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Jeffrey A Brinker, M.D.

Jeffrey A Brinker, M.D.

  • Professor of Medicine
  • Joint Appointment in Radiology and Radiological Science

https://www.hopkinsmedicine.org/profiles/results/directory/profile/0001297/jeffrey-brinker

Results: 154 patients were identified with micrometastatic disease with a median follow-up of 4 buy aurogra us impotence ka ilaj. The 5 year locoregional recurrence free survival and overall survival for all patients was 92 purchase generic aurogra on line erectile dysfunction treatments that work. Future work is needed to aurogra 100 mg sale erectile dysfunction symptoms determine strategies to decrease the rates of recurrence in these high risk groups and to define subgroups of patients with micrometastatic disease for whom radiation is particularly beneficial. Treatment was less frequent among patients who were older, patients with high-income, and patients with right-side tumor. Key words: Breast cancer, postmastectomy radiotherapy, isolated tumor cells, axillary nodes micrometastases, overall survival, breast cancer-specific mortality. Data analysis was performed for the entire cohort, and separately for patients <70 years and ≥ 70 years of age. Methods this retrospective, whole-of-population cohort study used linked dispensing, medical services, and death records. We considered a gap of ≥90 days between trastuzumab dispensings a separate course of treatment. In Group 3, 25% of patients died within 15 months of starting trastuzumab, 50% survived beyond 3 years and 25% survived beyond 7 years. These estimates will be useful for clinicians discussing expected survival time with patients in routine practice. Although the cardiotoxicity of trastuzumab is well recognised, baseline cardiac assessment was not universal, even in the most recent cohort. A population-based analysis 1,2,3 1,2,3 2,4 3 3 2,4 3 Nafisha Lalani, Lawrence Paszat, Sharon Nofech-Mozes, Rinku Sutradhar, Sumei Gu, Wedad Hanna, Cindy Fong, 4,5 4,5 4,5 6 7 8 9 Naomi Miller, Bruce Youngson, Susan J Done, Alan Tuck, Martin C Chang, Sandip Sengupta, Prashant A Jani, Michel 10 1,2,3 1 2 Bonin and Eileen Rakovitch. Data on outcomes following breast-conserving therapy are predominantly based on women with small (<25mm) lesions. Distribution of tumor size: 707 (22%) ≤10mm, 524 (16%) 11-25mm, 107 (3%) 26-39mm, 84 (3%) ≥40mm, unable to determine in 1840 (56%). Women with lesions ≥ 40mm were more likely to be ≤50 years of age at diagnosis (p=. Based upon presentation of the guideline recommendations in October 2013, the pre-guideline period was defined from January 2012 to September 2013. On-line publication of the guideline in February 2014 led to definition of the post-guideline period from March 2014 onwards. The peri-guideline period was defined as the time between the pre and post-guideline intervals. We used a regression model to evaluate the association between pre-peri-post guideline period and re-excision while adjusting for important covariates. Results: A total of 38,573 patients were included (20,159 in the pre-guideline, 4,607 peri-guideline and 13,807 post-guideline). We observed significant geographic variability by state in the decrease of the re-excision rates. No change in re-excision rates was seen in Mississippi, Vermont, Georgia, Oregon, West Virginia, Arkansas, Oklahoma and Tennessee. An absolute decrease greater than 10% in the re-excision rate was observed in Indiana, Nebraska, Alabama, Maine and Nevada. The wide geographical variation observed suggests differences in the adoption rates. Our study confirms the impact that guidelines have modifying patterns of practice, reducing the frequency of unnecessary surgical interventions. Bulent Ecevit 2 University the School of Medicine, Zonguldak, Turkey; Bulent Ecevit University the School of Medicine, Zonguldak, Turkey; 3 4 Bulent Ecevit University the School of Medicine, Zonguldak, Turkey and Bulent Ecevit University the School of Medicine, Zonguldak, Turkey. One of the major aims is to downstage tumor status allowing more conservative surgery with the most acceptable cosmetic outcome. The relationship between intraoperative assessment of gross macroscopic and ultrasonographic margins and cavity shavings results, were also analyzed. The sensitivity of intraoperative ultrasound localization was 100% (194/194 cases). There was no difference with respect to patient characteristics including age, menopausal status, personal-family history, oral contraceptive usage, body mass index and tumor localization. Moreover, the involved margins were correctly identified by the surgeon via specimen sonography in %71. No frozen section analysis was performed and macroscopic evaluation of the specimen predicted nothing significant. According to permanent section analysis of the resected specimens and cavity shavings, no further intervention was required due to margin positivity. Accordingly, negative margins were achieved in 100% of cases at the initial procedure verified by permanent analysis. Furthermore, meticulous sonographic assessment of specimen margins together with cavity shavings from tumor bed could be a feasible method to decrease re-excision rates without frozen section analysis leading to cost-effectiveness. However, the accuracy of sonography should be questioned in case of lobular histology. Body: Background: Obtaining tumor-free margins is critical for local control in breast conserving surgery. Currently, 20-40% of lumpectomy patients have positive margins that require surgical re-excision. Areas of fluorescence generated at potential sites of residual tumor in lumpectomy cavities were evaluated with a sterile hand-held device, displayed on a monitor, excised and correlated with histopathology. The test set included 569 cavity margin surfaces assessed intraoperatively and excised.

