Impact of obesity on diagnosis and treatment of breast cancer

In this population-based study, we evaluated the impact of obesity on presentation, diagnosis and treatment of breast cancer. Among all women diagnosed with invasive breast cancer in the canton Geneva (Switzerland) between 2003 and 2005, we identified those with information on body mass index (BMI) and categorized them into normal/underweight (BMI <25kg/m2), overweight (BMI ≥-<30kg/m2) and obese (BMI ≥30kg/m2) women. Using multivariate logistic regression, we compared tumour, diagnosis and treatment characteristics between groups. Obese women presented significantly more often with stage III-IV disease (adjusted odds ratio [ORadj]: 1.8, 95% CI: 1.0-3.3). Tumours ≥1cm and pN2-N3 lymph nodes were significantly more often impalpable in obese than in normal/underweight patients (ORadj 2.4, [1.1-5.3] and ORadj 5.1, [1.0-25.4], respectively). Obese women were less likely to have undergone ultrasound (ORadj 0.5, [0.3-0.9]) and MRI (ORadj 0.3, [0.1-0.6]) and were at increased risk of prolonged hospital stay (ORadj 4.7, [2.0-10.9]). This study finds important diagnostic and therapeutic differences between obese and lean women, which may impair survival of obese women with breast cancer. Specific strategies are needed to optimize the care of obese women with or at risk of breast cance

Antimicrobial stewardship in primary health care programs in humanitarian settings: the time to act is now

Abstract Fragile and conflict-affected settings bear a disproportionate burden of antimicrobial resistance, due to the compounding effects of weak health policies, disrupted medical supply chains, and lack of knowledge and awareness about antibiotic stewardship both among health care providers and health service users. Until now, humanitarian organizations intervening in these contexts have confronted the threat of complex multidrug resistant infections mainly in their surgical projects at the secondary and tertiary levels of care, but there has been limited focus on ensuring the implementation of adequate antimicrobial stewardship in primary health care, which is known to be setting where the highest proportion of antibiotics are prescribed. In this paper, we present the experience of two humanitarian organizations, Médecins sans Frontières and the International Committee of the Red Cross, in responding to antimicrobial resistance in their medical interventions, and we draw from their experience to formulate practical recommendations to include antimicrobial stewardship among the standards of primary health care service delivery in conflict settings. We believe that expanding the focus of humanitarian interventions in unstable and fragile contexts to include antimicrobial stewardship in primary care will strengthen the global response to antimicrobial resistance and will decrease its burden where it is posing the highest toll in terms of mortality

Impact of obesity on diagnosis and treatment of breast cancer

10.1007/s10549-009-0459-1Breast Cancer Research and Treatment1201185-19