Personalized early detection and prevention of breast cancer: ENVISION consensus statement

Abstract: The European Collaborative on Personalized Early Detection and Prevention of Breast Cancer (ENVISION) brings together several international research consortia working on different aspects of the personalized early detection and prevention of breast cancer. In a consensus conference held in 2019, the members of this network identified research areas requiring development to enable evidence-based personalized interventions that might improve the benefits and reduce the harms of existing breast cancer screening and prevention programmes. The priority areas identified were: 1) breast cancer subtype-specific risk assessment tools applicable to women of all ancestries; 2) intermediate surrogate markers of response to preventive measures; 3) novel non-surgical preventive measures to reduce the incidence of breast cancer of poor prognosis; and 4) hybrid effectiveness–implementation research combined with modelling studies to evaluate the long-term population outcomes of risk-based early detection strategies. The implementation of such programmes would require health-care systems to be open to learning and adapting, the engagement of a diverse range of stakeholders and tailoring to societal norms and values, while also addressing the ethical and legal issues. In this Consensus Statement, we discuss the current state of breast cancer risk prediction, risk-stratified prevention and early detection strategies, and their implementation. Throughout, we highlight priorities for advancing each of these areas

Desempenho do membro não-acometido em pacientes com reconstrução do ligamento cruzado anterior Performance of uninjured lower limb after anterior cruciate ligament reconstruction

Défices sensoriais persistentes após a reconstrução do ligamento cruzado anterior (LCA) podem causar alterações como fraqueza muscular e comprometimento do equilíbrio e do desempenho funcional. Diversos estudos discutem se essas alterações também estão presentes no membro inferior não-acometido e se esse membro pode ser utilizado como referência nas avaliações desses pacientes. O objetivo do presente estudo foi comparar o torque extensor e flexor do joelho, o equilíbrio unipodal e o desempenho funcional sobre o membro não-acometido de pacientes submetidos à reconstrução do LCA, com membros inferiores de sujeitos saudáveis. Participaram do estudo 23 indivíduos submetidos à reconstrução do LCA e 22 sujeitos saudáveis, que foram avaliados quanto ao torque extensor e flexor do joelho durante contração isocinética concêntrica a 60 graus/s no dinamômetro isocinético, à velocidade média de oscilação do centro de pressão em apoio unipodal no baropodômetro, e submetidos a dois testes de salto para avaliar o desempenho funcional. Os resultados não revelaram diferenças entre o membro não-acometido e os membros inferiores do grupo controle em todas as variáveis estudadas (p>0,05). Esses resultados sugerem que o membro não-acometido de pacientes submetidos à reconstrução do LCA pode ser utilizado como referência nos estudos de avaliação desses pacientes.<br>Persistent sensorial deficits after anterior cruciate ligament (ACL) reconstruction might lead to muscle weakness, balance and functional performance disorders. Several studies inquire whether these alterations also appear in the uninjured limb and whether the latter could be used as reference for patient assessment. The aim of the present study was to compare knee extensor and flexor torque, balance and functional performance of non-injured lower limb, after contralateral ACL reconstruction, with lower limbs of healthy subjects. Twenty-three male patients who had had ACL reconstruction, and 22 control subjects were assessed as to knee flexor and extensor torque during concentric isokinetic contraction at 60o/s with an isokinetic dynamometer, mean speed of centre of pressure swing during single-limb stance, and submitted to two hop tests to assess functional performance. Results showed no significant differences between uninjured side and healthy subjects lower limbs at all assessed variables (p>0.05). These findings suggest that the uninjured limb may be safely used as reference in studies to assess post-ACL patients