Incidence and outcomes of pregnancy‐associated melanoma in New South Wales

Background: There is controversy about the interaction between melanoma and pregnancy. There is a lack of Australian data on pregnancy outcomes associated with melanoma in pregnancy, despite Australia having the highest incidence of melanoma in the world. Aims: Describe trends, maternal characteristics and pregnancy outcomes associated with pregnancy‐associated melanoma in New South Wales Materials and Methods: Population‐based cohort study of all births (n=1,309,501) of at least 20 weeks gestation or 400g birthweight in New South Wales, 1994‐2008. Logistic regression was used to analyse the association between melanoma in pregnancy and adverse birth outcomes. Results: 577 pregnancy‐associated melanomas were identified, including 195 diagnosed during pregnancy and 382 diagnosed within 12 months postpartum. The crude incidence of pregnancy‐associated melanoma increased from 37.1 per 100,000 maternities in 1994 to 51.84 per 100,000 maternities in 2008. Adjusting for maternal age accounted for the trend in pregnancy‐associated melanoma. Melanomas diagnosed in pregnancy were thicker (median=0.75mm) than melanomas diagnosed postpartum (median=0.60mm) (p=0.002). Pregnancy‐associated melanoma was associated with increased risk of large for gestational age infant but not preterm birth, planned birth, caesarean section or stillbirth. Parity was inversely associated with pregnancy‐associated melanoma, as women with 3 or more previous pregnancies had 0.59 times the odds of pregnancy‐associated melanoma compared to nulliparous women (95% CI 0.42‐0.84, p=0.003). Conclusions: The incidence of pregnancy‐associated melanoma has increased with increasing maternal age. The observation of thicker melanomas in pregnancy and increased risk of large for gestational age infants may suggest a role for growth‐related pregnancy factors in pregnancy‐associated melanoma.We would like to acknowledge the NSW Ministry of Health and the NSW Central Cancer Registry for maintaining and providing the population health data sets and the NSW Centre for Record Linkage for linking the data sets. MBT is supported by a NHMRC capacity building grant (573122), JBF is supported by an ARC Future Fellowship (FT120100069) and CLR is supported by a NHMRC Senior Research Fellowship (457078)

Pregnancy and Breast Cancer: when They Collide

Women of childbearing age experience an increased breast cancer risk associated with a completed pregnancy. For younger women, this increase in breast cancer risk is transient and within a decade after parturition a cross over effect results in an ultimate protective benefit. The post-partum peak of increased risk is greater in women with advanced maternal age. Further, their lifetime risk for developing breast cancer remains elevated for many years, with the cross over to protection occurring decades later or not at all. Breast cancers diagnosed during pregnancy and within a number of years post-partum are termed pregnancy-associated or PABC. Contrary to popular belief, PABC is not a rare disease and could affect up to 40,000 women in 2009. The collision between pregnancy and breast cancer puts women in a fear-invoking paradox of their own health, their pregnancy, and the outcomes for both. We propose two distinct subtypes of PABC: breast cancer diagnosed during pregnancy and breast cancer diagnosed post-partum. This distinction is important because emerging epidemiologic data highlights worsened outcomes specific to post-partum cases. We reported that post-partum breast involution may be responsible for the increased metastatic potential of post-partum PABC. Increased awareness and detection, rationally aggressive treatment, and enhanced understanding of the mechanisms are imperative steps toward improving the prognosis for PABC. If we determine the mechanisms by which involution promotes metastasis of PABC, the post-partum period can be a window of opportunity for intervention strategies

The Palliative Radiotherapy and Inflammation Study (PRAIS) - protocol for a longitudinal observational multicenter study on patients with cancer induced bone pain

BackgroundRadiation therapy (RT) results in pain relief for about 6 of 10 patients with cancer induced bone pain (CIBP) caused by bone metastases. The high number of non-responders, the long median time from RT to pain response and the risk of adverse effects, makes it important to determine predictors of treatment response. Clinical features such as cancer type, performance status and pain intensity, and biomarkers for osteoclast activity are proposed as predictors of response to RT. However, results are inconsistent and there is a need for better predictors of RT response. A similar argument can be stated for the development of cachexia; there are currently no predictors that can identify patients who will develop cachexia later in the cancer disease trajectory. Experimental and preclinical studies show that pain, depression and cachexia are related to inflammation. However, it is not known if inflammatory biomarkers can predict CIBP, depression or development of cachexia.MethodsThis multicenter, multinational longitudinal observational study will include 600 adult patients receiving RT for CIBP. Demographic data, clinical variables, osteoclast and inflammatory biomarkers will be assessed before start of RT, and 3, 8, 16, 24 and 52 weeks after last course of RT. The primary aim of the study is to identify potential predictors for pain relief from RT. Secondary aims are to explore potential predictors for development of cachexia, the longitudinal relationship between pain intensity and depression, and if inflammatory biomarkers are associated with changes in pain intensity, cachexia and depression during one-year follow up.DiscussionThe immediate clinical implication of the PRAIS study is to identify potential predictive factors for a RT response on CIBP, and thereby reduce non-efficacious RT. Patient benefits are fewer hospital visits, reduced risk of adverse effects and more individualized pain treatment. The long-term clinical implication of the PRAIS study is to improve the knowledge about inflammation in relation to CIBP, cachexia and depression and potentially identify associations and mechanisms that can be targeted for treatment.Trial registrationClinicalTrials.gov NCT02107664, date of registration April 8, 2014 (retrospectively registered).Trial sponsorThe European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, NTNU, Faculty of medicine and Health Sciences, Trondheim, N-7491, Norway