Using data on breast cancer incidence and abortion rates from eight European countries, the document examines trends and forecasts future trends. It finds that induced abortion is the best predictor of breast cancer incidence, while fertility is also a useful predictor. A linear regression model including abortion and fertility rates as explanatory variables accurately predicted observed breast cancer incidence in subsequent years in England and Wales. The model forecasts a 50.9% increase in breast cancer incidence in England and Wales by 2025, corresponding to an annual 1.7% compound increase.
Prediccion y prevencion del parto preterminorubenhuaraz
This document discusses screening and prevention of preterm birth, which is the leading cause of neonatal mortality in the US. It describes various risk factors for preterm birth such as a prior preterm birth, short cervical length on ultrasound, vaginal bleeding, infections, and behavioral factors like smoking. Transvaginal ultrasound is an effective way to screen for short cervical length, which is a strong predictor of preterm birth risk. The document reviews evidence for different proposed screening and treatment methods, noting that while some risk factors are associated with preterm birth, treatments have not been shown to consistently and definitively reduce that risk.
Angela Lanfranchi - Abortion as a Cause of Breast Cancertjfjustice
The document discusses several studies that found associations between induced abortion and increased breast cancer risk, including one study that found a 40% increased risk and another that analyzed over 800 breast cancer cases and found consistent results with other studies. It also discusses the biological plausibility of the link, noting that abortion leaves the breast with more places for cancers to start due to interrupted lobular development during pregnancy.
INTERNATIONAL PUBLICATION International journal of gynecology & obstetri...Dr Muhammad Mustansar
This document summarizes a 5-year study of maternal mortality in Faisalabad City, Pakistan from 1989-1993. The study found 215 maternal deaths during this period, giving a maternal mortality rate of 0.77 deaths per 1,000 live births. The main causes of death were postpartum hemorrhage (23.3%), pregnancy induced hypertension/eclampsia (15.8%), and non-obstetric causes (15.8%). Efforts like traditional birth attendant training, community education, antenatal checkups, and improved obstetric care were found to help reduce the maternal mortality rate in the region over this time period.
- Maternal mortality in Ethiopia is a significant problem, with an estimated 25,000 maternal deaths per year. The major causes of maternal death are similar to other developing countries and include hemorrhage, sepsis, obstructed labor, hypertension, and unsafe abortion.
- There have been some changes in trends over time, with increasing proportions of deaths due to hypertension and hemorrhage, and a declining proportion due to unsafe abortion. Distance to health facilities remains a major factor influencing maternal outcomes.
Low birth beight and associated maternal factors in ghanaAlexander Decker
This study examined the prevalence of low birth weight (LBW) in Ghana and its association with maternal factors using data from the 2011 Multiple Indicator Cluster Survey. The estimated LBW prevalence was 9.2%, higher than other parts of the world. Factors found to be highly significantly associated with LBW included antenatal care, mother's educational level, location, and economic status. Maternal age under 24 or over 35, giving birth in the Central region, and having more than four children were also found to increase LBW risk. However, factors like malaria in pregnancy, ethnicity, and marital status were not significantly associated with LBW.
BLACK LIVES MATTER:
The latest Abortion report issued from the CDC in 2014. Displays that Black women (14% of the US population) make up 29.6 % of the nations abortions.
This document discusses neonatal mortality measurement and summarizes recent developments. It covers:
1) Neonatal mortality rates can now be estimated annually through improved surveys, though data reliability remains a concern. Pregnancy history modules may better capture neonatal deaths.
2) Estimates of neonatal causes of death have been improved through increased country data, especially for large countries like India and China. Rates of infections and tetanus appear to be declining in some areas.
3) Surveys can be improved by modifying questions to better capture neonatal mortality and stillbirths, and through follow up verbal autopsies to obtain cause of death data for over 75% of neonatal deaths dependent on surveys.
Prediccion y prevencion del parto preterminorubenhuaraz
This document discusses screening and prevention of preterm birth, which is the leading cause of neonatal mortality in the US. It describes various risk factors for preterm birth such as a prior preterm birth, short cervical length on ultrasound, vaginal bleeding, infections, and behavioral factors like smoking. Transvaginal ultrasound is an effective way to screen for short cervical length, which is a strong predictor of preterm birth risk. The document reviews evidence for different proposed screening and treatment methods, noting that while some risk factors are associated with preterm birth, treatments have not been shown to consistently and definitively reduce that risk.
Angela Lanfranchi - Abortion as a Cause of Breast Cancertjfjustice
The document discusses several studies that found associations between induced abortion and increased breast cancer risk, including one study that found a 40% increased risk and another that analyzed over 800 breast cancer cases and found consistent results with other studies. It also discusses the biological plausibility of the link, noting that abortion leaves the breast with more places for cancers to start due to interrupted lobular development during pregnancy.
INTERNATIONAL PUBLICATION International journal of gynecology & obstetri...Dr Muhammad Mustansar
This document summarizes a 5-year study of maternal mortality in Faisalabad City, Pakistan from 1989-1993. The study found 215 maternal deaths during this period, giving a maternal mortality rate of 0.77 deaths per 1,000 live births. The main causes of death were postpartum hemorrhage (23.3%), pregnancy induced hypertension/eclampsia (15.8%), and non-obstetric causes (15.8%). Efforts like traditional birth attendant training, community education, antenatal checkups, and improved obstetric care were found to help reduce the maternal mortality rate in the region over this time period.
- Maternal mortality in Ethiopia is a significant problem, with an estimated 25,000 maternal deaths per year. The major causes of maternal death are similar to other developing countries and include hemorrhage, sepsis, obstructed labor, hypertension, and unsafe abortion.
- There have been some changes in trends over time, with increasing proportions of deaths due to hypertension and hemorrhage, and a declining proportion due to unsafe abortion. Distance to health facilities remains a major factor influencing maternal outcomes.
Low birth beight and associated maternal factors in ghanaAlexander Decker
This study examined the prevalence of low birth weight (LBW) in Ghana and its association with maternal factors using data from the 2011 Multiple Indicator Cluster Survey. The estimated LBW prevalence was 9.2%, higher than other parts of the world. Factors found to be highly significantly associated with LBW included antenatal care, mother's educational level, location, and economic status. Maternal age under 24 or over 35, giving birth in the Central region, and having more than four children were also found to increase LBW risk. However, factors like malaria in pregnancy, ethnicity, and marital status were not significantly associated with LBW.
BLACK LIVES MATTER:
The latest Abortion report issued from the CDC in 2014. Displays that Black women (14% of the US population) make up 29.6 % of the nations abortions.
This document discusses neonatal mortality measurement and summarizes recent developments. It covers:
1) Neonatal mortality rates can now be estimated annually through improved surveys, though data reliability remains a concern. Pregnancy history modules may better capture neonatal deaths.
2) Estimates of neonatal causes of death have been improved through increased country data, especially for large countries like India and China. Rates of infections and tetanus appear to be declining in some areas.
3) Surveys can be improved by modifying questions to better capture neonatal mortality and stillbirths, and through follow up verbal autopsies to obtain cause of death data for over 75% of neonatal deaths dependent on surveys.
Maternal mortality remains a significant issue worldwide, with over 500,000 deaths annually. Through initiatives like the Confidential Enquiries into Maternal Deaths system, Malaysia has significantly reduced its maternal mortality rate from 540/100,000 live births in 1950 to 28.1/100,000 in 2000. Postpartum hemorrhage is a leading cause of death in Malaysia, while medical conditions, sepsis, and hypertensive disorders also contribute substantially. Recommendations focus on increasing access to emergency care and transportation, improving provider training, and expanding family planning programs.
Female fertility begins to decline many years prior to the onset of menopause despite continued regular ovulatory cycles. Although there is no strict definition of advanced reproductive age in women, infertility becomes more pronounced after the age of 35.
In India, roughly one maternal death occurs every five minutes. Maternal mortality is defined as the death of a woman during or within 42 days of pregnancy termination from pregnancy-related causes. The highest maternal mortality rates in 2010 were in Chad, Somalia, Central African Republic, Sierra Leone and Burundi, while the lowest were in Estonia and Singapore. Though India's maternal mortality ratio has declined from 400 in 1997 to 212 per 100,000 live births in 2007-2009, it still has a long way to go to meet its Millennium Development Goal of 109 by 2015. Anemia and unsafe abortion are significant causes of maternal death in India. National initiatives aim to strengthen antenatal, intranatal and
This document provides information on measures of fertility. It defines terms related to fertility such as fertility, fertility rate, crude birth rate, general fertility rate, age-specific fertility rate, total fertility rate, and gross and net reproduction rates. It explains how to calculate various fertility indicators and describes the importance and uses of fertility data as well as common sources of this type of demographic information.
Maternal mortality remains a significant global issue, with nearly 830 women dying daily from preventable causes related to pregnancy and childbirth. The majority (99%) of maternal deaths occur in developing countries, where access to skilled healthcare is limited. Key factors that influence a woman's risk include her location (rural areas pose higher risk), economic status (poorer communities at higher risk), and age (adolescents at highest risk). While the global maternal mortality ratio has declined 44% between 1990-2015, many countries still show no progress. Reliable data remains scarce but interventions like skilled birth attendance and access to family planning can significantly reduce maternal deaths.
Infant Mortality Rate in India -Millennium Development GoalVijay Kumar Modi
The document discusses infant mortality rate (IMR) and under-5 mortality rate (U5MR) in India. It defines IMR as the number of infant deaths per 1000 live births and notes that IMR and U5MR are sensitive indicators of socioeconomic development. It outlines the Millennium Development Goal of reducing IMR and notes that while India has made progress, it may narrowly miss the 2015 targets for IMR and U5MR reduction. It identifies factors that influence mortality rates and government initiatives to reduce them.
Women’s sexual and reproductive health – increasing the evidence baseIDS
The document discusses women's sexual and reproductive health issues in sub-Saharan Africa. It outlines high maternal mortality rates, low modern contraceptive use, high HIV prevalence disproportionately affecting women, and high rates of unsafe abortion and gender-based violence in the region. It also notes data and methodological challenges in studying these issues and proposes responses like integrating reproductive health services, prioritizing adolescents and unsafe abortion, and increasing domestic resource mobilization.
