The Cancer Epidemiology and Prevention Research Group contributes to reducing the burden of cancer in the community by conducting research on cancer etiology, prevention, early detection and survivorship. A particular area of focus is on skin cancer and the group is also affiliated with the Melanoma Institute Australia. We have a strong emphasis on translational outcomes relevant to cancer control policy and clinical practice.
The group conducts epidemiological and intervention research with a strong translational focus across the spectrum of cancer control, including prevention, early detection, diagnosis, management and outcomes of cancer.
We have expertise in quantitative and qualitative research design, and observational, intervention and data linkage studies. Our group addresses all types of cancer but has particular expertise in skin cancer. We have strong national and international multidisciplinary engagement including collaborations with clinicians, health economists, psychologists, sociologists, bioethicists, geneticists, laboratory scientists and others.
Australia has the highest incidence rates of melanoma in the world and skin cancer is the most expensive cancer for our health care system. Research has shown that early detection of melanoma is associated with better health outcomes. However, unlike some other cancers such as breast and bowel cancer, there is no structured screening program for melanoma in Australia.
Currently, there is insufficient evidence to support the introduction of a structured melanoma screening program for the Australian population. The introduction of an organised screening program targeted at people who have a high-risk of developing melanoma might enable resources to be spent more efficiently and improve health outcomes, however more evidence is needed.
Our project will evaluate the benefits, harms, cost-effectiveness and resource implications of implementing a national risk-based melanoma screening program that aims to more accurately identify a person’s personal risk of melanoma and tailor the screening strategy according to their risk level. The project involves a multidisciplinary team of clinicians, researchers, and policy experts, and we will work closely with the microsimulation modelling team at the Cancer Council NSW, under the supervision of Professor Karen Canfell. The project also integrates implementation science approaches to inform the modelled scenarios and assess acceptability and other implementation outcomes. Policy-relevant translation mechanisms will be tailored according to our findings.
The project is funded by a four year grant (2019-2022) from the National Health and Medical Research Council (NHMRC).
The Melanoma Patterns of Care 10-year follow-up study is a continuation of the first Melanoma Patterns of Care study conducted in 2006-07, which examined the clinical management of melanoma patients diagnosed with an in situ or invasive primary melanoma over a 12-month period. The follow-up study will use linked data from the NSW Cancer Registry, ACT and NSW Registries of Births Deaths and Marriages, Cause of Death Unit Record File, NSW Admitted Patient Data Collection (APDC) and The Melanoma Institute Australia (MIA) to 1) determine risk of recurrence and death associated with different aspects of melanoma diagnosis, clinical management, treatment, and patient and histopathological factors, and compliance with clinical practice guidelines; and 2) assess the risk of new primary melanoma and other cancers and determine whether planned follow-up, patient and histopathological factors are related to the stage and other characteristics of the new primary melanoma or occurrence of other type of cancer.
This study aims to improve primary students’ knowledge and attitudes towards UV radiation, the UV Index, and sun protection behaviours. Over the 2018-19 summer and autumn months, students completed a short questionnaire assessing their current knowledge and attitudes towards UV exposure, the UV index, and SunSmart behaviours. After this, they performed a hands-on interactive classroom experiment, using UV dosimeters to measure the real-time UV exposure in their school playground. These students were also shown an interactive presentation to reinforce correct SunSmart behaviours. These students then completed the questionnaire again to assess whether there were any changes in their baseline responses. The data are currently being analysed and will be disseminated as a peer-reviewed published paper, to the participating schools and to the Cancer Council and Cancer Institute NSW.
The Cancer Epidemiology and Prevention Research group has a strong partnership with the Melanoma Institute Australia. We run several clinical projects with the multidisciplinary clinical team.
Tailored Surveillance Project: Recent Australian clinical practice guidelines for the diagnosis and management of melanoma recommend that all patients should be assessed for future risk of melanoma, using validated risk factors and a model that integrates personal risk factors into an overall index of risk. At the Dermatology clinics at the Melanoma Institute Australia, Royal Prince Alfred Hospital and Westmead Hospital, we are implementing systematic risk assessment and tailored surveillance and patient education as part of routine care. In this project, we seek to evaluate the implementation of personalised melanoma risk assessment and tailored patient education and skin surveillance in these dermatology clinics, specifically by evaluating the acceptability, feasibility and fidelity of the more systematic approach to tailoring patient clinical management, its impact on sun protection and skin examination behaviours, detection of new melanomas and other skin cancers, and data on relevant costs.
Kate Dunlop PhD
Publicly-funded national screening programs for healthy people that aim to reduce cancer related death are available in Australia for breast, bowel and cervical cancer. Risk-stratified screening is a new paradigm for screening that is likely to eventuate in Australia within the next 10 years. It will provide personalised cancer screening tailored to individual risk rather than the current ‘one-size-fits-all’ programs designed for the average person. Risk-stratified screening is also relevant for cancers for which targeting high-risk groups may be appropriate, such as prostate cancer, melanoma and lung cancer. There is increasing evidence of benefits for a risk-stratified approach, which also offers the potential for healthcare improvements through improved cost-effectiveness and reducing harms related to overdiagnosis and false positive results. Risk-stratified screening focuses interventions on those who benefit most. There are considerable challenges facing the implementation of risk-stratified screening on a national scale, including the acceptability and feasibility of reducing screening frequency for those at low risk, and the communication of multiple risk factors including, potentially, genetic susceptibility variants. Implementation will also require a change of practice within our current health system and for the end-users, particularly general practitioners and the community. My PhD program will focus on implementation research to identify the steps that are needed to deliver this new paradigm for cancer screening in Australia.
