Incidence Of Cancer In Women Research Articles

Increased incidence of cancer in the follow-up of obstetric antiphospholipid syndrome within the NOH-APS cohort.

Malignancies can be associated with positive antiphospholipid antibodies but the incidence of cancer among women with the purely obstetric form of antiphospholipid syndrome (APS) is currently unknown. Our aim was to investigate the comparative incidence of cancers in women with a history of obstetric APS within a referral university hospital-based cohort (NOH-APS cohort). We performed a 17-year observational study of 1,592 non-thrombotic women with three consecutive spontaneous abortions before the 10th week of gestation or one fetal death at or beyond the 10th week of gestation. We compared the incidence of cancer diagnosis during follow-up among the cohort of women positive for antiphospholipid antibodies (n=517), the cohort of women carrying the F5 rs6025 or F2 rs1799963 polymorphism (n=279) and a cohort of women with negative thrombophilia screening results (n=796). The annualized rate of cancer was 0.300% (0.20%-0.44%) for women with obstetric APS and their cancer risk was substantially higher than that of women with negative thrombophilia screening [adjusted hazard ratio (aHR) 2.483; 95% confidence interval (CI) 1.27-4.85]. The computed standardized incidence ratio for women with obstetric APS was 2.89; 95% CI: 1.89-4.23. Among antiphospholipid antibodies, lupus anticoagulant was associated with incident cancers (aHR 2.608; 95% CI: 1.091-6.236). Our cohort study shows that the risk of cancer is substantially higher in women with a history of obstetric APS than in the general population, and in women with a similar initial clinical history but negative for antiphospholipid antibodies.

Pengaruh Psikoedukasi terhadap Kecemasan Ibu Pre Operasi Kanker Payudara

International Agency for Research on Cancer (IARC) in 2012, The incidence of cancer in women in Indonesia 134 per 100,000 population with the highest incidence in women is breast cancer of 40 per 100,000. The problem that often arises before surgery is anxiety. The client's anxiety generates a psychosocial response. There is psychological therapy for preoperative patient anxiety treatment with psychoeducation. This study aims to determine the effect of psychoeducation on anxiety levels of patients preoperative breast cancer in RSUD DR. H. Abdul Moeloek Year 2018. Type of quantitative research method using quasi-experiment design with one group pretest design approach posttests design Sampling technique using purposive sampling technique as much as 30 respondents. The time of the study date of May 18, 2018, to June 30, 2018, in the Room of Roses RSUD DR. H. Abdul Moeloek Lampung Province. The data were collected using a self-Rating Anxiety Scale (SAS/ZSRAS) Zung questionnaire. Statistical test using t dependent Wilcoxon.

Lung cancer incidence in female rises significantly in urban sprawl of Shanghai after introduction of LDCT screening

ObjectivesLDCT screening for lung cancer has been widely used in China since the release of the NLST trial data in 2011, but little is known about its impact on the incidence and mortality rates of lung cancer in China. MethodsOfficial cancer registry data of lung cancer incidence and mortality were collected by Shanghai Municipal Center for Disease Control and Prevention from 2005 to 2014. Two districts (Xuhui and Songjiang Districts) were selected to represent populations with different levels of accessibility to LDCT. Incidence and mortality age-standardized rates (ASRs) were calculated using the Segi/Doll 1960 world standard population. Trends in lung cancer incidence and mortality rate over time, the average annual percent change (APC) and the corresponding 95% confidence interval (CI) were calculated using Joinpoint. ResultsIn Shanghai, lung cancer incidence rate in men did not change significantly between 2005 and 2014 (APC = 0.76%; 95% CI: -0.27%, 1.80%; P = 0.127); while lung cancer incidence in women increased significantly (APC: 5.50%; 95% CI: 2.94%, 8.13%; P = 0.001). In Xuhui district, where eight tertiary hospitals was located, including Shanghai Cancer Center and Shanghai Chest Hospital, both of which provided LDCT lung cancer screening for eligible patients, the incidence rate of lung cancer increased significantly in women only since 2011(APC: 19.84%, P < 0.001). Overall mortality rate of lung cancer showed a significantly decreasing trend from 2005 to 2014 in men (APC = -2.68%, P = 0.009) but not in women (APC = -0.91%, P = 0.305). In Songjiang district, where limited access to LDCT was provided, lung cancer incidence in women increased significantly between 2005 and 2014 (APC: 5.42%, P = 0.001). Lung cancer incidence rates did not change significantly in men in either district from 2005 to 2014. Mortality rate of lung cancer did not change significantly from 2005 to 2014 in both men (APC = -0.51%, P = 0.259) and women (APC = -1.46%, P = 0.186). ConclusionThere is a steady increase in the incidence of lung cancer in women, especially after the wide use of LDCT screening, but without a clear mortality reduction.

