Publications by authors named "Peter Baade"

217 Publications

Crude probability of death for cancer patients by spread of disease in New South Wales, Australia 1985 to 2014.

Cancer Med 2021 May 6. Epub 2021 May 6.

Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia.

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.
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http://dx.doi.org/10.1002/cam4.3844DOI Listing
May 2021

Projections of the future burden of cancer in Australia using Bayesian age-period-cohort models.

Cancer Epidemiol 2021 Apr 7;72:101935. Epub 2021 Apr 7.

The Viertel Cancer Research Centre, Cancer Council Queensland, PO Box 201, Spring Hill, Brisbane, Queensland, 4004, Australia; School of Mathematical Sciences, Queensland University of Technology, GPO Box 2434, Brisbane, Queensland, 4001, Australia; Menzies Health Institute Queensland, Griffith University, G40 Griffith Health Centre, Gold Coast Campus, Queensland, Gold Coast, 4222, Australia. Electronic address:

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.
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http://dx.doi.org/10.1016/j.canep.2021.101935DOI Listing
April 2021

Risk of thyroid cancer following hysterectomy.

Cancer Epidemiol 2021 Mar 31;72:101931. Epub 2021 Mar 31.

Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia; School of Public Health, The University of Queensland, Brisbane, QLD, Australia. Electronic address:

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.
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http://dx.doi.org/10.1016/j.canep.2021.101931DOI Listing
March 2021

Colorectal cancer incidence in Australia before and after mandatory fortification of bread flour with folic acid.

Public Health Nutr 2021 Feb 9:1-4. Epub 2021 Feb 9.

Queensland University of Technology (QUT), Faculty of Health, School of Exercise and Nutrition Sciences, Faculty of Health, Kelvin Grove Campus, QLD4059, Brisbane, Australia.

Objective: Mandatory fortification of bread flour with folic acid has helped to reduce the incidence of neural tube defects in several countries. However, it has been suggested that folic acid may have potential adenoma-promoting effects, and reports from some countries have suggested that mandatory folic acid food fortification programmes have increased the incidence of colorectal cancer. The objective of this study was to evaluate colorectal cancer incidence patterns before and after introduction of mandatory folic acid fortification of bread flour in Australia in 2009.

Design: Data from the Australian Cancer Database were used to plot age-standardised incidence of colorectal cancer. We calculated age-adjusted rate ratios with 95 % CIs.

Setting: Australia.

Participants: We used population-level aggregate data obtained from cancer registries.

Results: Age-standardised colorectal cancer incidence generally decreased between 1999 and 2016. Although there was a slight increase in rates in 2010 compared with 2009 (62·8 v. 61·6 cases per 100 000, age-adjusted rate ratio 1·02 (95 % CI 0·99, 1·04), joinpoint regression indicated decreases of -0·4 % (95 % CI -0·7, 0·0) per year from 1999 to 2010 and -2·2 % (95 % CI -3·1, -1·3) per year from 2010 to 2016.

Conclusions: While causation cannot be assessed from these population-level data, our observations indicate that there is no evidence that introduction of mandatory folic acid fortification of bread flour has influenced colorectal cancer incidence in Australia.
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http://dx.doi.org/10.1017/S1368980021000562DOI Listing
February 2021

Temporal and area-level variation in prevalence of high-grade histologically confirmed cervical abnormalities among Indigenous and non-Indigenous women, Queensland, Australia, 2008-2017.

J Med Screen 2021 Jan 21:969141320984199. Epub 2021 Jan 21.

Cancer Council Queensland, Brisbane, QLD, Australia.

Objective: Despite Australia's National Cervical Screening Program, Indigenous women have a disproportionately high burden of cervical cancer. We describe temporal and area-level patterns in prevalence of histologically conformed high-grade cervical abnormalities (hHGA) among cytologically screened women by Indigenous status.

Methods: This was a population-based study of 2,132,925 women, aged 20-69, who underwent cervical screening between 2008 and 2017, in Queensland, Australia. Of these, 47,136 were identified as Indigenous from linked hospital records. Overall patterns in hHGA prevalence by Indigenous status were quantified using prevalence rate ratios (PrRR) from negative binomial models. Bayesian spatial models were used to obtain smoothed prevalence estimates of hHGA across 528 small areas compared to the state average. Results are presented as maps and graphs showing the associated uncertainty of the estimates.

Results: Overall, screened Indigenous women had significantly higher hHGA prevalence than non-Indigenous women. However, the magnitude of the difference reduced over time ( < 0.001). Adjusted for age and area-level variables, Indigenous women had 36% higher hHGA prevalence (PrRR 1.36, 95% confidence interval [1.21-1.52]) than non-Indigenous women between 2013 and 2017. The overall effect of age decreased over time ( = 0.021). Although there was evidence of moderate spatial variation in 10-year prevalence estimates for both groups of women, the high levels of uncertainty for many estimates, particularly for Indigenous women, limited our ability to draw definitive conclusions about the spatial patterns.

