Overdiagnosis of prostate cancer in Australia

An increase in prostate cancer incidence since the introduction of publicly funded PSA testing in 1989 but minimal changes in the mortality rate suggest a high degree of overdiagnosis in Australia.

Medicare data showed PSA testing increased steeply in men aged 45-74 years, 75-84 years and 85+ from 1989 to 2008 then declined in men in both younger age groups.

“While reported incidence of prostate cancer was rising before 1989, it appears that the introduction of the PSA test in 1989 was associated with a dramatic increase in incidence to a peak in 1994.”

“Prostate cancer mortality rates followed less well-marked trends,” the study found.

“Prostate cancer specific mortality rates in men aged 45–74 years remained low throughout the study period. Mortality in the older two age groups increased until the mid-1990s, more so in men ≥85 years. The more gradual increase in men aged 75–84 years until the mid 1990s was followed by a gradual decrease, while mortality rates stabilised in men ≥85 years (around ~800 per 100,000).”

The study said an effect of screening on mortality would be expected to occur many years after early detection but was not apparent.

Read more in Cancer Epidemiology

Male BRCA1 and BRCA2 carriers have higher cancer risks

The BRCA1 and BRCA2 pathogenic variants are associated with cancers other than female breast and ovarian cancers, new research shows.

Data from 5,341 families with at least one family member having a BRCA1 or BRCA2 variant showed that BRCA1 was associated with increased risks of male breast (RR = 4.30), pancreatic (RR = 2.36), and stomach (RR = 2.17) cancers.  BRCA2 pathogenic variants were also associated with increased risks of male prostate cancers (RR = 2.22) as well as increased risks of breast (RR = 44.0), stomach (RR = 3.69) and pancreatic (RR = 3.34) cancers

Previously suggested associations of BRCA1/2 variants with risks of other genitourinary cancers and melanoma were not observed.

The study authors said the findings had implications for screening male BRCA1/2 carriers where there were robust associations and higher lifetime risks such as gastrointestinal tract malignancies.

“The results also suggest that male relatives of known BRCA1/2 carriers should be informed about their individual cancer risk and encouraged to be tested,” they wrote in the Journal of Clinical Oncology

Most hospital-acquired complications are not preventable

Complications are common in hospitalised patients but rates are driven more by patient factors rather than hospital care quality factors that can be modified, new Australian research shows.

A review of 1.5 million admissions at 38 major public hospitals in South Australia and Victoria between 2015–2018 found that almost one in ten patients (9.7%) had a complication episode.

However the variations between hospitals were determined mostly by patient factors (overall correlation coefficient 0.55) whereas hospital factors accounted for only 5% of the variation.

The findings have important implications for the interpretation of hospital‐acquired complication reports and implementation of mitigation programs, the study authors said.

“Failure to differentiate between the two groups of factors may lead to practice changes that are clinically sound but ineffective in reducing complication rates. Increasing the funding of health care, improved clinical guidelines, and training and education may reduce rates of complications attributable to hospital factors and health care errors, but are unlikely to reduce those linked with patient‐related factors,” they wrote in the MJA.