Evaluation of appropriate short-term mammographic surveillance in patients who undergo breast-conserving Surgery (BCS).

BACKGROUND: Mammography is an important surveillance tool for detecting ipsilateral breast tumor recurrence (IBTR) after BCS. Although IBTR is rare in the first 2 years, various organizations have established protocols for postoperative mammographic surveillance. Currently there is no consensus on the optimal interval for imaging evaluation of patients following BCS. METHODS: We conducted a retrospective review of patients who underwent BCS at Aultman Hospital between 1/06 and 12/08. To be included in the study, patients had to be diagnosed with invasive primary breast carcinoma or ductal carcinoma in situ (DCIS), treated with BCS (with or without postoperative breast radiation), and have had at least one postoperative surveillance mammogram at our Breast Care Center. Our mammographic surveillance protocol for patients undergoing BCS consists of ipsilateral mammograms (affected side) around 6 and 18 months and bilateral mammograms around 12 and 24 months. All mammograms that were Breast Imaging-Reporting and Data System (BIRADS) 0 or 4 were reviewed by a single radiologist (T.B.P.). RESULTS: A total of 375 patients constituted the core group for this study. Each interval mammographic screening (6- and 18-month mammograms) resulted in additional imaging in 3-4 % of patients. There was a very low yield for identifying IBTR: 1/266 (0.4 %) for the 5-10-month postoperative mammogram and 1/286 (0.3 %) for the 16-21-month postoperative mammogram. CONCLUSIONS: Based on our data and the low expected yield of IBTR in the first 2 years, annual mammographic surveillance appears adequate following BCS and interval ipsilateral mammograms at 6 and 18 months do not provide additional clinical benefit.

The burden of unhelmeted and uninsured ATV drivers and passengers.

OBJECTIVE: Injured all-terrain vehicle (ATV) riders contribute to the national trauma burden. The importance of helmet use on injury severity and outcomes in ATV drivers versus passengers that receive care is unknown along with the association of payor status and helmet use in this population. An investigation of whether helmet use protects ATV drivers and passengers resulting in less severe injuries, better outcomes, and a lower cost burden to society is to be conducted. METHODS: A retrospective review of injured ATV riders in the National Trauma Data Bank from the United States for 2000-2004. RESULTS: Helmet use status was recorded for 5897 drivers and 836 passengers; 83 percent of drivers were male; 41 percent of passengers were female. Helmets were not widely worn (35% of drivers, 19% of passengers, p < .0001) and were less common among female than male drivers who crashed and received care (26% versus 37%, p < .0001). Drivers were older than passengers (p < .0001) and had more thorax, spine, and upper extremity injuries (p < .05). Helmets protected drivers and passengers: decreased head injuries, face injuries, injury severity, and mortality with increased likelihood of being discharged home rather than elsewhere (p < .0001). Personal insurance was more frequent in helmeted riders: 66 percent versus 55 percent of helmeted versus nonhelmeted drivers (p < .0001) and 69 percent versus 55 percent of helmeted versus nonhelmeted passengers (p = .03). CONCLUSIONS: Helmets are frequently not worn by ATV riders. Helmets protect ATV drivers and passengers and decrease societal costs associated with ATV crashes.