Sentinel Node Biopsy Versus Axillary Clearance In Early Breast Cancer: The SNAC Trial
Funder
National Health and Medical Research Council
Funding Amount
$1,257,525.00
Summary
Over 10,000 Australian women are diagnosed with breast cancer each year. Most need surgery to remove the cancer and determine if it has spread to glands in the armpit (axillary lymph nodes). Knowing whether the cancer has spread to the axillary lymph nodes helps determine prognosis and plan treatment. Surgical removal is the most reliable way to assess the axillary lymph nodes. This study compares two operations for assessing cancer spread to the lymph nodes in women with early breast cancer: 1) ....Over 10,000 Australian women are diagnosed with breast cancer each year. Most need surgery to remove the cancer and determine if it has spread to glands in the armpit (axillary lymph nodes). Knowing whether the cancer has spread to the axillary lymph nodes helps determine prognosis and plan treatment. Surgical removal is the most reliable way to assess the axillary lymph nodes. This study compares two operations for assessing cancer spread to the lymph nodes in women with early breast cancer: 1) axillary clearance and 2) sentinel node biopsy. Axillary clearance involves removal of most lymph nodes in the armpit. In sentinel node biopsy only a few lymph nodes most closely related to the breast cancer are removed. Axillary clearance is the current standard operation. However, it is associated with risks including infection, pain, stiffness, numbness and lymphoedema (arm swelling). Lymphoedema may occur in 5-50% of women treated for breast cancer and can cause major symptoms and disabilities. In many women the breast cancer has not spread to the lymph nodes, and axillary clearance is unnecessary. Recent studies suggest sentinel node biopsy may provide as much information as axillary clearance. Scans and dye are used to help locate the sentinel nodes. Minimising the amount of surgery to the armpit should reduce the side effects. However, the long term safety and effectiveness of removing only a few nodes is unknown. This trial will determine if sentinel node biopsy reduces lymphoedema and gives equivalent cure rates. If it does, then it should become standard practice. The study compliments comparable studies being done in US, UK and Europe by providing unique information about symptoms and quality of life from the women's perspective. One thousand Australian women will take part. The is study is being conducted by Australian breast surgeons under the auspices of the Royal Australasian College of Surgeons and the NHMRC Clinical Trials Centre.Read moreRead less
Effective Management Of Acute Whiplash Injuries Requires A Pragmatic Approach: An RCT With Stratified Treatments
Funder
National Health and Medical Research Council
Funding Amount
$382,550.00
Summary
Whiplash injuries from a motor vehicle crash continue to incur substantial personal and financial costs to the community and the insurance industry. The current approaches to an acute whiplash injury in Australia and internationally have failed to lessen the rate of how many people develop chronic neck pain. Between 40 and 60% still have pain 6 months after injury. Motor Accident Insurance Commission (Qld) figures indicate that 20% of patients with chronic whiplash account for 60% of the costs. ....Whiplash injuries from a motor vehicle crash continue to incur substantial personal and financial costs to the community and the insurance industry. The current approaches to an acute whiplash injury in Australia and internationally have failed to lessen the rate of how many people develop chronic neck pain. Between 40 and 60% still have pain 6 months after injury. Motor Accident Insurance Commission (Qld) figures indicate that 20% of patients with chronic whiplash account for 60% of the costs. Transition from an acute to a chronic condition must be prevented. A new direction in management in the acute stage is urgently required as once the pain has become chronic, it is difficult to help. This research will conduct a novel randomised controlled trial for acute whiplash. It will test individually prescribed multi-professional management against usual care with the aim to lessen the numbers who go on to develop chronic pain. It will be the first clinical trial that acknowledges from the outset that the whiplash injuries and affects people in different ways. Our previous research with acute whiplash patients has documented the variations in presentation from physical, physiological and psychological perspectives. In this trial, management will be prescribed as directed by measurable pain, muscle and psychological impairments in the individual, rather than regard all patients as the same as in other trials. This trial will offer individualised treatments; medical, physiotherapy and-or psychological using an empirically derived treatment algorithm. Cost-effectiveness of the program will be evaluated against that incurred during usual care. It is predicted that early multi-professional management will be less expensive in the long term than existing approaches. This RCT stands to extend knowledge in the management of whiplash associated disorders (WAD).Read moreRead less
Occupational Exposure To Lead Compounds And Human Cancer
Funder
National Health and Medical Research Council
Funding Amount
$222,887.00
Summary
