Education and training in breast cancer surgery in Europe

Background: The substantial increase in the complexity of breast cancer care in the last few decades has resulted in significant improvements in survival rates and also in the quality of life of breast cancer survivors. However, across Europe there are variations in outcomes and access to the latest techniques. Whilst much of this variance is due to differences in health economies between European member states, training variation may also play a part. Training in breast cancer surgery varies greatly across Europe, not only in its basal discipline (general surgery, gynaecology or plastic surgery) but also in the length of training and whether there is any requirement for specialist training. Several countries have been leading the way in training breast specialist surgeons (the USA, the UK, Australia and New Zealand) with dedicated 1- or 2-year fellowships either within or in addition to standard training. Access to such training is limited and consequently many women in Europe are still treated by generalists, potentially denying them access to the best care. This paper reviews the issues surrounding training provision in breast surgery and some of the challenges which need to be addressed to improve the current situation. Summary: Breast surgery training in Europe is of variable quality and duration, which may result in variations in the quality of care received by patients with breast cancer. Specialist training standards are urgently required which should be adopted by all European member states. Excellent models are available in the USA, the UK and Australia and New Zealand on which to base this training. Key Messages: The quality of training in breast surgery needs to be upgraded and harmonised across Europe

Should breast reconstruction and breast oncoplastic procedures be performed during the coronavirus pandemic?

The onset of the COVID-19 pandemic has changed the face of the treatment of breast cancer and breast reconstruction globally. Mastectomy with immediate implant-based breast reconstruction was on the rise due to advances in meshes and implants. However, due to the prioritisation of the critically ill and diversion of the work force, breast cancer treatment has drastically changed. This is an opinion paper written by the authors with experience and importance in the scenario of breast reconstructive surgery. The authors are from different countries with the COVID-19 pandemic in different stages

Five microRNAs in Serum Are Able to Differentiate Breast Cancer Patients From Healthy Individuals

Breast cancer is the cancer with the most incidence and mortality in women. microRNAs are emerging as novel prognosis/diagnostic tools. Our aim was to identify a serum microRNA signature useful to predict cancer development. We focused on studying the expression levels of 30 microRNAs in the serum of 96 breast cancer patients vs. 92 control individuals. Bioinformatic studies provide a microRNA signature, designated as a predictor, based on the expression levels of five microRNAs. Then, we tested the predictor in a group of 60 randomly chosen women. Lastly, a proteomic study unveiled the overexpression and downregulation of proteins differently expressed in the serum of breast cancer patients vs. that of control individuals. Twenty-six microRNAs differentiate cancer tissue from healthy tissue, and 16 microRNAs differentiate the serum of cancer patients from that of the control group. The tissue expression of miR-99a, miR-497, miR-362, and miR-1274, and the serum levels of miR-141 correlated with patient survival. Moreover, the predictor consisting of miR-125b, miR-29c, miR-16, miR-1260, and miR-451 was able to differentiate breast cancer patients from controls. The predictor was validated in 20 new cases of breast cancer patients and tested in 60 volunteer women, assigning 11 out of 60 women to the cancer group. An association of low levels of miR-16 with a high content of CD44 protein in serum was found. Circulating microRNAs in serum can represent biomarkers for cancer prediction. Their clinical relevance and the potential use of the predictor here described are discussed

Oncoplastic Breast Consortium consensus conference on nipple-sparing mastectomy

Purpose Indications for nipple-sparing mastectomy (NSM) have broadened to include the risk reducing setting and locally advanced tumors, which resulted in a dramatic increase in the use of NSM. The Oncoplastic Breast Consortium consensus conference on NSM and immediate reconstruction was held to address a variety of questions in clinical practice and research based on published evidence and expert panel opinion. Methods The panel consisted of 44 breast surgeons from 14 countries across four continents with a background in gynecology, general or reconstructive surgery and a practice dedicated to breast cancer, as well as a patient advocate. Panelists presented evidence summaries relating to each topic for debate during the in-person consensus conference. The iterative process in question development, voting, and wording of the recommendations followed the modified Delphi methodology. Results Consensus recommendations were reached in 35, majority recommendations in 24, and no recommendations in the remaining 12 questions. The panel acknowledged the need for standardization of various aspects of NSM and immediate reconstruction. It endorsed several oncological contraindications to the preservation of the skin and nipple. Furthermore, it recommended inclusion of patients in prospective registries and routine assessment of patient-reported outcomes. Considerable heterogeneity in breast reconstruction practice became obvious during the conference. Conclusions In case of conflicting or missing evidence to guide treatment, the consensus conference revealed substantial disagreement in expert panel opinion, which, among others, supports the need for a randomized trial to evaluate the safest and most efficacious reconstruction techniques

