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    Setting the policy agenda for cancer control reform: Australia's first national cancer control plan

    Daniel Chaji, Anna Boltong, Carolyn Der Vartanian, Adam Lambert, Cindy Toms, Vivienne Milch, Claire Howlett and Dorothy Keefe
    Med J Aust 2023; 219 (10): . || doi: 10.5694/mja2.52120
    Published online: 20 November 2023

    Cancer outcomes in Australia are among the best in the world;1 however, these outcomes are not experienced equitably. There are significant disparities in cancer outcomes and experience among specific groups in Australia, including Aboriginal and Torres Strait Islander people.2 Such disparities are unacceptable and require whole‐of‐system, coordinated, national level effort, to ensure the future of cancer control in Australia is one where world class cancer outcomes and experiences are within reach for all Australians.

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    • 1 Cancer Australia, Sydney, NSW
    • 2 Kirby Institute, UNSW Sydney, Sydney, NSW
    • 3 Caring Futures Institute, Flinders University, Adelaide, SA
    • 4 Adelaide Medical School, University of Adelaide, Adelaide, SA


    Acknowledgements: 

    This work was funded by Cancer Australia and the Department of Health and Aged Care – Australian Government. Cancer Australia owes a debt of gratitude to the numerous stakeholder organisations and people who contributed to the Australian Cancer Plan either by way of submissions and/or by attendance at workshops and other public forums. We give particular thanks to all the cancer consumers who generously gave their time and experience to help us ensure the patient is at the very centre of this Plan.

    Competing interests:

    No relevant disclosures.

    • 1. Arnold M, Rutherford MJ, Bardot A, et al. Progress in cancer survival, mortality, and incidence in seven high‐income countries 1995‐2014 (ICBP SURVMARK‐2): a population‐based study. Lancet Oncol 2019; 20: 1493‐1505.
    • 2. Peng Y, Baade P. Survival disparities among recently diagnosed Aboriginal and Torres Strait Islander cancer patients in Australia remain. Cancer Causes Control 2021; 32: 1315‐1320.
    • 3. Romero Y, Trapani D, Johnson S, et al. National cancer control plans: a global analysis. Lancet Oncol 2018; 19: e546‐e555.
    • 4. Torode JS, Tittenbrun Z, Romero Y, et al. Ten years of the International Cancer Control Partnership: promoting national cancer control plans to shape the health system response for cancer control. JCO Glob Oncol 2023; 9: e2200232.
    • 5. Australian Institute of Health and Welfare. Cancer in Australia 2021 (Cat. no. CAN 144). Canberra: AIHW, 2021. https://www.aihw.gov.au/reports/cancer/cancer‐in‐australia‐2021 (viewed Apr 2023).
    • 6. Australian Institute of Health and Welfare. Cancer in Aboriginal and Torres Strait Islander people of Australia (Cat. no. CAN 109). Canberra: AIHW, 2018. https://www.aihw.gov.au/reports/cancer/cancer‐in‐indigenous‐australians (viewed Apr 2023).
    • 7. Anderson K, Gall A, Butler T, et al. Development of key principles and best practices for co‐design in health with First Nations Australians. Int J Environ Res Public Health 2022; 20: 147.
    • 8. Sørensen K. Health literacy is an emerging strategic priority in national cancer control plans in the EU. J Cancer Pol 2020; 26: 100255.
    • 9. Bourque JM, Tittenbrun Z, Hohman K, et al. Why cancer control is fundamental during a pandemic. Int J Cancer 2021; 148: 2362‐2363.
    • 10. Edge R, Meyers J, Tiernan G, et al. Cancer care disruption and reorganisation during the COVID‐19 pandemic in Australia: a patient, carer and healthcare worker perspective. PLoS One 2021; 16: e0257420.
    • 11. Milch V, Nelson AE, Austen M, et al. Conceptual framework for cancer care during a pandemic incorporating evidence from the COVID‐19 pandemic. JCO Glob Oncol 2022; 8: e2200043.
    • 12. Nogueira LM, Yabroff KR, Bernstein A. Climate change and cancer. CA Cancer J Clin 2020; 70: 239‐244.
    • 13. Vineis P, Huybrechts I, Millett C, et al. Climate change and cancer: converging policies. Mol Oncol 2021; 15: 764‐769.
    • 14. Oar A, Moraes FY, Romero Y, et al. Core elements of national cancer control plans: a tool to support plan development and review. Lancet Oncol 2019; 20: e645‐e652.
    • 15. World Health Assembly, World Health Organization. Cancer prevention and control in the context of an integrated approach. WHA70.12. 31 May 2017. https://apps.who.int/iris/handle/10665/275676 (viewed April 2023).
    • 16. Duncan K, Cira MK, Barango P, et al. Challenges and opportunities in the creation and implementation of cancer‐control plans in Africa. Ecancermedicalscience 2019; 13: 938.
    • 17. Vinson CA, Staples C, Shafir S, et al. Collaborating to conquer cancer: the role of partnerships in comprehensive cancer control. Cancer Causes Control 2018; 29: 1173‐1180.

