Rates In Young Women Research Articles

The Effect of Additional Embryo Transfer on the Pregnancy Rate in Young Women Receiving in vitro Fertilization: A Natural Experiment Study.

PurposeTo assess the impact of additional embryo transfer (ET) on pregnancy in young women, we used a natural-experiment approach.Patients and MethodsThe design was based on the national policy of South Korea limiting the number of embryos transferred in vitro fertilization (IVF):≦2 embryos on day 2–4 or one on day 5–6 for patients aged <35, with one extra embryo allowed for patients aged ≥35. Using the data from 1909 ET cycles of 1287 women aged ≥34 and ≤35, we calculated adjusted risk ratios (RRs) for pregnancy.ResultsHalf of cycles were undertaken by women aged 35, and additional ET was performed in 68.7% of them. Intrauterine pregnancy (45.2% vs 51.3%) and multiple gestation (30.5% vs 6.9%) were more common in women aged 35 than in those aged 34. The RR for intrauterine pregnancy was 1.34 (95% confidence interval: 1.12–1.59) when comparing double ET to single ET in frozen day 5–6 cycles.ConclusionWe observed no evidence of a higher probability of pregnancy with additional ET in fresh or frozen day 3–4 ET, or in fresh day 5–6 ET of women aged 35. Additional ET may not increase the successful pregnancy rate in the 35-year-old group, unless it is a frozen day 5–6 ET cycle.

2008 financial crisis versus 2020 economic fallout: how COVID-19 might influence fertility treatment and live births

Research questionThe economic and reproductive medicine response to the coronavirus disease 2019 (COVID-19) pandemic in the USA has reduced the affordability and accessibility of fertility care. What is the impact of the 2008 financial recession and the COVID-19 recession on fertility treatments and cumulative live births? DesignThe study examined annual US natality, Centers for Disease Control and Prevention IVF cycle activity and live birth data from 1999 to 2018 encompassing 3,286,349 treatment cycles, to estimate the age-stratified reduction in IVF cycles undertaken after the 2008 financial recession, with forward quantitative modelling of IVF cycle activity and cumulative live births for 2020 to 2023. ResultsThe financial recession of 2008 caused a 4-year plateau in fertility treatments with a predicted 53,026 (95% confidence interval [CI] 49,581 to 56,471) fewer IVF cycles and 16,872 (95% CI 16,713 to 17,031) fewer live births. A similar scale of economic recession would cause 67,386 (95% CI 61,686 to 73,086) fewer IVF cycles between 2020 and 2023, with women younger than 35 years overall undertaking 22,504 (95% CI 14,320 to 30,690) fewer cycles, compared with 4445 (95% CI 3144 to 5749) fewer cycles in women over the age of 40 years. This equates to overall 25,143 (95% CI 22,408 to 27,877) fewer predicted live births from IVF, of which only 490 (95% CI 381 to 601) are anticipated to occur in women over the age of 40 years. ConclusionsThe COVID-19 recession could have a profound impact on US IVF live birth rates in young women, further aggravating pre-existing declines in total fertility rates.

Breast Cancer Mortality in Young Women in Brazil.

ObjectiveMalignant breast cancer is the leading cause of death by cancer in young women. The study aimed to determine if breast cancer mortality among young women has increased between the period from 1996 to 2017 in Brazil.MethodsA time-series analysis of breast cancer mortality rate in young women (20–39 years old) was carried out. Mortality data, from 1996 to 2017, were collected from the Mortality Information System of the Health Ministry, and demographic data, from the Brazilian Institute of Geography and Statistics. Trends in mortality were performed by Joinpoint Regression, the spatial distribution of the mortality rate was done with the QGIZ Software version 2.18, and Spearman’s correlation coefficient was used to correlate the mortality rates with the Human Development Index.ResultsThere was an increase in breast cancer mortality rates in young women in the majority of Brazilian states, with an upward trend in all regions. The correlation with the Municipal Human Development Index, income, and education had a significant impact on the mortality rate for women from 30–39 years old in both time frames evaluated and for women from 20–29 years old, only from 1996 to 2000.ConclusionThe data obtained in the study, showed that even though the breast cancer mortality rate of young women is lower than women over 40 years old, it has been increasing in all regions of Brazil, mostly for women from 30–39 years old, suggesting that this group should be included in screening programs.

