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National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people


Chapter 15: Prevention and early detection of cancer
Prevention and early detection of cervical cancer
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☰ Table of contents


Recommendations: Prevention and early detection of cervical cancer

Preventive intervention type

Who is at risk?

What should be done?

How often?

Level/ strength of evidence

References

Immunisation

Adolescents (girls and boys) aged 9–18 years Promote human papillomavirus (HPV) vaccination for the prevention of cervical cancer – ideally age 11–13 years, prior to onset of sexual activity (Can be accessed through National Immunisation Program [NIP] – school vaccination programs or through clinic/ community services for those aged 10–15 years, timing depending on state or territory)

Vaccination up to age 18 years is recommended but should include discussion of potential benefit based on risk of previous exposure
As per National Immunisation Program Schedule (NIPS) (varies between states and territories)22 IIB 6,23
Women and men aged ≥19 years (not subsidised through the NIPS – check state/ territory rules regarding catch-up programs) Vaccination of all women and men against HPV not recommended – conduct individual risk and benefit assessment As per The Australian immunisation handbook IIB 6
Men who have sex with men (not subsidised through the NIPS – check state/ territory rules regarding catch-up programs) 4vHPV vaccine recommended for men who have not been vaccinated, but should take into account likelihood of past exposure to HPV and risk of future exposure As per The Australian immunisation handbook IIB 6

Screening

Asymptomatic women aged 25–69 years who have ever been sexually active

Offer cervical screening test (HPV) from age 25 years (or two years after commencing sexual activity, whichever is later) regardless of whether HPV vaccination has been given

Note: As of 1 December 2017, Pap smears are no longer recommended as a screening test for cervical cancer

Every five years II, III–IIA 24-27
Asymptomatic women aged 70–74 years who have ever been sexually active Exit cervical screening test (HPV) for those who have been regularly screened Exit test between ages 70 and 74 years III–IIA 24, 25
Asymptomatic underscreened women – women who are 30 years of age and have never been screened or women aged ≥30 years who are at least two years late for cervical screening Offer clinician-collected cervical screening test (HPV). If declined, recommend self-collected sample (should become available in 2018) and explain slightly lower accuracy of testing. Inform clients on the recommendation for clinician-collected liquid-based cytology (LBC) sample or colposcopy if self-collected sample is oncogenic HPV positive Promote cervical screening if overdue, and then routine fiveyearly screening if negative II, III–IIA 28
Women with recent abnormal Pap smears, previously treated for high-grade squamous intraepithelial lesion (HSIL), or at high risk of cervical abnormalities (eg immune suppression, in-utero exposure to diethylstilbestrol [DES]) Screening recommendations are more complex and recommend consultation of guidelines for higher risk groups – refer to ‘Resources’ Follow-up intervals vary by condition II, III–IIC 24, 28

Behavioural

All women Assess smoking status and advise that smoking increases risks of cervical dysplasia and cervical cancer (refer to Chapter 1: Lifestyle, ‘Smoking’) As part of annual health assessment III–IIB 29,30
Offer a sexual health review (refer to Chapter 14: Sexual health and bloodborne viruses) As part of annual health assessment GPP  

Overview


Cancer is estimated to cause 9% of the burden of disease for Aboriginal and Torres Strait Islander peoples, and accounts for 9% of the health gap between Aboriginal and Torres Strait Islander peoples and the non-Indigenous population. Aboriginal and Torres Strait Islander peoples have a 1.7 times higher burden of disease due to cancer when compared to the non-Indigenous population.1
Inadequate recording of Aboriginal and Torres Strait Islander status on cancer registries and in death registers in many jurisdictions means that reported statistics on cancer incidence and mortality are likely to underestimate true rates of cancer. Aboriginal and Torres Strait Islander peoples have a higher incidence of preventable cancers, such as lung, cervical and liver cancer. In addition, due to later diagnosis and poorer access to adequate treatment, Aboriginal and Torres Strait Islander peoples have higher case fatality rates for many cancers compared to the rest of the population.2–4

