Digital breast tomosynthesis changes management in patients seen at a tertiary care breast center.

Objectives. To study factors that predict changes in management with digital breast tomosynthesis (DBT). Methods. The Institutional Review Board approved this HIPAA compliant study. 996 patients had DBT with full field digital mammography (FFDM). Univariate analysis evaluated predictors of management change and cancer detection. Results. DBT changed management in 109 of 996 (11%); 77 (71%) required less imaging. Recalled patients after abnormal FFDM screen were most likely to have management change-25% (24 of 97 patients) compared to 8% (13/163) of symptomatic patients and 10% (72/736) of screening patients (P < 0.001). Dense breasted patients had a higher likelihood of having DBT change management: 13% (68/526) compared to 9% (41/470) (P = 0.03). Of the 996 patients, 19 (2%) were diagnosed with breast cancer. 15 cancers (83%) were seen on FFDM and DBT; 3 (17%) were diagnosed after DBT (0.3%, 95%CI: 0.1-0.9%). One recurrence was in the skin and was not seen on DBT nor was it seen on FFDM. The increase in cancer detection rate was 17% for asymptomatic patients, 0% for symptomatic patients, and 100% for recalled patients. Conclusions. DBT increased cancer detection rate by 20% and decreased the recall rate in 8-25%. Advances in Knowledge. DBT led to a doubling of the cancer detection rate in recalled patients.

Violence at the door: treatment of lesbian batterers.

PIP: This article presents the clinical experiences on more than 30 lesbian batterers during a 5-year period in a large city and a small rural community in the US. Data on the psychological profile of batterers and relationships in which abuse occurs are given. The two treatment models described are group therapy, and a three-phase community model. The authors suggest that lesbian batterers are women who have broken the norm of compliant victim, running counter to the expectations of female survivors of childhood family violence. This study concluded that lesbian battering is a social and psychological problem, which can be solved through proper therapy. This was demonstrated by the treatment models, which have been successful in eliminating violence among a diverse group of batterers. However, the lack of understanding about lesbian batterers has resulted to the cycle of violence that continues to be unchallenged.^ieng

The process of social urbanization in Latin America.

PIP: The role of rural-urban migration in increased urban growth in Latin America is analyzed, with a focus on the sociocultural consequences of rapid and sustained urbanization. Patterns of urbanization in the colonial period and in the nineteenth century are briefly reviewed. The extent to which social urbanization has contributed to the economic dependence of less developed areas on urban areas, to imbalances in regional development, and to changes in life-style and standard of living is considered.^ieng