Population-based Cohort Of Women Research Articles

The impact of obesity on outcomes in a population-based cohort of women with early-onset breast cancer

The impact of obesity on outcomes in a population-based cohort of women with early-onset breast cancer

The impact of obesity on outcomes in a population-based cohort of women with early-onset breast cancer

9540 Background: Obesity (defined by body mass index, BMI≥30kg/m2) has been associated with adverse outcomes in postmenopausal women with breast cancer (BC). In premenopausal women the relationship is less clear. The impact of obesity on disease recurrence and death was studied in the population-based Australian Breast Cancer Family Study (ABCFS). Methods: 1108 early-stage BC patients, 47% diagnosed age< 40, were followed prospectively. Details on weight and height were collected by face-to-face interview at recruitment to the ABCFS. BC treatment and outcome data were abstracted from medical records. Ideal dose of chemotherapy was calculated and compared to actual dose received at cycle 1. The hazard ratio (HR) for disease recurrence and death associated with obesity was estimated using Cox proportional hazard survival models adjusting for number of axillary nodes, age, tumor size, grade and ER/PR at diagnosis. Results: Median follow-up was 5(0.4–10.8) years. 133 were obese. 75%(817/1108) were premenopausal. Obesity was associated with increased tumor size (p=0.001), more involved axillary nodes (p=0.005) but not hormone receptor status. Multivariate analysis found that compared with those non-obese, obese women were more likely to develop both BC recurrence, HR 1.57(95% CI:1.11–2.22) or die HR 1.55(95%CI:1.01–2.39). In obese premenopausal women the HRs for disease recurrence and death were 1.50(95%CI:1.00–2.26) and 1.71(95%CI:1.05–2.77) respectively. No differences in prescribing patterns or underdosing of adjuvant chemotherapy were observed. Conclusions: A BMI ≥30kg/m2 is associated with poorer BC outcomes in both pre- and post-menopausal women. Other biological and hormonal factors apart from estrogen are probably responsible for this increased risk. Targeting obesity is a potential approach to reduce the risk of BC recurrence in young women. No significant financial relationships to disclose.

Prospectively Measured Levels of Serum Follicle-Stimulating Hormone, Estradiol, and the Dimeric Inhibins during the Menopausal Transition in a Population-Based Cohort of Women

Prospectively Measured Levels of Serum Follicle-Stimulating Hormone, Estradiol, and the Dimeric Inhibins during the Menopausal Transition in a Population-Based Cohort of Women

Fetal outcome and maternal morbidity after early amniocentesis

We have studied a large population-based cohort of women who had amniocentesis at 14 weeks' gestation (early amniocentesis) in Victoria, a state of Australia, to determine fetal loss rates and maternal morbidity. This was done by linking two registers--one containing information on all prenatal diagnostic tests in the state, and the other a register of all births at or after 20 weeks' gestation. Almost complete follow-up was achieved. The spontaneous fetal loss rate was significantly higher for women of age 37 years and over having early amniocentesis (2.5 per cent), as compared with the fetal loss rate found previously on the same geographically defined population who had amniocentesis at about 16 weeks' gestational age (1.1 per cent). Three classes of maternal morbidity reported to the birth register (post 20 weeks' gestation) were also analysed. The most significant finding was a reduced rate of premature rupture of membranes with early amniocentesis when compared with a group having later amniocentesis, or the background population not having any amniocentesis. There was no significant increase in the occurrence of antepartum bleeding or genito-urinary tract infection for women having early amniocentesis. These data agree with other studies in showing that early amniocentesis is associated with a significant increased risk of fetal loss, as compared with later amniocentesis. In addition we have shown no significant increase in the occurrence of three indicators of maternal morbidity, reported at or after 20 weeks' gestation.

Compliance with practice guidelines for node-negative breast cancer.

Practice guidelines for cancer management have been in use in the province of British Columbia (BC), Canada, since the mid 1970s. To evaluate practice guideline compliance, treatment received was compared with treatment recommended in a population-based cohort of women with breast cancer. All incident cases (n = 939) of invasive, pathologically node-negative breast cancer diagnosed in 1991 were identified from the BC Cancer Registry. Treatment details were abstracted from cancer clinic records for cases referred to the BC Cancer Agency (BCCA) (n = 661) and original source documents for nonreferred cases. Management decisions were considered compliant if the patient received the recommended treatment or was entered onto a randomized trial of the modality being assessed. Overall compliance with adjuvant therapy guidelines was 97% for radiotherapy, 96% for chemotherapy, and 89% for tamoxifen. An oncology specialist was consulted by 94% of patients with an indication for adjuvant treatment and by 58% of those without an indication (odds ratio [OR] = 10.7; 95% confidence interval, 7.0 to 16.4). Compliance with a guideline to deliver radiotherapy was 95%; with chemotherapy, 77%; and with tamoxifen, 68%. Compliance with a guideline that stated no adjuvant treatment was indicated was 99% for radiotherapy, 98% for chemotherapy, and 92% for tamoxifen. Noncompliance among patients with an indication for treatment was related to nonreferral to an oncology specialist and less complete implementation of guideline changes in the community as compared with cancer center practices. Compliance was high, but scheduled updating and more effective community implementation could further improve consistency of care.

Bacteriuria in a Population-Based Cohort of Women

A survey for bacteriuria was conducted in a community-wide, unselected population of women 16--69 years old. The overall prevalence of bacteriuria was 3.5%. The prevalence of bacteriuria increased with age with a linear trend, but with a significant nonlinear component as well. Bacteriuria was associated with parity after correction for the effects of age. Current symptoms of dysuria and a history of previous urinary tract infection were slightly but significantly more common in women with bacteriuria. The population described should serve as an adequate base for continuing studies of the possible consequences of bacteriuria.