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Sallam I, Pereira J, Amira G, Downey S, Down S, Leeper A, El Ayyan R. P239 Multi-institutional Experience of Modified Lateral Intercostal Artery Perforator (LICAP) Flap Operation: Surgical and Patient Reported Outcomes (PROMs). Breast 2023. [DOI: 10.1016/s0960-9776(23)00357-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
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Alwan M, Down S. Improving pain outcomes after breast cancer surgery using a novel psychoeducational intervention. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30665-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Masannat YA, Agrawal A, Maraqa L, Fuller M, Down SK, Tang SSK, Pang D, Kontos M, Romics L, Heys SD. Multifocal and multicentric breast cancer, is it time to think again? Ann R Coll Surg Engl 2020; 102:62-66. [PMID: 31891668 PMCID: PMC6937617 DOI: 10.1308/rcsann.2019.0109] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2019] [Indexed: 11/22/2022] Open
Abstract
Multifocal multicentric breast cancer has traditionally been considered a contraindication to breast conserving surgery because of concerns regarding locoregional control and risk of disease recurrence. However, the evidence supporting this practice is limited. Increasingly, many breast surgeons are advocating breast conservation in selected cases. This short narrative review summarises current evidence on the role of surgery in multifocal multicentric breast cancer and shows that when technically feasible the option of breast conservation is oncologically safe.
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Affiliation(s)
- YA Masannat
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
- University of Aberdeen, School of Medicine, Medical Science and Nutrition, Aberdeen, UK
| | - A Agrawal
- Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - L Maraqa
- Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - M Fuller
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
- University of Aberdeen, School of Medicine, Medical Science and Nutrition, Aberdeen, UK
| | - SK Down
- James Paget University Hospitals NHS Foundation Trust, Great, UK
- University of East Anglia, Norwich Medical School, Athens, Greece
| | - SSK Tang
- St George’s University Hospitals NHS Foundation Trust, London, UK
| | - D Pang
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - M Kontos
- National and Kapodistrian University of Athens, Athens, Greece
| | - L Romics
- New Victoria Hospital and Queen Elizabeth University Hospital, Glasgow, UK
| | - SD Heys
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
- University of Aberdeen, School of Medicine, Medical Science and Nutrition, Aberdeen, UK
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Capehorn M, Polonsky WH, Edelman S, Belton A, Down S, Gamerman V, Nagel F, Lee J, Alzaid A. Challenges faced by physicians when discussing the Type 2 diabetes diagnosis with patients: insights from a cross-national study (IntroDia ® ). Diabet Med 2017; 34:1100-1107. [PMID: 28370335 DOI: 10.1111/dme.13357] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2017] [Indexed: 12/30/2022]
Abstract
AIMS To investigate physicians' recalled experiences of their conversations with patients at diagnosis of Type 2 diabetes, because physician-patient communication at that time may influence the patient's subsequent self-care and outcomes. METHODS As part of a large cross-national study of physician-patient communication during early treatment of Type 2 diabetes (IntroDia® ), we conducted a cross-sectional survey of physicians treating people with Type 2 diabetes in 26 countries across Africa, Asia, Europe, Latin America, the Middle East, North America and Oceania. The survey battery was designed to evaluate physician experiences during diagnosis conversations as well as physician empathy (measured using the Jefferson Scale of Physician Empathy). RESULTS A total of 6753 of 9247 eligible physicians completed the IntroDia® survey (response rate 73.0%). Most respondents (87.5%) agreed that the conversation at diagnosis of Type 2 diabetes impacts the patient's acceptance of the condition and self-care. However, almost all physicians (98.9%) reported challenges during this conversation. Exploratory factor analysis revealed two related yet distinct types of challenges (r = 0.64, P < 0.0001) associated with either patients (eight challenges, α = 0.87) or the situation itself at diagnosis (four challenges, α = 0.72). There was a significant inverse association between physician empathy and overall challenge burden, as well as between empathy and each of the two types of challenges (all P < 0.0001). Study limitations include reliance on accurate physician recall and inability to assign causality to observed associations. CONCLUSIONS Globally, most physicians indicated that conversations with patients at diagnosis of Type 2 diabetes strongly influence patient self-care. Higher physician empathy was associated with fewer challenges during the diagnosis conversation.
