To reduce late-stage breast cancer occurrence, reaching unscreened women, including elderly, unmarried, low-income, and less educated women, should be made a top priority for screening implementation.

Cohort study designs have several advantages over case-control studies in terms of exposure measurement. If exposure measurement occurs before disease occurrence, cohort studies are much less prone to differential measurement error. Prospective data collection should also reduce measurement error due to poor recall of past exposures. The primary drawback of cohort studies is the large sample size leading to high data collection costs. Several approaches to reduce such costs have been discussed in this presentation, such as selection of lower cost measurement methods and fully measuring the exposure only on a subsample of the cohort (e.g., nested case-control design). However, other innovative approaches to reduce costs are needed. In addition, study reviewers should also consider that the higher costs are justified in relation to the several benefits of this study design, which include not only less measurement error, but also less susceptibility to selection bias and often the ability to study multiple disease outcomes. Improving the accuracy of exposure measurement is increasingly important for cohort studies as we move on to the study of exposures that are difficult to measure or to those with lower relative risks of disease. In such studies, attenuation of the relative risk by the effects of measurement error can lead to failure to detect an association between exposure and disease. The validity of exposure measurements could be improved by a better understanding of the biologically active agent and etiologically important time period of the exposure-disease relation, and by incorporating these into the measure. Long-term cohort studies which cover the etiologically relevant time period could improve the accuracy of measures of exposures by use of repeated biologic measures or repeated updates of self-reported exposures. Measurement error also can be reduced by judicious choice of a cohort to study and by careful attention to quality control procedures. Continued emphasis on the evaluation and improvement of the measurement properties of instruments used in epidemiologic studies will improve the validity of the results of cohort studies.

Objectives Pyruvate kinase deficiency (PK deficiency) is a rare disorder caused by compound heterozygosity or homozygosity for > 300 mutations in the PKLR gene. To understand PK deficiency prevalence, we conducted a systematic literature review. Methods We queried Embase and Medline for peer‐reviewed references reporting PK deficiency prevalence/incidence, PKLR mutant allele frequency (MAF) among the general population, or crude results from which these metrics could be derived. Results Of 1390 references screened, 1296 were excluded after title/abstract review; 60 were excluded after full‐text review. Four of the remaining 34 studies were considered high‐quality for estimating PK deficiency prevalence. Two high‐quality studies identified cases from source populations of known sizes, producing estimates of diagnosed PK deficiency prevalence of 3.2 and 8.5 per million. Another high‐quality study derived an estimate of diagnosed PK deficiency prevalence of 6.5 per million by screening jaundiced newborns. The final high‐quality study estimated total diagnosed and undiagnosed PK deficiency prevalence to be 51 per million through extrapolation from observed MAFs. Conclusions We conclude that prevalence of clinically diagnosed PK deficiency is likely between 3.2 and 8.5 per million in Western populations, while the prevalence of diagnosed and undiagnosed PK deficiency could possibly be as high as 51 per million.

BackgroundThe purpose of this report is to examine the correlates of quality of life (QOL) of a well-defined group of long-term breast cancer survivors diagnosed between the ages of 40 and 49.MethodsWomen were eligible if they were diagnosed with invasive breast cancer or ductal carcinoma in situ 5 to 10 years before June 30, 1998 and were enrolled at Group Health Cooperative, a health maintenance organization in western Washington State. A questionnaire was mailed to 290 women; 216 were included in this analysis. The questionnaire included standardized measures of QOL [e.g., the Cancer Rehabilitation Evaluation System (CARES-SF) and SF-36] as well as general demographic and medical information. ANOVA and logistic regression were used to estimate correlates of self-reported QOL.ResultsThe mean age at diagnosis was 44.4 years, and the average time since diagnosis was 7.3 years. Women reported high levels of functioning across several standardized QOL scales; mild impairment was found on the CARES-SF Sexual Scale. The presence of breast-related symptoms at survey, use of adjuvant therapy, having lower income, and type of breast surgery were significantly associated with lower QOL 5 to 10 years post-diagnosis on one or more of the scales.ConclusionsOur results emphasize that younger long-term survivors of breast cancer have a high QOL across several standardized measures. However, the long-term consequences of adjuvant therapy and the management of long-term breast-related symptoms are two areas that may be important for clinicians and women with breast cancer in understanding and optimizing long-term QOL.

Biologic-treated psoriasis patients had inadequate adherence (i.e., MPR <80%) and modest persistence to biologics, with moderate and severe patients demonstrating lower adherence and persistence than mild patients.