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Breast cancer is the most common non-skin cancer in Australia, affecting 1 in 7 women by the age of 85 years. Current management of early breast cancer is becoming increasingly variable and complex. The typical range of treatments include some combination of surgery, chemotherapy and targeted therapy, immunotherapy, radiotherapy, and endocrine therapy. Neoadjuvant chemotherapy (NACT) in carefully selected patients can facilitate increased rates of breast conservation therapy, and when successful, offers improved cosmesis due to less extensive resection of tissue. A neoadjuvant approach also provides biological insight into a patient's tumour, prognostication based on a patient's response to therapy, as well as enabling their treating oncologist to personalise adjuvant strategies based on the presence or absence of residual cancer at surgery. Neoadjuvant chemotherapy has become an integral element in the provision of breast conserving surgery to selected early-stage breast cancer patients. Appreciating the indications and understanding the likely outcomes from NACT in select situations, can result in significant improvements in patient tailored care. • Neoadjuvant chemotherapy has significantly influenced surgical management. • There are multiple indications for NACT, however weaknesses do exist. • An understanding of NACT can provide best oncological and cosmetic outcomes for patients. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To explore the influences on accessibility of compounded progesterone therapy for Australian women. Study design: A cross-sectional survey of a stratified sample of Australian women who use progesterone only products using the ‘Perspectives on Progesterone’ questionnaire. Main outcome measures: Principle components analysis (PCA) to determine components of access to progesterone treatment and multi-way analysis of variance to compare groups. Results: Women using compounded progesterone were likely to have made at least one lifestyle adaptation (73%), and to have tried and stopped using at least one complementary and alternative medicine therapy (63%) or conventional hormone therapy (41%). PCA revealed six components of access to progesterone treatment: affordable, values natural treatments and is concerned about other treatments, conventionally available, perceived knowledge, values information gathered from a variety of sources, and rural & disadvantaged. The multifaceted nature of progesterone use illustrates that there are multiple aspects to use of non-conventional medicines. Women looking for non-conventional treatment are neither stupid nor uninformed, their understandings, based on experience and research, need to be addressed by health professionals while assessing their condition prior to discussing the risks and benefits of non-conventional medicines. Conclusion: Access to compounded progesterone is multifaceted, and many of the women who use it have tried other treatments first. Despite the clinical ambivalence towards progesterone as an alternative for women who may have tried and rejected other treatments, including conventional hormone therapy, the women described in this paper are using it. [Copyright &y& Elsevier]

Abstract: Background: Different jurisdictions report different breast cancer treatment rates. Evidence-based optimal utilization models may be specific to the derived population. We compared predicted optimal with actual endocrine and chemotherapy utilization in British Columbia, Canada; Dundee, Scotland; and Perth, Western Australia. Design: Data were analyzed for differences in demography, tumour, and treatment. Epidemiological data were fitted to published Australian optimal radiotherapy utilization trees and region-specific optimal treatment rates were calculated. Optimal and actual systemic therapy rates from 2 population-based and 1 institution-based cancer registries were compared for patients diagnosed with breast cancer between 2000–2004, and 2002 for British Columbia. Results: Chemotherapy rates differed between British Columbia (32%), Perth (29%), and Dundee (24%, p = 0.014). Endocrine therapy rates were similar between British Columbia (56%), Perth (59%), and Dundee (64%, p > 0.05). Actual utilization rates were lower than optimal estimates for chemotherapy, but higher for endocrine therapy. Region-specific optimal utilization rates at diagnosis varied between 50–56% for chemotherapy, and 49–54% for endocrine therapy. Variation was attributed to local differences in demographics, and tumour stage. Conclusion: Actual treatment rates varied. There was lower than estimated optimal chemotherapy use but higher than expected use of endocrine therapy. [Copyright &y& Elsevier]

Abstract: Purpose: Uncertainty remains about the impact of bilateral breast cancer. Characteristics and outcomes of unilateral and bilateral breast cancer were compared within an Australian multi-institutional cohort. Methods: Demographic, tumour and treatment characteristics were compared among unilateral (n = 2336) and bilateral cases (52 synchronous, 35 metachronous) using descriptive analyses. Disease-specific outcomes were investigated using Cox regression modelling to adjust for prognostic and treatment factors. Results: Factors associated with increased risk of bilateral breast cancer included lobular histology (p = 0.046), family history (p = 0.025) and metropolitan residence (p = 0.006). Mastectomy was more common for bilateral cases (p = 0.001) while radiotherapy was less common (p = 0.015). Index metachronous cases were less likely to receive hormonal therapy (p = 0.001). Five-year survivals for metachronous, synchronous and unilateral cases were 79%, 88% and 94%, respectively. Poorer outcomes remained after adjusting for prognostic factors [HR = 2.26, 1.21–4.21]. Conclusion: Our results confirm international findings indicating worse outcomes from bilateral compared with unilateral breast cancer. [Copyright &y& Elsevier]

