MJA
MJA

    Monitoring changes in infant feeding practices after changes to guidelines for food allergy prevention

    Rachel L Peters and Kirsten P Perrett
    Med J Aust 2020; 212 (6): . || doi: 10.5694/mja2.50535
    Published online: 6 April 2020

    It may soon be possible to reverse the increase in food allergy of the past few decades

    IgE‐mediated food allergy is a significant public health problem in many countries, and its prevalence in Australia is the highest of any country.1 As no curative treatments are available in routine practice, effective prevention strategies are essential for managing the increasing burden. Modifying infant feeding practices has emerged as a key approach.

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      Testing the effect of discharge destination on outcomes for people with isolated lower limb fractures

      Ian D Cameron
      Med J Aust 2020; 212 (6): . || doi: 10.5694/mja2.50540
      Published online: 6 April 2020

      Some patients may not benefit from inpatient rehabilitation, but numerous factors must be considered

      In this issue of the MJA, Kimmel and her co‐authors report analysing data from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR)1 with the aim of determining whether inpatient rehabilitation after isolated lower extremity fracture in working age people might be associated with poorer long term outcomes. For those of us in the rehabilitation services, this investigation further develops a familiar theme, doubt about the value of inpatient rehabilitation services.


      • John Walsh Centre for Rehabilitation Research, University of Sydney, Sydney, NSW


      Correspondence: ian.cameron@sydney.edu.au
      Acknowledgements: 

      I am supported by a National Health and Medical Research Council (NHMRC) Practitioner Fellowship, the NSW State Insurance Regulatory Authority, and Insurance and Care (icare) NSW.

      Competing interests:

      I have received grants from the NHMRC, the Australian Research Council, the New South Wales State Insurance Regulatory Authority, and icare NSW.

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        Citation metrics for appraising scientists: misuse, gaming and proper use

        John PA Ioannidis and Kevin W Boyack
        Med J Aust 2020; 212 (6): . || doi: 10.5694/mja2.50493
        Published online: 6 April 2020

        We need informative citation metrics that will be less prone to misuse and gaming

        Citation and other metrics are widely misused, but when properly used, they can be valuable. Science itself thrives on quantitative measurement. Quantitative indicators aim to provide objective data instead of biased beliefs. Here, we focus on citation metrics in appraising scientists1 for hiring, promotion, tenure, funding, selection for some award, recognition or bonus, or other reasons. Many tricks exist to game citation metrics (Box); however, proper use of metrics may overcome these deficiencies. Generic challenges that we describe here may partly apply also to larger, more composite entities such as the appraisal of journals, institutions or large research portfolios, for example, at a national level.


        • 1 Stanford Prevention Research Center, Stanford University, Stanford, CA, United States
        • 2 SciTech Strategies, Albuquerque, NM, United States


        Correspondence: jioannid@stanford.edu
        Competing interests:

        No relevant disclosures.

