Topics

Phasing out tobacco retailing is gaining traction as the natural next step in controlling the tobacco pandemic

The commercial tobacco trade is a complex system involving multiple actors, from tobacco growers and manufacturers to the importers and wholesalers that distribute products to retailers, who onsell to consumers. Consumers who purchase and use products form the demand side. Governments can influence each actor through policy, but have historically focused on the demand‐side measures in the World Health Organization Framework Convention on Tobacco Control (WHO FCTC; Articles 6–14). These outnumber the supply‐side measures (Articles 15–17), which have primarily focused on constraining tobacco product manufacturers. Calls are growing for governments to increase attention on retail supply — the critical link in the supply chain between manufacturers and consumers.1

1 University of Queensland, Brisbane, QLD
2 Charles Darwin University, Darwin, NT
3 Australian National University, Canberra, ACT
4 University of Otago, Dunedin, New Zealand

Correspondence: c.gartner@uq.edu.au

Acknowledgements:

Coral Gartner is the chief investigator in a National Health and Medical Research Council (NHMRC) grant (GNT1198301). Andrew Perusco holds an Australian Government Research Training Scholarship administered by Australian National University. The manuscript was written as part of the activities of the NHMRC‐funded Centre of Research Excellence on Achieving the Tobacco Endgame. The funder played no role in the study design, manuscript preparation, or the decision to submit it for publication.

Competing interests:

No relevant disclosures.

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Editorials

Who cares about climate?

Hugh Montgomery and Fintan Hughes

Med J Aust 2021; 215 (9): . || doi: 10.5694/mja2.51300
Published online: 1 November 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Environment and public health

The threat of climate change is immediate and grave, and now is the time to act

1 University College London, London, UK
2 Duke University, Durham, NC, USA

Correspondence: h.montgomery@ucl.ac.uk

Competing interests:

Hugh Montgomery chairs the Lancet Countdown on health and climate change, which is funded by the Wellcome Trust.

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Medical education
Lessons from practice

Mucormycosis: early treatment is the key to survival

Timothy R Holmes, Jenny L Hepschke, Ian Jacobson and Anthony Maloof

Med J Aust 2021; 215 (9): . || doi: 10.5694/mja2.51290
Published online: 1 November 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Infectious diseases

Eye diseases

Otorhinolaryngologic diseases

Immune system diseases

Endocrine system diseases

Prince of Wales Hospital and Community Health Services, Sydney, NSW

Correspondence: timothyrobert.holmes@health.NSW.gov.au

Acknowledgements:

We thank the patient and his wife for their insights and help in preparing this article. Their fortitude and commitment throughout his illness were remarkable. We also acknowledge the many other clinicians involved in the patient's care, without whose contributions the outcome might have been quite different.

Competing interests:

No relevant disclosures.

1. Cornely OA, Alastruey‐Izquierdo A, Arenz D, et al. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect Dis 2019; 19: e405–e421.
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Perspectives

The 2021 report of the MJA–Lancet Countdown on health and climate change: Australia increasingly out on a limb

Paul J Beggs, Ying Zhang, Alice McGushin, Stefan Trueck, Martina K Linnenluecke, Hilary Bambrick, Helen L Berry, Ollie Jay, Lucie Rychetnik, Ivan C Hanigan, Geoffrey G Morgan, Yuming Guo, Arunima Malik, Mark Stevenson, Donna Green, Fay H Johnston, Celia McMichael, Ian Hamilton and Anthony G Capon

Med J Aust 2021; 215 (9): . || doi: 10.5694/mja2.51302
Published online: 21 October 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Environment and public health

