Search

Purpose: Locally advanced breast cancer (LABC) includes inflammatory breast cancer (IBC) as well as non-inflammatory LABC (NI-LABC). The aim of this population-based study was to compare the tumour characteristics, treatment and relative survival of IBC and NI-LABC patients. Methods: Patients with either IBC (cT4d) or NI-LABC (cT4a-c) were identified from the nationwide Netherlands Cancer Registry from the period 1989-2015. In each group, patients are divided into three time periods in order to perform a trend analysis: 1989-1997, 1998-2006, and 2007-2015. Results: IBC comprised 1.1% and NI-LABC 4.6% of all diagnosed breast cancer patients. IBC patients showed more nodal metastases (77.8 vs. 69.7%, P < 0.001) and distant metastases (39.7 vs. 34.1%, P < 0.001). IBC tumours were more often triple negative (23.2 vs. 12.8%, P < 0.001) and poorly differentiated (69.8 vs. 53.8%, P < 0.001). Trimodality therapy (neoadjuvant chemotherapy, surgery and adjuvant radiotherapy) was more often applied over time in both groups (IBC: 23.7% -56.0%-68.6%; NI-LABC: 3.7%-25.9%-43.6%; P < 0.001). In IBC patients, relative 5-year survival was significantly shorter than in patients with NI-LABC (30.2 vs. 45.1%, P < 0.001). The relative survival significantly improved for IBC from 17.2% (1989-1997) to 30.0 and 38.9% for the last two time periods (1998-2006: P < 0.001; 2007-2015: P < 0.001). In contrast, survival did not significantly improve in NI-LABC breast cancer: from 44.7% (1989-1997) to 44.0 and 48.4% (1998-2006: P = 0.483; 2007-2015: P = 0.091). Conclusions: IBC has tumour characteristics that determine its aggressive biology compared to NI-LABC. Trimodality therapy was increasingly applied in both groups, but did not improve survival in NI-LABC. Although relative survival in IBC patients has improved during the last decades, it remains a disease with a dismal prognosis. [ABSTRACT FROM AUTHOR]

Abstract Some pesticides may interfere with the female hormonal function, which may lead to negative effects on the reproductive system through disruption of the hormonal balance necessary for proper functioning. Previous studies primarily focused on interference with the estrogen and/or androgen receptor, but the hormonal function may be disrupted in many more ways through pesticide exposure. The aim of this review is to give an overview of the various ways in which pesticides may disrupt the hormonal function of the female reproductive system and in particular the ovarian cycle. Disruption can occur in all stages of hormonal regulation: 1. hormone synthesis; 2. hormone release and storage; 3. hormone transport and clearance; 4. hormone receptor recognition and binding; 5. hormone postreceptor activation; 6. the thyroid function; and 7. the central nervous system. These mechanisms are described for effects of pesticide exposure in vitro and on experimental animals in vivo. For the latter, potential effects of endocrine disrupting pesticides on the female reproductive system, i.e. modulation of hormone concentrations, ovarian cycle irregularities, and impaired fertility, are also reviewed. In epidemiological studies, exposure to pesticides has been associated with menstrual cycle disturbances, reduced fertility, prolonged time-to-pregnancy, spontaneous abortion, stillbirths, and developmental defects, which may or may not be due to disruption of the female hormonal function. Because pesticides comprise a large number of distinct substances with dissimilar structures and diverse toxicity, it is most likely that several of the above-mentioned mechanisms are involved in the pathophysiological pathways explaining the role of pesticide exposure in ovarian cycle disturbances, ultimately leading to fertility problems and other reproductive effects. In future research, information on the ways in which pesticides may disrupt the hormonal function as described in this review, can be used to generate specific hypotheses for studies on the effects of pesticides on the ovarian cycle, both in toxicological and epidemiological settings.

