Cancer

A national survey found that many respondents were under the false impression that solariums are safer since regulations were introduced to ban their use by certain vulnerable groups of people, backing calls for a complete nationwide ban on solariums.

Suzanne J Dobbinson · Angela Volkov · Melanie A Wakefield

A cohort comparison of colorectal cancer patient data from the National Bowel Cancer Screening Program register and the South Australian Cancer Registry found that cancers were diagnosed at a significantly earlier stage in people invited to the screening program compared with those who were not invited. A further shift towards earlier stage was seen in those who participated in screening and those with positive test results compared with the rest of the study population.

Stephen R Cole BSc, MPH · Graeme R Tucker BSc · Joanne M Osborne MPH · Susan E Byrne BN · Peter A Bampton MD, FRACP, AGAF · Robert J L Fraser MB BS, FRACP, PhD · Graeme P Young MD, FRACP, FTSE

Introducing the MJA Ethics series, the series editor outlines some of the ethical challenges for medicine and society in the 21st century. The long-unresolved ethical conflicts surrounding the issue of providing “futile” care are discussed from clinical, ethical and legal perspectives, in this, the first instalment of the series.

Dominic J C Wilkinson MB BS, DPhil, FRACP

Deciding when to stop treatment can be a challenging task for health professionalsWith advances of modern medicine come increased expectations from society, and dilemmas regarding when to stop treatment are becoming increasingly common. The Medical Board of Australia code of conduct explicitly states “you do not have a duty to try to prolong life at all cost. However, you do have a duty to know ...

Bogda Koczwara BM BS, MBioethics, FRACP

We need to pay attention to the reasons why treatment is judged to be futileWhen doctors are confronted with making treatment decisions in the context of a terminally ill patient, the way forward is often difficult and confused. Bringing an ethics perspective to bear on the problem can help to resolve what the essential issues are, in turn enabling a clearer path to appropriate decisions ...

Dominic J C Wilkinson MB BS, DPhil, FRACP

To the Editor: In September 2012, the Australian Institute of Health and Welfare (AIHW) released its report on cancer survival and prevalence in Australia from 1982 to 2010, incorporating incidence and mortality estimates for all malignancies reported to Australian cancer registries.1 Cancer is a leading cause of morbidity and mortality in Australia, accounting for about 20% of the total disease burden and 30% of deaths.2 Liver cancer ...

Jennifer H MacLachlan · Benjamin C Cowie

Australian cancer care is among the best provided in the world. Yet, many cancer patients choose to either forgo aspects of conventional treatment or seek unproven complementary therapies. My own recent cancer treatment prompted me to wonder whether these choices may, at least in part, be due to the failure of Western medicine to address the psychological ...

Tanya L Hall BMed, FRANZCP

ALTHOUGH THIS compendium cannot possibly encompass the depth and breadth of complementary and alternative medicines (CAMs) as they are practised today, it does provide an array of interesting insights into what is a relatively uncharted field within the “modern occidental” medical community.Aligned with the background of the editors — Ian Olver and Monica Robotin — from the Cancer Council Australia, Perspectives has a clear focus ...

Hosen Kiat

Making cancer drugs affordable requires coherent policy and cannot be left to market forcesMelanoma is 10 times more common in Australia than in most countries,1 and kills more than 1300 Australians every year.2 The good news is that we now have effective drug treatments for metastatic melanoma. Two drugs, ipilimumab3,4 and vemurafenib,5 are now approved by the United States Food and Drug Administration and the Australian Therapeutic ...

Richard F Kefford AM, PhD, FRACP

Information from clinical trials informs our treatment of breast cancer, as it does that of many other common diseases. The trials establish “ideal” management, but the relevance of this information to any individual patient varies because the strict inclusion criteria used for trials exclude many important groups in the community. In breast cancer trials, the old, the poor and the rural-dwelling are often underrepresented. So, ...

Annette Katelaris MB BS, MPH, FRACGP

To the Editor: Although both sides of the debate about screening mammography1,2 acknowledge the mortality benefit due to screening and the risk of overdiagnosis, the magnitude and relative value of these need further clarification and reflection. In calculating the number of breast cancer deaths averted using a relative risk reduction of 35%, Roder and Olver overstate the benefit. Other estimates of effect are lower (eg, ...

Alexandra L Barratt · Paul P Glasziou

Objectives: To estimate the incidence of metastatic breast cancer (MBC) in Australian women with an initial diagnosis of non-metastatic breast cancer.Design, setting and participants: A population-based cohort study of all women with non-metastatic breast cancer registered on the New South Wales Central Cancer Register (CCR) in 2001 and 2002 who received care in a NSW hospital.Main outcome measures: 5-year cumulative incidence ...

Sarah J Lord MB BS, MS, FRACGP · M Luke Marinovich BA, MPH · Jillian A Patterson BSc, MBiostats · Nicholas Wilcken MB BS, PhD, FRACP · Belinda E Kiely MB BS, FRACP · Val Gebski BA, MStats, FRANZCR(Hons) · Sally Crossing AM, BEc · David M Roder AM, MPH, DDSc · Melina Gattellari PhD, MPH, BSc(Psychol) · Nehmat Houssami MB BS, PhD, FAFPHM

Objectives: To quantify the effect of previous false-positive mammogram results on rescreening rates in a population of women participating in the BreastScreen WA (BSWA) program.Design and participants: Retrospective cohort study of women aged 50–69 years who received free screening mammograms at BSWA between 1 January 1995 and 31 December 2007.Main outcome measures: Percentages of women attending rescreening, and risk ratios for rescreening.Results: ...

