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Weller RB. Sunlight: Time for a Rethink? J Invest Dermatol 2024:S0022-202X(24)00280-X. [PMID: 38661623 DOI: 10.1016/j.jid.2023.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 04/26/2024]
Abstract
UVR is a skin carcinogen, yet no studies link sun exposure to increased all-cause mortality. Epidemiological studies from the United Kingdom and Sweden link sun exposure with reduced all-cause, cardiovascular, and cancer mortality. Vitamin D synthesis is dependent on UVB exposure. Individuals with higher serum levels of vitamin D are healthier in many ways, yet multiple trials of oral vitamin D supplementation show little benefit. Growing evidence shows that sunlight has health benefits through vitamin D-independent pathways, such as photomobilization of nitric oxide from cutaneous stores with reduction in cardiovascular morbidity. Sunlight has important systemic health benefit as well as risks.
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Affiliation(s)
- Richard B Weller
- Centre for Inflammation Research, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, United Kingdom; Department of Dermatology, The University of Edinburgh, Edinburgh, United Kingdom.
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Taylor EV, Dugdale S, Connors CM, Garvey G, Thompson SC. "A Huge Gap": Health Care Provider Perspectives on Cancer Screening for Aboriginal and Torres Strait Islander People in the Northern Territory. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:141. [PMID: 38397632 PMCID: PMC10887611 DOI: 10.3390/ijerph21020141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024]
Abstract
Cancer is one of the leading causes of death for Aboriginal and Torres Strait Islander people in the Northern Territory (NT). Accessible and culturally appropriate cancer screening programs are a vital component in reducing the burden of cancer. Primary health care plays a pivotal role in facilitating the uptake of cancer screening in the NT, due to the significant challenges caused by large distances, limited resources, and cultural differences. This paper analyses health care provider perspectives and approaches to the provision of cancer screening to Aboriginal people in the NT that were collected as part of a larger study. Semi-structured interviews were conducted with 50 staff from 15 health services, including 8 regional, remote, and very remote primary health care (PHC) clinics, 3 hospitals, a cancer centre, and 3 cancer support services. Transcripts were thematically analysed. Cancer screening by remote and very remote PHC clinics in the NT is variable, with some staff seeing cancer screening as a "huge gap", while others see it as lower priority compared to other conditions due to a lack of resourcing and the overwhelming burden of acute and chronic disease. Conversely, some clinics see screening as an area where they are performing well, with systematic screening, targeted programs, and high screening rates. There was a large variation in perceptions of the breast screening and cervical screening programs. However, participants universally reported that the bowel screening kit was complicated and not culturally appropriate for their Aboriginal patients, which led to low uptake. System-level improvements are required, including increased funding and resourcing for screening programs, and for PHC clinics in the NT. Being appropriately resourced would assist PHC clinics to incorporate a greater emphasis on cancer screening into adult health checks and would support PHCs to work with local communities to co-design targeted cancer screening programs and culturally relevant education activities. Addressing these issues are vital for NT PHC clinics to address the existing cancer screening gaps and achieving the Australian Government pledge to be the first nation in the world to eliminate cervical cancer as a public health problem by 2035. The implementation of the National Lung Cancer Screening Program in 2025 also presents an opportunity to deliver greater benefits to Aboriginal communities and reduce the cancer burden.
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Affiliation(s)
- Emma V Taylor
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, WA 6530, Australia
| | - Sarah Dugdale
- Health Statistics and Informatics, NT Health, Darwin, NT 0800, Australia
| | | | - Gail Garvey
- The School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD 4006, Australia
| | - Sandra C Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, WA 6530, Australia
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Banham D, Karnon J, Brown A, Roder D, Lynch J. The fraction of life years lost after diagnosis (FLYLAD): a person-centred measure of cancer burden. Popul Health Metr 2023; 21:14. [PMID: 37704992 PMCID: PMC10500871 DOI: 10.1186/s12963-023-00314-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 09/07/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Cancer control initiatives are informed by quantifying the capacity to reduce cancer burden through effective interventions. Burden measures using health administrative data are a sustainable way to support monitoring and evaluating of outcomes among patients and populations. The Fraction of Life Years Lost After Diagnosis (FLYLAD) is one such burden measure. We use data on Aboriginal and non-Aboriginal South Australians from 1990 to 2010 to show how FLYLAD quantifies disparities in cancer burden: between populations; between sub-population cohorts where stage at diagnosis is available; and when follow-up is constrained to 24-months after diagnosis. METHOD FLYLADcancer is the fraction of years of life expectancy lost due to cancer (YLLcancer) to life expectancy years at risk at time of cancer diagnosis (LYAR) for each person. The Global Burden of Disease standard life table provides referent life expectancies. FLYLADcancer was estimated for the population of cancer cases diagnosed in South Australia from 1990 to 2010. Cancer stage at diagnosis was also available for cancers diagnosed in Aboriginal people and a cohort of non-Aboriginal people matched by sex, year of birth, primary cancer site and year of diagnosis. RESULTS Cancers diagnoses (N = 144,891) included 777 among Aboriginal people. Cancer burden described by FLYLADcancer was higher among Aboriginal than non-Aboriginal (0.55, 95% CIs 0.52-0.59 versus 0.39, 95% CIs 0.39-0.40). Diagnoses at younger ages among Aboriginal people, 7 year higher LYAR (31.0, 95% CIs 30.0-32.0 versus 24.1, 95% CIs 24.1-24.2) and higher premature cancer mortality (YLLcancer = 16.3, 95% CIs 15.1-17.5 versus YLLcancer = 8.2, 95% CIs 8.2-8.3) influenced this. Disparities in cancer burden between the matched Aboriginal and non-Aboriginal cohorts manifested 24-months after diagnosis with FLYLADcancer 0.44, 95% CIs 0.40-0.47 and 0.28, 95% CIs 0.25-0.31 respectively. CONCLUSION FLYLAD described disproportionately higher cancer burden among Aboriginal people in comparisons involving: all people diagnosed with cancer; the matched cohorts; and, within groups diagnosed with same staged disease. The extent of disparities were evident 24-months after diagnosis. This is evidence of Aboriginal peoples' substantial capacity to benefit from cancer control initiatives, particularly those leading to earlier detection and treatment of cancers. FLYLAD's use of readily available, person-level administrative records can help evaluate health care initiatives addressing this need.
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Affiliation(s)
- David Banham
- School of Public Health, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia.
- Wardliparingga Aboriginal Health Research, South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, 5000, Australia.
| | - Jonathan Karnon
- College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, SA, 5042, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Health Research, South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, 5000, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia
| | - David Roder
- School of Health Sciences, Cancer Research Institute, University of South Australia, North Terrace, Adelaide, SA, 5000, Australia
| | - John Lynch
- School of Public Health, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia
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Qama A, Allard N, Cowie B, Davis JS, Davies J. Hepatitis B in the Northern Territory: insights into the changing epidemiology of an ancient condition. Intern Med J 2021; 51:910-922. [PMID: 32975893 PMCID: PMC8362129 DOI: 10.1111/imj.15069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/04/2020] [Accepted: 09/10/2020] [Indexed: 01/04/2023]
Abstract
Background Aboriginal and Torres Strait Islander people are disproportionately affected by hepatitis B virus (HBV) infection. A proposed mismatch between standard vaccines and the HBV/C4 sub‐genotype prevalent in Aboriginal people in the Northern Territory (NT) may reduce vaccine effectiveness. Aims To determine HBV prevalence in the NT by Indigenous status and to explore patterns of immunity following implementation of universal vaccination, using a large longitudinal diagnostic dataset. Methods A retrospective analysis of all available HBV serology results in the NT from 1991 to 2011 was conducted, with HBV prevalence and vaccination status analysed according to adigenous status, age and sex using individuals' patterns of HBsAg, anti‐HBs and anti‐HBc serology over repeated tests. Results 100 790 individuals were tested (33.4% Indigenous) between 1991 and 2011 (26.1% of the 2011 NT population), with a total of 211 802 tests performed. In 2011, the proportion of HBV positive individuals in the NT was 3.17% (5.22% in Indigenous populations) compared to previous 2011 estimates of 1.70% (3.70% in Indigenous populations). The vaccine failure rate was lower than expected with only one presumed vaccinated person subsequently developing HBsAg positivity (0.02%). Evidence of suboptimal vaccine efficacy by breakthrough anti‐HBc positivity in vaccinated individuals was demonstrated in 3.1% of the vaccinated cohort, of which 86.4% identified as Indigenous (HR 1.17). No difference in HBeAg positivity or seroconversion was observed between Indigenous and non‐Indigenous individuals living with CHB. Conclusions The burden of CHB in Indigenous people in the NT has previously been underestimated. A higher HBV prevalence in the NT than described in previous cross‐sectional studies was found, including a higher prevalence in Indigenous people. Evidence of suboptimal vaccine efficacy was demonstrated predominantly in Indigenous individuals.
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Affiliation(s)
- Ashleigh Qama
- WHO Collaborating Centre for Viral Hepatitis, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Department of Medicine (RMH), University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Nicole Allard
- WHO Collaborating Centre for Viral Hepatitis, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Department of Medicine (RMH), University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia.,cohealth, Parkville, Victoria, Australia
| | - Benjamin Cowie
- WHO Collaborating Centre for Viral Hepatitis, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Department of Medicine (RMH), University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Joshua S Davis
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia.,Division of Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Jane Davies
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia.,The Infectious Diseases Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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Fitzadam S, Lin E, Creighton N, Currow DC. Lung, breast and bowel cancer treatment for Aboriginal people in New South Wales: a population-based cohort study. Intern Med J 2021; 51:879-890. [PMID: 32638476 PMCID: PMC8362177 DOI: 10.1111/imj.14967] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 04/23/2020] [Accepted: 06/21/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Aboriginal Australians have higher cancer mortality than non-Aboriginal Australians. Lower rates of cancer treatment among Aboriginal people can contribute to this. AIMS To investigate demographic, clinical and access factors associated with lung, breast and bowel cancer treatment for Aboriginal people compared with non-Aboriginal people in New South Wales, Australia. METHODS Population-based cohort study using linked routinely collected datasets, including all diagnoses of primary lung, breast or bowel cancer from January 2009 to June 2012. Treatment (surgery, radiotherapy or chemotherapy) within 6 months from diagnosis was measured. Access was measured using minimum distance to radiotherapy or hospital with a cancer-specific multidisciplinary team, visit to a specialist and possession of private health insurance. Logistic regression modelling was employed. RESULTS There were 587 Aboriginal and 34 015 non-Aboriginal people diagnosed with cancer. For lung cancer, significantly fewer Aboriginal than non-Aboriginal people received surgery (odds ratio 0.46, 95% confidence interval 0.29-0.73, P < 0.001) or any treatment (surgery, chemotherapy or radiotherapy; odds ratio 0.64, 95% confidence interval 0.47-0.88, P = 0.006) after adjusting for sex, age, disease extent and comorbidities. They were less likely to have an attendance with a surgeon (27.0%, 62/230 vs 33.3%, 2865/8597, P = 0.04) compared with non-Aboriginal people. There were no significant differences in cancer treatment for Aboriginal people compared with non-Aboriginal people for breast or bowel cancers after adjusting for patient sex, age, disease extent and comorbidities. CONCLUSION Aboriginal people were significantly less likely to receive surgery for lung cancer than non-Aboriginal people and had fewer attendances with a surgeon, suggesting a need to strengthen referral pathways.