Association of antidiabetic medication and statins with breast cancer incidence in women with type 2 diabetes

PurposeTo address the possible association between the use of metformin, other forms of antidiabetic medication (ADM) and statins with the incidence of breast cancer in women with type 2 diabetes (T2D).MethodsData were collected from a Finnish nationwide diabetes database (FinDM). The study cohort consisted of women diagnosed with T2D in 1996–2011 in Finland. In full-cohort analysis, Poisson regression was used to estimate hazard ratios (HRs) in relation to use of metformin, insulin, other forms of oral ADM and statins. In nested case–control analysis, up to 20 controls were matched for age and duration of diabetes to each case of breast cancer. Conditional logistic regression was used to estimate HRs in relation to medication use and cumulative use of different forms of ADM, and statins.Results2300 women were diagnosed with breast cancer during follow-up. No difference in breast cancer incidence was observed between metformin users [HR 1.02, 95% confidence interval (CI) 0.93–1.11] or statin users (HR 0.97, 95% CI 0.89–1.05) compared with non-users. In nested case–control analysis the results were similar. Use of insulin (HR 1.18, 95% CI 1.03–1.36) was associated with a slightly increased incidence of breast cancer.ConclusionsNo evidence of an association between the use of metformin or statins and the incidence of breast cancer in women with T2D was found. Among insulin users, a slightly higher incidence of breast cancer was observed.

P003: Incidence of cancer in women with a history of placenta-mediated complications: French national data

P003: Incidence of cancer in women with a history of placenta-mediated complications: French national data

The Incidence of Breast Cancer in Women with Thyroid Dysfunction in Al-Najaf Province

The problem of B.C. is growing in both established and developing states, and in many provinces of the domain, it is the utmost frequently arising malignant sickness in females; it is including (18 percent) from the all cancers that effected woman, and the global, B.C. is the 5th greatest public cause of death with cancer. In year (2008), almost (1.4) m. female were established with B.C.in universal with a consistent about (460.000) demises.

HUBUNGAN FAKTOR REPRODUKSI DENGAN KEJADIAN KANKER PAYUDARA PADA WANITA DI RSUP DR. M. DJAMIL PADANG

Breast cancer is a non-contagious disease, currently a major health problem both in the world and in Indonesia. The incidence of breast cancer is believed to be related to several risk factors. This study aims to determine the relationship of reproductive factors (age of menarche, parity and history of breastfeeding) with the incidence of breast cancer in women. Case control research was carried out at DR. M. Djamil Padang with univariate and bivariate analysis using Chi-square test. Of the 72 samples (36 cases and 36 controls) it was found that respondents with menarche age were 80.6% at risk in the case group and 19.4% in the control group, respondents with risk parity were 33.3% in the case group and 66 , 7% in the control group, respondents with a breastfeeding history were at risk of 65.6% in the case group and 34.4% in the control group. There is a relationship between age of menarche and history of breastfeeding with the incidence of breast cancer. There is no relationship between parity and the incidence of breast cancer. Strengthen health promotion efforts as an effort to prevent breast cancer.Keywords: Reproductive factors, breast cancer

Changes in lung cancer incidence by sex and smoking status in China: a multicentre observational study