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      The complex impact of COVID‐19 on cancer outcomes in Australia

      Karen Canfell, Karen Chiam, Carolyn Nickson and G Bruce Mann
      Med J Aust 2023; 219 (9): . || doi: 10.5694/mja2.52125
      Published online: 6 November 2023

      In 2019, before the coronavirus disease 2019 (COVID‐19) pandemic, about 145 000 new cases of cancer (excluding non‐melanoma skin cancer) were diagnosed, and there were nearly 50 000 cancer‐related deaths in Australia.1 The cancer burden is expected to remain substantial over the next quarter‐century, with an estimated cumulative 4.56 million new cases and 1.45 million cancer deaths in that period.2 The impact of the pandemic on cancer care and outcomes is multifaceted and expected to be heterogenous across settings and subpopulations. This is partly due to differences in the stringency of public health controls, and thus the extent and timing of health services disruptions, which varied greatly between jurisdictions during the pandemic. The effect on specific cancer types also depends on their natural history, cancer control measures already in place, and susceptibility of those measures to broader public health controls. This article summarises the known data on the impact of the pandemic on cancer services, identifies gaps in current knowledge, and discusses the implications for future research priorities.

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      • 1 The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW
      • 2 Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC
      • 3 Breast Service, Royal Melbourne and Royal Women's Hospitals, Melbourne, VIC


      Correspondence: karen.canfell@sydney.edu.au


      Open access:

      Open access publishing facilitated by the University of Sydney, as part of the Wiley – the University of Sydney agreement via the Council of Australian University Librarians.

      Acknowledgements: 

      Karen Canfell receives salary funding from the National Health and Medical Research Council Australia (NHMRC Leadership Fellowship APP1194679). The funding source had no role in the work described in this article. We also acknowledge the International Cancer Benchmarking Partnership for commissioning related international work which has informed this article.

      Competing interests:

      Karen Canfell is co‐principal investigator (PI) of an investigator‐initiated trial of HPV screening in Australia (Compass), which is conducted and funded by the Australian Centre for the Prevention of Cervical Cancer (ACPCC), a government‐funded health promotion charity. The ACPCC has previously received equipment and a funding contribution for the Compass trial from Roche Molecular Systems USA. She is also co‐PI on a major implementation program, “Elimination of Cervical Cancer in the Western Pacific”, which receives support from the Minderoo Foundation and equipment donations from Cepheid Inc.

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        Hepatocellular carcinoma surveillance in Australia: current and future perspectives

        Samuel Hui, Sally Bell, Suong Le and Anouk Dev
        Med J Aust || doi: 10.5694/mja2.52124
        Published online: 23 October 2023

        Summary

        • Hepatocellular carcinoma (HCC) is a leading cause of cancer‐related death worldwide, and is increasing in incidence in Australia.
        • For most people with cirrhosis and chronic hepatitis B, HCC screening and surveillance is recommended with 6‐monthly ultrasound. However, most patients with HCC are still diagnosed outside of surveillance with incurable disease.
        • While HCC surveillance almost certainly reduces cancer‐related mortality, the potential harms of surveillance are incompletely understood.
        • Surveillance uptake remains suboptimal in many contexts, and stems from a combination of patient, clinician and system level barriers.
        • Improved case‐finding strategies may be required to identify high risk individuals in need of surveillance, as cirrhosis and viral hepatitis are often asymptomatic.
        • HCC prediction models and novel surveillance tools such as biomarker panels, computed tomography and magnetic resonance imaging may have a future role in personalised HCC surveillance.
        • Analyses suggest surveillance may be cost‐effective, but Australian data remain limited.
        • A centralised HCC surveillance program may ultimately have a role in delivering improved and more equitable care.

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        • 1 School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC
        • 2 Department of Gastroenterology and Hepatology, Monash Health, Melbourne, VIC


        Correspondence: samuel.hui@monash.edu


        Open access:

        Open access publishing facilitated by Monash University, as part of the Wiley ‐ Monash University agreement via the Council of Australian University Librarians.

        Acknowledgements: 

        Samuel Hui is supported by a Research Training Program stipend from Monash University.

        Competing interests:

        No relevant disclosures.