Amelia Smit PhD
My PhD (2017-2019) research is looking at how genomics-based melanoma risk information could be incorporated into Australian healthcare to improve prevention and early detection strategies. The delivery of genomic risk information is widely anticipated to be mainstreamed into clinical practice, and through my research I have engaged with key stakeholders in this process including members of the public, patients and health professionals. This has led to the generation of novel evidence on the individual-level impact of receiving personal melanoma genomic risk information such as behavioural and psychosocial implications, in addition to evidence on broader considerations for the implementation of genomic testing such as general practitioner attitudes and preferences. Incorporating genomic information into melanoma risk assessment has the potential to improve our assessment of individual melanoma risk (for melanoma patients and the wider Australian community) and to further tailor our recommendations for sun-protection and skin-examinations, with the ultimate goal of improving prevention and early detection in the population. I receive PhD funding from the University of Sydney (Research Training Program, Merit Scholarship), Sydney Catalyst, and the Melanoma Institute Australia.
Juliet Smith MPhil
People who have been diagnosed with a melanoma have an increased risk of developing a subsequent primary melanoma. This project will examine risk factors for subsequent primary melanoma and evaluate the optimal strategies for surveillance.
Established in 2018, the NHMRC-funded Melanoma Centre of Research Excellence (Melanoma CRE) is a strategic collaboration of clinicians and researchers from melanoma centres in New South Wales (Melanoma Institute Australia) and Victoria (Peter MacCallum Cancer Centre; Victorian Melanoma Service), Australia, and implementation scientists from the Australian Institute of Health Innovation, Macquarie University, Sydney. This multidisciplinary partnership combines leading clinical expertise in melanoma diagnosis and treatment with methodological expertise in epidemiology, bioinformatics, economics, qualitative research and implementation science. Associate Professor Cust from the Cancer Epidemiology and Prevention Research Group is the Principal Investigator on the CRE.
The Melanoma CRE is tasked with three primary objectives: pursuing collaborative research; developing capacity; and ensuring translation of research outcomes into policy and practice. It will achieve this in three core areas:
Sentinel lymph node (SLN) biopsy (a core 2 project)
Optimum treatment for melanoma, whether surgery, radiation or drug-based, depends on adequate assessment of the risk that the melanoma has spread to nearby lymph nodes. Sentinel lymph node (SLN) biopsy is a diagnostic test used in staging melanoma patients. The SLN biopsy project is examining the factors influencing doctors' and patients' decision to have, or not to have, a SLN biopsy and developing strategies to ensure the procedure is used to greatest benefit.
Melanoma High Risk Clinic Study and the Tailored Surveillance Project (core 1 projects)
Individual risk of melanoma differs widely between people and yet melanoma screening and surveillance strategies mostly rely on a one-size fits all approach. Melanoma risk prediction tools enable clinicians to more accurately advise patients on their risk of developing a first or subsequent melanoma based on sun exposure, phenotypic, genetic and histopathological risk factors. Knowing this personalised melanoma risk information can serve as a motivator for improved sun protection and skin self-examination behaviours, and permit tailoring of the frequency of surveillance follow-up visits and use of surveillance technologies (such as total body photography or teledermatology) according to risk level. Our previous research from the melanoma High Risk Clinics has shown that a program of specialised surveillance for people at very high risk of melanoma that includes 6-monthly visits, total body photography and sequential digital dermoscopy imaging, resulted in earlier diagnosis and fewer excisions under a careful ‘wait-and-watch’ approach, and cost savings for the health system (Watts, C.G., et al., Cost-Effectiveness of Skin Surveillance Through a Specialized Clinic for Patients at High Risk of Melanoma. J Clin Oncol, 2017. 35(1): p. 63-71). We are now analysing data from other High Risk Clinics in NSW to examine whether similar results are seen in different clinical settings, including a primary care skin cancer clinic.
In the Tailored Surveillance Project, we seek to evaluate the implementation of personalised melanoma risk assessment and tailored patient education and skin surveillance in dermatology clinics, specifically by evaluating the acceptability, feasibility and fidelity of the more systematic approach to tailoring patient clinical management, and its impact on sun protection and skin
A/Prof Anne Cust is actively involved in several international melanoma consortia. These consortia bring together world-class researchers with multi-disciplinary expertise to answer important questions concerning melanoma aetiology and treatment. Many of these questions can only be answered with large numbers of participants and samples, which is made possible through consortia.
The Genetics of Melanoma (GenoMEL) Consortium is funded through the NIH and other Australian and European grants, is a world leader in familial melanoma research and in the genetics of melanoma in families and the general population. A/Prof Cust is a member of the Analysis Team.
The Genes, Environment and Melanoma (GEM) Consortium examines genetic and environmental risk factors for melanoma using data from an international population-based study that used a novel study design where cases had mulitple primary melanoma and controls had a single primary melanoma. A/Prof Cust is a member of the Steering group.
Head of group: Prof Anne Cust, NHMRC and Cancer Institute NSW Career Development Fellow
Dr Caroline Watts, Research Fellow
Dr Anne Kricker, Honorary Associate
Caro Badcock, Biostatistician
Amelia Smit, Project Manager and PhD Candidate
Kate Dunlop, PhD Candidate
Dr Juliet Smith, MPhil Candidate
Gillian Reyes-Marcelino, Research Assistant
Brooke Beswick, Research Assistant
Ashleigh Sharman, Research Assistant
The group is funded through competitive grants, fellowships and scholarships from different organisations including: