Vicky Thursfield

Has mortality from melanoma stopped rising in Australia? Analysis of trends between 1931 and 1994.

Abstract Objective: To describe recent trends in mortality from melanoma in Australia. Design: An analysis of trends in age standardised and age and sex specific mortalities by year of death and median year of birth (cohort). Setting: Australia. Subjects: All deaths from melanoma registered in Australia between 1931 and 1994. Results: Melanoma mortality rose steadily from 1931 to 1985. From 1959 the annual rate of increase was 6.3% in men and 2.9% in women, resulting in mortalities of 4.82 and 2.51 per 100000 person years in 1985 and 1989, respectively. Mortalities for both sexes seem to have plateaued from June 1985 onwards. In 1990-4 the rate rose by 3.7% in men to 5.00 per 100000 and in women it fell by 5.2% to 2.38 per 100000. The non-significant increase after 1985 in mortality in men was restricted to those aged over 70 years of age, whereas the fall in rates in women was mostly in those aged under 55 years. This pattern was generally reflected in the state trends, though with some variation: rates for women in Queensland had peaked in the late 1970s; while rates for men in New South Wales continued to rise in 1990-4, placing them above those for Queensland. Examination of mortalities specific for age, period, and cohort for Australia as a whole showed several salient features. Rates in men rose steeply in cohorts born before about 1930; were stable in cohorts born between 1930 and 1950; and fell in more recent cohorts. Rates in women showed similar changes but about five years earlier. Conclusion: Melanoma mortality in Australia peaked in about 1985 and has now plateaued. On the basis of trends in cohorts it can be expected to fall in coming years. Key messages Key messages On the basis of cohort trends up to 1977 previ- ous analysis predicted that melanoma mortality would not reach its peak before 2010 Mortality, however, peaked in around 1985 and is now falling in women Variation in this trend between states underlines the need to evaluate the cost effectiveness of differ- ent strategies to promote early detection

Rising incidence of oesophageal adenocarcinoma in men in Australia

Adenocarcinomas of the oesophagus and of the gastric cardia have been reported to be increasing in incidence in many countries, while the incidence of squamous cell carcinoma of the oesophagus is stable and non‐cardia gastric cancers are decreasing in incidence. Age‐standardized incidence rates for the years 1982–93 for oesophageal adenocarcinoma and non‐adenocarcinoma, and gastric cardia and non‐cardia cancers were calculated based on state cancer registry incidence data. Time trends in the age‐standardized rates were assessed using linear regression. A consistent increasing trend in the incidence of oesophageal adenocarcinoma in men was seen in all states of Australia and was statistically significant in all states except South Australia. There were no consistent nationwide trends in the incidence of oesophageal adenocarcinoma in women, although a trend towards an increase in the incidence of this cancer reached statistical significance (P < 0.05) in three states (New South Wales, Victoria, Queensland). There were no important trends in the incidence of oesophageal non‐adenocarcinoma in either men or women. There were no consistent nationwide changes in the incidence of gastric cardia cancer in either men or women, although this cancer was significantly increasing in Tasmania in both men and women. The incidence of cancer of the stomach not arising at the gastric cardia was significantly decreasing in men in all states and was also decreasing in women in all states, although in women this decrease was statistically significant only in New South Wales, Victoria and Western Australia. There has been a dramatic increase in the incidence of oesophageal adenocarcinoma in men in Australia. The incidence of this cancer in men is now approximately equal with that of non‐adenocarcinoma of the oesophagus. The incidence of non‐cardia stomach cancer continues to fall.

A case-control study of melanomas of the soles and palms (Australia and Scotland)

Objectives: Because the factors that influence risk of acral melanomas on the soles and palms in White populations are unknown, we investigated these in a multi-center case-control study.Methods: Cases of melanoma of the feet and hands diagnosed from 1987–93 in persons aged over 18 years were ascertained in eastern Australia and western Scotland. There were 275 cases of melanoma on the soles and palms matched to 496 controls (selected from the electoral roll) in Australia, and 36 cases matched to 72 controls (nominated by general practitioners) in Scotland.Results: Acral melanoma was strongly associated with high total body nevus counts (adjusted relative risk [RR]=6.3, 95% confidence interval [CI]=2.5–15.6), and with nevi on the soles (RR=7.5, CI=3.0–18.6). There were also significant positive associations with a penetrative injury of the feet or hands (RR=5.0, CI=3.0–8.6) and with heavy exposure to agricultural chemicals (RR=3.6, CI=1.5–8.3). Sun-sensitive complexions, cumulative sun exposure and a past history of nonmelanoma skin cancer were also associated with increased risk of acral melanoma. Current cigarette smoking was inversely related to acral melanoma (RR=0.6, CI=0.4–0.9).Conclusions: Melanomas of the soles and palms resemble other cutaneous melanomas in their association with sun exposure, but are distinguished from them by their strong positive associations with nevi on the soles, previous penetrative injury, and exposure to agricultural chemicals, and by their inverse association with smoking.

Pancreatic cancer: surgical management and outcomes after 6 years of follow-up.

Objective: To describe the management and outcomes of a population‐based cohort of patients with pancreatic cancer in Victoria, Australia.