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          The National Indigenous Kidney Transplantation Taskforce: changing systems to achieve equitable access to kidney transplantation

          Jaquelyne T Hughes, Katie Cundale, Kelli J Owen and Stephen P McDonald
          Med J Aust 2023; 219 (8): . || doi: 10.5694/mja2.52107
          Published online: 16 October 2023

          Aboriginal and Torres Strait Islander people with chronic kidney disease seek good health, good kidney health, and good experiences of health care at all stages of their kidney journeys.1,2,3 Kidney replacement therapy is crucial for people with kidney failure, so needs to be accessed regularly, safely and sustainably alongside high quality cultural and clinical support. However, access to kidney transplantation, often the best kidney replacement therapy option, is not equally available to Aboriginal and Torres Strait Islander people in Australia.4

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          • 1 Rural and Remote Health, Flinders University, Darwin, NT
          • 2 Royal Darwin Hospital, Darwin, NT
          • 3 National Indigenous Kidney Transplantation Taskforce (NIKTT), South Australian Health and Medical Research Institute, Adelaide, SA
          • 4 Adelaide Medical School, University of Adelaide, Adelaide, SA
          • 5 Central and Northern Adelaide Renal and Transplantation, Royal Adelaide Hospital, Adelaide, SA
          • 6 Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health and Medical Research Institute, Adelaide, SA


          Correspondence: katie@anzdata.org.au
          Acknowledgements: 

          We acknowledge and thank the Australian Government, represented by the Department of Health and Aged Care, for their funding of the National Indigenous Kidney Transplantation Taskforce (NIKTT) through an Indigenous Australians’ Health Programme grant. This funding enabled the work described here to be undertaken, as well as the publication of the supplement that accompanies this issue of the MJA. We thank the Aboriginal and Torres Strait Islander people living with kidney disease and transplantation who have worked with the NIKTT. We acknowledge that Aboriginal and Torres Strait Islander people in Australia face inequities in accessing transplantation because of the barriers that exist within our health care system due to the lasting and ongoing impacts of colonisation. We thank everyone who has helped us to work towards improving access to transplantation. We thank and acknowledge the dedicated members of the NIKTT who have walked with us for the past few years, as well as the partner organisations and societies with whom we work on advancing access to kidney transplantation.

          Competing interests:

          No relevant disclosures.

          • 1. Devitt J, Anderson K, Cunningham J, et al. Difficult conversations: Australian Indigenous patients’ views on kidney transplantation. BMC Nephrol 2017; 18: 1‐14.
          • 2. Hughes JT, Dembski L, Kerrigan V, et al. Gathering perspectives – finding solutions for chronic and end stage kidney disease. Nephrology (Carlton) 2017; 23: 5‐13.
          • 3. Cormick A, Owen K, Turnbull D, et al. Renal healthcare: voicing recommendations from the journey of an Aboriginal woman with chronic kidney disease. Ren Soc Australas J 2022; 18: 88‐100.
          • 4. Wyld ML, Wyburn KR, Chadban SJ. Global perspective on kidney transplantation: Australia. Kidney360 2021; 2: 1641.
          • 5. Hughes, JT. Kidney health equity for Indigenous Australians: an achievable goal. Nat Rev Nephrol 2021; 17: 505.
          • 6. Mick‐Ramsamy L, Kelly J, Duff D, et al. Catching some air: asserting Aboriginal and Torres Strait Islander information rights in renal disease – the final report. Darwin: Menzies School of Health Research, 2019. https://www.menzies.edu.au/icms_docs/307210_Catching_Some_Air.pdf (viewed Dec 2022).
          • 7. Hoy WE, Mott SA, McDonald SP. An update on chronic kidney disease in Aboriginal Australians. Clin Nephrol 2020; 93: 124‐128.
          • 8. Garrard E, McDonald SP. Improving access to and outcomes of kidney transplantation for Aboriginal and Torres Strait Islander People in Australia: performance report. Sydney: TSANZ, 2019. https://tsanz.com.au/storage/NIKTT/TSANZ‐Performance‐Report‐‐‐Improving‐Indigenous‐Transplant‐Outcomes‐Final‐edited‐1.pdf (viewed Dec 2022).
          • 9. Tiong MK, Thomas S, Fernandes DK, Cherian S. Examining barriers to timely waitlisting for kidney transplantation for Indigenous Australians in Central Australia. Intern Med J 2022; 52: 288‐294.
          • 10. Sypek MP, Clayton PA, Lim W, et al. Access to waitlisting for deceased donor kidney transplantation in Australia. Nephrology (Carlton) 2019; 24: 758‐766.
          • 11. Hughes JT, Cundale K, Owen K, McDonald SP. Advancing accessible kidney transplantation for Aboriginal and Torres Strait Islander peoples: the National Indigenous Kidney Transplantation Taskforce. Med J Aust 2023; 219 (8 Suppl): S3‐S6.
          • 12. Cundale K, McDonald SP, Irish A, et al. Improving equity in access to kidney transplantation: implementing targeted models of care focused on improving timely access to waitlisting. Med J Aust 2023; 219 (8 Suppl): S7‐S10.
          • 13. Hughes JT, Owen K, Kelly J, et al. Cultural bias in kidney care and transplantation: review and recommendations to improve kidney care for Aboriginal and Torres Strait Islander people. Med J Aust 2023; 219 (8 Suppl): S11‐S14.
          • 14. Owen K, Cundale K, Hughes JT, et al. From talk to action: Indigenous reference groups drive practice change in kidney transplantation care. Med J Aust 2023; 219 (8 Suppl): S15‐S18.
          • 15. Hughes JT, Cundale K, Webster AC, et al. Towards equity in kidney transplantation: the next steps. Med J Aust 2023; 219 (8 Suppl): S19‐S22.

