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Background Interval breast cancers (BC) are those diagnosed within 24 months of a negative mammogram. This study estimates the odds of being diagnosed with high-severity BC among screen-detected, interval, and other symptom-detected BC (no screening history within 2 years); and explores factors associated with being diagnosed with interval BC. Methods Telephone interviews and self-administered questionnaires were conducted among women (n = 3,326) diagnosed with BC in 2010–2013 in Queensland. Respondents were categorised into screen-detected, interval, and other symptom-detected BCs. Data were analysed using logistic regressions with multiple imputation. Results Compared with screen-detected BC, interval BC had higher odds of late-stage (OR = 3.50, 2.9–4.3), high-grade (OR = 2.36, 1.9–2.9) and triple-negative cancers (OR = 2.55, 1.9–3.5). Compared with other symptom-detected BC, interval BC had lower odds of late stage (OR = 0.75, 0.6–0.9), but higher odds of triple-negative cancers (OR = 1.68, 1.2–2.3). Among women who had a negative mammogram (n = 2,145), 69.8% were diagnosed at their next mammogram, while 30.2% were diagnosed with an interval cancer. Those with an interval cancer were more likely to have healthy weight (OR = 1.37, 1.1–1.7), received hormone replacement therapy (2–10 years: OR = 1.33, 1.0–1.7; > 10 years: OR = 1.55, 1.1–2.2), conducted monthly breast self-examinations (BSE) (OR = 1.66, 1.2–2.3) and had previous mammogram in a public facility (OR = 1.52, 1.2–2.0). Conclusion These results highlight the benefits of screening even among those with an interval cancer. Women-conducted BSE were more likely to have interval BC which may reflect their increased ability to notice symptoms between screening intervals.

Spatial modelling of cancer survival is an important tool for identifying geographic disparities and providing an evidence base for resource allocation. Many different approaches have attempted to understand how survival varies geographically. This is the first scoping review to describe different methods and visualization techniques and to assess temporal trends in publications. The review was carried out using the PRISMA guideline using PubMed and Web of Science databases. Two authors independently screened articles. Articles were eligible for review if they measured cancer survival outcomes in small geographical areas by using spatial regression and/or mapping. Thirty-two articles were included, and the number increased over time. Most articles have been conducted in high-income countries using cancer registry databases. Eight different methods of modelling spatial survival were identified, and there were seven different ways of visualizing the results. Increasing the use of spatial modelling through enhanced data availability and knowledge sharing could help inform and motivate efforts to improve cancer outcomes and reduce excess deaths due to geographical inequalities. Efforts to improve the coverage and completeness of population-based cancer registries should continue to be a priority, in addition to encouraging the open sharing of relevant statistical programming syntax and international collaborations.

Background: This study quantified differences in remaining life expectancy (RLE) among Aboriginal and Torres Strait Islander and other Australian patients with cancer. We assessed how much of this disparity was due to differences in cancer and noncancer mortality and calculated the population gain in life years for Aboriginal and Torres Strait Islanders cancer diagnoses if the cancer survival disparities were removed. Methods: Flexible parametric relative survival models were used to estimate RLE by Aboriginal and Torres Strait Islander status for a population-based cohort of 709,239 persons (12,830 Aboriginal and Torres Strait Islanders), 2005 to 2016. Results: For all cancers combined, the average disparity in RLE was 8.0 years between Aboriginal and Torres Strait Islanders (12.0 years) and other Australians (20.0 years). The magnitude of this disparity varied by cancer type, being >10 years for cervical cancer versus Conclusions: A cancer diagnosis exacerbates the existing disparities in RLE among Aboriginal and Torres Strait Islanders. Addressing them will require consideration of both cancer-related factors and those contributing to noncancer mortality. Impact: Reported survival-based measures provided additional insights into the overall impact of cancer over a lifetime horizon among Aboriginal and Torres Strait Islander peoples.

Estimates of childhood cancer survival are usually reported at 5 years after diagnosis only. Using cases prevalent between 2014 and 2018 from the population-based Australian Childhood Cancer Registry, we used the period method to calculate relative survival up to 20 years post diagnosis by cancer type. Twenty-year relative survival for all childhood cancers combined (n = 14,353) was 83.8% (95% confidence interval [CI] = 82.6%-85.0%). Survival decreased only slightly after 10 years for most childhood cancers, except for some types of brain and liver tumours. These contemporary estimates of long-term survival provide valuable information to assist childhood cancer patients and their families in planning for the future.

Rare cancers collectively account for around a quarter of cancer diagnoses and deaths. However, epidemiological studies are sparse. We describe spatial and geographical patterns in incidence and survival of rare cancers across Australia using a population-based cancer registry cohort of rare cancer cases diagnosed among Australians aged at least 15 years, 2007 to 2016. Rare cancers were defined using site- and histology-based categories from the European RARECARE study, as individual cancer types having crude annual incidence rates of less than 6/100 000. Incidence and survival patterns were modelled with generalised linear and Bayesian spatial Leroux models. Spatial heterogeneity was tested using the maximised excess events test. Rare cancers (n = 268 070) collectively comprised 22% of all invasive cancer diagnoses and accounted for 27% of all cancer-related deaths in Australia, 2007 to 2016 with an overall 5-year relative survival of around 53%. Males and those living in more remote or more disadvantaged areas had higher incidence but lower survival. There was substantial evidence for spatial variation in both incidence and survival for rare cancers between small geographical areas across Australia, with similar patterns so that those areas with higher incidence tended to have lower survival. Rare cancers are a substantial health burden in Australia. Our study has highlighted the need to better understand the higher burden of these cancers in rural and disadvantaged regions where the logistical challenges in their diagnosis, treatment and support are magnified.

PURPOSE: Australian Aboriginal and Torres Strait Islander diagnosed with cancer are known to experience poorer survival, with these survival disparities mainly restricted to the first 2 years after diagnosis. With improved accuracy and completeness of identifying Aboriginal and Torres Strait Islander peoples over the whole study period, our goal was to examine whether the survival disparity among Aboriginal and Torres Strait Islander peoples diagnosed with cancer in Queensland has changed over time. METHODS: Population-based data from the Queensland Cancer Register between 1998 and 2017 for Queenslanders aged 15 years and over at diagnosis (n = 377,963; 1.6% Aboriginal and/or Torres Strait Islander) were used to determine whether this disparity has reduced over time. Flexible parametric survival models incorporating time-varying coefficients were used to examine the association between Aboriginal and Torres Strait Islander status and cancer-specific survival within 5 years of diagnosis. RESULTS: The adjusted 5-year cancer-specific survival rate for Aboriginal and Torres Strait Islander people diagnosed with cancer increased from 60.5% (95% CI 59.2-61.9%) in 1998-2007 to 65.5% (95% CI 64.3-66.6%) in 2008-2017, with the corresponding estimates for other Queenslanders being 66.6% (95% CI 66.4-66.8%) and 70.1% (95% CI 69.9-70.3%). The survival disparity was significant only for the first 3 years since diagnosis for 1998-2007; however, it was significantly (p ≤ 0.02) elevated for all five time intervals for 2008-2017, with similar average hazard ratios (95% CIs) over the 5-year interval after diagnosis of 1.45 (1.36-1.55) for 1998-2007 and 1.42 (1.34-1.50) for 2008-2017. CONCLUSION: Although survival has increased over time, the lack of improvement in the disparity in cancer survival experienced by Aboriginal and Torres Strait Islander cancer patients highlights the urgent need to better understand the multifaceted and completed factors that underlie this gap to guide targeted, evidence-based interventions and support their implementation across the health sector.

