The effect of the Flemish breast cancer screening program on breast cancer-specific mortality: A case-referent study.

BACKGROUND: Breast cancer screening programs were introduced in many countries worldwide following randomized controlled trials in the 1980s showing a reduction in breast cancer-specific mortality. However, their effectiveness remains debated and estimates vary. A breast cancer screening program was introduced in 2001 in Flanders, Belgium where high levels of opportunistic screening practices are observed. The effectiveness of this program was estimated by measuring its effect on breast cancer-specific mortality. METHODS: We performed a case-referent study to investigate the effect of participation in the Flemish population-based mammography screening program (PMSP) on breast cancer-specific mortality from 2005 to 2017. A multiple logistic regression model assessed the association between breast cancer-specific death and screening program participation status in the four years prior to (pseudo)diagnosis (yes/no), with adjustment for potential confounders (individual socio-economic position and calendar year of diagnosis) and stratified for age. In addition, we performed different sensitivity analyses. RESULTS: We identified 1571 cases and randomly selected 6284 referents. After adjustment, women who participated in PMSP had a 51 % lower risk of breast cancer-specific mortality compared to those who did not (adjusted odds ratio [aOR] =0.49, 95 % CI: 0.44-0.55). Sensitivity analyses did not markedly change the estimated associations. Correction for self-selection bias reduced the effect size, but the estimate remained significant. CONCLUSION: Our results indicate that in a context of high opportunistic screening rates, participation in breast cancer screening program substantially reduces breast cancer-specific mortality. For policy, these results should be balanced against the potential harms of screening, including overdiagnosis and overtreatment.

Risk of neurovascular injuries in flexor hallucis longus tendon transfers: an anatomic cadaver study.

BACKGROUND: Flexor hallucis longus (FHL) tendon transfer is a frequently used treatment for both posterior tibial tendon insufficiency and chronic Achilles tendinopathy. We observed difficulties in harvesting the FHL tendon that may arise from cross-attachments with the flexor digitorum longus (FDL) tendon near the knot of Henry. The posterior tibial nerve is located nearby the decussation of these tendons. This study examined whether the difficult harvesting may be the cause of nerve injury. METHODS: A cadaver study was performed on 24 foot specimens. In all feet, we used a double-incision technique. The FHL tendon was transected in the distal medial midfoot incision and retracted through the posteromedial hindfoot incision. After harvesting the FHL tendon, we exposed the posterior tibial nerve and its lateral and medial plantar branches to identify if any lesion had occurred. RESULTS: The retraction failed at the first attempt in all specimens because of the presence of cross-attachments between the FHL and FDL tendons. A more extensive dissection of the FHL and FDL tendons was therefore required. We found lesions in 33% of all foot specimens, including two complete ruptures of the medial plantar nerve. CONCLUSIONS: Harvesting of the FHL tendon when transection is made distal to the knot of Henry may cause injuries to the medial and lateral plantar nerves. Experience in this procedure may reduce the risk of nerve injuries but even then nerve lesions remain possible. The clinical significance of these nerve lesions is not described in literature and remains to be determined.