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Affiliation(s)
- Suzanne Fitzadam
- Cancer Services and Information, Cancer Institute NSW, Sydney, New South Wales, Australia
| | - Enmoore Lin
- Cancer Services and Information, Cancer Institute NSW, Sydney, New South Wales, Australia
| | - Nicola Creighton
- Cancer Services and Information, Cancer Institute NSW, Sydney, New South Wales, Australia
| | - David C Currow
- Chief Cancer Officer, Cancer Institute NSW, Sydney, New South Wales, Australia
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Read DJ, Frentzas S, Ward L, De Ieso P, Chen S, Devi V. Do histopathological features of breast cancer in Australian Indigenous women explain the survival disparity? A two decade long study in the Northern Territory. Asia Pac J Clin Oncol 2020; 16:348-355. [PMID: 32573084 DOI: 10.1111/ajco.13377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 05/05/2020] [Indexed: 12/15/2022]
Abstract
AIMS In the Northern Territory (NT) of Australia, Indigenous women have a lower incidence of breast cancer, but a higher mortality than Non-indigenous women. The aim of this study was to describe and compare breast cancer pathological features related to stage and biological aggression between the two groups. METHODS Subjects were identified by extract from the NT Cancer Registry in two separate cohorts, cohort 1 (1991-2000) and cohort 2 (2001-2010). Data from cohort 1 included age, stage, tumor grade and estrogen receptor status (ER) and treatment completion. Additional pathological variables including tumor size, HER2 status, lymphovascular invasion and derived tumor phenotype were available for cohort 2. Bivariate P values for categoric variables were calculated using Fisher's exact tests. The Wilcoxon rank-sum test was used to compare cohort 2. Logistic regression was used to calculate odds ratios. RESULTS There were 359 (44 indigenous) eligible women in cohort 1 and 526 (100 indigenous) for cohort 2. In cohort 1, in both cohorts, indigenous women were more likely to present at an advanced stage, but there was no difference in ER status or tumor grade. When derived phenotypes were compared, indigenous women were less likely to have better prognosis luminal A tumors, and more likely to have HER2-enriched tumors. CONCLUSION This two decade long comparison of the pathological features of breast cancer between indigenous and nonindigenous women of the NT has confirmed that Indigenous women not only present at a later stage than NI women but are also afflicted by poorer prognosis tumors, particularly HER2 enriched.
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Affiliation(s)
- David J Read
- Department of Surgery, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Sophia Frentzas
- Alan Walker Cancer Centre, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Linda Ward
- Menzies School of Health Research, Northern Territory, Australia
| | - Paolo De Ieso
- Northern Territory Radiation Oncology, Northern Territory, Australia
| | - Samantha Chen
- Department of Surgery, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Vanitha Devi
- Department of Surgery, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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Banham D, Roder D, Eckert M, Howard NJ, Canuto K, Brown A. Cancer treatment and the risk of cancer death among Aboriginal and non-Aboriginal South Australians: analysis of a matched cohort study. BMC Health Serv Res 2019; 19:771. [PMID: 31665005 PMCID: PMC6820943 DOI: 10.1186/s12913-019-4534-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 09/13/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Aboriginal and Torres Strait Islander Australians have poorer cancer outcomes than other Australians. Comparatively little is known of the type and amount of cancer treatment provided to Aboriginal and Torres Strait Islander people and the consequences for cancer survival. This study quantifies the influence of surgical, systemic and radiotherapy treatment on risk of cancer death among matched cohorts of cancer cases and, the comparative exposure of cohorts to these treatments. METHODS Cancers registered among Aboriginal South Australians in 1990-2010 (N = 777) were matched with randomly selected non-Indigenous cases by sex, birth and diagnostic year, and primary site, then linked to administrative cancer treatment for the period from 2 months before to 13 months after diagnosis. Competing risk regression summarised associations of Indigenous status, geographic remoteness, comorbidities, cancer stage and treatment exposure with risk of cancer death. RESULTS Fewer Aboriginal cases had localised disease at diagnosis (37.2% versus 50.2%) and they were less likely to: experience hospitalisation with cancer diagnosis, unadjusted odds ratio (UOR) = 0.76; 95%CI = 0.59-0.98; have surgery UOR = 0.65; 95%CI = 0.53-0.80; systemic therapies UOR = 0.64; 95%CI = 0.52-0.78; or radiotherapy, UOR = 0.76; 95%CI = 0.63-0.94. Localised disease carried lower risk of cancer death compared to advanced cases receiving surgery or systemic therapies, SHR = 0.34; 95%CI = 0.25-0.47 and SHR = 0.35; 95%CI = 0.25-0.48. Advanced disease and no treatment carried higher risk of cancer death, SHR = 1.82; 95%CI = 1.26-2.63. CONCLUSION The effects of treatment did not differ between Aboriginal and non-Indigenous cohorts. However, comparatively less exposure to surgical and systemic treatments among Aboriginal cancer cases further complicated the disadvantages associated with geographic remoteness, advanced stage of disease and co-morbid conditions at diagnosis and add to disparities in cancer death. System level responses to improving access, utilisation and quality of effective treatments are needed to improve survival after cancer diagnosis.
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Affiliation(s)
- David Banham
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia.
| | - David Roder
- School of Health Sciences, Cancer Research Institute, University of South Australia, Adelaide, Australia
| | - Marion Eckert
- Rosemary Bryant AO Research Centre, School of Nursing and Midwifery, University of South Australia North Terrace, Adelaide, Australia
| | - Natasha J Howard
- School of Health Sciences, Cancer Research Institute, University of South Australia, Adelaide, Australia
| | - Karla Canuto
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia
- Aboriginal Health Research Group, Cancer Research Institute, University of South Australia, Adelaide, Australia
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Secco JM, Elias S, de Carvalho CV, da Silva IDCG, de Campos KJ, Facina G, Nazário ACP. Mammographic density among indigenous women in forested areas in the state of Amapá, Brazil: a cross-sectional study. SAO PAULO MED J 2017; 135:355-362. [PMID: 28767986 PMCID: PMC10016001 DOI: 10.1590/1516-3180.2016.0146150317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 03/15/2017] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVE: There is no register of breast cancer cases among indigenous populations in Brazil. The objective here was to evaluate the association of clinical and demographic characteristics with mammographic density among indigenous women. DESIGN AND SETTING: Cross-sectional analytical study conducted in indigenous territories in the state of Amapá, Brazil. METHODS: Women were recruited from three indigenous territories and underwent bilateral mammography and blood collection for hormonal analysis. They were interviewed with the aid of an interpreter. Mammographic density was calculated using computer assistance, and was expressed as dense or non-dense. RESULTS: A total of 137 indigenous women were included in this study, with an average age of 50.4 years, and an average age at the menarche of 12.8 years. Half (50.3%) of the 137 participants had not reached the menopause at the time of this study. The women had had an average of 8.7 children, and only two had never breastfed. The average body mass index of the population as a whole was 25.1 kg/m2. The mammographic evaluation showed that 82% of women had non-dense breasts. The clinical characteristics associated with mammographic density were age (P = 0.0001), follicle-stimulating hormone (FSH) (P < 0.001) and estrogen levels (P < 0.01). CONCLUSIONS: The majority of the indigenous women had non-dense breasts. Age, menopausal status and FSH and estrogen levels were associated with mammographic density.
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Affiliation(s)
- José Mauro Secco
- MD, PhD. Researcher, Universidade Federal de São Paulo (Unifesp), São Paulo (SP), and Adjunct Professor, Universidade Federal do Amapá (Unifap), Amapá (AP), Brazil.
| | - Simone Elias
- MD, PhD. Researcher, Universidade Federal de São Paulo (Unifesp), São Paulo (SP), Brazil.
| | - Cristina Valletta de Carvalho
- BSc, PhD. Researcher, Universidade Federal de São Paulo (Unifesp), and Adjunct Professor, Department of Biological Sciences, Centro Universitário Fundação Santo André, and Department of Genetics, Fundação ABC, São Paulo (SP), Brazil.
| | - Ismael Dale Cotrim Guerreiro da Silva
- MD, PhD. Researcher, Universidade Federal de São Paulo (Unifesp); Adjunct Professor and Coordinator of Molecular Gynecology Laboratory, Department of Gynecology; and Coordinator of Research and Technological Innovation within Biology, Universidade Federal de São Paulo (Unifesp), São Paulo (SP), Brazil.
| | - Kátia Jung de Campos
- MD, PhD. Researcher, Universidade Federal de São Paulo (Unifesp), São Paulo (SP), and Attending Physician and Residency Coordinator, Department of Gynecology, Universidade Federal do Amapá, Amapá (AP), Brazil.
| | - Gil Facina
- MD, PhD. Full Professor, Department of Gynecology and Head of Department of Mastology, Universidade Federal de São Paulo (Unifesp), São Paulo (SP), Brazil.
| | - Afonso Celso Pinto Nazário
- MD, PhD. Researcher and Full Professor, Universidade Federal de São Paulo (Unifesp), São Paulo (SP), Brazil.
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Tervonen HE, Walton R, You H, Baker D, Roder D, Currow D, Aranda S. After accounting for competing causes of death and more advanced stage, do Aboriginal and Torres Strait Islander peoples with cancer still have worse survival? A population-based cohort study in New South Wales. BMC Cancer 2017; 17:398. [PMID: 28577351 PMCID: PMC5457659 DOI: 10.1186/s12885-017-3374-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 05/18/2017] [Indexed: 01/07/2023] Open
Abstract
Background Aboriginal and Torres Strait Islander peoples in Australia have been found to have poorer cancer survival than non-Aboriginal people. However, use of conventional relative survival analyses is limited due to a lack of life tables. This cohort study examined whether poorer survival persist after accounting for competing risks of death from other causes and disparities in cancer stage at diagnosis, for all cancers collectively and by cancer site. Methods People diagnosed in 2000–2008 were extracted from the population-based New South Wales Cancer Registry. Aboriginal status was multiply imputed for people with missing information (12.9%). Logistic regression models were used to compute odds ratios (ORs) with 95% confidence intervals (CIs) for ‘advanced stage’ at diagnosis (separately for distant and distant/regional stage). Survival was examined using competing risk regression to compute subhazard ratios (SHRs) with 95%CIs. Results Of the 301,356 cases, 2517 (0.84%) identified as Aboriginal (0.94% after imputation). After adjusting for age, sex, year of diagnosis, socio-economic status, remoteness, and cancer site Aboriginal peoples were more likely to be diagnosed with distant (OR 1.30, 95%CI 1.17–1.44) or distant/regional stage (OR 1.29, 95%CI 1.18–1.40) for all cancers collectively. This applied to cancers of the female breast, uterus, prostate, kidney, others (those not included in other categories) and cervix (when analyses were restricted to cases with known stages/known Aboriginal status). Aboriginal peoples had a higher hazard of death than non-Aboriginal people after accounting for competing risks from other causes of death, socio-demographic factors, stage and cancer site (SHR 1.40, 95%CI 1.31–1.50 for all cancers collectively). Consistent results applied to colorectal, lung, breast, prostate and other cancers. Conclusions Aboriginal peoples with cancer have an elevated hazard of cancer death compared with non-Aboriginal people, after accounting for more advanced stage and competing causes of death. Further research is needed to determine reasons, including any contribution of co-morbidity, lifestyle factors and differentials in service access to help explain disparities.
