A case-control study of the protective benefit of cervical screening against invasive cervical cancer in NSW women.

Objective: To examine the effects of different Pap screening patterns in preventing invasive cervical cancer among women in New South Wales, Australia.

Methods: A total of 877 women aged 20-69 years diagnosed with invasive cervical cancer during 2000-2003 were matched with 2,614 controls by month and year of birth. Screening behavior patterns in 4 years preceding the time of cancer diagnosis in the cases were classified into none (no Pap test in the 4 years), 'irregular' (1 of the 4 years with Pap test(s)), and 'regular' (2 or more of the 4 years with a Pap test), and compared with those in the matched non-cases over the same period.

Comparing cancer profiles and survival of aboriginal and non-aboriginal patients in South Australia: where are the opportunities for improving Aboriginal health?

Data from the South Australian Cancer Registry (SACR) for 1977-2003 were used to calculate expected and actual distributions of cancer sites in Aboriginal versus non-Aboriginal populations. Expected distributions were calculated using indirect standardisation and compared with actual distributions using a global Chi-square test. Individual contributions to the Chi-square statistic (from each cancer site) were examined using a z-test and Bonferroni corrected p-value.

A cost-effectiveness analysis of adding a human papillomavirus vaccine to the Australian National Cervical Cancer Screening Program.

Background: The cost-effectiveness of adding a human papillomavirus (HPV) vaccine to the Australian National Cervical Screening Program compared to screening alone was examined.

Methods: A Markov model of the natural history of HPV infection that incorporates screening and vaccination was developed. A vaccine that prevents 100% of HPV 16/18-associated disease, with a lifetime duration of efficacy and 80% coverage offered through a school program to girls aged 12 years, in conjunction with current screening was compared with screening alone using cost (in Australian dollars) per life-year (LY) saved and quality-adjusted life-year (QALY) saved.

Asbestos-related cancers in refinery workers in the Australian petroleum industry.

In this study of the incidence of asbestos-related cancer in the Australian petroleum industry, the authors traced a cohort of 16,543 petroleum industry workers for a total of 226,989 person-years. There were 18 cases of pleural mesothelioma; 12 occurred in refinery nonoffice workers, for whom the Standardized Incidence Ratio was 3.77 (95% confidence interval = 1.

Benchmarking epidemiological characteristics of cervical cancer in advance of change in screening practice and commencement of vaccination.

Objectives: To investigate trends in cervical cancer incidence, mortality and survival by histology for benchmarking purposes ahead of practice change and the introduction of Human Papilloma Virus (HPV) vaccine.

Methods: Using data from the South Australian Cancer Registry, age-standardised rates are presented for four-year periods from 1977 to 2004. Socio-demographic and secular predictors of glandular as opposed to squamous cancers are investigated, using multivariable logistic regression.

Endometrial cells as a predictor of uterine cancer.

Background: With the recent cervix screening national guidelines recommending against reporting of benign endometrial cells, we examined South Australian data to see what impact this would have on detecting uterine cancers.

Aims: To test whether benign endometrial cells detected in cervical cytology testing confer an increased risk of uterine cancer, and to ascertain what percentage of uterine cancers will be missed in cervical screening programs if these cells are not reported.

Methods: The study was a retrospective cohort design of 1585 women with shed endometrial cells, each matched with three women without shed cells.

Tobacco and alcohol-related mortality in men: estimates from the Australian cohort of petroleum industry workers.

Objective: To measure the association between major causes of mortality and tobacco use; and the association between major causes of mortality and alcohol use, after adjusting for tobacco use.

Method: Employees of Australian Institute of Petroleum member companies were enrolled in the cohort in four industry-wide surveys between 1981 and 1999. Mortality of 16,547 men was determined up to 31 December 2001 and cancer incidence to 31 December 2000.

Factors predictive of preferred place of death in the general population of South Australia.

