Estimating cancer distant recurrence rates from administrative datasets: comparison of cancer registry and hospital records.

We thank the NSW Central Cancer Registry and the NSW Department of Health for providing data for this study and the Centre for Health Research Linkage for undertaking the record linkage. This study was supported through an Australian National Health and Medical Research Council Project Grant (No 633223) and the NSW Health BiostatisticalOfficer Training Program (for J Patterson)

Erythropoietin Selectively Attenuates Cytokine Production and Inflammation in Cerebral Ischemia by Targeting Neuronal Apoptosis

Ischemic brain injury resulting from stroke arises from primary neuronal losses and by inflammatory responses. Previous studies suggest that erythropoietin (EPO) attenuates both processes. Although EPO is clearly antiapoptotic for neurons after experimental stroke, it is unknown whether EPO also directly modulates EPO receptor (EPO-R)–expressing glia, microglia, and other inflammatory cells. In these experiments, we show that recombinant human EPO (rhEPO; 5,000 U/kg body weight, i.p.) markedly reduces astrocyte activation and the recruitment of leukocytes and microglia into an infarction produced by middle cerebral artery occlusion in rats. In addition, ischemia-induced production of the proinflammatory cytokines tumor necrosis factor, interleukin 6, and monocyte chemoattractant protein 1 concentration is reduced by >50% after rhEPO administration. Similar results were also observed in mixed neuronal-glial cocultures exposed to the neuronal-selective toxin trimethyl tin. In contrast, rhEPO did not inhibit cytokine production by astrocyte cultures exposed to neuronal homogenates or modulate the response of human peripheral blood mononuclear cells, rat glial cells, or the brain to lipopolysaccharide. These findings suggest that rhEPO attenuates ischemia-induced inflammation by reducing neuronal death rather than by direct effects upon EPO-R–expressing inflammatory cells

Imaging in measurement of response to neoadjuvant chemotherapy in breast cancer

Neoadjuvant chemotherapy (NAC) is chemotherapy delivered prior to breast cancer surgery, aimed at reducing tumour size and inducing pathologic complete response (pCR). The studies in this thesis evaluated the accuracy of imaging tests for assessing response during and after NAC. A systematic review of magnetic resonance imaging (MRI) during NAC to predict pCR (13 studies, N=605) found that accuracy was highest for alternatives to tumour size measurements (quantitative dynamic contrast and volumetric parameters). In a study of ultrasound for the same purpose (N=832), accuracy was higher than previously reported, suggesting that ultrasound’s role may have been underestimated. A meta-analysis of MRI for detecting pCR post-NAC (44 studies, N=2,050) showed that MRI was more accurate than mammography and clinical examination, but no difference with ultrasound was found. A study-level meta-analysis (19 studies, N=958) found small systematic bias in tumour size measurement by MRI and ultrasound; mammography and clinical examination were less accurate. A patient-level meta-analysis (N=300) confirmed those findings, suggesting the choice of test should be informed by preference for slight overestimation (MRI) or underestimation (ultrasound). Collectively, these studies show relatively high MRI accuracy for assessing NAC response; however, ultrasound performed comparably and may have practical advantages (accessibility and cost)

Digital breast tomosynthesis (3D mammography) for breast cancer screening and for assessment of screen-recalled findings: review of the evidence

<p><b>Introduction</b>: Digital breast tomosynthesis (DBT) addresses some of the limitations of digital mammography (DM) by reducing the effect of overlapping tissue. Emerging data have shown that DBT increases breast cancer (BC) detection and reduces recall in BC screening programs. Studies have also suggested that DBT improves assessment of screen-recalled findings.</p> <p><b>Areas covered</b>: Studies of DBT for population BC screening and those for assessment of screen-detected findings were reviewed to provide an up-to-date summary of the evidence on DBT in the screening setting. A systematic literature search was conducted for each of the topics; study-specific information and/or quantitative data on detection or accuracy were extracted and collated in tables.</p> <p><b>Expert commentary</b>: The evidence on DBT for BC screening reinforces that DBT integrated with DM increases cancer detection rates compared to DM alone, although the extent of improved detection varied between studies. The effect of DBT on recall rates was heterogeneous with substantial reductions evident noticeably in retrospective comparative studies. The evidence on DBT for workup was sparse and those studies had limitations related to design and methods. Even though the majority showed improved specificity using DBT compared with conventional imaging, there was little evidence on how DBT impacts assessment outcomes.</p

Screening outcomes by risk factor and age: evidence from BreastScreen WA for discussions of risk-stratified population screening.

The outcome of this study was to estimate rates of screen-detected and interval breast cancers, stratified by risk factor, to inform discussions of risk-stratified population screening. We conducted a retrospective population-based cohort study; analysis of routinely collected BreastScreen WA program clinical and administrative data. All BreastScreen WA mammography screening episodes for women aged 40 years or more during 1 July 2007 ‒ 30 June 2017. The main outcomes and measures were cancer detection rate (CDR) and interval cancer rate (ICR), by risk factor

69 Impact of full-field digital mammography versus film-screen mammography: systematic review

Most breast screening programs worldwide have replaced screen-film mammography (SFM) with full-field digital mammography (FFDM) in expectation of technical, clinical and economic advantages. However, we are only just now able to begin to measure the effects of this practice shift in population screening on health outcomes among asymptomatic women eligible for population screening. This systematic review aims to assess the impact of digital mammography on breast cancer detection rates at screening and on interval cancer rates, as indicators of additional net benefit through early detection, or additional net harm from overdiagnosis

The Association of Surgical Margins and Local Recurrence in Women with Ductal Carcinoma In Situ Treated with Breast-Conserving Therapy: A Meta-Analysis.

Purpose: There is no consensus on adequate negative margins in breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS). We systematically reviewed the evidence on margins in BCS for DCIS. Methods: A study-level meta-analysis of local recurrence (LR), microscopic margin status and threshold distance for negative margins. LR proportion was modeled using random-effects logistic meta-regression (frequentist) and network meta-analysis (Bayesian) that allows for multiple margin distances per study, adjusting for follow-up time