Breast radiation correlates with side of parathyroid adenoma.

BACKGROUND: Prior head and neck irradiation is a known risk factor for hyperparathyroidism. It is not clear whether irradiation for breast cancer, which may expose the neck to radiation, is also a risk factor for hyperparathyroidism. The present study analyzes the association between the side of radiation to the chest following breast surgery and the side of subsequent parathyroid adenoma development. METHODS: We analyzed a prospective database of 1,428 consecutive patients who underwent parathyroidectomy at our institution between November 2000 and August 2010. Patients who had previously undergone breast surgery were identified. Patients with multigland disease were excluded. Patients with bilateral breast surgery were counted as having had two separate procedures; one on each side. Patients who had radiation therapy following breast surgery (RadRx) were compared to those who had breast surgery without radiation treatment (No RadRx). RESULTS: A total of 146 breast procedures were performed in 121 patients. Forty procedures were in the RadRx group versus 106 cases in the No RadRx group. Patients with radiation therapy were older (68 ± 1.8 years versus 63 ± 1.2 years; P = 0.02) and had higher preoperative calcium levels (11.3 ± 0.1 mg/dl versus 10.9 ± 0.1 mg/dl; P = 0.001). However, there was no significant difference in either parathyroid hormone (PTH) level or gland weight. The latency period between breast irradiation and parathyroid surgery was 8 ± 0.9 years. Interestingly, the side of radiation therapy was associated with the side of the parathyroid adenoma in 76% of cases, compared to only 44% in those who had breast surgery without radiation exposure (P = 0.0004). CONCLUSIONS: The present study demonstrates that, similar to prior head and neck radiation, prior breast irradiation correlates with the development of parathyroid disease. Specifically, there is a strong correlation between the side of the radiation therapy and the side of a subsequent parathyroid adenoma. Breast irradiation should therefore be considered a risk factor for the development of parathyroid adenomas.

Spirituality and religion in the care of surgical oncology patients with life-threatening or advanced illnesses.

Spiritual and religious concerns often become of central importance in the care of surgical oncology patients confronted with their mortality. Unfortunately, surgeons are often ill prepared or reluctant to address the spiritual and religious needs of their patients. In this article, working definitions of spirituality versus religiosity will be developed in the context of the three largest monotheistic religions in America: Christianity, Islam, and Judaism. Disease, dying, and death will be explored with respect to these faiths and examples of how to address religious beliefs in practical clinical settings will be given. Finally, specific suggestions will be made for surgeons to better understand, empathize with, and address the needs of their seriously ill patients in a holistic manner.