OBJECTIVE: Smoking has been associated with a reduced risk of thyroid cancer, but whether the association varies between higher- and lower-risk cancers remains unclear. We aimed to assess the association between smoking and risk of thyroid cancer overall as well as by tumour BRAF mutational status as a marker of potentially higher-risk cancer. DESIGN AND PATIENTS: We recruited 1013 people diagnosed with thyroid cancer and 1057 population controls frequency-matched on age and sex. METHODS: Multivariable logistic regression was used to assess the association overall and in analyses stratified by tumour characteristics. We used sensitivity analysis to assess the potential for selection bias. RESULTS: We found little evidence of an association with current smoking (odds ratio [OR] = 0.93; 95% confidence interval [CI]: 0.69-1.26; current vs. never smoking), but a higher number of pack-years of smoking was associated with a lower risk of thyroid cancer (OR = 0.75; 95% CI: 0.57-0.99; ≥20 pack-years vs. never). However, after correcting for potential selection bias, we observed a statistically significant inverse association between current smoking and risk of thyroid cancer (bias-corrected OR = 0.65; 95% CI: 0.51-0.83). Those with BRAF-positive cancers were less likely to be current smokers than those with BRAF-negative cancers (prevalence ratio: 0.79; 95% CI: 0.62-0.99). CONCLUSION: We found smoking was inversely related to thyroid cancer risk and, in particular, current smoking was associated with a reduced risk of potentially more aggressive BRAF-positive than the likely more indolent BRAF-negative papillary thyroid cancers.

OBJECTIVE: To identify whether supportive care needs vary according to remoteness and area-level socio-economic status and to identify the combinations of socio-demographic, area-level and health factors that are associated with poorer quality of life, psychological distress and severity of unmet supportive care needs. METHODS: Cross sectional data was collected from women with a breast cancer diagnosis (n = 2635) in Queensland, Australia, through a telephone survey including socio-demographic, health, psychosocial and supportive care needs measures. Hierarchical regression and cluster analyses were applied to assess the predictors of unmet need and psychosocial outcomes and to identify socio-demographic and health status profiles of women, comparing their level of unmet needs and psychosocial outcomes. RESULTS: Women living in outer regional areas reported the highest severity of unmet need in the patient care domain. Greater unmet need for health systems and information and patient care was also evident for those in moderately and most disadvantaged areas. Three clusters were identified reflecting (1) older women with poorer health and lower education (19%); (2) younger educated women with better health and private insurance (61%); and (3) physically active women with localised cancer who had completed treatment (20%). Poorer outcomes were evident in the first two of these clusters. CONCLUSIONS: This better understanding of the combinations of characteristics associated with poorer psychosocial outcomes and higher unmet need can be used to identify women with higher supportive care needs early and to target interventions.

Dear Editor, Despite overall favourable prognosis, thin (≤ 1·0 mm) cutaneous melanomas account for 23% of melanoma deaths in the high-risk general population of Queensland, Australia (2005–2009), because of the sheer volume of disease. The prospect of adjuvant systemic therapy has increased the focus on identifying patients with thin melanoma who are at high risk of death, such as through gene expression profiling (GEP), sentinel lymph node biopsy (SLNB) or prognostic models.

Background The literature surrounding survival of patients with multiple primary melanomas (MPM) yields variable and opposing findings, constrained by statistical challenges. Objectives To critically examine the available literature regarding survival of patients with MPM compared with a single primary melanoma and detail statistical methods used. Methods Electronic searches were performed of PubMed, Embase, Web of Science, and Scopus, with cross-checking of references, for the period January 1956 to June 2019. Studies published in English examining survival in patients with multiple melanomas were included. Case studies and small case series were excluded. Results There were 14 studies eligible for inclusion. Conclusions on survival varied markedly depending on the statistical method used. Four studies that accounted for survival bias by partitioning the survival time were included in the quantitative review, with 3 of these reporting a survival disadvantage for MPM, whereas the fourth showed no difference in survival. The pooled hazard ratio was 1.39 (95% confidence interval, 1.07-1.81) but with significant heterogeneity (I2 = 96.8%, Phet Limitations Studies showed significant heterogeneity in methodology. Conclusion When data were analyzed with robust statistical methods, patients with MPM had a survival disadvantage compared with patients with a single primary melanoma.

Purpose This study explores factors that are associated with the severity of breast cancer (BC) at diagnosis. Methods Interviews were conducted among women (n = 3326) aged 20–79 diagnosed with BC between 2011 and 2013 in Queensland, Australia. High-severity cancers were defined as either Stage II–IV, Grade 3, or having negative hormone receptors at diagnosis. Logistic regression models were used to estimate odds ratios (ORs) of high severity BC for variables relating to screening, lifestyle, reproductive habits, family history, socioeconomic status, and area disadvantage. Results Symptom-detected women had greater odds (OR 3.38, 2.86–4.00) of being diagnosed with high-severity cancer than screen-detected women. Women who did not have regular mammograms had greater odds (OR 1.78, 1.40–2.28) of being diagnosed with high-severity cancer than those who had mammograms biennially. This trend was significant in both screen-detected and symptom-detected women. Screen-detected women who were non-smokers (OR 1.77, 1.16–2.71), postmenopausal (OR 2.01, 1.42–2.84), or employed (OR 1.46, 1.15–1.85) had greater odds of being diagnosed with high-severity cancer than those who were current smokers, premenopausal, or unemployed. Symptom-detected women being overweight (OR 1.67, 1.31–2.14), postmenopausal (OR 2.01, 1.43–2.82), had hormone replacement therapy (HRT) 10 years. Conclusion Screen-detected women and women who had mammograms biennially had lower odds of being diagnosed with high-severity breast cancer, which highlighted the benefit of regular breast cancer screening. Women in subgroups who are more likely to have more severe cancers should be particularly encouraged to participate in regular mammography screening.

Background: This study quantifies the number of potentially “avoided”cancer deaths due to differences in 10-year relative survival between three time periods, reflecting temporal improvements in cancer diagnostic and/or treatment practices in Australia. Methods: National population-based cohort of 2,307,565 Australians ages 15 to 89 years, diagnosed with a primary invasive cancer from 1985 to 2014 with mortality follow-up to December 31, 2015. Excess mortality rates and crude probabilities of cancer deaths were estimated using flexible parametric relative survival models. Crude probabilities were then used to calculate “avoided cancer deaths” (reduced number of cancer deaths within 10 years of diagnosis due to survival changes since 1985–1994) for all cancers and 13 leading cancer types. Results: For each cancer type, excess mortality (in the cancer cohort vs. the expected population mortality) was significantly lower for more recently diagnosed persons. For all cancers combined, the number of “avoided cancer deaths” (vs. 1985–1994) was 4,877 (1995–2004) and 11,385 (2005–2014) among males. Prostate (1995–2004: 2,144; 2005–2014: 5,099) and female breast cancer (1,127 and 2,048) had the highest number of such deaths, whereas Conclusions: Screening and early detection likely contributed to the high number of “avoided cancer deaths” for prostate and female breast cancer, whereas early detection remains difficult for lung and pancreatic cancers, highlighting the need for improved preventive and screening measures. Impact: Absolute measures such as “avoided cancer deaths” can provide a more tangible estimate of the improvements in cancer survival than standard net survival measures.

Background: With the improvements in cancer diagnosis and treatment, more patients with cancer are surviving for longer periods than before. This study aims to quantify the proportion cured and median survival time for those who are not cured for major cancers in Australia. Methods: Australian population-based cohort of 2,164,172 cases, ages 15 to 89 years, whose first cancer diagnosis between 1982 and 2014 was one of 22 leading cancers, were followed up to December 2014. Flexible parametric cure models were used to estimate the proportion cured and median survival time for those uncured by age, sex, and spread of disease, and temporal trends in these measures. Results: Cure estimates could be generated for 19 of the 22 cancer types. The unadjusted proportion cured ranged from 5.0% for pancreatic cancer to 90.0% for melanoma. Median survival time for those uncured ranged from 0.35 years for pancreatic cancer to 6.05 years for prostate cancer. Cancers were divided into four groups according to their proportion cured in the 1980s and the degree of improvement over 28 years. Esophageal, stomach, pancreatic, liver, gallbladder, lung, and brain cancer had lower proportion cured and smaller improvements over time. Conclusions: For cancers with poor survival in which little has changed over time either in prolonging life or achieving statistical cure, efforts should be focused on reducing the prevalence of known risk factors and earlier detection, thereby enabling more effective treatment. Impact: Cure models provide unique insights into whether survival improvements are due to prolonging life or through curing the disease.

