Personalised electronic messages to improve sun protection in young adults

The incidence of all skin cancers, including melanoma, continues to rise. It is well known that ultraviolet (UV) radiation is the main environmental risk factor for skin cancer, and excessive exposure at a young age increases the risk of developing skin cancer. The aim of this study was to determine the acceptability and feasibility of delivering sun protection messages via electronic media such as short message services (SMS) to people 18-40 years, and explore factors associated with their acceptability. Overall, 80% of participants agreed that they would like to receive some form of sun protection advice; of these, 20% prefer to receive it via SMS and 42% via email. Willingness to receive electronic messages about the UV index was associated with being unsure about whether a suntanned person would look healthy and greater use of sun protection in the past. Careful attention to message framing and timing of message delivery and focus on short-term effects of sun exposure such as sunburn and skin ageing should increase the acceptability of such messages to young people. We conclude that sun protection messages delivered to young adults via electronic media appear feasible and acceptable

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

Association of the SNP rs2623047 in the HSPG modification enzyme SULF1 with an Australian Caucasian Breast Cancer Cohort

Breast cancer is the second most common cancer worldwide and the most common cancer reported in women. This malignant tumour is characterised by a number of specific features including uncontrolled cell proliferation. It ranks fifth in the world as a cause of cancer death in women. Early diagnosis increases 5 year survival rates up to 95%. Heparan sulfate proteoglycans (HSPGs) are complex proteins composed of a core protein to which a number of highly sulfated side chains are synthesised by a highly co-ordinated process resulting in distinct sulfation patterns, which determine specific interations with cell-signaling partners including growth factors, their receptors, ligands and morphogens. The enzymes responsible for chain initiation, elongation and sulfation are critical for creating HS chain variability conferring biological functionality. This study investigated single nucleotide polymorphism in SULF1, the enzyme responsible for the 6-0 desulfation of heparan sulfate side chains. We investigated this SNP in an Australian Caucasian case-control breast cancer population and found a significant association between SULF1 and breast cancer at both the allelic and genotypic level (allele, p=0.016; genotype, p=0.032). Our results suggest the res2623047 SNP in SULF1 may impact breast cancer susceptibility. Specifically, the T allele of rs2623047 in SULF1 is associated with a increased risk of developing breast cancer in our cohort. The identification of markers including SULF1 may improve detection of this disease at its earliest stages improving patient treatment and prognosis

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

Clinical skin examination outcomes after a video-based behavioral intervention analysis from a randomized clinical trial

IMPORTANCE Older men are at risk of dying of melanoma. OBJECTIVE To assess attendance at and clinical outcomes of clinical skin examinations (CSEs) in older men exposed to a video-based behavioral intervention. DESIGN, SETTING, AND PARTICIPANTS This was a behavioral randomized clinical trial of a video-based intervention in men aged at least 50 years. Between June 1 and August 31, 2008, men were recruited, completed baseline telephone interviews, and were than randomized to receive either a video-based intervention (n = 469) or brochures only (n = 461; overall response rate, 37.1%) and were again interviewed 7 months later (n = 870; 93.5% retention). INTERVENTIONS Video on skin self-examination and skin awareness and written informational materials. The control group received written materials only. MAIN OUTCOMES AND MEASURES Participants who reported a CSE were asked for the type of CSE (skin spot, partial body, or whole body), who initiated it, whether the physician noted any suspicious lesions, and, if so, how lesions were managed. Physicians completed a case report form that included the type of CSE, who initiated it, the number of suspicious lesions detected, how lesions were managed (excision, nonsurgical treatment, monitoring, or referral), and pathology reports after lesion excision or biopsy. RESULTS Overall, 540 of 870 men (62.1%) self-reported a CSE since receiving intervention materials, and 321 of 540 (59.4%) consented for their physician to provide medical information (received for 266 of 321 [82.9%]). Attendance of any CSE was similar between groups (intervention group, 246 of 436 [56.4%]; control group, 229 of 434 [52.8%]), but men in the intervention group were more likely to self-report a whole-body CSE (154 of 436 [35.3%] vs 118 of 434 [27.2%] for control group; P = .01). Two melanomas, 29 squamous cell carcinomas, and 38 basal cell carcinomas were diagnosed, with a higher proportion of malignant lesions in the intervention group (60.0% vs 40.0% for controls; P = .03). Baseline attitudes, behaviors, and skin cancer history were associated with higher odds of CSE and skin cancer diagnosis. CONCLUSIONS AND RELEVANCE A video-based intervention may increase whole-body CSE and skin cancer diagnosis in older men. Copyright 2014 American Medical Association. All rights reserved

