Aboriginal women in New South Wales, Australia have lower rates of survival from breast cancer than non-Aboriginal women. Aboriginal women were less likely to receive surgical treatment for their breast cancer and were more likely to have other health issues. After accounting for differences in factors like age, disease stage at diagnosis, surgical treatment, and health issues, Aboriginal women still had a 30% higher risk of death from breast cancer. Improving access to surgical treatment and reducing health issues may help increase breast cancer survival rates for Aboriginal women.
Characteristics of cases with unknown stage prostate cancerCancer Council NSW
Stage of cancer at diagnosis (e.g. localised, regional involvement, metastatic) is an important predictor of survival. This paper identifies there is cause for concern surrounding the 40% of "unknown" or unrecorded stage of diagnosis on prostate cancer patient records in NSW. This means crucial information is missing from their records. The second stage of this project, scheduled for completion in late 2014, is to identify the reasons for these missing data. Once this has been completed we can inform policy makers to ensure the data completeness can be improved. Studies using cancer staging data can then increase in quality and quantity.
Inside you will find:
* 8 Australians a day saved from cancer: Over 61,000 Australian lives have been saved by improvements in cancer prevention, screening and greatment over the past 20 years
* CLEAR Study: What might happen next with the data we've collected
* Our achievements: The results of our cancer resarch over the past 20 years
* Annual resarch awards: New research projects that were awarded funding
* Join a Research Study - Make yourself available for research and help reduce the burden of cancer
Weber - Cancer Screening among Immigrants Living in Urban and Regional Austra...Cancer Council NSW
Cancer Screening among Immigrants Living in Urban and Regional Australia: Results from the 45 and Up Study. This study explored differences in cancer screening participation by place of birth and residence - self-reported use of mammogram, faecal occult blood test (FOBT), and/or prostate specific antigen (PSA) tests
International Journal for Environmental and Research Public Health
Int. J. Environ. Res. Public Health 2014, 11(8), 8251-8266
Rodger - Prostate cancer mortality outcomes and patterns of primary treatment...Cancer Council NSW
Prostate cancer mortality outcomes and patterns of primary treatment for Aboriginal men in New South Wales, Australia
BJU International http://onlinelibrary.wiley.com/doi/10.1111/bju.12899/abstract
Characteristics of cases with unknown stage prostate cancerCancer Council NSW
Stage of cancer at diagnosis (e.g. localised, regional involvement, metastatic) is an important predictor of survival. This paper identifies there is cause for concern surrounding the 40% of "unknown" or unrecorded stage of diagnosis on prostate cancer patient records in NSW. This means crucial information is missing from their records. The second stage of this project, scheduled for completion in late 2014, is to identify the reasons for these missing data. Once this has been completed we can inform policy makers to ensure the data completeness can be improved. Studies using cancer staging data can then increase in quality and quantity.
Inside you will find:
* 8 Australians a day saved from cancer: Over 61,000 Australian lives have been saved by improvements in cancer prevention, screening and greatment over the past 20 years
* CLEAR Study: What might happen next with the data we've collected
* Our achievements: The results of our cancer resarch over the past 20 years
* Annual resarch awards: New research projects that were awarded funding
* Join a Research Study - Make yourself available for research and help reduce the burden of cancer
Weber - Cancer Screening among Immigrants Living in Urban and Regional Austra...Cancer Council NSW
Cancer Screening among Immigrants Living in Urban and Regional Australia: Results from the 45 and Up Study. This study explored differences in cancer screening participation by place of birth and residence - self-reported use of mammogram, faecal occult blood test (FOBT), and/or prostate specific antigen (PSA) tests
International Journal for Environmental and Research Public Health
Int. J. Environ. Res. Public Health 2014, 11(8), 8251-8266
Rodger - Prostate cancer mortality outcomes and patterns of primary treatment...Cancer Council NSW
Prostate cancer mortality outcomes and patterns of primary treatment for Aboriginal men in New South Wales, Australia
BJU International http://onlinelibrary.wiley.com/doi/10.1111/bju.12899/abstract
Colorectal cancer screening and subsequent incidence of colorectal cancer: re...Cancer Council NSW
Colorectal cancer screening and subsequent incidence of colorectal cancer: results from the 45 and Up Study
Annika Steffen, Marianne F Weber, David M Roder and Emily Banks
The ban on phenacetin is associated with changes in the incidence trends of u...Cancer Council NSW
Australian and New Zealand Journal of Public Health "The ban on phenacetin is associated with changes
in the incidence trends of upper-urinary tract
cancers in Australia"
Sebastien Antoni,1 Isabelle Soerjomataram,1 Suzanne Moore,1 Jacques Ferlay,1 Freddy Sitas,2-4
David P. Smith,2,5 David Forman1
Relationship between lifestyle and health factors and severe Lower Urinary Tract Symptoms (LUTS) in 106,435 middle-aged and older Australian men: population-based study
Cancer Council NSW Research Report Newsletter - November 2013Cancer Council NSW
Inside you will find:
Forgotten cancers: Bringing research funds and resources to bear on this area
Our Staff: 5 minutes with Dr Lini Nair-Shalliker
Our Insight: TA small change to the Death Registration Notice could save lives
Research Discovery: How cancer cells learn to resist the drug treatments
Join a Research Study - Make yourself available for research and help reduce the burden of cancer by completing a 5 minute questionnaire.
Knowledge, Attitude and Practice toward Cervical Cancer and Cervical Cancer S...ijtsrd
BACKGROUND Invasive Cervical Cancer ICC has been identified as the second most common cause of morbidity and mortality compared to other cancers among women in Cameroon. Cervical cancer can be treated e ectively if diagnosed early. Less than half the number of participants presented with good practice.The correlation between participants’ knowledge, attitude and practice showed that there was a significant association which therefore provides sufficient evidence to reject the null hypothesis. The result obtained in this study indicates how useful it will be to establish health education programs to increase women’s awareness and knowledge about cervical cancer. Fongang Che Landis | Enow-Orock George | Njajou Omer | Ngowe Ngowe Marcelin "Knowledge, Attitude and Practice toward Cervical Cancer and Cervical Cancer Screening and Its Associated Factors among Women in the City of Bamenda, Cameroon" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-4 , June 2021, URL: https://www.ijtsrd.compapers/ijtsrd43667.pdf Paper URL: https://www.ijtsrd.commedicine/other/43667/knowledge-attitude-and-practice-toward-cervical-cancer-and-cervical-cancer-screening-and-its-associated-factors-among-women-in-the-city-of-bamenda-cameroon/fongang-che-landis
Estimating the proportion cured of cancer: Some practical advice for usersCancer Council NSW
Cure models can provide improved possibilities for inference if used appropriately, but there is potential for misleading results if care is not taken. In this study, we compared five commonly used approaches for modelling cure in a relative survival framework and provide some practical advice
on the use of these approaches.
Background: The incidence of cancers is increasing worldwide, particularly in the developing countries as shown by recent cancer stastics from the WHO. It is even anticipated that with the increase in life expentancy, consequent upon inproved standard of living and globalization, the burden of cancers will increase within this millenium. With respective to cancer of the prostate, it is the most common type of cancer in urology. In developing countries, diagnostic is done at a late stage of evolution. In Cameroon, data on prostate cancer are scanty whereas the incidence of this disease is increasing. Objective: This article is designed to describe the epidemiological features of prostate cancer at the General Hospital of Yaoundé. Patients and methods: A 4-year retrospective study of patients seen with the diagnosis of cancer at the Medical Oncology unit of the Yaoundé General Hospital between January 2012 and December 2015. The demographic pattern (age of patients, socio professional activity, marital status), clinical features (cancer diagnosis), treatment modalities and outcome were studied. Main results: Of the 7 775 patients enrolled in the Medical Oncology Service over the study period, 1.4% (n = 108) cases of prostate cancer were seen. The prevalence over the study period was 1.38% and a relatively large annual growth of cases with an annual average of 27 cases was noted. The average age of patients was 67.82 years with a range of 34-83 years. The commonest presenting symptoms were the urinary frequency (54.63%) whereas the least common were fatigue (05.5%) and straining (03.70%). PSA was obtained in 49 patients, representing about 45.4% of all patients. Only 14 (01.26%) had biopsy reports. Conclusion: Prostate cancer is a major problem facing the aging male, and inadequate facilities make early detection difficult. Therefore, treatment is mainly palliative because of late diagnosis.
