lung cancer patients (hazard ratios 0.86 [95% CI 0.83-0.89], 0.95 [95% CI 0.92-0.97] and 0.95 [95% CI 0.93-0.98] respectively). Cumulative sunlight exposure in the months preceding diagnosis was also a predictor of subsequent survival, although season of diagnosis was a stronger predictor than cumulative sunlight exposure. We found seasonality in cancer survival to be stronger in women than in men. Our results add to a growing body of evidence that vitamin D metabolites play an important role in cancer survival.

Objective: To assess how much of the urban-rural disparity in melanoma survival in Queensland is due to later diagnosis. Methods: Data were obtained from the population-based Queensland Cancer Registry. We used incident cases for the six years 1996 to 2001 with follow-up to the end of 2002, so that all patients were followed for at least 12 months with a median follow-up time of 41 months. Cox regression models were used to compare urban versus rural case-fatality rates, after adjusting for thickness, level, subsite, age and sex. Results: The adjusted case-fatality rate was 20% higher in rural versus urban areas (hazard ratio 1.20, 95% Cl 1.02-1.43). Conclusions: There is some characteristic of living in an urban area, other than earlier diagnosis, that improves melanoma survival. In the first instance, differences in access to services and variation in management practices deserve investigation and exclusion.

With the uptake of cigarette smoking hypothesised to occur through a series of contemplation and action stages, we sought to investigate what factors are associated with the contemplation of smoking among secondary school students in Queensland, Australia. A series of four cross-sectional surveys were conducted among secondary schools in Queensland in 1993, 1996, 1999 and 2002. Respondents (n = 9993) were asked about the stages of smoking. Nearly half (43%) of secondary school students reported some contemplation of smoking. Increased levels of smoking contemplation were observed among females, earlier survey years, Junior level students, students with average or below average scholastic ability, those prepared to go out with a smoker, those with recent alcohol experience, those who had influenced other students to smoke or had not discouraged other students smoking. The results of this study provide further information about the factors relevant to stages of smoking uptake among secondary school students and the influence that students may have on their peers.

OBJECTIVE: To assess whether the stabilisation in melanoma mortality rates observed from 1985 to 1994 has progressed to a statistically significant decrease. METHOD: Joinpoint trends analyses of Australian melanoma mortality data between 1950 and 2002, stratified by age. RESULTS: The latest data showed statistically significant decreases in mortality rates for both men and women younger than 55 years (percentage change per year, men 35-55 years: -2.4%; 95% CI -3.5% -- -1.3%; women: -2.9%; 95% CI -4.7%-- -1.1%). For ages 55-79 years, rates are now stable for both men (+0.3%; 95% CI -0.6%-- +1.1%) and women (-0.5%; 95% CI -1.4%-- +0.4%), whereas previously the rates were increasing. For both men and women 80 years or older, rates have continued their statistically significant increase of 3-4% per year. CONCLUSIONS AND IMPLICATIONS: Since no similar reductions in incidence have been reported, the most likely cause of the recent statistically significant decreases in mortality is early detection. Although it may be too early to be seeing the full benefits of primary prevention programs that started in the 1980s, they have the potential to lead to large reductions in mortality in the future.

The ability of general practitioners to make important clinical decisions about the diagnosis and management of skin lesions is poorly understood.A questionnaire on the diagnosis and management of eight photographed skin lesions was sent to 150 GPs in southeast Queensland.The questionnaire was completed by 114 GPs (response rate 77%). General practitioners' provisional diagnoses and management of photographed skin lesions were mostly or always correct, and there was general high consistency between diagnosis and intended management. Pigmented seborrhoeic keratoses were the most difficult lesions for GPs to diagnose correctly. Whether a lesion was different to usual moles appears to have the strongest association with clinical diagnosis.The high ability of GPs as measured in this artificial study is encouraging. The strong association between identifying moles that appear different to usual and correct clinical diagnoses suggest that unless GPs can increase the number of skin lesions they see as part of their typical workload, their clinical ability may not increase further.