Cancer incidence and mortality

Overall, the most recent analysis reports an age-standardised incidence rate for cancer that is 10% higher for Aboriginal and Torres Strait Islander peoples compared to non-Indigenous people. The most commonly diagnosed cancer in Aboriginal and Torres Strait Islander peoples for 2008–12 was lung cancer (average of 173 cases per year), followed by breast cancer in females (143), colorectal cancer (116) and prostate cancer (101). Age-standardised incidence rates are higher in Aboriginal and Torres Strait Islander peoples for liver cancer (2.8 times as high), cervical cancer (2.2), lung cancer (2.0), cancer of unknown primary site (1.9), uterine cancer (1.7) and pancreatic cancer (1.4) when compared to non-Indigenous people.3 Conversely, age-standardised incidence rates for Aboriginal and Torres Strait Islander peoples are lower for colorectal cancer and breast cancer in females (rate ratio of 0.9), non-Hodgkin lymphoma (0.8) and prostate cancer (0.7) when compared to non-Indigenous people. Some of this may be attributable to lower uptake of screening by Aboriginal and Torres Strait Islander peoples.3

Age-standardised mortality rates are higher for Aboriginal and Torres Strait Islander peoples compared to non-Indigenous people for cervical cancer (3.8 times as high), liver cancer (2.5), lung cancer (1.8), uterine cancer and cancer of unknown primary site (both 1.6) and pancreatic cancer (1.3).3 The age-standardised mortality rate was lower for Aboriginal and Torres Strait Islander peoples Australians than for non-Indigenous Australians for colorectal cancer (rate ratio 0.7).5


Prevention and early detection of cervical cancer


Background

The incidence of cervical cancer in Aboriginal and Torres Strait Islander women is 2.2 times higher than in non-Indigenous women. Cervical cancer mortality is 3.8 times higher in Aboriginal and Torres Strait Islander versus non-Indigenous women.3

Interventions

Vaccination against human papillomavirus (HPV) is recommended due to the link between cervical HPV infection and the development of cervical dysplasia. As the vaccine works by preventing HPV infection and cervical dysplasia, and cannot treat existing HPV infection or disease, vaccination is ideally given prior to onset of sexual activity, or otherwise as early as possible. The HPV vaccine is provided free in schools to all males and females aged 12–13 years under the National HPV Vaccination Program. Some older women and men at higher risk of HPV-related cancers may also benefit from HPV vaccination, which may be funded in some states through catch-up programs if adolescent vaccination was missed. Refer to The Australian immunisation handbook for more details.6

Pap smears have been shown to reduce the risk of developing cervical cancer due to detecting and treating cervical changes before they develop into invasive cancer, with 80% of cervical cancers occurring in women who have never been screened or who have not had timely screening. In 2014–15 in Australia, 57% of the target population participated in screening.3 National participation rates have remained stable over the last 10 years, with participation rates tending to be lower in lower socioeconomic groups and remote areas.7

Cervical screening state registers have not systematically collected information on the Aboriginal and Torres Strait Islander status of women screened3 because pathology report forms, the main data source for the registers, do not collect Aboriginal and Torres Strait Islander status. This is expected to change with the commencement of the national cancer screening register.8

Aboriginal and Torres Strait Islander women tend to have lower participation rates in cervical screening programs, with studies finding participation rates that are 30–50% lower than for non-Indigenous women.9–11 One study recently showed a higher rate of screen-detected low-grade and high-grade lesions and histologically confirmed high-grade lesions.12

In one jurisdiction, it was found that Aboriginal and Torres Strait Islander women who participated in cervical screening appeared to participate just as regularly as non-Indigenous women, indicating that increasing the participation among Aboriginal and Torres Strait Islander women who never screen is critical to improving participation rates and cancer outcomes. Factors that may increase participation of Aboriginal and Torres Strait Islander women in cervical cancer screening are inclusion of cervical screening programs within primary healthcare services; culturally appropriate care; appropriate staff, including female staff, and involvement of Aboriginal health workers; community participation; linkages between services; continuous quality improvement activities; reminder letters and patient educational events.9,13–17 The Practice Incentives Program (PIP) currently provides financial incentives for accredited health services to provide cervical screening, including additional incentives for screening in under-screened women. This will change with the implementation of a quality improvement PIP in mid-2018.18

