Patterns in the incidence of age-related ovarian cancer in South East England 1967-1996

Objective To study the age-related trends in the incidence rates of ovarian cancer in South East England between 1967 and 1996.
Design A retrospective review of systematically collected data on ovarian cancer in South East England.
Methods Data were obtained from the Thames Cancer Registry on the numbers and rates per 100,000 population of ovarian cancer per five-year age group (0–85+) in the 30-year period from 1967 to 1996 from the 26 health authorities in the Thames region. Linear regression was performed to determine the changes in incidence rates of ovarian cancer per age group over time.
Main outcome measures The change in overall incidence of ovarian cancer in South East England, as well as the change in incidence of ovarian cancer in each five-year age groups (20–85+) in the 30-year study period.
Results There was a strong positive correlation between ovarian cancer rates and year of diagnosis in women aged ≥ 70 years, and this was particularly marked in women > 85 years of age. There was a negative correlation between rates and year of diagnosis in women aged 45–59 years. The analysis did not demonstrate a significant correlation between ovarian cancer rates and year of diagnosis in women < 44 years of age or women aged 60–69 years.
Conclusions There have been significant changes in the pattern of ovarian cancer incidence in South East England during the 30-year period studied. The observed changes in ovarian cancer incidence in younger women may, in part, be explained by known reproductive factors. The rise in ovarian cancer rates among the older age group is difficult to explain, but has important implications for the future planning and provision of cancer services.     

The epidemiologic incidence of congenital gastroschisis in Western Australia

OBJECTIVE: The purpose of this study was to review the population incidence of congenital gastroschisis in Western Australia over the past 2 decades. STUDY DESIGN: A population-based incidence study of congenital gastroschisis from 1980 to 2001. Maternal and perinatal outcome data were collected to ascertain incidence, treatment, and outcome trends. RESULTS: One hundred twenty-two cases of gastroschisis were identified. The median maternal age was 23 years (range, 16-35 years). Women aged <20 years were at a 7.82 increased risk (95% CI, 4.34-14.08); women aged 20 to 24 years were at a 3.24 increased risk (95% CI, 1.88-5.61) for fetal gastroschisis compared with women aged >or=25 years. An incidence analysis over time indicated a significant increase of gastroschisis cases from 1 of 10,000 births during the period 1980-1990 to the current rate of 2.4 of 10,000 births (P<.001). The perinatal mortality rate was 12.7% (95% CI, 8.7-16.7) with a 9.8% stillbirth rate (95% CI, 6.3-13.3). CONCLUSION: There has been a sustained increase in the birth incidence of gastroschisis over the past decade, particularly in teenage women. A significant fetal death rate in the third trimester is observed.     

Age related trends in the incidence of endometrial cancer in South East England 1962-1997.

Important population demographic changes have occurred over the last 50 years in the UK. Birth rates have fallen, obesity rates have increased and there has been an increase in the use of reproductive hormones, factors which may influence the epidemiology of endometrial cancer. We analysed the age-related trends in the incidence of endometrial cancer in South East England between 1962 and 1997 to determine if there was a correlation with the population demographic changes over this time period. We undertook a retrospective review of systematically collected data, looking specifically at the change in overall incidence of endometrial cancer and the age-related incidence for each five year group from 25 to 85 + years. The overall incidence of endometrial cancer remained unchanged over the 35-year study period. In women aged 35-54 years there was a decrease in incidence of endometrial cancer and this was significant in the 40-45 year age group. The study also revealed a statistically significant increase in incidence of endometrial cancer in women aged over 65 years with a greater rate of increase in older women, particularly those aged over 85. Thus, there is evidence from this study of significant changes in the age-related incidence of endometrial cancer in the 35-year study period that may be explained by alterations in life style and behaviour. The increased incidence in women aged 85 and over have potential implications for the planning and provision of cancer services in the future.     

Increase in the incidence of gestational trophoblastic disease in The Netherlands

Objective

The objective of this study is to determine the incidence and time trends of gestational trophoblastic disease (GTD) in The Netherlands using population-based data.

Methods

Data on patients with a pathologically confirmed diagnosis of GTD from 1995 to 2008 were obtained from PALGA, a national archive containing all histopathology reports in The Netherlands. Data on number of deliveries were obtained from the Database of Statistics Netherlands.

