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No abstract

Risk-reducing mastectomy (RRM) is often advocated for BRCA1/2 mutation carriers who face a heightened lifetime risk of breast cancer. However, many carrier patients seek alternative risk-reducing measures. In a phase II nonrandomized trial, we previously reported that prophylactic irradiation to the contralateral breast among BRCA carriers undergoing breast-conserving treatment significantly reduced subsequent contralateral breast cancer. Herein, we report the outcome of salvage mastectomy and reconstruction in 11 patients that suffered reoccurrences of breast cancer in either the ipsilateral or contralateral breast or elected to have the procedure for risk reduction during the eight-year follow-up period. Patients’ satisfaction with the procedure and physicians’ assessment of the cosmetic outcome were not inferior for previously irradiated compared to non-irradiated breasts. Although the numbers are small, the results are encouraging and sustain hope in a challenging population. Our findings support continuing research as well as a discussion of risk-reduction alternatives besides mastectomy, including prophylactic breast irradiation, in BRCA1/2 mutation carriers.

Introduction Work overload in hospitals enforced reducing shifts length of physicians in many countries over the last decade. In Israel, the current shift standard is of 26 hours, however, there is a residents’ struggle alongside a governmental intent to short the shifts to 16 hour. We aim to evaluate residents and interns support and preferences regarding shortening shifts and their ramifications to quality of life and residency programs. Methods A structured questionnaire was distributed to all resident and interns in a single center. We evaluated their current quality of residency and life, their support in the shorter shifts model, offering alternative program components such as reduced pay, longer residency or replacement in order to allow rest. We compared those who support the new model to those who objected to identify common characteristics to draw a resident profile for acceptance of change. Results Overall, 151 physicians answer the questionnaire. 70.2% support the shorter shifts model. Residents above 35 years old and those reaching completion of residency, significantly less support the shortening shifts model. No other demographic nor professional parameters were different between the supporters and non-supporters. Option of reduced pay or longer residency dramatically reduced the support rate to less than 30% and 20%, respectively. Replacement by other physician (resident or senior physician) in order to allow rest was supported by only 40%. Conclusion Residents’ standpoints regarding a desirable change are crucial to plan a successful implementation. A national survey is required before a new model is introduced, to achieve an optimal transparent efficient process.