There is little long-term follow-up information about how the number of melanoma deaths and case fatality vary over time according to the measured thickness of melanoma at diagnosis. This population-based longitudinal cohort study examines patterns and trends in case fatality among 44,531 people in Queensland (Australia) diagnosed with a single invasive melanoma (International Classification of Diseases for Oncology, third revision [ICD-O-3], C44, Morphology 872-879) between 1987 and 2011, including 11,883 diagnosed between 1987 and 1996, with up to 20 years follow-up (to December 2016). The 20-year case fatality increased by thickness, with the percentage of melanoma deaths within 20 years of diagnosis being up to 4.8% for melanomas with measured thickness

This study reports cancer incidence and survival among Aboriginal and Torres Strait Islander children and other Australian children, and assesses changes over time.Data were from the population-based Australian Childhood Cancer Registry. The study comprised children aged under 15 diagnosed between 1997 and 2016 and with mortality follow-up until 31 December 2017. Incidence trends were analysed using JoinPoint regression. Five-year cancer-specific survival was calculated using the semi-complete approach with survival comparisons made using multivariable flexible parametric models.Aboriginal and Torres Strait Islander children accounted for 506 of 13,299 eligible cases (3.8%). Incidence rates for Aboriginal and Torres Strait Islander children across the study period increased by 2.3% annually (95% confidence interval [CI]: +0.6% to +4.0%) and for other Australian children increased by 0.6% annually (95% CI: +0.3% to +0.9%; p = .05). Nonetheless, cancer incidence was consistently lower for Aboriginal and Torres Strait Islander children, with an incidence rate ratio of 0.73 (95% CI: 0.62-0.85; p .01) between 2012 and 2016. Survival for Aboriginal and Torres Strait Islander children with solid tumours was 70.6% (95% CI: 62.5%-77.3%) and for other Australian children was 83.5% (95% CI: 82.3%-84.7%; p.01), with indications of this difference diminishing in recent years.Improvements in identification, particularly in urban areas, most likely accounts for the greater increase in cancer incidence rates among Aboriginal and Torres Strait Islander children. Examination of data on stage at diagnosis and treatment may provide important insights into survival for children with solid tumours.

Background Myeloproliferative neoplasms (MPNs) are a relatively new group of blood cancers arising from genetic mutations in haematopoietic stem cells. Diagnostic delay is associated with thromboses, strokes and heart attacks. We investigated geographic variation in diagnosis and survival for classic MPNs. Methods Data for classic MPNs were obtained from the Australian Cancer Database. Leroux spatial models for incidence and survival were fitted using CARBayes, WinBUGS via R and tests for spatial clustering were conducted. Results The age-standardised incidence rate was 4.9 (95% CI: 4.8-5.0) per 100,000 person-years during 2007-2016 with relative survival of 78% (77%, 79%) at 5 years after diagnosis. Strong evidence of spatial variation in incidence was observed (p Differences between states and territories could not be explained by population rates of genetic testing or the proportion of registered cases with histological evidence. Conclusions Stark spatial differences in incidence rates of classic MPNs suggest that varying diagnosis and registration patterns between states results in under-recognition, and potentially undertreatment. It is imperative that reporting is consistent so that sound evidence is available for efforts to reduce disparities in diagnosis and management. Key messages Early identification of MPNs is crucial, however, strong spatial geographical variation in incidence rates suggest diagnostic and notification practices may not be consistent across the country.

BackgroundAboriginal and Torres Strait Islander Community-Controlled Health Organisations (ACCHOs) provides culturally appropriate primary care for Aboriginal and Torres Strait Islander people in Australia. The population of North Queensland has a higher proportion of Aboriginal and Torres Strait Islander people, a greater population coverage of ACCHOs, and higher cervical screening participation than the Rest of Queensland. The association between regional differences in the use of ACCHOs for cervical screening and variations in screening participation among Aboriginal and Torres Strait Islander women is currently unknown.MethodsThis is a population-based study of 1,107,233 women, aged 20–69 years who underwent cervical screening between 2013 and 2017. Of these women, 132,972 (12%) were from North Queensland, of which 9% were identified as Aboriginal and Torres Strait Islander women (2% Rest of Queensland) through linkage to hospital records. Regional differentials in screening by Aboriginal and Torres Strait Islander status were quantified using participation rate ratios (PRRs) with 95% confidence intervals (CIs) from negative binomial regression models. Logistic regression was used to identify factors associated with Aboriginal and Torres Strait Islander women being screened at ACCHOs.ResultsAboriginal and Torres Strait Islander women from North Queensland (versus) Rest of Queensland had higher odds of screening at ACCHOs after adjusting for age and area-level variables. After adjustment for non-ACCHO variables, the regional differential in screening among Aboriginal and Torres Strait Islander women was significantly higher (PRR 1.28, 95% CI 1.20–1.37) than that among other Australian women [PRR = 1.11 (1.02–1.18)], but was attenuated on further adjustment for ACCHO variables, [PRR = 1.15, (1.03–1.28)] to become similar to the corresponding point estimate for other Australian women [PRR = 1.09, (1.01–1.20)]. However, the significant interaction between Aboriginal and Torres Strait Islander status and region (p < 0.001) remained, possibly reflecting the large cohort size. Screening participation increased with better access to health services for all women.ConclusionsImproving access to primary health care for Aboriginal and Torres Strait Islander women, especially through ACCHOs, may reduce existing disparities in cervical screening participation. Further gains will require greater levels of local community engagement and understanding of the experiences of screened Aboriginal and Torres Strait Islander women to inform effective interventions.

Background: China contributes to almost half of the esophageal cancer cases diagnosed globally each year. However, the prognosis information of this disease in this large population is scarce. Methods: Data on a population-based cohort consisting of residents of Shandong Province, China who were diagnosed with esophageal cancer during the period from 2005 to 2014 were analyzed. The cancer-specific survival rates were estimated using Kaplan–Meier analysis. Discrete-time multilevel mixed-effects survival models were used to investigate socioeconomic status (SES) disparities on esophageal cancer survival. Results: The unadjusted 1-, 3-, and 5-year cause-specific survival rates were 59.6% [95% confidence interval (CI), 59.2%–59.9%], 31.9% (95% CI, 31.5%–32.3%), and 23.6% (95% CI, 23.1%–24.0%), respectively. Patients of blue-collar occupations had higher risk of esophageal cancer–related death than those of white-collar occupations in the first 2 years after diagnosis. Rural patients had higher risk of death than urban patients in the first 3 years after diagnosis. The risks of esophageal cancer–related death among patients living in low/middle/high SES index counties were not different in the first 2 years after diagnosis. However, patients living in high SES index counties had better long-term survival (3–5 years postdiagnosis) than those living in middle or low SES index counties. Conclusions: Socioeconomic inequalities in esophageal cancer survival exist in this Chinese population. Higher individual- or area-level SES is associated with better short-term or long-term cancer survival. Impact: Elucidation of the relative roles of the SES factors on survival could guide interventions to reduce disparities in the prognosis of esophageal cancer.

