Extent of ductal carcinoma in situ according to breast cancer subtypes: a population-based cohort study

Ductal carcinoma in situ (DCIS) is a precursor of invasive breast carcinoma (IBC). The DCIS component is often more extensive than the invasive component, which affects local control. The aim of our study was to analyze features of DCIS within different IBC subtypes, which may contribute to the optimization of personalized approaches for patients with IBC. Patients with IBC reported according to the synoptic reporting module in the Netherlands between 2009 and 2015 were included. Data extraction included characteristics of the invasive component and, if present, several features of the DCIS component. Resection margin status analyses were restricted to patients undergoing breast-conserving surgery (BCS). Differences between subtypes were tested by a Chi-square test, spearman’s Rho test or a one-way ANOVA test. Overall, 36.937 cases of IBC were included. About half of the IBCs (n = 16.014; 43.4 %) were associated with DCIS. Her2+ IBC (irrespective of ER status) was associated with a higher prevalence of adjacent DCIS, a larger extent of DCIS and a higher rate of irradicality of the DCIS component as compared to ER+/Her2− and triple-negative subtypes (P < 0.0001 for all variables). The prevalence of DCIS in triple-negative IBC on the other hand was lowest. In this large population-based cohort study, we showed significant differences between the prevalence and extent of DCIS according to IBC subtypes, which is also reflected in the resection margin status in patients treated with BCS. Our data provide important information regarding the optimization of local therapy according to IBC subtypes

Possible hampered effectiveness of second-line treatment with rituximab-containing chemotherapy without signs of rituximab resistance: a population-based study among patients with chronic lymphocytic leukemia

Rituximab-containing chemotherapy remains a viable frontline treatment option for patients with chronic lymphocytic leukemia (CLL) in the era of novel agents. However, its effectiveness in the second-line setting—in relation to previous rituximab exposure in first-line—has hardly been evaluated in a population-based setting. Therefore, in this comprehensive, population-based study, we assessed the impact of first-line treatment with rituximab-containing chemotherapy on the effectiveness of second-line treatment with rituximab-containing chemot

Social and Economic Challenges of Implementing Sustainable Materials on Buildings in Kuwait

Many factors affect attaining the required credits for LEED materials and Many factors affect attaining the required credits for LEED materials and resources (MR) section. There are disadvantages in obtaining credits and LEED certifying an existing building in Kuwait to become a sustainable green building. LEED is still relatively new in Kuwait and the Gulf region, therefore, when certifying an existing governmental building, difficultly is faced with obtaining complete building owners, building upper management and occupant cooperation. This raises challenges when requiring cooperation from building occupants and cleaning staff for the solid waste management credits which require dedication to reduce the amount of waste going to landfills and incinerating facilities. The mindset of the contractor and subcontractor has to change to gain full understanding and cooperation in the waste management of construction materials when constructing new buildings and performing facility alterations on site. The selection of sustainable materials is more challenging as many materials are not available in Kuwait and the surrounding Gulf countries. Transportation from aboard should be decreased as much as possible to reduce cost as well as decreasing negative environmental impacts. Green certified materials are more expensive, therefore decision maker have to be willing to pay the extra cost. This paper discusses the challenges faced by KISR team as a consultancy body to certify an existing building according to LEED rating system from the material and resources aspect. It discusses the acceptance of the building owners, building upper management and the building occupants to this change and their understanding and cooperation. Many materials for MR credits 2 and 3 were found difficult to be obtained in Kuwait and the surrounding gulf region. Some materials were found to be available in the resources (MR) section. There are disadvantages in obtaining credits and LEED certifying an existing building in Kuwait to become a sustainable green building. LEED is still relatively new in Kuwait and the Gulf region, therefore, when certifying an existing governmental building, difficultly is faced with obtaining complete building owners, building upper management and occupant cooperation. This raises challenges when requiring cooperation from building occupants and cleaning staff for the solid waste management credits which require dedication to reduce the amount of waste going to landfills and incinerating facilities. The mindset of the contractor and subcontractor has to change to gain full understanding and cooperation in the waste management of construction materials when constructing new buildings and performing facility alterations on site. The selection of sustainable materials is more challenging as many materials are not available in Kuwait and the surrounding Gulf countries. Transportation from aboard should be decreased as much as possible to reduce cost as well as decreasing negative environmental impacts. Green certified materials are more expensive, therefore decision maker have to be willing to pay the extra cost. This paper discusses the challenges faced by KISR team as a consultancy body to certify an existing building according to LEED rating system from the material and resources aspect. It discusses the acceptance of the building owners, building upper management and the building occupants to this change and their understanding and cooperation. Many materials for MR credits 2 and 3 were found difficult to be obtained in Kuwait and the surrounding gulf region. Some materials were found to be available in th

Chemotherapy for pulmonary large cell neuroendocrine carcinomas: Does the regimen matter?

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Risk of breast cancer in women after a salivary gland carcinoma or pleomorphic adenoma in the Netherlands

Salivary and mammary gland tumors show morphological similarities and share various characteristics, including frequent overexpression of hormone receptors and female preponderance. Although this may suggest a common etiology, it remains unclear whether patients with a salivary gland tumor carry an increased risk of breast cancer (BC). Our purpose was to determine the risk of BC in women diagnosed with salivary gland carcinoma (SGC) or pleomorphic adenoma (SGPA). BC incidence (invasive and in situ) was assessed in two nationwide cohorts: one comprising 1567 women diagnosed with SGC and one with 2083 women with SGPA. BC incidence was compared with general population rates using standardized incidence ratio (SIR). BC risk was assessed according to age at SGC/SGPA diagnosis, follow-up time and (for SGC patients) histological subtype. The mean follow-up was 7.0 years after SGC and 9.9 after SGPA diagnosis. During follow-up, 52 patients with SGC and 74 patients with SGPA developed BC. The median time to BC was