Surgeon perspectives about local therapy for breast carcinoma

BACKGROUND Geographic variations in the use of mastectomy and the use of radiation therapy (RT) after breast-conserving surgery (BCS) have motivated concerns that surgeons are not uniformly adhering to treatment standards. METHODS The authors surveyed attending surgeons of a population-based sample of patients with breast carcinoma diagnosed in Detroit and Los Angeles from December 2001 to January 2003 ( n = 365; response rate, 80.0%). Clinical scenarios were used to evaluate opinions about local therapy. RESULTS On average, surgeons reported that they devoted 31.3% of their total practice to breast carcinoma. Approximately one-half of surgeons practiced in a community hospital setting, whereas 18.8% practiced in a cancer center. Compared to low volume surgeons, high volume surgeons were more likely to favor BCS with RT for invasive breast carcinoma (60.8%, 74.0%, and 87.2% for low, moderate, and high volume surgeons, respectively, P < 0.001). Surgeons who favored BCS were more likely to perceive greater quality of life (QOL) benefits for BCS than mastectomy (85.9%) compared with surgeons who favored mastectomy (28.6%) and those who did not favor 1 procedure over the other (60.0%, P < 0.001). In a ductal carcinoma in situ scenario, 35.0% of surgeons favored BCS without RT and 61.0% favored BCS with RT. Opinions regarding the role of RT after BCS varied by geographic site, surgeon volume, and patient age. CONCLUSIONS Variation in surgeon opinion concerning local therapy reflected clinical uncertainty about the benefits of alternative treatments. High volume surgeons more frequently endorsed current clinical guidelines that favor BCS compared with mastectomy. This may partly be explained by the greater belief that BCS confers a better patient QOL than mastectomy. Cancer 2005. © 2005 American Cancer Society.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/48757/1/21396_ftp.pd

Satisfaction with Surgery Outcomes and the Decision Process in a Population-Based Sample of Women with Breast Cancer

OBJECTIVE: To better understand medical decision making in the context of “preference sensitive care,” we investigated factors associated with breast cancer patients' satisfaction with the type of surgery received and with the decision process. DATA SOURCES/DATA COLLECTION: For a population-based sample of recently diagnosed breast cancer patients in the Detroit and Los Angeles metropolitan areas (N=1,633), demographic and clinical data were obtained from the Surveillance, Epidemiology, and End Results tumor registry, and self-reported psychosocial and satisfaction data were obtained through a mailed survey (78.4 percent response rate). STUDY DESIGN: Cross-sectional design in which multivariable logistic regression was used to identify sociodemographic and clinical factors associated with three satisfaction measures: low satisfaction with surgery type, low satisfaction with the decision process, and decision regret. PRINCIPAL FINDINGS: Overall, there were high levels of satisfaction with both surgery and the decision process, and low rates of decision regret. Ethnic minority women and those with low incomes were more likely to have low satisfaction or decision regret. In addition, the match between patient preferences regarding decision involvement and their actual level of involvement was a strong indicator of satisfaction and decision regret/ambivalence. While having less involvement than preferred was a significant indicator of low satisfaction and regret, having more involvement than preferred was also a risk factor. Women who received mastectomy without reconstruction were more likely to report low satisfaction with surgery (odds ratio [OR]=1.54, p<.05), low satisfaction with the process (OR=1.37, p<.05), and decision regret (OR=1.55, p<.05) compared with those receiving breast conserving surgery (BCS). An additional finding was that as patients' level of involvement in the decision process increased, the rate of mastectomy also increased (p<.001). CONCLUSIONS: A significant proportion of breast cancer patients experience a decision process that matches their preferences for participation, and report satisfaction with both the process and the outcome. However, women who report more involvement in the decision process are significantly less likely to receive a lumpectomy. Thus, increasing patient involvement in the decision process will not necessarily increase use of BCS or lead to greater satisfaction. The most salient aspect for satisfaction with the decision making process is the match between patients' preferences and experiences regarding participation

Antisite disorder and Berry curvature driven anomalous Hall effect in the spin gapless semiconducting Mn2_2CoAl Heusler compound

Spin gapless semiconductors exhibit a finite band gap for one spin channel and a closed gap for another spin channel, and they have emerged as a new state of magnetic materials with a great potential for spintronic applications. The first experimental evidence for spin gapless semiconducting behavior was observed in an inverse Heusler compound Mn$_2$CoAl. Here, we report a detailed investigation of the crystal structure and anomalous Hall effect in Mn$_2$CoAl using experimental and theoretical studies. The analysis of the high-resolution synchrotron x-ray diffraction data shows antisite disorder between Mn and Al atoms within the inverse Heusler structure. The temperature-dependent resistivity shows semiconducting behavior and follows Mooij's criteria for disordered metal. The scaling behavior of the anomalous Hall resistivity suggests that the anomalous Hall effect in Mn$_2$CoAl is primarily governed by an intrinsic mechanism due to the Berry curvature in momentum space. The experimental intrinsic anomalous Hall conductivity (AHC) is found to be ∼35 S/cm, which is considerably larger than the theoretically predicted value for ordered Mn$_2$CoAl. Our first-principles calculations conclude that the antisite disorder between Mn and Al atoms enhances the Berry curvature and hence the value of intrinsic AHC, which is in very good agreement with the experiment

Atomic disorder and Berry phase driven anomalous Hall effect in a Co 2 FeAl Heusler compound

Co$_2$-based Heusler compounds are promising materials for spintronics applications due to their high Curie temperature, large spin polarization, large magnetization density, and exotic transport properties. In the present paper, we report the anomalous Hall effect (AHE) in a polycrystalline Co$_2$FeAl Heusler compound using combined experimental and theoretical studies. The Rietveld analysis of high-resolution synchrotron x-ray diffraction data reveals a large degree (∼50%) of antisite disorder between Fe and Al atoms. The analysis of anomalous transport data provides the experimental anomalous Hall conductivity (AHC) about 227 S/cm at 2 K with an intrinsic contribution of 155 S/cm, which has nearly constant variation with temperature. The detailed scaling analysis of anomalous Hall resistivity suggests that the AHE in Co$_2$FeAl is governed by the Berry phase driven intrinsic mechanism. Our theoretical calculations reveal that the disorder present in the Co$_2$FeAl compound enhances the Berry curvature induced intrinsic AHC