RESUMEN
The aim of this study was to describe the type of risk-reducing gynaecologic surgery (RRGS) and the extent of pathological evaluation being undertaken for Australasian women at high familial risk of pelvic serous cancer. Surgical and pathology reports were reviewed for women with BRCA1/BRCA2 mutations, or a family history of breast and ovarian cancer, who underwent RRGS between 1998 and 2008. "Adequate" surgery was defined as complete removal of all ovarian and extra-uterine fallopian tube tissue. "Adequate" pathology was defined as paraffin embedding of all removed ovarian and tubal tissue. Predictors of adequacy were assessed using logistic regression. There were 201 women, including 173 mutation carriers, who underwent RRGS. Of these, 91% had adequate surgery and 23% had adequate pathology. Independent predictors of adequate surgery were surgeon type (OR = 20; 95% CI 2-167; P = 0.005 for gynaecologic oncologists versus general gynaecologists), more recent surgery (OR = 1.33/year; 95% CI 1.07-1.67; P = 0.012) and younger patient age (OR = 0.93/year of age; 95% CI 0.87-0.99; P = 0.028). Independent predictors of adequate pathology were more recent surgery (OR = 1.26/year; 95% CI 1.06-1.49; P = 0.008) and surgeon type (OR = 3.1; 95% CI 1.4-6.7; P = 0.004 for gynaecologic oncologists versus general gynaecologists). Four serous ovarian cancers and one endometrioid endometrial cancer were detected during surgery or pathological examination. In conclusion Australasian women attending a specialist gynaecologic oncologist for RRGS are most likely to have adequate surgery and pathological examination. Additional education of clinicians and consumers is needed to ensure optimal surgery and pathology in these women.
Asunto(s)
Proteína BRCA1/genética , Proteína BRCA2/genética , Neoplasias de la Mama/cirugía , Cistadenocarcinoma Seroso/cirugía , Mutación/genética , Neoplasias Ováricas/cirugía , Neoplasias Pélvicas/cirugía , Adulto , Australia , Neoplasias de la Mama/genética , Neoplasias de la Mama/patología , Cistadenocarcinoma Seroso/genética , Cistadenocarcinoma Seroso/patología , Femenino , Predisposición Genética a la Enfermedad , Procedimientos Quirúrgicos Ginecológicos , Heterocigoto , Humanos , Persona de Mediana Edad , Oportunidad Relativa , Neoplasias Ováricas/genética , Neoplasias Ováricas/patología , Neoplasias Pélvicas/genética , Neoplasias Pélvicas/patología , Factores de RiesgoRESUMEN
Home observations were done on sibling interactions in 31 families with a child having Down's syndrome and a non-handicapped sibling. The siblings with Down's syndrome initiated less prosocial and agonistic behaviour, but imitated more frequently than their non-handicapped siblings. These effects were found regardless of birth order. There were no effects of gender. Higher levels of prosocial behaviours among large interval dyads and in dyads with a second-born Down's syndrome child were primarily due to the age of the non-handicapped sibling. Results were similar to those in previous "normative" studies of sibling interactions.