Chapter 6 considers many of the same issues in the context of physicians in practice outside academic settings discount 100 mg aurogra mastercard impotence in men symptoms and average age. During the middle decades of the 20th century order aurogra 100 mg free shipping impotence antonym, an increasingly elaborate structure of graduate (post-M cheap aurogra 100 mg with mastercard erectile dysfunction drugs at walgreens. The latter half of the century saw the growth of requirements by state licensing boards and specialty certifcation boards for demonstrated participation in accredited continuing education activities (Caplan, 1996). Accreditation bodies defne the core competencies for students, residents, and fellows and ensure that the formal curriculum covers all essential aspects of medical education. Consistent with common usage, this report uses the phrase accredited continuing medical education to refer to education that is (1) presented by accredited providers and (2) certifed for course credits. Changing Environment and Fiscal Challenges Academic medical centers dominate the provision of undergraduate and graduate medical education. The institutions consist of two related enterprises: a medical school that trains physicians and conducts research and a system that provides health care services. The latter system may include teaching hospitals, satellite clinics, and physician offce practices. Academic health centers include other health professions schools, such as a school of dentistry, nursing, or pharmacy (Wartman, 2007). In 2006, the median levels of debt of medical students graduating from public and private medical schools were $120,000 and $160,000, respectively (Jolly, 2007). Medical school graduates can expect to pay approximately 9 to 12 percent of their after-tax income after graduation for educational debt service (Jolly, 2007). This level of indebtedness and the delayed gratifcation of a profession that requires years of training before independent practice is permitted can contribute to a sense of entitlement, which, in turn, may position medical students, residents, and fellows to be strongly infuenced by gifts and attention from representatives of pharmaceutical and medical device companies (see. Sierles and colleagues (2005) found that 80 percent of the medical students that they surveyed believed that they were entitled to gifts. In addition, as discussed in Chapter 6, once they are in practice, limits on reimbursements for physician services make debt repayment more of a burden than in the past and may make gifts and other fnancial relationships with industry more appealing. Industry Funding of Medical Education During most of the 20th century, medical product companies were not major participants in medical education. The exception was sales representatives, who provided information to residents and faculty as well as to nonacademic physicians. In the latter decades of the century, however, medical product companies became increasingly involved in sponsoring continuing medical education, including grand rounds and other academicbased programs. This reliance raises concerns because such support, including gifts, can infuence the objectivity and integrity of academic teaching, learning, and practice, thereby calling into question the commitment of academia and industry together to promote the public’s interest by fostering the most cost-effective, evidence-based medical care possible. It also found little systematic information on specific categories of financial support, for example, grants for residencies or fellowships, direct or indirect financial support for grand rounds, or donations for buildings or other capital items. The most extensive information on academic institutions’ ties with industry comes from a 2006 survey of department chairs at medical schools and the 15 largest independent teaching hospitals (67 percent response rate). The responses indicated that 65 percent of clinical departments received industry support for continuing medical education, 37 percent received industry support for residency or fellowship training, 17 percent received industry support for research equipment, and 19 percent received unrestricted funds from industry for department operations (Campbell et al. The committee did not categorize industry payments for meals, gifts, and visits by sales representatives as support for medical education because these activities do not fit the learning objectives in the formal curriculum. Figure 5-1 shows that commercial sources (excluding advertising and exhibits at programs organized by accredited providers) provide a substantially larger share of income for education providers today than they did in 1998. By 2003, about half of all funding for accredited continuing medical education programs came from commercial sources. The fees paid by program attendees once provided the majority of provider income, but today industry-supported programs are often provided free or at reduced cost to physicians (Steinbrook, 2008a). Figure 5-1 ing how to critically review the evidence and to commit to lifelong learning about scientifc advances. To achieve accreditation, institutions providing undergraduate or graduate medical education must have curricula and resources that, among other requirements, (1) promote the development of appropriate professional attributes; (2) help learners at all levels think critically and appraise the evidence base for research reports, practice guidelines, and marketing materials; and (3) provide appropriate role models and mentoring. Table 5-1 summarizes the results from a survey of third-year medical students at eight major medical schools. Information from two surveys of residency directors similarly documents frequent interactions with pharmaceutical companies. For example, a 2002 survey of emergency medicine residency program directors found that approximately 40 percent allowed industry to fund social activities, and a similar percentage allowed pharmaceutical representatives to teach residents (Keim et al. Twenty-nine percent said that industry travel support could be made contingent on residents attending an industry event. In a 2002 survey of psychiatric residency program directors, 88 percent reported that they allowed industry to provide lunches for their residents, and among this group, the mean was about fve lunches per week (Varley et al. Approximately a third of the programs solicited travel funds from industry (31 percent) or allowed residents to seek such funding from industry on their own (34 percent). Value of Relationships Some interactions with industry can have educational value, for example, when an industry scientist participates in a seminar on drug development strategies or when a device company representative provides supervised training on a complex and innovative medical device that has recently been approved for marketing. Other examples may include unrestricted grants to academic medical centers that support student or resident research stipends or participation in scientifc conferences. On a much larger scale, universities have benefted from company gifts for buildings, research programs, and auditoriums. Pharmaceutical companies argue that their representatives provide information on new drugs. The committee recognizes that some medical students and residents who have become accustomed to interactions with representatives may value the meals that they receive as a respite and may view the gifts that they bring as either inconsequential or as an appropriate reward for their demanding schedules and economic sacrifces.

