Woolloomooloo, Australia
Woolloomooloo, Australia

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Yu X.Q.,Cancer Epidemiology Research Unit | Chen W.H.,Macquarie Hospital | O'Connell D.L.,Cancer Epidemiology Research Unit
BMC Cancer | Year: 2010

Background: We evaluated if the survival benefit of adding rituximab to standard chemotherapy for non-Hodgkin lymphoma (NHL) observed in clinical trials has been experienced by an Australian NHL patient population.Methods: NHL cases diagnosed in 1985-2004 in New South Wales (NSW) were followed-up to the end of 2004. Rituximab prescription data were obtained from Medicare Australia. Using a Poisson regression model adjusted for age group, sex, NHL subtype and time period (1990-1994, 1995-1999 and 2000-2004), we estimated excess risk of death after a diagnosis of NHL. To give context to the survival trend, trends in incidence and mortality were also estimated.Results: Compared with 1990-1994, after adjusting for age, sex and NHL subtype the relative excess risk of death was significantly lower (p < 0.0001) in 1995-1999 (0.89) and 2000-2004 (0.74). A sharp fall in mortality was observed from 2000 to 2004 (annual percentage change (APC) = -4.7, p = 0.009), while a small but significant rise in incidence was seen from 1990 to 2004 (APC = 0.5, p = 0.01). The number of times rituximab was dispensed in NSW increased rapidly from 1274 in 1999 to 9250 in 2004.Conclusion: It is likely that some benefit of adding rituximab to the standard chemotherapy for NHL has been experienced at the population level. © 2010 Yu et al; licensee BioMed Central Ltd.


Simonella L.,Cancer Epidemiology Research Unit | Simonella L.,University of Sydney | Simonella L.,National University of Singapore | Canfell K.,Cancer Epidemiology Research Unit | And 2 more authors.
Cancer Causes and Control | Year: 2013

Objectives: To assess the impact of cervical screening interval recommendations on cervical cancer incidence and mortality during periods of organized and opportunistic screening in Australia (2-yearly screening interval for organized screening), New Zealand (3 yearly interval for organized screening), and England (3/5 yearly interval for organized screening). Methods: Changes in cervical cancer rates over two 10-year periods were assessed in each country among women aged 20-69 years using a standardized rate ratio (SRR). The SRR for opportunistic screening was calculated from 1973-1977 to 1983-1987 (mortality only), and for organized screening from 1993-1997 to 2003-2007 (mortality and incidence). Results: During the period of opportunistic cervical screening, mortality reduced by 24 % in Australia and 10 % in England and Wales [Australia: SRR 0.76 (95 % CI 0.71-0.83); England and Wales: SRR 0.90 (95 % CI 0.87-0.93)]; no statistically significant reduction was observed in New Zealand [SRR 0.95 (95 % CI 0.82-1.11)]. After the introduction of organized screening, mortality reduced 39-45 % in each country [Australia: SRR 0.56 (95 % CI 0.51-0.62); New Zealand: SRR 0.53 (95 % CI 0.44-0.63); England and Wales: SRR 0.61 (95 % CI 0.58-0.64)], while incidence reduced 19-38 % [New Zealand: SRR 0.62 (95 % CI 0.56-0.69); Australia: SRR 0.64 (95 % CI 0.61-0.72); England: SRR 0.81 (95 % CI 0.78-0.83)]. Conclusion: In the era of opportunistic screening, some reductions were observed in cervical cancer mortality rates, but these were relatively modest and seen inconsistently between countries. After the introduction of organized cervical screening, cervical cancer mortality rates fell by a similar amount (~40 % or more) in all countries, and incidence fell by more than a third in Australia and New Zealand and by approximately one-fifth in England. Although several factors are likely to have influenced these observed reductions in cervical cancer rates, these findings do not support the more frequent 2-yearly cervical screening interval recommendation in Australia. © 2013 Springer Science+Business Media Dordrecht.


