Background: Over 3,000 new cases of breast cancer are diagnosed annually in Ireland, an increase of 3.5 percent over the last 10 years. In 1999, breast screening was introduced nationally for women aged between 50 and 64 and is currently being extended. With the advent of Breastcheck, we decided to review the age profile of cancers presenting to our symptomatic breast clinic over this time period with the expectation that the percentage of breast cancers diagnosed in this age group would decline. Methods: A retrospective review was carried out on a prospectively maintained database of all breast cancer patients diagnosed in Beaumont Hospital over the last 13 years. This cohort of patients was stratified based on age, focusing on patients aged 51–65, excluding those presenting with recurrent disease. We recorded their cancer subtype, nodal involvement and evidence of metastatic disease at presentation. Results: Over the last 13 years there has been a steady increase in new breast cancers diagnosed via our symptomatic clinic from 133 [2006] to 393 [2018]. During this time period there has been an almost constant percentage of these patients within the 51–65-year-old age group (range, 15–24.5%). Overall, 11.64% of breast cancers diagnosed were DCIS, and 7.8% presented with metastatic disease in 2018 alone. Conclusions: Despite the introduction of a national breast screening service and increased awareness around health promotion, there is a persistent percentage of our new breast cancers diagnosed within the age-group of patients eligible for breast cancer screening. The reasons for this remain unclear.
Abstract Background The aim of this multicentre prospective audit was to describe the current practice in the management of mastitis and breast abscesses in the UK and Ireland, with a specific focus on rates of surgical intervention. Methods This audit was conducted in two phases from August 2020 to August 2021; a phase 1 practice survey and a phase 2 prospective audit. Primary outcome measurements for phase 2 included patient management pathway characteristics and treatment type (medical/radiological/surgical). Results A total of 69 hospitals participated in phase 2 (1312 patients). The key findings were a high overall rate of incision and drainage (21.0 per cent) and a lower than anticipated proportion of ultrasound-guided aspiration of breast abscesses (61.0 per cent). Significant variations were observed regarding the rate of incision and drainage (range 0–100 per cent; P < 0.001) and the rate of needle aspiration (range 12.5–100 per cent; P < 0.001) between individual units. Overall, 22.5 per cent of patients were admitted for inpatient treatment, out of whom which 72.9 per cent were commenced on intravenous antibiotics. The odds of undergoing incision and drainage for a breast abscess or being admitted for inpatient treatment were significantly higher if patients presented at the weekend compared with a weekday (P ≤ 0.023). Breast specialists reviewed 40.9 per cent of all patients directly, despite the majority of patients (74.2 per cent) presenting within working hours on weekdays. Conclusions Variation in practice exists in the management of mastitis and breast abscesses, with high rates of incision and drainage in certain regions of the UK. There is an urgent need for a national best-practice toolbox to minimize practice variation and standardize patient care.
Background: Papillary thyroid cancer accounts for greater than 85% of thyroid cancer. 3.9% of thyroid cancers develop bone metastases with a greater association with follicular and medullary subtypes. However, data on bone metastases in differentiated thyroid cancer is limited and not well reported.Methods: A 53-year-old female underwent a thyroid lobectomy for a left sided goitre.Results: Histopathology results identified a papillary thyroid cancer of follicular variant, and consequently a completion thyroidectomy was performed. Post-operative recovery was uncomplicated and normal TSH levels were recorded. Four months later, the patient developed mild bony pain and subsequent PET scans revealed multiple bony metastases, the largest in the left proximal humeral shaft. Subsequently, a proximal humeral resection with glenohumeral reconstruction was performed. External beam radiotherapy and radioactive iodine treatment was also carried out.Conclusions: Bony metastases secondary to thyroid cancer are rare, however clinical history and examination is imperative for early detection. The shoulder girdle represents the least common site of spread at an incidence of 5.4%. As such, requirements for prosthetic replacement of the shoulder girdle are rare. Conventional surgical strategies for humeral metastases are intramedullary nails, plate fixation and cement augmentation for reconstruction of large bone defects.
Background: Pancreatic ductal adenocarcinoma (PDAC) is a solid organ malignancy with a mortality rate almost equal to its incidence. Chronic pancreatitis has been suggested in cohort and case-control studies as a possible cause for PDAC in a similar fashion to chronic inflammatory processes in the development of other malignancies. The aim of this study was to examine by means of systematic review and meta analysis, the incidence of PDAC in chronic pancreatitis (CP) cohorts among the published literature.
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