"Sorry for Holding You Up": Surgeons' Apologies for Lateness in Clinic Settings.

Doctors running late may convey a lack of respect which can impair the therapeutic relationship. This study examines how surgeons address lateness in consultations with patients. We analyzed 52 consultation recordings from a range of surgical specialties in an Australian metropolitan setting. Conversation analysis was used to analyze interactional sequences where lateness was addressed. Six sequences were identified within four recordings. The two consultations with two apologies include a surgeon and registrar apologizing in a neurosurgical consultation and a surgeon apologizing twice within a colorectal consultation. Apologies were either accepted or responded to with an account for not accepting the apology. When these accounts were made, consultations could only progress when patients accepted an explanation for lateness or the degree of complainability about lateness was reduced. The infrequent occurrence of apologies for lateness, and the way in which these sequences unfolded when they did occur, suggest that there is greater acceptability of lateness for surgeons than in ordinary social situations.

Examination of fully automated mammographic density measures using LIBRA and breast cancer risk in a cohort of 21,000 non-Hispanic white women.

BACKGROUND: Breast density is strongly associated with breast cancer risk. Fully automated quantitative density assessment methods have recently been developed that could facilitate large-scale studies, although data on associations with long-term breast cancer risk are limited. We examined LIBRA assessments and breast cancer risk and compared results to prior assessments using Cumulus, an established computer-assisted method requiring manual thresholding. METHODS: We conducted a cohort study among 21,150 non-Hispanic white female participants of the Research Program in Genes, Environment and Health of Kaiser Permanente Northern California who were 40-74 years at enrollment, followed for up to 10 years, and had archived processed screening mammograms acquired on Hologic or General Electric full-field digital mammography (FFDM) machines and prior Cumulus density assessments available for analysis. Dense area (DA), non-dense area (NDA), and percent density (PD) were assessed using LIBRA software. Cox regression was used to estimate hazard ratios (HRs) for breast cancer associated with DA, NDA and PD modeled continuously in standard deviation (SD) increments, adjusting for age, mammogram year, body mass index, parity, first-degree family history of breast cancer, and menopausal hormone use. We also examined differences by machine type and breast view. RESULTS: The adjusted HRs for breast cancer associated with each SD increment of DA, NDA and PD were 1.36 (95% confidence interval, 1.18-1.57), 0.85 (0.77-0.93) and 1.44 (1.26-1.66) for LIBRA and 1.44 (1.33-1.55), 0.81 (0.74-0.89) and 1.54 (1.34-1.77) for Cumulus, respectively. LIBRA results were generally similar by machine type and breast view, although associations were strongest for Hologic machines and mediolateral oblique views. Results were also similar during the first 2 years, 2-5 years and 5-10 years after the baseline mammogram. CONCLUSION: Associations with breast cancer risk were generally similar for LIBRA and Cumulus density measures and were sustained for up to 10 years. These findings support the suitability of fully automated LIBRA assessments on processed FFDM images for large-scale research on breast density and cancer risk.

Navigating parenthood in the surgical profession: mixed-methods study.

BACKGROUND: Significant barriers exist to surgeons being good parents and parents being good surgeons, and these barriers are heightened for women. Considering the gender balance now present in postgraduate medical schools, it is critical that these barriers are overcome if surgery is to attract and retain applicants. This study aimed to investigate patterns of parenthood in surgery, explore associated attitudes and experiences, and identify barriers and solutions within an Australian and New Zealand context. METHODS: Surgeons and trainees were invited to participate in a survey and focus groups. Quantitative results were described, and textual responses and focus group transcriptions were analysed thematically. RESULTS: There were 261 survey respondents (62.8 per cent women, 37.2 per cent men) and six focus groups (34 participants). Of the survey respondents, 79.6 per cent of women and 86.5 per cent of men had children. Women were more likely to time childbirth around training or work, and most respondents without children attributed this to their career. Tensions between parenthood and surgery engendered guilt for surgeon-parents. Parenthood was often the 'elephant in the room' in training and employment discussions. Breaking the silence around parenthood and surgery made it more acceptable, normalising positive behaviour changes. The major barrier to parenthood and surgery was the lack of flexible training opportunities. Participants called for top-down establishment of mandated, stand-alone, permanent part-time training positions. CONCLUSION: Many barriers to parenthood in surgery are created by rigid workplace and professional structures that are reflective of male-dominated historical norms. A willingness to be flexible, innovative and rethink models of training and employment is central to change.

