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Background Pregnancy and lactation may constitute radiation-sensitive reproductive periods due to rapid cell proliferation and concentration of radioiodine in the lactating breast. However, there are limited epidemiological data among women exposed to radiation during these periods. Methods We examined incidence of breast cancer in a cohort of 3214 women who were pregnant and/or lactating within 2 months (26 April to 30 June 1986) of the Chernobyl accident and residing in contaminated regions of Belarus. There were 33 breast cancers identified through linkage with the Belarusian National Cancer Registry. Breast cancer rates among women who were either pregnant and/or lactating were compared with population rates by calculating standardized incidence ratios (SIR) and 95% confidence intervals (CI) adjusting for attained age, oblast, urban/rural residence and calendar year. Results Among women who were lactating, we found a greater than 2-fold increased risk of breast cancer compared with the general population, SIR = 2.49 (95% CI: 1.55, 3.75). In contrast, women who were pregnant were not at increased risk (SIR = 0.84 95% CI: 0.46, 1.38). The SIR was highest in women who were exposed at a younger age and at the earliest time period since the accident, though stratified analyses had limited sample sizes. Conclusions We found a significantly increased risk of breast cancer among women residing in contaminated areas of Belarus who were lactating at the time of the accident and may have had elevated exposure to radioiodine, when compared with the general population. Studies of breast cancer with individual radiation dose estimates among women exposed during lactation are warranted.

BACKGROUND: Postdonation information (PDI) occurs when a donor fails to report a risk that would have resulted in deferral, but at some subsequent point is disclosed. Donors' perspectives on and perceived reasons for their PDIs have not been previously studied. STUDY DESIGN AND METHODS: A qualitative interview study was conducted with PDI, appropriately deferred (and not PDI), and accepted donors from the six REDS-II blood centers. Telephone interviews were conducted with donors using semistructured discussion guides after their most recent donation or donation attempt. Salient themes were identified within and across the three donor categories using interview recordings and notes. RESULTS: Sixty-six donors were interviewed (35 PDIs, 21 appropriately deferred, and 10 accepted). Cases could be grouped into one of three broad clusters according to the apparent primary reason for the PDI event: perceived changes in rules or application of more intensive screening procedures at this visit versus prior visit(s), issues of recall or interpretation of a question, and discrepancies in recollections of timing. CONCLUSIONS: While descriptive and demographic information exists on the numbers and types of PDI events and donors, there has never been a qualitative study exploring donation experiences and possible reasons for their PDIs. This exploratory study based on semistructured interviews of donors identified several potentially actionable areas including the need for screeners to clarify the meaning of and answers to certain questions and helping donors accurately remember the details and dates of deferrable activities.

The determinants of frequent donation and factors that lead to high return rates among volunteer blood donors are increasingly important as the eligible donor population continues to be reduced. Deferrals for medications, travel, lifestyle, and emergent diseases and the increasing age of the donor population decrease the pool of available donors. To address concerns about the adequacy of the blood supply, blood centers need to not only recruit new donors but to understand what motivates donors to give again to improve donor retention and increase donation frequency. Previous studies have suggested that the total number of first-time donors is decreasing1 and that only 8% of those new donors continue donating.2 Other reports suggest that younger and minority donors were less likely to donate again within 12 months,3 shorter intervals between a first and second donation increased the likelihood of subsequent donations,4 and first-year donation frequency is a strong predictor of long-term donor return.2 Variables such as age, ethnicity, blood type, and education have also been shown to influence donor return behavior.4 The Retrovirus Epidemiology Donor Study-II (REDS-II) Donor Iron Status Evaluation (RISE) study was a prospective cohort study of hemoglobin (Hb) and iron metabolism in first-time and frequent blood donors. By the midpoint of the 15-month study it became clear that RISE subjects in both cohorts were presenting to donate blood more frequently than predicted. This analysis sought to determine if the reason(s) for higher-than-expected donor return rates involved the donor’s participation in a nonremunerated study.

Author(s): Cable, Ritchard G; Glynn, Simone A; Kiss, Joseph E; Mast, Alan E; Steele, Whitney R; Murphy, Edward L; Wright, David J; Sacher, Ronald A; Gottschall, Jerry L; Vij, Vibha; Simon, Toby L; NHLBI Retrovirus Epidemiology Donor Study-II | Abstract: BackgroundRegular blood donors are at risk of iron deficiency, but characteristics that predispose to this condition are poorly defined.Study design and methodsA total of 2425 red blood cell donors, either first-time (FT) or reactivated donors (no donations for 2 years) or frequent donors, were recruited for follow-up. At enrollment, ferritin, soluble transferrin receptor (sTfR), and hemoglobin were determined. Donor variables included demographics, smoking, dietary intake, use of iron supplements, and menstrual and/or pregnancy history. Models to predict two measures of iron deficiency were developed: Absent iron stores (AIS) were indicated by a ferritin level of less than 12 ng/mL and iron-deficient erythropoiesis (IDE) by a log(sTfR/ferritin) value of 2.07 or greater.ResultsA total of 15.0% of donors had AIS and 41.7% IDE. In frequent donors, 16.4 and 48.7% of males had AIS and IDE, respectively, with corresponding proportions of 27.1 and 66.1% for females. Donation intensity was most closely associated with AIS and/or IDE (odds ratios from 5.3 to 52.2 for different donation intensity compared to FT donors). Being female, younger, and/or menstruating also increased the likelihood of having AIS and/or IDE, as did having a lower weight. Marginally significant variables for AIS and/or IDE were being a nonsmoker, previous pregnancy, and not taking iron supplements. Dietary variables were in general unrelated to AIS and/or IDE, as was race and/or ethnicity.ConclusionA large proportion of both female and male frequent blood donors have iron depletion. Donation intensity, sex and/or menstrual status, weight, and age are important independent predictors of AIS and/or IDE. Reducing the frequency of blood donation is likely to reduce the prevalence of iron deficiency among blood donors, as might implementing routine iron supplementation.