Abstract
Background
Extended, more effective breast cancer treatments have increased the prevalence of long-term survivors. We investigated the risk of late breast cancer recurrence (BCR), 10 years ...or more after primary diagnosis, and associations between patient and tumor characteristics at primary diagnosis and late BCR up to 32 years after primary breast cancer diagnosis.
Methods
Using the Danish Breast Cancer Group clinical database, we identified all women with an incident early breast cancer diagnosed during 1987-2004. We restricted to women who survived 10 years without a recurrence or second cancer (10-year disease-free survivors) and followed them from 10 years after breast cancer diagnosis date until late recurrence, death, emigration, second cancer, or December 31, 2018. We calculated incidence rates per 1000 person-years and cumulative incidences for late BCR, stratifying by patient and tumor characteristics. Using Cox regression, we calculated adjusted hazard ratios for late BCR accounting for competing risks.
Results
Among 36 924 women with breast cancer, 20 315 became 10-year disease-free survivors. Of these, 2595 developed late BCR (incidence rate = 15.53 per 1000 person-years, 95% confidence interval = 14.94 to 16.14; cumulative incidence = 16.6%, 95% confidence interval = 15.8% to 17.5%) from year 10 to 32 after primary diagnosis. Tumor size larger than 20 mm, lymph node–positive disease, and estrogen receptor–positive tumors were associated with increased cumulative incidences and hazards for late BCR.
Conclusions
Recurrences continued to occur up to 32 years after primary diagnosis. Women with high lymph node burden, large tumor size, and estrogen receptor–positive tumors had increased risk of late recurrence. Such patients may warrant extended surveillance, more aggressive treatment, or new therapy approaches.
To describe prevalence, prenatal diagnosis and epidemiological data on oesophageal atresia from 23 well-defined European regions and compare the prevalence between these regions.
Population-based ...study using data from a large European database for surveillance of congenital anomalies (EUROCAT) for two decades (1987-2006).
Twenty-three participating registries based on multiple sources of information including information about live births, fetal deaths with gestational age ≥20 weeks and terminations of pregnancy.
1222 cases of oesophageal atresia in a population of 5 019 804 births.
The overall prevalence was 2.43 cases per 10 000 births (95% CI 2.30 to 2.57). There were regional differences in prevalence ranging from 1.27 to 4.55. Prenatal detection rates varied by registry from >50% of cases to <10% of cases. A total of 546 cases (44.7%) had an isolated oesophageal anomaly, 386 (31.6%) were multiple malformed and 290 (23.7%) had an association or a syndrome. There were 1084 live born cases (88.7%), 43 cases were fetal deaths and 95 cases were terminations of pregnancy. One-week survival for live births was 86.9% and 99.2% if the gestational age was ≥38 weeks and isolated oesophageal atresia was present. Males accounted for 57.3% of all cases and 38.5% of live born cases were born with gestational age <37 weeks.
There were regional differences in prevalence of oesophageal atresia in Europe. Half of all cases had associated anomalies. Prenatal detection rate increased from 26% to 36.5% over the two decades. Survival in infants with isolated oesophageal atresia born at term is high.
Late breast cancer (BC) recurrence (ie, ≥ 10 years after primary diagnosis) may have a more favorable prognosis than earlier recurrence. We investigated the risk of BC death after late recurrence, ...identified prognostic factors, and compared survival after early and late recurrence.
Using the Danish Breast Cancer Group and other nationwide databases, we identified women with early or late BC recurrence during 2004-2018, who were alive 6 months after recurrence. We followed them until BC death, death from other causes, emigration, 10 years, or December 31, 2018, whichever came first. We calculated mortality rates (MRs) per 1,000 person-years (PY) and cumulative BC mortality, for early versus late recurrence, and by characteristics of the primary tumor and the late recurrence. Using Cox regression, we calculated adjusted hazard ratios (HRs) for BC death, accounting for death from other causes as competing risks.