Results

During the study period, 4249 GTD patients were registered. Overall incidence rates of hydatidiform mole (HM), choriocarcinoma and placental site trophoblastic tumor (PSTT) were 1.34 per 1000 deliveries, 3.1 per 100,000 deliveries, and 1.0 per 100,000 deliveries, respectively. Incidence rates of HM increased from 1.02 per 1000 deliveries in 1995 to 1.56 per 1000 in 2001, an increase of 0.091 per year (95% CI 0.081-0.101). After 2001 incidence rates remained constant (increase per year −0.010, 95% CI −0.045-0.024). Maternal age and ethnicity are known to influence the risk of HM. Highest incidences were observed in women under 20 and over 40 years of age. The proportion of deliveries accounted for by women over 40 years of age increased from 1.5% to 2.9%, whereas women under 20 accounted for 1.5% of deliveries. The proportion of live births of Asian descent increased from 2.6% to 3.7%.

Conclusion

The incidence of GTD in The Netherlands increased significantly from 1995 to 2008. This can partially be explained by increased maternal age and increased proportion of live births of Asian descent. Part of the increase might result from improved diagnostic techniques. However, these factors do not seem to account for the total observed increase and part of the increase therefore remains unexplained.     

Increase in the incidence of gestational trophoblastic disease in The Netherlands

Objectives

The purpose of this study was to clarify the clinical outcome of patients with stage IA mucinous epithelial ovarian cancer (mEOC) treated with fertility-sparing surgery (FSS).

Methods

After a central pathological review and search of the medical records from multiple institutions, a total of 148 stage I mEOC patients were retrospectively evaluated in the current study. All mEOC patients were divided into three groups: group A (FSS; age, 40≥); groups B and C {radical surgery; age, 40≥ (B); 40< (C)}. Survival analysis was performed among these three groups using Kaplan-Meier methods.

Results

The median follow-up time of all mEOC patients was 71.6 (4.8-448.3) months. Among the 41 patients in group A, 27 patients (65.9%) had IA disease, and 14 (34.1%) had IC disease. Five-year overall survival (OS) and disease-free survival (DFS) rates of patients in the groups were as follows: group A, 97.3% (OS)/90.5% (DFS); group B, 94.4% (OS)/94.4% (DFS); group C; 97.3% (OS)/89.3% (DFS). Collectively, there was no significant difference in OS or DFS among these groups even though they were stratified to each substage (IA/IC) (OS, P = 0.180; DFS, P = 0.445, respectively). Furthermore, in multivariate analyses, the surgical procedure was not an independent prognostic factor for either OS or DFS (OS, HR: 0.340, 95% CI: 0.034-3.775, P = 0.352; DFS, HR: 0.660, 95% CI: 0.142-3.070, P = 0.596).

Conclusions

Patients with stage I mEOC treated with FSS did not necessarily show a poorer prognosis than those receiving radical surgery.     

Stage III and IV ovarian cancer in the South West of England: five-year outcome analysis for cases treated in 1998

Abstract.   Bailey J, Murdoch J, Anderson R, Weeks J, Foy C. Stage III and IV ovarian cancer in the South West of England: five-year outcome analysis for cases treated in 1998. Int J Gynecol Cancer 2006; 16(Suppl. 1): 25–29.
This study evaluates the 5-year outcome data for the management of advanced ovarian cancer in the South West of England. Anonymized data for 361 stage III and IV ovarian cancers registered between January 1, 1998, and December 31, 1998, were obtained from the central gynecological tumor database. The following data were identified: age at diagnosis, FIGO stage, American Society of Anesthesiologists (ASA) grade, tumor differentiation, treating network and surgeon, amount of residual disease after debulking surgery, current life status, and date of death if applicable. Survival analysis was performed using Kaplan–Meier crude survival for univariate analysis, and multivariate analysis was performed by Cox regression. In our data the 5-year survival for patients with stage III was 16% and with stage IV was 10%. Survival analysis demonstrated that patients in whom the disease was debulked to less than 1 cm were more likely to be alive 5 years after diagnosis than those with a 2-cm residuum ( P < 0.0001). There was no significant survival difference for those patients operated on by subspecialist surgeons despite these surgeons being twice as likely to achieve optimal debulking. Therefore, there must be other variables influencing survival apart from cytoreductive surgery. While there is near-complete data collection about ovarian cancer surgery, our database on chemotherapy is incomplete. This is clearly crucial for a complete view of cancer care in our region.     