Is There Any Association Between the Number of Oocytes Retrieved, Women Age, and Embryo Development?

While most studies focused on the association between the number of oocytes retrieved and LBR, there is lack of analysis highlighting the effect of the number of oocyte retrieved on top quality embryo (TQE) rate in different age groups. We aimed to study the correlations between the number and ratio of TQE, as assessed by morphology only, according to the number of oocytes retrieved, and to evaluate the impact of patients' age. This was a retrospective study that includes 1639 patients who underwent 2263 IVF cycles between 2016 and 2019. Patients were categorized into four groups according to the number of oocytes retrieved: 1-3, 4-9, 10-14, or > 15 oocytes (OPU groups A-D, respectively). Another classification was according to patient's age < 35, 35-40, and > 40years. Morphologically, TQE (both cleavage stage and blastocyst) was defined as those eligible for transfer or vitrification. TQE was assessed both as a fraction of oocytes retrieved per patients (rate) and the average TQE per number oocytes retrieved category. For all age subgroups, a negative significant association was observed between the number of oocytes retrieved and TQE rate (56.1%, 43.6%, 35.9%, and 34.3% for groups A-D, respectively). The reduction was significant up to 14 oocytes retrieved and plateau thereafter. On the other hand, TQE rate was significantly increased as women age increased, from 36.1% TQE rate in young women (< 35years) to 40.3% for 35-40years to 42.5% in older patients (> 40years). Finally, a linear regression revealed a drop in TQE rate of - 0.5% for every oocyte retrieved, while an increased in TQE rate of + 0.7%, as the women age increased by 1year. While young women are able to recruit more oocyte, including medium/low quality, older women recruit less oocytes, with good quality, as demonstrated by their higher morphologically TQE rate relative to the number of oocyte retrieved.

Outcome of mock embryo transfer before the first IVF cycle: A randomized control trial.

Background There is a lack of agreement among fertility specialists with regard to the routine use of mock embryo transfer (MET) before each in vitro fertilization (IVF) treatment cycle. While MET may be beneficial with previous difficult embryo transfer cases, its routine use before first IVF cycle has not been evaluated.ObjectiveTo find out the effect of MET before the first IVF cycle on clinical pregnancy rate.Materials and Methods This is a single-centre randomized controlled trial with a balanced randomization (1:1), carried out between November 2015 and October 2017, with 200 subjects at Homerton university hospital, London, randomized into either MET or control. The primary outcome was clinical pregnancy rate (detection of heart activity on the ultrasound scan), the secondary outcome measures were live birth rate, miscarriage and multiple pregnancy rates, difficult ETs, rate of blood or mucus on the catheter tip.Results No significant differences were observed in the baseline or cycle characteristics between the two groups. The clinical pregnancy rate was similar between the MET and control groups based on both intension to treat and per protocol analyses (p = 0.98, p = 0.92, respectively). Additionally, no significant difference was seen in the live birth rate in both groups on intension to treat and per protocol analyses (p = 0.67, p = 0.47), respectively.ConclusionOur study concludes that MET prior to first IVF cycle may not improve the success rate in young women without risk factors for a difficult embryo transfer.

Intra-subject consistency of spontaneous eye blink rate in young women across the menstrual cycle

The spontaneous eye blink rate (EBR) has been linked to different cognitive processes and neurobiological factors. It has also been proposed as a putative index for striatal dopaminergic function. While estradiol is well-known to increase dopamine levels through multiple mechanisms, no study up to date has investigated whether the EBR changes across the menstrual cycle. This question is imperative however, as women have sometimes been excluded from studies using the EBR due to potential effects of their hormonal profile. Fifty-four women were tested for spontaneous EBR at rest in three different phases of their menstrual cycle: during menses (low progesterone and estradiol), in the pre-ovulatory phase (when estradiol levels peak and progesterone is still low), and during the luteal phase (high progesterone and estradiol). No significant differences were observed across the menstrual cycle and Bayes factors show strong support for the null hypothesis. Instead, we observed high intra-individual consistency of the EBR in our female sample. Accordingly, we strongly encourage including female participants in EBR studies, regardless of their cycle phase.

