My patients prepared me well

“When doctors become patients, they shouldn’t be surprised that the experience is frightening, undignified and disempowering.” Stories of doctors experiencing illness are common. Major illness is life-changing for most people, and the impact on doctors can be particularly profound.1–5 But why do so many doctors seemingly have to experience a life-threatening illness before they truly develop empathy? Despite years spent caring for patients, why is it that it takes their own illness to realise that being unwell can be frightening and demoralising for the soul as well as wreaking havoc on the body

The impact of breast awareness on the early detection of breast cancer in young women: A systematic review

Background: “Breast awareness” is a recommendation that women understand the symptoms of breast cancer and become familiar with the usual look and feel of their breasts. It is recommended for women of all ages in breast cancer screening guidelines around the world. The objective of this study was to assess the evidence for breast awareness by investigating its effect on breast cancer outcomes in women of pre-mammographic-screening age (under age 40), at average risk of breast cancer. Methods: A systematic review was performed using PRISMA methodology. Following the search, abstracts and full-text articles were assessed against eligibility criteria. Data were extracted into evidence tables, risk of bias was assessed, narrative synthesis was performed, and results were described. Eligible studies were original research studies assessing the impact of breast awareness on cancer outcomes (such as stage at diagnosis or survival) in women ≤40. Medline, PubMed, and Cochrane Library were searched. Results: After screening the 6,204 abstracts identified in the search, no studies meeting all eligibility criteria were found. Two partially eligible studies were identified. These met the intervention and outcomes criteria but included mixed-age cohorts that included but were not limited to women ≤40. These studies provided low-level (Level IV) evidence of moderate quality that there is some benefit (earlier stage at diagnosis and/or improved survival) of breast awareness in a mixed-age cohort that included some younger women. Conclusions: No studies evaluating the impact of breast awareness exclusively in young women were identified. Limited evidence of benefit of breast awareness was found. Guidelines that recommend breast awareness should be reviewed and qualified with an explanation that the evidence of benefit is weak. Women have limited screening options available to them for the early detection of breast cancer until they reach mammographic screening age. The study was registered on Prospero (ID: CRD42021279457)

Contralateral prophylactic mastectomy for unilateral breast cancer in women at average risk: Systematic review of patient reported outcomes

Objective: The rate of contralateral prophylactic mastectomy (CPM) in women with early, unilateral cancer is relatively high and is increasing around the world a previous study. Women choose this option for many reasons other than reducing their risk of future cancer, including symmetry, reasons related to breast reconstruction and attempting to manage fear of recurrence. This systematic review evaluated patient‐reported quality of life outcomes following CPM. Methods: A literature search of MEDLINE, PubMed and PsycINFO was performed to February 2019. Abstracts and full‐text articles were assessed for eligibility according to pre‐determined criteria. Data were extracted into evidence tables for analysis. Results: A total of 19 articles met eligibility criteria and were included in analysis. These included patient‐reported data from 6088 women undergoing CPM. They reported high levels of satisfaction with the decision for surgery, low levels of decisional regret and high satisfaction with cosmesis and reconstruction. Breast‐specific and general quality of life was high overall but was even better in women choosing breast reconstruction after surgery. Fear of cancer recurrence was high after CPM. Depression, distress and a negative impact on body image were evident; however, levels were high in both CPM and non‐CPM groups. Conclusions: This study provides information that can be used by surgeons and psychologists when counselling women about the potential benefits and harms of CPM. This process must include discussion about the trade‐offs such as body image issues and ongoing fear of recurrence in addition to the positive aspect of cancer risk reduction. Women are unlikely to regret their decision for CPM

The Challenge of Breast Density– Options for Management and Breast Cancer Screening

Invited commentary on breast density

Breast density notification: A systematic review of the impact on primary care practitioners