Survivors of invasive melanoma have an increased risk of developing second primary cancers; however, similar risks associated with in situ melanoma have not been established. We evaluated 39,872 survivors of first primary in situ melanoma diagnosed from 1982 through 2012 in Queensland, Australia. Relative risk of second nonmelanoma primary cancers was estimated from standardized incidence ratios with 95% confidence intervals. A total of 4,823 (12%) in situ melanoma survivors developed a second primary cancer. A small increased risk (6%) compared with the general population was found. In those younger than 50 years, risk was increased by 14% for all cancers combined. In situ melanoma survivors had significantly increased risks of developing lip, thyroid, pancreatic, and brain cancers and decreased risks of head and neck, and lung cancers. Male in situ melanoma survivors had a significantly increased risk of prostate cancer; female survivors had an increased risk of thyroid cancer and lymphoid leukemia. Findings indicate that in situ melanoma may predict the diagnosis of certain second primary cancers. This altered risk may be due to biological, behavioral, or genetic factors or increased medical surveillance, and it requires further investigation, particularly among people younger than 50 years.

Objectives This study will assess the relationship between vitamin D concentration at melanoma diagnosis and melanoma tumor characteristics, in individuals in a high ultraviolet radiation (UVR) environment. Methods We aim to recruit 600 recently diagnosed melanoma patients from Queensland, Australia, a high UVR location with one of the world’s highest melanoma incidence rates. Patients are recruited through general practitioner, skin cancer specialist, dermatological and hospital-based practices. As close as possible to diagnosis, participants provide a blood sample for vitamin D analysis and have their sun exposure/sun protection behavior, melanoma risk factors and dietary vitamin D intake assessed by questionnaire and phone interview. Details of tumor pathology, including tumor level, thickness, and ulceration, are abstracted from cancer registry records. Here, we describe the study methods and present preliminary findings from early participants. Results As of December 2017, we have recruited 128 participants (48% male, mean age 60.2 years, mean Breslow thickness 0.63 mm). Conclusions When complete, this study will give insights into the association between vitamin D at diagnosis and melanoma tumor characteristics whilst adjusting for recent sun exposure and sun protection use. This study may impact military sun exposure and nutrition policies as vitamin D may play a role in melanomagenesis.

The International Agency for Research on Cancer first concluded that alcohol causes cancer in humans in 1988. The World Cancer Research Fund has declared that alcohol causes cancer of the oral cavity, pharynx, larynx, oesophagus (squamous cell carcinoma), female breast, colon, rectum, stomach and liver. It recommended that alcohol be avoided altogether to prevent cancer. We aimed to quantify the impact of reducing alcohol consumption on future cancer incidence in Australia. We used PREVENT 3.01 simulation modelling software to estimate the proportion of cancers that could potentially be prevented over a 25-year period under two hypothetical intervention scenarios and two latency periods (20 and 30 years). Under a scenario where alcohol consumption abruptly ceases, we estimated up to 4% of alcohol-related cancers could be avoided over a 25-year period (~49,500 cancers, depending on assumed latency). If the maximum consumption of all Australian adults was ≤20 g/day (~two Australian standard drinks), up to 2% of alcohol-related cancers could be avoided (~29,600 cancers). The maximum proportions were higher for men (6% for no alcohol consumption; 5% for ≤20 g/day) than women (3%; 1%). The proportion avoidable was highest for oesophageal squamous cell carcinoma (17% no alcohol consumption; 9% ≤20 g/day), followed by cancers of the oral cavity (12%; 5%) and pharynx (11%; 5%). The cancer sites with the highest numbers of potentially avoidable cases were colon in men (11,500; 9,900) and breast in women (14,400; 4,100). Successful interventions to reduce alcohol intake could lead to significant reductions in cancer incidence. This article is protected by copyright. All rights reserved.

Background To estimate trends in the crude probability of death for cancer patients by sex, age and spread of disease over the past 30 years in New South Wales, Australia. Methods Population‐based cohort of 716,501 people aged 15–89 years diagnosed with a first primary cancer during 1985–2014 were followed up to 31 December 2015. Flexible parametric relative survival models were used to estimate the age‐specific crude probability of dying from cancer and other causes by calendar year, sex and spread of disease for all solid tumours combined and cancers of the colorectum, lung, female breast, prostate and melanoma. Results Estimated 10‐year sex, age and spread‐specific crude probabilities of cancer death generally decreased over time for most cancer types, although the magnitude of the decrease varied. For example, out of 100 fifty‐year old men with localized prostate cancer, 12 would have died from their cancer if diagnosed in 1985 and 3 in 2014. Greater degree of spread was consistently associated with higher probability of dying from cancer, although outcomes for lung cancer were consistently poor. For both males and females, the probability of non‐cancer deaths was higher among older patients, those diagnosed with localized cancers and where cancer survival was higher. Conclusion Crude probabilities presented here may be useful in helping clinicians and their patients better understand prognoses and make informed decisions about treatment. They also provide novel insights into the relative contributions that early detection and improved treatments have on the observed temporal patterns in cancer survival., This study provides a more relevant measure of prognosis for cancer patients ‐ crude probabilities of death due to cancer and other causes. Such information may be useful to clinicians and patients making treatment choices based on cancer type, age and stage at diagnosis.

Background Accurate forecasts of cancer incidence, with appropriate estimates of uncertainty, are crucial for planners and policy makers to ensure resource availability and prioritize interventions. We used Bayesian age-period-cohort (APC) models to project the future incidence of cancer in Australia. Methods Bayesian APC models were fitted to counts of cancer diagnoses in Australia from 1982 to 2016 and projected to 2031 for seven key cancer types: breast, colorectal, liver, lung, non-Hodgkin lymphoma, melanoma and stomach. Aggregate cancer data from population-based cancer registries were sourced from the Australian Institute of Health and Welfare. Results Over the projection period, total counts for these cancer types increased on average by 3 % annually to 100 385 diagnoses in 2031, which is a 50 % increase over 2016 numbers, although there is considerable uncertainty in this estimate. Counts for each cancer type and sex increased over the projection period, whereas decreases in the age-standardized incidence rates (ASRs) were projected for stomach, colorectal and male lung cancers. Large increases in ASRs were projected for liver and female lung cancer. Increases in the percentage of colorectal cancer diagnoses among younger age groups were projected. Retrospective one-step-ahead projections indicated both the incidence and its uncertainty were successfully forecast. Conclusions Increases in the projected incidence counts of key cancer types are in part attributable to the increasing and ageing population. The projected increases in ASRs for some cancer types should increase motivation to reduce sedentary behaviour, poor diet, overweight and undermanagement of infections. The Bayesian paradigm provides useful measures of the uncertainty associated with these projections.

It has long been recognized that knowledge of cancer can influence an individual’s lifestyle and health behaviors, and it is hoped that policy makers and medical professionals will use cancer knowledge as a tool in the fight against cancer. However, it is important not only for levels of cancer prevention knowledge to be increased in the community but also for key barriers to subsequent behavioral changes to be identified and removed if the massive cancer burden in China is to be addressed.

Background: Primary liver cancer is a leading cause of cancer deaths worldwide. Global burden varies, reflecting geographical distribution of viral hepatitis. Our objective was to perform a systematic review and meta-analysis of published current trends in incidence of adult liver cancers and histological types worldwide. Methods: This study used systematic searches of PubMed, Embase, CINAHL, and Web of Science databases for English-language peer-reviewed articles published from 1 January 2008 to 01 September 2019. Inclusion criteria were population-based studies of adult liver cancer patients with quantitative estimates of temporal trends in incidence for liver cancers and/or histological types. For multiple studies from the same geographical area, only the publication that reported the most recent trends for the same cancer type and population subgroup was included. Review was conducted per PRISMA guidelines. Two authors independently extracted data and critically assessed studies. Proposed contributors to observed trends were extracted from included articles. Study-specific estimates of the annual percentage change (APC) in incidence rates with 95% confidence intervals (CIs) were pooled using random-effects meta-analysis models. Heterogeneity was measured using the I2 statistics and publication bias evaluated using funnel plots and Egger's tests. Results: Overall, 53 studies met the inclusion criteria, of which 31 were included in the meta-analysis. Overall, pooled APC estimates were +0.8 (95% CI −0.3, +2.0) for liver cancers combined, +2.6 (95% CI +1.2, +4.0) for hepatocellular carcinoma (HCC), and +4.3 (95% CI +2.5, +6.1) for intrahepatic cholangiocarcinoma. Subgroup analyses indicated increasing trends for liver cancers (APC +3.2, 95% CI +2.5, +3.9) and HCC (APC +3.6, 95% CI +2.9, +4.4) in the region of North America/Europe/Australia, whereas corresponding trends were decreasing (APC −1.7, 95% CI −2.2, −1.1) and stable (APC −0.7, 95% CI −1.9, +0.5) in Asia, respectively. Conclusions: Incidence is increasing for adult liver cancers and HCC in Western countries, whereas trends are decreasing in the Asian region, although still remaining high. Our findings highlight the importance of viral hepatitis control and lifestyle interventions to reduce global liver cancer burden. Ongoing surveillance is also vital to detect early shifts in incidence trends.