IMPACT OF 2008 AND COVID-19 ECONOMIC RECESSIONS ON FERTILITY TREATMENTS AND LIVE BIRTHS

The economic and reproductive medicine response to the COVID-19 pandemic in the United States has reduced the affordability and accessibility of fertility care. We sought to determine the impact of the 2008 financial and the COVID-19 recession on fertility treatments and cumulative live-births. prospective projection modeling. We examined annual US natality, CDC IVF cycle activity and live birth data from 1999 to 2018 encompassing 3,286,349 treatment cycles, to estimate the age-stratified reduction in IVF cycles undertaken after the 2008 financial recession, with forward quantitative modelling of IVF cycle activity and cumulative live-births for 2020 to 2023. The financial recession of 2008 caused a four-year plateau in fertility treatments with a predicted 53,026 (95% CI 49,581 to 56,471) fewer IVF cycles and 16,872 (95% CI 16,713 to 17,031) fewer live births. A similar scale of economic recession would cause 67,386 (95% CI: 61,686 to 73,086) fewer IVF cycles between 2020 and 2023, with women younger than 35 years overall undertaking 22,504 (95% CI 14,320 to 30,690) fewer cycles, as compared to 4,445 (95% CI 3,144 to 5749) fewer cycles in women over the age of 40 years. This equates to overall 25,143 (95% CI: 22,408 to 27,877) fewer predicted live-births from IVF, of which only 490 (95% CI 381 to 601) are anticipated to occur in women over the age of 40 years. The COVID-19 recession could have a profound impact on US IVF live-birth rates in young women, further aggravating pre-existing declines in total fertility rates.

Gender difference in suicide in Taiwan over a century: a time trend analysis in 1905–1940 and 1959–2012

BackgroundSuicide rates are higher in men than in women in most countries, although the gender ratios vary markedly worldwide. We investigated long-term trends in suicide rates and the male-to-female ratios...

Health disparities in cervical cancer: Prevalence of high-risk HPV and cytologic diagnoses according to race.

In the United States, the rate of cervical cancer is disproportionally higher in Hispanic and Black women compared with White women. In the current study, the authors compared human papillomavirus (HPV) testing and cytology results among Black and White women over a 24-month period. They then assessed the rates in young women in 2011 compared with 2017 according to race. The authors searched the gynecologic cytology case files for Black and White women treated at Johns Hopkins Hospital across all ages for a period of 24 months (2017-2019) and compared HPV results and cytologic interpretations. They then compared results among Black and White cohorts of young women (aged 21-29 years) in 2011 versus 2017. A total of 26,302 specimens from January 2017 to January 2019, including 11,676 Black women and 14,626 White women, were reviewed. The most common HPV genotype(s) detected were non-HPV-16 and/or HPV-18 (non-16/18) high-risk HPV (hrHPV) (84% of positive results). Non-16/18 hrHPV was more common in Black women (1309 women; 15%) compared with White women (1075 women; 9%). Non-16/18 hrHPV was more commonly observed in association with atypical squamous cells, cannot rule out high-grade squamous intraepithelial lesion and/or high-grade squamous intraepithelial lesion (ASC-H/HSIL) in HPV-positive Black women compared with White women (P=.007). Black women were found to have higher rates of HPV-positive Papanicolaou results and high-grade lesions, including carcinoma (P<.01). In the 2011 cohort, young Black women were found to have a higher rate of ASC-H/HSIL (P=.003) compared with White women. However, the difference was not noted in the 2017 cohort. There was a decrease in ASC-H/HSIL in 2017 compared with 2011, with a lower incidence of ASC-H/HSIL noted among Black women in 2017. Black women appear to have a higher incidence of higher grade lesions, but the difference between Black and White cohorts was not found to be significant in young women in more recent years.

