Correlation between Margin Width and Time to Local and Systemic Recurrence of Ductal Carcinoma in Situ

Abstract Background:Recurrence after DCIS treatment is common and half are invasive cancers. Positive excision margin is significantly associated with recurrence, however; debate exists about close margin. We examine the pattern of treatment and recurrences at a single institute. Objective: To investigate, in women with DCIS treated at KFMC and long follow-up, the relationship between margin width and time to local or systemic recurrence of disease, controlling the other characteristics. Method:We retrospectively reviewed a prospectively maintained database of DCIS patients treated at single institution from 2014-2018. A multivariable Cox model was used to evaluate the association of margin width with recurrence while controlling for other variables. Results:We identified 56 cases with a median follow-up of 51 months (range 3 - 120), of which four (7%) had a recurrence within 2 years of initial treatment. Three were invasive ductal cancer while one was high grade DCIS. After controlling the other variables, no association of margin width with recurrence was identified (p-value 0.81) in the current study, however; all recurrences were on the left side (p-value &lt;0.001). Conclusion:The current study did not identify any correlation between margin width and LR, however; relation between site and LR was statistically significant as more LR was identified in left breast. Low rate of LR in current study could be due to more aged population of patients in present study.</jats:p

Anthropometry, bone mineral density and risk of breast cancer in premenopausal and postmenopausal Saudi women

IntroductionAnthropometry and bone mineral density are linked to hormonal imbalance, which plays a possible role in breast carcinogenesis. The current study was designed to explore the relationship between selected anthropometric and bone mineral density parameters and the risk of breast cancer in premenopausal and postmenopausal Saudi women.Material and methodsmethods: A cross-sectional study was carried out among premenopausal (n = 308) and postmenopausal (n = 148) women at two Medical Cities in Riyadh, Saudi Arabia from May 2015 to June 2016. Selected anthropometric measurements were obtained from 456 women; 213 of them had breast cancer. Bone mineral density was also measured using dual-energy X-ray absorptiometry.ResultsGreater waist circumference was significantly correlated with a higher breast cancer risk in premenopausal women (OR = 1.02, p = 0.03) but not in postmenopausal women. Greater triceps skinfold thickness had been found to be significantly correlated with a higher risk of breast cancer in premenopausal (OR = 1.06, p = 0.001) and postmenopausal (OR = 1.06, p = 0.001) women. However, bone mineral density was not significantly associated with breast cancer risk in either group of participants.ConclusionsBreast cancer risk was significantly associated with waist circumference and triceps skinfold thickness in premenopausal women and with only triceps skinfold thickness in postmenopausal women.</jats:sec

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population