The National Cervical Screening Program changed on 1 December 2017. The Pap smear test has been replaced by a new HPV cervical screening test with reflex liquid-based cytology (LBC) for oncogenic HPV positive samples. Evidence shows that HPV-based cervical screening is more sensitive than Pap smear screening, will detect high-grade cervical lesions earlier, and will prevent more cervical cancers. Other program changes include five-yearly HPV screening from age 25 years (or two years after commencing sexual activity, whichever is later) with an exit test for women between the ages of 70 and 74 years. For women with previously normal Pap smears, the new test will be performed two years after the last Pap test. For women with positive HPV and LBC results or with recent abnormalities under the previous Pap smearbased cervical screening program, new guidelines are available online with details of further screening and follow-up recommendations – refer to ‘Resources’.19,20

There is no evidence to suggest that receiving an HPV positive test result would be any different to receiving an abnormal Pap test result for Aboriginal and Torres Strait Islander women. Cervical screening providers and other relevant health service staff should discuss HPV in terms of being the most common sexually transmitted infection (STI) that affects most sexually active people at some point in their life, explain the renewed cervical screening program using the HPV test, and answer questions that patients may have about the test. Specific educational information for Aboriginal and Torres Strait Islander women may be useful once developed.20

Cervical screening self-collection – for women who are under-screened (aged >30 years and never screened, or >30 years and two years or more overdue for screening), the cervical screening provider is able to offer the option of a self-collected HPV test in the clinic once testing arrangements are finalised in 2018. The self-collected test has slightly reduced sensitivity – that is, it may be slightly more likely to miss picking up cervical HPV than a clinician-collected sample, but is preferable to remaining unscreened. Under-screened women who elect to perform self-sampling should be encouraged to have a clinician-collected sample when next due. For women with an oncogenic HPV-positive (type 16 or 18) result on a self-collected test, it is recommended that they are referred directly for colposcopy with LBC to be collected at colposcopy; women with HPV-positive (not type 16 or 18) result on a self-collected sample are recommended to return for a clinician-collected LBC test – refer to National Cervical Screening Program guidelines for further management.20

Women vaccinated against HPV should follow the same cervical screening recommendations as unvaccinated women because the vaccine does not cover all strains of HPV that cause cervical cancer, and some women may have been exposed to HPV prior to being vaccinated.20,21

Symptomatic women – cervical screening recommendations apply to asymptomatic women. Women with symptoms or abnormalities of the cervix on examination should be investigated appropriately and referred for specialist review and treatment as required.

Assess smoking status – smoking is a risk factor for development of cervical cancer. Refer to ‘Recommendations’ for more detail.

 

Resources

National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people

 





 
 
