MJA
MJA

    Is it time to abandon clinical breast examination?

    Belinda E Kiely and Annabel Goodwin
    Med J Aust 2021; 215 (10): . || doi: 10.5694/mja2.51285
    Published online: 15 November 2021

    Despite limits to its clinical value, the potential benefits for women should not be overlooked

    Women with mutations in breast cancer predisposition genes have a very high risk of developing breast cancer and are offered risk‐reducing strategies and intensified surveillance; many are referred to specialist risk management clinics. Because magnetic resonance imaging (MRI) is more sensitive for detecting breast cancer at an early stage than mammography,1 it is part of most high risk breast cancer screening programs, and in Australia is covered by Medicare for women at high risk under 50 years of age.2

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      Universal genetic testing of patients with newly diagnosed breast cancer — ready for prime time?

      Dilanka L De Silva, Paul A James, G Bruce Mann and Geoffrey J Lindeman
      Med J Aust 2021; 215 (10): . || doi: 10.5694/mja2.51317
      Published online: 15 November 2021

      Current genetic testing guidelines may overlook patients with actionable mutations in high risk breast and ovarian cancer predisposition genes

      The discovery of the BRCA1 and BRCA2 genes just over 25 years ago1 ushered in a new era of genetic testing for patients diagnosed with breast and/or ovarian cancer. A new field of practice in familial cancer emerged that has continued to evolve at an accelerating pace over the intervening years. With improvements in technology, changing patient attitudes and striking new clinical data, genetic testing may have now arrived at another defining moment — as a routine investigation for virtually all patients with newly diagnosed breast cancer (universal testing), a notion that was unimaginable a quarter of a century ago.


      • 1 Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC
      • 2 Memorial Sloan Kettering Cancer Center, New York, USA
      • 3 University of Melbourne, Melbourne, VIC
      • 4 Royal Melbourne and Royal Women's Hospitals, Melbourne, VIC
      • 5 Peter MacCallum Cancer Centre, Melbourne, VIC
      • 6 Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC


      Correspondence: lindeman@wehi.edu.au
      Acknowledgements: 

      Geoffrey Lindeman is supported by a National Health and Medical Research Council (NHMRC) Leadership Fellowship (1175960). The NHMRC played no role in the planning, writing or publication of this work.

      Competing interests:

      No relevant disclosures.

