Does eating dairy foods increase your risk of prostate cancer?



If you’re a male who enjoys dairy, there’s no reason to stop having it.
From shutterstock.com

Rosemary Stanton, UNSW

Research Checks interrogate newly published studies and how they’re reported in the media. The analysis is undertaken by one or more academics not involved with the study, and reviewed by another, to make sure it’s accurate.


Recent headlines have warned a diet high in dairy foods may increase men’s risk of prostate cancer.

The news is based on a recent review published in the Journal of the American Osteopathic Association which claimed to find eating high quantities of plant-based foods may be associated with a decreased risk of prostate cancer, while eating high quantities of dairy products may be associated with an increased risk.

But if you’re a man, before you forego the enjoyment and known nutritional benefits of milk, cheese and yoghurt, let’s take a closer look at the findings.

What the study did

This study was a review, which means the researchers collated the findings of a number of existing studies to reach their conclusions.

They looked at 47 studies which they claim constitute a comprehensive review of all available data from 2006-2017. These studies examined prostate cancer risk and its association with a wide variety of foods including vegetables, fruits, legumes, grains, meat (red, white and processed), milk, cheese, butter, yoghurt, total diary, calcium (in foods and supplements), eggs, fish and fats.




Read more:
Six foods that increase or decrease your risk of cancer


Some studies followed groups of men initially free of prostate cancer over time to see if they developed the disease (these are called cohort studies). Others compared health habits of men with and without prostate cancer (called case-control studies). Some studies recorded the incidence of prostate cancer in the group while others concentrated on the progression of the cancer.

For every potential risk factor, the reviewers marked studies as showing no effect, or an increased or decreased risk of prostate cancer. The results varied significantly for all the foods examined.

For cohort studies (considered more reliable than case-control studies), three studies for vegan diets and one for legumes recorded decreased risk of prostate cancer. For vegetarian diets and vegetables, some reported decreased risk and some recorded no effect. Fruits, grains, white meat and fish appeared to have no effect either way.

An increased risk was reported for eggs and processed meats (one study each), red meat (one out of six studies), fats (two out of five), total dairy (seven out of 14), milk (six out of 15), cheese (one out of six), butter (one out of three), calcium (three out of four from diet and two out of three from supplements) and fats (two out of five).

Notably, some very large cohort studies included in the review showed no association for milk or other dairy products. And most case-control studies, though admittedly less reliable, showed no association.

The authors also omitted other studies published within the review period which showed no significant association between dairy and prostate cancer.

A person’s weight likely has more influence on their risk of developing prostate cancer than whether or not they eat dairy.
From shutterstock.com

So the inconsistency in results across the studies reviewed – including large cohort studies – amount to very limited evidence dairy products are linked to prostate cancer.

Could it be vitamin D?

In earlier research, a link between milk and prostate cancer has been attributed to a high calcium intake, possibly changing the production of a particular form of vitamin D within the body.

Vitamin D is an important regulator of cell growth and proliferation, so scientists believed it may lead to prostate cancer cells growing unchecked. But the evidence on this is limited, and the review adds little to this hypothesis.




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Perhaps the review’s most surprising omission is mention of the World Cancer Research Fund (WCRF) Continuous Update Project report on prostate cancer. This rigorous global analysis of the scientific literature identified much stronger risk factors that should be considered as possible confounding factors.

For example, the evidence is rated as “strong” that being overweight or obese, and being tall (separate to weight), are associated with increased risk of prostate cancer. The exact reasons for this are not fully understood but could be especially significant in Australia where 74% of men are overweight or obese.

A new Australian study found a higher body mass index was a risk factor for aggressive prostate cancer.

For dairy products and diets high in calcium, according to the WCRF, the evidence remains “limited”.




Read more:
Why full-fat milk is now OK if you’re healthy, but reduced-fat dairy is still best if you’re not


It’s about the whole diet

It’s not wise to judge any diet by a single food group or nutrient. A healthy diet overall should be the goal.

That being said, milk, cheese and yoghurt are included in Australia’s Dietary Guidelines because of evidence linking them with a lower risk of heart disease, type 2 diabetes, bowel cancer and excess weight. These dairy products are also sources of protein, calcium, iodine, several of the B complex vitamins, and zinc.

Evidence about dairy products and prostate cancer remains uncertain. So before fussing about whether to skip milk, cheese and yoghurt, men who wish to reduce their risk of prostate cancer would be better advised to lose any excess weight. – Rosemary Stanton


Blind peer review

I agree with the author of this Research Check who highlights there is a high degree of variability in the results of the studies examined in this review.

While the authors searched three journal databases, most comprehensive reviews search up to eight databases. Further, the authors did not undertake any assessment of the methodological quality of the studies they looked at. So the results should be interpreted with caution.

Although the authors concluded higher amounts of plant foods may be protective against prostate cancer, the figure presented within the paper indicates more studies reported no effect compared to a decreased risk, so how they came to that conclusion in unclear. For total dairy they present a figure showing there were as many studies suggesting no effect or lower risk as there were showing higher risk.

Importantly, they did not conduct any meta-analyses, where data are mathematically pooled to generate and overall effect across all studies.

As the reviewer points out, many other important sources of high quality data have not been included and there are a number of recent higher quality systematic reviews that could be consulted on this topic. – Clare CollinsThe Conversation

Rosemary Stanton, Visiting Fellow, School of Medical Sciences, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Do new cancer drugs work? Too often we don’t really know (and neither does your doctor)



The effectiveness of a drug may be evaluated based on its potential to shrink tumours – but this doesn’t necessarily equate to improved survival rates.
From shutterstock.com

Barbara Mintzes, University of Sydney and Agnes Vitry, University of South Australia

It’s hard to find anyone who hasn’t been touched by cancer. People who haven’t had cancer themselves will likely have a close friend or family member who has been diagnosed with the disease.