Community responses (n=925, response rate=71%) of a series of eight photographs of pigmented skin lesions were compared against those of general practitioners (n=114, response rate=77%), considered to be the most relevant gold standard. The eight photographs included three melanomas, two potentially malignant lesions and three benign pigmented lesions. Over the pool of lesions examined, the average probability that community members thought a lesion was likely to be skin cancer (0.68 [99% CI=0.66-0.69]) was higher (p

Until definitive evidence of the effectiveness of prostate cancer screening is available, most guidelines advocate that men make their own decisions about testing, after being fully informed. A man's perception of his personal risk is a key element in the decision-making process. In this decision-making, the current routine use of population risk estimates may be misleading. Risk estimates need to be relevant to the man making the choice. In particular, they should be age-specific and, where possible, include adjustments for known risk factors such as family history. As an example, although the population risk of lung cancer mortality is twice that of prostate cancer, for a non-smoking man with a family history of prostate cancer the direction of this comparison would be reversed. A man aged 50 diagnosed with prostate cancer has a greater likelihood (60%) of dying prematurely (before 80 years) from prostate cancer than a man diagnosed when aged 70 (38%). This can be attributed to the longer time available for the prostate cancer to progress, and the increased effect of competing causes of death among older men. This suggests that the oft-used statement "men are more likely to die with prostate cancer than from prostate cancer" is misleading, particularly for men diagnosed in their 50s or 60s. Decisions need to be made by men based on the best possible understanding of their personal vulnerability, and the individualisation of risk provides a more realistic appraisal of potential threat posed by the disease.

Men aged 50 years or older are at high risk of melanoma, and both incidence and mortality are increasing in this group1. Skin self-examination (SSE) could be one avenue to improve outcomes from melanoma. Several recent intervention trials successfully increased SSE, but resistance to such interventions is less well studied. This posthoc secondary analysis of interventional study data aimed to identify characteristics of older men who did not take up SSE for the early signs of skin cancer, despite exposure to educational materials during a randomized intervention trial

Free access to health care for all Australians is enshrined in the publicly funded Medicare programme, which coexists with and subsidises the private sector. Information about equitable access under this system is scarce. In other countries with free health insurance, patients of low socioeconomic status (SES) have low rates of invasive coronary procedures (ICP): angiography, angioplasty, and bypass surgery.1,2 The purpose of this study was to examine whether SES has a differential effect on ICP rates across the public and private sectors in Queensland (population: 3.5 million), Australia. We used computerised discharge abstracts to conduct a population-based cohort study of the 3531 patients admitted to Queensland hospitals for acute myocardial infarction (AMI) during 1998. AMI patients were identified using the ICD9-CM code 410. x 1: first episode of care for a newly diagnosed myocardial infarction . Follow up was for one year and used probabilistic matching based on Medicare number, date of birth, sex, country of birth and address of usual residence. We applied two exclusion criteria: (1) age younger than 30 years or older than 89 years, …

Objective: To determine whether an association exists between distance from radiotherapy facilities and survival outcomes of people diagnosed with rectal cancer. Design and setting: Descriptive population-based study using data from the Queensland Cancer Registry. Patients: All patients aged 20–79 years (n = 6848) diagnosed with invasive rectal cancer between 1 January 1996 and 31 December 2006. Main outcome measure: Cause-specific survival. Results: The 5-year cause-specific survival was 62% (95% CI, 61%–64%); it was strongly influenced by stage at diagnosis (American Joint Committee on Cancer, Stages I–IV), ranging from 86% (Stage I) to 9% (Stage IV). After adjusting for age, sex, and stage at diagnosis, patients who lived 100–199 km, 200–399 km and 400 km or more from a radiotherapy facility were 16%, 30%, and 25%, respectively, more likely to die from rectal cancer than patients living within 50 km of such a facility. On average, there was a 6% increase in mortality risk (95% CI, 3%–8%; P < 0.001) for each 100 km increment in distance from the nearest radiotherapy facility. Shared frailty models showed that this association persisted after adjusting for the correlation between individual cancer patients living in the same remoteness or area-level socioeconomic status categories. Conclusions: While centralisation of cancer treatment services has merit, our study provides evidence of a shorter survival for people with rectal cancer who live relatively far from radiotherapy facilities. It remains a priority to develop and implement policy, cultural and clinical measures to reduce the burden faced by rural and remote patients with rectal cancer.