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Affiliation(s)
- Hanna E Tervonen
- School of Health Sciences, Centre for Population Health Research, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia.
| | - Richard Walton
- Information Analysis Unit, Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW, 1435, Australia
| | - Hui You
- Information Analysis Unit, Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW, 1435, Australia
| | - Deborah Baker
- Information Analysis Unit, Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW, 1435, Australia
| | - David Roder
- School of Health Sciences, Centre for Population Health Research, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia.,Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW, 1435, Australia
| | - David Currow
- Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW, 1435, Australia
| | - Sanchia Aranda
- Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW, 1435, Australia
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10
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Tapia KA, Garvey G, Mc Entee M, Rickard M, Brennan P. Breast Cancer in Australian Indigenous Women: Incidence,
Mortality, and Risk Factors. Asian Pac J Cancer Prev 2017; 18:873-884. [PMID: 28545182 PMCID: PMC5494235 DOI: 10.22034/apjcp.2017.18.4.873] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The Indigenous people of Australia face significant health gaps compared with the general population, with lower life
expectancies, higher rates of death, and chronic illness occurring more often than in non-indigenous Australians. Cancer
is the second largest contributor to the burden of disease with breast cancer being the most common invasive cancer
diagnosed for females. Despite a lower breast cancer incidence compared with non-indigenous women, fatalities occur
at an elevated rate and breast cancers have an earlier age of onset. For indigenous women there are also more advanced
and distant tumours at diagnosis, fewer hospitalisations for breast cancer, and lower participation in breast screening.
Concomitantly there are demographic, socio-economic and lifestyle factors associated with breast cancer risks that
are heavily represented within Indigenous communities. The aim of this two-part narrative review is to examine the
available evidence on breast cancer and its risk factors in Australian Indigenous women. Part One presents a summary
of the latest incidence, survival and mortality data. Part Two presents the risk factors most strongly associated with
breast cancer including age, place of residence, family risk, genetics, reproductive history, tobacco use, alcohol intake,
physical activity, participation in screening and breast density. With increasing emphasis on personalized health care, a
clear understanding of breast cancer incidence, survival, mortality, and causal agents within the Indigenous population
is required if breast cancer prevention and management is to be optimized for Indigenous Australians.
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Affiliation(s)
- Kriscia A Tapia
- Faculty of Health Sciences, The University of Sydney, New South Wales, Australia.
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Meiklejohn JA, Adams J, Valery PC, Walpole ET, Martin JH, Williams HM, Garvey G. Health professional's perspectives of the barriers and enablers to cancer care for Indigenous Australians. Eur J Cancer Care (Engl) 2017; 25:254-61. [PMID: 26918690 DOI: 10.1111/ecc.12467] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2016] [Indexed: 11/29/2022]
Abstract
To investigate health professionals' perspectives about factors that impede or facilitate cancer care for Indigenous people. Semi-structured interviews with 22 health professionals involved in Indigenous cancer care. Data were interpreted using an inductive thematic analysis approach. Participants presented their perspectives on a number of barriers and enablers to Indigenous cancer care. Barriers were related to challenges with communication, the health system and coordination of care, issues around individual and community priorities and views of cancer treatment and health professional judgement. Enablers to cancer care were related to the importance of trust and rapport as well as health care system and support factors. The findings highlighted the need for recording of Indigenous status in medical records and a coordinated approach to the provision of evidence-based and culturally appropriate cancer care. This could go some way to improving Indigenous patient's engagement with tertiary cancer care services.
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Affiliation(s)
- J A Meiklejohn
- Cancer Epidemiology, Menzies School of Health Research, Brisbane, Qld.,Cancer & Chronic Disease Research Group, QIMR Berghofer Medical Research Institute, Royal Brisbane Hospital, Brisbane, Brisbane, Qld
| | - J Adams
- Faculty of Health, University of Technology, Sydney, NSW, Australia
| | - P C Valery
- Cancer & Chronic Disease Research Group, QIMR Berghofer Medical Research Institute, Royal Brisbane Hospital, Brisbane, Brisbane, Qld.,Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - E T Walpole
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Qld, Australia.,Metro South Health and Hospital Service/Medicine, University of Queensland, Brisbane, Qld, Australia
| | - J H Martin
- Clinical Pharmacology, University of Newcastle School of Medicine and Public Health, Mater Hospital, Waratah, NSW, Australia.,Southside Clinical School, University of Queensland, Brisbane, Qld, Australia
| | - H M Williams
- Epidemiology and Health Systems, Menzies School of Health Research, Brisbane, Qld, Australia
| | - G Garvey
- Epidemiology and Health Systems, Menzies School of Health Research, Brisbane, Qld, Australia
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12
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Meiklejohn JA, Garvey G, Bailie R, Walpole E, Adams J, Williamson D, Martin J, Bernardes CM, Arley B, Marcusson B, Valery PC. Follow-up cancer care: perspectives of Aboriginal and Torres Strait Islander cancer survivors. Support Care Cancer 2017; 25:1597-1605. [DOI: 10.1007/s00520-016-3563-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 12/27/2016] [Indexed: 12/27/2022]
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13
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Cuesta-Briand B, Bessarab D, Shahid S, Thompson SC. 'Connecting tracks': exploring the roles of an Aboriginal women's cancer support network. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:779-788. [PMID: 26099647 DOI: 10.1111/hsc.12261] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/05/2015] [Indexed: 06/04/2023]
Abstract
Aboriginal Australians are at higher risk of developing certain types of cancer and, once diagnosed, they have poorer outcomes than their non-Aboriginal counterparts. Lower access to cancer screening programmes, deficiencies in treatment and cultural barriers contribute to poor outcomes. Additional logistical factors affecting those living in rural areas compound these barriers. Cancer support groups have positive effects on people affected by cancer; however, there is limited evidence on peer-support programmes for Aboriginal cancer patients in Australia. This paper explores the roles played by an Aboriginal women's cancer support network operating in a regional town in Western Australia. Data were collected through semi-structured interviews with 24 participants including Aboriginal and mainstream healthcare service providers, and network members and clients. Interviews were audiotaped and transcribed verbatim. Transcripts were subjected to inductive thematic analysis. Connecting and linking people and services was perceived as the main role of the network. This role had four distinct domains: (i) facilitating access to cancer services; (ii) fostering social interaction; (iii) providing a culturally safe space; and (iv) building relationships with other agencies. Other network roles included providing emotional and practical support, delivering health education and facilitating engagement in cancer screening initiatives. Despite the network's achievements, unresolved tensions around role definition negatively impacted on the working relationship between the network and mainstream service providers, and posed a threat to the network's sustainability. Different perspectives need to be acknowledged and addressed in order to build strong, effective partnerships between service providers and Aboriginal communities. Valuing and honouring the Aboriginal approaches and expertise, and adopting an intercultural approach are suggested as necessary to the way forward.
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Affiliation(s)
- Beatriz Cuesta-Briand
- Western Australian Centre for Rural Health, University of Western Australia, Crawley, Western Australia, Australia.
| | - Dawn Bessarab
- Centre for Aboriginal Medical and Dental Health, University of Western Australia, Crawley, Western Australia, Australia
| | - Shaouli Shahid
- Western Australian Centre for Rural Health, University of Western Australia, Crawley, Western Australia, Australia
| | - Sandra C Thompson
- Western Australian Centre for Rural Health, University of Western Australia, Crawley, Western Australia, Australia
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14
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Aguiar PN, Stock GT, Lopes GDL, Almeida MSD, Tadokoro H, Gutierres BDS, Rodrigues DA. Disparities in cancer epidemiology and care delivery among Brazilian indigenous populations. EINSTEIN-SAO PAULO 2016; 14:330-337. [PMID: 27759820 PMCID: PMC5234743 DOI: 10.1590/s1679-45082016ao3754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 07/29/2016] [Indexed: 12/22/2022] Open
Abstract
Objective: To assess aspects related to cancer in indigenous population. Methods: This is a retrospective study developed in a public university hospital. We included patients with 18 or more years of age, diagnosed with solid tumors, and followed between 2005 and 2015. Clinical features were assessed by descriptive statistics, and survival was evaluated by Kaplan-Meier curves and multivariate Cox regression. Results: Fifty patients were included. The cancer incidence was 15.73 per 100,000. The mean age at diagnosis was 54 years and most patients were female (58%). Cancer of the cervix (28%) and prostate (16%) were the most common. The mean time between the onset of symptoms and the diagnosis was 9 months and from diagnosis to the treatment was 3.4 months. Disease diagnosed at stage IV (17%) had worse overall survival (HR: 11.4; p<0.05). The 5-year survival rate ranged from 88% for prostate cancer to 0% for lung cancer. All 5-year survival rates were lower as compared to other populations. Conclusion: The most prevalent cancer sites were cervix and prostate. Disease stage and primary site were prognostic factors. Objetivo: Avaliar os aspectos relacionados a câncer em populações indígenas. Métodos: Estudo retrospectivo conduzido em um hospital universitário público. Foram incluídos pacientes com 18 anos ou mais, diagnosticados com tumores sólidos e acompanhados entre 2005 e 2015. Os aspectos clínicos foram avaliados por meio de estatística descritiva, e a sobrevida foi avaliada por meio de curvas de Kaplan-Meier e regressão multivariada de Cox. Resultados: Foram incluídos 50 pacientes. A incidência de câncer foi 15,73 por 100 mil. A média de idade ao diagnóstico foi 54 anos, e a maioria era do sexo feminino (58%). O câncer de colo uterino (28%) e o de próstata (16%) foram os mais frequentes. O tempo médio entre o início dos sintomas e o diagnóstico foi 9 meses, e entre o diagnóstico e o tratamento, de 3,4 meses. Doença diagnosticada no estágio IV (17%) resultou em pior sobrevida global (HR: 11,4; p<0,05). A sobrevida em 5 anos variou de 88% para o câncer de próstata a 0% para pulmão. Todas as taxas de sobrevida em 5 anos foram menores em comparação a outras populações. Conclusão: Os locais mais frequentes de neoplasia foram colo de útero e próstata. O estágio da doença e o sítio primário foram fatores prognósticos.
