Search

Background: We aimed to assess whether socioeconomic status (SES) and ethnicity affect adjuvant systemic therapy (AST) guideline adherence in early breast cancer patients in a health care setting with assumed equal access to care. Methods: Data from all female patients surgically treated for primary unifocal early breast cancer between January 2005 and December 2014 were retrieved from the Netherlands Cancer Registry. We assessed the association between SES, ethnicity and non-adherence to adjuvant chemotherapy (CT) or endocrine therapy (ET) guideline indications with Poisson regression models, adjusting for clinicopathological variables. Results: A total of 104 201 patients were included in the current analysis. Of patients without an indication, 4% and 13% received adjuvant CT or ET (overtreatment), whereas 39% and 14% of patients with an indication did not receive CT or ET (undertreatment). Medium and low SES patients were 1.01 (95% CI 1.00-1.01) and 1.01 (95% CI 1.00-1.01) times more likely to be undertreated and 0.85 (95% CI 0.76-0.94) and 0.67 (95% CI 0.60-0.75) times more likely to be overtreated with CT compared with high SES patients [resulting in an overall relative risk of CT use of 0.94 (95% CI 0.92-0.96) and 0.85 (95% CI 0.83-0.87), respectively]. No association between SES and ET guideline adherence or ethnicity and CT/ET guideline adherence was observed. Conclusion: In the Netherlands, minimal SES disparities in CT guideline adherence were observed: low SES patients are less likely be overtreated and marginally more likely to be undertreated with CT resulting in an overall decreased risk of receiving CT. No ethnical disparities in AST guideline adherence were observed. [ABSTRACT FROM AUTHOR]

Objective Women exposed to diethylstilbestrol in utero (DES) have an increased risk of clear cell adenocarcinoma (CCA) of the vagina and cervix, while their risk of non-CCA invasive cervical cancer is still unclear. Methods We studied the risk of pre-cancerous (CIN) lesions and non-CCA invasive cervical cancer in a prospective cohort of 12,182 women with self-reported DES exposure followed from 2000 till 2008. We took screening behavior carefully into account. Incidence was obtained through linkage with the Netherlands Nationwide Pathology database (PALGA). General population data were also derived from PALGA. Results The incidence of CIN1 was increased (Standardized Incidence Ratio (SIR) = 2.8, 95% Confidence Interval (CI) = 2.3 to 3.4), but no increased risk was observed for CIN2 + (CIN2, CIN3 or invasive cancer) compared to the screened general population (SIR = 1.1, 95% CI = 0.95 to1.4). Women with DES-related malformations had increased risks of both CIN1 and CIN2 + (SIR = 4.1, 95%CI = 3.0 to 5.3 and SIR = 1.5, 95%CI = 1.1 to 2.0, respectively). For CIN2 +, this risk increase was largely restricted to women with malformations who were more intensively screened. Conclusions An increased risk of CIN1 among DES daughters was observed, especially in women with DES-related malformations, probably mainly due to screening. The risk of CIN2 + (including cancer) was not increased. However, among DES daughters with DES-related malformations a true small risk increase for non-CCA cervical cancer cannot be excluded. [ABSTRACT FROM AUTHOR]

In many studies, possibilities are being explored to adjust farm management to increase or maintain soil organic matter (SOM) contents in agricultural soils. Some options may be conflicting with efficient nutrient (N and P) management, i.e. management aiming at maximum conversion of imported nutrients into exported products (milk and meat in the case of dairy farms). This study explored long term effects of efficient nutrient management on SOM dynamics on an experimental dairy farm with three types of land use: permanent grassland, a 3 year grass–3 year arable crop rotation (ROTI), and a 3 year grass–5 year arable crop rotation (ROTII). The arable phase in the crop rotations consisted predominantly of maize. The experimental farm, called ‘De Marke’, is located on a Spodosol with an Anthropic Epipedon in the Netherlands. The study consisted of: i) trend analyses based on data of measured SOM mass percentage (SOM %) from 1989–2010, and ii) simulations of long term (50 years) SOM dynamics for four management alternatives. Three alternatives were related to manure digestion: no digestion; ‘mild anaerobic digestion’ (degrading 35% of organic matter) and; ‘strong digestion’ (degrading 70% of organic matter). The fourth management alternative was similar to the first (no digestion) but differed in that no catch crop was grown after maize. The trend analyses showed that SOM % of the 0–0.2 m layer was approximately stable under permanent grassland. In ROTI, SOM % decreased on average by 0.04 y − 1 and in ROTII by 0.03 y − 1 . The decline did not slow down over time. SOM decline was more severe on plots with relatively high initial SOM %. Decomposition was described using a mono-component model with a time dependent relative decomposition rate. Decomposition rates in the rotations with arable crops were not higher than those for permanent grassland indicating that tillage did not affect decomposition rate and that SOM dynamics were dominated by the quantity and quality of the substrate input. Simulations indicated that in the long term, decline of SOM must be expected both under arable crop–grassland rotations and under permanent grassland, even in the case of permanent grassland receiving undigested manure. Our results further indicate that strong manure digestion puts pressure on future SOM levels suggesting a trade-off with bio-energy production, and that the contribution of a catch crop to long term SOM is marginal. [ABSTRACT FROM AUTHOR]

Explores the increased risk of hypospadias in male offspring of women exposed to diethylstilbestrol in utero in the Netherlands. Assessment of late effects of subfertility problems.

Proffered Papers: Proffered papers 7: Evaluating and predicting toxicity in RT OC-0109: Cardiovascular risk assessment based on cardiac calcifications on breast RT planning CT scans R. Gal, I. IÅ¡gum, S.G.M. Van Velzen, M.J. Emaus, D.H.J.G. Van den Bongaard, M.L. Gregorowitsch, E.L.A. Blezer, S.A.M. Gernaat, N. Lessmann, M.G.A. Sattler, A.J. Teske, J. Penninkhof, H. Meijer, J.J. Van Tol-Geerdink, J. Pignol, J. Verloop, H.M. Verkooijen. [Extracted from the article]