Factors predictive of treatment by Australian breast surgeons of invasive female breast cancer by mastectomy rather than breast conserving surgery

Background: The National Breast Cancer Audit Database of the Society of Breast Surgeons of Australia and New Zealand is used by surgeons to monitor treatment quality and for research. About 60% of early invasive female breast cancers in Australia are recorded. The objectives of this study are: (1) to investigate associations of socio-demographic, health-system and clinical characteristics with treatment of invasive female breast cancer by mastectomy compared with breast conserving surgery; and (2) to consider service delivery implications. Materials and Methods: Bi-variable and multivariable analyses of associations of characteristics with surgery type for cancers diagnosed in 1998-2010. Results: Of 30,299 invasive cases analysed, 11,729 (39%) were treated by mastectomy as opposed to breast conserving surgery. This proportion did not vary by diagnostic year (p>0.200). With major city residence as the reference category, the relative rate (95% confidencelimits) of mastectomy was 1.03 (0.99, 1.07) for women from inner regional areas and 1.05 (1.01, 1.10) for those from more remote areas. Low annual surgeon case load (≤10) was predictive of mastectomy, with a relative rate of 1.08 (1.03, 1.14) when compared with higher case loads. Tumour size was also predictive, with a relative rate of 1.05 (1.01, 1.10) for large cancers (40+ mm) compared with smaller cancers (<30 mm). These associations were confirmedin multiple logistic regression analysis. Conclusions: Results confirmprevious studies showing higher mastectomy rates for residents of more remote areas, those treated by surgeons with low case loads, and those with large cancers. Reasons require further study, including possible effects of surgeon and woman’s choice and access to radiotherapy services.David Roder, Helen Zorbas, James Kollias, Chris Pyke, David Walters, Ian Campbell, Corey Taylor, Fleur Webste

Comparison of Informational Needs among Newly Diagnosed Breast Cancer Women Undergoing Different Surgical Treatment Modalities

Breast cancer is the most commonly diagnosed cancer for women worldwide. Almost all women with breast cancer will have some type of surgery in the course of their treatment either breast conservation surgery or modified radical mastectomy. Informational needs for such types of patients are critical step in providing high quality care. Aim: Comparing the informational needs among newly diagnosed breast cancer women with different surgical treatment modalities. Sample: A purposeful sample of 100 adult women with breast cancer undergoing surgery divided into two equal groups according to type of surgery. Design: Comparative descriptive design was utilized. Setting: This study was conducted at National Cancer Institute affiliated to Cairo University. Tools: Structured Interview Questionnaire and The Arabic translated version of Toronto Informational Needs Questionnaire of Breast Cancer, scored with likert scale as low, moderate and high important informational needs. The study findings revealed that newly diagnosed women with breast cancer undergoing surgery either breast conservation surgery or modified radical mastectomy were different in regard to age, marital status, residence, education, income and type of breast cancer. Although both groups had informational needs in different rates related to disease, investigative tests and treatment; they expressed that the highest informational needs was related to physical information, while the least important was related to psychosocial needs. Conclusion: information related to physical, disease, investigative tests and treatment are important needs for newly diagnosed breast cancer women regardless their type of surgery. Key words: newly diagnosed , breast cancer women, informational needs, different surgical treatment modalities.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               

Beyond Breast Cancer: An exploration of the experiences of middle-aged female breast cancer survivors in Australia.

Objective: Middle-aged women (40 – 65 years) who live with, through and beyond breast cancer (survivors), are a relatively under-researched population group, particularly within an Australian context. The unmet needs reported within this population include fatigue, psychological distress, body image concerns, early onset menopause, and a lack of information of these issues. The present study aims to explore how the experiences of breast cancer survivorship impact the lives of Australian middle-aged women (n = 644), and to inform future provision of care and support. Methods: This qualitative study used secondary survey data from the Australian Longitudinal Study of Women’s Health (ALSWH) middle-age cohort gathered between 1996 – 2013. Researchers conducted a thematic analysis using consensus coding on data collected from participants in this group who reported breast cancer (including metastasised) in any survey. Results: This cohort reported a unique experience of breast cancer survivorship due to their age. Analysis developed the following themes: the middle-aged context of breast cancer; care and support, body changes, overcoming fears and maintaining balance; and finding a ‘new normal’. Conclusions: Breast cancer survivorship is a subjective experience; for many it involves chronic limitations and challenges. Investigation and application of survivorship care plans in Australia would benefit from greater inclusion of multidisciplinary professionals. This will help satisfy heretofore unmet information needs and associated psychological distress of breast cancer survivors which go above their biomedical concerns. Further recommendations include development of online support groups providing access to rehabilitation professionals, especially for otherwise isolated rural women.Australian Longitudinal Study of Women's Healt

