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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

Juzeniene A, Baturaite Z, Moan J
Sun exposure and melanomas on sun-shielded and sun-exposed body areas.
Adv Exp Med Biol. 2014; 810:375-89 [PubMed] Related Publications
Malignant melanoma is a tumor that arises from melanocytes and accounts for around 4% of all malignancies in Europe and Northern America and for about 11% in Australia and New Zealand. About 10% of primary melanomas arise from sites not exposed to sun. Acral lentiginous melanoma, mucosal melanoma (in the oral cavities, nasal sinuses, genital tract and rectum) and uveal melanoma are all on non-sun-exposed tissues. Epidemiologic aspects ofmelanomas on non-sun-exposed areas in comparison with melanomas in sun-exposed areas have been reviewed. We focus on the relationship between melanoma incidence, geographic latitude of residence, race/ethnicity and host factors as well as time trends.

Related: Melanoma Skin Cancer

Moan JE, Baturaite Z, Dahlback A, Porojnicu AC
Ultraviolet radiation and cutaneous malignant melanoma.
Adv Exp Med Biol. 2014; 810:359-74 [PubMed] Related Publications
Essential features of the epidemiology and photobiology of cutaneous malignant melanoma (CMM) in Norway were studied in comparison with data from countries at lower latitudes. Arguments for and against a relationship between ultraviolet radiation (UV) from sun and artificial light and CMM are discussed. Our data indicate that UV is a carcinogen for CMM and that intermittent exposures are notably melanomagenic. This hypothesis was supported both by latitude gradients, by time trends and by changing patterns of tumor density on different body localizations. However, even though UV radiation generates CMM, it may also have a protective action and/or an action that improves prognosis. There appears to be no, or even an inverse latitude gradient for CMM arising on non-UV exposed body localizations (uveal melanoma, CMMs arising in the vulva, perianal/anorectal regions, etc.). Furthermore, CMM prognosis was gradually improved over all years of increasing incidence (up to 1990), but during the past 20 years, incidence rates stabilized and prognosis was not improved significantly. Comparisons of skin cancer data from Norway, Australia and New Zealand indicate that squamous cell carcinoma and basal cell carcinoma are mainly related to annual solar UVB fluences, while UVA fluences play a larger role of CMM.

Related: Basal Cell Carcinoma Squamous Cell Carcinoma - Skin Cancer Melanoma Skin Cancer

Dembinsky M
Exploring Yamatji perceptions and use of palliative care: an ethnographic study.
Int J Palliat Nurs. 2014; 20(8):387-93 [PubMed] Related Publications
BACKGROUND: The Yamatji people comprise several Aboriginal groups living in the Midwest region of Western Australia. Palliative care remains underutilised among Aboriginal groups, but little is known about Yamatji people's thoughts about and experiences of accessing services.
AIM: As part of a broader study focusing on Yamatji's lived experiences of breast cancer, this study analysed their perceptions and use of palliative care services.
METHODS: The study used grounded theory and 28 in-depth interviews with Aboriginal and non-Aboriginal health-care providers as well as Yamatji patients, carers, and families.
RESULTS: Palliative care services are underutilised by Yamatji breast cancer patients. The reasons for this include misperceptions about what palliative care entails, cultural and structural barriers to adequate service provision, and the inflexibility of institutionalised death.
CONCLUSIONS: Efforts to raise awareness among Yamatji that palliative care is broader than end-of-life care would be a step in the right direction, but would not be sufficient to significantly increase uptake among Yamatji if culturally specific perceptions of death and dying are not included in the dialogue.

Related: Breast Cancer
Lecturer in Social Anthropology, School of Anthropology and Conservation, Marlowe Building, University of Kent, Canterbury, CT2 7NR, England.

Waldon J, Lamb DS, Delahunt B, et al.
A comparison of cancer statistics in New Zealand and Australia: 1996-2007.
N Z Med J. 2014; 127(1400):20-9 [PubMed] Related Publications
AIM: To compare the burden and outcomes of cancer in New Zealand with those in Australia.
METHODS: For the years 1996-1997 and 2006-2007, the incidence and mortality of cancer in New Zealand and Australia was compared to determine if differences between the two countries had changed over the decade under study. Summarised cancer data from New Zealand and Australia, age standardised to the 2002 World Health Organisation's standard population, were used to make the comparisons.
RESULTS: For the 11 year timeframe of this study, total rates of cancer incidence reduced in New Zealand and increased in Australia. The incidence of cancer in New Zealand, relative to Australia, changed from an excess of +10.3 to a deficit of -27.5 per 100,000 people. When considering the excess in terms of gender, the annual excess of cancer registrations for New Zealand females fell from +19.9 to +0.9 per 100,000, and male cancer registration fell from an excess of +3.7 to a deficit of -58.0 per 100,000, due almost entirely to a surge in prostate cancer registration in Australia. Over the same 11-year timeframe, cancer-specific mortality rates decreased in both countries, but there was no change in the difference between New Zealand and Australian rates, which remained 10% higher in New Zealand. Similar to findings on 1996/7 data, the main cancer sites responsible for the overall excess mortality in 2006/7 were colorectal cancer in both sexes, and lung and breast cancer in females.
CONCLUSION: The persisting different cancer mortality rates between the two countries is likely to have been partly due to lifestyle and ethnic differences in the populations, and partly due to New Zealanders presenting with more advanced cancers and having less easy access to some treatments. Until we know the relative contributions of these factors, it will be difficult for New Zealand to plan interventions in the future which have a good chance of lifting our cancer survival rates to those of our closest neighbour. The collection of clinical stage on all new cancer registrations would provide the base information required.