Purpose: Breast cancer is the most common cancer diagnosed among adolescent and young adult (AYA) females worldwide, but epidemiological patterns unique to this group are often obscured when results are combined with older patients. This study investigates breast cancer incidence and survival among AYA females, including differences by broad stage at diagnosis.Methods: A retrospective, population-based cohort study was conducted using de-identified data for females in Queensland, Australia, aged 15–39 diagnosed with a first primary breast cancer between 1997 and 2014 with follow-up to December 31, 2016. Incidence rate trends were examined with Joinpoint analysis. Cause-specific survival was calculated for key characteristics, and 5-year adjusted hazard ratios (HRs) were estimated from a multivariable flexible parametric model. Results: The study cohort comprised 2337 patients, of whom two-thirds (n = 1565, 67%) were diagnosed with advanced disease (tumor diameter >20 mm, lymph node involvement or presence of distant metastases at diagnosis). Incidence rates of localized tumors decreased by 1.9% per year (95% confidence interval [CI] −3.5% to −0.4%) over the study period, whereas the trend for advanced breast cancers remained stable. Five-year cause-specific survival increased from 85% to 92% for 2011–2014 compared to 1997–2001 (adjusted HR = 0.43, 95% CI = 0.29–0.65). Patients who were Indigenous from disadvantaged areas or diagnosed with advanced stage experienced significantly worse survival. Conclusion: The high proportion of younger females diagnosed with advanced breast cancer should be the focus of future campaigns to improve awareness and earlier detection. While survival has increased over time, further work is required to ensure that this progress is experienced equitably by all patients. Refereed/Peer-reviewed

Globally, 39% of the world's adult population is overweight or obese and 23% is insufficiently active. These percentages are even larger in high-income countries with 58% overweight/obese and 33% insufficiently active. Fourteen cancer types have been declared by the World Cancer Research Fund to be causally associated with being overweight or obese: oesophageal adenocarcinoma, stomach cardia, colon, rectum, liver, gallbladder, pancreas, breast, endometrium, ovary, advanced/fatal prostate, kidney, thyroid and multiple myeloma. Colon, postmenopausal breast and endometrial cancers have also been judged causally associated with physical inactivity. We aimed to quantify the proportion of cancer cases that would be potentially avoidable in Australia if the prevalence of overweight/obesity and physical inactivity in the population could be reduced. We used the simulation modelling software PREVENT 3.01 to calculate the proportion of avoidable cancers over a 25-year period under different theoretical intervention scenarios that change the prevalence of overweight/obesity and physical inactivity in the population. Between 2013 and 2037, 10-13% of overweight/obesity-related cancers in men and 7-11% in women could be avoided if overweight and obesity were eliminated in the Australian population. If everyone in the population met the Australian physical activity guidelines for cancer prevention (i.e. engaged in at least 300 min of moderate-intensity physical activity per week), an estimated 2-3% of physical inactivity-related cancers could be prevented in men (colon cancer) and 1-2% in women (colon, breast and endometrial cancers). This would translate to the prevention of up to 190,500 overweight/obesity-related cancers and 19,200 inactivity-related cancers over 25 years.

Public campaigns encouraging sun protection for skin cancer prevention began in Queensland, Australia, in the early 1980s. We examined recent trends to assess whether earlier evidence of stabilizing melanoma incidence in young people has persisted. Anonymised incidence and mortality data for in situ and invasive melanoma for the 20 years 1995-2014 were obtained from the Queensland Cancer Registry. Time trends were analysed using joinpoint regression. Birth cohort patterns were assessed using age-period-cohort models. Melanoma incidence in Queensland remains the highest recorded in the world (age-standardised incidence of invasive melanoma (2010-2014) = 72/100,000/annum). Over the 20-year period, incidence of in situ melanoma increased in all age groups. Incidence of both thin (≤1mm) and thick (>1mm) invasive melanoma was either stable or decreased in people under 60, while it increased in those aged 60 and above, particularly in men. Age-period-cohort analysis revealed decreasing age-specific incidence of invasive melanoma under 40 years of age, beginning with the birth cohort born around the mid-1960s, with steepest falls for those born around 1980 and later. Age-specific incidence was stable between 40-59 years of age from the 1945 birth cohort onwards. Melanoma mortality over the period was stable or decreased in all groups except in men aged 60 or over. These findings are evidence of real advances in the prevention and early detection of invasive melanoma in this very high-risk population. They make a compelling case for continued public health efforts to reduce the burden of melanoma in susceptible populations. This article is protected by copyright. All rights reserved.

Background To describe trajectories of health-related quality of life (QoL), life satisfaction, and psychological adjustment for men with prostate cancer over the medium to long term and identify predictors of poorer outcomes using growth mixture models. Methods One-thousand sixty-four (82.4% response) men diagnosed with prostate cancer were recruited close to diagnosis and assessed over a 72-month (6-year) period with self-report assessment of health-related QoL, life satisfaction, cancer-related distress, and prostate specific antigen anxiety. Urinary, bowel, and sexual function were also assessed using validated questionnaires. Results Poorer physical QOL was predicted by older age, lower education, lower income, comorbidities, and receiving hormone therapy. Lower life satisfaction was related to younger age, lower income, not being partnered, and comorbidities. Poorer psychological trajectories were predicted by younger age, lower income, comorbidities, and receiving radical prostatectomy or brachytherapy. Better urinary, bowel, and sexual function were related to better global outcomes over time. Anxiety about prostate specific antigen testing was rare. Conclusions Distinct trajectories exist for medium- to long-term QoL, life satisfaction, and psychological adjustment after prostate cancer; with age and socioeconomic deprivation playing a differential role in men's survivorship profile and the impact of functional status on outcomes increasing over time. These results reinforce the need for an appraisal of men's life course in addition to treatment side effects when planning survivorship care after cancer.

Squamous cell carcinoma (SCC) is the second most commonly diagnosed type of skin cancer after basal cell carcinoma.1 Cumulative exposure to ultraviolet radiation has long been established as the strongest risk factor for SCC.2 Family history of any skin cancer also has an independent role in the development of SCC, associated with a fourfold higher risk3 after adjusting for other factors (including self‐reported sun exposure).

