home *** CD-ROM | disk | FTP | other *** search
| Unknown | 1992-06-06 | 189.5 KB |
open in: 
MacOS 8.1
|
Win98
|
DOS
view JSON data
|
view as text
This file was not able to be converted.
This format is not currently supported by dexvert.
| Confidence | Program | Detection | Match Type | Support
|
|---|
| 66%
| dexvert
| OS/2 Installation Package (archive/os2InstallPackage)
| ext
| Supported |
| 1%
| dexvert
| BeOS Installation Package (archive/beOSInstallPackage)
| ext
| Unsupported |
| 1%
| dexvert
| Newton Package (archive/newtonPackage)
| ext
| Unsupported |
| 1%
| dexvert
| Independence War 2 mod Package (other/independenceWar2ModPackage)
| ext
| Unsupported |
| 100%
| file
| data
| default
|
|
hex view+--------+-------------------------+-------------------------+--------+--------+
|00000000| 1a 44 50 31 2e 31 00 00 | 00 00 00 00 00 05 38 00 |.DP1.1..|......8.|
|00000010| 00 00 16 00 00 00 30 30 | 00 00 00 01 34 03 00 00 |......00|....4...|
|00000020| d0 0d 00 00 30 31 00 00 | 00 01 04 11 00 00 1d 0d |....01..|........|
|00000030| 00 00 30 32 00 00 00 01 | 21 1e 00 00 5c 0b 00 00 |..02....|!...\...|
|00000040| 30 33 00 00 00 01 7d 29 | 00 00 82 0c 00 00 30 34 |03....})|......04|
|00000050| 00 00 00 01 ff 35 00 00 | bc 0c 00 00 30 35 00 00 |.....5..|....05..|
|00000060| 00 01 bb 42 00 00 13 0c | 00 00 35 30 00 00 00 01 |...B....|..50....|
|00000070| ce 4e 00 00 58 0e 00 00 | 35 31 00 00 00 01 26 5d |.N..X...|51....&]|
|00000080| 00 00 3c 11 00 00 35 32 | 00 00 00 01 62 6e 00 00 |..<...52|....bn..|
|00000090| c3 0a 00 00 35 33 00 00 | 00 01 25 79 00 00 54 0d |....53..|..%y..T.|
|000000a0| 00 00 35 34 00 00 00 01 | 79 86 00 00 40 09 00 00 |..54....|y...@...|
|000000b0| 35 35 00 00 00 01 b9 8f | 00 00 d0 0a 00 00 35 36 |55......|......56|
|000000c0| 00 00 00 01 89 9a 00 00 | 7d 0f 00 00 35 37 00 00 |........|}...57..|
|000000d0| 00 01 06 aa 00 00 44 18 | 00 00 35 38 00 00 00 01 |......D.|..58....|
|000000e0| 4a c2 00 00 5d 0d 00 00 | 35 39 00 00 00 01 a7 cf |J...]...|59......|
|000000f0| 00 00 3d 08 00 00 36 30 | 00 00 00 01 e4 d7 00 00 |..=...60|........|
|00000100| 2f 0b 00 00 36 31 00 00 | 00 01 13 e3 00 00 5e 0e |/...61..|......^.|
|00000110| 00 00 36 32 00 00 00 01 | 71 f1 00 00 69 0c 00 00 |..62....|q...i...|
|00000120| 36 33 00 00 00 01 da fd | 00 00 46 0c 00 00 36 34 |63......|..F...64|
|00000130| 00 00 00 01 20 0a 01 00 | 2b 0f 00 00 36 35 00 00 |.... ...|+...65..|
|00000140| 00 01 4b 19 01 00 e6 09 | 00 00 36 36 00 00 00 01 |..K.....|..66....|
|00000150| 31 23 01 00 53 0a 00 00 | 36 37 00 00 00 01 84 2d |1#..S...|67.....-|
|00000160| 01 00 10 0c 00 00 36 38 | 00 00 00 01 94 39 01 00 |......68|.....9..|
|00000170| 26 09 00 00 36 39 00 00 | 00 01 ba 42 01 00 b4 14 |&...69..|...B....|
|00000180| 00 00 37 30 00 00 00 01 | 6e 57 01 00 c5 18 00 00 |..70....|nW......|
|00000190| 37 31 00 00 00 01 33 70 | 01 00 9d 0f 00 00 37 32 |71....3p|......72|
|000001a0| 00 00 00 01 d0 7f 01 00 | df 0a 00 00 37 33 00 00 |........|....73..|
|000001b0| 00 01 af 8a 01 00 97 11 | 00 00 37 34 00 00 00 01 |........|..74....|
|000001c0| 46 9c 01 00 61 0f 00 00 | 37 35 00 00 00 01 a7 ab |F...a...|75......|
|000001d0| 01 00 a4 0b 00 00 37 36 | 00 00 00 01 4b b7 01 00 |......76|....K...|
|000001e0| aa 0a 00 00 37 37 00 00 | 00 01 f5 c1 01 00 9c 10 |....77..|........|
|000001f0| 00 00 37 38 00 00 00 01 | 91 d2 01 00 71 09 00 00 |..78....|....q...|
|00000200| 37 39 00 00 00 01 02 dc | 01 00 bd 0b 00 00 38 30 |79......|......80|
|00000210| 00 00 00 01 bf e7 01 00 | bb 08 00 00 38 31 00 00 |........|....81..|
|00000220| 00 01 7a f0 01 00 23 0d | 00 00 38 32 00 00 00 01 |..z...#.|..82....|
|00000230| 9d fd 01 00 e6 17 00 00 | 38 33 00 00 00 01 83 15 |........|83......|
|00000240| 02 00 d0 0c 00 00 38 34 | 00 00 00 01 53 22 02 00 |......84|....S"..|
|00000250| 4c 14 00 00 38 35 00 00 | 00 01 9f 36 02 00 56 0e |L...85..|...6..V.|
|00000260| 00 00 38 36 00 00 00 01 | f5 44 02 00 98 0d 00 00 |..86....|.D......|
|00000270| 38 37 00 00 00 01 8d 52 | 02 00 1e 12 00 00 38 38 |87.....R|......88|
|00000280| 00 00 00 01 ab 64 02 00 | 5b 09 00 00 38 39 00 00 |.....d..|[...89..|
|00000290| 00 01 06 6e 02 00 f9 0a | 00 00 39 30 00 00 00 01 |...n....|..90....|
|000002a0| ff 78 02 00 98 14 00 00 | 39 31 00 00 00 01 97 8d |.x......|91......|
|000002b0| 02 00 bd 0b 00 00 39 32 | 00 00 00 01 54 99 02 00 |......92|....T...|
|000002c0| f5 0b 00 00 39 33 00 00 | 00 01 49 a5 02 00 4e 08 |....93..|..I...N.|
|000002d0| 00 00 39 34 00 00 00 01 | 97 ad 02 00 9b 0e 00 00 |..94....|........|
|000002e0| 39 35 00 00 00 01 32 bc | 02 00 87 08 00 00 39 36 |95....2.|......96|
|000002f0| 00 00 00 01 b9 c4 02 00 | e7 0b 00 00 39 37 00 00 |........|....97..|
|00000300| 00 01 a0 d0 02 00 b0 09 | 00 00 39 38 00 00 00 01 |........|..98....|
|00000310| 50 da 02 00 0b 0d 00 00 | 39 39 00 00 00 01 5b e7 |P.......|99....[.|
|00000320| 02 00 98 0e 00 00 00 00 | 00 00 00 00 f3 f5 02 00 |........|........|
|00000330| 00 00 00 00 24 55 6e 69 | 71 75 65 5f 49 44 7b 59 |....$Uni|que_ID{Y|
|00000340| 52 42 31 31 38 30 30 7d | 0d 0a 24 54 69 74 6c 65 |RB11800}|..$Title|
|00000350| 7b 4d 61 6d 6d 6f 67 72 | 61 70 68 69 63 20 53 63 |{Mammogr|aphic Sc|
|00000360| 72 65 65 6e 69 6e 67 20 | 61 6e 64 20 4d 6f 72 74 |reening |and Mort|
|00000370| 61 6c 69 74 79 20 46 72 | 6f 6d 20 42 72 65 61 73 |ality Fr|om Breas|
|00000380| 74 20 43 61 6e 63 65 72 | 3a 20 20 54 68 65 20 4d |t Cancer|: The M|
|00000390| 61 6c 6d 6f 20 4d 61 6d | 6d 6f 67 72 61 70 68 69 |almo Mam|mographi|
|000003a0| 63 20 53 63 72 65 65 6e | 69 6e 67 20 54 72 69 61 |c Screen|ing Tria|
|000003b0| 6c 7d 0d 0a 24 41 75 74 | 68 6f 72 7b 41 6e 64 65 |l}..$Aut|hor{Ande|
|000003c0| 72 73 73 6f 6e 2c 20 49 | 0d 0a 41 73 70 65 67 72 |rsson, I|..Aspegr|
|000003d0| 65 6e 2c 20 4b 0d 0a 4a | 61 6e 7a 6f 6e 2c 20 4c |en, K..J|anzon, L|
|000003e0| 0d 0a 4c 61 6e 64 62 65 | 72 67 2c 20 54 0d 0a 4c |..Landbe|rg, T..L|
|000003f0| 69 6e 64 68 6f 6c 6d 2c | 20 4b 0d 0a 4c 69 6e 65 |indholm,| K..Line|
|00000400| 6c 6c 2c 20 46 0d 0a 4c | 6a 75 6e 67 62 65 72 67 |ll, F..L|jungberg|
|00000410| 2c 20 4f 0d 0a 52 61 6e | 73 74 61 6d 2c 20 4a 0d |, O..Ran|stam, J.|
|00000420| 0a 53 69 67 66 75 73 73 | 6f 6e 2c 20 42 7d 0d 0a |.Sigfuss|on, B}..|
|00000430| 24 41 66 66 69 6c 69 61 | 74 69 6f 6e 7b 4d 61 6c |$Affilia|tion{Mal|
|00000440| 6d 6f 20 47 65 6e 20 48 | 6f 73 70 2c 20 53 77 65 |mo Gen H|osp, Swe|
|00000450| 64 65 6e 7d 0d 0a 24 4a | 6f 75 72 6e 61 6c 7b 42 |den}..$J|ournal{B|
|00000460| 72 20 4d 65 64 20 4a 7d | 0d 0a 24 56 6f 6c 75 6d |r Med J}|..$Volum|
|00000470| 65 7b 32 39 37 7d 0d 0a | 24 50 61 67 65 7b 39 34 |e{297}..|$Page{94|
|00000480| 33 2d 39 34 38 7d 0d 0a | 24 44 61 74 65 7b 4f 63 |3-948}..|$Date{Oc|
|00000490| 74 20 31 35 2c 20 31 39 | 38 38 7d 0d 0a 24 59 42 |t 15, 19|88}..$YB|
|000004a0| 56 6f 6c 7b 31 39 39 30 | 20 59 65 61 72 20 42 6f |Vol{1990| Year Bo|
|000004b0| 6f 6b 20 6f 66 20 4f 62 | 73 74 65 74 72 69 63 73 |ok of Ob|stetrics|
|000004c0| 20 61 6e 64 20 47 79 6e | 65 63 6f 6c 6f 67 79 7d | and Gyn|ecology}|
|000004d0| 0d 0a 24 43 68 61 70 74 | 65 72 7b 32 31 2d 31 32 |..$Chapt|er{21-12|
|000004e0| 7d 0d 0a 24 59 42 45 64 | 69 74 6f 72 7b 44 72 73 |}..$YBEd|itor{Drs|
|000004f0| 2e 20 4d 69 73 68 65 6c | 6c 2c 20 4b 69 72 73 63 |. Mishel|l, Kirsc|
|00000500| 68 62 61 75 6d 2c 20 61 | 6e 64 20 4d 6f 72 72 6f |hbaum, a|nd Morro|
|00000510| 77 7d 0d 0a 24 54 61 62 | 6c 65 7b 7d 0d 0a 24 43 |w}..$Tab|le{}..$C|
|00000520| 6f 6d 6d 65 6e 74 61 74 | 6f 72 7b 57 2e 48 2e 20 |ommentat|or{W.H. |
|00000530| 48 69 6e 64 6c 65 2c 20 | 4d 2e 44 2e 7d 0d 0a 0d |Hindle, |M.D.}...|
|00000540| 0a 43 6f 70 79 72 69 67 | 68 74 20 28 63 29 20 59 |.Copyrig|ht (c) Y|
|00000550| 65 61 72 62 6f 6f 6b 20 | 4d 65 64 69 63 61 6c 20 |earbook |Medical |
|00000560| 50 75 62 6c 69 73 68 65 | 72 73 2c 20 49 6e 63 2e |Publishe|rs, Inc.|
|00000570| 2c 20 31 39 39 30 0d 0a | 0d 0a 31 39 39 30 20 59 |, 1990..|..1990 Y|
|00000580| 65 61 72 20 42 6f 6f 6b | 20 6f 66 20 4f 62 73 74 |ear Book| of Obst|