Conclusions: While the temporal reduction in Indigenous: non-Indigenous differential in hHGA prevalence is encouraging, further research into the key drivers of the continuing higher risk among Indigenous women is warranted.
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http://dx.doi.org/10.1177/0969141320984199DOI Listing
January 2021

Spatial and temporal variations in cervical cancer screening participation among indigenous and non-indigenous women, Queensland, Australia, 2008-2017.

Cancer Epidemiol 2020 12 4;69:101849. Epub 2020 Nov 4.

Cancer Council Queensland, Brisbane, QLD, 4006, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD, 4222, Australia; School of Mathematical Sciences, Queensland University of Technology, Gardens Point, Brisbane, QLD, 4000, Australia. Electronic address:

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 <30 % of areas among non-Indigenous women. Disparities by Indigenous status persisted over time and remained across broader geographical groups of accessibility and area disadvantage.

Conclusions: Cervical cancer burden in Australia can only be reduced through concentrated efforts on identifying and addressing key drivers of the continuing disparities in screening participation. Achieving equitable screening participation for all women especially Indigenous women requires community engagement and localised interventions.
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http://dx.doi.org/10.1016/j.canep.2020.101849DOI Listing
December 2020

Hospital characteristics associated with better 'quality of surgery' and survival following oesophagogastric cancer surgery in Queensland: a population-level study.

ANZ J Surg 2021 03 5;91(3):323-328. Epub 2020 Nov 5.

Upper-GI, Soft Tissue and Melanoma Unit, Princess Alexandra Hospital, Cancer Alliance Queensland, The University of Queensland, Brisbane, Queensland, Australia.

Background: The impact of hospital characteristics on the quality of surgery and survival following oesophagogastric cancer surgery has not been well established in Australia. We assessed the interaction between hospital volume, service capability and surgical outcomes, with the hypothesis that both the quality of surgery and survival are better following treatment in high-volume, high service capability hospitals.

Methods: All patients undergoing oesophagectomy and gastrectomy for cancer in Queensland, between 2001 and 2015, were included. Demographic, pathology and outcome data were collected. Hospitals were categorized into high (HV) (≥5 gastrectomies; ≥6 oesophagectomies) and low volume (LV). Hospital service capability was defined as high (HS) and low (LS), and then linked to hospital volume: HVHS, LVHS and LVLS. Higher quality surgery was defined using six perioperative parameters. Univariable comparisons of quality of surgery between hospital groups used chi-squared tests. The 5-year overall survival was compared using log-rank tests and Cox proportional hazard models.

Results: For both gastrectomy and oesophagectomy, higher quality surgery occurred more frequently in HVHS hospitals (gastrectomy: HVHS = 44.2%, LVHS = 23.1%, LVLS = 29.1% (P < 0.01); oesophagectomy: HVHS = 34.5%, LVHS = 24.4%, LVLS = 21.7% (P = 0.01)). Following oesophagectomy, the 3- and 5-year overall survival was better following treatment in HVHS (P < 0.01). There was no difference between the groups following gastrectomy.

Conclusion: In Queensland, the quality of surgery was higher in HVHS hospitals performing gastrectomy and oesophagectomy; however, the impact on cancer survival was only seen following oesophagectomy.
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http://dx.doi.org/10.1111/ans.16397DOI Listing
March 2021

Multivariate Bayesian meta-analysis: joint modelling of multiple cancer types using summary statistics.

Int J Health Geogr 2020 10 17;19(1):42. Epub 2020 Oct 17.

ARC Centre of Excellence in Mathematical and Statistical Frontiers, School of Mathematical Sciences, Science and Engineering Faculty, Queensland University of Technology, Brisbane, QLD 4001, Australia.

Background: Cancer atlases often provide estimates of cancer incidence, mortality or survival across small areas of a region or country. A recent example of a cancer atlas is the Australian cancer atlas (ACA), that provides interactive maps to visualise spatially smoothed estimates of cancer incidence and survival for 20 different cancer types over 2148 small areas across Australia.

Methods: The present study proposes a multivariate Bayesian meta-analysis model, which can model multiple cancers jointly using summary measures without requiring access to the unit record data. This new approach is illustrated by modelling the publicly available spatially smoothed standardised incidence ratios for multiple cancers in the ACA divided into three groups: common, rare/less common and smoking-related. The multivariate Bayesian meta-analysis models are fitted to each group in order to explore any possible association between the cancers in three remoteness regions: major cities, regional and remote areas across Australia. The correlation between the pairs of cancers included in each multivariate model for a group was examined by computing the posterior correlation matrix for each cancer group in each region. The posterior correlation matrices in different remoteness regions were compared using Jennrich's test of equality of correlation matrices (Jennrich in J Am Stat Assoc. 1970;65(330):904-12. https://doi.org/10.1080/01621459.1970.10481133 ).

