ABSTRACT
Background: The risk of breast cancer may be decreased in women who undergo reduction mammoplasty. The purpose of this study was to describe the incidence and treatment of breast cancer after reduction mammoplasty and to better understand the use of breast cancer screening modalities in these patients. Methods: This population-based retrospective analysis utilized the Discharge Abstract Database held by the Canadian Institute for Health Information and the National Ambulatory Care Reporting System to identify all women aged 20 years or older who underwent reduction mammoplasty in Alberta, Canada. The incidence and treatment of breast cancer were compared among patients who underwent reduction mammoplasty and age-sex-matched controls. Imaging utilization, including the use of mammography, ultrasound, and breast biopsy, was also compared. Results: Between 2003 and 2007, 8021 patients over 20 years old underwent reduction mammoplasty in Alberta. Patients were followed for an average of 12.6 years. Eighty-nine (1.1%) patients who underwent reduction mammoplasty developed breast cancer after surgery, compared to 453 (1.9%) controls (P < 0.0001). Among patients diagnosed with breast cancer, there was no difference in patient and tumor characteristics. Women who underwent reduction mammoplasty were more likely to undergo mastectomy for cancer (41.6% vs 1.5%; P < 0.0001) and were more likely to undergo mammography (66.7% vs 58.7%; P < 0.0001), ultrasound (29.2% vs 26.2%; P < 0.0001) and biopsy for benign disease (7.2% vs 6%, P < 0.0001) compared to controls. Conclusions: Despite an increased frequency of breast cancer screening, the incidence of breast cancer is lower after reduction mammoplasty compared with women who did not undergo breast reduction. After a diagnosis of breast cancer, surgical treatment patterns differ between groups, whereby mastectomy is more common after reduction mammoplasty.
ABSTRACT
Hepatozoon clamatae naturally infects the erythrocytes of green frogs (Rana clamitans), bullfrogs (Rana catesbeiana), and northern leopard frogs (Rana pipiens) in northeastern North America and uses the mosquito Culex territans as a definitive host. In this study, we show that the wood frog, Rana sylvatica, supports merogonic development, but not gamogonic development, of this protozoan parasite, and that the mosquito Culex pipiens serves as an experimental definitive host for sporogonic development. Two wood frogs were each force-fed Cx. territans, containing oocysts of H. clamatae in their Malpighian tubules, which had fed on blood of infected green frogs 30 days previously. Free merozoites were observed in 1 wood frog 35 days after inoculation, but intraerythrocytic gamonts were not observed. Fifteen Cx. pipiens were fed on a mixture of infected frog blood and physiological saline. Thirty days after blood feeding, 2 mosquitoes were infected with oocysts of H. clamatae, whereas the other 13 mosquitoes either were negative for infection or had died. The observed absence of gamogonic development of this parasite in wood frogs are discussed in light of previous records of host specificity of Hepatozoon species for their anuran hosts, and the importance of Cx. pipiens as an additional definitive host for H. clamatae.