In a population survey, 2652 respondents aged 15+ years reported their preferred place of death, if dying of 'a terminal illness such as cancer or emphysema', to be home (70%), a hospital (19%), hospice (10%), or nursing home (<1%). The majority of respondents in all socio-demographic categories reported a preference for dying at home, with the greatest majorities occurring in younger age groups. After weighting to the age-sex distribution of all South Australian cancer deaths, 58% in our survey declared a preference to die at home, which is much higher than the 14% of cancer deaths that actually occurred at home in South Australia in 2000-2002.

Myeloid leukaemia treatment and survival--the South Australian experience, 1977 to 2002.

Objective: To evaluate trends in survival and treatment for myeloid leukaemia in South Australia during 1977-2002, using population-based survival data plus data on survival and treatment of patients at three teaching hospitals.

Methods: Population data were analysed using relative survival methods and hospital registry data using disease-specific survival. Univariate and multivariable analyses were undertaken.

Prognostic importance of palpability as a feature of screen-detected breast cancers.

Objectives: To determine epidemiological characteristics of palpability as a feature of asymptomatic invasive breast cancers detected through screening mammography, and to determine whether palpability is predictive of case survival after adjusting for conventional prognostic indicators such as diameter, grade and nodal status.

Setting: The University of Adelaide, South Australian Department of Health, and The Cancer Council South Australia, Adelaide, South Australia.

Methods: Sociodemographic and clinical characteristics of 2108 screen-detected invasive breast cancers were compared by tumour palpability using univariate and multiple logistic regression analysis.

Changes in incidence of in situ and invasive breast cancer by histology type following mammography screening.

Objective: To investigate secular trends and correlates of incidence of breast cancer by histology type following the introduction of population-based mammography screening.

Methods: Analysis of age-standardised incidence rates for 1,423 in situ and 16,157 invasive carcinomas recorded on the South Australian population-based cancer registry for the 1985-2004 diagnostic period. Multiple logistic regression was undertaken to compare socio-demographic characteristics by histology.

Evaluation of NHMRC funded research completed in 1992, 1997 and 2003: gains in knowledge, health and wealth.

Objective: To report on strategies for, and outcomes of, evaluation of knowledge (publications), health and wealth (commercial) gains from medical research funded by the Australian Government through the National Health and Medical Research Council (NHMRC).

Design And Methods: End-of-grant reports submitted by researchers within 6 months of completion of NHMRC funded project grants which terminated in 2003 were used to capture self-reported publication number, health and wealth gains. Self-reported gains were also examined in retrospective surveys of grants completed in 1992 and 1997 and awards primarily supporting people ("people awards") held between 1992 and 2002.

Multiple primary cancers of separate organ sites: implications for research and cancer control (Australia).

Objective: To identify cancers which occur as second primaries following the diagnosis of cancers of other sites, as a basis for formulating causal hypotheses and planning medical surveillance.

Methods: Analyses of fifteen common cancer sites were undertaken to examine the occurrence of multiple primaries. These cancers were notified to the South Australian Cancer Registry during 1977-2001.

Female breast cancers are getting smaller, but socio-demographic differences remain.

Objective: To investigate trends towards early detection of infiltrating ductal carcinomas, possible effects on patients' prognosis, and characteristics of women still at high risk of late detection.

Methods: South Australian Cancer Registry data were analysed to compare breast tumour diameters for the 1980-86 and 1997-2002 diagnostic periods by age. Relative survivals for 1980-86 were compared with corresponding survival estimates for 1997-2000, obtained by weighting diameter-specific survivals for 1980-86 to equate with the diameter distribution for 1997-2002.

Does emotional support influence survival? Findings from a longitudinal study of patients with advanced cancer.

A total of 163 patients with advanced cancer at an Australian teaching hospital were interviewed to investigate whether emotional support was predictive of survival duration. Survival was analysed using the Kaplan-Meier product-limit estimate, and multivariable Cox proportional hazards regression, from entry to the study in 1996 to date of death, or 31 March 2003, whichever came first. The number of confidants with whom feelings were being shared at the time of study entry was predictive of survival duration.

Reasons for lower survival from non-Hodgkin's lymphoma among older patients.