Canfell K.,Cancer Epidemiology Research Unit | Canfell K.,University of Sydney | Chesson H.,Centers for Disease Control and Prevention | Kulasingam S.L.,University of Minnesota | And 3 more authors.
Vaccine | Year: 2012

Over the last 5 years, prophylactic vaccination against human papillomavirus (HPV) in pre-adolescent females has been introduced in most developed countries, supported by modeled evaluations that have almost universally found vaccination of pre-adolescent females to be cost-effective. Studies to date suggest that vaccination of pre-adolescent males may also be cost-effective at a cost per vaccinated individual of ~US$400-500 if vaccination coverage in females cannot be increased above ~50%; but if it is possible, increasing coverage in females appears to be a better return on investment. Comparative evaluation of the quadrivalent (HPV16,18,6,11) and bivalent (HPV16,18) vaccines centers around the potential trade-off between protection against anogenital warts and vaccine-specific levels of cross-protection against infections not targeted by the vaccines. Future evaluations will also need to consider the cost-effectiveness of a next generation nonavalent vaccine designed to protect against ~90% of cervical cancers. The timing of the effect of vaccination on cervical screening programs will be country-specific and will depend on vaccination catch-up age range and coverage and the age at which screening starts. Initial evaluations suggest that if screening remains unchanged, it will be less cost-effective in vaccinated compared to unvaccinated women but, in the context of current vaccines, will remain an important prevention method. Comprehensive evaluation of new approaches to screening will need to consider the population-level effects of vaccination over time. New screening strategies of particular interest include delaying the start age of screening, increasing the screening interval and switching to primary HPV screening. Future evaluations of screening will also need to focus on the effects of disparities in screening and vaccination uptake, the potential effects of vaccination on screening participation, and the effects of imperfect compliance with screening recommendations. This article forms part of a special supplement entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012. © 2012 Elsevier Ltd.


Kahn C.,Cancer Epidemiology Research Unit | Simonella L.,Cancer Epidemiology Research Unit | Sywak M.,University of Sydney | Boyages S.,Westmead Hospital | And 2 more authors.
Cancer Causes and Control | Year: 2012

Background: Over the past few decades, an increase in the incidence of thyroid cancer has been recorded in many countries around the world including Australia. Heightened medical surveillance and increased technological sensitivity could be contributing to greater detection of asymptomatic disease. Objectives: To describe the pathways to diagnosis of thyroid cancer for a cohort of newly diagnosed patients in New South Wales (NSW), Australia, and compare these pathways by age, sex, place of residence, ethnic background, medical insurance status, and disease characteristics. Methods: A total of 452 newly diagnosed cases of thyroid cancer were recruited through the population-based NSW Central Cancer Registry. Participants completed a questionnaire and diary of doctor visits and investigations that led to their diagnosis. Tumor characteristics were obtained from pathology reports. Results: Forty percent of patients initially presented to their doctor with a lump or symptom specific to thyroid cancer and 60% had their cancer detected incidentally during a medical encounter. Men were more likely than women to be diagnosed after imaging for another health concern versus reporting a thyroid lump or symptom (p = 0.001). Thyroid cancer diagnosis after imaging for another health concern increased with age (p = 0.023), and larger tumors were less likely to be diagnosed after treatment for a benign thyroid disease (p = 0.040). Conclusion: As the majority of participants had incidental diagnoses, the reported incidence of thyroid cancer is likely to be influenced by diagnostic technology and medical surveillance practices. This, however, probably only partly explains the observed rise in the incidence of thyroid cancer in NSW. © 2011 Springer Science+Business Media B.V.


Vinod S.K.,University of New South Wales | Simonella L.,Cancer Epidemiology Research Unit | Goldsbury D.,Cancer Epidemiology Research Unit | Delaney G.P.,University of New South Wales | And 2 more authors.
Cancer | Year: 2010