IMPORTANCE Older men are at risk of dying of melanoma. OBJECTIVE To assess attendance at and clinical outcomes of clinical skin examinations (CSEs) in older men exposed to a video-based behavioral intervention. DESIGN, SETTING, AND PARTICIPANTS This was a behavioral randomized clinical trial of a video-based intervention in men aged at least 50 years. Between June 1 and August 31, 2008, men were recruited, completed baseline telephone interviews, and were than randomized to receive either a video-based intervention (n = 469) or brochures only (n = 461; overall response rate, 37.1%) and were again interviewed 7 months later (n = 870; 93.5% retention). INTERVENTIONS Video on skin self-examination and skin awareness and written informational materials. The control group received written materials only. MAIN OUTCOMES AND MEASURES Participants who reported a CSE were asked for the type of CSE (skin spot, partial body, or whole body), who initiated it, whether the physician noted any suspicious lesions, and, if so, how lesions were managed. Physicians completed a case report form that included the type of CSE, who initiated it, the number of suspicious lesions detected, how lesions were managed (excision, nonsurgical treatment, monitoring, or referral), and pathology reports after lesion excision or biopsy. RESULTS Overall, 540 of 870 men (62.1%) self-reported a CSE since receiving intervention materials, and 321 of 540 (59.4%) consented for their physician to provide medical information (received for 266 of 321 [82.9%]). Attendance of any CSE was similar between groups (intervention group, 246 of 436 [56.4%]; control group, 229 of 434 [52.8%]), but men in the intervention group were more likely to self-report a whole-body CSE (154 of 436 [35.3%] vs 118 of 434 [27.2%] for control group; P = .01). Two melanomas, 29 squamous cell carcinomas, and 38 basal cell carcinomas were diagnosed, with a higher proportion of malignant lesions in the intervention group (60.0% vs 40.0% for controls; P = .03). Baseline attitudes, behaviors, and skin cancer history were associated with higher odds of CSE and skin cancer diagnosis. CONCLUSIONS AND RELEVANCE A video-based intervention may increase whole-body CSE and skin cancer diagnosis in older men. Copyright 2014 American Medical Association. All rights reserved.

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. 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. 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. Refereed/Peer-reviewed

Perineal trauma is the most frequently reported complication of labour and delivery in the Qld Perinatal Data Collection. It is documented that some individual accoucheurs seem to be particularly skillful in assisting at birth in a way that minimises perineal trauma. Recent trends within the Qld health industry have emphasised the importance of quality improvement activities focussing on health outcomes. Midwives accoucheur most of the "normal" deliveries in public hospitals, thus it is important that midwives play a leading part in the development and improvement of tools which identify quality outcomes and pinpoint areas for improvement. This study aims to benchmark current practices regarding perineal outcomes. Moreover, the authors aim to initiate discussion towards the development of the first clinical indicators appropriate to midwifery care.