|00000590| 65 74 72 69 63 73 20 61 | 6e 64 20 47 79 6e 65 63 |etrics a|nd Gynec|
|000005a0| 6f 6c 6f 67 79 20 28 52 | 29 0d 0a 0d 0a 43 68 61 |ology (R|)....Cha|
|000005b0| 70 74 65 72 20 32 31 2d | 2d 42 72 65 61 73 74 20 |pter 21-|-Breast |
|000005c0| 44 69 73 65 61 73 65 73 | 0d 0a 0d 0a 2d 2d 2d 2d |Diseases|....----|
|000005d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000005e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000005f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000600| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000610| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 0d 0a 4d 61 6d 6d |--------|--..Mamm|
|00000620| 6f 67 72 61 70 68 69 63 | 20 53 63 72 65 65 6e 69 |ographic| Screeni|
|00000630| 6e 67 20 61 6e 64 20 4d | 6f 72 74 61 6c 69 74 79 |ng and M|ortality|
|00000640| 20 46 72 6f 6d 20 42 72 | 65 61 73 74 20 43 61 6e | From Br|east Can|
|00000650| 63 65 72 3a 20 20 54 68 | 65 20 4d 61 6c 6d 6f 0d |cer: Th|e Malmo.|
|00000660| 0a 4d 61 6d 6d 6f 67 72 | 61 70 68 69 63 20 53 63 |.Mammogr|aphic Sc|
|00000670| 72 65 65 6e 69 6e 67 20 | 54 72 69 61 6c 0d 0a 0d |reening |Trial...|
|00000680| 0a 41 6e 64 65 72 73 73 | 6f 6e 20 49 2c 20 41 73 |.Anderss|on I, As|
|00000690| 70 65 67 72 65 6e 20 4b | 2c 20 4a 61 6e 7a 6f 6e |pegren K|, Janzon|
|000006a0| 20 4c 2c 20 4c 61 6e 64 | 62 65 72 67 20 54 2c 20 | L, Land|berg T, |
|000006b0| 4c 69 6e 64 68 6f 6c 6d | 20 4b 2c 20 4c 69 6e 65 |Lindholm| K, Line|
|000006c0| 6c 6c 20 46 2c 0d 0a 4c | 6a 75 6e 67 62 65 72 67 |ll F,..L|jungberg|
|000006d0| 20 4f 2c 20 52 61 6e 73 | 74 61 6d 20 4a 2c 20 53 | O, Rans|tam J, S|
|000006e0| 69 67 66 75 73 73 6f 6e | 20 42 0d 0a 28 4d 61 6c |igfusson| B..(Mal|
|000006f0| 6d 6f 20 47 65 6e 20 48 | 6f 73 70 2c 20 53 77 65 |mo Gen H|osp, Swe|
|00000700| 64 65 6e 29 0d 0a 42 72 | 20 4d 65 64 20 4a 20 32 |den)..Br| Med J 2|
|00000710| 39 37 3a 39 34 33 2d 39 | 34 38 2c 20 4f 63 74 20 |97:943-9|48, Oct |
|00000720| 31 35 2c 20 31 39 38 38 | 0d 0a 2d 2d 2d 2d 2d 2d |15, 1988|..------|
|00000730| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000740| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000750| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000760| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000770| 2d 2d 2d 2d 2d 2d 2d 2d | 0d 0a 0d 0a 41 62 73 74 |--------|....Abst|
|00000780| 72 61 63 74 0d 0a 0d 0a | 20 20 20 20 20 4d 61 6d |ract....| Mam|
|00000790| 6d 6f 67 72 61 70 68 79 | 20 69 73 20 61 20 73 65 |mography| is a se|
|000007a0| 6e 73 69 74 69 76 65 20 | 6d 65 74 68 6f 64 20 6f |nsitive |method o|
|000007b0| 66 20 64 65 74 65 63 74 | 69 6e 67 20 74 68 65 20 |f detect|ing the |
|000007c0| 65 61 72 6c 79 20 6f 6e | 73 65 74 20 6f 66 20 62 |early on|set of b|
|000007d0| 72 65 61 73 74 0d 0a 63 | 61 6e 63 65 72 2e 20 20 |reast..c|ancer. |
|000007e0| 54 6f 20 64 65 74 65 72 | 6d 69 6e 65 20 77 68 65 |To deter|mine whe|
|000007f0| 74 68 65 72 20 6d 6f 72 | 74 61 6c 69 74 79 20 66 |ther mor|tality f|
|00000800| 72 6f 6d 20 62 72 65 61 | 73 74 20 63 61 6e 63 65 |rom brea|st cance|
|00000810| 72 20 63 61 6e 20 62 65 | 20 72 65 64 75 63 65 64 |r can be| reduced|
|00000820| 20 62 79 0d 0a 72 65 70 | 65 61 74 65 64 20 6d 61 | by..rep|eated ma|
|00000830| 6d 6d 6f 67 72 61 70 68 | 69 63 20 73 63 72 65 65 |mmograph|ic scree|
|00000840| 6e 69 6e 67 2c 20 77 6f | 6d 65 6e 20 62 6f 72 6e |ning, wo|men born|
|00000850| 20 62 65 74 77 65 65 6e | 20 31 39 30 38 20 61 6e | between| 1908 an|
|00000860| 64 20 31 39 33 32 20 77 | 65 72 65 0d 0a 72 61 6e |d 1932 w|ere..ran|
|00000870| 64 6f 6d 69 7a 65 64 20 | 69 6e 74 6f 20 61 20 73 |domized |into a s|
|00000880| 74 75 64 79 20 67 72 6f | 75 70 20 61 6e 64 20 69 |tudy gro|up and i|
|00000890| 6e 76 69 74 65 64 20 66 | 6f 72 20 6d 61 6d 6d 6f |nvited f|or mammo|
|000008a0| 67 72 61 70 68 69 63 20 | 73 63 72 65 65 6e 69 6e |graphic |screenin|
|000008b0| 67 20 61 74 0d 0a 69 6e | 74 65 72 76 61 6c 73 20 |g at..in|tervals |
|000008c0| 6f 66 20 31 38 2d 32 34 | 20 6d 6f 6e 74 68 73 2e |of 18-24| months.|
|000008d0| 20 20 54 68 65 72 65 20 | 77 65 72 65 20 32 31 2c | There |were 21,|
|000008e0| 30 38 38 20 70 61 74 69 | 65 6e 74 73 20 61 6e 64 |088 pati|ents and|
|000008f0| 20 32 31 2c 31 39 35 20 | 63 6f 6e 74 72 6f 6c 73 | 21,195 |controls|
|00000900| 2e 0d 0a 42 72 65 61 73 | 74 20 63 61 6e 63 65 72 |...Breas|t cancer|
|00000910| 20 77 61 73 20 74 72 65 | 61 74 65 64 20 61 63 63 | was tre|ated acc|
|00000920| 6f 72 64 69 6e 67 20 74 | 6f 20 73 74 61 67 65 20 |ording t|o stage |
|00000930| 61 74 20 64 69 61 67 6e | 6f 73 69 73 2e 20 20 54 |at diagn|osis. T|
|00000940| 68 65 20 6d 65 61 6e 20 | 64 75 72 61 74 69 6f 6e |he mean |duration|
|00000950| 0d 0a 6f 66 20 66 6f 6c | 6c 6f 77 2d 75 70 20 77 |..of fol|low-up w|
|00000960| 61 73 20 38 2e 38 20 79 | 65 61 72 73 2e 20 20 54 |as 8.8 y|ears. T|
|00000970| 68 65 20 63 61 75 73 65 | 20 6f 66 20 64 65 61 74 |he cause| of deat|
|00000980| 68 20 77 61 73 20 64 65 | 74 65 72 6d 69 6e 65 64 |h was de|termined|
|00000990| 20 66 72 6f 6d 20 74 68 | 65 0d 0a 6e 61 74 69 6f | from th|e..natio|
|000009a0| 6e 61 6c 20 6d 6f 72 74 | 61 6c 69 74 79 20 72 65 |nal mort|ality re|
|000009b0| 67 69 73 74 72 79 20 61 | 6e 64 20 77 61 73 20 76 |gistry a|nd was v|
|000009c0| 61 6c 69 64 61 74 65 64 | 20 69 6e 64 65 70 65 6e |alidated| indepen|
|000009d0| 64 65 6e 74 6c 79 20 69 | 6e 20 70 61 74 69 65 6e |dently i|n patien|
|000009e0| 74 73 20 77 69 74 68 0d | 0a 62 72 65 61 73 74 20 |ts with.|.breast |
|000009f0| 63 61 6e 63 65 72 2e 0d | 0a 20 20 20 20 20 42 72 |cancer..|. Br|
|00000a00| 65 61 73 74 20 63 61 6e | 63 65 72 20 64 65 76 65 |east can|cer deve|
|00000a10| 6c 6f 70 65 64 20 69 6e | 20 31 2c 30 33 35 20 77 |loped in| 1,035 w|
|00000a20| 6f 6d 65 6e 2c 20 35 38 | 38 20 69 6e 20 74 68 65 |omen, 58|8 in the|
|00000a30| 20 73 74 75 64 79 20 67 | 72 6f 75 70 20 61 6e 64 | study g|roup and|
|00000a40| 20 34 34 37 20 69 6e 0d | 0a 74 68 65 20 63 6f 6e | 447 in.|.the con|
|00000a50| 74 72 6f 6c 20 67 72 6f | 75 70 2e 20 20 54 68 65 |trol gro|up. The|
|00000a60| 20 74 75 6d 6f 72 73 20 | 61 70 70 65 61 72 65 64 | tumors |appeared|
|00000a70| 20 64 75 72 69 6e 67 20 | 74 68 65 20 69 6e 74 65 | during |the inte|
|00000a80| 72 76 61 6c 73 20 62 65 | 74 77 65 65 6e 20 73 63 |rvals be|tween sc|
|00000a90| 72 65 65 6e 69 6e 67 0d | 0a 69 6e 20 31 37 25 20 |reening.|.in 17% |
|00000aa0| 6f 66 20 74 68 65 20 73 | 74 75 64 79 20 70 61 74 |of the s|tudy pat|
|00000ab0| 69 65 6e 74 73 20 61 6e | 64 20 69 6e 20 31 38 25 |ients an|d in 18%|
|00000ac0| 20 6f 66 20 63 6f 6e 74 | 72 6f 6c 73 2e 20 20 54 | of cont|rols. T|
|00000ad0| 68 65 20 63 61 6e 63 65 | 72 73 20 63 6c 61 73 73 |he cance|rs class|
|00000ae0| 65 64 20 61 73 0d 0a 73 | 74 61 67 65 73 20 49 49 |ed as..s|tages II|
|00000af0| 2d 49 56 20 6f 63 63 75 | 72 72 65 64 20 69 6e 20 |-IV occu|rred in |
|00000b00| 33 33 25 20 6f 66 20 74 | 68 65 20 73 74 75 64 79 |33% of t|he study|
|00000b10| 20 67 72 6f 75 70 20 61 | 6e 64 20 69 6e 20 35 32 | group a|nd in 52|
|00000b20| 25 20 6f 66 20 74 68 65 | 20 63 6f 6e 74 72 6f 6c |% of the| control|
|00000b30| 73 2e 0d 0a 42 72 65 61 | 73 74 20 63 61 6e 63 65 |s...Brea|st cance|
|00000b40| 72 20 77 61 73 20 74 68 | 65 20 75 6e 64 65 72 6c |r was th|e underl|
|00000b50| 79 69 6e 67 20 63 61 75 | 73 65 20 6f 66 20 64 65 |ying cau|se of de|
|00000b60| 61 74 68 20 69 6e 20 36 | 33 20 73 74 75 64 79 20 |ath in 6|3 study |
|00000b70| 70 61 74 69 65 6e 74 73 | 20 61 6e 64 20 36 36 0d |patients| and 66.|
|00000b80| 0a 63 6f 6e 74 72 6f 6c | 73 3b 20 74 68 65 20 72 |.control|s; the r|
|00000b90| 65 6c 61 74 69 76 65 20 | 72 69 73 6b 20 77 61 73 |elative |risk was|
|00000ba0| 20 2e 39 36 2e 20 20 57 | 6f 6d 65 6e 20 79 6f 75 | .96. W|omen you|
|00000bb0| 6e 67 65 72 20 74 68 61 | 6e 20 35 35 20 79 65 61 |nger tha|n 55 yea|
|00000bc0| 72 73 20 69 6e 20 74 68 | 65 20 73 74 75 64 79 0d |rs in th|e study.|
|00000bd0| 0a 67 72 6f 75 70 20 68 | 61 64 20 61 20 32 39 25 |.group h|ad a 29%|