Trends in Maternal Mortality: 1990 to 2013 is jointly produced by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division.
The new data show a 45 per cent reduction in maternal deaths since 1990. An estimated 289,000 women died in 2013 due to complications in pregnancy and childbirth, down from 523,000 in 1990.
While impressive, the average annual rate of reduction of 2.6 per cent is still less than half the 5.5 per cent rate needed to achieve the Millennium Development Goal 5 which calls for a three-quarters reduction in maternal mortality between 1990 and 2015.
Saving Mothers and Babies: Introduction to maternal and perinatal mortalitySaide OER Africa
Newborn Care was written for healthcare workers providing special care for newborn infants in level 2 hospitals. It covers: An essential tool in the initial and ongoing training and teaching of any healthcare worker – Miriam Adhikari, South African Journal of Child Health, Primary Newborn Care was written specifically for nurses, midwives and doctors who provide primary care for newborn infants in level 1 clinics and hospitals. It covers: Mother and Baby Friendly Care describes gentler, kinder, evidence-based ways of caring for women during pregnancy, labour and delivery. It also presents improved methods of providing infant care with an emphasis on kangaroo mother care and exclusive breastfeeding. It covers: Saving Mothers and Babies was developed in response to the high maternal and perinatal mortality rates found in most developing countries. Learning material used in this book is based on the results of the annual confidential enquiries into maternal deaths and the Saving Mothers and Saving Babies reports published in South Africa. It addresses: the basic principles of mortality audit, maternal and perinatal mortality, managing mortality meetings, ways of reducing maternal and perinatal mortality rates, This book should be used together with the Perinatal Problem Identification Programme (PPIP).
Early Detection of Breast Cancer: Awareness and Practice of Self Breast Exami...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Increasing rates of prenatal testing among Jewish and Arab women in Israel ov...Jenny Ostrovsky
This study compared rates of prenatal testing among Jewish and Arab women in Israel over a decade from 2001 to 2010 using data from national surveys. The key findings were:
1) Rates of nuchal translucency screening and early ultrasound increased significantly for both groups but remained higher for Jewish women.
2) Rates of biochemical triple marker tests and amniocentesis did not change significantly for either group. Amniocentesis uptake among older women was higher for Jewish women.
3) Carrier screening rates increased more for Jewish women. Factors associated with higher uptake included income, education, insurance, and receiving information.
The infant mortality rate (IMR) is the number of infant deaths per 1000 live births. IMR is an important indicator of a country's development level and standard of living. Globally, IMR has significantly declined since 1960 due to improved healthcare, though it remains much higher in less developed countries. Common causes of infant mortality include low birth weight, respiratory issues, SIDS, and lack of essentials like food, shelter and water. Reducing behaviors like smoking during pregnancy and improving literacy, prenatal care, and access to health services can help lower IMR.
1) The document discusses the history and epidemiology of the HIV/AIDS epidemic from its earliest known cases in 1981 to modern day. It describes key events like the identification of HIV as the cause and the development of antiretroviral treatments.
2) Surveillance methods for HIV are discussed, including case reporting systems and sentinel surveillance at specific sites. Three types of epidemics - generalized, concentrated, and low-level - are also summarized.
3) Statistics and maps show the current global status of the HIV epidemic, with parts of sub-Saharan Africa most severely affected. Resources for further information are listed.
This document discusses maternal mortality in Malaysia and Sarawak. It defines maternal death and classifications like direct, indirect, and fortuitous causes. The maternal mortality ratio is used to measure maternal deaths per 100,000 live births. The national MMR has plateaued between 28-30 in recent years, though one state achieved the MDG 5 target of 11.08 in 2013. Confidential enquiries from 2009-2011 found the leading causes were medical disorders during pregnancy, hypertensive disorders, and obstetric complications. Over 60% of deaths occurred postnatally. Key recommendations include improving prenatal care, early intervention for high-risk women, strengthening referral systems, and addressing substandard care issues.
This document discusses severe maternal morbidity, also known as near-misses, which are life-threatening complications during pregnancy, childbirth, or postpartum that women survive only through medical intervention. It notes that over 50 million women experience maternal health issues annually. The document then provides definitions of near-miss cases and discusses risk factors. It presents statistics on near-miss cases from a private hospital in India compared to a rural hospital, finding higher rates in the rural hospital. The leading causes of near-misses are identified as pre-eclampsia/eclampsia and hemorrhage. The conclusion emphasizes the need for improved management of near-miss cases to reduce maternal mortality.
Female Infertility can be caused by physical obstructions like endometriosis or pelvic inflammatory disease blocking the fallopian tubes, hormonal issues interfering with ovulation, or problems with fertilization or early development. Around 12% of women experience infertility, which is generally treated through fertility drugs, surgery, artificial insemination or assisted reproductive technologies like in vitro fertilization. Coping strategies include considering other family planning options, seeking counseling or support groups, and maintaining a healthy lifestyle to potentially overcome infertility issues.
Indications and Outcomes of Emergency Caesarean Section at St Paul’s Hospital...Crimsonpublishers-IGRWH
Cesarean Section (CS) rates and their indications vary all over the World. Audit of indications and factors affecting infant and maternal outcome remain an important activity in rationalizing the use of this major procedure in obstetrics practice. Cesarean section (CS) carries a higher maternal morbidity and mortality compared to vaginal delivery. Noresearches have been done on this area.
Breast cancer is a disease in which cells in the breast grow out of control and can begin in different parts of the breast such as the lobules, ducts, or connective tissue. Signs of breast cancer include breast lumps, nipple discharge, or changes in breast appearance. Risk factors include being female, increasing age, family history, obesity, alcohol consumption, and not being physically active. Prevention methods consist of maintaining a healthy weight, regular exercise, limiting alcohol intake, and avoiding unnecessary radiation exposure. In Iraq, breast cancer rates have been increasing from 2000-2009 with the highest incidence rates among women ages 50-59.
This document summarizes epidemiological data on breast cancer incidence and mortality rates globally and in various countries and populations. It finds that breast cancer incidence is highest in more developed countries and among white women in the US. Known risk factors include reproductive factors like early menarche, nulliparity, late age at first birth, and lack of breastfeeding; exogenous hormones from oral contraceptives and post-menopausal hormones; family history and genetic factors; and certain medical factors.
Maternal mortality remains a significant issue worldwide, with over 500,000 deaths annually. Through initiatives like the Confidential Enquiries into Maternal Deaths system, Malaysia has significantly reduced its maternal mortality rate from 540/100,000 live births in 1950 to 28.1/100,000 in 2000. Postpartum hemorrhage is a leading cause of death in Malaysia, while medical conditions, sepsis, and hypertensive disorders also contribute substantially. Recommendations focus on increasing access to emergency care and transportation, improving provider training, and expanding family planning programs.
Female fertility begins to decline many years prior to the onset of menopause despite continued regular ovulatory cycles. Although there is no strict definition of advanced reproductive age in women, infertility becomes more pronounced after the age of 35.
In India, roughly one maternal death occurs every five minutes. Maternal mortality is defined as the death of a woman during or within 42 days of pregnancy termination from pregnancy-related causes. The highest maternal mortality rates in 2010 were in Chad, Somalia, Central African Republic, Sierra Leone and Burundi, while the lowest were in Estonia and Singapore. Though India's maternal mortality ratio has declined from 400 in 1997 to 212 per 100,000 live births in 2007-2009, it still has a long way to go to meet its Millennium Development Goal of 109 by 2015. Anemia and unsafe abortion are significant causes of maternal death in India. National initiatives aim to strengthen antenatal, intranatal and
This document provides information on measures of fertility. It defines terms related to fertility such as fertility, fertility rate, crude birth rate, general fertility rate, age-specific fertility rate, total fertility rate, and gross and net reproduction rates. It explains how to calculate various fertility indicators and describes the importance and uses of fertility data as well as common sources of this type of demographic information.
Maternal mortality remains a significant global issue, with nearly 830 women dying daily from preventable causes related to pregnancy and childbirth. The majority (99%) of maternal deaths occur in developing countries, where access to skilled healthcare is limited. Key factors that influence a woman's risk include her location (rural areas pose higher risk), economic status (poorer communities at higher risk), and age (adolescents at highest risk). While the global maternal mortality ratio has declined 44% between 1990-2015, many countries still show no progress. Reliable data remains scarce but interventions like skilled birth attendance and access to family planning can significantly reduce maternal deaths.
Infant Mortality Rate in India -Millennium Development GoalVijay Kumar Modi
The document discusses infant mortality rate (IMR) and under-5 mortality rate (U5MR) in India. It defines IMR as the number of infant deaths per 1000 live births and notes that IMR and U5MR are sensitive indicators of socioeconomic development. It outlines the Millennium Development Goal of reducing IMR and notes that while India has made progress, it may narrowly miss the 2015 targets for IMR and U5MR reduction. It identifies factors that influence mortality rates and government initiatives to reduce them.
Women’s sexual and reproductive health – increasing the evidence baseIDS
The document discusses women's sexual and reproductive health issues in sub-Saharan Africa. It outlines high maternal mortality rates, low modern contraceptive use, high HIV prevalence disproportionately affecting women, and high rates of unsafe abortion and gender-based violence in the region. It also notes data and methodological challenges in studying these issues and proposes responses like integrating reproductive health services, prioritizing adolescents and unsafe abortion, and increasing domestic resource mobilization.
Trends in Maternal Mortality: 1990 to 2013 is jointly produced by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division.
The new data show a 45 per cent reduction in maternal deaths since 1990. An estimated 289,000 women died in 2013 due to complications in pregnancy and childbirth, down from 523,000 in 1990.
While impressive, the average annual rate of reduction of 2.6 per cent is still less than half the 5.5 per cent rate needed to achieve the Millennium Development Goal 5 which calls for a three-quarters reduction in maternal mortality between 1990 and 2015.