Related: Cancer Prevention and Risk Reduction
Prostate Cancer Trials Unit, Department of Pathology and Molecular Medicine, University of Otago - Wellington, PO Box 7343, Wellington South 6242, New Zealand.

Alafeishat L, Elwood M, Ioannides S
Cancer mortality and incidence trends comparing New Zealand and Australia for the period 2000-2007.
N Z Med J. 2014; 127(1400):9-19 [PubMed] Related Publications
BACKGROUND AND AIMS: A previous study showed that cancer mortality in New Zealand in 1996-97 was substantially higher than that expected from Australian rates. This study compared cancer mortality and incidence in New Zealand for 2000-2007 with rates in Australia, to assess if any differences had persisted or changed.
METHODS: The numbers of cancer deaths in New Zealand, by type of cancer, year, sex, and 5 year age group, were compared to the numbers that would have occurred if NZ rates had been the same as those in Australia. Trends over time, and also cancer incidence, were assessed.
RESULTS: From 2000-2007, there were each year an average of 586 (15.1% of the total) more deaths from cancer in New Zealand women than expected from Australian rates; and 197 (4.7%) more deaths in men. There was no significant change over time in these differentials. Higher cancer mortality was seen for most common sites; the greatest excesses were for colorectal cancer in both men and women. Cancer incidence in New Zealand women was 3.3% higher, and incidence in men was 4.7% lower, than in Australia over this period; thus the higher cancer deaths in New Zealand are not due simply to higher incidence. Over this time period, cancer mortality has fallen substantially in both countries; in New Zealand, it fell from 1990 to 2007 by 20% in women and 24% in men.
CONCLUSION: Cancer mortality remains substantially higher in New Zealand than in Australia, especially for women, although mortality has reduced in both countries. While the differences in 2000-07 were slightly smaller than in 1996-97, there has been little change since 2000. The greater differences in deaths than in incidence suggest that patient survival is lower in New Zealand.

Related: Cancer Prevention and Risk Reduction Children's Cancer Web: Home Page
Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand.

Youlden DR, Youl PH, Soyer HP, et al.
Distribution of subsequent primary invasive melanomas following a first primary invasive or in situ melanoma Queensland, Australia, 1982-2010.
JAMA Dermatol. 2014; 150(5):526-34 [PubMed] Related Publications
IMPORTANCE: Melanoma survivors are known to have a highly elevated risk of subsequent primary melanomas.
OBJECTIVE: To determine the relative risk of subsequent primary invasive melanomas following a first primary invasive or in situ melanoma, with a focus on body site.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study was conducted using population-based administrative data for melanoma diagnoses collected by the Queensland Cancer Registry, Queensland, Australia. Deidentified records of all cases of melanoma among Queensland residents during the period 1982-2005 were obtained and reviewed to December 31, 2010. There were 39,668 eligible cases of first primary invasive melanoma and 22,845 cases of first primary in situ melanoma.
MAIN OUTCOMES AND MEASURES: Standardized incidence ratios (SIRs), a proxy measure for relative risk, were calculated by dividing the observed number of subsequent primary invasive melanomas by the product of the strata-specific incidence rates that occurred in the general population and the cumulative time at risk for the cohort. Synchronous subsequent melanomas (diagnosed within 60 days of the first primary melanoma) were excluded. Differences between SIRs were assessed using multivariate negative binomial regression adjusted for sex, age group, time to second diagnosis, and body site and expressed in terms of adjusted SIR ratios with corresponding 95% CIs.
RESULTS: There were 5358 subsequent primary invasive melanomas diagnosed, resulting in SIRs of 5.42 (95% CI, 5.23-5.61) and 4.59 (4.37-4.82) for persons with a first primary invasive or in situ melanoma, respectively. The SIRs remained elevated throughout the follow-up period. In general, subsequent primary invasive melanomas were more likely to occur at the same body site as the initial invasive or in situ melanoma. The largest relative risk was for females with a first primary invasive melanoma on the head followed by a subsequent primary invasive melanoma also on the head (SIR, 13.32; 95% CI, 10.28-16.98).
CONCLUSIONS AND RELEVANCE: Melanoma survivors require ongoing surveillance, with particular attention required for the body site of the initial lesion. Clinical practice guidelines have recognized the importance of monitoring for people with invasive melanoma; the results of the present study highlight the need for similar levels of supervision for those with a diagnosis of in situ melanoma.

