The study aimed to describe the surgical treatment in cases of primary, operable breast cancer in Victoria. Allpatients who were entered in a population-based cancer registry and who met the entry criteria over a six-month period were identified . In respect of each patient, the treating surgeon completed a questionnaire about patient characteristics, investigations, tumour description, surgery, radiotherapy and chemotherapy. For 716 eligible cases, 635 (89%) questionnaires were returned by 200 treating surgeons; this gave a mean rate of 6.3 breast-eancer patients per surgeon per year. Most (61%) surgeons treated one to four breast-eancer patients per year and only 4% of surgeons treated more than 20 breast-eancer patients each. Little systematic difference was found in the treatment approach that was adopted by the surgeons with heavy or light case-loads of patients with breast cancer. Twenty-two per cent of patients underwent breast-eonserving operations. Virtually all the remainder underwent mastectomy, most commonly modified radical mastectomy. (Med J Aust 1990; 152: 67-72)

The selection of entrants for medical school, as now widely agreed, should include measurements of non-academic as well as academic attributes. The authors have developed a process to assess the personal attributes of applicants. This included a structured panel interview carried out twice on each applicant by independent interviewers and a group exercise in which several applicants were observed whilst discussing a problem. Training for interviewers took the form of a half-day interactive workshop. One hundred and forty-one school-leaving applicants completed the new assessment. No relationship was found between academic achievement as reflected by marks in a national examination and scores in the panel interview, the group exercise, or the school principal's report. However, significant intercorrelations were found between the panel interview, group exercise and school report. The results of this experience have encouraged the Auckland School to continue to explore methods to measure these attributes in a carefully controlled study.

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Donor T cell chimerism is associated with relapse outcomes after allogeneic stem cell transplantation (alloSCT) for acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS). However, measures of statistical association do not adequately assess the performance of a prognostic biomarker, which is best characterized by its sensitivity and specificity for the chosen outcome. We analyzed donor T cell chimerism results at day 100 (D100chim) after myeloablative alloSCT for AML or MDS in 103 patients and determined its sensitivity and specificity for relapse-free survival at 6 months (RFS6) and 12 months (RFS12) post-alloSCT. The area under the receiver operating characteristic curve for RFS6 was .68, demonstrating only modest utility as a predictive biomarker, although this was greater than RFS12 at .62. Using a D100chim threshold of 65%, the specificity for RFS6 was 96.6%; however, sensitivity was poor at 26.7%. This equated to a negative predictive value of 88.5% and positive predictive value of 57.1%. Changing the threshold for D100chim to 75% or 85% modestly improved the sensitivity of D100chim for RFS6; however, this was at the expense of specificity. D100chim is specific but lacks sensitivity as a prognostic biomarker of early RFS after myeloablative alloSCT for AML or MDS. Caution is required when using D100chim to guide treatment decisions including immunologic manipulation, which may expose patients to unwarranted graft-versus-host disease.