It is difficult for surgeons to be good parents and parents to be good surgeons. This is a problem because it means that fewer doctors may want to be surgeons. This study asked surgeons and trainee surgeons what it is like to do their job as a parent. They were asked about this on their own and in groups. It was found that it is more difficult for female surgeons to have children than male surgeons. Surgeons with children feel guilty that they are not able to do a good job both at work and at home. Surgeons often avoid talking about parenting at work, because it is not normal to do so and they are afraid that it will have a negative effect on their career. If surgeons can work part-time while training, it would enable them to better balance their responsibilities as surgeons and parents. At the moment, there are not many opportunities to train part-time in Australia and New Zealand. This study suggests that surgeons and hospitals should make sure that this becomes accessible and normal.

Why do women leave surgical training? A qualitative and feminist study.

BACKGROUND: Women are under-represented in surgery and leave training in higher proportions than men. Studies in this area are without a feminist lens and predominantly use quantitative methods not well suited to the complexity of the problem. METHODS: In this qualitative study, a researcher interviewed women who had chosen to leave surgical training. Women were recruited using a purposive snowball strategy through the routine communications of the Royal Australasian College of Surgeons and Royal Australasian College of Surgeons Trainee Association over a 3-week period, and were interviewed over the following 4 months in the past 4 years in person or by telephone. More specific details are available on request from the authors. Supported by male and female co-researchers, and in dialogue with study participants, she then coded the findings and defined themes. An explanatory model was developed by integrating findings with different theories and previous literature. The research team developed three aspects of the model into a visual analogue. FINDINGS: 12 women participated in the study, with all Australian states and territories, and New Zealand, as well as five medical specialty streams, represented. The time spent in training ranged from 6 months to 4 years, and all participants, except two, had trained in both metropolitan and rural locations. The findings confirmed factors identified in earlier reports as reasons women leave surgical training, and contributed six new factors: unavailability of leave, a distinction between valid and invalid reasons for leave, poor mental health, absence of interactions with the women in surgery section of their professional body and other supports, fear of repercussion, and lack of pathways for independent and specific support. The relationships between factors was complex and sometimes paradoxical. The visual analogue is a tower of blocks, with each block representing a factor that contributed to the decision to leave surgical training, and with the toppling of the tower representing the choice to leave. The visual analogue indicates that effective action requires attention to the contributory factors, the small actions that can topple the tower, and the contexts in which the blocks are stacked. INTERPRETATION: Women might be best helped by interventions that are alert to the possibility of unplanned negative effects, do not unduly focus on gender, and address multiple factors. This should inform interventions in surgical training, with attention to local social context, health-care setting, and training programme structure. FUNDING: Royal Australasian College of Surgeons Ian and Ruth Gough Surgical Education Scholarship.

Reproductive Factors and Mammographic Density: Associations Among 24,840 Women and Comparison of Studies Using Digitized Film-Screen Mammography and Full-Field Digital Mammography.

Breast density is a modifiable factor that is strongly associated with breast cancer risk. We sought to understand the influence of newer technologies of full-field digital mammography (FFDM) on breast density research and to determine whether results are comparable across studies using FFDM and previous studies using traditional film-screen mammography. We studied 24,840 screening-age (40-74 years) non-Hispanic white women who were participants in the Research Program on Genes, Environment and Health of Kaiser Permanente Northern California and underwent screening mammography with either Hologic (Hologic, Inc., Marlborough, Massachusetts) or General Electric (General Electric Company, Boston, Massachusetts) FFDM machines between 2003 and 2013. We estimated the associations of parity, age at first birth, age at menarche, and menopausal status with percent density and dense area as measured by a single radiological technologist using Cumulus software (Canto Software, Inc., San Francisco, California). We found that associations between reproductive factors and mammographic density measured using processed FFDM images were generally similar in magnitude and direction to those from prior studies using film mammography. Estimated associations for both types of FFDM machines were in the same direction. There was some evidence of heterogeneity in the magnitude of the effect sizes by machine type, which we accounted for using random-effects meta-analysis when combining results. Our findings demonstrate the robustness of quantitative mammographic density measurements across FFDM and film mammography platforms.

