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Objective To determine outcomes at age 3 years in babies born before 27 completed weeks' gestation in 2006, and to evaluate changes in outcome since 1995 for babies born between 22 and 25 weeks' gestation.Design Prospective national cohort studies, EPICure and EPICure 2. Setting Hospital and home based evaluations, England.Participants 1031 surviving babies born in 2006 before 27 completed weeks' gestation. Outcomes for 584 babies born at 22-25 weeks' gestation were compared with those of 260 surviving babies of the same gestational age born in 1995.Main outcome measures Survival to age 3 years, impairment (2008 consensus definitions), and developmental scores. Multiple imputation was used to account for the high proportion of missing data in the 2006 cohort. ResultsOf the 576 babies evaluated after birth in 2006, 13.4% (n=77) were categorised as having severe impairment and 11.8% (n=68) moderate impairment. The prevalence of neurodevelopmental impairment was significantly associated with length of gestation, with greater impairment as gestational age decreased: 45% at 22-23 weeks, 30% at 24 weeks, 25% at 25 weeks, and 20% at 26 weeks (P<0.001). Cerebral palsy was present in 83 (14%) survivors. Mean developmental quotients were lower than those of the general population (normal values 100 (SD 15)) and showed a direct relation with gestational age: 80 (SD 21) at 22-23 weeks, 87 (19) at 24 weeks, 88 (19) at 25 weeks, and 91 (18) at 26 weeks. These results did not differ significantly after imputation. Comparing imputed outcomes between the 2006 and 1995 cohorts, the proportion of survivors born between 22 and 25 weeks' gestation with severe disability, using 1995 definitions, was 18% (95% confidence interval 14% to 24%) in 1995 and 19% (14% to 23%) in 2006. Fewer survivors had shunted hydrocephalus or seizures. Survival of babies admitted for neonatal care increased from 39% (35% to 43%) in 1995 to 52% (49% to 55%) in 2006, an increase of 13% (8% to 18%), and survival without disability increased from 23% (20% to 26%) in 1995 to 34% (31% to 37%) in 2006, an increase of 11% (6% to 16%). ConclusionSurvival and impairment in early childhood are both closely related to gestational age for babies born at less than 27 weeks' gestation. Using multiple imputation to account for the high proportion of missing values, a higher proportion of babies admitted for neonatal care now survive without disability, particularly those born at gestational ages 24 and 25 weeks. IntroductionThe survival of babies born at extremely low gestational ages increased in England between 1995 and 2006 but there were few improvements in neonatal morbidity. 1 Indeed, higher survival rates were reported in the Swedish population study, EXPRESS (Extremely Preterm Infants in Sweden Study), 2 yet the proportions of survivors without major neonatal morbidity was similar to those in this, the EPICure 2 study, and described in the accompanying paper.1 This is despite the widespread introduction of interventions to improve outcomes such as the ...

Using a model-based approach, we estimated the probability that an individual, with a specified combination of risk factors, would develop lung cancer within a 5-year period. Data from 579 lung cancer cases and 1157 age-and sex-matched population-based controls were available for this analysis. Significant risk factors were fitted into multivariate conditional logistic regression models. The final multivariate model was combined with agestandardised lung cancer incidence data to calculate absolute risk estimates. Combinations of lifestyle risk factors were modelled to create risk profiles. For example, a 77-year-old male non-smoker, with a family history of lung cancer (early onset) and occupational exposure to asbestos has an absolute risk of 3.17% (95% CI, 1.67 -5.95). Choosing a 2.5% cutoff to trigger increased surveillance, gave a sensitivity of 0.62 and specificity of 0.70, while a 6.0% cutoff gave a sensitivity of 0.34 and specificity of 0.90. A 10-fold cross validation produced an AUC statistic of 0.70, indicating good discrimination. If independent validation studies confirm these results, the LLP risk models' application as the first stage in an early detection strategy is a logical evolution in patient care. In addition, being the most common cancer with over 1.3 million incident cases per year, lung cancer has the highest worldwide rate of cancer mortality (Parkin et al, 2005). More than half of all cases are diagnosed at an advanced stage when surgical removal is no longer a viable treatment strategy. As a result, the overall 5-year survival rate is low, but stage-specific survival rates differ substantially by stage at presentation (van Rens et al, 2000). This raises the possibility that lung cancer may be an attractive candidate for screening, to detect disease at an early stage when treatment would be more effective. Recent results from the International Early Lung Cancer Action Program would appear to support this argument (I-ELCAP Investigators et al, 2006). While the International Early Lung Cancer Action Program results are very encouraging, there are also potential negative consequences of screening, including screen-detected false positives.Although a mortality benefit from spiral CT has not yet been confirmed in ongoing, large-scale randomised studies, the need to specify a high-risk target population is well accepted, and there has been increasing interest in methods of individual risk prediction for lung cancer. Models have been developed for use within highrisk groups (Bach et al, 2003), and for the general population (van Klaveren et al, 2002), although the latter tend to rely only on age and smoking. While epidemiological risk factors usually show poor discrimination between those who do and do not develop disease (Wald et al, 1999), lung cancer is an exception in that a high proportion of cases are attributable to one risk factor, smoking. However, there is room for further improvement in that many long-term smokers do not develop lung cancer. The predictive accuracy of lung cancer ri...

SLNB in patients undergoing surgery for breast cancer results in a significant reduction in physical and psychological morbidity.