Mental disorders

Health services administration

Statistics, epidemiology and research design

Summary

The MJA–Lancet Countdown on health and climate change in Australia was established in 2017, and produced its first national assessment in 2018, its first annual update in 2019, and its second annual update in 2020. It examines indicators across five broad domains: climate change impacts, exposures and vulnerability; adaptation, planning and resilience for health; mitigation actions and health co‐benefits; economics and finance; and public and political engagement.
Our special report in 2020 focused on the unprecedented and catastrophic 2019–20 Australian bushfire season, highlighting indicators that explore the relationships between health, climate change and bushfires. For 2021, we return to reporting on the full suite of indicators across each of the five domains and have added some new indicators.
We find that Australians are increasingly exposed to and vulnerable to excess heat and that this is already limiting our way of life, increasing the risk of heat stress during outdoor sports, and decreasing work productivity across a range of sectors. Other weather extremes are also on the rise, resulting in escalating social, economic and health impacts. Climate change disproportionately threatens Indigenous Australians’ wellbeing in multiple and complex ways.
In response to these threats, we find positive action at the individual, local, state and territory levels, with growing uptake of rooftop solar and electric vehicles, and the beginnings of appropriate adaptation planning. However, this is severely undermined by national policies and actions that are contrary and increasingly place Australia out on a limb. Australia has responded well to the COVID‐19 public health crisis (while still emerging from the bushfire crisis that preceded it) and it now needs to respond to and prepare for the health crises resulting from climate change.

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1 Macquarie University, Sydney, NSW
2 University of Sydney, Sydney, NSW
3 Institute for Global Health, University College London, London, UK
4 Queensland University of Technology, Brisbane, QLD
5 Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
6 University Centre for Rural Health, University of Sydney, Sydney, NSW
7 University Centre for Rural Health, University of Sydney, Lismore, NSW
8 Monash University, Melbourne, VIC
9 Integrated Sustainability Analysis, University of Sydney, Sydney, NSW
10 University of Melbourne, Parkville, VIC
11 Climate Change Research Centre and ARC Centre of Excellence for Climate Extremes, University of New South Wales, Sydney, NSW
12 Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS
13 UCL Energy Institute, University College London, London, UK
14 Monash Sustainable Development Institute, Monash University, Melbourne, VIC

Correspondence: paul.beggs@mq.edu.au

Acknowledgements:

We thank Katie Quail for assistance with indicator 1.2 Indigenous health and climate change. We thank Robert Fawcett, John Nairn (retired), Elizabeth Ebert and Bronwyn Brown (all from the Australian Bureau of Meteorology) for indicators 1.3 Health effects of heatwaves and 2.4 Climate information services for health. We thank Nathan Morris for assistance with the analysis for indicator 1.4 Heat impact on physical and sporting activities. We thank Tord Kjellstrom and Matthias Otto for providing the results for indicator 1.5 Change in labour capacity. The Bushfires indicator was generated with support from NASA Applied Sciences Program (grant no. 80NSSC21K0507) and we thank Yang Liu, Bryan Vu and Liuhua Shi (all from Emory University) for the Australian data used for this indicator (1.7), and Nicolas Borchers Arriagada (Menzies Institute for Medical Research, University of Tasmania) for assistance with analysis. Shouro Dasgupta conducted the sea level rise‐related data analysis for indicator 1.9 Migration, displacement, and environmental change. He is an author on the Lancet Countdown global report, and contributor to the sea level rise indicator. The global version of this indicator was developed in collaboration also with Ilan Kelman and Sonja Ayeb‐Karlsson. We thank Kerry Nice (University of Melbourne) who worked on indicator 2.6 Urban green space. The assistance of Zahra Borghei Ghomi (Macquarie University) in compiling the data for indicators 3.1 Carbon intensity of the energy system, 3.2 Coal phase‐out, 3.3 Zero carbon emission electricity, and 3.4 Clean household energy is acknowledged. We thank Marco Springman from the Lancet Countdown for providing the results for indicator 3.9 Diet and health co‐benefits. We thank Maddie Heenan for searching and data compilation for indicator 5.3 Government engagement in health and climate change in Australia. We thank the NHMRC for providing the data for indicator 5.4 Health and climate change research funding.

Competing interests:

No relevant disclosures.

