Venous thrombosis and breast cancer in older women: Racial differences in risk factors and mortality.

BACKGROUND: Risk factors for venous thromboembolism (VTE) in women with breast cancer are not known by race. OBJECTIVES: The purpose of our study was to determine risk factors for VTE and VTE associated mortality in white and black women with breast cancer. PATIENTS AND METHODS: The SEER-Medicare merged database (2000 to 2011) was used for women 65 years and older diagnosed with breast cancer. Stratified by race, logistic regression was used to examine risk factors for VTE and Cox proportional hazards regression was used to evaluate the effect of VTE on mortality. RESULTS: There were 276,028 women 65 years and older with breast cancer. Of those, 6.4% white and 10.1% black women with breast cancer had a diagnosis of VTE. In adjusted analyses by race, risk of VTE increased with each year of age in both white and black cohorts. VTE was independently associated with distant metastasis and coexisting medical conditions in white women and in black women, hypertension, heart failure and hyperlipidemia were determinants of VTE. VTE was not associated with distant metastasis in black women. Tumor size, grade, and receptor status were also not independently associated with VTE risk in either white or black women. VTE accorded a higher risk of death in both white (HR = 1.49, 95% CI, 1.34-1.65) and black women (HR = 1.57, 95% CI, 1.23-2.00) with breast cancer. CONCLUSION: The study identified VTE risk factors and effect of VTE on mortality in white and black older women with breast cancer.

Screening of female family members of von Willebrand disease patients: utility of a modified screening tool in a high-risk population.

INTRODUCTION: Family members of Von Willebrand disease (VWD) patients may have low levels of VWF without major bleeding episodes and often remain undiagnosed. AIM: The purpose of this study was to assess the utility of a modified Screening Tool in identifying previously untested reproductive age female family members of VWD patients for haemostatic evaluation. METHODS: Ninety-four reproductive age women including 41 previously untested family members of VWD patients, 26 previously diagnosed VWD patients and 27 healthy controls were administered a modified Screening Tool and had blood drawn for CBC, ferritin, and VWF testing. Participants completed a pictorial blood assessment chart (PBAC) with menses. RESULTS: The modified Screening Tool was positive in 32% family members, 77% VWD patients, and 19% controls (P < 0.001). Combined with low ferritin, the modified Screening Tool was positive in 66% family members, 92% VWD patients, and 44% controls (P = 0.001). In family members, incorporating low ferritin with the modified Screening Tool resulted in a sensitivity of 86% (95% CI, 42-100) and negative predictive value of 93% (95% CI, 66-100). In the control group, NPV was between 92% and 95% for the modified Screening Tool and also for the modified Screening Tool combined with low ferritin or a positive PBAC. CONCLUSION: These data in a racially diverse population suggest the usefulness of a simple, easy to administer modified Screening Tool. In conjunction with ferritin it could be used in a primary care setting to stratify reproductive age women with a family history of VWD for haemostatic evaluation.

Etiology and risk factors for placenta previa: an overview and meta-analysis of observational studies.

OBJECTIVE: Several clinical and epidemiologic studies have reported disparate data on the prevalence rate as well as risk factors associated with placenta previa--a major cause of third-trimester bleeding. We performed a systematic literature review and identified 58 studies on placenta previa published between 1966 and 2000. STUDY DESIGN: Each study was reviewed independently by the two authors and was scored (on the basis of established criteria) on method of diagnosis of placenta previa and on quality of study design. We extracted data on the prevalence rate of placenta previa, as well as associations with various risk factors from each study. A meta-analysis was then performed to determine the extent to which different risk factors predispose women to placenta previa. RESULTS: Our results showed that the overall prevalence rate of placenta previa was 4.0 per 1000 births, with the rate being higher among cohort studies (4.6 per 1000 births), USA-based studies (4.5 per 1000 births) and hospital-based studies (4.4 per 1000 births) than among case-control studies (3.5 per 1000 births), foreign-based studies (3.7 per 1000 births) and population-based studies (3.7 per 1000 births), respectively. Advancing maternal age, multiparity, previous Cesarean delivery and abortion, smoking and cocaine use during pregnancy, and male fetuses all conferred increased risk for placenta previa. Strong heterogeneity in the associations between risk factors and placenta previa were noted by study design, accuracy in the diagnosis of placenta previa and population-based versus hospital-based studies. CONCLUSION: Future etiological studies on placenta previa must, at the very least, adjust for potentially confounding effects of maternal age, parity, prior Cesarean delivery and abortions.

Risk of abruptio placentae by region of birth and residence among African-American women in the USA.

OBJECTIVE: To determine whether Southern-born African-American women have higher incidence of abruptio placentae, irrespective of their region of residence. METHODS: For this retrospective cohort study we used vital statistics data of the US for the years 1995 and 1996. Age-adjusted rates of abruption were derived for combinations of regions of birth (Northeast, Midwest, South, West, and Foreign-born) and regions of residence (Northeast, Midwest, South, and West) for all singleton live births among African-American women. RESULTS: The incidence of abruptio placentae among African-American women was 6.7 per 1,000 live births. The age-adjusted rates of abruption among women who had not migrated showed that those in the Northeast had the highest rates (8.3 per 1,000), followed by those in the Midwest (6.3 per 1,000), South (6.0 per 1,000) and in the West (4.9 per 1,000). The prevalence of risk factors showed the same pattern. CONCLUSION: The results of the study suggest that place of residence rather than place of birth was associated with the risk of placental abruption. However, foreign-born African-American women had lower rates of abruption irrespective of the region of residence.