BackgroundLung cancer is traditionally more prevalent in elderly people, men, and smokers, and is usually diagnosed at an advanced stage. However, as low-dose CT (LDCT) lung cancer screening is increasingly popular in some regions of China, and since it might lead to the detection of more small-sized lung cancers, we hypothesised the spectrum of lung cancer might change. MethodsThis observational study included three datasets. The first dataset included LDCT lung cancer screening results for employees from five hospitals in different regions of China in 2012–17. The second dataset included lung cancer incidence and mortality from the Shanghai Cancer Registry in 2005–14. The third dataset included clinicopathologic data for patients with primary lung cancer undergoing surgical resection in the Fudan University Shanghai Cancer Center (FUSCC), Shanghai, in 2008–17. To characterise trends in lung cancer incidence over time, we calculated the average annual percent change (APC) using Joinpoint (version 4.1.1.3) by the National Cancer Institute. We used the Cochrane Armitage trend test to determine if the proportion of the young, female, non-smoking, or stage 0/IA patients increased over the years. This study was approved by the ethics committee of each participating institution. FindingsLDCT screening detected lung cancer in 164 hospital employees with pathological confirmation. Of the hospital employees with lung cancer, a high proportion were female (81·7%), non-smokers (91·5%), younger than 55 years (58·5%), and had stage 0/IA cancer (93·3%). The proportion of hospital employees with lung cancer was 1·2% in women and 0·7% in men. In Shanghai, lung cancer incidence in women increased significantly (APC 5·50%, p=0·0008) from 17·6 cases per 100 000 in 2005 to 25·8 cases per 100 000 in 2014, while the incidence in men did not change significantly (p=0·1255). Incidence in women increased significantly in all the age subgroups between 30 and 64 years. Among 8355 patients with lung cancer undergoing surgery in FUSCC in 2008–17, the proportion of women (from 32·8% to 55·7%), non-smokers (from 43·9% to 68·5%), patients aged 40 years or younger (from 2·2% to 8·6%), and patients with stage 0/IA cancer (from 32·2% to 73·0%) increased significantly from 2008 to 2017. InterpretationWe observed an increasing trend of young, female, non-smoking, and early-stage lung cancer in China, which is in contradictory to classical concepts and brings new challenges and opportunities to change clinical practice. FundingNational Natural Science Foundation of China (81330056, 81572253, 81572264, 81772466, and 81702258) and Chinese Minister of Science and Technology grant (2016YFA0501800 and 2017YFA0505501).

County-Level Radon and Incidence of Female Thyroid Cancer in Iowa, New Jersey, and Wisconsin, U.S.A.

Background: Few studies have investigated the association between radon and thyroid cancer despite the sensitivity of the thyroid gland to radiation. Our goal is to investigate the association between county-level radon and incidence of female thyroid cancer in the US States of Iowa, New Jersey, and Wisconsin.Methods: Thyroid cancer incidence data were provided by individual state cancer registries and span 1990&amp;#8211;2013. Radon data come from a publicly available third-party database, AirChek, accessed in 2017. We tabulated the percent of radon above four picocuries per liter and the female thyroid cancer incidence rate in each county. Quantile maps were constructed, and an ordinary least-squares regression model was run using Geoda 1.10.0.8 (Chicago, IL, USA).Results: No association was observed between county-level radon and incidence of female thyroid cancer in any of the States: New Jersey (&amp;#946; &amp;#61; 0.06, p &amp;#61; 0.23); Iowa (&amp;#946; &amp;#61; &amp;#8722;0.07, p &amp;#61; 0.07); or Wisconsin (&amp;#946; &amp;#61; &amp;#8722;0.01, p &amp;#61; 0.78). A spatial regression model was considered, but the Moran&amp;#8217;s I of the residuals from each of the models was not significant, so no spatial term was required.Discussion: In this county-level ecological study across three different States in the US, we did not find an association between elevated radon and thyroid cancer incidence in women. While this ecologic study reports null findings, due to the ecologic fallacy, individual-level studies of this association may still be warranted.