Among 2,004 patients with late recurrence, 721 died of BC with a median survival time of 10 years (MR = 84.8 per 1,000 PY; 10-year cumulative mortality = 50%). Among 1,528 patients with early recurrence, 1,092 BC deaths occurred with a median survival time of 4 years (MR = 173.9 per 1,000 PY; 10-year cumulative mortality = 72%). We observed a lower hazard of BC-specific death among patients who developed late compared with early recurrence (hazard ratio = 0.72; 95% CI, 0.62 to 0.85). Advanced stage at primary diagnosis, distant metastases, adjuvant treatment for locoregional recurrence, and systemic treatment for distant recurrence were associated with increased mortality after late recurrence. Breast-conserving surgery at primary diagnosis, locoregional recurrence, and surgery for recurrence were associated with lower mortality after late recurrence.
Patients with late recurrence had more favorable prognosis than patients with early recurrence. The localization of recurrent disease was the main prognostic factor for BC death.
Unrest began in July 2021 at Askja volcano in the Northern Volcanic Zone (NVZ) of Iceland. Its most recent eruption, in 1961, was predominantly effusive and produced ∼0.1 km3 lava field. The last ...plinian eruption at Askja occurred in 1875. Geodetic measurements between 1983 and 2021 detail subsidence of Askja, decaying in an exponential manner. At the end of July 2021, inflation was detected at Askja volcano, from GNSS observations and Sentinel‐1 interferograms. The inflationary episode can be divided into two periods from the onset of inflation until September 2023. An initial period until 20 September 2021 when geodetic models suggest transfer of magma (or magmatic fluids) from within the shallowest part of the magmatic system (comprising an inflating and deflating source), potentially involving silicic magma. A following period when one source of pressure increase at shallow depth can explain the observations.
Plain Language Summary
Askja volcano, situated in the Northern Volcanic Zone in Iceland, has been quiet since its last eruption in 1961, with surface deformation measurements from 1983 to 2021 displaying a decaying subsidence signal within the Askja caldera. However, at the end of July 2021, the volcano began to inflate. This was detected on both GNSS and satellite observations. As of September 2023, ∼65 cm of uplift had been measured at GNSS station OLAC. Modeling of surface deformation measurements indicates that the inflation was triggered by upward migration of melt (or magmatic fluids).
Key Points
At the end of July 2021, Askja volcano began to inflate—detected on both GNSS and satellite observations, ending 1983–2021 subsidence
Geodetic modeling indicates upward migration of magma, feeding a magma body at an inferred depth of 2.5–3.1 km under the main Askja caldera
Start of unrest was associated with magma transfer within the upper part of the system, followed by possible additional influx from depth
Large earthquakes alter the stress in the surrounding crust, leading to triggered earthquakes and aftershocks. A number of time-dependent processes, including afterslip, pore-fluid flow and viscous ...relaxation of the lower crust and upper mantle, further modify the stress and pore pressure near the fault, and hence the tendency for triggered earthquakes. It has proved difficult, however, to distinguish between these processes on the basis of direct field observations, despite considerable effort. Here we present a unique combination of measurements consisting of satellite radar interferograms and water-level changes in geothermal wells following two magnitude-6.5 earthquakes in the south Iceland seismic zone. The deformation recorded in the interferograms cannot be explained by either afterslip or visco-elastic relaxation, but is consistent with rebound of a porous elastic material in the first 1-2 months following the earthquakes. This interpretation is confirmed by direct measurements which show rapid (1-2-month) recovery of the earthquake-induced water-level changes. In contrast, the duration of the aftershock sequence is projected to be ∼3.5 years, suggesting that pore-fluid flow does not control aftershock duration. But because the surface strains are dominated by pore-pressure changes in the shallow crust, we cannot rule out a longer pore-pressure transient at the depth of the aftershocks. The aftershock duration is consistent with models of seismicity rate variations based on rate- and state-dependent friction laws.
About 70% of women with breast cancer survive at least 10 years after diagnosis. We constructed an algorithm to ascertain late breast cancer recurrence-which we define as breast cancer that recurs 10 ...years or more after primary diagnosis (excluding contralateral breast cancers)-using Danish nationwide medical registries. We used clinical information recorded in medical records as a reference standard.