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Plus aurogra 100mg amex erectile dysfunction gif, their textured shells are Drug Administration study less likely to purchase cheap aurogra online erectile dysfunction due to drug use lead to quality aurogra 100mg erectile dysfunction zenerx contracture, a found that about eight condition in which fbrous tissue grows percent of implants used around the implant. If you’ve opted for siliconethat performs Eklund view gel implants, don’t worry about mammograms, designed silicone getting into your breast milk. The Gravity, pregnancy, nursing type of incision and placement of the and age all contribute to implants can make a difference. A breast lift, or mastopexy, can restore your breasts to a perkier, more youthful appearance. Sometimes mastopexy is performed together with a breast implant, particularly if a woman’s breasts have shrunk after pregnancy. The best candidates for mastopexy are healthy, emotionally stable women with realistic expectations of what the procedure will accomplish, particularly women with small, sagging breasts. This procedure isn’t worth having, however, if you plan to have more children—another pregnancy and breastfeeding will just stretch your breasts again. Also keep in mind that the results of a mastopexy aren’t permanent; gravity and age will continue to wreak their effects. Breast reduction (reduction mammoplasty) Extremely large breasts (also called hypermastia ) can cause numerous physical problems, including neck, back and shoulder pain, chafng or rash under the fold of the breast, headaches and even nerve damage. They can also signifcantly limit physical activities and lead to emotional issues regarding your appearance, including depression, stigmatization, poor self-esteem and anxiety. Most only pay for the procedure if you’re within 10 percent of your ideal body weight, since being overweight can make the surgery more diffcult and increase the risk of complications. For reconstruction following mastectomy, the implant is placed below the pectoralis muscle (not shown). Study after study shows that women’s greatest health-related fear is breast cancer. Even if you get breast cancer, it is much less likely to kill you than lung cancer. Everywhere you turn in our society women are confronted with reminders about breast cancer. Today’s women, however, are too strong and savvy to allow fear of this disease to dominate their thinking. This section of the National Women’s Health Resource Center’s Guide to Breast Health is designed to arm you with knowledge about your individual risk of breast cancer, what you can do to reduce that risk and the most important steps you can take to identify any breast cancer as early as possible—when the fve-year 16 survival rate is 98 percent. The bulk of the sudden decline occurred in women 50 to 69 and in tumors that depend on estrogen for their growth. The number of women getting mammograms peaked professional: around 1999, meaning breast cancer rates Am I at higher risk might have continued increasing if more for breast cancer women were getting mammograms. Because estrogen fuels most breast cancers, researchers suspect this sudden withdrawal may be slowing the growth of miniscule tumors too small to be seen on mammogram, at least in the short term. Only time will tell, but as we learn more about preventable risk factors for breast cancer and about preventing breast cancer in high-risk women, it’s quite likely that we’ll continue to see rates dropping or, at the very least, remaining steady. Breast Cancer and Ethnicity Your risk of