Background Uterine fibroids (UFs) are the most common neoplasm affecting women that can cause significant morbidity and may adversely impact fertility.Objectives To examine UF epidemiology and to evaluate the relative strengths of putative risk factors.Search strategy MEDLINE and Embase were searched for studies published in English between January 1995 and April 2015.Selection criteria Publications reporting relevant data from registries and other observational studies with over 1000 patients and single-centre studies with over 100 patients were selected.Data collection and analysis Data on UF incidence, prevalence and associated risk factors were extracted from 60 publications.Main results Wide ranges were reported in both UF incidence (217-3745 cases per 100 000 women-years) and prevalence (4.5-68.6%), depending on study populations and diagnostic methods. Black race was the only factor that was recurrently reported to increase UF risk, by two-threefold compared with white race. Eleven other factors affected UF risk to a magnitude similar to or greater than race. Age, premenopausal state, hypertension, family history, time since last birth, and food additive and soybean milk consumption increased UF risk; use of oral contraceptives or the injectable contraceptive depot medroxyprogesterone acetate, smoking in women with low body mass index and parity reduced UF risk.Conclusions We identified 12 risk factors that play an important role in UF epidemiology. The UF risk factor with the strongest evidence is black race. High-quality prospective observational data are needed to improve our understanding of UF epidemiology, and thus its aetiology and optimal management.Keywords Epidemiology, incidence, leiomyoma, prevalence, race, risk factors, uterine fibroids.Tweetable abstract Uterine fibroids occur in about 70% of women. Black race and 11 other factors affect uterine fibroid risk.

A case control study was conducted where cases were children younger than 5 years (diseased between 1980 and 2003) registered at the german childhood cancer registry (GCCR). Populationbased matched controls (1:3) were selected from the corresponding registrar's office. Residential proximity to the nearest nuclear power plant was determined for each subject individually (with a precision of about 25 m). The report is focused on leukaemia and mainly on cases in the inner 5-km zone around the plants. The study includes 593 leukaemia cases and 1,766 matched controls. All leukaemia combined show a statistically significant trend for 1/distance with a positive regression coefficient of 1.75 [lower 95%-confidence limit (CL): 0.65]; for acute lymphoid leukaemia 1.63 (lower 95%-CL: 0.39), for acute non-lymphocytic leukaemia 1.99 (lower 95%-CL: 20.41). This indicates a negative trend for distance. Cases live closer to nuclear power plants than the randomly selected controls. A categorical analysis shows a statistically significant odds ratio of 2.19 (lower 95%-CL: 1.51) for residential proximity within 5 km compared to residence outside this area. This result is largely attributed to cases in previous studies of the GCCR (especially in the inner zone) as there is clearly some overlap between those studies. The result was not to be expected under current radiation-epidemiological knowledge. Considering that there is no evidence of relevant accidents and that possible confounders could not be identified, the observed positive distance trend remains unexplained. ' 2007 Wiley-Liss, Inc.Key words: childhood; leukaemia; nuclear power plants; populationbased; cancer registry To date, the aetiology of childhood leukaemia has remained inconclusive even though numerous epidemiological studies have addressed this question. There are some risk factors discussed as possibly causal or protective include lifestyle, genetic disposition, course of pregnancy and perinatal development, the immune system and environmental hazards. 1-5 One generally accepted risk factor for leukaemia is exposure to ionising radiation. 6,7 Whether there is a threshold level at which any higher level of exposure will be associated with occurrence of leukaemias, however, is subject to controversy. Internationally, currently used estimates of cancerogenic radiation effects in the low-dose range are based on linear no-threshold extrapolation; regarding leukaemia, a quadratic model is also applicable. 8,9 Other authors work on the assumption that these models overestimate the effects in a dose range of <10 milli Sievert considerably. 10 Child-specific conclusions are either not given in these published reports or data are reported to be insufficient for any conclusions to be drawn. 8 For many years, there has been controversy over whether or not the emission of ionising radiation during routine operation of nuclear plants will already increase the risk of leukaemia in children. Such an effect is not too likely as present-day emissions of ionising radiation from nu...

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BACKGROUND: Adenomyosis symptoms are disabling. Populationbased data on incidence and prevalence of adenomyosis are lacking that could guide future evidence-based treatments and clinical management. OBJECTIVE: To evaluate the incidence, 10-year secular trends, and prevalence of adenomyosis diagnoses and to describe symptoms and treatment patterns in a large U.S. cohort. STUDY DESIGN: We performed a retrospective population-based cohort study of women aged 16e60 years in 2006e2015, enrolled in Kaiser Permanente Washington, a mixed-model health insurance and care delivery system. Adenomyosis diagnoses identified by ICD codes from the International Classification of Diseases 9th and 10th editions and potential covariates were extracted from computerized databases. Women with prior hysterectomy, and for incidence estimates women with prior adenomyosis diagnoses, were excluded. Linear trends in incidence rates over the 10-year study period were evaluated using Poisson regression. Rates and trend tests were examined for all women adjusting for age using direct standardization to the 2015 study population, by age groups, and by race/ethnicity. Chart reviews were performed to validate diagnostic accuracy of ICD codes in identifying adenomyosis incidence. Symptoms and treatment patterns at diagnosis and in the following 5 years were assessed. RESULTS: A total of 333,693 women contributed 1,185,855 woman-years (2006e2015) for incidence calculations. Associated symptom-related codes (menorrhagia or abnormal uterine bleeding, dysmenorrhea or pelvic pain, dyspareunia, and infertility) were observed in 90.8%; 18.0% had co-occurrent endometriosis codes and 47.6% had cooccurrent uterine fibroid codes. The overall adenomyosis incidence was 1.03% or 28.9 per 10,000 woman-years, with a high of 30.6 in 2007 and a low of 24.4 in 2014. Overall age-adjusted estimated incidence rates declined during the 10-year study interval (linear trend P < .05). Incidence was highest for women aged 41e45 years (69.1 per 10,000 womanyears in 2008) and was higher for black (highest 44.6 per 10,000 woman-years in 2011) vs white women (highest 27.9 per 10,000 womanyears in 2010). Overall prevalence in 2015 was 0.8% and was highest among women aged 41e45 years (1.5%). Among the 624 potential adenomyosis cases identified by diagnostic codes in 2012e2015 and with sufficient information in the medical record to determine true case status, 490 were confirmed as incident cases, yielding a 78.5% (95% confidence interval, 75.1%, 81.7%) positive predictive value of adenomyosis ICD-9/ICD-10 codes for identifying an incident adenomyosis case. Health care burden was substantial: 82.0% of women had hysterectomies, nearly 70% had imaging studies suggestive of adenomyosis, and 37.6% used chronic pain medications. CONCLUSION: Adenomyosis burden to the individual and the health care system is high. Incidence rates are disproportionately high among black women. These findings are of concern, as currently available longterm medical therapies remain limited beyond hysterec...

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