If the cancer has already spread, the diagnosis may feel like a death sentence. News that a new drug is available can be a big relief.

But imagine a cancer patient asks their doctor: “Can this drug help me stay alive longer?” And in all honesty the doctor answers: “I don’t know. There’s one study that says the drug works, but it didn’t show whether patients lived longer, or even if they felt any better.”

This might sound like an unlikely scenario, but it’s precisely what a team of UK researchers found to be the case when it comes to many new cancer drugs.




Read more:
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A look at the research

A study published last week in the British Medical Journal reviewed 39 clinical trials supporting approval of all new cancer drugs in Europe from 2014 to 2016.

The researchers found more than half of these trials had serious flaws likely to exaggerate treatment benefits. Only one-quarter measured survival as a key outcome, and fewer than half reported on patients’ quality of life.

Of 32 new cancer drugs examined in the study, only nine had at least one study without seriously flawed methods.

The researchers evaluated methods in two ways. First, they used a standard “risk of bias” scale that measures shortcomings shown to lead to biased results, such as if doctors knew which drug patients were taking, or if too many people dropped out of the trial early.

Second, they looked at whether the European Medicines Agency (EMA) had identified serious flaws, such as a study being stopped early, or if the drug was compared to substandard treatment. The EMA identified serious flaws in trials for ten of the 32 drugs. These flaws were rarely mentioned in the trials’ published reports.

From clinical trials to treatment – faster isn’t always better

Before a medicine is approved for marketing, the manufacturer must carry out studies to show it’s effective. Regulators such as the EMA, the US Food and Drug Administration (FDA) or Australia’s Therapeutic Goods Administration (TGA) then judge whether to allow it to be marketed to doctors.

National regulators mainly examine the same clinical trials, so the findings from this research are relevant internationally, including in Australia.




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Spot the snake oil: telling good cancer research from bad


There’s strong public pressure on regulators to approve new cancer drugs more quickly, based on less evidence, especially for poorly treated cancers. The aim is to get treatments to patients more quickly by allowing medicines to be marketed at an earlier stage. The downside of faster approval, however, is more uncertainty about treatment effects.

One of the arguments for earlier approvals is the required studies can be carried out later on, and sick patients can be given an increased chance of survival before it’s too late. However, a US study concluded that post-approval studies found a survival advantage for only 19 of 93 new cancer drugs approved from 1992 to 2017.

If the evidence for a new cancer drug is flawed, this leaves patients vulnerable to false hope.
From shutterstock.com

So how is effectiveness measured currently?

Approval of new cancer drugs is often based on short-term health outcomes, referred to as “surrogate outcomes”, such as shrinking or slower growth of tumours. The hope is these surrogate outcomes predict longer-term benefits. For many cancers, however, they have been found to do a poor job of predicting improved survival.

A study of cancer trials for more than 100 medicines found on average, clinical trials that measure whether patients stay alive for longer take an extra year to complete, compared to trials based on the most commonly used surrogate outcome, called “progression free survival”. This measure describes the amount of time a person lives with a cancer without tumours getting larger or spreading further. It’s often poorly correlated with overall survival.

A year may seem like a long wait for someone with a grim diagnosis. But there are policies to help patients access experimental treatments, such as participating in clinical trials or compassionate access programmes. If that year means certainty about survival benefits, it’s worth waiting for.

Approving drugs without enough evidence can cause harm

In an editorial accompanying this study, we argue that exaggeration and uncertainty about treatment benefits cause direct harm to patients, if they risk severe or life-threatening harm without likely benefit, or if they forgo more effective and safer treatments.

For example, the drug panobinostat, which is used for multiple myeloma patients who have not responded to other treatments, has not been shown to help patients live longer, and can lead to serious infections and bleeding.

Inaccurate information can also encourage false hope and create a distraction from needed palliative care.

And importantly, the ideal of shared informed decision-making based on patients’ values and preferences falls apart if neither the doctor nor the patient has accurate evidence to inform decisions.




Read more:
If we don’t talk about value, cancer drugs will become terminal for health systems


In countries with public health insurance, such as Australia’s Pharmaceutical Benefits Scheme (PBS), patients’ access to new cancer drugs depends not just on market approval but also on payment decisions. The PBS often refuses the pay for new cancer drugs because of uncertain clinical evidence. In the cases of the drugs in this research, some are available on the PBS, while others are not.

New cancer drugs are often very expensive. On average in the US, a course of treatment with a new cancer drug costs more than US$100,000 (A$148,000).

Cancer patients need treatments that help them to live longer, or at the very least to have a better quality of life during the time that they have left. In this light, we need stronger evidence standards, to be sure there are real health benefits when new cancer drugs are approved for use.

The article has been updated to reflect Agnes Vitry’s current role at the University of South Australia.The Conversation

Barbara Mintzes, Senior Lecturer, Faculty of Pharmacy, University of Sydney and Agnes Vitry, Senior lecturer, University of South Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Here’s what you can eat and avoid to reduce your risk of bowel cancer



It’s not certain why, but fibre has protective effects against bowel cancer.
http://www.shutterstock.com

Suzanne Mahady, Monash University

Australia has one of the highest rates of bowel cancer in the world. In 2017, bowel cancer was the second most common cancer in Australia and rates are increasing in people under 50.

Up to 35% of cancers worldwide might be caused by lifestyle factors such as diet and smoking. So how can we go about reducing our risk of bowel cancer?




