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Babidge W.,University of Adelaide | Zorbas H.N.,National Breast and Ovarian Cancer Center | Roder D.,National Breast and Ovarian Cancer Center | Maddern G.,University of Adelaide
Breast Journal | Year: 2010

Although treatment recommendations have been advocated for all women with early breast cancer regardless of age, it is generally accepted that different treatments are preferred based on the age of the patient. The aim of this study was to assess the pattern of breast cancer surgery after adjusting for other major prognostic factors in relation to patient age. Data on cancer characteristics and surgical procedures in 31,298 patients with early breast cancer reported to the National Breast Cancer Audit between 1999 and 2006 were used for the study. There was a close association between age and surgical treatment pattern after adjusting for other prognostic factors, including tumor size, histologic grade, number of tumors, lymph node positivity, lymphovascular invasion (LVI), and extensive intraduct component. Breast Conserving Surgery (BCS) was highest among women aged ≤40 years (OR = 1.140; 95% CI: 1.004-1.293) compared to women aged 51-70 years (reference group). BCS was lowest in women aged >70 years (OR = 0.498, 95% CI: 0.455-0.545). Significantly more women aged ≤50 years underwent more than one operation for breast conservation (20.4-24.8%) compared with women aged >50 years (11.4-17.0%). Women aged >70 years were more likely to receive no surgical treatment, 3.5% versus 1.0-1.3% in all other age groups (≤40, 41-50 51-70 years). There is an association between patient age and the type of breast cancer surgery for women in Australia and New Zealand. Women age ≤40 years are more likely to undergo BCS despite having adverse histologic features and have more than one procedure to achieve breast conservation. Older women (>70 years) more commonly undergo mastectomy and are more likely to receive no surgical treatment. © 2009 Wiley Periodicals, Inc., 1075-122X/09.


Whitfield R.,Royal Adelaide Hospital | Kollias J.,Royal Adelaide Hospital | Zorbas H.,National Breast and Ovarian Cancer Center | Maddern G.,University of Adelaide
ANZ Journal of Surgery | Year: 2012

Background: Trastuzumab increases disease-free and overall survival in HER-2-positive, early breast cancer. In 2007, the National Breast and Ovarian Cancer Centre recommended that patients with HER-2 positive cancers (node positive or node negative tumours >1cm) be offered adjuvant trastuzumab with chemotherapy. The aim of this study was to evaluate recent trends in trastuzumab therapy in Australia and New Zealand. Methods: Following data were obtained from the National Breast Cancer Audit for patients treated between 2006 and 2008: tumour size, number of cases recorded per surgeon per year, location of hospital, HER-2 receptor status, age, lymph node status, chemotherapy and trastuzumab treatment. Results: Data were available from 23290 patients. During the study period, the percentage of breast cancers tested for HER-2 rose from 77% to 91%. Patients over 70 had fewer HER-2 tests than their younger counterparts. Fourteen percent of tumours were HER-2 positive; the proportion treated with trastuzumab in 2006, 2007 and 2008 was 50%, 66% and 74%, respectively. Significantly more node-positive patients (77%) were given trastuzumab than node-negative patients (52%). All the patients prescribed trastuzumab also received chemotherapy. Patients under 70 years, patients treated in Australia and patients treated by higher caseload surgeons were more likely to be prescribed trastuzumab than those over 70, patients in New Zealand and patients treated by lower caseload surgeons. Conclusions: Trastuzumab-prescribing trends conform to the published guidelines. However, older patients and those with HER-2 positive, node-negative tumours >1cm may be undertreated in some cases. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.