Don't miss our upcoming webinars! Subscribe today!
Presented by: Dr. Poul Sorensen, MD, PhD, FRCPC; Dr. Muhammad Zulfiqar, MD; Ted Taylor, Patient Advocate
In this webinar, we will hear from Dr. Sorensen about his groundbreaking discovery and how it contributed to the development of tumour agnostic treatments. Dr. Zulfiqar, a medical oncologist at the BC Cancer Agency, will further discuss TRK fusion cancers and how he has been able to treat patients. Lastly, we will hear from Ted Taylor, a TRK fusion cancer patient diagnosed with glioblastoma (GBM) multiform being treated with Vitrakvi.
Watch the YouTube video: https://youtu.be/RAkItUeZ23Q
Follow CCSN on social media:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Instagram: https://www.instagram.com/survivornet_ca/
Pinterest - https://www.pinterest.com/survivornetwork
HPV infection, cervical abnormalities, and cancer in HIV-infected women in Mu...Dr.Samsuddin Khan
Background: HIV-infected women are at a higher risk of cervical intraepithelial neoplasia (CIN) and cancer than women in the general population, partly due to a high prevalence of persistent human papillomavirus (HPV) infection. The aim of the study was to assess the burden of HPV infection, cervical abnormalities, and cervical cancer among a cohort of HIV-infected women as part of a routine screening in an urban overpopulated slum setting in Mumbai, India.
Methods: From May 2010 to October 2010, Médecins Sans Frontières and Tata Memorial Hospital Mumbai offered routine annual Pap smears and HPV DNA testing of women attending an antiretroviral therapy (ART) clinic and a 12-month follow-up. Women with abnormal test results were offered cervical biopsy and treatment, including treatment for sexually transmitted infections (STIs).
Results: Ninety-five women were screened. Median age was 38 years (IQR: 33–41); median nadir CD4-count 143 cells/µL (IQR: 79–270); and median time on ART 23 months (IQR:10–41). HPV DNA was detected in 30/94 women (32%), and 18/94 (19%) showed either low-grade or high-grade squamous intraepithelial lesions (LSIL/HSIL) on Pap smear. Overall, >50% had cervical inflammatory reactions including STIs. Of the 43 women with a cervical biopsy, eight (8.4%) had CIN-1, five (5.3%) CIN-2, and two (2.1%) carcinoma in situ. All but one had HPV DNA detected (risk ratio: 11, 95% confidence interval: 3.3–34). By October 2011, 56 women had completed the 12-month follow-up and had been rescreened. No new cases of HPV infection/LSIL/HSIL were detected.
Conclusion: The high prevalence of HPV infection, STIs, and cervical lesions among women attending an ART clinic demonstrates a need for routine screening. Simple, one-stop screening strategies are needed. The optimal screening interval, especially when resources are limited, needs to be determined.
Colorectal cancer screening and subsequent incidence of colorectal cancer: re...Cancer Council NSW
Colorectal cancer screening and subsequent incidence of colorectal cancer: results from the 45 and Up Study
Annika Steffen, Marianne F Weber, David M Roder and Emily Banks
The ban on phenacetin is associated with changes in the incidence trends of u...Cancer Council NSW
Australian and New Zealand Journal of Public Health "The ban on phenacetin is associated with changes
in the incidence trends of upper-urinary tract
cancers in Australia"
Sebastien Antoni,1 Isabelle Soerjomataram,1 Suzanne Moore,1 Jacques Ferlay,1 Freddy Sitas,2-4
David P. Smith,2,5 David Forman1
Relationship between lifestyle and health factors and severe Lower Urinary Tract Symptoms (LUTS) in 106,435 middle-aged and older Australian men: population-based study
Cancer Council NSW Research Report Newsletter - November 2013Cancer Council NSW
Inside you will find:
Forgotten cancers: Bringing research funds and resources to bear on this area
Our Staff: 5 minutes with Dr Lini Nair-Shalliker
Our Insight: TA small change to the Death Registration Notice could save lives
Research Discovery: How cancer cells learn to resist the drug treatments
Join a Research Study - Make yourself available for research and help reduce the burden of cancer by completing a 5 minute questionnaire.
Knowledge, Attitude and Practice toward Cervical Cancer and Cervical Cancer S...ijtsrd
BACKGROUND Invasive Cervical Cancer ICC has been identified as the second most common cause of morbidity and mortality compared to other cancers among women in Cameroon. Cervical cancer can be treated e ectively if diagnosed early. Less than half the number of participants presented with good practice.The correlation between participants’ knowledge, attitude and practice showed that there was a significant association which therefore provides sufficient evidence to reject the null hypothesis. The result obtained in this study indicates how useful it will be to establish health education programs to increase women’s awareness and knowledge about cervical cancer. Fongang Che Landis | Enow-Orock George | Njajou Omer | Ngowe Ngowe Marcelin "Knowledge, Attitude and Practice toward Cervical Cancer and Cervical Cancer Screening and Its Associated Factors among Women in the City of Bamenda, Cameroon" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-4 , June 2021, URL: https://www.ijtsrd.compapers/ijtsrd43667.pdf Paper URL: https://www.ijtsrd.commedicine/other/43667/knowledge-attitude-and-practice-toward-cervical-cancer-and-cervical-cancer-screening-and-its-associated-factors-among-women-in-the-city-of-bamenda-cameroon/fongang-che-landis
Estimating the proportion cured of cancer: Some practical advice for usersCancer Council NSW
Cure models can provide improved possibilities for inference if used appropriately, but there is potential for misleading results if care is not taken. In this study, we compared five commonly used approaches for modelling cure in a relative survival framework and provide some practical advice
on the use of these approaches.
Background: The incidence of cancers is increasing worldwide, particularly in the developing countries as shown by recent cancer stastics from the WHO. It is even anticipated that with the increase in life expentancy, consequent upon inproved standard of living and globalization, the burden of cancers will increase within this millenium. With respective to cancer of the prostate, it is the most common type of cancer in urology. In developing countries, diagnostic is done at a late stage of evolution. In Cameroon, data on prostate cancer are scanty whereas the incidence of this disease is increasing. Objective: This article is designed to describe the epidemiological features of prostate cancer at the General Hospital of Yaoundé. Patients and methods: A 4-year retrospective study of patients seen with the diagnosis of cancer at the Medical Oncology unit of the Yaoundé General Hospital between January 2012 and December 2015. The demographic pattern (age of patients, socio professional activity, marital status), clinical features (cancer diagnosis), treatment modalities and outcome were studied. Main results: Of the 7 775 patients enrolled in the Medical Oncology Service over the study period, 1.4% (n = 108) cases of prostate cancer were seen. The prevalence over the study period was 1.38% and a relatively large annual growth of cases with an annual average of 27 cases was noted. The average age of patients was 67.82 years with a range of 34-83 years. The commonest presenting symptoms were the urinary frequency (54.63%) whereas the least common were fatigue (05.5%) and straining (03.70%). PSA was obtained in 49 patients, representing about 45.4% of all patients. Only 14 (01.26%) had biopsy reports. Conclusion: Prostate cancer is a major problem facing the aging male, and inadequate facilities make early detection difficult. Therefore, treatment is mainly palliative because of late diagnosis.