Objective: To measure and compare the casemix and diagnostic accuracy of excised or biopsied skin lesions managed by mainstream general practitioners and doctors within primary care skin cancer clinics. Design, setting and participants: Prospective comparative study of 104 GPs and 50 skin cancer clinic doctors in south-eastern Queensland, involving 28 755 patient encounters. The study was conducted in 2005. Main outcome measures: Prevalence of each type of skin lesion; sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the clinical diagnosis against histology; number needed to excise or biopsy (NNE) for a diagnosis of skin cancer. Results: GPs excised or biopsied 3175 skin lesions (mean 2.5/week) including 743 basal cell carcinomas (BCCs) (23.4%), 704 squamous cell carcinomas (SCCs) (22.2%) and 49 melanomas (1.5%). Skin cancer clinic doctors excised or biopsied 7941 skin lesions (mean 34/week), including 2701 BCCs (34.0%), 1274 SCCs (16.0%) and 103 melanomas (1.3%). Overall, sensitivity for diagnosing any skin cancer was similar for skin cancer clinic doctors (0.94) and GPs (0.91), although higher for skin cancer clinic doctors for BCC (0.89 v 0.79; P < 0.01) and melanoma (0.60 v 0.29; P < 0.01). The overall NNE was similar for skin cancer clinic doctors (1.9; 95% CI, 1.8%–2.1%) and GPs (2.1; 95% CI, 1.9%–2.3%). This did not change after adjusting for years of clinical experience. Conclusions: GPs and skin cancer clinic doctors in Queensland treat large numbers of skin cancers and diagnose these with overall high sensitivity. The two groups diagnosed skin cancer with similar accuracy.

The Rand Corporation medical outcomes short-form 36 health survey (SF-36) is a multidimensional measure of self-perceived general health status, which has been validated in adult populations in the United States and Great Britain, and, more recently, in an Australian population. The SF-36 is increasingly being used in health outcomes research internationally, mainly as a self-administered tool, and clearly has potential for use in Australia. This study aimed to assess the acceptability, reliability and validity of telephone administration of the instrument in the Queensland adult population, and to provide reliable population norms. We report the results of a telephone survey in which we interviewed 12,793 adults. It was the first large-scale, statewide application of the SF-36 in Australia. A response rate of 82 per cent was achieved, and the SF-36 satisfied psychometric criteria for reliability and construct validity. Population norms broken down by age and sex are provided. They will be important for the interpretation of future studies using the SF-36 in particular population or patient groups.

To improve the proportion of men 50 years or older who conduct a thorough whole-body skin self-examination (SSE), because these men are at increased risk of being diagnosed as having thick melanomas and dying of melanoma.Randomized trial of a video-based intervention to increase whole-body SSE compared with brochures-only control.Men from an Australian population register.The study included 930 men 50 years or older.The men were randomly assigned to receive either written materials only (control) or written materials along with a DVD or video and 2 postcard reminders (intervention). Telephone interviews were conducted at baseline and at 7 and 13 months.The proportion of men who conducted a whole-body SSE with the help of 2 mirrors and/or a person to assist with difficult-to-see areas.Compared with baseline (10%), by 13 months both groups had increased their whole-body SSE behaviors similarly (36% intervention and 31% control) (P = .85). At 7 months, the intervention group was significantly more likely to examine at least 1 part of their back (P.001) and to examine a greater number of body sites (P.001). At 7 months, the proportion of men conducting any SSE increased by 28% in the intervention group compared with 13% in the control group (P.001), but at 13 months, the prevalence of any self-examination (83% vs 80%) was again similar.While men 50 years or older are responsive to appropriately targeted intervention materials to increase their SSE behaviors, the addition of a video or DVD to written materials had only a transient advantage for optimal SSE practices.anzctr.org.au Identifier: 12608000384358.

Background Achieving health equity has been identified as a major challenge, both internationally and within Australia. Inequalities in cancer outcomes are well documented, and must be quantified before they can be addressed. One method of portraying geographical variation in data uses maps. Recently we have produced thematic maps showing the geographical variation in cancer incidence and survival across Queensland, Australia. This article documents the decisions and rationale used in producing these maps, with the aim to assist others in producing chronic disease atlases. Methods Bayesian hierarchical models were used to produce the estimates. Justification for the cancers chosen, geographical areas used, modelling method, outcome measures mapped, production of the adjacency matrix, assessment of convergence, sensitivity analyses performed and determination of significant geographical variation is provided. Conclusions Although careful consideration of many issues is required, chronic disease atlases are a useful tool for assessing and quantifying geographical inequalities. In addition they help focus research efforts to investigate why the observed inequalities exist, which in turn inform advocacy, policy, support and education programs designed to reduce these inequalities.