Related: Melanoma Skin Cancer

Jelinek GA, Boughey M, Marck CH, et al.
"Better pathways of care": suggested improvements to the emergency department management of people with advanced cancer.
J Palliat Care. 2014; 30(2):83-9 [PubMed] Related Publications
OBJECTIVE: It is difficult to provide optimal care to people with advanced cancer presenting to emergency departments (EDs). Recent data suggest that the ED environment, the skills and priorities of treating staff, and the lack of clear communication related to goals of care contribute to the difficulty. By exploring the views of emergency, palliative care (PC), and oncology clinicians on the care of these patients, this study aimed to describe potential solutions.
METHODS: This qualitative study involved focus groups with clinicians at two major hospitals and two community PC services in Melbourne, Australia, and semistructured telephone interviews with emergency clinicians from all other Australian states and territories. Discussions were recorded and transcribed verbatim. Thematic analysis identified ways to improve or enhance care.
RESULTS: Throughout discussions with 94 clinicians, a number of possible improvements to care were raised; these were broadly grouped into service areas: clinical care, pathways, information access, and education.
CONCLUSION: The provision of care to patients with advanced cancer in the ED occurs across sites, across disciplines, and across teams. To make improvements to care, we must address these complexities. The improvements suggested in this study place the patient (and the patient's family) at the centre of care.

Related: Cancer Prevention and Risk Reduction

Berry NM, Miller MD, Woodman RJ, et al.
Differences in chronic conditions and lifestyle behaviour between people with a history of cancer and matched controls.
Med J Aust. 2014; 201(2):96-100 [PubMed] Related Publications
OBJECTIVE: To determine whether people with a history of cancer have a higher prevalence of chronic conditions or different lifestyle behaviour compared with controls.
DESIGN, SETTING AND PARTICIPANTS: Cross-sectional, self-reported data from a telephone survey conducted between 1 January 2010 and 31 March 2012 of adult residents of South Australia who self-reported a previous cancer diagnosis (cases) and randomly selected age- and sex-matched residents with no cancer diagnosis (controls).
MAIN OUTCOME MEASURES: Self-reported medically diagnosed cardiovascular disease, hypertension, hyperlipidaemia, diabetes and osteoporosis; lifestyle behaviour (smoking, physical activity and diet); body mass index (BMI); psychological distress and self-reported health.
RESULTS: A total of 2103 cases and 4185 controls were included in the analyses. For men, after adjusting for age, cancer survivors were more likely than controls to have ever had cardiovascular disease (P<0.001), high blood pressure (P=0.001), high cholesterol (P<0.001) and diabetes (P=0.04). These associations remained significant after controlling for socioeconomic status (SES), with the exception of high blood pressure (P=0.09). For women, there was an increased prevalence of high cholesterol (P=0.005), diabetes (P=0.02) and osteoporosis (P=0.005) in cancer cases, but after adjusting for SES, these associations were no longer significant. Women with a previous cancer diagnosis were more likely than controls to have ever smoked, after adjusting for SES (P=0.001). There were no other differences in lifestyle behaviour or BMI between cases and controls for men or women.
CONCLUSION: Despite similar lifestyle habits and BMI, the prevalence of chronic conditions was significantly higher among people with a history of cancer than among controls without cancer. This supports the importance of chronic disease management as part of health care after a diagnosis of cancer.

Related: Cancer Prevention and Risk Reduction
Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.

Bobridge A, Bampton P, Cole S, et al.
The psychological impact of participating in colorectal cancer screening by faecal immuno-chemical testing--the Australian experience.
Br J Cancer. 2014; 111(5):970-5 [PubMed] Article available free on PMC after 26/08/2015 Related Publications
BACKGROUND: Occult blood-based colorectal cancer (CRC) screening may result in adverse psychological outcomes for participants. The aims of this study were to measure the psychological consequences of participating in screening at key points along the screening and diagnostic pathway, and examine variation over time within or between test outcome groups.
METHODS: A total of 301 people (positives=165, negatives=136) aged 50-76 years were surveyed via validated psychological questionnaires after result notification, post colonoscopy (positives only) and 1 year following result notification.
RESULTS: Negatives scored significantly higher in quality of life domains and lower state anxiety, anger and depression in comparison to positives both after result notification and at 1 year follow-up. Positives had significantly decreased state anxiety and depression at 1 year and improvement in HLoC power and reduced screening decision doubtfulness post colonoscopy. Positives experienced heightened CRC risk perception both after result notification and at 1 year follow-up in comparison to negatives, but reported less difficulty participating in ongoing screening.
CONCLUSIONS: In positives, increased anxiety and doubtfulness about the decision to screen declined over time. Lower CRC risk perception in negatives indicates the need for education to promote CRC screening participation.

