The effectiveness of mammography surveillance after treatment of primary breast cancer: A single centre retrospective cohort study.

INTRODUCTION: There is a little evidence that routine follow-up of patients treated for early breast cancer (BC) to detect ibsilateral breast tumour recurrence (IBTR), or contralateral breast cancer (CBC), is either effective or offers any mortality benefits. We report our experience of following patients with early BC for recurrences and new primaries in order to determine the role of mammogram surveillance. METHODS: Single centre, retrospective primary observational study was designed. Patients who had BC during year 2001-2006 were included and followed for a minimum of ten years. Patients were divided based on the modalities of detecting BC in to screen detected group and clinically detected one i.e. symptomatic BC. These two groups were compared. RESULTS: Total number of patients considered for analysis was 2530 (screen detected BC - 703 patients and symptomatic BC - 1827 patients). The rate of recurrence including regional and distant metastasis in screen detected BC group was 8% (57/703) and 2% (43/1827) in symptomatic one. However, the prevalence of IBTR/CBC in the whole cohort was 2% (62/2530). Mammography surveillance identified 60% (37/62) of patients who had IBTRs/CBCs.Mammography surveillance detected 85% (29/34) of all IBTRs/CBCs in the screen detected BC group. In contrast, it picked up only 29% (8/28) in the other group (Chi squared 20.5 p < 0.005). CONCLUSIONS: Mammography surveillance is efficient for the screen detected BC group but not for the symptomatic one. Hence, it is worth suggesting different follow-up strategies for both groups. Further studies are therefore recommended.

How do students with dyslexia perform in extended matching questions, short answer questions and observed structured clinical examinations?

There are an increasing number of students with learning difficulties attending university, and currently much debate about the suitability and ability of students with dyslexia at both medical school and once they graduate into clinical practice. In this study we describe the performance of students with dyslexia compared to fellow students in extended matching questions (EMQ), short answer question (SAQ) and observed structured clinical examinations (OSCE) and discuss the implications of differences identified. End of year assessment results for 5 cohorts of medical students were analysed. Students with dyslexia did less well overall in all assessment types in year 1 but this difference was not evident in later years. Dyslexic students who were allowed extra time in written assessments did better than dyslexic students who did not have their assessment concessions in place. When station type within OSCE assessments was analysed students with dyslexia did less well in both examination skills and data interpretation stations in years 1, 2 & 3. In conclusion, differences in performance in written assessments are only evident early in training and may be partly due to delayed adjustment to medical school or implementation of assessment concessions. Performance in individual OSCE stations is dependent on station type. Why students with specific learning difficulties (SpLDs) perform less well in examination skills and data analysis OSCE stations requires further investigation.

Aromatase inhibitors versus tamoxifen as adjuvant hormonal therapy for oestrogen sensitive early breast cancer in post-menopausal women: meta-analyses of monotherapy, sequenced therapy and extended therapy.

Adjuvant tamoxifen reduces relapses and prolongs survival in patients with oestrogen sensitive breast cancer. Development of resistance is however common. Tamoxifen can be given for a maximum of five years; although the risk of recurrences remains high after this period. This review examines nine randomised controlled trials including 28,632 women, which studied aromatase inhibitors (AIs) as an alternative to tamoxifen in three treatment settings: monotherapy (instead of tamoxifen), sequenced therapy (tamoxifen is switched to an AI) and extended therapy (following adjuvant tamoxifen). Disease free survival was significantly improved for monotherapy (HR 0.89, [95% CI 0.83-0.96] p = 0.002) and sequenced therapy (HR 0.72, [0.63-0.83] p < 0.00001). There was no difference in overall survival for monotherapy (HR 0.94, [0.82-1.08] p = 0.39) or extended therapy (HR 0.86 [0.79-1.16] p = 0.67). Importantly, overall survival was prolonged for patients who switched from tamoxifen to AI therapy (HR 0.78 95%CI 0.68-0.91, p = 0.001).

Verbal and nonverbal indices of learning during problem-based learning (PBL) among first year medical students and the threshold for tutor intervention.