        • 1. Cronin B, Sugimoto CR, editors. Beyond bibliometrics: harnessing multidimensional indicators of scholarly impact. Cambridge: MIT Press, 2014.
        • 2. Hicks D, Wouters P, Waltman L, et al. Bibliometrics: the Leiden Manifesto for research metrics. Nature 2015; 520: 429–431.
        • 3. Ioannidis JP, Klavans R, Boyack KW. Multiple citation indicators and their composite across scientific disciplines. PLoS Biol 2016; 14: e1002501.
        • 4. Simone JV. Understanding academic medical centers: Simone's Maxims. Clin Cancer Res 1999; 5: 2281–2285.
        • 5. Biagioli M. Watch out for cheats in citation game. Nature 2016; 535: 201.
        • 6. Beall J. Predatory publishers are corrupting open access. Nature 2012; 489: 179.
        • 7. Ioannidis JPA, Thombs BD. A user's guide to inflated and manipulated impact factors. Eur J Clin Invest 2019; 49: e13151.
        • 8. Van Noorden R, Singh Chawla D. Hundreds of extreme self‐citing scientists revealed in new database. Nature 2019; 572: 578–579.
        • 9. Davis P. The emergence of a citation cartel. The Scholarly Kitchen 2012; 10 Apr http://scholarlykitchen.sspnet.org/2012/04/10/emergence-of-a-citation-cartel (viewed Sept 2019).
        • 10. Wilhite AW, Fong EA. Coercive citation in academic publishing. Science 2012; 335: 542–543.
        • 11. Mowatt G, Shirran L, Grimshaw JM, et al. Prevalence of honorary and ghost authorship in Cochrane reviews. JAMA 2002 Jun 5; 287: 2769–2771.
        • 12. Ioannidis JPA, Klavans R, Boyack KW. Thousands of scientists publish a paper every five days. Nature 2018; 561: 167–169.
        • 13. Ioannidis JPA, Baaas J, Klavans R, Boyack KW. A standardized citation metrics author database annotated for scientific field. PLoS Biol 2019; 17: e3000384.
        • 14. Rennie D, Yank V, Emanuel L. When authorship fails. A proposal to make contributors accountable. JAMA 1997; 278: 579–585.
        • 15. Sauermann H, Haeussler C. Authorship and contribution disclosures. Sci Adv 2017; 3: e1700404.
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          Cardiovascular disease risk assessment for Aboriginal and Torres Strait Islander adults aged under 35 years: a consensus statement

          Jason W Agostino, Deborah Wong, Ellie Paige, Vicki Wade, Cia Connell, Maureen E Davey, David P Peiris, Dana Fitzsimmons, C Paul Burgess, Ray Mahoney, Emma Lonsdale, Peter Fernando, Leone Malamoo, Sandra Eades, Alex Brown, Garry Jennings, Raymond W Lovett and Emily Banks
          Med J Aust 2020; 212 (9): . || doi: 10.5694/mja2.50529
          Published online: 16 March 2020

          Summary

          Cardiovascular disease (CVD) is a leading cause of preventable morbidity and mortality in Aboriginal and Torres Strait Islander peoples. This statement from the Australian Chronic Disease Prevention Alliance, the Royal Australian College of General Practitioners, the National Aboriginal Community Controlled Health Organisation and the Editorial Committee for Remote Primary Health Care Manuals communicates the latest consensus advice of guideline developers, aligning recommendations on the age to commence Aboriginal and Torres Strait Islander CVD risk assessment across three guidelines.

          Main recommendations: In Aboriginal and Torres Strait Islander peoples without existing CVD:

          • CVD risk factor screening should commence from the age of 18 years at the latest, including for blood glucose level or glycated haemoglobin, estimated glomerular filtration rate, serum lipids, urine albumin to creatinine ratio, and other risk factors such as blood pressure, history of familial hypercholesterolaemia, and smoking status.
          • Individuals aged 18–29 years with the following clinical conditions are automatically conferred high CVD risk:
            1. ▶type 2 diabetes and microalbuminuria;
            2. ▶moderate to severe chronic kidney disease;
            3. ▶systolic blood pressure ≥ 180 mmHg or diastolic blood pressure ≥ 110 mmHg;
            4. ▶familial hypercholesterolaemia; or
            5. ▶serum total cholesterol > 7.5 mmol/L.
          • Assessment using the National Vascular Disease Prevention Alliance absolute CVD risk algorithm should commence from the age of 30 years at the latest — consider upward adjustment of calculated CVD risk score, accounting for local guideline use, risk factor and CVD epidemiology, and clinical discretion.
          • Assessment should occur as part of an annual health check or opportunistically. Subsequent review should be conducted according to level of risk.

          Changes in management as a result of this statement: From age 18 years (at the latest), Aboriginal and Torres Strait Islander adults should undergo CVD risk factor screening, and from age 30 years (at the latest), they should undergo absolute CVD risk assessment using the NVDPA risk algorithm.

