Distribution of subsequent primary invasive melanomas following a first primary invasive OR in situ Melanoma Queensland, Australia, 1982-2010

IMPORTANCE: Melanoma survivors are known to have a highly elevated risk of subsequent primary melanomas. OBJECTIVE: To determine the relative risk of subsequent primary invasive melanomas following a first primary invasive or in situ melanoma, with a focus on body site. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort studywas conducted using population-based administrative data for melanoma diagnoses collected by the Queensland Cancer Registry, Queensland, Australia. Deidentified records of all cases of melanoma among Queensland residents during the period 1982-2005 were obtained and reviewed to December 31, 2010. There were 39 668 eligible cases of first primary invasive melanoma and 22 845 cases of first primary in situ melanoma. MAIN OUTCOMES AND MEASURES: Standardized incidence ratios (SIRs), a proxy measure for relative risk, were calculated by dividing the observed number of subsequent primary invasive melanomas by the product of the strata-specific incidence rates that occurred in the general population and the cumulative time at risk for the cohort. Synchronous subsequent melanomas (diagnosed within 60 days of the first primary melanoma) were excluded. Differences between SIRs were assessed using multivariate negative binomial regression adjusted for sex, age group, time to second diagnosis, and body site and expressed in terms of adjusted SIR ratios with corresponding 95%CIs. RESULTS: There were 5358 subsequent primary invasive melanomas diagnosed, resulting in SIRs of 5.42 (95%CI, 5.23-5.61) and 4.59 (4.37-4.82) for persons with a first primary invasive or in situ melanoma, respectively. The SIRs remained elevated throughout the follow-up period. In general, subsequent primary invasive melanomas were more likely to occur at the same body site as the initial invasive or in situ melanoma. The largest relative risk was for females with a first primary invasive melanoma on the head followed by a subsequent primary invasive melanoma also on the head (SIR, 13.32; 95%CI, 10.28-16.98). CONCLUSIONS AND RELEVANCE: Melanoma survivors require ongoing surveillance, with particular attention required for the body site of the initial lesion. Clinical practice guidelines have recognized the importance of monitoring for people with invasive melanoma; the results of the present study highlight the need for similar levels of supervision for those with a diagnosis of in situ melanoma

Cancer survival in New South Wales, Australia: socioeconomic disparities remain despite overall improvements

Background\ud \ud Disparities in cancer survival by socioeconomic status have been reported previously in Australia. We investigated whether those disparities have changed over time.\ud Methods\ud \ud We used population-based cancer registry data for 377,493 patients diagnosed with one of 10 major cancers in New South Wales (NSW), Australia. Patients were assigned to an area-based measure of socioeconomic status. Five-year relative survival was estimated for each socioeconomic quintile in each ‘at risk’ period (1996–2000 and 2004–2008) for the 10 individual cancers. Poisson-regression modelling was used to adjust for several prognostic factors. The relative excess risk of death by socioeconomic quintile derived from this modelling was compared over time.\ud Results\ud \ud Although survival increased over time for most individual cancers, Poisson-regression models indicated that socioeconomic disparities continued to exist in the recent period. Significant socioeconomic disparities were observed for stomach, colorectal, liver, lung, breast and prostate cancer in 1996–2000 and remained so for 2004–2008, while significant disparities emerged for cervical and uterus cancer in 2004–2008 (although the interaction between period and socioeconomic status was not significant). About 13.4 % of deaths attributable to a diagnosis of cancer could have been postponed if this socioeconomic disparity was eliminated.\ud Conclusion\ud \ud While recent health and social policies in NSW have accompanied an increase in cancer survival overall, they have not been associated with a reduction in socioeconomic inequalities

Developing the atlas of cancer in Queensland: methodological issues

Background: Achieving health equity has been identified as a major challenge, both internationally and within Australia. Inequalities in cancer outcomes are well documented, and must be quantified before they can be addressed. One method of portraying geographical variation in data uses maps. Recently we have produced thematic maps showing the geographical variation in cancer incidence and survival across Queensland, Australia. This article documents the decisions and rationale used in producing these maps, with the aim to assist others in producing chronic disease atlases. Methods: Bayesian hierarchical models were used to produce the estimates. Justification for the cancers chosen, geographical areas used, modelling method, outcome measures mapped, production of the adjacency matrix, assessment of convergence, sensitivity analyses performed and determination of significant geographical variation is provided. Conclusions: Although careful consideration of many issues is required, chronic disease atlases are a useful tool for assessing and quantifying geographical inequalities. In addition they help focus research efforts to investigate why the observed inequalities exist, which in turn inform advocacy, policy, support and education programs designed to reduce these inequalities

The first year counts: cancer survival among Indigenous and non-Indigenous Queenslanders, 1997–2006