  1. Australian Institute of Health and Welfare. Australian burden of disease study: Impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2011. Canberra: AIHW, 2016.
  2. Cunningham J, Rumbold AR, Zhang X, Condon JR. Incidence, aetiology, and outcomes of cancer in Indigenous peoples in Australia. Lancet Oncology 2008;9(6):585–95.
  3. Australian Institute of Health and Welfare. Cancer in Australia 2017. Canberra: AIHW, 2017.
  4. Australian Institute of Health and Welfare. Australia’s health 2016. Canberra: AIHW, 2016.
  5. National Health and Medical Research Council. Prostate-specific antigen (PSA) testing in asymptomatic men. Canberra: NHMRC, 2013.
  6. Australian Technical Advisory Group on Immunisation. The Australian immunisation handbook. 10th edn. Canberra: Department of Health, 2015.
  7. Australian Institute of Health and Welfare. Cervical screening in Australia 2013–2014. Canberra: AIHW, 2016.
  8. Commonwealth Department of Health. National cancer screening register.[Accessed 8 February 2017].
  9. Coory MD, Fagan PS, Muller JM, Dunn NA. Participation in cervical cancer screening by women in rural and remote Aboriginal and Torres Strait Islander communities in Queensland. Med J Aust 2002;177(10):544–47.
  10. Binns PL, Condon JR. Participation in cervical screening by Indigenous women in the Northern Territory: A longitudinal study. Med J Aust 2006;185(9):490–95.
  11. Whop LJ, Garvey G, Baade P, et al. The first comprehensive report on Indigenous Australian women’s inequalities in cervical screening: A retrospective registry cohort study in Queensland, Australia (2000–2011). Cancer 2016;122(10):1560–69.
  12. Whop LJ, Baade P, Garvey G, et al. Cervical abnormalities are more common among Indigenous than other Australian women: A retrospective record-linkage study, 2000–2011. PLoS One 2016;11(4):e0150473.
  13. Gilles M, Crewe S, Granites I, Coppola A. A community-based cervical screening program in a remote Aboriginal community in the Northern Territory. Aust J Public Health 1995;19(5):477–81.
  14. Hunt JM, Gless GL, Straton JA. Pap smear screening at an urban aboriginal health service: Report of a practice audit and an evaluation of recruitment strategies. Aust N Z J Public Health 1998;22(6):720–25.
  15. Reath J, Carey M. Breast and cervical cancer in indigenous women-overcoming barriers to early detection. Aust Fam Physician 2008;37(3):178–82.
  16. Dorrington M, Herceg A, Douglas K, Tongs J, Bookallil M. Increasing Pap smear rates at an urban Aboriginal Community Controlled Health Service through translational research and continuous quality improvement. Aust J Prim Health 2015;21(4):417–22.
  17. Everett T, Bryant A, Griffin MF, Martin-Hirsch PP, Forbes CA, Jepson RG. Interventions targeted at women to encourage the uptake of cervical screening. Cochrane Database Syst Rev 2011;(5):CD002834.
  18. Services CDoH. Practice Incentives Program. 25 November 2016.  [Accessed 18 January 2017].
  19. Commonwealth Department of Health. National Cervical Screening Progam. Available at www.health.gov.au/internet/screening/publishing.nsf/Content/cervical-screening-1 [Accessed 18 January 2017].
  20. Cancer Council Australia. National Cervical Screening Program: Guidelines for the management of screen-detected abnormalities, screening in specific populations and investigation of abnormal vaginal bleeding.  [Accessed 20 April 2017].
  21. Commonwealth Department of Health. About the human papillomavirus (HPV) and cervical cancer.  [Accessed 18 January 2017].
  22. Commonwealth Department of Health. Immunise Australia Program.  [Accessed 18 January 2017].
  23. Australian Technical Advisory Group on Immunisation. Systematic review of the safety, immunogenicity and efficacy of HPV vaccines. Canberra: DoHA, 2007.
  24. Commonwealth Department of Health. Future changes to cervical screening.  [Accessed 18 January 2017].
  25. International Collaboration of Epidemiological Studies of Cervical Cancer. Comparison of risk factors for invasive squamous cell carcinoma and adenocarcinoma of the cervix: Collaborative reanalysis of individual data on 8097 women with squamous cell carcinoma and 1374 women with adenocarcinoma from 12 epidemiological studies. Int J Cancer 2007;120(4):885–91.
  26. UK National Screening Committee (UK NSC) recommendation on cervical cancer screening in women.  [Accessed 18 January 2017].
