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About 125,000 people are diagnosed with cancer in Australia each year. With population growth and aging this is set to rise to 150,000 new cases each year by 2020.1 in 2 Australian men and 1 in 3 Australian women will be diagnosed with cancer by the age of 85. Cancer is a leading cause of death in Australia. (Source: Cancer Council Australia)

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Latest Research Publications

Smith RC, Creighton N, Lord RV, et al.
Survival, mortality and morbidity outcomes after oesophagogastric cancer surgery in New South Wales, 2001-2008.
Med J Aust. 2014; 200(7):408-13 [PubMed] Related Publications
OBJECTIVES: To examine the relationship between hospital volume and patient outcomes for New South Wales hospitals performing oesophagectomy and gastrectomy for oesophagogastric cancer.
DESIGN, SETTING AND PATIENTS: A retrospective, population-based cohort study of NSW residents diagnosed with a new case of invasive oesophageal or gastric cancer who underwent oesophagectomy or gastrectomy between 2001 and 2008 in NSW hospitals using linked de-identified data from the NSW Central Cancer Registry, the National Death Index and the NSW Admitted Patient Data Collection. A higher-volume hospital was defined as one performing > 6 relevant procedures per year.
MAIN OUTCOME MEASURES: Odds ratios for > 21-day length of stay, 28-day unplanned readmission, 30-day mortality and 90-day mortality, and hazard ratios (HRs) for 5-year absolute and conditional survival.
RESULTS: Oesophagectomy (908 patients) and gastrectomy (1621 patients) were undertaken in 42 and 84 hospitals, respectively, between 2001 and 2008. Median annual hospital volume ranged from 2 to 4 for oesophagectomies and ranged from 2 to 3 for gastrectomies. Controlling for known confounders, no associations between hospital volume and > 21-day length of stay and 28-day unplanned readmission were found. Overall 30-day mortality was 4.1% and 4.4% for oesophagectomy and gastrectomy, respectively. Five-year absolute survival was significantly better for patients who underwent oesophagectomy in higher-volume hospitals (adjusted HR for lower-volume hospitals, 1.28 [95% CI, 1.10-1.49]; P = 0.002) and for those with localised gastric cancer who underwent gastrectomy in higher-volume hospitals (adjusted HR for lower-volume hospitals, 1.83 [95% CI, 1.28-2.61]; P = 0.001).
CONCLUSIONS: These data support initial surgery for oesophagogastric cancer in higher-volume hospitals.

Related: Cancer of the Esophagus Esophageal Cancer Stomach Cancer Gastric Cancer
Northern Clinical School, University of Sydney, Sydney, NSW, Australia.

Jorgensen ML, Young JM, Dobbins TA, Solomon MJ
Predictors of variation in colorectal cancer care and outcomes in New South Wales: a population-based health data linkage study.
Med J Aust. 2014; 200(7):403-7 [PubMed] Related Publications
OBJECTIVE: To identify predictors of variation in colorectal cancer care and outcomes in New South Wales.
DESIGN, SETTING AND PATIENTS: Multilevel logistic regression analysis using a linked population-based dataset based on the records of patients with cancer of the colon, rectosigmoid junction or rectum who were registered in 2007 and 2008 by the NSW Central Cancer Registry and treated in 105 hospitals in NSW.
MAIN OUTCOME MEASURES: Six outcome measures (30-day mortality, 28-day emergency readmission, prolonged length of stay, 30-day wound infection, 90-day venous thromboembolism, 1-year mortality) and five care process measures (discussion at multidisciplinary team [MDT] meeting, documented cancer stage, recorded pathological stage, treatment within 31 days of decision to treat, treatment within 62 days of referral).
RESULTS: We analysed data for 6890 people. There was wide variation between hospitals in care process measures, even after adjusting for patient and hospital factors. Older adults were less likely to be discussed at an MDT meeting and receive treatment within suggested time frames (all P < 0.001 for colon cancer). Increasing patient age, greater extent of disease, higher Charlson comorbidity score and resection after emergency admission consistently showed strong evidence of an association with poor outcomes. Much of the variation between hospitals in outcome measures was accounted for by patient characteristics.
CONCLUSIONS: Patient characteristics should be included in risk-adjustment models for comparing outcomes between hospitals and for quantifying hospital variation. Further exploration of the reasons why certain hospitals and patients appear to be at risk of poorer care is needed.

Related: Colorectal (Bowel) Cancer
Cancer Epidemiology and Services Research, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.

Sneesby L
Home is where I want to die: Kelly's journey.
Contemp Nurse. 2014; 46(2):251-3 [PubMed] Related Publications
The definition of a 'good death' is centred on being peaceful, dignified and pain free. The preferred place of death has also been highlighted as an important concept in defining a good death (Cox, Almack, Pollack, & Seymour, 2011). Seventy percent of Australians express the desire to spend their last days at home. In reality only 16% of people die at home (Preferred Place of Death, 2008). With 10% of Australians dying in residential aged care facilities and approximately 20% in hospices, the rest die in hospitals (Parish et al., 2006). Family support and the family's care giving ability play a major role in determining whether a person is able to die at home. Other factors include the availability of medical and nursing care. This story has been written with the consent of Kelly's husband. All efforts have been made to maintain privacy and confidentiality: Pseudonyms have been used.

Related: Ovarian Cancer
Calvary Mater Newcastle Department of Palliative Care, Hunter Region Mail Centre, Newcastle, NSW, Australia.

Barling JA, Stevens JA, Davies KM
The reality of hospitalisation: stories from family members of their hospital experience for adolescents and young adults living with and dying from cancer.
Contemp Nurse. 2014; 46(2):150-60 [PubMed] Related Publications
BACKGROUND: Adolescents and Young Adults (AYAs) with cancer are being disadvantaged within the present health care system. Some of the factors identified as leading to this disadvantage include medical issues specific to AYAs with cancer, delay in diagnosis, fragmented services, lack of access to clinical trials and psychosocial life stage issues.
OBJECTIVE: A major study investigated the experience that accompanies the stages of diagnosis, treatment, dying and death of an AYA from the perspective of family members. This paper discusses the major theme of the reality of hospitalisation.
METHODS: Narrative inquiry was the methodology for this study. The participants were a self-selected purposeful sample of 26 family members. Open-ended interviews were conducted to obtain a story of the experience of having an AYA family member live with and die of cancer. A meta-narrative of the family member's experience was developed by NVivo8. Results: In amongst the mass of data this study produced, a major theme to emerge was the experience 'of the reality of hospitalisation'. Within this theme issues regarding: The place of treatment; the hospital experience; not fitting in; and, confronting illness and death were revealed.
CONCLUSION: While on the whole the cancer was treated with state of the art medicine, the experiences of the hospitalisation repeated consistently throughout this narrative reveals a failure to meet the higher order needs specific to adolescents and young adults and their families As a result this cohort were exposed to a landscape which did not facilitate a therapeutic experience, as well as would be expected for children and older adults.