Saving Mothers and Babies: Introduction to maternal and perinatal mortalitySaide OER Africa
Newborn Care was written for healthcare workers providing special care for newborn infants in level 2 hospitals. It covers: An essential tool in the initial and ongoing training and teaching of any healthcare worker – Miriam Adhikari, South African Journal of Child Health, Primary Newborn Care was written specifically for nurses, midwives and doctors who provide primary care for newborn infants in level 1 clinics and hospitals. It covers: Mother and Baby Friendly Care describes gentler, kinder, evidence-based ways of caring for women during pregnancy, labour and delivery. It also presents improved methods of providing infant care with an emphasis on kangaroo mother care and exclusive breastfeeding. It covers: Saving Mothers and Babies was developed in response to the high maternal and perinatal mortality rates found in most developing countries. Learning material used in this book is based on the results of the annual confidential enquiries into maternal deaths and the Saving Mothers and Saving Babies reports published in South Africa. It addresses: the basic principles of mortality audit, maternal and perinatal mortality, managing mortality meetings, ways of reducing maternal and perinatal mortality rates, This book should be used together with the Perinatal Problem Identification Programme (PPIP).
Early Detection of Breast Cancer: Awareness and Practice of Self Breast Exami...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Increasing rates of prenatal testing among Jewish and Arab women in Israel ov...Jenny Ostrovsky
This study compared rates of prenatal testing among Jewish and Arab women in Israel over a decade from 2001 to 2010 using data from national surveys. The key findings were:
1) Rates of nuchal translucency screening and early ultrasound increased significantly for both groups but remained higher for Jewish women.
2) Rates of biochemical triple marker tests and amniocentesis did not change significantly for either group. Amniocentesis uptake among older women was higher for Jewish women.
3) Carrier screening rates increased more for Jewish women. Factors associated with higher uptake included income, education, insurance, and receiving information.
The infant mortality rate (IMR) is the number of infant deaths per 1000 live births. IMR is an important indicator of a country's development level and standard of living. Globally, IMR has significantly declined since 1960 due to improved healthcare, though it remains much higher in less developed countries. Common causes of infant mortality include low birth weight, respiratory issues, SIDS, and lack of essentials like food, shelter and water. Reducing behaviors like smoking during pregnancy and improving literacy, prenatal care, and access to health services can help lower IMR.
1) The document discusses the history and epidemiology of the HIV/AIDS epidemic from its earliest known cases in 1981 to modern day. It describes key events like the identification of HIV as the cause and the development of antiretroviral treatments.
2) Surveillance methods for HIV are discussed, including case reporting systems and sentinel surveillance at specific sites. Three types of epidemics - generalized, concentrated, and low-level - are also summarized.
3) Statistics and maps show the current global status of the HIV epidemic, with parts of sub-Saharan Africa most severely affected. Resources for further information are listed.
This document discusses maternal mortality in Malaysia and Sarawak. It defines maternal death and classifications like direct, indirect, and fortuitous causes. The maternal mortality ratio is used to measure maternal deaths per 100,000 live births. The national MMR has plateaued between 28-30 in recent years, though one state achieved the MDG 5 target of 11.08 in 2013. Confidential enquiries from 2009-2011 found the leading causes were medical disorders during pregnancy, hypertensive disorders, and obstetric complications. Over 60% of deaths occurred postnatally. Key recommendations include improving prenatal care, early intervention for high-risk women, strengthening referral systems, and addressing substandard care issues.
This document discusses severe maternal morbidity, also known as near-misses, which are life-threatening complications during pregnancy, childbirth, or postpartum that women survive only through medical intervention. It notes that over 50 million women experience maternal health issues annually. The document then provides definitions of near-miss cases and discusses risk factors. It presents statistics on near-miss cases from a private hospital in India compared to a rural hospital, finding higher rates in the rural hospital. The leading causes of near-misses are identified as pre-eclampsia/eclampsia and hemorrhage. The conclusion emphasizes the need for improved management of near-miss cases to reduce maternal mortality.
Female Infertility can be caused by physical obstructions like endometriosis or pelvic inflammatory disease blocking the fallopian tubes, hormonal issues interfering with ovulation, or problems with fertilization or early development. Around 12% of women experience infertility, which is generally treated through fertility drugs, surgery, artificial insemination or assisted reproductive technologies like in vitro fertilization. Coping strategies include considering other family planning options, seeking counseling or support groups, and maintaining a healthy lifestyle to potentially overcome infertility issues.
Indications and Outcomes of Emergency Caesarean Section at St Paul’s Hospital...Crimsonpublishers-IGRWH
Cesarean Section (CS) rates and their indications vary all over the World. Audit of indications and factors affecting infant and maternal outcome remain an important activity in rationalizing the use of this major procedure in obstetrics practice. Cesarean section (CS) carries a higher maternal morbidity and mortality compared to vaginal delivery. Noresearches have been done on this area.
Breast cancer is a disease in which cells in the breast grow out of control and can begin in different parts of the breast such as the lobules, ducts, or connective tissue. Signs of breast cancer include breast lumps, nipple discharge, or changes in breast appearance. Risk factors include being female, increasing age, family history, obesity, alcohol consumption, and not being physically active. Prevention methods consist of maintaining a healthy weight, regular exercise, limiting alcohol intake, and avoiding unnecessary radiation exposure. In Iraq, breast cancer rates have been increasing from 2000-2009 with the highest incidence rates among women ages 50-59.
This document summarizes epidemiological data on breast cancer incidence and mortality rates globally and in various countries and populations. It finds that breast cancer incidence is highest in more developed countries and among white women in the US. Known risk factors include reproductive factors like early menarche, nulliparity, late age at first birth, and lack of breastfeeding; exogenous hormones from oral contraceptives and post-menopausal hormones; family history and genetic factors; and certain medical factors.
This document summarizes risk factors for breast cancer. It finds that age is a major risk factor, with risk doubling every 10 years until menopause. Geographic location also impacts risk, with Western countries having higher rates than Eastern countries. Family history is another key risk factor, as up to 10% of breast cancers have a genetic component. Having a first degree relative diagnosed under age 50 more than doubles an individual's risk. Other risk factors include early menarche, late menopause, late first pregnancy, previous benign breast disease, and exposure to ionizing radiation. Certain genetic mutations like BRCA1 and BRCA2 account for many high risk familial cases.
This study examined trends in the incidence of ectopic pregnancy in England and Wales from 1966 to 1996 using official hospitalization statistics. The results showed that the recorded incidence of ectopic pregnancy increased approximately 4.5 times over this period, from 3.45 to 15.5 per 1000 maternities. The rate of increase was not uniform, approximately doubling between 1966-1985, then again nearly doubling by 1989. The incidence has remained stable in recent years. The trends were similar across different age groups. The increasing incidence is likely due to both improved diagnostic tests and an actual increase possibly related to a sexually transmitted infection.
Dr Ayman Ewies - Cervical screening 2009AymanEwies
Cervical cancer is caused by persistent infection with high-risk HPV types. Screening programs that use cervical cytology have significantly reduced cervical cancer rates in developed nations. However, most developing countries lack organized screening programs. New screening methods like VIA may be effective alternatives in resource-poor settings. HPV vaccination aims to prevent HPV 16/18 infection and further reduce cancer rates, though screening will still be important, especially for older unvaccinated women.
Cancer epidemiology is the study of cancer occurrence and distribution in human populations. Some key points from the document include:
- The earliest known descriptions of cancer come from ancient Egyptian medical texts from 3000-1500 BC.
- Important historical discoveries in cancer epidemiology include linking tobacco smoking to lung cancer in 1950 and occupations like chimney sweeping to scrotum cancer in 1775.
- Common sources of cancer epidemiology data include registries like SEER in the US and IARC internationally, which provide statistics on incidence, mortality, survival rates.
- Cancer risk varies based on age, sex, race, and other demographic factors. Globally, lung cancer is the most commonly diagnosed cancer while breast
This document summarizes risk factors for breast cancer. It discusses both endogenous (internal) factors like age, family history and genetics, as well as exogenous (external) factors like hormone therapy, weight, diet and environmental exposures. Endogenous factors that increase risk include older age, positive family history, genetic mutations, earlier age of menarche or later age of menopause. Exogenous risks include long term hormone therapy, obesity, alcohol consumption, and exposure to ionizing radiation. Maintaining a healthy weight and physical activity are recommended for primary prevention, along with a plant-based diet and limiting alcohol intake.
This document discusses cancers in Barnet and the UK. It covers several key points:
1) Cancer is the second leading cause of death in Barnet and the UK. There are many types of cancer that impact different organs. Lung, colon/rectum, breast and prostate cancers cause the most deaths in Barnet based on 2004-2007 data.
2) Risk factors for cancer include tobacco use, alcohol intake, diet, obesity and family history. Screening programs have helped reduce cancer mortality through earlier detection.
3) The document examines relationships between cancer rates and socioeconomic factors like deprivation. Lung cancer deaths are higher in more deprived areas while trends for breast and colorectal cancers are less
Women under 30years of age are not offered free cervical screen. However some women with symptoms present for a diagnostic cervical smear. These women have a high incidence of High Grade Lesions requiring Colposcopy and treatment.
The document discusses various topics related to cancer epidemiology. It provides statistics showing that lung, breast, colon, stomach, prostate, liver and cervix cancers are among the most common types of cancer. It also discusses factors contributing to cancer deaths, finding that tobacco use accounts for 30%, diet 35%, infections 10%, and other factors like occupation, pollution and genetics account for smaller percentages. The document also discusses associations between specific cancers and factors like infections, radiation, chemicals, diet, obesity and geography.
The incidence of significant lesions on cervical smears in women under thirty...Genevieve Warner Learmonth
The incidence of HIgh Grade Lesions ( HSIL) on cervical smears from women under 30 years in Cape Town, South Africa is recorded. Women in SA are only offered a free cervical smear at age 30 and then every ten years until age 50.. The clinical, public health, and psycho social implications of this issue are discussed.
This document discusses cervical cancer screening in South Africa. It finds that 21% of cervical smear tests in Cape Town from 2010-2011 were from women under 30 years old, and 19% of women referred to colposcopy for suspicious lesions or high-grade abnormalities were under 30. This suggests that starting cervical cancer screening at age 30, as currently recommended in South Africa, may be too late to identify pre-cancerous lesions in many young women. Given risk factors like early sexual debut, HPV infection rates of 21%, and peak HIV rates in women aged 25-29, revising national screening guidelines to start screening earlier is imperative to prevent morbidity and mortality from cervical cancer in South Africa.
