Cancer

Climate change affects skin health and skin diseases; mitigation and adaptation strategies are required and are time-critical

Austen Anderson · Fiona Bruce · H Peter Soyer · Crystal Williams · Rebecca B Saunderson

Australians should be confident that their generalist GP is trained to an acceptable level of competence in skin cancer diagnostics

Cliff Rosendahl · Simon Clark

Most incident melanomas are managed by primary care practitioners, underscoring the need for specific training

Nirmala Pandeya · Catherine M Olsen · Maja M Shalit · Jean Claude Dusingize · Rachel E Neale · David C Whiteman

Pioneering cancer epidemiologist and champion of women in science

Karen Canfell · Bette Liu · Emily Banks

Timely delivery of results to guide index cancer treatment and greater equity of access are among the goals of broader testing

Stephanie M Wong · William D Foulkes

Routine testing removes barriers to testing, identifies additional women with pathogenic variants, leading to revised treatment for many

Dilanka L De Silva · Lesley Stafford · Anita R Skandarajah · Michelle Sinclair · Lisa Devereux · Kirsten Hogg · Maira Kentwell · Allan Park · Luxi Lal · Magnus Zethoven · Madawa W Jayawardana · Fiona Chan · Phyllis N Butow · Paul A James · G Bruce Mann · Ian G Campbell · Geoffrey J Lindeman

Clinically meaningful outcomes can be achieved with matched germline/tumour whole genome sequencing

The Q‐IMPROvE study group

The management of cutaneous melanoma has been revolutionised in the past decade, with ongoing efforts to improve patient outcomes centred on rich translational research endeavours and robust clinical trials

Prachi Bhave · Jessica Wong · Aideen McInerney‐Leo · Anne E Cust · Craig Lawn · Monika Janda · Victoria J Mar

Although radiotherapy costs for most people are moderate, some face very high costs, and these vary markedly by location

Dan Liu · Serena Yu · Samuel BG Webster · Bahare Moradi · Philip Haywood · Jane Hall · Sanchia Aranda · Kees Gool

To the Editor: The article by Williams and colleagues1 is a narrative review of prostate cancer care from a urological perspective. However, developing recommendations for prostate cancer screening requires complementary perspectives, including population health, general practice, and the wider community. Population‐based prostate‐specific antigen (PSA) testing to screen asymptomatic men for prostate cancer is not supported by the references cited by Williams and colleagues or by systematic reviews, which identify and account for bias.2 The Royal Australian College of General Practitioners (RACGP) has assessed the current evidence and has advised against prostate cancer screening.3 The RACGP guidelines specifically state that GPs have no obligation to offer prostate cancer screening, and advise against adding PSA to a battery of pathology tests. The RACGP and the National Health and Medical Research Council have developed information sheets drawing attention to the numbers of men with screen‐detected prostate cancers who would never know they had cancer if they had not undergone screening, as well as to the impotence, incontinence and bowel problems that prostate cancer diagnosis and treatment can cause, whether necessary or not.3,4 Between 42% and 66% of screen‐detected prostate cancers would not have been diagnosed without screening. Prostate cancer is discovered at autopsy in 36% of men of European ancestry and in 21% of Asian men aged 70–79 years.5 As Williams and colleagues note, prostate cancer screening can lead to earlier diagnosis of aggressive cancers, and modern techniques enable individualised patient‐centred treatment.1 However, for the men whose cancers would never have been detected without screening, any treatment is unnecessary and potentially harmful.5 Prostate cancer screening does not meet the aim of reducing overall mortality.2 After 11 years of annual screening, four of 1000 screened men compared with five of 1000 unscreened men have died of prostate cancer. Among the screened men are 87 cases with a false positive PSA test result, of whom 28 have complications of biopsy, including 0.5 extra heart attacks. Both groups have lost 190 men from all causes.3 Australia's GPs manage a growing demand for evidence‐based primary health care, and the RACGP supports them by developing standards and guidelines. These are based on unbiased approaches and, with the current evidence, they cannot recommend prostate cancer screening.3

Rosalie Schultz

Health care professionals caring for men with prostate cancer starting ADT should ensure that their bone health is routinely assessed

Mariya F Hamid · Amy Hayden · Tania Moujaber · Sandra Turner · Howard Gurney · Mathis Grossmann · Peter Wong