|00000be0| 20 68 69 67 68 65 72 20 | 6d 6f 72 74 61 6c 69 74 | higher |mortalit|
|00000bf0| 79 20 66 72 6f 6d 20 62 | 72 65 61 73 74 20 63 61 |y from b|reast ca|
|00000c00| 6e 63 65 72 20 28 72 65 | 6c 61 74 69 76 65 20 72 |ncer (re|lative r|
|00000c10| 69 73 6b 2c 20 31 2e 32 | 39 29 2e 0d 0a 4d 6f 72 |isk, 1.2|9)...Mor|
|00000c20| 65 20 77 6f 6d 65 6e 20 | 69 6e 20 74 68 65 20 73 |e women |in the s|
|00000c30| 74 75 64 79 20 67 72 6f | 75 70 20 64 69 65 64 20 |tudy gro|up died |
|00000c40| 6f 66 20 62 72 65 61 73 | 74 20 63 61 6e 63 65 72 |of breas|t cancer|
|00000c50| 20 64 75 72 69 6e 67 20 | 74 68 65 20 66 69 72 73 | during |the firs|
|00000c60| 74 20 37 20 79 65 61 72 | 73 0d 0a 6f 66 20 74 68 |t 7 year|s..of th|
|00000c70| 65 20 73 63 72 65 65 6e | 69 6e 67 20 70 72 6f 67 |e screen|ing prog|
|00000c80| 72 61 6d 2c 20 62 75 74 | 20 74 68 65 20 74 72 65 |ram, but| the tre|
|00000c90| 6e 64 20 77 61 73 20 72 | 65 76 65 72 73 65 64 20 |nd was r|eversed |
|00000ca0| 74 68 65 72 65 61 66 74 | 65 72 2c 20 65 73 70 65 |thereaft|er, espe|
|00000cb0| 63 69 61 6c 6c 79 20 69 | 6e 0d 0a 77 6f 6d 65 6e |cially i|n..women|
|00000cc0| 20 61 67 65 64 20 35 35 | 20 61 6e 64 20 6f 76 65 | aged 55| and ove|
|00000cd0| 72 20 61 74 20 65 6e 74 | 72 79 2e 20 20 4f 76 65 |r at ent|ry. Ove|
|00000ce0| 72 61 6c 6c 2c 20 77 6f | 6d 65 6e 20 69 6e 20 74 |rall, wo|men in t|
|00000cf0| 68 65 20 73 74 75 64 79 | 20 67 72 6f 75 70 20 61 |he study| group a|
|00000d00| 67 65 64 20 35 35 0d 0a | 68 61 64 20 61 20 32 30 |ged 55..|had a 20|
|00000d10| 25 20 72 65 64 75 63 74 | 69 6f 6e 20 69 6e 20 64 |% reduct|ion in d|
|00000d20| 65 61 74 68 73 20 66 72 | 6f 6d 20 62 72 65 61 73 |eaths fr|om breas|
|00000d30| 74 20 63 61 6e 63 65 72 | 20 28 72 65 6c 61 74 69 |t cancer| (relati|
|00000d40| 76 65 20 72 69 73 6b 2c | 20 2e 37 39 29 2e 20 20 |ve risk,| .79). |
|00000d50| 41 6e 0d 0a 69 6e 76 69 | 74 61 74 69 6f 6e 20 74 |An..invi|tation t|
|00000d60| 6f 20 6d 61 6d 6d 6f 67 | 72 61 70 68 69 63 20 73 |o mammog|raphic s|
|00000d70| 63 72 65 65 6e 69 6e 67 | 20 66 6f 72 20 62 72 65 |creening| for bre|
|00000d80| 61 73 74 20 63 61 6e 63 | 65 72 20 6d 61 79 20 6c |ast canc|er may l|
|00000d90| 65 61 64 20 74 6f 20 72 | 65 64 75 63 65 64 0d 0a |ead to r|educed..|
|00000da0| 6d 6f 72 74 61 6c 69 74 | 79 20 66 72 6f 6d 20 74 |mortalit|y from t|
|00000db0| 68 69 73 20 64 69 73 65 | 61 73 65 2c 20 61 74 20 |his dise|ase, at |
|00000dc0| 6c 65 61 73 74 20 69 6e | 20 77 6f 6d 65 6e 20 61 |least in| women a|
|00000dd0| 67 65 64 20 35 35 20 6f | 72 20 6d 6f 72 65 2e 0d |ged 55 o|r more..|
|00000de0| 0a 0d 0a 50 6f 73 74 2d | 43 6f 6d 6d 65 6e 74 0d |...Post-|Comment.|
|00000df0| 0a 0d 0a 20 20 20 20 20 | 42 65 63 61 75 73 65 20 |... |Because |
|00000e00| 6f 66 20 69 74 73 20 73 | 74 61 62 6c 65 20 70 6f |of its s|table po|
|00000e10| 70 75 6c 61 74 69 6f 6e | 2c 20 68 69 67 68 20 6c |pulation|, high l|
|00000e20| 65 76 65 6c 20 6f 66 20 | 63 6f 6d 70 6c 69 61 6e |evel of |complian|
|00000e30| 63 65 2c 20 61 6e 64 20 | 61 63 63 75 72 61 74 65 |ce, and |accurate|
|00000e40| 0d 0a 72 65 70 6f 72 74 | 69 6e 67 20 6f 66 20 64 |..report|ing of d|
|00000e50| 65 61 74 68 20 69 6e 66 | 6f 72 6d 61 74 69 6f 6e |eath inf|ormation|
|00000e60| 2c 20 53 77 65 64 65 6e | 20 69 73 20 61 6e 20 65 |, Sweden| is an e|
|00000e70| 78 63 65 6c 6c 65 6e 74 | 20 73 6f 75 72 63 65 20 |xcellent| source |
|00000e80| 6f 66 20 73 74 61 74 69 | 73 74 69 63 61 6c 0d 0a |of stati|stical..|
|00000e90| 64 61 74 61 20 6f 6e 20 | 74 68 65 20 65 66 66 65 |data on |the effe|
|00000ea0| 63 74 69 76 65 6e 65 73 | 73 20 6f 66 20 70 72 65 |ctivenes|s of pre|
|00000eb0| 76 65 6e 74 61 74 69 76 | 65 20 68 65 61 6c 74 68 |ventativ|e health|
|00000ec0| 20 6d 65 61 73 75 72 65 | 73 2e 20 20 4d 61 6e 79 | measure|s. Many|
|00000ed0| 20 70 72 65 63 69 73 65 | 0d 0a 6c 61 72 67 65 2d | precise|..large-|
|00000ee0| 73 63 61 6c 65 20 72 65 | 70 6f 72 74 73 20 6f 6e |scale re|ports on|
|00000ef0| 20 74 68 65 20 75 73 65 | 20 6f 66 20 73 63 72 65 | the use| of scre|
|00000f00| 65 6e 69 6e 67 20 6d 61 | 6d 6d 6f 67 72 61 70 68 |ening ma|mmograph|
|00000f10| 79 20 68 61 76 65 20 62 | 65 65 6e 20 70 75 62 6c |y have b|een publ|
|00000f20| 69 73 68 65 64 20 62 79 | 0d 0a 63 65 6e 74 65 72 |ished by|..center|
|00000f30| 73 20 69 6e 20 53 77 65 | 64 65 6e 2e 20 20 54 68 |s in Swe|den. Th|
|00000f40| 69 73 20 73 74 75 64 79 | 20 61 64 64 73 20 74 6f |is study| adds to|
|00000f50| 20 74 68 65 20 70 72 65 | 76 69 6f 75 73 20 72 65 | the pre|vious re|
|00000f60| 70 6f 72 74 73 20 73 75 | 70 70 6f 72 74 69 6e 67 |ports su|pporting|
|00000f70| 20 74 68 65 0d 0a 76 61 | 6c 69 64 69 74 79 20 6f | the..va|lidity o|
|00000f80| 66 20 73 63 72 65 65 6e | 69 6e 67 20 6d 61 6d 6d |f screen|ing mamm|
|00000f90| 6f 67 72 61 70 68 79 20 | 69 6e 20 77 6f 6d 65 6e |ography |in women|
|00000fa0| 20 6d 6f 72 65 20 74 68 | 61 6e 20 35 30 20 79 65 | more th|an 50 ye|
|00000fb0| 61 72 73 20 6f 66 20 61 | 67 65 2e 20 20 54 68 65 |ars of a|ge. The|
|00000fc0| 0d 0a 63 6f 73 74 2f 62 | 65 6e 65 66 69 74 20 72 |..cost/b|enefit r|
|00000fd0| 61 74 69 6f 20 61 6e 64 | 20 70 75 62 6c 69 63 20 |atio and| public |
|00000fe0| 68 65 61 6c 74 68 20 65 | 66 66 65 63 74 69 76 65 |health e|ffective|
|00000ff0| 6e 65 73 73 20 6f 66 20 | 73 63 72 65 65 6e 69 6e |ness of |screenin|
|00001000| 67 20 6d 61 6d 6d 6f 67 | 72 61 70 68 79 0d 0a 66 |g mammog|raphy..f|
|00001010| 6f 72 20 77 6f 6d 65 6e | 20 79 6f 75 6e 67 65 72 |or women| younger|
|00001020| 20 74 68 61 6e 20 35 30 | 20 79 65 61 72 73 20 63 | than 50| years c|
|00001030| 6f 6e 74 69 6e 75 65 20 | 74 6f 20 62 65 20 64 65 |ontinue |to be de|
|00001040| 62 61 74 65 64 2e 20 20 | 54 68 65 20 73 75 72 76 |bated. |The surv|
|00001050| 69 76 61 6c 20 62 65 6e | 65 66 69 74 0d 0a 74 6f |ival ben|efit..to|
|00001060| 20 74 68 65 20 69 6e 64 | 69 76 69 64 75 61 6c 20 | the ind|ividual |
|00001070| 77 6f 6d 61 6e 20 6f 66 | 20 61 6e 79 20 61 67 65 |woman of| any age|
|00001080| 20 77 68 6f 73 65 20 6e | 6f 6e 70 61 6c 70 61 62 | whose n|onpalpab|
|00001090| 6c 65 20 62 72 65 61 73 | 74 20 63 61 6e 63 65 72 |le breas|t cancer|
|000010a0| 20 69 73 20 64 65 74 65 | 63 74 65 64 0d 0a 62 79 | is dete|cted..by|
|000010b0| 20 73 63 72 65 65 6e 69 | 6e 67 20 6d 61 6d 6d 6f | screeni|ng mammo|
|000010c0| 67 72 61 70 68 79 20 69 | 73 20 77 65 6c 6c 20 64 |graphy i|s well d|
|000010d0| 6f 63 75 6d 65 6e 74 65 | 64 20 69 6e 20 6e 75 6d |ocumente|d in num|
|000010e0| 65 72 6f 75 73 20 73 74 | 75 64 69 65 73 2e 2d 2d |erous st|udies.--|
|000010f0| 57 2e 48 2e 20 48 69 6e | 64 6c 65 2c 0d 0a 4d 2e |W.H. Hin|dle,..M.|
|00001100| 44 2e 0d 0a 24 55 6e 69 | 71 75 65 5f 49 44 7b 59 |D...$Uni|que_ID{Y|
|00001110| 52 42 31 31 38 30 31 7d | 0d 0a 24 54 69 74 6c 65 |RB11801}|..$Title|
|00001120| 7b 44 65 63 72 65 61 73 | 65 64 20 42 72 65 61 73 |{Decreas|ed Breas|
|00001130| 74 20 43 61 6e 63 65 72 | 20 4d 6f 72 74 61 6c 69 |t Cancer| Mortali|
|00001140| 74 79 20 54 68 72 6f 75 | 67 68 20 4d 61 6d 6d 6f |ty Throu|gh Mammo|
|00001150| 67 72 61 70 68 69 63 20 | 53 63 72 65 65 6e 69 6e |graphic |Screenin|
|00001160| 67 3a 20 20 52 65 73 75 | 6c 74 73 20 6f 66 20 43 |g: Resu|lts of C|
|00001170| 6c 69 6e 69 63 61 6c 20 | 54 72 69 61 6c 73 7d 0d |linical |Trials}.|
|00001180| 0a 24 41 75 74 68 6f 72 | 7b 46 65 69 67 2c 20 53 |.$Author|{Feig, S|
|00001190| 41 7d 0d 0a 24 41 66 66 | 69 6c 69 61 74 69 6f 6e |A}..$Aff|iliation|
|000011a0| 7b 54 68 6f 6d 61 73 20 | 4a 65 66 66 65 72 73 6f |{Thomas |Jefferso|
|000011b0| 6e 20 55 6e 69 76 7d 0d | 0a 24 4a 6f 75 72 6e 61 |n Univ}.|.$Journa|
|000011c0| 6c 7b 52 61 64 69 6f 6c | 6f 67 79 7d 0d 0a 24 56 |l{Radiol|ogy}..$V|
|000011d0| 6f 6c 75 6d 65 7b 31 36 | 37 7d 0d 0a 24 50 61 67 |olume{16|7}..$Pag|
|000011e0| 65 7b 36 35 39 2d 36 36 | 35 7d 0d 0a 24 44 61 74 |e{659-66|5}..$Dat|
|000011f0| 65 7b 4a 75 6e 65 20 31 | 39 38 38 7d 0d 0a 24 59 |e{June 1|988}..$Y|
|00001200| 42 56 6f 6c 7b 31 39 39 | 30 20 59 65 61 72 20 42 |BVol{199|0 Year B|