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Affiliation(s)
- M Capehorn
- Rotherham Institute for Obesity, Rotherham, UK
- Clifton Medical Centre, Rotherham, UK
| | - W H Polonsky
- Department of Psychiatry, University of California San Diego, San Diego, USA
- Behavioral Diabetes Institute, San Diego, USA
| | - S Edelman
- Division of Endocrinology and Metabolism, University of California San Diego, San Diego, USA
- Veterans Affairs Medical Center, San Diego, USA
| | - A Belton
- International Diabetes Federation, Brussels, Belgium
- The Michener Institute of Education at UHN, Toronto, Ontario, Canada
| | - S Down
- Somerset Partnership NHS Foundation Trust, Bridgwater, UK
| | - V Gamerman
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, USA
| | - F Nagel
- Boehringer Ingelheim GmbH, Ingelheim, Germany
| | - J Lee
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - A Alzaid
- Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Abstract
For every breast surgeon's toolbox
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Affiliation(s)
- J R Benson
- Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge CB2 0QQ, and Faculty of Medical Science, Anglia Ruskin University, Cambridge, UK
| | - S K Down
- Department of Surgery, James Paget University Hospital, Great Yarmouth, and University of East Anglia, Norwich, UK
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Soumian S, Down SK, Roked F, Chaudhri S, Francis A. P5-12-02: Vacuum Assisted Biopsies of Ductal Carcinoma In Situ and Concordance with Post-Operative Histology: Implications for the Low Risk DCIS Trial. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p5-12-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Aim The enormous increase in the diagnosis of ductal carcinoma in situ (DCIS) by the NHS Breast screening has not lead to an expected decrease in the incidence of invasive breast cancer. It is not clear if all grades of DCIS progress inexorably to invasive cancer if left untreated. There is recognition that DCIS is overtreated, ie if left alone may not cause harm during the woman's lifetime. In the absence of new clinical trial data, surgery still remains the universal treatment. It is known that a higher proportion of patients with screen detected DCIS receive mastectomy than those with screen detected invasive cancer. Recently a randomized trial called the Low risk DCIS Trial has been proposed which intends to specifically compare the current treatment of low grade DCIS ie surgery with active monitoring using annual mammography. In order to effectively implement this, concordance between diagnostic biopsy and excision histology is vital and therefore vacuum assisted mammotome biopsy (VAB) and a central pathology review of diagnostic biopsy specimens prior to randomization will be mandatory. Therefore, in this study, we assessed the concordance between diagnostic biopsies performed by VAB technique and the post operative histology for DCIS in our institution.
Methods Retrospective data of all diagnostic breast biopsies specifically using the VAB technique with the primary diagnosis of DCIS from year 2001 to 2010 in our institution was collected. Both screening and symptomatic patients were included. Concordance between diagnostic histology and post operative excision histology was assessed for high, intermediate and low grade DCIS. Demographic details and potential factors influencing concordance including number of cores taken and lesion size were also collected for analysis.
Results A total of 161 cases were identified out of which 102 (63%) were of high grade, 35 (22%) of intermediate grade and 24 (15%) were of low grade histology. In the High grade group, the concordance with final histology was 70% (72/102). In this group, the diagnosis was upgraded to invasive carcinoma in 21% (21/102). 9% (9/102) were downgraded to intermediate or low grade. In the intermediate grade group, the concordance with final histology was 66% (23/35). In this group, the diagnosis was upgraded to invasive carcinoma in 11% (4/35) and to high grade in 17% (6/35). 6% (2/35) were downgraded to low grade. In the low grade group, the concordance with final histology was 71% (17/24). In this group, the diagnosis was upgraded to intermediate grade in 17% (4/24) and invasive carcinoma in 12% (3/24). All factors associated with lack of concordance were noted.
Conclusion Concordance between VAB diagnostic biopsies of high, intermediate and low grade DCIS and post operative histology is good in this series and is to our knowledge the first to be reported using only large volume biopsies by VAB techniques. This audit has identified possible factors influencing the lack of concordance and these results with concordance data from other UK centres will be used by trial pathologists to refine protocols for the Low risk DCIS trial.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-12-02.