A single dose of quadrivalent human papillomavirus (HPV) vaccine is immunogenic and reduces HPV detection rates in young women in Mongolia, six years after vaccination

BackgroundEmerging observational evidence suggests a single-dose of human papillomavirus (HPV) vaccine may be protective against vaccine-targeted HPV infection and associated cervical dysplasia. We aimed to demonstrate whether a single dose of quadrivalent HPV (4vHPV) vaccine was immunogenic and reduced HPV detection rates in young women in Mongolia. We also assessed knowledge and attitudes regarding HPV and the HPV vaccine. MethodsA retrospective paired cohort study was undertaken to evaluate the effect of a single dose of 4vHPV, given at age 11–17 years in 2012, on HPV detection rates, when compared with unvaccinated women. Real time PCR was performed on self-administered vaginal swabs for HPV detection. An immunological analysis detecting neutralising antibodies (NAb) to high-risk HPV (HRHPV) genotypes 16 and 18 was performed on sera from a subset of 58 participants. Questionnaires evaluated knowledge, attitudes and self-swab acceptability. FindingsA total of 475 women (mean age 20.4 years ± 1.6) were recruited; 118 vaccinated and 357 unvaccinated women. The prevalence of vaccine-targeted HRHPV16 and 18 was reduced by 92% (95%CI 44–99%) in the vaccinated (1·1%) compared with the unvaccinated (15.4%) group. The percentage of non-vaccine HPV genotypes was similar between vaccinated (26.5%) and unvaccinated (26.7%) groups. Approximately 90% and 58% of vaccinated women remained seropositive after six years for HRHPV16 and 18, respectively, with neutralising antibody levels 5- and 2-fold higher than unvaccinated women (p < 0.001). InterpretationOne dose of 4vHPV vaccine reduces vaccine-targeted HPV genotypes, six years following vaccination, with high levels of HR genotype seropositivity among young Mongolian women.

HPV genotype distribution and age correlation in a selected Italian population undergoing conization.

Detection and genotyping of human papillomavirus (HPV) has gained increasing importance in cervical cancer prevention and treatment of cervical intraepithelial neoplasia (CIN). This study aims to determine the HPV type distribution in cervical specimens obtained from women diagnosed with CIN. We evaluated in a selected Italian population the distribution of HPV genotypes. Cervical samples were collected from women undergoing laser CO2 conization for high grade at Colposcopic Laser Surgery Unit of the Careggi University Hospital and at the Colposcopy Service of Local Health Unit Toscana Centro in Florence, Italy, between September 2014 and February 2017. HPV genotyping was performed using the LINEAR ARRAY® HPV Genotyping Test. Three hundred and six patients were enrolled. HPV infection was detected on 244 samples (79.7%). A different rate of mono- and poly-infections was observed, with higher poly-infection rates in younger women. Moreover, depending on different age groups (clustered in 5-years interval from 22 to 69 years old) significant different distribution of HPV was fund as genotype, phylogenetic type and cancer-related risk. Our results suggest that some physiological conditions (i.e. menopause), could influence selection and clearance of specific HPV genotypes. The results of this study represent the basis for supporting the HPV genotyping as clinical tool providing benefits in the management of women with high CIN grade.

Abstract P4-05-04: Advanced breast cancer (ABC) in young women (YW): A comprehensive genomic profiling (CGP) study