Roder D.,National Breast and Ovarian Cancer Center | Zorbas H.,National Breast and Ovarian Cancer Center | Kollias J.,University of Adelaide
ANZ Journal of Surgery | Year: 2010

Background: The National Breast Cancer Audit (NBCA) of the Royal Australasian College of Surgeons has collected data on early breast cancer since 1998. In this project, deaths were traced by linkage of NBCA patient identifiers (first three digits of surname and date of birth) with the National Death Index that covers all deaths in Australia.Methods: Death data were traced to 31 December 2007. Invasive cancers diagnosed in 1998-2005 were included in survival analyses to allow enough follow-up for assessment. Survivals were compared with survivals for similar stages recorded by the New South Wales (NSW) Cancer Registry and USA Surveillance Epidemiology and End Results (SEER) programme. Survivals were analysed by conventional clinical risk factors to see if expected differences presented.Results: The 5-year survival from breast cancer of 93% for NBCA cases was the same as the SEER figure for local and regional cases combined in 1996-2004. The NBCA figure for localized cases was 97%, which was the same as for NSW. Node-positive NBCA cancers had a 5-year survival of 89%, which was slightly higher than the corresponding 86% for NSW, which may reflect exclusion from the NBCA of some cases with a poorer prognosis, including those with positive fixed nodes. As expected, lower survivals presented for older cases and those with conventional clinical risk factors.Conclusions: These survivals are credible both overall and by clinical risk factor. Opportunities present to use these data for survival monitoring and to investigate survival by socio-demographic characteristic, treatment protocol, case volume and provider characteristics. © 2010 The Authors. ANZ Journal of Surgery © 2010 Royal Australasian College of Surgeons.


Jones S.C.,University of Wollongong | Magee C.A.,University of Wollongong | Francis J.,National Breast and Ovarian Cancer Center | Luxford K.,National Breast and Ovarian Cancer Center | And 3 more authors.
Cancer Causes and Control | Year: 2010

Objective: To examine Australian women's perceived risk of ovarian cancer, reasons for perceived risk levels, and knowledge of ovarian cancer symptoms at two timepoints (2003 and 2007). Methods: A computer-assisted telephone (CATI) survey of 2,954 Australian women with no history of ovarian cancer was conducted. Results: Approximately 60% of women perceived their risk of ovarian cancer was similar to other women of their age; 10% indicated an increased risk, and 30% indicated a lower risk. These figures were similar in 2003 and 2007. Logistic regression found that lower income, increased age, being born overseas, and being retired were significantly associated with lower perceived risk (accounted for only 7.5% of the variance). Common reasons for higher perceived risk included family history of ovarian/other cancers, increasing age, and having had other types of cancer or health problems. Reasons for lower than average risk included absence of family history, having a hysterectomy, and having regular Pap smears (indicating confusion between ovarian and cervical cancer). There appeared to be substantial confusion in women's understanding of ovarian cancer symptoms; this was similar in 2003 and 2007. Conclusion: The observed misperceptions and confusion regarding ovarian cancer symptoms and risk factors suggest ongoing public education campaigns are needed to improve knowledge and awareness. © 2010 Springer Science+Business Media B.V.


Jones S.C.,University of Wollongong | Gregory P.,University of Wollongong | Nehill C.,National Breast and Ovarian Cancer Center | Barrie L.,University of Wollongong | And 4 more authors.
Cancer Causes and Control | Year: 2010

Objectives Poor awareness of breast cancer symptoms has been associated with patient delay in seeking help; thus reduced survival, more aggressive treatment, and fewer treatment choices. The aim of this study was to develop a representative picture of Australian women's knowledge of symptoms, experienced potential symptoms, and behavioral responses. Methods A general population sample of approximately 3,000 women aged 30-69 completed a telephone survey; results were compared to previous surveys conducted in 1996 and 2003. Results The most commonly cited potential symptom of breast cancer was a lump in the breast, identified by 86% of respondents (an increase from 75% in 2003). Other commonly mentioned symptoms were discharge from the nipple, pain/soreness, skin puckering, or dimpling; and a change in breast shape. The proportion unable to name any potential symptoms of breast cancer decreased from one in ten in 2003 to approximately one in twenty in 2007. The primary reason for not seeking medical advice in response to a potential symptom was the belief that breast cancer was not present. Conclusions Health promotion efforts need to continue to aim at increasing community understanding of potential breast cancer symptoms and encouraging women to act on potential symptoms by seeking medical advice. © Springer Science+Business Media B.V. 2010.