A prospective cohort examination of haematological parameters in relation to cancer death and incidence: the Busselton Health Study

BackgroundCancer risk is associated with serum iron levels. The aim of this study was to evaluate whether haematological parameters reflect serum iron levels and may also be associated with cancer risk.MethodsWe studied 1564 men and 1769 women who were enrolled in the Busselton Health Study, Western Australia. Haematological parameters evaluated included haemoglobin (Hb), mean cell volume (MCV), mean cell haemoglobin (MCH) and mean cell haemoglobin concentration (MCHC) and red cell distribution width (RCDW). Statistical analyses included t-tests for quantitative variables, chi-square tests for categorical variables and Cox proportional hazards regression modelling for cancer incidence and death.ResultsThere was marginal evidence of an association between MCV (as a continuous variable) and non-skin cancer incidence in women (HR 1.15, 95% CI 1.013, 1.302; p = 0.030) but the hazard ratio was attenuated to non-significance after adjustment for serum ferritin (SF), iron and transferrin saturation (TS) (HR 1.11, 95% CI 0.972, 1.264; p = 0.126). There was strong evidence of an association between MCHC and prostate cancer incidence in men; the estimated hazard ratio for an increase of one SD (0.5) in MCHC was 1.27 (95% CI 1.064, 1.507; p = 0.008). These results remained significant after further adjustment for SF and iron; the estimated hazard ratio for an increase of one SD (0.5) in MCHC was 1.25 (p = 0.014, 95% CI 1.05 to 1.48).ConclusionsThe MCHC and MCV were associated with cancer incidence in a Western Australian population, although only MCHC remained associated with prostate cancer after adjusting with serum iron and TS (circulating iron) and SF (storage iron). Haematological parameters are thus of limited utility in population profiling for future cancer risk.

Chemoprevention acceptance and adherence in women with high-risk breast lesions.

Patients with atypical hyperplasia and lobular carcinoma insitu (LCIS) (atypical breast lesions) are at high risk of developing breast cancer, and chemoprevention has been shown to confer a substantial reduction in that risk. Despite this, the overall rate of chemoprevention utilization in this group is low. This study evaluates the efficacy of a formal individualized education and counseling session on patient acceptance and adherence to chemoprevention. Patients with atypical breast lesions having an individualized education and counseling session in a single surgical oncology practice were prospectively entered into a database from 2001 to 2016, and with IRB approval, their data were analyzed. Chemoprevention recommendations, acceptance, duration of treatment, and side effects were recorded. A total of 536 patients were included in this study. Mean age at diagnosis was 52years (range: 19-86years). Chemoprevention was recommended for 386 (72%) of whom 199 (52%) elected to take medication or participate in a chemoprevention clinical trial. At the time of this writing, 72 patients had completed therapy, 69 were still in treatment, and 58 had stopped chemoprevention prematurely. Approximately 55% of the women who accepted chemoprevention in this study will complete 5years of therapy. A formal individualized education and counseling session can improve chemoprevention acceptance and achieve a reasonable completion rate, thus reducing cancer incidence in women with atypical breast lesions.

Increased risk of thyroid cancer in female residents nearby nuclear power plants in Korea: was it due to detection bias?

BackgroundThe Korea Radiation Effect & Epidemiology Cohort - The resident cohort (KREEC-R) study concluded that there is no epidemiological or causal evidence supporting any increase in cancer risks resulting from radiation from Korean nuclear power plants (NPPs). But the risks of thyroid cancer in women were significantly higher in residents living near NPPs than control. Debate about the cause of the pattern of thyroid cancer incidence in women is ongoing and some researchers argue that detection bias influenced the result of KREEC-R study. Therefore there was a need to investigate whether residents living near NPPs who were assessed in the KREEC-R were actually tested more often for thyroid cancer. We evaluated the possibility of detection bias in the finding of the KREEC-R study based on materials available at this time.MethodsUsing the KREEC-R raw data, we calculated age standardized rates (ASRs) of female thyroid cancer and re-analyzed the results of survey on the use of medical services. We also marked the administrative districts of residents who received the Radiation Health Research Institute (RHRI) health examinations and those in which thyroid cancer case occurred as per the Chonnam National University Research Institute of Medical Sciences (RIMS) final report on maps where the locations of NPPs and 5 km-radii around them were also indicated. And we compared the incidence rates of Radiation-induced cancer measured between the first period when RHRI health examinations were not yet implemented, and the second period when the RHRI health examinations were implemented.ResultsThe ASR for the far-distance group, which comprised residents living in areas outside the 30 km radius of the NPPs, increased rapidly after 2000; however, that of the exposed group, which comprised residents living within a 5 km radius of the NPPs, started to increase rapidly even before 1995. The frequencies of the use of medical services were significantly higher in the intermediate proximate group, which comprised residents living within a 5–30 km radius of the NPPs, than in the exposed group in women. In case of female thyroid cancer, the second period ASR was higher than the first period ASR, but in case of female liver cancer and female stomach cancer no significant difference were observed between the periods. On map, many administrative districts of residents who received RHRI health examinations and most administrative districts in which thyroid cancer case occurred on RIMS final report were outside 5 km-radii around NPPs.ConclusionsWe could not find any evidence supporting the assertion that detection bias influenced the increased risks of female thyroid cancer observed in the exposed group of the KREEC-R study, as opposed to the control group.

