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We investigated the predictors of the risk of developing a second primary cancer after breast cancer, this occurring in about 12% of affected women. The analysis included 335 191 females, registered in the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) database, who had been diagnosed with breast cancer. Observed numbers of subsequent cancers in the SEER database with a first breast cancer diagnosed from 1973 to 2000 were compared with the expected numbers based on age-adjusted incidence rates to calculate standardised incidence ratios. Kaplan -Meier curves were conducted to determine the median time until the second primary cancer diagnosis. Average number of years until diagnosis varied by site and by age as well as median years until second cancer diagnosis. Most cancer risks decreased with age, but there was an increase in aging-related cancers such as lung cancer. The median years of follow-up were well beyond the 5-year mark. Breast cancer survivors should be advised of their increased risk for developing certain cancers in their lifetime. Approximately, 600 000 women in the US are diagnosed with cancer in a given year, and 31% of them will be diagnosed with breast cancer. Breast cancer is the leading cancer for women, and deaths associated with breast cancer are second behind lung cancer and account for 15% of all cancer deaths (American Cancer Society, 2004). Survival rates (5, 10, and 20-year) continue to increase and many women will survive their breast cancer diagnosis and treatment (Rosen et al, 1989;Jones and Raghavan, 1993; American Cancer Society, 2004).Second primary tumours may develop in women previously diagnosed with breast cancer. Yet, little is known about the risk of multiple primary tumours among breast cancer survivors. The purpose of this study was to examine whether women diagnosed with breast cancer have an increased risk of developing a subsequent cancer compared with women of equal age without an initial breast cancer diagnosis. The current study reports the most common second primary tumours following breast cancer, the time to diagnosis for women with a second tumour and how overall survival is affected for these women. MATERIALS AND METHODS PopulationThe study population was derived from the SEER Cancer Registry database, which encompasses approximately 11% of the national cancer burden (Fritz and Ries, 1998; SEER*Stat software, 2004). All patients in this study were women in the SEER Cancer Registry diagnosed with breast cancer between 1 January, 1973 and 31 December 2000. There were 335 191 women diagnosed with breast cancer (International Classification of Diseases for Oncology 2 (ICD-O-2) code C50) (Percy et al, 1990). Women were included if the breast cancer was categorised as in situ or malignant and if the morphology was either ductal, lobular, or medullary neoplasm (ICD-O-2 codes 8500 -8540). A total of 2330 women developed a second cancer, but the information was not completely entered into the SEER database. These women were used in the su...

, approximately 99,000 residents of Flint, Michigan, were affected by changes in drinking water quality after their water source was switched from the Detroit Water Authority (DWA), sourced from Lake Huron, to the Flint Water System (FWS), sourced from the Flint River.* Because corrosion control was not used at the FWS water treatment plant, the levels of lead in Flint tap water increased over time. Adverse health effects are associated with lead exposure (1). On January 2, 2015, a water advisory was issued because of detection of high levels of trihalomethanes, byproducts of disinfectants. †, § Studies conducted by local and national investigators detected an increase in the prevalence of blood lead levels (BLLs) ≥5 µg/dL (the CDC reference level) among children aged <5 years living in Flint (2) and an increase in water lead levels after the water source switch (3). On October 16, 2015, the Flint water source was switched back to DWA, and residents were instructed to use filtered tap water for cooking and drinking. During that time, pregnant and breastfeeding women and children aged <6 years were advised to consume bottled water. ¶ To assess the impact on BLLs of consuming contaminated drinking water, CDC examined the distribution of BLLs ≥5 µg/dL among children aged <6 years before, during, and after the switch in water source. This analysis enabled determination of whether the odds of having BLLs ≥5 µg/dL before the switch differed from the odds during the switch to FWS (before and after the January 2, 2015, water advisory was issued), and after the switch back to DWA. Overall, among 9,422 blood lead tests in children aged <6 years, 284 (3.0%) BLLs were ≥5 µg/dL during April 25, 2013-March 16, 2016. The adjusted probability of having BLLs ≥5 µg/dL was 46% higher during the period after the switch from DWA to FWS (and before the January 2, 2015, water advisory) than during the period before the water switch to FWS. Although unrelated to lead in the water, the water advisory likely reduced tap water consumption and increased consumption of bottled water. Characterizing exposure to lead contaminated drinking water among children aged <6 years living in Flint can help guide appropriate interventions.Blood lead testing in Michigan is targeted to children living at or below the poverty level as well as to children enrolled in Medicaid. The Centers for Medicare & Medicaid Services requires all children on Medicaid to receive blood lead screening at ages 12 and 24 months, or at ages 36 and 72 months if previous screening has not been conducted. Confirmed BLLs ≥5 µg/dL are defined as having one venous blood lead test result ≥5 µg/dL or two capillary blood lead test results ≥5 µg/dL drawn within 12 weeks of each other.Analyses of BLLs obtained during four periods were conducted. These included the period 1) before the switch from DWA to FWS (April 25, 2013-April 24, 2014; 2) after the switch from DWA to FWS, but before the water advisory was issued (April 25, 2014-January 2, 2015); 3) after the switch to FWS, and after...

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Background: Amyotrophic lateral sclerosis (ALS) is a progressive fatal disease with a varying range of clinical characteristics. Objective: To describe the clinical characteristics in a large cohort of ALS participants enrolled in the National ALS Registry. Methods: Data from ALS participants who completed the Registry's online clinical survey module during 2010-2015 were analyzed to determine characteristics, such as site of onset, associated symptoms, time of symptom onset to diagnosis, time of diagnosis to hospice referral, and pharmacological and non-pharmacological interventions. Results: Of the 1758 participants who completed the survey, 60.9% were male, 62.1% were 50-69 years old, and 95.5% white. Approximately, 72.0% reported initial limb weakness onset of disease, followed by bulbar (22.1%), and trunk/global onset (6.1%). Other symptoms ever experienced included cramps (56.7%), fasciculations (56.3%), and dysarthria (33.0%). The median time between an increase of muscle cramps until an ALS diagnosis was 12 months; limb onset participants had cramps longer preceding diagnosis versus those with bulbar onset. The most frequent interventions used included riluzole (48.3% currently using), wheelchairs/scooters (32.8%), and noninvasive breathing equipment (30.0%). Participants with trunk/global onset were referred to hospice almost four times earlier than others. Conclusions: These data show how ALS clinical characteristics differ widely in a large cohort of participants preceding diagnosis and reflect variations in disease onset, progression, and prognosis. Better characterization of symptom onset may assist clinicians in diagnosing ALS sooner, which could lead to earlier therapeutic interventions.

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