Marcus J H Sim · Siva Prema Siva · Intan S Ramli · Lin Fritschi MB BS, PhD, FAFPHM · Janette Tresham BSc(Agric) · Elizabeth J Wylie MB BS, FRANZCR

While the government’s implementation of the National Bowel Cancer Screening Program remains stalled, Australians are dying unnecessarilyOne in 12 Australians will develop colorectal cancer (CRC), and it is the second most common cause of cancer death. It is one of only three cancers for which organised population screening is recommended, and it is the first to ...

Ian N Olver MD, PhD, FRACP · Graeme P Young MD, FRACP, AGAF

Objectives: To determine current colorectal cancer (CRC) screening rates and the level of adherence to screening guidelines at a community level.Setting: A cross-sectional cohort of at-risk people aged 56–88 years randomly selected from the Hunter Community Study (HCS), Australia.Main outcome measures: Proportion ever reporting undertaking any CRC testing; current screening ...

Ryan J Courtney BPsych(Hons) · Christine L Paul PhD · Robert W Sanson-Fisher PhD, MClinPsych · Finlay A Macrae MD, FRACP, FRCP · Mariko L Carey PhD · John R Attia MD, PhD · Mark A McEvoy MClinEpi

Objectives: To identify barriers to and facilitators of colorectal cancer (CRC) screening participation among different cultural subgroups in South Australia, and to describe how these might be shared or be distinct across these groups.Design, participants and setting: Qualitative study using individual interviews in Adelaide, South Australia, between July 2009 and December 2010. ...

Sara Javanparast MD, PhD · Paul R Ward PhD · Stacy M Carter MPH(Hons), PhD · Carlene J Wilson BA(Hons), MBA, PhD

Reconsidering the place of disease monitoring after treatmentWomen who have completed primary chemotherapy for ovarian cancer commonly have serial assessment of the serum tumour marker cancer antigen 125 (CA-125).1 This practice has been based on the ...

Paul Harnett MB BS(Hons), FRACP, PhD · Ian H Kerridge BMed(Hons), FRCPA, FRACP · Christopher F C Jordens BA(Hons), MPH, PhD · Kim Hobbs BSocStud(Hons) · Catherine Mason MB BS, MPH, FRANZCP · Bronwen M Morrell BA(Hons)

David Wigg MB BS, MD, PhD, FRCR, FRANZCR,made a considerable contribution and left a lasting legacy to radiation oncology and radiobiology in Australia. David was born in Adelaide on 14 September 1933 into a family with strong medical ...

Margaret M Wallington · Linda M Swaney

Incidence rates of cancer vary over time;1 this is called a “period effect”. Incidence rates of cancer also tend to increase with age;1 this is called an “age effect”. Another time variable that is associated with the incidence of cancer is year of birth of the patient — the “cohort effect”. Many authors have used real data to emphasise the importance of cohort effects for assessing trends in incidence.2,3 Here, I present a simple, hypothetical example to illustrate the cohort effect. Consider the data shown in the Box. In this hypothetical population, the age groups are 0–29, 30–59 and 60–89 years and everyone dies on their 90th birthday. The Box contains data for three years (1940, 1970 and 2000). For each year and age group, n denotes the size of the population, P denotes the probability of being diagnosed with cancer in the year, and EI denotes the expected incidence (the expected number of new cases of cancer), which is calculated with the formula: EI = n × P In 1940, in the 0–29-year age group, there were 600 people, the probability of being diagnosed with cancer was 0.01, and the EI was thus 600 × 0.01 = 6. In the whole population, 41 of 1000 people are expected to be diagnosed with cancer. In this scenario, a wonder drug that prevents cancer was discovered in 1941. However, it must be administered in utero, so only people born since 1941 can benefit. In 1970, assume there were 100 people aged 0–29 years. In this group, the probability of being diagnosed with cancer was 0, because they were born since 1941, and the EI was 0. The 600 people, who were aged 0–29 years in 1940, were aged 30–59 years in 1970; the probability of being diagnosed with cancer in that age group was 0.05, as in 1940; so the EI was 30. In the whole population, 90 of 1000 people are expected to be diagnosed with cancer in 1970. In 2000, only those aged 60–89 years were born before 1941. Overall, 120 of 1000 people are expected to be diagnosed with cancer. Thus, in 1940 there would be 41 new cases in a population of 1000, in 1970 there would be 90 new cases in a population of 1000, and in 2000 there would be 120 new cases in a population of 1000. This trend suggests that things will be worse in 2030. In fact, the disease will disappear in 2030. A hypothetical population that illustrates the cohort effect 1940 1970 2000 Age (years) n P EI n P EI n P EI 0–29 600 0.01 6 100 0 0 300 0 0 30–59 300 0.05 15 600 0.05 30 100 0 0 60–89 100 0.20 20 300 0.20 60 600 0.20 120 0–89 1000 41 1000 90 1000 120 In this scenario, n denotes the population size, P denotes the probability of being diagnosed with cancer in the year and EI denotes the expected incidence of cancer, and a drug that prevents cancer when administered in utero was discovered in 1941.

Terence M Mills