      • 1. Narod SA, Foulkes WD. BRCA1 and BRCA2: 1994 and beyond. Nat Rev Cancer 2004; 4: 665–676.
      • 2. Cancer Australia. Advice about familial aspects of breast cancer and epithelial ovarian cancer. Sydney: Cancer Australia, 2015. https://www.canceraustralia.gov.au/publications‐and‐resources/cancer‐australia‐publications/advice‐about‐familial‐aspects‐breast‐cancer‐and‐epithelial‐ovarian‐cancer (viewed Oct 2021).
      • 3. Tung NM, Garber JE. BRCA1/2 testing: therapeutic implications for breast cancer management. Br J Cancer 2018; 119: 141–152.
      • 4. Robson M, Im SA, Senkus E, et al. Olaparib for metastatic breast cancer in patients with a germline BRCA mutation. N Engl J Med 2017; 377: 523–533.
      • 5. EviQ. BRCA1 and BRCA2 genetic testing: Cancer Institute NSW. https://www.eviq.org.au/cancer‐genetics/adult/genetic‐testing‐for‐heritable‐pathogenic‐variants/620‐brca1‐and‐brca2‐genetic‐testing (viewed Oct 2021).
      • 6. Antoniou AC, Hardy R, Walker L, et al. Predicting the likelihood of carrying a BRCA1 or BRCA2 mutation: validation of BOADICEA, BRCAPRO, IBIS, Myriad and the Manchester scoring system using data from UK genetics clinics. J Med Genet 2008; 45: 425–431.
      • 7. Kirk J, Barlow‐Stewart KK, Poplawski NK, et al. Medicare‐funded cancer genetic tests: a note of caution. Med J Aust 2018; 209: 193–196. https://www.mja.com.au/journal/2018/209/5/medicare‐funded‐cancer‐genetic‐tests‐note‐caution
      • 8. Hu C, Hart SN, Gnanaolivu R, et al. A population‐based study of genes previously implicated in breast cancer. N Engl J Med 2021; 384: 440–451.
      • 9. Audeh MW, Carmichael J, Penson RT, et al. Oral poly(ADP‐ribose) polymerase inhibitor olaparib in patients with BRCA1 or BRCA2 mutations and recurrent ovarian cancer: a proof‐of‐concept trial. Lancet 2010; 376: 245–251.
      • 10. Moore K, Colombo N, Scambia G, et al. Maintenance olaparib in patients with newly diagnosed advanced ovarian cancer. N Engl J Med 2018; 379: 2495–505.
      • 11. Tutt ANJ, Garber JE, Kaufman B, et al. Adjuvant olaparib for patients with BRCA1‐ or BRCA2‐mutated breast cancer. N Engl J Med 2021; 384: 2394–2405.
      • 12. Tung NM, Zakalik D, Somerfield MR, for the Hereditary Breast Cancer Guideline Expert Panel. Adjuvant PARP inhibitors in patients with high‐risk early‐stage HER2‐negative breast cancer and germline BRCA mutations: ASCO hereditary breast cancer guideline rapid recommendation update. J Clin Oncol 2021; 39: 2959–2961.
      • 13. Kuchenbaecker KB, Hopper JL, Barnes DR, et al. Risks of breast, ovarian, and contralateral breast cancer for BRCA1 and BRCA2 mutation carriers. JAMA 2017; 317: 2402–2416.
      • 14. Fasching PA, Yadav S, Hu C, et al. Mutations in BRCA1/2 and other panel genes in patients with metastatic breast cancer ‐association with patient and disease characteristics and effect on prognosis. J Clin Oncol 2021; 39: 1619–1630.
      • 15. Plon SE, Eccles DM, Easton D, et al. Sequence variant classification and reporting: recommendations for improving the interpretation of cancer susceptibility genetic test results. Hum Mutat 2008; 29: 1282–1291.
      • 16. Robson M, Domchek S. Broad application of multigene panel testing for breast cancer susceptibility ‐ Pandora’s Box Is opening wider. JAMA Oncol 2019; 5: 1687–1688.
      • 17. Kemp Z, Turnbull A, Yost S, et al. Evaluation of cancer‐based criteria for use in mainstream BRCA1 and BRCA2 genetic testing in patients with breast cancer. JAMA Netw Open 2019; 2: e194428.
      • 18. Beard C, Monohan K, Cicciarelli L, et al. Mainstream genetic testing for breast cancer patients: early experiences from the Parkville Familial Cancer Centre. Eur J Hum Genet 2021; 29: 872–880.
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        It is time for governments to support retailers in the transition to a smoke‐free society

        Coral E Gartner, April Wright, Marita Hefler, Andrew Perusco and Janet Hoek
        Med J Aust 2021; 215 (10): . || doi: 10.5694/mja2.51312
        Published online: 15 November 2021

        Phasing out tobacco retailing is gaining traction as the natural next step in controlling the tobacco pandemic

        The commercial tobacco trade is a complex system involving multiple actors, from tobacco growers and manufacturers to the importers and wholesalers that distribute products to retailers, who onsell to consumers. Consumers who purchase and use products form the demand side. Governments can influence each actor through policy, but have historically focused on the demand‐side measures in the World Health Organization Framework Convention on Tobacco Control (WHO FCTC; Articles 6–14). These outnumber the supply‐side measures (Articles 15–17), which have primarily focused on constraining tobacco product manufacturers. Calls are growing for governments to increase attention on retail supply — the critical link in the supply chain between manufacturers and consumers.1