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71. Clean Energy Council. Solar. https://www.cleanenergycouncil.org.au/resources/technologies/solar‐energy#:~:text=The%20growth%20of%20solar,the%20third%2Dhighest%20number%20ever (viewed May 2021).
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74. United States Environmental Protection Agency. Integrated science assessment (ISA) for particulate matter (Final Report, Dec 2019). EPA/600/R‐19/188. Washington, DC: USEPA, 2019.
75. Hanigan IC, Johnston FH, Morgan GG. Vegetation fire smoke, indigenous status and cardio‐respiratory hospital admissions in Darwin, Australia, 1996–2005: a time‐series study. Environ Health 2008; 7: 42.
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77. Hanigan IC, Broome RA, Chaston TB, et al. Avoidable mortality attributable to anthropogenic fine particulate matter (PM2.5) in Australia. Int J Environ Res Public Health 2021; 18: 254.
78. Broome RA, Powell J, Cope ME, Morgan GG. The mortality effect of PM2.5 sources in the Greater Metropolitan Region of Sydney, Australia. Environ Int 2020; 137: 105429.
79. Australian Government Department of Industry, Science, Energy and Resources. Australian energy statistics 2020 update published. https://www.energy.gov.au/news‐media/news/australia‐energy‐statistics‐2020‐update‐published (viewed May 2021).
80. ClimateWorks Australia. Moving to zero: accelerating the transition to zero‐emissions transport. Melbourne: ClimateWorks Australia, 2020.
81. Australian Government Department of Industry, Science, Energy and Resources. Australian energy update 2020. Canberra: DISER, 2020. https://www.energy.gov.au/publications/australian‐energy‐update‐2020 (viewed Oct 2020).
82. Budget Direct. Electric car sales 2020. https://www.budgetdirect.com.au/car‐insurance/research/electric‐car‐sales‐australia.html (viewed Mar 2021).
83. Electric Vehicle Council. State of electric vehicles: August 2020. Sydney: Electric Vehicle Council, 2020. https://electricvehiclecouncil.com.au/reports/state‐of‐electric‐vehicles‐2020/ (viewed Sept 2021).
84. Climate Change Commission. Ināia tonu nei: a low emissions future for Aotearoa. Advice to the New Zealand Government on its first three emissions budgets and direction for its emissions reduction plan 2022–2025. Wellington: New Zealand Government, 2021.
85. Hamilton I, Kennard H, McGushin A, et al. The public health implications of the Paris Agreement: a modelling study. Lancet Planet Health 2021; 5: e74–e83.
86. Goel R, Goodman A, Aldred R, et al. Cycling behaviour in 17 countries across 6 continents: levels of cycling, who cycles, for what purpose, and how far? Transport Rev 2021; https://doi.org/10.1080/01441647.2021.1915898.
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89. Malik A, Padget M, Carter S, et al. Environmental impacts of Australia’s largest health system. Resour Conserv Recycl 2021; 169: 105556.
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93. Conti S, Meli P, Minelli G, et al. Epidemiologic study of mortality during the Summer 2003 heat wave in Italy. Environ Res 2005; 98: 390–399.
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96. Australian Bureau of Statistics. 3222.0 ‐ Population Projections. Canberra: ABS, 2008. https://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/3222.0Main+Features12006%20to%202101?OpenDocument (viewed July 2021).
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100. Australian Bureau of Statistics. Employment in renewable energy activities, Australia: 2018–19 financial year. Canberra: ABS, 2020. https://www.abs.gov.au/statistics/labour/employment‐and‐unemployment/employment‐renewable‐energy‐activities‐australia/latest‐release (viewed May 2021).
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102. Fossil Free. 1200+ divestment commitments. https://gofossilfree.org/divestment/commitments/ (viewed Apr 2021).
103. Clean Energy Regulator. Australian carbon credit units. Canberra: CER, 2020. http://www.cleanenergyregulator.gov.au/OSR/ANREU/types‐of‐emissions‐units/australian‐carbon‐credit‐units (viewed July 2021).
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105. The Australia Institute. Australian fossil fuel subsidies hit $10.3 billion in 2020‐21 [media release]. 26 Apr 2021. https://australiainstitute.org.au/post/australian‐fossil‐fuel‐subsidies‐hit‐10‐3‐billion‐in‐2020‐21/ (viewed July 2021).
106. Organisation for Economic Co‐operation and Development. OECD.Stat. Fossil fuel support ‐ AUS. https://stats.oecd.org/Index.aspx?DataSetCode=FFS_AUS (viewed Mar 2021).
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108. Market Forces. How your tax dollars subsidise fossil fuels. https://www.marketforces.org.au/campaigns/ffs/tax‐based‐subsidies/ (viewed Mar 2021).
109. Australian Government Department of Health. Bushfire smoke and health: summary of the current evidence. Canberra: Department of Health, 2020. https://www1.health.gov.au/internet/main/publishing.nsf/Content/A12B57E41EC9F326CA257BF0001F9E7D/$File/Bushfire‐smoke‐health‐Summary‐current‐evidence.pdf (viewed May 2021).
110. Commonwealth of Australia. Disaster and emergency management for environmental health practitioners. Canberra: Commonwealth of Australia, 2020. https://www1.health.gov.au/internet/main/publishing.nsf/Content/A12B57E41EC9F326CA257BF0001F9E7D/$File/Disaster_and_Emergency_Management_for_EHPs.pdf (viewed May 2021).
111. National Health and Medical Research Council. NHMRC Special Initiative in Human Health and Environmental Change. Canberra: NHMRC, 2021. https://www.nhmrc.gov.au/funding/find‐funding/nhmrc‐special‐initiative‐human‐health‐and‐environmental‐change (viewed May 2021).