County-Level Radon and Incidence of Female Thyroid Cancer in Iowa, New Jersey, and Wisconsin, USA.

Background: Few studies have investigated the association between radon and thyroid cancer despite the sensitivity of the thyroid gland to radiation. Our goal is to investigate the association between county-level radon and incidence of female thyroid cancer in the US States of Iowa, New Jersey, and Wisconsin. Methods: Thyroid cancer incidence data were provided by individual state cancer registries and span 1990–2013. Radon data come from a publicly available third-party database, AirChek, accessed in 2017. We tabulated the percent of radon above four picocuries per liter and the female thyroid cancer incidence rate in each county. Quantile maps were constructed, and an ordinary least-squares regression model was run using Geoda 1.10.0.8 (Chicago, IL, USA). Results: No association was observed between county-level radon and incidence of female thyroid cancer in any of the States: New Jersey (β = 0.06, p = 0.23); Iowa (β = −0.07, p = 0.07); or Wisconsin (β = −0.01, p = 0.78). A spatial regression model was considered, but the Moran’s I of the residuals from each of the models was not significant, so no spatial term was required. Discussion: In this county-level ecological study across three different States in the US, we did not find an association between elevated radon and thyroid cancer incidence in women. While this ecologic study reports null findings, due to the ecologic fallacy, individual-level studies of this association may still be warranted.

Association of Schizophrenia With the Risk of Breast Cancer Incidence

Patients with schizophrenia are considered to have many risk factors for the development of cancer. However, the incidence of breast cancer in women with schizophrenia compared with the general population remains uncertain. To perform an updated meta-analysis to evaluate the association between schizophrenia and the risk of breast cancer. A systematic search of the PubMed and EMBASE databases was conducted using the search terms schizophrenia, schizophrenic, psychosis, combined with breast and cancer, tumor, neoplasm, or carcinoma. The final literature search was performed on August 15, 2017. Cohort studies reporting the standardized incidence ratio (SIR) for the risk of breast cancer in women with schizophrenia compared with the general population. The meta-analysis adhered to Meta-analysis of Observational Studies in Epidemiology and the Cochrane Handbook for Systematic Reviews of Interventions. Data extraction was performed independently. A random-effects model was used to pool the results, and a recently proposed prediction interval was calculated to describe the heterogeneity. The SIR for the risk of breast cancer in women with schizophrenia compared with the general population or those without schizophrenia. Twelve cohorts including 125 760 women were included in this meta-analysis. The results of the meta-analysis showed that schizophrenia was associated with a significantly increased risk of breast cancer incidence in women (SIR, 1.31; 95% CI, 1.14-1.50; P < .001), with significant heterogeneity (P < .001; I2 = 89%). Substantial between-study variance was also suggested by the wide prediction interval (0.81-2.10), which indicated that it is possible that a future study will show a decreased breast cancer risk in women with schizophrenia compared with the general population. The subgroup analysis results showed that the association was not significantly affected by whether breast cancer cases were excluded at baseline or the sample size of the included studies. The incidence of breast cancer in women with schizophrenia is higher than that of the general female population. However, significant heterogeneity exists among the included studies. Women with schizophrenia deserve intensive prevention and treatment of breast cancer.

Sex differences in obesity related cancer incidence in relation to type 2 diabetes diagnosis (ZODIAC-49).