|00001210| 6f 6f 6b 20 6f 66 20 4f | 62 73 74 65 74 72 69 63 |ook of O|bstetric|
|00001220| 73 20 61 6e 64 20 47 79 | 6e 65 63 6f 6c 6f 67 79 |s and Gy|necology|
|00001230| 7d 0d 0a 24 43 68 61 70 | 74 65 72 7b 32 31 2d 31 |}..$Chap|ter{21-1|
|00001240| 33 7d 0d 0a 24 59 42 45 | 64 69 74 6f 72 7b 44 72 |3}..$YBE|ditor{Dr|
|00001250| 73 2e 20 4d 69 73 68 65 | 6c 6c 2c 20 4b 69 72 73 |s. Mishe|ll, Kirs|
|00001260| 63 68 62 61 75 6d 2c 20 | 61 6e 64 20 4d 6f 72 72 |chbaum, |and Morr|
|00001270| 6f 77 7d 0d 0a 24 54 61 | 62 6c 65 7b 7d 0d 0a 24 |ow}..$Ta|ble{}..$|
|00001280| 43 6f 6d 6d 65 6e 74 61 | 74 6f 72 7b 57 2e 48 2e |Commenta|tor{W.H.|
|00001290| 20 48 69 6e 64 6c 65 2c | 20 4d 2e 44 2e 7d 0d 0a | Hindle,| M.D.}..|
|000012a0| 0d 0a 43 6f 70 79 72 69 | 67 68 74 20 28 63 29 20 |..Copyri|ght (c) |
|000012b0| 59 65 61 72 62 6f 6f 6b | 20 4d 65 64 69 63 61 6c |Yearbook| Medical|
|000012c0| 20 50 75 62 6c 69 73 68 | 65 72 73 2c 20 49 6e 63 | Publish|ers, Inc|
|000012d0| 2e 2c 20 31 39 39 30 0d | 0a 0d 0a 31 39 39 30 20 |., 1990.|...1990 |
|000012e0| 59 65 61 72 20 42 6f 6f | 6b 20 6f 66 20 4f 62 73 |Year Boo|k of Obs|
|000012f0| 74 65 74 72 69 63 73 20 | 61 6e 64 20 47 79 6e 65 |tetrics |and Gyne|
|00001300| 63 6f 6c 6f 67 79 20 28 | 52 29 0d 0a 0d 0a 43 68 |cology (|R)....Ch|
|00001310| 61 70 74 65 72 20 32 31 | 2d 2d 42 72 65 61 73 74 |apter 21|--Breast|
|00001320| 20 44 69 73 65 61 73 65 | 73 0d 0a 0d 0a 2d 2d 2d | Disease|s....---|
|00001330| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001340| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001350| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001360| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001370| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 0d 0a 44 65 63 |--------|---..Dec|
|00001380| 72 65 61 73 65 64 20 42 | 72 65 61 73 74 20 43 61 |reased B|reast Ca|
|00001390| 6e 63 65 72 20 4d 6f 72 | 74 61 6c 69 74 79 20 54 |ncer Mor|tality T|
|000013a0| 68 72 6f 75 67 68 20 4d | 61 6d 6d 6f 67 72 61 70 |hrough M|ammograp|
|000013b0| 68 69 63 20 53 63 72 65 | 65 6e 69 6e 67 3a 20 20 |hic Scre|ening: |
|000013c0| 52 65 73 75 6c 74 73 20 | 6f 66 0d 0a 43 6c 69 6e |Results |of..Clin|
|000013d0| 69 63 61 6c 20 54 72 69 | 61 6c 73 0d 0a 0d 0a 46 |ical Tri|als....F|
|000013e0| 65 69 67 20 53 41 0d 0a | 28 54 68 6f 6d 61 73 20 |eig SA..|(Thomas |
|000013f0| 4a 65 66 66 65 72 73 6f | 6e 20 55 6e 69 76 29 0d |Jefferso|n Univ).|
|00001400| 0a 52 61 64 69 6f 6c 6f | 67 79 20 31 36 37 3a 36 |.Radiolo|gy 167:6|
|00001410| 35 39 2d 36 36 35 2c 20 | 4a 75 6e 65 20 31 39 38 |59-665, |June 198|
|00001420| 38 0d 0a 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |8..-----|--------|
|00001430| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001440| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001450| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001460| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001470| 2d 0d 0a 0d 0a 41 62 73 | 74 72 61 63 74 0d 0a 0d |-....Abs|tract...|
|00001480| 0a 20 20 20 20 20 4e 61 | 74 69 6f 6e 61 6c 20 62 |. Na|tional b|
|00001490| 72 65 61 73 74 20 63 61 | 6e 63 65 72 20 6d 6f 72 |reast ca|ncer mor|
|000014a0| 74 61 6c 69 74 79 20 72 | 61 74 65 73 20 68 61 76 |tality r|ates hav|
|000014b0| 65 20 63 68 61 6e 67 65 | 64 20 6c 69 74 74 6c 65 |e change|d little|
|000014c0| 20 6f 72 20 6e 6f 74 20 | 61 74 20 61 6c 6c 0d 0a | or not |at all..|
|000014d0| 64 75 72 69 6e 67 20 72 | 65 63 65 6e 74 20 79 65 |during r|ecent ye|
|000014e0| 61 72 73 2e 20 20 41 73 | 20 74 68 65 72 65 20 69 |ars. As| there i|
|000014f0| 73 20 6e 6f 20 64 65 6d | 6f 6e 73 74 72 61 74 65 |s no dem|onstrate|
|00001500| 64 20 77 61 79 20 74 6f | 20 70 72 65 76 65 6e 74 |d way to| prevent|
|00001510| 20 62 72 65 61 73 74 0d | 0a 63 61 6e 63 65 72 2c | breast.|.cancer,|
|00001520| 20 6d 61 73 73 20 73 63 | 72 65 65 6e 69 6e 67 20 | mass sc|reening |
|00001530| 72 65 6d 61 69 6e 73 20 | 74 68 65 20 6f 6e 6c 79 |remains |the only|
|00001540| 20 6b 6e 6f 77 6e 20 6d | 65 61 6e 73 20 6f 66 20 | known m|eans of |
|00001550| 72 65 64 75 63 69 6e 67 | 20 62 72 65 61 73 74 20 |reducing| breast |
|00001560| 63 61 6e 63 65 72 0d 0a | 72 61 74 65 73 2e 20 20 |cancer..|rates. |
|00001570| 41 6c 74 68 6f 75 67 68 | 20 69 74 20 69 73 20 67 |Although| it is g|
|00001580| 65 6e 65 72 61 6c 6c 79 | 20 61 67 72 65 65 64 20 |enerally| agreed |
|00001590| 74 68 61 74 20 77 6f 6d | 65 6e 20 61 67 65 64 20 |that wom|en aged |
|000015a0| 35 30 20 79 65 61 72 73 | 20 61 6e 64 20 6f 6c 64 |50 years| and old|
|000015b0| 65 72 0d 0a 73 68 6f 75 | 6c 64 20 75 6e 64 65 72 |er..shou|ld under|
|000015c0| 67 6f 20 61 6e 6e 75 61 | 6c 20 73 63 72 65 65 6e |go annua|l screen|
|000015d0| 69 6e 67 20 6d 61 6d 6d | 6f 67 72 61 70 68 79 2c |ing mamm|ography,|
|000015e0| 20 74 68 65 20 61 64 76 | 69 73 61 62 69 6c 69 74 | the adv|isabilit|
|000015f0| 79 20 6f 66 20 73 63 72 | 65 65 6e 69 6e 67 0d 0a |y of scr|eening..|
|00001600| 77 6f 6d 65 6e 20 61 67 | 65 64 20 34 30 2d 35 30 |women ag|ed 40-50|
|00001610| 20 79 65 61 72 73 20 69 | 73 20 63 6f 6e 74 72 6f | years i|s contro|
|00001620| 76 65 72 73 69 61 6c 2c | 20 61 73 20 69 73 20 77 |versial,| as is w|
|00001630| 68 65 74 68 65 72 20 65 | 61 72 6c 79 20 64 65 74 |hether e|arly det|
|00001640| 65 63 74 69 6f 6e 20 61 | 6e 64 0d 0a 69 6e 63 72 |ection a|nd..incr|
|00001650| 65 61 73 65 64 20 73 75 | 72 76 69 76 61 6c 20 61 |eased su|rvival a|
|00001660| 63 74 75 61 6c 6c 79 20 | 72 65 73 75 6c 74 20 69 |ctually |result i|
|00001670| 6e 20 72 65 64 75 63 65 | 64 20 6d 6f 72 74 61 6c |n reduce|d mortal|
|00001680| 69 74 79 2e 0d 0a 20 20 | 20 20 20 41 20 63 6f 6d |ity... | A com|
|00001690| 62 69 6e 65 64 20 61 6e | 61 6c 79 73 69 73 20 77 |bined an|alysis w|
|000016a0| 61 73 20 6d 61 64 65 20 | 6f 66 20 64 61 74 61 20 |as made |of data |
|000016b0| 61 76 61 69 6c 61 62 6c | 65 20 66 72 6f 6d 20 6d |availabl|e from m|
|000016c0| 61 6a 6f 72 20 73 63 72 | 65 65 6e 69 6e 67 0d 0a |ajor scr|eening..|
|000016d0| 73 74 75 64 69 65 73 20 | 63 61 72 72 69 65 64 20 |studies |carried |
|000016e0| 6f 75 74 20 69 6e 20 74 | 68 65 20 55 6e 69 74 65 |out in t|he Unite|
|000016f0| 64 20 53 74 61 74 65 73 | 20 61 6e 64 20 61 62 72 |d States| and abr|
|00001700| 6f 61 64 2e 20 20 4f 66 | 20 32 20 73 74 75 64 69 |oad. Of| 2 studi|
|00001710| 65 73 20 64 6f 6e 65 20 | 69 6e 20 74 68 65 0d 0a |es done |in the..|
|00001720| 55 6e 69 74 65 64 20 53 | 74 61 74 65 73 2c 20 74 |United S|tates, t|
|00001730| 68 65 20 48 65 61 6c 74 | 68 20 49 6e 73 75 72 61 |he Healt|h Insura|
|00001740| 6e 63 65 20 50 6c 61 6e | 20 28 48 49 50 29 20 73 |nce Plan| (HIP) s|
|00001750| 74 75 64 79 20 77 61 73 | 20 72 61 6e 64 6f 6d 69 |tudy was| randomi|
|00001760| 7a 65 64 20 61 6e 64 0d | 0a 73 63 72 65 65 6e 65 |zed and.|.screene|
|00001770| 64 20 33 31 2c 30 30 30 | 20 77 6f 6d 65 6e 20 61 |d 31,000| women a|
|00001780| 67 65 64 20 34 30 2d 36 | 34 20 79 65 61 72 73 20 |ged 40-6|4 years |
|00001790| 62 79 20 6d 61 6d 6d 6f | 67 72 61 70 68 79 20 61 |by mammo|graphy a|
|000017a0| 6e 64 20 70 68 79 73 69 | 63 61 6c 0d 0a 65 78 61 |nd physi|cal..exa|
|000017b0| 6d 69 6e 61 74 69 6f 6e | 2c 20 77 68 65 72 65 61 |mination|, wherea|
|000017c0| 73 20 74 68 65 20 42 72 | 65 61 73 74 20 43 61 6e |s the Br|east Can|
|000017d0| 63 65 72 20 44 65 74 65 | 63 74 69 6f 6e 20 44 65 |cer Dete|ction De|
|000017e0| 6d 6f 6e 73 74 72 61 74 | 69 6f 6e 20 50 72 6f 6a |monstrat|ion Proj|
|000017f0| 65 63 74 20 77 61 73 20 | 6e 6f 74 0d 0a 72 61 6e |ect was |not..ran|
|00001800| 64 6f 6d 69 7a 65 64 2c | 20 61 6e 64 20 73 63 72 |domized,| and scr|
|00001810| 65 65 6e 65 64 20 32 38 | 30 2c 30 30 30 20 77 6f |eened 28|0,000 wo|
|00001820| 6d 65 6e 20 61 6c 73 6f | 20 62 79 20 6d 61 6d 6d |men also| by mamm|
|00001830| 6f 67 72 61 70 68 79 20 | 61 6e 64 20 70 68 79 73 |ography |and phys|
|00001840| 69 63 61 6c 0d 0a 65 78 | 61 6d 69 6e 61 74 69 6f |ical..ex|aminatio|
|00001850| 6e 2e 20 20 54 77 6f 20 | 72 61 6e 64 6f 6d 69 7a |n. Two |randomiz|
