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Background: Sentinel-lymph-node (SLN) surgery was designed to minimise the side-effects of lymph-node surgery but still offer outcomes equivalent to axillary-lymph-node dissection (ALND). The aims of National Surgical Adjuvant Breast and Bowel Project (NSABP) trial B-32 were to establish whether SLN resection in patients with breast cancer achieves the same survival and regional control as ALND, but with fewer side-effects., Methods: NSABP B-32 was a randomised controlled phase 3 trial done at 80 centres in Canada and the USA between May 1, 1999, and Feb 29, 2004. Women with invasive breast cancer were randomly assigned to either SLN resection plus ALND (group 1) or to SLN resection alone with ALND only if the SLNs were positive (group 2). Random assignment was done at the NSABP Biostatistical Center (Pittsburgh, PA, USA) with a biased coin minimisation approach in an allocation ratio of 1:1. Stratification variables were age at entry (≤ 49 years, ≥ 50 years), clinical tumour size (≤ 2·0 cm, 2·1-4·0 cm, ≥ 4·1 cm), and surgical plan (lumpectomy, mastectomy). SLN resection was done with a blue dye and radioactive tracer. Outcome analyses were done in patients who were assessed as having pathologically negative sentinel nodes and for whom follow-up data were available. The primary endpoint was overall survival. Analyses were done on an intention-to-treat basis. All deaths, irrespective of cause, were included. The mean time on study for the SLN-negative patients with follow-up information was 95·6 months (range 70·1-126·7). This study is registered with ClinicalTrials.gov, number NCT00003830., Findings: 5611 women were randomly assigned to the treatment groups, 3989 had pathologically negative SLN. 309 deaths were reported in the 3986 SLN-negative patients with follow-up information: 140 of 1975 patients in group 1 and 169 of 2011 in group 2. Log-rank comparison of overall survival in groups 1 and 2 yielded an unadjusted hazard ratio (HR) of 1·20 (95% CI 0·96-1·50; p=0·12). 8-year Kaplan-Meier estimates for overall survival were 91·8% (95% CI 90·4-93·3) in group 1 and 90·3% (88·8-91·8) in group 2. Treatment comparisons for disease-free survival yielded an unadjusted HR of 1·05 (95% CI 0·90-1·22; p=0·54). 8-year Kaplan-Meier estimates for disease-free survival were 82·4% (80·5-84·4) in group 1 and 81·5% (79·6-83·4) in group 2. There were eight regional-node recurrences as first events in group 1 and 14 in group 2 (p=0·22). Patients are continuing follow-up for longer-term assessment of survival and regional control. The most common adverse events were allergic reactions, mostly related to the administration of the blue dye., Interpretation: Overall survival, disease-free survival, and regional control were statistically equivalent between groups. When the SLN is negative, SLN surgery alone with no further ALND is an appropriate, safe, and effective therapy for breast cancer patients with clinically negative lymph nodes., Funding: US Public Health Service, National Cancer Institute, and Department of Health and Human Services., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Background: Mass media interventions for reduction of youth cigarette smoking have been recommended based on a broad array of evidence, although few randomized community trials have been reported., Design: Four matched pairs of independent media markets were identified; one member of each pair was randomized to receive the intervention. School surveys were conducted in all markets, in 2001 before (n=19,966) and in 2005 after (n=23,246) the interventions were completed., Setting/participants: Grade 7-12 students from public schools in these eight medium-sized metropolitan areas participated in the summative evaluations; Grades 4-12 students were targeted to receive mass media interventions in four of these markets., Intervention: Four simultaneous campaigns consisting of specially developed messages based on behavioral theory and targeted to defined age groups of racially and ethnically diverse young people were placed in popular TV, cable, and radio programming using purchased time for 4 years., Main Outcome Measures: Prevalence of youth smoking and psychosocial mediators of smoking., Results: No significant impacts of these interventions on smoking behaviors or mediators were found for the overall samples. A positive effect was found for one mediator in subgroups. Among Hispanic participants a marginally favorable effect on smoking prevalence and significant effects on mediators were found. General awareness of smoking prevention TV messages was slightly higher over time in the intervention areas., Conclusions: Mass media interventions alone were unable to induce an incremental difference in youth smoking prevalence, probably because of a relatively strong tobacco control environment that included a substantial national smoking prevention media campaign., (Copyright 2010 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

The disablement process model proposed by Nagi in 1965 and subsequently expanded by Verbrugge and Jette was used heuristically to study the relationships among morbidities and arm/shoulder function limitations that breast cancer survivors experience in the period following treatment. A telephone survey was administered to 148 patients (67%) from among 222 breast cancer survivors who had undergone surgery in 1997 and 1998. Sixty-three percent of respondents reported experiencing some numbness, while 35% noticed swelling. Between 13% and 15% reported moderate to severe pain. Similar proportions said the occurrence of pain ranged from intermittent to constant. Between 1% and 4% reported problems with shoulder abduction and flexion and a decrease in arm strength and daily use of the arm. Swellings in the torso and arm tended to cluster into two different factors. Numbness followed a similar pattern. Apart from numbness in the arm, all the other factors had strong significant associations with one another. In multiple regression analyses, current pain intensity and swelling in the arm were independently related to current functional status of the arm/shoulder. The results suggest that it may be feasible to use patients' self-reports to develop a simple lymphedema-specific tool to monitor the functional status of women living with or at risk for lymphedema. Such a tool, if properly designed and implemented, would allow for the timely introduction of lymphedema or pain management strategies to improve arm function and ultimately the quality of life of breast cancer survivors.

Questionnaire cards were sent to 45,000 family shoe store customers; 15,000 cards were completed and returned, thereby permitting a broad statistical base in respect to the incidence and types of foot problems encountered in the United States. The incidence of corns, calluses, warts, ingrown toenails, bunions, hallux rigidus, hammer toes, cavus, and pes planus were correlated with age, sex, race, and demographic background, along with the incidence of surgery, conservative treatment, or no treatment. The extrapolated data indicated that 40% of the population have foot problems, of which 12% had surgery and 7% have been untreated.