RESUMO
OBJECTIVE: Compare detection of Lynch syndrome in endometrial cancer between regions of a health care system with different screening strategies. METHODS: A retrospective study of endometrial cancer (EC) cases from 2 regions of an integrated health care system (Kaiser Permanente Northern (KPNC) and Southern (KPSC) California). Within KPNC, immunohistochemistry tumor screening (IHC) was physician ordered and risk-based; within KPSC, IHC was universal and automated. Clinical risk factors associated with abnormal IHC and Lynch Syndrome (LS) were identified. RESULTS: During the study, there were 2045 endometrial cancers: 1399 in the physician-order group and 646 in the universal testing group. In the physician-order group: among women < age 60, 34% underwent IHC; 9.6% were abnormal, and 3% were possible LS after methylation testing; among women ≥60, 11% underwent IHC, 3% were abnormal and <1% were possible LS. In the universal group, 87% of women age <60 had IHC, 19.4% were abnormal, and 6% were possible LS; Among women age ≥60, 82% underwent IHC, 26% were abnormal, and 2% were possible LS. There were no differences in LS cases between the physician-order group and the universal group in either age strata (<60: 3% vs. 3.6%, p=0.62; ≥60: <1% vs. 1%, p=0.63) Factors associated with LS were younger age (odds ratio (OR) 0.11, 95% confidence interval (CI) 0.04-0.29) and lower body mass index (BMI), (OR 0.38 95% CI 0.18-0.80). CONCLUSIONS: Universal IHC screening did not result in increased LS detection in EC.
Assuntos
Neoplasias Colorretais Hereditárias sem Polipose/diagnóstico , Neoplasias Colorretais Hereditárias sem Polipose/metabolismo , Neoplasias do Endométrio/diagnóstico , Neoplasias do Endométrio/metabolismo , California , Estudos de Coortes , Neoplasias Colorretais Hereditárias sem Polipose/genética , Neoplasias Colorretais Hereditárias sem Polipose/patologia , Detecção Precoce de Câncer/métodos , Neoplasias do Endométrio/genética , Neoplasias do Endométrio/patologia , Feminino , Aconselhamento Genético , Testes Genéticos , Humanos , Imuno-Histoquímica/métodos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos RetrospectivosRESUMO
OBJECTIVES: Abortion incidence is correlated with seasonal trends in conceptions and births. This retrospective review looks at monthly abortion incidence to detect a seasonal trend. STUDY DESIGN: Data on abortion incidence in 2012 were obtained from the Kentucky Department of Vital Statistics. A regression analysis was performed to detect differences in abortion annualized rates by month. RESULTS: A total of 3810 abortions analyzed showed a trend in abortion incidence peaking in February and March with 444 and 378 abortions per month, respectively, compared to a mean of 299 in other months (p<.001). This trend persisted for second-trimester abortions with 64 and 56 abortions per month in February and March, respectively, compared to a mean of 30 in other months (p<.001). CONCLUSION: The peak in first-trimester abortions correlate with the expected peaks of December conceptions. However, the same trend in second-trimester abortions suggests that women are delaying care.