Abstract Background: ABC in YW is an aggressive disease with a higher mortality rate than that seen in older women (OW). Pre-menopausal women face challenges in balancing treatment with reproductive health and are often excluded from promising clinical trials. Studies from NCI SEER suggest that the rate of YW breast cancer has nearly doubled in the last 40 years from 1.5 to 2.9 cases per 100,000. In this study, we compare the genomic alterations (GA) in ABC in YW vs OW across ancestry groups. Methods: Hybrid-capture based CGP of at least 315 cancer-related genes was performed on 21,440 clinically advanced breast cancers in 4,303 YW (&amp;lt;45) and 17,137 OW (≥45). Predominant ancestry was assessed using a SNP-based approach (Connelly et al, 2018). Subgroups were analyzed on histological (Invasive Ductal Carcinoma (IDC), Invasive Lobular Carcinoma (ILC) and molecular subtypes (ER-positive (ER+), HER2-amplified (HER2+), TNBC). Results: Our cohort of young women (YW) exhibit different frequencies of genetic driver events compared to older women (OW) (25 genes with a corrected p &amp;lt; 0.01) including a lower frequency of alterations in PIK3CA (23% in YW v 36% in OW, p = 8E-63), TBX3 (1.1% v 3.9%, p = 1E-16), and RUNX1 (1.2% v 2.4%, p = 6E-08) and a higher frequency of BRCA1 (8.5% in YW vs 3.2% in OW; p = 1E-32), BRCA2 (6.3% v 4.3%, p = 9E-08), and GATA3 (12.5% v 8.4%, p = 5E-16). When accounting for histological and molecular subtype, many of the same trends hold (Table 1). For example, PIK3CA alterations were observed at a significantly reduced rate in YW in ER+, HER2+, and TNBC disease. Although BRCA1 mutations are generally associated with TNBC, we observed a significantly higher frequency of alterations in YW with ILC (4.7% v 0.8%, p = 0.01) and ER+ disease (5.9% v 2.2%; p = 0.003). ESR1 point mutations were lower in YW v OW (6% v 13%, p = 3E-38), possibly reflecting differences in therapy. Unexpectedly, the distribution of ESR1 LBD alterations differed between the cohorts, with Y537S as the most common alteration in YW (40% v 24% in OW; p = 1E-06). YW with ILC showed a significantly higher rate of biopsy from the female reproductive tract (40% v 7.5% in OW, p =0.0001). TNBC tumors exhibited a higher rate of brain metastasis rate in YW (23% v 6% in OW, p = 0.003). HER2 tumors exhibited a lower rate of metastases to the skin in YW (8% v 14%, p = 0.02). No significant differences were observed in sites of distant metastasis in the ER+ subtype (all p &amp;gt;0.08). YW ABC was depleted in European ancestry (OR = 0.56, p = 2e-56) and strongly enriched in Asian and American ancestry (OR = 1.7 and 1.9, respectively, p &amp;lt; 6E-15) relative to the cohort of OW. No genes exhibited significant differences in frequency across ancestry groups (p &amp;gt;0.05). Across ancestry groups, BRCA1/2, ESR1, GATA3, and TBX3 show similar patterns between YW and OW. Patterns of metastatic tissue tropism were also largely similar across ancestry groups. significance YW v OW in groupGenefreq YWfreq OWoverallILCIDCER+HER2+TNBCPIK3CA23.1%36.3%P&amp;lt;0.0001nsP&amp;lt;0.0001P&amp;lt;0.0001P&amp;lt;0.001P&amp;lt;0.01TBX31.1%3.9%P&amp;lt;0.0001p&amp;lt;0.05P&amp;lt;0.0001P&amp;lt;0.01P&amp;lt;0.01nsRUNX11.2%2.4%P&amp;lt;0.0001nsP&amp;lt;0.01nsP&amp;lt;0.001nsBRCA18.5%3.2%P&amp;lt;0.0001P&amp;lt;0.01P&amp;lt;0.0001P&amp;lt;0.01nsP&amp;lt;0.01BRCA26.3%4.3%P&amp;lt;0.0001p&amp;lt;0.05nsnsnsnsGATA312.5%8.4%P&amp;lt;0.0001nsP&amp;lt;0.0001P&amp;lt;0.0001nsnsESR16.0%12.6%P&amp;lt;0.0001P&amp;lt;0.01P&amp;lt;0.0001P&amp;lt;0.0001P&amp;lt;0.01ns Conclusions: CGP of ABC in YW vs OW revealed consistent genetic differences across molecular and histological subtypes, which may impact targeted therapies. YW have a lower frequency of alterations in PIK3CA across all molecular subtypes, potentially limiting the utility of PI3K-alpha inhibitors, such as alpelisib. The high frequency of BRCA1/2 alterations across subtypes may predict sensitivity to PARP inhibitors. While there are differences in the relative prevalence of ancestry groups in our population, we did not observe significant differences in driver alterations or tissue tropism across these groups. Citation Format: Ethan S Sokol. Advanced breast cancer (ABC) in young women (YW): A comprehensive genomic profiling (CGP) study [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-05-04.