Background: In the last decade, there has been an unprecedented amount of advocacy and attention surrounding the issue of breast density (BD) in relation to mammography screening. It is largely unknown what impact notifying women of their BD has had on clinical practice for PCPs. This systematic review aimed to synthesize evidence from existing studies to understand the impact of BD notification on primary care practitioners\u27 (PCPs) knowledge, attitudes, and practice implications. Methods: Empirical studies were identified through relevant database searches (database inception to May 2020). Two authors evaluated the eligibility of studies, extracted and crosschecked data, and assessed the risk of bias. Results were synthesized in a narrative form. Results: Six studies of the 232 titles identified and screened were included. All studies were undertaken in the United States, with five conducted postlegislation in their respective states, and one study conducted in states that were both prelegislation and postlegislation. Five studies were quantitative, including four cross-sectional surveys, and one study was qualitative. Findings consistently demonstrated PCPs\u27 overall lack of knowledge about BD, low level of comfort in discussing and managing patients in relation to dense breasts, and limited consensus on the most appropriate approach for managing women with dense breasts, particularly in relation to supplemental screening. Conclusions: This review highlights important gaps in PCPs\u27 understanding of BD and confidence in having discussions with women about the implications of dense breasts. It identifies the need for high-quality research and the development of evidence-based guidelines to better support PCPs

Breast density notification: Evidence on whether benefit outweighs harm is required to inform future screening practice

We believe that it is imperative to have robust evidence about whether to communicate breast density information to women and, if so, how best to do it. Before this happens, there first needs to be an assessment of the balance between the benefits and harms at the societal level. There is also a need for a better understanding of both the short-term and long-term effects that breast density notification have had on women in the USA. Developing an appropriate strategy for whether to and for whom to inform, including how to effectively notify women and communicate the potential benefits and harms of density information in other countries may still be feasible. This will take time, so for now, screening services and programmes could contribute through carefully planned research that assesses the impact of providing breast density information to women on both the societal and individual levels

“It’s about our bodies… we have the right to know this stuff”: a qualitative focus group study on Australian women’s perspectives on breast density

Objective This study aimed to explore Australian women’s current knowledge, perspectives and attitudes about breast density (BD); and information needs to inform effective evidence-based communication strategies. Methods Fourteen online focus group sessions with a total of 78 women in New South Wales and Queensland, Australia aged 40–74 years without a personal diagnosis of breast cancer were conducted. Audio-recorded data was transcribed and analysed thematically. Results Women had a very limited knowledge of BD. Overall, women expressed a preference for more frequent mammograms and/or supplemental screening should they be told they had dense breasts, despite being presented with information on potential downsides of additional testing. The majority of women were supportive of the notion of BD notification, often suggesting they had a ‘right to know’ and they would prefer to be educated and informed about it. Conclusion The potential of being informed and notified of BD is found to be of interest and importance to Australian women of breast screening age despite lacking current knowledge. Practice Implications This study highlights that policy makers and screening services need to consider how to weigh up these views and preferences of women with current evidence surrounding BD in deciding about implementing population-based BD notification

Body Fluid Estimation Via Segmental Multi-Frequency Bioelectrical Impedance Analysis Following Acute Resistance Exercise

Segmental multi-frequency bioelectrical impedance analysis (S-MFBIA) estimates body composition and fluids by passing electrical currents through the body and can separate the body into distinct segments. The minimum required abstention from exercise before S-MFBIA is unclear. PURPOSE: The purpose of this study was to monitor changes in total body water (TBW), intracellular water (ICW), and extracellular water (ECW) estimated via S-MFBIA following acute, localized bouts of resistance exercise (RE). METHODS: Thirty-two female (n = 18; age: 22.7 ± 1.4 y; height: 167.5 ± 7.5 cm; body mass: 66.6 ± 14.5 kg; body fat: 30.3 ± 6.2%) and male (n= 14; age: 24.2 ± 2.9; height: 178.7 ± 5.3; body mass: 85.7 ± 7.8 kg; body fat: 19.6 ± 6.9%) resistance-trained volunteers completed three randomly assigned conditions in a crossover design. Each RE protocol (REUPPER or RELOWER) consisted of three exercises and began with two warm-up sets of 12-15 repetitions per exercise. This was followed by a RE circuit of 5 sets of 10 repetitions per exercise with a one-minute rest interval between circuits. In the resting (REST) condition, participants did not complete any physical activity. S-MFBIA was performed at five timepoints: pre-exercise, immediate post-exercise, 15-, 30-, and 60-minutes post-exercise. Data were analyzed using linear mixed-effects models with a random intercept for participant. In all models, REST was the reference condition, and pre-exercise was the reference time point. RESULTS: Although body mass did not differ between conditions, condition by time interactions were observed for TBW, ICW, and ECW (p\u3c0.001 each), with the higher values observed at post-exercise time points in REUPPER as compared to the REST condition. Mean differences between REUPPER and REST for TBW, ICW, and ECW ranged from 0.6-1.0 kg, 0.4-0.6 kg, and 0.2-0.4 kg, respectively. Conversely, RELOWER did not alter fluid estimates. CONCLUSION: An acute increase in TBW, ICW, and ECW is detected by S-MFBIA after a single bout of upper body, but not lower body, RE. This could be due to the smaller initial diameter and greater relative change in diameter of the arms as compared to legs. Due to the potential of artificial body fluid changes, users should avoid exercise – particularly upper body exercise – prior to S-MFBIA assessments