Read more:
What’s behind the increase in bowel cancer among younger Australians?


What to eat

Based on current evidence, a high fibre diet is important to reduce bowel cancer risk. Fibre can be divided into 2 types: insoluble fibre, which creates a bulky stool that can be easily passed along the bowel; and soluble fibre, which draws in water to keep the stool soft.

Fibre from cereal and wholegrains is an ideal fibre source. Australian guidelines suggest aiming for 30g of fibre per day for adults, but fewer than 20% of Australian adults meet that target.

Wheat bran is one of the richest sources of fibre, and in an Australian trial in people at high risk of bowel cancer, 25g of wheat bran reduced precancerous growths. Wheat bran can be added to cooking, smoothies and your usual cereal.

It’s not clear how fibre may reduce bowel cancer risk but possible mechanisms include reducing the time it takes food to pass through the gut (and therefore exposure to potential carcinogens), or through a beneficial effect on gut bacteria.

Once bowel cancer is diagnosed, a high fibre diet has also been associated with improved survival.

Dairy is ‘probably’ protective against bowel cancer.
from http://www.shutterstock.com



Read more:
Interactive body map: what really gives you cancer?


Milk and dairy products are also thought to reduce bowel cancer risk. The evidence for milk is graded as “probably protective” in current Australian bowel cancer guidelines, with the benefit increasing with higher amounts.

Oily fish may also have some protective elements. In people with hereditary conditions that make them prone to developing lots of precancerous growths (polyps) in the bowel, a trial where one group received a daily supplement of an omega 3 polyunsaturated fatty acid (found in fish oil) and one group received a placebo, found that this supplement was associated with reduced polyp growth. Whether this is also true for people at average risk of bowel cancer, which is most of the population, is unknown.

And while only an observational study (meaning it only shows a correlation, and not that one caused the other), a study of bowel cancer patients showed improved survival was associated with daily consumption of coffee.

What to avoid

It’s best to avoid large quantities of meat. International cancer authorities affirm there is convincing evidence for a relationship between high meat intake and bowel cancer. This includes red meat, derived from mammalian muscle such as beef, veal, lamb, pork and goat, and processed meat such as ham, bacon and sausages.

Processed meats have undergone a preservation technique such as smoking, salting or the addition of chemical preservatives which are associated with the production of compounds that may be carcinogenic.

Evidence also suggests a “dose-response” relationship, with cancer risk rising with increasing meat intake, particularly processed meats. Current Australian guidelines suggest minimising intake of processed meats as much as possible, and eating only moderate amounts of red meat (up to 100g per day).

What else can I do to reduce the risk of bowel cancer?

The key to reducing cancer risk is leading an overall healthy lifestyle. Adequate physical activity and avoiding excess fat around the tummy area is important. Other unhealthy lifestyle behaviours such as eating lots of processed foods have been associated with increased cancer risk.

And for Australians over 50, participating in the National Bowel Cancer Screening program is one of the most effective, and evidence-based ways, to reduce your risk.




Read more:
INTERACTIVE: We mapped cancer rates across Australia – search for your postcode here


The Conversation


Suzanne Mahady, Gastroenterologist & Clinical Epidemiologist, Senior Lecturer, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Shorten promises $2.3 billion package to relieve costs for cancer patients


Michelle Grattan, University of Canberra

Bill Shorten has promised his government would introduce a A$2.3 billion four year package to slash cancer patients’ out-of-pocket costs, and has committed $1 billion to give extra tax relief for low income earners, above what they would get from Tuesday’s budget.

In his budget reply on Thursday night, the opposition leader pitched to voters on a Labor strength – health – declaring his cancer care plan would be the “most important investment in Medicare since Bob Hawke created it”.

Shorten rejected the government’s second and third tranches of tax cuts, due to start in 2022-23 and 2024-25 and worth about $143 billion of the $158 billion ten year package. The last stage was a “radical, right-wing, flat tax experiment”, far off in time and skewed disproportionately to a relative few, he said.

Stressing Labor’s economic responsibility, Shorten recommitted to delivering “stronger surpluses, paying down debt faster” than the government.

“What we need is a fighting fund for the country, a strong surplus to protect us from international shocks”, he said.

He attacked the government – which has a $7.1 billion surplus in its budget for next financial year – for “shortchanging the NDIS [National Disability Insurance Scheme] by $1.6 billion, to prop up a flimsy surplus forecast”.

Shorten – who in his speech referred to his late mother Ann’s battle with breast cancer – said the cancer care plan would provide for millions of free scans and consultations, and cheaper medicines.

Cancer “is frightening, it’s isolating, it’s exhausting”. And all too often, it was impoverishing, he said.

“For so many people, cancer makes you sick and then paying for the treatment makes you poor. And that’s a fact that I think a lot of Australians would be surprised to learn.

“Because if you haven’t been through it yourself, you might not realise that all those vital scans and tests and consultations with specialists aren’t fully covered by Medicare. Instead, they cost hundreds of dollars, adding up to thousands, out of your own pocket,” he said.

One in four women with breast cancer paid more than $10,000 for two years of scans and tests, he said. Some men with prostate cancer were paying more than $18,000. Most people with skin cancer – and Australia has the highest rates of this cancer in the world – paid more than $5000 for the first two years of treatment.

Each year 300,000 people who needed radiology did not get it, because they couldn’t afford it.

People needing treatment for cancer were often not well enough to work, so they were already under massive financial strain, Shorten said. Those living in regional areas had the extra costs of travel and accommodation.