|00001860| 65 64 20 74 72 69 61 6c | 73 20 63 6f 6d 70 6c 65 |ed trial|s comple|
|00001870| 74 65 64 20 69 6e 20 53 | 77 65 64 65 6e 20 77 69 |ted in S|weden wi|
|00001880| 74 68 20 77 6f 6d 65 6e | 20 61 67 65 64 20 35 30 |th women| aged 50|
|00001890| 2d 37 34 0d 0a 79 65 61 | 72 73 20 75 73 65 64 20 |-74..yea|rs used |
|000018a0| 6f 6e 6c 79 20 6d 61 6d | 6d 6f 67 72 61 70 68 79 |only mam|mography|
|000018b0| 20 73 63 72 65 65 6e 69 | 6e 67 2c 20 61 6e 64 20 | screeni|ng, and |
|000018c0| 32 20 63 61 73 65 2d 63 | 6f 6e 74 72 6f 6c 20 73 |2 case-c|ontrol s|
|000018d0| 74 75 64 69 65 73 20 63 | 61 72 72 69 65 64 20 6f |tudies c|arried o|
|000018e0| 75 74 0d 0a 69 6e 20 54 | 68 65 20 4e 65 74 68 65 |ut..in T|he Nethe|
|000018f0| 72 6c 61 6e 64 73 20 77 | 69 74 68 20 77 6f 6d 65 |rlands w|ith wome|
|00001900| 6e 20 61 67 65 64 20 33 | 35 2d 36 35 20 79 65 61 |n aged 3|5-65 yea|
|00001910| 72 73 20 75 73 65 64 20 | 6f 6e 6c 79 20 73 69 6e |rs used |only sin|
|00001920| 67 6c 65 2d 76 69 65 77 | 0d 0a 6d 61 6d 6d 6f 67 |gle-view|..mammog|
|00001930| 72 61 70 68 79 20 70 65 | 72 66 6f 72 6d 65 64 20 |raphy pe|rformed |
|00001940| 62 69 61 6e 6e 75 61 6c | 6c 79 2e 0d 0a 20 20 20 |biannual|ly... |
|00001950| 20 20 41 6e 61 6c 79 73 | 69 73 20 6f 66 20 74 68 | Analys|is of th|
|00001960| 65 20 64 61 74 61 20 63 | 6f 6e 66 69 72 6d 65 64 |e data c|onfirmed|
|00001970| 20 61 20 6d 6f 72 74 61 | 6c 69 74 79 20 72 65 64 | a morta|lity red|
|00001980| 75 63 74 69 6f 6e 20 61 | 6d 6f 6e 67 20 61 6c 6c |uction a|mong all|
|00001990| 20 77 6f 6d 65 6e 0d 0a | 73 63 72 65 65 6e 65 64 | women..|screened|
|000019a0| 20 62 65 66 6f 72 65 20 | 61 67 65 20 35 30 20 79 | before |age 50 y|
|000019b0| 65 61 72 73 20 69 6e 20 | 74 68 65 20 53 77 65 64 |ears in |the Swed|
|000019c0| 69 73 68 20 73 74 75 64 | 79 20 61 6e 64 20 74 68 |ish stud|y and th|
|000019d0| 65 20 48 49 50 20 73 74 | 75 64 79 2c 20 61 6e 64 |e HIP st|udy, and|
|000019e0| 0d 0a 73 74 72 6f 6e 67 | 6c 79 20 73 75 67 67 65 |..strong|ly sugge|
|000019f0| 73 74 65 64 20 61 20 73 | 69 6d 69 6c 61 72 20 62 |sted a s|imilar b|
|00001a00| 65 6e 65 66 69 74 20 61 | 6d 6f 6e 67 20 77 6f 6d |enefit a|mong wom|
|00001a10| 65 6e 20 61 67 65 64 20 | 34 30 2d 35 30 20 79 65 |en aged |40-50 ye|
|00001a20| 61 72 73 20 66 6f 72 20 | 61 6c 6c 0d 0a 73 74 75 |ars for |all..stu|
|00001a30| 64 69 65 73 2e 20 20 43 | 6f 6d 70 61 72 65 64 20 |dies. C|ompared |
|00001a40| 77 69 74 68 20 74 68 65 | 73 65 20 62 65 6e 65 66 |with the|se benef|
|00001a50| 69 74 73 2c 20 74 68 65 | 20 70 6f 73 73 69 62 6c |its, the| possibl|
|00001a60| 65 20 72 61 64 69 61 74 | 69 6f 6e 20 72 69 73 6b |e radiat|ion risk|
|00001a70| 20 66 72 6f 6d 0d 0a 6c | 6f 77 2d 64 6f 73 65 20 | from..l|ow-dose |
|00001a80| 6d 61 6d 6d 6f 67 72 61 | 70 68 79 20 69 73 20 65 |mammogra|phy is e|
|00001a90| 69 74 68 65 72 20 6e 65 | 67 6c 69 67 69 62 6c 65 |ither ne|gligible|
|00001aa0| 20 6f 72 20 6e 6f 6e 65 | 78 69 73 74 65 6e 74 2e | or none|xistent.|
|00001ab0| 20 20 49 6e 63 72 65 61 | 73 69 6e 67 6c 79 0d 0a | Increa|singly..|
|00001ac0| 63 6f 6d 70 65 6c 6c 69 | 6e 67 20 65 76 69 64 65 |compelli|ng evide|
|00001ad0| 6e 63 65 20 6f 66 20 74 | 68 65 20 62 65 6e 65 66 |nce of t|he benef|
|00001ae0| 69 74 20 6f 66 20 61 6e | 6e 75 61 6c 20 6d 61 6d |it of an|nual mam|
|00001af0| 6d 6f 67 72 61 70 68 79 | 20 73 63 72 65 65 6e 69 |mography| screeni|
|00001b00| 6e 67 20 69 6e 20 79 6f | 75 6e 67 65 72 0d 0a 77 |ng in yo|unger..w|
|00001b10| 6f 6d 65 6e 2c 20 61 6e | 64 20 74 68 65 20 63 6f |omen, an|d the co|
|00001b20| 6e 74 69 6e 75 69 6e 67 | 20 72 65 64 75 63 74 69 |ntinuing| reducti|
|00001b30| 6f 6e 20 69 6e 20 72 61 | 64 69 61 74 69 6f 6e 20 |on in ra|diation |
|00001b40| 64 6f 73 65 2c 20 69 6e | 64 69 63 61 74 65 20 74 |dose, in|dicate t|
|00001b50| 68 61 74 20 61 6e 6e 75 | 61 6c 0d 0a 73 63 72 65 |hat annu|al..scre|
|00001b60| 65 6e 69 6e 67 20 66 6f | 72 20 61 6c 6c 20 77 6f |ening fo|r all wo|
|00001b70| 6d 65 6e 20 61 67 65 64 | 20 34 30 2d 35 30 20 79 |men aged| 40-50 y|
|00001b80| 65 61 72 73 20 69 73 20 | 77 65 6c 6c 20 6a 75 73 |ears is |well jus|
|00001b90| 74 69 66 69 65 64 2e 0d | 0a 20 20 20 20 20 54 68 |tified..|. Th|
|00001ba0| 65 73 65 20 66 69 6e 64 | 69 6e 67 73 20 69 6e 64 |ese find|ings ind|
|00001bb0| 69 63 61 74 65 20 74 68 | 61 74 20 61 6e 6e 75 61 |icate th|at annua|
|00001bc0| 6c 20 73 63 72 65 65 6e | 69 6e 67 20 6f 66 20 61 |l screen|ing of a|
|00001bd0| 6c 6c 20 77 6f 6d 65 6e | 20 61 67 65 64 20 34 30 |ll women| aged 40|
|00001be0| 20 79 65 61 72 73 0d 0a | 61 6e 64 20 6f 6c 64 65 | years..|and olde|
|00001bf0| 72 20 75 73 69 6e 67 20 | 73 74 61 74 65 2d 6f 66 |r using |state-of|
|00001c00| 2d 74 68 65 2d 61 72 74 | 20 6d 61 6d 6d 6f 67 72 |-the-art| mammogr|
|00001c10| 61 70 68 79 20 77 69 74 | 68 20 32 20 76 69 65 77 |aphy wit|h 2 view|
|00001c20| 73 20 70 65 72 20 62 72 | 65 61 73 74 20 61 6e 64 |s per br|east and|
|00001c30| 0d 0a 70 68 79 73 69 63 | 61 6c 20 65 78 61 6d 69 |..physic|al exami|
|00001c40| 6e 61 74 69 6f 6e 20 63 | 6f 75 6c 64 20 72 65 64 |nation c|ould red|
|00001c50| 75 63 65 20 62 72 65 61 | 73 74 20 63 61 6e 63 65 |uce brea|st cance|
|00001c60| 72 20 6d 6f 72 74 61 6c | 69 74 79 20 62 79 20 61 |r mortal|ity by a|
|00001c70| 74 20 6c 65 61 73 74 20 | 34 30 25 20 61 6e 64 0d |t least |40% and.|
|00001c80| 0a 70 6f 73 73 69 62 6c | 79 20 62 79 20 61 73 20 |.possibl|y by as |
|00001c90| 6d 75 63 68 20 61 73 20 | 35 30 25 2e 0d 0a 0d 0a |much as |50%.....|
|00001ca0| 50 6f 73 74 2d 43 6f 6d | 6d 65 6e 74 0d 0a 0d 0a |Post-Com|ment....|
|00001cb0| 20 20 20 20 20 54 68 69 | 73 20 64 65 74 61 69 6c | Thi|s detail|
|00001cc0| 65 64 20 61 6e 61 6c 79 | 73 69 73 20 6f 66 20 35 |ed analy|sis of 5|
|00001cd0| 20 6c 61 72 67 65 20 73 | 63 72 65 65 6e 69 6e 67 | large s|creening|
|00001ce0| 20 6d 61 6d 6d 6f 67 72 | 61 70 68 79 20 73 74 75 | mammogr|aphy stu|
|00001cf0| 64 69 65 73 20 63 6f 6e | 63 6c 75 64 65 73 0d 0a |dies con|cludes..|
|00001d00| 74 68 61 74 20 74 68 65 | 20 61 63 63 65 70 74 65 |that the| accepte|
|00001d10| 64 20 62 65 6e 65 66 69 | 74 73 20 6f 66 20 61 6e |d benefi|ts of an|
|00001d20| 6e 75 61 6c 20 73 63 72 | 65 65 6e 69 6e 67 20 6d |nual scr|eening m|
|00001d30| 61 6d 6d 6f 67 72 61 70 | 68 79 20 61 6e 64 20 63 |ammograp|hy and c|
|00001d40| 6c 69 6e 69 63 61 6c 0d | 0a 65 78 61 6d 69 6e 61 |linical.|.examina|
|00001d50| 74 69 6f 6e 20 66 6f 72 | 20 77 6f 6d 65 6e 20 6f |tion for| women o|
|00001d60| 6c 64 65 72 20 74 68 61 | 6e 20 35 30 20 61 72 65 |lder tha|n 50 are|
|00001d70| 20 61 70 70 6c 69 63 61 | 62 6c 65 20 74 6f 20 77 | applica|ble to w|
|00001d80| 6f 6d 65 6e 20 61 67 65 | 64 20 34 30 2d 35 30 20 |omen age|d 40-50 |
|00001d90| 61 73 0d 0a 77 65 6c 6c | 2e 20 20 54 68 65 20 70 |as..well|. The p|
|00001da0| 6f 74 65 6e 74 69 61 6c | 20 69 6d 70 72 6f 76 65 |otential| improve|
|00001db0| 6d 65 6e 74 20 69 6e 20 | 62 72 65 61 73 74 20 63 |ment in |breast c|
|00001dc0| 61 6e 63 65 72 20 73 75 | 72 76 69 76 61 6c 20 69 |ancer su|rvival i|
|00001dd0| 73 20 73 75 67 67 65 73 | 74 65 64 20 74 6f 20 62 |s sugges|ted to b|
|00001de0| 65 0d 0a 61 74 20 6c 65 | 61 73 74 20 34 30 25 20 |e..at le|ast 40% |
|00001df0| 61 6e 64 20 70 6f 73 73 | 69 62 6c 79 20 61 73 20 |and poss|ibly as |
|00001e00| 6d 75 63 68 20 61 73 20 | 35 30 25 2e 2d 2d 57 2e |much as |50%.--W.|
|00001e10| 48 2e 20 48 69 6e 64 6c | 65 2c 20 4d 2e 44 2e 0d |H. Hindl|e, M.D..|
|00001e20| 0a 24 55 6e 69 71 75 65 | 5f 49 44 7b 59 52 42 31 |.$Unique|_ID{YRB1|
|00001e30| 31 38 30 32 7d 0d 0a 24 | 54 69 74 6c 65 7b 4d 61 |1802}..$|Title{Ma|
|00001e40| 6d 6d 6f 67 72 61 70 68 | 79 20 69 6e 20 74 68 65 |mmograph|y in the|
|00001e50| 20 53 79 6d 70 74 6f 6d | 61 74 69 63 20 57 6f 6d | Symptom|atic Wom|
|00001e60| 61 6e 7d 0d 0a 24 41 75 | 74 68 6f 72 7b 45 64 65 |an}..$Au|thor{Ede|
|00001e70| 69 6b 65 6e 2c 20 53 7d | 0d 0a 24 41 66 66 69 6c |iken, S}|..$Affil|
|00001e80| 69 61 74 69 6f 6e 7b 4a | 65 72 73 65 79 20 53 68 |iation{J|ersey Sh|
|00001e90| 6f 72 65 20 4d 65 64 20 | 43 74 72 2c 20 4e 65 70 |ore Med |Ctr, Nep|