        • 1 University of Queensland, Brisbane, QLD
        • 2 Charles Darwin University, Darwin, NT
        • 3 Australian National University, Canberra, ACT
        • 4 University of Otago, Dunedin, New Zealand


        Correspondence: c.gartner@uq.edu.au
        Acknowledgements: 

        Coral Gartner is the chief investigator in a National Health and Medical Research Council (NHMRC) grant (GNT1198301). Andrew Perusco holds an Australian Government Research Training Scholarship administered by Australian National University. The manuscript was written as part of the activities of the NHMRC‐funded Centre of Research Excellence on Achieving the Tobacco Endgame. The funder played no role in the study design, manuscript preparation, or the decision to submit it for publication.

        Competing interests:

        No relevant disclosures.

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          Who cares about climate?

          Hugh Montgomery and Fintan Hughes
          Med J Aust 2021; 215 (9): . || doi: 10.5694/mja2.51300
          Published online: 1 November 2021

          The threat of climate change is immediate and grave, and now is the time to act


          • 1 University College London, London, UK
          • 2 Duke University, Durham, NC, USA


          Correspondence: h.montgomery@ucl.ac.uk
          Competing interests:

          Hugh Montgomery chairs the Lancet Countdown on health and climate change, which is funded by the Wellcome Trust.

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            Mucormycosis: early treatment is the key to survival

            Timothy R Holmes, Jenny L Hepschke, Ian Jacobson and Anthony Maloof
            Med J Aust 2021; 215 (9): . || doi: 10.5694/mja2.51290
            Published online: 1 November 2021

             


            • Prince of Wales Hospital and Community Health Services, Sydney, NSW


            Acknowledgements: 

            We thank the patient and his wife for their insights and help in preparing this article. Their fortitude and commitment throughout his illness were remarkable. We also acknowledge the many other clinicians involved in the patient's care, without whose contributions the outcome might have been quite different.

            Competing interests:

            No relevant disclosures.

            • 1. Cornely OA, Alastruey‐Izquierdo A, Arenz D, et al. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect Dis 2019; 19: e405–e421.
            • 2. Vaughan C, Bartolo A, Vallabh N, Leong SC. A meta‐analysis of survival factors in rhino‐orbital‐cerebral mucormycosis‐has anything changed in the past 20 years? Clin Otolaryngol 2018; 43: 1454–1464.
            • 3. Prakash H, Ghosh AK, Rudramurthy SM, et al. A prospective multicenter study on mucormycosis in India: epidemiology, diagnosis, and treatment. Med Mycol 2019; 57: 395–402.
            • 4. Chamilos G, Lewis RE, Kontoyiannis DP. Delaying amphotericin B‐based frontline therapy significantly increases mortality among patients with hematologic malignancy who have zygomycosis. Clin Infect Dis 2008; 47: 503–509.
            • 5. Gamba JL, Woodruff WW, Djang WT, Yeates AE. Craniofacial mucormycosis: assessment with CT. Radiology 1986; 160: 207–212.
            • 6. Fanos V, Cataldi L. Amphotericin B‐induced nephrotoxicity: a review. J Chemother 2000; 12: 463–470.
            • 7. Saedi B, Sadeghi M, Seilani P. Endoscopic management of rhinocerebral mucormycosis with topical and intravenous amphotericin. Br J Laryngol Otol 2011; 125: 807–810.
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              The 2021 report of the MJA–Lancet Countdown on health and climate change: Australia increasingly out on a limb

              Paul J Beggs, Ying Zhang, Alice McGushin, Stefan Trueck, Martina K Linnenluecke, Hilary Bambrick, Helen L Berry, Ollie Jay, Lucie Rychetnik, Ivan C Hanigan, Geoffrey G Morgan, Yuming Guo, Arunima Malik, Mark Stevenson, Donna Green, Fay H Johnston, Celia McMichael, Ian Hamilton and Anthony G Capon
              Med J Aust 2021; 215 (9): . || doi: 10.5694/mja2.51302
              Published online: 21 October 2021