Women and non communicable diseases (chronic conditions)

Non-communicable diseases (cancer, cardiovascular disease, diabetes, chronic respiratory conditions, and musculo-skeletal conditions) are the number one cause of death and disablement for women and men globally and in Australia, with increasing recognition that women and men experience those conditions differently. This position paper examines the gender dimensions of those diseases to raise awareness, and to inform prevention and treatment guidelines. Building on the inequities for women documented in the AWHN Position Paper on Women’s Health and Wellbeing, this paper highlights the specific areas where gender blindness is occurring and the areas where change is&nbsp;needed. Despite the prevalence of Non-communicable diseases (NCDs) among women, there has been little emphases and even less action, on the differences that women experience in these diseases. Most guidelines and policies on NCDs are gender neutral. This has meant that women with non-communicable diseases have not received the level of support and services needed to ensure the best possible outcomes or that necessary research and education into gender differences has been&nbsp;funded. The lack of research into gender differences and the consequent lack of education for health providers and the population generally, potentially promotes poorer outcomes for women and increases gender inequities. When there is mounting evidence that women’s experience of NCDs is different to that of men’s experience, the gender neutrality of policies, research and education programs contributes to gender&nbsp;inequities. The impact of NCDs on women’s lives, the differences in risk factors for women than for men and the social determinants of NCDs are highlighted. Specific risks include, that: Lung cancer is responsible for more women’s deaths than breast cancer although more women are diagnosed with breast cancer than lung cancer Mortality rates from lung cancer in women are continuing to rise while they have plateaued or are&nbsp;dropping among men Chronic Obstructive Pulmonary Disease (COPD) occurs at lower levels of exposure to tobacco smoking in women than men women with diabetes have a higher risk of stroke than their male counterparts women with diabetes have poorer survival after stroke than men. This paper also highlights the low rate of women in research trials and the low levels of reporting of sex-disaggregated findings. These indicate that treatment recommendations are more generalisable for males than females and the research benefits are therefore greater for men. In turn, this accords a lower status in research to women’s health. Failure to act on gender differences in non-communicable disease costs lives. It is no longer satisfactory for prevention and treatment guidelines to remain gender neutral. Leadership from governments and peak health bodies is required to drive change in both policy and research. Understanding the ways in which gender interacts with NCDs will be enhanced by explicitly mainstreaming gender in policy, research, treatment guidelines and professional and public education. This paper recommends actions that can be taken to redress these problems, and achieve gender aware, gender sensitive and gender transformative care for women. &nbsp

National Aboriginal and Torres Strait Islander cancer framework 2015

Overview The National Aboriginal and Torres Strait Islander Cancer Framework (the Framework) provides high-level guidance and direction for the many individuals, communities, organisations and governments whose combined efforts are required to address disparities and improve cancer outcomes for Aboriginal and Torres Strait Islander peoples. This Framework is designed to complement and enhance national, jurisdictional, regional and local efforts to improve Aboriginal and Torres Strait Islander cancer outcomes, including cancer plans and related policies, frameworks and action plans. It sets out priority areas for action, and allows the flexibility for jurisdictions, communities and organisations to address those priorities in ways that suit their local context and local needs. This Framework encompasses the full continuum of cancer control, including cancer prevention, screening and early detection, diagnosis and treatment, palliative care and survivorship; and the policy, systems, research and infrastructure that surround these service areas

Outcomes of ethnic minority groups with node-positive, non-metastatic breast cancer in two tertiary referral centers in Sydney, Australia

