Cancer Australia

Sydney, Australia

Cancer Australia

Sydney, Australia

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Buckley E.S.,University of South Australia | Webster F.,Cancer Australia | Hiller J.E.,Australian Catholic University | Hiller J.E.,University of Adelaide | And 2 more authors.
European Journal of Surgical Oncology | Year: 2014

Background The natural history of lobular carcinoma in-situ (LCIS) suggests that women are at increased risk of subsequent invasive breast cancer. Questions of effective management for women with this lesion have led to the need for evidence-based guidance and, in particular, guidance regarding management after LCIS is found at core needle biopsy (CNB). Methods A systematic review was conducted to determine the most appropriate management for women with LCIS found at CNB. A comprehensive search of the scientific literature was conducted to identify the literature pertaining to this population. Critical appraisal of the literature, data extraction and a narrative synthesis of the results were conducted. The outcome of interest was upgrade of diagnosis to invasive breast cancer or ductal carcinoma in-situ (DCIS). Results Sparse data, with limited generalisability and considerable uncertainty, are available for women with LCIS at CNB. Nine studies were identified that met pre-specified inclusion criteria. The reported estimates of upgrade of diagnosis from LCIS to invasive breast cancer or DCIS ranged from 2% to 25%. The body of evidence was limited by its retrospective nature, risk of selection bias and poor generalisability to all women with LCIS at CNB. Further, higher quality research is required to determine the best approach for women with LCIS at CNB with any certainty. © 2013 Elsevier Ltd. All rights reserved.


Best M.,University of Sydney | Aldridge L.,University of Sydney | Butow P.,University of Sydney | Olver I.,Cancer Council Australia | And 2 more authors.
Palliative and Supportive Care | Year: 2015

Objective: An important goal of cancer medicine is relief of patients' suffering. In view of the clinical challenges of identifying suffering patients, we sought to identify valid instruments for assessing the spiritual suffering of people diagnosed with cancer. Method: A systematic review of the literature was conducted in the Medline, Embase, the Cochrane Library, and PsycINFO databases seeking assessment instruments that measure either suffering or one of its synonyms or symptoms. The psychometric properties of the identified measures were compared. Results: A total of 90 articles were identified that supplied information about 58 measures. The constructs examined were: suffering, hopelessness/demoralization, hope, meaning, spiritual well-being, quality of life where a spiritual/existential dimension was included, distress in the palliative care setting and pain, distress or struggle of a spiritual nature. The Pictorial Representation of Illness and Self Measure (PRISM) (patient completed) was the most promising measure identified for measuring the burden of suffering caused by illness due to its ease of use and the inclusion of a subjective component. Significance of Results: Although the appropriateness of any measure for the assessment of spiritual suffering in cancer patients will depend on the context in which it is intended to be utilized, the PRISM is promising for measuring the burden of suffering due to illness. Copyright © Cambridge University Press 2014.


Morrell S.,University of Sydney | Morrell S.,Cancer Institute NSW | Taylor R.,University of Sydney | Roder D.,Cancer Australia | And 2 more authors.
Journal of Medical Screening | Year: 2012

Background Evidence that mammography screening reduces breast cancer mortality derives from trials, with observational studies broadly supporting trial findings. The purpose of this study was to evaluate the national mammographic screening programme, BreastScreen Australia, using aggregate screening and breast cancer mortality data. Methods Breast cancer mortality from 1990 to 2004 in the whole Australian population was assessed in relation to screening exposure in the target of women aged 50-69 years. Population cohorts were defined by year of screening (and diagnosis), five-year age group at screening (and diagnosis), and local area of residence at screening (and diagnosis). Biennial screening data for BreastScreen Australia were related to cumulated mortality from breast cancer in an event analysis using Poisson regression, and in a time-to-event analysis using Cox proportional hazards regression. Results were adjusted for repeated measures and the potential effects of mammography outside BreastScreen Australia, regionality, and area socio-economic status. Results From the adjusted Poisson regression model, a 22% (95% CI:12-31%) reduction in six-year cumulated mortality from breast cancer was predicted for screening participation of approximately 60%, compared with no screening; 21% (95% CI:11-30%) for the most recently reported screening participation of 56%; and 25% (95% CI:15-35%) for the programme target of 70% biennial screening participation. Corresponding estimates from the Cox proportional hazard regression model were 30% (95% CI:17-41%), 28% (95% CI:16-38%) and 34% (95% CI:20-46%). Conclusions Despite data limitations, the results of this nationwide study are consistent with the trial evidence, and with results of other service studies of mammography screening. With sufficient participation, mammography screening substantially reduces mortality from breast cancer.