Results: Substantive correlation was observed among some cancer types. There was evidence that the magnitude of this correlation varied according to remoteness of a region. For example, there has been significant negative correlation between prostate and lung cancer in major cities, but zero correlation found in regional and remote areas for the same pair of cancer types. High risk areas for specific combinations of cancer types were identified and visualised from the proposed model.

Conclusions: Publicly available spatially smoothed disease estimates can be used to explore additional research questions by modelling multiple cancer types jointly. These proposed multivariate meta-analysis models could be useful when unit record data are unavailable because of privacy and confidentiality requirements.
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http://dx.doi.org/10.1186/s12942-020-00234-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7568363PMC
October 2020

Augmenting disease maps: a Bayesian meta-analysis approach.

R Soc Open Sci 2020 Aug 5;7(8):192151. Epub 2020 Aug 5.

School of Mathematical Science, ARC Centre of Excellence for Mathematical and Statistical Frontiers, Queensland University of Technology, Queensland, Australia.

Analysis of spatial patterns of disease is a significant field of research. However, access to unit-level disease data can be difficult for privacy and other reasons. As a consequence, estimates of interest are often published at the small area level as disease maps. This motivates the development of methods for analysis of these ecological estimates directly. Such analyses can widen the scope of research by drawing more insights from published disease maps or atlases. The present study proposes a hierarchical Bayesian meta-analysis model that analyses the point and interval estimates from an online atlas. The proposed model is illustrated by modelling the published cancer incidence estimates available as part of the online Australian Cancer Atlas (ACA). The proposed model aims to reveal patterns of cancer incidence for the 20 cancers included in ACA in major cities, regional and remote areas. The model results are validated using the observed areal data created from unit-level data on cancer incidence in each of 2148 small areas. It is found that the meta-analysis models can generate similar patterns of cancer incidence based on urban/rural status of small areas compared with those already known or revealed by the analysis of observed data. The proposed approach can be generalized to other online disease maps and atlases.
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http://dx.doi.org/10.1098/rsos.192151DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7481717PMC
August 2020

Impact of area-level socioeconomic status and accessibility to treatment on life expectancy after a cancer diagnosis in Queensland, Australia.

Cancer Epidemiol 2020 12 11;69:101803. Epub 2020 Sep 11.

Cancer Council Queensland, Brisbane, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD 4222, Australia; School of Mathematical Sciences, Queensland University of Technology, Gardens Point, Brisbane, QLD 4000, Australia. Electronic address:

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.
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http://dx.doi.org/10.1016/j.canep.2020.101803DOI Listing
December 2020

Factors associated with being diagnosed with high severity of breast cancer: a population-based study in Queensland, Australia.

Breast Cancer Res Treat 2020 Dec 14;184(3):937-950. Epub 2020 Sep 14.

Cancer Council Queensland, Brisbane, Australia.

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) < 2 years (OR 1.60, 1.02-2.51) had greater odds of being diagnosed with high-severity cancer than those of healthy weight, premenopausal, had 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.
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http://dx.doi.org/10.1007/s10549-020-05905-xDOI Listing
December 2020

Cancer prevention: When knowledge of cancer prevention is not enough.

Cancer 2020 Oct 11;126(20):4451-4454. Epub 2020 Aug 11.

Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia.

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http://dx.doi.org/10.1002/cncr.33090DOI Listing
October 2020

Quantifying the Number of Cancer Deaths Avoided Due to Improvements in Cancer Survival since the 1980s in the Australian Population, 1985-2014.

Cancer Epidemiol Biomarkers Prev 2020 Sep 22;29(9):1825-1831. Epub 2020 Jul 22.

Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia.

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 <400 were avoided for pancreatic or lung cancers across each period.

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.
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http://dx.doi.org/10.1158/1055-9965.EPI-20-0299DOI Listing
September 2020

Global trends in incidence rates of childhood liver cancers: A systematic review and meta-analysis.

Paediatr Perinat Epidemiol 2020 09 26;34(5):609-617. Epub 2020 Apr 26.

Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.

Background: Childhood liver cancers are relatively rare, hence inferences on incidence trends over time are limited by lack of precision in most studies.

Objective: To conduct a systematic review and meta-analysis of published contemporary trends on childhood liver cancer incidence rates worldwide.

Data Sources: PubMed, EMBASE, CINAHL, Web of Science.

Study Selection And Data Extraction: English-language peer-reviewed articles published from 1 January 2008 to 1 December 2019 that presented quantitative estimates of incidence trends for childhood liver cancer and diagnostic subgroups. Review was conducted per PRISMA guidelines. Two authors independently extracted data and critically assessed studies.