              Summary

              • The MJA–Lancet Countdown on health and climate change in Australia was established in 2017, and produced its first national assessment in 2018, its first annual update in 2019, and its second annual update in 2020. It examines indicators across five broad domains: climate change impacts, exposures and vulnerability; adaptation, planning and resilience for health; mitigation actions and health co‐benefits; economics and finance; and public and political engagement.
              • Our special report in 2020 focused on the unprecedented and catastrophic 2019–20 Australian bushfire season, highlighting indicators that explore the relationships between health, climate change and bushfires. For 2021, we return to reporting on the full suite of indicators across each of the five domains and have added some new indicators.
              • We find that Australians are increasingly exposed to and vulnerable to excess heat and that this is already limiting our way of life, increasing the risk of heat stress during outdoor sports, and decreasing work productivity across a range of sectors. Other weather extremes are also on the rise, resulting in escalating social, economic and health impacts. Climate change disproportionately threatens Indigenous Australians’ wellbeing in multiple and complex ways.
              • In response to these threats, we find positive action at the individual, local, state and territory levels, with growing uptake of rooftop solar and electric vehicles, and the beginnings of appropriate adaptation planning. However, this is severely undermined by national policies and actions that are contrary and increasingly place Australia out on a limb. Australia has responded well to the COVID‐19 public health crisis (while still emerging from the bushfire crisis that preceded it) and it now needs to respond to and prepare for the health crises resulting from climate change.

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              • 1 Macquarie University, Sydney, NSW
              • 2 University of Sydney, Sydney, NSW
              • 3 Institute for Global Health, University College London, London, UK
              • 4 Queensland University of Technology, Brisbane, QLD
              • 5 Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
              • 6 University Centre for Rural Health, University of Sydney, Sydney, NSW
              • 7 University Centre for Rural Health, University of Sydney, Lismore, NSW
              • 8 Monash University, Melbourne, VIC
              • 9 Integrated Sustainability Analysis, University of Sydney, Sydney, NSW
              • 10 University of Melbourne, Parkville, VIC
              • 11 Climate Change Research Centre and ARC Centre of Excellence for Climate Extremes, University of New South Wales, Sydney, NSW
              • 12 Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS
              • 13 UCL Energy Institute, University College London, London, UK
              • 14 Monash Sustainable Development Institute, Monash University, Melbourne, VIC


              Correspondence: paul.beggs@mq.edu.au
              Acknowledgements: 

              We thank Katie Quail for assistance with indicator 1.2 Indigenous health and climate change. We thank Robert Fawcett, John Nairn (retired), Elizabeth Ebert and Bronwyn Brown (all from the Australian Bureau of Meteorology) for indicators 1.3 Health effects of heatwaves and 2.4 Climate information services for health. We thank Nathan Morris for assistance with the analysis for indicator 1.4 Heat impact on physical and sporting activities. We thank Tord Kjellstrom and Matthias Otto for providing the results for indicator 1.5 Change in labour capacity. The Bushfires indicator was generated with support from NASA Applied Sciences Program (grant no. 80NSSC21K0507) and we thank Yang Liu, Bryan Vu and Liuhua Shi (all from Emory University) for the Australian data used for this indicator (1.7), and Nicolas Borchers Arriagada (Menzies Institute for Medical Research, University of Tasmania) for assistance with analysis. Shouro Dasgupta conducted the sea level rise‐related data analysis for indicator 1.9 Migration, displacement, and environmental change. He is an author on the Lancet Countdown global report, and contributor to the sea level rise indicator. The global version of this indicator was developed in collaboration also with Ilan Kelman and Sonja Ayeb‐Karlsson. We thank Kerry Nice (University of Melbourne) who worked on indicator 2.6 Urban green space. The assistance of Zahra Borghei Ghomi (Macquarie University) in compiling the data for indicators 3.1 Carbon intensity of the energy system, 3.2 Coal phase‐out, 3.3 Zero carbon emission electricity, and 3.4 Clean household energy is acknowledged. We thank Marco Springman from the Lancet Countdown for providing the results for indicator 3.9 Diet and health co‐benefits. We thank Maddie Heenan for searching and data compilation for indicator 5.3 Government engagement in health and climate change in Australia. We thank the NHMRC for providing the data for indicator 5.4 Health and climate change research funding.