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          • 1 Australian National University, Canberra, ACT
          • 2 National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
          • 3 RHD Australia, Menzies School of Health Research, Darwin, NT
          • 4 National Heart Foundation of Australia, Melbourne, VIC
          • 5 Tasmanian Aboriginal Centre, Hobart, TAS
          • 6 George Institute for Global Health, UNSW Sydney, Sydney, NSW
          • 7 Top End Health Services, Northern Territory Government, Darwin, NT
          • 8 Northern Territory Medical Program, Flinders University, Darwin, NT
          • 9 Australian E‐Health Research Centre, CSIRO, Brisbane, QLD
          • 10 Australian Chronic Disease Prevention Alliance, Sydney, NSW
          • 11 SEARCH, Sax Institute, Sydney, NSW
          • 12 University of Technology Sydney, Sydney, NSW
          • 13 Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, VIC
          • 14 University of Adelaide, Adelaide, SA
          • 15 University of South Australia, Adelaide, SA


          Correspondence: jason.agostino@anu.edu.au
          Acknowledgements: 

          This work was supported by a grant from the Australian Government Department of Health on improving cardiovascular disease prevention for Aboriginal and Torres Strait Islander peoples. The funding body had no role in the design of the consensus statement or in writing the statement. In addition to the co‐authors of this article, the consensus statement was reviewed and endorsed by the RACGP's Aboriginal and Torres Strait Islander Health Council, the RACGP's Expert Committee — Quality Care, the Heart Foundation's Clinical Committee, the Heart Foundation's Heart Health Committee, the Editorial Committee for RPHCM and NACCHO.

          Competing interests:

          No relevant disclosures.

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            Ending cheap alcohol gets promising results

            Mike Daube and Julia Stafford
            Med J Aust 2020; 212 (5): . || doi: 10.5694/mja2.50515
            Published online: 16 March 2020

            The evidence from real world implementation is compelling

            There is no shortage of evidence‐based recommendations regarding measures for reducing the considerable health and social harms associated with alcohol misuse in Australia and elsewhere1 — nor of opposition from the powerful alcohol industry and its allies to anything that might be effective. Their counter‐arguments, here as elsewhere, are all too familiar: voluntary approaches are best; anything that might reduce alcohol harms is draconian, penalises ordinary consumers, and interferes with individual liberties; no one measure will solve the problem overnight; more research is needed — and above all, as in other areas, nothing should ever be done for the first time.2


            • 1 Curtin University, Perth, WA
            • 2 Public Health Advocacy Institute of Western Australia, Curtin University, Perth, WA


            Correspondence: m.daube@curtin.edu.au
            Competing interests:

            No relevant disclosures.

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              Time to develop guidelines for screening and management of atrial fibrillation in Indigenous Australians

              Nicole Lowres and Ben Freedman
              Med J Aust 2020; 212 (5): . || doi: 10.5694/mja2.50513
              Published online: 16 March 2020

              Screening guidelines specific to the needs of Australia's Indigenous population are needed

              One‐third of all ischaemic strokes are associated with atrial fibrillation (AF).1 Over the next 15 years, the number of AF‐related strokes in Australia is likely to rise substantially because of the predicted rise in AF prevalence.2 It is conservatively estimated that by 2034 more than 600 000 people in Australia will have AF, but these numbers do not take into account the higher prevalence of AF among Indigenous Australians.2 The prevalence of AF among hospitalised Indigenous patients under 60 years of age was reported by one study to be 2.57%, compared with 1.73% for non‐Indigenous patients.3 These hospital‐specific figures possibly underestimate prevalence, however, as they do not include cases of AF detected in Indigenous medical centres or general practices, or people with undiagnosed AF.

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              • Heart Research Institute, Charles Perkins Centre, University of Sydney, Sydney, NSW


              Correspondence: nicole.lowres@sydney.edu.au
              Acknowledgements: 

              Nicole Lowres is funded by a NSW Health Early Career Fellowship (H16/52168).

              Competing interests:

              Ben Freedman has previously received fees and advisory board honoraria from Bayer, Daiichi‐Sankyo, and Pfizer/Bristol‐Myers Squibb, and an honorarium from Omron. Ben Freedman and Nicole Lowres have received investigator‐initiated grants from Pfizer and Bristol‐Myers Squibb.