Synthesis: Random effects meta-analysis models were used to estimate pooled incidence trends by diagnostic subgroups. Heterogeneity was measured using the Q and I statistics and publication bias evaluated using Egger's test.

Results: Eighteen studies were included, all based on population-based cancer registries. Trends were reported on average for 18 years. Overall pooled estimates of the annual percentage change (APC) were 1.4 (95% confidence interval [CI] 0.5, 2.3) for childhood liver cancers, 2.8 (95% CI 1.8, 3.8) for hepatoblastoma and -3.0 (95% CI -11.0, 4.9) for hepatocellular carcinoma. Sub-group analysis by region indicated increasing trends for childhood liver cancers in North America/Europe/Australia (APC 1.7, 95% CI 0.7, 2.8) whereas corresponding trends were stable in Asia (APC 1.4, 95%CI -0.3, 2.7). Publication bias was not detected for any of these analyses. The I statistic indicated that the heterogeneity among included studies was low for combined liver cancers, moderate for hepatoblastoma and high for hepatocellular carcinoma.

Conclusions: Incidence is increasing for childhood liver cancers and the most commonly diagnosed subgroup hepatoblastoma. Lack of knowledge of the etiology of childhood liver cancers limited the ability to understand the reasons for observed incidence trends. This review highlighted the need for ongoing monitoring of incidence trends and etiological studies.
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http://dx.doi.org/10.1111/ppe.12671DOI Listing
September 2020

Survival in patients with multiple primary melanomas: Systematic review and meta-analysis.

J Am Acad Dermatol 2020 Nov 1;83(5):1406-1414. Epub 2020 Apr 1.

Queensland Skin and Cancer Foundation, Queensland Institute of Dermatology, South-Brisbane, Queensland, Australia; The Diamantina Institute, Translational Research Institute, The University of Queensland, Brisbane, Queensland, Australia; The Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia. Electronic address:

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 (I = 96.8%, P < .001).

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.
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http://dx.doi.org/10.1016/j.jaad.2020.03.076DOI Listing
November 2020

Obesity Is Associated with -Mutated Thyroid Cancer.

Thyroid 2020 10 4;30(10):1518-1527. Epub 2020 May 4.

Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Australia.

Thyroid cancer incidence has increased in many parts of the world since the 1980s, as has the prevalence of obesity. Evidence suggests that people with greater body size have higher thyroid cancer risk. However, it is unclear whether this association is causal or is driven by over-diagnosis of indolent cancers, because overweight/obese people use health services more frequently than those of normal weight, thus conferring greater opportunity for incidental diagnosis. Assessing whether obesity is associated with higher-risk thyroid cancers might help clarify this issue. We recruited 1013 people diagnosed with thyroid cancer between 2013 and 2016 and 1057 population controls, frequency matched by sex and age group. We used logistic regression to assess the association between body mass index (BMI) and overall thyroid cancer risk as well as by tumor mutational status as a marker of potentially higher-risk cancer. Overall, obesity was associated with greater risk of thyroid cancer (odds ratio [OR] = 1.72; 95% confidence interval [CI 1.37-2.16] for obese vs. normal BMI). The association with obesity was significantly stronger for -mutation positive than -negative papillary thyroid cancers (PTCs; OR = 1.71 [CI 1.17-2.50] for positive vs. -negative cancers). The increased risks associated with overweight/obesity did not vary by histological subtypes or presence/absence of adverse tumor histologic features. Greater risk of -mutated PTCs among those with high BMI suggests that the association may not merely reflect greater health care service use and indicates an independent relationship between obesity and clinically important thyroid cancer.
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http://dx.doi.org/10.1089/thy.2019.0654DOI Listing
October 2020

Early detection of melanoma: a consensus report from the Australian Skin and Skin Cancer Research Centre Melanoma Screening Summit.

Aust N Z J Public Health 2020 Apr 19;44(2):111-115. Epub 2020 Mar 19.

QIMR Berghofer Medical Research Institute, Queensland.

Introduction: A Melanoma Screening Summit was held in Brisbane, Australia, to review evidence regarding current approaches for early detection of melanomas and explore new opportunities.

Results: Formal population-based melanoma screening is not carried out in Australia, but there is evidence of considerable opportunistic screening as well as early detection. Biopsy rates are rising and most melanomas are now diagnosed when in situ. Based on evidence review and expert opinion, the Summit attendees concluded that there is currently insufficient information in terms of comparative benefits, harms and costs to support change from opportunistic to systematic screening. Assessment of gains in precision and cost-effectiveness of integrating total body imaging, artificial intelligence algorithms and genetic risk information is required, as well as better understanding of clinical and molecular features of thin fatal melanomas.