              Competing interests:

              No relevant disclosures.

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                Towards risk‐stratified population breast cancer screening: more than mammographic density

                John L Hopper and Tuong Linh Nguyen
                Med J Aust 2021; 215 (8): . || doi: 10.5694/mja2.51268
                Published online: 18 October 2021

                Powerful new automated tools are being developed to identify the women most likely to have an existing or future cancer

                The article by Noguchi and colleagues in this issue of the MJA1 is timely and motivated by an important aim: to improve breast screening for both women and its funders. The authors conducted a comprehensive analysis of routinely collected data for all screening mammograms by BreastScreen WA over the ten years from July 2007. Although they studied screening episodes rather than individual women, they found evidence that key performance indicators — screen‐detected and interval cancer rates — differed by age, family history, hormone replacement therapy use, benign breast disease, and breast density. Importantly, the strengths of the relationships between some factors and performance varied by age group.1


                • Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC


                Correspondence: j.hopper@unimelb.edu.au
                Acknowledgements: 

                We acknowledge the generous support for our work in this area over many years from the National Breast Cancer Foundation, the Cancer Council Victoria, Cancer Australia, the National Health and Medical Research Council, and the National Institutes of Health (USA).

                Competing interests:

                No relevant disclosures.

                • 1. Noguchi N, Marinovich ML, Wylie EJ, et al. Screening outcomes by risk factor and age: evidence from BreastScreen WA for discussions of risk‐stratified population screening. Med J Aust 2021; 215: 359–365.
                • 2. Allweis TM, Hermann N, Bernstein‐Molho R, Guindy M. Personalized screening for breast cancer: rationale, present practices, and future directions. Ann Surg Oncol 2021; 28: 4306–4317.
                • 3. Eklund M, Broglio K, Yau C, Connor JT, et al. The WISDOM personalized breast cancer screening trial: simulation study to assess potential bias and analytic approaches. JNCI Cancer Spectr 2018; 2: pky067.
                • 4. Hopper JL, Nguyen TL, Schmidt DF, et al. Going beyond conventional mammographic density to discover novel mammogram‐based predictors of breast cancer risk. J Clin Med 2020; 9: 627.
                • 5. Boyd NF, Guo H, Martin LJ, Sun L, et al. Mammographic density and the risk and detection of breast cancer. N Engl J Med 2007; 3563: 227–236.
                • 6. Cappello NM, Richetelli D, Lee CI. The impact of breast density reporting laws on women’s awareness of density‐associated risks and conversations regarding supplemental screening with providers. J Am Coll Radiol 2019; 16: 139–146.
                • 7. Nguyen TL, Aung YK, Evans CF, et al. Mammographic density defined by higher than conventional brightness thresholds better predicts breast cancer risk. Int J Epidemiol 2017; 46: 652–661.
                • 8. Schmidt DF, Makalic E, Goudey B, et al. Cirrus: an automated mammography‐based measure of breast cancer risk based on textural features. JNCI Cancer Spectr 2018; 2: pky057.
                • 9. Nguyen TL, Schmidt DF, Makalic E, et al. Novel mammogram‐based measures improve breast cancer risk prediction beyond an established mammographic density measure. Int J Cancer 2021; 148: 2193–2202.
                • 10. Hopper JL. Genetics for population and public health. Int J Epidemiol 2017; 46: 8–11.
                • 11. Freeman K, Geppert J, Stinton C, et al. Use of artificial intelligence for image analysis in breast cancer screening programmes: systematic review of test accuracy. BMJ 2021; 374: n1872.
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                  Abortion care in the 21st century

