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OBJECTIVE: To examine the prognostic performance of the revised 2018 International Federation of Gynecology and Obstetrics (FIGO) cervical cancer staging schema. METHODS: We used the National Cancer Database to identify women with cervical cancer diagnosed from 2004 to 2015. Using clinical and pathologic data, each patient's stage was classified using three staging schemas: American Joint Committee on Cancer 7th edition, FIGO 2009 and FIGO 2018. The FIGO 2018 revised staging classifies stage IB tumors into three substages based on tumor size (IB1–IB3) and classifies patients with positive lymph nodes (pathologically or clinically detected) as stage IIIC1 (positive pelvic nodes) or IIIC2 (positive para-aortic nodes). Five-year survival rates were estimated for each stage grouping. We sought to determine whether the 2018 FIGO staging system was able to offer improved 5-year survival rate differentiation compared with older staging schemas. RESULTS: A total of 62,212 women were identified. The classification of stage IB tumors into three substages improved discriminatory ability. Five-year survival in the FIGO 2018 schema was 91.6% (95% CI 90.4–92.6%) for stage IB1 tumors, 83.3% (95% CI 81.8–84.8%) for stage IB2 neoplasms, and 76.1% (95% CI 74.3–77.8%) for IB3 lesions. In contrast, for women with stage III tumors, higher FIGO staging was not consistently associated with worse 5-year survival rates: stage IIIA (40.7%, 95 CI 37.1–44.3%), stage IIIB (41.4%; 95% CI 39.9–42.9%), stage IIIC1 (positive pelvic nodes) was 60.8% (95% CI 58.7–62.8%) and stage IIIC2 37.5% (95% CI 33.3–41.7%). CONCLUSION: The FIGO 2018 staging schema provides improved discriminatory ability for women with stage IB tumors; however, classification of all women with positive lymph nodes into a single stage results in a very heterogeneous group of patients with highly variable survival rates.

A 2007 report by the International Agency for Research on Cancer classified night-shift work as possibly carcinogenic to humans, emphasizing, in particular, its association with breast cancer. Since this report and the publication of the last systematic review on this topic, several new studies have examined this association. Hence, to provide a comprehensive update on this topic, we performed a systematic review and meta-analysis. We searched Medline, Embase, CINAHL, Web of Science (Conference Proceedings), and ProQuest dissertations for studies published before March 1, 2012, along with a manual search of articles that cited or referenced the included studies. Included were observational case-control or cohort studies examining the association between night-shift work and breast carcinogenesis in women, which all ascertained and quantified night-shift work exposure. The search yielded 15 eligible studies for inclusion in the systematic review and meta-analysis. Using random-effects models, the pooled relative risk (RR) and 95 % confidence intervals (CIs) of breast cancer for individuals with ever night-shift work exposure was 1.21 (95 % CI, 1.00-1.47, p = 0.056, I (2) = 76 %), for short-term night-shift workers (<8 years) was 1.13 (95 % CI, 0.97-1.32, p = 0.11, I (2) = 79 %), and for long-term night-shift workers (≥8 years) was 1.04 (95 % CI, 0.92-1.18, p = 0.51, I (2) = 55 %), with substantial between-study heterogeneity observed in all analyses. Subgroup analyses suggested that flight attendants with international or overnight work exposure and nurses working night-shifts long-term were at increased risk of breast cancer, however, these findings were limited by unmeasured confounding. Overall, given substantial heterogeneity observed between studies in this meta-analysis, we conclude there is weak evidence to support previous reports that night-shift work is associated with increased breast cancer risk.