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Objectives Mammography screening is generally accepted in women aged 50–69, but the balance between benefits and harms remains controversial in other age groups. This study systematically reviews these effects to inform the European Breast Cancer Guidelines. Methods We searched PubMed, EMBASE and Cochrane Library for randomised clinical trials (RCTs) or systematic reviews of observational studies in the absence of RCTs comparing invitation to mammography screening to no invitation in women at average breast cancer (BC) risk. We extracted data for mortality, BC stage, mastectomy rate, chemotherapy provision, overdiagnosis and false-positive-related adverse effects. We performed a pooled analysis of relative risks, applying an inverse-variance random-effects model for three age groups (Results We identified 10 RCTs including 616,641 women aged 38–75. Mammography reduced BC mortality in women aged 50–69 (relative risk (RR) 0.77, 95%CI (confidence interval) 0.66–0.90, high certainty) and 70–74 (RR 0.77, 95%CI 0.54–1.09, high certainty), with smaller reductions in under 50s (RR 0.88, 95%CI 0.76–1.02, moderate certainty). Mammography reduced stage IIA+ in women 50–69 (RR 0.80, 95%CI 0.64–1.00, very low certainty) but resulted in an overdiagnosis probability of 23% (95%CI 18–27%) and 17% (95%CI 15–20%) in under 50s and 50–69, respectively ( moderate certainty). Mammography was associated with 2.9% increased risk of invasive procedures with benign outcomes ( low certainty). Conclusions For women 50–69, high certainty evidence that mammography screening reduces BC mortality risk would support policymakers formulating strong recommendations. In other age groups, where the net balance of effects is less clear, conditional recommendations will be more likely, together with shared decision-making.

Introduction/Background In developed countries, endometrial cancer is the fourth most common cancer in women. ESGO guidelines propose appropriate strategies based on risk factors. Lymphadenectomy is a staging procedure and even if it does not seem to have a therapeutic role, it is crucial for tailoring adjuvant therapy. The aim of the study is to verify the reliability of expert transvaginal sonographer (TVS) and frozen section (FS) to assess myometrial infiltration ( Methodology To verify the accuracy of expert TVS and intraoperative frozen section to evaluate myometrial infiltration, 364 consecutive patients affected by EC were prospectively followed in 3 centres of the Oncological Network of Piemonte and Valle d’Aosta from 01/2016 to 10/2018. Definitive pathological report sensitivity, specificity, PPV, NPV, LR + LR- of TVUS and FS are obtained. The results were evaluated overall and by centre. Results TVUS by expert ultra-sonographer has obtained a diagnostic accuracy with sensitivity 76% specificity 73% PPV 66% NPP 82%. The variability observed between hospitals: centre A sensitivity 76% specificity 86% PPV 85% NPP 82%; centre B sensitivity 60% specificity 75% PPV 59% NPP 76%; centre C sensitivity 95% specificity 58% PPV 58% NPP 95%. The overall FS examination has the following values: sensitivity 86% specificity 97% PPV 95% NPP 92%. Stratifying by centres: A sensitivity 91% specificity 96% PPV 95% NPP 93%; B sensitivity 87% specificity 97% PPV 93% NPP 95%; C sensitivity 85% specificity 100% PPV 100% NPP 91%. Patients who add FS to TVUS had a reclassification improvement of 7.5%. Conclusion FS remains the most reliable method in the ‘real world’ to assess myometrial infiltration and to direct the staging procedures in endometrial cancer. The variability of FS among centres belonging to an oncological network is lower than what observed for TVUS. Disclosure Prof. Paolo Zola has received grants from Astrazeneca, Roche, Pharmamar and Tesaro.

RESUMEN Introducción: el síndrome metabólico (SM) es una entidad clínica con alteraciones vasculares y metabólicas que predisponen a la enfermedad cardiovascular (ECV). El estado nutricional es un factor predominante en la evolución del SM y el riesgo de ECV. Objetivo: analizar el estado nutricional a través de indicadores antropométricos y alimentarios en pacientes con SM. Métodos: estudio observacional, de corte transversal. Participaron 41 personas de ambos sexos (20 hombres y 21 mujeres), entre 30 y 60 años, que asistieron a consulta ambulatoria del Servicio de Cardiología y Clínica Médica de la Clínica Universitaria Reina Fabiola (CURF) y del Servicio de Cardiología No Invasiva del Hospital Nacional de Clínicas (HNC), durante el periodo 2015-2016. Se realizó toma de indicadores antropométricos para determinar el estado nutricional (índice de masa corporal o IMC), circunferencia de cintura (CC), presión arterial sistólica (PAS) y diastólica (PAD). Las variables alimentarias incluidas fueron valor calórico total (VET), consumo de colesterol (CCol) y consumo de sodio (CS). El estudio cuenta con la aprobación del Comité de Ética del CURF y HNC. Para estimar el VET, el consumo de colesterol y de sodio se utilizó el programa informático Interfood v.1.3. El análisis de los datos se llevó a cabo con el programa InfoStat. Para analizar si existían diferencias por sexo, se utilizó el test de Wilcoxon para variables continuas y Kruskal Wallis para las categóricas. Resultados: el 93% de los pacientes presentaron exceso de peso (el 61% con IMC superior a 30kg/mts2). En relación a CC, el 75% de las mujeres y 86% de hombres presentaron riesgo cardiovascular muy aumentado. La media de PAS fue 131,18±18,96 mmHg y la de PAD fue 79,88±12,29 mmHg. El VET fue 2828,45±1255,42 Kcal, el consumo promedio de colesterol fue 380,09±191mg y el de sodio fue 2072,26±1195,44 mg, siendo estas ingestas superiores a las recomendadas. Al analizar las comparaciones por sexo, no se encontraron diferencias estadísticamente significativas para las variables en estudio. Conclusión: estos resultados preliminares resaltan el perfil de riesgo para el desarrollo de ECV de los pacientes con SM. Se necesita continuar profundizando el estudio de estas poblaciones, para aportar evidencia que contribuya a la promoción de hábitos saludables y la prevención de patologías crónicas vinculadas a la alimentación y nutrición.