BACKGROUND: Lung cancer is the leading cause of cancer death in most developed countries. Radiotherapy is important in its treatment, with an estimated optimal utilization rate between 45% and 68% at initial diagnosis. The objective of this study was to describe radiotherapy practice for lung cancer in New South Wales (NSW), Australia. METHODS: Patients with lung cancer were identified prospectively from the NSW Central Cancer Registry (CCR) from November 1, 2001 to December 31, 2002. Questionnaires were mailed to diagnosing and treating clinicians to obtain detailed information on diagnosis, staging, referrals, and treatment. The authors describe referral for and receipt of radiotherapy treatment. RESULTS: Of 1812 patients with lung cancer patients who were identified, 943 patients (52%) were referred for radiotherapy, 846 patients (47%) received a radiotherapy questionnaire, and 727 patients (40%) received radiotherapy. Compared with optimal radiotherapy, there was less curative radiotherapy to the primary site (20% actual vs 50% optimal), and there was more palliative radiotherapy to metastatic sites (36% actual vs 11% optimal). The greatest shortfall in radiotherapy use was observed in patients who had limited stage small cell lung cancer (46% actual vs 94% optimal). The use of combined-modality treatment for stage III nonsmall cell lung cancer and for limited stage small cell lung cancer was uncommon. CONCLUSIONS: There is underutilization of radiotherapy for lung cancer in NSW, especially in small cell lung cancer. The use of combined-modality treatment for potentially curable lung cancers is suboptimal. These issues have to be addressed to improve survival and quality of life for patients with lung cancer. © 2009 American Cancer Society.


Nair-Shalliker V.,University of Sydney | Nair-Shalliker V.,Cancer Epidemiology Research Unit | Clements M.,Australian National University | Clements M.,Karolinska Institutet | And 2 more authors.
Photochemistry and Photobiology | Year: 2013

Solar ultraviolet-B radiation (UVB) is essential for epidermal vitamin D production. We aimed to quantitate the relationship between personal solar UV exposure and serum 25hydroxy vitamin D (25[OH]D) concentration. Blood was collected for 25(OH)D analysis in 207 South Australian adults aged 27-61 years. At the time of blood collection, each participant completed a questionnaire, which included a calendar for recall of sun exposure in the preceding 16 weeks. We examined the association between solar UV exposure and serum 25(OH)D graphically from smoothed scatter plots, and modeled it using multiple linear regression, with age, sex and body mass index as covariates. Estimated erythemal solar UV exposure in the 6 weeks before blood collection best predicted serum 25(OH)D concentrations. Serum 25(OH)D rose with increasing personal solar UV exposure to a maximum of about 89 nmol L-1 at an estimated mean weekly solar erythemal UV exposure of about 1230 mJ cm-2. The maximum was the same after accounting for clothing coverage and was reached at an estimated whole body equivalent exposure to ambient UV of ca 700 mJ cm -2. These results suggest that an average maximum serum 25(OH)D of ca 89 nmol L-1 is achieved from sun exposure in a healthy Australian adult population. Sun exposure is the major source of vitamin D in most population. However, the amount of incidental sun exposure conducive to the production of serum vitamin D remains unclear. This study shows a quantitative link between recalled personal solar UV exposure and serum 25(OH)D. The relationship was curvilinear and reached a plateau at about 89 nmol L -1. The plateau level appeared to be higher in men than in women. Further understanding of the significance of these plateaus, which suggest physiological maxima, could contribute to future recommendations for fortification or supplementation with vitamin D. © 2012 Wiley Periodicals, Inc. Photochemistry and Photobiology © 2012 The American Society of Photobiology.


Canfell K.,Cancer Epidemiology Research Unit | Canfell K.,University of Sydney
Sexual Health | Year: 2010

Epidemiologic and economic evaluation using simulation modelling can support complex policy decisions, and is an important tool in predicting the future interaction between human papillomavirus vaccination and cervical screening. Several categories of screening program evaluation are of interest, including: (1) changes to screening considered over the short term, over which the effects of vaccination should be confined to the youngest age groups (30 years old); (2) the medium and long-term effect of vaccination on the screening program; and (3) changes to screening in context of vaccination. This review considers some of the policy questions in each category and discusses the modelling implications, with particular focus on the Australian context. © CSIRO 2010.