Several components of the metabolic syndrome, particularly diabetes and CVD, are known to be oxidative stress-related conditions and there is research to suggest that antioxidant nutrients may play a protective role in these conditions. Carotenoids are compounds derived primarily from plants and several have been shown to be potent antioxidant nutrients. The aim of the present study was to examine the associations between metabolic syndrome status and major serum carotenoids in adult Australians. Data on the presence of the metabolic syndrome, based on International Diabetes Federation 2005 criteria, were collected from 1523 adults aged 25 years and over in six randomly selected urban centres in Queensland, Australia, using a cross-sectional study design. Weight, height, BMI, waist circumference, blood pressure, fasting and 2 h blood glucose and lipids were determined, as well as five serum carotenoids. Mean serum alpha-, beta-carotenes and the sum of the five carotenoid concentrations were significantly lower (P < 0.05) in persons with the metabolic syndrome (after adjusting for age, sex, education, BMI status, alcohol intake, smoking, physical activity status and vitamin/mineral use) than persons without the syndrome. alpha-, beta- and total carotenoids also decreased significantly (P < 0.05) with increased number of components of the metabolic syndrome, after adjusting for these confounders. These differences were significant among former smokers and non-smokers, but not in present smokers. Low concentrations of serum alpha-, beta-carotenes and the sum of five carotenoids appear to be associated with metabolic syndrome status. Additional research, particularly longitudinal studies, may help to determine whether these associations are causally related to the metabolic syndrome, or are a result of the pathologies of the syndrome.

6619 Background: Survivorship research after a breast cancer (BC) diagnosis has identified psychosocial, functional and comorbidity outcomes that adversely influence daily life. Little is known, however, about non-breast cancer (NBC) mortality after a BC diagnosis. Methods: This retrospective cohort study included Australian women aged 30–79 years diagnosed with BC between January 1982 and December 2004, with mortality examined from January 1993 to December 2005. The age-standardized mortality ratio (SMR) was used to compare NBC causes of death in the BC cohort and the age-matched Australian female population between January 1993 and December 2005. Results: The median follow-up time for the cohort of 159,550 Australian women diagnosed with BC was 7.04 years (range 0–24.7 years). During the follow-up period, 30,819 (19.3%) died of BC, 5,403 (3.4%) died of other cancers (OC), 18,349 (11.5%) died of non-cancer (NC) causes, while 104,979 (65.8%) were still alive at the end of the follow-up period. Excluding the first year after diagnosis, women with a prior BC diagnosis had a higher risk of mortality (SMR = 328.6.95% CI = 324.8–332.3, p < 0.001) than the age matched female population. NBC mortality risk was elevated for OC (SMR = 103.7, CI = 100.1–107.5, p = 0.022) but reduced for NC causes (SMR = 94.9, CI = 92.3–97.5, p < 0.001). For the age groupings 30–49 years (n = 46,736), 50–69 years (n = 82,967), and 70–79 years (n = 29,847), SMR's for NC causes were 168.2 (CI = 144.1–195.1, p < 0.001), 100.9 (CI = 95.9–106.1, p = 0.355), and 90.5 (CI = 87.5–93.5, p < 0.001) respectively. Following the first year of diagnosis, the SMR for OC was non-significantly elevated with time after diagnosis. In comparison, the SMR for NC causes reduced with time after diagnosis; SMR = 96.4 (CI = 92.1–100.8, p = 0.055) at 2–5 years after diagnosis, 98.2 (CI = 93.7–102.8, p = 0.222) at 6–10 years, 92.8 (CI = 87.2–98.7, p = 0.008) at 11–15 years and 82.2 (CI = 74.8–90.2, p < 0.001) at more than 15 years. Conclusions: BC survivors have a higher risk of mortality from OC compared to the aged-matched Australian female population, but a reduced risk from NC causes. Although NC mortality is lower in older women and as time from BC diagnosis increases, women less than 50 years have a higher risk of NC mortality. No significant financial relationships to disclose.

