BackgroundPrevious studies have shown that mammographic screening is associated with earlier stage diagnosis of breast cancer and use of breast conserving surgery. AimsThe current study aimed to quantify and validate these associations in multivariate analysis and investigate surgery type, adjuvant radiotherapy and immediate breast reconstruction (IBR) for invasive breast cancer or ductal carcinoma in situ (DCIS) by participation in BreastScreen NSW mammographic screening. MethodsA data linkage study of 10,931 women aged 40+ years surgically treated for breast cancers diagnosed in 2009-2011 using registry and routinely-collected data.Multivariable logistic regression was used to adjust treatment outcomes for patient and tumour characteristics. ResultsA third of women undergoing surgery had never screened, 46 per cent had screened recently (within 24 months) through BreastScreen NSW.Breast-conserving surgery (BCS) and use of adjuvant radiotherapy following BCS were more common among recently screened compared with never screened women.Differences in treatment outcomes remained after adjusting for patient and tumour characteristics.There were no significant differences in use of IBR with mastectomy by screening participation, with 9 per cent and 33 per cent of women receiving IBR for invasive cancer and DCIS respectively. ConclusionTreatments received by women with invasive breast cancer and DCIS varied by mammographic screening history.This may be due to differences in treatment referral pathways or patient engagement in healthcare.

BACKGROUND:Translating outcomes achieved by clinical trials into routine care is crucial to improving outcomes of glioblastoma (GBM). This study examines the extent to which an advance in treatment for GBM has translated into meaningful, population-level survival benefits in New South Wales (NSW), Australia.METHODS:This retrospective cohort study used linked population-based cancer registry, admitted patient, and mortality datasets. The cohort (n = 2604) included NSW residents aged ≥18 years with a histologically confirmed GBM and a surgical resection between July 2001 and December 2012. The study outcome was all-cause survival, examined using multivariable proportional hazard models. The main study factor was period of surgery, categorized into 4 periods corresponding to different eras in temozolomide (TMZ) use. Survival was examined over time by age (≤70 and >70 years) and for a subcohort selected to approximate the seminal European Organisation for Research and Treatment of Cancer (Stupp) protocol trial cohort. TMZ use was estimated using aggregate prescription claims data.RESULTS:Median survival in 2001-2003, 2004-2006, 2007-2009, and 2010-2012 was 7.4, 9.0, 9.8, and 10.6 months, and risk-adjusted 2-year survival was 8.2%, 13.8%, 15.5%, and 18.3%, respectively. Survival improved for those aged ≤70 years and those aged >70 years. In the proxy trial subcohort, median and 2-year survival were 14.3 months and 27.3%, respectively. The volume of TMZ prescribed annually increased rapidly from 2005.CONCLUSIONS:Introduction of TMZ into standard care in 2005 coincided with improvements in survival and a rapid increase in TMZ prescribing. Optimization of care has continued to improve survival of people with GBM in subsequent years.

OBJECTIVE:To examine risk of emergency hospital admission and survival following adjuvant chemotherapy for early breast cancer.METHODS:Linked data from New South Wales population-based and clinical cancer registries (2008-2012), hospital admissions, official death records and pharmaceutical benefit claims. Women aged ≥18 years receiving adjuvant chemotherapy for early-stage operable breast cancer in NSW public hospitals were included. Odds ratios (OR) for emergency hospitalisation within 6 months following chemotherapy initiation were estimated using logistic regression and survival using Kaplan-Meier and Cox proportional hazards methods.RESULTS:A total of 3,950 women were included and 30.6% were hospitalised. The most common principal diagnosis at admission was neutropenia (30.8%). Women receiving docetaxel/carboplatin/trastuzumab (TCH) and docetaxel/cyclophosphamide (TC) were the most frequently hospitalised. After adjustment for demographic and clinical factors, the increased risk of hospitalisation for TCH and TC remained compared with doxorubicin/cyclophosphamide 3-weekly (OR 1.71, 95% confidence interval [CI] 1.24-2.37 and OR 1.47, 95% CI 1.17-1.85 respectively). Five-year overall survival was similar for women who were (92.2%, 95% CI 90.7-93.8) and were not hospitalised (93.1%, 95% CI 92.1-94.1).CONCLUSION:Emergency hospitalisations following chemotherapy for early breast cancer were relatively common, especially following docetaxel-containing protocols. Further examination of reasons for admission is needed to inform actions to improve patient safety.