Roder D.,Cancer Australia | Roder D.,University of South Australia
Cancer Forum | Year: 2012

Age-standardised breast cancer mortality fell by around 26% in Australian females in the 15 years following introduction of the BreastScreen Australia program. The relative contributions of breast screening and treatment advances to this reduction are open to debate. Three evaluations of breast screening in Australia point to reductions in breast cancer mortality in screening participants consistent with the collective trial results, estimated to be around 35% by an expert panel of the International Agency for Research on Cancer. The collective results of evaluations in other countries are similar but individual results vary widely, from little or no benefit to reductions of up to 76%. Over-diagnosis is a controversial issue, with some results indicating it to be of negligible magnitude and others indicating that it could represent 30% or more of breast cancers in populations exposed to breast screening. Meanwhile, age-standardised cervical cancer mortality reduced by over 50% in the 15 years following introduction of an organised approach to screening. This followed earlier reductions also likely to reflect cervical screening. The roll-out of bowel screening in 2006 is too recent for reporting on effects on colorectal cancer mortality, although it is expected that effects from the one-off screening offered at 50, 55 and 65 years of age would be less than in trials where annual or biennial screening was undertaken.


Best M.,University of Sydney | Aldridge L.,University of Sydney | Butow P.,University of Sydney | Olver I.,Cancer Council Australia | And 2 more authors.
Palliative Medicine | Year: 2015

Background: Holistic suffering is a debilitating problem for cancer patients. Although many treatments have been suggested for its alleviation, they have not been compared for effectiveness. Aim: This literature review seeks to identify what interventions are effective in treatment of holistic suffering of cancer patients. Design: A systematic review was conducted to identify and evaluate studies of interventions for holistic suffering in adult cancer patients. Search terms were generated iteratively from the literature. Data sources: MEDLINE, EMBASE, the Cochrane Library and PsycINFO databases were searched for the years 1992-2015. Included studies were peer-reviewed, English language reports of either a controlled trial or a randomised controlled trial focusing on therapies aimed at relieving suffering in adult cancer patients. Articles were excluded if focused predominantly on spiritual or existential issues or concerns not leading to suffering. Studies were graded for quality using the QualSyst quantitative checklist. Levels of evidence were ascertained by completing the National Health and Medical Research Council criteria. Results are reported according to AMSTAR guidelines. Results: The studies represented seven intervention types. Meaning-centred, hope-centred and stress-reduction interventions were found to be effective. Results of both psycho-educational and spiritual interventions in improving spiritual well-being were mixed. Supportive-expressive interventions - with the exception of forgiveness therapy - were not efficacious. There was little or no evidence for the efficacy of creative and healing arts and other assessed interventions such as animal therapy and haptotherapy. Conclusion: This systematic review found that spiritual well-being, meaning, hope and benefit finding can be positively impacted by a variety of treatment modalities. © The Author(s) 2015..


Best M.,University of Sydney | Aldridge L.,University of Sydney | Butow P.,University of Sydney | Olver I.,Khan Research Laboratories | Webster F.,Cancer Australia
Psycho-Oncology | Year: 2015

Objective Patient suffering is a neglected area of care, partly because of poor definitions. The aim of this study was to distill what is currently known about suffering in the health literature in order to generate a conceptual basis for further research. Methods A systematic review focusing on suffering across all cancers was undertaken. The search included peer-reviewed English articles published between 1992 and 2012 in MEDLINE, Embase, PsycINFO and the Cochrane Library databases focusing on conceptualisation of suffering in adult cancer patients. Seminal theoretical articles conceptualising suffering more generally were also eligible. To ensure identification of a sufficiently broad range of conceptualisations of suffering in cancer, the search strategy was drafted iteratively. Study findings were subjected to conceptual analysis using the evolutionary method. Results One hundred twenty-eight studies were identified, which discussed definitions or conceptualisations of suffering. In terms of its attributes, suffering is defined as 'an all-encompassing, dynamic, individual phenomenon characterized by the experience of alienation, helplessness, hopelessness and meaninglessness in the sufferer which is difficult for them to articulate. It is multi-dimensional and usually incorporates an undesirable, negative quality.' Surrogate terms, antecedents and consequences of suffering are described. Conclusions The systematic review revealed that suffering includes holistic suffering, which is multidimensional, oscillating, individual and difficult for individuals to express. Opportunities should be provided for patients to express their suffering. The potential for suffering to be transcended needs to be recognized and facilitated by healthcare staff. © 2015 John Wiley & Sons, Ltd.