breast cancer differs based on your ethnicity. Before age 40, African-American women are more likely to develop the disease; after age 40, Caucasian women are. Some in Caucasian women, caveats about the tool, however: African-American women It is designed for use by health care are more likely to die from professionals. The possible with your health care professional, explanations are numerous: ask your health care professional to African-American women are take it for you or make an appointmore likely to develop more ment to discuss the results with your aggressive types of cancer health care professional. Understanding the tool does not consider the imYour Breast pact of radiation therapy to the chest or recent immigration from a country Cancer Risk with low breast cancer rates. Women who are diagnosed with breast cancer often wonder what they did to cause the cancer. While there are certain risk factors for breast cancer, described on pages 22 to 24, none is singlehandedly responsible for your cancer. Most cancers result from the complex interplay between environmental factors and genetic factors. The 2008 National Women’s Health Resource Center’s Breast Cancer Awareness Survey of 815 women aged 30 to 70 found that most women identify family history as the greatest risk factor for breast cancer. The reason for this is simple: the older you are, the more times the cells in your breasts have divided. If you don’t have an Ashkenazi Jewish background, your risk is higher if you have had: Two frst-degree relatives (mother or sister) with breast cancer, one of whom received the diagnosis before the age of 50 A combination of three or more frstor second-degree (aunt, frst cousin) relatives with breast cancer, regardless of age at diagnosis A combination of breast and ovarian cancer among frstand seconddegree relatives A frst-degree relative with cancer in both breasts Two or more frstor second-degree relatives with ovarian cancer regardless of age at diagnosis A frstor second-degree relative with both breast and ovarian cancer at any age A history of breast cancer in a male relative26 If you are of Ashkenazi Jewish heritage, your risk is higher if you have had: Any frst-degree relative with breast or ovarian cancer Two second-degree relatives on the same side of the family with breast or ovarian cancer If your health care professional suspects you may have a genetic mutation, you should talk to an oncologist or genetic counselor. You can fnd a genetic counselor in your area through the National Society of Genetic Counselors: Your body has mechanisms in place designed to seek out and destroy these abnormal cells; indeed, many commit cellular suicide, called apoptosis, on their own. Then it keeps dividing, making more and more copies of itself, recruiting its own blood supply, taking up space that should be allotted to healthy Ask your cells. Should I have a So the less estrogen in your body, the less those cells divide, meaning the fewer opporgenetic test for tunities for mistakes. Women who have their frst child at 30 or older, or who never have children, have nearly twice the risk of breast cancer as a woman who had a child earlier (See Your Real Risk on page 20. These stem cells give rise to all other breast cells, which are less likely to become cancerous. Other risk factors for breast cancer include: Benign breast disease Benign breast disease includes breast pain, breast cysts, mastitis (breast infammation/infection), fbrocystic breasts and related lesions. If you required a biopsy for any of these conditions, your risk of breast cancer is higher.

