Mapping Cancer incidence across Western Victoria: the association with age, accessibility, and socioeconomic status among men and women

Forecasting of overall and aggressive prostate cancer incident counts at the small area level

OBJECTIVES

This study aims to forecast overall and aggressive prostate cancer counts at the local government area (LGA) level over 10 years (2019-2028) in Victoria, Australia, using Victorian Cancer Registry (2001-2018) data.

METHODS

We used the Age-Period-Cohort approach to estimate the annual age-specific incidence and used Bayesian spatiotemporal models that account for non-linear temporal trends and area-level risk factors. We evaluated the models' performance by withholding and comparing forecasts with the 2014-2018 data.

RESULTS

There were 80,449 prostate cancer cases between 2001 and 2018, with an overall increasing trend. Compared to 2001, prostate cancer incidence increased by 69%, from 3049 to 5167 cases in 2018. Prostate cancer counts are expected to reach 7631 cases in 2028, a further 48% increase. Unexplained area-level spatial variation was substantially reduced after adjusting for the area-level elderly population. Aggressive prostate cancer cases increased by 107% between 2001 and 2018 and are expected to rise by 123% increase in 2028. The proportion of aggressive prostate cancer cases will increase to 31% in 2028 from 20% in 2018. By 2028, overall and aggressive prostate cancer cases are projected to be increasing in 66% and 61% of LGAs.

CONCLUSION

Prostate cancer cases are projected to rise at the state level and most LGAs in the next 10 years, with much steeper increases in aggressive cases. Population growth and an ageing population have primarily contributed to this rise besides prostate-specific antigen testing. These prediction estimates help inform prostate cancer burden and facilitate efficient healthcare delivery.

Differences in Uveal Melanoma Age-Standardized Incidence Rates in Two Eastern States of Australia Are Driven by Differences in Rurality and Ultraviolet Radiation

Uveal melanoma (UM) is the second-most-common melanoma in humans and has a high age-standardized incidence rate (ASR) in Australia. Regional patterns of UM ASRs in Australia are unknown. The aim of this study was to determine and compare UM ASRs in two geographically disparate eastern states, Queensland (QLD) and Victoria (VIC), by using cancer registry data that was obtained from 2001 to 2013. World-standardized UM ASRs and incidence-rate ratios (IRRs) were calculated. Higher UM ASR was also observed in anterior UM compared to posterior UM ASR. UM ASR remained unchanged from 2001 to 2013 in QLD but decreased in VIC. A south-to-north latitude trend in UM ASR along the east of Australia is weakly evident, and rural populations have higher UM ASRs than major city populations in both states. Differences in ultraviolent radiation (UVR) susceptibility, indigenous populations, social behaviours, chemical exposure, and socioeconomic status could all be contributing to differences in UM rates between QLD and VIC and between rural compared to major city areas. It is possible that a minority of cases in QLD and VIC might be prevented by sun-protective behaviours. This is important, because these findings suggest that QLD, which is already known to have one of the highest cutaneous melanoma (CM) ASRs in the world, also has one of the highest UM ASRs.

Forecasting of Lung Cancer Incident Cases at the Small-Area Level in Victoria, Australia

Predicting lung cancer cases at the small-area level is helpful to quantify the lung cancer burden for health planning purposes at the local geographic level. Using Victorian Cancer Registry (2001-2018) data, this study aims to forecast lung cancer counts at the local government area (LGA) level over the next ten years (2019-2028) in Victoria, Australia. We used the Age-Period-Cohort approach to estimate the annual age-specific incidence and utilised Bayesian spatio-temporal models that account for non-linear temporal trends and area-level risk factors. Compared to 2001, lung cancer incidence increased by 28.82% from 1353 to 1743 cases for men and 78.79% from 759 to 1357 cases for women in 2018. Lung cancer counts are expected to reach 2515 cases for men and 1909 cases for women in 2028, with a corresponding 44% and 41% increase. The majority of LGAs are projected to have an increasing trend for both men and women by 2028. Unexplained area-level spatial variation substantially reduced after adjusting for the elderly population in the model. Male and female lung cancer cases are projected to rise at the state level and in each LGA in the next ten years. Population growth and an ageing population largely contributed to this rise.