7052 Background: AML is a widely reported complication of chemotherapy for HM and BC but few population based studies have investigated the nature and magnitude of AML risk after a diagnosis of cancer. Methods: This retrospective study examined 3 cohorts of female patients 30 years and over reported to state and territory cancer registries in Australia between 1982 and 2002. The cohorts comprised 40,030 women with HM, 162,142 with BC and 379,347 with OC. Results: The AML incidence rate/100,000 (IR) was 4.1 for all Australian females. The rate was much higher in the cohort with HM (IR 36.2; CI 25.3 –51.7), and slightly higher among those with BC (IR 11.7; CI 9.4 –14.9) and OC (IR 7.7; CI 6.4 –9.2). Standardized incidence ratio (SIR) estimates confirmed that women in the 3 cohorts had higher risks of subsequent AML than the general female population. These ranged from 5.5 times higher for those with HM (p No significant financial relationships to disclose.

Background Determining whether men diagnosed with early prostate cancer (PCa) will live long enough to benefit from interventions with curative intent is difficult. Although validated instruments for predicting patient survival are available, these do not have clinical utility so are not used routinely in practice. Objective To test the hypothesis that volunteers who provided ejaculate specimens had a high survival rate at 10 and 15 yr and beyond. Design, setting, and participants A total of 290 patients investigated because of high serum prostate-specific antigen donated ejaculate specimens for research between January 1992 and May 2003. The median age at the time of ejaculation was 63.5 yr. 153 of the donors were diagnosed with PCa and followed up to December 31, 2013. Outcome measurements and statistical analysis Survival outcomes were compared with those for the whole population, as indicated by life expectancy tables up to 20 yr. Results and limitations Men in the PCa group had life expectancies comparable with values listed in life expectancy tables for the whole population. Overall, PCa-specific and relative survival were significantly better for men in the non-PCa and PCa groups in comparison with men diagnosed with PCa in Queensland during the same period. Relative survival for those aged 20–49, 50–64, and ≥65 yr was >100% for ejaculate donors and 81.5%, 82.7%, and 65.2%, respectively, for the Queensland Cancer Registry reference at 10 yr. These findings for this highly selected patient cohort support the hypothesis that an ability to provide an ejaculate specimen is associated with a high likelihood of surviving 10–20 yr after donation, whether or not PCa was detected. Conclusion Life expectancy tables may serve as a quick and simple life expectancy indicator for biopsy patients who donate ejaculate. Patient summary Life expectancy tables indicated survival of up to 20 yr for men who provided ejaculate specimens for prostate cancer research.

Objective: To describe the process of colorectal cancer diagnosis in Queensland, and to determine factors associated with time to diagnosis. Design, setting and participants: Cross-sectional study of 1996 patients with colorectal cancer recruited through the Queensland Cancer Registry. Data were collected by computer-assisted telephone interview between May 2003 and August 2005. Main outcome measures: Time to diagnosis: pre-presentation time (time from first noticing a symptom to first presenting to a doctor); and post-presentation time (time between the first presentation and diagnosis). Results: Most patients (90%) had experienced symptoms before being diagnosed with colorectal cancer; only 2% of patients were diagnosed by faecal occult blood testing. Older participants and those who experienced abdominal pain had the-shortest time from symptom onset to their first doctor consultation, while participants with a change in bowel habit, or rectal bleeding, and those without private health insurance tended to wait longer to see a doctor Participants who experienced abdominal pain were diagnosed more quickly, whereas those who experienced a change in bowel habit, women, and those without private health insurance experienced a longer time to diagnosis. Conclusions: The strong association between not having health insurance and longer post-presentation times is concerning. The other hypothesised predictors of time to diagnosis were not as strongly associated as we anticipated.

