Estimates of the eligible population for Australia's targeted National Lung Cancer Screening Program, 2025-2030.

Australia's National Lung Cancer Screening Program will commence in July 2025, targeted at individuals aged 50-70 years with a 30 pack-year smoking history (equivalent to 20 cigarettes per day for 30 years), who either currently smoke or have quit within the past 10 years. We forecasted the number of screening-eligible individuals over the first 5 years of the program using data from the 2019 National Drug Strategy Household Survey and the 2022 Australian Bureau of Statistics population projections. Multiple imputation integrated with predictive modelling of future or unmeasured smoking characteristics was used to address missing data and, simultaneously, to project individuals' smoking histories to 2030.

The association between alcohol consumption and all-cause mortality: An umbrella review of systematic reviews using lifetime abstainers or low-volume drinkers as a reference group.

Background And Aims: Systematic reviews of the relationship between alcohol consumption and all-cause mortality have reported different relative risk (RR) curves, possibly due to the choice of reference group. Results have varied from 'J-shaped' curves, where low-volume consumption is associated with reduced risk, to monotonically increased risk with increasing consumption. We summarised the evidence on alcohol consumption and all-cause mortality exclusively from systematic reviews using lifetime abstainers or low-volume/occasional drinkers as the reference group.

Fifty-year forecasts of daily smoking prevalence: can Australia reach 5% by 2030?

Objective: To compare 50-year forecasts of Australian tobacco smoking rates in relation to trends in smoking initiation and cessation and in relation to a national target of ≤5% adult daily prevalence by 2030.

Methods: A compartmental model of Australian population daily smoking, calibrated to the observed smoking status of 229 523 participants aged 20-99 years in 26 surveys (1962-2016) by age, sex and birth year (1910-1996), estimated smoking prevalence to 2066 using Australian Bureau of Statistics 50-year population predictions. Prevalence forecasts were compared across scenarios in which smoking initiation and cessation trends from 2017 were continued, kept constant or reversed.

Health services costs for ovarian cancer in Australia: Estimates from the 45 and Up Study.

Introduction: There have been significant advancements in risk identification and treatment for ovarian cancer over the last decade. However, their impact on health services costs is unclear. This study estimated the direct health system costs (government perspective) for women diagnosed with ovarian cancer in Australia during 2006-2013, as a benchmark prior to opportunities for precision-medicine approaches to treatment, and for health care planning.

Economic impact of using risk models for eligibility selection to the International lung screening Trial.

Objectives: Using risk models as eligibility criteria for lung screening can reduce race and sex-based disparities. We used data from the International Lung Screening Trial(ILST; NCT02871856) to compare the economic impact of using the PLCOm2012 risk model or the US Preventative Services' categorical age-smoking history-based criteria (USPSTF-2013).

Materials And Methods: The cost-effectiveness of using PLCOm2012 versus USPSTF-2013 was evaluated with a decision analytic model based on the ILST and other screening trials.

The 45 and Up Study: reflecting on contributions to global evidence using case studies on cardiovascular disease and smoking.

Background/objective: To describe the attributes that have underscored the success of the 45 and Up Study (the Study) and demonstrate its value by reflecting on two case studies: our research on socioeconomic inequalities in cardiovascular disease; and the harms of smoking. Type of program or service: The Study is the largest study of healthy ageing in Australia, and one of the biggest in the world; it recruited 267 357 participants aged 45 years and older from NSW, Australia from 2005 to 2009. For more than 15 years, it has provided high-quality evidence on a broad range of public health related issues.

Capacity of the 45 and Up Study to mobilise evidence-based improvements in cancer control: lung cancer case study.

Objective: Over the 15 years since the 45 and Up Study (the Study) was established, researchers have harnessed its capacity for enabling rigorous, comprehensive investigation of cancer causes, care, and outcomes. For the first time in Australia, the entire cancer-control continuum could be investigated by linking questionnaire data with cancer registry notifications, hospital records, outpatient medical services and prescription medications at scale. Here, we use lung cancer as a case study to demonstrate the Study's potential to improve cancer control.