To the Editor: Lord and colleagues’ article1 provides a much‐needed snapshot of breast cancer distant recurrence and metastatic survival. As one of Australia's leading breast cancer advocacy organisations, Breast Cancer Network Australia (BCNA) has long been calling for reporting of recurrence data. Although we can justifiably celebrate a 5‐year survival rate of 92%,2 the long term data on distant recurrence reported by Lord and colleagues demonstrate the importance of looking beyond 5 years to understand the full burden of disease. In addition, Lord and colleagues’ survival data after distant recurrence is a critical first step in understanding the survival experience of this important but neglected group. In the associated Editorial, Redfern and Martin3 highlight that Australia's cancer registries do not systematically collect or report recurrence. The same applies for stage at diagnosis. Consequently, the number of Australians living with metastatic breast cancer is unknown. This is a fundamental problem. Without information to quantify this group of people we cannot adequately plan or deliver services. The problem extends beyond breast cancer to cancers such as prostate, melanoma, colorectal and lung, where targeted therapies, immunotherapies, and antibody drug conjugates are driving improvements in survival for patients with metastatic disease.4 These patients often have long term, complex supportive care needs yet have little visibility in our health care system. BCNA's 2017 national survey of 10318 people with breast cancer identified higher information and support needs among patients with metastatic compared with non‐metastatic breast cancer.5 These information and support needs were also less likely to be met by services for people with metastatic compared with non‐metastatic breast cancer.5 On 13 October 2022, which was Metastatic Breast Cancer Awareness Day, BCNA launched its Making metastatic breast cancer count Issues Paper to draw much‐needed attention to these issues.6 In the absence of cancer registry data, we applied Australian modelling from 2008 to current breast cancer mortality data.2,7 We estimate that in 2020 there were at least 10553 Australians living with metastatic breast cancer. Data from the United States suggest this number will continue to grow.8 Collection of recurrence and stage at diagnosis data will require national leadership and accountability, including continued investment in Cancer Australia's Stage, Treatment and Recurrence Project. Critically, it will also require input from key stakeholders including data‐management experts, cancer epidemiologists, cancer registries, clinicians and consumers. The time for action is now.

Andrea Smith · Vicki Durston · Sam Mills

Australian skin cancer registries need to sensitively capture data on race and ethnicity to improve skin cancer outcomes for people with skin of colour

Ayooluwatomiwa I Oloruntoba · Michelle Rodrigues

An 83-year-old woman of European ancestry had an initial diagnostic consideration of arsenical keratosis

Lachlan DW Lau · Anneliese Willems · Laura Scardamaglia

A 91-year-old man presented with a more than 10-year history of a slow growing horn- like lesion on the right side of the face

Li‐wen Zhang · Tao Chen

The DANGER acronym is a simple, evidence-based aid to identify high risk squamous cell carcinoma

Richard Tjahjono · Hubert TH Low · Jenny Lee · Deshan F Sebaratnam · Ruta Gupta · Michael J Veness · Jonathan Clark · Carsten E Palme

Australia should develop a sustainable evidence-based pharmacogenomic screening program, with DPYD genotyping at the forefront

Cassandra White · Rodney Scott · Christine L Paul · Stephen P Ackland

Improving patient communication on fertility risk and cancer is vital for quality in oncofertility care

Violet Kieu · Catharyn Stern · Jessica Harris · Yasmin Jayasinghe · Natalie Bradford · Wanyuan Cui · Rebecca Deans · Tamara Hunter · Catherine Allingham · Stefan C Kane · Lei Shong Lau · Shanna Logan · Robert McLachlan · Kristen Neville · Michelle Peate · Marianne Phillips · Carla Saunders · Marianne Tome · Rita Upreti · Kate White · Antoinette Anazodo · Roger J Hart

An understanding of the landscape of clinical trials in pancreatic cancer available to the Australian population may assist in informing gaps and opportunities for future trial interventions and increased participation

Nadia N Khan · Harleen Basrai · Sue M Evans · Liane J Ioannou · Charles HC Pilgrim · John R Zalcberg · Gayle M Jones · Susan Hanson

Characterising the ongoing but changing risk of relapse after breast cancer diagnosis improves surveillance planning and patient care

Andrew Redfern · Hilary Martin

Over the past decade, detection and management of prostate cancer have evolved, with the focus now placed on harm minimisation, reducing overdiagnosis and avoiding overtreatment

Isabella SC Williams · Aoife McVey · Sachin Perera · Jonathan S O’Brien · Louise Kostos · Kenneth Chen · Shankar Siva · Arun A Azad · Declan G Murphy · Veeru Kasivisvanathan · Nathan Lawrentschuk · Mark Frydenberg

Early detection remains an important strategy to reduce melanoma mortality and improve survival, and novel precision medicine technologies for melanoma diagnosis are rapidly changing this field

Rashidul A Mahumud · Monika Janda · H Peter Soyer · Pablo Fernández‐Peñas · Victoria J Mar · Rachael L Morton

DM risk declines with time from diagnosis, and the risk of breast cancer death declines with time from initial DM detection

Sarah (Sally) J Lord · Benjamin Daniels · Belinda E Kiely · Dianne L O'Connell · Jane Beith · Sallie Pearson · Kim‐Lin Chiew · Max K Bulsara · Nehmat Houssami

Increased understanding of how to predict who is most at risk of breast cancer is leading to the possibility of risk-based screening, allowing better and more targeted early detection and treatment for women at high risk

Christobel M Saunders

Breast cancer commonly causes significant physical and psychological sequelae; guidelines and models of care exist to ameliorate these

Christobel M Saunders · Lesley Stafford · Martha Hickey