Article Date: 22 Nov 2006 - 0:00am (PST) The teen birth rate in the

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New Report Shows Teen Births Drop To Lowest Level Ever

Article Date: 22 Nov 2006 - 0:00am (PST)
The teen birth rate in the United States fell to its lowest level ever in 2005, according to the latest birth statistics for the nation, released today by the Centers for Disease Control and Prevention (CDC).

The report, "Births: Preliminary Data for 2005," includes figures from over 99 percent of birth certificates filed in the U.S. and reveals that between 2004 and 2005, the birth rate for teenagers aged 15-19 fell 2 percent, to 40.4 births per 1,000 -- a 35 percent decrease from the peak of 61.8 births per 1,000 in 1991.

The decline in teen childbearing was especially pronounced for non- Hispanic black teens ages 15-17 -- the birth rate for this group fell 6 percent in 2005 compared to 2004 and 59 percent since 1991. In total, there were 421,123 births to females under age 20 in 2005.

"The decline in teenage childbearing has been documented across all race and ethnic populations, but most impressive has been the decline in these rates for non-Hispanic black teenagers," said Brady Hamilton, a researcher at CDC's National Center for Health Statistics and lead author of the report.

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Among other key findings:

-- There was another increase in unmarried childbearing in 2005. The number of births to unmarried mothers of all ages rose 4 percent from 1.47 million in 2004 to 1.52 million in 2005; while the rate increased to 47.6 births per 1,000 unmarried females aged 15-44 in 2005, up from 46.1 in 2004. The percentage of births to unmarried mothers also increased in 2005, from 35.8 to 36.8 percent.

-- The total number of U.S. births increased by 1 percent in 2005 to 4,140,419. The general fertility rate (number of births per 1,000 women ages 15-44) also increased slightly to 66.7 from 66.3 in 2004.

-- Childbearing by women in their early 20s increased slightly in 2005, and also continued to increase among women in their 30s and 40s. Birth rates for women aged 20-24 and 30-34 rose less than 1 percent between 2004 and 2005, while rates for women aged 35-44 years rose by 2 percent.

-- The Caesarean delivery rate rose 4 percent in 2005 to 30.2 percent of all births, a record high. The C-section rate has risen 46 percent since 1996.

-- The preterm birth rate (percentage of infants delivered at less than 37 completed weeks of gestation) rose from 12.5 in 2004 to 12.7 in 2005. This rate has increased 20 percent since 1990.

-- The percentage of babies born at low birth weight also increased in 2005, to 8.2 percent of all births (up from 8.1 in 2004). The percentage of low birth weight babies has increased more than 20 percent since the mid 1980's.

"Births: Preliminary Data for 2005" is available at http://www.cdc.gov/nchs.

Centers for Disease Control and Prevention
http://www.cdc.gov/nchs

NICE Publishes Final Guidance For Aromatase Inhibitors, UK

Aromatase inhibitors (AIs) will be freely available across England and Wales for the 23,000 postmenopausal women diagnosed with hormone receptor-positive (HR+) early breast cancer each year.1 The National Institute for Health and Clinical Excellence (NICE) announced today the final findings of its technology appraisal on the use of AIs in early breast cancer. 1 This guidance will also benefit women with early breast cancer who are partway through treatment with tamoxifen.

"We have been waiting for NICE's guidance for nearly two years. Today's announcement should finally put an end to the postcode lottery for AIs, such as anastrozole, which have been shown to greatly improve women's chances of not having a breast cancer recurrence, over and above the benefit seen with tamoxifen. What's more, this recommendation brings the UK into line with most Western European nations, where AIs have already become the gold standard treatment," said Professor Jeffrey Tobias, Professor of Cancer Medicine at University College London, London.

NICE's recommendations were based on the results of seven AI trials.1 Four of these involved Arimidex, including the largest international breast cancer trial ever conducted, which was designed in the UK - the Anastrozole, Tamoxifen, Alone or in Combination (ATAC) study.1 This trial showed that in women treated with anastrozole (Arimidex) immediately after surgery, an additional 26% of recurrences are prevented compared with tamoxifen.2 These results are over and above the 47% reduction already seen with tamoxifen (versus placebo).2

The published guidance on the use of hormonal therapies for post-surgery (adjuvant) treatment of HR+ early breast cancer upholds NICE's interim Appraisal Consultation Document of 23 May 2006 NICE 3 and their Final Appraisal Determination of 11 August 2006 4 that AIs, such as anastrozole (Arimidex) are clinically and cost-effective for use in newly diagnosed women when given immediately after surgery, and also for patients currently halfway or nearing the end of their tamoxifen treatment.1 Primary Care Trusts (PCTs) in England and Wales now have up to three months to make these treatments available to their patients.