Acute Resistance Exercise Influences Bioelectrical Impedance Analysis Segmental Fat Mass Estimates

Bioelectrical impedance analysis (BIA) is an attractive tool for routine assessment of human body composition. However, there is also concern regarding how some variables, particularly exercise, may affect its measurements and therefore limit the conditions under which this technology can provide useful body composition data. PURPOSE: The purpose of this study was to determine if acute, localized resistance exercise (RE) compromises the validity of BIA segmental fat mass (FM) estimates. METHODS: In a crossover design, 32 healthy, resistance trained adults (18 F, 14 M; age: 23.4 ± 2.3 y; height: 172.4 ± 8.7 cm; body mass: 74.9 ± 15.3 kg; body fat: 25.6 ± 8.4%) completed three conditions in a randomized order: lower-body resistance exercise (L), upper-body resistance exercise (U), and rest (R). The RE protocol included a warm-up consisting of 2 sets of 12-15 repetitions of 3 upper-body exercises (U), or 3 lower-body exercises (L), followed by 5 sets of 10 repetitions per exercise, with 1-minute rest intervals. The R condition involved no exercise. BIA (InBody 770) was completed immediately pre- and post-exercise and at 15-, 30-, and 60-minutes post-exercise. The effects of the acute RE session on BIA estimates of total and segmental FM were analyzed using linear mixed-effects models with condition and time specified as within-subject factors and a random intercept for participant. In all models, the reference groups were R for condition and the pre-exercise time point for time. RESULTS: Condition by time interactions were observed for total and segmental FM. Examination of model coefficients indicated that most condition by time interactions were attributable to differences in the U condition across time relative to the reference group (i.e., R condition at baseline). In relation to the reference group, mean decreases of 0.75 to 1.25 kg for total FM, 0.38 to 0.58 kg for trunk FM, 0.27 to 0.47 kg for leg FM, and 0.15 to 0.22 kg for arm FM were observed in the U condition (p≤0.001 for all). In contrast, no changes across time were observed in the L condition. CONCLUSION: These findings suggest that an acute bout of localized RE influences BIA total and segmental FM estimates to an extent that can compromise accurate interpretation of the results. These data corroborate the need for a period of rest from physical activity, particularly upper body RE, prior to BIA body composition assessment

Australian Women’s Intentions and Psychological Outcomes Related to Breast Density Notification and Information

Objective To assess the effect of mammographic breast density notification and information provision on women’s intention to seek supplemental screening and psychological outcomes. Design, Setting, and Participants A 3-arm online randomized clinical trial was conducted from August 10 to 31, 2021. Data analysis was conducted from September 1 to October 20, 2021. Participants included Australian residents identifying as female, aged between 40 and 74 years, with no history of breast cancer who were residing in jurisdictions without existing breast density notification with screening mammograms. Interventions Women were randomized to receive 1 of the following hypothetical breast screening test result letters: screening mammogram result letter without breast density messaging (control), screening mammogram result letter with breast density messaging and an existing density information letter taken from a screening service in Australia (intervention 1), and screening mammogram result letter with breast density messaging and a health literacy–sensitive version of the letter adapted for people with lower health literacy (intervention 2). Main Outcomes and Measures Primary outcomes were intention to seek supplemental screening; feeling anxious (uneasy, worried, or nervous), informed, or confused; and having breast cancer worry