  27. Kitchener H. Advisory Committee for Cervical Screening: Report to the National Screening Committee 2015.
  28. Cancer Council Australia. Cervical cancer screening. Available at www.cancer.org.au/cervicalscreening [Accessed 16 January 2018].
  29. Appleby P, Beral V, Berrington de González A, et al. Carcinoma of the cervix and tobacco smoking: Collaborative reanalysis of individual data on 13,541 women with carcinoma of the cervix and 23,017 women without carcinoma of the cervix from 23 epidemiological studies. Int J Cancer 2006;118(6):1481–95.
  30. Collins S, Rollason TP, Young LS, Woodman CBJ. Cigarette smoking is an independent risk factor for cervical intraepithelial neoplasia in young women: A longitudinal study. Eur J Cancer 2010;46(2):405–11.
  31. Australian Bureau of Statistics and Australian Institute of Health and Welfare. The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples 2008. Canberra: ABS and AIHW, 2008.
  32. Parker C, Tong SY, Dempsey K, et al. Hepatocellular carcinoma in Australia’s Northern Territory: High incidence and poor outcome. Med J Aust 2014;201(8):470–74.
  33. The Kirby Institute. Bloodborne viral and sexually transmissible infections in Aboriginal and Torres Strait Islander people: Annual surveillance report 2016. Sydney: Kirby Institute, UNSW, 2016.
  34. Commonwealth Department of Health. Fourth National Hepatitis C Strategy 2014–2017. Canberra: DoH, 2014.
  35. World Health Organization. Hepatitis B vaccines: WHO position statement. WHO Weekly epidemiological record 2009;40(84):405–20.
  36. Commonwealth Department of Health. National Immunisation Program Schedule.  [Accessed 20 January 2017].
  37. Commonwealth Department of Health. Pharmaceutical Benefits Scheme: General statement for drugs for the treatment of hepatitis C. 2017.  [Accessed 20 January 2017].
  38. Chang MH, You SL, Chen CJ, et al. Long-term effects of hepatitis B immunization of infants in preventing liver Cancer. Gastroenterology 2016;151(3):472–80.
  39. Commonwealth Department of Health. Second national hepatitis B strategy 2014–2017. Canberra: DoH, 2014.
  40. Commonwealth Department of Health. Fourth national Aboriginal and Torres Strait Islander blood-borne viruses and sexually transmissible infections strategy 2014–2017. Canberra: DoH, 2014.
  41. National Institute for Health and Care Excellence. Hepatitis B (chronic): Diagnosis and management. London: NICE, 2013.
  42. Australasian Society for HIV medicine. Decison-making in HBV. Sydney: ASHM, 2013.
  43. Australasian Society for HIV medicine. Hepatitis B and primary care providers. Sydney: ASHM, 2012.
  44. Zhang BH, Yang BH, Tang ZY. Randomized controlled trial of screening for hepatocellular carcinoma. J Cancer Res Clin Oncol 2004;130(7):417–22.
  45. National Cancer Institute. Liver (hepatocellular) cancer screening. Bethesda, MD: NCI, 2010.
  46. Australasian Society for HIV medicine. Decision-making in viral hepatitis related advanced liver disease for primary care providers. Sydney: ASHM, 2015.
  47. Aghoram R, Cai P, Dickinson JA. Alpha-foetoprotein and/or liver ultrasonography for screening of hepatocellular carcinoma in patients with chronic hepatitis B. Cochrane Database Syst Rev 2012;(9):CD002799.
  48. Australasian Society for HIV medicine. Decision-making in HCV. Sydney: ASHM, 2016.
  49. Australasian Society for HIV medicine. Primary care providers and hepatitis C. Sydney: ASHM, 2016.National Institute for Health and Care Excellence. Cirrhosis in over 16s: Assessment and management. London: NICE, 2016.
  50. Bagnardi V, Blangiardo M, La Vecchia C, Corrao G. A meta-analysis of alcohol drinking and cancer risk. Br J Cancer 2001;85(11):1700–05.
  51. Peng L, Jiyao W, Feng L. Weight reduction for non-alcoholic fatty liver disease. Cochrane Database Syst Rev 2011;(6): CD14003619.
  52. Lok AS, McMahon BJ, Brown RS, et al. Antiviral therapy for chronic hepatitis B viral infection in adults: A systematic review and metaanalysis. Hepatology 2016;63(1):284–306.
  53. Australian Institute of Health and Welfare and Cancer Australia. Breast cancer in Australia: An overview. Canberra: AIHW and Cancer Australia, 2012.
  54. Australian Institute of Health and Welfare. BreastScreen Australia monitoring report 2013–2014. Canberra: AIHW, 2016.
