Is mammographic density differentially associated with breast cancer according to receptor status? A meta-analysis.

Mammographic density (MD) is a strong marker of breast cancer risk, but it is debated whether the association holds, and is of a similar magnitude, for different subtypes of breast cancer defined by receptor status or gene expression profiles. A literature search conducted in June 2012 was used to identify all studies that had investigated the association of MD with subtype-specific breast cancer, independent of age. 7 cohort/case-control and 12 case-only studies were included, comprising a total of >24,000 breast cancer cases. Random effects meta-analysis models were used to combine relative risks (RR) of MD with subtype-specific breast cancer for case-control studies, and in case-only studies to combine relative risk ratios (RRR) of receptor positive versus negative breast tumors. In case-control/cohort studies, relative to women in the lowest density category, women in the highest density category had 3.1-fold (95 % confidence interval [CI] 2.2, 4.2) and 3.2-fold (1.7, 5.9) increased risk of estrogen receptor positive (ER+) and ER- breast cancer, respectively. In case-only analyses, RRRs of breast tumors being ER+ versus ER- were 1.13 (95 % CI 0.89, 1.42) for medium versus minimal MD. MD remained associated with screen-detected ER+ tumors, despite the expectation of this association to be attenuated due to masking bias and overdiagnoses of ER+ tumors. In eight contributing studies, the association of MD did not differ by HER2 status. This combined evidence strengthens the importance of MD as a strong marker of overall and of subtype-specific risk, and confirms its value in overall breast cancer risk assessment and monitoring for both research and clinical purposes

Sex Ratio Changes as Sentinel Health Events of Endocrine Disruption

The production and widespread use of synthetic chemicals since the 1940s have resulted in ubiquitous contamination of fish, wildlife and human populations. Since the 1960s, observers have documented major damage to wildlife reproduction across the globe, and subsequently, damage to reproductive health in exposed humans as well. The sex ratio in human communities and populations can be readily measured to ascertain whether reproductive effects, such as subtle birth defects of the reproductive tract caused by exposures to chemicals, might be occurring. Male to femalesex ratios appear to be declining in populations in several parts of the globe, possibly as a result of prenatal exposures to chemicals. Sex ratio data for communitieswith unusual occupational or environmental exposures can be compiled using traditional epidemiological techniques in pursuit of environmental justice. Local, regional and national population health researchers and occupational hygienists can use health statistics toexamine sex ratios as sentinel health events that might portend patterns of subtle structural birth defects of the reproductive tract and functional deficits in neurodevelopment

Challenges in integrating cervical cancer screening in HIV care clinics in West Africa: a pilot study in Abidjan, Côte d’Ivoire

International audiencen.

Separate and combined analysis of successive dependent outcomes after breast-conservation surgery: recurrence, metastases, second cancer and death

<p>Abstract</p> <p>Background</p> <p>In the setting of recurrent events, research studies commonly count only the first occurrence of an outcome in a subject. However this approach does not correctly reflect the natural history of the disease. The objective is to jointly identify prognostic factors associated with locoregional recurrences (LRR), contralateral breast cancer, distant metastases (DM), other primary cancer than breast and breast cancer death and to evaluate the correlation between these events.</p> <p>Methods</p> <p>Patients (n = 919) with a primary invasive breast cancer and treated in a cancer center in South-Western France with breast-conserving surgery from 1990 to 1994 and followed up to January 2006 were included. Several types of non-independent events could be observed for the same patient: a LRR, a contralateral breast cancer, DM, other primary cancer than breast and breast cancer death. Data were analyzed separately and together using a random-effects survival model.</p> <p>Results</p> <p>LRR represent the most frequent type of first failure (14.6%). The risk of any event is higher for young women (less than 40 years old) and in the first 10 years of follow-up after the surgery. In the combined analysis histological tumor size, grade, number of positive nodes, progesterone receptor status and treatment combination are prognostic factors of any event. The results show a significant dependence between these events with a successively increasing risk of a new event after the first and second event. The risk of developing a new failure is greatly increased (RR = 4.25; 95%CI: 2.51-7.21) after developing a LRR, but also after developing DM (RR = 3.94; 95%CI: 2.23-6.96) as compared to patients who did not develop a first event.</p> <p>Conclusion</p> <p>We illustrated that the random effects survival model is a more satisfactory method to evaluate the natural history of a disease with multiple type of events.</p

Legislación sobre el consumo de tabaco en el ámbito laboral y en los espacios públicos de la Unión Europea

En este trabajo, realizado a partir de contactos con referentes en las autoridades sanitarias complementados con otros informadores clave y la consulta del Repertorio Internacional de Legislación Sanitaria, se describen las características actuales de la legislación sobre el consumo de tabaco en el lugar de trabajo de los 15 Estados miembros de la Unión Europea (UE), así como de otros países europeos como Hungría, Islandia, Noruega, Polonia, Rumania y Suiza. Se revisan también los procesos judiciales que se han producido en base a esta legislación en relación al consumo de tabaco en el ámbito laboral en estos países. La legislación es una parte crucial de toda estrategia de control del tabaquismo. Sin ella, ninguna acción contra la exposición al aire contaminado por el humo de tabaco será eficaz. Sin embargo, una ley en sí misma no es suficiente y sólo será eficaz si recibe el apoyo de la opinión pública