Higher rates of stillbirths and infant mortality in the UK compared to other European countries may be due to several complex, interacting risk factors such as obesity, smoking during pregnancy, maternal age, socioeconomic inequalities, and certain ethnic groups having higher risks. Improving care during pregnancy, labor, and early infancy could help reduce mortality rates, though many existing clinical guidelines aimed at higher-risk groups are not always followed. Addressing modifiable risk factors like smoking and obesity through public health interventions may help improve health outcomes for infants and families in the UK.
This document discusses variations in breast cancer incidence and mortality rates globally. Some key points:
- Breast cancer remains the most commonly diagnosed cancer in women worldwide, with 1.6 million new cases annually.
- Incidence rates have doubled in developed countries over the last three decades due to screening programs and other factors. Rates are also rising sharply in developing nations.
- Mortality rates show geographic variations and have declined in some countries likely due to earlier detection and improved treatment. However, breast cancer deaths remain a significant burden, especially in developing world.
According to Dr. Vo Dang Hung, Director of TMMC Healthcare's Oncology Center. Breast Cancer is the most popular cancer among women. Know your risks and get frequent Breast Cancer Screenings to protect yourself.
The document discusses breast cancer screening guidelines and recommendations. It notes that various medical organizations have different guidelines for mammography screening, with some recommending annual screening beginning at age 40 while others recommend biennial screening between ages 50-74. The document also discusses debates around overdiagnosis from mammography screening and challenges in assessing its effectiveness due to the slow progression of breast cancer.
The document discusses plans for a new randomized trial in the UK to assess the effects of additional breast cancer screening invitations outside of the standard age range of 50-70. It will involve millions of women being randomized to receive either one extra screening invitation before age 50 or one or more extra invitations after age 70. The main results on breast cancer mortality will not emerge until the 2020s, but the trial aims to help determine the effects of screening at younger or older ages. It also discusses an ongoing collaboration between breast cancer trialists to further review data from past screening trials and help assess the impact of screening on breast cancer mortality rates.
Knowledge, Attitude and Practice toward Cervical Cancer and Cervical Cancer S...ijtsrd
BACKGROUND Invasive Cervical Cancer ICC has been identified as the second most common cause of morbidity and mortality compared to other cancers among women in Cameroon. Cervical cancer can be treated e ectively if diagnosed early. Less than half the number of participants presented with good practice.The correlation between participants’ knowledge, attitude and practice showed that there was a significant association which therefore provides sufficient evidence to reject the null hypothesis. The result obtained in this study indicates how useful it will be to establish health education programs to increase women’s awareness and knowledge about cervical cancer. Fongang Che Landis | Enow-Orock George | Njajou Omer | Ngowe Ngowe Marcelin "Knowledge, Attitude and Practice toward Cervical Cancer and Cervical Cancer Screening and Its Associated Factors among Women in the City of Bamenda, Cameroon" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-4 , June 2021, URL: https://www.ijtsrd.compapers/ijtsrd43667.pdf Paper URL: https://www.ijtsrd.commedicine/other/43667/knowledge-attitude-and-practice-toward-cervical-cancer-and-cervical-cancer-screening-and-its-associated-factors-among-women-in-the-city-of-bamenda-cameroon/fongang-che-landis
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El documento presenta una lista de candidatos a cargos políticos de diferentes partidos y secciones/departamentos de Mendoza, incluyendo nombres, cargos e identificación de la boleta electoral.
La Unión Europea ha anunciado nuevas sanciones contra Rusia por su invasión de Ucrania. Las sanciones incluyen prohibiciones de viaje y congelamiento de activos para más funcionarios rusos, así como restricciones a las importaciones de productos rusos de acero y tecnología. Los líderes de la UE esperan que estas medidas adicionales aumenten la presión sobre Rusia para poner fin a su guerra contra Ucrania.
El programa Precios Cuidados se renovó en 2021 con el doble de productos que en 2020, totalizando 660 artículos. Se incorporaron más de 260 nuevos productos y 38 primeras marcas. También se ampliaron las categorías a 13 rubros y se triplicó la oferta de leches larga vida. El objetivo es generar referencias de precios accesibles y proteger el poder adquisitivo de los consumidores.
El documento lista 28 categorías de productos que incluyen alimentos para mascotas, golosinas, cervezas, gaseosas, panes, pastas, quesos, snacks, vegetales congelados, aceites aromatizantes, bolsas, ceras, cremas corporales, cuidado bucal, cuidado del cabello, desodorantes, escobas, jabones, limpiadores, pañales, papeles, productos para el baño del bebé, productos para lavar ropa, protección femenina, repelentes, ropa interior descartable, tal
El documento expresa que las leyes y legisladores argentinos deben proteger la vida humana desde la concepción hasta los 18 años de acuerdo a tratados internacionales y la constitución nacional. Argumenta que el pueblo de Mendoza se ha manifestado en contra del aborto y los legisladores deben representar la voluntad mayoritaria de proteger ambas vidas. Insta a los legisladores a implementar políticas que protejan toda vida humana desde la concepción.
El documento lista los montos de suplementos particulares para diferentes grados y funciones dentro del Ministerio de Seguridad de Argentina a partir del 1 de octubre de 2020, incluyendo comandantes generales, mayores, principales y otros rangos, así como suboficiales mayores, principales, sargentos y cabos.
El documento lista los haberes mensuales para diferentes rangos en la Gendarmería Nacional, que van desde 98.589,86 pesos para el Comandante General hasta 29.116,89 pesos para el Gendarme II. Establece también el haber mensual para el personal con estado militar de Gendarme en actividad a partir del 1 de octubre de 2020.
Este documento lista los haberes mensuales a partir del 1 de octubre de 2020 para los grados militares en la República Argentina, que van desde Teniente General con un haber de 117,168 pesos hasta Voluntario 2da y Marinero 2da con 25,457 pesos.
Gobierno otorga $1.300 millones a 202 obras sociales para cancelar pagos a pr...Mario Guillermo Simonovich
Este documento presenta un listado de distribución de obras sociales para el mes de septiembre de 2020, con el número de registro nacional de obras sociales, el nombre de cada obra social y el monto asignado a cada una. Se incluyen más de 100 obras sociales de diferentes sectores como la industria, el comercio, los servicios y el sector público, con montos que van desde $8.137 hasta $152.050.740.
El documento describe cómo la pandemia de COVID-19 ha exacerbado las desigualdades económicas debido a las acciones de grandes corporaciones. Estas empresas han antepuesto los beneficios de los accionistas ricos a la protección de los trabajadores, agravando los impactos de la crisis. En particular, han pagado excesivos dividendos antes de la pandemia, dejándolas vulnerables, y han continuado haciéndolo durante la crisis a pesar de las pérdidas, en lugar de usar esos fondos para apoyar a los empleados y las com
La Corte Suprema de Justicia de Mendoza dispuso medidas adicionales para reducir la cantidad de personal en el Poder Judicial debido a la pandemia de COVID-19, incluyendo inhabilitar el trabajo entre el 17 y 31 de marzo e implementar el teletrabajo. También aprobó un plan de contingencia tecnológico para permitir la presentación remota de documentos, audiencias virtuales y trabajo remoto, a fin de garantizar el acceso a la justicia durante la emergencia.
La Unión Europea ha acordado un paquete de sanciones contra Rusia por su invasión de Ucrania. Las sanciones incluyen restricciones a las transacciones con bancos rusos clave y la prohibición de la venta de aviones y equipos a Rusia. Los líderes de la UE esperan que las sanciones aumenten la presión económica sobre Rusia y la disuadan de continuar su agresión contra Ucrania.
Procedimiento para la revisión de concursos de personal y de nombramientos en...Mario Guillermo Simonovich
Este documento presenta una guía de implementación para las acciones instruidas por el Decreto No 36/2019, el cual ordena la revisión de procesos concursales y de selección de personal en el sector público nacional. Se establece la conformación de un equipo técnico revisor integrado por 3 miembros de cada jurisdicción y un veedor de la Secretaría de Gestión y Empleo Público. También se detallan los pasos a seguir en el análisis de expedientes, como definir el universo a revisar, analizar documentación
El documento trata sobre el manejo del cianuro en la extracción de oro. Explica que el cianuro es una sustancia química común e importante industrialmente que se usa ampliamente en la industria minera, particularmente para extraer oro debido a su capacidad única de disolver el metal precioso. Luego describe los usos generales del cianuro, su química, y los procesos empleados para su producción, manejo y monitoreo en las operaciones mineras, con el fin de minimizar riesgos para la salud y el ambiente.
The Children are very vulnerable to get affected with respiratory disease.
In our country, the respiratory Disease conditions are consider as major cause for mortality and Morbidity in Child.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
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The Breast Cancer Epidemic: Modeling and Forecasts Based on Abortion and Other Risk Factors
1. ABSTRACT
Using national cancer registration data for female breast cancer
incidence in eight European countries—England & Wales,
Scotland, Northern Ireland, the Irish Republic, Sweden, the Czech
Republic, Finland, and Denmark—for which there is also
comprehensive data on abortion incidence, trends are examined
and future trends predicted. Seven reproductive risk factors are
considered as possible explanatory variables. Induced abortion is
found to be the best predictor, and fertility is also a useful predictor.
Forecasts are made using a linear regression model with these
explanatory variables. Previous forecasts using the same model
and incidence data for years through 1997 for England & Wales are
compared with numbers of cancers observed in years from
1998–2004 in an Appendix. The forecast predicted 100.5% of the
cancers observed in 2003, and 97.5% of those observed in 2004.
TheChallengeofAbortion forEpidemiologists
inFemaleBreastCancerResearch
Trends
It is difficult for epidemiologists to discover women’s abortion
history. In any study the numbers of women who have had abortions
maybeunderreported.
National data on abortions in most countries tends to be
deficient, with abortions underreported. Official abortion statistics
in the United States and France are known to understate the
numbers of legal induced abortions.The countries considered in this
studyarebelieved tohavenearlycompleteofficialabortioncounts.
The long lag time for the development of breast cancer
magnifies the problem. The average age of diagnosis is over 60,
while most abortions and live births occur at ages under 30. The
modern increase in breast cancer incidence is obvious at ages over
45, and Figure 1 for England & Wales shows the increase is small
belowage45.