BackgroundDiabetes and obesity seem to be partly overlapping risk factors for the development of obesity-related cancer (mainly breast, prostate and colorectal cancer) in patients with type 2 diabetes (T2DM). In the general population, women have a lower risk for obesity-related cancer compared to men. Previous studies involving cardiovascular disease have shown that T2DM eliminates a female advantage of lower CVD risk in the general population compared to men. It is unclear whether the same could be true for obesity-related cancer. This study aimed to this investigate obesity-related cancer incidence in women and men known with T2DM as compared to the Dutch general population.MethodsThis study included 69,583 patients with T2DM selected from a prospective primary care cohort, which was linked to the Dutch National Cancer Registry to obtain cancer specific data. Obesity-related cancers included liver, kidney, colorectal, gallbladder, pancreas, ovarian, endometrial, advanced prostate cancer, post-menopausal breast cancer and oesophageal adenocarcinoma. Primary outcome was sex-stratified, age and year of cancer diagnosis adjusted standardized incidence ratios (SIRs) for three time periods: 5 years before, the year after diagnosis and the next 4 years after T2DM diagnosis. The Dutch general population was used as reference group.ResultsWomen with T2DM were at an increased risk for obesity-related cancer compared to women in the general population already 5 years before diabetes diagnosis (SIR 1.77; 95%CI: 1.63–1.91). In both men and women, there was a peak in obesity-related cancer incidence following diabetes diagnosis (SIR: 1.38; 95%CI 1.11–1.64 and SIR: 2.21; 95%CI 1.94–2.30, respectively). From the second to the fifth year after diabetes diagnosis the obesity-related cancer incidence was higher in women compared to women in the general population (SIR: 2.12; 95%CI 1.94–2.30).ConclusionsWomen with T2DM seem to have a substantially higher obesity-related cancer risk. As opposed to men, in women this risk was already increased years before diabetes diagnosis. These results could imply that a relative advantage of women in the general population with regard to cancer risk is lost in women with T2DM.

Experience in the Implementation of Programs for Primary Prevention of Human Papillomavirus-associated Diseases in the Moscow region)

The aim of the study was to evaluate the effectiveness of the programme of Human papillomavirus (HPV) vaccination and cervical cancer in girls and women in the Moscow region. Materials and methods. The statistical reports of the specialists of the Moscow region, as well as on the basis of data of state statistics to assessment of the incidence of anogenital warts in girls, as well as the dynamics of the incidence of cervical cancer in women in the Moscow region. Results. Based on the analysis of statistical reports of the Moscow region as a result of vaccination of girls observed a reduction in the incidence of anogenital warts in 2016 compared to 2009, from 14.2 to 5.9 (per 100 000 for girls). Based on date of the state ststistics there has been a reduction in the incidence of anogenital warts in the population in the Moscow region with up 56.7 to 20.2 (per 100-000 population). But the most important effect of vaccination in 2015 was the lack of a rise in the incidence of cervical cancer in women in the region, as well as the reduction in the incidence in young women aged 1524 years. Conclusion. Held in Moscow region the program of HPV vaccination and cervical cancer after 9 years resulted in a reduction of HPV-associated pathology, which determines the need to continue vaccination programs, including inclusion of vaccination in the immunization schedule.

Thyroid cancer incidence in women and proximity to industrial air pollution sources: A spatial analysis in a middle size city in Colombia

Manizales, a mid-size city in Colombia, hosts industries like metallurgy, electrical, chemical, and rubber and plastic industrial facilities that have released into atmosphere some pollutants postulated as thyroid cancer (TC) promoters, such as dioxins and furans, dichloromethane, lead and copper. In this article we aim to detect clusters of TC and analyze their spatial association with industrial pollution. TC cases (2003–2010) were obtained from Manizales' Population-based Cancer Registry (PCR-Mz). Atmospheric emissions from industries were obtained from official reports of environmental authority. Data was spatially aggregated into census tracts and analyzed with Bayesian Besag-York and Mollié (BYM) models. Three exposure approaches were used: i) presence or absence of industries into census tracts, ii) sum of air discharges, and iii) an exposure index (EI) that considered the distance and orientation of the census tract regard to industries, average wind direction and speed, and population mobility. Models were fitted by exposure definition and sex, and included traffic and socioeconomic variables for adjustment. Using the Kulldorff's spatial exploration statistic we also performed point-data analyses in order to detect and localize clusters with individual data.Ecological regression models showed that, for women, smoothed standardized incidence ratio (sSIR) increase in 15% [95% credibility interval: 3–27%] and 63% [95%CI: 18–125%] per one standard deviation increase in EI for dichloromethane and PCDDs/Fs, respectively. Point-data analysis confirmed a cluster of female cases close to an industry emitting chlorinated solvents. These results suggest that dichloromethane and PCDDs/Fs emitted from industrial sources might be suspected as thyroid cancer risk factors.

