Doctors' recognition and management of melanoma patients' risk: An Australian population-based study

BACKGROUND

Guidelines recommend that health professionals identify and manage individuals at high risk of developing melanoma, but there is limited population-based evidence demonstrating real-world practices.

OBJECTIVE

A population-based, observational study was conducted in the state of New South Wales, Australia to determine doctors' knowledge of melanoma patients' risk and to identify factors associated with better identification and clinical management.

METHODS

Data were analysed for 1889 patients with invasive, localised melanoma in the Melanoma Patterns of Care study. This study collected data on all melanoma diagnoses notified to the state's cancer registry during a 12-month period from 2006 to 2007, as well as questionnaire data from the doctors involved in their care.

RESULTS

Three-quarters (74%) of patients had doctors who were aware of their risk factor status with respect to personal and family history of melanoma and the presence of many moles. Doctors working in general practice, skin cancer clinics and dermatology settings had better knowledge of patients' risk factors than plastic surgeons. Doctors were 15% more likely to know the family history of younger melanoma patients (<40years) than of those ≥80 years (95% confidence interval 4-26%). Early detection-related follow-up advice was more likely to be given to younger patients, by doctors aware of their patients' risk status, by doctors practising in plastic surgery, dermatology and skin cancer clinic settings, and by female doctors.

CONCLUSION

Both patient-related and doctor-related factors were associated with doctors' recognition and management of melanoma patients' risk and could be the focus of strategies for improving care.

Accuracy of Self-Report of Nevus and Pigmentation Phenotype Compared to Clinical Assessment in Young Australian Adults

There is no formal community-wide melanoma screening program in Australia, but the importance of early detection and regular skin self-examination is generally well understood. It is important that individuals are able to identify key melanoma risk factors so that those at high risk can modify their sun-related behaviours and take appropriate preventative actions from a young age. Aims: 1) To evaluate the accuracy of self-reported pigmentation and nevus phenotype compared to clinical assessment, and 2) to examine agreement between clinically-measured whole-body nevus count and clinically-measured nevus count on selected anatomical regions, given that localised mole count is often used as a proxy measure. Methods: The sample included 456 cases with invasive cutaneous melanoma diagnosed between ages 18–39 years and 538 controls from the population-based Australian Melanoma Family Study. Participants completed a questionnaire regarding their pigmentation and nevus phenotype, and attended a clinical skin examination with a dermatologic trainee. Results: There was strong agreement between self-reported and clinical measurement for eye color (weighted kappa, Kw, = 0.83, 95% confidence interval (CI) 0.80–0.86); and moderate agreement for hair color (Kw = 0.52, 95% CI 0.47–0.56) There was poor agreement for skin color when using spectrophotometer-derived individual typography angle (ITA) scores as the objective measure (Kw = 0.18, 95% CI 0.14–0.22). Participants underestimated their nevus counts. The Spearman correlation was 0.43 (95% CI 0.38–0.49) when comparing clinically-measured total body nevus count (≥2 mm) with self-reported nevus density categories, and the intraclass correlation was 0.36 (95% CI 0.30–0.41) when comparing nevus counts on the back. There was good agreement between quartile distributions of clinically-measured site-specific nevus counts with total body nevus counts, particularly for the arms (Kw = 0.76 for men and 0.80 for women). Conclusions: Agreement between self-reported pigmentation and nevus phenotype compared to clinical assessment ranges from poor to excellent, depending on the measure. For studies where a full body nevus count is impractical, measuring nevus counts on the arms would be an acceptable alternative.

A national epidemiological study of Myasthenia Gravis in Australia

BACKGROUND AND PURPOSE

Existing epidemiological studies of Myasthenia Gravis have generally examined small populations. Few national studies have been conducted, and published incidence and prevalence rates vary widely. We report one of the largest national studies of Myasthenia Gravis, and the first incidence and prevalence rates for Australia.

METHODS

Prescriptions for Pyridostigmine Bromide in 2009 were utilized from a national prescribing database to estimate incidence and the prevalence of symptomatic and treated disease. Crude rates were age-standardized to the WHO world population. We compared standardized rates to recent national studies from Norway and Taiwan.

RESULTS

In 2009, there were 2574 prevalent cases of symptomatic and treated Myasthenia Gravis, corresponding to an annual crude prevalence rate of 117.1 per 1 million residents. There were 545 incident cases, yielding a crude incidence rate of 24.9 per 1 million residents. The crude incidence in women and men was estimated to be 27.9 and 21.9 per 1 million, respectively. Prevalence and incidence rates were higher in women than men between the ages of 15 and 64 years, and were higher in men than women in those older than 65 years. Rates peaked between the ages of 74 and 84 years, declining thereafter. Standardized incidence was higher in Australia than Norway, but similar to Taiwan (P-values = 0.007 and 1.00, respectively).

CONCLUSIONS

This first Australian epidemiological study of symptomatic Myasthenia Gravis is one of the largest population-based studies ever reported and supports higher incidence rates for Myasthenia Gravis. Myasthenia Gravis disproportionately affected younger females and older males.

Ductal carcinoma in situ of the breast, a population-based study of epidemiology and pathology

In a population-based series of 2109 women with ductal carcinoma in situ (DCIS) diagnosed in 1995–2000 in New South Wales, Australia, incidence increased by an average of 5.5% a year, mostly between 1995 and 1996 and in women 50–69 years of age. This increase paralleled the increases in mammographic screening. BreastScreen NSW, an organised mammographic screening programme, detected 65% of all DCIS. High-grade lesions were 54% of all lesions and were more likely to be 2+ cm in diameter (OR=2.12, 95%CI 1.46–3.14) than low-grade lesions. In all, 40% of DCIS in women younger than 40 years was 2+ cm in diameter compared with 21% in women 40 years and older. Young age, high grade, mixed architecture and multifocality were significant and independent predictors of 2+ cm DCIS.

Bowling workload and the risk of injury in elite cricket fast bowlers

This study examined the relationship between the bowling workload of first-class cricket fast bowlers and injury with the aim of identifying a workload threshold at which point the risk of injury increases. Ninety male fast bowlers (mean age 27 years, range 18-38 years) from six Australian state squads were observed for the 2000-2001 and/or 2001-2002 cricket seasons. Workload was quantified by examining fixture scorecards and conducting surveillance at training sessions. Injury data was obtained from the Cricket Australia's Injury Surveillance System. Compared to bowlers with an average of 3-3.99 days between bowling sessions, bowlers with an average of less than 2 days (risk ratio (RR) = 2.4, 95% confidence interval (CI) 1.6 to 3.5) or 5 or more days between sessions (RR = 1.8, 95% CI 1.1 to 2.9) were at a significantly increased risk of injury. Compared to those bowlers with an average of 123-188 deliveries per week, bowlers with an average of fewer than 123 deliveries per week (RR = 1.4, 95% CI 1.0 to 2.0) or more than 188 deliveries per week (RR= 1.4, 95% CI 0.9 to 1.6) may also be at an increased risk of injury. There appears to be a dual fast bowling workload threshold beyond which the risk of injury increases and maintaining a workload that is too low or infrequent is an equally significant risk factor for injury as maintaining a high bowling workload. Further study is required to determine the reason why players who bowl infrequently suffer more injuries.