Abortion did not become legal in most Western countries until
the 1970s, and earlier abortions among older women are not
recorded. Consequently, the older women, whose breast cancer
incidence is known, have abortions not detectable by a longitudinal
study, while the younger women, whose abortion history is
known, tend to be too young to have experienced most of the
modern increase in breast cancer. Where the increased risk is
apparent, even under age 40 in a study free of recall bias, there is
anacknowledgedneedtoextendthestudytowomenolderthan40.
The long time lags, however, can be used to make long-term
forecastsofcancertrends.
Since 1971 the overall increase has been 80%, as shown for
England&WalesinFigure1.
1
2 3
4
1,5,6
1,5,7-11
12
4
In contrast to other cancers, breast cancer is more common in
upper-class women. This reverse gradient is becoming steeper:
see Figure 2. The reported standardized mortality ratio (SMR) in
England for the highest social class I increased to 174 for the years
1997–2000, compared to an SMR of 169 for the years 1993–1996.
As upper-class women have higher survival rates, the incidence
gradient is steeper than the mortality gradient. Fertility differences
do little to explain this gradient. However, the age at first birth
among women who have children does provide a two-fold partial
explanation. The least deprived women studied in a British survey
were found to have a greater preference for abortion when
pregnant. Higher-class women have a later age at first birth and
consequently higher-class women have nulliparous abortions,
whicharemorecarcinogenic.
Local variation within countries can be examined in addition to
international comparisons. The South East of England has more
breast cancer than other parts of the British Isles. It also has the
highest abortion rate. Ireland has the lowest rate of breast cancer
13
14
15
16
17
0
50
100
150
200
250
300
350
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year
Rateper100,000women
40-44 45-49 50-54 55-59
0
20
40
60
80
100
120
140
160
180
200
I II IIIN IIIM IV V
Social Class
Social Class I is the highest profesional. Social Class IIIN is Skilled Non-Manual and IIIM is Skilled Manual.
ProprotionalMortalityRatio
2001-2004 Forecast
1997-2000
1993-1996
Patrick S. Carroll, M.A.
The Breast Cancer Epidemic:
Modeling and Forecasts Based on Abortion
and Other Risk Factors
Figure 1. Average Yearly Rate of Incidence of Female Breast Cancer in
England & Wales within Age Groups 40-44, 45-49, 50-54 and 55-59 from
1971-2004
Figure 2. Female Breast Cancer Mortality by Social Class: Proportional
mortality ratios show increased reverse gradient across social class of
women in England & Wales.
Journal of American Physicians and Surgeons Volume 12 Number 3 Fall 200772
2. 0.00
0.05
0.10
0.15
0.20
0.25
0.30
1923 1928 1933 1938 1943 1948 1953 1958 1963 1968
Year of Birth
CumulatedCohortAbortionRate
0.000
0.002
0.004
0.006
0.008
0.010
0.012
0.014
0.016
CumulatedCohortBreastCancerRate
Nulliparous Abortion Rate
Parous Abortion Rate
Breast Cancer Rate
0.00
0.05
0.10
0.15
0.20
0.25
0.30
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
Year of Birth
CohortAbortion
0.000
0.002
0.004
0.006
0.008
0.010
0.012
0.014
0.016
CohortBreastCancer
Abortion Rate per w oman
Breast Cancer Rate per w oman
Correlation Coefficient: 0.98
and the lowest abortion rate. Fertility, higher in Ireland than in
England, is also a factor. But in the South East of England fertility is
not lower than the English average and does not explain the above-
averagebreastcancerrate.
Seven known risk factors were examined as an explanation for
thesetrends:
When a woman is nulliparous, an induced abortion has a greater
carcinogenic effect because it leaves breast cells in a state of
interrupted hormonal development in which they are more
susceptible.
Alowageatfirstbirthisprotective.
Childlessnessincreasestherisk.
A larger number of children (higher fertility) increases
protection.
Breastfeedinggivesadditionalprotection.
Hormonalcontraceptivesareconducivetobreastcancer.
Hormone replacement therapy (HRT) is also conducive to
breastcancer.
For four of these risk factors we are fortunate to have useful
English national data.The total fertility rates (TFRs) and completed
cohort fertility rates are as published by the Office for National
Statistics (ONS), and the total abortion rates (TARs) and cohort
abortionratesarederivedbytheauthorfromofficialdata.
Figure 3 shows cumulated cohort abortion rates for successive
birth cohorts of women born since 1926 in England & Wales,
together with cumulated cohort breast cancer rates for women aged
50–54. The correlation coefficient is high (>0.9), and it is useful to
includethisvariableasanexplanatoryvariableinmodeling.
Figure 4 shows the rates decomposed into parous and
nulliparous cohort rates. The increasing proportion of nulliparous
abortions affecting the women now entering age groups where they
are likely to have breast cancer is apparent. This trend is a driver of
thefurtherincreasesinbreastcancerincidencenow observed.
Figure 5 shows average number of children, representing the
cumulated cohort fertility rate for successive birth cohorts of
English women compared with their breast cancer rate for cancer in
women aged 50–54. The correlation coefficient is -0.57, so this
variableisalsousefultoincludeinmodeling.
Figure 6 shows mean age at first birth in England & Wales for
successive birth cohorts. If the correlation were positive it could
helptoexplainthetrend,butitisnegative.
Figure 7 shows cohort childlessness. The correlation in the
graph is negative, and this variable is not used in the model to
explaintheBritishtrend.
Two explanatory variables are selected for modeling:
(abortion) and (fertility). The trends for abortion and fertility are
shown inFigures8and9forcountriesconsidered.
TheMathematicalModelisthen:
where represents cumulated cohort incidence of breast cancer
within a particular age group; is intercept, and are
coefficients,and israndomerror.
Risk Factors
ModelingforEngland &Wales
18
19
20
15
17
x
x
Y
a b b
e
1
2
1 2
Y = a + b x + b x + ei i i i1 1 2 2
1.80
1.90
2.00
2.10
2.20
2.30
2.40
2.50
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
Year of Birth
CohortFertility
0.000
0.002
0.004
0.006
0.008
0.010
0.012
0.014
0.016
CohortBrestCancer
Fertility Rate per w oman
Breast Cancer Rate per w oman
Correlation Coefficient: -0.57
Figure 3. Cohort Breast Cancer Incidence within Ages 50-54 vs. Cumulated
Cohort Abortion Rate for Women in England & Wales: Cohorts are defined
by year of birth.
Figure 4. Cumulated Cohort Rates of Abortion (Parous and Nulliparous)
and Cumulated Cohort Rate of Breast Cancer within Ages 50-54 for Women
in England & Wales
Figure 5. Cohort Breast Cancer Incidence within Ages 50-54 vs.
Cumulated Cohort Fertility for Women in England & Wales: Cohorts are
defined by year of birth.
22.5
23.0
23.5
24.0
24.5
25.0
1926 1928 1930 1932 1934 1936 1938 1940 1942 1944 1946 1948 1950 1952 1954
Year of Birth
MeanAgeatFirstBirth
0.000
0.001
0.002
0.003
0.004
0.005
0.006
0.007
0.008
0.009
0.010
CohortBreastCancerRate
Mean Age at First Birth
Breast Cancer Cohort
Correlation Coefficient: -0.56
Figure 6. Cohort Mean Age at First Birth vs Cumulated Breast
Cancer within Age Group 45-49 for
Cohort
Women in England & Wales
Journal of American Physicians and Surgeons Volume 12 Number 3 Fall 2007 73
3. This model has desirable mathematical properties such as
dimensional homogeneity, linearity, additivity, and parsimonious
parameterization.
The model makes sense in terms of the factors not explicitly
included. Higher fertility is associated with a lower age at first birth
and less childlessness. Breastfeeding is strongly linked to fertility.
Likewise lower fertility is associated with more use of hormonal
contraceptives. Abortion can lead to prescription of hormonal
contraceptives, and the mental health sequelae of abortion may lead
touseofhormonereplacementtherapy.
The model was fitted to English female cohorts born in the years
up to 1950 for cancer in women aged 50–54. The multiple was
0.951. The estimated coefficient of abortion ( ) is 0.0166 (95% CI,
.0065-.0396), and the coefficient of fertility ( ) is −0.0047 (95%
CI, −.0135-.0041). The coefficient of fertility is rather small, with
the 95% confidence interval straddling zero. Some improvement in
breastfeeding may be offsetting fertility decline. These results are
summarized inTable1.
Forecasts are made using the model with the latest TFRs and
TARs to estimate cumulated cohort rates of fertility and abortion
for 25 years in the future. Here the recent rates for England & Wales
in 2006 ofTFR 1.86 andTAR 0.55 are used. Fitting this model gives
an overall increase in the rate of cancer of 50.9%, which
corresponds to a yearly compound increase of 1.7%.Assuming the
breast cancer incidence rates for ages below 45 are constant, for
ages 45–49 follow the trend as modeled for this age group, and for
ages over 50 follow the trend as modeled for ages 50–54, we can
estimate future breast cancer incidence rates for 25 future years
with 2004 as base year for prediction. The numbers of new cancers
to be expected in these years is then estimated using the
Government Actuary’s population projections by applying the
forecast incidence rates to the expected numbers of women in the
relevantagegroups ineachyear.
The numbers of newly diagnosed cancers forecast by this model
are expected to increase to 65,252 in 2025, compared to the
reported number 39,229 in 2004 (a 66.3% increase). These are
shown withforecastsforintermediateyearsinTable2.
The 1997-based forecasts using this model published in 2002
have anticipated quite well the reported increases in female breast
cancerinEngland&Walesin1998to2004[AppendixA].
Cases of ductal carcinoma in situ (DCIS), which also requires
treatment, are registered separately and are also forecast. DCIS is
shown on mammography, and the number of cases has increased in
the age groups targeted by screening. In 2004 there were 39,229
breast cancers and 3,827 cases of DCIS registered in England &
Wales. The number of future cases is forecast by assuming that the
ratio of cancers to DCIS stays constant in the main age groups
affected.Theincreasednumbersforecastareshown inTable2.
These forecast numbers can be used to plan treatment facilities
forwomendiagnosedwithcancer.
