Associations between endogenous sex hormone levels and mammographic and bone densities in premenopausal women

PURPOSE: Mammographic breast and bone mineral densities (BMD) have been associated with luteal phase hormone concentrations in premenopausal women. We assessed the associations of breast and bone densities with follicular phase hormones and sex hormone binding globulin (SHBG) in premenopausal women given that follicular phase hormones have been shown to be positively associated with premenopausal breast cancer risk. METHODS: One hundred and ninety two 40-45 year old women provided a spot urine and/or blood sample during the follicular phase. Hormone and SHBG concentrations and bone density were measured and routine mammograms were accessed and digitized to obtain breast density measures. Regression models were fit to assess the associations between hormones and SHBG and breast and bone densities. RESULTS: Positive associations were observed between percent breast density and SHBG (p trend = 0.02), as well as estradiol (p trend = 0.08), after controlling for body mass index (BMI), number of pregnancies, and breast feeding history. In addition, a statistically significant inverse association was observed between total testosterone and head BMD (p trend = 0.01), after controlling for BMI. CONCLUSIONS: Associations were observed between breast and bone densities and serum hormone concentrations during the follicular phase of the menstrual cycle

Validity of the recorded International Classification of Diseases, 10th edition diagnoses codes of bone metastases and skeletal-related events in breast and prostate cancer patients in the Danish National Registry of Patients

Annette Østergaard Jensen1, Mette Nørgaard1, Mellissa Yong2, Jon P Fryzek2, Henrik Toft Sørensen11Department of Clinical Epidemiology, Aarhus University hospital, Århus, Denmark; 2Global Epidemiology, Amgen inc., Thousands Oaks, CA, USAObjective: The clinical history of bone metastases and skeletal-related events (SREs) secondary to cancers is not well understood. In support of studies of the natural history of bone metastases and SREs in Danish prostate and breast cancer patients, we estimated the sensitivity and specificity of hospital diagnoses for bone metastases and SREs (ie, radiation therapy to the bone, pathological or osteoporotic fractures, spinal cord compression and surgery to the bone) in a nationwide medical registry in Denmark.Study design and setting: In North Jutland County, Denmark, we randomly sampled 100 patients with primary prostate cancer and 100 patients with primary breast cancer diagnoses from the National Registry of Patients (NRP), during the period January 1st, 2000 to December 31st, 2000 and followed them for up to five years after their cancer diagnosis. We used information from medical chart reviews as the reference for estimating sensitivity, and specificity of the NRP International Classification of Diseases, 10th edition (ICD-10) coding for bone metastases and SRE diagnoses. Results: For prostate cancer, the overall sensitivity of bone metastases or SRE coding in the NRP was 0.54 (95% confidence interval [CI]: 0.39–0.69), and the specificity was 0.96 (95% CI: 0.87–1.00). For breast cancer, the overall sensitivity of bone metastases or SRE coding in the NRP was 0.58 (95% CI: 0.34–0.80), and the specificity was 0.95 (95% CI: 0.88–0.99). Conclusion: We measured the validity of ICD-10 coding in the Danish NRP for bone metastases and SREs in prostate and breast cancer patients and found it has adequate sensitivity and high specificity. The NRP remains a valuable tool for clinical epidemiological studies of bone metastases and SREs.Keywords: bone metastases, skeletal-related events (SRE), sensitivity, specificit

Predictors and patterns of red blood cell transfusion use among newly diagnosed cancer patients with chemotherapy-associated anemia in Western Denmark (1998–2003)

Mellissa Yong1, Anders H. Riis3, Jon P. Fryzek2, Bjarne K. Møller4, Søren P. Johnsen3 1Department of Global Biostatistics and Epidemiology, Amgen Inc, Thousand Oaks, CA, USA; 2Department of Epidemiology and Computational Biology, Exponent, Alexandria, VA, USA; 3Department of Clinical Epidemiology; 4Department of Clinical Immunology, Aarhus University Hospital, Aarhus, DenmarkObjective: Cancer patients receiving chemotherapy are at increased risk of anemia. We conducted a population-based historical cohort study in newly diagnosed cancer patients with chemotherapy-associated anemia in order to characterize red blood cell transfusion (RBCT) use.Design: This study evaluated cancer patients diagnosed between January 1, 1998 and December 31, 2003 using Danish National Patient Registry data. Patients were receiving chemotherapy and had a hemoglobin level ≤10.9 g/dL during the 4 months following cancer diagnosis. We characterized patterns of RBCT use and inpatient and outpatient hospitalization for transfusion. Adjusted Poisson regression models were used to evaluate the likelihood of RBCT, estimated by relative risk (RR), based on demographic and clinical factors.Results: Women constituted 58% of 1782 patients studied; the median age was 58 years. Two-thirds (67%) had solid tumors; 67% had stage III or IV disease at diagnosis. Overall, 713 (40%) patients received an RBCT within 120 days of cancer diagnosis, of which 94% were administered in the inpatient setting; 84% of these patients required subsequent transfusions. The median (Q1, Q3) pretransfusion hemoglobin level was 9.0 (8.4, 9.8) g/dL. Patients aged <20 years were more likely to receive an RBCT than older patients (RR 1.89; 95% confidence interval [CI] 1.44–2.49). Compared with stage IV disease, those with stage II or III disease had a lower likelihood of RBCT (stage II: RR 0.52, 95% CI: 0.37–0.72; stage III: RR 0.68, 95% CI: 0.55–0.83). Patients diagnosed with breast cancer were less likely to receive an RBCT than patients with hematologic cancers (RR 0.34, 95% CI: 0.21–0.55).Conclusion: In this study, 40% of cancer patients with chemotherapy-associated anemia in Western Denmark received an RBCT, usually in the inpatient setting; of these, most required subsequent transfusions. Younger age increased the likelihood of receiving an RBCT, and earlier stage or breast cancer decreased RBCT likelihood.Keywords: red blood cell transfusions, epidemiology, anemi