Objective: To examine the differential in cancer survival between Indigenous and non-Indigenous people in Queensland in relation to time after diagnosis, remoteness and area-socioeconomic disadvantage. Design, setting and participants: Descriptive study of population-based data on all 150 059 Queensland residents of known Indigenous status aged 15 years and over who were diagnosed with a primary invasive cancer during 1997–2006. Main outcome measures: Hazard ratios for the categories of area- socioeconomic disadvantage, remoteness and Indigenous status, as well as conditional 5-year survival estimates. Results: Five-year survival was lower for Indigenous people diagnosed with cancer (50.3%; 95% CI, 47.8%–52.8%) compared with non-Indigenous people (61.9%; 95% CI, 61.7%–62.2%). There was no evidence that this differential varied by remoteness (P = 0.780) or area-socioeconomic disadvantage (P = 0.845). However, it did vary by time after diagnosis. In a time-varying survival model stratified by age, sex and cancer type, the 50% excess mortality in the first year (adjusted HR, 1.50; 95% CI, 1.38–1.63) reduced to near unity at 2 years after diagnosis (HR, 1.03; 95% CI, 0.78–1.35). Conclusions: After a wide disparity in cancer survival in the first 2 years after diagnosis, Indigenous patients with cancer who survive these 2 years have a similar outlook to non-Indigenous patients. Access to services and socioeconomic factors are unlikely to be the main causes of the early lower Indigenous survival, as patterns were similar across remoteness and area- socioeconomic disadvantage. There is an urgent need to identify the factors leading to poor outcomes early after diagnosis among Indigenous people with cancer

Spatial disparities in the reported incidence and survival of myeloproliferative neoplasms in Australia

Acknowledgments:The authors wish to thank the MPN Alliance Australia for motivating this study and financial support. We would also like to thank the reviewers for their helpful comments. Funding: was provided by the MPN Alliance Australia. The MPN Alliance Australia did not play any role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.Peer reviewedPostprintPostprintPostprin

The impact of rurality and disadvantage on the diagnostic interval for breast cancer in a large population-based study of 3202 women in Queensland, Australia

Delays in diagnosing breast cancer (BC) can lead to poorer outcomes. We investigated factors related to the diagnostic interval in a population-based cohort of 3202 women diagnosed with BC in Queensland,Australia. Interviews ascertained method of detection and dates of medical/procedural appointments,and clinical information was obtained from medical records. Time intervals were calculated from self-recognition of symptoms (symptom-detected) or mammogram (screen-detected) to diagnosis (diagnostic interval (DI)). The cohort included 1560 women with symptom-detected and 1642 with screen-detected BC. Symptom-detected women had higher odds of DI of >60 days if they were Indigenous (OR = 3.12,95% CI = 1.40,6.98); lived in outer regional (OR = 1.50,95% CI = 1.09,2.06) or remote locations (OR = 2.46,95% CI = 1.39,4.38); or presented with a “non-lump” symptom (OR = 1.84,95% CI = 1.43,2.36). For screen-detected BC,women who were Indigenous (OR = 2.36,95% CI = 1.03,5.80); lived in remote locations (OR = 2.35,95% CI = 1.24,4.44); or disadvantaged areas (OR = 1.69,95% CI = 1.17,2.43) and attended a public screening facility (OR = 2.10,95% CI = 1.40,3.17) had higher odds of DI > 30 days. Our study indicates a disadvantage in terms of DI for rural,disadvantaged and Indigenous women. Difficulties in accessing primary care and diagnostic services are evident. There is a need to identify and implement an efficient and effective model of care to minimize avoidable longer diagnostic intervals

Spatial variation in cancer incidence and survival over time across Queensland, Australia

Interpreting changes over time in small-area variation in cancer survival, in light of changes in cancer incidence, aids understanding progress in cancer control, yet few space-time analyses have considered both measures. Bayesian space-time hierarchical models were applied to Queensland Cancer Registry data to examine geographical changes in cancer incidence and relative survival over time for the five most common cancers (colorectal, melanoma, lung, breast, prostate) diagnosed during 1997-2004 and 2005-2012 across 516 Queensland residential small-areas. Large variation in both cancer incidence and survival was observed. Survival improvements were fairly consistent across the state, although small for lung cancer. Incidence changes varied by location and cancer type, ranging from lung and colorectal cancers remaining relatively constant over time, to prostate cancer dramatically increasing across the entire state. Reducing disparities in cancer-related outcomes remains a health priority, and space-time modelling of different measures provides an important mechanism by which to monitor progress

Analysis of the Flux and Polarization Spectra of the Type Ia Supernova SN 2001el: Exploring the Geometry of the High-velocity Ejecta