              • 1. Friberg L, Rosenqvist M, Lindgren A, et al. High prevalence of atrial fibrillation among patients with ischemic stroke. Stroke 2014; 45: 2599–2605.
              • 2. Ball J, Thompson DR, Ski CF, et al. Estimating the current and future prevalence of atrial fibrillation in the Australian adult population. Med J Aust 2015; 202: 32–35. https://www.mja.com.au/journal/2015/202/1/estimating-current-and-future-prevalence-atrial-fibrillation-australian-adult.
              • 3. Wong CX, Brooks AG, Cheng YH, et al. Atrial fibrillation in Indigenous and non‐Indigenous Australians: a cross‐sectional study. BMJ Open 2014; 4: e006242.
              • 4. Nedkoff L, Kelty EA, Hung J, et al. Stroke risk and cardiovascular mortality for Aboriginal and other Australian patients with atrial fibrillation. Med J Aust 2020; 212: 215–222.
              • 5. Katzenellenbogen JM, Woods JA, Teng TH, Thompson SC. Atrial fibrillation in the Indigenous populations of Australia, Canada, New Zealand, and the United States: a systematic scoping review. BMC Cardiovasc Disord 2015; 15: 87.
              • 6. Poppe K, Rambaldini B, Rolleston A, et al. Atrial fibrillation among indigenous populations globally. Heart Lung Circ 2019; 28 Suppl 2: S39–S40.
              • 7. He VYF, Condon John R, Ralph AP, et al. Long‐term outcomes from acute rheumatic fever and rheumatic heart disease. Circulation 2016; 134: 222–232.
              • 8. Healey JS, Connolly SJ, Gold MR, et al; ASSERT Investigators. Subclinical atrial fibrillation and the risk of stroke. New Engl J Med 2012; 366: 120–129.
              • 9. NHFA CSANZ Atrial Fibrillation Guideline Working Group; Brieger D, Amerena J, Attia J, et al. National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the diagnosis and management of atrial fibrillation 2018. Heart Lung Circ 2018; 27: 1209–1266.
              • 10. Gwynne K, Flaskas Y, Brien C, et al. Opportunistic screening to detect atrial fibrillation in Aboriginal adults in Australia. BMJ Open 2016; 6: e013576.
              • 11. Macniven R, Gwynn J, Fujimoto H, et al. Feasibility and acceptability of opportunistic screening to detect atrial fibrillation in Aboriginal adults. Aust N Z J Public Health 2019; 43: 313–318.
              • 12. Bellinge JW, Paul JJ, Walsh LS, et al. The impact of non‐vitamin K antagonist oral anticoagulants (NOACs) on anticoagulation therapy in rural Australia. Med J Aust 2018; 208: 18–23. https://www.mja.com.au/journal/2018/208/1/impact-non-vitamin-k-antagonist-oral-anticoagulants-noacs-anticoagulation
              • 13. Wong CX, Lee SW, Gan SW, et al. Underuse and overuse of anticoagulation for atrial fibrillation: a study in Indigenous and non‐Indigenous Australians. Int J Cardiol 2015; 191: 20–24.
              • 14. Balabanski AH, Newbury J, Leyden JM, et al. Excess stroke incidence in young Aboriginal people in South Australia: Pooled results from two population‐based studies. Int J Stroke 2018; 13: 811–814.
              • 15. Zhang J, Tang J, Cui X, et al. Indirect comparison of novel oral anticoagulants among Asians with non‐valvular atrial fibrillation in the real world setting: a network meta‐analysis. BMC Cardiovasc Disord 2019; 19: 182.
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                More than a refresh required for closing the gap of Indigenous health inequality

                Chelsea J Bond and David Singh
                Med J Aust 2020; 212 (5): . || doi: 10.5694/mja2.50498
                Published online: 16 March 2020

                If we are committed to closing the gap, we should be committed to transforming relationships of power between Indigenous and non‐Indigenous people

                After over a decade of tabling annual reports of policy failure in Closing the Gap in Indigenous health inequality, the Morrison government announced in 2019 a refresh of the targets, rather than a rethink of the policy approach.1 This refresh includes a process of Indigenous consultation and codesign via the Coalition of the Peaks (a representative body of about 40 Aboriginal and Torres Strait Islander organisations), which makes for a refreshing change in Indigenous health policy.2 Whether such engagement will engender the radical reimagining required to transform persisting Indigenous health disparities remains to be seen.

