Objective-To investigate maternal serum unconjugated oestriol (uE,) and human chorionic gonadotrophin (hCG) levels in twin pregnancies and to considcr the implications of the results for antenatal screening for Down's syndrome. Design-Measurement of maternal serum uE, and hCG levels from 15-22 weeks of gestation in twin and singleton pregnancies. Previously available maternal serum alpha-fetoprotein (AFP) levels were also presented. Setting-Stored serum samples collected from women receiving routine antenatal care in Oxford were used. Subjects-200 women with a twin pregnancy and, for each, three singleton control pregnancies matched for gestational age (same completed week of pregnancy) and duration of storage of the serum sample (same calendar quarter). Results-The median uE,, hCG and AFP levels in the twin pregnancies were respectively, 1.67 (95% CI 1.56-1.79), 1-84 (95% CI 164-2.07) and 2.13 (95% C1 1.97-2-31) multiples of the median (MOM) for singleton pregnancies at the samc gestational age. The variance of values for the threc serum markers (expressed in logarithms), and the correlation coefficients between any two, were similar in the twin and singleton pregnancies. Conclusion-In maternal serum screening programmes for Down's syndrome dividing uE,, hCG and AFP MOM values in twin pregnancies by the corresponding medians for twin pregnancies will, in expectation, yield a similar falsepositive rate in twin pregnancies as in singleton pregnancies.

Insulin-like growth factor-1 (IGF-1), insulin-like growth factor-2 (IGF-2), and insulin-like growth factor binding protein-3 (IGFBP-3) were measured in frozen serum samples from 1051 men with cancer and 3142 controls in a nested case -control study from the British United Provident Association (BUPA) study cohort and associations with 14 cancers were examined, including prostate, colorectal, and lung. A meta-analysis of studies on these three cancer sites was also conducted. In the meta-analysis the odds ratio between the highest quartile IGF-1 group and the lowest quartile group was 1.31 (95% confidence interval (CI): 1.03 -1.67) for prostate, 1.37 (1.05 -1.78) for colorectal and 1.02 (0.80 -1.31) for lung cancer, and for IGF-2 it was 0.72 (0.36 -1.44) for prostate and 1.95 (1.26 -3.00) for colorectal cancer. Results from the BUPA study were consistent with the estimates from the other studies. There were no statistically significant associations with IGFBP-3 and any of the cancer sites considered. Our results suggest that IGF-1, IGF-2, and IGFBP-3 measurements have no value in cancer screening, although IGF-1 and IGF-2 may be of aetiological significance in relation to colorectal and prostate cancer. Prospective studies have shown that higher circulating concentrations of insulin-like growth factor 1 (IGF-1), insulin-like growth factor 2 (IGF-2), and insulin-like growth factor binding protein-3 (IGFBP-3) are associated with an increased risk of prostate cancer, colorectal cancer, and premenopausal breast, and ovarian cancer Renehan et al, 2004). Aetiological importance has been attributed to these associations, and it has been suggested that they may be of value in screening for these cancers.We here report results on measurements of IGF-1, IGF-2, and IGFBP-3 from the British United Provident Association (BUPA) prospective study, based on 1051 new cases of cancer at 14 different cancer sites, and we combine the results on prostate, colorectal, and lung cancer with those from published studies in a meta-analysis. METHODSThe BUPA study is a prospective study of 21 520 professional men aged 35 -64 years resident in Britain who attended the BUPA medical centre in London between 1975 and 1982 for a routine medical examination. Serum samples were stored at À401C. The men were flagged at the National Health Service Central Register in Southport, permitting automatic notification of death (with the certified cause) and cancer incidence by the Office for National Statistics. Further information on the causes of death was obtained by writing to each certifying doctor. This analysis is based on a maximum follow-up of 15 years and is restricted to those cancers for which at least 10 cases occurred. In this period, there were 1059 men for whom we had a cancer notification. For each case, three controls (who were still alive and for whom we did not have a cancer notification) were selected; they were matched for age and duration of storage of the serum sample each to one year.In 2003 the frozen serum samples were retrieved....

Adding screening for pre-eclampsia to an existing Down syndrome screening programme using the Quadruple test markers is simple and worthwhile. It will detect over 40% of pregnancies with pre-eclampsia at an acceptable false-positive rate (about 6%) and with minimal additional costs.

Objective To estimate the pre-eclampsia screening performance of PAPP-A (pregnancy-associated plasma protein-A) and ADAM12 (A Disintegrin And Metalloprotease 12) in the early second trimester of pregnancy. Methods Stored frozen serum samples from a previously published nested case-control study comprising 77 women who developed pre-eclampsia and 224 unaffected controls were thawed and assayed for PAPP-A and ADAM12. Levels were converted into multiple of the unaffected median (

Adding PlGF to the Quadruple test Down's syndrome screening markers improves pre-eclampsia screening performance. There is a modest extra benefit in also adding the measurement of endoglin.