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Editorials

Towards risk‐stratified population breast cancer screening: more than mammographic density

John L Hopper and Tuong Linh Nguyen

Med J Aust 2021; 215 (8): . || doi: 10.5694/mja2.51268
Published online: 18 October 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Neoplasms

Environment and public health

Information science

Powerful new automated tools are being developed to identify the women most likely to have an existing or future cancer

The article by Noguchi and colleagues in this issue of the MJA1 is timely and motivated by an important aim: to improve breast screening for both women and its funders. The authors conducted a comprehensive analysis of routinely collected data for all screening mammograms by BreastScreen WA over the ten years from July 2007. Although they studied screening episodes rather than individual women, they found evidence that key performance indicators — screen‐detected and interval cancer rates — differed by age, family history, hormone replacement therapy use, benign breast disease, and breast density. Importantly, the strengths of the relationships between some factors and performance varied by age group.1

Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC

Correspondence: j.hopper@unimelb.edu.au

Acknowledgements:

We acknowledge the generous support for our work in this area over many years from the National Breast Cancer Foundation, the Cancer Council Victoria, Cancer Australia, the National Health and Medical Research Council, and the National Institutes of Health (USA).

Competing interests:

No relevant disclosures.

1. Noguchi N, Marinovich ML, Wylie EJ, et al. Screening outcomes by risk factor and age: evidence from BreastScreen WA for discussions of risk‐stratified population screening. Med J Aust 2021; 215: 359–365.
2. Allweis TM, Hermann N, Bernstein‐Molho R, Guindy M. Personalized screening for breast cancer: rationale, present practices, and future directions. Ann Surg Oncol 2021; 28: 4306–4317.
3. Eklund M, Broglio K, Yau C, Connor JT, et al. The WISDOM personalized breast cancer screening trial: simulation study to assess potential bias and analytic approaches. JNCI Cancer Spectr 2018; 2: pky067.
4. Hopper JL, Nguyen TL, Schmidt DF, et al. Going beyond conventional mammographic density to discover novel mammogram‐based predictors of breast cancer risk. J Clin Med 2020; 9: 627.
5. Boyd NF, Guo H, Martin LJ, Sun L, et al. Mammographic density and the risk and detection of breast cancer. N Engl J Med 2007; 3563: 227–236.
6. Cappello NM, Richetelli D, Lee CI. The impact of breast density reporting laws on women’s awareness of density‐associated risks and conversations regarding supplemental screening with providers. J Am Coll Radiol 2019; 16: 139–146.
7. Nguyen TL, Aung YK, Evans CF, et al. Mammographic density defined by higher than conventional brightness thresholds better predicts breast cancer risk. Int J Epidemiol 2017; 46: 652–661.
8. Schmidt DF, Makalic E, Goudey B, et al. Cirrus: an automated mammography‐based measure of breast cancer risk based on textural features. JNCI Cancer Spectr 2018; 2: pky057.
9. Nguyen TL, Schmidt DF, Makalic E, et al. Novel mammogram‐based measures improve breast cancer risk prediction beyond an established mammographic density measure. Int J Cancer 2021; 148: 2193–2202.
10. Hopper JL. Genetics for population and public health. Int J Epidemiol 2017; 46: 8–11.
11. Freeman K, Geppert J, Stinton C, et al. Use of artificial intelligence for image analysis in breast cancer screening programmes: systematic review of test accuracy. BMJ 2021; 374: n1872.