Risk Factors for Late Screening Mammography

Background: Breast cancer has the highest incidence of cancers in women in the United States. Previous research has shown that screening mammography contributes to reduced breast cancer mortality. This study aimed to clarify why late screening might occur in an at-risk population. Materials and MethodsThis study was a prospective cross-sectional study including 758 patients presenting to our radiology department for routine screening mammography who completed a 30-question survey regarding personal characteristics and mammography history. Univariate and multivariate logistic regression were performed to determine whether survey responses correlated with late screening. ResultsOf the 758 patients, 184 (24%) were noncompliant with screening mammography guidelines. Risk factors for late screening included younger age (P = 0.001), white race/ethnicity (P = 0.03), self-reported lack of financial means or health insurance (P = 0.005), lack of satisfaction with a previous mammogram experience (P = 0.001), inadequate mammography education by a physician (P = 0.001), and lack of awareness/comprehension of screening mammography guidelines (P = 0.002). ConclusionMany factors contribute to late screening mammography. Although some are outside physician control, others can be influenced: patient education regarding screening mammography guidelines, and patient satisfaction with the mammography experience. This study highlights the importance of communication with and education of patients.

Reviewing the Evidence to Guide Clinical Care

The number of reduction mammoplasties performed in the United States continues to increase annually. Given the high incidence of breast cancer in women, it is routine practice for breast tissue excised during routine breast reductions procedures to be sent for pathology review. During pathology assessment, occult malignancy and on-occasion proliferative breast lesions of unknown and/or variable malignancy may also be present. We provide a review of commonly diagnosed atypical proliferative breast lesions in breast reduction specimens and a guide to plastic surgeons for further management.

Long-Term Use of Long-Acting Insulin Analogs and Breast Cancer Incidence in Women With Type 2 Diabetes.

Purpose The association between long-acting insulin analogs and increased breast cancer risk is uncertain, particularly with the short follow-up in previous studies. We assessed this risk long term in women with type 2 diabetes. Methods A population-based cohort of women 40 years or older, all of whom were treated with long-acting (glargine, detemir) or neutral protamine Hagedorn (NPH) insulin between 2002 and 2012, was formed using the United Kingdom's Clinical Practice Research Datalink. Women were followed until February 2015 or breast cancer diagnosis. Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) and 95% CIs of incident breast cancer, comparing long-acting insulin analogs with NPH overall, as well as by duration and cumulative dose. Results The cohort included 22,395 women who received insulin treatment, with 321 incident breast cancer events occurring during up to 12 years of follow-up (incidence rate 3.3 per 1,000 person-years). Compared with NPH insulin, insulin glargine was associated with an increased risk of breast cancer (HR, 1.44; 95% CI, 1.11 to 1.85), mainly increasing 5 years after glargine initiation (HR, 2.23; 95% CI, 1.32 to 3.77) and after > 30 prescriptions (HR, 2.29; 95% CI, 1.26 to 4.16). The risk was particularly elevated among prior insulin users (HR, 1.53; 95% CI, 1.10 to 2.12) but not for new users, which included fewer patients and for which one cannot rule out an HR of 1.81. The risk associated with insulin detemir was not significantly elevated (HR, 1.17; 95% CI, 0.77 to 1.77). Conclusion Long-term use of insulin glargine is associated with an increased risk of breast cancer in women with type 2 diabetes. The risk associated with insulin detemir remains uncertain because there are fewer users of this insulin.