Risk factors for stage IV breast cancer at the time of presentation in Turkey.

BACKGROUND: Breast cancer (BC) is the one of the most common cancers in women. It is also a leading cause of death. Unfortunately, some patients initially present with distant metastases and are diagnosed with stage IV disease that is nearly always, by then, incurable. This retrospective analysis investigated the risk factors for stage IV BC that may underlie such late presentation. MATERIALS AND METHODS: In all, 916 patients with BC who visited the medical oncology polyclinic of eight different centres in Turkeybetween December 2011 and January 2013 were analysed. RESULTS: A total of 115 patients (12.6%) presented with stage IV disease. In univariate analysis; to comparing these with patients at other stages, no statistical difference was found for median diagnosis age or age at menarche (p=0.611 and p=0.820), whereas age at menopause and age at first live birth were significant (p=0.018 and p=0.003). No difference was detected in terms of accompanying diseases, use of oral contraceptives and hormone replacement therapy, smoking, alcohol consumption and the rate of family history of BC between the patients (p=0.655, p=0.389, p=0.762, p=0.813, p=0.229, p=0.737). However, screening methods were employed less often, the rate of illiteracy was higher, and the rate of other cancers was higher in patients with stage IV BC (p=0.022, p=0.022, p=0.018). No statistical difference was observed between the patients in terms of tumour histopathology, and status of oestrogen receptor, progesterone receptor, or human epidermal growth factor-2 receptor (p=0.389, p=0.326, p=0.949, p=0.326). Grade 3 tumours were more frequent in patients with stage IV disease (p<0.001). On multivariate analysis, risk factors for stage IV breast cancer at the time of presentation were found to be age at first live birth and educational level (p=0.003 and p=0.047). CONCLUSIONS: Efforts should be made to perform mammography scans, in particular, at regular intervals through national training programs for all women, particularly those with family histories of breast and other types of cancer, and to establish early diagnosis of BC long before it proceeds to stage IV. Additionally, women's education had better be upgraded. In order to make women aware of BC, national education-programmes must be organised.

"Sandwich block" for eyelid reconstruction.

PURPOSE: To report on a one-stage technique for eyelid reconstruction with preservation of the eyelid margin. DESIGN: Prospective study. METHODS: Five patients with small-to-intermediate full-thickness lower eyelid defects (n = 3) and upper eyelid defects (n = 2) after tumor excision. Defect size ranged from 5 to 7 mm vertically and from 7 to 12 mm horizontally. For eyelid reconstruction, a full-thickness pentagonal graft from the opposite lid was sutured into the full-thickness defect after removal of the orbicularis oculi muscle from the graft. The orbicularis muscle flap from the recipient eyelid was mobilized and brought in for vascular supply between tarsus and skin of the graft. The outcome after surgery was assessed using a subjective scoring system with 4 subsequent grades. RESULTS: At 1 week postoperatively, adequate viability of the grafts was noted in all patients. After a mean follow-up of 13 months (range 3-33 months) the cosmetic and functional outcome was adequate in 1 case, good in 2 cases, and excellent in 2 cases. CONCLUSION: Reconstruction of small to intermediate full-thickness defects of both lower and upper eyelid with the "sandwich block"-technique is associated with a good functional and cosmetic outcome.