Read more:
Shorten’s budget reply will outbid government on tax relief for low income earners


A Labor government would:

  • invest $600 million towards eliminating all out-of-pocket costs for diagnostic imaging, with up to six million free cancer scans funded through Medicare – reducing out-of-pocket costs from hundreds of dollars to zero. This would include MRIs too. At present only half the MRI machines were covered by Medicare, and regional patients often had to drive for hours or pay thousands of dollars. “If we win the election, not only will we provide more MRI machines to communities where they are needed most, but Labor will guarantee that every single MRI machine in Australia that meets a national quality standard is covered by Medicare for cancer scans.”

  • invest $433 million to fund three million free consultations with oncologists and surgeons. Over four years this would mean an extra three million appointments were bulk billed, reducing costs of hundreds of dollars to nothing

  • guarantee that every drug recommended by independent experts would be listed on the Pharmaceutical Benefits Scheme.

On tax, Shorten said people earning between $48,000 and $126,000, no matter who they voted for in May, would get the same tax refund.

But the Liberal plan did not do enough for the 2.9 million people who earned less than $40,000 – about 57% of whom were women.

In Labor’s first budget Labor would provide a bigger tax refund for low earners than the Liberals proposed.

“6.4 million working people will pay the same amount of income tax under Labor as the Liberals – and another 3.6 million will pay less tax under Labor,” he said. “All told, an extra billion dollars, for low income earners”.

Under further details provided by Labor, it said workers earning up to $37,000 a year would receive a tax cut of up to $350. For workers earning between $37,000 and $48,000 the value of the tax offset would increase up to the maximum tax offset of $1,080.

A worker on $35,000 would get a tax cut of $255 a year under the Liberals, compared to $350 under Labor. A worker on $40,000 would receive a cut of $480 under the Liberals compared to $549 under Labor.

On TAFE Shorten promised to double the size of Labor’s rebuilding TAFE program – up to $200 million – to renovate campuses.

Labor is committed to paying the upfront fees for 100,000 TAFE places to get more Australians in high priority courses. “I am proud to announce that 20,000 of these places will be allocated to a new generation of aged care workers and paid carers for the NDIS,” Shorten said.

Finance minister Mathias Cormann said Shorten had put forward an agenda for $200 billion in higher taxes that would weaken the economy and bring higher unemployment. The Conversation

Provided by Labor.

Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.

As Mediscare 2.0 takes centre stage, here’s what you need to know about hospital ‘cuts’ and cancer funding


Stephen Duckett, Grattan Institute

Health is proving a bone of contention in the 2019 election campaign. Labor has positioned health as a key point of difference, and the Coalition is arguing that Labor’s promises are untrue in one case and underfunded in another.

This cheat sheet will help you sort fact from fiction in two key health policy areas: public hospital funding and cancer care.

Public hospitals

In his budget reply, Opposition Leader Bill Shorten promised that Labor would restore every dollar the government had “cut” from public hospital funding.

The government counter-claimed that hospital funding has increased. So who is right?

The short answer is both.

In 2011, the then Labor government negotiated a funding agreement with the states for the Commonwealth to share 45% of the growth in the cost of public hospital care, funded at the “national efficient price”. This price is based on the average cost of the procedure, test or treatment.

The funding share was to increase to 50% of growth from July 1, 2017.




Read more:
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At the 2013 election, the then Liberal opposition agreed to match that promise and, indeed, claimed they were the only ones who could be trusted to keep the promise:

A Coalition government will support the transition to the Commonwealth providing 50% growth funding of the efficient price are hospital services as proposed. But only the Coalition has the economic record to be able to deliver.

However, in the 2014 budget the Coalition scrapped its promise. The 2014 budget papers list the savings that were made by the decision. It was a clear and documented cut that the Coalition was proud to claim at the time.

The green line represents the Gillard hospital funding agreement; the blue line is the revised projection from the 2014 budget.
Budget 2014-15

Since then, the Turnbull government has backtracked on the 2014 cuts to health but only to restore sharing to 45% of the costs of growth.

Labor has estimated the impact of the gap between 45% and 50% on every public hospital in the country, and spruiks the difference at every opportunity.

Hospital costs increase faster than inflation because of growth and ageing population, the introduction of new technologies, and new approaches to treatment.

As a result, the Commonwealth’s existing 45% sharing policy drives increased spending, and so Commonwealth spending is now at record levels, albeit not at the even higher levels that Labor had promised.

Labor’s promise is, appropriately, phrased as an additional quantum of money to the states, sufficient to restore the 50% share in the cost of growth.

The public hospital funding gap comes down to how much of the growth in hospital funding each party has committed to.
Shutterstock

The details of how this funding should be operationalised to the states should be left to detailed negotiations after the election as it is not good practice for all the details of your negotiating position to be aired in the heat of a campaign.

So Labor is right to say hospital funding is lower than it would have been if the 50% growth share commitment had been maintained. But the Coalition is right to say the Commonwealth is spending more on hospital care than when it came to office.

Cancer care

The second major element of the Labor campaign was a high-profile A$2.3 billion package to address high out-of-pocket costs for Australians with cancer. The package has three key components:

  • additional public hospital outpatient funding to reduce waiting times
  • a new bulk-billing item for consultations
  • more funding for MRI machines for cancer diagnosis.



Read more:
Labor’s cancer package would cut the cost of care, but beware of unintended side effects


Labor did not promise to eliminate out-of-pocket costs for cancer, not even for consultations. It claimed bulk-billing would increase from 40% to 80% of consultations.

This promise has led to another showdown between Labor and the Coalition. Health Minister Greg Hunt claims to have found a A$6 billion black hole in Labor’s cancer policy.

The Coalition has produced a list of 421 Medicare items used for cancer treatment – including treatment in private hospitals – and noted Labor has not allocated funds to cover the fees specialists charge for these items.

