RESUMO
PURPOSE: The use of adjuvant radiotherapy (RT) in the management of ductal carcinoma in situ (DCIS) is increasing. Left-sided breast irradiation may involve exposure of the heart to ionising radiation, increasing the risk of ischemic heart disease (IHD). We examined the incidence of IHD in a population-based cohort of women with DCIS. METHODS: The Breast Cancer DataBase Sweden (BCBase) cohort includes women registered with invasive and in situ breast cancers 1992-2012 and age-matched women without a history of breast cancer. In this analysis, 6270 women with DCIS and a comparison cohort of 31,257 women were included. Through linkage with population-based registers, data on comorbidity, socioeconomic status and incidence of IHD was obtained. Hazard ratios (HR) for IHD with 95% confidence intervals (CI) were analysed. RESULTS: Median follow-up time was 8.8 years. The risk of IHD was not increased for women with DCIS versus women in the comparison cohort (HR 0.93; 95% CI 0.82-1.06), after treatment with radiotherapy versus surgery alone (HR 0.77; 95% CI 0.60-0.98) or when analysing RT by laterality (HR 0.85; 95% CI 0.53-1.37 for left-sided versus right-sided RT). CONCLUSIONS: The risk of IHD was lower for women with DCIS allocated to RT compared to non-irradiated women and to the comparison cohort, probably due to patient selection. Comparison of RT by laterality did not show any over-risk for irradiation of the left breast.
Assuntos
Carcinoma Intraductal não Infiltrante/complicações , Isquemia Miocárdica/epidemiologia , Isquemia Miocárdica/etiologia , Radioterapia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Intraductal não Infiltrante/radioterapia , Comorbidade , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Vigilância da População , Modelos de Riscos Proporcionais , Radioterapia/métodos , Sistema de Registros , Suécia/epidemiologia , Carga TumoralRESUMO
BACKGROUND: Studies to date have failed to demonstrate any survival benefit from preventing local recurrence after treatment for ductal breast carcinoma in situ (DCIS). Patient- and tumour-related risk factors for death from breast cancer in women with a primary DCIS were analysed here in a large case-control study. METHODS: A nested case-control study was conducted in a population-based cohort of women with primary DCIS between 1992 and 2012. Women who later died from breast cancer were identified. Four controls per case were selected randomly by incidence density sampling. Medical records and pathology reports were retrieved. Conditional logistic regression was used to calculate odds ratios (ORs) and 95 per cent confidence intervals for risk of death from breast cancer. RESULTS: From a cohort of 6964 women, 96 who died from breast cancer were identified and these were compared with a group of 318 controls. Tumour size over 25 mm or multifocal DCIS (OR 2·55, 95 per cent c.i. 1·53 to 4·25), a positive or uncertain margin status (OR 3·91, 1·59 to 9·61) and detection outside the screening programme (OR 2·12, 1·16 to 3·86) increased the risk of death from breast cancer. The risks were not affected by age or type of treatment. In the multivariable analysis, tumour size (OR 1·95, 1·06 to 3·67) and margin status (OR 2·69, 1·15 to 7·11) remained significant. CONCLUSION: In the present study, large tumour size and positive or uncertain margin status were associated with a higher risk of death from breast cancer after treatment for primary DCIS. More extensive treatment was not associated with lower risk, which may be due to confounding by indication, or indicate that some DCIS has an inherent potential for metastatic spread.
Assuntos
Neoplasias da Mama/mortalidade , Carcinoma Intraductal não Infiltrante/mortalidade , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Carcinoma Intraductal não Infiltrante/patologia , Carcinoma Intraductal não Infiltrante/terapia , Estudos de Casos e Controles , Feminino , Humanos , Margens de Excisão , Pessoa de Meia-Idade , Análise Multivariada , Suécia/epidemiologiaRESUMO
In a randomized trial, 55 patients with acute external otitis were treated with either topical framycitin/gramicidin (Sofradex) or oxytetracycline/hydrocortisone (Terracortril) with polymyxin B (TPB) ear-drops for 1 week. Staphylococcus aureus and Pseudomonas pyocyanea were the bacteria most frequently found in the ear canal; 78% of the patients were cured. However, no significant differences in therapy were found when either of the preparations was used. S. aureus seemed to be most resistant to treatment, while P. pyocyanea was less of a therapeutic problem. Additionally, previous episodes of external otitis or other skin diseases did not seem to influence any treatment given.