Are There Disparities in Breast Reconstruction After Contralateral Prophylactic Mastectomy?

INTRODUCTION: Despite national guidelines against contralateral prophylactic mastectomy (CPM) in low- to moderate-risk breast cancer, CPM use continues to rise. Breast reconstruction improves health-related quality of life and satisfaction among women undergoing mastectomy. Given the lack of data regarding factors associated with reconstruction after CPM and the known benefits of reconstruction, we sought to investigate whether disparities exist in receipt of reconstruction after CPM. METHODS: The 2004-2017 National Cancer Database was queried to identify women diagnosed with breast cancer who underwent unilateral mastectomy with CPM. Patients were divided into two groups: those who underwent planned reconstruction at any timepoint and those who did not. A secondary analysis comparing types of reconstruction (tissue, implant, combined) was conducted. Patient, tumor, and demographic characteristics were analyzed using chi-square test and odds ratios were calculated using generalized estimating equations. RESULTS: The cohort included 1,73,249 women: 95,818 (55.3%) underwent reconstruction and 77,431 (45.7%) did not. Both the rate CPM and the proportion of women undergoing reconstruction after CPM increased between 2004 and 2017. Of the women who had reconstruction, 40,840 (51.7%) received implants, 29,807 (37.7%) had tissue, and 8352 (10.6%) had combined reconstruction. After adjusted analysis, factors associated with reconstruction were young age, Hispanic ethnicity, private insurance, and living in an area with the highest education and median income (P < 0.01). Patients who underwent reconstruction were less likely to have radiation (P < 0.01) and chemotherapy (P < 0.01), more likely to have stage I disease (P < 0.01), and to be treated at an integrated cancer center (P < 0.01). CONCLUSIONS: Reconstruction after CPM is disproportionately received by younger women, Hispanics, those with private insurance, and higher socioeconomic status and education. While the rate of reconstruction after CPM is increasing, there remain significant disparities. Conscious efforts must be made to eliminate these disparities, especially given the known benefits of reconstruction after mastectomy.

Vermeer: los colores tóxicos del plomo y del mercurio / Vermeer: the toxic colours of lead and mercury

¿Qué sucede con Vermeer?, se preguntan los historiadores y amantes del arte. El enigmático pintor permaneció en la oscuridad después de su muerte hasta el siglo XIX, en donde capturaría la imaginación y el gusto estético de los tiempos modernos. Aunque han llegado a nosotros sólo treinta y seis de sus obras, su originalidad y refinamiento le colocan entre los más grandes artistas holandeses del siglo XVII. La vida de Vermeer sólo puede recompuesta a través de actas notariales y su dramático final es conocido por boca de su viuda. Nosotros pretendemos aportar un nuevo punto de vista de las razones de su muerte a causa de una intoxicación por plomo y mercurio, y las repercusiones que esta causa tuvo en su pintura (AU)

What is it about Johannes Vermeer? contemporary art lovers and historians ask. The enigmatic painter lapsed into obscurity after his death only to surface again in the 19th century and capture the imagination and esthetic taste of modern times. Even though he produced no more than 40 paintings, their originality and refinement place him among the greatest 17th-century Dutch artists. Vermeer's life story can only be patched together from public records, and the dramatic end of Vermeer`s life was told by his widow after his death.We contribute our point of view of the reason of his death because of a poisoning for lead and mercury and the repercussions that it had in his painting (AU)

Estudio de inmunogenicidad para dos vacunas recombinantes contra hepatitis B comparando dos esquemas / Study of the immunogenicity of two recombinant hepatitis B vaccine comparating schedules

Este estudio compara la inmunogenicidad (seroconversión, seroprotección e hiperrespuesta), producida por dos vacunas recombinantes contra la hepatitis B (Engerix-B de Bélgica y Cubana), en dos esquemas (012 y 016 meses), empleando los métodos de cuantificación para anti-HBsAg (Abbott y Organón), los cuales fueron también comparados. En el estudio participaron 257 voluntarios, divididos al azar en 4 grupos (dos vacunas, dos esquemas). Resultados: los dos métodos de Abbott y Organon, no presentan diferencias estadísticas significativas. La vacuna cubana muestra una mayor respuesta inmunogénica para dos dosis de vacuna y para el esquema 012. No hay diferencia entre los esquemas 012 y 016 y en el esquema 016 no se ven diferencias estadísticamente significativas con la vacuna Engerix-B. En esta última el esquema 016 muestra mejores resultados que el 012