In Scotland the incidence gradient (Figure 10) is less than the
gradient in England (Figure 2), and the mortality gradient is almost
R
b
b
1
2
ForecastingforEngland &Wales
ModelingApplied totheSocialGradient
21
4
0.00
0.20
0.40
0.60
0.80
1.00
1.20
1.40
1.60
1.80
1968 1970 1972 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006
Year
TotalAbortionRate
England & Wales Scotland Northern Ireland Republic of Ireland Sw eden
Czech Republic Finland Denmark 0.5 Level 0.25 Level
0
2
4
6
8
10
12
14
16
18
1926 1928 1930 1932 1934 1936 1938 1940 1942 1944 1946 1948 1950 1952 1954
Year of Birth
CohortChildlessness%
0.000
0.001
0.002
0.003
0.004
0.005
0.006
0.007
0.008
0.009
0.010
CohortBreastCancerRate
Cohort Childlessness
Cohort Breast Cancer Rate
Correlation Coefficient: -0.01
Country
No of
Years
Used
Goodness of Fit
Multiple R
Intercept (a)
Coefficient of
Abortion (b1)
(95% CI)
Coefficient of
Fertility (b2)
(95% CI)
Increase
Forecast
England & Wales 15 0.951 .0202
.0166
(.0065, .0396)
–.0047
(–.0135, .0041)
50.9%
Scotland * 28 0.603 .0093
.0040
(–.0047, .0127)
–.00053
(–.0029, .0018)
17.2%
Northern Ireland * 8 0.998 .0082
.0107
(.0074, .0140)
–.00020
(–.0006, .0002)
9.3%
Irish Republic * 8 0.997 .0083
.0099
(.0018, .0182)
–.00029
(–.0013, –0007)
8.3%
Sweden 6 0.998 .0097
.0128
(.0059, .0197)
–.00023
(–.0027, .0022)
31.3%
Czech Republic 9 0.859 .021
.0083
(.0014, .0151)
–.0094
(–.0423, .0236)
53%
Finland 16 0.630 .0058
.0298
(–.0092, .0687)
–.0014
(–.0101, .0072)
–6.8%
Denmark 8 0.991 .0065
.0155
(.00046, 0.0305)
–.00024
(–.003, 0.0026)
–4.1%
Table 1. Model Fitting by Country: Regression Intercept and Coefficients,
and Increase in Breast Cancer Incidence Forecast to Occur in 25Years
†
Table 2. Summary: Forecast Cases of Breast Cancer and DCIS
England & Wales
Scotland
Northern Ireland
Republic of Ireland
Sweden
Czech Republic
Finland
Denmark
39229
3917
1117
2336
7293
5449
3794
3952
40018
3963
1137
2336
7777
5596
3824
4043
45529
4482
1256
2560
8519
6200
3931
4175
51849
5058
1382
2883
9288
6804
4005
4325
58567
5639
1508
3222
10096
7561
4024
4452
65252
6177
1626
3601
10895
8412
4045
4533
3827
333
87
163
950
248
-
-
3848
345
87
163
981
258
-
-
4373
392
99
178
1077
278
-
-
5074
450
111
200
1177
300
-
-
5765
502
119
223
1281
334
-
-
6319
537
122
248
1384
372
-
-
Base Year Base Year2005 20052010 20102015 20152020 20202025 2025
In Situ CancersCancers
* 45-49 modeling used
25 years after latest year for which breast cancer incidence is available (2005 for Republic of Ireland;
2004 for England & Wales, Scotland, Northern Ireland, and Sweden; 2003 for Czech Republic and
Finland; 2001 for Denmark).
Linear Regression. Response variable: cumulated cohort breast cancer incidence for women aged 50–54
or 45–49. Explanatory variables: cumulated cohort abortion rates and cumulated cohort fertility rates.
†
Figure 7. Cumulated Cohort Breast Cancer Rates within Ages 45-49 vs.
Cohort Childlessness Percentage for England & Wales
Figure 8. Total Abortion Rates: TARs in England & Wales, Scotland,
Northern Ireland, Republic of Ireland, Sweden, Czech Republic, Finland,
and Denmark; 1968-2006
Journal of American Physicians and Surgeons Volume 12 Number 3 Fall 200774
4. flat. These differences could result in part from the fact that the
abortion rate has been lower in Scotland than in England since 1968
(Figure 8). Currently, the abortion rate is about 50% higher in
England than in Scotland. However, over the same period, there has
beenagreaterdeclineinfertilityinScotland(Figure9).
Five social classes for Scotland are distinguished according to
deprivation, whereas in England there are six social classes
distinguished by occupation. The Scottish ratios of mortality to
incidence for the social classes were used to derive an approximate
gradient of incidence for England. The modeling for England for
the age groups 45–49 and 50–54 described in the last section was
used to estimate a further increase in incidence of breast cancer in
England of 14.4% in the period 2001–2004, compared to
1997–2000. This was spread across the six social classes in
England in proportion to the existing gradient, and an increased
gradient of incidence across social class for England for the years
2001–2004 was determined. Using the Scottish ratios, this was then
converted into the increased breast cancer mortality gradient for
England&Walesshown inFigure2.
Cancer registrations in Scotland started in 1960. Rates have
been higher than in England, but recently the increase over all ages
in Scottish breast cancer rates has been less than in England
(Figures 11 and 12). Figure 8 shows the lower Scottish abortion
rates. Figure 9 shows the greater decline in Scottish birth rates. The
trend in cohort breast cancer in ages 50–54 up to 2004 proved non-
linear and difficult to fit the model. The model was fitted for
Scotlandforages45–49withresultsshown inTable1.
Forecasts were made using the latest 2006 TAR for Scotland,
0.376, and the latestTFR, 1.67, giving an overall increase in the rate
of cancer of 17.2%, or a yearly increase of 0.64%. Numbers of new
cancers expected in Scotland are 6,177 in 2025 compared to the
3,917 reported for 2004, which is a 57.7% increase, in line with the
agingofthepopulation.
The lower abortion rates in Scotland lead to a forecast of a
lesser further increase in incidence of breast cancer in Scotland
compared to England, partly offset by lower fertility now in
Scotland. Breastfeeding rates have been very low in Scotland,
and this has reduced the protective effects of higher Scottish
fertility in the past. With encouragement in recent years, the
increase in breastfeeding has apparently offset the effects of the
declinein theScottish birth rate.
Data is limited, as cancer registration started in 1993. The
incidence trends for the age groups 45–49 and 50–54 are shown in
Figures 11 and 12. Abortions in England on women resident in
Northern Ireland as reported in English abortion statistics are used
to derive abortion rates for Northern Ireland. The trends in abortion
and fertility in Northern Ireland are shown in Figures 8 and 9.
Abortion rates in Ireland, where abortion is illegal, are much lower
than in Great Britain. By smoothing the graph of cohort cancer
incidence for Northern Ireland it was possible to fit the model and
makeestimates.
With this model fitted on the available years of data to 2004 for
the age range 45–49, and the latest abortion and fertility rates
22
22
23
Modelingand ForecastingforScotland
NorthernIreland
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
4.50
1968 1970 1972 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006
Year
TotalFertilityRate
England & Wales Scotland Northern Ireland
Republic of Ireland Sw eden Czech Republic
Denmark Replacement Level 2.07 Finland
0
20
40
60
80
100
1 2 3 4 5
%survival
0
25
50
75
100
125
Least
deprived
Most
deprived
Deprivation quintile
Incidence
Survival
Mortality
0
50
100
150
200
250
300
1943 1948 1953 1958 1963 1968 1973 1978 1983 1988 1993 1998 2003
Year
Rateper100,000women
England and Wales Scotland Northern Ireland Republic of Ireland
Sw eden Czech Republic Finland Denmark
0
50
100
150
200
250
300
350
1943 1948 1953 1958 1963 1968 1973 1978 1983 1988 1993 1998 2003
Year
Rateper100,000women
England and Wales Scotland Northern Ireland Republic of Ireland
Sw eden Czech Republic Finland Denmark
Figure 9. Total Fertility Rates: TFR in England & Wales, Scotland, Northern
Ireland, Republic of Ireland, Sweden, , Finland, and
Denmark; 1968-2006
Czech Republic
Figure 10. Cancer of the Female Breast, Scotland: Incidence, mortality and
cause-specific survival at 5 years by deprivation quintile, for patients
diagnosed 1991-95. ISD publicationSource: Trends in Cancer Survival in
Scotland 1971-1995
Figure 11. Breast Cancer in Women within Ages 45-49 in England & Wales,
Scotland, Northern Ireland, Republic of Ireland, Sweden, Czech Republic,
Finland, and Denmark; 1943-2005
Figure 12. Breast Cancer in Women within Ages 50-54 in England & Wales,
Scotland, Northern Ireland, Republic of Ireland, Sweden, Czech Republic,
Finland, and Denmark; 1943-2005
Journal of American Physicians and Surgeons Volume 12 Number 3 Fall 2007 75
5. entered, the 2006TAR for Northern Ireland is 0.16, the latestTFR is
1.87, and the forecast increase in the rate of cancer is 9.3% (yearly
increase0.36%).
This forecasts an increase in new cancers in Northern Ireland to
1,626 in 2025 compared to the 1,117 reported for 2004, which is a
46% increase, largely due to aging of the population. This small
increase follows from the very low abortion rate and comparatively
highfertilityinNorthernIreland.
Data is limited, as cancer registration started in 1994. The
incidence trends for the age groups 45–49 and 50–54 are shown in
Figures 11 and 12. Data on women resident in the Republic in
English abortion statistics are used to derive Irish abortion rates.
The trends in abortion and fertility in the Republic of Ireland are
shown in Figures 8 and 9. Abortion rates in the Republic are low,
andIrishfertilityratesarehighcomparedwithEngland.
Modeling used the latest available cancer data up to 2005 fitted
for cohort incidence within ages 45–49. Forecasting used the TAR
of 0.18 for 2006 and TFR of 1.86, giving a forecast increase in the
rate of cancer of 8.3%, which corresponds to a yearly compound
increase of 0.32%. This predicts an increase in numbers of new
cancers in the Republic of Ireland to around 3,601 in 2025,
compared to the 2,336 reported for 2005. The 54% increase is
largely a consequence of the expected growth and aging of the Irish
population.