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            Dietary management of eosinophilic oesophagitis

            Jessica Fitzpatrick, Sarah L Melton and Rebecca E Burgell
            Med J Aust 2023; 219 (8): . || doi: 10.5694/mja2.52101
            Published online: 16 October 2023

            Eosinophilic oesophagitis is a chronic inflammatory disease characterised by eosinophilic inflammation of the oesophagus and sometimes scarring, and is associated with difficulty swallowing, dyspepsia and choking. Since spontaneous resolution is rare, therapeutic options have centred around use of medication or dietary manipulation. First described in the mid‐1990s, the condition is now recognised to affect about 42 per 100 000 of the adult population and 34 per 100 000 of the paediatric population.1 These data may be an underestimate of the true prevalence of eosinophilic oesophagitis due to the diagnosis requiring oesophageal biopsies and a high index of suspicion. Up to 12–23% of patients undergoing endoscopy for dysphagia and 50% of those presenting with food bolus obstruction have eosinophilic oesophagitis as the cause of their symptoms.2,3 The prevalence of eosinophilic oesophagitis has steadily (and in some populations exponentially) increased, and although prevalence data from Australia are lacking, anecdotally a similar phenomenon has been observed.2,4

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            • 1 Alfred Health, Melbourne, VIC
            • 2 Monash University, Melbourne, VIC



            Open access:

            Open access publishing facilitated by Monash University, as part of the Wiley – Monash University agreement via the Council of Australian University Librarians.

            Acknowledgements: 

            Jessica Fitzpatrick and Sarah Melton are supported by a Crohn's Colitis Australia PhD Scholarship.

            Competing interests:

            Rebecca Burgell has received speaker fees from Falk Pharmaceutical. Jessica Fitzpatrick has received speaker fees from Pepsi Co.