Salagame U.,Cancer Epidemiology Research Unit | Canfell K.,Cancer Epidemiology Research Unit | Banks E.,Australian National University
Expert Review of Endocrinology and Metabolism | Year: 2011

Large-scale randomized clinical trials and observational studies have consistently found that use of hormone replacement therapy (HRT) increases the risk of breast cancer. More recently, ecological studies have shown correlations between dramatic reductions in use of HRT in many countries, and declines in the rates of breast cancer in older women. Meta-analyses of data from the trials and observational studies show that the increase in breast cancer risk is greater for combined estrogen-progestin therapies compared with estrogen alone; that for both types of preparation, breast cancer risk increases with duration of use; and that the risks decrease relatively quickly after cessation of use. For both estrogen-only and combined therapies, the risk of breast cancer is higher if therapy is initiated close to the time of the menopause, relative to the risks in women starting HRT later. Most drug regulatory authorities currently recommend that HRT be prescribed only to fully informed women who have moderate-to-severe menopausal symptoms, for the shortest duration possible; and it is recommended that the need for therapy be reviewed at least every 6-12 months. © 2011 Expert Reviews Ltd.


Smith M.A.,Cancer Epidemiology Research Unit | Lew J.-B.,Cancer Epidemiology Research Unit | Walker R.J.,Cancer Epidemiology Research Unit | Brotherton J.M.L.,Registries Victorian Cytology Service | And 4 more authors.
Vaccine | Year: 2011

Australia implemented a National HPV Vaccination Program in 2007, with routine vaccination of 12-13 year old females and catch-up in females aged 13-26. years to 2009. The aim of this study was to estimate the impact of the current female-only national vaccination program on males, and then to estimate the incremental benefits to males from being included in the program. We used preliminary data to estimate vaccination coverage in females. We then fitted a dynamic model of sexual behaviour and HPV transmission in Australia to local data on female pre-vaccination age-specific HPV prevalence, predicted the corresponding pre-vaccination prevalence in males due to heterosexual transmission, and modelled the short and long term impact of female-only versus female-and-male vaccination programs. The estimated 3-dose female coverage rates were 78% (range 70-80%) for ongoing coverage in 12-13 year old girls; and from 74% (range 70-80%) in 14 year olds, to 25% (range 15-35%) for women aged 26. years old in 2007. The median estimate for age-standardised pre-vaccination HPV 16 prevalence in females and males aged 15-59. years was 3.2% (95% range: 2.4-4.1%) and 3.1% (95% range: 2.2-4.2%), respectively. The current program in females is predicted to result in a 68% reduction in male HPV 16 infections by 2050, leading to an estimated long term reduction of 14% in rates of cancers of the head, neck and anogenital area. The estimated proportion of the maximum possible vaccine-conferred benefit to males from a female-and-male program which will be achieved by female-only vaccination is 73% (range in probabilistic sensitivity analysis: 53-78%). In conclusion, up to three-quarters of the maximum possible vaccination-conferred benefit to males due to reduced heterosexual transmission will be achieved by the existing female-only program. © 2011 Elsevier Ltd.


Nair-Shalliker V.,Cancer Epidemiology Research Unit | Armstrong B.K.,University of Sydney | Fenech M.,CSIRO
Mutation Research - Fundamental and Molecular Mechanisms of Mutagenesis | Year: 2012

Vitamin D is a secosteroid best known for its role in maintaining bone and muscle health. Adequate levels of vitamin D may also be beneficial in maintaining DNA integrity. This role of vitamin D can be divided into a primary function that prevents damage from DNA and a secondary function that regulates the growth rate of cells. The potential for vitamin D to reduce oxidative damage to DNA in a human has been suggested by clinical trial where vitamin D supplementation reduced 8-hydroxy-2'-deoxyguanosine, a marker of oxidative damage, in colorectal epithelial crypt cells. Studies in animal models and in different cell types have also shown marked reduction in oxidative stress damage and chromosomal aberrations, prevention of telomere shortening and inhibition of telomerase activity following treatment with vitamin D. The secondary function of vitamin D in preventing DNA damage includes regulation of the poly-ADP-ribose polymerase activity in the DNA damage response pathway involved in the detection of DNA lesions. It is also able to regulate the cell cycle to prevent the propagation of damaged DNA, and to regulate apoptosis to promote cell death. Vitamin D may contribute to prevention of human colorectal cancer, though there is little evidence to suggest that prevention of DNA damage mediates this effect, if real. Very limited human data mean that the intake of vitamin D required to minimise DNA damage remains uncertain. © 2012 Elsevier B.V.

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