|00001ea0| 74 75 6e 65 2c 20 4e 4a | 7d 0d 0a 24 4a 6f 75 72 |tune, NJ|}..$Jour|
|00001eb0| 6e 61 6c 7b 43 61 6e 63 | 65 72 7d 0d 0a 24 56 6f |nal{Canc|er}..$Vo|
|00001ec0| 6c 75 6d 65 7b 36 33 7d | 0d 0a 24 50 61 67 65 7b |lume{63}|..$Page{|
|00001ed0| 31 34 31 32 2d 31 34 31 | 34 7d 0d 0a 24 44 61 74 |1412-141|4}..$Dat|
|00001ee0| 65 7b 41 70 72 20 31 2c | 20 31 39 38 39 7d 0d 0a |e{Apr 1,| 1989}..|
|00001ef0| 24 59 42 56 6f 6c 7b 31 | 39 39 30 20 59 65 61 72 |$YBVol{1|990 Year|
|00001f00| 20 42 6f 6f 6b 20 6f 66 | 20 4f 62 73 74 65 74 72 | Book of| Obstetr|
|00001f10| 69 63 73 20 61 6e 64 20 | 47 79 6e 65 63 6f 6c 6f |ics and |Gynecolo|
|00001f20| 67 79 7d 0d 0a 24 43 68 | 61 70 74 65 72 7b 32 31 |gy}..$Ch|apter{21|
|00001f30| 2d 31 34 7d 0d 0a 24 59 | 42 45 64 69 74 6f 72 7b |-14}..$Y|BEditor{|
|00001f40| 44 72 73 2e 20 4d 69 73 | 68 65 6c 6c 2c 20 4b 69 |Drs. Mis|hell, Ki|
|00001f50| 72 73 63 68 62 61 75 6d | 2c 20 61 6e 64 20 4d 6f |rschbaum|, and Mo|
|00001f60| 72 72 6f 77 7d 0d 0a 24 | 54 61 62 6c 65 7b 7d 0d |rrow}..$|Table{}.|
|00001f70| 0a 24 43 6f 6d 6d 65 6e | 74 61 74 6f 72 7b 57 2e |.$Commen|tator{W.|
|00001f80| 48 2e 20 48 69 6e 64 6c | 65 2c 20 4d 2e 44 2e 7d |H. Hindl|e, M.D.}|
|00001f90| 0d 0a 0d 0a 43 6f 70 79 | 72 69 67 68 74 20 28 63 |....Copy|right (c|
|00001fa0| 29 20 59 65 61 72 62 6f | 6f 6b 20 4d 65 64 69 63 |) Yearbo|ok Medic|
|00001fb0| 61 6c 20 50 75 62 6c 69 | 73 68 65 72 73 2c 20 49 |al Publi|shers, I|
|00001fc0| 6e 63 2e 2c 20 31 39 39 | 30 0d 0a 0d 0a 31 39 39 |nc., 199|0....199|
|00001fd0| 30 20 59 65 61 72 20 42 | 6f 6f 6b 20 6f 66 20 4f |0 Year B|ook of O|
|00001fe0| 62 73 74 65 74 72 69 63 | 73 20 61 6e 64 20 47 79 |bstetric|s and Gy|
|00001ff0| 6e 65 63 6f 6c 6f 67 79 | 20 28 52 29 0d 0a 0d 0a |necology| (R)....|
|00002000| 43 68 61 70 74 65 72 20 | 32 31 2d 2d 42 72 65 61 |Chapter |21--Brea|
|00002010| 73 74 20 44 69 73 65 61 | 73 65 73 0d 0a 0d 0a 2d |st Disea|ses....-|
|00002020| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002030| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002040| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002050| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002060| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 0d 0a 4d |--------|-----..M|
|00002070| 61 6d 6d 6f 67 72 61 70 | 68 79 20 69 6e 20 74 68 |ammograp|hy in th|
|00002080| 65 20 53 79 6d 70 74 6f | 6d 61 74 69 63 20 57 6f |e Sympto|matic Wo|
|00002090| 6d 61 6e 0d 0a 0d 0a 45 | 64 65 69 6b 65 6e 20 53 |man....E|deiken S|
|000020a0| 0d 0a 28 4a 65 72 73 65 | 79 20 53 68 6f 72 65 20 |..(Jerse|y Shore |
|000020b0| 4d 65 64 20 43 74 72 2c | 20 4e 65 70 74 75 6e 65 |Med Ctr,| Neptune|
|000020c0| 2c 20 4e 4a 29 0d 0a 43 | 61 6e 63 65 72 20 36 33 |, NJ)..C|ancer 63|
|000020d0| 3a 31 34 31 32 2d 31 34 | 31 34 2c 20 41 70 72 20 |:1412-14|14, Apr |
|000020e0| 31 2c 20 31 39 38 39 0d | 0a 2d 2d 2d 2d 2d 2d 2d |1, 1989.|.-------|
|000020f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002100| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002110| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002120| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002130| 2d 2d 2d 2d 2d 2d 2d 0d | 0a 0d 0a 41 62 73 74 72 |-------.|...Abstr|
|00002140| 61 63 74 0d 0a 0d 0a 20 | 20 20 20 20 54 68 65 20 |act.... | The |
|00002150| 65 66 66 69 63 61 63 79 | 20 6f 66 20 6d 61 6d 6d |efficacy| of mamm|
|00002160| 6f 67 72 61 70 68 79 20 | 61 73 20 61 20 73 63 72 |ography |as a scr|
|00002170| 65 65 6e 69 6e 67 20 74 | 65 73 74 20 74 6f 20 66 |eening t|est to f|
|00002180| 69 6e 64 20 6e 6f 6e 70 | 61 6c 70 61 62 6c 65 0d |ind nonp|alpable.|
|00002190| 0a 75 6e 73 75 73 70 65 | 63 74 65 64 20 62 72 65 |.unsuspe|cted bre|
|000021a0| 61 73 74 20 63 61 6e 63 | 65 72 20 69 73 20 75 6e |ast canc|er is un|
|000021b0| 71 75 65 73 74 69 6f 6e | 65 64 2e 20 20 49 74 73 |question|ed. Its|
|000021c0| 20 76 61 6c 75 65 20 69 | 6e 20 77 6f 6d 65 6e 20 | value i|n women |
|000021d0| 77 68 6f 20 68 61 76 65 | 0d 0a 73 79 6d 70 74 6f |who have|..sympto|
|000021e0| 6d 73 2c 20 68 6f 77 65 | 76 65 72 2c 20 68 61 73 |ms, howe|ver, has|
|000021f0| 20 6e 6f 74 20 62 65 65 | 6e 20 77 65 6c 6c 20 65 | not bee|n well e|
|00002200| 73 74 61 62 6c 69 73 68 | 65 64 2e 20 20 41 20 70 |stablish|ed. A p|
|00002210| 68 79 73 69 63 69 61 6e | 20 63 61 6e 6e 6f 74 20 |hysician| cannot |
|00002220| 64 65 70 65 6e 64 0d 0a | 6f 6e 20 6d 61 6d 6d 6f |depend..|on mammo|
|00002230| 67 72 61 70 68 79 20 74 | 6f 20 72 75 6c 65 20 6f |graphy t|o rule o|
|00002240| 75 74 20 62 72 65 61 73 | 74 20 63 61 6e 63 65 72 |ut breas|t cancer|
|00002250| 2c 20 62 75 74 20 6d 61 | 6d 6d 6f 67 72 61 70 68 |, but ma|mmograph|
|00002260| 79 20 69 73 20 65 73 73 | 65 6e 74 69 61 6c 20 69 |y is ess|ential i|
|00002270| 6e 20 74 68 65 0d 0a 64 | 65 63 69 73 69 6f 6e 20 |n the..d|ecision |
|00002280| 74 6f 20 64 6f 20 61 6e | 20 6f 70 65 6e 20 62 69 |to do an| open bi|
|00002290| 6f 70 73 79 20 6f 66 20 | 74 68 65 20 62 72 65 61 |opsy of |the brea|
|000022a0| 73 74 2e 0d 0a 20 20 20 | 20 20 49 6e 20 74 68 69 |st... | In thi|
|000022b0| 73 20 73 65 72 69 65 73 | 20 66 72 6f 6d 20 31 39 |s series| from 19|
|000022c0| 37 36 20 74 6f 20 31 39 | 38 37 2c 20 36 32 36 20 |76 to 19|87, 626 |
|000022d0| 77 6f 6d 65 6e 20 68 61 | 64 20 70 61 6c 70 61 62 |women ha|d palpab|
|000022e0| 6c 65 20 63 61 72 63 69 | 6e 6f 6d 61 20 61 6e 64 |le carci|noma and|
|000022f0| 0d 0a 75 6e 64 65 72 77 | 65 6e 74 20 6d 61 6d 6d |..underw|ent mamm|
|00002300| 6f 67 72 61 70 68 79 2e | 20 20 4f 66 20 74 68 65 |ography.| Of the|
|00002310| 73 65 2c 20 34 35 35 20 | 77 65 72 65 20 6f 6c 64 |se, 455 |were old|
|00002320| 65 72 20 74 68 61 6e 20 | 35 30 20 79 65 61 72 73 |er than |50 years|
|00002330| 3b 20 38 38 25 20 68 61 | 64 20 61 0d 0a 6d 61 6d |; 88% ha|d a..mam|
|00002340| 6d 6f 67 72 61 70 68 69 | 63 61 6c 6c 79 20 6d 61 |mographi|cally ma|
|00002350| 6c 69 67 6e 61 6e 74 20 | 6c 65 73 69 6f 6e 2e 20 |lignant |lesion. |
|00002360| 20 4f 6e 6c 79 20 35 37 | 25 20 6f 66 20 74 68 65 | Only 57|% of the|
|00002370| 20 77 6f 6d 65 6e 20 79 | 6f 75 6e 67 65 72 20 74 | women y|ounger t|
|00002380| 68 61 6e 20 35 31 0d 0a | 79 65 61 72 73 20 6f 66 |han 51..|years of|
|00002390| 20 61 67 65 20 68 61 64 | 20 61 20 6d 61 6d 6d 6f | age had| a mammo|
|000023a0| 67 72 61 70 68 69 63 61 | 6c 6c 79 20 6d 61 6c 69 |graphica|lly mali|
|000023b0| 67 6e 61 6e 74 20 6c 65 | 73 69 6f 6e 2e 20 20 57 |gnant le|sion. W|
|000023c0| 68 65 6e 20 74 68 65 20 | 63 61 6e 63 65 72 0d 0a |hen the |cancer..|
|000023d0| 70 72 65 73 65 6e 74 65 | 64 20 61 73 20 6e 69 70 |presente|d as nip|
|000023e0| 70 6c 65 20 64 69 73 63 | 68 61 72 67 65 20 6f 72 |ple disc|harge or|
|000023f0| 20 50 61 67 65 74 27 73 | 20 64 69 73 65 61 73 65 | Paget's| disease|
|00002400| 20 77 69 74 68 6f 75 74 | 20 61 20 6d 61 73 73 2c | without| a mass,|
|00002410| 20 6d 61 6d 6d 6f 67 72 | 61 70 68 79 0d 0a 64 69 | mammogr|aphy..di|
|00002420| 64 20 6e 6f 74 20 64 65 | 6d 6f 6e 73 74 72 61 74 |d not de|monstrat|
|00002430| 65 20 61 20 73 69 67 6e | 69 66 69 63 61 6e 74 20 |e a sign|ificant |
|00002440| 6c 65 73 69 6f 6e 2e 20 | 20 49 6e 20 74 68 65 20 |lesion. | In the |
|00002450| 63 6f 6e 74 72 61 6c 61 | 74 65 72 61 6c 20 62 72 |contrala|teral br|
|00002460| 65 61 73 74 2c 20 31 0d | 0a 75 6e 73 75 73 70 65 |east, 1.|.unsuspe|
|00002470| 63 74 65 64 20 73 79 6e | 63 68 72 6f 6e 6f 75 73 |cted syn|chronous|
|00002480| 20 63 61 6e 63 65 72 20 | 70 65 72 20 31 30 30 20 | cancer |per 100 |
|00002490| 70 61 74 69 65 6e 74 73 | 20 77 61 73 20 66 6f 75 |patients| was fou|
|000024a0| 6e 64 20 62 79 20 6d 61 | 6d 6d 6f 67 72 61 70 68 |nd by ma|mmograph|
|000024b0| 79 2e 20 20 49 6e 0d 0a | 77 6f 6d 65 6e 20 77 68 |y. In..|women wh|
|000024c0| 6f 20 68 61 64 20 70 72 | 65 76 69 6f 75 73 20 62 |o had pr|evious b|
|000024d0| 72 65 61 73 74 20 63 61 | 6e 63 65 72 73 20 61 6e |reast ca|ncers an|
|000024e0| 64 20 77 68 6f 20 77 65 | 72 65 20 66 6f 6c 6c 6f |d who we|re follo|