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15
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Wattiaux AL, Yin JK, Beard F, Wesselingh S, Cowie B, Ward J, Macartney K. Hepatitis B immunization for indigenous adults, Australia. Bull World Health Organ 2016; 94:826-834A. [PMID: 27821885 PMCID: PMC5096351 DOI: 10.2471/blt.16.169524] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 06/28/2016] [Accepted: 07/12/2016] [Indexed: 12/01/2022] Open
Abstract
Objective To quantify the disparity in incidence of hepatitis B between indigenous and non-indigenous people in Australia, and to estimate the potential impact of a hepatitis B immunization programme targeting non-immune indigenous adults. Methods Using national data on persons with newly acquired hepatitis B disease notified between 2005 and 2012, we estimated incident infection rates and rate ratios comparing indigenous and non-indigenous people, with adjustments for underreporting. The potential impact of a hepatitis B immunization programme targeting non-immune indigenous adults was projected using a Markov chain Monte Carlo simulation model. Findings Of the 54 522 persons with hepatitis B disease notified between 1 January 2005 and 31 December 2012, 1953 infections were newly acquired. Acute hepatitis B infection notification rates were significantly higher for indigenous than non-indigenous Australians. The rates per 100 000 population for all ages were 3.6 (156/4 368 511) and 1.1 (1797/168 449 302) for indigenous and non-indigenous people respectively. The rate ratio of age-standardized notifications was 4.0 (95% confidence interval: 3.7–4.3). If 50% of non-immune indigenous adults (20% of all indigenous adults) were vaccinated over a 10-year programme a projected 527–549 new cases of acute hepatitis B would be prevented. Conclusion There continues to be significant health inequity between indigenous and non-indigenous Australians in relation to vaccine-preventable hepatitis B disease. An immunization programme targeting indigenous Australian adults could have considerable impact in terms of cases of acute hepatitis B prevented, with a relatively low number needed to vaccinate to prevent each case.
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Affiliation(s)
- Andre Louis Wattiaux
- National Centre for Immunisation Research and Surveillance, Kerry Packer Building, Children's Hospital at Westmead, corner Hawkesbury Rd and Hainsworth St, Westmead NSW 2145, Australia
| | - J Kevin Yin
- National Centre for Immunisation Research and Surveillance, Kerry Packer Building, Children's Hospital at Westmead, corner Hawkesbury Rd and Hainsworth St, Westmead NSW 2145, Australia
| | - Frank Beard
- National Centre for Immunisation Research and Surveillance, Kerry Packer Building, Children's Hospital at Westmead, corner Hawkesbury Rd and Hainsworth St, Westmead NSW 2145, Australia
| | - Steve Wesselingh
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Benjamin Cowie
- WHO Collaborating Centre for Viral Hepatitis, Doherty Institute, Melbourne, Australia
| | - James Ward
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Kristine Macartney
- National Centre for Immunisation Research and Surveillance, Kerry Packer Building, Children's Hospital at Westmead, corner Hawkesbury Rd and Hainsworth St, Westmead NSW 2145, Australia
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16
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Castles S, Wainer Z, Jayasekara H. Risk factors for cancer in the Australian Aboriginal and Torres Strait Islander population: a systematic review. Aust J Prim Health 2016; 22:190-197. [PMID: 27118100 DOI: 10.1071/py15048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 10/07/2015] [Indexed: 11/23/2022]
Abstract
Cancer incidence in the Australian Aboriginal and Torres Strait Islander population is higher and survival lower compared with non-Indigenous Australians. A proportion of these cancers are potentially preventable if factors associated with carcinogenesis are known and successfully avoided. We conducted a systematic review of the published literature to examine risk factors for cancer in the Australian Aboriginal and Torres Strait Islander population. Electronic databases Medline, Web of Science and the Australian Aboriginal and Torres Strait Islander Health Bibliographic Index were searched through August 2014 using broad search terms. Studies reporting a measure of association between a risk factor and any cancer site in the Australian Aboriginal and Torres Strait Islander population were eligible for inclusion. Ten studies (1991-2014) were identified, mostly with small sample sizes, showing marked heterogeneity in terms of methods used to assess exposure and capture outcomes, and often using descriptive comparative analyses. Relatively young (as opposed to elderly) and geographically remote Aboriginal and Torres Strait Islanders were found to be at increased risk for selected cancers while most modifiable lifestyle and behavioural risk factors were rarely assessed. Further studies examining associations between potential risk factors and cancer will help define public health policy for cancer prevention in the Australian Aboriginal and Torres Strait Islander population.
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Affiliation(s)
- Simon Castles
- Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, East Melbourne, Vic. 8006, Australia
| | - Zoe Wainer
- Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, East Melbourne, Vic. 8006, Australia
| | - Harindra Jayasekara
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3010, Australia
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17
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Withrow DR, Racey CS, Jamal S. A critical review of methods for assessing cancer survival disparities in indigenous population. Ann Epidemiol 2016; 26:579-591. [PMID: 27431064 DOI: 10.1016/j.annepidem.2016.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/27/2016] [Accepted: 06/06/2016] [Indexed: 12/24/2022]
Abstract
PURPOSE An increasing cancer burden among indigenous populations has led to a growing literature about survival disparities between indigenous and nonindigenous persons. We aim to describe and appraise methods used to measure cancer survival in indigenous persons in the United States, Canada, Australia, and New Zealand. METHODS We searched Medline, Web of Science, and EMBASE for articles published between 1990 and 2015 that estimated survival in populations indigenous to one of these four countries. We gathered information about data sources, analytical methods, and the extent to which threats to validity were discussed. RESULTS The search retrieved 83 articles. The most common approach to survival analysis was cause-specific survival (n = 49). Thirty-eight articles measured all-cause survival and 11 measured excess mortality attributable to cancer (relative survival). Three sources of information bias common to all studies (ethnic misclassification, incomplete case ascertainment, and incomplete death ascertainment) were acknowledged in a minority of articles. CONCLUSIONS The methodological considerations we present here are shared with studies of cancer survival across other subpopulations. We urge future researchers on this and related topics to clearly describe their data sources, to justify analytic choices, and to fully discuss the potential impact of those choices on the results and interpretation.
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Affiliation(s)
- Diana R Withrow
- Aboriginal Cancer Control Unit, Prevention and Cancer Control, Cancer Care Ontario, Toronto, Canada; Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - C Sarai Racey
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sehar Jamal
- Aboriginal Cancer Control Unit, Prevention and Cancer Control, Cancer Care Ontario, Toronto, Canada
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Moore SP, Green AC, Bray F, Coory M, Garvey G, Sabesan S, Valery PC. Colorectal cancer among Indigenous and non-Indigenous people in Queensland, Australia: Toward survival equality. Asia Pac J Clin Oncol 2016; 12:e209-14. [PMID: 24571285 DOI: 10.1111/ajco.12164] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2013] [Indexed: 12/13/2022]
Abstract
AIM While Indigenous people in Queensland have lower colorectal cancer (CRC) incidence and mortality than the rest of the population, CRC remains the third most frequent cancer among Australian Indigenous people overall. This study aimed to investigate patterns of care and survival between Indigenous and non-Indigenous Australians with CRC. METHODS Through a matched-cohort design we compared 80 Indigenous and 85 non-Indigenous people all diagnosed with CRC and treated in Queensland public hospitals during 1998-2004 (frequency matched on age, sex, geographical remoteness). We compared clinical and treatment data (Pearson's chi-square) and all-cause and cancer survival (Cox regression analysis). RESULTS Indigenous patients with CRC were not significantly more likely to have comorbidity, advanced disease at diagnosis or less treatment than non-Indigenous people. There was also no statistically significant difference in all-cause survival (HR 1.14, 95% CI 0.69, 1.89) or cancer survival (HR 1.01, 95% CI 0.60, 1.69) between the two groups. CONCLUSIONS Similar CRC mortality among Indigenous and other Australians may reflect both the lower incidence and adequate management. Increasing life expectancy and exposures to risk factors suggests that Indigenous people are vulnerable to a growing burden of CRC. Primary prevention and early detection will be of paramount importance to future CRC control among Indigenous Australians. Current CRC management must be maintained and include prevention measures to ensure that predicted increases in CRC burden are minimized.
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Affiliation(s)
- Suzanne P Moore
- Queensland Institute of Medical Research, Brisbane
- International Agency for Research on Cancer, Lyon, France
| | - Adèle C Green
- Queensland Institute of Medical Research, Brisbane
- University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
| | - Michael Coory
- Murdoch Childrens Research Institute, Parkville, Victoria
| | - Gail Garvey
- Cancer Epidemiology, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | | | - Patricia C Valery
- Cancer Epidemiology, Menzies School of Health Research, Darwin, Northern Territory, Australia
- International Agency for Research on Cancer, Lyon, France
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19
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Lawrenson R, Seneviratne S, Scott N, Peni T, Brown C, Campbell I. Breast cancer inequities between Māori and non-Māori women in Aotearoa/New Zealand. Eur J Cancer Care (Engl) 2016; 25:225-30. [DOI: 10.1111/ecc.12473] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2016] [Indexed: 11/30/2022]
Affiliation(s)
- R. Lawrenson
- Waikato Clinical Campus; The University of Auckland; Hamilton New Zealand
| | - S. Seneviratne
- Department of Surgery; Faculty of Medicine; National Hospital of Sri Lanka; University of Colombo; Colombo Sri Lanka
| | - N. Scott
- Te Puna Oranga; Waikato District Health Board; Hamilton New Zealand
| | - T. Peni
- Waikato Clinical Campus; The University of Auckland; Hamilton New Zealand
| | - C. Brown
- Waikato Clinical Campus; The University of Auckland; Hamilton New Zealand
| | - I. Campbell
- Waikato Clinical Campus; The University of Auckland; Hamilton New Zealand
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20
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Moore SP, Antoni S, Colquhoun A, Healy B, Ellison-Loschmann L, Potter JD, Garvey G, Bray F. Cancer incidence in indigenous people in Australia, New Zealand, Canada, and the USA: a comparative population-based study. Lancet Oncol 2015; 16:1483-1492. [PMID: 26476758 DOI: 10.1016/s1470-2045(15)00232-6] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 08/11/2015] [Accepted: 08/12/2015] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Indigenous people have disproportionally worse health and lower life expectancy than their non-indigenous counterparts in high-income countries. Cancer data for indigenous people are scarce and incidence has not previously been collectively reported in Australia, New Zealand, Canada, and the USA. We aimed to investigate and compare, for the first time, the cancer burden in indigenous populations in these countries. METHODS We derived incidence data from population-based cancer registries in three states of Australia (Queensland, Western Australia, and the Northern Territory), New Zealand, the province of Alberta in Canada, and the Contract Health Service Delivery Areas of the USA. Summary rates for First Nations and Inuit in Alberta, Canada, were provided directly by Alberta Health Services. We compared age-standardised rates by registry, sex, cancer site, and ethnicity for all incident cancer cases, excluding non-melanoma skin cancers, diagnosed between 2002 and 2006. Standardised rate ratios (SRRs) and 95% CIs were computed to compare the indigenous and non-indigenous populations of each jurisdiction, except for the Alaska Native population, which was compared with the white population from the USA. FINDINGS We included 24 815 cases of cancer in indigenous people and 5 685 264 in non-indigenous people from all jurisdictions, not including Alberta, Canada. The overall cancer burden in indigenous populations was substantially lower in the USA except in Alaska, similar or slightly lower in Australia and Canada, and higher in New Zealand compared with their non-indigenous counterparts. Among the most commonly occurring cancers in indigenous men were lung, prostate, and colorectal cancer. In most jurisdictions, breast cancer was the most common cancer in women followed by lung and colorectal cancer. The incidence of lung cancer was higher in indigenous men in all Australian regions, in Alberta, and in US Alaska Natives than in their non-indigenous counterparts. For breast cancer, rates in women were lower in all indigenous populations except in New Zealand (SRR 1·23, CI 95% 1·16-1·32) and Alaska (1·14, 1·01-1·30). Incidence of cervical cancer was higher in indigenous women than in non-indigenous women in most jurisdictions, although the difference was not always statistically significant. INTERPRETATION There are clear differences in the scale and profile of cancer in indigenous and non-indigenous populations in Australia, New Zealand, Canada, and the USA. Our findings highlight the need for much-improved, targeted programmes of screening, vaccination, and smoking cessation, among other prevention strategies. Governments and researchers need to work in partnership with indigenous communities to improve cancer surveillance in all jurisdictions and facilitate access to cancer data. FUNDING International Agency for Research on Cancer-Australia Fellowship.