King E.L.,Cancer Australia | Grunseit A.C.,University of Sydney | O'Hara B.J.,University of Sydney | Bauman A.E.,University of Sydney
Health Education Research | Year: 2013

In 2008, the Australian Government launched a mass-media campaign 'Measure-Up' to reduce lifestyle-related chronic disease risk. Innovative campaign messages linked waist circumference and chronic disease risk. Communication channels for the campaign included television, press, radio and outdoor advertising and local community activities. This analysis examines the impact of the campaign in the state of New South Wales, Australia. Cross-sectional telephone surveys (n=1006 adults pre- and post-campaign) covered self-reported diet and physical activity, campaign awareness, knowledge about waist circumference, personal relevance of the message, perceived confidence to make lifestyle changes and waist-measuring behaviours. The campaign achieved high unprompted (38%) and prompted (89%) awareness. From pre- to post-campaign, knowledge and personal relevance of the link between waist circumference and chronic disease and waist measuring behaviour increased, although there were no significant changes in reported fruit and vegetable intake nor in physical activity. Knowledge of the correct waist measurement threshold for chronic disease risk increased over 5-fold, adjusted for demographic characteristics. 'Measure-Up' was successful at communicating the new campaign messages. Continued long-term investment in campaigns such as 'Measure-Up', supplemented with community-based health promotion, may contribute to population risk factor understanding and behaviour change to reduce chronic disease.© The Author 2013. Published by Oxford University Press. All rights reserved.


News Article | November 18, 2016
Site: www.eurekalert.org

The research into T cell development within an organ called the thymus revealed for the first time that a protein complex called LUBAC enables 'quality control' of the cells before they are released into the bloodstream. T cells are an important component of the immune system, orchestrating immune responses in reaction to infections. The thymus is like a 'school' for T cells, training them how to fight infections and eliminating the 'naughty' cells that have the potential to launch dangerous autoimmune attacks on the body's own tissues. Only a small proportion of the T cells that begin their development 'graduate' and are allowed out of the thymus, into the bloodstream - the rest do not survive. Dr Charis Teh, Dr Daniel Gray and colleagues made the discovery, published in the journal Nature Communications, when investigating the link between faulty LUBAC and T cell defects. Dr Teh said the team were surprised to discover that LUBAC was important for a very late stage of T cell development within the thymus. "Since the function of the thymus was discovered by Professor Jacques Miller almost 60 years ago, there has been an intense research effort to reveal the intricate details of how immune T cells develop," she said. "By showing that LUBAC is essential for T cell development, we also revealed a new stage of 'T cell education' that had not previously been appreciated. We're excited by the prospect that this new checkpoint may be important for ensuring autoimmune T cells are not allowed to complete their development," she said. "In most people, this prevents the development of autoimmune diseases such as type 1 diabetes and multiple sclerosis," Dr Teh said. Dr Gray said the team hoped that by understanding the newly discovered process better, they may be able to develop new approaches to 'switch off' autoimmune T cells. "This may have therapeutic applications in the future for treating autoimmune diseases," Dr Gray said. "Another interesting aspect of this research relates to rare inherited immune disorders caused by defects in the genes that encode the components of LUBAC. Our research has provided new insights into how these disorders are linked to faulty T cell function. This may inspire to new immune-based therapies for these conditions," he said. The research was supported by Diabetes Australia, the National Health and Medical Research Council, Cancer Australia, the Australian Research Council, the Leukemia and Lymphoma Society (US), the Wellcome Trust (UK), and the Victorian Government Operational Infrastructure Scheme.