SN 2001el is the first normal Type Ia supernova to show a strong, intrinsic polarization signal. In addition, during the epochs prior to maximum light, the CaII IR triplet absorption is seen distinctly and separately at both normal photospheric velocities and at very high velocities. The high-velocity triplet absorption is highly polarized, with a different polarization angle than the rest of the spectrum. The unique observation allows us to construct a relatively detailed picture of the layered geometrical structure of the supernova ejecta: in our interpretation, the ejecta layers near the photosphere (v \approx 10,000 km/s) obey a near axial symmetry, while a detached, high-velocity structure (v \approx 18,000-25,000 km/s) with high CaII line opacity deviates from the photospheric axisymmetry. By partially obscuring the underlying photosphere, the high-velocity structure causes a more incomplete cancellation of the polarization of the photospheric light, and so gives rise to the polarization peak and rotated polarization angle of the high-velocity IR triplet feature. In an effort to constrain the ejecta geometry, we develop a technique for calculating 3-D synthetic polarization spectra and use it to generate polarization profiles for several parameterized configurations. In particular, we examine the case where the inner ejecta layers are ellipsoidal and the outer, high-velocity structure is one of four possibilities: a spherical shell, an ellipsoidal shell, a clumped shell, or a toroid. The synthetic spectra rule out the spherical shell model, disfavor a toroid, and find a best fit with the clumped shell. We show further that different geometries can be more clearly discriminated if observations are obtained from several different lines of sight.Comment: 14 pages (emulateapj5) plus 18 figures, accepted by The Astrophysical Journa

Geographical Variations in Prostate Cancer Outcomes: A Systematic Review of International Evidence

Background: Previous reviews of geographical disparities in the prostate cancer continuum from diagnosis to mortality have identified a consistent pattern of poorer outcomes with increasing residential disadvantage and for rural residents. However, there are no contemporary, systematic reviews summarizing the latest available evidence. Our objective was to systematically review the published international evidence for geographical variations in prostate cancer indicators by residential rurality and disadvantage.Methods: Systematic searches of peer-reviewed articles in English published from 1/1/1998 to 30/06/2018 using PubMed, EMBASE, CINAHL, and Informit databases. Inclusion criteria were: population was adult prostate cancer patients; outcome measure was PSA testing, prostate cancer incidence, stage at diagnosis, access to and use of services, survival, and prostate cancer mortality with quantitative results by residential rurality and/or disadvantage. Studies were critically appraised using a modified Newcastle-Ottawa Scale.Results: Overall 169 studies met the inclusion criteria. Around 50% were assessed as high quality and 50% moderate. Men from disadvantaged areas had consistently lower prostate-specific antigen (PSA) testing and prostate cancer incidence, poorer survival, more advanced disease and a trend toward higher mortality. Although less consistent, predominant patterns by rurality were lower PSA testing, prostate cancer incidence and survival, but higher stage disease and mortality among rural men. Both geographical measures were associated with variations in access and use of prostate cancer-related services for low to high risk disease.Conclusions: This review found substantial evidence that prostate cancer indicators varied by residential location across diverse populations and geographies. While wide variations in study design limited comparisons across studies, our review indicated that internationally, men living in disadvantaged areas, and to a lesser extent more rural areas, face a greater prostate cancer burden. This review highlights the need for a better understanding of the complex social, environmental, and behavioral reasons for these variations, recognizing that, while important, geographical access is not the only issue. Implementing research strategies to help identify these processes and to better understand the central role of disadvantage to variations in health outcome are crucial to inform the development of evidence-based targeted interventions

Cancer survival for Aboriginal and Torres Strait Islander Australians: a national study of survival rates and excess mortality

BackgroundNational cancer survival statistics are available for the total Australian population but not Indigenous Australians, although their cancer mortality rates are known to be higher than those of other Australians. We aimed to validate analysis methods and report cancer survival rates for Indigenous Australians as the basis for regular national reporting.MethodsWe used national cancer registrations data to calculate all-cancer and site-specific relative survival for Indigenous Australians (compared with non-Indigenous Australians) diagnosed in 2001-2005. Because of limited availability of Indigenous life tables, we validated and used cause-specific survival (rather than relative survival) for proportional hazards regression to analyze time trends and regional variation in all-cancer survival between 1991 and 2005.ResultsSurvival was lower for Indigenous than non-Indigenous Australians for all cancers combined and for many cancer sites. The excess mortality of Indigenous people with cancer was restricted to the first three years after diagnosis, and greatest in the first year. Survival was lower for rural and remote than urban residents; this disparity was much greater for Indigenous people. Survival improved between 1991 and 2005 for non-Indigenous people (mortality decreased by 28%), but to a much lesser extent for Indigenous people (11%) and only for those in remote areas; cancer survival did not improve for urban Indigenous residents.ConclusionsCancer survival is lower for Indigenous than other Australians, for all cancers combined and many individual cancer sites, although more accurate recording of Indigenous status by cancer registers is required before the extent of this disadvantage can be known with certainty. Cancer care for Indigenous Australians needs to be considerably improved; cancer diagnosis, treatment, and support services need to be redesigned specifically to be accessible and acceptable to Indigenous people