But Labor rightly claims the 421-item list is not what it promised. Labor’s promise was about increasing the rate of bulk-billing for consultations and is based on a new item which is only available if the specialist bulk-bills.

Expect more claims and counter-claims in the weeks ahead.The Conversation

Stephen Duckett, Director, Health Program, Grattan Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Cutting cancer costs is a worthy policy, but we need to try to prevent it too


Terry Slevin, Australian National University and Simone Pettigrew, Curtin University

Removing the financial worries from Australians diagnosed with cancer is bound to be a popular move.

The Opposition’s A$2.3 billion cancer care plan – announced in Bill Shorten’s budget reply speech on Thursday night – aims to ensure cancer treatment costs for scans, specialists and drugs are bulk billed or subsidised under the Pharmaceutical Benefits Scheme (PBS). It would be a hard heart indeed that did not welcome such a move.

Maybe even better than avoiding the out-of-pocket costs of treatment is preventing future cases of cancer. Around one-third of all cancers are preventable by not smoking, staying at a healthy weight, eating healthy food, being physically active, minimising alcohol consumption, and avoiding excessive sun exposure.

But apart from a small commitment to tobacco control in the 2019 budget, neither the government or opposition has made even the vaguest commitment to, or investment in, cancer prevention.




Read more:
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So far we have heard virtually nothing from either party on efforts to tackle obesity, promote healthy eating, encourage more physical activity, reduce alcohol consumption, promote sun protection, or boost efforts to increase participation in cancer screening and vaccination programs.

The government currently spends around A$2 billion a year on “public health”, which includes monitoring, regulation, as well as prevention and vaccination. This amounts to less than 2% of the nation’s total health expenditure of A$170 billion. That is about half of what we spend on patient transport.

A boost to 5% – or closer to A$8.5 billion – could make enormous strides in better prevention programs, driven by high-quality research.

Poor track record

When it comes to investment in disease prevention, the story is not strong for the Coalition.

The Rudd Labor government established the Australian National Preventive Health Agency (ANPHA) in 2009, with funding of around A$60 million a year. The agency ran national programs focusing on tobacco, alcohol, healthy eating and reducing alcohol consumption.

But the new Abbott government axed the agency in 2014, after drafting legislation to expunge it from the books.




Read more:
INTERACTIVE: We mapped cancer rates across Australia – search for your postcode here


From 2008 to 2014, the National Partnership Agreement on Preventive Health (NPAPH) funded programs in Australia tackling unhealthy eating, physical inactivity, drinking too much, and smoking, via a funding pool of A$872 million.

Programs such as Live Lighter and Foodcents, for example, provided evidenced-based and practical help for people to live healthy lives. Other programs improved the availability of nutritious foods, and ensured walking and cycling were safe and viable components of transport planning.

In 2012, the then Labor government committed to the continuation of the NPAPH to 2018, but it was axed by the Abbott government in the 2014 federal budget.

Prevention programs aim to make it easier for people to make healthy choices, such as being physically active and eating a nutritious diet.
Annie Spratt

This took hundreds of millions of dollars otherwise committed to prevention efforts out of the federal budget calculations.

All of these discontinued efforts were likely to have had a major effect on reducing future generations of Australians from hearing those awful words: you have cancer.

Like any human endeavour that aims for big changes in systems and behaviours, stopping and starting the programs that lead these changes diminishes the prospect of success.

So why is it hard to get governments to invest in prevention?

Strong and influential industries consistently lobby governments to protect their commercial interests. That’s what happens in a market economy democracy. The alcohol, processed food and even tobacco industries continue to exercise an influential voice in the halls of power.

Unsurprisingly, industry aggressively opposes higher taxes on these products (“sin taxes”) and programs discouraging their use.




Read more:
More than one in four Aussie kids are overweight or obese: we’re failing them, and we need a plan


It is common to hear politicians tell stories of individuals, “real people” who benefit from a new treatment or access to new life-saving medical care or drugs. We all connect with these heart-warming stories and they illustrate the importance of the public funding investment.

Such stories are harder to tell in prevention. How do we find the 64-year-old enjoying his granddaughter’s first day at school, largely because he did not die of a smoking-related disease in his 50s because tobacco control efforts in his youth meant he did not take up smoking?

To tell of our success, we revert to dry and dusty but impressive statistics, with one estimate of 500,000 premature deaths prevented over the past 20 years.

Effective prevention policies, such as putting a minimum floor price on alcohol, work to reduce alcohol-related harm. But making it more difficult to reduce the price of alcohol is politically unpopular.

Reforms such as expanding smoke-free areas are taken for granted now, but were opposed when first introduced.

Tobacco control measures are now accepted and welcomed, but that wasn’t always so.
Patrick Brinksma

Finally, the benefits of prevention often take many years, even decades, to arrive. Political timeframes are often linked to election cycles of three or four years.

A long-term view is vital. Each dollar invested in skin cancer prevention, for example, returns about A$2.20 in cost saving in avoiding cost of treating the disease. But there are decades between reducing kids’ sun exposure and avoiding treatment when those kids reach their 50s and 60s.