"In the current climate, with many competing priorities for NHS funding, it's important that clinicians and PCTs grant access to these innovative treatments. Having them more widely available on the NHS to all women who need them will reduce breast cancer recurrence rates in the UK and also improve quality of life by cutting down side effects. In my view, anastrozole provides good value for the NHS," Professor Tobias continued.

Since the submission of evidence to NICE, Arimidex received a licence for unplanned switch in July 2006, and can be prescribed for women who have already taken tamoxifen for 2 to 3 years. 5 Although submitted, these data are not included in the final NICE decision, as Arimidex received a switch licence after the NICE review was conducted in February 2006. Arimidex is the first and only AI licensed in the UK for both primary adjuvant and unplanned switch.5

NICE's final guidance clearly states that the choice of treatment should be made after open discussion between the responsible clinician and the woman about the risks and benefits of each therapy option and treatment strategy. 1

NICE's equivalent body in Scotland, the Scottish Medicines Consortium (SMC) has already recommended anastrozole for use after surgery in the adjuvant treatment of postmenopausal women with early invasive breast cancer when prescribed by a specialist doctor 6 and, more recently recommended anastrozole is used for the adjuvant treatment of early breast cancer in HR+ postmenopausal women who have received 2-3 years of adjuvant tamoxifen, when prescribed by a breast cancer specialist. 7

Therapeutic indications of all AIs:

-- Anastrozole (Arimidex), AstraZeneca: Treatment of advanced breast cancer in postmenopausal women. Efficacy has not been demonstrated in oestrogen receptor negative patients unless they had a previous positive clinical response tamoxifen. Adjuvant treatment of postmenopausal women with hormone receptor positive invasive breast cancer. Adjuvant treatment of early breast cancer in hormone receptor positive postmenopausal women who have received 2 to 3 years of adjuvant tamoxifen. 8

-- Letrozole (Femara), Novartis: Adjuvant treatment of postmenopausal women with hormone receptor positive invasive early breast cancer. Treatment of early invasive breast cancer in postmenopausal women who have received prior standard adjuvant tamoxifen therapy. First line treatment in postmenopausal women with advanced breast cancer. Advanced breast cancer in postmenopausal women in whom tamoxifen or other anti-oestrogen therapy has failed. Pre-operative therapy in postmenopausal women with localised hormone receptor positive breast cancer, to allow subsequent breast-conserving surgery in women not originally considered candidates for breast-conserving surgery. Subsequent treatment after surgery should be in accordance with standard of care.8

-- Exemestane (Aromasin), Pfizer: Indicated for the adjuvant treatment of postmenopausal women with oestrogen receptor positive invasive early breast cancer, following 2-3 years of initial adjuvant tamoxifen therapy. Aromasin is indicated for the treatment of advanced breast cancer in women with natural or induced postmenopausal status whose disease has progressed following anti-oestrogen therapy. Efficacy has not been demonstrated in patients with oestrogen receptor negative status.8

NICE Guidance:

-- Details of the NICE Health Technology Appraisal of hormonal therapies, assessing the clinical and cost effectiveness of all three AIs - anastrozole (Arimidex), exemestane (Aromasin) and letrozole (Femara) - in the treatment of early breast cancer compared with tamoxifen can be found on http://www.nice.org.uk along with information on the appraisal process.

-- NICE guidance is only applied directly in England and Wales. Northern Ireland reviews NICE guidance for local applicability before implementing it.

-- Anastrozole has an annual cost of £891.80 and is the least expensive AI drug available British National Formulary. 9 - costing 17% less than letrozole and exemestane.10 The annual costs of trastuzumab (Herceptin) and taxanes, such as paclitaxel, are significantly higher.

-- Anastrozole is the most comprehensively studied of all the AIs and the only one with efficacy and tolerability data for the full five-year (68 months) adjuvant setting.2

-- The NICE recommendation includes an independent cost-effectiveness analysis, which shows that anastrozole use immediately after surgery for five years has a cost per quality-adjusted life-year (QALY) gain of £12,310 when compared with tamoxifen therapy for the same time period. Based on this analysis, anastrozole was considered to be cost effective by NICE in comparison with tamoxifen.1

Breast Cancer

-- Breast cancer is the most common form of cancer in women, accounting for 30% of all female cancers. 11 The lifetime risk of being diagnosed with breast cancer is one in nine. 12

-- Every year 41,700 women in the UK are diagnosed with breast cancer, 13 and approximately 32,800 of these (80%) are postmenopausal. 14

-- Breast cancer accounts for around 17% of female deaths from cancer in the UK. 15 Survival rates for breast cancer have improved due to earlier detection and more effective treatments becoming available.

-- More women are being successfully treated now than ever before.16 The estimated relative five-year survival rate for women diagnosed in England and Wales in 2001-2003 was 80%, compared with only 52% for women diagnosed in 1971-1975. 17,18

http://www.nice.org.uk

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