Related: Cancer Prevention and Risk Reduction Children's Cancer Web: Home Page
School of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia.

Scott N, Donato-Hunt C, Crane M, et al.
Knowledge, attitudes and beliefs about lung cancer in three culturally and linguistically diverse communities living in Australia: a qualitative study.
Health Promot J Austr. 2014; 25(1):46-51 [PubMed] Related Publications
ISSUE ADDRESSED: Knowledge, attitudes and beliefs about lung cancer among Chinese, Vietnamese and Arabic-speaking communities in Sydney, New South Wales (NSW) are explored.
METHODS: Seven focus groups were completed with a total of 51 participants (smokers and non-smokers) from three culturally and linguistically diverse communities (CALD). Five topics were discussed and translated summaries from focus groups were thematically analysed.
RESULTS: There were variations in perceived susceptibility to lung cancer between the CALD groups and between smokers and non-smokers. Fatalistic views towards lung cancer were apparent across all three CALD communities. There were low levels of awareness of lung cancer signs and symptoms, with the exception of haemoptysis. Differences in help-seeking behaviour and levels of trust of general practitioners (GP) were apparent.
CONCLUSION: Limited awareness of the signs and symptoms of lung cancer, combined with cultural perceptions about cancer, impacted on attitudes towards help-seeking behaviour in these three CALD communities. So what? The prevalence of smoking among Chinese men, Vietnamese men and Arabic-speaking communities in NSW puts them at increased risk of lung cancer. Health promotion initiatives for lung cancer should be tailored for CALD communities and could focus on increasing knowledge of key symptoms, awareness that ex-smokers are at risk and awareness of the diagnostic pathway including the importance of avoiding delays in help-seeking.

Related: Lung Cancer
NSW Public Health Officer Training Program, NSW Ministry of Health, NSW 2060, Australia.

Christou A, Thompson SC
Missed opportunities in educating Aboriginal Australians about bowel cancer screening: whose job is it anyway?
Contemp Nurse. 2013; 46(1):59-69 [PubMed] Related Publications
BACKGROUND: A culturally relevant educational flipchart targeting Aboriginal people was distributed across Western Australia to support education on bowel cancer screening and encourage participation in the National Bowel Cancer Screening Program.
METHODS: Respondents sampled from the flipchart distribution list were surveyed on the appropriateness, usefulness, and the extent to and manner in which they used the flipchart for educating Aboriginal clients.
RESULTS: Despite praising the resource, few respondents used the flipchart as intended for various reasons, including the view that Aboriginal health education was the responsibility of Aboriginal health workers.
CONCLUSIONS: Greater recognition by all health service providers is needed of their potential role in Aboriginal health education. Promoting a national health program of under-appreciated importance for a marginalised population is challenging. Effective utilisation of an educational tool is predicated on factors beyond its production quality and wide dissemination. Intended users require awareness of the underlying problem, and adequate time for and specific training in implementation of the tool.
Centre for International Health, Curtin University, Perth, WA, Australia.

Roder D, Zorbas HM, Kollias J, et al.
Analysing risk factors for poorer breast cancer outcomes in residents of lower socioeconomic areas of Australia.
Aust Health Rev. 2014; 38(2):134-41 [PubMed] Related Publications
OBJECTIVE: To investigate patient, cancer and treatment factors associated with the residence of female breast cancer patients in lower socioeconomic areas of Australia to better understand factors that may contribute to their poorer cancer outcomes.
METHODS: Bivariable and multivariable analyses were performed using the Breast Quality Audit database of Breast Surgeons of Australia and New Zealand. RESULTS Multivariable regression indicated that patients from lower socioeconomic areas are more likely to live in more remote areas and to be treated at regional than major city centres. Although they appeared equally likely to be referred to surgeons from BreastScreen services as patients from higher socioeconomic areas, they were less likely to be referred as asymptomatic cases from other sources. In general, their cancer and treatment characteristics did not differ from those of women from higher socioeconomic areas, but ovarian ablation therapy was less common for these patients and bilateral synchronous lesions tended to be less frequent than for women from higher socioeconomic areas.
CONCLUSIONS: The results indicate that patients from lower socioeconomic areas are more likely to live in more remote districts and have their treatment in regional rather than major treatment centres. Their cancer and treatment characteristics appear to be similar to those of women from higher socioeconomic areas, although they are less likely to have ovarian ablation or to be referred as asymptomatic patients from sources other than BreastScreen. What is known about this topic? It is already known from Australian data that breast cancer outcomes are not as favourable for women from areas of socioeconomic disadvantage. The reasons for the poorer outcomes have not been understood. Studies in other countries have also found poorer outcomes in women from lower socioeconomic areas, and in some instances, have attributed this finding to more advanced stages of cancers at diagnosis and more limited treatment. The reasons are likely to vary with the country and health system characteristics. What does this paper add? The present study found that in Australia, women from lower socioeconomic areas do not have more advanced cancers at diagnosis, nor, in general, other cancer features that would predispose them to poorer outcomes. The standout differences were that they tended more to live in areas that were more remote from specialist metropolitan centres and were more likely to be treated in regional settings where prior research has indicated poorer outcomes. The reasons for these poorer outcomes are not known but may include lower levels of surgical specialisation, less access to specialised adjunctive services, and less involvement with multidisciplinary teams. Women from lower socioeconomic areas also appeared more likely to attend lower case load surgeons. Little difference was evident in the type of clinical care received, although women from lower socioeconomic areas were less likely to be asymptomatic referrals from other clinical settings (excluding BreastScreen). What are the implications for practitioners? Results suggest that poorer outcomes in women from lower socioeconomic areas in Australia may have less to do with the characteristics of their breast cancers or treatment modalities and more to do with health system features, such as access to specialist centres. This study highlights the importance of demographic and health system features as potentially key factors in service outcomes. Health system research should be strengthened in Australia to augment biomedical and clinical research, with a view to best meeting service needs of all sectors of the population.

