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Introduction: Breast conserving surgery (BCS) is associated with unsatisfactory cosmetic outcomes in up to 30% of patients, carrying psychological and quality-of-life implications. This study compares long-term cosmetic outcomes after BCS for breast cancer with v without simple oncoplastic defect closure. Methods: A randomised controlled trial was performed, recruiting patients who underwent BCS over four years and randomising to the “reshaping” group (closure of excision defect with mobilised breast tissue; n = 124) and to the “control” group (no attempt at defect closure; n = 109). The estimated excision volume (EEV) was

Abstract Background Oncotype DX testing has reduced the use of adjuvant chemotherapy in node‐negative early breast cancer but less is known about its impact in node positive patients. Aim This study aimed to investigate the impact of Oncotype DX gene assay testing on the decision to offer adjuvant chemotherapy in oestrogen positive, human epidermal growth factor receptor 2 negative, 1–3 lymph node positive patients. Methods Retrospective review of all node positive patients who underwent Oncotype DX testing at a single centre. Clinicopathological data, as well as estimated survival benefit data (from the PREDICT tool), was evaluated by a multidisciplinary group of surgeons and oncologists. Treatment decisions based on clinicopathological data were compared to recurrence scores (RS). A cut off RS > 30 was used to offer adjuvant chemotherapy. Results The 69 patients were identified, of which 9 (13%) had an RS > 30 and assigned a high‐genomic risk of recurrence. The 32 patients (46.4%) were offered adjuvant chemotherapy. Overall based on the use of the RS, the decision to offer adjuvant chemotherapy changed in 36% of patients, and ultimately 24 patients (34.7%) would have been spared chemotherapy. Conclusion Using clinicopathological data alone to make decisions regarding adjuvant chemotherapy in node positive breast cancer leads to overtreatment. Additional information on tumour biology as assessed by the Oncotype DX RS helps to select those patients who will benefit from adjuvant chemotherapy and spare patients from unnecessary chemotherapy.

Responding to the call for circular transition, the Dutch and French governments aspire to achieve a fully circular economy by developing a transitional agenda in various sectors, including fashion and construction. The two countries are among the top 10 waste generators in the European Union (EU), while the two sectors—fashion and construction—are the largest polluters in the EU. The aim of this study, and its main contribution, is to harmonize circular design principles, which vary by sector into common types, and identify the circular design principle that balances the sustainability dimensions the most. This responds to research gaps that merely describe these design principles applicable to different sectors but which are also silent on which achieves sustainability balance. Using multicriteria decision analysis, selected case studies of companies in the two sectors and countries were scored and ranked according to environmental, economic, and social sustainability indicators. The case projects were selected based on the circular design principle that the enterprises were applying. These principles were standardized for the two sectors to come up with five distinct types, namely, design for (i) biobased materials, (ii) service/adaptability, (iii) disassembly, (iv) waste and material recovery, and (v) longevity. Three forms of triangulation were used to achieve reliability, validity, and equivalence of the findings: (i) data—by doubling the size of the sample cases to 40 establishments from 20, (ii) investigator—by having the authors score the projects separately, and (iii) method—by using two objective weighting methods in scoring the criteria. These techniques resulted in similar rankings of the cases in terms of triple bottom-line scores per design principle. Designing for biobased materials turned out to achieve the most balance. The case projects were also compared regarding performance in achieving the UN Sustainability Development Goals (SDGs), which companies use to integrate sustainability with business. Circularity in fashion and construction primarily targets responsible consumption, production, and climate action. A tertiary SDG was life on water and access to clean water for fashion and life on land and sustainable cities for construction.