[Overall survival and survival without local recurrence in case of radiotherapy of the tumor bed of ductal carcinomas in situ of the breast: Review of the literature]. / Survie globale et sans récidive locale en cas de radiothérapie du lit tumoral des carcinomes canalaires in situ du sein : revue de la littérature.

INTRODUCTION: Carcinomas in situ represent more than 15 to 20% of breast cancers. Radiotherapy of whole breast is part of the therapeutic standard and follows surgery. However, the indication of tumor bed irradiation is still controversial and heterogeneous according to international practice even though it is a very frequent clinical situation. The aim of this study is to define the indications of tumor bed irradiation in the context of ductal carcinomas in situ and to discuss accelerated partial irradiation of the breast. METHOD: The selected papers were published between 2015 and 2020 and included as MeSH terms "ductal carcinoma in situ" and "boost" for the analysis of tumor bed irradiation, and "ductal carcinoma in situ" and "accelerated partial breast irradiation" for the analysis of accelerated partial irradiation. RESULTS: Boost was more often performed when risk factors for local recurrence were present, such as age less than 40 or 50 years old, clinical mode of detection, tumor size greater than 15 to 20mm, high nuclear grade, presence of necrosis, positive or insufficient surgical margins, associated atypical hyperplastic lesions, and lobular carcinoma in situ. Accelerated partial irradiation is an option for favorable or intermediate prognosis CCIS, further studies involving more patients are required. CONCLUSION: Radiotherapy of the mammary gland in the context of DCIS has shown its effectiveness in terms of local and locoregional control of the disease, thus reducing in situ and infiltrating recurrences. However, the indication of operating bed irradiation is still debated, and the practice is very heterogeneous depending on the country. Another possible alternative for patients with a favorable prognosis and a small tumor bed volume would be IPA.

[Metastatic breast cancer to the stomach: An uncommon evolution of breast carcinoma]. / La linite gastrique métastatique: une évolution peu connue des carcinomes mammaires.

Breast carcinoma exceptionally leads to metastatic linitis plastica. Distinguishing a breast cancer metastasis to the stomach from a primary gastric cancer on the basis of clinical and radiological signs is very challenging. Thanks to being cognizant of the previous history of invasive lobular carcinoma and the gastric biopsy followed by immunohistochemical analysis, gastric metastasis can be diagnosed. Despite the use of chemotherapy and hormonal therapy, gastric metastasis remains often associated with poor prognosis. We present a case where gastric biopsy allowed a metastatic breast cancer to the stomach to be diagnosed and we discuss its clinical, diagnostic, pathological and therapeutic particularities.

Cultural concerns regarding contaminants in Alaskan local foods.

Indigenous people of Alaska, who depend in many ways on foods which they obtain locally by hunting, fishing, and gathering, have raised concerns about the changing quality of their foods in light of confirmation of the long-range transport of global pollutants. A review of a variety of parallel research efforts has shown little consistency in practice, no clear evaluation of exposure levels through dietary surveys on a broad scale, and no comprehensive educational effort to inform the general public of the changing levels of pollutants in local foods. Nor has there been adequate communication regarding the source of the contamination, whether natural contaminants or anthropogenic pollution. Alaska Native cultural issues that contribute to the risk perception of a health problem inherent in eating a traditional diet that is showing signs of increasing levels of pollution, no matter how small, must be considered in any recommendations regarding locally obtained foods and in public health efforts. Recommended cross-cultural communication methods should be employed in dealing with topics of high community concern.

The next step in assessing Arctic human health.

The mapping of global pathways along which trace elements and persistent organic compounds are distributed has set the stage for parallel monitoring of levels of contamination in humans. Before expanded monitoring is undertaken, decisions must be made on which contaminants to study, what tissues to sample, how samples should be taken and evaluated, and what units should be used for consistent reporting. Once international guidelines are in place, a process should be initiated to similarly address general human health conditions. It is recommended that the next step be a global mapping of various health conditions and disease. Computer analysis should be performed to identify any correlation to known pollution plumes or deposition patterns. In addition, cultural or behavioral patterns, as well as geographic distributions, should be evaluated. The general trends would be important, as major synergistic effects might be masked if only one contaminant or health concern were monitored at a time.

Occupational safety and health training in Alaska.

We have eleven years of experience delivering a wide variety of worker education programs in cross-cultural settings to reduce the levels of occupational fatalities and injuries in Alaska. We published an instructional manual and informational poster for workers, on Alaska's "Right-To-Know" law regarding chemical and physical hazards. The "Job Hazard Recognition Program" curriculum for high school students has received national acclaim for being proactive in dealing with worker safety education before the student becomes a member of the work force. Adult educational programs and materials have been designed to include less lecture and formal presentation, and more practical "hands on" and on-the-job experience for specific trades and hazards. New industry specific manuals deal with hazardous waste reduction as a method to reduce harm to the employee. Difficulty in getting instructors and training equipment to rural locations is dealt with by becoming creative in scheduling classes, using locally available equipment, and finding regional contacts who support the overall program. Alternative approaches to funding sources include building on regional long-term plans and establishing complementary program objectives.