            • 1. Navarro P, Arias Á, Arias‐González L, et al. Systematic review with meta‐analysis: the growing incidence and prevalence of eosinophilic oesophagitis in children and adults in population‐based studies. Aliment Pharmacol Ther 2019; 49: 1116‐1125.
            • 2. Dellon ES, Hirano I. Epidemiology and natural history of eosinophilic esophagitis. Gastroenterology 2018; 154: 319‐332.
            • 3. Kerlin P, Jones D, Remedios M, Campbell C. Prevalence of eosinophilic esophagitis in adults with food bolus obstruction of the esophagus. J Clin Gastroenterol 2007; 41: 356‐361.
            • 4. Cherian S, Smith NM, Forbes DA. Rapidly increasing prevalence of eosinophilic oesophagitis in Western Australia. Arch Dis Child 2006; 91: 1000‐1004.
            • 5. Straumann A, Katzka DA. Diagnosis and treatment of eosinophilic esophagitis. Gastroenterology 2018; 154: 346‐359.
            • 6. Dellon ES, Liacouras CA, Molina‐Infante J, et al. Updated international consensus diagnostic criteria for eosinophilic esophagitis: proceedings of the AGREE Conference. Gastroenterology 2018; 155: 1022‐1033.
            • 7. Mayerhofer C, Kavallar AM, Aldrian D, et al. Efficacy of elimination diets in eosinophilic esophagitis: a systematic review and meta‐analysis. Clin Gastroenterol Hepatol 2023; 21: 2197‐2210.
            • 8. Dhar A, Haboubi HN, Attwood SE, et al. British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults. Gut 2022; 71: 1459‐1487.
            • 9. Lucendo AJ, Arias Á, Molina‐Infante J. Efficacy of proton pump inhibitor drugs for inducing clinical and histologic remission in patients with symptomatic esophageal eosinophilia: a systematic review and meta‐analysis. Clin Gastroenterol Hepatol 2016; 14: 13‐22.
            • 10. Rank MA, Sharaf RN, Furuta GT, et al. Technical review on the management of eosinophilic esophagitis: a report from the AGA Institute and the Joint Task Force on Allergy‐Immunology Practice Parameters. Gastroenterology 2020; 158: 1789‐1810.
            • 11. Arias A, González‐Cervera J, Tenias JM, Lucendo AJ. Efficacy of dietary interventions for inducing histologic remission in patients with eosinophilic esophagitis: a systematic review and meta‐analysis. Gastroenterology 2014; 146: 1639‐1648.
            • 12. Kagalwalla AF, Sentongo TA, Ritz S, et al. Effect of six‐food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis. Clin Gastroenterol Hepatol 2006; 4: 1097‐1102.
            • 13. Spergel JM, Beausoleil JL, Mascarenhas M, Liacouras CA. The use of skin prick tests and patch tests to identify causative foods in eosinophilic esophagitis. J Allergy Clin Immunol 2002; 109: 363‐368.
            • 14. Molina‐Infante J, Arias Á, Alcedo J, et al. Step‐up empiric elimination diet for pediatric and adult eosinophilic esophagitis: the 2‐4‐6 study. J Allergy Clin Immunol 2018; 141: 1365‐1372.
            • 15. Eckmann JD, Ravi K, Katzka DA, et al. Efficacy of atopy patch testing in directed dietary therapy of eosinophilic esophagitis: a pilot study. Dig Dis Sci 2018; 63: 694‐702.
            • 16. Wechsler JB, Schwartz S, Arva NC, et al. A single‐food milk elimination diet is effective for treatment of eosinophilic esophagitis in children. Clin Gastroenterol Hepatol 2022; 20: 1748‐1756.
            • 17. Teoh T, Mill C, Chan E, et al. Liberalized versus strict cow's milk elimination for the treatment of children with eosinophilic esophagitis. J Can Assoc Gastroenterol 2019; 2: 81‐85.
            • 18. de Rooij WE, Vlieg‐Boerstra B, Warners MJ, et al. Effect of amino acid‐based formula added to four‐food elimination in adult eosinophilic esophagitis patients: a randomized clinical trial. Neurogastroenterol Motil 2022; 34: e14291.
            • 19. Kliewer KL, Gonsalves N, Dellon ES, et al. One‐food versus six‐food elimination diet therapy for the treatment of eosinophilic oesophagitis: a multicentre, randomised, open‐label trial. Lancet Gastroenterol Hepatol 2023; 8: 408‐421.
            • 20. Sheedy K, Patel N, Porter J, Silva H. Cost and accessibility of empiric food elimination diets for treatment of eosinophilic oesophagitis. Nutr Diet 2022; 79: 238‐246.
            • 21. Wang L, Mara KC, Ravi K, et al. Predictors of histologic response to dietary therapy in eosinophilic oesophagitis. Aliment Pharmacol Ther 2022; 56: 1444‐1452.
            • 22. Egan M, Atkins D. What is the relationship between eosinophilic esophagitis (EoE) and aeroallergens? Implications for allergen immunotherapy. Curr Allergy Asthma Rep 2018; 18: 43.
            • 23. Safroneeva E, Straumann A, Coslovsky M, et al. Symptoms have modest accuracy in detecting endoscopic and histologic remission in adults with eosinophilic esophagitis. Gastroenterology 2016; 150: 581‐590.
            • 24. Philpott H, Dellon E. Histologic improvement after 6 weeks of dietary elimination for eosinophilic esophagitis may be insufficient to determine efficacy. Asia Pac Allergy 2018; 8: e20.
            • 25. Chang JW, Kliewer K, Haller E, et al. Development of a practical guide to implement and monitor diet therapy for eosinophilic esophagitis. Clin Gastroenterol Hepatol 2023; 21: 1690‐1698.
            • 26. Katzka DA, Smyrk TC, Alexander JA, et al. Accuracy and safety of the cytosponge for assessing histologic activity in eosinophilic esophagitis: a two‐center study. Am J Gastroenterol 2017; 112: 1538‐1544.
            • 27. Philpott H, Nandurkar S, Royce SG, Gibson PR. Ultrathin unsedated transnasal gastroscopy in monitoring eosinophilic esophagitis. J Gastroenterol Hepatol 2016; 31: 590‐594.

