Search

Background Tamoxifen use has been associated with increased risk of thromboembolic events (TEs) in women with breast cancer and women at high risk for the disease. Factor V Leiden (FVL) is the most common inherited clotting factor mutation and also confers increased thrombosis risk. We investigated whether FVL was associated with TE risk in women with early-stage breast cancer who took adjuvant tamoxifen. Methods A case--control study was conducted among 34 Cancer and Leukemia Group B (CALGB) institutions. We matched each of 124 women who had experienced a documented TE while taking adjuvant tamoxifen for breast cancer (but who were not necessarily on a CALGB treatment trial) to two control subjects (women who took adjuvant tamoxifen but did not experience TE) by age at diagnosis ([+ or -] 5 years). DNA from blood was analyzed for FVL mutations. Conditional logistic regression was used to estimate odds ratios (ORs) and to evaluate other potential factors associated with TE and tamoxifen use. All P values are based on two-sided tests. Results FVL mutations were identified in 23 (18.5%) case and 12 (4.8%) control subjects (OR = 4.66, 95% confidence interval = 2.14 to 10.14, P< .001). In the multivariable model, FVL mutation was associated with TE (OR = 4.73, 95% confidence interval = 2.10 to 10.68, P < .001). Other statistically significant factors associated with TE risk were personal history of TE and smoking. Conclusions Among women taking adjuvant tamoxifen for early-stage breast cancer, those who had a TE were nearly five times more likely to carry a FVL mutation than those who did not have a TE. Postmenopausal women should be evaluated for the FVL mutation before prescription of adjuvant tamoxifen if a positive test would alter therapeutic decision making. DOI: 10.1093/jnci/djq211

Background: Reduced rank regression (RRR) has been used to identify dietary patterns that predict variation in a selected risk factor and may be useful in describing dietary exposures associated with glycemic index (GI) and glycemic load (GL). Objective: To estimate breast cancer risk, we compared the relative utility of RRR-derived dietary patterns predictive of GI and GL with those of simple GI and GL. Design: RRR was used to identify dietary patterns predicting GI and GL from food-frequency data obtained in the Western New York Exposure and Breast Cancer Study (1166 cases, 2105 controls). Odds ratios (ORs) and 95% CIs were estimated with unconditional logistic regression, adjusted for energy and nondietary breast cancer risk factors. Results: Sweets, refined grains, and salty snacks explained 34% of the variance in GI and 68% of the variance in GL. In general, breast cancer risks were not associated with GI, GL, or dietary pattern score. However, we observed a significant reduction in postmenopausal breast cancer risk with GI and GL pattern scores combined (OR: 0.68; 95% CI: 0.50, 0.93), especially in women with a body mass index (in kg/[m.sup.2]) [greater than or equal to]25 (OR: 0.64; 95% CI: 0.44, 0.93). Conversely, in premenopausal women, increased risks were associated with high GL pattern scores only for women with a body mass index [greater than or equal to]25 (OR: 2.21; 95% CI: 1.04, 4.69). Conclusions: Although RRR may be useful in studies of diet and disease, our results suggest that RRR dietary patterns based on GI and GL provide similar information regarding the association between breast cancer, GI, and GL. Am J Clin Nutr 2007;86: 465-71. KEY WORDS Dietary patterns, glycemic index, glycemic load, breast cancer, body mass index

Background: Ongoing clinical trials are addressing the accuracy and safety of sentinel node biopsy (SNB) in the treatment of breast cancer; however, SNB is already increasingly being used in clinical practice. This study examined the extent and time trends of the use of SNB in stage I and II breast cancer patients. Methods: Clinical data were collected from stage I and II (tumor size [less than or equal to] 5.0 cm) breast cancer patients (n = 3003) who were treated at five comprehensive cancer centers between July 1, 1997, and December 31, 2000. Axillary surgery was classified as SNB alone, SNB + axillary node dissection (AND), AND alone, or none. Patterns of use of axillary surgery were summarized as the percentage of patients receiving each surgery type. The statistical significance of time trends for the use of SNB alone was analyzed by logistic regression models. All statistical tests were two-sided. Results: Overall, SNB alone was used in 13% of patients, SNB + AND in 22%, AND alone in 59%, and no axillary surgery in 6%. Use of SNB alone was statistically significantly associated with breast-conserving surgery of both smaller ([less than or equal to] 2 cm) and larger tumors (2-5 cm) (P

We compared the results of concurrently performed laparoscopie versus open appendectomy as treatments for suspected acute appendicitis. The 68 laparoscopic procedures resulted in 62 appendectomies, 47 by the laparoscopic (LA) technique and 15 by the open (LO) technique. Another 54 patients underwent open appendectomy (OA). Significantly more females underwent laparoscopy (LA and LO: 52% versus OA: 33%, p: 0.047). Operative duration was shortest for OA (81 [+ or -] 3 minutes ), which was shorter than for LO ( 108 [+ or -] 7 minutes), but not different than LA (86 [+ or-] 6 minues ). The postoperative length of stay was not different for LA (3.5 [+ or -] 0.5 days ) compared with OA (5.9 [+ or -] 1.6 days) or LO (4.8 [+ or -] 1.3 days). One death occurred in the OA group. Wound complication rates were not significantly different for LA (4.3%) compared with OA (9.4%) and LO (13.3% ). Overall complication rates were lower for LA (10.6%) and OA (18.9%) compared with LO (46.7%, p (O.01). Median hospital cost for LO ($10,425) was higher (p