A multi-level spatio-temporal analysis on prostate cancer outcomes

BACKGROUND

Geographic and temporal variation in positive surgical margins (PSM) for prostate cancer after radical prostatectomy (RP) has been observed. However, it is unclear how much of this variation could be attributed to patient, surgeon, institution, or socioeconomic-related factors and the impact of PSM on death among localized prostate cancer patients.

METHODS

This study aimed to assess the independent and relative contribution of the patient, surgeon, institution and area-level risk factors on geographic and temporal variation of PSM and evaluate the impact of PSM on five-year all-cause and prostate cancer-specific mortality among localized prostate cancer patients. Within the hierarchical-related regression approach, we utilised Bayesian spatial-temporal multi-level models to study individual and area-level predictors with the outcomes, while accounting for geographically structured and unstructured correlation and non-linear trends.

RESULTS

Individual-level data included 10,075 localized prostate cancer cases with RP reported to the Prostate Cancer Outcomes Registry Victoria between 2009 and 2018. Area-level data comprised socio-economic disadvantage and remoteness data at the local government area level in Victoria, Australia. 26 % of patients had PSM, and the rates varied across areas by years. This variation was mainly associated with NCCN risk, followed by RP techniques, surgical institution type, surgeon volume and socio-economic disadvantage. Intermediate (Odds ratio/OR = 1.21,95 % credible interval/Crl = 1.05-1.41), high/very-high risk groups (OR = 2.24,95 % Crl = 1.91-2.64) and public surgical institution (OR = 1.64, 95 % Crl = 1.46-1.84) were independently associated with a higher likelihood of PSM. Robot-assisted (OR = 0.61, 95 % Crl = 0.55-0.68), laparoscopic RP (OR = 0.76, 95 % Crl = 0.62-0.93), high-volume surgeon (OR = 0.84, 95 % Crl = 0.76-0.93) and socio-economically least disadvantaged status (OR = 0.78, 95 % Crl = 0.64-0.94) showed a lower likelihood of PSM. PSM was also independently associated with a higher five-year all-cause and prostate cancer-specific mortality.

CONCLUSION

Aggressive tumour characteristics and RP techniques were the main contributors to the likelihood of PSM following RP. Reducing the prevalence of PSM will generally improve prostate cancer-specific and all-cause mortality.

Geospatial and temporal variation of prostate cancer incidence

OBJECTIVES

The objective of this study was to evaluate geographical and temporal variations in prostate cancer incidence in Victoria, Australia.

STUDY DESIGN & METHODS

This study analysed 105,349 cases of incident prostate cancer between 1982 and 2016 from the population-based Victorian Cancer Registry. We performed Poisson regression analyses to identify an association between an annual number of prostate cancer counts, prostate-specific antigen (PSA) tests and the elderly male population (≥65) after adjusting for population at risk and years. We also applied Bayesian spatial-temporal models to determine any association with prostate cancer incidence and area-level factors.

RESULTS

The overall trend of the age-standardized prostate cancer incidence was increasing. The highest age-specific incidence was observed among people aged 65-74 years in the pre- and post-PSA periods. Every increase in 1000 PSA tests per 100,000 population, prostate cancer incidence increased by 17% (relative risk [RR] = 1.17, 95% confidence interval [CI] = 1.13-1.22). A 1% increase in the proportion of the male population (≥65) correlated with a 7% increase in prostate cancer cases (RR = 1.07, 95% CI = 1.06-1.10). Compared with early PSA periods, decreasing trends of low-grade cases and growing trends of high- and intermediate-grade cases were observed after a decline in PSA test usage in late PSA periods. Men living in the most socioeconomically advantaged postal areas had a decreased risk of prostate cancer (RR = 0.914, 95% CI = 0.858-0.976).

CONCLUSIONS

Age-specific risk of developing biological prostate cancer, temporal changes in PSA testing and an increasingly elderly population contributed to an increasing trend of prostate cancer incidence. When incidence trends were investigated at a more granular geographic level, socioeconomically advantaged status was associated with decreased prostate cancer risk.

Association between Receipt of Guideline-Concordant Lung Cancer Treatment and Individual- and Area-Level Factors: A Spatio-Temporal Analysis

BACKGROUND

Guideline-concordant treatment (GCT) of lung cancer has been observed to vary across geographic regions over the years. However, there is little evidence as to what extent this variation is explained by differences in patients' clinical characteristics versus contextual factors, including socioeconomic inequalities.

