Is clinical breast examination important for breast cancer detection?

BACKGROUND: Screening clinical breast examination (cbe) is controversial; the use of cbe is declining not only as a screening tool, but also as a diagnostic tool. In the present study, we aimed to assess the value of cbe in breast cancer detection in a tertiary care centre for breast diseases. METHODS: This retrospective study of all breast cancers diagnosed between July 1999 and December 2010 at our centre categorized cases according to the mean of detection (cbe, mammography, or both). A cbe was considered "abnormal" in the presence of a mass, nipple discharge, skin or nipple retraction, edema, erythema, peau d'orange, or ulcers. RESULTS: During the study period, a complete dataset was available for 6333 treated primary breast cancers. Cancer types were ductal carcinoma in situ (15.3%), invasive ductal carcinoma (75.7%), invasive lobular carcinoma (9.0%), or others (2.2%). Of the 6333 cancers, 36.5% (n = 2312) were detected by mammography alone, 54.8% (n = 3470) by mammography and cbe, and 8.7% (n = 551) by physician-performed cbe alone (or 5.3% if considering ultrasonography). Invasive tumours diagnosed by cbe alone were more often triple-negative, her2-positive, node-positive, and larger than those diagnosed by mammography alone (p < 0.05). CONCLUSIONS: A significant number of cancers would have been missed if cbe had not been performed. Compared with cancers detected by mammography alone, those detected by cbe had more aggressive features. Clinical breast examination is a very low-cost test that could improve the detection of breast cancer and could prompt breast ultrasonography in the case of a negative mammogram.

Canadian supportive care recommendations for the management of neutropenia in patients with cancer.

Hematologic toxicities of cancer chemotherapy are common and often limit the ability to provide treatment in a timely and dose-intensive manner. These limitations may be of utmost importance in the adjuvant and curative intent settings. Hematologic toxicities may result in febrile neutropenia, infections, fatigue, and bleeding, all of which may lead to additional complications and prolonged hospitalization. The older cancer patient and patients with significant comorbidities may be at highest risk of neutropenic complications. Colony-stimulating factors (csfs) such as filgrastim and pegfilgrastim can effectively attenuate most of the neutropenic consequences of chemotherapy, improve the ability to continue chemotherapy on the planned schedule, and minimize the risk of febrile neutropenia and infectious morbidity and mortality. The present consensus statement reviews the use of csfs in the management of neutropenia in patients with cancer and sets out specific recommendations based on published international guidelines tailored to the specifics of the Canadian practice landscape. We review existing international guidelines, the indications for primary and secondary prophylaxis, the importance of maintaining dose intensity, and the use of csfs in leukemia, stem-cell transplantation, and radiotherapy. Specific disease-related recommendations are provided related to breast cancer, non-Hodgkin lymphoma, lung cancer, and gastrointestinal cancer. Finally, csf dosing and schedules, duration of therapy, and associated acute and potential chronic toxicities are examined.

Evaluation of an audiovisual-FM system: speechreading performance as a function of distance.

A research program was undertaken to evaluate the efficacy of an audiovisual-FM system as a speechreading aid. The present study investigated the effects of the distance between the talker and the speechreader on a visual-speech perception task. Sentences were recorded simultaneously with a conventional Hi8 mm video camera, and with the microcamera of an audiovisual-FM system. The recordings were obtained from two talkers at three different distances: 1.83 m, 3.66 m, and 7.32 m. Sixteen subjects completed a visual-keyword recognition task. The main results of the investigation were as follows: For the recordings obtained with the conventional video camera, there was a significant decrease in speechreading performance as the distance between the talker and the camera increased. For the recordings obtained with the microcamera of the audiovisual-FM system, there were no differences in speechreading as a function of the test distances. The findings of the investigation confirm that in a classroom setting the use of an audiovisual-FM system may constitute an effective way of overcoming the deleterious effects of distance on speechreading performance.

Trypanosoma musculi in CBA mice: trypanocidal mechanism eliminating dividing forms.

Large, inocula of dividing form-enriched Trypanosoma musculi parasites, harvested from the peritoneal cavity of infected CBA mice, were given intravenously to mice at various times during the infection. Mice infected for 10 or 15 days (including T cell-deprived, infected mice) eliminated dividing parasites from the blood within a few min, whereas those at earlier stages (1 or 5 days) were less efficient. The initial control of T. musculi parasitaemia thus appears to be due to a trypanocidal mechanism rather than reproduction-inhibiting factor (ablastin).