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For researchers and hobbyists that have access to buy aurogra 100mg cheap generic erectile dysfunction drugs online a laser cutter buy aurogra cheap online erectile dysfunction daily pill, the described methods provide a novel way of designing and producing low-cost custom pneumatic devices order 100 mg aurogra with mastercard erectile dysfunction kolkata. In addition, it can be applied to other actuation systems where pressurized air is available and lightweight, rapid prototypeable actuators are needed. Five pneumatically-driven linear and rotational stepper motors have been developed, with forces up to 330 N, torques up to 3. All five motors are constructed from six 3-D printed parts and four seals, held together by nylon screws or clips. The described stepper motors outperform state-of-the-art plastic pneumatic stepper motor designs, both in specifications and in manufacturability. Off-the-shelf stepper motors are generally driven by electromagnetic forces, constructed from an electromagnetic stator and a permanent magnet rotor. The stator has two or more phases, each consisting of an electromagnetic coil which can generate a magnetic field to apply a torque on the rotor. By driving the coils with appropiate waveforms, step-wise rotational motion is achieved. A rack-and-pinion or leadscrew mechanism can convert rotational to translational movements, but pure electromagnetic linear stepper motors also exist in which the stator is a track of magnets on which a moving platform with electromagnetic coils can slide back and forth. Taking the available space and the range of forces into account, we can specify the requirements for a linear actuator as follows: free of conductive materials, size under 50 mm, positional accuracy 1 mm or better, force at least 50 N and velocity up to 5 mm/s. They are compared by specifications such as motor dimensions, step size, force, stepping frequency and power. Because there is no uniform test protocol, not all figures are directly comparable. This especially applies to the maximum power, for which certain authors push the motor outside the normal operation range using short tubes, high pressure and fast valves, while other authors only perform measurements using a practical setup with longer tubes and/or slower valves. This design avoids sliding parts as much as possible by using diaphragm sealing and ball bearings. It provides 3 W output power in normal operation range, and up to 37 W when pushed for power. However, the PneuStep design is relatively large and also very complex to manufacture due to the 26 different components made out of 11 materials. Also, it makes use of commercial Lego cylinders, limiting the rapid prototypeability. Besides rotational stepper motors which could drive a spindle or rack-andpinion mechanism to actuate linear motion, true linear stepper motors also have been developed. Due to the choice of valves, these have only been tested at speeds up to 20 steps/s, delivering 0. To our knowledge, no other linear pneumatic stepper motors have been developed, but the generic mechanism has been described in a patent application [16]. Furthermore, many motors are hard to replicate and therefore a new design is required. Besides the motors presented in this paper, two other novel motors that meet the stated requirements are published by the same authors [50]. The T26 is a further miniaturized version of the T-63 presented in this paper, while the C-30 is a curved stepper motor similar to the T-26 but in which the rack is curved to make a rotational motion. Each motor consists of two pistons, which push against a rack (in linear motors) or geared axle (in rotational motors) by a wedge mechanism inside the pistons. Each piston moves back and forth in a double-acting cylinder, therefore a single motor is driven by four pneumatic tubes in total. This section describes the principle of operation, a study on teeth geometry, calculations on valve airflow, and two concrete stepper motor designs. The position of a motor is controlled by driving quadrature-encoded waveforms to the two cylinders. The reason is that the piston which was pressurized most recently, temporarily released its grip during its move, allowing the other piston to fully engage to the rack. This is also the reason why the actual position lags by one step from time t = 8 when piston A switches state. The actual motor position not only depends on the current valve states, but also on the direction of the previous step. This phenomenon is called hysteresis and results in an offset between nominal and actual position, depending on the movement direction. However, this is by design since a consequence is that the motor has zero backlash, even under the presence of finite clearances in the cylinders. Furthermore, it is not envisaged to obtain a smooth motion, or enable any form of microstepping in the operation of the motors. Sharp teeth have a higher wedge ratio resulting higher force output, and allows for smaller step sizes for a given teeth depth, but 3-D printability and mechanical stresses put constraints on this and other design parameters. Additional manufacturing effects such as seams, clearances in mechanical parts and bending under loads up to 0. The pistons (A and B) alternatingly move up and down, pushing the rack (R) four steps to the right. As the step size is one quarter of the pitch size, the pitch size is then equal to 4. To avoid bending or cracking under high cyclic load, a stress analysis (by simulation and/or measurement) needs to be conducted to determine the maximum load. The pressure in each chamber is controlled by a system of remote electromagnetic valves, supplied with system (gauge) pressure P. With tube length Lt, inner diameter dt and cylinder bore volume Vc, the total air volume Va associated with pressurizing one cylinder bore is: π 2 Va = L dt t + Vc 4 With Lt = 5. With a step size of 1 mm and a required velocity of 5 mm/s, a stepping frequency of 5 Hz is required. As the instantaneous airflow through a valve depends on the pressure drop, and there are also delay and friction effects in the tube, the actual airflow requirement is higher than 30.