Objective: To study the effect of ERAS on a textbook outcome (TO) after elective renal surgery., Patients and Methods: Retrospective study of all patients who underwent a robot-assisted laparoscopic partial or radical nephrectomy or robot-assisted laparoscopic radical nephroureterectomy in Medisch Spectrum Twente (MST), Enschede, the Netherlands. In total, 277 patients were included. 66 patients from 2018 to 2021 (pre-ERAS group) and 211 patients from 2021 to 2023 (ERAS group). TO is a maximum of two nights in the hospital after surgery, no severe complications during or after surgery ≥ grade IIIb, no blood transfusions, no intensive care, no readmissions, and no mortality within 30 days after surgery. Comparisons were made between the pre-ERAS and ERAS groups using unpaired t-test, Mann-Whitney U test, the chi-squared test or Fisher's exact test. Multivariate logistic regression was used to adjust for possible confounding., Results: TO was significantly (p = 0.005) better in the ERAS group (TO = 76.8%) compared to the pre-ERAS group (TO = 59.1%). Compared to a pre-ERAS patient, the adjusted odds ratio for achieving a TO as an ERAS patient is 2.1 (95% CI 1.15-3.78)., Conclusions: The implementation of ERAS showed a positive effect on the TO of elective renal surgery patients., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: According to current guidelines, hormonal therapy may be applied in endometrioid type endometrial cancer as an alternative to surgery for fertility preservation and in medically unfit patients. Since it is unknown how often hormonal therapy is applied, the objective of this study was to investigate trends over time in hormonal therapy use in the background of the overall incidence of endometrial cancer., Methods: All patients with endometrial cancer (n=48 222) registered in the Netherlands Cancer Registry in the period 1989-2018 were included. European age-standardized incidence rates with corresponding estimated annual percentage change were calculated to describe trends in the incidence of endometrial cancer. The use of hormonal therapy was analyzed in the three periods 1989-1998, 1999-2008, and 2009-2018 for the following sub-groups: primary and adjuvant therapy, International Federation of Gynecology and Oncology (FIGO) stage I-II and III-IV, and by age group., Results: The European age-standardized incidence rate of endometrioid endometrial cancer peaked in 2004 with a significant increase from 1989 to 2004 (annual percentage change 0.55; 95% CI 0.10 to 0.99, p=0.020) and a subsequent decrease from 2005 to 2018 (annual percentage change -1.79; 95% CI -2.28 to -1.31, p<0.001). The incidence rate of non-endometrioid type endometrial cancer increased significantly in the study period. Hormonal therapy was used in 1482 (3.5%) patients with endometrioid endometrial cancer. Among patients with FIGO stage I aged ≤40 years, hormonal therapy increased from 0% in 1989-1998 to 27% in 2009-2018. Primary hormonal treatment increased from 175 patients (5.5%) to 329 patients (7.8%) in those aged ≥75 years. Adjuvant hormonal treatment was mostly used in advanced stage endometrial cancer., Conclusions: The use of primary hormonal therapy in endometrioid type endometrial cancer increased over time in patients aged ≤40 years and among elderly patients. The observed trends in the current use of hormonal therapy support the need to study the effect of hormonal treatment in elderly patients and as adjuvant treatment in advanced stage endometrial cancer., Competing Interests: Competing interests: None declared., (© IGCS and ESGO 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To assess influence of stage at breast cancer diagnosis, tumour biology, and therapy on survival in contemporary times of better (neo-)adjuvant systemic therapy., Design: Prospective nationwide population based study., Method: Female primary breast cancer patients diagnosed between 1999 and 2012 (173,797). Participants were subdivided into two time cohorts on the basis of breast cancer diagnosis; 1999 through 2005 (n = 80,228) and 2006 through 2012 (n = 93,569). Main outcome measures were relative survival, compared between both cohorts, and the influence of traditional prognostic factors on overall mortality, analyzed with Cox regression for both cohorts separately., Results: Compared to 1999-2005 patients from 2006-2012 had smaller ( ≤ T1 65 vs. 60%; p < 0.001), more often lymph node negative (N0 68 vs. 65%; p < 0.001) tumours, but they received more chemotherapy, hormonal therapy, and targeted therapy (neo-adjuvant/adjuvant systemic therapy 60 vs. 53%; p < 0.001). Median follow-up was 9.8 years for 1999-2005 and 3.9 years for 2006-2012. Relative 5-years survival rate was 96% in 2006-2012, improved in all tumour and nodal stages compared to 1999-2005, and 100% in tumours ≤ 1 cm. With multivariable analyses, adjusted for age and tumour type, overall mortality decreased by surgery (especially breast conserving), radiotherapy and systemic therapies. Mortality increased with progressing tumour size in both cohorts (2006-2012 T1c vs. T1a HR 1.54, 95% CI 1.33 to 1.78), but without significant difference in invasive breast cancers until 1 cm (2006-2012 T1b vs. T1a HR 1.04, 95% CI 0.88 to 1.22), and independently with progressing number of positive lymph nodes (2006-2012 N1 vs. N0 HR 1.25, 95% CI 1.17 to 1.32)., Conclusion: Tumour stage at breast cancer diagnosis influences overall survival significantly also in the current era of effective systemic therapy. Early tumour stage at breast cancer diagnosis remains vital.