Case-control study of mammographic density and breast cancer risk using processed digital mammograms.

BACKGROUND: Full-field digital mammography (FFDM) has largely replaced film-screen mammography in the US. Breast density assessed from film mammograms is strongly associated with breast cancer risk, but data are limited for processed FFDM images used for clinical care. METHODS: We conducted a case-control study nested among non-Hispanic white female participants of the Research Program in Genes, Environment and Health of Kaiser Permanente Northern California who were aged 40 to 74 years and had screening mammograms acquired on Hologic FFDM machines. Cases (n = 297) were women with a first invasive breast cancer diagnosed after a screening FFDM. For each case, up to five controls (n = 1149) were selected, matched on age and year of FFDM and image batch number, and who were still under follow-up and without a history of breast cancer at the age of diagnosis of the matched case. Percent density (PD) and dense area (DA) were assessed by a radiological technologist using Cumulus. Conditional logistic regression was used to estimate odds ratios (ORs) for breast cancer associated with PD and DA, modeled continuously in standard deviation (SD) increments and categorically in quintiles, after adjusting for body mass index, parity, first-degree family history of breast cancer, breast area, and menopausal hormone use. RESULTS: Median intra-reader reproducibility was high with a Pearson's r of 0.956 (range 0.902 to 0.983) for replicate PD measurements across 23 image batches. The overall mean was 20.02 (SD, 14.61) for PD and 27.63 cm(2) (18.22 cm(2)) for DA. The adjusted ORs for breast cancer associated with each SD increment were 1.70 (95 % confidence interval, 1.41-2.04) for PD, and 1.54 (1.34-1.77) for DA. The adjusted ORs for each quintile were: 1.00 (ref.), 1.49 (0.91-2.45), 2.57 (1.54-4.30), 3.22 (1.91-5.43), 4.88 (2.78-8.55) for PD, and 1.00 (ref.), 1.43 (0.85-2.40), 2.53 (1.53-4.19), 2.85 (1.73-4.69), 3.48 (2.14-5.65) for DA. CONCLUSIONS: PD and DA measured using Cumulus on processed FFDM images are positively associated with breast cancer risk, with similar magnitudes of association as previously reported for film-screen mammograms. Processed digital mammograms acquired for routine clinical care in a general practice setting are suitable for breast density and cancer research.

Safety of vaginal oestrogens for genitourinary symptoms in women with breast cancer.

BACKGROUND: Oestrogen deprivation is the mainstay of treatment for women with hormone receptor-positive breast cancer, but unfortunately it causes multiple side effects that can significantly impair quality of life. Genitourinary symptoms are very common and although these symptoms can be effectively managed with vaginal oestrogens, concerns about their safety in women with breast cancer limits their use. OBJECTIVE: The aim of this review is to provide a summary of the data on the safety of vaginal oestrogens in women with breast cancer to help general practitioners advise their patients in this situation. DISCUSSION: Although there are no large randomised prospective studies to assess safety, the current evidence suggests reassurance can be provided to the majority of women with a history of breast cancer considering vaginal oestrogens. Consultation with the oncology team is advised for women taking aromatase inhibitors, where the safety of vaginal oestrogens is less certain.

Clinicians' perceptions of "enhanced recovery after surgery" (ERAS) protocols to improve patient safety in surgery: a national survey from Australia.