Background Estimated conditional survival for cancer patients diagnosed at different ages and disease stage provides important information for cancer patients and clinicians in planning follow-up, surveillance and ongoing management. Methods Using population-based cancer registry data for New South Wales Australia, we estimated conditional 5-year relative survival for 11 major cancers diagnosed 1972–2006 by time since diagnosis and age and stage at diagnosis. Results 193,182 cases were included, with the most common cancers being prostate (39,851), female breast (36,585) and colorectal (35,455). Five-year relative survival tended to increase with increasing years already survived and improvement was greatest for cancers with poor prognosis at diagnosis (lung or pancreas) and for those with advanced stage or older age at diagnosis. After surviving 10 years, conditional 5-year survival was over 95% for 6 localised, 6 regional, 3 distant and 3 unknown stage cancers. For the remaining patient groups, conditional 5-year survival ranged from 74% (for distant stage bladder cancer) to 94% (for 4 cancers at different stages), indicating that they continue to have excess mortality 10–15 years after diagnosis. Conclusion These data provide important information for cancer patients, based on age and stage at diagnosis, as they continue on their cancer journey. This information may also be used by clinicians as a tool to make more evidence-based decisions regarding follow-up, surveillance, or ongoing management according to patients' changing survival expectations over time.

Background: This study reviewed the published evidence as to how prostate cancer outcomes vary across geographical remoteness and area level disadvantage. Materials and Methods: A review of the literature published from January 1998 to January 2014 was undertaken: Medline and CINAHL databases were searched in February to May 2014. The search terms included terms of 'Prostate cancer' and 'prostatic neoplasms' coupled with 'rural health', 'urban health', 'geographic inequalities', 'spatial', 'socioeconomic', 'disadvantage', 'health literacy' or 'health service accessibility'. Outcome specific terms were 'incidence', 'mortality', 'prevalence', 'survival', 'disease progression', 'PSA testing' or 'PSA screening', 'treatment', 'treatment complications' and 'recurrence'. A further search through internet search engines was conducted to identify any additional relevant published reports. Results: 91 papers were included in the review. While patterns were sometimes contrasting, the predominate patterns were for PSA testing to be more common in urban (5 studies out of 6) and affluent areas (2 of 2), higher prostate cancer incidence in urban (12 of 22) and affluent (18 of 20), greater risk of advanced stage prostate cancer in rural (7 of 11) and disadvantaged (8 of 9), higher survival in urban (8 of 13) and affluent (16 of 18), greater access or use of definitive treatment services in urban (6 of 9) and affluent (7 of 7), and higher prostate mortality in rural (10 of 20) and disadvantaged (8 of 16) areas. Conclusions: Future studies may need to utilise a mixed methods approach, in which the quantifiable attributes of the individuals living within areas are measured along with the characteristics of the areas themselves, but importantly include a qualitative examination of the lived experience of people within those areas. These studies should be conducted across a range of international countries using consistent measures and incorporate dialogue between clinicians, epidemiologists, policy advocates and disease control specialists.

Physical activity improves the health outcomes of colorectal cancer (CRC) survivors, yet few are exercising at levels known to yield health benefits. Baseline demographic, clinical, behavioral, and psychosocial predictors of physical activity at 12 months were investigated in CRC survivors. Participants were CRC survivors (n = 410) who completed a 12-month multiple health behavior change intervention trial (CanChange). The outcome variable was 12 month sufficient physical activity (≥150 min of moderate–vigorous physical activity/week). Baseline predictors included demographics and clinical variables, health behaviors, and psychosocial variables. Multivariate linear regression revealed that baseline sufficient physical activity (p