                  Caroline M Costa and Kirsten I Black
                  Med J Aust 2021; 215 (8): . || doi: 10.5694/mja2.51274
                  Published online: 18 October 2021

                  Identifying inequity of access and assessing the effectiveness of interventions is difficult without systematic abortion data collection

                  The past two decades have seen major changes in both abortion law and abortion provision across Australia. Safe legal abortion is now available to all Australian women, and is accessible to many. Decriminalisation in all states and territories and legislated safety zones around abortion services have led to wider discussion of abortion in Australian society and softening of the attached stigma.1


                  • 1 The Cairns Institute, James Cook University, Cairns, QLD
                  • 2 The University of Sydney, Sydney, NSW
                  • 3 Royal Prince Alfred Hospital, Sydney, NSW


                  Correspondence: caroline.decosta@jcu.edu.au
                  Competing interests:

                  No relevant disclosures.

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                    Self‐collection for HPV screening: a game changer in the elimination of cervical cancer

                    Karen Canfell, Megan A Smith and Deborah J Bateson
                    Med J Aust 2021; 215 (8): . || doi: 10.5694/mja2.51262
                    Published online: 18 October 2021

                    Self‐collection will facilitate new community‐led, co‐designed delivery models that could greatly increase the acceptability and uptake of screening

                    In December 2017, the Australian National Cervical Screening Program (NCSP) underwent a major renewal, transitioning from two‐yearly cytology screening for people with a cervix (“women”) aged 18‒20 to 69 years, to five‐yearly primary human papillomavirus (HPV) screening for women aged 25‒74 years. The NCSP renewal was driven by accumulated international evidence for the very high effectiveness of primary HPV screening for predicting current and future risk of pre‐cancerous lesions and invasive cancer.1 It was also prompted by the Australian HPV vaccination program that commenced in 2007, which has resulted in rapid population‐level reductions in the incidence of pre‐cancerous lesions in young women.2

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                    • 1 The Daffodil Centre at the University of Sydney (Cancer Council NSW/University of Sydney), Sydney, NSW
                    • 2 Family Planning New South Wales, Sydney, NSW
                    • 3 The University of Sydney, Sydney, NSW


                    Correspondence: karen.canfell@nswcc.org.au
                    Acknowledgements: 

                    Karen Canfell receives salary support from the National Health and Medical Research Council (NHMRC; APP1194679). Megan Smith receives salary support from the NHMRC (APP1159491) and the Cancer Institute NSW (ECF181561).

                    Competing interests:

                    Karen Canfell is co‐principal investigator in an unrelated investigator‐initiated trial of cervical screening in Australia (Compass; ACTRN12613001207707 and NCT02328872), conducted and funded by the VCS Foundation, a Victorian government‐funded health promotion charity. The VCS Foundation has received equipment and a funding contribution from Roche Molecular Systems USA. Neither Karen Canfell nor her institution on her behalf (Cancer Council NSW) receives direct funding from industry for this trial or any other project.