BACKGROUND: Surgical patients are at risk of postoperative complications, which may lead to increased morbidity, mortality, hospital length-of-stay and healthcare costs. Enhanced Recovery After Surgery (ERAS®) protocols are evidence-based and have demonstrated effectiveness in decreasing complications and associated consequences. However, their adoption in Australia has been limited and the reason for this is unclear. This study aimed to describe clinicians' perceptions of ERAS protocols in Australia. METHODS: A national online survey of anaesthetists, surgeons and nurses was undertaken. Invitations to participate were distributed via emails from professional colleges. The 30-item survey captured respondent characteristics, ERAS perceptions, beliefs, education and learning preferences and future planning considerations. The final question was open-ended for elaboration of perceptions of ERAS. Descriptive and inferential statistics were used to describe and compare group differences across disciplines relative to perceptions of ERAS. RESULTS: The sample included 178 responses (116 nurses, 65.2%; 36 surgeons, 20.2%; 26 anaesthetists, 14.6%) across six states and two territories. More than half (n = 104; 58.8%) had used ERAS protocols in patient care, and most perceived they were 'very knowledgeable' (n = 24; 13.6%) or 'knowledgeable' (n = 71; 40.3%) of ERAS. However, fewer nurses had cared for a patient using ERAS (p <.01) and nurses reported lower levels of knowledge (p <.001) than their medical counterparts. Most respondents agreed ERAS protocols improved patient care and financial efficiency and were a reasonable time investment (overall Md 3-5), but nurses generally recorded lower levels of agreement (p.013 to < 0.001). Lack of information was the greatest barrier to ERAS knowledge (n = 97; 62.6%), while seminars/lectures from international and national leaders were the preferred learning method (n = 59; 41.3%). Most supported broad implementation of ERAS (n = 130; 87.8%). CONCLUSION: There is a need to promote ERAS and provide education, which may be nuanced based on the results, to improve implementation in Australia. Nurses particularly need to be engaged in ERAS protocols given their significant presence throughout the surgical journey. There is also a need to co-design implementation strategies with stakeholders that target identified facilitators and barriers, including lack of support from senior administration, managers and clinicians and resource constraints.

Rehabilitation for Women Undergoing Breast Cancer Surgery: A Systematic Review and Meta-Analysis of the Effectiveness of Early, Unrestricted Exercise Programs on Upper Limb Function.

Upper limb impairments are common in women following surgery for breast cancer. Range of movement (ROM) exercises are commonly prescribed, but the optimal timing to begin these exercises is not clear. The aim of this systematic review and meta-analysis was to evaluate the effectiveness of early ROM exercises (Early ROM) compared to delayed ROM exercises (Delayed ROM) or usual care (UC) in reducing common complications in women following breast cancer surgery. Cochrane Central Register of Controlled Trials, Pubmed, EMBASE, CINAHL, and PEDro were searched from date of inception until the 15th of February 2021, to identify randomized controlled trials which compared Early ROM to either Delayed ROM or UC in women following surgery for breast cancer. Outcomes included shoulder range, wound outcomes and lymphedema incidence. Risk of bias was evaluated with the PEDro scale. Data analysis was conducted in R (version 3.6.0), with a priori sensitivity analyses conducted for studies with low risk of bias and published after the year 2000. Of the 703 articles retrieved, 20 trials (2442 participants) were eligible for inclusion. There were few differences between groups in ROM, except for flexion ROM when more recent evidence was considered. Total drainage time and hematoma incidence were significantly higher in the Early ROM group compared to Delayed ROM (WMD 1·2 days [95%CI 0·7,1·7], and RR 1·6 [95%CI 1·1,2·3], respectively). When considering more recent evidence, there were no differences between groups for these outcomes. There were no differences between groups in other wound outcomes. Lymphedema incidence was higher in the Early ROM group compared to Delayed ROM in the short-term only (RR 3·7 [95% CI 1·3;10·9]), and there was no difference when compared to UC. The quality of evidence using the GRADE approach was generally low to very low. This review found that when considering more contemporary evidence, the timing of exercise may influence ROM, but not wound outcomes. Further research is recommended to understand the effect on lymphedema incidence. No funding was sought for this review. A protocol for this systematic review was posted on the Open Science Framework prior to commencement (DOI: 10.17605/OSF.IO/Q5FHS).

Representation of Women in Internal Medicine Specialties in North America, the United Kingdom, and Australasia: Cardiology's Outlier Status and the Importance of Diversity.