Search for periodic signals in the dielectron and diphoton invariant mass spectra using 139 fb−1 of pp collisions at √s = 13 TeV with the ATLAS detector

A search for physics beyond the Standard Model inducing periodic signals in the dielectron and diphoton invariant mass spectra is presented using 139 fb−1 of √s =13 TeV pp collision data collected by the ATLAS experiment at the LHC. Novel search techniques based on continuous wavelet transforms are used to infer the frequency of periodic signals from the invariant mass spectra and neural network classifiers are used to enhance the sensitivity to periodic resonances. In the absence of a signal, exclusion limits are placed at the 95% confidence level in the two-dimensional parameter space of the clockwork gravity model. Model-independent searches for deviations from the background-only hypothesis are also performed

A century of trends in adult human height

Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.5-22.7) and 16.5 cm (13.3-19.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people over these 100 years are men born in the Netherlands in the last quarter of 20th century, whose average heights surpassed 182.5 cm, and the shortest were women born in Guatemala in 1896 (140.3 cm; 135.8-144.8). The height differential between the tallest and shortest populations was 19-20 cm a century ago, and has remained the same for women and increased for men a century later despite substantial changes in the ranking of countries

Simulation Of Segmented Waveguide Crossing Using The 2d Finite Element Method

A rigorous simulation of segmented waveguide (SWG) crossing is presented, using the two-dimensional finite element method (2D-FEM). The transmission and crosstalk of the SWG crossing are computed and compared with equivalent continuous waveguide (CWG) crossing. © 2011 IEEE.819820Bock, P.J., Cheben, P., Schmid, J.H., Lapointe, J., Delâge, A., Xu, D.-X., Janz, S., Hall, T.J., Subwavelength grating crossing for silicon wire waveguides (2010) Optics Express, 18 (15), pp. 16146-16155. , JulyBock, P.J., Cheben, P., Schmid, J.H., Lapointe, J., Delâge, A., Janz, S., Aers, G.C., Hall, T.J., Subwavelength grating periodic structures in silicon-on-insulator: A new type of microphotonic waveguide (2010) Optics Express, 18 (19), pp. 20251-20262. , SeptemberCheben, P., Bock, P.J., Schmid, J.H., Lapointe, J., Janz, S., Xu, D.-X., Densmore, A., Hall, T.J., Refractive index engineering with subwavelength gratings for efficient microphotonic couplers and planar waveguide multiplexers (2010) Optics Letters, 35 (15), pp. 2526-2528. , AugustCheben, P., Xu, D.-X., Janz, S., Densmore, A., Subwavelength waveguide grating for mode conversion and light coupling in integrated optics (2006) Optics Express, 14 (11), pp. 4695-4702. , http://www.opticsexpress.org/ViewMedia.cfm?id=90061&seq=0, DOI 10.1364/OE.14.004695Rubio-Mercedes, C.E., Hernández-Figueroa, H.E., Padé boundary conditions for the finite-element solution of arbitrary planar junctions (2004) Journal of Lightwave Technology, 22 (2), pp. 669-676. , Fe

Perspectives on preoperative systemic treatment and breast conservative surgery: One step forward or two steps back?

Preoperative systemic therapy (PST) has become an accepted treatment not only for locally advanced but also for early stage breast cancer patients. Clinical trials have demonstrated that the use of PST is equally to adjuvant treatments in terms of overall survival, and has the advantage of increasing rates of breast conservative surgery and rates of pathologic complete response, a surrogate endpoint for the effectiveness of systemic therapy. Initial studies have suggested higher rates of locoregional recurrence with this approach. However, the optimization of systemic and targeted therapy and the multidisciplinary care is key to achieving optimal outcomes in this setting

Erratum to “Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up”

International audienc