Western Australian Cancer Registry Research Articles

Surgical management of lung cancer in Western Australia in 1996 and its outcomes

All cases of lung cancer diagnosed in Western Australia in 1996 in which surgery was the primary treatment, were reviewed. Reported herein are the characteristics of the patients, the treatment outcomes and a comparison of the management undertaken with that recommended by international guidelines. All patients with a new diagnosis of lung cancer in Western Australia in the calendar year of 1996 were identified using two different population-based registration systems: the Western Australian (WA) Cancer Registry and the WA Hospital Morbidity Data System. A structured questionnaire on the diagnosis and management was completed for each case. Date of death was determined through the WA Cancer Registry. Six hundred and sixty-eight patients with lung cancer were identified; 132 (20%) were treated with surgery. Lobectomy was the most frequently performed procedure (71%), followed by pneumonectomy (19%). Major complications affected 23% of patients. Postoperative mortality was 6% (3% lobectomy, 12% pneumonectomy). At 5 years the absolute survival was as follows for stage I, II, IIIA, IIIB, respectively: 51%, 45%, 12%, 5%. Investigations and choice of surgery in WA in 1996 reflect current international guidelines. The survival of patients with resectable lung cancer remains unsatisfactory.

Model for collecting colorectal cancer staging information in Western Australia.

There is recognition that to improve the management of patients with cancer we need to monitor outcomes, especially survival outcomes based on tumour stage. Unfortunately, there are few centres in Australia that can provide stage stratified survival information, despite the large investments that have been made in data collection. The aim of this study was to collect staging information for all colorectal cancers diagnosed in Western Australia over a 12-month period. This information could then serve as a basis for more meaningful analysis. A project officer was appointed to coordinate a programme through the Western Australian Cancer Registry. A consensus was reached among pathologists on the standardized reporting of colorectal cancers to the registry. Clinicians were asked to provide, on pathology request forms, information on tumour location, the presence of metastatic disease (on X-ray or at laparotomy), and type of surgery. Use was also made of existing hospital and unit based databases to acquire and crosscheck information. Over a 12-month study period, 1008 patients with colorectal cancers were notified to the Cancer Registry. Their mean age was 69.1 years (range 23-100 years), 56% were men and 44% women. The rectum was the most common site for disease location (32.5%). At cessation of the project, 743 patients (74%) were fully staged, with a further 221 patients (22%) having completed data on tumour depth of penetration and nodal status, but insufficient information on the presence of metastases. The stage distributions were: stage I - 20.5%; stage II - 29.9%; stage III - 26.2%; stage IV - 23.4%. It is feasible to collect staging information on colorectal cancers notified to a population based cancer registry. This information will be invaluable for stage stratified survival analysis and research.

Breast cancer in Western Australia: clinical practice and clinical guidelines.

To review changes in patterns of care for women with early invasive breast cancer in Western Australia from 1989 to 1999, and compare management with recommendations in the 1995 National Health and Medical Research Council guidelines. Population-based surveys of all cases listed in the Western Australian Cancer Registry and Western Australian Hospital Morbidity Data System. Congruence of care with guidelines. Data were available for 1649 women with early invasive breast cancer (categories pT1or pT2; pN0 or pN1; and M0). In 1999, 96% had a preoperative diagnosis by fine-needle aspiration or core biopsy (compared with 66% in 1989), with a synoptic pathology report on 95%. Breast-conserving surgery was used for 66% of women with mammographically detected tumours (v 35% in 1989) and 46% of those with clinically detected tumours (v 28% in 1989), with radiotherapy to the conserved breast in 90% of these cases (83% in 1989). Adjuvant chemotherapy was given to 92% of premenopausal women with node-positive disease and 63% with poor-prognosis node-negative tumours (v 78% and 14%, respectively, in 1989). Among postmenopausal women with receptor-positive tumours, tamoxifen was prescribed for 91% of those with positive nodes (85% in 1989) and 79% of those with negative nodes (30% in 1989). Among postmenopausal women with receptor-negative tumours, chemotherapy was prescribed for 70% with positive nodes (v 33%) and 58% with negative nodes (v none). Patterns of management of women with early invasive breast cancer in Western Australia during the 1990s changed significantly in all respects toward those recommended in the 1995 guidelines.

Treatment of Helicobacter pylori infection to reduce gastric cancer incidence: uncertain benefits of a community based programme in Australia.

Helicobacter pylori is a cause of gastric adenocarcinoma, but the role of H. pylori eradication in reducing cancer risk is unknown. We sought to estimate the benefits of a screening and treatment programme for H. pylori infection, aimed at reducing the incidence of gastric cancer in Australia. The impact of this programme on cancer incidence was evaluated in sensitivity analyses utilizing Western Australian Cancer Registry data and published data on the epidemiology of H. pylori and gastric cancer. The impact of variation in parameters used in the sensitivity analyses was substantial, ranging from a 38% reduction in lifetime risk of gastric cancer in a best-case to 3% in a worst-case scenario. In an intermediate-case scenario there is a 23% reduction in lifetime risk, but in real terms this reflects a fall in cumulative incidence from 0.7 to 0.5% for males or 0.3 to 0.2% for females. The projected cumulative lifetime incidence of gastric cancer in H. pylori-infected males is 2.2% and 0.9% for females; this contrasts with 0.4 and 0.2%, respectively, for those never infected. According to an intermediate-case scenario, to prevent one gastric cancer, screening with or without subsequent treatment would be required in 617 men or 1639 women. Furthermore, this programme may be less effective in reducing cancer incidence than would be achieved naturally over the next 15 years, providing the current annual decline in gastric cancer incidence continues. In conclusion, the benefits of a community based programme of H. pylori eradication in terms of cancer risk reduction remain unclear, related largely to uncertainties in the parameters used to calculate these benefits. In Australia, any benefits obtained are likely to be, at best, modest.

Prostate cancer in Western Australia: trends in incidence and mortality from 1985 to 1996.

To measure trends in recorded incidence and mortality rates of prostate cancer in Western Australia from 1985 to 1996 and to relate these to prostate-specific antigen (PSA) testing for prostate cancer. Descriptive study based on data from the Western Australian Cancer Registry, the Australian Bureau of Statistics and the Health Insurance Commission. All newly diagnosed cases of prostate cancer and all deaths from prostate cancer in Western Australia from 1985 to 1996. Recorded incidences and mortality rates for prostate cancer. After increasing steadily from 42 per 100,000 person-years in 1985 to 61 in 1992, the recorded incidence more than doubled to 134 per 100,000 person-years in 1994, then fell sharply to 87 in 1996. Among men aged 50 years or more, those aged 50-54 years had the largest annual increases: 14% (95% confidence interval [CI], 10%-19%) from 1985 to 1992 and 108% (95% CI, 84%-134%) from 1992 to 1994. They also had the smallest annual decline between 1994 and 1996 (8%; 95% CI, 1% increase to 16% decrease). The mortality rate showed no sudden increases or decreases. In men aged 60 years or older, the mortality rate increased annually by 2.9% (95% CI, 2%-4%) from 1985 to 1996. The number of Medicare reimbursements for PSA tests increased until May 1995, then fell. There was a significant correlation between the monthly number of PSA tests and new cases of prostate cancer (P < 0.01). Following a period of steady increase, the recorded incidence of prostate cancer increased dramatically in 1992 because of screening by PSA testing. From 1994, these incidence figures declined almost as sharply, partly because of reductions in testing. The mortality rate has not shown any systematic deviation from its long-term trend.