Decades of research demonstrate the value of workplace diversity. Reports from individual countries show that women are underrepresented in internal medicine workforces. However, large pooled international studies are not available. This study investigates the current representation of women in the internal medicine workforce internationally and identifies specialties in which underrepresentation is evident. Peer-reviewed studies, government reports, and medical association reports were used to determine proportions of specialists and doctors training in internal medical specialties and in comparator surgical specialties. Data were available from Australia, Canada, England, New Zealand, the United States, Wales, Scotland, and Northern Ireland. A total of 380,263 doctors were studied, including 268,822 practicing specialist physicians (also known as attendings or consultants) and 53,226 doctors in internal medicine specialty training programs (also known as residents, fellows, advanced trainees, or specialist registrar trainees). Among practicing physician specialists, the rate of representation of women was 35% (95,195/268,822, p <0.001). Among trainees, the rate of representation of women was 43% (22,728/53,226, p <0.001). Among physician specialties evaluated, cardiology (15%, 4,152 of 27,328), gastroenterology (20%, 3,765 of 18,893), and respiratory/critical care (24%, 5,255 of 21,870) had the lowest representations of women compared with men (p <0.001 for all). Cardiology and particularly the subspecialty of interventional cardiology were clear outliers as the internal medicine specialties with the lowest representation of women at practicing specialist and trainee levels. In conclusion, this study is the largest international study of women in internal medicine specialties. It found that cardiology, gastroenterology, and respiratory/critical care specialties have the most substantial underrepresentation of women. These data are a global call to action to establish more successful strategies to provide a diverse and representative cardiology workforce.

Diagnostic Difficulties and Complexities in the Management of Dermatofibrosarcoma Protuberans in the Breast: A Case Report and Review of the Literature.

Dermatofibrosarcoma protuberans (DFSP) is an extremely rare sarcoma with an incidence between 0.8-5.0 cases per one million persons per year. DFSP accounts for less than 0.1% of all malignancies and approximately 1-6% of all soft tissue sarcomas. Only a few cases of DFSP have been found within the breast tissue. We report a case of DFSP in a 30-year-old female within the left breast. The sarcoma presented as a painless, rubbery, mobile lump that gradually increased in size. It was initially identified on an ultrasound scan and subsequently confirmed with MRI and core biopsy. DFSP is a rare condition and treatment guidelines are not well established. The current recommendation is for surgical excision with 2-cm margins. Mastectomy may be considered in some circumstances. In our case, the aim was for surgical resection with 2-cm margins at both breast tissue and skin, but insufficient margins were taken. The recommendation for re-excision of the inadequate margins was declined. It is uncertain what the implications of this are given the lack of research on DFSP in the breast. Therefore, close surgical surveillance will be imperative. We present this case to highlight the difficulties associated with the diagnosis, treatment, and management of DFSP due to the lack of literature on this disease.

Unmet needs in breast cancer survivors are common, and multidisciplinary care is underutilised: the Survivorship Needs Assessment Project.

PURPOSE: The transition from a breast cancer patient to a survivor can be associated with significant physical, psychological, and social challenges. Development of multidisciplinary evidence-based care during the post-treatment period is a key area of cancer research. This study examined survivorship issues, unmet needs and perceptions about care among a cohort of breast cancer survivors. METHODS: Participants were 130 women diagnosed with breast cancer for at least one year, and attending a hospital breast or oncology outpatient clinic. They completed a series of self-report questionnaires assessing demographic and clinical characteristics, unmet needs, severity of survivorship issues, use of multidisciplinary services, clinical benchmarks, survivorship care satisfaction, and suggestions for service improvements. RESULTS: There was an average of 4.9 unmet survivorship needs, with 67% of participants reporting at least one unmet need. Fear of cancer recurrence, stress, coordination of medical care and negative iatrogenic impacts of hormonal treatments were key concerns. The cancer support team typically consisted of medical and nursing staff, and family/friends, and most were satisfied with their survivorship care. There was minimal use of other multidisciplinary clinicians and support groups. Provision of additional dietary and cancer recurrence education, and a written treatment plan were identified as key areas of service improvement. CONCLUSION: Despite high satisfaction ratings, survivorship issues and unmet needs were relatively common, particularly among younger participants. Use of multidisciplinary care was inconsistent and overall underutilised. IMPLICATIONS FOR CANCER SURVIVORS: Ongoing specific evaluation and optimisation of existing models of multidisciplinary survivorship care are essential in meeting the complex needs of breast cancer survivors.