                    • 1. Ronco G, Dillner J, Elfström KM, et al; International HPV screening working group. Efficacy of HPV‐based screening for prevention of invasive cervical cancer: follow‐up of four European randomised controlled trials. Lancet 2014; 383: 524–532.
                    • 2. Australian Institute of Health and Welfare. Cervical screening in Australia 2019 (Cat. no. CAN 124). May 2019. https://www.aihw.gov.au/reports/cancer‐screening/cervical‐screening‐in‐australia‐2019/summary 2019 (viewed Aug 2021).
                    • 3. Lew JB, Simms KT, Smith MA, et al. Primary HPV testing versus cytology‐based cervical screening in women in Australia vaccinated for HPV and unvaccinated: effectiveness and economic assessment for the National Cervical Screening Program. Lancet Public Health 2017; 2: e96–e107.
                    • 4. Creagh NS, Zammit C, Brotherton JML, et al. Self‐collection cervical screening in the renewed National Cervical Screening Program: a qualitative study. Med J Aust 2021; 215: 354–358.
                    • 5. Medical Services Advisory Committee. MSAC outcomes application no. 1276. Renewal of the National Cervical Screening Program. Apr 2014. http://www.msac.gov.au/internet/msac/publishing.nsf/Content/D924E2F768B13C4BCA25801000123B9E/$File/1276%20‐%20Final%20MSAC%20PSD%20‐%20NCSP%20Renewal.pdf (viewed Aug 2021).
                    • 6. Arbyn M, Smith SB, Temin S, et al; Collaboration on Self‐Sampling and HPV Testing. Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta‐analyses. BMJ 2018; 363: k4823.
                    • 7. Smith MA, Hall MT, Saville M, et al. Could HPV testing on self‐collected samples be routinely used in an organized cervical screening program? A modeled analysis. Cancer Epidemiol Biomarkers Prev 2021; 30: 268–77.
                    • 8. Medical Services Advisory Committee. MSAC application no. 1664 (public summary document). Apr 2021. http://www.msac.gov.au/internet/msac/publishing.nsf/Content/69F7A5B132EA653ECA258646001B5CD5/$File/1664%20Final%20PSD%20‐%20Mar‐Apr%202021.pdf (viewed Aug 2021).
                    • 9. Davies‐Oliveira JC, Smith MA, Grover S, et al. Eliminating cervical cancer: progress and challenges for high‐income countries. J Clin Oncol (R Coll Radiol) 2021; 33: 550–559.
                    • 10. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68: 394–424.
                    • 11. World Health Organization. Global strategy to accelerate the elimination of cervical cancer as a public health problem (Report no. 9789240014107). Nov 2020. https://www.who.int/publications/i/item/9789240014107 (viewed Aug 2021).
                    • 12. Hall MT, Simms KT, Lew JB, et al. The projected timeframe until cervical cancer elimination in Australia: a modelling study. Lancet Public Health 2019; 4: e19–e27.
                    • 13. NHMRC Centre of Research Excellence in Cervical Cancer Control. Cervical cancer elimination progress report: Australia’s progress towards the elimination of cervical cancer as a public health problem. Mar 2021. https://www.cervicalcancercontrol.org.au/wp‐content/uploads/2021/03/2021‐C4‐CRE‐Elim‐Report.pdf (viewed Aug 2021).
                    • 14. Whop LJ, Smith MA, Butler TL, et al. Achieving cervical cancer elimination among Indigenous women. Prev Med 2021; 144: 106314.
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                      Treatment of alcohol problems: current status and future directions

                      Paul S Haber, Benjamin C Riordan and Kirsten C Morley
                      Med J Aust 2021; 215 (7): . || doi: 10.5694/mja2.51265
                      Published online: 4 October 2021

                      Scaling up the treatment of alcohol problems will lead to considerable health benefit across the nation

                      Alcohol is Australia’s most widely used drug, consumed by nearly 80% of the adult population.1 We lack recent prevalence data for alcohol use disorder in Australia but previous estimates vary from about 800 0002 to over a million.3 With such large numbers, it is quite a paradox that we are not better equipped to manage those who develop problems related to its use.

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                      • 1 Central Clinical School, University of Sydney, Sydney, NSW
                      • 2 Edith Collins Centre (Translational Research Centre in Alcohol Drugs and Toxicology), Sydney, NSW
                      • 3 Drug Health Services, Royal Prince Alfred Hospital, Sydney, NSW
                      • 4 Centre for Alcohol Policy Research, Melbourne, VIC


                      Correspondence: paul.haber@sydney.edu.au
                      Competing interests:

                      Paul Haber has been funded by the Lambert Initiative for Cannabinoid Therapeutics at the University of Sydney to undertake clinical trials of cannabinoid treatment for alcohol withdrawal syndrome; has served on industry advisory boards for Indivior, AbbVie and Gilead; and has been an investigator on clinical trials supported by Camurus. He has also served on international and Australian advisory boards for Lundbeck in relation to nalmefene (2013–2015 and 2014, respectively).

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