scholarly journals Cancer Before, During and After Pregnancy

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 202s-202s
Author(s):  
B. Ndlela ◽  
S. Sandhu ◽  
J. Lai ◽  
K. Lavelle ◽  
L. Elliss-Brookes ◽  
...  

Background: The occurrence of cancer during pregnancy is uncommon with an incidence rate of ∼1 in 1000 pregnancies. The rate of pregnancy-associated cancer is increasing and this is partly caused by a trend in delaying child bearing to an older age. Aim: With little data in the UK concerning the number of women diagnosed with cancer during pregnancy, the purpose of this study was to compare incidence of cancer in pregnant women to the general female population. Methods: Cancer registry data for England were linked to hospital activity data to establish pregnancy-associated cancers. For this study, women aged 15 to 44 years diagnosed with a malignant cancer between 2012 and 2014 and a pregnancy or delivery code 1 year before or up to 1 year after diagnosis were defined as pregnant women. Age-standardized and age-specific incidence rates of cancer in pregnant women and the general female population in England were compared by 5-year age-group, geographic region of residence, income deprivation quintile and stage of cancer diagnosis. Results: A total of 3272 pregnancy-associated cancers were identified in 2,503,174 pregnancies. The age-standardized incidence rate (ASIR) of cancer in pregnant women was 48% higher than the equivalent ASIR of cancer in the female population aged 15-44 nationally (173 vs 117 per 100,000). This trend of higher incidence of cancer among pregnant women persisted for most regions, ages and stages, and was particularly high in the most deprived quintile. The most common cancers diagnosed around the time of pregnancy were breast (n = 784), melanoma of skin (n = 504), cervical (n = 498), hematologic (n = 286), ovarian (n = 240) and colorectal (n = 188). Comparing the ASIR of cancer in pregnant women with the female population, by site, rates were over 30% higher for breast cancer (55 vs 41 per 100,000 respectively) and around double those for melanoma (26 vs 13 per 100,000). Conclusion: The higher rates of pregnancy-associated cancers compared with the general female population may be due to frequent obstetric examinations which increases the chances of cancer detection. Further work using a more robust maternity dataset would be required to ascertain timing of cancer diagnosis in relation to delivery.

2019 ◽  
Vol 119 (03) ◽  
pp. 490-495 ◽  
Author(s):  
Shéhérazade Rézig ◽  
Raphael Mao ◽  
Francis Couturaud ◽  
Karine Lacut ◽  
Aurélien Delluc

AbstractPatients with two unprovoked venous thromboembolism (VTE) events could be at high risk for cancer diagnosis and may therefore benefit from extended cancer screening strategies. However, accurate data on the incidence of cancer in this population is lacking. In a prospective cohort study, we followed-up with all patients who experienced two unprovoked symptomatic VTE events that occurred in less than 2 years apart. We estimated the 1-year incidence rate of cancer following the second unprovoked VTE event using the Kaplan–Meier method. Potential predictors for cancer diagnosis were assessed using a Cox proportional hazard regression model. Between May 2000 and December 2013, we included 197 patients with two episodes of symptomatic unprovoked VTE that occurred in less than 2 years apart. Their mean age was 66.2 ± 16.3 years, and 122 (51.8%) were male. Seventeen patients were diagnosed with cancer during the year following the second episode of unprovoked VTE, corresponding to a cumulative incidence rate of 9.19% (95% confidence interval [CI]: 5.81–14.37). The 1-year cumulative incidence rate of cancer was 35.88% (95% CI: 19.75–59.25) in patients with VTE recurrence on anticoagulation, 5.51% (95% CI: 2.9–10.32) among patients with a second episode of unprovoked VTE occurring after stopping anticoagulation and 1.15% (95% CI: 0.16–7.88) when time elapsed between the first and recurrent VTE was > 1 year. Our study suggests that the incidence of cancer in patients with a second episode of unprovoked VTE that occurs off anticoagulation, or > 1 year after the first event, is similar to that of patients with a first unprovoked VTE event.