Related: Breast Cancer
Cancer Australia, Locked Bag 3, Strawberry Hills, NSW 2012, Australia. Email:

Robles-Espinoza CD, Harland M, Ramsay AJ, et al.
POT1 loss-of-function variants predispose to familial melanoma.
Nat Genet. 2014; 46(5):478-81 [PubMed] Related Publications
Deleterious germline variants in CDKN2A account for around 40% of familial melanoma cases, and rare variants in CDK4, BRCA2, BAP1 and the promoter of TERT have also been linked to the disease. Here we set out to identify new high-penetrance susceptibility genes by sequencing 184 melanoma cases from 105 pedigrees recruited in the UK, The Netherlands and Australia that were negative for variants in known predisposition genes. We identified families where melanoma cosegregates with loss-of-function variants in the protection of telomeres 1 gene (POT1), with a proportion of family members presenting with an early age of onset and multiple primary tumors. We show that these variants either affect POT1 mRNA splicing or alter key residues in the highly conserved oligonucleotide/oligosaccharide-binding (OB) domains of POT1, disrupting protein-telomere binding and leading to increased telomere length. These findings suggest that POT1 variants predispose to melanoma formation via a direct effect on telomeres.

Related: Melanoma
1] Experimental Cancer Genetics, Wellcome Trust Sanger Institute, Hinxton, UK. [2].
Research funded by:

Ung L, Chua TC, Morris DL
The importance of gender in patients with peritoneal metastases of appendiceal origin treated by cytoreduction and intraperitoneal chemotherapy: an analysis of 257 consecutive patients from an Australian centre.
J Cancer Res Clin Oncol. 2014; 140(6):1037-45 [PubMed] Related Publications
BACKGROUND AND OBJECTIVES: In the setting of colorectal cancer, female gender has been associated with superior long-term outcomes. Our aim is to investigate the gender differences for metastatic epithelial neoplasms of the appendix treated by cytoreductive surgery (CS) and intraperitoneal chemotherapy (IPC).
METHODS: The survival outcomes of patients treated with CS/IPC from 1996 to 2013 at St. George Hospital, Sydney, Australia, for peritoneal metastases of appendiceal origin were retrospectively analysed.
RESULTS: Two hundred and fifty-seven consecutive patients were followed for a median of 35.3 months. Baseline characteristics between genders were comparable, including age (p = 0.13) and peritoneal cancer index (p = 0.94). Median overall survival (OS) and progression-free survival (PFS) was not reached (NR) and 44.4 months, with a 3-, 5- and 10-year survival of 82, 74 and 64 %. OS and PFS for females was NR and 50.7 months, compared to NR (p = 0.007) and 31.5 months for males (p = 0.07). Three-, 5- and 10-year survival rates for females were 88, 84 and 72 % compared to 74, 61 and 53 % for males.
CONCLUSION: Observed gender differences for neoplasms of the appendix may direct future research in gender-specific tumour markers and the development of adjuvant therapies to improve patient outcomes.

Related: Appendix Cancers
Hepatobiliary and Surgical Oncology Unit, UNSW Department of Surgery, St George Hospital, Kogarah, Sydney, NSW, 2217, Australia.

Ferro A, Peleteiro B, Malvezzi M, et al.
Worldwide trends in gastric cancer mortality (1980-2011), with predictions to 2015, and incidence by subtype.
Eur J Cancer. 2014; 50(7):1330-44 [PubMed] Related Publications
Gastric cancer incidence and mortality decreased substantially over the last decades in most countries worldwide, with differences in the trends and distribution of the main topographies across regions. To monitor recent mortality trends (1980-2011) and to compute short-term predictions (2015) of gastric cancer mortality in selected countries worldwide, we analysed mortality data provided by the World Health Organization. We also analysed incidence of cardia and non-cardia cancers using data from Cancer Incidence in Five Continents (2003-2007). The joinpoint regression over the most recent calendar periods gave estimated annual percent changes (EAPC) around -3% for the European Union (EU) and major European countries, as well as in Japan and Korea, and around -2% in North America and major Latin American countries. In the United States of America (USA), EU and other major countries worldwide, the EAPC, however, were lower than in previous years. The predictions for 2015 show that a levelling off of rates is expected in the USA and a few other countries. The relative contribution of cardia and non-cardia gastric cancers to the overall number of cases varies widely, with a generally higher proportion of cardia cancers in countries with lower gastric cancer incidence and mortality rates (e.g. the USA, Canada and Denmark). Despite the favourable mortality trends worldwide, in some countries the declines are becoming less marked. There still is the need to control Helicobacter pylori infection and other risk factors, as well as to improve diagnosis and management, to further reduce the burden of gastric cancer.

Related: Canada Stomach Cancer Gastric Cancer USA
Institute of Public Health of the University of Porto (ISPUP), Rua das Taipas n° 135, 4050-600 Porto, Portugal.

Coventry BJ, Kroon HM, Giles MH, et al.
Australian multi-center experience outside of the Sydney Melanoma Unit of isolated limb infusion chemotherapy for melanoma.
J Surg Oncol. 2014; 109(8):780-5 [PubMed] Related Publications
INTRODUCTION: Isolated limb infusion (ILI) is a minimally invasive alternative to isolated limb perfusion (ILP) for delivering high-dose regional chemotherapy to treat locally advanced limb melanoma. The current study aimed to evaluate the applicability of ILI in four Australian tertiary referral centers outside of its originating institution, the Sydney Melanoma Unit (SMU; currently known as the Melanoma Institute Australia).
METHODS: Data of 131 patients, treated between 1992 and 2008 were collectively analyzed. The ILI procedures were based on the Sydney Melanoma Unit protocol using melphalan. Response was determined using the WHO criteria and toxicity was assessed using the Wieberdink scale.
RESULTS: The median patient age was 74 years (range 28-100). Fifty-six percent were female. Overall response (OR) rate to ILI was 63% (CR 27%; PR 36%). Wieberdink toxicity grade III or higher was seen in 13%. No toxicity-related amputations occurred. Median follow-up was 24 months; median survival was 58 months. In patients with a complete response (CR), median survival was 101 months; in patients with a partial response (PR) this was 41 months (P = 0.026). On univariate analysis a younger age, lower-limb procedures and a lower Breslow thickness of the primary melanoma were associated with a favorable response. On multivariate analysis Breslow thickness and lower-limb ILI remained significant predictors for response.
CONCLUSION: In this, to date, largest multi-center study of ILI for melanoma the results are comparable to other reports and demonstrate that ILI can be widely implemented and safely applied across tertiary referral centers.

Related: Melanoma Skin Cancer
Discipline of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia.