Worldwide incidence of surgical site infections in general surgical patients: A systematic review and meta-analysis of 488,594 patients.

BACKGROUND: Establishing worldwide incidence of general surgical site infections (SSI) is imperative to understand the extent of the condition to assist decision-makers to improve the planning and delivery of surgical care. This systematic review and meta-analysis aimed to estimate the worldwide incidence of SSI and identify associated factors in adult general surgical patients. MATERIALS AND METHODS: A systematic review was undertaken using MEDLINE (Ovid), CINAHL (EBSCO), EMBASE (Elsevier) and the Cochrane Library to identify cross-sectional, cohort and observational studies reporting SSI incidence or prevalence. Studies of less than 50 participants were excluded. Data extraction and quality appraisal were undertaken independently by two review authors. The primary outcome was cumulative incidence of SSI occurring up to 30 days postoperative. The secondary outcome was the severity/depth of SSI. The I2 statistic was used to explore heterogeneity. Random effects models were used in the presence of substantial heterogeneity. Subgroup, meta-regression sensitivity analyses were used to explore the sources of heterogeneity. Publication bias was assessed using Hunter's plots and Egger's regression test. RESULTS: Of 2091 publications retrieved, 62 studies were included. Of these, 57 were included in the meta-analysis across six anatomical locations with 488,594 patients. The pooled 30-day cumulative incidence of SSI was 11% (95% CI 10%-13%). No prevalence data were identified. SSI rates varied across anatomical location, surgical approach, and priority (i.e., planned, emergency). Multivariable meta-regression showed SSI is significantly associated with duration of surgery (estimate 1.01, 95% CI 1.00-1.02, P = .014). CONCLUSIONS: and Relevance: 11 out of 100 general surgical patients are likely to develop an infection 30 days after surgery. Given the imperative to reduce the burden of harm caused by SSI, high-quality studies are warranted to better understand the patient and related risk factors associated with SSI.

Five myths about unacceptable behaviour in surgical education.

Recent evidence of the occurrence of discrimination, bullying and sexual harassment in surgery and more generally within healthcare has led to widespread discussion about the effects of unacceptable behaviour in surgical education and practice. Despite accumulating evidence of the adverse effects of unacceptable behaviour in clinical practice, not only on health care professionals but on patient care and outcomes, many surgeons and other health care professionals continue to embrace false perceptions about appropriate professional behaviour, interactions and approaches to teaching within surgical departments and more generally within healthcare institutions. This article explores five misperceptions about unacceptable behaviour in surgical education and provides evidence that supports a change in practice.

Alcohol and Tobacco Use in Relation to Mammographic Density in 23,456 Women.

BACKGROUND: Percent density (PD) is a strong risk factor for breast cancer that is potentially modifiable by lifestyle factors. PD is a composite of the dense (DA) and nondense (NDA) areas of a mammogram, representing predominantly fibroglandular or fatty tissues, respectively. Alcohol and tobacco use have been associated with increased breast cancer risk. However, their effects on mammographic density (MD) phenotypes are poorly understood. METHODS: We examined associations of alcohol and tobacco use with PD, DA, and NDA in a population-based cohort of 23,456 women screened using full-field digital mammography machines manufactured by Hologic or General Electric. MD was measured using Cumulus. Machine-specific effects were estimated using linear regression, and combined using random effects meta-analysis. RESULTS: Alcohol use was positively associated with PD (P trend = 0.01), unassociated with DA (P trend = 0.23), and inversely associated with NDA (P trend = 0.02) adjusting for age, body mass index, reproductive factors, physical activity, and family history of breast cancer. In contrast, tobacco use was inversely associated with PD (P trend = 0.0008), unassociated with DA (P trend = 0.93), and positively associated with NDA (P trend<0.0001). These trends were stronger in normal and overweight women than in obese women. CONCLUSIONS: These findings suggest that associations of alcohol and tobacco use with PD result more from their associations with NDA than DA. IMPACT: PD and NDA may mediate the association of alcohol drinking, but not tobacco smoking, with increased breast cancer risk. Further studies are needed to elucidate the modifiable lifestyle factors that influence breast tissue composition, and the important role of the fatty tissues on breast health.

