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

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

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

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

Star Clusters in the Nearby Late-Type Galaxy NGC 1311

Ultraviolet, optical and near infrared images of the nearby (D ~ 5.5 Mpc) SBm galaxy NGC 1311, obtained with the Hubble Space Telescope, reveal a small population of 13 candidate star clusters. We identify candidate star clusters based on a combination of their luminosity, extent and spectral energy distribution. The masses of the cluster candidates range from ~1000 up to ~100000 Solar masses, and show a strong positive trend of larger mass with increasing with cluster age. Such a trend follows from the fading and dissolution of old, low-mass clusters, and the lack of any young super star clusters of the sort often formed in strong starbursts. The cluster age distribution is consistent with a bursting mode of cluster formation, with active episodes of age ~10 Myr, ~100 Myr and ~1 Gyr. The ranges of age and mass we probe are consistent with those of the star clusters found in quiescent Local Group dwarf galaxies.Comment: 21 pages, 11 figures, accepted by A

Spectropolarimetry of the Type IIb Supernova 2001ig

We present spectropolarimetric observations of the Type IIb SN 2001ig in NGC 7424; conducted with the ESO VLT FORS1 on 2001 Dec 16, 2002 Jan 3 and 2002 Aug 16 or 13, 31 and 256 days post-explosion. These observations are at three different stages of the SN evolution: (1) The hydrogen-rich photospheric phase, (2) the Type II to Type Ib transitional phase and (3) the nebular phase. At each of these stages, the observations show remarkably different polarization properties as a function of wavelength. We show that the degree of interstellar polarization is 0.17%. The low intrinsic polarization (~0.2%) at the first epoch is consistent with an almost spherical (<10% deviation from spherical symmetry) hydrogen dominated ejecta. Similar to SN 1987A and to Type IIP SNe, a sharp increase in the degree of the polarization (~1%) is observed when the outer hydrogen layer becomes optically thin by day 31; only at this epoch is the polarization well described by a ``dominant axis.'' The polarization angle of the data shows a rotation through ~40 degrees between the first and second epochs, indicating that the asymmetries of the first epoch were not directly coupled with those observed at the second epoch. For the most polarized lines, we observe wavelength-dependent loop structures in addition to the dominant axis on the Q-U plane. We show that the polarization properties of Type IIb SNe are roughly similar to one another, but with significant differences arising due to line blending effects especially with the high velocities observed for SN 2001ig. This suggests that the geometry of SN 2001ig is related to SN 1993J and that these events may have arisen from a similar binary progenitor system.Comment: 42 pages, 12 figures (figs. 11 and 12 are both composed of four subpanels, figs. 6,7,8,11 and 12 are in color, fig. 1 is low res and a high res version is available at http://www.as.utexas.edu/~jrm/), ApJ Accepte

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

Spectropolarimetry of SN 2001el in NGC 1448: Asphericity of a Normal Type Ia Supernova

High-quality spectropolarimetry (range 417-860 nm; spectral resolution 1.27 nm and 0.265 nm/pixel) of the SN Ia 2001el were obtained with the ESO Very Large Telescope Melipal (+ FORS1) at 5 epochs. The spectra a week before maximum and around maximum indicate photospheric expansion velocities of about 10,000 km s$^{-1}$. Prior to optical maximum, the linear polarization of the continuum was $\approx 0.2 - 0.3$ with a constant position angle, showing that SN 2001el has a well-defined axis of symmetry. The polarization was nearly undetectable a week after optical maximum. The spectra are similar to those of the normally-bright SN 1994D with the exception of a strong double-troughed absorption feature seen around 800 nm (FWHM about 22 nm). This feature could be an important clue to the binary nature of SN Ia, perhaps associated with an accretion disk, or to the nature of the thermonuclear burning. If modeled in terms of an oblate spheroid, the continuum polarization implies a minor to major axis ratio of around 0.9 if seen equator-on; this level of asymmetry would produce an absolute luminosity dispersion of about 0.1 mag when viewed at different viewing angles. If typical for SNe Ia, this would create an RMS scatter of several hundredths of a magnitude around the mean brightness-decline relation.Comment: ApJ, in pres