The surgical management of cervical carcinoma within the South West of England: progress through an audit loop. Gynaecology Tumour Panel

Objective To define and use a minimum clinical dataset for prospective data collection in order to audit the surgical management of cervical cancer in the South West of England. To compare this data set with a retrospective audit allowing assessment of the quality of care offered to patients.
Design Prospective collection of a defined dataset on paper forms which were put into a computerised database for analysis. Registrations validated against histopathology databases and hospital coding.
Setting All 13 hospitals in the South West of England which participated in the retrospective audit.
Participants One hundred and sixty-five women with cervical cancer diagnosed in 1997.
Main outcome measures Distribution of cases by hospital and surgeon; workload of individual surgeons; adequacy and accuracy of FIGO staging; adequacy of histological information; and adequacy of surgery.
Results There is a trend to centralisation of cancer care and radical surgery in the region. Prospective collection of data has dramatically improved FIGO staging with 92% of all cases staged. For cases greater than Stage la, 98% were staged suggesting that a target of 100% staging is feasible. The histological dimensions of tumours were not measured in a high proportion of cases (20% of tumour diameters and 28% of tumour thicknesses). Apparent inadequacies in surgical management are explored. In 10/165 cases (6%) inappropriate conservative surgery may have been unavoidable, suggesting that a quality standard of 95% for appropriate radical surgical management of cervical cancer can be achieved. An anatomically complete removal of pelvic node-bearing tissue, yielding greater than 10 nodes in more than 95% cases, should be achievable with each surgeon/pathologist achieving a mean of more than 20 nodes.
Conclusion Regional audit of cervical cancer management is feasible. It can be used to improve the quality of information on management and guide improved service provision.     

The impact of screening on the incidence of cervical cancer in England and Wales

Summary. Age-specific incidence curves for clinical cancer of the cervix in England and Wales show progressive changes over the period 1963–1978; in particular, a large reduction in incidence is seen in the age group 35–54. Since screening on any scale began in the early 1960s, we have investigated how much of this reduction in incidence in the middle age range can be attributed to detection of pre-invasive disease. Data on registrations of in-situ cancer have been used to estimate the patterns that might have been observed in the absence of screening. The results indicate clear cohort effects on incidence, with rising rates in the generations born 1906–1921 and since 1931, with a fall in the decade between. In addition to this, screening has probably led to a substantial reduction in the number of cases of clinical cancer in women aged 35–54, but has had little effect over the age of 60 where virtually no screening has been performed. Below age 35 the observed increase in incidence may be considerably less than it would have been in the absence of screening.     

The impact of screening on the incidence of cervical cancer in England and Wales

Age-specific incidence curves for clinical cancer of the cervix in England and Wales show progressive changes over the period 1963-1978; in particular, a large reduction in incidence is seen in the age group 35-54. Since screening on any scale began in the early 1960s, we have investigated how much of this reduction in incidence in the middle age range can be attributed to detection of pre-invasive disease. Data on registrations of in-situ cancer have been used to estimate the patterns that might have been observed in the absence of screening. The results indicate clear cohort effects on incidence, with rising rates in the generations born 1906-1921 and since 1931, with a fall in the decade between. In addition to this, screening has probably led to a substantial reduction in the number of cases of clinical cancer in women aged 35-54, but has had little effect over the age of 60 where virtually no screening has been performed. Below age 35 the observed increase in incidence may be considerably less than it would have been in the absence of screening.     

Trends in the incidence of ectopic pregnancy in England and Wales from 1966 to 1996

Objective To examine the incidence of ectopic pregnancy over the period 1966 to 1996.
Setting England and Wales.
Design Use of official statistics on hospital discharges, maternities, legal abortions and estimated populations of women aged 15–44 years.
Main outcome measures Incidence rates of ectopic pregnancies.
Results Between 1966 to 1970 and 1994 to 1996 the recorded incidence increased 4.5-fold from 3.45 to 15.5 per 1000 maternities, 3.8-fold from 3.25 to 12.4 per 1000 pregnancies and 3.1-fold from 30.2 to 94.8 per 100,000 women aged 15–44. The rate of increase was not uniform. Incidence approximately doubled between 1966 and 1985, when the official data collection system changed. By 1989, when data from the new system became available, there had been a further almost doubling of recorded incidence. Subsequently, the upward trend appears to have continued until 1991 to 1992 and has remained stable in the last four years of the study. The trends were similar in each of three 10-year age groups.
Conclusions The recorded incidence of ectopic pregnancy has increased markedly over the last three decades. This may be partly due to artefacts of data recording and more sensitive diagnostic tests, but it is likely that the actual incidence has increased, probably due to a sexually transmitted agent.     