Rowlands IJ, Beesley VL, Janda M, et al.
Quality of life of women with lower limb swelling or lymphedema 3-5 years following endometrial cancer.
Gynecol Oncol. 2014; 133(2):314-8 [PubMed] Related Publications
OBJECTIVE: To quantitatively assess and compare the quality of life (QoL) of women with a self-reported diagnosis of lower limb lymphedema (LLL), to women with lower limb swelling (LLS), and to women without LLL or LLS following treatment for endometrial cancer.
METHODS: 1399 participants in the Australian National Endometrial Cancer Study were sent a follow-up questionnaire 3-5 years after diagnosis. Women were asked if they had experienced swelling in the lower limbs and, if so, whether they had received a diagnosis of lymphedema by a health professional. The 639 women who responded were categorized as: Women with LLL (n=68), women with LLS (n=177) and women without LLL or LLS (n=394). Multivariable-adjusted generalized linear models were used to compare women's physical and mental QoL by LLL status.
RESULTS: On average, women were 65 years of age and 4 years after diagnosis. Women with LLL had clinically lower physical QoL (M=41.8, SE=1.4) than women without LLL or LLS (M=45.1, SE=0.8, p=.07), however, their mental QoL was within the normative range (M=49.6; SE=1.1 p=1.0). Women with LLS had significantly lower physical (M=41.0, SE=1.0, p=.003) and mental QoL (M=46.8; SE=0.8, p<.0001) than women without LLL or LLS (Mental QoL: M=50.6, SE=0.8).
CONCLUSION: Although LLL was associated with reductions in physical QoL, LLS was related to reductions in both physical and mental QoL 3-5 years after cancer treatment. Early referral to evidence-based lymphedema programs may prevent long-term impairments to women's QoL.

Related: Endometrial (Uterus) Cancer Endometrial Cancer
Gynaecological Cancers Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia. Electronic address:

Khosrotehrani K, van der Ploeg AP, Siskind V, et al.
Nomograms to predict recurrence and survival in stage IIIB and IIIC melanoma after therapeutic lymphadenectomy.
Eur J Cancer. 2014; 50(7):1301-9 [PubMed] Related Publications
BACKGROUND: Current staging algorithms in melanoma patients undergoing therapeutic lymph node dissection (LND) fail to accurately distinguish long-term survivors from those at risk of rapid relapse. Our goal was to establish and validate nomograms for predicting both recurrence and survival after LND.
METHODS: A prospective cohort of stage IIIB and IIIC melanoma patients was ascertained from a tertiary hospital in Brisbane, Australia. Failure-time multivariate analysis identified key factors that, in adjusted combinations, generated nomograms to predict 2-year recurrence and 5-year melanoma-specific survival. The predictive value of these nomograms was further validated in a patient cohort from Rotterdam, The Netherlands.
RESULTS: In 494 Australian patients, number of positive lymph nodes, extra-capsular extension and nodular histopathological subtype were the main independent predictors of 2-year recurrence while age, number of positive nodes and extra-capsular extension were the independent predictors of survival. Predictive value was confirmed in The Netherlands cohort of 331 patients. The nomograms were able to classify patients according to their 2-year recurrence and 5-year survival rates even within each stage III sub-class.
CONCLUSIONS: Models that include extra-capsular extension predict outcomes in patients with clinically involved lymph nodes. This tool may help tailor treatment and monitoring of this group of patients.

Related: Melanoma Skin Cancer
The University of Queensland, UQ Centre for Clinical Research, Experimental Dermatology Group, Brisbane, QLD, Australia; The University of Queensland, UQ Diamantina Institute, Translational Research Institute, Woolloongabba, QLD, Australia. Electronic address:

Dobbins TA, Young JM, Solomon MJ
Uptake and outcomes of laparoscopically assisted resection for colon and rectal cancer in Australia: a population-based study.
Dis Colon Rectum. 2014; 57(4):415-22 [PubMed] Related Publications
BACKGROUND: Meta-analyses of randomized controlled trials support the use of laparoscopically assisted resection for colon cancer. The evidence supporting its use in rectal cancer is weak.
OBJECTIVE: The purpose of this work was to investigate the uptake of laparoscopically assisted resection for colon and rectal cancer and to compare short- and long-term outcomes using population data.
DESIGN: This was a retrospective cohort study using linked administrative health data.
SETTINGS: The study encompassed all of the public and private hospitals in New South Wales, Australia, between 2000 and 2008.
PATIENTS: A total of 27,947 patients with colon or rectal cancer undergoing surgery with curative intent were included in the study.
MAIN OUTCOME MEASURES: We summarized the proportion of resections performed laparoscopically. Short-term outcomes were extended stay, 28-day readmission, 28-day emergency readmission, 30- and 90-day mortality, and 90-day readmission with pulmonary embolism or deep-vein thrombosis. Long-term outcomes were all-cause and cancer-specific death and admission with obstruction or incisional hernia repair.
RESULTS: Laparoscopic procedures increased between 2000 and 2008 for colon (1.5%-20.7%) and rectal cancer (0.6%-15.5%). Laparoscopic procedures reduced rates of extended stay (OR, 0.60; 95% CI, 0.49-0.72) and 28-day readmission (OR, 0.86; 95% CI, 0.74-0.99) for colon cancer. For rectal cancer, laparoscopic procedures had lower rates of 28-day readmission (OR, 0.58; 95% CI, 0.42-0.78) and 28-day emergency readmission (OR, 0.54; 95% CI, 0.34-0.85). Laparoscopic procedures improved cancer-specific survival for rectal cancer (HR, 0.71; 95% CI, 0.51-1.00). Survival benefits were observed for laparoscopically assisted colon resection in higher-caseload hospitals but not lower-caseload hospitals.
LIMITATIONS: It was not possible to identify laparoscopically assisted resections converted to open procedures because of the claims-based nature of the data.
CONCLUSIONS: Despite increases in laparoscopically assisted resections for colon and rectal cancer, the majority of resections are still treated by open procedures. Our data suggest that laparoscopic resection reduces the lengths of stay and rates of readmission and may result in improved cancer-specific survival for both colon and rectal resections.
1Cancer Epidemiology and Services Research, Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia 2Cancer Institute of New South Wales, Everleigh, New South Wales, Australia 3Surgical Outcomes Research Centre, Sydney Local Health District, Sydney, New South Wales,...