Conclusions: Research is needed to understand how to further optimise early detection of melanoma in Australia. Integrating risk-based population stratification and more precise diagnostic tests is likely to improve the balance of benefits and harms of opportunistic screening, pending assessment of cost-effectiveness. Implications for public health: The Summit Group identified that the personal and financial costs to the community of detecting and treating melanoma are rising, and this may be mitigated by developing and implementing a more systematic process for diagnosing melanoma.
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http://dx.doi.org/10.1111/1753-6405.12972DOI Listing
April 2020

Global Trends in Incidence Rates of Primary Adult Liver Cancers: A Systematic Review and Meta-Analysis.

Front Oncol 2020 28;10:171. Epub 2020 Feb 28.

Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.

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. 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 statistics and publication bias evaluated using funnel plots and Egger's tests. 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. 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.
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http://dx.doi.org/10.3389/fonc.2020.00171DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7058661PMC
February 2020

Geographical Disparities in Screening and Cancer-Related Health Behaviour.

Int J Environ Res Public Health 2020 02 14;17(4). Epub 2020 Feb 14.

Cancer Council Queensland, 553 Gregory Terrace, Fortitude Valley QLD 4006, Australia.

This study aimed to identify whether cancer-related health behaviours including participation in cancer screening vary by geographic location in Australia. Data were obtained from the 2014-2015 Australian National Health Survey, a computer-assisted telephone interview that measured a range of health-related issues in a sample of randomly selected households. Chi-square tests and adjusted odds ratios from logistic regression models were computed to assess the association between residential location and cancer-related health behaviours including cancer screening participation, alcohol consumption, smoking, exercise, and fruit and vegetable intake, controlling for age, socio-economic status (SES), education, and place of birth. The findings show insufficient exercise, risky alcohol intake, meeting vegetable intake guidelines, and participation in cervical screening are more likely for those living in inner regional areas and in outer regional/remote areas compared with those living in major cities. Daily smoking and participation in prostate cancer screening were significantly higher for those living in outer regional/remote areas. While participation in cancer screening in Australia does not appear to be negatively impacted by regional or remote living, lifestyle behaviours associated with cancer incidence and mortality are poorer in regional and remote areas. Population-based interventions targeting health behaviour change may be an appropriate target for reducing geographical disparities in cancer outcomes.
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http://dx.doi.org/10.3390/ijerph17041246DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7068477PMC
February 2020

Long-term deaths from melanoma according to tumor thickness at diagnosis.

Int J Cancer 2020 09 28;147(5):1391-1396. Epub 2020 Feb 28.

Cancer Council Queensland, Brisbane, Queensland, Australia.

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 <0.80 mm, 10.6% for tumors 0.8 to <1.0 mm and generally more than 30% for melanomas measuring 3 mm and more. For melanomas <1.0 mm, most deaths occurred between 5 and 20 years after diagnosis, whereas for thicker melanomas the reverse was true with most deaths occurring within the first 5 years. Five-year case fatality decreased over successive calendar time periods for melanomas <1.0 mm, but not for melanomas ≥1.0 mm. These findings demonstrate that the time course for fatal melanomas varies markedly according to tumor thickness at diagnosis. Improved understanding of the patient factors and characteristics of melanomas, in addition to tumor thickness, which increase the likelihood of progression, is needed to guide clinical diagnosis, communication with patients and ongoing surveillance pathways of patients with potentially fatal lesions.
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http://dx.doi.org/10.1002/ijc.32930DOI Listing
September 2020

Temporal trends in loss of life expectancy after a cancer diagnosis among the Australian population.

Cancer Epidemiol 2020 04 13;65:101686. Epub 2020 Feb 13.

Cancer Research Centre, Cancer Council Queensland, Brisbane, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD 4222, Australia; School of Mathematical Sciences, Queensland University of Technology, Gardens Point, Brisbane, QLD 4000, Australia. Electronic address:

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.
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http://dx.doi.org/10.1016/j.canep.2020.101686DOI Listing
April 2020

Temporal Trends in Population-Level Cure of Cancer: The Australian Context.

Cancer Epidemiol Biomarkers Prev 2020 03 13;29(3):625-635. Epub 2020 Jan 13.

Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia.

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.
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http://dx.doi.org/10.1158/1055-9965.EPI-19-0693DOI Listing
March 2020

The incidence of childhood cancer in Australia, 1983-2015, and projections to 2035.

Med J Aust 2020 02 26;212(3):113-120. Epub 2019 Dec 26.

Cancer Council Queensland, Brisbane, QLD.

Objectives: To describe changes in childhood cancer incidence in Australia, 1983-2015, and to estimate projected incidence to 2035.

Design, Setting: Population-based study; analysis of Australian Childhood Cancer Registry data for the 20 547 children under 15 years of age diagnosed with cancer in Australia between 1983 and 2015.

Main Outcome Measures: Incidence rate changes during 1983-2015 were assessed by joinpoint regression, with rates age-standardised to the 2001 Australian standard population. Incidence projections to 2035 were estimated by age-period-cohort modelling.