Related: Colorectal (Bowel) Cancer Screening for Colorectal (Bowel) Cancer Cancer Screening and Early Detection
School of Nursing & Midwifery, University of South Australia, Room 44, Level 6, Centenary Building, North Terrace, Adelaide, South Australia 5000, Australia.

Morrell S, Qian L
A whole-population profile of HPV testing as a test of cure for high-grade cervical dysplasia in NSW, Australia.
J Med Screen. 2014; 21(3):151-62 [PubMed] Related Publications
INTRODUCTION: Few population-based studies have been conducted on the efficacy of human papilloma virus (HPV) testing as a test of cure for high grade cervical dysplasia.
METHODS: A cohort of women (n = 11,521) with high grade (CIN2+) cervical dysplasia diagnosed during 2006-2010, who also had accompanying HPV testing (n = 19,434 HPV tests), was analyzed with respect to National Health and Medical Research Council (NHMRC) follow-up guidelines. Cure rates, and number of follow-up tests and times to reach a cure were estimated.
RESULTS: In the ≥2-years following high grade dysplasia, 53% of women had a single follow-up HPV test, 33% had two, and 14% had three or more HPV follow-up tests. 75% of women with follow-up HPV and cytology testing according to NHMRC guidelines were cured (2,210 from 2,948). Cure rates were lowest in those aged <30 (71%) and highest in women aged 30-49 (80%). Of those cured, 68% attained cure by the second HPV test, 21% by the third, and 11% at the fourth or later HPV test. The median time to cure was 1,097 days. In non-cured women, 56% of test results originated from all-negative cytology with positive HPV, compared with 9% from all-negative HPV results.
CONCLUSIONS: Cure rates in women with follow-up testing according to NHMRC guidelines are high. Further studies are needed of the high proportion of women with negative cytology classed as not cured due to HPV positivity, and of the high proportion of women with high grade dysplasia who had one follow-up HPV test only.
Cancer Institute NSW, Level 9, 8 Central Avenue, Australian Technology Park, Sydney, NSW, Australia School of Public Health and Community Medicine, UNSW, Kensington, NSW, Australia

Youlden DR, Soyer HP, Youl PH, et al.
Incidence and survival for Merkel cell carcinoma in Queensland, Australia, 1993-2010.
JAMA Dermatol. 2014; 150(8):864-72 [PubMed] Related Publications
IMPORTANCE: Merkel cell carcinoma (MCC) is an uncommon but highly invasive form of skin cancer. The mechanisms that cause MCC are yet to be fully determined.
OBJECTIVES: To compare the incidence and survival rates of MCC in Queensland, Australia, known to be a high-risk area, with MCC incidence and survival elsewhere in the world. We also analyzed incidence trends and differences in survival by key demographic and clinical characteristics.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of population-based administrative data for MCC collected by the Queensland Cancer Registry and supplemented with detailed histopathologic data. Deidentified records were obtained of all Queensland residents diagnosed as having MCC during the period from 1993 to 2010. A subsample of histopathologic records were reviewed by a senior dermatopathologist to determine the potential for misclassification. A total of 879 eligible cases of MCC were included in the study.
MAIN OUTCOMES AND MEASURES: Incidence rates were directly age standardized to the 2000 United States Standard Population. Trends were examined using Joinpoint software with results expressed in terms of the annual percentage change. The period method was used to calculate 5-year relative survival, and adjusted hazard ratios were obtained from multivariate Poisson models.
RESULTS: There were 340 cases of MCC diagnosed in Queensland between 2006 and 2010, corresponding to an incidence rate of 1.6 per 100,000 population. Men (2.5 per 100,000) had higher incidence than women (0.9 per 100,000), and rates peaked at 20.7 per 100,000 for persons 80 years or older. The overall incidence of MCC increased by an average of 2.6% per year from 1993 onwards. Relative survival was 41% after 5 years, with significantly better survival found for those younger than 70 years at diagnosis (56%-60%), those with tumors on the face or ears (51%), and those with stage I lesions (49%).
CONCLUSIONS AND RELEVANCE: Incidence rates for MCC in Queensland are at least double those of any that have been previously published elsewhere in the world. It is likely that Queensland's combination of a predominantly white population, outdoor lifestyle, and exposure to sunlight has played a role in this unwanted result. Interventions are required to increase awareness of MCC among clinicians and the public.

Related: Merkel Cell Carcinoma Skin Cancer
Cancer Council Queensland, Brisbane, Queensland, Australia.