Copyright © 2019 Dasgupta, Baade, Aitken, Ralph, Chambers and Dunn. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Background: Previous reviews of geographical disparities in the prostate cancer continuum from diagnosis to mortality have identified a consistent pattern of poorer outcomes with increasing residential disadvantage and for rural residents. However, there are no contemporary, systematic reviews summarizing the latest available evidence. Our objective was to systematically review the published international evidence for geographical variations in prostate cancer indicators by residential rurality and disadvantage. Methods: Systematic searches of peer-reviewed articles in English published from 1/1/1998 to 30/06/2018 using PubMed, EMBASE, CINAHL, and Informit databases. Inclusion criteria were: population was adult prostate cancer patients; outcome measure was PSA testing, prostate cancer incidence, stage at diagnosis, access to and use of services, survival, and prostate cancer mortality with quantitative results by residential rurality and/or disadvantage. Studies were critically appraised using a modified Newcastle-Ottawa Scale. Results: Overall 169 studies met the inclusion criteria. Around 50% were assessed as high quality and 50% moderate. Men from disadvantaged areas had consistently lower prostate-specific antigen (PSA) testing and prostate cancer incidence, poorer survival, more advanced disease and a trend toward higher mortality. Although less consistent, predominant patterns by rurality were lower PSA testing, prostate cancer incidence and survival, but higher stage disease and mortality among rural men. Both geographical measures were associated with variations in access and use of prostate cancer-related services for low to high risk disease. Conclusions: This review found substantial evidence that prostate cancer indicators varied by residential location across diverse populations and geographies. While wide variations in study design limited comparisons across studies, our review indicated that internationally, men living in disadvantaged areas, and to a lesser extent more rural areas, face a greater prostate cancer burden. This review highlights the need for a better understanding of the complex social, environmental, and behavioral reasons for these variations, recognizing that, while important, geographical access is not the only issue. Implementing research strategies to help identify these processes and to better understand the central role of disadvantage to variations in health outcome are crucial to inform the development of evidence-based targeted interventions.

The incidence of thyroid cancer has rapidly increased, and ecological evidence suggests this is due in some part to over-diagnosis. Understanding pathways to diagnosis could help determine whether unnecessary diagnosis can be avoided.A population-based sample (n = 1007) of thyroid cancer patients diagnosed between July 2013 and August 2016 was recruited from Queensland, Australia (response rate 67%). Information from structured telephone interviews was used to describe diagnostic pathways for thyroid cancer, to investigate factors associated with diagnostic pathways, and to assess the most prevalent modes of diagnoses by which the lowest-risk, potentially over-diagnosed thyroid cancers (intrathyroidal microcarcinomas) are detected.Only 38% of participants presented with symptoms potentially related to thyroid cancer. Older age at diagnosis was associated with a lower prevalence of symptomatic diagnosis (prevalence ratio [PR] = 0.46 [confidence interval (CI) 0.31-0.68] for 70-79 vs.30 years), as was frequent medical contact, while living in rural/regional areas was associated with a higher prevalence of symptomatic diagnosis (PR = 1.17 [CI 1.00-1.37] for rural/regional areas vs. major cities). Symptomatic diagnosis also occurred more for those whose tumors had adverse histopathological features (larger size, lymph node involvement, lymphovascular invasion). The likelihood of diagnosis of intrathyroidal microcarcinomas was greatest for those having surgical resection or monitoring for benign thyroid disease (PR = 3.87 [CI 2.81-5.32] and PR = 2.21 [CI 1.53-3.18], respectively).A minority of newly detected thyroid cancer cases were diagnosed because of symptoms. Access to medical care and factors related to cancer aggressiveness were associated with how diagnoses occurred. The likelihood of diagnosing the lowest-risk thyroid cancers was higher in situations related to management of other thyroid conditions. Adherence to thyroid management guidelines could reduce some thyroid cancer over-diagnosis, but ultimately better diagnostic tools are needed to differentiate between indolent cancers and those of clinical significance.

Background While net probabilities of death in the relative survival framework ignore competing causes of death, crude probabilities allow estimation of the real risk of cancer deaths. This study quantifies temporal trends in net and crude probabilities of death. Methods Australian population-based cohort of 2,015,903 people aged 15-89 years, diagnosed with a single primary invasive cancer from 1984 to 2013 with mortality follow-up to 31 December 2014. Survival was analyzed with the cohort method. Flexible parametric relative survival models were used to estimate both probability measures by diagnosis year for all cancers and selected leading sites. Results For each site, excess mortality rates reduced over time, especially for prostate cancer. While both the 10-year net and crude probability of cancer deaths decreased over time, specific patterns varied. For example, the crude probability of lung cancer deaths for males aged 50 years decreased from 0.90 (1984) to 0.79 (2013); whereas the corresponding probabilities for kidney cancer were 0.64 and 0.18 respectively. Patterns for crude probabilities of competing deaths were relatively constant. Although for younger patients, both net and crude measures were similar, crude probability of competing deaths increased with age, hence for older ages net and crude measures were different except for lung and pancreas cancers. Conclusions The observed reductions in probabilities of death over three decades for Australian cancer patients are encouraging. However, this study also highlights the ongoing mortality burden following a cancer diagnosis, and the need for continuing efforts to improve cancer prevention, diagnosis and treatment.

Background Hysterectomy has been associated with increased thyroid cancer risk but whether this reflects a biological link or increased diagnosis of indolent cancers due to greater medical contact remains unclear. Methods We recruited 730 women diagnosed with thyroid cancer and 785 age-matched population controls. Multivariable logistic regression was used to assess the association overall, and by tumour BRAF mutational status as a marker of potentially higher-risk cancers. We used causal mediation analysis to investigate potential mediation of the association by healthcare service use. Results Having had a hysterectomy was associated with an increased risk of thyroid cancer (odds ratio [OR] = 1.45, 95 % confidence interval [CI] 1.07–1.96). When stratified by indication for hysterectomy, the risk appeared stronger for those who had a hysterectomy for menstrual disorders (OR = 1.67, 95 % CI 1.17–2.37) but did not differ by tumour BRAF status. Approximately 20 % of the association between hysterectomy and thyroid cancer may be mediated by more frequent use of healthcare services. Conclusions The observed increased risk of thyroid cancer among those with hysterectomy may be driven, at least partly, by an altered sex steroid hormone milieu. More frequent healthcare service use by women with hysterectomy accounts for only a small proportion of the association.

Despite improvements in cancer survival across many developed countries, it is unclear how survival is changing over time in small areas. This study investigated changes in breast and colorectal cancer survival across 478 areas over 11 years (2001–2011), and the influence of early diagnosis on changes. Queensland Cancer Registry data were analysed using an introduced Bayesian spatio-temporal flexible parametric relative survival model. All areas showed survival improvements between 2001–2003 and 2008–2011. The median absolute 5-year survival improvement for localised breast cancer was small (1.8%), compared to advanced (4.8%) and unknown (7.9%) breast cancer, as well as localised (2.6%), advanced (5.0%) and unknown (4.8%) colorectal cancers. Improvements in non-diagnostic factors, such as patient treatment and management, appear to be the main influence on recent survival increases for breast and colorectal cancers. Important inequalities in cancer survival between small areas remain.

Aim We examined how sociodemographic, clinical and area-level factors are related to short-term prostate cancer mortality versus mortality from other causes, a crucial distinction for this disease that disproportionately affects men older than 60 years. Methods We applied competing risk survival models to administrative data from the Queensland Cancer Registry (Australia) for men diagnosed with prostate cancer between January 2005 and July 2007, including stratification by Gleason score. Results The men (n = 7393) in the study cohort had a median follow-up of 5 years 3 months. After adjustment, remoteness and area-level disadvantage were not significantly associated with prostate cancer mortality. However, area-level disadvantage had a significant negative relationship with hazard of death from a cause other than prostate cancer within 7 years; compared with those living in the most advantaged areas, the likelihood of mortality was higher for those in the most disadvantaged (subhazard ratio [SHR] = 1.39; 95% CI, 1.01–1.90; P = 0.041), disadvantaged (SHR = 1.51; 95% CI, 1.14–2.00; P = 0.004), middle (SHR = 1.34; 95% CI, 1.02–1.75; P = 0.034) and advantaged areas (SHR = 1.44; 95% CI, 1.09–1.89; P = 0.009). Those with Gleason score of 7 and higher had a lower hazard of prostate cancer mortality if they were living with a partner, whereas those with lower Gleason scores and living a partner had lower hazards of other-cause mortality. Conclusions Understanding why men living in more disadvantaged areas have higher risk of non-prostate cancer mortality should be a priority.