Don't miss our upcoming webinars! Subscribe today!
Presented by: Dr. Poul Sorensen, MD, PhD, FRCPC; Dr. Muhammad Zulfiqar, MD; Ted Taylor, Patient Advocate
In this webinar, we will hear from Dr. Sorensen about his groundbreaking discovery and how it contributed to the development of tumour agnostic treatments. Dr. Zulfiqar, a medical oncologist at the BC Cancer Agency, will further discuss TRK fusion cancers and how he has been able to treat patients. Lastly, we will hear from Ted Taylor, a TRK fusion cancer patient diagnosed with glioblastoma (GBM) multiform being treated with Vitrakvi.
Watch the YouTube video: https://youtu.be/RAkItUeZ23Q
Follow CCSN on social media:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Instagram: https://www.instagram.com/survivornet_ca/
Pinterest - https://www.pinterest.com/survivornetwork
HPV infection, cervical abnormalities, and cancer in HIV-infected women in Mu...Dr.Samsuddin Khan
Background: HIV-infected women are at a higher risk of cervical intraepithelial neoplasia (CIN) and cancer than women in the general population, partly due to a high prevalence of persistent human papillomavirus (HPV) infection. The aim of the study was to assess the burden of HPV infection, cervical abnormalities, and cervical cancer among a cohort of HIV-infected women as part of a routine screening in an urban overpopulated slum setting in Mumbai, India.
Methods: From May 2010 to October 2010, Médecins Sans Frontières and Tata Memorial Hospital Mumbai offered routine annual Pap smears and HPV DNA testing of women attending an antiretroviral therapy (ART) clinic and a 12-month follow-up. Women with abnormal test results were offered cervical biopsy and treatment, including treatment for sexually transmitted infections (STIs).
Results: Ninety-five women were screened. Median age was 38 years (IQR: 33–41); median nadir CD4-count 143 cells/µL (IQR: 79–270); and median time on ART 23 months (IQR:10–41). HPV DNA was detected in 30/94 women (32%), and 18/94 (19%) showed either low-grade or high-grade squamous intraepithelial lesions (LSIL/HSIL) on Pap smear. Overall, >50% had cervical inflammatory reactions including STIs. Of the 43 women with a cervical biopsy, eight (8.4%) had CIN-1, five (5.3%) CIN-2, and two (2.1%) carcinoma in situ. All but one had HPV DNA detected (risk ratio: 11, 95% confidence interval: 3.3–34). By October 2011, 56 women had completed the 12-month follow-up and had been rescreened. No new cases of HPV infection/LSIL/HSIL were detected.
Conclusion: The high prevalence of HPV infection, STIs, and cervical lesions among women attending an ART clinic demonstrates a need for routine screening. Simple, one-stop screening strategies are needed. The optimal screening interval, especially when resources are limited, needs to be determined.
Annals of Translational Medicine & Epidemiology is a peer-reviewed, open access journal published by Austin Publishers. It provides easy access to high quality Manuscripts in all related aspects of biomedical and public health research that aims to improve the health of individuals and the community by "translating" findings into diagnostic tools, medicines, procedures, policies and education and occurrences of diseases in people.
Austin Publishing Group is a successful host of more than hundred peer reviewed, open access journals in various fields of science and medicine with intent to bridge the gap between academia and research access.
Annals of Translational Medicine & Epidemiology accepts original research articles, review articles, case reports, mini reviews, rapid communication, opinions and editorials on all the related aspects of "translating" findings into diagnostic tools, medicines, procedures, policies and education and occurrences of diseases in people.
26th International Papillomavirus Conference: Satellite Symposium
Enhancing HPV Prevention among Indigenous Populations: International Perspectives on Health and Well-Being
Montreal, Quebec
July 5, 2010
Panel 1 , Researching the Burden of HPV Disease, Immunization, and Cervical Screening among Indigenous Populations.
Cancer Magnitude in Elderly Indian Women, an Experience from Regional Cancer ...Crimsonpublishers-IGRWH
Cancer Magnitude in Elderly Indian Women, an Experience from Regional Cancer Centre, India by Ravi Kiran Pothamsetty in Open access journal of Gynecology
Sharad Ghamande, MD, FACOG
Professor and Director of Gynecologic Oncology
Augusta University Cancer Center
Presentation to the Georgia Senate Women's Adequate Healthcare Study Committee
www.gacommissiononwomen.org
ORIGINAL PAPERRisk of colorectal cancer among long-term ce.docxalfred4lewis58146
ORIGINAL PAPER
Risk of colorectal cancer among long-term cervical cancer
survivors
Ana M. Rodriguez • Yong-Fang Kuo •
James S. Goodwin
Received: 1 February 2014 / Accepted: 25 March 2014 / Published online: 3 April 2014
! Springer Science+Business Media New York 2014
Abstract Because advances in therapy have increased
long-term survival for women with cervical cancer, it is
important to study the risk of secondary primary malig-
nancies in high-dose organ areas. From the 1973–2009
National Cancer Institute Surveillance, Epidemiology, and
End Results (SEER) program, we studied the risk of
developing cancer of the colon and rectum in 64,507 cer-
vical cancer patients over 35 years after initial radiation
treatment. We also assessed change in risk over time.
Kaplan–Meier estimator for survival curve and Cox pro-
portional hazards models was used. More than half (52.6 %)
of the cervical cancer patients received radiation treatment.
In the analyses adjusted for race/ethnicity, age, marital
status, surgery status, stage and grade, the risk of colon
cancer between those both with and without XRT diverged
beginning at approximately 8 years. After 8 years, the
hazard ratio for developing colon cancer was 2.00 (95 % CI
1.43–2.80) for women with radiation versus those without
radiation treatment. The risk of rectal cancer diverged after
15 years of follow-up (HR 4.04, 95 % CI 2.08–7.86). After
35 years of follow-up, the absolute risk of developing colon
cancer was 6.5 % for those who received radiation versus
2.5 % for those without, and 3.7 versus 0.8 % for rectum.
The risk of colon and rectum cancer over 20 years of fol-
low-up after radiation remained the same across three eras
(1973–1980, 1981–1990, and 1991–2000). Radiation-
induced second cancers of the colon and rectum may occur
8 years after radiation treatment for cervical cancer.
Keywords Cervical cancer ! SEER ! Second primary
cancer ! Radiotherapy ! Colon cancer ! Rectal cancer
Introduction
The incidence and mortality for cervical cancer has
decreased in the United States [1, 2]. As of 2012, of the
245,022 women surviving cervical cancer, 83 % have
already lived 5 years or more after the diagnosis [3, 4].
With the growing number of people surviving cancer in
general, it is vital to study the health complications that
might develop during the months or years following the
completion of the given treatment to treat the primary
tumor [5]. Developing a second cancer is one of the most
serious complications of cancer treatment [6, 7]. An esti-
mated 18 % of the incident malignancies in the United
States are a second (subsequent) cancer [8].
Patients with cervical cancer provide an excellent
opportunity to study the lasting effects of radiotherapy [6].
There is a sufficient number of patients available to study,
including non-irradiated patients available for comparison.
In addition, radiation doses received by other organs while
treating cervical cancer can be .
Survival Analysis of Determinants of Breast Cancer Patients at Hossana Queen ...Premier Publishers
Breast cancer is one of the most severe diseases in the world and become the public’s ever day’s agenda in both developed and developing countries. The primary goal of this study was to identify the determinants of survival time of breast cancer patients at Hossana hospital, south Ethiopia. Kaplan-Meier estimation method and a new two-parameter probability distribution called hypertabastic are introduced to model the survival time of the data. A simulation study was carried out to evaluate the performance of the hypertabastic distribution in comparison with popular distribution with the help of R and SAS statistical software Packages. One-fourth (25%) of the total patients survived for only 2 days. 31(35.2%) were censored, and 55(62.5%) were died. Hypertabastic survival model was found to be best fitting to the breast cancer data and age, level of education, family history, breast problem before, High fat diet, child late age, early menarche, late menopause were significant risk factors for the death of breast cancer patients. Awareness has to be given for the society on causes of breast cancer and screening test and early detection policies for most risky groups has to be established.