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                • University of Queensland, Brisbane, QLD


                Correspondence: c.bond3@uq.edu.au
                Acknowledgements: 

                Chelsea Bond is a recipient of an Australian Research Council Discovery Early Career Research Fellowship.

                Competing interests:

                No relevant disclosures.

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                  Antiplatelet therapy within 30 days of percutaneous coronary intervention with stent implantation

                  Benjumin Hsu, Michael O Falster, Andrea L Schaffer, Sallie Pearson, Louisa Jorm and David B Brieger
                  Med J Aust 2020; 213 (3): . || doi: 10.5694/mja2.50507
                  Published online: 9 March 2020

                  Percutaneous coronary intervention with stent implantation (PCI‐S) has revolutionised the management of patients with coronary artery disease at high risk of myocardial infarction and stroke.1 Dual antiplatelet therapy (aspirin with clopidogrel, prasugrel or ticagrelor) is superior to aspirin alone for preventing atherothrombotic events, including stent thrombosis, in patients undergoing PCI‐S,2 and is recommended by Australian guidelines.3

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                  • 1 Centre for Big Data Research in Health, UNSW Australia, Sydney, NSW
                  • 2 Menzies Centre for Health Policy, University of Sydney, Sydney, NSW
                  • 3 Concord Repatriation General Hospital, Sydney, NSW


                  Correspondence: benjumin.hsu@unsw.edu.au
                  Competing interests:

                  No relevant disclosures.

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                    Blood lead levels in children have fallen, but vigilance is still needed

                    Mark P Taylor and Bruce P Lanphear
                    Med J Aust 2020; 212 (4): . || doi: 10.5694/mja2.50495
                    Published online: 2 March 2020

                    Ongoing population‐level strategies are needed to further reduce lead exposure

                    The largest survey of blood lead levels in children in Australia outside high risk mining and smelting communities since the phasing out of leaded petrol was undertaken as part of the Barwon Infant Study in Victoria. As reported in this issue of the MJA,1 the investigators found that blood lead concentrations in children were considerably lower (geometric mean, 0.95 μg/dL) than those measured in the last major survey of Australian children, more than 25 years ago (geometric mean, 5.05 μg/dL).2 Blood lead levels have declined dramatically over the past 50 years,3,4 and Symeonides and colleagues have found that levels in children continue to fall. Nevertheless, they are still about 60 times higher than in pre‐industrial humans (0.016 μg/dL),5 and health agencies have declared that there is no safe level of lead for children.6,7


                    • 1 Macquarie University, Sydney, NSW
                    • 2 Simon Fraser University, Burnaby, BC, Canada


                    Correspondence: mark.taylor@mq.edu.au
                    Competing interests:

                    Mark Patrick Taylor is affiliated with the Broken Hill Lead Reference Group, The LEAD Group (Australia), and the Broken Hill Environmental Lead Program of the NSW Environmental Protection Agency (EPA). He has received funding from the Broken Hill Environmental Lead Program for lead‐related research; Australian federal government Citizen Science grants for the project, “Citizen insights to the composition and risks of household dust” (CSG55984); from the Australian Research Council (ARC) for perfluorinated alkylated substances (PFAS)‐related research (SR180100021), an ARC Special Research Initiative Collaboration Agreement; an ARC Linkage grant (with Rio Tinto) for “Improved control of dioxin emissions during iron ore sintering”; and from the Metropolitan Fire Brigade (Victoria) for a clinical trial of PFAS removal from firefighters by phlebotomy. Mark Patrick Taylor has also prepared commissioned reports and provided expert advice on environmental contamination and human health for a range of bodies, including the Australian Building Codes Board (lead in plumbing fittings and materials), lawyers, governments, union agencies, and private companies. He has also received funding from Macquarie University for sabbatical research and major equipment purchases. Bruce Lanphear serves as an expert witness in plaintiff cases of childhood lead poisoning in Milwaukee (WI) and Flint (MI) in the United States, but receives no personal compensation.