Identification of 31 loci for mammographic density phenotypes and their associations with breast cancer risk.

Mammographic density (MD) phenotypes are strongly associated with breast cancer risk and highly heritable. In this GWAS meta-analysis of 24,192 women, we identify 31 MD loci at P < 5 × 10-8, tripling the number known to 46. Seventeen identified MD loci also are associated with breast cancer risk in an independent meta-analysis (P < 0.05). Mendelian randomization analyses show that genetic estimates of dense area (DA), nondense area (NDA), and percent density (PD) are all significantly associated with breast cancer risk (P < 0.05). Pathway analyses reveal distinct biological processes involving DA, NDA and PD loci. These findings provide additional insights into the genetic basis of MD phenotypes and their associations with breast cancer risk.

Age at Menarche and Late Adolescent Adiposity Associated with Mammographic Density on Processed Digital Mammograms in 24,840 Women.

Background: High mammographic density is strongly associated with increased breast cancer risk. Some, but not all, risk factors for breast cancer are also associated with higher mammographic density.Methods: The study cohort (N = 24,840) was drawn from the Research Program in Genes, Environment and Health of Kaiser Permanente Northern California and included non-Hispanic white females ages 40 to 74 years with a full-field digital mammogram (FFDM). Percent density (PD) and dense area (DA) were measured by a radiological technologist using Cumulus. The association of age at menarche and late adolescent body mass index (BMI) with PD and DA were modeled using linear regression adjusted for confounders.Results: Age at menarche and late adolescent BMI were negatively correlated. Age at menarche was positively associated with PD (P value for trend <0.0001) and DA (P value for trend <0.0001) in fully adjusted models. Compared with the reference category of ages 12 to 13 years at menarche, menarche at age >16 years was associated with an increase in PD of 1.47% (95% CI, 0.69-2.25) and an increase in DA of 1.59 cm2 (95% CI, 0.48-2.70). Late adolescent BMI was inversely associated with PD (P < 0.0001) and DA (P < 0.0001) in fully adjusted models.Conclusions: Age at menarche and late adolescent BMI are both associated with Cumulus measures of mammographic density on processed FFDM images.Impact: Age at menarche and late adolescent BMI may act through different pathways. The long-term effects of age at menarche on cancer risk may be mediated through factors besides mammographic density. Cancer Epidemiol Biomarkers Prev; 26(9); 1450-8. ©2017 AACR.

Imprint cytology versus frozen section: intraoperative analysis of sentinel lymph nodes in breast cancer.

BACKGROUND: Intraoperative analysis of the sentinel node status in breast cancer adds the benefit of proceeding to axillary dissection at the same time as the primary breast operation, without the need for a second trip to theatre. However, the method of intra-operative analysis must be both rapid and accurate for use in this setting. METHODS: A prospective series of 20 consecutive patients in one hospital who underwent sentinel node biopsy was performed. Intraoperative evaluation by imprint cytology and frozen section was compared with the final histopathological results. The time taken for both procedures was recorded. RESULTS: A total of 21 sentinel node procedures was performed. The sentinel node was found in 20 procedures (95%). The average time to perform intraoperative pathological analysis was 17 min (range: 5-35 min). Of the eight positive sentinel nodes, five were positive on imprint cytology alone and five were positive on frozen section alone (62.5% accuracy). The statistical false negative rate was 18.8% and the 'false reassurance rate' (patients with an initially negative node that was subsequently positive on formal histology who required a second trip to theatre for axillary dissection) was 37.5%. All patients with a negative sentinel node had a negative axilla. CONCLUSIONS: Intraoperative analysis of sentinel lymph nodes in breast cancer can be performed quickly. Imprint cytology and frozen section show comparable accuracy in predicting sentinel node status.