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              Undiagnosed coeliac disease identified by active case finding in first degree relatives of people with coeliac disease in Australia: a prospective observational study

              Richard Muir, Anuj Sehgal, Jason A Tye‐Din and A James M Daveson
              Med J Aust || doi: 10.5694/mja2.52105
              Published online: 2 October 2023

              Coeliac disease is a lifelong, systemic inflammatory disease triggered by dietary gluten.1 Expeditious diagnosis and treatment can reduce morbidity and the impact on quality of life, but many people with the disorder have not been tested and consequently have not been diagnosed.2 A family history of coeliac disease is the strongest risk factor,3 and active case finding among people in at‐risk groups is appropriate. A meta‐analysis found that the pooled prevalence of coeliac disease among 10 252 first degree relatives of people with diagnosed coeliac disease was 7.5%, but the local prevalence differed widely between Asia, Europe, North America, and South America.4

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              • 1 The Wesley Hospital, Brisbane, QLD
              • 2 St Andrew's War Memorial Hospital, Brisbane, QLD
              • 3 Wesley Research Institute, Brisbane, QLD
              • 4 The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC
              • 5 The Royal Melbourne Hospital, Melbourne, VIC
              • 6 The University of Queensland, Brisbane, QLD


              Correspondence: jamesdaveson@uq.edu.au


              Open access:

              Open access publishing facilitated by The University of Queensland, as part of the Wiley – The University of Queensland agreement via the Council of Australian University Librarians.

              Acknowledgements: 

              This analysis was supported by direct funding for the Coeliac Disease and Immune Health Program at Wesley Research Institute.

              Competing interests:

              No relevant disclosures.

              • 1. Catassi C, Verdu EF, Bai JC, Lionetti E. Coeliac disease. Lancet 2022; 399: 2413‐2426.
              • 2. Anderson RP, Henry MJ, Taylor R, et al. A novel serogenetic approach determines the community prevalence of celiac disease and informs improved diagnostic pathways. BMC Med 2013; 11: 188.
              • 3. Elwenspoek MMC, Thom H, Sheppard A, et al. Defining the optimum strategy for identifying adults and children with coeliac disease: a systematic review and economic modelling. Health Technol Assess 2022; 26: 1‐310.
              • 4. Singh P, Arora S, Lal S, et al. Risk of celiac disease in the first‐ and second‐degree relatives of patients with celiac disease: a systematic review and meta‐analysis. Am J Gastroenterol 2015; 110: 1539‐1548.
              • 5. Oberhuber G, Granditsch G, Vogelsang H, et al. The histopathology of celiac disease: time for a standardized report scheme for pathologists. Eur J Gastroenterol Hepatol 1999; 11: 1185‐1194.
              • 6. Martínez‐Ojinaga E, Moline M, Polanco I, et al. HLA‐DQ distribution and risk assessment of celiac disease in a Spanish center. Rev Esp Enferm Dis 2018;1107: 421‐426.
              • 7. Singh P, Arora A, Strand TA, et al. Global prevalence of celiac disease: systematic review and meta‐analysis. Clin Gastroenterol Hepatol 2018; 16: 823‐836.
              • 8. Tye‐Din. Interpreting tests for coeliac disease: tips, pitfalls and updates. Aust J Gen Pract 2018; 47: 28‐33.
              • 9. Downey L, Houten R, Murch S, Longson D; Guideline Development Group. Recognition, assessment, and management of coeliac disease: summary of updated NICE guidance. BMJ 2015; 351: h4513.
              • 10. Al‐Toma A, Volta U, Auricchio R, et al. European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten‐related disorders. United European Gastroenterol J 2019; 7: 583‐613.
              • 11. Rubio‐Tapia A, Hill ID, Kelly CP, et al; American College of Gastroenterology. ACG clinical guidelines: diagnosis and management of celiac disease. Am J Gastroenterol 2013; 108: 656‐676.

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                Child abuse and premature mortality: disrupting the harm cascade

                Leonie Segal and Harriet Hiscock
                Med J Aust 2023; 219 (7): . || doi: 10.5694/mja2.52092
                Published online: 2 October 2023

                In this issue of the MJA,1 Papalia and colleagues report extremely high age‐ and sex‐standardised rates of death before age 50 years among people who had experienced medically confirmed sexual abuse in Victoria before the age of 16 years. The all‐cause mortality incidence rate was more than eight times as high for this cohort as for the general population (incidence rate ratio [IRR], 8.25; 95% confidence interval [CI], 5.92–11.5); the difference with regard to external cause deaths (suicide, accidents, assaults) was greater following penetrative (IRR, 14.9; 95% CI, 10.9–20.5) than non‐penetrative sexual abuse (IRR, 8.92; 95% CI, 5.35–14.9).1 The reported risk ratios are higher than those reported for outcomes in other studies; for example, we found that the mortality risk (between the ages of 16 and 33 years) was 5.77 times as high for people removed to out‐of‐home care after the age of three years as for people who had no contact with child protection services.2 However, the magnitude of the reported IRRs are consistent with other studies; for instance, that the risk of attempted suicide by boys subjected to familial child sexual abuse is fifteen times the population level.3


                • 1 The University of South Australia, Adelaide, SA
                • 2 Royal Children's Hospital, Melbourne, VIC


                Correspondence: leonie.segal@unisa.edu.au
                Competing interests:

                No relevant disclosures.