PURPOSE: To evaluate changes in cancer mortality burden over time by assessing temporal trends in life expectation for Australian residents diagnosed with cancer. METHODS: The study cohort consisted of all people diagnosed with cancer in the period 1990-2000 and aged 15-89 years (n = 1,275,978), with mortality follow-up to 31 December 2010. Flexible parametric survival models incorporating background age-sex-year-specific population mortality rates were applied to generate the observed survival curves for all cancers combined and selected major cancer types. Predicted values of loss of life expectancy (LOLE) in years were generated and then averaged across calendar year and age group (15-49, 50-69 and 70-89 years) or spread of disease (localized, regional, distant, unknown). RESULTS: The greatest LOLE burden was for lung cancer (14.3 years per diagnosis) and lowest for melanoma (2.5 years). There was a significant decrease in LOLE over time (-0.13 LOLE per year) for all cancers combined. Decreases were also observed for female breast cancer (-0.21), prostate cancer (-0.17), colorectal cancer (-0.08), melanoma (-0.07) and stomach cancer (-0.02), with slight increases for lung cancer (+0.04). When restricted to the sub-cohort from New South Wales with spread of disease information, these decreases in LOLE were primarily among cancers categorized as localized or regional spread at diagnosis. CONCLUSIONS: In Australia, persons diagnosed with cancer have a steadily improving outlook that exceeds that expected by general improvement in population life expectancy. The overall improvement is observed in persons with localized or regional cancers but not in those with advanced cancers, findings which encourage earlier diagnosis.

Aim Our previous population-based research found prophylactic surgery (hysterectomy and bilateral salpingo-oophorectomy [BSO]) halved the mortality risk for premenopausal breast cancer patients. Here we aim to replicate findings in a Western Australia dataset. Method Data from the Western Australia Cancer Registry of 15 395 women 20–79 years diagnosed with primary breast cancer (1997–2011) was categorized into four groups: neither hysterectomy nor BSO, hysterectomy only, BSO only, or hysterectomy + BSO. We fitted flexible parametric breast cancer–specific and overall survival models with 95% confidence intervals (also known as Royston–Parmar models) to assess the impact of prophylactic surgery. Results A total of 12 630 (82.0%) patients had no surgery, 1799 (11.7%) had a hysterectomy only, 337 (2.2%) had BSO only and 629 (4.1%) had both a hysterectomy and BSO. For all-causes mortality, unadjusted 10-year survival was highest for women who had either a hysterectomy + BSO (84.7%) or a hysterectomy only (84.2%). After adjusting for covariates, the survival advantage compared to women without any surgery remained significant for the hysterectomy only group (hazard ratio [HR] = 0.89; 95% confidence interval [CI], 0.81–0.98; P = 0.02). A similar pattern emerged in breast cancer–specific survival with significantly improved survival for women who had a hysterectomy only (HR = 0.83; 95% CI, 0.74–0.94; P = 0.003). However, for non-breast cancer-related survival, having a BSO alone increased risk of death (HR = 1.83; 95% CI, 1.14–2.93; P = 0.01). Conclusion We observed significantly improved overall and breast cancer-specific survival among women who had a hysterectomy only, but increased non-breast cancer-related risk after BSO only. Breast cancer patients must weigh up pros and cons of prophylactic surgery.

Objective The survival benefits of having a partner for all cancers combined is well recognized, however its prognostic importance for individual cancer types, including competing mortality causes, is less clear. This study was undertaken to quantify the impact of partner status on survival due to cancer-specific and competing mortality causes. Methods Data were obtained from the population-based Queensland Cancer Registry on 176,050 incident cases of ten leading cancers diagnosed in Queensland (Australia) from 1996 to 2012. Flexible parametric competing-risks models were used to estimate cause-specific hazards and cumulative probabilities of death, adjusting for age, stage (breast, colorectal and melanoma only) and stratifying by sex. Results Both unpartnered males and females had higher total cumulative probability of death than their partnered counterparts for each site. For example, the survival disadvantage for unpartnered males ranged from 3% to 30% with higher mortality burden from both the primary cancer and competing mortality causes. The cause-specific age-adjusted hazard ratios were also consistent with patients without a partner having increased mortality risk although the specific effect varied by site, sex and cause of death. For all combined sites, unpartnered males had a 46%, 18% and 44% higher risk of cancer-specific, other cancer and non-cancer mortality respectively with similar patterns for females. The higher mortality risk persisted after adjustment for stage. Conclusions It is important to better understand the mechanisms by which having a partner is beneficial following a cancer diagnosis, so that this can inform improvements in cancer management for all people with cancer.

The aim of this systematic review was to examine variations in psychosocial outcomes by residential location and Indigenous status in women diagnosed with breast cancer (BC) in Australia. Systematic searches were undertaken using multiple databases covering articles between 1 January 1990 and 1 March 2015 focusing on adult women with BC in an Australian setting and measuring quality of life (QOL), psychological distress or psychosocial support. Thirteen quantitative and three qualitative articles were included. Two quantitative and one qualitative article were rated high quality, seven moderate and the remaining were low quality. No studies examining inequalities by Indigenous status were identified. Non-metropolitan women were more likely to record lower QOL relating to breast cancer-specific concerns and reported a lack of information and resources specific to their needs. Continuity of support, ongoing care and access to specialist and allied health professionals were major concerns for non-metropolitan women. Non-metropolitan women identified unmet needs in relation to travel, fear of cancer recurrence and lack of psychosocial support. Overall, there was a lack of evidence relating to variations in psychosocial outcomes for women with BC according to residential status or Indigenous status. While the review identified some specific concerns for non-metropolitan women with BC, it was limited by the lack of good quality studies using standardised measures. Copyright © 2016 John Wiley & Sons, Ltd.

With increasing incidence and mortality, cancer is the leading cause of death in China and is a major public health problem. Because of China's massive population (1.37 billion), previous national incidence and mortality estimates have been limited to small samples of the population using data from the 1990s or based on a specific year. With high-quality data from an additional number of population-based registries now available through the National Central Cancer Registry of China, the authors analyzed data from 72 local, population-based cancer registries (2009-2011), representing 6.5% of the population, to estimate the number of new cases and cancer deaths for 2015. Data from 22 registries were used for trend analyses (2000-2011). The results indicated that an estimated 4292,000 new cancer cases and 2814,000 cancer deaths would occur in China in 2015, with lung cancer being the most common incident cancer and the leading cause of cancer death. Stomach, esophageal, and liver cancers were also commonly diagnosed and were identified as leading causes of cancer death. Residents of rural areas had significantly higher age-standardized (Segi population) incidence and mortality rates for all cancers combined than urban residents (213.6 per 100,000 vs 191.5 per 100,000 for incidence; 149.0 per 100,000 vs 109.5 per 100,000 for mortality, respectively). For all cancers combined, the incidence rates were stable during 2000 through 2011 for males (+0.2% per year; P = .1), whereas they increased significantly (+2.2% per year; P < .05) among females. In contrast, the mortality rates since 2006 have decreased significantly for both males (-1.4% per year; P < .05) and females (-1.1% per year; P < .05). Many of the estimated cancer cases and deaths can be prevented through reducing the prevalence of risk factors, while increasing the effectiveness of clinical care delivery, particularly for those living in rural areas and in disadvantaged populations.

Aims This study quantifies geographic inequities in loss of life expectancy (LOLE) by area-level socioeconomic status (SES) and accessibility to treatment. Methods Analysis was conducted using a population-based cancer-registry cohort (n = 371,570) of Queensland (Australia) residents aged 50−89 years, diagnosed between 1997–2016. Flexible parametric survival models were used to estimate LOLE by area-level SES and accessibility for all invasive cancers and the five leading cancers. The gain in life years that could be achieved if all cancer patients experienced the same relative survival as those in the least disadvantaged-high accessibility category was estimated for the 2016 cohort. Results For all invasive cancers, men living in the most disadvantaged areas lost 34 % of life expectancy due to their cancer diagnosis, while those from the least disadvantaged areas lost 25 %. The corresponding percentages for women were 33 % and 23 %. Accessibility had a lower impact on LOLE than SES, with patients from low accessibility areas losing 0–4 % more life expectancy than those from high accessibility areas. For cancer patients diagnosed in 2016 (n = 24,423), an estimated 101,387 life years will be lost. This would be reduced by 19 % if all patients experienced the same relative survival as those from the least disadvantaged-high accessibility areas. Conclusion The impact of a cancer diagnosis on remaining life expectancy varies by geographical area. Establishing reasons why area disadvantage impacts on life expectancy is crucial to inform subsequent interventions that could increase the life expectancy of cancer patients from more disadvantaged areas.