As the election campaign unfolds, let’s hope both aspiring Australian governments continue to show a genuine interest in the health of Australians and commit to preventing disease. Is 5% of the health budget too much to ask for that?The Conversation

Terry Slevin, Adjunct Professor, School of Psychology, Curtin University and College of Health and Medicine, Australian National University and Simone Pettigrew, Professor, School of Psychology, Curtin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Labor’s cancer package would cut the cost of care, but beware of unintended side effects



File 20190408 2909 1dbbi9k.jpg?ixlib=rb 1.1
The median out-of-pocket expenses for breast cancer treatment is A$4,192.
ESB Professional/Shutterstock

Kees Van Gool, University of Technology Sydney and Jane Hall, University of Technology Sydney

Labor’s big-ticket election promise is a A$2.3 billion package to provide free medical scans and specialist consultations for cancer patients, plus automatic listing of new cancer therapies on the Pharmaceutical Benefits Scheme (PBS) once they’re recommended by the nation’s expert advisory panel.

One in two Australians will be diagnosed with cancer by the age of 85, and around 145,000 new diagnoses are made each year. So most of us have a close relative or friend who will be affected by the policy.

But there are some important policy considerations a Shorten government would need to plan for to ensure the package provides optimal care, improves patient outcomes, and does actually reduce out-of-pocket costs.




Read more:
Shorten promises $2.3 billion package to relieve costs for cancer patients


What’s the problem with cancer care?

New therapies for cancer are rapidly evolving, and are often extremely expensive. Seeking treatment involves navigating a complex array of public and private providers across multiple health care sectors, often leaving patients with high out-of-pocket costs.

These costs are highly dependent on which providers the patients choose (and the fees they charge), the level of private insurance cover, and the volume of services used.

A recent Queensland study found the median out-of-pocket expenses for a breast cancer patient, for example, was A$4,192.

It’s possible but very time-consuming for patients to “shop around” to reduce costs. But this is an unreasonable burden to place on patients.

The Labor proposal provides an opportunity to develop a comprehensive cancer control program that encompasses prevention, early diagnosis, treatment and follow-up – at a reasonable cost.




Read more:
Cutting cancer costs is a worthy policy, but we need to try to prevent it too


Better care for cancer patients

Cancer treatment is well researched; there are clear evidence-based guidelines that establish clinical pathways for the best treatment.

Nevertheless, there is substantial variation in treatments given to cancer patients. This difference cannot always be explained by their clinical conditions, and sometimes the care is not evidence-based.

It’s important that the proposed reforms do not just fund more care, but support more of the best care.

The approach that has shown promise in other countries is known as “bundled payments”.

Under bundled payments, a series of health care services – that can span over time and across multiple health care sectors and providers – are bundled together for funding purposes. This gives providers or institutions greater flexibility in how they spend money delivering care to the patient.

There is a danger that bundling can provide incentives to skimp on care, because the provider receives the same amount of funding no matter how much care is provided. But this can be addressed by monitoring the quality of care and the patients’ outcomes.

Ensuring the financial benefits flow to patients

Australian governments have made several attempts to provide better safety nets that cushion patients from extra charges.

Study after study shows that, in these circumstances, providers are likely to raise their fees. So while patients get some financial benefit, the doctors benefit also.

Under current Medicare rules, the Australian government does not and cannot determine doctors’ fees. It can only determine the amount of the Medicare benefit.

In general practice, most consultations are bulk-billed implying that the fee the doctor charges is equivalent to the Medicare benefit.

Only 31% of specialist consultations are bulk-billed, leaving more patients with an out-of-pocket payment.




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What can government do to encourage cancer care providers to bulk-bill?

Labor has announced they will add a bulk-billing incentive payment, as occurs in primary care. Specialists will receive an additional payment if they bulk-bill a cancer-related service.

This will not guarantee that every patient will not incur any out-of-pocket costs – although it should increase the likelihood that they will. Indeed, the Labor target is that 80% of patients will be bulk-billed.

However, previous research has shown that while the GP bulk-billing incentive led to a reduction in costs for those eligible (concession card holders), it also increased costs for those not eligible.

Careful monitoring is required to ensure the volume of services – and their fees for non-cancer patients – do not go up.

Not all cancer care is based on the best available evidence.
Napocska/Shutterstock

A further unprecedented complication is that for some services, it will be necessary to differentiate Medicare payments on the basis of the patient’s cancer status.

To guarantee patients face no out-of-pocket costs would require more radical reform. Again, the bundled payment system could be a vehicle for such reforms whereby payments are conditional on all the patient’s service providers agreeing to deliver care with no additional fee to the patient.

Depending on whether a patient is privately insured, the bundled payment could be financed by private health funds and Medicare.

Of course, it’s not yet clear that bundled payment schemes can be directly applied to the Australian setting.

The Labor cancer package requires careful and rigorous research effort to inform and guide the policy development.

A new vision for Medicare

Medicare is now 35 years old. It was built on fee-for-service payment, and focused on short, acute episodes of illness.

Now it’s time to move to new funding mechanisms that provide better care for complex, ongoing conditions, at a cost patients and the country can be sure represent efficient use of resources.




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Cancer is a good place to start and it could indeed be the most significant reform of Medicare so far.

Imagine a health system where every Australian was assured of optimal care, no matter what their illness or economic circumstances. That is a health system worth paying taxes for.The Conversation

Kees Van Gool, Health economist, University of Technology Sydney and Jane Hall, Professor of Health Economics and Director, Centre for Health Economics Research and Evaluation, University of Technology Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

What’s behind the increase in bowel cancer among younger Australians?



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Bowel cancer was the second most commonly diagnosed cancer in Australia in 2017.
from shutterstock.com

Suzanne Mahady, Monash University; Eleonora Feletto, Cancer Council NSW, and Karen Canfell, UNSW

Bowel cancer mostly affects people over the age of 50, but recent evidence suggests it’s on the rise among younger Australians.

Our study, published recently in Cancer Epidemiology, Biomarkers and Prevention, found the incidence of bowel cancer, which includes colon and rectal cancer, has increased by up to 9% in people under 50 from the 1990s until now.