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Affiliation(s)
- Suzanne P Moore
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France; Epidemiology and Health Services Division, Menzies School of Health Research, Charles Darwin University, Australia.
| | - Sébastien Antoni
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Amy Colquhoun
- Epidemiology and Surveillance, Alberta Ministry of Health, Edmonton, AB, Canada; School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Bonnie Healy
- Alberta First Nations Information Governance Centre, Calgary, AB, Canada
| | | | - John D Potter
- Centre for Public Health Research, Massey University, Wellington, New Zealand; Division of Public Health Sciences, Fred Hutchinson Cancer Research Centre, Seattle, WA, USA; University of Washington, Seattle, WA, USA
| | - Gail Garvey
- Epidemiology and Health Services Division, Menzies School of Health Research, Charles Darwin University, Australia
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
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21
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Ethnic differences in breast cancer survival in New Zealand: contributions of differences in screening, treatment, tumor biology, demographics and comorbidities. Cancer Causes Control 2015; 26:1813-24. [PMID: 26407955 DOI: 10.1007/s10552-015-0674-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 09/19/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE We investigated the breast cancer survival disparity between Indigenous Māori and non-Indigenous European women in New Zealand, and quantified the relative contributions of patient, tumor and healthcare system factors toward this disparity. METHODS All women diagnosed with breast cancer in Waikato, New Zealand, during 1999-2012 were identified from the Waikato Breast Cancer Register. Cancer-specific survivals were compared using Kaplan-Meier survival curves, while contributions of different factors toward the survival disparity were quantified with serial Cox proportional hazard modeling. RESULTS Of the 2,679 women included in this study, 2,260 (84.4%) were NZ European and 419 (15.6%) were Māori. Compared with NZ European women, Māori women had a significantly higher age-adjusted cancer-specific mortality (HR 2.02, 95% CI 1.59-2.58) with significantly lower 5-year (86.8 vs. 76.1%, p < 0.001) and 10-year (79.9 vs. 66.9%, p < 0.001%) crude cancer-specific survivals. Stage at diagnosis made the greatest contribution (approximately 25-40%), while screening, treatment and patient factors (i.e., comorbidity, obesity and smoking) contributed by approximately 15% each toward the survival disparity. The final model accounted for almost all of the cancer survival disparity (HR 1.07, 95% CI 0.80-1.44). CONCLUSIONS Māori women experience an age-adjusted risk of death from breast cancer, which is more than twice that for NZ European women. Equity-focussed improvements in health care, including increasing mammographic screening coverage and providing equitable quality and timely cancer care, may improve the survival disparity between Māori and NZ European women.
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22
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Risk factors associated with mortality from breast cancer in Waikato, New Zealand: a case-control study. Public Health 2015; 129:549-54. [DOI: 10.1016/j.puhe.2015.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 01/07/2015] [Accepted: 02/01/2015] [Indexed: 11/19/2022]
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Harrod ME, Couzos S, Delaney-Thiele D, Dore GJ, Hammond B, Saunders M, Belfrage M, Williams S, Kaldor JM, Ward J. Markers of hepatitis B infection and immunity in patients attending Aboriginal community controlled health services. Med J Aust 2014; 201:339-42. [PMID: 25222458 DOI: 10.5694/mja14.00121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 05/21/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Hepatitis B virus (HBV) infection remains an important cause of morbidity and mortality in Aboriginal and Torres Strait Islander people, who have high rates of infection compared with non-Indigenous Australians. We aimed to increase the evidence base around HBV in Aboriginal and Torres Strait Islander people through an analysis of routine clinical encounter data. DESIGN A cross-sectional study of de-identified records from electronic patient systems over 5 years (8 January 2009 to 11 July 2013). SETTING Four Aboriginal community controlled health services. PARTICIPANTS All patients attending for a clinical visit were included in the study. Hepatitis B testing records were included if at least one serological test for HBV was done. MAIN OUTCOME MEASURES Percentage of clinical patients tested for hepatitis B, compliance with guidelines and serological status. RESULTS A total of 2959 people aged 15-54 years were screened for HBV, representing 17.2% of all people with a clinical visit in the study period. A total of 865 Aboriginal patients were tested concurrently for hepatitis B surface antigen (HBsAg), hepatitis B core antibody and hepatitis B surface antibody. Of those, 352 (40.7%) were susceptible to HBV infection (95% CI, 37.4%-43.9%) and 34 (3.9%) had either an acute or chronic infection indicated by a positive HBsAg result (95% CI, 2.6%-5.2%). In 329 women with antenatal screening, six (1.8%) returned a positive HBsAg result (95% CI, 0.37%-3.28%). CONCLUSION A substantial proportion of patients tested were susceptible to HBV, with a high percentage potentially infectious compared with the general population. High levels of active infection and susceptibility to infection suggest many opportunities for transmission and indicate the potential benefit of routine HBV testing and vaccination in this population.
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Affiliation(s)
- Mary E Harrod
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| | - Sophia Couzos
- General Practice and Rural Medicine, James Cook University, Townsville, QLD, Australia
| | - Dea Delaney-Thiele
- Public Health Unit, Aboriginal Medical Service Western Sydney, Sydney, NSW, Australia
| | - Gregory J Dore
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Belinda Hammond
- Quality, Safety and Reporting, Nunkuwarrin Yunti of South Australia Inc, Adelaide, SA, Australia
| | - Mark Saunders
- National Aboriginal Community Controlled Health Organisation, Canberra, ACT, Australia
| | - Mary Belfrage
- Victorian Aboriginal Health Service, Melbourne, VIC, Australia
| | | | - John M Kaldor
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - James Ward
- Baker IDI Central Australia, Alice Springs, NT, Australia
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Olsen A, Wallace J, Maher L. Responding to Australia's National Hepatitis B Strategy 2010-13: gaps in knowledge and practice in relation to Indigenous Australians. Aust J Prim Health 2014; 20:134-42. [PMID: 24216010 DOI: 10.1071/py12162] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 08/27/2013] [Indexed: 11/23/2022]
Abstract
The Australian National Hepatitis B Strategy 2010-13 outlines five priority areas for developing a comprehensive response to the hepatitis B virus (HBV): building partnerships and strengthening community action; preventing HBV transmission; optimising diagnosis and screening; clinical management of people with chronic hepatitis B (CHB); and developing health maintenance, care and support for people with HBV. A scoping study was used to map the main sources and types of evidence available on the epidemiology and natural history of HBV among Indigenous Australians as well as public health responses published since 2001 (January 2001-May 2013). Gaps in current knowledge were identified. While the literature documents the success of universal infant immunisation and indicates the potential for screening initiatives to identify infected and susceptible individuals, prevalence of CHB and hepatocellular cancer remain high in Indigenous Australians. Significant gaps in knowledge and practice were identified in relation to each of the five National Hepatitis B Strategy priority action areas. Successful implementation of the strategy in Indigenous communities and reducing the burden of HBV and hepatocellular cancer in Indigenous Australians will require increased investment in research and knowledge transfer across all priority areas.
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Affiliation(s)
- Anna Olsen
- The Kirby Institute, The University of New South Wales, Sydney, NSW 2052, Australia
| | - Jack Wallace
- Australian Research Centre in Sex, Health and Society, Latrobe University, 215 Franklin Street, Melbourne, Vic. 3000, Australia
| | - Lisa Maher
- The Kirby Institute, The University of New South Wales, Sydney, NSW 2052, Australia
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Moore SP, Green AC, Bray F, Garvey G, Coory M, Martin J, Valery PC. Survival disparities in Australia: an analysis of patterns of care and comorbidities among indigenous and non-indigenous cancer patients. BMC Cancer 2014; 14:517. [PMID: 25037075 PMCID: PMC4223410 DOI: 10.1186/1471-2407-14-517] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/04/2014] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Indigenous Australians have lower overall cancer survival which has not yet been fully explained. To address this knowledge deficit, we investigated the associations between comorbidities, cancer treatment and survival in Indigenous and non-Indigenous people in Queensland, Australia. METHODS A cohort study of 956 Indigenous and 869 non-Indigenous patients diagnosed with cancer during 1998-2004, frequency-matched on age, sex, remoteness of residence and cancer type, and treated in Queensland public hospitals. Survival after cancer diagnosis, and effect of stage, treatment, and comorbidities on survival were examined using Cox proportional hazard models. RESULTS Overall Indigenous people had more advanced cancer stage (p = 0.03), more comorbidities (p < 0.001), and received less cancer treatment (77% vs. 86%, p = 0.001). Among patients without comorbidities and social disadvantage, there was a lower uptake of treatment among Indigenous patients compared to non-Indigenous patients. For those who received treatment, time to commencement, duration and dose of treatment were comparable. Unadjusted cancer survival (HR = 1.30, 95% CI 1.15-1.48) and non-cancer survival (HR = 2.39, 95% CI 1.57-3.63) were lower in the Indigenous relative to non-Indigenous patients over the follow-up period. When adjusted for clinical factors, there was no difference in cancer-specific survival between the groups (HR = 1.10, 95% CI 0.96-1.27). One-year survival was lower for Indigenous people for all-causes of death (adjusted HR = 1.33, 95% CI 1.12-1.83). CONCLUSION In this study, Indigenous Australians received less cancer treatment, had more comorbidities and had more advanced cancer stage at diagnosis, factors which contribute to poorer cancer survival. Moreover, for patients with a more favourable distribution of such prognostic factors, Indigenous patients received less treatment overall relative to non-Indigenous patients. Personalised cancer care, which addresses the clinical, social and overall health requirements of Indigenous patients, may improve their cancer outcomes.