Anal cancer risk: HPV-based cervical screening programmes

Anal cancer risk: HPV-based cervical screening programmes

Adjusting progesterone (P) dosage to compensate for a non-homogeneous hyperechogenic (HH) echo pattern three days after embryo transfer

Purpose: To determine if in the modern era failing to attain a homogenous hyperechogenic (HH) pattern three days after embryo transfer is still associated with a lower pregnancy rates. The study evaluates the efficacy of adding extra progesterone (P) at the time of the non-HH pattern. Materials and Methods: A five-year retrospective cohort analysis was performed evaluating two age groups (≤ 34 vs. 35-39 years). If an HH pattern was not attained, 50 mg IM P was added to the vaginal P supplementation already given in the IVF-ET cycle. The first two IVF cycles were evaluated. Results: There was no difference in live delivered pregnancy rates in younger women not attaining the HH pattern but it was lower in those aged 36-39 years. Conclusions: A randomized study adding extra IM P or not in women aged 36-39 or even the younger women is needed to determine if adding extra IM P improves the pregnancy rates or not.

Predictors of Discontinuation of Long-Acting Reversible Contraception Before 30 Months of Use by Adolescents and Young Women

PurposeThe purpose of the article was to describe adolescent and young women's rates of discontinuation of intrauterine devices (IUDs) and contraceptive implants, the extent to which discontinuation is predicted by baseline factors, reasons for discontinuation, and subsequent contraceptive initiation. MethodsWe recruited English-speaking women, aged 13–24 years, from a family planning clinic serving clients <25 years old. Participants completed surveys before and after contraceptive initiation visits. We reviewed medical records and contacted participants who initiated use of an IUD or contraceptive implant and assessed contraceptive discontinuation before 30 months of use. We collected follow-up data on duration of use, reasons for discontinuation, and new method selected. We used multivariable regression models to ascertain factors associated with method discontinuation. ResultsFrom 2011 to 2013, 775 young women completed surveys and initiated IUD or implant use. We determined 30-month discontinuation status of 633 women (81.7%). Among those with known outcome, fewer IUD than implant initiators had discontinued use (36.3% vs. 45.4%, p = .02). Mean duration of use was 733 days (95% confidence interval 702–763 days) for the IUD and 697 days (95% confidence interval 666–728 days) for the implant. Participants who stated at baseline that it was “very important” to avoid pregnancy were about half as likely to discontinue use. The most common reasons for discontinuation were pain (IUD) and bleeding (implant). Most participants initiated alternate contraception after discontinuing their original method. ConclusionsAdolescents and young women who initiate an IUD or implant make decisions for discontinuation based on weighing high contraceptive effectiveness with other reproductive health values and preferences.

Five-Year Randomized Study Demonstrates Blood Pressure Increases in Young Women With Turner Syndrome Regardless of Estradiol Dose.

