ABSTRACT
African-American (AA) women are more likely to have late stage, aggressive, rapidly growing, and less hormone-responsive breast tumors. An aggressive subtype of cancer, known as "Triple-Negative" (TN), that is negative for Her-2 and for estrogen and progesterone receptors (ER and PR), is reported to be more common in AA women. We examined the clinical, histopathologic, and prognostic features of TN tumors in AA and Caucasian women. Tumor size, grade, histologic type, lymphovascular invasion (LVI), lymph node status, patient survival, ploidy status, and expression of ER, PR, p53, epidermal growth factor receptor (EGFR), MIB-1, Bcl-2, Her-2, p27, and p21 were evaluated. The TN tumors (75%) were high grade, large, aneuploid tumors that occurred in younger women and were more likely to have a high rate of LVI, elevated MIB-1 score, and nodal metastases. Patients with TN tumors showed poorer overall survival. There was no difference in overall or disease-free survival (p = 0.46) in the AA versus Caucasian women. LVI was a significant predictor of overall survival in AA but not in Caucasian women. There were minor differences in histopathologic features, biomarker expressions, and survival in AA and Caucasian women with TN tumors. The absence of LVI in AA patients predicted an excellent probability of survival.
Subject(s)
Black or African American , Breast Neoplasms/metabolism , Breast Neoplasms/pathology , Receptor, ErbB-2 , Receptors, Estrogen , Receptors, Progesterone , White People , Biomarkers, Tumor/metabolism , Disease-Free Survival , Female , Humans , Immunohistochemistry , Middle Aged , Neoplasm Invasiveness , Neoplasm Proteins/metabolism , Receptor, ErbB-2/analysis , Receptors, Estrogen/analysis , Receptors, Progesterone/analysis , Time FactorsABSTRACT
BACKGROUND: The Advanced Trauma Operative Management (ATOM) course uses standardized porcine simulation to teach the repair of penetrating trauma. It is offered in 26 sites in the United States, Canada, Africa, the Middle East, and Japan. The purpose of the present study was to query ATOM participants regarding their perceptions of the value and influence of the ATOM course on knowledge, confidence, and skill to repair penetrating injuries. METHODS: An anonymous, voluntary survey was posted on the Internet at surveymonkey.com. E-mail notification was sent to all 1,001 ATOM participants through May 2008. Items requested agreement/disagreement on a 5-point Likert scale and space for comments. Agreement indicated positive perceptions of ATOM. RESULTS: A total of 962 surgeons received the request to complete the survey; 444 ATOM participants from 36 states and 17 countries participated, for a response rate of 46%. Range of agreement with all of the items was 75.4-99.0%. Results include the following: 78.9% (95% CI, 74.7-82.6%) can identify injuries more quickly; 80.7% (95% CI, 76.6-84.3%) have a more organized operative approach; 81.1% (95% CI, 77.0-84.6%) can control bleeding more quickly; 86.1% (95% CI, 82.4-89.2%) can control injuries more effectively; 86.4% (95% CI, 82.7-89.4%) are more competent trauma surgeons; 87.0% are more confident (95% CI, 83.4-89.9%), and 89.2% are more knowledgeable (95% CI, 85.8-91.8%) about repairing penetrating injuries; 99% (95% CI, 97.4-99.7%) said ATOM is worthwhile. Overall, 87.4% of the comments were positive. CONCLUSIONS: Participants worldwide perceive that ATOM is worthwhile and helps surgeons improve knowledge, confidence, and skill in repairing penetrating injuries.