Ardeshna KM, Qian W, Smith P, et al.
Rituximab versus a watch-and-wait approach in patients with advanced-stage, asymptomatic, non-bulky follicular lymphoma: an open-label randomised phase 3 trial.
Lancet Oncol. 2014; 15(4):424-35 [PubMed] Related Publications
BACKGROUND: Patients with advanced-stage, low-tumour-burden follicular lymphoma have conventionally undergone watchful waiting until disease progression. We assessed whether rituximab use could delay the need for chemotherapy or radiotherapy compared with watchful waiting and the effect of this strategy on quality of life (QoL).
METHODS: Asymptomatic patients (aged ≥18 years) with low-tumour-burden follicular lymphoma (grades 1, 2, and 3a) were randomly assigned centrally (1:1:1), by the minimisation approach stratified by institution, grade, stage, and age, to watchful waiting, rituximab 375 mg/m(2) weekly for 4 weeks (rituximab induction), or rituximab induction followed by a maintenance schedule of 12 further infusions given at 2-monthly intervals for 2 years (maintenance rituximab). On Sept 30, 2007, recruitment into the rituximab induction group was closed and the study was amended to a two-arm study. The primary endpoints were time to start of new treatment and QoL at month 7 (ie, 6 months after completion of rituximab induction). All randomly assigned patients were included in the analysis of time to start of new treatment on an intention-to-treat basis. The main study is now completed and is in long-term follow-up. The study is registered with, NCT00112931.
FINDINGS: Between Oct 15, 2004, and March 25, 2009, 379 patients from 118 centres in the UK, Australia, New Zealand, Turkey, and Poland were randomly assigned to watchful waiting or maintenance rituximab. 84 patients were recruited to the rituximab induction group before it was closed early. There was a significant difference in the time to start of new treatment, with 46% (95% CI 39-53) of patients in the watchful waiting group not needing treatment at 3 years compared with 88% (83-92) in the maintenance rituximab group (hazard ratio [HR] 0·21, 95% CI 0·14-0·31; p<0·0001). 78% (95% CI 69-87) of patients in the rituximab induction group did not need treatment at 3 years, which was significantly more than in the watchful waiting group (HR 0·35, 95% CI 0·22-0·56; p<0·0001), but no different compared with the maintenance rituximab group (0·75, 0·41-1·34; p=0·33). Compared with the watchful waiting group, patients in the maintenance rituximab group had significant improvements in the Mental Adjustment to Cancer scale score (p=0·0004), and Illness Coping Style score (p=0·0012) between baseline and month 7. Patients in the rituximab induction group did not show improvements in their QoL compared with the watchful waiting group. There were 18 serious adverse events reported in the rituximab groups (four in the rituximab induction group and 14 in the maintenance rituximab group), 12 of which were grade 3 or 4 (five infections, three allergic reactions, and four cases of neutropenia), all of which fully resolved.
INTERPRETATION: Rituximab monotherapy should be considered as a treatment option for patients with asymptomatic, advanced-stage, low-tumour-burden follicular lymphoma.
FUNDING: Cancer Research UK, Lymphoma Research Trust, Lymphoma Association, and Roche.

Related: Rituximab (Mabthera)
Department of Haematology, University College Hospital, London, UK. Electronic address:
Research funded by:

Nahar VK
Skin cancer prevention among school children: a brief review.
Cent Eur J Public Health. 2013; 21(4):227-32 [PubMed] Related Publications
In many countries the incidence of melanoma has been doubling in every 10 years. Since 1930, the rate of melanoma has increased over 1,800% and researchers are expecting this trend to continue and increase for the next 10 to 20 years. Primary prevention and early detection of skin cancer in childhood is important to reduce the risk of developing skin cancer later in life. Primary prevention programmes are more beneficial and effective in children, not only due to the particular importance of sunlight exposure during this period, but because this is when individuals are more open to changes and adopt new attitudes and behaviour. The purpose of this manuscript is to review the results of intervention studies designed to modify sun exposure behaviour among children in the United States of America, Australia and Europe. An additional purpose is to summarize the recommendations obtained from the reviewed studies. The strongest recommendation to emerge from this review is that the skin cancer primary prevention programme should be carried out over several school years, not just one time, to produce changes in the sun safety behaviour. Moreover, it recommends that parents should be targeted to educate their children about sun protective skills and promote skin cancer prevention behaviour.

Related: Melanoma USA
Department of Health, Exercise Science and Recreation Management, The University of Mississippi, Oxford, MS, USA.

Larkin J, Del Vecchio M, Ascierto PA, et al.
Vemurafenib in patients with BRAF(V600) mutated metastatic melanoma: an open-label, multicentre, safety study.
Lancet Oncol. 2014; 15(4):436-44 [PubMed] Related Publications
BACKGROUND: The orally available BRAF kinase inhibitor vemurafenib, compared with dacarbazine, shows improved response rates, progression-free survival (PFS), and overall survival in patients with metastatic melanoma that has a BRAF(V600) mutation. We assessed vemurafenib in patients with advanced metastatic melanoma with BRAF(V600) mutations who had few treatment options.
METHODS: In an open-label, multicentre study, patients with untreated or previously treated melanoma and a BRAF(V600) mutation received oral vemurafenib 960 mg twice a day. The primary endpoint was safety. All analyses were done on the safety population, which included all patients who received at least one dose of vemurafenib. This report is the third interim analysis of this study. This study is registered with, number NCT01307397.
FINDINGS: Between March 1, 2011, and Jan 31, 2013, 3226 patients were enrolled in 44 countries. 3222 patients received at least one dose of vemurafenib (safety population). At data cutoff, 868 (27%) patients were on study treatment and 2354 (73%) had withdrawn, mainly because of disease progression. Common adverse events of all grades included rash (1592 [49%]), arthralgia (1259 [39%]), fatigue (1093 [34%]), photosensitivity reaction (994 [31%]), alopecia (826 [26%]), and nausea (628 [19%]). 1480 (46%) patients reported grade 3 or 4 adverse events, including cutaneous squamous cell carcinoma (389 [12%]), rash (155 [5%]), liver function abnormalities (165 [5%]), arthralgia (106 [3%]), and fatigue (93 [3%]). Grade 3 and 4 adverse events were reported more frequently in patients aged 75 years and older (n=257; 152 [59%, 95% CI 53-65] and ten [4%, 2-7], respectively) than in those younger than 75 years (n=2965; 1286 [43%, 42-45] and 82 [3%, 2-3], respectively).
INTERPRETATION: Vemurafenib safety in this diverse population of patients with BRAF(V600) mutated metastatic melanoma, who are more representative of routine clinical practice, was consistent with the safety profile shown in the pivotal trials of this drug.
FUNDING: F Hoffmann-La Roche.