  55. Cancer Australia. Advice about familial aspects of breast cancer and epithelial ovarian cancer: A guide for health professionals. Strawberry Hills, NSW: Cancer Australia, 2015.
  56. Cancer Australia. Familial Risk Assessment: FRA-BOC.  [Accessed 23 January 2017].
  57. Moyer VA. Risk assessment, genetic counseling, and genetic testing for BRCA-related cancer in women: US Preventive Services Task Force recommendation statement. Ann Intern Med 2014;160(4):271–81.
  58. Hilgart JS, Coles B, Iredale R. Cancer genetic risk assessment for individuals at risk of familial breast cancer. Cochrane Database Syst Rev 2012;(2):CD003721.
  59. Siu AL. Screening for breast cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med 2016;164(4):279–96.
  60. Cancer Australia. Position statement: Early detection of breast cancer. Strawberry Hills, NSW: Cancer Australia, 2015.  [Accessed 23 January 2017].
  61. Gotzsche PC, Jorgensen KJ. Screening for breast cancer with mammography. Cochrane Database Syst Rev 2013;(6):CD001877.
  62. Mandelblatt JS, Cronin KA, Bailey S, et al. Effects of mammography screening under different screening schedules: Model estimates of potential benefits and harms. Ann Intern Med 2009;151:738–14.
  63. Independent UK Panel on Breast Cancer Screening. The benefits and harms of breast cancer screening: An independent review. Lancet 2012;380(9855):1778–86.
  64. Cancer Australia. Position statement: Overdiagnosis from mammographic screening. Strawberry Hills, NSW: Cancer Australia, 2014.  [Accessed 23 January 2017].
  65. Bonfill Cosp X, Marzo Castillejo M, Pladevall Vila M, Marti J, Emparanza J. Strategies for increasing the participation of women in community breast cancer screening. Cochrane Database Syst Rev 2001;(1):CD002943.
  66. Cancer Australia. MRI for high risk women.  [Accessed 23 January 2017].
  67. National Institute for Health and Care Excellence. Familial breast cancer: Classification, care and managing breast cancer and related risks in people with a family history of breast cancer. London: NICE, 2015.
  68. Kösters J, Gøtzsche P. Regular self-examination or clinical examination for early detection of breast cancer. Cochrane Database Syst Rev 2003;(2):CD003373.
  69. US Preventive Services Task Force. Screening for breast cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med 2009;151:716–26.
  70. Fitzgerald SP. Breast cancer screening: Viewpoint of the IARC Working Group. N Engl J Med 2015;373(15):1479.
  71. Hackshaw AK, Paul EA. Breast self-examination and death from breast cancer: A meta-analysis. Br J Cancer 2003;88(7):1047–53.
  72. Marjoribanks J, Farquhar C, Roberts H, Lethaby A, Lee J. Long-term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev 2017;1:CD004143.
  73. Commonwealth Department of Health. Pharmaceutical Benefits Scheme: Raloxifene.  [Accessed 23 January 2017].
  74. Cuzick J, Sestak I, Cawthorn S, et al. Tamoxifen for prevention of breast cancer: Extended long-term follow-up of the IBIS-I breast cancer prevention trial. Lancet Oncol 2015;16(1):67–75.
  75. Moyer VA. Medications to decrease the risk for breast cancer in women: Recommendations from the US Preventive Services Task Force recommendation statement. Ann Intern Med 2013;159(10):698–708.
  76. Cuzick J, DeCensi A, Arun B, et al. Preventive therapy for breast cancer: A consensus statement. Lancet Oncol 2011;12(5):496–503.
  77. Lostumbo L, Carbine NE, Wallace J. Prophylactic mastectomy for the prevention of breast cancer. Cochrane Database Syst Rev 2010;(11):CD002748.
  78. National Breast and Ovarian Cancer Centre. Early detection of breast cancer: NBOCC position statement.  [Accessed October 10 2011].
  79. Cancer Council Australia. National cancer prevention policy 2007−09. Sy: Cancer Council Australia, 2007.
  80. Commonwealth Department of Health. BreastScreen Australia Program. Policy on screening women aged 40–49 years. Canberra: DoH, 2013.  [Accessed 16 January 2018].
  81. Australian Insititute of Health and Welfare. Cancer in Australia: An overview. Canberra: AIHW, 2014.
  82. Eliassen AH, Hankinson SE, Rosner B, Holmes MD, Willett WC. Physical activity and risk of breast cancer among postmenopausal women. Arch Intern Med 2010;170(19):1758–64.
  83. International Agency for Research on Cancer. World cancer report 2014. Geneva: World Health Organization, 2014.
  84. Gaudet MM, Gapstur SM, Sun J, Diver WR, Hannan LM, Thun MJ. Active smoking and breast cancer risk: Original cohort data and meta-analysis. J Natl Cancer Inst 2013;105(8):515–25.