An Audit of the Management and Associated Contextual Correlates of Clinical P...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Genotypes and Associated Risk Levels of Human Papilloma Virus among Female Pa...IIJSRJournal
Background: Human papillomavirus is the main factor in the etiology of cervical cancer, with over 99.7% of cases being associated with high-risk human papillomavirus infection. Although the majority of HPV infections are asymptomatic and self-limiting, persistent HPV infection can result in genital warts, oropharyngeal cancer, and cervical cancer in women, in addition to various anogenital malignancies and other genital warts in both men and women.
Method: This was a cross-sectional descriptive study which employed a convenience sampling technique where both qualitative and quantitative methods were used for data collection. A total of 374 participants were enrolled in the study and a semi structured questionnaire was administered to collect socio-demographic, reproductive and sexual history data. Laboratory analysis involved detection of HPV DNA hybrids with a chemiluminescent substrate, Digene Hybrid Capture 2 technology. Descriptive and inferential (logistic regression) analyses at level of significant (α=0.05) were used to summarize the data, and results illustrated using charts and tables.
Results: The study findings reported a significant risk level of human papillomavirus among female of age group 40-49 years (AOR; 0.15, 95% CI: 0.03-0.79; p = 0.026). Furthermore, in bivariate logistic regression the circulating HPV genotypes among the respondents was significantly characterized among women of the same age group (95% CI; 0.09-0.7; p = 0.008) as well as in the multivariate regression (AOR = 0.13; 95% CI: 0.02-0.72; p = 0.019).
Conclusion: The study thus concluded that there is 23/94 (25.67%) risk of developing cervical cancer due to high risk level HPV (with the presence of low risk level HPV 71/94 (74.33%) known for causing various forms of warts. Therefore, there is need for combined efforts from the Ministry of health and stakeholders to avail and train health care workers on the usage of HPV DNA kits to ensure timely detection of low and high-risk levels HPV. This will ensure timely identification of women at increased risk for the development of cervical cancer, thereby reducing mortality rate.
Similar to Aboriginal Patterns of Cancer Care Project Breast Cancer paper BMCCancer 1471 2407-14-163 (20)
Antoni, S., Soerjomataram, I., Moore, S., Ferlay, J., Sitas, F., Smith, D. P. and Forman, D. (2014), The ban on phenacetin is associated with changes in the incidence trends of upper-urinary tract cancers in Australia. Australian and New Zealand Journal of Public Health. doi: 10.1111/1753-6405.12252
If you're a researcher interested in Cancer Council NSW grant funding, this presentation will guide you through the application process, as well as how and why we ask you to get consumers involved.
Cancer incidence and mortality in people aged less than 75 years: Changes in ...Cancer Council NSW
Australia has one of the highest rates of cancer incidence worldwide and, despite improving
survival, cancer continues to be a major public health problem. Our aim was to provide simple summary
measures of changes in cancer mortality and incidence in Australia so that progress and areas for
improvement in cancer control can be identified.
Infographic: At Least 2 in 3 Australia's Will Be Diagnosed With Skin CancerCancer Council NSW
New findings from the latest Cancer Council National Sun Protection Survey shows that Australians are at the same risk of being sunburnt at sporting venues as they are at the beach. The research shows a clear link between sporting venues and sun damage, with 22% of Australians at sports grounds and centres getting sunburnt – as high as the percentage of Australians at the beach, local lake or river who got sunburnt (22%).
Chair of Cancer Council Australia’s Skin Cancer Committee, Louise Baldwin, said over the next three years, 44,000 Australians (40 a day) would be told they had the deadliest form of skin cancer, melanoma. Almost two in three would be men.
“The figures are startling when you put them in perspective,” Louise said. “Forty four thousand people is more than a full capacity crowd at the Gabba.”
“Cancer Council is reminding Australians that the ‘slip, slop, slap, seek and slide’ message doesn’t just apply at the beach."
Dermatologist and Honorary Secretary, Australasian College of Dermatologists, Dr Patricia Lowe, says in a new blog that the earlier a skin cancer was detected, the better the outcome in terms of complete removal and survival rate.
“Many Australians are under the impression that all skin cancers are easily treated, and most are, but only if picked up early,” Dr Lowe said. “Too often I see patients who had noticed something unusual on their skin yet didn’t seek advice soon enough. National Skin Cancer Action Week serves as a timely reminder to all Australians to check their skin now and keep a close eye on it all year-round.”
Australian test cricket captain and Cancer Council SunSmart Ambassador, Michael Clarke, said two of the things Australia was most famous for were cricket and skin cancer.
“I’ve had experience with both,” he said. “I’m only 32 and unfortunately I’ve already had three skin cancers on my face. I’m lucky they were picked up early. We all know the slip, slop, slap, seek and slide message, but too many of us forget to keep an eye on our skin.
“Remember, get to know your skin and if something changes, act fast and get it checked by your GP.”
Cricket Commentator, Jim Maxwell, is also supporting the campaign, following his own experience with skin cancer.
“Sun exposure has ravaged my face and kept dermatologists busy,” he said. “Be smart, wear a hat and slip, slop, slap, se
The NSW Cancer, Lifestyle and Evaluation of Risk Study (CLEAR)Cancer Council NSW
The NSW CLEAR case-control study commenced in 2006.
It collects lifestyle and demographic information as well as
biospecimens from people with all types of cancer and controls, which are available as an open resource for researchers.
Tobacco-attributed mortality from a question on smoking on the South African ...Cancer Council NSW
In 1997, the South African death notification form was revised to include questions on the smoking status of the deceased. This study used 481,640 notifications of deaths occurring between 1999 and 2007 to assess smoking-attributed mortality in South Africa.
Methods: A case-control proportional mortality design was used to estimate smoking-associated relative risks and attributable fractions for a number of potentially smoking-related causes of death. Cases: deaths from underlying causes known from other studies to be causally associated with smoking. Controls: deaths from medical conditions expected to be largely unrelated to smoking. The attributable fractions were then used to calculate the annual average number of deaths attributable to smoking in South Africa.
Cancer Council NSW has revealed the impact visual marketing can make for serious health campaigns after its first infographic 'Hope' went global, providing crucial cancer information to people in 100 countries.
This award winning infographic 'Hope – Turning the Page on Cancer' uses creative design and an interactive build to demystify cancer myths and reveal evidence-based facts on what causes cancer, primary risk factors and five pillars of prevention.
Cancer Research Activity Report 2012 By Cancer Council New South WalesCancer Council NSW
Research and Cancer Council NSW
We want to know the ‘whys’ of cancer, so that we can best understand how to positively improve the lives of those with the disease, their families and the wider community. We focus on those cancers that are the most lethal yet underfunded, such as brain, pancreatic and liver cancer. We also focus on disadvantaged groups, such as Aboriginal communities – among whom the cancer mortality rate is up to 60% higher than among non‑Aboriginal Australians – and seek to rectify such inequalities.
To realise our vision of cancer defeated, Cancer Council NSW must seek out opportunities to improve our collective knowledge about cancer. This understanding does not just lead to better diagnostics and treatments, but is also used to encourage healthy behaviours in community members, to persuade governments to develop better policy, and to provide programs and services to support people through each step of their cancer journey.
In the last fifteen years, we have awarded well over $120 million to Australia’s best and brightest cancer researchers. As the largest non‑government funder of cancer research in NSW, we are able to invest strategically in research, and contribute to sustaining research momentum.