Our research examined all recorded cases of bowel cancer from the past 40 years in Australians aged 20 and over. Previous studies assessing bowel cancer incidence in young Australians have also documented an increase in the younger age group.




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Bowel cancer includes cancer of the colon and rectum.
Wikimedia Commons

This trend is also being seen internationally. A study from the United States suggests an increase in bowel cancer incidence in people aged 54 and younger. The research shows rectal cancer incidence increased by 3.2% annually from 1974 to 2013 among those aged age 20-29.

Bowel cancers are predicted to be the third most commonly diagnosed cancer in Australia this year. In 2018, Australians have a one in 13 chance of being diagnosed with bowel cancer by their 85th birthday.

Our study also found bowel cancer incidence is falling in older Australians. This is likely, in part, to reflect the efficacy of the National Bowel Cancer Screening Program, targeted at those aged 50-74. Bowel cancer screening acts to reduce cancer incidence, by detecting and removing precancerous lesions, as well as reducing mortality by detecting existing cancers early.

This is important, as bowel cancer has a good cure rate if discovered early. In 2010 to 2014, a person diagnosed with bowel cancer had a nearly 70% chance of surviving the next five years. Survival is more than 90% for people who have bowel cancer detected at an early stage.

That is why screening is so effective – and we have previously predicted that if coverage rates in the National Bowel Screening Program can be increased to 60%, around 84,000 lives could be saved by 2040. This would represent an extraordinary success. In fact, bowel screening has potential to be one of the greatest public health successes ever achieved in Australia.

Why the increase in young people?

Our study wasn’t designed to identify why bowel cancer is increasing among young people. However, there are some factors that could underpin our findings.

The increase in obesity parallels that of bowel cancer, and large population based studies have linked obesity to increased cancer risk.




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Unhealthy lifestyle behaviours, such as increased intake of highly processed foods (including meats), have also been associated with increased bowel cancer risk. High quality studies are needed to explore this role further.

Alcohol is also thought to be a contributor to increasing the risk of bowel cancer.

Alcohol is thought to contribute to an increased risk of bowel cancer.
from shutterstock.com

So, should we be lowering the screening age in Australia to people under the age of 50?

Evaluating a cancer screening program for the general population requires a careful analysis of the potential benefits, harms, and costs.

A recent Australian study modelled the trade-offs of lowering the screening age to 45. It showed more cancers would potentially be detected. But there would also be more colonoscopy-related harms such as perforation (tearing) in an extremely small proportion of people who require further evaluation after screening.

A lower screening age would also increase the number of colonoscopies to be performed in the overstretched public health system and therefore could have the unintended consequence of lengthening colonoscopy waiting times for people at high risk.




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How to reduce bowel cancer risk

One of the most common symptoms of bowel cancer is rectal bleeding. So if you notice blood when you go to the toilet, see your doctor to have it checked out.

A healthy lifestyle including adequate exercise, avoiding smoking, limiting alcohol intake and eating well, remains most important to reducing cancer risk.

Aspirin may also lower risk of cancer, but should be discussed with your doctor because of the potential for side effects including major bleeding.

Most importantly, we need to ensure eligible Australians participate in the current evidence-based screening program. Only 41% of the population in the target 50-74 age range completed their poo tests in 2015-2016. The test is free, delivered by post and able to be self-administered.The Conversation

Suzanne Mahady, Gastroenterologist & Clinical Epidemiologist, Senior Lecturer, Monash University; Eleonora Feletto, Research fellow, Cancer Council NSW, and Karen Canfell, Adjunct professor, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Time doesn’t heal all wounds: how DNA damage as we age causes cancer


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Our risk of cancer is determined by a complex mix of genes, environment and lifestyle factors.
Claudia van Zyl

Ian Majewski, Walter and Eliza Hall Institute and Edward Chew, Walter and Eliza Hall Institute

As we age, our bodies inevitably deteriorate. Some changes, like grey hair and wrinkles, are easily visible. Others, like high blood pressure, often go unnoticed, but can be deadly.

Just as our body shows signs of ageing, so does our genome. Damage comes from chemical reactions that alter our DNA, and from errors introduced when it is copied. Our cells protect against these ravages, but these mechanisms are not foolproof and cells gradually accumulate DNA damage over a lifetime.

As a consequence of this damage, your genome is not the same in every cell; you are a patchwork of cells with subtle differences in their DNA. When a cell divides it will pass on these changes, and as they accumulate there is more and more likelihood that there will be consequences.

If these changes – we call them mutations – chip away at the systems that govern cell proliferation and survival, this can lead to cancer.

Our latest research, published today in the journal Blood, provides new clues about how our cells protect their genome and guard against cancer.

Guarding the genome

Nearly 10% of cancers have a familial component. Genes like BRCA1 and TP53 are among the best known cancer susceptibility genes, and both are involved in coordinating the cell’s response to DNA damage.

BRCA1 helps to repair a specific type of DNA damage, in which both strands of DNA are broken. Inheriting a defective BRCA1 gene elevates the lifetime risk of both breast and ovarian cancer.




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When DNA repair mechanisms break down, cells can accumulate staggering numbers of mutations, and cancer becomes almost inevitable.

Beyond genetics, a complex mix of environmental and lifestyle factors modify cancer risk.

When we read the genome of a cancer it is possible to attribute mutations to certain types of stress. UV radiation, for example, will fuse certain DNA bases. The UV damage signature is writ large in melanoma, a cancer linked to sun exposure.

Lung cancers from smokers and non-smokers have different mutation patterns because of the action of chemicals in cigarette smoke that attack the DNA.