                    • 1. Symeonides C, Vuillermin P, Sly PD, et al. Pre‐school child blood lead levels in a population‐derived Australian birth cohort: the Barwon Infant Study. Med J Aust 2019; 211: 169–174.
                    • 2. Donovan J. Lead in Australian children. Report on the national survey of lead in children. Canberra: Australian Institute of Health and Welfare, 1996. https://www.aihw.gov.au/getmedia/b6d0e6d2-09f1-4ef1-b62b-a0930557509b/lead-in-australian-children.pdf.aspx?inline=true (viewed Aug 2019).
                    • 3. Kristensen LJ, Taylor MP, Flegal AR. An odyssey of environmental pollution: the rise, fall and remobilisation of industrial lead in Australia. Applied Geochemistry 2017; 83: 3–13.
                    • 4. Robbins N, Zhang Z‐F, Sun J, et al. Childhood lead exposure and uptake in teeth in the Cleveland area during the era of leaded gasoline. Sci Total Environ 2010; 408: 4118–4127.
                    • 5. Flegal AR, Smith DR. Lead levels in preindustrial humans. N Engl J Med 1992; 326: 1293–1294.
                    • 6. Centers for Disease Control and Prevention. Childhood lead poisoning prevention. July 2019. https://www.cdc.gov/nceh/lead/prevention/default.htm (viewed Nov 2019)
                    • 7. World Health Organization. Lead poisoning and health. Aug 2019. https://www.who.int/news-room/fact-sheets/detail/lead-poisoning-and-health (viewed Nov 2019).
                    • 8. Canfield RL, Henderson CR, Cory‐Slechta DA, et al. Intellectual impairment in children with blood lead concentrations below 10 μg per deciliter. N Engl J Med 2003; 348: 1517–1526.
                    • 9. Budtz‐Jørgensen E, Bellinger D, Lanphear B, et al. An international pooled analysis for obtaining a benchmark dose for environmental lead exposure in children. Risk Anal 2013; 33: 450–461.
                    • 10. Reuben A, Schaefer JD, Moffitt TE, et al. Association of childhood lead exposure with adult personality traits and lifelong mental health. JAMA Psychiatry 2019; 76: 418–425.
                    • 11. Lanphear BP, Rauch S, Auinger P, et al. Low‐level lead exposure and mortality in US adults: a population‐based cohort study. Lancet Public Health 2018; 3: e177–e184.
                    • 12. Reuben A, Caspi A, Belsky DW, et al. Association of childhood blood lead levels with cognitive function and socioeconomic status at age 38 years and with IQ change and socioeconomic mobility between childhood and adulthood. JAMA 2017; 317: 1244–1251.
                    • 13. National Toxicology Program. Health effects of low‐level lead (NTP monograph). U.S. Department of Health and Human Services, June 2012. https://ntp.niehs.nih.gov/ntp/ohat/lead/final/monographhealtheffectslowlevellead_newissn_508.pdf (viewed Aug 2019).
                    • 14. Lanphear BP. Low‐level toxicity of chemicals: no acceptable levels? PLoS Biol 2017; 15: e2003066.
                    • 15. National Health and Medical Research Council. Managing individual exposure to lead in Australia: a guide for health practitioners. Canberra: NHMRC, 2016. https://www.nhmrc.gov.au/about-us/publications/managing-individual-exposure-lead-australia (viewed Nov 2019.
                    • 16. Centers for Disease Control and Prevention. National Health and Nutrition Examination Survey (NHANES): blood lead levels in the US population. Updated July 2019. https://www.cdc.gov/nceh/lead/data/nhanes.htm (viewed Aug 2019).
                    • 17. Taylor MP, Harvey PJ, Morrison AM. Lead in plumbing products and materials. June 2018. https://www.abcb.gov.au/Resources/Publications/Consultation/Lead-in-Plumbing-Products-and-Materials (viewed Sept 2019).
                    • 18. Shaffer RM, Gilbert SG. Reducing occupational lead exposures: strengthened standards for a healthy workforce. NeuroToxicology 2018; 69: 181–186.
                    • 19. Safe Work Australia. Lead. Updated July 2019. https://www.safeworkaustralia.gov.au/topic/lead (viewed Aug 2019).
                    • 20. Navas‐Acien A, Tellez‐Plaza M, Guallar E, et al. Blood cadmium and lead and chronic kidney disease in US adults: a joint analysis. Am J Epidemiol 2009; 170: 1156–1164.
                    • 21. Kamel F, Umbach DM, Hu H, et al. Lead exposure as a risk factor for amyotrophic lateral sclerosis. Neurodegener Dis 2005; 2: 195–201.
                    • 22. Bakulski KM, Rozek LS, Dolinoy DC, et al. Alzheimer's disease and environmental exposure to lead: the epidemiologic evidence and potential role of epigenetics. Curr Alzheimer Res 2012; 9: 563–573.
                    • 23. Health Canada. Fourth Report on human biomonitoring of environmental chemicals in Canada. Aug 2017. https://www.canada.ca/en/health-canada/services/environmental-workplace-health/reports-publications/environmental-contaminants/fourth-report-human-biomonitoring-environmental-chemicals-canada.html (viewed Sept 2019).
                    • 24. Nussbaumer‐Streit B, Yeoh B, Griebler U, et al. Household interventions for preventing domestic lead exposure in children. Cochrane Database Syst Rev 2016; CD006047.
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                      Overdiagnosis of cancer in Australia: the role of screening

