Summary Background 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov , NCT03471494 . Findings Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding National Institute for Health Research Global Health Research Unit.

The study aimed to determine and compare cadmium (Cd) concentration in different biological media of breast cancer and benign breast tumor patients. Methods Concentration of Cd was determined in breast tissue, urine and blood of 57 breast cancer and 51 benign tumor patients. Two samples of breast tissue from each patient, i.e. tumor and healthy tissue were taken for the analysis. Cd in biological media was determined by atomic absorption spectrometry (Perkin-Elmer, Zeeman 3030). Results The mean Cd concentration in breast cancer patients was 0.053 µg/g (95% CI=0.042-0.065) for tumor sample and 0.02 µg/g (95% CI=0.014-0.026) for healthy breast tissue sample (p<0.001). In benign tumor patients the figures were following: 0.037 µg/g (95% CI=0.023-0.051) and 0.032 µg/g (95% CI=0.018-0.047) (p>0.05). Cd content in malignant tumor significantly differed from that in benign tumor (p<0.01). Cancer patients with positive estrogenreceptors had significantly greater concentration of breast tissue Cd compared to patients with negative estrogenreceptors (p=0.035). Adjusted for creatinine Cd in urine was significantly higher in cancer patients than in controls (p<0.001). In cancer patients a positive Spearman's correlation was found between Cd in tumor and healthy breast tissue, blood (r=0.44 and r=0.39, respectively, p<0.01). Correlation between Cd in urine of cancer patients and number of cigarettes smoked during lifetime was suggestive (r=0.59, p=0.075). Conclusion The data obtained show higher concentration of cadmium in breast tumor and urine of cancer patients and support a possible relationship between cadmium and breast cancer.

The optimal surgical management of locally advanced breast cancer (LABC) remains undefined. The aim of the study was to obtain long-term results of oncoplastic surgery in terms of overall survival, loco-regional recurrence, and quality of life in case of LABC. Prospective cohort study enrolled 60 patients with stage III breast cancer. Forty-two (70%) patients received neo-adjuvant chemotherapy, 28 patients were considered suitable for surgery as initial treatment option. Type II oncoplastic surgery was performed for all patients: hemimastectomy and breast reconstruction with latissimus dorsi flap - for 29 (48.3%), lumpectomy - 31 (51.7%), and reconstruction with subaxillary flap for four (6.7%), with bilateral reduction mammoplasty - 14 (23.3%) and with J-plastic - 13 (21.7%) patients. Adjuvant chemotherapy and hormonal therapy followed surgery for all, except one, patients. Sequential radiotherapy was administered for all patients. The mean period of follow-up was 86 months. Postoperative morbidity rate was 5%. Local-regional recurrence was detected in six (10%) patients. After reoperation no local relapse was diagnosed. However, three of these patients had systemic dissemination of the disease. Distant metastasis was detected in 23 (38.3%) patients. Distant metastasis-free survival at 5 years was 61.7%. Fourteen patients died (23.3%). A total of 87.2% of the patients had good and excellent esthetic outcome. Oncoplastic breast-conserving surgery can be proposed for selected patients with LABC with acceptable complication, local recurrence rate, and good esthetic results.

The study aimed to examine the association between cadmium (Cd) and the risk of breast cancer according to estrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2). A hospital-based case-control study was carried out in 585 cases and 1,170 controls. Information on possible risk factors was collected via a structured questionnaire. Urinary Cd was determined by atomic absorption spectrometry. The ER and HER2 levels in tumor tissue were analyzed by immunohistochemistry. Logistic regression was used to calculate odds ratios (ORs) and 95 % confidence intervals (CIs) for breast cancer by creatinine-adjusted urinary Cd. Women with greater creatinine-adjusted urine Cd (3rd quartile: 0.241-0.399 μg/g and 4th quartile: ≥ 0.4 μg/g) experienced 1.6 times higher risk of breast cancer compared with those having Cd concentration lower than 0.147 μg/g (1st quartile) [OR = 1.6, (95 % CI 1.19, 2.17) and OR = 1.62 (95 % CI 1.19, 2.21), respectively, P trend = 0.001] after adjustment for age and other confounders. Both ER+ and HER2- cases from the highest quartile of urine Cd exhibited approximately twice the breast cancer risk of those in the lowest quartile [OR = 1.9, (95 % CI 1.31, 2.74) and OR = 1.87, (95 % CI 1.33, 2.62), respectively, P trend <0.001) after adjustment for confounders. The data support cadmium as a risk factor for breast cancer, especially for both ER+ and HER2- cancer patients.

The rates of incidence and mortality of breast cancer in Lithuania are increasing and, although a mammography screening program is present, attendance rate is rather low. The aim of this study was to assess the reliability and validity of the revised Champion's Health Belief Model Scale in measuring Lithuanian women's beliefs about breast cancer and screening. The data were collected from 350 female citizens 40 to 69 years old living in the urban district, and having no history of breast cancer and no mammogram in the past. The Champion's Health Belief Model Scale was translated to Lithuanian, validated by professional judges, back-translated to English, and pretested. Analysis included descriptive statistics of demographic data, content and construct validity, using factorial analysis, internal consistency, reliability estimates, and using the Cronbach alpha technique. Factor analysis yielded 11 factors related to breast self-examination and 7 factors to mammography. All items on each factor were from the same construct. The motivation subscale split into the items related to general concern about health and preventive health practices. Alpha coefficients ranged from.61 to.92. Only the mammography barrier item "having a routine mammogram or x-ray of the breast would make me worry about breast cancer" loaded as a separate factor in factor analysis and showed low correlation with other subscale items. Participants in the mammography group showed lower perceived susceptibility in 3 items and perceived severity in 1 item. They reported having not enough privacy for breast self-examination, and were less confident in their skills to perform it. However, the women in the nonparticipating mammography group showed lower results in one benefit-mammogram item, and had more barriers for mammography in comparison with the participating group. We conclude that the Champion's Health Belief Model Scale is a reliable and valid tool for measuring the screening beliefs toward breast cancer among Lithuanian women. The model gave better results when the motivation items were subdivided into subscales related to general concern about health and related to preventive health practices and were considered separately. Mammography barrier item "having a routine mammogram or x-ray of the breast would make me worry about breast cancer" was deleted from the Lithuanian Champion's Health Belief Model Scale.