Jones S.C.,University of Wollongong | Magee C.A.,University of Wollongong | Barrie L.R.,University of Wollongong | Iverson D.C.,University of Wollongong | And 6 more authors.
Women's Health Issues | Year: 2011

Background: Numerous studies have shown that the majority of women overestimate both their own risk and the populations' risk of developing breast cancer. A number of factors have been found to correlate with perceived risk. Methods: This paper reports on a telephone survey of a nationally representative sample of approximately 3,000 Australian women aged 30 to 69 years, conducted in 2007, and compares the findings with those of a similar survey conducted in 2003. Results: There was a clear tendency for respondents to overestimate the proportion of women who will develop breast cancer during their lifetime. Approximately half the respondents perceived themselves as being at the same risk of developing breast cancer as other women their age; older respondents were more likely to perceive themselves to be at a lower than average risk. Family history was recognized as a risk factor for breast cancer, although there was evident confusion in relation to risk from paternal family history. It was also evident that the association between age and risk status is poorly understood, and misconceptions of breast cancer risk factors identified in the previous survey persisted in 2007. Conclusion: Overall, these results suggest that there remains an educational challenge if we seek to increase the accuracy of women's perceptions of their risk for developing breast cancer, primarily in relation to the significance of age and family history as breast cancer risk factors. © 2011 Jacobs Institute of Women's Health.


Clements M.S.,Karolinska Institutet | Clements M.S.,Australian National University | Roder D.M.,National Breast and Ovarian Cancer Center | Yu X.Q.,Cancer Council NSW | And 5 more authors.
Cancer Causes and Control | Year: 2012

Purpose To develop and validate a method for estimating numbers of people with distant cancer metastases, for evidence-based service planning. Methods Estimates were made employing an illness-death model with distant metastatic cancer as the illness state- and site-specific mortality as an outcome, using MIAMOD software. To demonstrate the method, we estimated numbers of females alive in Australia following detection of distant metastatic breast cancer during 1980-2004, using data on patient survival from an Australian population-based cancer registry. We validated these estimates by comparing them with direct prevalence counts. Results Relative survival at 10 years following detection of distant metastases was low (5-20 %), with better survival experienced by: (1) females where distant metastatic disease was detected at initial diagnosis rather than subsequently (e.g., at recurrence); (2) those diagnosed in more recent calendar years; and (3) younger age groups. For Australian females aged less than 85 years, the modeled cumulative risk of detection of distant metastatic breast cancer (either at initial diagnosis or subsequently) declined over time, but numbers of cases with this history rose from 71 per 100,000 in 1980 to 84 per 100,000 in 2004. The model indicated that there were approximately 3-4 prevalent distant metastatic breast cancer cases for every breast cancer death. Comparison of estimates with direct prevalence counts showed a reasonable level of agreement. Conclusions The method is straightforward to apply and we recommend its use for breast and other cancers when registry data are insufficient for direct prevalence counts. This will provide estimates of numbers of people who would need ongoing medical surveillance and care following detection of distant metastases. © 2012 Springer Science+Business Media B.V.


De Morgan S.E.,University of Newcastle | De Morgan S.E.,University of Sydney | Butow P.N.,University of Sydney | Lobb E.A.,University of Sydney | And 2 more authors.
Supportive Care in Cancer | Year: 2011

Purpose: The literature highlights the confusion amongst women diagnosed with ductal carcinoma in situ (DCIS) about aspects of their disease and treatment and the wide variation in how doctors communicate about DCIS. The DCIS communication aid (CA) was developed to assist clinicians to communicate with women diagnosed with DCIS and to improve women's understanding about their disease, prognosis and treatment options. This study aimed to assess patient and clinician perceptions of the CA. Methods: The CA included information and diagrams about key aspects of the diagnosis, prognosis, treatment and support. It was designed to be used in clinical consultations and taken home after the consultation. Australian women with DCIS (n=18) participated in structured interviews and clinicians (n=7), including surgeons and radiation oncologists, completed surveys to assess their perceptions of the CA. Main outcome measures included satisfaction with the content, design and diagrams in the CA, and perceptions of the benefits of the CA and its impact on doctor-patient communication. Results: All clinicians and women with DCIS reported that the CA would assist communication and help women understand their diagnosis. Conclusions: This is the first intervention designed to decrease the confusion amongst women with DCIS and improve doctor-patient communication in this area. This study highlights that interventions such as the DCIS communication aid may be a valuable resource for clinicians and women with DCIS. This study also highlights key communication challenges relating to DCIS. © Springer-Verlag 2010.