Abstract: Background: There are no evidence-based benchmarks to establish optimal rates of use of endocrine therapy in the whole breast cancer population. Reported utilization rates vary widely. The aim of the study was to estimate the optimal proportion of breast cancer patients who should receive endocrine therapy based on treatment guideline recommendations and to compare this with actual treatment rates. Methods: An optimal endocrine therapy utilization tree was constructed based on indications from evidence-based treatment guidelines. Frequency data on patient and tumour attributes were obtained from Australian cancer registries where possible and merged with the guideline recommendations to calculate the optimal utilization rate. These were compared with actual proportions obtained from published reports. Results: According to the best available evidence, the proportion of invasive breast cancer patients in whom endocrine therapy is indicated at diagnosis is 67%. Endocrine therapy is under-utilized in Australia (actual utilization rate 41%), and USA (35%), but approximate the benchmark rate in the UK (75%) and Italy (63%). Conclusion: This evidence-based model provides a benchmark for optimal endocrine therapy utilization rates in the breast cancer population, and comparison of best practice evidence and actual treatment. The results show an underutilization of endocrine therapy in Australia and the USA, with more appropriate utilization in the UK and Italy. [ABSTRACT FROM AUTHOR]

Abstract: The purposes of this study were to analyse trends in hip fracture (HF) epidemiology over a 13-year period (1994–2007) in the Australian Capital Territory (ACT), to assess the potential impact of concurrent changes in hormone replacement therapy (HRT) and bisphosphonate use and to present a new prediction of HFs in Australia up to 2021. Annual sex- and age-specific incidence rates (per 100,000 population) were determined and standardized using the Australian 2006 population. The projected number of HFs was estimated by two models applying age- and sex-specific HF rates averaged for 2002–2006 (model 1) or continuously changing as observed in this period (model 2, Poisson regression) to the projected population. In 2006 compared to 2001, the population ≥60 years in the ACT increased by 19.7%. Over the last 5 years the average annual incidence HF rate compared to the previous 3-year period decreased in females ≥60 years of age by 28.3%. Between 2001 and 2006 the number of prescriptions for HRT dispensed in the ACT declined by 54.6, while the number of prescriptions for bisphosphonate increased by 245%, accompanied by a decline in standardized incidence of HF rates of 36.4%, mainly in women (42.1%). This represents an annual cost for bisphosphonates per one prevented HF, of $A45,250 or $A576 person/year. Compared to 2006 the total number of HFs in Australia according to model 1 will increase in 2011 by 20.1% and in 2021 by 58.8%, but according to model 2 will decrease by 15.5% in 2011 and 27.5% in 2021. Our data suggest that the previously predicted rising trend in HFs in elderly women reversed, but did not so for men. This was coincident with a significant fall in HRT use and increased prescribing of bisphosphonates, which is cost-effective. However caution should be used in attributing causation as this is an ecological study. If trends in HF observed in 2002–2006 continue, the absolute number of HFs in Australia in 2011–2021 will stabilise or decline (which is more likely), despite the rapid ageing of the population. [Copyright &y& Elsevier]

For many years, radical feminists have been warning about the dangers inherent in the use of Hormone Replacement Therapy. Until the release of the Women''s Health Initiative results in 2002, these warnings were dismissed and discredited. In this article I summarise these recent debates. In addition, I also draw upon findings from my doctoral research, the first study in Australia to examine lesbians'' experiences of menopause, to highlight how lesbian voices and radical feminist analyses of the medicalisation of midlife are overlooked and dismissed. For the purpose of this article, I restrict my critique to the issue of Hormone Replacement Therapy. Throughout this article I challenge negative, stereotypical views of lesbians at menopause and suggest that listening to lesbians adds a new dimension to the presently narrow, heterosexist and medicalised view of women at midlife. [Copyright &y& Elsevier]

Synopsis: In April 2004, the Family Court of Australia made the decision that a 13-year-old girl, said to be suffering from gender identity disorder (GID), should be treated as a boy and embark upon a course of female hormone treatment to suppress menstruation. The treatment is expected to change to the administration of male hormones at 16, and surgery after she reaches 18. This decision is in line with a developing trend internationally to normalise the phenomenon of sex reassignment. I shall argue that gender identity disorder is a social construction created by the medical profession, and that it is culturally and historically specific. By imposing a diagnosis and treatment that will cause irreversible changes to an adolescent underaged girl''s body, this decision should be seen as judicial child abuse rather than an enlightened decision in the child''s best interests. [Copyright &y& Elsevier]