Mark Elwood

Cost-effectiveness of annual versus biennial screening mammography for women with high mammographic breast density

Objectives The sensitivity of screening mammography is much lower among women who have dense breast tissue, compared with women who have largely fatty breasts, and they are also at much higher risk of developing the disease. Increasing mammography screening frequency from biennially to annually has been suggested as a policy option to address the elevated risk in this population. The purpose of this study was to assess the cost-effectiveness of annual versus biennial screening mammography among women aged 50–79 with dense breast tissue. Methods A Markov model was constructed based on screening, diagnostic, and treatment pathways for the population-based screening and cancer care programme in British Columbia, Canada. Model probabilities and screening costs were calculated from screening programme data. Costs for breast cancer treatment were calculated from treatment data, and utility values were obtained from the literature. Incremental cost-effectiveness was expressed as cost per quality adjusted life year (QALY), and probabilistic sensitivity analysis was conducted. Results Compared with biennial screening, annual screening generated an additional 0.0014 QALYs (95% CI: −0.0480–0.0359) at a cost of

Treatment and survival disparities by ethnicity in New Zealand women with stage I–III breast cancer tumour subtypes

819 (

Urban Rural Differences in Breast Cancer in New Zealand

 = Canadian dollars) per patient (95% CI: 506–1185), resulting in an incremental cost effectiveness ratio of

The use of trastuzumab in New Zealand women with breast cancer

565,912/QALY. Annual screening had a 37.5% probability of being cost-effective at a willingness-to-pay threshold of

Bioelectromagnetics Research within an Australian Context: The Australian Centre for Electromagnetic Bioeffects Research (ACEBR)

100,000/QALY. Conclusion There is considerable uncertainty about the incremental cost-effectiveness of annual mammography. Further research on the comparative effectiveness of screening strategies for women with high mammographic breast density is warranted, particularly as digital mammography and density measurement become more widespread, before cost-effectiveness can be reevaluated.

Ad hominem attacks on vaccine safety researchers

PurposeThis study aims to look at the distribution of different subtypes of stage I–III breast cancer in Māori and Pacific versus non-Māori/Pacific women, and to examine cancer outcomes by ethnicity within these different subtypes.MethodThis study included 9,015 women diagnosed with stage I–III breast cancer between June 2000 and May 2013, recorded in the combined Waikato and Auckland Breast Cancer Registers, who had complete data on ER, PR and HER2 status. Five ER/PR/HER2 subtypes were defined. Kaplan–Meier method and Cox proportional hazards model were used to examine ethnic disparities in breast cancer-specific survival.ResultsOf the 9,015 women, 891 were Māori, 548 were Pacific and 7,576 others. Both Māori and Pacific women were less likely to have triple negative breast cancer compared to others (8.6, 8.9 vs. 13.0%). Pacific women were more than twice as likely to have ER−, PR− and HER2+ cancer than Māori and others (14.2 vs. 6.0%, 6.7%). After adjustment for age, year of diagnosis, stage, grade and treatment, the hazard ratios of breast cancer-specific mortality for Māori and Pacific women with ER+, PR+ and HER2− were 1.52 (95% CI 1.06–2.18) and 1.55 (95% CI 1.04–2.31) compared to others, respectively. Māori women with HER2+ cancer were twice more likely to die of their cancer than others.ConclusionsOutcomes for Māori and Pacific women could be improved by better treatment regimens especially for those with HER2+ breast cancer and for women with ER+, PR+ and HER2− breast cancer.

The characteristics, management and outcomes of older women with breast cancer in New Zealand

Many rural communities have poor access to health services due to a combination of distance from specialist services and a relative shortage of general practitioners. Our aims were to compare the characteristics of urban and rural women with breast cancer in New Zealand, to assess breast cancer-specific and all-cause survival using the Kaplan–Meier method and Cox proportional hazards model, and to assess whether the impact of rurality is different for Māori and New Zealand (NZ) European women. We found that rural women tended to be older and were more likely to be Māori. Overall there were no differences between urban and rural women with regards their survival. Rural Māori tended to be older, more likely to be diagnosed with metastatic disease and less likely to be screen detected than urban Māori. Rural Māori women had inferior breast cancer-specific survival and all-cause survival at 10 years at 72.1% and 55.8% compared to 77.9% and 64.9% for urban Māori. The study shows that rather than being concerned that more needs to be done for rural women in general it is rural Māori women where we need to make extra efforts to ensure early stage at diagnosis and optimum treatment.