Jordan S.J.,University of Queensland | Jordan S.J.,Queensland Institute of Medical Research | Francis J.E.,National Breast and Ovarian Cancer Center | Nelson A.E.,National Breast and Ovarian Cancer Center | And 3 more authors.
Medical Journal of Australia | Year: 2010

Objective: To describe the diagnostic pathways experienced by a large, representative group of Australian women with ovarian cancer, and to document the time between first presentation to a medical professional and clinical diagnosis. Design, setting and participants: 1463 women with epithelial ovarian cancer from an Australia-wide population-based study (2002-2005) completed a telephone interview in which they described the events that led to the diagnosis of their cancer. Main outcome measures: Number and type of doctors consulted, investigations performed, referral patterns and the time from first presentation to diagnosis. Results: Of the 1463 women, 145 had their cancer diagnosed incidentally and were excluded from analysis. Most of the remaining 1318 women (1222, 93%) presented first to their general practitioner. As a result of their first medical consultation, 75 women (6%) were given a diagnosis, and 484 (37%) were referred to a gynaecologist, gynaecological oncologist or oncologist for further assessment. Overall, 85% of women visited three or fewer doctors before their cancer was diagnosed; 66% of cancers were diagnosed within 1 month of the initial presentation, and 80% were diagnosed within 3 months. For 12% of women, the diagnostic process took longer than 6 months; this was more likely for women residing in remote Australia, those with lower incomes, and those presenting with abdominal pain or bowel symptoms, or with more than one symptom. Conclusions: Despite anecdotal suggestions to the contrary, most women with ovarian cancer in Australia are investigated and diagnosed promptly. The diagnostic process is more protracted for a minority of women, and the factors we found to be associated with diagnostic delay warrant further investigation.


Wilcoxon H.,National Breast and Ovarian Cancer Center | Luxford K.,National Breast and Ovarian Cancer Center | Saunders C.,University of Western Australia | Peterson J.,National Breast and Ovarian Cancer Center | Zorbas H.,National Breast and Ovarian Cancer Center
Asia-Pacific Journal of Clinical Oncology | Year: 2011

Aim: Multidisciplinary care (MDC) is accepted as best practice in cancer treatment planning and care. Despite recognition of the importance of a team approach, limited data are available about the extent to which MDC has been implemented in Australia. The aim of the audit was to investigate the implementation of MDC for five main cancer types across Australia in line with best practice. Methods: A sample of 155 hospitals was surveyed to investigate the status of MDC for cancer treatment planning in Australia across five cancer types (breast, gynecological, lung, prostate and colorectal). The survey investigated team structure, meetings, patient consent, documentation of team recommendations and communication with the patient. Results: Two-thirds of hospitals surveyed did not have a multidisciplinary team. Of those with such a team; in one-third patients were not informed their case would be discussed by the team, in half patient consent was not sought for all cases discussed by the team, in one-quarter the team's recommended treatment plan was not noted in the patient record. Less than 1% of teams reported routine attendance by the tumour-specific minimum core team. Conclusion: MDC is not being implemented in line with best practice or applied consistently across Australia. This audit has highlighted gaps in care delivery, despite national recommendations about MDC. Areas being neglected can affect the quality of care provided and may put clinicians at medico-legal risk. Recommendations to improve uptake and effectiveness of MDC are provided. © 2011 Blackwell Publishing Asia Pty Ltd.

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