Increased risk for breast cancer after childbirth may last more than 20 years

1. Increased risk for breast cancer after childbirth may last more than 20 years

Breastfeeding did not mitigate the increased cancer risk
Abstract: http://annals.org/aim/article/doi/10.7326/M18-1323
Free Summary for Patients: http://annals.org/aim/article/doi/10.7326/P18-0020
URLs go live when the embargo lifts

The increased risk for breast cancer that occurs after childbirth can last more than 20 years. The risk may be enhanced when a woman is older at first birth or has a family history of breast cancer, and is not mitigated by breastfeeding. Findings from pooled analysis of 15 prospective studies are published in Annals of Internal Medicine.

Childbirth is widely recognized as protective against breast cancer, but breast cancer risk has been shown to be increased shortly after childbirth. Just how long this heightened risk lasts and factors that contribute to the risk have rarely been assessed.

Researchers from the University of North Carolina Gillings School of Global Public Health (with co-authors from the Institute of Cancer Research in London and the National Institute of Environmental Health Sciences in North Carolina) analyzed individual-level data from 15 prospective cohort studies to characterize breast cancer risk in relation to recent childbirth. The data showed that compared with women of the same age who had never given birth, women who had given birth had an increased risk for breast cancer that peaked about 5 years after birth and continued for about 24 years after birth. The increased risk was seen for both estrogen receptor (ER) positive and ER negative breast cancer, and breastfeeding did not modify risk patterns.

According to the researchers, these findings show that risk factors for breast cancer can differ between older and younger women, and should be considered in combination with other characteristics than may influence risk, such as a family history of breast cancer. Combined with evidence from other studies, this research may help to develop better breast cancer risk prediction models to inform decision-making around breast cancer screening and prevention strategies.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author, Hazel Nichols, PhD, please contact Laura Oleniacz at laura_oleniacz@med.unc.edu.

2. VA hospitals consistently outperform non-VA hospitals in several measures of quality of care
Abstract: http://annals.org/aim/article/doi/10.7326/M18-1540
URLs go live when the embargo lifts

Health care provided by the Veterans Health Administration (VA) is likely to be better than that provided by non-VA settings in several measures of quality of care. Findings from a brief research report are published in Annals of Internal Medicine.

Veterans trying to make an informed decision about whether to seek care at a VA or non-VA hospital want to know which health care setting will have the best outcomes. Using the most current publicly available Hospital Care data, researchers from The Dartmouth Institute for Health Policy and Clinical Practice compared 15 important outcomes for VA to non-VA hospitals within 121 local health care markets. Outcomes included 30-day risk-adjusted mortality rates for four common diseases plus 11 additional patient safety indicators. The data showed that VA hospitals were likely to provide the best care in a local health care market, and rarely provided the worst care in local markets.

According to the authors, these findings suggest that, despite recent negative reports, the VA generally provides truly excellent care and efforts to outsource VA care to non-VA settings solely for patient convenience should be reconsidered. The authors caution that VA and non-VA hospitals may report data differently to Hospital Compare. If so, then the VA and Centers for Medicare and Medicaid Services (CMS) should take steps to adapt reporting methods that ensure fair and accurate comparisons.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author, William B Weeks, MD, PhD, MBA, please contact Paige Stein at Paige.Stein@dartmouth.edu.

3. Biosimilar to infliximab shows equivalent safety and efficacy for treating Crohn's disease
Abstract: http://annals.org/aim/article/doi/10.7326/M18-1512
Editorial: http://annals.org/aim/article/doi/10.7326/M18-3060
URLs go live when the embargo lifts

A biosimilar of infliximab, CT-P13, has equivalent safety and efficacy to that of the anti-tumor necrosis factor (TNF) monoclonal antibody for treating Crohn's disease in infliximab-naïve patients. Findings from a comparative equivalence cohort study are published in Annals of Internal Medicine.

The TNF inhibitors, including infliximab, have improved the management of inflammatory bowel disease. The U.S. Food and Drug Administration defines biosimilars as "highly similar to the reference product notwithstanding minor differences in clinically inactive components and for which there are no clinically meaningful differences between the biologic product and the reference product in terms of safety, purity, and potency of the product." CT-P13 is a biosimilar to infliximab that has demonstrated efficacy and safety for some inflammatory arthritides and was approved for Crohn's disease on that basis, without specific studies examining its effects in Crohn's disease.

Researchers from Caisse Nationale de I'Assurance Maladie studied a French nationwide database to compare the effectiveness and safety of CT-P13 and the reference product (infliximab). The study included 5,050 infliximab-naïve patients who started treatment with infliximab (n = 2,551) or CT-P13 (n = 2,499). The researchers found that CT-P13 had equivalent efficacy to infliximab and no difference was observed in terms of safety outcomes. Based on these findings, the researchers suggest that the choice between the two products could be based solely on cost.

The authors of an accompanying editorial from the University of Copenhagen Herlev Hospital point out that the introduction of biosimilars has resulted in cost savings for patients. Further economic benefits may also be realized as access to treatment increases. Regardless, the authors stress that full transparency is a must when patients are switched to or begin treatment with a biosimilar. Health care professionals must be proactive in increasing patients' confidence by providing evidence-based information from the growing experience with biosimilars.

Media Contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview someone the lead author, Antoine Meyer, MD, please contact him directly at antoinemeyer@gmail.com.

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Also in this issue:

The U.S. Medicine Chest: Implications of Increased Reliance on China
Rosemary Gibson, MSc
Ideas and Opinions
Abstract: http://annals.org/aim/article/doi/10.7326/M18-2552