The effect of age in the outcome and treatment of older women with ductal carcinoma in situ

AbstractThe effect of increasing age on outcomes and type of treatment given to older women with ductal carcinoma in situ (DCIS) was assessed. 646 women ≥60 years old (654 cases) receiving surgery for DCIS at Memorial Sloan-Kettering Cancer Center between 2000 and 2007 (8 bilateral) had wide local excision (WLE; 37%), WLE plus radiotherapy (WLE+RT; 41%), or mastectomy (22%). 45%, 38%, and 16% of patients 60–69 years, 70–79 years, and ≥80 years, respectively, received WLE+RT (P<0.001) and 25%, 20%, and 13%, received mastectomy, respectively (P<0.001). Age (P<0.001), grade (P<0.001), and necrosis (P<0.01) were highly associated with treatment. Four-year local recurrence was 3.6%. Overall local recurrence differed by treatment (mastectomy, 0%; WLE, 5%; WLE+RT, 4%; P<0.00001) but not age. It is possible to identify older women with DCIS in whom the risk of recurrence is acceptably low after WLE alone. WLE alone may be a viable treatment option for select older women with DCIS

A recycler’s perspective on the implications of REACH and food contact material (FCM) regulations for the mechanical recycling of FCM plastics

This manuscript provides an overview of the legislative requirements for the use of mechanical recycled plastics in articles placed on the EU market, as seen from the perspective of a plastics recycler. The first part reviews the main principles included in the overarching legislation on Registration, Evaluation, Authorisation and Restrictions of Chemicals (REACH) and to what extent these are applicable for mechanical recyclers of plastics. The interactions between REACH and the Waste Framework Directive (WFD) is discussed, as well as the difficulties for recyclers to comply with certain REACH requirements. In a second part, the focus is moved to the use of recycled plastics as Food Contact Material (FCM). The scope of the different applicable EU FCM regulations is inventorised as well as the key legislative principles involved. A final section is dedicated to the discussion on the authorisation of recycling processes under the FCM regulation and the practical challenges involved for the effective introduction of FCMs containing recycled plastics. Altogether it could be concluded that the complexity of the different legal perspectives, a lack of communication and transparency within the plastic value chain together with technical challenges related to recycling processes have been hindering the effective uptake of recycled plastic FCM (with the exception for bottle PET). The development of targeted solutions across the entire valuechain, taking into account different perspectives in terms of legislation and health protection, economic growth and technical innovations, will be crucial in achieving a circular economy for plastics, including recycled plastics for FCM

Clinical aspects of sentinel node biopsy

Sentinel lymph node (SLN) biopsy requires validation by a backup axillary dissection in a defined series of cases before becoming standard practice, to establish individual and institutional success rates and the frequency of false negative results. At least 90% success in finding the SLN with no more than 5-10% false negative results is a reasonable goal for surgeons and institutions learning the technique. A combination of isotope and dye to map the SLN is probably superior to either method used alone, yet a wide variety of technical variations in the procedure have produced a striking similarity of results. Most breast cancer patients are suitable for SLN biopsy, and the large majority reported to date has had clinical stage T1-2N0 invasive breast cancers. SLN biopsy will play a growing role in patients having prophylactic mastectomy, and in those with 'high-risk' duct carcinoma in situ, microinvasive cancers, T3 disease, and neoadjuvant chemotherapy. SLN biopsy for the first time makes enhanced pathologic analysis of lymph nodes logistically feasible, at once allowing greater staging accuracy and less morbidity than standard methods. Retrospective data suggest that micrometastases identified in this way are prognostically significant, and prospective clinical trials now accruing promise a definitive answer to this issue