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Minimal excess risk of cancer and reduced risk of death from cancer in Australian Department of Veterans’ Affairs clients: a record linkage study

Authors

  • Claire M. Vajdic,

    Corresponding author
    1. Adult Cancer Program, Lowy Cancer Research Centre, Prince of Wales Clinical School, University of New South Wales
    • Correspondence to: Associate Professor Claire M. Vajdic, Level 4, Lowy Cancer Research Centre. University of New South Wales, Sydney NSW 2052; e-mail: claire.vajdic@unsw.edu.au

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  • Efty P. Stavrou,

    1. Adult Cancer Program, Lowy Cancer Research Centre, Prince of Wales Clinical School, University of New South Wales
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  • Robyn L. Ward,

    1. Adult Cancer Program, Lowy Cancer Research Centre, Prince of Wales Clinical School, University of New South Wales
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  • Michael O. Falster,

    1. Adult Cancer Program, Lowy Cancer Research Centre, Prince of Wales Clinical School, University of New South Wales
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  • Sallie-Anne Pearson

    1. Adult Cancer Program, Lowy Cancer Research Centre, Prince of Wales Clinical School, University of New South Wales
    2. Pharmacoepidemiology & Pharmaceutical Policy Research Group, Faculty of Pharmacy, The University of Sydney, New South Wales
    3. School of Public Health, Sydney Medical School, The University of Sydney, New South Wales
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  • The authors have stated they have no conflict of interest.

  • This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced without prior written permission. Requests and enquiries concerning reproduction and rights should be directed in the first instance to Wiley; alternatively to the Commonwealth Copyright Administration, Attorney General's Department, Robert Garran Offices, National Circuit, Barton ACT 2600 or posted at http://www.ag.gov.au/cca.

  • The Work has been produced using data provided by the Department of Veterans’ Affairs. However, the views expressed in this version of the work do not necessarily represent the views of the Minister for Veterans’ Affairs or the Department of Veterans’ Affairs. The Commonwealth does not give any warranty nor accept any liability in relation to the contents of this work.

Abstract

Objective: To quantify the risk of incident cancer and cancer-related mortality in Australian Government Department of Veterans’ Affairs (DVA) clients.

Methods: A population-based record linkage study of 75,482 adult clients residing in New South Wales (NSW) from 2000 to 2007; median age 75 years (interquartile range, 68–79); 57% male. Standardised incidence ratios (SIRs) and mortality ratios (SMRs) for any cancer and by cancer type were calculated, relative to the NSW population.

Results: The risk of any cancer was slightly increased for males (SIR 1.07, 95%CI 1.04–1.10) but not females (SIR 1.00, 95%CI 0.96–1.04). Males exhibited a significantly elevated risk of prostate cancer (SIR 1.08), cutaneous melanoma (SIR 1.19), head and neck cancer (SIR 1.27) and connective tissue cancer (SIR 1.52). Females did not exhibit excess risk for any cancer type. Risk of cancer death was significantly reduced for any cancer (male SMR 0.78, 95%CI 0.75–0.81; female SMR 0.80, 95%CI 0.76–0.85) and for a range of haematopoietic and solid neoplasms including prostate (SMR 0.57), breast (SMR 0.62) and colon cancer (male SMR 0.67; female SMR 0.71).

Conclusion: Cancer incidence rates are largely similar, and mortality rates moderately lower, for DVA clients compared to the NSW general population.

Implications: These risk patterns may reflect service-related history, a healthy-survivor effect, competing risk of death, and/or comprehensive health care entitlements with minimal to no co-payments. Our findings suggest DVA clients are probably accessing cancer screening services. Outcomes after cancer diagnosis are good, most probably due to comprehensive health care entitlements.

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