Vallance JK, Boyle T, Courneya KS, Lynch BM
Associations of objectively assessed physical activity and sedentary time with health-related quality of life among colon cancer survivors.
Cancer. 2014; 120(18):2919-26 [PubMed] Related Publications
BACKGROUND: The primary purpose of this study was to determine associations of accelerometer-assessed moderate- to vigorous-intensity physical activity (MVPA) and sedentary time with health-related quality of life (HRQoL) and physical function and well-being in colon cancer survivors.
METHODS: Colon cancer survivors (N = 178) from Alberta, Canada (n = 92) and Western Australia (n = 86) completed a mailed survey that assessed HRQoL (Functional Assessment of Cancer Therapy-Colorectal), physical function and well-being (Trial Outcome Index-Colorectal), and relevant covariates. MVPA and sedentary time were assessed using the Actigraph GT3X+ accelerometer (60-second epochs) via a 7-day monitoring protocol. Average daily MVPA and sedentary time was corrected for wear time and then examined as quartiles.
RESULTS: Adjusting for relevant demographic, behavioral, and clinical covariates, a significant difference in HRQoL scores emerged between quartile 1 (Q1) and Q4 (M(diff) = 11.5, P = .038). For physical function and well-being, a significant difference emerged between Q1 and Q4 (M(diff) = 9.1, P = .009). For fatigue, a significant difference emerged between Q1 and Q4 (M(diff) = 7.1, P = .05). Significant differences were also observed for between Q1 and Q3 (M(diff) = 2.4, P = .041), and Q1 and Q4 (M(diff) = 3.5, P = .002) for colorectal cancer-specific symptoms. There were no statistically significant associations of sedentary time with HRQoL, physical function and well-being, fatigue, or colorectal cancer-specific symptoms.
CONCLUSIONS: Objectively measured MVPA, but not sedentary time, was associated with better HRQoL, physical function and well-being, and colorectal cancer-specific symptoms in colon cancer survivors. For MVPA, differences met or exceeded contemporary cutpoints for determining clinically important differences.

Related: Canada
Faculty of Health Disciplines, Athabasca University, Athabasca, Canada.

Wilcox CB, Gilbourd D, Louie-Johnsun M
Anxiety and health-related quality of life (HRQL) in patients undergoing active surveillance of prostate cancer in an Australian centre.
BJU Int. 2014; 113 Suppl 2:64-8 [PubMed] Related Publications
OBJECTIVE: To assess anxiety, health-related quality of life (HRQL) and understanding of active surveillance (AS) in a cohort of patients enrolled in AS of prostate cancer in an Australian setting.
PATIENTS AND METHODS: Survey of 61 men currently enrolled in AS for prostate cancer, which included validated measures of sexual function using the International Index of Erectile Function (IIEF-5), voiding using the International Prostate Symptom Severity Score (IPSS) and the Memorial Anxiety Scale for Prostate Cancer (MAX-PC), a measure of prostate cancer specific anxiety. Three novel questions to assess patients' Understanding of AS (UAS). IIEF-5 and IPSS scores obtained through the present survey were compared with patients' scores at initiation of AS.
RESULTS: In all, 47 of 61 (77%) patients responded to the survey. There was no significant difference in patients' IIEF-5 and IPSS scores at commencement of AS compared with the survey results. Our patients' on AS MAX-PC scores were consistent with other published cohorts and did not suggest high rates of clinically significant anxiety amongst this cohort. Most (89%) of the patients' responses to the UAS indicated a correct understanding of AS.
CONCLUSION: Our patients on AS maintained their HRQL with low levels of anxiety, which did not differ from those reported in other groups of men with prostate cancer and most had an appropriate understanding of AS. This study represents one of the first Australasian investigations on HRQL and anxiety in men on AS of prostate cancer.

Related: Prostate Cancer
Department of Urology, Gosford Hospital and Gosford Private Hospital, Gosford, NSW, Australia.

Pearse M, Fraser-Browne C, Davis ID, et al.
A Phase III trial to investigate the timing of radiotherapy for prostate cancer with high-risk features: background and rationale of the Radiotherapy -- Adjuvant Versus Early Salvage (RAVES) trial.
BJU Int. 2014; 113 Suppl 2:7-12 [PubMed] Related Publications
OBJECTIVES: To test the hypothesis that observation with early salvage radiotherapy (SRT) is not inferior to 'standard' treatment with adjuvant RT (ART) with respect to biochemical failure in patients with pT3 disease and/or positive surgical margins (SMs) after radical prostatectomy (RP). To compare the following secondary endpoints between the two arms: patient-reported outcomes, adverse events, biochemical failure-free survival, overall survival, disease-specific survival, time to distant failure, time to local failure, cost utility analysis, quality adjusted life years and time to androgen deprivation.
PATIENTS AND METHODS: The Radiotherapy - Adjuvant Versus Early Salvage (RAVES) trial is a phase III multicentre randomised controlled trial led by the Trans Tasman Radiation Oncology Group (TROG), in collaboration with the Urological Society of Australia and New Zealand (USANZ), and the Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP). In all, 470 patients are planned to be randomised 1:1 to either ART commenced at ≤4 months of RP (standard of care) or close observation with early SRT triggered by a PSA level of >0.20 ng/mL (experimental arm). Eligible patients have had a RP for adenocarcinoma of the prostate with at least one of the following risk factors: positive SMs ± extraprostatic extension ± seminal vesicle involvement. The postoperative PSA level must be ≤0.10 ng/mL. Rigorous investigator credentialing and a quality assurance programme are designed to promote consistent RT delivery among patients.
RESULTS: Trial is currently underway, with 258 patients randomised as of 31 October 2013. International collaborations have developed, including a planned meta-analysis to be undertaken with the UK Medical Research Council/National Cancer Institute of Canada Clinical Trials Group RADICALS (Radiotherapy and Androgen Deprivation In Combination with Local Surgery) trial and an innovative psycho-oncology sub-study to investigate a patient decision aid resource.
CONCLUSION: On the current evidence available, it remains unclear if ART is equivalent or superior to observation with early SRT.