Updated cost-effectiveness analysis of lung cancer screening for Australia, capturing differences in the health economic impact of NELSON and NLST outcomes.

Background: A national, lung cancer screening programme is under consideration in Australia, and we assessed cost-effectiveness using updated data and assumptions.

Methods: We estimated the cost-effectiveness of lung screening by applying screening parameters and outcomes from either the National Lung Screening Trial (NLST) or the NEderlands-Leuvens Longkanker Screenings ONderzoek (NELSON) to Australian data on lung cancer risk, mortality, health-system costs, and smoking trends using a deterministic, multi-cohort model. Incremental cost-effectiveness ratios (ICERs) were calculated for a lifetime horizon.

45 and Up COVID Insights: a dynamic and collaborative approach to evidence-making during the COVID-19 pandemic.

Objectives: In response to the coronavirus 2019 (COVID-19) pandemic, a research project was developed with a cohort of 45 and Up Study participants to generate timely, relevant evidence to guide policy, practice and planning. This paper describes the research model, the cohort establishment and characteristics, and some findings.

Methods: A subgroup of 45 and Up Study participants was invited to enrol in 45 and Up COVID Insights -a series of five online surveys conducted during 2020-22.

Health utilities for participants in a population-based sample who meet eligibility criteria for lung cancer screening.

Introduction: Trial-based, risk-targeted lung cancer screening with low-dose computed tomography has been shown to reduce lung cancer mortality but implementation may depend on favourable cost-effectiveness evaluations where quality-adjusted life-years are a key metric. Baseline health utility values for a screening population at high risk of lung cancer are not likely to match age-specific population norms, and utilities derived from screening trials may not be representative of real-world screening populations. We estimated utility values for screening-eligible individuals in a population-based cohort study in Australia.

Large-Scale Population-Based Surveys Linked to Administrative Health Databases as a Source of Data on Health Utilities in Australia.

Objectives: Large-scale health surveys that contain quality-of-life instruments are a rich source of health utility data for health economic evaluations, especially when linked to routinely collected, administrative health databases. We derived health utility values for a wide range of health conditions using a large Australian cohort study linked to population-wide health databases.

Methods: Short-Form 6-Dimension utility values were calculated for 56 094 adults, aged 47+ years, in the New South Wales 45 and Up Study who completed the Social, Economic, and Environmental Factors survey (2010-2011).

Tobacco smoking changes during the first pre-vaccination phases of the COVID-19 pandemic: A systematic review and meta-analysis.

Background: Globally, tobacco smoking remains the largest preventable cause of premature death. The COVID-19 pandemic has forced nations to take unprecedented measures, including 'lockdowns' that might impact tobacco smoking behaviour. We performed a systematic review and meta-analyses to assess smoking behaviour changes during the early pre-vaccination phases of the COVID-19 pandemic in 2020.

Applying utility values in cost-effectiveness analyses of lung cancer screening: A review of methods.

Lung cancer screening with low-dose computed tomography (LDCT) in high-risk populations has been shown in randomised controlled trials to lead to early diagnosis and reduced lung cancer mortality. However, investment into screening will largely depend on the outcomes of cost-effectiveness analyses that demonstrate acceptable costs for every quality-adjusted life year (QALY) gained. The methods used to apply utility values to measure QALYs can significantly impact the outcomes of cost-effectiveness analyses and if applied inaccurately can lead to unreliable estimates.

Evaluating Prognostic Factors for Sex Differences in Lung Cancer Survival: Findings From a Large Australian Cohort.

Introduction: Women tend to survive a lung cancer diagnosis longer than men; however potential drivers of this sex-related disparity remain largely elusive. We quantified factors related to sex differences in lung cancer survival in a large prospective cohort in Australia.

Methods: Participants in the 45 and Up Study (recruited 2006-2009) diagnosed with incident lung cancer were followed up to December 2015.

Cutaneous β HPVs, Sun Exposure, and Risk of Squamous and Basal Cell Skin Cancers in Australia.

Background: Sun exposure causes cutaneous squamous (SCC) and basal cell (BCC) carcinomas. Human papillomavirus (HPV) infection might cause SCC.