Using the Danish Breast Cancer Group clinical database, we ascertained data on 21,134 women who survived recurrence-free 10 years or more after incident stage I-III breast cancer diagnosed in 1987-2004. We used a combination of Danish registries to construct the algorithm-the Danish National Patient Registry for information on diagnostic, therapeutic and procedural codes; and cancer diagnoses from the Danish Pathology Registry, the Danish Cancer Registry and the Contralateral Breast Cancer database. To estimate the positive predictive value (PPV), we selected 105 patients who, according to our algorithm, had late recurrence diagnosed at Aarhus University Hospital. To estimate the sensitivity, specificity and negative predictive value (NPV), we selected 114 patients diagnosed with primary breast cancer at Aalborg University Hospital. We abstracted clinical information on late recurrence for patients with medical record-confirmed late recurrence at Aarhus University Hospital.
Our algorithm had a PPV of late recurrence of 85.7% (95% CI: 77.5-91.3%), a sensitivity of 100.0% (95% CI, 39.8-100.0%), a specificity of 97.3 (95% CI, 92.2-99.4) and a NPV of 100% (95% CI, 96.6-100.0%).
Our algorithm for late recurrence showed a moderate to high PPV and high sensitivity, specificity and negative predictive value. The algorithm could be an important tool for future studies of late breast cancer recurrence.
Eyjafjallajökull volcano, located in southern Iceland, is characterized by its quiet nature. Only about a handful of earthquakes associated with the volcanic system had been detected prior to the ...1990s. Earthquake swarms did, however, occur in 1994 and 1999. Here we investigate the spatio-temporal evolution of a magmatic intrusion associated with the 1999 earthquake swarm via analysis of produced surface deformation. A series of interferometric synthetic aperture radar (InSAR) images, spanning various periods of the intrusion, show that in 1999 surface deformation occurred mainly on the southern flanks of the volcano. The deformation amounts to more than 20 cm of range change. Inverse modeling resolves the deformation source to be a sill intrusion at 6.3 km depth. Sill opening was up to 1 m and the total intruded volume amounts to 0.03 km^sup 3^. The InSAR data display a migration of the center of deformation through time, enabling us to create time-dependant sill-opening models. Furthermore, we investigate the spatio-temporal distribution of earthquakes and find that the distribution supports the InSAR derived model and additionally provides indications for a possible site of a feeder channel. Magmatic flow-rate estimates indicate an initial intrusion rate of 4-6 m^sup 3^/s, declining over a few weeks.PUBLICATION ABSTRACT
We present InSAR observations of deformation due to an intrusion in the Eyjafjallajökull volcano, Southern Iceland, in 1994. More than 15 cm of deformation in the line of sight (LOS) direction is ...detected in a series of interferograms spanning a micro‐earthquake swarm occurring in June 1994. The location of the seismicity is more than 6 km offset compared to the area of inferred maximum surface uplift. Through an inversion scheme we find that a horizontal sill intrusion experiencing variable opening of up to 0.36 m agrees well with the deformation data. The total intrusion volume is 0.017 km3. The northern periphery of the modeled intrusion fits well with the area of recorded seismicity, indicating a close connection. Several processes may be responsible. Our preferred explanation is that the earthquakes are caused by opening of a narrow magma channel from depth, feeding the sill.
The African wild dog (
Lycaon pictus) is one of Africa's most endangered species and therefore classified as endangered by IUCN. Earlier distributions included most of Africa but currently the ...African wild dog only has populations larger than 300 individuals in three countries (Botswana, Tanzania and South Africa). In 1998, a plan was launched in South Africa to manage sub-populations of the African wild dog in several small, geographically isolated, conservation areas. This management program involved the reintroduction of wild dogs into suitable conservation areas and periodic translocations among them. We used the stochastic population simulation model VORTEX to evaluate the Limpopo Valley Conservancy in the north of South Africa, as a possible reintroduction site for African wild dogs. The simulations showed that the size of the initial population released only had a small effect on the population dynamics. However, when individuals were supplemented and harvested over a longer period the probability of persistence increased. Number of females breeding, male mortality, and carrying capacity were key factors in the population dynamics, but according to VORTEX the severity of natural catastrophes had the greatest influence on the extinction risk and inbreeding. We suggest that the reintroduction program may be successful, if areas are properly secured, the dogs are held in a boma before release, wild animals or at least a mix of wild and captive animals are used for the release and the animals are vaccinated against rabies. It is, however, essential to continue monitoring followed by modelling efforts to re-evaluate the success of the reintroduction program.
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