Related: Prostate Cancer
Department of Radiation Oncology, Auckland City Hospital, Auckland, New Zealand.

Tay SK, Cheong MA
Evidence for ethnic and environmental contributions to frequency of ovarian clear cell carcinoma.
Aust N Z J Obstet Gynaecol. 2014; 54(3):225-30 [PubMed] Related Publications
BACKGROUND: Ovarian clear cell carcinoma (OCCC) is reportedly more common in Asians than Caucasians. We investigated the epidemiology of OCCC in an Asian population.
MATERIALS AND METHODS: Cases of epithelial ovarian cancer (EOC) diagnosed between January 2004 and December 2009 in a gynaecologic oncology unit were studied retrospectively. Patient details and tumour characteristics were retrieved from hospital records and tested for their association with OCCC by univariate and binomial logistic regression analysis. A time trend in the proportion of OCCC among EOC was computed with data from the National Cancer Registry of Singapore (1968-2006).
RESULTS: The institutional cohort of 341 cases included 81 OCCC and 260 non-OCCC EOC. Independent risk factors for OCCC were nulliparity (OR = 1.36) and endometriosis (OR = 4.87). Compared with other EOC, OCCC was significantly larger in tumour size (13.5 vs. 11.3 cm), more frequently located unilaterally (84.3 vs. 65.5%), diagnosed at FIGO stage-1 (63.0 vs. 33.9%) and negative for serum CA125 (34.2 vs. 8.2%), and less often (53 vs. 85%) associated with a positive Risk of Malignancy Index. Nation-wide statistics revealed a steady increase in the proportion of OCCC among EOC from 5.2 to 13.4% between 1968 and 2006. The frequency of OCCC in Singapore was higher than American Whites, similar to American Asians but lower than Japanese.
CONCLUSION: The difference in epidemiologic and tumour characteristics between OCCC and other EOC was nondiscriminatory. Three distinct ethnic-related clusters of frequency distribution globally and the rising trend in proportion of OCCC in Singapore suggested that ethnic-genetic predisposition and economy-related environmental factors contributed to development of OCCC.

Related: Ovarian Cancer USA
Department of Obstetrics & Gynaecology, Singapore General Hospital, Singapore.

Brown BB, Young J, Smith DP, et al.
Clinician-led improvement in cancer care (CLICC)--testing a multifaceted implementation strategy to increase evidence-based prostate cancer care: phased randomised controlled trial--study protocol.
Implement Sci. 2014; 9:64 [PubMed] Article available free on PMC after 26/08/2015 Related Publications
BACKGROUND: Clinical practice guidelines have been widely developed and disseminated with the aim of improving healthcare processes and patient outcomes but the uptake of evidence-based practice remains haphazard. There is a need to develop effective implementation methods to achieve large-scale adoption of proven innovations and recommended care. Clinical networks are increasingly being viewed as a vehicle through which evidence-based care can be embedded into healthcare systems using a collegial approach to agree on and implement a range of strategies within hospitals. In Australia, the provision of evidence-based care for men with prostate cancer has been identified as a high priority. Clinical audits have shown that fewer than 10% of patients in New South Wales (NSW) Australia at high risk of recurrence after radical prostatectomy receive guideline recommended radiation treatment following surgery. This trial will test a clinical network-based intervention to improve uptake of guideline recommended care for men with high-risk prostate cancer.
METHODS/DESIGN: In Phase I, a phased randomised cluster trial will test a multifaceted intervention that harnesses the NSW Agency for Clinical Innovation (ACI) Urology Clinical Network to increase evidence-based care for men with high-risk prostate cancer following surgery. The intervention will be introduced in nine NSW hospitals over 10 months using a stepped wedge design. Outcome data (referral to radiation oncology for discussion of adjuvant radiotherapy in line with guideline recommended care or referral to a clinical trial of adjuvant versus salvage radiotherapy) will be collected through review of patient medical records. In Phase II, mixed methods will be used to identify mechanisms of provider and organisational change. Clinicians' knowledge and attitudes will be assessed through surveys. Process outcome measures will be assessed through document review. Semi-structured interviews will be conducted to elucidate mechanisms of change.
DISCUSSION: The study will be one of the first randomised controlled trials to test the effectiveness of clinical networks to lead changes in clinical practice in hospitals treating patients with high-risk cancer. It will additionally provide direction regarding implementation strategies that can be effectively employed to encourage widespread adoption of clinical practice guidelines.
TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12611001251910.