Results: The overall age-standardised incidence rate of childhood cancer increased by 34% between 1983 and 2015, increasing by 1.2% (95% CI, +0.5% to +1.9%) per annum between 2005 and 2015. During 2011-2015, the mean annual number of children diagnosed with cancer in Australia was 770, an incidence rate of 174 cases (95% CI, 169-180 cases) per million children per year. The incidence of hepatoblastoma (annual percentage change [APC], +2.3%; 95% CI, +0.8% to +3.8%), Burkitt lymphoma (APC, +1.6%; 95% CI, +0.4% to +2.8%), osteosarcoma (APC, +1.1%; 95%, +0.0% to +2.3%), intracranial and intraspinal embryonal tumours (APC, +0.9%; 95% CI, +0.4% to +1.5%), and lymphoid leukaemia (APC, +0.5%; 95% CI, +0.2% to +0.8%) increased significantly across the period 1983-2015. The incidence rate of childhood melanoma fell sharply between 1996 and 2015 (APC, -7.7%; 95% CI, -10% to -4.8%). The overall annual cancer incidence rate is conservatively projected to rise to about 186 cases (95% CI, 175-197 cases) per million children by 2035 (1060 cases per year).

Conclusions: The incidence rates of several childhood cancer types steadily increased during 1983-2015. Although the reasons for these rises are largely unknown, our findings provide a foundation for health service planning for meeting the needs of children who will be diagnosed with cancer until 2035.
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http://dx.doi.org/10.5694/mja2.50456DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7065138PMC
February 2020

Pancreaticoduodenectomy in a low-resection volume region: a population-level study examining the impact of hospital-volume on surgical quality and longer-term survival.

HPB (Oxford) 2020 Sep 14;22(9):1288-1294. Epub 2019 Dec 14.

Cancer Alliance Queensland, University of Queensland, Upper-GI, Soft Tissue and Melanoma Unit, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, QLD, 4102, Australia.

Background: An association between higher hospital-volume and better "quality of surgery" and long-term survival has not been reported following pancreatic cancer surgery in low resection-volume regions such as in Australia. Using a population-level study, we compare "quality of surgery" and two-year survival following pancreaticoduodenectomy between Australian hospitals grouped by resection-volume.

Methods: Data on all patients undergoing pancreaticoduodenectomy for adenocarcinoma in the Australian state of Queensland, between 2001 and 2015, were obtained from the Queensland Oncology Repository. Hospitals were grouped into high (≥6 resections annually) and low (<6) volume centres. Following adjustment for case-mix, "quality-of-treatment" indicators were compared between hospital groups using multivariate logistic regression and Poisson regression analysis; and two-year cancer-specific and overall survival were compared using multivariate Cox proportional hazard models.

Results: Compared with high-volume centres, low-volume centres had worse two-year cancer-specific survival (Adjusted HR = 1.31; 95% CI:1.03-1.68), higher 30-day mortality (Adjusted IRR = 3.81; 95% CI: 1.36-10.62) and fewer patients received "high-quality surgery" (Adjusted OR = 0.55; 95% CI: 0.33-0.90). Differences in 30-day mortality, or "quality-of-treatment" indicators did not entirely explain the observed survival difference between hospital-volume groups.

Conclusion: In an Australian environment, a "high" hospital-volume was significantly associated with better quality surgery and two-year survival following pancreaticoduodenectomy.
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http://dx.doi.org/10.1016/j.hpb.2019.11.015DOI Listing
September 2020

Impact of hospital resection volume and service capability on post-operative mortality following gastrectomy.

ANZ J Surg 2020 01 16;90(1-2):86-91. Epub 2019 Dec 16.

Upper-GI, Soft Tissue and Melanoma Unit, Princess Alexandra Hospital, The University of Queensland, Brisbane, Queensland, Australia.

Background: Improved post-operative mortality following gastrectomy for cancer in hospitals with higher resection volumes has not been reported in Australia. Using a population-based study in Queensland, we aimed to compare post-operative mortality following gastrectomy between high- and low-volume hospitals stratified by their service capability.

Methods: All patients undergoing gastrectomy for adenocarcinoma in Queensland between 2001 and 2015 were obtained from the Queensland Oncology Repository. Hospital service capability was defined using the 2015 Australian Institute of Health and Welfare hospital peer groupings. Hospitals were grouped into 'high-volume (≥5 gastrectomies annually), high service capability' (HVHS); 'low-volume (<5), high service capability'; and 'low-volume, low service capability' (LVLS). Negative binomial regression models were used to compare 30- and 90-day mortality rates between hospital groups adjusting for age, sex, socio-economic status, Charlson and American Society of Anesthesiologists scores, treatment regimen, stage and time-period. Potential mediation of mortality differences between hospital groups due to differences in the type of gastrectomy performed was also examined.