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Editorials

Abortion care in the 21st century

Caroline M Costa and Kirsten I Black

Med J Aust 2021; 215 (8): . || doi: 10.5694/mja2.51274
Published online: 18 October 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Women's health

General medicine

Identifying inequity of access and assessing the effectiveness of interventions is difficult without systematic abortion data collection

The past two decades have seen major changes in both abortion law and abortion provision across Australia. Safe legal abortion is now available to all Australian women, and is accessible to many. Decriminalisation in all states and territories and legislated safety zones around abortion services have led to wider discussion of abortion in Australian society and softening of the attached stigma.1

1 The Cairns Institute, James Cook University, Cairns, QLD
2 The University of Sydney, Sydney, NSW
3 Royal Prince Alfred Hospital, Sydney, NSW

Correspondence: caroline.decosta@jcu.edu.au

Competing interests:

No relevant disclosures.

1. Miller E, Baird B. Abortion is no longer a crime in Australia. But legal hurdles to access remain. The Conversation (Australia), 4 Mar 2021. https://theconversation.com/abortion‐is‐no‐longer‐a‐crime‐in‐australia‐but‐legal‐hurdles‐to‐access‐remain‐156215 (viewed Aug 2021).
2. de Costa CM, Russell DB, de Costa NR, et al. Early medical abortion in Cairns, Queensland: July 2006 – April 2007. Med J Aust 2007; 187: 171–173. https://www.mja.com.au/journal/2007/187/3/early‐medical‐abortion‐cairns‐queensland‐july‐2006‐april‐2007
3. Goldstone P, Michelson J, Williamson E. Early medical abortion using low‐dose mifepristone followed by buccal misoprostol: a large Australian observational study. Med J Aust 2012; 197: 282–286. https://www.mja.com.au/journal/2012/197/5/early‐medical‐abortion‐using‐low‐dose‐mifepristone‐followed‐buccal‐misoprostol
4. NPS MedicineWise. Mifepristone (Mifepristone Linepharma) followed by misoprostol (GyMiso) for medical termination of pregnancy of up to 49 days’ gestation. Aug 2013. https://www.nps.org.au/radar/articles/mifepristone‐mifepristone‐linepharma‐followed‐by‐misoprostol‐gy‐miso‐for‐medical‐termination‐of‐pregnancy‐of‐up‐to‐49‐days‐gestation#r39 (viewed Sept 2021).
5. Wellings K, Palmer MJ, Geary RS, et al. Changes in conceptions in women younger than 18 years and the circumstances of young mothers in England in 2000–12: an observational study. Lancet 2016; 388: 586–595.
6. Centers for Disease Control and Prevention. Reproductive health: CDCs abortion surveillance system FAQs. Updated Nov 2020. https://www.cdc.gov/reproductivehealth/Data_Stats/Abortion.htm (viewed Sept 2021).
7. Keogh LA, Gurrin LC, Moore P. Estimating the Australian abortion rate from National Hospital Morbidity and Pharmaceutical Benefits Scheme data. Med J Aust 2021; 215: 375–376.
8. Subasinghe AK, McGeechan K, Moulton JE, et al. Early medical abortion services provided in Australian primary care. Med J Aust 2021; 215: 366–370.
9. de Costa CM, Black KI, Russell DB. Medical abortion: it is time to lift restrictions. Med J Aust 2019; 211: 428–428.e1. https://www.mja.com.au/journal/2019/210/6/medical‐abortion‐it‐time‐lift‐restrictions.
10. Shankar M, Black KI, Goldstone P, et al. Access, equity and costs of induced abortion services in Australia: a cross‐sectional study. Aust N Z J Public Health 2017; 41: 309–314.
11. Australian Department of Health. National Women’s Health Strategy 2020–2030. https://www.health.gov.au/resources/publications/national‐womens‐health‐strategy‐2020‐2030 (viewed Aug 2021).

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Editorials

Self‐collection for HPV screening: a game changer in the elimination of cervical cancer

Karen Canfell, Megan A Smith and Deborah J Bateson

Med J Aust 2021; 215 (8): . || doi: 10.5694/mja2.51262
Published online: 18 October 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Neoplasms

Environment and public health

Self‐collection will facilitate new community‐led, co‐designed delivery models that could greatly increase the acceptability and uptake of screening