Methods: We examined associations of β and γ HPV infection in skin-swab DNA and serum antibodies with skin cancer risk, and modification of the carcinogenic effects of sun exposure by them, in case-control studies of 385 SCC cases, 832 BCC cases, and 1,100 controls nested in an Australian prospective cohort study (enrolled 2006-2009).

Health system costs and days in hospital for colorectal cancer patients in New South Wales, Australia.

Introduction: Colorectal cancer (CRC) care costs the Australian healthcare system more than any other cancer. We estimated costs and days in hospital for CRC cases, stratified by site (colon/rectal cancer) and disease stage, to inform detailed analyses of CRC-related healthcare.

Methods: Incident CRC patients were identified using the Australian 45 and Up Study cohort linked with cancer registry records.

Lung cancer treatment patterns and factors relating to systemic therapy use in Australia.

Aim: Systemic therapies for lung cancer are rapidly evolving. This study aimed to describe lung cancer treatment patterns in New South Wales, Australia, prior to the introduction of immunotherapy and latest-generation targeted therapies.

Methods: Systemic therapy utilization and treatment-related factors were examined for participants in the New South Wales 45 and Up Study with incident lung cancer ascertained by record linkage to the New South Wales Cancer Registry (2006-2013).

Cancer incidence and cancer death in relation to tobacco smoking in a population-based Australian cohort study.

Tobacco smoke is a known carcinogen, but the magnitude of smoking-related cancer risk depends on country-specific, generational smoking patterns. We quantified cancer risk in relation to smoking in a population-based cohort, the 45 and Up Study (2006-2009) in New South Wales, Australia. Cox proportional hazards regressions estimated adjusted hazard ratios (HR) by self-reported smoking history at baseline (2006-2009) for incident, primary cancers via linkage to cancer registry data to 2013 and cancer death data to 2015.

Patterns of care for men with prostate cancer: the 45 and Up Study.

Objectives: To describe patterns of care in New South Wales for men with prostate cancer, and to ascertain factors associated with receiving different types of treatment.

Design: Individual patient data record linkage study.

Setting, Participants: 4003 New South Wales men aged 45 years or more enrolled in the population-based 45 and Up Study in whom prostate cancer was first diagnosed during 2006-2013.

Alcohol consumption, drinking patterns and cancer incidence in an Australian cohort of 226,162 participants aged 45 years and over.

Background: Although overall alcohol consumption is known to increase the risk of a number of cancers internationally, evidence for Australia and evidence regarding the pattern of drinking and cancer risk is limited.

Methods: Adjusted hazard ratios (HR) and 95% confidence intervals (CI) for cancer risk in relation to overall alcohol consumption (drinks/week) and pattern of drinking were calculated using Cox proportional hazard regressions for 226,162 participants aged ≥45 years (2006-2009) in the 45 and Up Study, an Australian prospective cohort study. Incident primary cancer cases were ascertained by linkage to the New South Wales Cancer Registry to 2013 by the Centre for Health Record Linkage.

Health services costs for lung cancer care in Australia: Estimates from the 45 and Up Study.

Background: Of all cancer types, healthcare for lung cancer is the third most costly in Australia, but there is little detailed information about these costs. Our aim was to provide detailed population-based estimates of health system costs for lung cancer care, as a benchmark prior to wider availability of targeted therapies/immunotherapy and to inform cost-effectiveness analyses of lung cancer screening and other interventions in Australia.

Methods: Health system costs were estimated for incident lung cancers in the Australian 45 and Up Study cohort, diagnosed between recruitment (2006-2009) and 2013.

Identifying incident cancer cases in routinely collected hospital data: a retrospective validation study.

Objective: Population-level cancer incidence data are critical for epidemiological cancer research, however provision of cancer registry data can be delayed. We previously reported that in a large population-based Australian cohort, registry-based incidence data were well matched by routinely collected hospital diagnosis data (sensitivities and positive predictive values (PPVs) > 80%) for six of the 12 most common cancer types: breast, colorectum, kidney, lung, pancreas and uterus. The available hospital data covered more recent time periods.