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Breast reconstruction can be performed immediately at the time of mastectomy or delayed to cheap aurogra on line erectile dysfunction treatment fruits sometime in the future buy cheap aurogra 100mg on-line erectile dysfunction treatment scams. Women should be advised of this possibility at the time of their initial surgical diagnosis and treatment purchase aurogra 100mg without prescription erectile dysfunction treatment viagra. Where units offer breast reconstruction they should have access to the full range of reconstructive options. If the full range of reconstructive options is not available locally, then women must be offered referral to an appropriate tertiary unit. Concerns that immediate reconstruction may compromise oncological safety or hide cancer recurrence are unfounded. Radiotherapy has been reported to have a detrimental effects on the cosmetic outcome of some types of breast reconstruction, especially if an implant is present. The risks of radiotherapy on outcome of breast reconstruction should be discussed and these women may be advised to consider a delayed rather than immediate reconstruction. Patients should have access to information about the various types of reconstruction available and the associated risks and complications. Patients should have access to a key worker with expertise in breast reconstruction and should receive information in a format and level of detail that meets their individual needs. Patients who have had a wide local excision for invasive disease who need adjuvant chemotherapy, but require completion mastectomy to gain adequate margins may be offered chemotherapy prior to completion mastectomy and immediate reconstruction. This enables patients to receive systemic treatment without delay, and allows more time for planning of further surgery. They will normally then be referred back to the peripheral unit for subsequent oncological treatment and surgical follow up. Therapeutic mammoplasty Patients with large tumours, who on the traditional criteria are regarded as only being suitable for wide local excision, but have large breasts should be considered for therapeutic mammoplasty. Specimen types Laboratories should be able to handle and report on the following specimen types Diagnostic specimens. Axillary clearance Specimen examination Each pathology service should establish a defined protocol for each type of diagnostic and therapeutic breast specimen type received by the laboratory. The protocols should be regularly reviewed and updated by the lead breast pathologist in consultation with other pathologists who participate in service delivery. They should include a protocol for specimen orientation as agreed with the local breast surgical team. Access to specimen radiography and specialist radiological opinion should be available for relevant cases. Breast tissue should only be removed and stored for the purposes of research if it is surplus to the requirements of the diagnostic process. Appropriate patient consent and ethical approval should be obtained prospectively. The following comments supplement this guidance: Radiological-pathological correlation Examination of specimen slice x-rays is of great benefit in accurate identification, localization assessment and sampling of impalpable abnormalities. This is particularly important in cases of mammographically detected microcalcification. Post neo-adjuvant chemotherapy specimens Thorough sampling is essential and more blocks are often required than from an equivalent specimen from a patient who has not received neo-adjuvant treatment. Identification of residual disease may be facilitated by identification of a marker inserted previously by the radiologist. Large blocks may be helpful in determining the distribution of residual tumour foci if residual disease is no longer contiguous. Specimen x-rays assist the identification of subtle alterations in tissue architecture in patients who have had a good response to treatment. In both wide local excision and mastectomy specimens, specimen slice x-ray permits identification of the targeted lesion and appropriate sampling. Particular attention should be given to excision at the margin nearest the nipple and this margin should be separately identified by the surgeon. Sentinel lymph nodes Each sentinel node should be sliced along the short axis at 1-2mm intervals and processed in its entirety. Use of ancillary techniques Invasive carcinomas should have their hormone receptor status assessed. Departments providing this service in-house must have at least conditional laboratory accreditation and participate in an appropriate external quality assurance programme to ensure that their laboratory performance is satisfactory. Tumour grading should be by the Nottingham modification of the Bloom and Richardson criteria. All malignancies must be reported to the West Midlands Cancer Registry, in accordance with the national contract for acute services. All breast lymphomas should be referred to a specialist haematopathologist for phenotypic analysis and confirmation of diagnosis. The progesterone receptor status of tumours in patients with invasive breast cancer should not be reported routinely but will be available where it is considered that it will influence the patient management. Decisions should be made based on assessment of the prognostic and predictive factors and the potential benefits and side effects of the treatment. Consideration should be given to using Adjuvant Online for patients with early invasive breast cancer to support estimations of individual prognosis and the absolute benefit of any proposed adjuvant treatment. Adjuvant chemotherapy or radiotherapy should be started as soon as clinically possible and certainly within 31 days of completion of surgery. Radiotherapy Radiotherapy after breast conserving surgery Patients with early invasive breast cancer who have had breast conserving surgery with clear margins should have breast radiotherapy.

References:

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  • http://www.modernfables.net/alan/unknown_armies/Unknown_Armies_2nd_Edition%20-%20Copy.pdf
  • http://crowston.syr.edu/papers/DDGDD01.pdf?page=2
  • https://www.abainternational.org/events/program-details/event-detail.aspx?intConvId=48&by=CE&cetype=BACB
 
 
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