|000024f0| 77 65 64 20 66 6f 72 20 | 75 70 20 74 6f 20 31 31 |wed for |up to 11|
|00002500| 0d 0a 79 65 61 72 73 2c | 20 63 61 6e 63 65 72 20 |..years,| cancer |
|00002510| 6f 66 20 74 68 65 20 63 | 6f 6e 74 72 61 6c 61 74 |of the c|ontralat|
|00002520| 65 72 61 6c 20 62 72 65 | 61 73 74 20 64 65 76 65 |eral bre|ast deve|
|00002530| 6c 6f 70 65 64 20 69 6e | 20 31 31 25 2e 20 20 46 |loped in| 11%. F|
|00002540| 69 66 74 79 20 70 65 72 | 63 65 6e 74 20 6f 66 0d |ifty per|cent of.|
|00002550| 0a 74 68 65 20 6d 65 74 | 61 63 68 72 6f 6e 6f 75 |.the met|achronou|
|00002560| 73 20 63 61 6e 63 65 72 | 73 20 77 65 72 65 20 64 |s cancer|s were d|
|00002570| 65 74 65 63 74 65 64 20 | 62 79 20 6d 61 6d 6d 6f |etected |by mammo|
|00002580| 67 72 61 70 68 79 20 6f | 6e 6c 79 2e 20 20 49 6e |graphy o|nly. In|
|00002590| 20 31 2c 30 30 30 0d 0a | 73 79 6d 70 74 6f 6d 61 | 1,000..|symptoma|
|000025a0| 74 69 63 20 77 6f 6d 65 | 6e 20 77 68 6f 20 64 69 |tic wome|n who di|
|000025b0| 64 20 6e 6f 74 20 68 61 | 76 65 20 61 6e 20 69 6e |d not ha|ve an in|
|000025c0| 64 69 63 61 74 69 6f 6e | 20 66 6f 72 20 62 69 6f |dication| for bio|
|000025d0| 70 73 79 20 62 79 20 70 | 68 79 73 69 63 61 6c 0d |psy by p|hysical.|
|000025e0| 0a 65 78 61 6d 69 6e 61 | 74 69 6f 6e 2c 20 6d 61 |.examina|tion, ma|
|000025f0| 6d 6d 6f 67 72 61 70 68 | 79 20 64 65 74 65 63 74 |mmograph|y detect|
|00002600| 65 64 20 35 20 63 61 6e | 63 65 72 73 2e 0d 0a 20 |ed 5 can|cers... |
|00002610| 20 20 20 20 4d 61 6d 6d | 6f 67 72 61 70 68 79 20 | Mamm|ography |
|00002620| 63 61 6e 20 64 65 6d 6f | 6e 73 74 72 61 74 65 20 |can demo|nstrate |
|00002630| 75 6e 73 75 73 70 65 63 | 74 65 64 20 63 61 6e 63 |unsuspec|ted canc|
|00002640| 65 72 20 69 6e 20 77 6f | 6d 65 6e 20 77 69 74 68 |er in wo|men with|
|00002650| 20 62 72 65 61 73 74 0d | 0a 73 79 6d 70 74 6f 6d | breast.|.symptom|
|00002660| 73 2e 20 20 49 74 73 20 | 67 72 65 61 74 65 73 74 |s. Its |greatest|
|00002670| 20 76 61 6c 75 65 20 61 | 6d 6f 6e 67 20 73 79 6d | value a|mong sym|
|00002680| 70 74 6f 6d 61 74 69 63 | 20 77 6f 6d 65 6e 20 69 |ptomatic| women i|
|00002690| 73 20 69 6e 20 64 65 74 | 65 63 74 69 6e 67 0d 0a |s in det|ecting..|
|000026a0| 6d 65 74 61 63 68 72 6f | 6e 6f 75 73 20 63 61 6e |metachro|nous can|
|000026b0| 63 65 72 73 2e 20 20 41 | 20 22 6e 65 67 61 74 69 |cers. A| "negati|
|000026c0| 76 65 22 20 6d 61 6d 6d | 6f 67 72 61 6d 20 6d 75 |ve" mamm|ogram mu|
|000026d0| 73 74 20 6e 6f 74 20 62 | 65 20 75 73 65 64 20 74 |st not b|e used t|
|000026e0| 6f 20 6f 62 76 69 61 74 | 65 20 6f 72 0d 0a 64 65 |o obviat|e or..de|
|000026f0| 6c 61 79 20 62 69 6f 70 | 73 79 20 69 6e 20 77 6f |lay biop|sy in wo|
|00002700| 6d 65 6e 20 77 68 6f 20 | 68 61 76 65 20 63 6c 69 |men who |have cli|
|00002710| 6e 69 63 61 6c 20 69 6e | 64 69 63 61 74 69 6f 6e |nical in|dication|
|00002720| 73 20 66 6f 72 20 6f 70 | 65 6e 20 62 69 6f 70 73 |s for op|en biops|
|00002730| 79 2e 0d 0a 0d 0a 50 6f | 73 74 2d 43 6f 6d 6d 65 |y.....Po|st-Comme|
|00002740| 6e 74 0d 0a 0d 0a 20 20 | 20 20 20 49 6e 20 61 64 |nt.... | In ad|
|00002750| 64 69 74 69 6f 6e 20 74 | 6f 20 74 68 65 20 77 69 |dition t|o the wi|
|00002760| 64 65 20 61 63 63 65 70 | 74 61 6e 63 65 20 6f 66 |de accep|tance of|
|00002770| 20 6d 61 6d 6d 6f 67 72 | 61 70 68 79 20 61 73 20 | mammogr|aphy as |
|00002780| 74 68 65 20 73 63 72 65 | 65 6e 69 6e 67 0d 0a 6d |the scre|ening..m|
|00002790| 6f 64 61 6c 74 79 20 66 | 6f 72 20 6e 6f 6e 70 61 |odalty f|or nonpa|
|000027a0| 6c 70 61 62 6c 65 20 62 | 72 65 61 73 74 20 63 61 |lpable b|reast ca|
|000027b0| 6e 63 65 72 73 2c 20 74 | 68 69 73 20 72 65 70 6f |ncers, t|his repo|
|000027c0| 72 74 20 64 6f 63 75 6d | 65 6e 74 73 20 74 68 65 |rt docum|ents the|
|000027d0| 20 65 73 73 65 6e 74 69 | 61 6c 0d 0a 76 61 6c 75 | essenti|al..valu|
|000027e0| 65 20 6f 66 20 6d 61 6d | 6d 6f 67 72 61 70 68 79 |e of mam|mography|
|000027f0| 20 69 6e 20 74 68 65 20 | 65 76 61 6c 75 61 74 69 | in the |evaluati|
|00002800| 6f 6e 20 6f 66 20 77 6f | 6d 65 6e 20 77 69 74 68 |on of wo|men with|
|00002810| 20 70 61 6c 70 61 62 6c | 65 20 62 72 65 61 73 74 | palpabl|e breast|
|00002820| 20 6d 61 73 73 65 73 2e | 0d 0a 54 68 69 73 20 73 | masses.|..This s|
|00002830| 65 72 69 65 73 20 63 6f | 6e 66 69 72 6d 73 20 74 |eries co|nfirms t|
|00002840| 68 65 20 6c 6f 77 65 72 | 20 61 63 63 75 72 61 63 |he lower| accurac|
|00002850| 79 20 28 35 36 25 29 20 | 6f 66 20 6d 61 6d 6d 6f |y (56%) |of mammo|
|00002860| 67 72 61 70 68 79 20 69 | 6e 20 64 65 74 65 63 74 |graphy i|n detect|
|00002870| 69 6e 67 0d 0a 62 72 65 | 61 73 74 20 63 61 6e 63 |ing..bre|ast canc|
|00002880| 65 72 20 69 6e 20 77 6f | 6d 65 6e 20 79 6f 75 6e |er in wo|men youn|
|00002890| 67 65 72 20 74 68 61 6e | 20 61 67 65 20 35 30 20 |ger than| age 50 |
|000028a0| 79 65 61 72 73 20 61 6e | 64 20 73 68 6f 77 73 20 |years an|d shows |
|000028b0| 74 68 61 74 20 31 32 25 | 20 6f 66 0d 0a 70 61 6c |that 12%| of..pal|
|000028c0| 70 61 62 6c 65 20 63 61 | 6e 63 65 72 73 20 77 69 |pable ca|ncers wi|
|000028d0| 6c 6c 20 62 65 20 75 6e | 64 65 74 65 63 74 65 64 |ll be un|detected|
|000028e0| 20 62 79 20 6d 61 6d 6d | 6f 67 72 61 70 68 79 20 | by mamm|ography |
|000028f0| 69 6e 20 77 6f 6d 65 6e | 20 6f 6c 64 65 72 20 74 |in women| older t|
|00002900| 68 61 6e 20 35 30 0d 0a | 79 65 61 72 73 2e 20 20 |han 50..|years. |
|00002910| 54 68 65 20 63 72 69 74 | 69 63 61 6c 20 6c 65 73 |The crit|ical les|
|00002920| 73 6f 6e 20 69 73 20 74 | 68 61 74 20 61 20 22 6e |son is t|hat a "n|
|00002930| 65 67 61 74 69 76 65 22 | 20 6d 61 6d 6d 6f 67 72 |egative"| mammogr|
|00002940| 61 6d 20 64 6f 65 73 20 | 6e 6f 74 20 72 75 6c 65 |am does |not rule|
|00002950| 20 6f 75 74 0d 0a 63 61 | 6e 63 65 72 20 61 74 20 | out..ca|ncer at |
|00002960| 61 6e 79 20 61 67 65 2e | 2d 2d 57 2e 48 2e 20 48 |any age.|--W.H. H|
|00002970| 69 6e 64 6c 65 2c 20 4d | 2e 44 2e 0d 0a 24 55 6e |indle, M|.D...$Un|
|00002980| 69 71 75 65 5f 49 44 7b | 59 52 42 31 31 38 30 33 |ique_ID{|YRB11803|
|00002990| 7d 0d 0a 24 54 69 74 6c | 65 7b 45 69 67 68 74 2d |}..$Titl|e{Eight-|
|000029a0| 59 65 61 72 20 52 65 73 | 75 6c 74 73 20 6f 66 20 |Year Res|ults of |
|000029b0| 61 20 52 61 6e 64 6f 6d | 69 7a 65 64 20 43 6c 69 |a Random|ized Cli|
|000029c0| 6e 69 63 61 6c 20 54 72 | 69 61 6c 20 43 6f 6d 70 |nical Tr|ial Comp|
|000029d0| 61 72 69 6e 67 20 54 6f | 74 61 6c 20 4d 61 73 74 |aring To|tal Mast|
|000029e0| 65 63 74 6f 6d 79 20 61 | 6e 64 20 4c 75 6d 70 65 |ectomy a|nd Lumpe|
|000029f0| 63 74 6f 6d 79 20 57 69 | 74 68 20 6f 72 20 57 69 |ctomy Wi|th or Wi|
|00002a00| 74 68 6f 75 74 20 49 72 | 72 61 64 69 61 74 69 6f |thout Ir|radiatio|
|00002a10| 6e 20 69 6e 20 74 68 65 | 20 54 72 65 61 74 6d 65 |n in the| Treatme|
|00002a20| 6e 74 20 6f 66 20 42 72 | 65 61 73 74 20 43 61 6e |nt of Br|east Can|
|00002a30| 63 65 72 7d 0d 0a 24 41 | 75 74 68 6f 72 7b 46 69 |cer}..$A|uthor{Fi|
|00002a40| 73 68 65 72 2c 20 42 0d | 0a 52 65 64 6d 6f 6e 64 |sher, B.|.Redmond|
|00002a50| 2c 20 43 0d 0a 50 6f 69 | 73 73 6f 6e 2c 20 52 0d |, C..Poi|sson, R.|
|00002a60| 0a 4d 61 72 67 6f 6c 65 | 73 65 2c 20 52 0d 0a 57 |.Margole|se, R..W|
|00002a70| 6f 6c 6d 61 72 6b 2c 20 | 4e 0d 0a 57 69 63 6b 65 |olmark, |N..Wicke|
|00002a80| 72 68 61 6d 2c 20 4c 0d | 0a 46 69 73 68 65 72 2c |rham, L.|.Fisher,|
|00002a90| 20 45 0d 0a 44 65 75 74 | 73 63 68 2c 20 4d 0d 0a | E..Deut|sch, M..|
|00002aa0| 43 61 70 6c 61 6e 2c 20 | 52 0d 0a 50 69 6c 63 68 |Caplan, |R..Pilch|
|00002ab0| 2c 20 59 0d 0a 47 6c 61 | 73 73 2c 20 41 0d 0a 53 |, Y..Gla|ss, A..S|
|00002ac0| 68 69 62 61 74 61 2c 20 | 48 0d 0a 4c 65 72 6e 65 |hibata, |H..Lerne|
|00002ad0| 72 2c 20 48 0d 0a 54 65 | 72 7a 2c 20 4a 0d 0a 53 |r, H..Te|rz, J..S|
|00002ae0| 69 64 6f 72 6f 76 69 63 | 68 2c 20 4c 7d 0d 0a 24 |idorovic|h, L}..$|
|00002af0| 41 66 66 69 6c 69 61 74 | 69 6f 6e 7b 4e 61 74 6c |Affiliat|ion{Natl|
|00002b00| 20 53 75 72 67 69 63 61 | 6c 20 41 64 6a 75 76 61 | Surgica|l Adjuva|
|00002b10| 6e 74 20 42 72 65 61 73 | 74 20 61 6e 64 20 42 6f |nt Breas|t and Bo|