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Affiliation(s)
- Suzanne P Moore
- Menzies School of Health Research, 147 Wharf St, Spring Hill, Brisbane 4000, Australia
- International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon, France
| | - Adèle C Green
- Cancer and Population Studies Group, Queensland Institute of Medical Research, 300 Herston Rd, Herston, 4006 Brisbane, Australia
- University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Freddie Bray
- International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon, France
| | - Gail Garvey
- Menzies School of Health Research, 147 Wharf St, Spring Hill, Brisbane 4000, Australia
| | - Michael Coory
- Murdoch Children’s Research Institute, Melbourne, Victoria, Royal Children’s Hospital, Flemington Road, Parkville, Melbourne 3052, Australia
| | - Jennifer Martin
- School of Medicine University of Queensland Translational Research Institute, 37 Kent ST, Woolloongabba 4071, Melbourne, Australia
- Monash University (Adjunct), Melbourne, Australia
| | - Patricia C Valery
- Menzies School of Health Research, 147 Wharf St, Spring Hill, Brisbane 4000, Australia
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Nishri ED, Sheppard AJ, Withrow DR, Marrett LD. Cancer survival among First Nations people of Ontario, Canada (1968-2007). Int J Cancer 2014; 136:639-45. [PMID: 24923728 DOI: 10.1002/ijc.29024] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 05/26/2014] [Indexed: 11/12/2022]
Abstract
We aimed to compare cancer survival in Ontario First Nations people to that in other Ontarians for five major cancer types: colorectal, lung, cervix, breast and prostate. A list of registered or "Status" Indians in Ontario was used to create a cohort of over 140,000 Ontario First Nations people. Cancers diagnosed in cohort members between 1968 and 2001 were identified from the Ontario Cancer Registry, with follow-up for death until December 31st, 2007. Flexible parametric modeling of the hazard function was used to compare the survival experience of the cohort to that of other Ontarians. We considered changes in survival from the first half of the time period (1968-1991) to the second half (1992-2001). For other Ontarians, survival had improved over time for every cancer site. For the First Nations cohort, survival improved only for breast and prostate cancers; it either declined or remained unchanged for the other cancers. For cancers diagnosed in 1992 or later, all-cause and cause-specific survival was significantly poorer for First Nations people diagnosed with breast, prostate, cervical, colorectal (male and female) and male lung cancers as compared to their non-First Nations peers. For female lung cancer, First Nations women appeared to have poorer survival; however, the result was not statistically significant. Ontario's First Nations population experiences poorer cancer survival when compared to other Ontarians and strategies to reduce these inequalities must be developed and implemented.
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Affiliation(s)
- E Diane Nishri
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON
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Cancer in Australia: Actual incidence data from 1991 to 2009 and mortality data from 1991 to 2010 with projections to 2012. Asia Pac J Clin Oncol 2014; 9:199-213. [PMID: 23961960 DOI: 10.1111/ajco.12127] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2013] [Indexed: 12/22/2022]
Abstract
AIMS The Australian Institute of Health and Welfare (AIHW) is a major national agency established by the Australian government to provide information and statistics on Australia's health and welfare. The AIHW and the Australasian Association of Cancer Registries collaborate every year to provide updated information on cancer occurrences and trends in Australia. METHOD Actual number of cases and deaths is presented together with age-standardized rates for all cancers combined and selected cancer sites from 1991 to 2009 for incidence and from 1991 to 2010 for mortality, with projections to 2012. Differences in incidence and mortality rates according to age, Indigenous status and remoteness areas are also provided. In addition, information on hospitalizations due to cancer, palliative care and participation in Australia's national screening programs for breast, cervical and bowel cancer is presented. RESULTS In 2012, it was estimated that 120 710 new cases of cancer (excluding basal and squamous cell carcinoma of the skin) were diagnosed. Prostate cancer was estimated to be the most commonly diagnosed cancer in males, while breast cancer was estimated to be the most commonly diagnosed cancer in females. In 2010, more than 42 800 deaths from cancer occurred in Australia. Lung cancer was by far the most common cause of cancer death in both males and females. CONCLUSION In the last decade, cancer incidence rates increased in males and stabilized in females, while mortality rates decreased steadily. The overall incidence and mortality rates of cancer for Indigenous Australians were higher than for non-Indigenous Australians.
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Adams MJ, Collins VR, Dunne MP, de Kretser DM, Holden CA. Male reproductive health disorders among Aboriginal and Torres Strait Islander men: a hidden problem? Med J Aust 2013; 198:33-8. [PMID: 23330768 DOI: 10.5694/mja12.10490] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 09/27/2012] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To better understand help-seeking behaviours and reproductive health disorders among Aboriginal and Torres Strait Islander men. DESIGN, SETTING AND PARTICIPANTS A cross-sectional mixed-methods study conducted from 1 May 2004 to 30 April 2005 of 293 Aboriginal and Torres Strait Islander men aged 18 years and over from urban, rural and remote communities in the Northern Territory and Queensland. MAIN OUTCOME MEASURES Subscale of the International Index of Erectile Function, self-reported help-seeking behaviours for erectile dysfunction (ED) and prostate disease, thematic analysis of semi-structured interviews and focus groups. RESULTS The prevalence of moderate-to-severe ED increased across age groups, from about 10% in younger men (under 35 years) to 28% in men aged 55-74 years. Moderate-to-severe ED was strongly associated with reporting a chronic condition (odds ratio [OR], 3.67) and residing in a remote area (OR, 2.94). Aboriginal and Torres Strait Islander men aged 40-59 years showed similar low levels of help-seeking behaviours compared with non-Indigenous men from a comparable population-based study. About half of the men with ED saw a doctor or received treatment for ED in each population. While prostate cancer rates were low in both studies, testing for prostate problems was less frequent in Aboriginal and Torres Strait Islander men (11.4%) than in non-Indigenous men (34.1%, P < 0.001), despite similar levels of concern about prostate cancer. Barriers to help-seeking included shame, culturally inappropriate services and lack of awareness. CONCLUSION This study, the first to investigate reproductive health of Aboriginal and Torres Strait Islander men, found low levels of help-seeking behaviours for reproductive health disorders, with implications for missing a predictor of chronic disease and late diagnosis of prostate disease.
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Affiliation(s)
- Michael J Adams
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
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Newman CE, Gray R, Brener L, Jackson LC, Johnson P, Saunders V, Harris M, Butow P, Treloar C. One size fits all? The discursive framing of cultural difference in health professional accounts of providing cancer care to Aboriginal people. ETHNICITY & HEALTH 2013; 18:433-447. [PMID: 23297651 DOI: 10.1080/13557858.2012.754408] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Cancer is the second biggest killer of Aboriginal Australians. For some cancers, the mortality rate is more than three times higher in Aboriginal people than for non-Aboriginal people. The Aboriginal Patterns of Cancer Care Study explored barriers to and facilitators of cancer diagnosis and treatment among Aboriginal and Torres Strait Islander people in New South Wales. DESIGN Our team--which includes both Aboriginal and non-Aboriginal researchers--conducted in-depth interviews between 2009 and 2010 with Aboriginal people with cancer, their carers and health professionals who care for them. In this paper, we identify recurrent patterns of 'discursive framing' in the 16 interviews with health care professionals. We are particularly interested in how these frames assisted participants in constructing a professional position on what 'cultural difference' means for the design and delivery of cancer care services to Aboriginal people. RESULTS Despite geographical, organisational, disciplinary and cultural diversity, these interview participants consistently drew upon six discursive frames, which we have interpreted as either eliding a discussion of difference ('everyone is the same' and 'everyone is different') or facilitating that discussion ('different priorities,' 'different practices' and 'making difference safe'). An additional strategy appeared to actively resist either of these positions but then tended to ultimately prioritise the eliding frames. CONCLUSIONS While none of our participants were dismissive of the idea that cultural identity might matter to Aboriginal people, their reliance upon familiar narratives about what that means for cancer care services has the potential to both symbolically and practically exclude the voices of a group of people who may already feel disenfranchised from the mainstream health care system. Critically unpacking the 'taken for granted' assumptions behind how health care professionals make sense of cultural difference can enrich our understanding of and response to the care needs of indigenous people affected by cancer.
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Affiliation(s)
- Christy E Newman
- National Centre in HIV Social Research, The University of New South Wales, Sydney, Australia.
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Davidson PM, Jiwa M, DiGiacomo ML, McGrath SJ, Newton PJ, Durey AJ, Bessarab DC, Thompson SC. The experience of lung cancer in Aboriginal and Torres Strait Islander peoples and what it means for policy, service planning and delivery. AUST HEALTH REV 2013; 37:70-8. [DOI: 10.1071/ah10955] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 05/04/2012] [Indexed: 11/23/2022]
Abstract
Background. Aboriginal and Torres Strait Islander peoples experience inferior outcomes following diagnosis of lung cancer. Aim. To examine the experience of lung cancer in this population and identify reasons for poorer outcomes and lower levels of treatment compared with non-Aboriginal and Torres Strait Islander peoples, and opportunities for early intervention. Method. Literature was sought via electronic database searches and journal hand-searching for the period from January 1995 to July 2010. Databases used included Indigenous HealthInfoNet, SCOPUS, PsycInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, HealthInsite and Google Scholar. Findings. Exposure to risk factors, cultural and spiritual values, remoteness and geographic characteristics, entrenched socioeconomic inequalities and racism contribute to reduced service access and poor outcomes. The review highlighted a complex interplay of individual, social, health system and environmental factors that impact on optimal lung cancer care and lung cancer outcomes. Considering the burden of lung cancer within a framework of social determinants of health is necessary for policy-making and service planning and delivery. Conclusions. It is imperative that the disproportionate burden of lung cancer in Aboriginal and Torres Strait Islander peoples is addressed immediately. Whilst strategic interventions in lung cancer prevention and care are needed, service providers and policy makers must acknowledge the entrenched inequality that exists and consider the broad range of factors at the patient, provider and system level. Primary care strategies and health promotion activities to reduce risk factors, such as smoking, must also be implemented, with Aboriginal and Torres Strait Islander peoples’ engagement and control at the core of any strategy. This review has indicated that multifaceted interventions, supported by enabling policies that target individuals, communities and health professionals, are necessary to improve lung cancer outcomes and disparities. What is known about the topic? Aboriginal Australians suffer a disproportionate burden of ill health including poor outcomes from lung cancer. What does this paper add? This paper reports the outcomes of an integrative literature review. The paper identifies potential barriers to optimal lung cancer care and management for Aboriginal Australians. This paper describes barriers within the context of individual beliefs and behaviours, healthcare systems issues and environmental issues. The authors conclude that acknowledging entrenched inequality and addressing factors at the patient, provider and system level are needed to reduce the lung cancer burden in Aboriginal Australians. What are the implications for practitioners? This paper highlights the need for a greater focus on lung cancer care, awareness and diagnosis within the Aboriginal Australian population. Addressing culturally appropriate smoking-cessation initiatives is of particular importance. Primary care practitioners are key to reducing the burden of lung cancer in Aboriginal Australians.