The burden of non-melanoma skin cancers in Auckland, New Zealand

Trastuzumab was first funded in New Zealand for use in HER2+ve stage I–III breast cancer in 2007. This observational study aims to ascertain the patterns of use of trastuzumab in women with invasive HER2+ve breast cancer, and assess the effectiveness of adjuvant trastuzumab in women with stage I–III HER2+ve breast cancer.

Comment on: Maternal Exposure to Domestic Hair Cosmetics and Occupational Endocrine Disruptors Is Associated with a Higher Risk of Hypospadias in the Offspring. Int. J. Environ. Res. Public Health 2017, 14, 27

Mobile phone subscriptions continue to increase across the world, with the electromagnetic fields (EMF) emitted by these devices, as well as by related technologies such as Wi-Fi and smart meters, now ubiquitous. This increase in use and consequent exposure to mobile communication (MC)-related EMF has led to concern about possible health effects that could arise from this exposure. Although much research has been conducted since the introduction of these technologies, uncertainty about the impact on health remains. The Australian Centre for Electromagnetic Bioeffects Research (ACEBR) is a National Health and Medical Research Council Centre of Research Excellence that is undertaking research addressing the most important aspects of the MC-EMF health debate, with a strong focus on mechanisms, neurodegenerative diseases, cancer, and exposure dosimetry. This research takes as its starting point the current scientific status quo, but also addresses the adequacy of the evidence for the status quo. Risk communication research complements the above, and aims to ensure that whatever is found, it is communicated effectively and appropriately. This paper provides a summary of this ACEBR research (both completed and ongoing), and discusses the rationale for conducting it in light of the prevailing science.

Stage of breast cancer at diagnosis in New Zealand: impacts of socio-demographic factors, breast cancer screening and biology

https://doi.org/10.1016/j.vaccine.2018.01.053 0264-410X/ 2018 Published by Elsevier Ltd. Dear Editor, We refer to the recent article by Bragazzi et al. [1]. In the article the authors ask that debate on vaccines should be conducted on methodology rather than personal attacks on vaccine safety researchers. The authors give several examples where they felt vaccine safety concerns were initially raised by such researchers only to be confirmed after heated initial arguments. They use the examples of intussusception after the original rotavirus vaccine and Guillain-Barre syndrome triggered by one of the influenza vaccines. The authors have advocated vocational protection and legal assistance if needed for vaccine safety researchers. Bragazzi et al. also comment many pro vaccine studies are funded by pharmaceutical companies and authors publishing articles on these vaccines may have conflicts of interest. We agree ad hominem attacks on vaccine safety researchers are unacceptable. We believe debate should focus on scientific evidence. This has been our approach when we recently provided robust evidence refuting the existence of the so-called ASIA (autoimmune/autoinflammatory syndrome induced by adjuvants) syndrome [2]. The aluminium containing vaccine adjuvants were stated to be a major cause of the disorder. We first examined the criteria for ASIA and showed they are non-specific and in addition to including all patients with autoimmune disease, could potentially include all members of the population. We next applied Sir Austin Bradford Hill’s criteria for causality and have concluded it is highly unlikely there is a causal link between aluminium containing adjuvants and autoimmunity. Animal models of the disorder are flawed [3] as evidenced by the recent retraction/withdrawal of three papers because of seriously compromised scientific data [4–6]. We have shown patients receiving much higher doses of aluminium in allergen immunotherapy injections have a significantly lower incidence of autoimmunity [7] and patients with systemic lupus erythematosus did not relapse following Hepatitis B vaccination [8]. In our view the association between vaccines and autoimmunity is spurious, most likely the result of random events [2]. ASIA constitutes only part of the article written by Bragazzi et al. It will be important for other aspects of this paper to be carefully analysed to determine whether legitimate scientific debate has been misinterpreted as ad hominem attacks.