In December 2017, the Australian National Cervical Screening Program (NCSP) underwent a major renewal, transitioning from two‐yearly cytology screening for people with a cervix (“women”) aged 18‒20 to 69 years, to five‐yearly primary human papillomavirus (HPV) screening for women aged 25‒74 years. The NCSP renewal was driven by accumulated international evidence for the very high effectiveness of primary HPV screening for predicting current and future risk of pre‐cancerous lesions and invasive cancer.1 It was also prompted by the Australian HPV vaccination program that commenced in 2007, which has resulted in rapid population‐level reductions in the incidence of pre‐cancerous lesions in young women.2

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1 The Daffodil Centre at the University of Sydney (Cancer Council NSW/University of Sydney), Sydney, NSW
2 Family Planning New South Wales, Sydney, NSW
3 The University of Sydney, Sydney, NSW

Correspondence: karen.canfell@nswcc.org.au

Acknowledgements:

Karen Canfell receives salary support from the National Health and Medical Research Council (NHMRC; APP1194679). Megan Smith receives salary support from the NHMRC (APP1159491) and the Cancer Institute NSW (ECF181561).

Competing interests:

Karen Canfell is co‐principal investigator in an unrelated investigator‐initiated trial of cervical screening in Australia (Compass; ACTRN12613001207707 and NCT02328872), conducted and funded by the VCS Foundation, a Victorian government‐funded health promotion charity. The VCS Foundation has received equipment and a funding contribution from Roche Molecular Systems USA. Neither Karen Canfell nor her institution on her behalf (Cancer Council NSW) receives direct funding from industry for this trial or any other project.

1. Ronco G, Dillner J, Elfström KM, et al; International HPV screening working group. Efficacy of HPV‐based screening for prevention of invasive cervical cancer: follow‐up of four European randomised controlled trials. Lancet 2014; 383: 524–532.
2. Australian Institute of Health and Welfare. Cervical screening in Australia 2019 (Cat. no. CAN 124). May 2019. https://www.aihw.gov.au/reports/cancer‐screening/cervical‐screening‐in‐australia‐2019/summary 2019 (viewed Aug 2021).
3. Lew JB, Simms KT, Smith MA, et al. Primary HPV testing versus cytology‐based cervical screening in women in Australia vaccinated for HPV and unvaccinated: effectiveness and economic assessment for the National Cervical Screening Program. Lancet Public Health 2017; 2: e96–e107.
4. Creagh NS, Zammit C, Brotherton JML, et al. Self‐collection cervical screening in the renewed National Cervical Screening Program: a qualitative study. Med J Aust 2021; 215: 354–358.
5. Medical Services Advisory Committee. MSAC outcomes application no. 1276. Renewal of the National Cervical Screening Program. Apr 2014. http://www.msac.gov.au/internet/msac/publishing.nsf/Content/D924E2F768B13C4BCA25801000123B9E/$File/1276%20‐%20Final%20MSAC%20PSD%20‐%20NCSP%20Renewal.pdf (viewed Aug 2021).
6. Arbyn M, Smith SB, Temin S, et al; Collaboration on Self‐Sampling and HPV Testing. Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta‐analyses. BMJ 2018; 363: k4823.
7. Smith MA, Hall MT, Saville M, et al. Could HPV testing on self‐collected samples be routinely used in an organized cervical screening program? A modeled analysis. Cancer Epidemiol Biomarkers Prev 2021; 30: 268–77.
8. Medical Services Advisory Committee. MSAC application no. 1664 (public summary document). Apr 2021. http://www.msac.gov.au/internet/msac/publishing.nsf/Content/69F7A5B132EA653ECA258646001B5CD5/$File/1664%20Final%20PSD%20‐%20Mar‐Apr%202021.pdf (viewed Aug 2021).
9. Davies‐Oliveira JC, Smith MA, Grover S, et al. Eliminating cervical cancer: progress and challenges for high‐income countries. J Clin Oncol (R Coll Radiol) 2021; 33: 550–559.
10. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68: 394–424.
11. World Health Organization. Global strategy to accelerate the elimination of cervical cancer as a public health problem (Report no. 9789240014107). Nov 2020. https://www.who.int/publications/i/item/9789240014107 (viewed Aug 2021).
12. Hall MT, Simms KT, Lew JB, et al. The projected timeframe until cervical cancer elimination in Australia: a modelling study. Lancet Public Health 2019; 4: e19–e27.
13. NHMRC Centre of Research Excellence in Cervical Cancer Control. Cervical cancer elimination progress report: Australia’s progress towards the elimination of cervical cancer as a public health problem. Mar 2021. https://www.cervicalcancercontrol.org.au/wp‐content/uploads/2021/03/2021‐C4‐CRE‐Elim‐Report.pdf (viewed Aug 2021).
14. Whop LJ, Smith MA, Butler TL, et al. Achieving cervical cancer elimination among Indigenous women. Prev Med 2021; 144: 106314.