Purpose: There is a lack of information in ethnic minority groups with regard to presentation and treatment of early node-positive breast cancer. We carried out a retrospective study of patients referred to two tertiary cancer centers in South Western Sydney, both of which serve a high proportion of this ethnic minority population. Patients and methods: Women who had pathologically node-positive non-metastatic breast cancer (T1-3, N1-3, M0) diagnosed between 2003 and 2006 were studied, with variables of interest being tumor size, number of positive nodes, histological grade, hormone receptor status, age at diagnosis, country of birth and treatment. We compared the Asian and Western subgroups with regard to tumor characteristics, treatment and clinical outcomes. Results: A total of 652 eligible patients were identified, with a median follow-up of 6.1 years. Women with Asian backgrounds (n = 125, 20%) were significantly younger at presentation (48 years versus 55 years, p-value <0.0001) and more likely to undergo mastectomy (53% versus 39%, p-value 0.0009) and chemotherapy (86% versus 72%, p-value 0.0063) than their non-Asian counterparts. Tumor stage, grade and receptor status were not statistically different between these two groups. There were also no differences in disease-free survival and overall survival, with medians of 12.7 and 14.8 years respectively. Conclusion: Women of Asian background are younger at diagnosis, which may reflect population epidemiology and likely results in higher uptake of chemotherapy. Higher mastectomy rates may be influenced by cultural factors. Future research is warranted to investigate potential differences in tumor biology, psychosocial, economic and cultural factors

Barriers to lung cancer care: health professionals' perspectives.

PURPOSE: Globally, lung cancer is the most common cancer and the leading cause of cancer death. Problematically, there is a wide variation in the management and survival for people with lung cancer and there is limited understanding of the reasons for these variations. To date, the views of health professionals across relevant disciplines who deliver such care are largely absent. The present study describes Australian health professionals' views about barriers to lung cancer care to help build a research and action agenda for improving lung cancer outcomes. METHODS: Qualitative semi-structured interviews were undertaken with a multidisciplinary group of 31 Australian health professionals working in lung cancer care for an average of 16 years (range 1-35 yrs.; SD = 10.2) seeing a mean of 116 patients annually. RESULTS: Three superordinate themes were identified: illness representations, cultural influences, and health system context. Illness representations included three themes: symptoms attributed as smoking-related but not cancer, health-related stigma, and therapeutic nihilism. Cultural influence themes included Indigenous health care preferences, language and communication, and sociodemographic factors. Health system context included lack of regional services and distance to treatment, poor care coordination, lack of effective screening methods, and health professional behaviours. CONCLUSIONS: Fractured and locally isolated approaches routinely confound responses to the social, cultural and health system complexities that surround a diagnosis of lung cancer and subsequent treatment. Improving outcomes for this disadvantaged patient group will require government, health agencies, and the community to take an aggressive, integrated approach balancing health policy, treatment priorities, and societal values

Information on 'overdiagnosis' in breast cancer screening on prominent United Kingdom- and Australia-oriented health websites

Objectives: Health-related websites are an important source of information for the public. Increasing public awareness of overdiagnosis and ductal carcinoma in situ (DCIS) in breast cancer screening may facilitate more informed decision-making. This study assessed the extent to which such information was included on prominent health websites oriented towards the general public, and evaluated how it was explained. Design: Cross-sectional study. Setting: Websites identified through Google searches in England (United Kingdom) and New South Wales (Australia) for “breast cancer screening” and further websites included based on our prior knowledge of relevant organisations. Main outcomes: Content analysis was used to determine whether information on overdiagnosis or DCIS existed on each site, how the concepts were described, and what statistics were used to quantify overdiagnosis. Results: After exclusions, ten UK websites and eight Australian websites were considered relevant and evaluated. They originated from charities, health service providers, government agencies, and an independent health organisation. Most contained some information on overdiagnosis (and/or DCIS). Descriptive information was similar across websites. In the UK sample, statistical information was often based on estimates from the Independent UK Panel on Breast Cancer Screening; the most commonly provided statistic was the ratio of breast cancer deaths prevented to overdiagnosed cases (1:3). A range of other statistics was included, such as the yearly number of overdiagnosed cases and the proportion of women screened who would be overdiagnosed. Information on DCIS and statistical information were found less commonly on the Australian websites. Conclusions: Online information about overdiagnosis has become more widely available in 2015-16 compared with the limited accessibility indicated by older research. However, there may be scope to offer more information on DCIS and overdiagnosis statistics on Australian websites. Moreover, the variability in how estimates are presented across UK websites may be confusing for the general public