                      David M Roder and Elizabeth Buckley
                      Med J Aust 2020; 212 (4): . || doi: 10.5694/mja2.50494
                      Published online: 2 March 2020

                      The balance between benefits and risks could be improved if effective risk‐based screening protocols were developed

                      Overdiagnosis can be defined as the proportion of diagnosed cancers that would not otherwise have come to a person's attention during their lifetime.1,2 Overdiagnosis provides no benefit to the patient but can have financial, psychosocial, and health consequences.2 While advances in imaging and other screening and diagnostic technologies can lead to therapeutic benefit, they can also increase overdiagnosis. Because overdiagnosed cancers are generally indistinguishable from potentially lethal cancers, the imperative to treat is equivalent.2


                      • Cancer Research Institute, University of South Australia, Adelaide, SA


                      Correspondence: david.roder@unisa.edu.au
                      Competing interests:

                      No relevant disclosures.

                      • 1. Brodersen J, Schwartz LM, Heneghan C, et al. Overdiagnosis: what is it and what it isn't. BMJ Evid Based Med 2018; 23: 1–3.
                      • 2. Marmot MG, Altman DG, Cameron DA, et al. The benefits and harms of breast cancer screening: an independent review. Br J Cancer 2013; 108: 2205–2240.
                      • 3. Rainey L, van der Waal D, Jervaeus A, et al. Are we ready for the challenge of implementing risk‐based breast cancer screening and primary prevention? Breast 2018; 39: 24–32.
                      • 4. Glasziou PP, Jones MA, Pathirana T, et al. Estimating the magnitude of cancer overdiagnosis in Australia. Med J Aust 2020; 212: 163–168.
                      • 5. Esserman LJ, Thompson IM, Reid B, et al. Addressing overdiagnosis and overtreatment in cancer: a prescription for change. Lancet Oncol 2014; 15: e234–e242.
                      • 6. Njor SH, Garne JP, Lynge E. Over‐diagnosis estimate from The Independent UK Panel on Breast Cancer Screening is based on unsuitable data. J Med Screen 2013; 20: 104–105.
                      • 7. Morrell S, Gregory M, Sexton K, et al. Absence of sustained breast cancer incidence inflation in a national mammography screening programme. J Med Screen 2019; 26: 26–34.
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