Breast cancer in neurofibromatosis type 1 : overrepresentation of unfavourable prognostic factors

Background: An increased breast cancer incidence and poor survival have been reported for women with neurofibromatosis 1 (NF1). To explain the poor survival, we aimed to link the histopathology and clinical characteristics of NF1-associated breast cancers. Methods: The Finnish Cancer Registry and the Finnish NF Registry were cross-referenced to identify the NF1 patients with breast cancer. Archival NF1 breast cancer specimens were retrieved for histopathological typing and compared with matched controls. Results: A total of 32 breast cancers were diagnosed in 1404 NF1 patients during the follow-up. Women with NF1 had an estimated lifetime risk of 18.0% for breast cancer, and this is nearly two-fold compared with that of the general Finnish female population (9.74%). The 26 successfully retrieved archival NF1 breast tumours were more often associated with unfavourable prognostic factors, such as oestrogen and progesterone receptor negativity and HER2 amplification. However, survival was worse in the NF1 group (P = 0.053) even when compared with the control group matched for age, diagnosis year, gender and oestrogen receptor status. Scrutiny of The Cancer Genome Atlas data set showed that NF1 mutations and deletions were associated with similar characteristics in the breast cancers of the general population. Conclusions: These results emphasise the role of the NF1 gene in the pathogenesis of breast cancer and a need for active follow-up for breast cancer in women with NF1.Peer reviewe

Risk of pneumonia and pneumococcal disease in people hospitalized with diabetes mellitus: English record-linkage studies

Background: The risk of invasive pneumococcal disease is higher in people with diabetes mellitus than those without. People with diabetes should be considered for routine pneumococcal immunization. This policy has been in place in England for more than a decade. We aimed to estimate, at the population level, the current scale of excess risk of pneumococcal disease in patients with diabetes, and whether the risks have decreased in recent years with the introduction of a pneumococcal vaccine. Methods: We used two data sets of linked hospital admission and death records-the Oxford Record Linkage Study (1963-1998) and all-England linked hospital episode statistics (1999-2011). As a measure of relative risk, we calculated the rate ratio of pneumococcal disease in cohorts of people hospitalized with diabetes compared with cohorts without a record of diabetes. Results: The risk of pneumococcal disease in patients hospitalized with diabetes mellitus has declined a little, but it is still high. The all-ages rate ratio in England declined from 1.92 (95% CI 1.89-1.94) in 1999-2002 to 1.68 (95% CI 1.65-1.71) in 2007-2011. In people aged under 60 years, rate ratios were higher and their decline was more substantial: rate ratios declined from 3.37 (95% CI 3.28-3.46) in 1999-2002 to 2.33 (95% CI 2.21-2.45) in 2007-2011. Conclusions: Patients admitted to hospital with diabetes mellitus remain at increased risk of pneumococcal infection despite a national immunization policy. Possible explanations for the elevated risk include low vaccine uptake or low effectiveness of available vaccine. Clinicians should be aware of the risk of pneumococcal infection in people with diabetes. © 2013 The Authors. Diabetic Medicine © 2013 Diabetes UK

Gout as a risk factor for myocardial infarction and stroke in England: evidence from record linkage studies.

OBJECTIVE: Some studies suggest that gout is a risk factor for cardiovascular disease. There is more evidence about the association between gout and acute myocardial infarction (MI) than about gout and stroke, and only limited information about risks by age group and sex. We aimed to study MI and stroke following gout, including types of stroke, by age group and comparing men and women. METHODS: We analysed an all-England national linked dataset of hospital admissions and death records from 1999 to 2011, and a similar dataset in the Oxford Record Linkage Study spanning 1963-98. The occurrence of MI and stroke was estimated in cohorts of patients admitted to hospital with gout, compared with MI and stroke in control cohorts, and the comparisons were expressed as rate ratios (RRs). RESULTS: The risk of MI and stroke was elevated, and similar, in both datasets. In the all-England dataset, which included 202 033 hospital patients with gout, the RR for MI following gout was 1.82 (95% CI 1.78, 1.85), for all stroke 1.71 (1.68, 1.75), ischaemic stroke 1.68 (1.64, 1.73), haemorrhagic stroke 1.69 (1.61, 1.77) and stroke of unspecified type 2.00 (1.95, 2.06). Associations were stronger in younger than older age groups, and in the younger were stronger in women than men. CONCLUSION: Gout was associated with increased risk of stroke as well as MI. These findings should be considered by clinicians and may have implications for preventive management of circulatory disease risks in people with gout

Gout as a risk factor for myocardial infarction and stroke in England: evidence from record linkage studies.

OBJECTIVE: Some studies suggest that gout is a risk factor for cardiovascular disease. There is more evidence about the association between gout and acute myocardial infarction (MI) than about gout and stroke, and only limited information about risks by age group and sex. We aimed to study MI and stroke following gout, including types of stroke, by age group and comparing men and women. METHODS: We analysed an all-England national linked dataset of hospital admissions and death records from 1999 to 2011, and a similar dataset in the Oxford Record Linkage Study spanning 1963-98. The occurrence of MI and stroke was estimated in cohorts of patients admitted to hospital with gout, compared with MI and stroke in control cohorts, and the comparisons were expressed as rate ratios (RRs). RESULTS: The risk of MI and stroke was elevated, and similar, in both datasets. In the all-England dataset, which included 202 033 hospital patients with gout, the RR for MI following gout was 1.82 (95% CI 1.78, 1.85), for all stroke 1.71 (1.68, 1.75), ischaemic stroke 1.68 (1.64, 1.73), haemorrhagic stroke 1.69 (1.61, 1.77) and stroke of unspecified type 2.00 (1.95, 2.06). Associations were stronger in younger than older age groups, and in the younger were stronger in women than men. CONCLUSION: Gout was associated with increased risk of stroke as well as MI. These findings should be considered by clinicians and may have implications for preventive management of circulatory disease risks in people with gout

Risk of pneumonia and pneumococcal disease in people hospitalized with diabetes mellitus: English record-linkage studies.

BACKGROUND: The risk of invasive pneumococcal disease is higher in people with diabetes mellitus than those without. People with diabetes should be considered for routine pneumococcal immunization. This policy has been in place in England for more than a decade. We aimed to estimate, at the population level, the current scale of excess risk of pneumococcal disease in patients with diabetes, and whether the risks have decreased in recent years with the introduction of a pneumococcal vaccine. METHODS: We used two data sets of linked hospital admission and death records-the Oxford Record Linkage Study (1963-1998) and all-England linked hospital episode statistics (1999-2011). As a measure of relative risk, we calculated the rate ratio of pneumococcal disease in cohorts of people hospitalized with diabetes compared with cohorts without a record of diabetes. RESULTS: The risk of pneumococcal disease in patients hospitalized with diabetes mellitus has declined a little, but it is still high. The all-ages rate ratio in England declined from 1.92 (95% CI 1.89-1.94) in 1999-2002 to 1.68 (95% CI 1.65-1.71) in 2007-2011. In people aged under 60 years, rate ratios were higher and their decline was more substantial: rate ratios declined from 3.37 (95% CI 3.28-3.46) in 1999-2002 to 2.33 (95% CI 2.21-2.45) in 2007-2011. CONCLUSIONS: Patients admitted to hospital with diabetes mellitus remain at increased risk of pneumococcal infection despite a national immunization policy. Possible explanations for the elevated risk include low vaccine uptake or low effectiveness of available vaccine. Clinicians should be aware of the risk of pneumococcal infection in people with diabetes