2021 ◽  
pp. 1-11
Author(s):  
Denise M. Oleske ◽  
Xianbin Cheng ◽  
Anna Jeong ◽  
Thomas J. Arndt

<b><i>Background:</i></b> Although stroke is rare among the pediatric population, it is nevertheless associated with serious or life-threatening consequences. The etiologic factors of acute ischemic stroke (AIS) are likely to vary over the course of childhood development. The incidence rates of AIS, not previously systematically examined by pediatric age subgroup, could guide studies of its etiology. <b><i>Objective:</i></b> The aim of this study is to evaluate the incidence rate of AIS by age-group in the pediatric population (aged 0–17/18 years) and identify any common trends or sources of variability across different countries. <b><i>Methods:</i></b> Rates of pediatric AIS were collated from a systematic literature review of published studies globally (1983–2020) and hospitalization records from Europe and the USA (2015–2018). Records that were included in the analysis reported the code or description used for AIS diagnosis and age-specific data for children aged 0–17/18 years. AIS incidence rates were summarized by age-group, data source, country, and geographic region. A meta-analysis was conducted to assess the heterogeneity of AIS rates in neonates. <b><i>Results:</i></b> The pooled AIS incidence rate was 5.6 per 100,000 children across all records. When only records reporting the AIS incidence rates for children across the full age range (0–17/18 years) were analyzed, the pooled AIS incidence rate was 4.6 per 100,000 children and ranged from 7.0 per 100,000 (Germany) to 1.3 per 100,000 (Denmark). The highest pooled rates were observed in the 0–28-day age-group (24.6 per 100,000 live births), declining to the lowest rates in the 5–9-year age-group, and rising again in the 10–17/18-year age-group. AIS rates were the most heterogeneous in the 0–28-day age-group and across European countries. Significantly higher AIS rates in neonates were observed from hospital databases (35.9 per 100,000) than in the literature (19.4 per 100,000). AIS rates may be underestimated as pediatric AIS events are rare and challenging to diagnose, and limited age-specific data are available. <b><i>Conclusions:</i></b> Incidence rates of pediatric AIS by age-groups followed a consistent overall pattern of a reverse J-shaped curve, with the highest rates in neonates, across predominantly European and North American countries. Further research is warranted to examine if this pattern is observed in other geographic regions and to identify AIS risk factors specific to different phases of childhood development.


2021 ◽  
Author(s):  
Florence Brellier ◽  
Mar Pujades-Rodriguez ◽  
Emma Powell ◽  
Kathleen Mudie ◽  
Eliana Mattos Lacerda ◽  
...  

Objectives To evaluate incidence rates of Lyme disease in the UK and to investigate a possible association with subsequent fatigue Design Population-based historical cohort study with a comparator cohort matched by age, sex, and general practice Setting Patients treated in UK general practices contributing to IQVIA Medical Research Data Participants 2,130 patients with a first diagnosis of Lyme disease between 2000 and 2018, and 8,510 randomly-sampled matched comparators, followed-up for a median time of 3 years and 8 months. Main outcome measures Time from Lyme disease diagnosis to consultation for any fatigue-related symptoms or diagnosis and for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Adjusted hazard ratios (HRs) were estimated from Cox models. Results Average incidence rate for Lyme disease across the UK was 5.18 per 100,000 py between 2000 and 2018, increasing from 2.55 in 2000 to 9.33 in 2018. In total 929 events of any types of fatigue were observed, i.e. an incidence rate of 307.90 per 10,000 py in the Lyme cohort (282 events) and 165.60 in the comparator cohort (647 events). Effect of Lyme disease on any subsequent fatigue varied by index season with highest adjusted HRs in autumn [3.14 (95%CI: 1.92 to 5.13)] and winter [2.23 (1.21 to 4.11)]. Incidence rates of ME/CFS were 11.16 per 10,000 py in Lyme patients (12 events) and 1.20 in comparators (5 events), corresponding to an adjusted HR of 16.95 (5.17 to 55.60). Effect on any types of fatigue and ME/CFS was attenuated 6 months after diagnosis but still clearly visible. Conclusions UK primary care records provided strong evidence that Lyme disease was associated with acute and chronic fatigue. Albeit weaker, these effects persisted beyond 6 months, suggesting that patients and healthcare providers should remain alert to fatigue symptoms months to years following Lyme disease diagnosis.


2021 ◽  
Author(s):  
◽  
Nicola Vousden ◽  
Kathryn Bunch ◽  
Edward Morris ◽  
Nigel Simpson ◽  
...  