                • 1. Papalia N, Spivak BL, Ashford L, et al. Sexual abuse during childhood and all‐cause mortality into middle adulthood: an Australian cohort study. Med J Aust 2023; 219: 310‐315.
                • 2. Segal L, Armfield JM, Gnanamanickam ES, et al. Child maltreatment and mortality in young adults. Pediatrics 2021; 147: e2020023416.
                • 3. Duke NN, Pettingell SL, McMorris BJ, Borowsky IW. Adolescent violence perpetration: associations with multiple types of adverse childhood experiences, Pediatrics 2010; 125: e778.
                • 4. US Department of Health and Human Services. Child maltreatment and brain development: a primer for child welfare professionals. Child Welfare Information Gateway; Mar 2023. https://www.childwelfare.gov/pubpdfs/brain_development.pdf (viewed Aug 2023).
                • 5. Shonkoff JP, Garner AS; Committee on Psychosocial Aspects of Child and Family Health; Committee on Early Childhood, Adoption, and Dependent Care; Section on Developmental and Behavioral Pediatrics. The lifelong effects of early childhood adversity and toxic stress. Pediatrics 2012; 129: e232‐e246.
                • 6. Amos J, Segal L. Disrupting intergenerational maternal maltreatment in middle childhood: therapeutic objectives and clinical translation. Front Psychiatry 2018; 9: 623.
                • 7. Bellis MA, Hughes K, Quigg Z, et al. Tackling adverse childhood experiences (ACEs): state of the art and options for action. 9 Mar 2023. https://phwwhocc.co.uk/resources/tackling‐adverse‐childhood‐experiences‐aces‐state‐of‐the‐art‐and‐options‐for‐action (viewed Aug 2023).
                • 8. Amos J, Todd B, Gibson B, et al. Using the Adult Exploration of Attachment Interview (AEAI) to break the cycle of intergenerational trauma: illustrations from a family reunification program. Aust N Z J Fam Ther 2022; 43: 168‐181.
                • 9. Armfield JM, Gnanamanickam ES, Johnston DW, et al. Intergenerational transmission of child maltreatment in South Australia, 1986–2017: a retrospective cohort study. Lancet Public Health 2021; 6: e450‐e461.
                • 10. Mulraney M, Hiscock H, Sciberras E, et al. Mental health difficulties across childhood and mental health service use: findings from a longitudinal population‐based study. Br J Psychiatry 2020; 217: 364‐369.
                • 11. Gnanamanickam ES, Nguyen H, Armfield JM, et al. Child maltreatment and emergency department visits: a longitudinal birth cohort study from infancy to early adulthood. Child Abuse Neglect 2022; 123: 105397.
                • 12. Australian Department of Health and Aged Care. Head to Health. Undated. https://www.headtohealth.gov.au (viewed Aug 2023).
                • 13. Ministry for Mental Health (Victoria). One‐stop mental health hubs for families a step closer [media release]. 13 July 2022. https://www.premier.vic.gov.au/one‐stop‐mental‐health‐hubs‐families‐step‐closer (viewed Aug 2023).

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                  Consensus statement for the management of incidentally found brain white matter hyperintensities in general medical practice

                  Thomas P Ottavi, Elizabeth Pepper, Grant Bateman, Mark Fiorentino and Amy Brodtmann
                  Med J Aust 2023; 219 (6): . || doi: 10.5694/mja2.52079
                  Published online: 18 September 2023

                  Abstract

                  Introduction: There is a paradigm shift in our understanding of white matter hyperintensities (WMH) found on brain imaging. They were once thought to be a normal phenomenon of ageing and, therefore, warranted no further investigation. However, evidence now suggests these lesions are markers of poor brain and cardiovascular health, portending an increased risk of stroke, cognitive decline, depression and death. Nevertheless, no specific guidelines exist for the management of incidentally found WMH for general medical practitioners and other clinicians ordering brain magnetic resonance imaging scans for diverse clinical indications. Informed by a literature review and expert opinion gleaned from stroke neurologists, medical and imaging specialists, and general practitioners, we present our consensus statement to guide the management of incidentally found WMH in adults.