Our research has found that major advances in screening, prevention and treatment have resulted in thousands of cancer deaths being avoided today compared to rates 20 years ago. More than 61,000 people are alive in Australia today thanks to knowledge that has been uncovered and put into practice over this time. All of this work is achieved in collaboration with the best universities, institutes and researchers throughout Australia and across the globe.
Tobacco Retail Report 2013 - Selling Tobacco Anywhere, Anytime Harmful Not He...Cancer Council NSW
Tobacco use remains an urgent health and social problem. Reform of the tobacco
retail environment would help achieve the NSW Government’s policy goals.
In the state plan, NSW 2021, the NSW Government has targets to lower smoking
rates by 3% for non-Aboriginal people and 4% for Aboriginal people by 2015.
1.Under the National Partnership Agreement on Preventative Health, the Government has committed to reduce daily smoking among adults to 10% or lower by 2020.
2. The NSW Minister for Health has endorsed the National Tobacco Strategy 2012–2018, undertaking to consider further options for tobacco retailer licensing and to commission
research on regulatory approaches to control the number and type of tobacco outlets.
3. Tobacco, a product that kills half its long-term users and is Australia’s leading
cause of preventable death and disease, is startlingly easy to buy. Cigarettes are available ‘anywhere, anytime’ – a legacy of the time when society was ignorant of their dire health effects. There are few limits on who may sell tobacco, where and when they may sell, or the number of outlets selling tobacco.
4. There are more than five times as many places to buy tobacco in NSW as there
are places to buy prescription medicines.
Visit canact.com.au for more information
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
2. in areas of higher socioeconomic disadvantage, and to live
in areas further from major cancer treatment centres [2].
Most of the published research has focused on Aboriginal
people living in sparsely populated, remote areas.
New South Wales (NSW) is the most populous state
in Australia, with over 6.8 million residents [11]. It also
has the largest number of Aboriginal residents (148 178),
representing approximately 29% of the total Australian
Aboriginal population [11]. Aboriginal people in NSW are
more likely to live in metropolitan areas than those in
other Australian states with Aboriginal populations of over
50,000 people. Nonetheless, Aboriginal people in NSW are
still less likely to live in metropolitan areas (43%) than
non-Aboriginal people (73%) [11].
As endorsed by the Aboriginal Health and Medical Re-
search Council in NSW and in accordance with the NSW
Health 2004 publication “Communicating Positively” we
use the descriptor ‘Aboriginal people’ throughout this re-
port to refer to the original people of Australia and their
descendants [12].
Using population-based linked health records, we have
compared the surgical treatment and survival of Aborigi-
nal and non-Aboriginal women diagnosed with breast
cancer in NSW. In particular, we investigated how the
potentially modifiable factors of health care access and
comorbidities influenced women’s treatment and survival.
Methods
This analysis was conducted as part of the Aboriginal
Patterns of Cancer Care Project (APOCC) which was
funded by a National Health and Medical Research
Council Health Services grant (Application Ref: 440202).
This analysis was approved by the NSW Population and
Health Service Research Ethics Committee and the
Aboriginal Health and Medical Research Council Human
Research Ethics Committee.
Data sources
We analysed linked routinely collected population-based
datasets of incident cancer cases, hospital inpatient epi-
sodes and deaths for NSW.
All invasive cancers diagnosed in NSW have been re-
quired to be notified to the NSW Central Cancer Registry
(CCR) since 1972. We obtained data from the CCR for all
invasive breast cancers (ICD-O-3 topography code C50
and morphology codes with a suffix of 3) diagnosed in
2001 to 2007 in women aged 18 years and over.
All inpatient episodes in public and private hospitals
in NSW for these women were obtained from the NSW
Ministry of Health’s Admitted Patient Data Collection
(APDC) for the period 1 July 2000 to 30 June 2009.
Information on their vital status to 31 December 2008
was obtained from the NSW Registry of Births, Deaths
and Marriages (RBDM). Deaths from breast cancer up
to 31 December 2007 were obtained from the Australian
Bureau of Statistics (ABS) and up to 31 December 2008
from the CCR.
The probabilistic linkage of the CCR, APDC, RBDM
and ABS data was carried out by the Centre for Health
Record Linkage (CHeReL) using ChoiceMaker software
(ChoiceMaker Technologies Inc., New York, US). The
CHeReL reviews all uncertain and samples of “certain”
matches and non-matches of records, and reports ap-
proximately 0.1% false positive and less than 0.1% false
negative linkages.
Variables for analysis
It is mandatory to ask about Aboriginal status in all
NSW public health facilities at each episode of care and
Aboriginal status is a mandatory field for all NSW health
data collection systems. In this analysis a woman was de-
termined to be Aboriginal if she had identified that she
was Aboriginal on a linked hospital admission or that
she was identified as Aboriginal on her death certificate.
Women’s demographic and disease information obtained
from the CCR included month and year of diagnosis, age
and spread of disease at diagnosis. Spread of disease at
diagnosis was reported by the CCR in four categories:
localised, regional, distant and unknown.
Each woman was assigned to one of three categories
according to the value of the Accessibility/Remoteness
Index for Australia (ARIA+) [13] for her Local Government
Area (LGA) of residence at the time of her diagnosis: major
cities, inner regional or rural. The rural category included
women living in outer regional, remote and very remote
LGAs. The ARIA+ index is calculated using road distances
of a LGA to the nearest population centres or ‘service
centres’. The service centres are categorised into major
cities, inner regional, outer regional, remote and very
remote based on population size. The road distances for
the LGA to the nearest service centre in each of the five
categories is then divided by the Australian mean to cre-
ate the LGA’s ARIA+ value [13]. Socioeconomic disad-
vantage was assigned to each woman according to the
value of the ABS Socio-Economic Indexes for Areas
Index of Relative Socio-Economic Advantage and Dis-
advantage (IRSAD) [14,15] for her LGA of residence at
diagnosis. The IRSAD is a summary of census informa-
tion about people and households within an area, in-
cluding measures of income, education, types and sizes
of housing and occupation [14,15]. LGAs were cate-
gorised into quintiles of socioeconomic disadvantage,
with each quintile containing equal proportions of the
NSW population.
Comorbidity information was derived from the APDC
diagnosis codes, which recorded the reasons for admis-
sion and other conditions that may affect treatment or
length of hospital stay. For each woman we noted any
Supramaniam et al. BMC Cancer 2014, 14:163 Page 2 of 9
http://www.biomedcentral.com/1471-2407/14/163
3. non-cancer condition described in the Charlson Comor-
bidity Index [16] in the 12 months prior to diagnosis
and up to 6 months following breast cancer diagnosis in
any hospital admission, including episodes where cancer
was not the main reason for admission. The comorbidi-
ties were then grouped as the presence or absence of:
diabetes, cardiovascular disease, chronic pulmonary dis-
ease (CPD) and any other non-cancer conditions. We ex-
cluded cancer as a comorbidity as we could not be certain
that the cancer was independent of the current breast can-
cer diagnosis. This exclusion may have resulted in an
underestimate of the overall impact of comorbidities on
breast cancer mortality.
Breast cancer surgical treatments were identified in the
APDC records by their ICD-10-AM codes and are reported
here as the most radical treatment of either mastectomy
(which may include a previous local excision/lumpectomy),
local excision/lumpectomy only or no surgical treatment.
We excluded 472 episodes of care that occurred more than
two months prior to diagnosis as they may have been re-
lated to another primary breast cancer.
We restricted our analysis to surgical treatment, as other
patterns of care studies have shown that there is high con-
cordance between the surgical procedure recorded in the
APDC and clinical audits of medical records, as surgical
treatments invariably require the woman to be admitted
pre- and/or post-operatively [17,18]. Conversely, adjuvant
chemotherapy and radiotherapy treatments received were
not assessed because they are largely administered as
outpatient services and are therefore rarely recorded in
the APDC.