Objectives: To assess the influence of stage at breast cancer diagnosis, tumour biology, and treatment on survival in contemporary times of better (neo-)adjuvant systemic therapy., Design: Prospective nationwide population based study., Setting: Nationwide Netherlands Cancer Registry., Participants: Female patients with primary breast cancer diagnosed between 1999 and 2012 (n=173,797), subdivided into two time cohorts on the basis of breast cancer diagnosis: 1999-2005 (n=80,228) and 2006-12 (n=93,569)., Main Outcome Measures: Relative survival was compared between the two cohorts. Influence of traditional prognostic factors on overall mortality was analysed with Cox regression for each cohort separately., Results: Compared with 1999-2005, patients from 2006-12 had smaller (≤ T1 65% (n=60,570) v 60% (n=48,031); P<0.001), more often lymph node negative (N0 68% (n=63,544) v 65% (n=52,238); P<0.001) tumours, but they received more chemotherapy, hormonal therapy, and targeted therapy (neo-adjuvant/adjuvant systemic therapy 60% (n=56,402) v 53% (n=42,185); P<0.001). Median follow-up was 9.8 years for 1999-2005 and 3.9 years for 2006-12. The relative five year survival rate in 2006-12 was 96%, improved in all tumour and nodal stages compared with 1999-2005, and 100% in tumours ≤ 1 cm. In multivariable analyses adjusted for age and tumour type, overall mortality was decreased by surgery (especially breast conserving), radiotherapy, and systemic therapies. Mortality increased with progressing tumour size in both cohorts (2006-12 T1c v T1a: hazard ratio 1.54, 95% confidence interval 1.33 to 1.78), but without a significant difference in invasive breast cancers until 1 cm (2006-12 T1b v T1a: hazard ratio 1.04, 0.88 to 1.22), and independently with progressing number of positive lymph nodes (2006-12 N1 v N0: 1.25, 1.17 to 1.32)., Conclusions: Tumour stage at diagnosis of breast cancer still influences overall survival significantly in the current era of effective systemic therapy. Diagnosis of breast cancer at an early tumour stage remains vital., (© Saadatmand et al 2015.)

The aim of this study was to assess exposure to pesticides for a longitudinal epidemiological study on adverse reproduction effects among greenhouse workers. Detailed information on pesticide use among greenhouse workers was obtained on a monthly basis through self-administered questionnaires and subsequent workplace surveys. Questionnaires were filled in for a whole year. Dermal exposure rankings were developed for each task using the observational method Dermal Exposure Assessment Method (DREAM). Exposure scores were calculated for each worker for each month during the year, taking into account frequency, duration and exposure intensity for each task. A total number of 116 different active ingredients were used in the population, whereas a mean number of 15 active ingredients were applied per greenhouse. DREAM observations provided insight into the exposure intensity of 12 application techniques and three mixing and loading activities. Relatively high DREAM scores were obtained for scattering, fogging, dusting, and mixing and loading of powders. Observations with DREAM indicated that application with a horizontal ground-boom, motor driven boom, and bulb shower resulted in low dermal exposure. Exposure scores showed substantial variation between workers and over the year. It can be concluded that exposure variation between- and within greenhouses is very large, both in terms of chemical composition and exposure intensity. This may be a significant contributor to the inconsistent results of studies evaluating health effects of pesticide exposure.

Several studies have shown a decline in human semen quality and increased risks of male subfertility. This paper provides an overview of the mechanisms of pesticide-induced reproductive toxicity and the effects on male fertility since exposure to pesticides may be one of the causes of these disorders. Pesticides may directly damage spermatozoa, alter Sertoli cell or Leydig cell function, or disrupt the endocrine function in any stage of hormonal regulation (hormone synthesis, release, storage, transport, and clearance; receptor recognition and binding; thyroid function; and the central nervous system). These mechanisms are described with respect to the effects of pesticide exposure in vitro and in vivo. In epidemiologic studies, effects on sperm quality and time to pregnancy are reviewed. Clear effects on male fertility have been demonstrated for some pesticides [eg, dibromochloropropane, ethylene dibromide]. But results from more recent studies are inconsistent, and no uniform conclusion can be drawn about the effects of pesticides on male reproduction.

Objectives: Female greenhouse workers, who constitute a major occupational group exposed to pesticides at childbearing age, were studied to measure the effects of pesticide exposure on time to pregnancy., Methods: Data were collected through postal questionnaires with detailed questions on time to pregnancy, lifestyle factors (eg, smoking habits, coffee and alcohol consumption), and worktasks (eg, application of pesticides, re-entry activities, and workhours) of the respondents and their partners in a 6-month period prior to conception of the most recent pregnancy. The relation between time to pregnancy and exposure to pesticides among 398 female greenhouse workers and 524 referents was studied in a Cox's proportional hazards model., Results: The crude fecundability ratio for female greenhouse workers versus the reference group was 1.18 [95% confidence interval (95% CI) 1.03-1.35], but correction for confounding changed the fecundability ratio to 1.11 (95% CI 0.96-1.29). An evaluation of specific biases for time-to-pregnancy studies showed that these results were biased by the reproductively unhealthy worker effect. Restricting the analyses to full-time workers or first pregnancies only resulted in an adjusted fecundability ratio of 0.89 (95% CI 0.67-1.19) and 0.90 (95% CI 0.62-1.32), respectively. Among the primigravidous greenhouse workers, an association was observed between prolonged time to pregnancy and gathering flowers (fecundability ratio 0.46, 95% CI 0.18-1.19)., Conclusions: This study may offer some evidence for the hypothesis of adverse effects of pesticide exposure on time to pregnancy, but more research is needed to elucidate these effects.