ABSTRACTBackgroundEvidence on risk factors, incidence and impact of SARS-CoV-2 infection in pregnant mothers and their babies has rapidly expanded but there is a lack of population level data to inform accurate incidence rates and unbiased descriptions of characteristics and outcomes. The primary aim of this study was to describe the incidence, characteristics and outcomes of hospitalized pregnant women with symptomatic and asymptomatic SARS-CoV-2 in the UK compared to pregnant women without SARS-CoV-2 in order to inform future clinical guidance and management.Methods and FindingsWe conducted a national, prospective cohort study of all hospitalized pregnant women with confirmed SARS-CoV-2 from 1st March 2020 to 31st August 2020 using the UK Obstetric Surveillance System (UKOSS) across all 194 hospitals in the UK with a consultant-led maternity unit. Incidence was estimated using the latest national maternity data. Overall, 1148 hospitalized women had confirmed SARS-CoV-2 in pregnancy, 63% of which were symptomatic. Therefore, the estimated incidence of hospitalization with symptomatic SARS-CoV-2 was 2.0 per 1000 maternities (95% CI 1.9-2.2) and for asymptomatic SARS-CoV-2 was 1.2 per 1000 maternities (95% CI 1.1-1.4). Compared to pregnant women without SARS-CoV-2, women hospitalized with symptomatic SARS-CoV-2 were more likely to be overweight or obese (adjusted OR 1.86, 95% CI 1.39-2.48 and aOR 2.07, 95% CI 1.53-2.29 respectively), to be of Black, Asian or Other minority ethnic group (aOR 6.24, 95% CI 3.93-9.90, aOR 4.36, 95% CI 3.19-5.95 and aOR 12.95, 95% CI 4.93-34.01 respectively), and to have a relevant medical comorbidity (aOR 1.83, 95% CI 1.32-2.54). Compared to pregnant women without SARS-CoV-2, hospitalized pregnant women with symptomatic SARS-CoV-2 were more likely to be admitted to intensive care (aOR 57.67, 95% CI 7.80-426.70) but the absolute risk of poor outcomes was low. Cesarean births and neonatal unit admission were increased regardless of symptom status (symptomatic aOR 2.60, 95% CI 1.97-3.42 and aOR 3.08, 95% CI 1.99-4.77 respectively; asymptomatic aOR 2.02, 95% CI 1.52-2.70 and aOR 1.84, 95% 1.12-3.03 respectively). Iatrogenic preterm births were more common in women with symptomatic SARS-CoV-2 (aOR 11.43, 95% CI 5.07-25.75). The risks of stillbirth or neonatal death were not significantly increased, regardless of symptom status but numbers were small. The limitations of this study include the restriction to women hospitalized with SARS-CoV-2, who may by nature of their admission have been at greater risk of adverse outcome.ConclusionsWe have identified factors that increase the risk of symptomatic and asymptomatic SARS-CoV-2 in pregnancy. The increased risks of cesarean and iatrogenic preterm birth provide clear evidence of the indirect impact of SARS-CoV-2 on mothers and maternity care in high income settings. Clinicians can be reassured that the majority of women do not experience severe complications of SARS-CoV-2 in pregnancy and women with mild disease can be discharged to continue their pregnancy safely.


2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e12500-e12500
Author(s):  
Margaret Elizabeth McCusker ◽  
Jian Huang ◽  
Robert Walls

e12500 Background: Pneumoncystis jiroveci pneumonia (PJP) causes severe, often life-threatening illness in immunocompromised patients, including patients with cancer. PJP incidence estimates have been reported for several different cancer types based on case series from single institutions. In order to obtain incidence estimates from a larger pool of patients, we studied PJP claims among patients with metastatic solid tumors (MSTs) or lymphomas in a large administrative healthcare claims database. Methods: Adults diagnosed with MSTs or lymphomas between January 1999-September 2011 were identified in the MarketScan commercial, Medicare supplemental and Medicaid databases based on ICD-9 diagnosis codes. First PJP after cancer diagnosis was defined by PJP ICD-9 code (136.3) associated with an inpatient hospital stay of at least 1 day. Patients with a PJP claim before their cancer diagnosis were excluded. PJP incidence proportions and rates (with 95% CIs) were calculated by age group, sex, HIV status, and tumor type. Results: There were 158 PJP cases (0.04%) among 392,369 HIV-negative MST patients, an incidence rate of 3.0/10,000 pt-yrs (95% CI 2.6-3.5). Incidence rates by metastatic cancer type were 6.8/10,000 pt-yrs for lung, 5.4/10,000 pt-yrs for pancreas, 4.1/10,000 pt-yrs for prostate, 3.0/10,000 pt-yrs for breast, and 0.9/10,000 pt-yrs each for colorectal and ovary. There were 337 PJP cases (0.21%) among 162,799 HIV-negative lymphoma patients, an incidence rate of 9.4/10,000 pt-yrs (95% CI 8.5-10.5). Incidence was higher among males compared to females in both MST and lymphoma patients. PJP incidence rates in HIV-positive patients were approximately 14 times higher than in HIV-negative patients. Conclusions: PJP is a rare occurrence among patients with MSTs or lymphomas. In this analysis of a large administrative healthcare claims database, PJP incidence was higher among lymphoma patients compared to MST patients. Incidence estimates were lower than reports from institutional case series, but patterns of occurrence were consistent in terms of higher incidence in patients with lymphomas or HIV. Differences in incidence by tumor type were also observed among MST patients.


Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Lauren A Barnett ◽  
Toby Helliwell ◽  
Kelvin Jordan ◽  
James Prior

Abstract Background Giant cell arteritis (GCA) is the most common form of medium and large vessel vasculitis. Diagnosis remains difficult since there are a multitude of symptoms experienced by patients with GCA and if not promptly identified or treated, patients with GCA are at risk of irreversible visual loss. Therefore, a clear understanding of recent trends in incidence is important for clinicians, researchers and policy-holders to better understand and address future healthcare resource needs. Our objective was to estimate the annual UK incidence of GCA and assess whether this is changing over time. Methods We used the Clinical Practice Research Datalink (CPRD), a database of routinely recorded primary care records from across the UK. CPRD is representative of the UK population and contains patient information from approximately 15% of the UK population. For each year from 1992-2017, the number of patients with a first Read coded record of GCA in that year, and aged 40 years or older at the time of diagnosis, was determined. The annual denominator population included the registered practice population without a prior record of GCA, aged 40 years or older. Annual incidence per 10,000 person-years (P-Y) at risk was derived overall and stratified by age, gender and region of the UK. Trends over time were modelled using Joinpoint regression. To be confident of the primary care diagnosis of GCA, a sensitivity analysis was undertaken which included a prescription of corticosteroids alongside the GCA Read code. Results There was a decrease in annual incidence of GCA in the UK between 1992 and 2017. Incidence was highest in 1994 (2.29/10,000 P-Y; 95% CI: 1.96, 2.67). This decreased to 1.51/10,000 P-Y in 2006, after which the incidence rates stabilised. Incidence rates for women were higher than men, irrespective of year. Incidence peaked between 70 and 89 years of age, with females aged 70-79 having the highest overall incidence rate of 5.20/10,000 P-Y (95% CI: 5.00, 5.40). The region of the UK with the highest incidence rate of GCA from 2015-2017 was Yorkshire & the Humber with 2.63/10,000 P-Y. The regions with the lowest incidence of 1.13/10,000 P-Y were the North East and West Midlands. Sensitivity analysis gave similar patterns. Conclusion The incidence of GCA in the UK has decreased slightly in recent years, which may reflect developments in more definitive early GCA diagnosis through fast-track clinics and improvements in imaging. However, further research into the presenting features of GCA in primary care is required. A set of early clinical features and comorbidities that are positively associated and predictive of a subsequent diagnosis of GCA would improve diagnosis and avert significant complications associated with delayed treatment. Disclosures L.A. Barnett None. T. Helliwell None. K. Jordan None. J. Prior None.


2021 ◽  
Vol 65 (3) ◽  
pp. 245-250
Author(s):  
Anna V. Rumyantseva ◽  
Tamara V. Azizova ◽  
Mariya V. Bannikova ◽  
Ol’ga V. Zubkova

Introduction. Breast cancer (BC) is one of the most common malignancies within female incidence and mortality patterns in the RF. Study objective. To analyze BC incidence in females exposed to occupational ionizing radiation over prolonged periods. Materials and methods. The study cohort included 5689 females who had been occupationally exposed to ionizing radiation throughout 1948-1982 and followed up until 31.12.2018. Results. BC was on the top of the list among females of the study cohort (11.9%). BC prevalence rate in the female cohort understudy was 28.3% as of 31.12.2018. The standardized BrCa incidence rate was 0.88 ± 0.07 per 1000 person-years of the follow-up. The absolute BrCa case increase in the females was 1.29, with the rise of 232.48% by the end of the follow-up due to the rise in age categories of females and the elevating risk of the disease occurrence. Discussion. The study cohort of females demonstrated standardized BrCa incidence rates consistent with the corresponding estimates for the general female population of the RF. Meanwhile, the observed rates were lower than those estimated for the female population of the Chelyabinsk region. The increasing trend of the standardized BC incidence rate by the end of the follow-up period (31.12.2018) was consistent with WHO statistics. The extended follow-up for an updated assessment of ionizing radiation effect on BC incidence is required to develop new cancer prevention strategies. Conclusion. The study demonstrated that BC incidence rates in the study cohort varied by age and calendar period of the follow-up. The increasing trend of the standardized rates of BC incidence was observed by the end of the follow-up.