Related: Canada BRAF gene Skin Cancer Vemurafenib (Zelboraf)
Royal Marsden Hospital NHS Foundation Trust, London, UK. Electronic address:

Donovan C, Butler L, Butt AJ, et al.
Evaluation of the impact of National Breast Cancer Foundation-funded research.
Med J Aust. 2014; 200(4):214-8 [PubMed] Related Publications
OBJECTIVE: To evaluate the impact of the National Breast Cancer Foundation's (NBCF's) research investment.
DESIGN AND PARTICIPANTS: Surveys based on the Payback Framework were sent to chief investigators involved in research funded by the NBCF during 1995-2012; a bibliometric analysis of NBCF-funded publications in 2006-2010 was conducted; and a purposive, stratified sample of case studies was obtained.
MAIN OUTCOME MEASURES: Research impact on knowledge production, the research system, informing policy, product development and broader health and economic benefits.
RESULTS: Of 242 surveys sent, 153 (63%) were returned. The average impact of journals in which NBCF publications appeared was double that of world publications. Seventy surveys (46%) reported career progression, and 185 higher degrees were obtained or expected, including 121 PhDs. One hundred and one grants (66%) produced tools that built capacity across the research system, and research teams leveraged an additional $1.40 in funding for every dollar invested. Fifteen applied grants and one basic grant impacted on policy. Ten basic and four applied grants led to the development of drugs, prognostic tools or diagnostic technologies. Twenty applied and two basic grants led to changes in practice and behaviour of health care staff, consumers and the public, with further impacts anticipated. Case studies provided illustrations of high impact.
CONCLUSIONS: NBCF's strategy of investing in a mixed portfolio of research areas and mechanisms encouraged a broad range of impacts across all Payback categories. The impacts from basic research tended to focus on knowledge production and drug development; while applied research generated greater impacts within the other Payback categories. The funding of shared infrastructure stimulated impact across the research system.

Related: Breast Cancer
Health Economics Research Group, Brunel University, London, UK.

Singh J, Ramamoorthi R, Baxi S, et al.
The risk factors of head and neck cancer and their general patterns in Australia: a descriptive review and update.
J Environ Pathol Toxicol Oncol. 2014; 33(1):45-57 [PubMed] Related Publications
The purpose of this article is to provide a descriptive review of risk factors of head and neck cancer (HNC), with particular interest in their general patterns in Australia. All these risk factors are deeply perplexing, with socioeconomic, cultural, and geographic variables. We reviewed articles from PubMed, MEDLINE, and Google Scholar by using keywords such as risk factors, alcohol, tobacco, human papilloma virus (HPV), environmental risk factors, and other risk factors. We selected relevant articles after they completely fit into the inclusion criteria for this review. Previous reports highlight that smoking tobacco, consuming alcohol, and HPV infection are the major risk factors for HNC. Geographical variations in incidence rates are indicative of differences in the prevalence of risk factors among countries. HNC could be prevented by reducing the prevalence of established risk factors.

Related: Head and Neck Cancers Head and Neck Cancers - Molecular Biology
School of Psychological and Clinical Sciences, Charles Darwin University, Darwin, Northern Territory, Australia.

MacWilliams J, Bramwell M, Brown S, O'Connor M
Reaching out to Ray: delivering palliative care services to a homeless person in Melbourne, Australia.
Int J Palliat Nurs. 2014; 20(2):83-8 [PubMed] Related Publications
Most terminally ill people express a preference for dying at home. Within established models of palliative care, achieving death at home is a particular challenge for homeless people. This paper describes a quality-improvement project undertaken by a community-based palliative care service in Melbourne, Australia, to understand homeless people's palliative care needs and the challenges that workers face. Six semi-structured interviews with workers in hospital and community-based settings were undertaken and a case study documented. The results were used to initiate discussion about how policy and protocols for the community-based palliative care service might serve this population more effectively. The findings confirmed that homeless people have complex psychosocial and medical needs. They may be periodically uncontactable or living in unsafe settings, experience isolation from social support networks, and have issues of compliance with treatment protocols exacerbated by mental health problems and/or substance abuse. Service providers had particular challenges in meeting the palliative care needs of homeless people. A flexible, compassionate, and coordinated response is required, and more work is needed to explore how the needs of this particular group can be met.

Related: Oral Cancer
Clinical Nurse Specialist.

Sung PL, Chang YH, Chao KC, et al.
Global distribution pattern of histological subtypes of epithelial ovarian cancer: a database analysis and systematic review.
Gynecol Oncol. 2014; 133(2):147-54 [PubMed] Related Publications
BACKGROUND: Epithelial ovarian cancer is basically a heterogeneous disease with different chemosensitivity and distinct molecular alternations for each histological subtype. In order to assess whether the results of clinical trials can be extrapolated to a new country, it is critical to first examine whether the relative frequencies is homogenous across countries.
METHODS: Cancer registry database from a single institution in Taiwan combined with systematic review of the global literature on the relative frequencies of histological subtypes between 2003 and 2012 was provided.
RESULTS: Of 175 titles identified, 41 studies met inclusion/exclusion criteria. Globally, for each subtype, the median value of relative frequencies for serous subtype was 45.0%, with the Philippines (16.0%), Indonesia (22.7%), and Brazil (30.1%) as the three lowest countries and South Africa (68.0%), Greece (71.5%), and India (86.7%) as the three highest countries; for mucinous subtype, 11.4%, Italy (3.0%), Australia (3.4%), and Japan (5.4%) were the three lowest countries, while Indonesia (29.1%), Singapore (30.3%), and South Korea (38.6%) were the three highest countries; for endometrioid subtype, 12.6%, India (1.6%), Greece (5.7%), and Portugal (7.6%) were the three lowest countries, while Taiwan (24.8%), Egypt (25.0%), and Austria (25.5%) were the three highest countries; and for clear cell subtype, 5.3%, Pakistan (1.0%), Iran (2.0%), and Brazil (2.1%) were the three lowest countries while Thailand (16.0%), Taiwan (16.8%), and Spain (18.8%) were the three highest countries.
CONCLUSIONS: Relative frequencies of subtypes were not homogenous across countries. This diversity may reflect the geographical and ethnic variations. Globally, epithelial ovarian cancer is a heterogeneous disease with a heterogeneous distribution pattern.

Related: Ovarian Cancer
Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.