Results: LVLS hospitals have higher adjusted 30-day (incidence rate ratio (IRR) 2.97, 95% confidence interval (CI) 1.65-5.35) and 90-day (IRR 1.95, 95% CI 1.23-3.09) mortality rates compared with HVHS hospitals. There is no significant difference in adjusted 30-day (IRR 1.16, 95% CI 0.48-2.79) and 90-day (IRR 1.12, 95% CI 0.59-2.13) mortality rates comparing low-volume, high service capability hospitals with HVHS hospitals. The type of gastrectomy performed did not significantly influence differences in mortality compared between hospital groups.

Conclusion: In the Australian environment, post-operative mortality following gastric cancer surgery may be optimized by centralizing gastrectomy away from hospitals characterized by LVLS.
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http://dx.doi.org/10.1111/ans.15616DOI Listing
January 2020

Breast Cancer Incidence and Survival Among Young Females in Queensland, Australia.

J Adolesc Young Adult Oncol 2020 06 12;9(3):402-409. Epub 2019 Dec 12.

Cancer Council Queensland, Brisbane, Australia.

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. 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. The study cohort comprised 2337 patients, of whom two-thirds ( = 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. 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.
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http://dx.doi.org/10.1089/jayao.2019.0119DOI Listing
June 2020

Second primary cancers in people who had cancer as children: an Australian Childhood Cancer Registry population-based study.

Med J Aust 2020 02 19;212(3):121-125. Epub 2019 Nov 19.

Cancer Council Queensland, Brisbane, QLD.

Objective: To investigate the incidence of second primary cancers in people diagnosed with cancer during childhood.

Design, Setting: Retrospective, population-based study; analysis of Australian Childhood Cancer Registry data.

Participants: People alive at least two months after being diagnosed before the age of 15 years with a primary cancer, 1983-2013, followed until 31 December 2015 (2-33 years' follow-up).

Main Outcome Measures: Risks of second primary cancer compared with the general population, expressed as standardised incidence ratios (SIRs).

Results: Among 18 230 people diagnosed with cancer during childhood, 388 (2%) were later diagnosed with second primary cancers; the estimated 30-year cumulative incidence of second cancers was 4.4% (95% CI, 3.8-5.0%). The risk of a new primary cancer was five times as high as for the general population (SIR, 5.13; 95% CI, 4.65-5.67). Relative risk of a second primary cancer was greatest for people who had childhood rhabdomyosarcoma (SIR, 19.9; 95% CI, 14.4-27.6). Relative risk was particularly high for children who had undergone both chemotherapy and radiotherapy (SIR, 9.80; 95% CI, 8.35-11.5). Relative risk peaked during the 5 years following the first diagnosis (2 to less than 5 years: SIR, 10.3; 95% CI, 8.20-13.0), but was still significant at 20-33 years (SIR, 2.58; 95% CI, 2.02-3.30). The most frequent second primary cancers were thyroid carcinomas (65 of 388, 17%) and acute myeloid leukaemias (57, 15%).

Conclusions: Survivors of childhood cancer remain at increased risk of a second primary cancer well into adulthood. As the late effects of cancer treatment probably contribute to this risk, treatments need to be refined and their toxicity reduced, without reducing their benefit for survival.
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http://dx.doi.org/10.5694/mja2.50425DOI Listing
February 2020

Development of the Australian Cancer Atlas: spatial modelling, visualisation, and reporting of estimates.

Int J Health Geogr 2019 10 1;18(1):21. Epub 2019 Oct 1.

Cancer Council Queensland, PO Box 201, Spring Hill, Brisbane, QLD, 4004, Australia.

Background: It is well known that the burden caused by cancer can vary geographically, which may relate to differences in health, economics or lifestyle. However, to date, there was no comprehensive picture of how the cancer burden, measured by cancer incidence and survival, varied by small geographical area across Australia.

Methods: The Atlas consists of 2148 Statistical Areas level 2 across Australia defined by the Australian Statistical Geography Standard which provide the best compromise between small population and small area. Cancer burden was estimated for males, females, and persons separately, with 50 unique sex-specific (males, females, all persons) cancer types analysed. Incidence and relative survival were modelled with Bayesian spatial models using the Leroux prior which was carefully selected to provide adequate spatial smoothing while reflecting genuine geographic variation. Markov Chain Monte Carlo estimation was used because it facilitates quantifying the uncertainty of the posterior estimates numerically and visually.

Results: The results of the statistical model and visualisation development were published through the release of the Australian Cancer Atlas ( https://atlas.cancer.org.au ) in September, 2018. The Australian Cancer Atlas provides the first freely available, digital, interactive picture of cancer incidence and survival at the small geographical level across Australia with a focus on incorporating uncertainty, while also providing the tools necessary for accurate estimation and appropriate interpretation and decision making.

