Ductal carcinoma in situ (DCIS) of the breast represents a heterogeneous group of neoplastic lesions in the breast ducts. The goal for management of DCIS is to prevent the development of invasive breast cancer. This manuscript focuses on the NCCN Guidelines Panel recommendations for the workup, primary treatment, risk reduction strategies, and surveillance specific to DCIS.

https://www.unitypoint.org/desmoines/filesimages/Cancer%20Education/Oncology%20Nursing%20Conference/2015/2014%20NCCN%20Clin%20Pract%20Guidelines%20Male%20Sex%20Dysf.pdf

Clinical practice guidelines in oncology

Study Selection: Eight randomized, controlled trials of mammography and 2 trials evaluating breast self-examination were included. One hundred fifty-four publications of the results of these trials, as well as selected articles about the test characteristics and harms associated with screening, were examined. Data Extraction: Predefined criteria were used to assess the quality of each study. Meta-analyses using a Bayesian randomeffects model were conducted to provide summary relative risk estimates and credible intervals (CrIs) for the effectiveness of screening with mammography in reducing death from breast cancer. Data Synthesis: For studies of fair quality or better, the summary relative risk was 0.84 (95% CrI, 0.77 to 0.91) and the number needed to screen to prevent one death from breast cancer after approximately 14 years of observation was 1224 (CrI, 665 to 2564). Among women younger than 50 years of age, the summary relative risk associated with mammography was 0.85 (CrI, 0.73 to 0.99) and the number needed to screen to prevent one death from breast cancer after 14 years of observation was 1792 (CrI, 764 to 10 540). For clinical breast examination and breast self-examination, evidence from randomized trials is inconclusive. Conclusions: In the randomized, controlled trials, mammography reduced breast cancer mortality rates among women 40 to 74 years of age. Greater absolute risk reduction was seen among older women. Because these results incorporate several rounds of screening, the actual number of mammograms needed to prevent one death from breast cancer is higher. In addition, each screening has associated risks and costs.

Breast Cancer Screening: A Summary of the Evidence for the U.S. Preventive Services Task Force

The assessment of fatigue A practical guide for clinicians and researchers

Fatigue is one of the most common and debilitating symptoms experienced by patients with cancer. Cancer-related fatigue (CRF) is characterized by feelings of tiredness, weakness, and lack of energy, and is distinct from the "normal" drowsiness experienced by healthy individuals in that it is not relieved by rest or sleep. It occurs both as a consequence of the cancer itself and as a side effect of cancer treatment, although the precise underlying pathophysiology is largely unknown. CRF may be an early symptom of malignant disease and is reported by as many as 40% of patients at diagnosis. Virtually all patients expect fatigue from cancer therapy. Up to 90% of patients treated with radiation and up to 80% of those treated with chemotherapy experience fatigue. CRF continues for months and even years ollowing completion of treatment in approximately one third of the patients with cancer. The impact of CRF on a patient's quality of life (QoL), particularly in relation to physical functioning and the ability to perform activities of daily living, is both profound and pervasive. In addition, CRF is associated with considerable psychological distress and can impose a significant financial burden by limiting a patient's ability to work. These effects can extend to caregivers and family members, who may also have to reduce their working capacity in order to provide additional care for a patient with CRF. This paper examines the prevalence of CRF and explores the impact of this distressing symptom on patients' functioning and QoL. Disclosure of potential conflicts of interest is found at the end of this article.

/pdf/cancer-related-fatigue-the-scale-of-the-problem-17xt3mqnwt.pdf

Cancer-related fatigue: the scale of the problem

Psychometric qualities of a brief self-rated fatigue measure: The Fatigue Assessment Scale.

Fatigue in the general norwegian population: Normative data and associations

https://www.jpsmjournal.com/article/S0885-3924(99)00148-7/pdf

Fatigue and Psychiatric Morbidity Among Hodgkin's Disease Survivors

Background Suicide rates are higher in certain educational groups. The highest rates are generally found in the medical and allied professions, but the empirical evidence for high suicide rates may be questionable. This study compares the rate of suicide among trained physicians, dentists, nurses, police officers and theologians with the rate among other university graduates and the general population according to sex, age and time period. Method Census data from 1960, 1970, 1980 and 1990 relating to education were linked to suicide as cause of death data from Statistics Norway, and followed up for the period 1960-2000, comprising 46 and 49 million person-years among men and women respectively. Results Physicians still have a higher rate compared with other graduates and the general population, both among males [43.0, 95% confidence interval (CI) 35.3-52.5] and females (26.1, 95% CI 15.1-44.9). Suicide rates increased steeply by age among physicians and other graduates, whereas for non-graduates the rate was highest in the 40-60 years age group. The suicide rate among female nurses was also elevated, whereas police officers seemed to have an intermediate suicide risk. The rate among theologians was low (7.0, 95% CI 2.9-16.9). The suicide rates in the 1990s were significantly lower than in the 1980s. Conclusions The high suicide rates among physicians and elderly graduates are of concern. The reasons why graduates are more vulnerable than others when getting older and the low rate among theologians warrant further study.

Suicide rates according to education with a particular focus on physicians in Norway 1960-2000.

Background. The aims of the study were to assess anxiety and depression in women who had experienced either a miscarriage or an induced abortion, to compare the women's level of distress with that of a general population sample, and to find predictors of anxiety and depression six months and five years after the event. Methods. A prospective, longitudinal follow-up study. Women who experienced miscarriage (n=40) and induced abortion (n=80) were interviewed ten days (T1), six months (T2), two years (T3), and five years (T4) after the event. On each occasion, they completed the Hospital Anxiety and Depression Scale and the Life Events Scale. Paired-sample t-test, logistic regression, and multiple linear regression statistical tests were used. Results.Women with miscarriage had significantly more anxiety and depression at T1 than the general population, while women with induced abortion had significantly more anxiety at all time points and more depression at T1 and T2. In both groups, important predictors of...

Øivind Ekeberg

Papers

Fatigue in the general norwegian population: Normative data and associations

Fatigue and Psychiatric Morbidity Among Hodgkin's Disease Survivors

Suicide rates according to education with a particular focus on physicians in Norway 1960-2000.

Predictors of anxiety and depression following pregnancy termination: a longitudinal five-year follow-up study

Psychological factors, pain attribution and medical morbidity in chest-pain patients with and without coronary artery disease