Related: Prostate Cancer
Sax Institute, Haymarket, Australia.

Yu XQ, Luo Q, Smith DP, et al.
Geographic variation in prostate cancer survival in New South Wales.
Med J Aust. 2014; 200(10):586-90 [PubMed] Related Publications
OBJECTIVES: To determine whether the previously reported urban-rural differential in prostate cancer survival remains after adjusting for demographic and clinical factors, and to investigate temporal trends in this differential.
DESIGN, SETTING AND PARTICIPANTS: Retrospective population-based survival analysis of 68 686 men diagnosed with prostate cancer from January 1982 to December 2007 in New South Wales.
MAIN OUTCOME MEASURES: Survival rate and relative excess risk (RER) of death over 10 years of follow-up in relation to geographic remoteness after adjusting for other prognostic factors.
RESULTS: Overall, 10-year survival increased during the study period, increasing from 57.5% in 1992-1996 and 75.7% in 1997-2001 to 83.7% in 2002-2007. The increasing trends were also observed across categories of geographic remoteness and socioeconomic status. Urban-rural differentials were significant (P < 0.001) after adjusting for five important prognostic factors, with men living outside major cities having higher risk of death from prostate cancer (RER, 1.18 and 1.32 for inner regional and rural areas, respectively). Socioeconomic status was also a significant factor (P < 0.001) for prostate cancer mortality, with the risk of dying being 34% to 40% higher for men living in socioeconomically disadvantaged areas than those living in least disadvantaged areas. There was no evidence that this inequality is reducing over time, particularly for men living in inner regional areas.
CONCLUSIONS: Despite the increasing awareness of urban-rural differentials in cancer outcomes, little progress has been made. Appropriately detailed data, including details of tumour characteristics, treatment and comorbid conditions, to help understand why these inequalities exist are required urgently so interventions and policy changes can be guided by appropriate evidence.

Related: Prostate Cancer
Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia.

Reid A, de Klerk NH, Magnani C, et al.
Mesothelioma risk after 40 years since first exposure to asbestos: a pooled analysis.
Thorax. 2014; 69(9):843-50 [PubMed] Related Publications
BACKGROUND: The risk of malignant mesothelioma (MM) increases proportionally to the cumulative exposure, and to the 3rd or 4th power of time since first exposed, to asbestos. However, little is known about the risk of MM after more than 40 years since first exposure because most epidemiological studies do not have follow-up for sufficient periods of time.
METHODS: The data from six cohort studies of exposed workers and two cohorts with residential exposure have been pooled. A nested case control design matched cases and controls on calendar period and age. Conditional logistic regression modelled the relationship between time since first exposure and risk of MM.
RESULTS: The combined data consisted of 22,048 people with asbestos exposure (5769 women), 707 cases of pleural MM (165 in women) and 155 cases of peritoneal MM (32 in women). Median time since first exposure for pleural MM cases was 38.4 years (IQR 31.3-45.3). Median duration of exposure for pleural MM cases was 3.75 years (IQR 0.7-18.2). The rate and risk of pleural MM increased until 45 years following first exposure and then appeared to increase at a slower power of time since first exposure. The rate of increase in peritoneal MM over the 10-50 years since first exposure continued to increase.
CONCLUSIONS: Exposure to asbestos confers a long-term risk of developing pleural and peritoneal mesothelioma which increases following cessation of exposure. While the rate of increase appears to start to level out after 40-50 years no one survives long enough for the excess risk to disappear.

Related: Mesothelioma
School of Public Health, Curtin University, Bentley, Western Australia.

Peris K, Neri L, Fargnoli MC, Pellacani G
Physicians' concerns towards prescription adherence and treatment effectiveness in the clinical management of actinic keratosis.
G Ital Dermatol Venereol. 2014; 149(2):193-8 [PubMed] Related Publications
AIM: We report concerns toward prescription adherence and treatment effectiveness in the clinical management of actinic keratosis (AK) in Italy.
METHODS: We carried out a cross-sectional web-based survey among Italian dermatologists across Italy. Physicians were asked to answer a self-administered questionnaire about their concerns around AK therapy and barriers to patients' adherence. Each physician also profiled his last patient and answered items concerning his experience with topical treatments and the suitability of current and future treatment options for the profiled patient.
RESULTS: Fifty practitioners answered the survey. Most dermatologists agreed that field-therapy is a key element for the management of AK in most patients, and 76% (N.=38) agreed that topical treatments were the best option in such cases given their ability to target subclinical lesions. However most interviewee underlined the importance of fostering patients' adherence and minimizing side effects in order to maximize benefits from therapy.
CONCLUSION: We showed that features of current therapeutic options for field-directed therapy (namely long duration of treatment, intensity and duration of local skin reaction) raise practitioners' concerns toward patients' prescription adherence and real-world effectiveness.