Statistical analysis
We used chi-squared tests to compare categorical patient
characteristics between Aboriginal and non-Aboriginal
women. The median number of days between diagnosis
and surgery was compared using the non-parametric two-
sided Wilcoxon rank sum test.
For women who had at least one linked APDC record
in the time period between the 12 months prior and
6 months after their breast cancer diagnosis uncondi-
tional logistic regression was used to compare the odds
of Aboriginal and non-Aboriginal women receiving sur-
gical treatment. Variables were entered into the model
using the method described in Hill et al. [19]. This in-
volved first sequentially adjusting for factors relating to
the woman (age at diagnosis and year of diagnosis)
then the disease (spread of disease). Next, the poten-
tially modifiable effects of factors relating to health
care access (place of residence and socioeconomic disad-
vantage) and comorbidities were added to the model in
order of their influence on the odds ratio for Aboriginal
compared with non-Aboriginal women receiving surgical
treatment.
Relative survival could not be estimated, as official lifeta-
bles are not available for NSW Aboriginal people. We
therefore analysed breast cancer specific survival. Cumula-
tive mortality curves [20] and Cox proportional hazards re-
gression models were used to analyse the time to death
from breast cancer after diagnosis and to adjust for known
confounders respectively. The follow-up time for all women
whose deaths were not recorded in any of the linked data-
sets was censored at 31 December 2008. For the Cox
models, women who died from causes other than breast
cancer were censored at the date of death. Variables were
entered into the model using the method described above.
As with the logistic regression we sequentially adjusted for
the same factors relating to the woman and the disease,
then for the potentially modifiable effects of comorbidities,
surgical treatment, place of residence and socioeconomic
disadvantage in order of their influence on the hazard ratio
for breast cancer death for Aboriginal compared with non-
Aboriginal women.
We tested for any significant interactions (p<0.05) be-
tween the variable indicating if a woman was Aboriginal
and all other covariates in both the logistic regression
and Cox proportional hazards regression. We also tested
whether the proportional hazards assumption was satis-
fied by the final Cox regression model [21].
All statistical analyses were performed using SAS soft-
ware (release 9.3; SAS Institute Inc, Cary, North Carolina)
and R 2.15.1 [22].
Results
There were 28 819 women diagnosed with primary breast
cancer in NSW in the period 2001–2007. We excluded
from the analysis 180 women (0.6% of all cases) who were
diagnosed by death certificate or autopsy only. A further
789 women (2.8% of 28 639 remaining cases) who had no
matching record in the APDC were also excluded; they
are likely to be women who were treated in a neighbour-
ing state [17].
Of the 27 850 remaining women, 288 (1.0%) identified as
Aboriginal. Compared with non-Aboriginal women, Abori-
ginal women were diagnosed at younger age (median=57,
interquartile range (IQR) 47–66) than non-Aboriginal
women (median=59, IQR 50–70). Aboriginal women were
also more likely to have regional or distant spread of dis-
ease, to live in rural or socioeconomically disadvantaged
areas, and to have diabetes or chronic pulmonary disease
(Table 1).
Aboriginal women were less likely to receive surgical
treatment than non-Aboriginal women (Table 1). More
Aboriginal women had a mastectomy as their first surgery
(46%) compared with non-Aboriginal women (34%). One
year after diagnosis almost half of the Aboriginal women
(48%) had undergone a mastectomy, compared with 39%
of the non-Aboriginal women. For Aboriginal women
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4. living in major cities, inner regional and rural areas, within
12 months of diagnosis, 45%, 51% and 52% respectively
had had a mastectomy compared with 39%, 42% and 42%
respectively for non-Aboriginal women. The median time
between diagnosis and the first surgical treatment was
similar for Aboriginal (15 days) and non-Aboriginal women
(14 days).
From our analysis of women who had at least one
linked APDC record in the time period between the
12 months prior and 6 months after their breast cancer
Table 1 Comparison of Aboriginal and non-Aboriginal women diagnosed with breast cancer in New South Wales
2001-2007
Aboriginal Non-Aboriginal p-value
n % n %
All women 288 1 27562 99
Age at diagnosis (years) <0.01
20-49 89 31 6621 24
50-59 75 26 7209 26
60-69 66 23 6446 23
70-79 45 16 4426 16
80+ 13 5 2860 10
Place of residence <0.01
Major cities 138 48 20021 73
Inner regional 90 31 5882 21
Rurala
60 21 1659 6
Spread of disease 0.04
Localised 133 46 14374 52
Regional 112 39 9652 35
Distant 24 8 1470 5
Unknown 19 7 2066 7
Socioeconomic disadvantage <0.01
Least disadvantaged 23 8 5968 22
Second least disadvantaged 42 15 6061 22
Third least disadvantaged 35 12 4536 16
Second most disadvantaged 74 26 5515 20
Most disadvantaged 114 40 5482 20
Breast cancer surgical treatment within 12 months of diagnosis <0.01
No surgical treatment 43 15 3061 11
Local excision/Lumpectomy only 106 37 13650 49
Mastectomyb
139 48 10851 39
Median (IQRc
) days between diagnosis 15 (4–28) 14 (4–26) 0.27
And first breast cancer surgery
Comorbiditiesd
n = 279 N = 26483
Diabetes 49 18 2079 8 <0.01
Cardiovascular disease 20 7 1130 4 0.02
Chronic pulmonary disease 29 10 1012 4 <0.01
Other comorbidities 13 5 1093 4 0.66
No comorbidities recorded 195 70 22317 84 <0.01
a
Includes outer regional, remote and very remote areas.
b
Includes mastectomy with or without local excision/lumpectomy.
c
IQR – interquartile range (25th and 75th centile).
d
Numbers were reduced due to absence of linked hospital records during 12 months before and up to 6 months after breast cancer diagnosis. For Aboriginal
women 9 did not have a linked record and 1161 non-Aboriginal women did not have a linked record in the time period. Note also that comorbidity categories
are not mutually exclusive, so the percentages add to more than 100%.
Supramaniam et al. BMC Cancer 2014, 14:163 Page 4 of 9
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5. diagnosis, 87% of Aboriginal women compared with 92%
of non-Aboriginal women received surgical treatment
and the unadjusted odds ratio (OR) was 0.59 (95% Con-
fidence Interval (CI) 0.42-0.86, p=0.006) (Table 2). After
accounting for differences in age at diagnosis, year of
diagnosis and spread of disease, Aboriginal women still
had lower odds of receiving surgical treatment than non-
Aboriginal women (OR 0.50, 95% CI 0.33-0.78, p=0.003).
Finally, after accounting for comorbidities, place of resi-
dence at diagnosis and socioeconomic disadvantage the
odds ratio for Aboriginal women receiving surgical treat-
ment increased to be almost identical to the unadjusted
value (OR 0.60, 95% CI 0.39-0.95, p=0.031). There were
no significant interactions between the variable indicating
if a woman identified as Aboriginal and any of the covari-
ates described.
All the factors listed in Table 3 were significantly asso-
ciated with the risk of death from breast cancer for
NSW women. However, in the multivariable model that
included all factors shown in Table 3, diabetes, CPD, and
place of residence were no longer significantly associated
with the increased risk of death from breast cancer for
NSW women. The differences in risk of death for Abori-
ginal and non-Aboriginal women was also no longer
statistically significant after adjusting for all the factors
in Table 3.
