Pregnancy-associated breast cancer: evaluating maternal and foetal outcomes. A national study.

PURPOSE: Pregnancy-associated breast cancer (PABC) is defined as breast cancer diagnosed during the gestational period (gp-PABC) or in the first postpartum year (pp-PABC). Despite its infrequent occurrence, the incidence of PABC appears to be rising due to the increasing propensity for women to delay childbirth. We have established the first retrospective registry study of PABC in Ireland to examine specific clinicopathological characteristics, treatments, and maternal and foetal outcomes. METHODS: This was a national, multi-site, retrospective observational study, including PABC patients treated in 12 oncology institutions from August 2001 to January 2020. Data extracted included information on patient demographics, tumour biology, staging, treatments, and maternal/foetal outcomes. Survival data for an age-matched breast cancer population over a similar time period was obtained from the National Cancer Registry of Ireland (NCRI). Standard biostatistical methods were used for analyses. RESULTS: We identified 155 patients-71 (46%) were gp-PABC and 84 (54%) were pp-PABC. The median age was 36 years. Forty-four patients (28%) presented with Stage III disease and 25 (16%) had metastatic disease at diagnosis. High rates of triple-negative (25%) and HER2+ (30%) breast cancer were observed. We observed an inferior 5-year overall survival (OS) rate in our PABC cohort compared to an age-matched breast cancer population in both Stage I-III (77.6% vs 90.9%) and Stage IV disease (18% vs 38.3%). There was a low rate (3%) of foetal complications. CONCLUSION: PABC patients may have poorer survival outcomes. Further prospective data are needed to optimise management of these patients.

Advance Care Planning for Adolescents and Young Adults with Cancer: A Retrospective Case Note Audit from a Regional Specialist Center in the United Kingdom.

The extent of Advance Care Planning (ACP) among Adolescent and Young Adult (AYA) cancer patients is not well characterized. This retrospective case note audit scrutinized the records of all AYA patients (aged 16-25 years) known to a regional specialist center in the United Kingdom, and who died between 2013 and 2019, for evidence of ACP. Eighty-four patients were included. ACP was identified for 67% of patients. Sixty-four percent expressed a preferred place of death; actual place of death reflected this in 65% of cases. Creation of a bespoke document may help to standardize ACP and improve end-of-life care.

Convergence of Password Guessing to Optimal Success Rates.

Password guessing is one of the most common methods an attacker will use for compromising end users. We often hear that passwords belonging to website users have been leaked and revealed to the public. These leaks compromise the users involved but also feed the wealth of knowledge attackers have about users' passwords. The more informed attackers are about password creation, the better their password guessing becomes. In this paper, we demonstrate using proofs of convergence and real-world password data that the vulnerability of users increases as a result of password leaks. We show that a leak that reveals the passwords of just 1% of the users provides an attacker with enough information to potentially have a success rate of over 84% when trying to compromise other users of the same website. For researchers, it is often difficult to quantify the effectiveness of guessing strategies, particularly when guessing different datasets. We construct a model of password guessing that can be used to offer visual comparisons and formulate theorems corresponding to guessing success.

Metastatic HER2+ Breast Cancer: A Potentially Curable Disease?

The advent of trastuzumab and other human epidermal growth factor receptor 2 (HER2)-directed therapies has revolutionized the treatment of metastatic HER2-positive breast cancer, leading to prolonged survival and appreciable clinical benefit for a substantial subset of patients. Previously, in a retrospective study at our institution, we observed that nearly 10% of patients achieved a durable complete remission (DCR) following a combination of HER2-directed therapy and cytotoxic chemotherapy. We are currently expanding this study to include patients who were treated since the initial introduction of trastuzumab. From our ongoing study, we present a selected case series of three patients with metastatic HER2-positive breast cancer who achieved a DCR. It is theorized that metastatic HER2-positive breast cancer may be potentially curable in certain patients with favorable clinicopathological and molecular factors, which the patients within our case series mostly demonstrate. These include de novo presentation, estrogen receptor (ER)-negative status, limited disease burden, and absence of deleterious gene or pathway mutations. More research is needed in order to incorporate these findings into clinical practice.

Cost-effectiveness of tuberculosis prophylaxis after release from short-term correctional facilities.

BACKGROUND: There is poor adherence with tuberculosis preventive therapy among patients released from short-term correctional facilities, leading to recommendations against screening for latent tuberculosis infection (LTBI) in this setting. OBJECTIVES: To assess adherence to isoniazid preventive therapy (IPT) following release from short-term correctional facilities, and to estimate the cost-effectiveness of this practice. METHODS: Records of individuals referred for IPT from the Connecticut Department of Corrections to the City of Hartford Chest Clinic between January 1993 and June 1997 were reviewed. The data abstracted included demographics, adherence to IPT, and the duration of IPT completed before release from prison. An analysis was performed to determine the cost-effectiveness of this program. RESULTS: A total of 168 records were reviewed. The mean duration of IPT completed before release from prison was 8 weeks. Eighty-six subjects (57%) never came to clinic after release. Of the 64 subjects (43%) who attended clinic at least once, 35 subjects (55%) completed IPT and 29 subjects (45%) were unavailable for follow-up before completing therapy. Thirty-three of the 64 subjects (52%) who attended the clinic had to be restarted on IPT due to a prolonged lapse in therapy prior to the first visit. We estimate that $32,866 was spent on this program, but $42,093 in future costs associated with reactivation tuberculosis was prevented. CONCLUSIONS: Adherence with IPT is poor in patients released from short-term correctional facilities. Nonetheless, this program was cost-effective. An alternative strategy may be to screen for LTBI among inmates of short-term correctional facilities but withhold IPT in inmates expected to be released before therapy would be completed. Instead, these inmates could be referred to an appropriate clinic after release. Prophylaxis may be started in subjects who keep an initial clinic appointment after release.