Related: Skin Cancer USA
Department of Dermatology University of L'Aquila, L'Aquila, Italy -

Lethborg C, Brown R, Posenelli S, et al.
Is it helpful to give older people with cancer the same chance at rehabilitation as older general medical patients?
J Psychosoc Oncol. 2014; 32(4):396-412 [PubMed] Related Publications
UNLABELLED: Although the complexity of age combined with a cancer diagnosis can result in unmet supportive care needs there are seldom resources to assess or address such needs for older people with cancer (OPWC). The purpose of this project was to trial a service to improve the care for OPWC through (1) an expanded supportive care screening process and (2) capacity building of subacute ambulatory care services (SACS) staff to increase referrals to community-based rehabilitation.
METHODS/DESIGN: Collaboration between allied health (AH) staff at an inner city general hospital with a large cancer service, a cancer specialist hospital, and a SACS service in Melbourne, Australia, developed an AH geriatric screening assessment (GSA) tool. Parallel to this process training was provided to SACS staff in relation to working with OPWC. Although close to one half (44%) of SACS staff who participated in this program (n = 22) had over 6 years' experience, 32% had not worked with OPWC. Prior to training, 81% did not feel confident in their knowledge about working with this cohort. After their training 72% were more confident about normal aging and implications for care of OPWC. Of the 491 patients screened, 80% were older than age 65, however, only 25 resided in the SACS catchment area. More than one third of these did not have clear rehabilitation needs, and the remainder were not referred due to ongoing medical issues. Less than one half of the patients in the catchment area were discussed in a Multi-disciplinary Meeting (MDM) but all were referred to allied health and assessed using the GSA. Although this project did not result in referrals of OPWC to SACS the training program for SACS staff was a success and allied health assessments were improved to include GSA factors. The complexity of care for OPWC was further highlighted through interviews with staff involved with the study.

Related: Cancer Prevention and Risk Reduction
a Department of Social Work, St. Vincent's Hospital , Melbourne , Australia.

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.

Munro A, Pavicic H, Leung Y, et al.
The role of general practitioners in the continued success of the National Cervical Screening Program.
Aust Fam Physician. 2014; 43(5):293-6 [PubMed] Related Publications
BACKGROUND: As the gateway to healthcare for Australian women, general practitioners (GPs) are critical to the success of the National Cervical Screening Program (NCSP). Despite an enviable record - halving the incidence and mortality of cervical cancer - in 2010-2011 more than 2.7 million women did not comply with the recommended 2-yearly screening interval.
OBJECTIVE: General practice strategies are presented to assist GPs in encouraging all women, in particular, high-risk and vulnerable women, to participate in cervical screening.
DISCUSSION: GPs play a crucial part in addressing the demographic, psychosocial and healthcare barriers that prevent women's participation in cervical screening. Encouraging uptake of the human papillomavirus vaccine and educating all patients on the importance of continued participation in cervical screening is essential for further decreasing the prevalence of this disease through early detection and treatment of cervical abnormalities.

Related: Cancer Screening and Early Detection Cervical Cancer Human Papillomavirus (HPV), Vaccination, and Cervical Cancer Cervical Cancer Screening
BExSc, MSc, PhD candidate, Women's Health Clinical Care Unit, WA Cervical Cancer Prevention Program, Perth, WA.

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:

McWhirter RE, Thomson RJ, Marthick JR, et al.
Runs of homozygosity and a cluster of vulvar cancer in young Australian Aboriginal women.
Gynecol Oncol. 2014; 133(3):421-6 [PubMed] Related Publications
OBJECTIVE: A cluster of vulvar cancer exists in young Aboriginal women living in remote communities in Arnhem Land, Australia. A genetic case-control study was undertaken involving 30 cases of invasive vulvar cancer and its precursor lesion, high-grade vulvar intraepithelial neoplasia (VIN), and 61 controls, matched for age and community of residence. It was hypothesized that this small, isolated population may exhibit increased autozygosity, implicating recessive effects as a possible mechanism for increased susceptibility to vulvar cancer.
METHODS: Genotyping data from saliva samples were used to identify runs of homozygosity (ROH) in order to calculate estimates of genome-wide homozygosity.
RESULTS: No evidence of an effect of genome-wide homozygosity on vulvar cancer and VIN in East Arnhem women was found, nor was any individual ROH found to be significantly associated with case status. This study found further evidence supporting an association between previous diagnosis of CIN and diagnosis of vulvar cancer or VIN, but found no association with any other medical history variable.
CONCLUSIONS: These findings do not eliminate the possibility of genetic risk factors being involved in this cancer cluster, but rather suggest that alternative analytical strategies and genetic models should be explored.

Related: Cervical Cancer Vulva Cancer
Menzies School of Health Research, Charles Darwin University, Casuarina, NT 0811, Australia; Menzies Research Institute Tasmania, University of Tasmania, Hobart, TAS 7000, Australia. Electronic address:

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:

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