The five-year crude breast cancer-specific mortality was
6.1% higher for Aboriginal women (17.7%, 95% CI: 12.9-
23.2) compared with non-Aboriginal women (11.6%, 95%
CI: 11.2-12.0) (Figure 1). Aboriginal women had a 69%
higher unadjusted risk of breast cancer death relative to
non-Aboriginal women (Hazard ratio (HR) 1.69, 95% CI
1.22-2.25, p=0.002) (Table 4). The hazard ratio for Abori-
ginal women compared with non-Aboriginal women was
similar to the unadjusted value at 1.67 (95% CI 1.21-2.23,
p=0.002) after adjusting for differences in age at diagnosis,
year of diagnosis and spread of disease (Table 4). However
after adjusting for surgical treatment the hazard ratio
decreased to 1.39 (95% CI 1.01-1.86, p=0.045). Also,
after accounting for comorbidities the risk of death
from breast cancer for Aboriginal women was still 34%
higher than for non-Aboriginal women, however this
difference was not statistically significant (HR 1.34, 95%
CI 0.97-1.79, p=0.075). Finally, after also accounting for
differences in socioeconomic disadvantage and place of
residence, there was little change in the hazard ratio
(HR 1.30, 95% CI 0.94-1.75, p=0.105). This final model
satisfied the proportional hazards assumption.
Discussion
We found that in NSW, Australia, Aboriginal women di-
agnosed with breast cancer were significantly less likely
to receive surgical treatment and had poorer survival
than non-Aboriginal women. The disparity in surgical
treatment was not accounted for by differences in age at
diagnosis, year of diagnosis, spread of disease, comorbid-
ities, place of residence at diagnosis or socioeconomic
disadvantage. After accounting for differences in age at
diagnosis, year of diagnosis and spread of disease Abori-
ginal women had a 67% higher risk of death from breast
cancer than non-Aboriginal women. However this in-
creased risk was reduced after accounting for differences
in the potentially modifiable factors of surgical treatment
received and comorbidities. These results suggest that
increasing rates of surgical treatment and preventing co-
morbidities may increase the survival of Aboriginal women
diagnosed with breast cancer in NSW.
Others have identified that place of residence and socio-
economic disadvantage manifest as barriers to treatment
uptake through lack of transportation, accommodation
and/or childcare facilities [23]. Our finding that Aboriginal
women were more likely to have a mastectomy, also found
in previous studies [24,25], may be a result not only of
more advanced disease at diagnosis, but also of poorer ac-
cess to adjuvant therapies. The proportion having mastec-
tomy increased with increasing remoteness of residence
indicating that this may be the case. However women may
have also chosen a mastectomy over a lumpectomy to
reduce the number of visits required for treatment. It is
also possible that having significant comorbidities limits
women’s access to surgery and adjuvant therapies, as
they may have lower tolerance of, or ability to recover
from, these treatments [26]. If the prevalence of comor-
bidities was reduced and access to, and acceptability of,
health care services improved, the disparities in surgical
treatment rates and survival from breast cancer between
NSW Aboriginal and non-Aboriginal women may be
reduced.
Table 2 Odds ratios for 279 Aboriginal women having
breast cancer surgical treatment compared with 26483
non-Aboriginal women
Covariate(s) adjusted fora
Odds ratiob
95% Confidence
interval
p-value
Aboriginal 0.59 0.42-0.86 0.006
+ Age at diagnosis 0.48 0.34-0.70 <0.001
+ Year of diagnosis 0.48 0.34-0.70 <0.001
+ Spread of disease 0.50 0.33-0.78 0.003
+ Place of residence 0.55 0.36-0.86 0.009
+ Comorbiditiesc
0.60 0.39-0.95 0.030
+ Socioeconomic
disadvantage
0.60 0.39-0.95 0.031
a
Covariates are entered sequentially and categories for each variable are as
shown in Table 1. All subsequent models include the covariates from the
previous model.
b
For Aboriginal women compared with non-Aboriginal women.
c
Comorbidities includes the presence or absence of: diabetes, cardiovascular
disease, chronic pulmonary disease and any other (non-cancer) comorbidity in
the Charlson Comorbidity Index.
Supramaniam et al. BMC Cancer 2014, 14:163 Page 5 of 9
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6. Free mammographic screening has been available
through BreastScreen NSW since 1991. In the period
2000–2008 participation by Aboriginal women in the
program ranged between 30% and 35% compared to be-
tween 50% and 56% for non-Aboriginal women [27].
This difference in participation may explain some of the
differences in stage at diagnosis between Aboriginal and
non-Aboriginal women. It is however, unlikely to be the
only factor, as more than half of all breast cancers are di-
agnosed outside BreastScreen NSW’s target age group of
50–69, and only 40% of cancers diagnosed annually in
the target age group are diagnosed through the screen-
ing program [27].
A limitation of this study is the identification of Abori-
ginal women in our source datasets, although this was
addressed by using any record of a woman identifying as
Aboriginal by the ABS death records or in any hospital
admission record, including non-cancer related admis-
sions, to indicate that a woman was Aboriginal. As 98%
of the NSW population is non-Aboriginal the chance of
a false positive misclassification is low. The NSW Ministry
of Health has recently evaluated a number of different
Table 3 Cox regression models of factors associated with breast cancer survival for NSW women 2001–2007 (n = 26762)
Unadjusted model Multivariable model
Hazard ratio (95% CI) p-value Hazard ratio (95% CI) p-value
Aboriginal 1.69 1.22-2.25 0.002 1.30 0.94-1.75 0.105
Age at diagnosis <0.001 <0.001
20-49 1.16 1.03-1.31 1.03 0.91-1.16
50-69 1.00 1.00
60-69 0.91 0.80-1.04 0.90 0.79-1.02
70-79 1.71 1.51-1.93 1.52 1.35-1.72
80+ 3.52 3.12-3.97 2.27 1.99-2.59
Year of diagnosis 0.97 0.95-1.00 0.018 0.96 0.94-0.98 <0.001
Spread of disease <0.001 <0.001
Localised 1.00 1.00
Regional 3.90 3.50-4.35 3.63 3.25-4.06
Distant 24.46 21.76-27.53 11.85 10.40-13.50
Unknown 5.40 4.64-6.29 2.41 2.05-2.83
Comorbiditiesa
Diabetes 1.52 1.33-1.72 <0.001 1.09 0.96-1.24 0.187
Cardiovascular disease 3.27 2.86-3.72 <0.001 1.18 1.02-1.37 0.030
Chronic pulmonary disease 1.63 1.37-1.92 <0.001 1.13 0.95-1.34 0.166
Other comorbidities 3.95 3.47-4.48 <0.001 1.60 1.38-1.84 <0.001
Surgical treatment <0.001 <0.001
No surgical treatment 1.00 1.00
Local excision/Lumpectomy only 0.06 0.06-0.07 0.17 0.15-0.19
Mastectomyb
0.17 0.15-0.18 0.31 0.28-0.34
Socioeconomic disadvantage <0.001 0.018
Least disadvantaged 1.00 1.00
Second least disadvantaged 1.14 1.00-1.29 1.09 0.96-1.24
Third least disadvantaged 1.31 1.15-1.49 1.17 1.03-1.34
Second most disadvantaged 1.33 1.17-1.50 1.25 1.09-1.42
Most disadvantaged 1.35 1.19-1.52 1.19 1.02-1.38
Place of residence 0.014 0.703
Major cities 1.00 1.00
Inner regional 1.11 1.01-1.22 1.03 0.92-1.15
Ruralb
1.20 1.02-1.40 0.96 0.80-1.15
a
Presence compared with the absence for each comorbidity.
b
Includes mastectomy with or without local excision/lumpectomy.