Janda M, Youl P, Neale R, et al.
Clinical skin examination outcomes after a video-based behavioral intervention: analysis from a randomized clinical trial.
JAMA Dermatol. 2014; 150(4):372-9 [PubMed] Related Publications
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.
TRIAL REGISTRATION: Identifier: ACTRN12608000384358.

Related: Basal Cell Carcinoma Cancer Screening and Early Detection Melanoma Skin Cancer
School of Public Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.

Work ME, John EM, Andrulis IL, et al.
Reproductive risk factors and oestrogen/progesterone receptor-negative breast cancer in the Breast Cancer Family Registry.
Br J Cancer. 2014; 110(5):1367-77 [PubMed] Article available free on PMC after 04/03/2015 Related Publications
BACKGROUND: Oestrogen receptor (ER)- and progesterone receptor (PR)-negative (ER-PR-) breast cancer is associated with poorer prognosis compared with other breast cancer subtypes. High parity has been associated with an increased risk of ER-PR- cancer, but emerging evidence suggests that breastfeeding may reduce this risk. Whether this potential breastfeeding benefit extends to women at high risk of breast cancer remains critical to understand for prevention.
METHODS: Using population-based ascertained cases (n=4011) and controls (2997) from the Breast Cancer Family Registry, we examined reproductive risk factors in relation to ER and PR status.
RESULTS: High parity (≥3 live births) without breastfeeding was positively associated only with ER-PR- tumours (odds ratio (OR)=1.57, 95% confidence interval (CI), 1.10-2.24); there was no association with parity in women who breastfed (OR=0.93, 95% CI 0.71-1.22). Across all race/ethnicities, associations for ER-PR- cancer were higher among women who did not breastfeed than among women who did. Oral contraceptive (OC) use before 1975 was associated with an increased risk of ER-PR- cancer only (OR=1.32, 95% CI 1.04-1.67). For women who began OC use in 1975 or later there was no increased risk.
CONCLUSIONS: Our findings support that there are modifiable factors for ER-PR- breast cancer and that breastfeeding in particular may mitigate the increased risk of ER-PR- cancers seen from multiparity.

Related: Breast Cancer
Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA.
Research funded by:

Green CJ, de Dauwe P, Boyle T, et al.
Tea, coffee, and milk consumption and colorectal cancer risk.
J Epidemiol. 2014; 24(2):146-53 [PubMed] Article available free on PMC after 04/03/2015 Related Publications
BACKGROUND: Data regarding the effects of tea, coffee, and milk on the risk of colorectal cancer are inconsistent. We investigated associations of tea, coffee, and milk consumption with colorectal cancer risk and attempted to determine if these exposures were differentially associated with the risks of proximal colon, distal colon, and rectal cancers.
METHODS: Data from 854 incident cases and 948 controls were analyzed in a case-control study of colorectal cancer in Western Australia during 2005-07. Multivariable logistic regression was used to analyze the associations of black tea (with and without milk), green tea, herbal tea, hot coffee, iced coffee, and milk with colorectal cancer.
RESULTS: Consumption of 1 or more cups of herbal tea per week was associated with a significantly decreased risk of distal colon cancer (adjusted odds ratio, 0.37; 95% CI, 0.16-0.82; PTrend = 0.044), and consumption of 1 or more cups of iced coffee per week was associated with increased risk of rectal cancer (adjusted odds ratio, 1.52; 95% CI, 0.91-2.54; PTrend = 0.004). Neither herbal tea nor iced coffee was associated with the risk of proximal colon cancer. Hot coffee was associated with a possible increased risk of distal colon cancer. Black tea (with or without milk), green tea, decaffeinated coffee, and milk were not significantly associated with colorectal cancer risk.
CONCLUSIONS: Consumption of herbal tea was associated with reduced risk of distal colon cancer, and consumption of iced coffee was associated with increased rectal cancer risk.

Related: Colorectal (Bowel) Cancer
School of Population Health, The University of Western Australia.

Lim WH, Turner RM, Chapman JR, et al.
Acute rejection, T-cell-depleting antibodies, and cancer after transplantation.
Transplantation. 2014; 97(8):817-25 [PubMed] Related Publications
BACKGROUND: Systemic inflammatory response has been shown to play a vital role in carcinogenesis and tumor progression. Acute rejection is a systemic inflammatory state and may share a common casual pathway for cancer development after transplantation. The increased burden of immunosuppression used in the treatment of acute rejection, particularly the use of T-cell-depleting antibody may further heighten the risk of cancer development. We aimed to determine the association between acute rejection, T-cell-depleting antibody use and cancer risk after kidney transplantation.
METHODS: Using the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA), we assessed the risk of incident cancer among those who had experienced rejection stratified by the use of T-cell-depleting antibody using adjusted Cox proportional hazard and competing risk models.
RESULTS: A total of 7153 kidney transplant recipients between 1997 and 2009 were included. A total of 467 (6.5%) recipients developed cancers. Recipients who experienced acute rejection and treated with T-cell-depleting antibody were at a 1.4-fold increased risk of cancer (adjusted hazard ratio [HR] 1.42, 95% CI 1.02-1.99, P=0.039) compared with those who did not experience acute rejection. There was an excess risk of genitourinary tract cancers among recipients who had experienced rejection requiring T-cell-depleting antibody compared with recipients who did not experience acute rejection (HR 2.20, 95% CI 1.33-3.66, P=0.007).
CONCLUSION: Acute rejection requiring T-cell-depleting antibody is a significant risk factor for cancer development in kidney transplant recipients independent of competing events such as age and cardiovascular deaths.

Related: Breast Cancer Colorectal (Bowel) Cancer Lung Cancer Melanoma Prostate Cancer
1 Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. 2 Sydney School of Public Health, University of Sydney, New South Wales, Australia. 3 Centre for Transplant and Renal Research, Westmead Hospital, New South Wales, Australia. 4 Department of Medicine...

O'Callaghan CC, McDermott F, Hudson P, Zalcberg JR
Sound continuing bonds with the deceased: the relevance of music, including preloss music therapy, for eight bereaved caregivers.
Death Stud. 2013; 37(2):101-25 [PubMed] Related Publications
This study examines music's relevance, including preloss music therapy, for 8 informal caregivers of people who died from cancer. The design was informed by constructivist grounded theory and included semistructured interviews. Bereaved caregivers were supported or occasionally challenged as their musical lives enabled a connection with the deceased. Music was often still used to improve mood and sometimes used to confront grief. Specific music, however, was sometimes avoided to minimize sadness. Continuing bonds theory's focus on connecting with the deceased through memory and imagery engagement may expand to encompass musical memories, reworking the meaning of familiar music, and discovering new music related to the deceased. Preloss music involvement, including music therapy, between dying patients and families can help in bereavement.