Psychological distress and quality of life in lung cancer: The role of health-related stigma, illness appraisals and social constraints

Psycho-Oncology Published by John Wiley & Sons Ltd. Objective Health-related stigma is associated with negative psychological and quality of life outcomes in lung cancer patients. This study describes the impact of stigma on lung cancer patients' psychological distress and quality of life and explores the role of social constraints and illness appraisal as mediators of effect. Methods A self-administered cross-sectional survey examined psychological distress and quality of life in 151 people (59% response rate) diagnosed with lung cancer from Queensland and New South Wales. Health-related stigma, social constraints and illness appraisals were assessed as predictors of adjustment outcomes. Results Forty-nine percent of patients reported elevated anxiety; 41% were depressed; and 51% had high global distress. Health-related stigma was significantly related to global psychological distress and quality of life with greater stigma and shame related to poorer outcomes. These effects were mediated by illness appraisals and social constraints. Conclusions Health-related stigma appears to contribute to poorer adjustment by constraining interpersonal discussions about cancer and heightening feelings of threat. There is a need for the development and evaluation of interventions to ameliorate the negative effects of health-related stigma among lung cancer patients

A multilevel investigation of inequalities in clinical and psychosocial outcomes for women after breast cancer

Background In Australia, breast cancer is the most common cancer affecting Australian women. Inequalities in clinical and psychosocial outcomes have existed for some time, affecting particularly women from rural areas and from areas of disadvantage. We have a limited understanding of how individual and area-level factors are related to each other, and their associations with survival and other clinical and psychosocial outcomes. Methods/Design This study will examine associations between breast cancer recurrence, survival and psychosocial outcomes (e.g. distress, unmet supportive care needs, quality of life). The study will use an innovative multilevel approach using area-level factors simultaneously with detailed individual-level factors to assess the relative importance of remoteness, socioeconomic and demographic factors, diagnostic and treatment pathways and processes, and supportive care utilization to clinical and psychosocial outcomes. The study will use telephone and self-administered questionnaires to collect individual-level data from approximately 3, 300 women ascertained from the Queensland Cancer Registry diagnosed with invasive breast cancer residing in 478 Statistical Local Areas Queensland in 2011 and 2012. Area-level data will be sourced from the Australian Bureau of Statistics census data. Geo-coding and spatial technology will be used to calculate road travel distances from patients' residence to diagnostic and treatment centres. Data analysis will include a combination of standard empirical procedures and multilevel modelling. Discussion The study will address the critical question of: what are the individual- or area-level factors associated with inequalities in outcomes from breast cancer? The findings will provide health care providers and policy makers with targeted information to improve the management of women with breast cancer, and inform the development of strategies to improve psychosocial care for women with breast cancer

