title: Increasing cancer mortality among opioid-dependent persons in Australia: a new public health challenge for a disadvantaged population.
abstract: OBJECTIVE
  To examine cancer mortality in a population-based cohort of opioid-dependent persons.
  
  
  METHODS
  New South Wales opioid substitution therapy (OST) program registrants from 1985 to 2005 (n=43,789) were probabilistically linked to the National Death Index. Crude and standardised mortality rates and standardised mortality ratios (SMRs) were calculated.
  
  
  RESULTS
  The crude cancer mortality rate increased from 4 to 65 deaths per 100,000 person-years (p trend <0.001). Overall, OST registrants were 1.7 times more likely to die of cancer than the general population (SMR 95% CI 1.4-1.9). Site-specific SMRs were significantly elevated for lung cancer (3.6, 95% CI 2.8-4.6), liver cancer (6.9, 95% CI 4.3-10.5), and anogenital cancers (2.8, 95% CI 1.3-5.3), and significantly reduced for breast cancer (0.4, 95% CI 0.1-0.9).
  
  
  CONCLUSIONS
  Cancer is an increasingly important cause of death among OST registrants as they live longer with their dependency. The site-specific excess deaths suggest the role of tobacco, alcohol, and infection with hepatitis C and human papillomavirus.
  
  
  CONCLUSIONS
  The OST setting may be a useful setting for the delivery of programs aimed at detection of precursor lesions, reducing exposure to established carcinogens, and treatment for those with HCV infection. Such targeted steps are likely to reduce the future cancer burden in this population.
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Australia. d.randall@uws.edu.au
authors.forename: Deborah
authors.initials: D
authors.lastname: Randall
authors.forename: Louisa
authors.initials: L
authors.lastname: Degenhardt
authors.forename: Claire M
authors.initials: CM
authors.lastname: Vajdic
authors.forename: Lucy
authors.initials: L
authors.lastname: Burns
authors.forename: Wayne D
authors.initials: WD
authors.lastname: Hall
authors.forename: Matthew
authors.initials: M
authors.lastname: Law
authors.forename: Tony
authors.initials: T
authors.lastname: Butler
mesh_terms: D000328:Adult; D017677:Age Distribution; D002423:Cause of Death / Q000639:trends; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000009:adverse effects*; D009369:Neoplasms / Q000401:mortality*; D009517:New South Wales / Q000453:epidemiology; D009293:Opioid-Related Disorders / Q000401:mortality*; D011159:Population Surveillance; D011634:Public Health; D017678:Sex Distribution; D035862:Vulnerable Populations; D055815:Young Adult
chemical_list: D009294:Narcotics