BACKGROUND: During problem-based learning (PBL), students brainstorm on a problem, generate hypotheses and formulate learning objectives. Certain verbal and non-verbal expressions are used by students in response to specific learning issues. AIMS: This study examines the use of these expressions as indices of the learning taking place and the tutors' threshold to intervene. METHODS: Common verbal expressions used by students during PBL were identified and scored on a Likert scale to indicate the learning taking place. These expressions were categorised into the following groups of learning interactions: exploratory questioning, cumulative reasoning and handling conflicts relating to learning. The tutor's threshold for intervention was also scored on a Likert scale. Means for each learning interaction and observed non-verbal expressions were used to construct bar charts for comparison. RESULTS: When the learning interactions involve exploratory questioning or cumulative reasoning, students tend to score high on learning and tutors have high threshold for intervention. When the learning interactions involve handling conflicts relating to knowledge, students score high on learning, but teachers have a low threshold for intervention. CONCLUSION: Verbal and non-verbal expressions from students during PBL are useful indices of learning and can be used to help tutors decide when and when not to intervene.

A comparison of clinicopathological features and molecular markers in british and nigerian women with breast cancer.

BACKGROUND: Some studies have suggested that breast cancer in black women is more aggressive than in white women. This study's aim was to look for evidence of differences in tumour biology between the two cohorts. METHODS: This study compared the stage, grade and pathological expression of five immunohistochemical markers (oestrogen receptor [ER], progesterone receptor [PR], ERBB2, P53 and cyclin D1 [CCND1]) in tumour biopsies from age-matched cohorts of patients from Nigeria and England. Sixty-eight suitable samples from Nigerian (n = 34) and British (n = 34) breast cancer patients were retrieved from histology tissue banks. RESULTS: There were significant differences between the two cohorts in the expression of ER and CCND1; and stark differences in the clinical stage at presentation. But no significant differences were observed for tumour grade. CONCLUSION: There was a significantly, low ER expression in the Nigerian cases which also predicts a poor response to hormonal therapy as well as a poorer prognosis. Differences in clinical stage at presentation will most likely influence prognosis between Nigerian and British women with breast cancer.

A comparison of the pattern of occurrence of breast cancer in Nigerian and British women.

Studies have suggested a predominance of premenopausal breast cancer in black compared to white women. The aim of the study was to compare the age specific incidence of breast cancer in Nigerian and British women. The mean age at presentation was 43.1 and 64 years for Jos (Nigeria) and Norfolk (United Kingdom), respectively. The age specific incidence rates were higher in women above 50 years compared to women less than 50 years of age in both populations. The odds of having breast cancer for women aged less than 50 years is 3.0 times higher in Norfolk (95% Confidence Interval 2.0-4.4) than Jos and 9.0 times higher for women over 50 years of age in Norfolk (95% Confidence Interval 5.3-18.3) than Jos. The age specific incidence rates are higher for postmenopausal women in both populations; with higher rates for all age groups in the United Kingdom population.

Association of S100A4 and osteopontin with specific prognostic factors and survival of patients with minimally invasive breast cancer.

PURPOSE: S100A4 and the estrogen-inducible osteopontin are alone capable of inducing angiogenesis and metastasis in rodent models for breast cancer. The present study assesses the relationship of S100A4 and osteopontin with vessel density and estrogen receptor alpha (ERalpha) in primary tumors and with survival of patients to ascertain their involvement in metastatic breast cancer. EXPERIMENTAL DESIGN: Primary tumors from 312 patients treated for minimally invasive human breast cancer were immunocytochemically stained and then assessed for the significance of their association with each other using Fisher's exact test or with patient survival over 18 years of follow-up using Kaplan-Meier plots and Wilcoxon-Gehan statistics. RESULTS: Antibodies to S100A4 significantly stained endothelial cells of vessels adjacent to S100A4-staining groups of carcinoma cells, and antibodies to osteopontin significantly stained groups of carcinoma cells staining for ERalpha (P < 0.0001). There was a significant association of tumors staining for S100A4 with those with high vessel density (P = 0.021) and of tumors staining for osteopontin with those staining for ERalpha (P = 0.034). The association of staining for S100A4, osteopontin, or vessel density with patient death was significant (P < 0.0001, P = 0.005, and P = 0.014, respectively). The difference in cumulative proportion surviving between S100A4-positive patients with higher or lower vessel density increased up to about 12 years, but thereafter decreased to virtually zero after 18 years of follow-up. Patients with both S100A4-positive and osteopontin-positive primary tumors showed a statistically significant reduction in survival time over those with either one alone (P < 0.019), although in multivariate regression analysis, only staining for S100A4 was significant (P < 0.001). CONCLUSIONS: It is suggested that in human breast cancer, S100A4 exerts some of its effects through angiogenesis, and that osteopontin is dependent on ERalpha for its expression.