                  Main recommendations: When incidental WMH are found on brain imaging:

                  • Perform a detailed history and examination to screen for neurological events.
                  • Investigate for potential undiagnosed or undertreated cardiovascular risk factors, especially hypertension and diabetes mellitus.
                  • Commence intensive and individualised cardiovascular risk management when risk factors are uncovered.
                  • Treat underlying risk factors via accepted guidelines but note that antiplatelet and anticoagulant medications should not be prescribed for incidental WMH in the absence of an alternative indication.

                  Changes to management as a result of this consensus statement: A brain health opportunity. We consider the discovery of incidental WMH on brain imaging to represent an opportunity to investigate for common cardiovascular risk factors and to optimise brain health. This can be commenced and monitored by the general practitioner or physician without delay in waiting for an outpatient neurology review.

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                  • 1 John Hunter Hospital, Newcastle, NSW
                  • 2 Monash University, Melbourne, VIC



                  Open access:

                  Open access publishing facilitated by Monash University, as part of the Wiley ‐ Monash University agreement via the Council of Australian University Librarians.

                  Acknowledgements: 

                  We thank and acknowledge Darshan Ghia, Bernard Yan, Mark Parsons, Andrew Wong, Neil Spratt, Ben Clissold, Anna Holwell, Henry Ma, Claire Muller, Kenneth Butcher, Candice Delcourt, Teddy Wu, and Anna Ranta for their contributions as the expert panel and their review of the manuscript. We also thank and acknowledge Andrew Lee, Rebecca Moore, Gregory Carter, and Kichu Nair for reviewing the manuscript.

                  Competing interests:

                  No relevant disclosures.

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                    Financial support provided to male and female physicians by pharmaceutical companies in New Zealand: a cross‐sectional study

                    Leah Jones
                    Med J Aust 2023; 219 (6): . || doi: 10.5694/mja2.52057
                    Published online: 18 September 2023

                    Despite progress, gender differences persist in many areas of medicine. In the United States, female physicians are paid less, are promoted more slowly, and fewer hold leadership or senior academic positions than male physicians.1

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                    • Te Whatu Ora Health New Zealand Te Toka Tumai, Auckland, New Zealand


                    Correspondence: leahjones@adhb.govt.nz

                    Correspondence: lkjones@hotmail.co.nz

                    Competing interests:

                    No relevant disclosures.

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                      Lung cancer screening for Aboriginal and Torres Strait Islander peoples: an opportunity to address health inequities

                      Alison Brown, Gail Garvey, Nicole M Rankin, Claire Nightingale and Lisa J Whop
                      Med J Aust || doi: 10.5694/mja2.52084
                      Published online: 11 September 2023

                      The implementation of a national Lung Cancer Screening Program (LCSP), commencing in July 2025, presents a significant opportunity to have an impact on an intractable health problem for Aboriginal and Torres Strait Islander communities.1 Lung cancer is the most common cancer and the leading cause of cancer death for Aboriginal and Torres Strait Islander peoples.2 The Aboriginal and Torres Strait Islander age‐standardised incidence rate was 85.2 cases per 100 000 for 2009–2013 and the mortality rate was 56.8 deaths per 100 000, which are double the rates found in non‐Indigenous populations.2 Lung cancer mortality rates for Aboriginal and Torres Strait Islander peoples are increasing, in contrast to falling rates in non‐Indigenous Australians.2 These diverging trends are expected to increase disparities for many years to come and clearly demonstrate the health system is failing Aboriginal and Torres Strait Islander peoples. The disproportionate lung cancer burden means that an LCSP could deliver greater benefits to Aboriginal and Torres Strait Islander communities and reduce the disparity with non‐Indigenous Australians.

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                      • 1 University of Melbourne, Melbourne, VIC
                      • 2 University of Queensland, Brisbane, QLD
                      • 3 National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT


                      Correspondence: alison.brown@unimelb.edu.au


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                      Open access publishing facilitated by The University of Melbourne, as part of the Wiley – The University of Melbourne agreement via the Council of Australian University Librarians.

                      Acknowledgements: 

                      Lisa Whop is supported by a National Health and Medical Research Council (NHMRC) Investigator Grant (2009380). Gail Garvey is funded by an NHMRC Investigator Grant (1176651). Claire Nightingale is supported by a Mid‐Career Research Fellowship (MCRF21039) from the Victorian Government acting through the Victorian Cancer Agency. Nicole Rankin is funded by an NHMRC Ideas Grant (2019/GA65812) and a Medical Research Future Fund Grant (2019/MRF2008603). The funding sources had no role in the content of this article.

                      Competing interests:

                      We received funding from Cancer Australia for conducting consultations with Aboriginal and Torres Strait Islander workforce around lung cancer screening but we were not directly funded for the publication of this article.

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