We evaluated the development in blood pressure (BP) and heart rate in young women with Turner syndrome (TS) and investigated potential influencing cofactors. Twenty TS women (mean±SD, 22.9±2.3 years of age) were investigated in a 5-year prospective setting. Data were derived from a randomized controlled clinical trial investigating 2 different doses of estradiol treatment (2 mg 17β-estradiol per day and placebo or 2+2 mg 17β-estradiol per day). A control group of 12 healthy age-matched young women (mean±SD, 23.11±2.2 years of age) was examined at the end of the study. BP and lipids were monitored yearly. At the end of the study, TS (n=15) and controls were examined by 24-hour ambulatory BP monitoring. Systolic and diastolic BPs increased regardless of estradiol dose ( P=0.005 and P=0.009) in TS patients, whereas heart rate decreased ( P=0.05). Neither body mass index, height, weight, nor lipids contributed significant to the changes. There was no difference in BP, heart rate, or lipids because of treatment. At the end of the study, diastolic BP and heart rate were significantly higher in TS during day, night, and over 24 hours. Systolic BP increased insignificantly. Lipids did not change during the study period, but body mass index determined individual levels. In conclusion, systolic and diastolic BPs increase significantly in late adolescence and early adulthood in TS. It remains an enigma why BP increases early in life in TS. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT00134745.

Lung cancer and smoking trends in the young in Switzerland: a study based on data of the National Institute for Cancer Epidemiology and Registration and of the Swiss Health Surveys.

We explored the trend in lung cancer incidence rates among a young Swiss population (30&ndash;54 years old) by sex from 1990 to 2014 to investigate the birth cohort effect on lung cancer. We evaluated smoking rates from 1992 to 2012 to explain sex differences in lung cancer incidence rates. The data of the Swiss National Institute for Cancer Epidemiology and Registration (NICER) were used. We extracted the data of age-standardized (world) and age-specific incidence rates (per 100,000 people at risk) of trachea, bronchus, and lung cancers by sex and year of diagnosis from 1990 to 2014. The data on tobacco consumption were generated from the Swiss Federal Statistical Office. These data were based on Swiss Health Surveys, involving 5-year intervals from 1992 to 2012. Incidence rates decreased among men in the age groups 40&ndash;44, 45&ndash;49, and 50&ndash;54 years. An increased rate was seen among women in age group 50&ndash;54 years. Among men, rates generally decreased in successive birth cohorts, whereas among women, the rates increased from the cohort born in 1935&ndash;1939 up to the 1950s, and then were steady. In the cohort born in 1940&ndash;1944 an increased rate was seen until the 1960s, and then they decreased. In the cohort born in 1945&ndash;1949 the rates remained steady. Smoking prevalence was higher among men than among women in all age and birth groups. Among men born in the mid-1950s or mid-1960s, smoking prevalence has become higher for younger compared to older men. This pattern was only seen among younger women born in the mid-1960s. Decreasing lung cancer incidence rates in young Swiss men but increasing rates in young women reflect the evolution of the smoking epidemic in the world. Our findings indicate an urgent need for implementing prevention strategies that target tobacco cessation and prevention among young women.

Breast cancer‐specific survival by clinical subtype after 7 years follow‐up of young and elderly women in a nationwide cohort

Age and tumor subtype are prognostic factors for breast cancer survival, but it is unclear which matters the most. We used population-based data to address this question. We identified 21,384 women diagnosed with breast cancer at ages 20-89 between 2005 and 2015 in the Cancer Registry of Norway. Subtype was defined using estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor 2 (HER2) status as luminal A-like (ER+PR+HER2-), luminal B-like HER2-negative (ER+PR-HER2-), luminal B-like HER2-positive (ER+PR+/-HER2+), HER2-positive (ER-PR-HER2+) and triple-negative (TNBC) (ER-PR-HER2-). Cox regression estimated hazard ratios (HR) for breast cancer-specific 7-year survival by age and subtype, while adjusting for year, grade, TNM stage and treatment. Young women more often had HER2-positive and TNBC tumors, while elderly women (70-89) more often had luminal A-like tumors. Compared to age 50-59, young women had doubled breast cancer-specific mortality rate (HR = 2.26, 95% CI 1.81-2.82), while elderly had two to five times higher mortality rate (70-79: HR = 2.25, 1.87-2.71; 80-89: HR = 5.19, 4.21-6.41). After adjustments, the association was non-significant among young women but remained high among elderly. Young age was associated with increased breast cancer-specific mortality among luminal A-like subtype, while old age was associated with increased mortality in all subtypes. Age and subtype were strong independent prognostic factors. The elderly always did worse, also after adjustment for subtype. Tumor-associated factors (subtype, grade and stage) largely explained the higher breast cancer-specific mortality among young. Future studies should address why luminal A-like subtype is associated with a higher mortality rate in young women.