Baseline characteristics and predictors of outcome in patients with myelodysplastic syndromes living in Western Pennsylvania

The myelodysplastic syndromes (MDS) are a collection of hematologic disorders that affect older adults, and whose baseline characteristics and risk factors for evolution to acute myeloid leukemia (AML) and death have not been completely defined. We analyzed a large unselected cohort of 214 patients with MDS from the University of Pittsburgh Network Cancer Registry in Western Pennsylvania. Patients' follow-up was 22 months, at the end of which 72.9%% of patients were dead. Overall, the 36-month survival rate was 19.0%% (95%% CI: 14.0--24.5%%); 22.4%% (95%% CI: 16.4--29.0%%) for patients with lower-risk MDS; and 5.0%% (95%% CI: 0.1--14.8%%) for patients with higher-risk MDS (p aEuroS== aEuroS0.0007). During follow-up, 32.9%% of the patients developed AML. Family history of cancer and having aEuroS >= a parts per thousand yen5%% blasts at diagnosis were statistically significant predictors for progression to AML. A higher risk of death also was associated with age aEuroS > 70 years and previous diagnosis of another cancer. More than three cycles of chemotherapy sessions and a platelet count of >= a parts per thousand yen50 aEuroSxx aEuroS10<SU3</SU/mm<SU3</SU were inversely associated with death. This study suggests the need to incorporate laboratory results such as percentage blasts and platelet counts as well as epidemiologic data on family history of cancer in future outcome studies on MDS.</

Predictors of Outcome In Patients with Myelodysplastic Syndromes Living In Western Pennsylvania

Abstract Abstract 4971 Introduction: The myelodysplastic syndromes (MDS) are a collection of hematologic disorders that affect older adults. The baseline characteristics and risk factors for evolution to acute myeloid leukemia (AML) and death in MDS have not been completely defined. To gain a better understanding of MDS disease progression, we analyzed data from a large unselected cohort of MDS patients from the University of Pittsburgh Medical Center Network Cancer Registry in Western Pennsylvania. Methods: Demographic and baseline clinical data, including MDS subtype, treatment, cytogenetics, and cytopenias were derived from both patients' medical charts and electronic medical records. The MDS subtypes were recorded according to the French-American-British classification system (FAB). The IPSS score was calculated by one of the study investigators using the following criteria: bone marrow blasts were scored as 0 for values of 3 abnormalities). The intermediate risk group included all other aberrations. Four risk groups were formed based on the scores; Low, Int-1, Int-2, and High. Multivariable Cox proportional hazard models were developed to assess factors associated with AML evolution and survival. Covariates in these models included gender, race, diagnosis, age, smoking status, alcohol history, family history of cancer, previous cancer, blast percentage, blood parameters, therapies, MDS subtypes, and International Prognostic Scoring System score (IPSS). Differences in survival were tested using the Wilcoxon Log-Rank test. Results: Of 214 MDS patients included in this study, 129 were male (60%), the majority were Caucasian, 34% were diagnosed after the age of 70 years. More than half of the patients (63%) had a history of smoking, while 44% reported alcohol use and roughly half of the population (49%) reported a family history of cancer. Patients were followed for an average of 22 months after diagnosis. At baseline, the median hemoglobin level for all patients was 9.4 g/dL, and median neutrophil count was 1.45 × 109/L, with no significant gender differences. The median platelet count was 88 × 109/mm3 with 26.1% of the patients presenting with a platelet count 70 years at diagnosis (aHR = 1.3; 95% CI = 0.9 – 1.8) and previous diagnosis of cancer other than MDS (aHR = 1.3; 95% CI = 0.9 – 1.9). Increasing numbers of chemotherapy sessions (3 or more sessions versus 1: aHR – 0.5; 95% CI = 0.3 – 0.8) and a platelet count of >50×103/mm3 (aHR = 0.8; 95% CI = 0.5 – 1.1) were inversely associated with death. Conclusions: This is one of the first studies to present the contribution of both demographic and clinical factors to survival and AML development in a large population-based cohort of MDS patients. Disclosures: Fryzek: MedImmune: Employment