Background: There is still lack of consensus on the benefit-harm balance of breast cancer screening. In this scenario, women's values and preferences are crucial for developing health-related recommendations. In the context of the European Commission Initiative on Breast Cancer, we conducted a systematic review to inform the European Breast Guidelines. Methods: We searched Medline and included primary studies assessing women's values and preferences regarding breast cancer screening and diagnosis decision making. We used a thematic approach to synthesise relevant data. The quality of evidence was determined with GRADE, including GRADE CERQual for qualitative research. Results: We included 22 individual studies. Women were willing to accept the psychological and physical burden of breast cancer screening and a significant risk of overdiagnosis and false-positive mammography findings, in return for the benefit of earlier diagnosis. The anxiety engendered by the delay in getting results of diagnostic tests was highlighted as a significant burden, emphasising the need for rapid and efficient screening services, and clear and efficient communication. The confidence in the findings was low to moderate for screening and moderate for diagnosis, predominantly because of methodological limitations, lack of adequate understanding of the outcomes by participants, and indirectness. Conclusions: Women value more the possibility of an earlier diagnosis over the risks of a false-positive result or overdiagnosis. Concerns remain that women may not understand the concept of overdiagnosis. Women highly value time efficient screening processes and rapid result delivery and will accept some discomfort for the peace of mind screening may provide.

Psycho-oncology addresses the psychological, social, behavioural, and ethical aspects of cancer. Identification and proper management of the patients' psychosocial needs, as well as the needs of their caregivers and family are essential for a person-centred concept of breast cancer care. The aim of this overview is to describe how psychosocial support in breast cancer is incorporated in cancer-related policy documents, such as national cancer plans and breast cancer care certification schemes. post-print 163 KB

Description The European Commission Initiative for Breast Cancer Screening and Diagnosis guidelines (European Breast Guidelines) are coordinated by the European Commission's Joint Research Centre. The target audience for the guidelines includes women, health professionals, and policymakers. Methods An international guideline panel of 28 multidisciplinary members, including patients, developed questions and corresponding recommendations that were informed by systematic reviews of the evidence conducted between March 2016 and December 2018. GRADE (Grading of Recommendations Assessment, Development and Evaluation) Evidence to Decision frameworks were used to structure the process and minimize the influence of competing interests by enhancing transparency. Questions and recommendations, expressed as strong or conditional, focused on outcomes that matter to women and provided a rating of the certainty of evidence. Recommendations This synopsis of the European Breast Guidelines provides recommendations regarding organized screening programs for women aged 40 to 75 years who are at average risk. The recommendations address digital mammography screening and the addition of hand-held ultrasonography, automated breast ultrasonography, or magnetic resonance imaging compared with mammography alone. The recommendations also discuss the frequency of screening and inform decision making for women at average risk who are recalled for suspicious lesions or who have high breast density.

A study was carried out on human subjects of various ages and backgrounds who had been drinking water containing more than 0.13 mg/l (0.13 ppm) arsenic for a period of at least 20 years. The main aim was not only to correlate the frequency of sister-chromatid exchanges in the lymphocytes with the amount of arsenic in water and urine but also to correlate the frequency of SCE with sex and age. In addition, family background regarding skin alterations or other arsenic-related symptoms was explored, so that individual health conditions could be assessed. External factors such as exposure to other chemical or contaminating agents (pesticides, battery manufacturing plants, foundries) were also taken into consideration. The data on sister-chromatid exchanges (282 exposed and 155 control individuals) showed that arsenic at concentrations used by our population (0.13 mg/l) induced a significantly elevated response. Other health effects of arsenic at these concentrations were found, e.g., hyperkeratosis, melanosis, actinic keratosis, basal cell carcinoma.

We studied the reproductive function of 32 male farm sprayers who were exposed to 2,4-D. Sperm analysis was made after 4 days of sexual inactivity. Parameters analyzed were volume, sperm count, mobility and morphology. Exposure level was estimated by measuring the concentration of 2,4-D in the urine. Significant levels of asthenospermia, necrospermia and teratospermia were found in exposed workers compared with unexposed controls. Over time, asthenospermia and necrospermia diminished but the abnormal spermatozoa (teratospermia) continued.

We here report two additional cases of HIV associated nephropathy ; the clinical and pathological features of these renal parenchymal complications are characteristic.