  85. Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and breastfeeding: Collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50,302 women with breast cancer and 96,973 women without the disease. Lancet 2002;360(9328):187–95.
  86. World Cancer Research Fund and American Institute for Cancer Research. Food, nutrition, physical activity, and the prevention of cancer: A global perspective. Washington, DC: AICR, 2007.
  87. Gramling R, Eaton CB, Rothman KJ, Cabral H, Silliman RA, Lash TL. Hormone replacement therapy, family history, and breast cancer risk among postmenopausal women. Epidemiology 2009;20(5):752–56.
  88. Australian Insititute of Health and Welfare. National bowel cancer screening program: Monitoring report 2016. Canberra: AIHW, 2016.
  89. Australian Institute of Health and Welfare and Department of Health and Ageing. National bowel cancer screening program: Annual monitoring report 2009. Canberra: AIHW, 2009.
  90. Bowel Cancer Screening Pilot Monitoring and Evaluation Steering Committee. The Australian bowel cancer screening pilot program and beyond: Final evaluation report. Canberra: Department of Health and Ageing, 2005.
  91. Christou A, Katzenellenbogen JM, Thompson SC. Australia’s national bowel cancer screening program: Does it work for Indigenous Australians? BMC Public Health 2010;10:373.
  92. Christou A, Thompson SC. How could the National bowel cancer screening program for Aboriginal people in Western Australia be improved? Report to the WA Bowel Cancer Screening Implementation Committee, Department of Health. Perth: Centre for International Health, Curtin University and Combined Universities Centre for Rural Health (University of Western Australia), 2010.
  93. Cancer Council Australia Colorectal Cancer Guidelines Working Party. Clinical practice guidelines for the prevention, early detection and management of colorectal cancer. Sydney: Cancer Council Australia, 2017.  [Accessed 9 January 2018].
  94. Australian Institute of Health and Welfare. Analysis of bowel cancer outcomes for the National bowel cancer screening program. Canberra: AIHW, 2014.
  95. Hewitson P, Glasziou P, Irwig L, Towler B, Watson E. Screening for colorectal cancer using the faecal occult blood test, Hemoccult. Cochrane Database Syst Rev 2007;(1):CD001216.
  96. Bibbins-Domingo K, Grossman DC, Curry SJ, et al. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA 2016;315(23):2564–75.
  97. Lin JS, Piper MA, Perdue LA, et al. Screening for colorectal cancer: Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 2016;315(23):2576–94.
  98. Holme Ø, Bretthauer M, Fretheim A, Odgaard-Jensen J, Hoff G. Flexible sigmoidoscopy versus faecal occult blood testing for colorectal cancer screening in asymptomatic individuals. Cochrane Database Syst Rev 2013;(9):CD009259.
  99. Commonwealth Department of Health. National bowel cancer screening program. [Accessed 30 January 2017].
  100. Cancer Council Australia. Understanding your FOBT. 2016. [Accessed 30 January 2017].
  101. Rothwell PM, Fowkes FG, Belch JF, Ogawa H, Warlow CP, Meade TW. Effect of daily aspirin on long-term risk of death due to cancer: Analysis of individual patient data from randomised trials. Lancet 2010;377(9759):31–41.
  102. Rothwell PM, Wilson M, Elwin CE, et al. Long-term effect of aspirin on colorectal cancer incidence and mortality: 20-year follow-up of five randomised trials. Lancet 2010;376(9754):1741–50.
  103. Cuzick J, Thorat MA, Bosetti C, et al. Estimates of benefits and harms of prophylactic use of aspirin in the general population. Ann Oncol 2014;26(1):47–57.
  104. Bibbins-Domingo K, US Preventive Services Task Force. Aspirin use for the primary prevention of cardiovascular disease and colorectal cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med 2016;164(12):836–45.
  105. Cole BF, Logan RF, Halabi S, et al. Aspirin for the chemoprevention of colorectal adenomas: Meta-analysis of the randomized trials. J Natl Cancer Inst 2009;101(4):256–66.
  106. Dubé C, Rostom A, Lewin G, et al. The use of aspirin for primary prevention of colorectal cancer: A systematic review prepared for the US Preventive Services Task Force. Ann Intern Med 2007;146(5):365–75.
  107. Barclay K, Cancer Council Australia Surveillance Colonoscopy Guidelines Working Party. Algorithm for colorectal cancer screening – Family history. Sydney: Cancer Council, 2013.