Aboriginal teenage pregnancies compared with non-Aboriginal in South Australia 1995-1999

OBJECTIVE: To compare pregnancy characteristics and outcomes between Aboriginal and non-Aboriginal teenagers. DESIGN, SETTING AND POPULATION: A retrospective cohort study using the perinatal data collection for South Australian births in 1995-1999: 449 Aboriginal and 4,625 non-Aboriginal teenagers. METHODS: Comparison of socio-demographic and clinical characteristics, using relative risks. MAIN OUTCOME MEASURES: Rates of pregnancy, smoking during pregnancy, induction, delivery method, preterm and small-for-gestational-age births and perinatal mortality RESULTS: Aboriginal teenagers have a pregnancy rate more than twice as high as non-Aboriginal, but a smaller proportion of pregnancies are terminated. They have pregnancies earlier, are more likely to be single, to smoke during pregnancy, to have few antenatal visits, to give birth in a country hospital and to have infections and anaemia. They have lower induction and analgesia rates, but a higher caesarean section rate. Their babies are more likely to be small-for-gestational-age and preterm, to have a congenital abnormality, to require special and intensive nursery care and stay longer in hospital. While their perinatal mortality rate has halved since a decade ago, their neonatal death rate is still twice that of non-Aboriginal births. CONCLUSIONS: Aboriginal teenagers need special attention. Support in particular is needed for Aboriginal health workers in preconceptional counselling and health promotion programs that build the capacity of the community, eg concerning proper nutrition during pregnancy, smoking cessation, breastfeeding, SIDS prevention, support for early and regular attendance for antenatal care in friendly and culturally appropriate environments. Outreach services and sexual health services for young Aboriginal people also need expansion.     

Accidental out-of-hospital births in Finland: incidence and geographical distribution 1963-1995.

BACKGROUND: The study aims to describe the incidence and geographical distribution of accidental out-of-hospital births (accidental births) in Finland in relation to the changes in the hospital network, and to compare the perinatal outcomes of accidental births and all hospital births. METHODS: Data for the incidence and distribution analyses of accidental births were obtained from the official statistics between 1962 and 1973 and from the national Medical Birth Registry (MBR) in 1992-1993. The infant outcomes were analyzed for the MBR data in 1991-1995. RESULTS: Between 1963 and 1975 the central hospital network expanded and by 1975 they covered 72% of births. The number of small maternity units has decreased since 1963. The incidence of accidental births decreased between 1963 and 1973, from 1.3 to 0.4 per 1000 births, and rose by the 1990s to 1/1000. In the 1990s the parity adjusted risk of an accidental birth was higher for residents of northern than of southern Finland, OR 2.51 (CI 1.75-3.60), and for residents of rural compared to urban municipalities, OR 3.26 (CI 2.48-4.27). The birthweight adjusted risk for a perinatal death was higher in accidental births than in hospital births, OR 3.11 (CI 1.42-6.84). CONCLUSIONS: A temporal correlation between closing of small hospitals and an increase in accidental birth rates was detected. Due to the poor infant outcomes of accidental births, centralization policies should include measures to their prevention.     

Acardia syndrome coexisting with gastroschisis in the co-twin

Acardia syndrome is a rare complication affecting monozygotic twins, wherein one twin fails to develop brain and thoracic structures, while the co-twin most often develops normally. In this report we present an acardiac anencephalic monozygotic twin with an omphalocoele and a co-twin with severe intrauterine growth retardation and gastroschisis. The presence of gastroschisis in the co-twin of an acardiac foetus is rare. The embryologic basis of the twin reversed arterial perfusion (TRAP) sequence is outlined and the observed anomalies in the co-twin traced to a similar pathophysiology.     

Congenital malformations of the diaphragm: findings of the West Midlands Congenital Anomaly Register 1995 to 2000

OBJECTIVES: To describe trends in incidence, associated anomalies, clinical outcomes and sensitivity of prenatal diagnosis for congenital malformations of the diaphragm in the West Midlands Region between 1995 and 2000. METHODS: Information was retrieved from a population-based register of major congenital malformations in a health region of England, the West Midlands Congenital Anomaly Register (WMCAR), between 1995 and 2000. RESULTS: One hundred and sixty-one confirmed cases of congenital malformations of the diaphragm were notified from 396 577 births. This gives an incidence of 4.1 per 10,000 births. After natural losses and terminations, the incidence at birth was 2.9 per 10,000 registered births. For live-born cases, the infant mortality rate was 317 per 1000 births. 47% of the cases had additional structural or chromosomal anomalies; the infant mortality rate for these complex cases was 533 per 1000, an increased relative risk of 2.37 compared with isolated lesions. 66% of the cases were diagnosed prenatally, 51% of isolated lesions and 84% of complex cases. Fourteen prenatally diagnosed cases (12%) were false-positives; however, 11 of these cases had other significant pathology. These 14 cases were not included in the 161 confirmed cases. CONCLUSION: Congenital malformations of the diaphragm remain associated with considerable infant mortality. Most cases are now diagnosed before birth and the prognosis is adversely affected by the presence of other structural or chromosomal anomalies. This presents significant challenges for those involved in counselling the parents of affected fetuses.     

