Breast cancer survival following MRI detection in a high-risk screening program.

Guidelines for high-risk screening with MRI were introduced by the American Cancer Society in 2007, based on superior sensitivity of MRI over mammography, albeit without proven mortality reduction. The mortality end point is still unconfirmed, but international data are maturing with improved survival apparent, albeit subject to lead time and length bias. In this observational study of survival, we review 41 consecutive patients whose cancers (85.3% invasive) were detected through 2039 asymptomatic MRI screenings. With a minimum follow-up of 5 years and median follow-up of 10.2 years (range: 5.0-15.1), disease-specific survival is 100%.

Time, space and opportunity in the outpatient consultation: 'the doctor's story'.

Using excerpts from videotaped consultations of physicians meeting with Inflammatory Bowel Disease (IBD) patients in a UK hospital, this article pays attention to biographic or narrative time over the course of three consultations. On the basis of this approach an important role emerges for what we term proto-stories that doctors may tell to their patients. This shift from patients' to doctors' stories is linked to visual evidence regarding the embodiment of doctor and patient. Taken together, these topics indicate differences in the way that space and time are constructed in the consultation, and with that the possibilities that arise for action and understanding. By examining what patients say about their treatment in interviews before and after the consultation, we develop a conceptual analysis in which the dominant medico-scientific regime (the 'voice of medicine' [Mishler, E. G. (1984). The discourse of medicine: Dialectics of medical interviews. Norwood, NJ: Ablex]) is compared to what we call the medico-presentational way of signifying. This enables proposals to be made about how these two regimes of representation operate together to facilitate treatment or, where they are separated, how this can lead to what patients see as an unsatisfactory outcome.