Malignant neoplasm of unknown primary site — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 103 of 2022

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting malignant neoplasm of unknown primary site or death from malignant neoplasm of unknown primary site with the circumstances of a person's relevant service:

1. (1)
   having smoked tobacco products: (a) in an amount of at least 10 pack-years before the clinical onset of malignant neoplasm of unknown primary site; and (b) commencing at least 5 years before the clinical onset of malignant neoplasm of unknown primary site; and if smoking has ceased before the clinical onset of malignant neoplasm of unknown primary site, then that onset occurred within 20 years of cessation;

   Note: one pack-year is defined in the Schedule 1 - Dictionary.

2. (2)
   consuming alcohol: (a) in an amount of at least 200 kilograms before the clinical onset of malignant neoplasm of unknown primary site; and (b) where consumption of alcohol commenced at least 5 years before the clinical onset of malignant neoplasm of unknown primary site; and if consumption of alcohol has ceased before the clinical onset of malignant neoplasm of unknown primary site, then that onset occurred within 40 years of cessation;

   Note: Alcohol consumption is calculated utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.

3. (3)
   having received a cumulative equivalent dose of at least 0.1 sievert of ionising radiation to at least one location in the body, at least 5 years before the clinical onset of malignant neoplasm of unknown primary site;

   Note: cumulative equivalent dose is defined in the Schedule 1 - Dictionary.

4. (4)
   for squamous cell carcinoma of unknown primary site of the head and neck only, having infection of the epithelium of the: (a) oral cavity; (b) oropharynx; or (c) larynx; with human papillomavirus type 16 or 18 before the clinical onset of malignant neoplasm of unknown primary site;

   Note: squamous cell carcinoma of unknown primary site of the head and neck is defined in the Schedule 1 - Dictionary.

5. (5)
   for squamous cell carcinoma of unknown primary site involving the inguinal lymph nodes only, having infection of the epithelium of the: (a) anus or anal canal; (b) cervix; (c) penis; (d) vagina; or (e) vulva; with a specified human papillomavirus before the clinical onset of malignant neoplasm of unknown primary site;

   Note: specified human papillomavirus is defined in the Schedule 1 - Dictionary.

6. (6)
   for squamous cell carcinoma of unknown primary site of the head and neck only, having infection with Epstein-Barr virus before the clinical onset of malignant neoplasm of unknown primary site;

   Note: squamous cell carcinoma of unknown primary site of the head and neck is defined in the Schedule 1 - Dictionary.

7. (7)
   having diabetes mellitus before the clinical onset of malignant neoplasm of unknown primary site;
8. (8)
   for adenocarcinoma of unknown primary site only, consuming an average of at least 25 grams per day of processed meat product, for at least 5 consecutive years within the 20 years before the clinical onset of malignant neoplasm of unknown primary site;

   Note: processed meat product is defined in the Schedule 1 - Dictionary.

9. (9)
   inability to obtain appropriate clinical management for malignant neoplasm of unknown primary site;

Aggravation-only factors: the factors in subsection 9(9) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.