Intrauterine repair of gastroschisis in fetal rabbits

OBJECTIVE: Infants with gastroschisis (GS) still face severe morbidity. Prenatal closure may prevent gastrointestinal organ damage, but intrauterine GS repair (GSR) has not been established yet. METHODS: In New Zealand White rabbits we developed and compared GS versus GSR: creation of GS was achieved by hysterotomy, right-sided laparotomy of the fetus and pressure on the abdominal wall to provoke evisceration. GSR was accomplished by careful reposition of eviscerated organs and a running suture of the fetal abdominal wall. For study purposes, 18 animals were divided equally into 3 groups: GS, GS with GSR after 2 h, and unmanipulated controls (C). Vitality was assessed by echocardiography. After 5 h all animals were sacrificed. RESULTS: GSR inflicted no increased mortality, because all fetuses survived GS or GS with GSR. All fetuses with GS demonstrated significant evisceration of abdominal organs. In contrast, the abdominal wall of the fetuses from GSR was intact. CONCLUSION: The present animal model demonstrated the technical feasibility and success of an intrauterine repair of GS for the first time. However, further long-term studies (leaving GS and GSR in utero for several days) will be necessary to compare survival rates and intestinal injury, motility or absorption. The clinical application of GSR in utero remains a vision so far.     

Female Sterilization in New South Wales, 1981 to 1994–1995

Summary: This paper investigates and confirms the dramatic decline in female sterilization in New South Wales over the past decade, a period when male sterilization has remained fairly constant. The most significant decline occurred among women under 30 years of age, which resulted in a rise in the mean age at sterilization. In 1994–1995, 70% of sterilization operations were performed for contraceptive management only, 11% were concurrent with Caesarean section, and 9% with abortion. Incidental findings were an increase in Caesarean section and the proportion of women having concurrent sterilization, and a large decline in intrauterine device removals, more than half of which were accompanied with sterilization in 1994–1995. Currently-married women accounted for 80% of sterilization cases. Immigrant women generally had lower incidence of sterilization compared to the Australian-born.     

Perinatal litigation in Scotland 1980-1995: its incidence, rate and nature.

Many claims about an increase in the incidence of perinatal litigation have been made, despite a lack of comprehensive data which might confirm this. A large scale study into litigation throughout Scotland from 1980 to 1995 revealed an initial sharp rise in the number of claims, but a fall in the overall number of claims made in 1994 and 1995; a similar picture was noted in a limited cross-border examination of English files. Not every area has experienced a reduction in incidence, and the rate of litigation (measured in deliveries per legal claim) varied hugely over time and between areas. A wide variety of head of claim was noted. Twenty-one percent of Scottish claims concerned cerebral palsy; of closed claims only 15% were successful, but a large proportion are still on-going. While the 'litigation crisis' is difficult to verify from these data, costs appear to be rising.     

An evaluation of the recording of folic acid use in the South West Congenital Anomaly Register

OBJECTIVE: Some congenital anomaly registers are collecting data on risk factors for pregnancies affected by anomalies; yet the quality of that information is rarely assessed. We assessed the quality of the risk factor data in the South West Congenital Anomaly Register (SWCAR) through a review of the data held on folic acid use, in cases of neural tube defect (NTD). METHODS: We reviewed all cases of NTD reported to SWCAR over 2 years and compared information held in the register with that in handwritten and computerised prenatal records, where available. RESULTS: Data on folic acid use was recorded in only 41 (36.9%) of the prenatal records of the 111 cases of NTDs reviewed. Information on any folic acid use in the prenatal records was transferred to the register in all instances where it existed. Information on the time of taking folic acid or not taking folic acid was rarely recorded in prenatal records. CONCLUSION: Incomplete recording of folic acid use and timing in prenatal records has limited the ability of SWCAR to collect accurate information on folic acid use in cases of NTDs. Minimal recording information on folic acid use in prenatal records is suggested.