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

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

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