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7. algorithms for improving identification of Aboriginal people
in linked health data sets and found that an ‘ever identified’
algorithm, as used here, increased the identification of
Aboriginal people in the CCR by 49% [28]. Finally, al-
though recent efforts to improve the identification of
Aboriginal people in health data systems have been largely
successful [29], it is likely that any statistics presented here
still underestimate the number of Aboriginal women diag-
nosed with breast cancer in NSW. A recent paper describ-
ing the same population, but for a different time period,
estimated the under-reporting of Aboriginal identifica-
tion to be between 12% and 14% [30]. If the unidentified
Aboriginal women had better outcomes than those who
were identified, the results of this study would likely be
biased away from the null hypotheses of no differences
in surgical treatment or survival rates for Aboriginal
and non-Aboriginal women. A further limitation is the
potential under-reporting of comorbidities in the hos-
pital records, although diabetes has been shown to be
reasonably reliably recorded [18]. Another limitation is
that we were unable to measure other reasons besides
access factors that may contribute to the observed lower
surgical treatment rates for Aboriginal women. A quali-
tative study in NSW identified several cultural barriers
between Aboriginal people and mainstream cancer ser-
vices that may be subtly contributing to lower usage or
acceptability of some cancer treatments. In particular it
identified lower cancer literacy for Aboriginal people [31], a
feeling of a lack of social inclusion when in hospital settings
[32], and the need for health services to openly discuss and
address cultural differences in service delivery [33].
A final potential limitation is a possible bias in our sur-
vival comparisons due to the identification of Aboriginal
women through the ABS death records. We investigated
the magnitude of this effect in a sensitivity analysis where
we determined Aboriginal status from the APDC only.
There were nine women who were identified as Aboriginal
by their ABS records only (of whom five died of breast
cancer and four died of other causes and were censored in
our analysis). When these nine women were excluded
from the analysis, the results and conclusions were
unchanged as the fully adjusted hazard ratio comparing
survival in Aboriginal and non-Aboriginal women de-
creased slightly from 1.30 (95% CI 0.94-1.75) to 1.19 (95%
CI: 0.84-1.63).
The strengths of our study include the whole popula-
tion approach to identifying cases. This is the first such
study conducted in NSW, the Australian state with the
largest Aboriginal population, including the largest num-
ber of Aboriginal women living in metropolitan areas.
This is also the first study to include detailed informa-
tion on comorbidities and to assess their effects on sur-
gical treatment and survival for Aboriginal women. Our
study is also the first to statistically account for the dis-
parities in the risk of breast cancer specific death by
adjusting for differences in comorbidities and surgical
treatment received in addition to age at diagnosis, year
of diagnosis, spread of disease, place of residence and so-
cioeconomic disadvantage. Previous published studies on
breast cancer survival for Aboriginal women have only
adjusted for differences in some of these covariates and
so were unable to discern the relative or combined
effects of all of the covariates [10,34].
Our results for NSW Aboriginal women, compared to
non-Aboriginal women, broadly concurred with the lower
incidence of breast cancer yet similar mortality rate for
Years since diagnosis
Cumulativeprobabilityofdeath(%)
Aboriginal
Non−Aboriginal
0 1 2 3 4 5
0
5
10
15
20
11.6%
17.7%
Figure 1 Cumulative mortality from breast cancer for 288
Aboriginal and 27562 non-Aboriginal women diagnosed in
NSW, 2001–2007.
Table 4 Hazard ratios for 279 Aboriginal women
dying from breast cancer compared with 26483
non-Aboriginal women
Covariate(s) adjusted fora
Hazard ratiob
95% Confidence
interval
p-value
Aboriginal 1.69 1.22-2.25 0.002
+ Age at diagnosis 1.88 1.36-2.51 <0.001
+ Year of diagnosis 1.88 1.36-2.51 <0.001
+ Spread of disease 1.67 1.21-2.23 0.002
+ Surgery 1.39 1.01-1.86 0.045
+ Comorbiditiesc
1.34 0.97-1.79 0.075
+ Socioeconomic
disadvantage
1.30 0.94-1.74 0.109
+ Place of residence 1.30 0.94-1.75 0.105
a
Covariates are entered sequentially and categories for each variable are as
shown in Table 3. All subsequent models include the covariates from the
previous model.
b
For Aboriginal women compared with non-Aboriginal women.
c
Comorbidities include the presence of absence of: diabetes, cardiovascular
disease, chronic pulmonary disease and any other (non-cancer) comorbidity in
the Charlson Comorbidity Index.
Supramaniam et al. BMC Cancer 2014, 14:163 Page 7 of 9
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8. the whole population observed in the less populous
jurisdictions of Australia [4,5,7] suggesting poorer sur-
vival for Aboriginal women. We found that Aboriginal
women in NSW were 69% more likely to die from their
breast cancer than non-Aboriginal women, while studies
from the Northern Territory and South Australia found
that Aboriginal women were almost twice as likely as
non-Aboriginal women to die of their breast cancer [4,34].
The Northern Territory study also found that differences
in age and stage did not explain the survival gap between
Aboriginal and non-Aboriginal women [4]. Similar dispar-
ities in the rates of surgical treatment between Aboriginal
and non-Aboriginal women to those we have reported
were found in Queensland and Western Australia [35,36].
Our results also seem comparable to international stud-
ies of cancer in Indigenous populations. A recent study in
New Zealand found that Maori women had lower breast
cancer survival than non-Maori women, and that this dif-
ference could not be accounted for by disparities in age
and spread of disease [37]. Studies of women with breast
cancer in the United States have also found poorer survival
for American Indian, Alaskan Native and Hawaiian Native
women compared to their respective non-Indigenous pop-
ulations [38-40], and again, differences in age and spread
of disease did not explain this disparity. Studies found that
the surgical treatment rates for American Indian and Al-
askan Native women with breast cancer were similar to
those for non-Indigenous women, however the time be-
tween diagnosis and treatment was longer [41,42].
Conclusions
Aboriginal women in NSW diagnosed with breast can-
cer received less surgical treatment than non-Aboriginal
women. Aboriginal women were also less likely to survive
their breast cancer than non-Aboriginal women. We have
shown that the disparity in survival could be reduced by
preventing comorbidities and increasing rates of surgical
treatment.
Competing interests
The authors declare that they have no competing interests.
Authors’ contributions
All authors listed in this paper fulfil the criteria of authorship, and there is no
one else who fulfils these criteria who is not listed here as an author.
Contributions were as follows: RS contributed to study design, led data
analysis and interpretation, and wrote all drafts of the paper; AG conducted
the data analysis and contributed to the interpretation and to draft revisions;
DG contributed to data analysis, interpretation and to draft revisions; AD
contributed to interpretation and to draft revisions; DO’C contributed to
study design, data interpretation and draft revisions. All authors read and
approved the final manuscript.
Acknowledgements
The Authors would like to acknowledge the Chief Investigators of the
Aboriginal Patterns of Cancer Care Project (APOCC), the APOCC Aboriginal
Advisory Group and Ethics Committee of The Aboriginal Health and Medical
Research Council for providing advice on the content of this paper.
Funding
The Aboriginal Patterns of Cancer Care Project (APOCC) was funded by a
National Health and Medical Research Council Health Services Research
grant (Application Ref: 440202).
Author details
1
Cancer Research Division, Cancer Council NSW, Sydney, Australia. 2
School of
Public Health, The University of Sydney, Sydney, Australia. 3
Institute for
Positive Psychology and Education, Australia Catholic University, Sydney,
Australia. 4
School of Public Health and Community Medicine, University of
New South Wales, Sydney, Australia. 5
School of Medicine and Public Health,
The University of Newcastle, Newcastle, Australia.
Received: 18 October 2013 Accepted: 26 February 2014
Published: 7 March 2014
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doi:10.1186/1471-2407-14-163
Cite this article as: Supramaniam et al.: Increasing rates of surgical
treatment and preventing comorbidities may increase breast cancer
survival for Aboriginal women. BMC Cancer 2014 14:163.
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Supramaniam et al. BMC Cancer 2014, 14:163 Page 9 of 9
http://www.biomedcentral.com/1471-2407/14/163