Differential Effects of Insulin-Like Growth Factor Binding Protein-6 (IGFBP-6) on Migration of Two Ovarian Cancer Cell Lines

Introduction: IGFBP-6 inhibits angiogenesis as well as proliferation and survival of rhabdomyosarcoma cells. However, it promotes migration of these cells in an IGF-independent manner. The IGF system is implicated in ovarian cancer, so we studied the effects of IGFBP-6 in ovarian cancer cells. Methods: The effects of wild type (wt) and a non-IGF-binding mutant (m) of IGFBP-6 on migration of HEY and SKOV3 ovarian cancer cells, which, respectively, represent aggressive and transitional cancers, were studied. ERK and JNK phosphorylation were measured by Western blotting. Results: IGF-II, wt-, and mIGFBP-6 each promoted SKOV3 cell migration by 77–98% (p < 0.01). In contrast, IGF-II also increased HEY cell migration to 155 ± 13% of control (p < 0.001), but wt-IGFBP-6 and mIGFBP-6 decreased migration to 62 ± 5 and 66 ± 3%, respectively (p < 0.001). In these cells, coincubation of IGF-II with wt but not mIGFBP-6 increased migration. MAP kinase pathways are involved in IGFBP-6-induced rhabdomyosarcoma cell migration, so activation of these pathways was studied in HEY and SKOV3 cells. Wt and mIGFBP-6 increased ERK phosphorylation by 62–99% in both cell lines (p < 0.05). Wt-IGFBP-6 also increased JNK phosphorylation by 139–153% in both cell lines (p < 0.05), but the effect of mIGFBP-6 was less clear. ERK and JNK inhibitors partially inhibited the migratory effects of wt and mIGFBP-6 in SKOV3 cells, whereas the ERK inhibitor partially restored wt and mIGFBP-6-induced inhibition of HEY cell migration. The JNK inhibitor had a lesser effect on the actions of wtIGFBP-6 and no effect on the actions of mIGFBP-6 in HEY cells. Conclusion: IGFBP-6 has opposing effects on migration of HEY and SKOV3 ovarian cancer cells, but activates MAP kinase pathways in both. Delineating the pathways underlying the differential effects on migration will increase our understanding of ovarian cancer metastasis and shed new light on the IGF-independent effects of IGFBP-6

Contrasting temporal trends in lung cancer incidence by socioeconomic status among women in New South Wales, Australia, 1985-2009

OBJECTIVE: We examined long-term trends in lung cancer incidence for women by socioeconomic groups in New South Wales (NSW), Australia. METHODS: Data on lung cancer incidence for women were extracted from the NSW Cancer Registry database. We divided the study cohort into five quintiles according to an area-based index of education and occupation (IEO) and calculated annual age-standardised incidence rates by IEO quintile for the period 1985-2009. The age-standardised incidence ratio (SIR) was estimated for IEO quintiles and 5-year period of diagnosis using the highest IEO quintile as the reference. RESULTS: Overall, lung cancer incidence for women aged 25-69 years increased gradually from 19.8 per 100,000 in 1985 to 25.7 per 100,000 in 2009. The trends by IEO quintile were somewhat comparable from 1985 through to 1995, but from then on rates remained relatively stable for women residing in the highest quintile while increasing for women residing in the remaining four quintiles. Consequently, the SIR for all four of the lower IEO quintiles increased significantly over the 25-year period. For example, the SIR in the lowest IEO quintile increased from 1.16 (95% CI, 0.99-1.37) during 1985-1989 to 1.70 (95% CI, 1.50-1.93) during 2005-2009. The corresponding estimates for women aged 70 years or older showed no clear pattern of socioeconomic gradient. CONCLUSION: The increasing gap in lung cancer incidence between women in the highest socioeconomic group and all others suggests that there is a continued need for the broad implementation of tobacco control interventions, so that smoking prevalence is reduced across all segments of the population and the subsequent benefits are shared more equitably across all demographic groups