In Sweden cancer registration started in 1958. The incidence
trends for the age groups 45–49 and 50–54 are shown in Figures
11and 12. The trends in abortion and fertility in Sweden are shown
in Figures 8 and 9. The nonlinear trend in fertility makes modeling
difficult.The abortion rates in Sweden are higher than in England at
the adult ages, but in Sweden most abortions are parous.
Breastfeeding is also successfully promoted in Sweden, offsetting
thecarcinogeniceffectofahighabortionrate.
Modeling is possible using recent years data. Forecasting with
the latest TAR for Sweden of 0.65 and the latest TFR of 1.75
produces an overall increase in the rate of cancer of 31.3%, which
corresponds to a yearly compound increase of 1.12%. From this
model, new cancers in Sweden are expected to be 10,895 in 2025,
comparedtothe7,293reportedfor2005,a49%increase.
In the Czech Republic cancer registration started in 1977. The
incidence trends are shown in Figures 11 and 12. Czech rates of
breast cancer are low by comparison with other countries
considered. Perhaps there is less genetic susceptibility.The trends in
abortion and fertility in the Czech Republic are shown in Figures 8
and 9. Abortion rates in the Czech Republic were high, and most
abortions areparous. Dataforrecentyears was usedtofitthemodel.
Forecasts using the latest TAR for the Czech Republic of 0.35
and the latest TFR of 1.23 gave an overall increase in the rate of
cancer of 39.2%, or a yearly increase of 1.33%. The Czech abortion
rate has declined markedly, but the Czech birth rate has declined
even more remarkably in recent years. These are offsetting factors
Republic ofIreland
Sweden
CzechRepublic
24
for breast cancer.The model predicts 8,412 new malignancies in the
Czech Republic in 2025 compared to the 5,449 reported for 2003, a
54%increase.
In Finland cancer registration started in 1953 and data is
available for years since 1977. The incidence trends are shown in
Figures 11 and 12. The trends in abortion and fertility in Finland are
shown in Figures 8 and 9. By using data for recent years it was
possibletofitthemodel.
The latest available TAR for Finland is 0.34 and the latest TFR
is 1.7. In the modeling these gave an expected decrease in the rate of
cancer of 6.8%, i.e. a yearly compound decrease of 0.28%,
reflecting the decline in the Finnish abortion rate and some
recovery in the birth rate in Finland. The forecast increase to 4,045
breast cancers in 2025, compared to the 3,794 reported for 2003,
resultsfromtheagingofthepopulation.
Anegative social gradient in Finland is reported in a large study.
“Cancers of the breast were most common in high social classes
throughout the whole observation period 1971–1995. The relative
difference between the SIRs (Standardised Incidence Ratios) of
social classes I and IV diminished from 2-fold in the period
1971–1975 to 1.5-fold in 1991–1995. SIRs were 1.67 in social class
I and 0.81 in social class IV in 1971–1975 and 1.4 and 0.81
respectivelyin1991–1995.”
The social gradient was not explicable in terms of fertility. “In
Finland there is relatively little difference between social classes in
the age at first birth and average number of children.” Abortion
was not considered as an explanatory variable in this study. If it had
been considered, the gradient might have been better understood.
The lessening of the social gradient may be linked to a decline in the
Finnishabortionrate.
In Denmark cancer registration goes back to the 1940s but data
after 2001 is not available. The trend is similar to other countries
discussed above (Figures 11 and 12). Abortion rates declined after
1989 (Figure 8) and are less than in Sweden and England. Fertility
shows adeclinesimilartothatinSweden(Figure9).
Cohort fertility for years of birth before 1945 and abortion rates
before 1973 were estimated. Age-specific fertility rates were not
available for earlier years, and approximate estimates were made.
Trend lines proved nonlinear, and model fitting was difficult.
Modeling used a fixed intercept and recent data with results
summarized in Table 1. The latest TAR (0.45) and TFR (1.8) gave
an expected decrease in the rate of cancer of 4.1%, i.e. a yearly
compound decrease of 0.16%. This decline reflects the decline in
theDanishabortionrate.
A social gradient has also been found in Denmark. A large
Danish national study found a higher incidence of breast cancer in
the higher social classes. Academics (persons with higher
education) had the highest risk of breast cancer, which was 74%
above that of women in agriculture, who had the lowest risk. The
records were adequate to control for various risk factors, and the
study concluded that “the large social differences in fertility history
among Danish women could not explain the social differences in
breast cancer risk.” In particular, “[a]ge at first birth and parity
Finland
Denmark
25
25
26,27
27
26
Journal of American Physicians and Surgeons Volume 12 Number 3 Fall 200776
6. could not explain the effect of socioeconomic group on breast
cancer incidence and mortality.” Abortion was not considered as a
relevant factor. If it had been considered the gradient might have
beenexplained.
In most countries considered, women now over age 45 have had
more abortions and fewer children than previous generations of
women, and a further increase in breast cancer incidence is to be
expected. Variations in breast cancer incidence across social class
andacrossgeographicregionscanalsobeexpectedtoincrease.
In England, a high rate of abortion leads to the large forecast
increase. In Scotland, the lower abortion rate, offset by lower
fertility than in England, leads to a slightly lower rate of increase
expected. In both Irish jurisdictions, a continuation of low abortion
rates and comparatively high fertility rates lead to low forecast
increases in incidence of breast cancer. In Sweden a high abortion
rate is offset partly by fewer nulliparous abortions and a high level
offertilityandbreastfeeding.
In the Czech Republic, the forecast of an increase in breast
cancer incidence is largely the result of the fallen birth rate. In
Finland and Denmark, lower abortion rates imply less breast cancer
inthefuture.
The negative or reverse social gradient whereby upper class
women have more breast cancer is apparent in four countries where
it is measured: England & Wales, Scotland, , and Denmark.
In all of these countries the known reproductive factors other than
abortion fail to explain the gradient. But the known likelihood for
upper class and upwardly mobile women to prefer abortions when
pregnant could provide some explanation of this gradient. If
abortions had been examined in the studies of this social gradient,
theroleofthisfactorcouldhavebeenmadeclear.
The increase in breast cancer incidence appears to be best
explained by an increase in abortion rates, especially nulliparous
abortions, and lower fertility. And the social gradient, which is not
explained by fertility, seems also attributable circumstantially to
abortion. A linear regression model of successive birth cohorts of
women with abortion and fertility as explanatory variables fitted to the
cancer incidence up to 1977 has produced forecasts that have
performed well in the years 1998–2004 in Great Britain (AppendixA).
Thenew forecasts foreightcountries canbetestedinthecoming years.
27
Summary
Conclusion
Finland
Patrick S. Carroll, M.A.,
Acknowledgements:
Potential conflicts of interest:
is Director of Research, Pension and Population
Research Institute (PAPRI), 35 Canonbury Road, London N1 2DG, UK.
Contact: papriresearch@btconnect.com.
Particular thanks are due to the charities LIFE and The
Medical Education Trust, which funded the research, to the national statistical
offices and cancer registries, which provided the data, and to the statisticians
who kindly gave advice. Figure 10 is reproduced from the publication
with permission of the Cancer
Surveillance Team, Information Services Division (ISD), NHS National
Services, Scotland. Computing was done by Andrew Chan and Lee Young.
none disclosed.
Trends
in Cancer Survival in Scotland 1971-1995
REFERENCES
1
Goldacre MJ, Kurina LM, Seagroat V, et al. A case control record
linkage study. 2001:55:336-337.J Epidemiol Community Health
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
18
19
20
21
22
23
26
27
28
29
Finer LB, Henshaw SK. Estimates of U.S. abortion incidence in 2001
and 2002. Alan Guttmacher Institute (AGI); 2005.
Blayo C. L’evolution du recourse a l’avortement en France depuis
1976. Institut National des Etudes Demographiques
(INED); 1995:779-810.
Cancer Incidence Data, Office for National Statistics and Welsh
Cancer Incidence and Surveillance Unit (WCISU). Available at:
www.statistics.gov.uk and www.wcisu.wales.nhs.uk. Accessed Jul
31, 2007.
Melbye M, Wohlfahrt J, Olsen JH, et al. Induced abortion and the risk
of breast cancer. 1997:336.81-85.
Brewster DH, Stockton DL, Dobbie R, et al. Risk of breast cancer after
miscarriage or induced abortion: a Scottish record linkage case
control study. 2005;59:283-287.
Lindefors Harris BM, Eklund G, et al. Risk of cancer of the breast after
legal abortion during first trimester: a Swedish register study.
1989:299:1430-1322.
Brind J. Induced abortion as an independent risk factor for breast
cancer. 2005;10:105-110.
Beral V, Bull D, Doll R, Peto R, Reeves G. Breast cancer and abortion:
collaborative reanalysis of data from 53 epidemiological studies.
2004;363:1007-1016.
Erlandsson G, Montgomery SM, Cnattingius S, Ekborn A. Abortions
and breast cancer: record based control study.
2003;103:676-679.
Schwerdlow A, dos Santos Silva I, Doll R.
. Oxford
University Press; 2001.
Howe H, Senie R T, Bzduch H, Herzfeld P. Early abortion and breast
cancer risk among women under age 40.
1989;18:300-304.
White C, van Galen F, Chow YH. Trends in social class differences in
mortality by cause, 1986-2000.
2003(winter):25-37. Available at: http://www.statistics.gov.uk/
statbase/Product.asp?vlnk=6725&More=N. Accessed Jul 31, 2007.
Lee E, Clements S, Ingham R, et al. York, UK:
Joseph Rowntree Foundation; 2004. Available at: http://www.
jrf.org.uk/. Accessed Jul 31, 2007.
Birth Statistics. Office for National Statistics (ONS) (UK).
London, UK: ONS; 2005.
Abortion Statistics . ONS 1968–2001. Department of
Health 2002–2006.
Russo J, Rivera R, Russo IH. Influence of age and parity on the
development of the human breast.
1992:23:211-218.
Leon D. A prospective study of the independent effects of parity and
age at first birth on breast cancer incidence in England & Wales.
1989:43:986-991.
Ramazzini B. London, UK; 1751:152.
Carroll P. Pregnancy related risk factors in female breast cancer
incidence. 2002;4:331-375.
Information and Statistics Division of the National Health Service in
Scotland. Edinburgh, Scotland; 1960–2004.
