Objective: To examine the prevalence across 25 years of overweight and obesity among nulliparous Australian women during early pregnancy; to estimate the proportions of adverse perinatal outcomes attributable to overweight and obesity in this population. Design: Cohort study; retrospective analysis of electronic maternity data. Setting, participants: 42 582 nulliparous women with singleton pregnancies giving birth at the Royal Prince Alfred Hospital, an urban teaching hospital in Sydney, January 1990 – December 2014. Main outcome measures: Maternal body mass index (BMI), socio‐demographic characteristics, and selected maternal, birth and neonatal outcomes; the proportion of adverse perinatal outcomes that could be averted by reducing the prevalence of overweight and obesity in women prior to first pregnancies (population attributable fraction, PAF). Results: The prevalence of overweight among nulliparous pregnant women increased from 12.7% (1990–1994) to 16.4% (2010–2014); the prevalence of obesity rose from 4.8% to 7.3% in the same period, while the proportion with normal range BMIs fell from 73.5% to 68.2%. The PAFs for key adverse maternal and neonatal outcomes increased across the study period; during 2010–2014, 23.8% of pre‐eclampsia, 23.4% of fetal macrosomia, and 17.0% of gestational diabetes were attributable to overweight and obesity. Were overweight and obese women to have moved down one BMI category during 2010–2014, 19% of pre‐eclampsia, 15.9% of macrosomia, 14.2% of gestational diabetes, 8.5% of caesarean deliveries, 7.1% of low for gestational age birthweight, 6.8% of post partum haemorrhage, 6.5% of admissions to special care nursery, 5.8% of prematurity, and 3.8% of fetal abnormality could have been averted. Conclusions: Over the past 25 years, the proportions of adverse perinatal outcomes attributable to overweight and obesity have risen with the increasing prevalence of maternal overweight and obesity. A substantial proportion of these outcomes might be averted with obesity prevention strategies that reduce pre‐pregnancy maternal weight.

Background Breast density (BD) is an independent risk factor for breast cancer and reduces the sensitivity of mammography. This systematic review aims to synthesize evidence from existing studies to understand the impact of BD information and/or notification on women's cognitive, psychological and behavioral outcomes. Methods Studies were identified via relevant database searches up to March 2020. Two authors evaluated the eligibility of studies with verification from the study team, extracted and crosschecked data, and assessed the risk of bias. Results Of the 1134 titles identified, 29 studies were included. Twenty-three studies were quantitative, including only 1 randomised controlled trial of women receiving BD information, and 6 were qualitative. Twenty-seven studies were conducted in the United States, with 19 conducted post-BD legislation. The overall results in terms of BD awareness, knowledge, attitudes, perceptions and intentions were heterogeneous across included studies, with the strongest consistency demonstrated regarding the importance of communication with and involvement of healthcare professionals. Together the studies did however highlight that there is still limited awareness of BD in the community, especially in more socio-economic disadvantaged communities, and limited knowledge about what BD means and the implications for women. Importantly, BD information in the context of overall breast cancer risk has not yet been studied. Conclusions There are important gaps in the understanding of the impact of BD information or notification on women and how best to communicate BD information to women. More high-quality evidence to inform both current and future practice related to BD is still needed.

Background Breast screening programs replaced film mammography with digital mammography, the effects of this practice shift in population screening on health outcomes can be measured through examination of cancer detection and interval cancer rates. Methods A systematic review and random effects meta-analysis were undertaken. Seven databases were searched for publications that compared film to digital mammography within the same population of asymptomatic women and reported cancer detection and/or interval cancer rates. Results The analysis included 24 studies with 16,583,743 screening examinations (10,968,843 film and 5,614,900 digital). The pooled difference in cancer detection rate showed an increase of 0.51 per 1,000 screens (95%CI: 0.19-0.83), greater relative increase for DCIS (25.2%, 95%CI: 17.4-33.5%) than invasive (4%, 95%CI: -3-13%), and a recall rate increase of 6.95 (95%CI: 3.47-10.42) per 1,000 screens after the transition from film to digital mammography. Seven studies (80.8% of screens) reported interval cancers: pooled difference showed no change in interval cancer rate with -0.02 per 1,000 screens (95%CI: -0.06-0.03). Restricting analysis to studies at low risk of bias resulted in findings consistent with the overall pooled results for all outcomes. Conclusions The increase in cancer detection following the practice shift to digital mammography did not translate into a reduction in the interval cancer rate. Recall rates were increased. These results suggest the transition from film to digital mammography did not result in health benefits for screened women. This analysis reinforces the need to carefully evaluate effects of future changes in technology, such as tomosynthesis, to ensure new technology leads to improved health outcomes and beyond technical gains.

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