Conclusions: The success of the Atlas will be measured by how widely it is used by key stakeholders to guide research and inform decision making. It is hoped that the Atlas and the methodology behind it motivates new research opportunities that lead to improvements in our understanding of the geographical patterns of cancer burden, possible causes or risk factors, and the reasons for differences in variation between cancer types, both within Australia and globally. Future versions of the Atlas are planned to include new data sources to include indicators such as cancer screening and treatment, and extensions to the statistical methods to incorporate changes in geographical patterns over time.
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http://dx.doi.org/10.1186/s12942-019-0185-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6771109PMC
October 2019

Service Level Factors Associated with Cervical Screening in Aboriginal and Torres Strait Islander Primary Health Care Centres in Australia.

Int J Environ Res Public Health 2019 09 27;16(19). Epub 2019 Sep 27.

Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Casuarina 0810, Australia.

Aboriginal and Torres Strait Islander women have significantly higher cervical cancer incidence and mortality than other Australian women. In this study, we assessed the documented delivery of cervical screening for women attending Indigenous Primary Health Care (PHC) centres across Australia and identified service-level factors associated with between-centre variation in screening coverage. We analysed 3801 clinical audit records for PHC clients aged 20-64 years from 135 Indigenous PHC centres participating in the Audit for Best Practice in Chronic Disease (ABCD) continuous quality improvement (CQI) program across five Australian states/territories during 2005 to 2014. Multilevel logistic regression models were used to identify service-level factors associated with screening, while accounting for differences in client-level factors. There was substantial variation in the proportion of clients who had a documented cervical screen in the previous two years across the participating PHC centres (median 50%, interquartile range (IQR): 29-67%), persisting over years and audit cycle. Centre-level factors explained 40% of the variation; client-level factors did not reduce the between-centre variation. Screening coverage was associated with longer time enrolled in the CQI program and very remote location. Indigenous PHC centres play an important role in providing cervical screening to Aboriginal and Torres Strait Islander women. Thus, their leadership is essential to ensure that Australia's public health commitment to the elimination of cervical cancer includes Aboriginal and Torres Strait Islander women. A sustained commitment to CQI may improve PHC centres delivery of cervical screening; however, factors that may impact on service delivery, such as organisational, geographical and environmental factors, warrant further investigation.
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http://dx.doi.org/10.3390/ijerph16193630DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6801551PMC
September 2019

Assessment of hospital characteristics associated with improved mortality following complex upper gastrointestinal cancer surgery in Queensland.

ANZ J Surg 2019 11 3;89(11):1404-1409. Epub 2019 Sep 3.

Upper-GI, Soft Tissue and Melanoma Unit, Princess Alexandra Hospital, The University of Queensland, Brisbane, Queensland, Australia.

Background: High hospital-volume and service capability are associated with improved mortality following complex cancer surgery. Using a population-based study in Queensland, we assessed differences in mortality following oesophagectomy and pancreaticoduodenectomy, comparing high- and low-volume hospitals stratified by service capability.

Methods: Data on all patients undergoing oesophagectomy and pancreaticoduodenectomy for cancer in Queensland between 2001 and 2015 were obtained from the Queensland Oncology Repository. Hospital service capability was defined using the 2015 Australian Institute of Health and Welfare hospital peer groupings. Hospitals were grouped into 'high-volume (≥6 oesophagectomies or pancreaticoduodenectomies annually) with high service capability'; 'low-volume (<6) with high service capability' and 'low-volume with low service capability'. Multivariate Poisson models were used to estimate differences in 30- and 90-day mortality between hospital groups adjusting for age, sex, socioeconomic status, Charlson and American Society of Anesthesiologists scores, chemotherapy, radiotherapy, stage and time-period.

Results: For oesophagectomy, adjusted 90-day mortality was higher in low-volume compared with high-volume hospitals, regardless of service capability (low-volume, high service: incident rate ratio (IRR) 3.86, 95% confidence interval (CI) 1.74-8.57; low-volume, low service: IRR 3.40, 95% CI 1.16-10.00). For pancreaticoduodenectomy, mortality was higher in low-volume compared with high-volume centres regardless of service capability: 30-day mortality (low-volume, high service: IRR 2.32, 95% CI 1.07-5.03; low-volume, low service: IRR 3.92, 95% CI 1.45-10.61); 90-day mortality (low-volume, high service: IRR 2.36, 95% CI 1.29-4.30; low-volume, low service: IRR 3.32, 95% CI 1.64-6.71).

Conclusion: High hospital resection volumes are associated with lower post-operative mortality following oesophagectomy and pancreaticoduodenectomy regardless of hospital service capability. This data supports centralization of these procedures to high-volume centres.
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http://dx.doi.org/10.1111/ans.15389DOI Listing
November 2019