White A, Freeth S, O’Brian M. London, UK: Office
for Population Censuses and Surveys (OPCS); 1992.
Stockholm, Sweden: Socialstyrelsen; 2000.
Pukkala E. Time trends in socio-economic differences in incidence
rates of cancers of the breast and female genital organs.
1999;81:56-61.
Dano H, Andersen O, Ewertz M, et al. Socio-economic status and
breast cancer in Denmark. 2003: 32: 216-226.
Dano H, Hansen KD, Jensen P, et. al. Fertility pattern does not explain
social gradient in breast cancer in Denmark.
2004:111:451-456.
Carroll P. Trends and reproductive risk factors in female breast cancer
incidence in Great Britain. 2004;91(Suppl 1):S24, Poster 2.
Carroll P. Trends and risk factors in British female breast cancer.
Joint Statistical Meetings (JSM), American
Statistical Association, Minneapolis, Minn.; 2005:2511-2519.
Population No. 3.
N Engl J Med
J Epidemiol Community Health
BMJ
J Am Phys Surg
Lancet
Int J Cancer
Cancer Incidence and
Mortality in England & Wales. Trends and Risk Factors
Int J Epidemiol
Health Statistics Quarterly No. 20;
A Matter of Choice.
Cancer Atlas of the United Kingdom and Ireland.
Breast Cancer Res Treat
Int J
Cancer
Of the Diseases of Artificers.
Int Congress of Actuaries, Transactions
Infant Feeding 1990.
Anning av barn foedda. [Breastfeeding of Infants Born in 1998].
Int J Cancer
Int J Epidemiol
Int J Cancer
Br J Cancer
Statistics in Epidemiology.
17
24
25
England & Wales
Statistical Bulletin;
Journal of American Physicians and Surgeons Volume 12 Number 3 Fall 2007 77
7. AppendixA. Female Breast Cancers and Ductal Carcinoma in Situ (DCIS) in
England &Wales: Comparison of Forecast Numbers Published in 2002 with
ReportedIncidenceintheYears 1998–2004
Modelling based on breast cancer incidence data up to 1997 was used
to forecast incidence over future years through 2027. Forecast rates were
applied to the projected female population in the 1998-based forecast made
bytheUK GovernmentActuarytocalculateforecastnumbersofcancers.
In these 1997-based forecasts, the same rate of increase in incidence
wasassumedtoapplytoallagegroups.
Two forecasts were made: (1) Using model fitting without weighting to
allow for additionally carcinogenic effect of nulliparous abortions gave a
lower increase in rates of 44.4% over 30 years, or 1.25% per annum. (2)
With weighting to allow for the additionally carcinogenic effects of
nulliparous abortions, the model gave a higher increase of 2.2% per annum
or92% over30years.
21
Tables 1A-3A show the observed cases from official counts of new
cases and the expected numbers calculated with the unweighted model, for
cancers, ductal carcinoma in situ (DCIS), and cancers combined with
DCIS, respectively. The forecast tended to underestimate slightly the
number of cancers; the ratio of observed to expected was 1.013 (101.3%) in
2004. For DCIS, the underestimate, O/E = 1.54 (154.3%) for 2004, was
much more notable, probably owing to extension of screening programs.
The combined rate of cancers and DCIS was somewhat underestimated,
O/E=1.04 (104.4%) in2004.
Weighting for the increased carcinogenicity of nulliparous abortions
gave the results shown in Tables 4A-6A for cancers, DCIS, and cancers
combined with DCIS, respectively. Cancers were slightly overestimated,
O/E = 0.946 (94.6%) for 2004. DCIS was underestimated, but less so than
with the first model: O/E = 1.44 (144%) in 2004. The combined forecast
proved quite good, with 100.5% of the total new malignancies anticipated
in2003, and97.5% in2004.
Year 15-44 45-49 50-54 55-59 60+ All ages
% Observed/
Expected
1998
1999
2000
2001
2002
2003
2004
Expected
Observed
Expected
Observed
Expected
Observed
Expected
Observed
Expected
Observed
Expected
Observed
Expected
Observed
Age Groups
3880
4005
4022
4153
4183
4151
4375
4161
4527
4101
4666
4214
4802
4312
3220
3099
3241
3088
3275
3042
3365
2950
3487
2993
3619
3066
3771
3268
4725
4633
4909
5031
5051
4951
5172
4957
5039
4514
5021
4554
5081
4439
3621
3880
3805
4198
4005
4138
4284
4477
4761
4819
5079
5396
5292
5136
19042
19029
19450
19791
19872
19544
20374
19846
20836
20293
21402
21575
21981
21557
34488
34646
35427
36261
36386
35826
37570
36391
38650
36720
39787
38805
40927
38712
100.5
102.4
98.5
96.9
95.0
97.5
94.6
Year 15-44 45-49 50-54 55-59 60+ All ages
% Observed/
Expected
1998
1999
2000
2001
2002
2003
2004
Expected
Observed
Expected
Observed
Expected
Observed
Expected
Observed
Expected
Observed
Expected
Observed
Expected
Observed
Age Groups
193
136
200
255
208
279
218
264
225
290
232
278
239
315
321
231
323
272
327
243
336
272
348
261
361
249
376
275
471
674
490
765
504
804
516
832
503
813
501
817
507
827
375
454
394
488
414
544
443
622
493
675
526
789
547
612
746
917
765
1006
784
1163
800
1163
819
1230
847
1530
881
1644
2106
2412
2172
2786
2237
3033
2313
3153
2388
3269
2467
3663
2550
3673
114.5
128.3
135.6
136.3
136.9
148.5
144.0
Year 15-44 45-49 50-54 55-59 60+ All ages
% Observed/
Expected
1998
1999
2000
2001
2002
2003
2004
Expected
Observed
Expected
Observed
Expected
Observed
Expected
Observed
Expected
Observed
Expected
Observed
Expected
Observed
Age Groups
4073
4141
4222
4408
4391
4430
4593
4425
4752
4391
4898
4492
5041
4627
3541
3330
3564
3360
3602
3285
3701
3222
3835
3254
3980
3315
4147
3543
5196
5307
5399
5796
5555
5755
5688
5789
5542
5327
5522
5371
5588
5266
3996
4334
4199
4686
4419
4682
4727
5099
5254
5494
5605
6185
5839
5748
19788
19946
20215
20797
20656
20707
21174
21009
21655
21523
22249
23105
22862
23201
36594
37058
37599
39047
38623
38859
39883
39544
41038
39989
42254
42468
43477
42385
101.3
103.9
100.6
99.2
97.4
100.5
97.5
Year 15-44 45-49 50-54 55-59 60+ All ages
% Observed/
Expected
1998
1999
2000
2001
2002
2003
2004
Expected
Observed
Expected
Observed
Expected
Observed
Expected
Observed
Expected
Observed
Expected
Observed
Expected
Observed
Age Groups
4033
4141
4140
4408
4264
4430
4415
4425
4524
4391
4558
4492
4705
4627
3507
3330
3494
3360
3497
3285
3559
3222
3650
3254
3752
3315
3871
3543
5145
5307
5294
5796
5393
5755
5468
5789
5275
5327
5205
5371
5216
5266
3956
4334
4117
4686
4290
4682
4545
5099
5002
5494
5284
6185
5451
5748
19595
19946
20453
20797
20055
20707
20357
21009
20616
21523
20975
23105
21365
23201
36236
37058
37498
39047
37499
38859
38344
39544
39067
39989
39774
42468
40608
42385
102.3
104.1
103.6
103.1
102.4
106.8
104.4
Year 15-44 45-49 50-54 55-59 60+ All ages
% Observed/
Expected
1998
1999
2000
2001
2002
2003
2004
Expected
Observed
Expected
Observed
Expected
Observed
Expected
Observed
Expected
Observed
Expected
Observed
Expected
Observed
Age Groups
191
136
196
255
202
279
209
264
214
290
219
278
223
315
318
231
317
272
317
243
323
272
331
261
340
249
351
275
467
674
480
765
489
804
496
832
478
813
472
817
473
827
371
454
386
488
402
544
426
622
469
675
496
789
511
612
739
917
751
1006
761
1163
769
1163
780
1230
799
1530
822
1644
2086
2412
2130
2786
2171
3033
2223
3153
2272
3269
2326
3663
2380
3673
115.6
130.8
139.7
141.8
143.9
157.5
154.3
Year 15-44 45-49 50-54 55-59 60+ All ages
% Observed/
Expected
1998
1999
2000
2001
2002
2003
2004
Expected
Observed
Expected
Observed
Expected
Observed
Expected
Observed
Expected
Observed
Expected
Observed
Expected
Observed
3842
4005
3944
4153
4062
4151
4206
4161
4310
4101
4339
4214
4482
4312
3189
3099
3177
3088
3180
3042
3236
2950
3319
2993
3412
3066
3520
3268
4678
4633
4814
5031
4904
4951
4972
4957
4797
4514
4733
4554
4743
4439
3585
3880
3731
4198
3888
4138
4119
4477
4533
4819
4788
5396
4940
5136
18856
19029
19702
19791
19294
19544
19588
19846
19836
20293
20176
21575
20543
21557
34150
34646
35368
36261
35328
35826
36121
36391
36795
36720
37448
38805
38228
38712
101.5
102.5
101.4
100.7
99.8
103.6
101.3
Age Groups
Table 6A. Combined Cases of Female Breast Cancer and DCIS in England &
Wales, Observed v. Predicted from Model Weighted for NulliparousAbortion
Table 5A. Number of Cases of Female DCIS in England & Wales, Observed
v. Predicted from Model Weighted for NulliparousAbortion
Table 4A. Number of Female Breast Cancers in England & Wales, Observed
v. Predicted from Model Weighted for NulliparousAbortions
Table 3A. Combined Cases of Female Breast Cancer and DCIS in England
& Wales, Observed v. Predicted from Unweighted Model
Table 2A. Number of Cases of Female DCIS in England & Wales, Observed
v. Predicted from Unweighted Model
Table 1A. Number of Female Breast Cancers in England & Wales, Observed
v. Predicted from Unweighted Model
Forecast based on incidence of breast cancer up to 1997
Journal of American Physicians and Surgeons Volume 12 Number 3 Fall 200778