Older women's experience with breast cancer treatment decisions.

The purpose of this study was to better understand older women's experience with breast cancer treatment decisions. We conducted a longitudinal study of non-demented, English-speaking women ≥ 65 years recruited from three Boston-based breast imaging centers. We interviewed women at the time of breast biopsy (before they knew their results) and 6 months later. At baseline, we assessed intention to accept different breast cancer treatments, sociodemographic, and health characteristics. At follow-up, we asked women about their involvement in treatment decisions, to describe how they chose a treatment, and influencing factors. We assessed tumor characteristics through chart abstraction. We used quantitative and qualitative analyses. Seventy women (43 ≥ 75 years) completed both interviews and were diagnosed with breast cancer; 91 % were non-Hispanic white. At baseline, women 75+ were less likely than women 65-74 to report that they would accept surgery and/or take a medication for ≥ 5 years if recommended for breast disease. Women 75+ were ultimately less likely to receive hormonal therapy for estrogen receptor positive tumors than women 65-74. Women 75+ asked their surgeons fewer questions about their treatment options and were less likely to seek information from other sources. A surgeon's recommendation was the most influential factor affecting older women's treatment decisions. In open-ended comments, 17 women reported having no perceived choice about treatment and 42 stated they simply followed their physician's recommendation for at least one treatment choice. In conclusion, to improve care of older women with breast cancer, interventions are needed to increase their engagement in treatment decision-making.

Separable pupillary signatures of perception and action during perceptual multistability.

The pupil provides a rich, non-invasive measure of the neural bases of perception and cognition and has been of particular value in uncovering the role of arousal-linked neuromodulation, which alters both cortical processing and pupil size. But pupil size is subject to a multitude of influences, which complicates unique interpretation. We measured pupils of observers experiencing perceptual multistability-an ever-changing subjective percept in the face of unchanging but inconclusive sensory input. In separate conditions, the endogenously generated perceptual changes were either task-relevant or not, allowing a separation between perception-related and task-related pupil signals. Perceptual changes were marked by a complex pupil response that could be decomposed into two components: a dilation tied to task execution and plausibly indicative of an arousal-linked noradrenaline surge, and an overlapping constriction tied to the perceptual transient and plausibly a marker of altered visual cortical representation. Constriction, but not dilation, amplitude systematically depended on the time interval between perceptual changes, possibly providing an overt index of neural adaptation. These results show that the pupil provides a simultaneous reading on interacting but dissociable neural processes during perceptual multistability, and suggest that arousal-linked neuromodulator release shapes action but not perception in these circumstances.

An Unusual Cause of a Breast Mass in a Patient from China.

Sparganosis is a parasitic infection caused by Spirometra spp. and often presents as a subcutaneous swelling, most commonly noticed in the abdominal wall or extremities. Amphibians such as frogs ingest infected copepods (crustaceans that have ingested coracidia, i.e., Spirometra spp. embryos) and serve as a secondary intermediate host. Complete surgical excision is recommended for definitive diagnosis and treatment. Granulomatous inflammation is the most common histologic finding. Although dissemination can occur, most cases are localized. Serum enzyme-linked immunosorbent assay (ELISA) has been suggested as a potential surveillance tool. Medical therapy with antiparasitic agents, such as praziquantel, is not typically recommended but may be effective at high doses. Preventing recurrence thus depends on adequate surgical removal of the parasite. We report a case of a breast mass caused by sparganosis infection in a Chinese female whose likely exposure was due to frog consumption. The diagnosis was confirmed on surgical excision and no systemic antiparasitic therapy was required.

Unresolved, atraumatic breast hematoma: post-irradiation or secondary breast angiosarcoma.

Post-irradiation or secondary angiosarcoma of the breast was first described in the 1980s in patients treated with breast conserving therapy for cancer. The primary management of radiation-induced breast angiosarcoma has focused on surgical resection with an emphasis on achieving negative tumor margins. While surgery remains a key component of treatment, novel therapeutic approaches have surfaced. Despite such advances in treatment, prognosis remains poor.