Background. Series of patients with pancreas cancer from single high-volume institutions or surgeons have demonstrated improvements in morbidity and mortality of pancreatic resection in recent decades. The experience of these single institutions or surgeons may not, however, reflect the results achieved by a cross-section of surgeons or hospitals. This article examines the resection outcome for a large unselected group of university hospitals and surgeons. Methods. Pancreas cancer resection morbidity and mortality were examined using a multiinstitution data base of discharge coding data from 26 American university hospitals. The data were analyzed for relationships of morbidity and mortality with the type of resection, patient age, hospital volume, and individual surgeon case load. Results. Two hundred twenty-three resections were performed in 1989-1990 (pancreaticoduodenectomy, 168 patients; total pancreatectomy, 11; distal pancreatectomy, 30; and islet tumor resection, 14). The mortality rate was 6% (13 of 223) with major complications in 21%. Patient age did not correlate with complications or death. The surgeon case load ranged from 1-15 cases (median, 1) over the 2-year period. The mortality rate did not correlate with the case load. Surgeons performing one to three resections had significantly more complications than those performing four or more resections (P = 0.011) Conclusions. Pancreas resection is performed by an unselected cross-section of surgeons in American university centers with acceptable morbidity and mortality rates.

The impact of introducing laparoscopy as part of the overall gastrointestinal endoscopy case load performed by residents was reviewed. During 1990, there was a significant increase (56.9%) in the number of flexible diagnostic endoscopic procedures performed compared with 1989. When the total number of laparoscopic procedures was considered, the increase was 117%. Residents participated in the 'surgeon's' position in 59% of the therapeutic laparoscopic procedures and as either surgeon or 'first assistant' in 86% of all therapeutic laparoscopic procedures and 94% of all diagnostic laparoscopic procedures. Complication rates for diagnostic laparoscopic procedures were low in 1989 (0.03%) and 1990 (0.2%). Complication rates for therapeutic laparoscopic procedures were also low (4%). There was no difference in the complication rate for cash in which residents were in the surgeon's position (4%) versus cases in which they were not (4%). Introduction of laparoscopic procedures into a surgical residency program can be done safely, especially in cases in which an established program in endoscopy exists.

Laparoscopic cholecystectomy (gallbladder removal) is a minimally invasive procedure carried out through several small abdominal incisions. A laparoscope and several trocars (sharply pointed instruments) fitted with surgical instruments are inserted through these incisions and under laparoscopic visualization the gallbladder is removed. This technique has received a significant amount of attention; over the last 18 months the number of procedures has increased from less than 500 to more than 20,000. Despite this increase, there have been few reports documenting the safety and usefulness of this procedure. A report is presented of 152 patients who had laparoscopic cholecystectomy attempted. All patients had symptomatic gallstones, and the age range was 17 to 83, with 78 percent being females. The average weight was 170 pounds. Exclusion criteria include common duct stone and inability to tolerate general anesthesia; relative contraindications may be upper abdominal scar formation and severe acute inflammation of the gallbladder. The technique is described in detail. Of the 152 procedures, 13 (8.2 percent) required conversion to open abdominal surgery. There were no deaths; major complication rate was 4 percent, and minor complication rate 7.2 percent (both relatively low). Postoperative pain relief was remarkably low; 36 percent of patients required no narcotic pain medication after surgery. Most (87 percent) of the patients were discharged on the first day after surgery; for most patients normal activities were resumed in less than one week. These findings confirm the benefit of laparoscopic cholecystectomy for most patients with symptoms of gallstones. This procedure results in significantly less discomfort after surgery, shorter hospitalization and quicker return to normal daily activities. (Consumer Summary produced by Reliance Medical Information, Inc.)

Mammography (X-ray study of the breast) screening for breast cancer has identified many noninvasive cancers as well as small invasive cancers. Often these nonpalpable invasive cancers have significant metastasis (spread) to the nearby lymph nodes. A study was undertaken to correlate tumor size, histology (tissue characteristics) and nodes positive for cancer with patient outcome. During a 10-year period mammography identified 1,464 breast abnormalities which were biopsied; 18 percent were found to be cancerous. Of these 264 breast cancers, 86 (33 percent) were invasive cancers. The main finding on mammography was a mass or density in the breast; other findings were either microcalcification (small deposits of calcium in tissue), or both mass and microcalcification. Sixty-three of the 86 cases were ductal cancer. Mastectomy (breast removal) was performed in 71 cases (82 percent), lumpectomy (removal of the tumor and surrounding tissue) with radiation in 14 (16 percent), and lumpectomy only in one case. The lesion size was less than 0.5 cm in 19 cases (22 percent), with no positive nodes; between 0.6 to 1 cm in 39 cases (46 percent), with 10 positive nodes; over 1.0 cm in 28 cases (32 percent), with 8 positive nodes. Overall 32 percent of the lesions were associated with nodes positive for cancer. Average patient follow-up has been 44 months. Disease-free survival is 92 percent; overall survival is 94 percent. There have been seven tumor recurrences, six in patients who had had positive lymph nodes. The disease-free survival for patients with negative lymph nodes is 98 percent. These findings reemphasize the benefit of mammography in the detection of early breast cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)