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Hill S, Sarfati D, Robson B, Blakely T. Indigenous inequalities in cancer: what role for health care? ANZ J Surg 2012; 83:36-41. [DOI: 10.1111/ans.12041] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Sarah Hill
- Global Public Health Unit; University of Edinburgh; Edinburgh; UK
| | - Diana Sarfati
- Department of Public Health; University of Otago Wellington; Wellington; New Zealand
| | - Bridget Robson
- Department of Public Health; University of Otago Wellington; Wellington; New Zealand
| | - Tony Blakely
- Department of Public Health; University of Otago Wellington; Wellington; New Zealand
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Cancer in Australia: actual incidence and mortality data from 1982 to 2007 and projections to 2010. Asia Pac J Clin Oncol 2012; 7:325-38. [PMID: 22151981 DOI: 10.1111/j.1743-7563.2011.01502.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The Australian Institute of Health and Welfare and the Australasian Association of Cancer Registries collaborate every year to provide updated information on cancer occurrences and trends in Australia. METHOD Actual number of cases and deaths is presented together with age-standardised rates for all cancers combined and selected cancer sites from 1982 to 2007, with projections to 2010. Differences in incidence and mortality rates according to age, Indigenous status and remoteness areas are also provided. In addition, change over time in 5-year relative survival estimates for those diagnosed with cancer is presented, as is information on the participation in Australia's national screening programs for breast, cervical and bowel cancer. The term 'cancer' is used to refer to primary tumours which are invasive. RESULTS In 2007, a total of 108,368 new cases of cancer (excluding basal and squamous cell carcinoma of the skin) and 39,884 deaths from cancer occurred in Australia. Prostate cancer was the most commonly diagnosed cancer in males, while breast cancer was the most commonly diagnosed cancer in females. Lung cancer was by far the most common cause of cancer death in both males and females. In the last decade, cancer incidence rates increased in males and stabilised in females, while mortality rates decreased steadily. The overall incidence rate of cancer for Indigenous Australians was lower than that for non-indigenous Australians, while the overall mortality rate from cancer was higher. Furthermore, the 5-year relative survival for many cancers improved markedly from 1982-1986 to 1998-2004.
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Affiliation(s)
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- Fern Hill Park, Bruce ACT, Australia
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Cramb SM, Garvey G, Valery PC, Williamson JD, Baade PD. The first year counts: cancer survival among Indigenous and non‐Indigenous Queenslanders, 1997–2006. Med J Aust 2012; 196:270-4. [DOI: 10.5694/mja11.11194] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Susanna M Cramb
- Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Brisbane, QLD
| | - Gail Garvey
- Epidemiology and Health Services Division, Menzies School of Health Research, Brisbane, QLD
| | - Patricia C Valery
- Epidemiology and Health Services Division, Menzies School of Health Research, Brisbane, QLD
| | - John D Williamson
- Policy, Strategy and Resourcing Division, Queensland Health, Brisbane, QLD
| | - Peter D Baade
- Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Brisbane, QLD
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35
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Elias B, Kliewer EV, Hall M, Demers AA, Turner D, Martens P, Hong SP, Hart L, Chartrand C, Munro G. The burden of cancer risk in Canada's indigenous population: a comparative study of known risks in a Canadian region. Int J Gen Med 2011; 4:699-709. [PMID: 22069372 PMCID: PMC3206113 DOI: 10.2147/ijgm.s24292] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Canadian First Nations, the largest of the Aboriginal groups in Canada, have had lower cancer incidence and mortality rates than non-Aboriginal populations in the past. This pattern is changing with increased life expectancy, a growing population, and a poor social environment that influences risk behaviors, metabolic conditions, and disparities in screening uptake. These factors alone do not fully explain differences in cancer risk between populations, as genetic susceptibility and environmental factors also have significant influence. However, genetics and environment are difficult to modify. This study compared modifiable behavioral risk factors and metabolic-associated conditions for men and women, and cancer screening practices of women, between First Nations living on-reserve and a non-First Nations Manitoba rural population (Canada). METHODS The study used data from the Canadian Community Health Survey and the Manitoba First Nations Regional Longitudinal Health Survey to examine smoking, binge drinking, metabolic conditions, physical activity, fruit/vegetable consumption, and cancer-screening practices. RESULTS First Nations on-reserve had significantly higher rates of smoking (P < 0.001), binge drinking (P < 0.001), obesity (P < 0.001) and diabetes (P < 0.001), and less leisure-time physical activity (P = 0.029), and consumption of fruits and vegetables (P < 0.001). Sex differences were also apparent. In addition, First Nations women reported significantly less uptake of mammography screening (P < 0.001) but similar rates for cervical cancer screening. CONCLUSIONS Based on the findings of this retrospective study, the future cancer burden is expected to be high in the First Nations on-reserve population. Interventions, utilizing existing and new health and social authorities, and long-term institutional partnerships, are required to combat cancer risk disparities, while governments address economic disparities.
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Affiliation(s)
- Brenda Elias
- Faculty of Medicine, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Erich V Kliewer
- Faculty of Medicine, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- CancerCare Manitoba, Winnipeg, MB, Canada
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Madelyn Hall
- Faculty of Medicine, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Alain A Demers
- Faculty of Medicine, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- CancerCare Manitoba, Winnipeg, MB, Canada
| | - Donna Turner
- Faculty of Medicine, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- CancerCare Manitoba, Winnipeg, MB, Canada
| | - Patricia Martens
- Faculty of Medicine, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Say P Hong
- Faculty of Medicine, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lyna Hart
- Assembly of Manitoba Chiefs Health Information Research Governance Committee, Winnipeg, MB, Canada
| | - Caroline Chartrand
- Manitoba First Nations Diabetes Integration Project, Winnipeg, MB, Canada
| | - Garry Munro
- Assembly of Manitoba Chiefs Health Information Research Governance Committee, Winnipeg, MB, Canada
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Youl PH, Baade PD, Aitken JF, Chambers SK, Turrell G, Pyke C, Dunn J. A multilevel investigation of inequalities in clinical and psychosocial outcomes for women after breast cancer. BMC Cancer 2011; 11:415. [PMID: 21951320 PMCID: PMC3195770 DOI: 10.1186/1471-2407-11-415] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 09/28/2011] [Indexed: 12/02/2022] Open
Abstract
Background In Australia, breast cancer is the most common cancer affecting Australian women. Inequalities in clinical and psychosocial outcomes have existed for some time, affecting particularly women from rural areas and from areas of disadvantage. We have a limited understanding of how individual and area-level factors are related to each other, and their associations with survival and other clinical and psychosocial outcomes. Methods/Design This study will examine associations between breast cancer recurrence, survival and psychosocial outcomes (e.g. distress, unmet supportive care needs, quality of life). The study will use an innovative multilevel approach using area-level factors simultaneously with detailed individual-level factors to assess the relative importance of remoteness, socioeconomic and demographic factors, diagnostic and treatment pathways and processes, and supportive care utilization to clinical and psychosocial outcomes. The study will use telephone and self-administered questionnaires to collect individual-level data from approximately 3, 300 women ascertained from the Queensland Cancer Registry diagnosed with invasive breast cancer residing in 478 Statistical Local Areas Queensland in 2011 and 2012. Area-level data will be sourced from the Australian Bureau of Statistics census data. Geo-coding and spatial technology will be used to calculate road travel distances from patients' residence to diagnostic and treatment centres. Data analysis will include a combination of standard empirical procedures and multilevel modelling. Discussion The study will address the critical question of: what are the individual- or area-level factors associated with inequalities in outcomes from breast cancer? The findings will provide health care providers and policy makers with targeted information to improve the management of women with breast cancer, and inform the development of strategies to improve psychosocial care for women with breast cancer.
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Affiliation(s)
- Philippa H Youl
- Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Spring Hill, QLD, Australia.
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Shahid S, Finn L, Bessarab D, Thompson SC. 'Nowhere to room … nobody told them': logistical and cultural impediments to Aboriginal peoples' participation in cancer treatment. AUST HEALTH REV 2011; 35:235-41. [PMID: 21612740 DOI: 10.1071/ah09835] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Accepted: 07/28/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cancer mortality among Indigenous Australians is higher compared to the non-Indigenous population and attributed to poor access to cancer detection, screening, treatment and support services. A large proportion of Indigenous Australians live in rural and remote areas which makes access to cancer treatment services more challenging. Factors, such as transport, accommodation, poor socio-economic status and cultural appropriateness of services also negatively affect health service access and, in turn, lead to poor cancer outcomes. DESIGN, SETTING AND PARTICIPANTS Qualitative research with 30 in-depth interviews was conducted with Aboriginal people affected by cancer from across WA, using a variety of recruitment approaches. RESULTS The infrastructure around the whole-of-treatment experience affected the decision-making and experiences of Aboriginal patients, particularly affecting rural residents. Issues raised included transport and accommodation problems, travel and service expenses, displacement from family, concerns about the hospital environment and lack of appropriate support persons. These factors are compounded by a range of disadvantages already experienced by Aboriginal Australians and are vital factors affecting treatment decision-making and access. CONCLUSION To improve cancer outcomes for Aboriginal people, logistical, infrastructure and cultural safety issues must be addressed. One way of ensuring this could be by dedicated support to better coordinate cancer diagnostic and treatment services with primary healthcare services.
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Affiliation(s)
- Shaouli Shahid
- WA Centre for Cancer and Palliative Care, Curtin Health Innovation Research Institute, Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
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Garvey G, Cunningham J, Valery PC, Condon J, Roder D, Bailie R, Martin J, Olver I. Reducing the burden of cancer for Aboriginal and Torres Strait Islander Australians: time for a coordinated, collaborative, priority‐driven, Indigenous‐led research program. Med J Aust 2011; 194:530-1. [DOI: 10.5694/j.1326-5377.2011.tb03090.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 04/04/2011] [Indexed: 11/17/2022]
Affiliation(s)
- Gail Garvey
- Indigenous Health Research Program, Queensland Institute of Medical Research, Brisbane, QLD
| | - Joan Cunningham
- Menzies School of Health Research, Charles Darwin University, Darwin, NT
| | - Patricia C Valery
- Indigenous Health Research Program, Queensland Institute of Medical Research, Brisbane, QLD
| | - John Condon
- Menzies School of Health Research, Charles Darwin University, Darwin, NT
| | - David Roder
- Cancer Council South Australia, Adelaide, SA
| | - Ross Bailie
- Menzies School of Health Research, Charles Darwin University, Darwin, NT
| | | | - Ian Olver
- Cancer Council Australia, Sydney, NSW
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Ward PR, Javanparast S, Ah Matt M, Martini A, Tsourtos G, Cole S, Gill T, Aylward P, Baratiny G, Jiwa M, Misan G, Wilson C, Young G. Equity of colorectal cancer screening: cross-sectional analysis of National Bowel Cancer Screening Program data for South Australia. Aust N Z J Public Health 2010; 35:61-5. [DOI: 10.1111/j.1753-6405.2010.00637.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Cunningham R, Shaw C, Blakely T, Atkinson J, Sarfati D. Ethnic and socioeconomic trends in breast cancer incidence in New Zealand. BMC Cancer 2010; 10:674. [PMID: 21138590 PMCID: PMC3017063 DOI: 10.1186/1471-2407-10-674] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Accepted: 12/07/2010] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Breast cancer incidence varies between social groups, but differences have not been thoroughly examined in New Zealand. The objectives of this study are to determine whether trends in breast cancer incidence varied by ethnicity and socioeconomic position between 1981 and 2004 in New Zealand, and to assess possible risk factor explanations. METHODS Five cohorts of the entire New Zealand population for 1981-86, 1986-1991, 1991-1996, 1996-2001, and 2001-2004 were created, and probabilistically linked to cancer registry records, allowing direct determination of ethnic and socioeconomic trends in breast cancer incidence. RESULTS Breast cancer rates increased across all ethnic and socioeconomic groups between 1981 and 2004. Māori women consistently had the highest age standardised rates, and the difference between Māori and European/Other women increased from 7% in 1981-6 to 24% in 2001-4. Pacific and Asian women had consistently lower rates of breast cancer than European/Other women over the time period studied (12% and 28% lower respectively when pooled over time), although young Pacific women had slightly higher incidence rates than young European/other women. A gradient between high and low income women was evident, with high income women having breast cancer rates approximately 10% higher and this difference did not change significantly over time. CONCLUSIONS Differences in breast cancer incidence between European and Pacific women and between socioeconomic groups are explicable in terms of known risk factors. However no straightforward explanation for the relatively high incidence amongst Māori is apparent. Further research to explore high Māori breast cancer rates may contribute to reducing the burden of breast cancer amongst Māori women, as well as improving our understanding of the aetiology of breast cancer.
