Breast cancer screening in the era of density notification legislation: summary of 2014 Massachusetts experience and suggestion of an evidence-based management algorithm by multi-disciplinary expert panel

Purpose: Stemming from breast density notification legislation in Massachusetts effective 2015, we sought to develop a collaborative evidence-based approach to density notification that could be used by practitioners across the state. Our goal was to develop an evidence-based consensus management algorithm to help patients and health care providers follow best practices to implement a coordinated, evidence-based, cost-effective, sustainable practice and to standardize care in recommendations for supplemental screening. Methods: We formed the Massachusetts Breast Risk Education and Assessment Task Force (MA-BREAST) a multi-institutional, multi-disciplinary panel of expert radiologists, surgeons, primary care physicians, and oncologists to develop a collaborative approach to density notification legislation. Using evidence-based data from the Institute for Clinical and Economic Review (ICER), the Cochrane review, National Comprehensive Cancer Network (NCCN) guidelines, American Cancer Society (ACS) recommendations, and American College of Radiology (ACR) appropriateness criteria, the group collaboratively developed an evidence-based best-practices algorithm. Results: The expert consensus algorithm uses breast density as one element in the risk stratification to determine the need for supplemental screening. Women with dense breasts and otherwise low risk (20% lifetime) should consider supplemental screening MRI in addition to routine mammography regardless of breast density. Conclusion: We report the development of the multi-disciplinary collaborative approach to density notification. We propose a risk stratification algorithm to assess personal level of risk to determine the need for supplemental screening for an individual woman

Combining regenerative medicine strategies to provide durable reconstructive options: auricular cartilage tissue engineering

Recent advances in regenerative medicine place us in a unique position to improve the quality of engineered tissue. We use auricular cartilage as an exemplar to illustrate how the use of tissue-specific adult stem cells, assembly through additive manufacturing and improved understanding of postnatal tissue maturation will allow us to more accurately replicate native tissue anisotropy. This review highlights the limitations of autologous auricular reconstruction, including donor site morbidity, technical considerations and long-term complications. Current tissue-engineered auricular constructs implanted into immune-competent animal models have been observed to undergo inflammation, fibrosis, foreign body reaction, calcification and degradation. Combining biomimetic regenerative medicine strategies will allow us to improve tissue-engineered auricular cartilage with respect to biochemical composition and functionality, as well as microstructural organization and overall shape. Creating functional and durable tissue has the potential to shift the paradigm in reconstructive surgery by obviating the need for donor sites

Costochondral Ossification and Aging in Five Populations

Age changes in extent of costochondral ossification of the first rib and of the lower ribs were evaluated separately from chest roentgenograms in five populations: European Americans, Lebanese, Solomon Islanders (the Lau and the Baegu), and a special veterans group. Increase in the ossification was closely associated with age in all groups. The shapes of the age curves were similar in all populations within each measure and within sexes. However, the Solomon Islanders showed less ossification than the Caucasians, and the Baegu showed less ossification than the Lau. These findings may be explained by the dietary differences in the populations. With respect to sex differences, for the first rib, males showed greater ossification than females regardless of age in each of the groups. For the lower ribs, males generally showed most age changes before age 45 and females after age 45. The sex differences may be related to endocrine factors. Ossification in the first rib cartilage was related to chest circumference in all three male groups investigated (the veterans, the Lau and the Baegu) but not in the females (the Lau and the Baegu). Ossification in the lower rib cartilages was related to chest expansion in the male veterans, the only group where such data were available. These latter findings supported the hypothesis that biomechanical factors influence costochondral ossification

BMP4 mutations as a novel cause of normosmic hypogonadotropic hypogonadism

WOS: 000485922401062

Performance of Breast Cancer Risk-Assessment Models in a Large Mammography Cohort

Background: Several breast cancer risk-assessment models exist. Few studies have evaluated predictive accuracy of multiple models in large screening populations