2018 ◽  
Vol 22 (06) ◽  
pp. 1138-1147 ◽  
Author(s):  
Huiqing Jiang ◽  
Hilary J Powers ◽  
Giulia S Rossetto

AbstractObjectiveThe present study reviewed the literature on iodine status among women of childbearing age and pregnant women in the UK. Particular attention was given to study quality and methods used to assess iodine status.DesignA systematic review was conducted to examine the literature and critically evaluate study design.SettingStudies were identified in PubMed, Web of Science, Scopus and Ovid MEDLINE databases, as well as from secondary references.ParticipantsWomen of childbearing age or pregnant, living in the UK.ResultsFifty-seven articles were identified and twelve articles were selected, including a total of 5283 women. Nine studies conducted urinary iodine assessments, three studies conducted dietary assessments only, and seven studies classified their target population as iodine deficient according to WHO criteria.ConclusionsNo single study from the selected articles could produce nationally representative results regarding the prevalence of iodine deficiency among the female population in the UK. Consideration of the evidence as a whole suggests that women of childbearing age and pregnant women in the UK are generally iodine insufficient. Further large-scale research is required for more accurate and reliable evidence on iodine status in the UK.


2018 ◽  
Vol 52 ◽  
pp. 63 ◽  
Author(s):  
Breno Souza de Aguiar ◽  
Cassia Maria Buchalla ◽  
Francisco Chiaravalloti Neto

OBJECTIVE: An ecological study describring the spatial characteristics of AIDS in São Paulo city between 2001 and 2010 according to the place of residence of reported cases in adults. METHODS: The AIDS reported cases (28,146), grouped by sex, were geocodified (25,969) and linked with a census tract database (18,953). Case and population at risk data supplied spatial cluster identification and relative risk estimate by the scan method, using the discrete Poisson model. Incidence rate and proportional distribution allowed comparing people living in the high-risk clusters areas to other locations by age, race/ethnicity, schooling and transmission category. RESULTS: The AIDS incidence rate decreased in both sexes except among young men and older people. The identification of spatial high-risk clusters showed that the decrease of AIDS did not occur in the same way in the city. Clusters located in the central area presented the highest AIDS incidence rates (245.7/100,000 men), especially among black women (RR = 7.9), men who have sex with men (66.2%) and injection drug users (10.7%) participation. In peripheral clusters, identified only in the female population, the epidemic can be related to the poverty of these women (22.5% low education level). Residents in the north and central-south areas of the city are generally black, with little schooling, and predominantly heterosexually infected. CONCLUSIONS: The study of spatial clusters using a census tract helps to determine epidemiological patterns inside the city and in specific populations. Spatial stratification and key population epidemiological patterns were identified in four regions in São Paulo city


2015 ◽  
Vol 2015 ◽  
pp. 1-8
Author(s):  
Pauline Duke ◽  
Marshall Godwin ◽  
Mandy Peach ◽  
Jacqueline Fortier ◽  
Stephen Bornstein ◽  
...  

Background. The Argentia region of Newfoundland and Labrador, Canada, was home to a US naval base during a 40-year period between the 1940s and the 1990s. Activities on the base resulted in contamination of the soil and groundwater in the region with chemicals such as heavy metals and dioxins, and residents have expressed concern about higher rates of cancer in their community. This study investigated the rate of cancer diagnosis that is disproportionately high in the Argentia region.Methods. Cases of cancer diagnosed between 1985 and 2011 were obtained for the Argentia region, two comparison communities, and the province of Newfoundland and Labrador. Crude and age-standardized incidence rates of cancer diagnosis were calculated and compared. The crude incidence rate was adjusted for differences in age demographics using census data, and age-standardized incidence rates were compared.Results. Although the Argentia region had a higher crude rate of cancer diagnosis, the age-standardized incidence rate did not differ significantly from the comparison communities or the provincial average. Argentia has an aging population, which may have influenced the perception of increased cancer diagnosis in the community.Conclusions. We did not detect an increased burden of cancer in the Argentia region.


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