Ian Ring

Trends for in situ and invasive melanoma in Queensland, Australia, 1982-2002

Objectives Queensland, the north-eastern state of Australia, has the highest incidence of melanoma in the world. Control measures started earlier here than probably anywhere else in the world; early detection programmes started in the 1960s and primary prevention in the 1980s. Data from the population-based Queensland Cancer Registry therefore provide an internationally unique data source with which to assess trends for in situ and invasive melanomas and to consider the implications for early detection and primary prevention.Methods We used Poisson regression to estimate the annual percentage change in rates across 21xa0years of incidence data for in situ and invasive lesions, stratified by age and sex. Joinpoint analyses were used to assess whether there had been a statistically significant change in the trends.Results In situ melanomas increased by 10.4% (95% CI: 10.1%, 11.1%) per year among males and 8.4% (7.9%, 8.9%) per year among females. The incidence of invasive lesions also increased, but not as quickly; males 2.6% (2.4%, 2.8%), females 1.2% (0.9%, 1.5%). Valid data on thickness was only available for 1991 to 2002 and for this period thin-invasive lesions were increasing faster than thick-invasive lesions (for example, among males: thin 3.8%, thick 2.0%). We found some suggestive evidence of lower proportionate increase for the most recent years for both in-situ and invasive lesions, but this did not achieve statistical significance. Among people younger than 35xa0years, the incidence of invasive melanoma was stable and there was a suggestion of a birth cohort effect from about 1958. Mortality rates were stable across all ages, and there was a suggestion of decreasing rates among young women, although this did not achieve statistical significance.Conclusion Age-standardised incidence is continuing to increase and this, in combination with a shift to proportionately more in situ lesions, suggests that the stabilisation of mortality rates is due, in large part, to earlier detection. For primary prevention, after a substantial period of sustained effort in Queensland, there is some suggestive, but not definitive, evidence that progress is being made. Incidence rates are stabilising in those younger than 35xa0years and the proportionate increase for both in situ and invasive lesions appears to be lower for the most recent period compared with previous periods. However, even taking the most favourable view of these trends, primary prevention is unlikely to lead to decreases in the overall incidence rate of melanoma for at least another 20xa0years. Consequently, the challenge for primary prevention programmes will be to maintain momentum over the long term. If this can be achieved, the eventual public-health benefits are likely to be substantial.

Telephone administration of the SF‐36 health survey: validation studies and population norms for adults in Queensland

Abstract: The Rand Corporation medical outcomes short‐form 36 health survey (SF‐36) is a multidimensional measure of self‐perceived general health status, which has been validated in adult populations in the United States and Great Britain, and, more recently, in an Australian population. The SF‐36 is increasingly being used in health outcomes research internationally, mainly as a self‐administered tool, and clearly has potential for use in Australia. This study aimed to assess the acceptability, reliability and validity of telephone administration of the instrument in the Queensland adult population, and to provide reliable population norms. We report the results of a telephone survey in which we interviewed 12 793 adults. It was the first large‐scale, statewide application of the SF‐36 in Australia. A response rate of 82 per cent was achieved, and the SF‐36 satisfied psychometric criteria for reliability and construct validity. Population norms broken down by age and sex are provided. They will be important for the interpretation of future studies using the SF‐36 in particular population or patient groups.

Prevalence of whole-body skin self-examination in a population at high risk for skin cancer (Australia).

AbstractObjective: Whole-body skin self-examination (SSE) with presentation of suspicious lesions to a physician may improve early detection of melanoma. The aim of this study was to establish the prevalence and determinants of SSE in a high-risk population in preparation for a community-based randomised controlled trial of screening for melanoma.nMethods: A telephone survey reached 3110 residents older than 30 years (overall response rate of 66.9%) randomly selected from 18 regional communities in Queensland, Australia.nResults: Overall, 804 (25.9%) participants reported whole-body SSE within the past 12 months and 1055 (33.9%) within the past three years. Whole-body SSE was associated in multivariate logistic regression analysis with younger age ( <50 years); higher education; having received either a whole-body skin examination, recommendation or instruction on SSE by a primary care physician; giving skin checks a high priority; concern about skin cancer and a personal history of skin cancer.nConclusion: Overall, the prevalence of SSE in the present study is among the highest yet observed in Australia, with about one-third of the adult population reporting whole-body SSE in the past threeyears. People over 50 years, who are at relatively higher risk for skin cancer, currently perform SSE less frequently than younger people.