Cancer-registry data for 710 patients, treated for non-Hodgkin's lymphoma (NHL) at a South Australian teaching hospital between 1977 and 2000, gave a five-year disease-specific survival of 53%, which was similar to population based estimates for Australia, the USA, and Europe. This figure reduced with age at diagnosis from 69% for patients less than 40 years at diagnosis to 30% for those aged 80 years or more. Multivariable analysis indicated that older age was predictive of lower survival (p<0.

Are cutaneous melanomas of specified thickness showing deeper levels of invasion at diagnosis?

Secular trends in Clark level were investigated by Breslow category for 8,432 invasive cutaneous melanomas diagnosed in South Australia in 1980-2000. More recently diagnosed lesions were found to have deeper levels. After adjusting for age at diagnosis, tumour site, histology, and thickness measured in half millimetres, the relative odds (95% confidence limits) of penetration to the reticular dermis or subcutaneous fat were 1.

Time trends in lung cancer incidence by histology in South Australia: likely causes and public health implications.

Objectives: In response to reported increases in ratios of adenocarcinomas to squamous cell carcinomas of the lung in other populations, to investigate and consider public health and clinical implications of time trends in lung cancer incidence by histological type in South Australia.

Methods: 11,898 lung cancers, diagnosed during 1982-2000, were analysed to determine age-adjusted incidence rates by sex, diagnostic epoch, and histological type, and changes in histological distribution at diagnosis.

Results: The age-adjusted incidence of squamous cell carcinoma reduced by 47.

A critical analysis of reasons for improved survival from invasive cutaneous melanoma.

Objective: To determine the extent to which increases in survival from melanoma are explained by changes in thickness, level, histological type, site of lesion, and sociodemographic characteristics.

Methods: Analyses of changes in survival among 9519 South Australians with melanoma reported to the State's population-based cancer registry during the 1980-2000 diagnostic period, using proportional hazards regression to adjust for thickness, level and other characteristics.

Results: Lower survivals applied for thicker lesions, deeper Clark levels, lesions on the trunk and scalp/neck, and for older cases and males.

Effects of variations in hysterectomy status on population coverage by cervical screening.

Objectives: To investigate geographic differences in hysterectomy rates and effects on estimated screening coverage in South Australia.

Methods: Hysterectomy data from South Australian hospitals for 1992-2000 were used to calculate age-specific hysterectomy rates for 20-69 year old women by residential subregion and postcode. Regional variations in rates were used to estimate variations in proportions of women with an intact uterus.

Comparative epidemiological characteristics of oesophageal adenocarcinoma and other cancers of the oesophagus and gastric cardia.

Secular trends and epidemiological characteristics of 1,581 oesophageal cancers, diagnosed in South Australian residents in 1977-2000, were analysed by histological type and diagnostic period, using multivariable Poisson regression and logistic regression. The age-adjusted incidence of squamous cell carcinoma did not vary significantly by diagnostic period, either in males (p = 0.195) or females (p = 0.

Use of radiotherapy in the primary treatment of cancer in South Australia.

Previous studies point to a lower use of radiotherapy by Australian cancer patients in lower socioeconomic areas and in country regions that are some distance from urban treatment centres. These were cross-sectional studies with the potential for error from changes in place of residence. We used a cohort design to avoid such error.

The epidemiology of gastric cancer.

Gastric cancer mortality has declined markedly around the world. In South Australia, the reduction approximated 40% over the last 20 years. Possible reasons include: better refrigeration; reduced consumption of salted, smoked, and chemically preserved foods; increased intake of fruit and vegetables; and improved living standards and a greater use of antibiotics, which may have reduced Helicobacter pylori infection.

Cervical cancer: effect of glandular cell type on prognosis, treatment, and survival.

Objective: To investigate survivals from cervical cancer, with special reference to effects of glandular histology and its influence on prognostic characteristics and management decisions.

Methods: Data on cervical cancers, diagnosed in 1984-2000, were obtained from the gynecologic oncology registry of hospitals of the University of Adelaide. Comparisons were made of disease-specific survival, age at diagnosis, diagnostic period, stage, grade, and primary course of treatment.