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Editorials

Treatment of alcohol problems: current status and future directions

Paul S Haber, Benjamin C Riordan and Kirsten C Morley

Med J Aust 2021; 215 (7): . || doi: 10.5694/mja2.51265
Published online: 4 October 2021

ARTICLE
AUTHORS
REFERENCES

Topics

General medicine

Substance-related disorders

Scaling up the treatment of alcohol problems will lead to considerable health benefit across the nation

Alcohol is Australia’s most widely used drug, consumed by nearly 80% of the adult population.1 We lack recent prevalence data for alcohol use disorder in Australia but previous estimates vary from about 800 0002 to over a million.3 With such large numbers, it is quite a paradox that we are not better equipped to manage those who develop problems related to its use.

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1 Central Clinical School, University of Sydney, Sydney, NSW
2 Edith Collins Centre (Translational Research Centre in Alcohol Drugs and Toxicology), Sydney, NSW
3 Drug Health Services, Royal Prince Alfred Hospital, Sydney, NSW
4 Centre for Alcohol Policy Research, Melbourne, VIC

Correspondence: paul.haber@sydney.edu.au

Competing interests:

Paul Haber has been funded by the Lambert Initiative for Cannabinoid Therapeutics at the University of Sydney to undertake clinical trials of cannabinoid treatment for alcohol withdrawal syndrome; has served on industry advisory boards for Indivior, AbbVie and Gilead; and has been an investigator on clinical trials supported by Camurus. He has also served on international and Australian advisory boards for Lundbeck in relation to nalmefene (2013–2015 and 2014, respectively).

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2. Teesson M, Hall W, Slade T, et al. Australia: findings of the 2007 National Survey of Mental Health and Wellbeing. Addiction 2010; 105: 2085–2094.
3. Mewton L, Slade T, McBride O, et al. An evaluation of the proposed DSM‐5 alcohol use disorder criteria using Australian national data. Addiction 2011; 106: 941–950.
4. Lensvelt E, Gilmore W, Liang W, et al. Estimated alcohol‐attributable deaths and hospitalisations in Australia, 2004 to 2015. National Alcohol Indicators, Bulletin 16. Perth: National Drug Research Institute, Curtin University, 2018. https://ndri.curtin.edu.au/ndri/media/documents/naip/naip016.pdf (viewed Aug 2021).
5. Gao C, Ogeil R, Lloyd B. Alcohol’s burden of disease in Australia. Canberra: FARE and VicHealth in collaboration with Turning Point, 2014. https://www.vichealth.vic.gov.au/~/media/ResourceCentre/PublicationsandResources/alcohol%20misuse/Alcohols-burden-of-disease-in-Australia.ashx (viewed Aug 2021).
6. Haber P, Riordan B. The guidelines for the treatment of alcohol problems. Sydney: University of Sydney, 2021. https://alcoholtreatmentguidelines.com.au/ (viewed Aug 2021).
7. Haber PS, Riordan BC, Winter DT, et al. New Australian guidelines for the treatment of alcohol problems: an overview of recommendations. Med J Aust 2021; 215 (7 Suppl): S1–S32.
8. Connor JP, Haber PS, Hall WD. Alcohol use disorders. Lancet 2016; 387: 988–998.
9. Chapman C, Slade T, Hunt C, Teesson M. Delay to first treatment contact for alcohol use disorder. Drug Alcohol Depend 2015; 147: 116–121.
10. Morley KC, Logge W, Pearson SA, et al. National trends in alcohol pharmacotherapy: findings from an Australian claims database. Drug Alcohol Depend 2016; 166: 254–257.
11. Australian Institute of Health and Welfare. Australian Burden of Disease Study: impact and causes of illness and death in Australia 2015 (Cat. No. BOD 22). Canberra: AIHW, 2019. https://www.aihw.gov.au/getmedia/c076f42f-61ea-4348-9c0a-d996353e838f/aihw-bod-22.pdf.aspx?inline=true (viewed Aug 2021).

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