Related: Cancer Prevention and Risk Reduction
Peter MacCallum Cancer Centre, The University of Melbourne, Melbourne, Australia.

Jokela M, Batty GD, Hintsa T, et al.
Is personality associated with cancer incidence and mortality? An individual-participant meta-analysis of 2156 incident cancer cases among 42,843 men and women.
Br J Cancer. 2014; 110(7):1820-4 [PubMed] Article available free on PMC after 01/04/2015 Related Publications
BACKGROUND: The putative role of personality in cancer risk has been controversial, and the evidence remains inconclusive.
METHODS: We pooled data from six prospective cohort studies (British Household Panel Survey; Health and Retirement Study; Household, Income, and Labour Dynamics in Australia; Midlife in the United Survey; Wisconsin Longitudinal Study Graduate; and Sibling samples) for an individual-participant meta-analysis to examine whether personality traits of the Five Factor Model (extraversion, neuroticism, agreeableness, conscientiousness, and openness to experience) were associated with the incidence of cancer and cancer mortality in 42,843 cancer-free men and women at baseline (mean age 52.2 years, 55.6% women).
RESULTS: During an average follow-up of 5.4 years, there were 2156 incident cancer cases. In random-effects meta-analysis adjusted for age, sex, and race/ethnicity, none of the personality traits were associated with the incidence of all cancers or any of the six site-specific cancers included in the analysis (lung, colon, breast, prostate, skin, and leukaemia/lymphoma). In the three cohorts with cause-specific mortality data (421 cancer deaths among 21,835 participants), none of the personality traits were associated with cancer mortality.
CONCLUSIONS: These data suggest that personality is not associated with increased risk of incident cancer or cancer-related mortality.

Related: Cancer Prevention and Risk Reduction
1] Institute of Behavioural Sciences, University of Helsinki, Siltavuorenpenger 1A, PO Box 9, 00014 Helsinki, Finland [2] Department of Psychology, University of Cambridge, Cambridge, UK.
Research funded by:

Trabert B, Ness RB, Lo-Ciganic WH, et al.
Aspirin, nonaspirin nonsteroidal anti-inflammatory drug, and acetaminophen use and risk of invasive epithelial ovarian cancer: a pooled analysis in the Ovarian Cancer Association Consortium.
J Natl Cancer Inst. 2014; 106(2):djt431 [PubMed] Article available free on PMC after 01/02/2015 Related Publications
BACKGROUND: Regular aspirin use is associated with reduced risk of several malignancies. Epidemiologic studies analyzing aspirin, nonaspirin nonsteroidal anti-inflammatory drug (NSAID), and acetaminophen use and ovarian cancer risk have been inconclusive.
METHODS: We analyzed pooled data from 12 population-based case-control studies of ovarian cancer, including 7776 case patients and 11843 control subjects accrued between 1992 and 2007. Odds ratios (ORs) for associations of medication use with invasive epithelial ovarian cancer were estimated in individual studies using logistic regression and combined using random effects meta-analysis. Associations between frequency, dose, and duration of analgesic use and risk of ovarian cancer were also assessed. All statistical tests were two-sided.
RESULTS: Aspirin use was associated with a reduced risk of ovarian cancer (OR = 0.91; 95% confidence interval [CI] = 0.84 to 0.99). Results were similar but not statistically significant for nonaspirin NSAIDs, and there was no association with acetaminophen. In seven studies with frequency data, the reduced risk was strongest among daily aspirin users (OR = 0.80; 95% CI = 0.67 to 0.96). In three studies with dose information, the reduced risk was strongest among users of low dose (<100 mg) aspirin (OR = 0.66; 95% CI = 0.53 to 0.83), whereas for nonaspirin NSAIDs, the reduced risk was strongest for high dose (≥500 mg) usage (OR = 0.76; 95% CI = 0.64 to 0.91).
CONCLUSIONS: Aspirin use was associated with a reduced risk of ovarian cancer, especially among daily users of low-dose aspirin. These findings suggest that the same aspirin regimen proven to protect against cardiovascular events and several cancers could reduce the risk of ovarian cancer 20% to 34% depending on frequency and dose of use.

Related: Ovarian Cancer USA
Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (BT, LAB, NW); University of Texas School of Public Health, Houston, TX (RBN); Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA (WL); Cha...
Research funded by:

Walton AE, Janda M, Youl PH, et al.
Uptake of skin self-examination and clinical examination behavior by outdoor workers.
Arch Environ Occup Health. 2014; 69(4):214-22 [PubMed] Related Publications
This study investigated the association between outdoor work and response to a behavioral skin cancer early detection intervention among men 50 years or older. Overall, 495 men currently working in outdoor, mixed, or indoor occupations were randomized to a video-based intervention or control group. At 7 months post intervention, indoor workers reported the lowest proportion of whole-body skin self-examination (wbSSE; 20%). However, at 13 months mixed workers engaged more commonly in wbSSE (36%) compared with indoor (31%) and outdoor (32%) workers. In adjusted analysis, the uptake of early detection behaviors during the trial did not differ between men working in different settings. Outdoor workers compared with men in indoor or mixed work settings were similar in their response to an intervention encouraging uptake of secondary skin cancer prevention behaviors during this intervention trial.

Related: Cancer Screening and Early Detection Skin Cancer
a Institute of Health and Biomedical Innovation, School of Public Health , Queensland University of Technology , Brisbane , Queensland , Australia.

Abikhair MR, Mahar PD, Cachia AR, Kelly JW
Liability in the context of misdiagnosis of melanoma in Australia.
Med J Aust. 2014; 200(2):119-21 [PubMed] Related Publications
Malignant melanoma is a serious and relatively common condition, the diagnosis of which may be difficult. In a recent Supreme Court of New South Wales case, misdiagnosis of melanoma occurred, but there was failure to establish causation of the patient's poor prognosis. Aggressive melanomas may grow quickly, fail to conform to standard and commonly taught diagnostic criteria, and frequently escape early detection. In the event of uncertain diagnosis or failed treatment of a lesion, an appropriate standard of care is full excisional biopsy if not previously performed, or referral of the case to an appropriate specialist or melanoma centre. Clinicians should remain aware of the existence of higher-risk, easily misdiagnosed melanomas with a high mortality rate. Therefore, they should aim to identify these at the earliest opportunity.

Related: Melanoma Skin Cancer
Department of Dermatology, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia.

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