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Affiliation(s)
- S Soumian
- 1Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, England, United Kingdom
| | - SK Down
- 1Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, England, United Kingdom
| | - F Roked
- 1Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, England, United Kingdom
| | - S Chaudhri
- 1Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, England, United Kingdom
| | - A Francis
- 1Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, England, United Kingdom
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Anwar IF, Down SK, Rizvi S, Farooq N, Burger A, Morgan A, Hussien MI. Invasive lobular carcinoma of the breast: should this be regarded as a chronic disease? Int J Surg 2010; 8:346-52. [PMID: 20420942 DOI: 10.1016/j.ijsu.2010.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2009] [Revised: 03/08/2010] [Accepted: 04/20/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND The surgical treatment of patients with invasive lobular carcinoma is still controversial due to its different clinical and pathological features. Most studies report local recurrence after relatively short follow-up periods, which is usually 5 years. However there is some evidence to suggest that local recurrence may occur late in the course of follow-up. AIM OF THE STUDY To study the implications and outcome of extending the follow-up period of patients treated for invasive lobular carcinoma. PATIENTS AND METHODS Patients (268) treated between 1989 and 1996 were reviewed. Thirty-three patients were excluded as they had primary hormonal therapy. The outcomes for 235 patients were analyzed. RESULTS Seventy-nine patients (33.6%) had breast conservation surgery (group I), which was followed by re-excision due to positive margins in 23 patients (29%), and 156 patients (66.3%) had mastectomy (group II). Compared to group II, tumours in group I were smaller (mean size 17 vs. 37 mm, P=0.001), multifocal [20 (25%) vs. 14 (9%), P=0.003] and with more positive margins [23 (29%) vs. 24 (15%), P=0.0009]. Only 33 patients (21%) in group II, and all patients in group I had post-operative radiotherapy (P=0.0001). Forty-eight patients (17.9%) developed local recurrence [27 (34%) in group I and 21 (13.4%) in group II, P=0.0005] after a median follow-up period of 167.8 months. The mean time to local recurrence was 127 (range 24-196) months. Univariate analysis showed that the type of surgery, margin status, adjuvant radiotherapy and chemotherapy significantly affected local recurrence (P=0.0005, 0.02, 0.04 and 0.05 respectively). Cox regression analysis showed that the only factor affected local recurrence was the type of surgery (relative risk 2.43, 95% confidence interval 1.22-4.83, P=0.01) The overall survival was 99.3 months (78.2%). Univariate and Cox regression analyses showed that only the patients age at diagnosis significantly affected survival (P=0.003). CONCLUSION Local recurrence may be a late event in patients treated for invasive lobular carcinoma of the breast and extended follow-up may be considered. In this study mastectomy offers better local control.
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Affiliation(s)
- I F Anwar
- Breast Surgery Unit, Norfolk & Norwich University Hospital, Norwich, UK
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Abstract
Abstract
Background
Accessory breasts occur in 0·4–6 per cent of women. They may be asymptomatic or cause pain, restriction of arm movement, cosmetic problems or anxiety. It is currently recommended that all accessory breasts be removed surgically but complications following this procedure have been poorly documented.
Methods
All patients who presented with axillary accessory breasts between July 1999 and October 2000 were identified from a computer database. A retrospective review of patients listed for excision of accessory breast tissue was undertaken to determine any postoperative complications.
Results
Women with axillary accessory breasts represented 0·5 per cent of all new referrals. A total of 28 women (80 per cent of those diagnosed) had surgery. Eleven patients experienced postoperative complications; the majority followed operations performed by a trainee.
Conclusion
Excision of accessory axillary breast tissue was associated with significant morbidity.
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Affiliation(s)
- S Down
- Manchester Breast Unit, South Manchester University Hospitals Trust, Manchester, UK
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Halket JM, Przyborowska A, Stein SE, Mallard WG, Down S, Chalmers RA. Deconvolution gas chromatography/mass spectrometry of urinary organic acids--potential for pattern recognition and automated identification of metabolic disorders. Rapid Commun Mass Spectrom 1999; 13:279-84. [PMID: 10097403 DOI: 10.1002/(sici)1097-0231(19990228)13:4<279::aid-rcm478>3.0.co;2-i] [Citation(s) in RCA: 126] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The National Institute of Standards and Technology (NIST) Automated Mass Spectral Deconvolution and Identification System (AMDIS) is applied to a selection of data files obtained from the gas chromatography/mass spectrometry (GC/MS) analysis of urinary organic acids. Mass spectra obtained after deconvolution are compared with a special user library containing both the mass spectra and retention indices of ethoxime-trimethylsilyl (EO-TMS) derivatives of a set of organic acids. Efficient identification of components is achieved and the potential of the procedure for automated diagnosis of inborn errors of metabolism and for related research is demonstrated.
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Affiliation(s)
- J M Halket
- Centre for Chemical Sciences, Royal Holloway, University of London, Egham, UK
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