An Evaluation of the Use of G-CSF as an Adjunct to IVF in Women Who Have Previously Failed Attempts at Pregnancy With IVF

Objectives: The present study aimed to evaluate the effects of granulocyte colony-stimulating factor (G-CSF) as an adjunct to in vitro fertilization (IVF). In other words, it delved into the influence of G-CSF on the endometrium and the achievement of pregnancy. Materials and Methods: This retrospective cross-sectional study was conducted on a subgroup of women with two or more previously failed IVFs, who attended a fertility clinic in Johannesburg. These women underwent a procedure of transvaginal infusion of G-CSF in addition to their IVF protocol although endometrial thickness was not a criterion for G-CSF use. Results: The group included 49 women with a mean age of 38.9 years (SD ± 6.11). The mean number of previous IVFs was 3.1 (SD ± 1.76). The mean endometrial thickness pre-G-CSF and post-G-CSF was 7.53 mm (SD ± 2.69) and 9.11 mm (SD ± 2.12), respectively. The clinical pregnancy rate was 34.69%. Univariate analysis between the groups of women who achieved or failed to achieve pregnancy showed that the age difference between the two groups was statistically significant (P=0.0005). Further, G-CSF use was associated with increased pregnancy rates in younger women. Finally, although the mean endometrial thickness pre and post-G-CSF were not statistically significant between the two groups (P&gt;0.05), the mean change in endometrial thickness was statistically significant in all women regardless of pregnancy outcome (P=0.0029). Conclusions: In general, G-CSF is considered as a useful adjunct for the treatment of women with recurrent failed IVFs and aged less than 38 years. Based on the findings, a statistically significant overall expansion of endometrial thickness was reported by using G-CSF. However, it failed to show any association between endometrial expansion and pregnancy outcome.

Stroke in Senegalese Young Women: About 109 Cases

Considered for a long time as pathology of the elderly, stroke is more and more frequent in the young subject, 12 to 15% of the stroke occurs in the people under 50 years old. The situation is alarming because the consequences are tragic on the economic and social levels. We will be interested in the stroke of the young women. This is a cross-sectional descriptive study over 22 month in neurology department in Fann teaching hospital, period from August 2012 to June 2014. This allowed to the compilation of 109 patients with stroke according to the WHO definition and aged between 16 and 50 years. This study focuses on 109 women aged between 17 and 50 years with an average age of 39.95 years. The most representative age range is between 36 and 45 years. Only 3.7% of patients had a level of education higher than baccalaureate, 59.6% were not in school.57.8% had an ischemic stroke and 42.2% had a hemorrhagic stroke, with an average age of 39 years for ischemic stroke and 40 years for hemorrhagic stroke. The most important cardiovascular risk factors for ischemic stroke were dyslipidemia (73%), high blood pressure (42.9%), sedentary lifestyle (38.1%), and estrogen-progestin contraception intake were found in 23.8 % of cases. According to the TOAST classification, the etiology is embolic heart disease (25.4%), macroangiopathy (17.5%), microangiopathy (7.9%), others (15.9%), and in 41.2% of the patients the etiology is not found. The main cardiovascular risk factors in hemorrhagic stroke were hypertension (80.4%), dyslipidemia (58.7%), sedentarily (59.1%), migraine (23.9%) an oestroprogestative contraception intake (6.5%).The etiologies of hemorrhagic stroke are arterial hypertension (80.4%), left middle cerebral artery aneurysm (6.5%), arteriovenous malformation (4.3%), infectious arteritis (4.3%), hemostasis disorder (2.2%), and undetermined origin (2.2%). Bad eating habits, sedentary lifestyle lead an increase cardiovascular risk factors and, at the same time, the stroke rate in young women. Prevention must go through a good awareness-raising policy.