We can also use this approach to diagnose defective DNA repair, as each defect triggers a characteristic pattern of mutations. In this way, mutation signatures can help us understand why a cancer has developed.

A ticking genetic clock

Smoking, UV radiation and X-rays all damage your DNA, but damage also comes from reactive molecules present within the cell. These molecules are fundamental to the chemistry of life – take water, for example.




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Water is a very reactive molecule and can do damage to our DNA. One of the most common mutations, either in cancer or in normal cells, results from water molecules reacting with methylated DNA.

DNA methylation is a small chemical modification that acts as a signpost on top of our genetic code. It helps to control which genes are switched on or off. This fine-tuning is essential for normal development, but methylation also makes DNA more susceptible to damage. Most of these events are quickly repaired, but the damage is unrelenting and some sneak through.

Cells accumulate mutations when DNA repair mechanisms break down.
K.D.P/Shutterstock

Methylation damage is the most prominent feature of an ageing genome. It’s so pervasive and reliable it has been proposed as a molecular clock that marks ageing. But our new research shows this process occurs more rapidly in some people.

We found and studied three people whose pathways to repair methylation damage had broken down. They all lacked a DNA repair protein called MBD4, which led to a marked accumulation of methylation damage – as though their cells were ageing prematurely.

All three developed an aggressive form of leukaemia in their early 30s, a cancer which usually wouldn’t be seen until the person is in their 60s or 70s.

Methylation damage plays a role in most cancers, but in these cases it was the primary driver of the disease.

While complete inactivation of MDB4 – as occurred in the three participants – is extremely rare, our findings raise the question of how more subtle differences in DNA repair shape cancer risk, particularly in the context of ageing.

Turning back the clock

Ageing contributes to cancer risk in myriad ways. While we’ve focused here on the buildup of DNA damage, our immune system also plays an important role and tends to fade as we get older.

Lifestyle factors – such as obesity, stress and diet – also provide a cumulative risk that builds over a lifetime.




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Understanding the interplay between these factors is key to finding strategies that will effectively diffuse the health consequences associated with ageing.

Our research is helping to tease apart the contribution of DNA damage in different disease processes. Our findings suggest that some people accumulate more DNA damage than others – their clocks are ticking a little faster – and measuring these differences may help to spot people at risk of developing cancer, or help match them with more effective treatments.The Conversation

Ian Majewski, Laboratory Head & Victorian Cancer Agency Fellow, Cancer & Haematology Division, Walter and Eliza Hall Institute and Edward Chew, PhD candidate, Cancer and Haematology Division, Walter and Eliza Hall Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Cancer costs Australia nearly $2 billion per year in lost labour



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A new study calls for additional support from government, employers and the medical profession for cancer survivors wanting to return to work.
from shutterstock.com

Antolin Bonnett, The Conversation

Australia loses nearly A$2 billion of GDP every year due to people with cancer leaving the workforce.

A study published today in BMC Public Health showed that 67% of Australians of working age (25-64) diagnosed with cancer reported changes to their employment in 2015, such as reduced hours and stopping work. Around 50,000 people with cancer weren’t working at all.

The authors calculated this equated to a loss of A$1.7 billion in GDP.

Compared to the workforce rates of other long-term health conditions, such as chronic epilepsy, heart disease and diabetes, those with cancer were almost twice as likely to not be in the workforce.

A previous report showed loss of productivity due to cancer diagnosis accounts for around 54% of the total lifetime cost of cancer. This is compared to only 29% in direct costs, such as medical treatment.

Previous studies show around 40% of cancer survivors will return to work after treatment at six months following a diagnosis, and 89% after two years.

The authors called for additional support from government, employers and the medical profession for cancer survivors wanting to return to work.

Lead author and lecturer at James Cook University, Nicole Bates, said returning to work was “an important milestone, both financially and emotionally”.

Australians with a cancer diagnosis who didn’t have a tertiary qualification were nearly four times as likely to not be working as those who did. Other factors affecting work status included having a manual labour job, less flexible working arrangement, and the type of cancer and treatment.




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We need more support systems for people who want to work during and after cancer treatment


Professor and medical oncologist at Flinders University, Bogda Koczwara, said lack of flexible employment was a significant roadblock to cancer survivors re-entering the workforce. She added Australian systems only allowed people to be either “on or off”.

“In Australia, there isn’t a lot of room for return to employment. Sometimes a person may be willing to return to work but not capable of doing so at full capacity. But they’re better off staying at home and claiming full insurance than going back to work partially because that way they lose their payments,” she said.

Professor Koczwara, who was not involved in the study, also said it was important to not only consider medical ways to assist cancer patients returning to work.

Miss Bates said employers could work with the cancer survivor and their medical professionals to “enable returning to work within their capabilities”.

Director of the Australian Healthy Policy Collaboration at Victoria University, Rosemary Calder, said it would be useful to explore how cancers that shared common risk factors with preventable chronic diseases contributed to the productivity impact.

“Given what we know about the shared risk factors for some cancers and other chronic diseases, if we invested in prevention of these risk factors, we potentially could reduce the productivity impact of cancers related to those risk factors,” she said.




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The researchers analysed data from the 2015 Australian Bureau of Statistics Survey of Disability, Ageing and Carers according to education, health condition, and employment status.

The study was limited by its inability to differentiate the rates of workforce participation of those currently undergoing treatment compared to those in remission.

The ConversationThis article has been updated to include other long-term health conditions that affected return to work, and clarify that the estimated loss of productivity due to cancer compared to direct medical costs was from a previous report.

Antolin Bonnett, Editorial Intern, The Conversation

This article was originally published on The Conversation. Read the original article.