Objectives: To describe the self-reported use of prostate specific antigen (PSA) tests, faecal occult blood tests (FOBTs), and whole-body skin examinations among Queensland men, reasons for use, and the personal characteristics of men undergoing the tests for cancer screening. Setting and design: Data were obtained from the Queensland Cancer Risk Study (QCRS), a population-based telephone survey conducted in 2004, which used random sampling stratified by age, sex, and geographic location. Participants: All men aged 50-75 years who participated in the QCRS (n = 2336). Main outcome measures: Use of PSA test, FOBT, or whole-body skin examination, specifically as a screening procedure; the probability of being screened; and associations with sociodemographic factors, risk behaviour, and cancer experience. Results: More than a third of men reported never having been screened for prostate, colorectal, or skin cancer. Of those who had been screened, the odds of PSA testing being reported were more than two times greater than the odds of whole-body skin examination (adjusted odds ratio [OR], 2.54; 95% CI, 1.49-4.32), and the odds of reporting an FOBT were less (adjusted OR, 0.48; 95% CI, 0.22-1.04). Men who participated in cancer screening tended to be older, white, living with a partner, and to have private health insurance. Smokers were less likely to be screened with any of the three screening tests. Conclusions: Of these three cancer screening tests, the FOBT has the best evidence for reducing mortality and yet is the least frequently used by Queensland men. There are disparities in reported screening prevalence between the specific tests and across certain population subgroups.

Background Disparities in cancer survival by socioeconomic status have been reported previously in Australia. We investigated whether those disparities have changed over time. Methods We used population-based cancer registry data for 377,493 patients diagnosed with one of 10 major cancers in New South Wales (NSW), Australia. Patients were assigned to an area-based measure of socioeconomic status. Five-year relative survival was estimated for each socioeconomic quintile in each ‘at risk’ period (1996–2000 and 2004–2008) for the 10 individual cancers. Poisson-regression modelling was used to adjust for several prognostic factors. The relative excess risk of death by socioeconomic quintile derived from this modelling was compared over time. Results Although survival increased over time for most individual cancers, Poisson-regression models indicated that socioeconomic disparities continued to exist in the recent period. Significant socioeconomic disparities were observed for stomach, colorectal, liver, lung, breast and prostate cancer in 1996–2000 and remained so for 2004–2008, while significant disparities emerged for cervical and uterus cancer in 2004–2008 (although the interaction between period and socioeconomic status was not significant). About 13.4 % of deaths attributable to a diagnosis of cancer could have been postponed if this socioeconomic disparity was eliminated. Conclusion While recent health and social policies in NSW have accompanied an increase in cancer survival overall, they have not been associated with a reduction in socioeconomic inequalities. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2065-z) contains supplementary material, which is available to authorized users.

Background Multilevel and spatial models are being increasingly used to obtain substantive information on area-level inequalities in cancer survival. Multilevel models assume independent geographical areas, whereas spatial models explicitly incorporate geographical correlation, often via a conditional autoregressive prior. However the relative merits of these methods for large population-based studies have not been explored. Using a case-study approach, we report on the implications of using multilevel and spatial survival models to study geographical inequalities in all-cause survival. Methods Multilevel discrete-time and Bayesian spatial survival models were used to study geographical inequalities in all-cause survival for a population-based colorectal cancer cohort of 22,727 cases aged 20–84 years diagnosed during 1997–2007 from Queensland, Australia. Results Both approaches were viable on this large dataset, and produced similar estimates of the fixed effects. After adding area-level covariates, the between-area variability in survival using multilevel discrete-time models was no longer significant. Spatial inequalities in survival were also markedly reduced after adjusting for aggregated area-level covariates. Only the multilevel approach however, provided an estimation of the contribution of geographical variation to the total variation in survival between individual patients. Conclusions With little difference observed between the two approaches in the estimation of fixed effects, multilevel models should be favored if there is a clear hierarchical data structure and measuring the independent impact of individual- and area-level effects on survival differences is of primary interest. Bayesian spatial analyses may be preferred if spatial correlation between areas is important and if the priority is to assess small-area variations in survival and map spatial patterns. Both approaches can be readily fitted to geographically enabled survival data from international settings. Electronic supplementary material The online version of this article (doi:10.1186/1476-072X-13-36) contains supplementary material, which is available to authorized users.