News Article | February 15, 2017
Site: www.medicalnewstoday.com

Walter and Eliza Hall Institute researchers have used advanced cellular, bioinformatics and imaging technology to reveal a long-lived type of stem cell in the breast that is responsible for the growth of the mammary glands during pregnancy. The newly discovered stem cells, which respond to the 'ovarian hormones' progesterone and oestrogen, may also be linked to a high-risk form of breast cancer. The discovery was made by Dr Nai Yang Fu, Dr Anne Rios, Professor Jane Visvader and Professor Geoff Lindeman as part of a 20-year research program into how the breast develops from stem cells, and how breast cancers can arise from stem cells and developing breast tissue. The research was published in Nature Cell Biology. Dr Fu said the team had been able to build on their earlier discovery of breast stem cells, by defining subsets of stem cells with different functions, a project that was conducted in collaboration with bioinformatics researchers Dr Matthew Ritchie and Professor Gordon Smyth. "When we looked at the genes that were switched on in these stem cells, we could distinguish subsets of stem cells that differed in their expression of genes encoding two proteins called Tetraspanin8 and Lgr5," he said. "By looking at the levels of Tetraspanin8 and Lgr5 protein on the surface of the cells, we could divide the stem cells into three separate groups." The team used advanced technologies including three-dimensional imaging to show that the three groups of stem cells are located in different parts of the breast and function differently, Dr Rios said. "We focused particularly on one stem cell subtype that had the highest levels of Tetraspanin8 and Lgr5 protein, which were located in the 'proximal' region of the breast around the nipple," Dr Rios said. Professor Visvader said these stem cells were normally dormant - sitting quietly and not dividing - and remained in the proximal region throughout life. "However, when they were exposed to the hormones progesterone and oestrogen these cells awakened and could rapidly give rise to new breast cells," she said. The research also revealed that the stem cells with high levels of Tetraspanin8 and Lgr5 protein had many similarities to a subtype of 'triple negative' breast cancers known as claudin-low cancers. "Compared to other types of breast cancer, claudin-low cancers have a high chance of recurrence after treatment, leading to a poor prognosis for patients" Professor Visvader said. Professor Lindeman, who is also a medical oncologist at the Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, said the research may lead to future improved outcomes for people with claudin-low cancers, "We hope that our discovery can be used to understand how cancers may arise from long-lived stem cells, and potentially lead to better outcomes for breast cancer patients in the future," he said. The research was supported by the National Health and Medical Research Council, the Australian Cancer Research Foundation, The Qualtrough Cancer Research Fund, the Joan Marshall Breast Cancer Research Fund, the National Breast Cancer Foundation, Cure Cancer Australia, the Victorian Cancer Agency and the Victorian Government Operational Infrastructure Support Scheme. Article: Identification of quiescent and spatially restricted mammary stem cells that are hormone responsive, Nai Yang Fu, Anne C. Rios, Bhupinder Pal, Charity W. Law, Paul Jamieson, Ruijie Liu, François Vaillant, Felicity Jackling, Kevin He Liu, Gordon K. Smyth, Geoffrey J. Lindeman, Matthew E. Ritchie & Jane E. Visvader, Nature Cell Biology, doi: 10.1038/ncb3471, published online 13 February 2017.


News Article | February 15, 2017
Site: www.eurekalert.org

Walter and Eliza Hall Institute researchers have used advanced cellular, bioinformatics and imaging technology to reveal a long-lived type of stem cell in the breast that is responsible for the growth of the mammary glands during pregnancy. The newly discovered stem cells, which respond to the 'ovarian hormones' progesterone and oestrogen, may also be linked to a high-risk form of breast cancer. The discovery was made by Dr Nai Yang Fu, Dr Anne Rios, Professor Jane Visvader and Professor Geoff Lindeman as part of a 20-year research program into how the breast develops from stem cells, and how breast cancers can arise from stem cells and developing breast tissue. The research was published today in Nature Cell Biology. Dr Fu said the team had been able to build on their earlier discovery of breast stem cells, by defining subsets of stem cells with different functions, a project that was conducted in collaboration with bioinformatics researchers Dr Matthew Ritchie and Professor Gordon Smyth. "When we looked at the genes that were switched on in these stem cells, we could distinguish subsets of stem cells that differed in their expression of genes encoding two proteins called Tetraspanin8 and Lgr5," he said. "By looking at the levels of Tetraspanin8 and Lgr5 protein on the surface of the cells, we could divide the stem cells into three separate groups." The team used advanced technologies including three-dimensional imaging to show that the three groups of stem cells are located in different parts of the breast and function differently, Dr Rios said. "We focused particularly on one stem cell subtype that had the highest levels of Tetraspanin8 and Lgr5 protein, which were located in the 'proximal' region of the breast around the nipple," Dr Rios said. Professor Visvader said these stem cells were normally dormant - sitting quietly and not dividing - and remained in the proximal region throughout life. "However, when they were exposed to the hormones progesterone and oestrogen these cells awakened and could rapidly give rise to new breast cells," she said. The research also revealed that the stem cells with high levels of Tetraspanin8 and Lgr5 protein had many similarities to a subtype of 'triple negative' breast cancers known as claudin-low cancers. "Compared to other types of breast cancer, claudin-low cancers have a high chance of recurrence after treatment, leading to a poor prognosis for patients" Professor Visvader said. Professor Lindeman, who is also a medical oncologist at the Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, said the research may lead to future improved outcomes for people with claudin-low cancers, "We hope that our discovery can be used to understand how cancers may arise from long-lived stem cells, and potentially lead to better outcomes for breast cancer patients in the future," he said. The research was supported by the National Health and Medical Research Council, the Australian Cancer Research Foundation, The Qualtrough Cancer Research Fund, the Joan Marshall Breast Cancer Research Fund, the National Breast Cancer Foundation, Cure Cancer Australia, the Victorian Cancer Agency and the Victorian Government Operational Infrastructure Support Scheme. The Walter and Eliza Hall Institute is the research powerhouse of the Victorian Comprehensive Cancer Centre, an alliance of leading Victorian hospitals and research centres committed to controlling cancer.

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