METHODS

This study evaluated the independent effects of individual- and area-level risk factors on geographic and temporal variation in receipt of GCT among patients with lung cancer. Receipt of GCT was defined on the basis of the National Comprehensive Cancer Network guidelines. We used Bayesian spatial-temporal multilevel models to combine individual and areal predictors and outcomes while accounting for geographically structured and unstructured correlation and linear and nonlinear trends.

RESULTS

Our study included 4,854 non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) cases, reported to the Victorian Lung Cancer Registry between 2011 and 2018. Area-level data comprised socioeconomic disadvantage and remoteness data at the local government area level in Victoria, Australia. Around 60.36% of patients received GCT, and the rates varied across geographic areas over time. This variation was mainly associated with poor performance status, advanced clinical stages, NSCLC types, public hospital insurance, area-level deprivation, and comorbidities.

CONCLUSIONS

This study highlights the need to address disparities in receipt of GCT among patients with lung cancer with poor performance status, NSCLC, advanced clinical stage, stage I-III SCLC, stage III NSCLC, public hospital insurance, and comorbidities, and living in socioeconomically disadvantaged areas.

IMPACT

Two-year mortality outcomes significantly improved with GCT. Interventions aimed at reducing these inequalities could help to improve lung cancer outcomes.

Validity of self-reported cancer: Comparison between self-report versus cancer registry records in the Geelong Osteoporosis Study

BACKGROUND

Determining the validity of self-reported data is important. The aim of this study was to assess the validity of self-reported cancer and investigate factors associated with accurate reporting in men and women.

METHODS

Study participants (n = 1727) from the Geelong Osteoporosis Study, located in south-eastern Australia, were utilised. Self-reported cancer data were compared to Victorian Cancer Registry records. Age, socioeconomic status (SES), education and time between cancer diagnosis and study appointment were investigated as factors associated with accuracy of self-report.

RESULTS

There were 142 participants who self-reported a cancer and 135 with a VCR record. Comparing self-report to any registry record, sensitivity was 63.7 %, specificity 96.5 %, PPV 60.6 %, NPV 96.9 %, and overall agreement ĸ0.588. Comparing exact-match records, sensitivity was 58.8 %, specificity 95.5 %, PPV 49.3 %, NPV 96.9 % and overall agreement ĸ0.499. In logistic regression models, post-secondary education was independently associated with accuracy of any (OR 1.72, 95 % CI 1.10-2.70) and exact-match (OR 1.59, 95 % CI 1.05-2.42) self-report, compared to cancer registry record. For any cancer, being aged >70 years was inversely associated with accuracy (OR 0.24, 95 % CI 0.15-0.38). Likewise, for matched cancer reporting, those aged 60-70 years (OR 0.51, 95 %CI 0.30-0.88) and >70 years (OR 0.23, 95 % CI 0.15-0.35) were less accurate. No other significant associations were detected.

CONCLUSION

Results suggest moderate agreement between self-report and registry data for any cancer among men and women. However, when comparing self-report to registry data for exact-match cancer type, level of overall agreement deteriorated. Self-report cancer data may be acceptable for determining a history of cancer, although, is less accurate in identifying history of specific cancer types documented in registry-based data.

Detection of clinically significant cancer in the anterior prostate by transperineal biopsy

OBJECTIVE

To determine the incidence of clinically significant prostate cancer (csPCa) detected exclusively in the anterior prostate using transperineal prostate biopsy.

PATIENTS AND METHODS

Histopathology results of all patients who underwent transperineal prostate biopsy between February 2016 and March 2018 at a single institution were assessed for distribution of cancer within the prostate. Patients with cancer found exclusively in the anterior prostate were then compared to those with any cancer found in the posterior or lateral prostate with International Society of Urological Pathology Grade Group 2-5 cancers being considered csPCa.

RESULTS

A total of 508 patients were included. Overall, 12.0% of the cohort had csPCa detected only in anterior biopsies. When stratified by prostate-specific antigen (PSA) level, 6.6% of men with a PSA level of 4.1-10.0 ng/mL and 8.2% of men with a PSA level of >10.0 ng/mL had csPCa detected in the anterior prostate alone.

CONCLUSION

Transperineal biopsy has the ability to diagnose anteriorly located csPCa that would potentially have been missed by the transrectal approach.