Childhood cancer incidence in Australia, 1982–1991

The data of the Australian Paediatric Cancer‐Registry on childhood cancer incidence in Australia for the 10‐year period 1982–1991 are presented. The crude average annual incidence of cancer in children under the age of 15 years was 13.8 per 100,000. The incidence of childhood cancer in Australia is rising. Significant increases were seen in acute non‐lymphoblastic leukaemia, astrocytoma and melanoma. The age‐standardised incidence of 14.4 per 100,000 is about 34% higher than in the UK. Most types of cancer had a higher incidence in Australia than in the UK, and the difference was significant for acute lymphoblastic leukaemia, astrocytoma and melanoma. Of particular interest is malignant melanoma, whose incidence in Australia is more than 5 times that in the UK, as a result of excessive UV exposure. Australia has a higher incidence of Ewings tumour than osteosarcoma, nearly twice that of the UK. International comparative studies may help to elucidate the aetiology of these tumours.

What motivates men age ≥ 50 years to participate in a screening program for melanoma?

The screening behavior and screening outcomes of men age ≥50 years was investigated within a randomized controlled trial of a community‐based intervention of screening for melanoma, consisting of a community education program, an education program for medical practitioners, and the provision of dedicated skin‐screening clinics.

Urban-rural differences in survival from cutaneous melanoma in Queensland

Objective:To assess how much of the urban‐rural disparity in melanoma survival in Queensland is due to later diagnosis.

Do centralised skin screening clinics increase participation in melanoma screening (Australia)

ObjectiveTo compare during the first 12xa0months of a 3-year randomised community-based trial of population screening for melanoma three methods of screening delivery: skin screening within day-to-day primary care (Group A); screening in dedicated skin screening clinics either organised privately by local physicians (Group B); or organised centrally with participants referred back to their physicians for definitive diagnosis and management (Group C).MethodsThe trial involved 18 regional communities in Queensland, Australia. Of the nine communities randomised to the intervention group, three communities were allocated to each of the Groups A, B or C. All intervention communities received a community education programme and an education and support programme for primary care physicians. The self-reported prevalence of clinical skin examination was assessed by surveying 3,110 residents (66.9% participation rate) aged ≥30xa0years by telephone at baseline, and 14,060 residents (70.9% participation rate) by self-administered mailed questionnaire at 12-month follow-up.ResultsAt baseline the prevalence of skin screening did not differ between intervention and control communities. At 12-month follow-up, participants within intervention communities reported skin screening significantly more frequently (20.9% versus 10.9%; p<0.001). Within intervention communities, the prevalence of clinical skin examinations in Group A was similar to that of control communities (12.6% and 10.9%; p = 0.33). Communities in Group B (16.5%; p = 0.001) and Group C (27.1%; p<0.001) reported significantly higher prevalence of clinical examinations than the control group.ConclusionsThe provision of centrally organised skin screening clinics significantly increases skin screening rates and may have relevance for future melanoma control programmes.

Factors associated with Pap smear taking in general practice: focusing public health initiatives

Abstract: This study ascertained the relationships of patient, practitioner and consultation factors with: 1. taking a Pap smear or referral to a specialist in the consultation; and 2. an unsuccessful offer to take a Pap smear or making an appointment for a smear. In a cross‐sectional study of 3478 women presenting to 230 randomly selected general practitioners in Brisbane and Toowoomba, information about most recent Pap smear, screening in the consultation, and independent variables were collected from patients and doctors. Relationships between three levels of outcome variable (no action, Pap smear taken or referral, appointment or refusal), and independent variables (practitioner variables, consultation variables, patient variables) were modelled using polytomous logistic regression. Presenting for a routine checkup and breast cancer screening were associated with all types of action. Younger age, longer consultations and consultations with a female practitioner were associated with Pap smear taking and referrals, and not appointments or refusals. Being due for a Pap smear, having blood pressure measured, consulting a younger general practitioner and one who ascribed to current guidelines on screening were associated with an appointment or a refusal, when compared with no action. Results identify different profiles of those who get a Pap smear and those who do not, the former indicating a more proactive patient group, while the latter suggest more active general practitioners who attempted opportunistic screening of passive patients, or women who do not specifically seek Pap smears. We have identified factors that have significance for developing public health programs focused on consumers and providers.