  108. National Institute for Health and Care Excellence. Colorectal cancer prevention: Colonoscopic surveillance in adults with ulcerative colitis, Crohn’s disease or adenomas. London: NICE, 2011.
  109. Cancer Council Australia Surveillance Colonoscopy Guidelines Working Party. Clinical practice guidelines for surveillance colonoscopy. Sydney: Cancer Council Australia, 2011.
  110. Rothwell PM, Wilson M, Elwin CE, et al. Long-term effect of aspirin on colorectal cancer incidence and mortality: 20-year follow-up of five randomised trials. Lancet 2010;376(9754):1741–50.
  111. Burn J, Gerdes AM, Macrae F, et al. Long-term effect of aspirin on cancer risk in carriers of hereditary colorectal cancer: An analysis from the CAPP2 randomised controlled trial. Lancet 2011;378(9809):2081–87.
  112. Zeegers MPA, Jellema A, Ostrer H. Empiric risk of prostate carcinoma for relatives of patients with prostate carcinoma: A metaanalysis. Cancer 2003;97(8):1894–1903.
  113. Liede A, Karlan BY, Narod SA. Cancer risks for male carriers of germline mutations in BRCA1 or BRCA2: A review of the literature. J Cancer Res Clin Oncol 2004;22(4):735–42.
  114. Institute NC. Genetics of Prostate Cancer (PDQ®) – Health professional version.  [Accessed 24 January 2017].
  115. Bruner DW, Moore D, Parlanti A, Dorgan J, Engstrom P. Relative risk of prostate cancer for men with affected relatives: Systematic review and meta-analysis. Int J Cancer 2003;107(5):797–803.
  116. Prostate Cancer Foundation of Australia and Cancer Council Australia PSA Testing Guidelines Expert Advisory Panel. Clinical practice guidelines PSA testing and early management of test-detected prostate cancer. Cancer Council Australia. [Accessed 16 January 2018].
  117. Ilic D, Neuberger MM, Djulbegovic M, Dahm P. Screening for prostate cancer. Cochrane Database Syst Rev 2013;(1):CD004720.
  118. Hayes JH, Barry MJ. Screening for prostate cancer with the prostate-specific antigen test: A review of current evidence. JAMA 2014;311(11):1143–49.
  119. Chou R, Croswell JM, Dana T, et al. Screening for prostate cancer: A review of the evidence for the US Preventive Services Task Force. Ann Intern Med 2011;155(11):762–71.
  120. Commonwealth Department of Health, Standing Committee on Screening. Prostate cancer screening position statement.  [Accessed 16 January 2018].
  121. Public Health England. Prostate cancer risk management programme (PCRMP): Benefits and risks of PSA testing.  [Accessed 24 January 2017].
  122. Prostate Cancer Foundation of Australia and Cancer Council Australia. PSA Testing Guidelines Expert Advisory Panel. Clinical practice guidelines PSA testing and early management of test-detected prostate cancer. Sydney: Cancer Council, 2015.
  123. The Royal Australian College of General Practitioners. Patient information sheet: Should I have prostate cancer screening? East Melbourne, Vic: RACGP, 2015.  [Accessed 17 January 2018].
  124. Fong K, Cancer Council Australia Lung Cancer Prevention and Diagnosis Guidelines Working Party. Clinical practice guidelines for the prevention and diagnosis of lung cancer: In people at risk of lung cancer, does population based screening with chest radiography reduce mortality?  [Accessed 31 January 2017].
  125. Lau E, Cancer Council Australia Lung Cancer Prevention and Diagnosis Guidelines Working Party. Clinical practice guidelines for the prevention and diagnosis of lung cancer: In people at risk of lung cancer, does population based CT screening reduce mortality? Cancer Council Australia. [Accessed 31 January 2017].
  126. Commonwealth Department of Health, Standing Committee on Screening. Position statement: Lung cancer screening using low-dose computed tomography. Canberra: DoH, 2015.
  127. Manser R, Lethaby A, Irving LB, et al. Screening for lung cancer. Cochrane Database Syst Rev 2013;(6):CD001991.
  128. Fong K, University of Queensland. International Lung Screen Trial (ILST). CinicalTrials.gov, 2016.  [Accessed 17 January 2018].
  129. Fu C, Liu Z, Zhu F, Li S, Jiang L. A meta-analysis: Is low-dose computed tomography a superior method for risky lung cancers screening population? Clin Respir J 2016;10(3):333–41.
  130. Moyer VA. Screening for lung cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med 2014;160(5):330–38.
  131.