Detection and Diagnosis of Skin Cancer in South-East Queensland

Introduction Skin cancer is the most common cancer diagnosed in Australia, and the burden is increasing primarily due to an ageing and increasing population. Historically in Australia the vast majority of skin cancers are diagnosed and managed within general practice. More recently primary care has witnessed the emergence of skin cancer clinics as an alternative to ‘mainstream’ general practice. This emergence has not been without controversy, primarily around issues such as diagnostic ability; skin cancer management strategies; and whether those at risk are more likely to attend skin cancer clinics over mainstream general practice. However to date, this debate has not been based on empirical evidence. Aims The aims of this thesis are firstly: to describe and compare the body site distribution of skin cancer, premalignant (actinic keratosis) and common benign pigmented skin lesions excised by doctors working in ‘mainstream’ general practice and skin cancer clinics; secondly, to describe and compare the accuracy of doctors working in ‘mainstream’ general practice and skin cancer clinics in diagnosing skin cancer; and finally to describe and compare the sociodemographics and skin cancer risk profiles, reasons for choice of service provider and perceived access to services of patients attending ‘mainstream’ general practice and primary care skin cancer clinics. Methods This prospective comparative study included 104 general practitioners (GPs) and 50 skin cancer clinic doctors and included 28,755 patient encounters. Additionally, 301 GP patients and 852 skin cancer clinic patients completed self-administered questionnaires following their skin examination. Descriptive statistics were used to examine the profiles of participating doctors, patients and the casemix of skin lesions. To examine the body site distribution of excised skin lesions, relative tumour densities (RTD) were calculated. Logistic regression models were used to estimate diagnostic accuracy using measures such as sensitivity; specificity; positive predictive value (PPV); and negative predictive value (NPV). The number of lesions needed to excise (NNE) for each malignant lesion was also calculated. A logistic regression model was used to examine factors associated with a patient’s choice of service provider (GP versus skin cancer clinics). All analyses were adjusted for clustering accounting for individual doctor and doctors within the same practice. Results Skin cancer clinic doctors excised significantly more BCCs than general practitioners who excised more SCCs. However, the overall proportion of all NMSCs excised was similar for the two groups. Compared to the whole body, the highest density for non-melanoma skin cancer and premalignant lesions was observed on chronically sun exposed areas of the body including the face in men and women, the scalp and ears in men, and the hands in women in both general practice and primary care skin cancer clinics. The density of basal cell carcinoma and melanoma was also high on intermittently exposed body sites. Women (p < 0.001), younger patients (p=0.01) and patients with benign naevi (

Body-site distribution of skin cancer, pre-malignant and common benign pigmented lesions excised in general practice

Background Concern about skin cancer is a common reason for people from predominantly fair-skinned populations to present to primary care doctors. Objectives To examine the frequency and body-site distribution of malignant, pre-malignant and benign pigmented skin lesions excised in primary care. Methods This prospective study conducted in Queensland, Australia, included 154 primary care doctors. For all excised or biopsied lesions, doctors recorded the patient's age and sex, body site, level of patient pressure to excise, and the clinical diagnosis. Histological confirmation was obtained through pathology laboratories. Results Of 9650 skin lesions, 57·7% were excised in males and 75·0% excised in patients ≥50years. The most common diagnoses were basal cell carcinoma (BCC) (35·1%) and squamous cell carcinoma (SCC) (19·7%). Compared with the whole body, the highest densities for SCC, BCC and actinic keratoses were observed on chronically sun-exposed areas of the body including the face in males and females, the scalp and ears in males, and the hands in females. The density of BCC was also high on intermittently or rarely exposed body sites. Females, younger patients and patients with melanocytic naevi were significantly more likely to exert moderate/high levels of pressure on the doctor to excise. Conclusions More than half the excised lesions were skin cancer, which mostly occurred on the more chronically sun-exposed areas of the body. Information on the type and body-site distribution of skin lesions can aid in the diagnosis and planned management of skin cancer and other skin lesions commonly presented in primary care

Evaluation of a skin self examination attitude scale using an item response theory model approach

Introduction The Skin Self-Examination Attitude Scale (SSEAS) is a brief measure that allows for the assessment of attitudes in relation to skin self-examination. This study evaluated the psychometric properties of the SSEAS using Item Response Theory (IRT) methods in a large sample of men ≥ 50 years in Queensland, Australia. Methods A sample of 831 men (420 intervention and 411 control) completed a telephone assessment at the 13-month follow-up of a randomized-controlled trial of a video-based intervention to improve skin self-examination (SSE) behaviour. Descriptive statistics (mean, standard deviation, item–total correlations, and Cronbach’s alpha) were compiled and difficulty parameters were computed with Winsteps using the polytomous Rasch Rating Scale Model (RRSM). An item person (Wright) map of the SSEAS was examined for content coverage and item targeting. Results The SSEAS have good psychometric properties including good internal consistency (Cronbach’s alpha = 0.80), fit with the model and no evidence for differential item functioning (DIF) due to experimental trial grouping was detected. Conclusions The present study confirms the SSEA scale as a brief, useful and reliable tool for assessing attitudes towards skin self-examination in a population of men 50 years or older in Queensland, Australia. The 8-item scale shows unidimensionality, allowing levels of SSE attitude, and the item difficulties, to be ranked on a single continuous scale. In terms of clinical practice, it is very important to assess skin cancer self-examination attitude to identify people who may need a more extensive intervention to allow early detection of skin cancer