Gender-specific activity of chemotherapy correlates with outcomes in chemosensitive cancers of young adulthood

Good evidence indicates that adolescents and young adults (AYAs) with cancer do badly compared with children with similar cancers. The reasons are poorly understood. Australian registry data on 14,824 cancers of adolescence and young adulthood seen between 1982 and 2002 were reviewed. A detailed substudy of clinical characteristics was analyzed from 179 AYAs with Hodgkin lymphoma (HL), Ewing sarcoma (ES) or osteosarcomas (OS) treated at a single institution. Despite significant improvements in survival for both groups over the period in question, for acute lymphoblastic leukaemia, rhabdomyosarcoma, ES, OS and HL, survival for AYAs was worse than for children. For ES, OS and HL, the survival gap occurred almost entirely in males (Hazard ratios compared with female AYAs of 1.8 [p < 0.01], 1.4 [p = 0.03] and 1.5 [p < 0.01] respectively). Survival outcomes from ES, OS and HL for female AYAs were not significantly different from children of either sex. For brain tumors and thyroid cancers, which are primarily treated surgically, there were no gender‐related differences in outcomes. Although no differences in tumor stage or compliance were identified, male AYAs experienced less toxicity and lower response rates to chemotherapy (p = 0.008). Young males account almost entirely for excess mortality from chemosensitive cancers of adolescence and young adulthood compared to children, which may be due to relative underdosing with current chemotherapy dosing algorithms.

Novel population-based study finding higher than reported hepatocellular carcinoma incidence suggests an updated approach is needed

Hepatocellular carcinoma (HCC) incidence is rising rapidly in many developed countries. Primary epidemiological data have invariably been derived from cancer registries that are heterogeneous in data quality and registration methodology; many registries have not adopted current clinical diagnostic criteria for HCC and still rely on histology for classification. We performed the first population‐based study in Australia using current diagnostic criteria, hypothesizing that HCC incidence may be higher than reported. Incident cases of HCC (defined by American Association for the Study of Liver Diseases diagnostic criteria or histology) were prospectively identified over a 12‐month period (2012‐2013) from the population of Melbourne, Australia. Cases were captured from multiple sources: admissions to any of Melbournes seven tertiary hospitals; attendances at outpatients; and radiology, pathology, and pharmacy services. Our cohort was compared to the Victorian Cancer Registry (VCR) cohort (mandatory notified cases) for the same population and period, and incidence rates were compared for both cohorts. There were 272 incident cases (79% male; median age: 65 years) identified. Cirrhosis was present in 83% of patients, with hepatitis C virus infection (41%), alcohol (39%), and hepatitis B virus infection (22%) the commonest etiologies present. Age‐standardized HCC incidence (per 100,000, Australian Standard Population) was 10.3 (95% confidence interval [CI]: 9.0‐11.7) for males and 2.3 (95% CI: 1.8 to 3.0) for females. The VCR reported significantly lower rates of HCC: 5.3 (95% CI: 4.4 to 6.4) and 1.0 (95% CI: 0.7 to 1.5) per 100,000 males and females respectively (P < 0.0001). Conclusions: HCC incidence in Melbourne is 2‐fold higher than reported by cancer registry data owing to under‐reporting of clinical diagnoses. Adoption of current diagnostic criteria and additional capture sources will improve registry completeness. Chronic viral hepatitis and alcohol remain leading causes of cirrhosis and HCC. (Hepatology 2016;63:1205–1212)

Lung cancer in Victoria: are we making progress?

Objectives: To identify areas to improve patient management in lung cancer, which remains the greatest cause of death from cancer in Australia.

The use of chemotherapy in patients with gliomas : Patterns of care in Victoria from 1998-2000

Chemotherapy has an increasing role in the management of gliomas. In particular, chemotherapy provides survival and quality of life benefits in the setting of recurrent high-grade gliomas and in patients with newly diagnosed glioblastoma multiforme. We have previously reported details on patterns of care regarding 828 patients diagnosed with a glioma in the state of Victoria for the period 1998-2000. We observed that 250 patients (30%) received chemotherapy at some stage of their illness, including neo-adjuvant, adjuvant and recurrent clinical settings. There was significant variation in the agents used and their scheduling. Chemotherapy was given at any time in only 15% of patients aged over 60 years. Eight percent of patients were enrolled on a chemotherapy clinical trial. As chemotherapy for gliomas becomes entrenched as the standard of care, this survey will provide an insight into changing patterns of care for the future and points to areas of need in management of these tumours.

Survival from colorectal cancer in Victoria: 10‐year follow up of the 1987 management survey

Background: In 1987, the Victorian Cancer Registry identified a population‐based sample of patients who underwent surgery for colorectal cancer for an audit of management following resection. Over 10 years have passed since this survey, and data on the survival of these patients (incorporating various prognostic indicators collected at the time of the survey) are now discussed in the present report.

Rectal cancer in Victoria in 1994: Patterns of reported management

Background: A retrospective survey of medical practitioners was conducted to describe the management of patients newly diagnosed with rectal cancer in 1994, prior to the publication of best practice guidelines.