BACKGROUND: Cervical cancer incidence and mortality have declined in Australia since the implementation of a national cervical screening program in 1991, however, disparities in both measures between Indigenous and non-Indigenous women remain. We describe spatial and temporal changes in Pap test participation rates by Indigenous status for Queensland (Australia). Analyses were done in the context of renewed screening program in December 2017. METHODS: Population-based study 2,132,925 Queensland female residents, aged 20-69 years who underwent cervical screening from 2008 to December 2017; 47,136 were identified as Indigenous through linkage to hospital records. Bayesian spatial models were used to generate smoothed estimates of participation across 528 small areas during 2008-2012 and 2013-2017 compared to the overall state average (2008-2017). Results are presented as thematic maps and graphs showing the associated uncertainty of the estimates. RESULTS: Overall screening participation decreased over time for both Indigenous and non-Indigenous women. Strong spatial patterns were evident in five-year participation for both groups. Indigenous women had significantly lower participation than the Queensland average for ≥ 88 % of areas during both reporting periods whereas corresponding estimates were lower than average for

Background : Loss of life expectancy (LOLE) provides valuable insights into the impact of cancer. We evaluated the temporal trends in LOLE for Australian cancer patients and the gain in life years for recently diagnosed patients due to survival improvements. Methods : Analysis was conducted using an Australian population-based cohort (n = 1,865,154) aged 50–89 years, who were primarily diagnosed with one of 19 leading cancers between 1982–2015. Flexible parametric survival models were used to estimate LOLE and the proportion of life lost (POLL) by year, age group, sex, and, for New South Wales only, spread of disease. The total years of LOLE and gain in life years due to survival improvements were estimated for those diagnosed in 2014. Results : For 19 cancers combined, LOLE and POLL were significantly lower for more recent diagnoses. Cancer-specific temporal trends were consistent by age, sex, and spread of disease (where relevant) although the magnitude varied. Prostate, kidney, or non-Hodgkin lymphoma experienced the largest decreases in POLL over time. For the 2014 diagnoses, an estimation of 403,094 life years lost will be caused by the 19 cancers. With the increase in cancer survival over time, the 2014 cohort will gain an extra 432,588 life years (52 %) compared to that experienced by the 1982 cohort. Conclusion : While reduced impact of a cancer diagnosis on LOLE over time is encouraging, the growing number of cancer survivors in Australia is likely to pose complex challenges for cancer patients, their care givers, and health-care systems.

Background: Stage of cancer at diagnosis is one of the strongest predictors of survival and is essential for population cancer surveillance, comparison of cancer outcomes and to guide national cancer control strategies. Our aim was to describe, for the first time, the distribution of cases by stage at diagnosis and differences in stage-specific survival on a population basis for a range of childhood solid cancers in Australia. Methods: The study cohort was drawn from the population-based Australian Childhood Cancer Registry and comprised children (

Objectives This study describes and compares the unmet supportive care needs between Indigenous and Non-Indigenous people with cancer. Methods Data from two cross-sectional supportive care needs studies were matched in a 1:1 ratio for Indigenous (n = 125) and Non-Indigenous (n = 125) Australian adults diagnosed with cancer. Descriptive statistics were used to compare type and prevalence of 24 need items measured by the SCNS-SF34 and SCNAT-IP. Results A higher proportion of Non-Indigenous participants compared to Indigenous participants reported having any moderate-to-high level of unmet needs (70% vs. 54%, p = 0.013) and the difference was consistently observed across non-matched characteristics. While concerns for caregivers, fear of recurrence and pain were central needs for both Indigenous participants and Non-Indigenous participants, there were some key differences in the specific unmet needs between groups. Physical issues including doing usual daily activities and dealing with fatigue were the top priorities for Non-Indigenous people, while money worries, dealing with psychological issues such as how to keep their spirit strong or hope about their future appeared to be priorities for Indigenous people. Conclusions Variations in the unmet supportive care needs between Indigenous and Non-Indigenous people with cancer may guide health professionals to target specific needs when preparing care plans.

© 2018 Goodwin, March, Ireland, Crawford-Williams, Ng, Baade, Chambers, Aitken and Dunn. Background: Geographical disparity in colorectal cancer (CRC) survival rates may be partly due to aging populations and disadvantage in more remote locations; factors that also impact the incidence and outcomes of other chronic health conditions. The current study investigates whether geographic disparity exists amongst previously diagnosed health conditions in CRC patients above and beyond age and area-level disadvantage and whether this disparity is linked to geographic disparity in CRC survival. Methods: Data regarding previously diagnosed health conditions were collected via computer-assisted telephone interviews with a cross-sectional sample of n = 1,966 Australian CRC patients between 2003 and 2004. Ten-year survival outcomes were acquired in December 2014 from cancer registry data. Multivariate logistic regressions were applied to test associations between previously diagnosed health conditions and survival rates in rural, regional, and metropolitan areas. Results: Results suggest that only few geographical disparities exist in previously diagnosed health conditions for CRC patients and these were largely explained by socio-economic status and age. Living in an inner regional area was associated with cardio-vascular conditions, one or more respiratory diseases, and multiple respiratory diagnoses. Higher occurrences of these conditions did not explain lower CRC-specific 10 years survival rates in inner regional Australia. Conclusion: It is unlikely that health disparities in terms of previously diagnosed conditions account for poorer CRC survival in regional and remote areas. Interventions to improve the health of regional CRC patients may need to target issues unique to socio-economic disadvantage and older age.

Background Little is known about the impact of comorbidity on cervical cancer survival in Australian women, including whether Indigenous women’s higher prevalence of comorbidity contributes to their lower survival compared to non-Indigenous women. Methods Data for cervical cancers diagnosed in 2003–2012 were extracted from six Australian state-based cancer registries and linked to hospital inpatient records to identify comorbidity diagnoses. Five-year cause-specific and all-cause survival probabilities were estimated using the Kaplan-Meier method. Flexible parametric models were used to estimate excess cause-specific mortality by Charlson comorbidity index score (0,1,2+), for Indigenous women compared to non-Indigenous women. Results Of 4,467 women, Indigenous women (4.4%) compared to non-Indigenous women had more comorbidity at diagnosis (score 1: 24.2% vs. 10.0%) and lower five-year cause-specific survival (60.2% vs. 76.6%). Comorbidity was associated with increased cervical cancer mortality for non-Indigenous women, but there was no evidence of such a relationship for Indigenous women. There was an 18% reduction in the Indigenous: non-Indigenous hazard ratio (excess mortality) when comorbidity was included in the model, yet this reduction was not statistically significant. The excess mortality for Indigenous women was only evidentamong those without comorbidity (Indigenous: non-Indigenous HR 2.5, 95%CI 1.9–3.4), indicating that factors other than those measured in this study are contributing to the differential. In a subgroup of New South Wales women, comorbidity was associated with advanced-stage cancer, which in turn was associated with elevated cervical cancer mortality. Conclusions Survival was lowest for women with comorbidity. However, there wasn’t a clear comorbidity-survival gradient for Indigenous women. Further investigation of potential drivers of the cervical cancer survival differentials is warranted. Impact The results highlight the need for cancer care guidelines and multidisciplinary care that can meet the needs of complex patients. Also, primary and acute care services may need to pay more attention to Indigenous Australian women who may not obviously need it (i.e. those without comorbidity) Refereed/Peer-reviewed