This study aims to investigate whether there is a link between cancer (in particular cancer of the stomach, lung, kidney and central nervous system) and occupational exposure to lead compounds. There are only a few published cohort studies available on occupational exposures in use and applications of lead compounds, despite the widespread use of these compounds in the past 50 years. Since the late 1980s the use of lead compounds in Australia has decreased, but Australian and world lead producti ....This study aims to investigate whether there is a link between cancer (in particular cancer of the stomach, lung, kidney and central nervous system) and occupational exposure to lead compounds. There are only a few published cohort studies available on occupational exposures in use and applications of lead compounds, despite the widespread use of these compounds in the past 50 years. Since the late 1980s the use of lead compounds in Australia has decreased, but Australian and world lead production has increased. Australia is the world's biggest producer of lead. The precise number of lead workers worldwide is unknown but there are likely to be more than 2 million workers of which many are in developing countries where control of lead exposure is unsatisfactory and occupational exposure limits are considerably higher than in developed countries. Evidence for or against cancer risk with exposure to lead compounds , in particular inorganic lead, will therefore have implications for many Australian and international workers. This is also important for health risk assessment for environmental contamination in the Australian community. In our study we will review the state government archived records of about 8,000 lead workers in New South Wales, Victoria and South Australia, who took part in lead compound exposure surveys and had blood tests in the 1970s, 1980s and 1990s, as part of government lead regulations in force at the time. We will then match the details of these workers against the National Cancer and Death registry data to calculate cancer rates. This should involve a sufficient number of workers to enable us to undertake a comprehensive health evaluation of cancer risk and exposure to lead compounds.Read moreRead less
Anogenital Human Papillomavirus Infection And Its Outcomes In Men
Funder
National Health and Medical Research Council
Funding Amount
$333,433.00
Summary
Anal human papillomavirus (HPV) infection is common in homosexual men. Low risk types cause anal warts and high risk types of HPV cause anal cancer. This study will determine incidence and risk factors for HPV infection in a cohort of young homosexual men, the association of anal warts treatment with HIV risk, and the specific association of HPV subtypes with anal cancer. The findings of this research will help delineate the potential benefits of HPV vaccination in this population.
Understanding The Health Effects Of Biomass Smoke In Australian Towns And Cities
Funder
National Health and Medical Research Council
Funding Amount
$172,392.00
Summary
Wildfires have become more frequent and severe the world over and the health impacts of the associated air pollution is a major gap in the current evidence. Working with lead agencies in air quality regulation, public health and fire management I will examine and compare the health effects of air pollution from deliberate burns, bushfires, wood heaters and other sources of air pollution. The research will focus on respiratory and heart disease to inform public health and individual patient care.
Metabolic And Hormonal Pathways In Gynecological Cancer - Epidemiological Studies Of Risk And Survival
Funder
National Health and Medical Research Council
Funding Amount
$288,275.00
Summary
Metabolic and hormonal factors probably play a role in a womans chance of developing and surviving gynecological cancer, but the exact mechanisms are unclear. This project will use questionnaire information, blood and tumour samples of over 5,000 Australian women to examine the mechanisms leading to cancer development and survival among women with uterine and ovarian cancer, the two commonest female reproductive cancers. Results will help plan primary prevention strategies and care.
David Whiteman is a medical epidemiologist with a special interest in the causes, diagnosis, prevention and treatment of cancer. His work has focussed on melanoma and skin cancer, and more recently, on cancers of the upper gastro-intestinal tract.
Novel Ways Of Utilizing Genome-wide DNA Methylation Data From Peripheral Blood Samples In Genetic Epidemiology
Funder
National Health and Medical Research Council
Funding Amount
$285,186.00
Summary
The aim of this project is to develop statistical methods and paradigms to better leverage the considerable amount of peripheral blood DNA methylation data that has been collected from large scale epidemiological studies. In particular, our focus is on developing and optimizing statistical methods of using DNA methylation profiles to “tag” environmental exposures, so that this information can be better utilized to investigate the genetic and environmental basis of complex traits and diseases.
Genetic And Environmental Epidemiology Of Early-onset Melanoma In The Australian Melanoma Family Study
Funder
National Health and Medical Research Council
Funding Amount
$412,210.00
Summary
This project will investigate the genetic and environmental causes of melanoma, especially melanoma developing under the age of 40 in Australian families. This project will help to identify which people are at greatest risk of developing melanoma, by identifying the genes involved in melanoma development and the contribution of environmental and lifestyle factors to the disease. We will also determine how much hereditary factors contribute to melanoma risk.