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Affiliation(s)
- Ruth Cunningham
- Department of Public Health, University of Otago Wellington, PO Box 7343, Wellington 6242, New Zealand
| | - Caroline Shaw
- Department of Public Health, University of Otago Wellington, PO Box 7343, Wellington 6242, New Zealand
| | - Tony Blakely
- Department of Public Health, University of Otago Wellington, PO Box 7343, Wellington 6242, New Zealand
| | - June Atkinson
- Department of Public Health, University of Otago Wellington, PO Box 7343, Wellington 6242, New Zealand
| | - Diana Sarfati
- Department of Public Health, University of Otago Wellington, PO Box 7343, Wellington 6242, New Zealand
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Katzenellenbogen JM, Sanfilippo FM, Hobbs MS, Briffa TG, Ridout SC, Knuiman MW, Dimer L, Taylor KP, Thompson PL, Thompson SC. Incidence of and Case Fatality Following Acute Myocardial Infarction in Aboriginal and Non-Aboriginal Western Australians (2000–2004): A Linked Data Study. Heart Lung Circ 2010; 19:717-25. [DOI: 10.1016/j.hlc.2010.08.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 08/09/2010] [Indexed: 10/19/2022]
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Moore SP, O'Rourke PK, Mallitt K, Garvey G, Green AC, Coory MD, Valery PC. Cancer incidence and mortality in Indigenous Australians in Queensland, 1997–2006. Med J Aust 2010; 193:590-3. [DOI: 10.5694/j.1326-5377.2010.tb04068.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 08/25/2010] [Indexed: 11/17/2022]
Affiliation(s)
| | - Peter K O'Rourke
- Queensland Institute of Medical Research, Brisbane, QLD
- Australian Centre for International and Tropical Health, University of Queensland, Brisbane, QLD
| | - Kylie‐Ann Mallitt
- Queensland Institute of Medical Research, Brisbane, QLD
- Australian Centre for International and Tropical Health, University of Queensland, Brisbane, QLD
| | - Gail Garvey
- Queensland Institute of Medical Research, Brisbane, QLD
| | - Adèle C Green
- Queensland Institute of Medical Research, Brisbane, QLD
| | | | - Patricia C Valery
- Queensland Institute of Medical Research, Brisbane, QLD
- Australian Centre for International and Tropical Health, University of Queensland, Brisbane, QLD
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Croager EJ, Eades T, Pratt IS, Slevin T. Impact of a short, culturally relevant training course on cancer knowledge and confidence in Western Australia's Aboriginal Health Professionals. Aust N Z J Public Health 2010; 34 Suppl 1:S76-9. [DOI: 10.1111/j.1753-6405.2010.00558.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Christou A, Katzenellenbogen JM, Thompson SC. Australia's national bowel cancer screening program: does it work for indigenous Australians? BMC Public Health 2010; 10:373. [PMID: 20579344 PMCID: PMC2915957 DOI: 10.1186/1471-2458-10-373] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Accepted: 06/25/2010] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Despite a lower incidence of bowel cancer overall, Indigenous Australians are more likely to be diagnosed at an advanced stage when prognosis is poor. Bowel cancer screening is an effective means of reducing incidence and mortality from bowel cancer through early identification and prompt treatment. In 2006, Australia began rolling out a population-based National Bowel Cancer Screening Program (NBCSP) using the Faecal Occult Blood Test. Initial evaluation of the program revealed substantial disparities in bowel cancer screening uptake with Indigenous Australians significantly less likely to participate in screening than the non-Indigenous population.This paper critically reviews characteristics of the program which may contribute to the discrepancy in screening uptake, and includes an analysis of organisational, structural, and socio-cultural barriers that play a part in the poorer participation of Indigenous and other disadvantaged and minority groups. METHODS A search was undertaken of peer-reviewed journal articles, government reports, and other grey literature using electronic databases and citation snowballing. Articles were critically evaluated for relevance to themes that addressed the research questions. RESULTS The NBCSP is not reaching many Indigenous Australians in the target group, with factors contributing to sub-optimal participation including how participants are selected, the way the screening kit is distributed, the nature of the test and comprehensiveness of its contents, cultural perceptions of cancer and prevailing low levels of knowledge and awareness of bowel cancer and the importance of screening. CONCLUSIONS Our findings suggest that the population-based approach to implementing bowel cancer screening to the Australian population unintentionally excludes vulnerable minorities, particularly Indigenous and other culturally and linguistically diverse groups. This potentially contributes to exacerbating the already widening disparities in cancer outcomes that exist among Indigenous Australians. Modifications to the program are recommended to facilitate access and participation by Indigenous and other minority populations. Further research is also needed to understand the needs and social and cultural sensitivities of these groups around cancer screening and inform alternative approaches to bowel cancer screening.
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Affiliation(s)
- Aliki Christou
- Centre for International Health, Curtin University of Technology, GPO Box U1987 Perth WA 6845, Australia
| | - Judith M Katzenellenbogen
- Centre for International Health, Curtin University of Technology, GPO Box U1987 Perth WA 6845, Australia
| | - Sandra C Thompson
- Centre for International Health, Curtin University of Technology, GPO Box U1987 Perth WA 6845, Australia
- Combined Universities Centre for Rural Health, University of Western Australia PO Box 109 Geraldton WA 6531, Australia
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Shahid S, Bleam R, Bessarab D, Thompson SC. "If you don't believe it, it won't help you": use of bush medicine in treating cancer among Aboriginal people in Western Australia. JOURNAL OF ETHNOBIOLOGY AND ETHNOMEDICINE 2010; 6:18. [PMID: 20569478 PMCID: PMC2902429 DOI: 10.1186/1746-4269-6-18] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Accepted: 06/23/2010] [Indexed: 05/10/2023]
Abstract
BACKGROUND Little is known about the use of bush medicine and traditional healing among Aboriginal Australians for their treatment of cancer and the meanings attached to it. A qualitative study that explored Aboriginal Australians' perspectives and experiences of cancer and cancer services in Western Australia provided an opportunity to analyse the contemporary meanings attached and use of bush medicine by Aboriginal people with cancer in Western Australia METHODS Data collection occurred in Perth, both rural and remote areas and included individual in-depth interviews, observations and field notes. Of the thirty-seven interviews with Aboriginal cancer patients, family members of people who died from cancer and some Aboriginal health care providers, 11 participants whose responses included substantial mention on the issue of bush medicine and traditional healing were selected for the analysis for this paper. RESULTS The study findings have shown that as part of their healing some Aboriginal Australians use traditional medicine for treating their cancer. Such healing processes and medicines were preferred by some because it helped reconnect them with their heritage, land, culture and the spirits of their ancestors, bringing peace of mind during their illness. Spiritual beliefs and holistic health approaches and practices play an important role in the treatment choices for some patients. CONCLUSIONS Service providers need to acknowledge and understand the existence of Aboriginal knowledge (epistemology) and accept that traditional healing can be an important addition to an Aboriginal person's healing complementing Western medical treatment regimes. Allowing and supporting traditional approaches to treatment reflects a commitment by modern medical services to adopting an Aboriginal-friendly approach that is not only culturally appropriate but assists with the cultural security of the service.
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Affiliation(s)
- Shaouli Shahid
- Centre for International Health, Curtin University, Perth, WA, Australia.
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Hill S, Sarfati D, Blakely T, Robson B, Purdie G, Dennett E, Cormack D, Dew K, Ayanian JZ, Kawachi I. Ethnicity and management of colon cancer in New Zealand. Cancer 2010; 116:3205-14. [DOI: 10.1002/cncr.25127] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Baade PD, Turrell G, Aitken JF. A multilevel study of the determinants of area-level inequalities in colorectal cancer survival. BMC Cancer 2010; 10:24. [PMID: 20109230 PMCID: PMC2837617 DOI: 10.1186/1471-2407-10-24] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Accepted: 01/28/2010] [Indexed: 12/01/2022] Open
Abstract
Background In Australia, associations between geographic remoteness, socioeconomic disadvantage, and colorectal cancer (CRC) survival show that survival rates are lowest among residents of geographically remote regions and those living in disadvantaged areas. At present we know very little about the reasons for these inequalities, hence our capacity to intervene to reduce the inequalities is limited. Methods/Design This study, the first of its type in Australia, examines the association between CRC survival and key area- and individual-level factors. Specifically, we will use a multilevel framework to investigate the possible determinants of area- and individual-level inequalities in CRC survival and quantify the relative contribution of geographic remoteness, socioeconomic and demographic factors, disease stage, and access to diagnostic and treatment services, to these inequalities. The multilevel analysis will be based on survival data relating to people diagnosed with CRC in Queensland between 1996 and 2005 (n = 22,723) from the Queensland Cancer Registry (QCR), area-level data from other data custodians such as the Australian Bureau of Statistics, and individual-level data from the QCR (including extracting stage from pathology records) and Queensland Hospitals. For a subset of this period (2003 and 2004) we will utilise more detailed, individual-level data (n = 1,966) covering a greater range of risk factors from a concurrent research study. Geo-coding and spatial technology will be used to calculate road travel distances from patients' residence to treatment centres. The analyses will be conducted using a multilevel Cox proportional hazards model with Level 1 comprising individual-level factors (e.g. occupation) and level 2 area-level indicators of remoteness and area socioeconomic disadvantage. Discussion This study focuses on the health inequalities for rural and disadvantaged populations that have often been documented but poorly understood, hence limiting our capacity to intervene. This study utilises and develops emerging statistical and spatial technologies that can then be applied to other cancers and health outcomes. The findings of this study will have direct implications for the targeting and resourcing of cancer control programs designed to reduce the burden of colorectal cancer, and for the provision of diagnostic and treatment services.
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Affiliation(s)
- Peter D Baade
- Viertel Centre for Research in Cancer Control, Cancer Council Queensland, PO Box 201, Spring Hill QLD 4004, Australia.
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Sanson-Fisher R, Carey M, Mackenzie L, Hill D, Campbell S, Turner D. Reducing inequities in cancer care: the role of cancer registries. Cancer 2009; 115:3597-605. [PMID: 19479975 DOI: 10.1002/cncr.24415] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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