|00002b20| 77 65 6c 20 50 72 6f 6a | 65 63 74 2c 20 55 6e 69 |wel Proj|ect, Uni|
|00002b30| 76 20 6f 66 20 50 69 74 | 74 73 62 75 72 67 68 7d |v of Pit|tsburgh}|
|00002b40| 0d 0a 24 4a 6f 75 72 6e | 61 6c 7b 4e 20 45 6e 67 |..$Journ|al{N Eng|
|00002b50| 6c 20 4a 20 4d 65 64 7d | 0d 0a 24 56 6f 6c 75 6d |l J Med}|..$Volum|
|00002b60| 65 7b 33 32 30 7d 0d 0a | 24 50 61 67 65 7b 38 32 |e{320}..|$Page{82|
|00002b70| 32 2d 38 32 38 7d 0d 0a | 24 44 61 74 65 7b 4d 61 |2-828}..|$Date{Ma|
|00002b80| 72 63 68 20 33 30 2c 20 | 31 39 38 39 7d 0d 0a 24 |rch 30, |1989}..$|
|00002b90| 59 42 56 6f 6c 7b 31 39 | 39 30 20 59 65 61 72 20 |YBVol{19|90 Year |
|00002ba0| 42 6f 6f 6b 20 6f 66 20 | 4f 62 73 74 65 74 72 69 |Book of |Obstetri|
|00002bb0| 63 73 20 61 6e 64 20 47 | 79 6e 65 63 6f 6c 6f 67 |cs and G|ynecolog|
|00002bc0| 79 7d 0d 0a 24 43 68 61 | 70 74 65 72 7b 32 31 2d |y}..$Cha|pter{21-|
|00002bd0| 31 35 7d 0d 0a 24 59 42 | 45 64 69 74 6f 72 7b 44 |15}..$YB|Editor{D|
|00002be0| 72 73 2e 20 4d 69 73 68 | 65 6c 6c 2c 20 4b 69 72 |rs. Mish|ell, Kir|
|00002bf0| 73 63 68 62 61 75 6d 2c | 20 61 6e 64 20 4d 6f 72 |schbaum,| and Mor|
|00002c00| 72 6f 77 7d 0d 0a 24 54 | 61 62 6c 65 7b 54 61 62 |row}..$T|able{Tab|
|00002c10| 6c 65 20 4f 6d 69 74 74 | 65 64 7d 0d 0a 24 43 6f |le Omitt|ed}..$Co|
|00002c20| 6d 6d 65 6e 74 61 74 6f | 72 7b 43 2e 50 2e 20 4d |mmentato|r{C.P. M|
|00002c30| 6f 72 72 6f 77 2c 20 4d | 2e 44 2e 7d 0d 0a 0d 0a |orrow, M|.D.}....|
|00002c40| 43 6f 70 79 72 69 67 68 | 74 20 28 63 29 20 59 65 |Copyrigh|t (c) Ye|
|00002c50| 61 72 62 6f 6f 6b 20 4d | 65 64 69 63 61 6c 20 50 |arbook M|edical P|
|00002c60| 75 62 6c 69 73 68 65 72 | 73 2c 20 49 6e 63 2e 2c |ublisher|s, Inc.,|
|00002c70| 20 31 39 39 30 0d 0a 0d | 0a 31 39 39 30 20 59 65 | 1990...|.1990 Ye|
|00002c80| 61 72 20 42 6f 6f 6b 20 | 6f 66 20 4f 62 73 74 65 |ar Book |of Obste|
|00002c90| 74 72 69 63 73 20 61 6e | 64 20 47 79 6e 65 63 6f |trics an|d Gyneco|
|00002ca0| 6c 6f 67 79 20 28 52 29 | 0d 0a 0d 0a 43 68 61 70 |logy (R)|....Chap|
|00002cb0| 74 65 72 20 32 31 2d 2d | 42 72 65 61 73 74 20 44 |ter 21--|Breast D|
|00002cc0| 69 73 65 61 73 65 73 0d | 0a 0d 0a 2d 2d 2d 2d 2d |iseases.|...-----|
|00002cd0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002ce0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002cf0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002d00| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002d10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 0d 0a 45 69 67 68 74 |--------|-..Eight|
|00002d20| 2d 59 65 61 72 20 52 65 | 73 75 6c 74 73 20 6f 66 |-Year Re|sults of|
|00002d30| 20 61 20 52 61 6e 64 6f | 6d 69 7a 65 64 20 43 6c | a Rando|mized Cl|
|00002d40| 69 6e 69 63 61 6c 20 54 | 72 69 61 6c 20 43 6f 6d |inical T|rial Com|
|00002d50| 70 61 72 69 6e 67 20 54 | 6f 74 61 6c 20 4d 61 73 |paring T|otal Mas|
|00002d60| 74 65 63 74 6f 6d 79 0d | 0a 61 6e 64 20 4c 75 6d |tectomy.|.and Lum|
|00002d70| 70 65 63 74 6f 6d 79 20 | 57 69 74 68 20 6f 72 20 |pectomy |With or |
|00002d80| 57 69 74 68 6f 75 74 20 | 49 72 72 61 64 69 61 74 |Without |Irradiat|
|00002d90| 69 6f 6e 20 69 6e 20 74 | 68 65 20 54 72 65 61 74 |ion in t|he Treat|
|00002da0| 6d 65 6e 74 20 6f 66 20 | 42 72 65 61 73 74 20 43 |ment of |Breast C|
|00002db0| 61 6e 63 65 72 0d 0a 0d | 0a 46 69 73 68 65 72 20 |ancer...|.Fisher |
|00002dc0| 42 2c 20 52 65 64 6d 6f | 6e 64 20 43 2c 20 50 6f |B, Redmo|nd C, Po|
|00002dd0| 69 73 73 6f 6e 20 52 2c | 20 4d 61 72 67 6f 6c 65 |isson R,| Margole|
|00002de0| 73 65 20 52 2c 20 57 6f | 6c 6d 61 72 6b 20 4e 2c |se R, Wo|lmark N,|
|00002df0| 20 57 69 63 6b 65 72 68 | 61 6d 20 4c 2c 20 46 69 | Wickerh|am L, Fi|
|00002e00| 73 68 65 72 20 45 2c 0d | 0a 44 65 75 74 73 63 68 |sher E,.|.Deutsch|
|00002e10| 20 4d 2c 20 43 61 70 6c | 61 6e 20 52 2c 20 50 69 | M, Capl|an R, Pi|
|00002e20| 6c 63 68 20 59 2c 20 47 | 6c 61 73 73 20 41 2c 20 |lch Y, G|lass A, |
|00002e30| 53 68 69 62 61 74 61 20 | 48 2c 20 4c 65 72 6e 65 |Shibata |H, Lerne|
|00002e40| 72 20 48 2c 20 54 65 72 | 7a 20 4a 2c 0d 0a 53 69 |r H, Ter|z J,..Si|
|00002e50| 64 6f 72 6f 76 69 63 68 | 20 4c 0d 0a 28 4e 61 74 |dorovich| L..(Nat|
|00002e60| 6c 20 53 75 72 67 69 63 | 61 6c 20 41 64 6a 75 76 |l Surgic|al Adjuv|
|00002e70| 61 6e 74 20 42 72 65 61 | 73 74 20 61 6e 64 20 42 |ant Brea|st and B|
|00002e80| 6f 77 65 6c 20 50 72 6f | 6a 65 63 74 2c 20 55 6e |owel Pro|ject, Un|
|00002e90| 69 76 20 6f 66 20 50 69 | 74 74 73 62 75 72 67 68 |iv of Pi|ttsburgh|
|00002ea0| 29 0d 0a 4e 20 45 6e 67 | 6c 20 4a 20 4d 65 64 20 |)..N Eng|l J Med |
|00002eb0| 33 32 30 3a 38 32 32 2d | 38 32 38 2c 20 4d 61 72 |320:822-|828, Mar|
|00002ec0| 63 68 20 33 30 2c 20 31 | 39 38 39 0d 0a 2d 2d 2d |ch 30, 1|989..---|
|00002ed0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002ee0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002ef0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002f00| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002f10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 0d 0a 0d 0a 41 |--------|---....A|
|00002f20| 62 73 74 72 61 63 74 0d | 0a 0d 0a 20 20 20 20 20 |bstract.|... |
|00002f30| 41 20 72 65 70 6f 72 74 | 20 6f 66 20 31 2c 38 34 |A report| of 1,84|
|00002f40| 33 20 77 6f 6d 65 6e 20 | 66 6f 6c 6c 6f 77 65 64 |3 women |followed|
|00002f50| 20 66 6f 72 20 35 20 79 | 65 61 72 73 20 70 72 65 | for 5 y|ears pre|
|00002f60| 76 69 6f 75 73 6c 79 20 | 69 6e 64 69 63 61 74 65 |viously |indicate|
|00002f70| 64 20 74 68 61 74 0d 0a | 6c 75 6d 70 65 63 74 6f |d that..|lumpecto|
|00002f80| 6d 79 20 77 69 74 68 20 | 62 72 65 61 73 74 20 69 |my with |breast i|
|00002f90| 72 72 61 64 69 61 74 69 | 6f 6e 20 73 75 62 73 65 |rradiati|on subse|
|00002fa0| 71 75 65 6e 74 6c 79 20 | 69 73 20 61 70 70 72 6f |quently |is appro|
|00002fb0| 70 72 69 61 74 65 20 66 | 6f 72 20 70 61 74 69 65 |priate f|or patie|
|00002fc0| 6e 74 73 0d 0a 77 69 74 | 68 20 73 74 61 67 65 20 |nts..wit|h stage |
|00002fd0| 49 20 6f 72 20 49 49 20 | 62 72 65 61 73 74 20 63 |I or II |breast c|
|00002fe0| 61 6e 63 65 72 20 34 20 | 63 6d 20 6f 72 20 6c 65 |ancer 4 |cm or le|
|00002ff0| 73 73 20 69 6e 20 73 69 | 7a 65 20 69 66 20 74 68 |ss in si|ze if th|
|00003000| 65 20 72 65 73 65 63 74 | 69 6f 6e 20 6d 61 72 67 |e resect|ion marg|
|00003010| 69 6e 73 0d 0a 61 72 65 | 20 74 75 6d 6f 72 20 66 |ins..are| tumor f|
|00003020| 72 65 65 2e 20 20 57 6f | 6d 65 6e 20 77 69 74 68 |ree. Wo|men with|
|00003030| 20 70 6f 73 69 74 69 76 | 65 20 61 78 69 6c 6c 61 | positiv|e axilla|
|00003040| 72 79 20 6e 6f 64 65 73 | 20 72 65 63 65 69 76 65 |ry nodes| receive|
|00003050| 20 61 64 6a 75 76 61 6e | 74 0d 0a 63 68 65 6d 6f | adjuvan|t..chemo|
|00003060| 74 68 65 72 61 70 79 2e | 20 20 46 69 76 65 2d 79 |therapy.| Five-y|
|00003070| 65 61 72 20 73 75 72 76 | 69 76 61 6c 20 61 6e 64 |ear surv|ival and|
|00003080| 20 64 69 73 65 61 73 65 | 2d 66 72 65 65 20 73 75 | disease|-free su|
|00003090| 72 76 69 76 61 6c 20 72 | 61 74 65 73 20 62 6f 74 |rvival r|ates bot|
|000030a0| 68 20 66 61 76 6f 72 65 | 64 0d 0a 74 68 69 73 20 |h favore|d..this |
|000030b0| 72 65 67 69 6d 65 6e 20 | 6f 76 65 72 20 74 6f 74 |regimen |over tot|
|000030c0| 61 6c 20 6d 61 73 74 65 | 63 74 6f 6d 79 2e 0d 0a |al maste|ctomy...|
|000030d0| 20 20 20 20 20 54 68 72 | 6f 75 67 68 20 38 20 79 | Thr|ough 8 y|
|000030e0| 65 61 72 73 20 6f 66 20 | 66 6f 6c 6c 6f 77 2d 75 |ears of |follow-u|
|000030f0| 70 2c 20 39 30 25 20 6f | 66 20 77 6f 6d 65 6e 20 |p, 90% o|f women |
|00003100| 68 61 76 69 6e 67 20 6c | 75 6d 70 65 63 74 6f 6d |having l|umpectom|
|00003110| 79 20 66 6f 6c 6c 6f 77 | 65 64 20 62 79 0d 0a 72 |y follow|ed by..r|
|00003120| 61 64 69 6f 74 68 65 72 | 61 70 79 20 61 6e 64 20 |adiother|apy and |
|00003130| 36 31 25 20 6f 66 20 74 | 68 6f 73 65 20 6e 6f 74 |61% of t|hose not|
|00003140| 20 69 72 72 61 64 69 61 | 74 65 64 20 77 65 72 65 | irradia|ted were|
|00003150| 20 66 72 65 65 20 6f 66 | 20 69 70 73 69 6c 61 74 | free of| ipsilat|
|00003160| 65 72 61 6c 20 62 72 65 | 61 73 74 0d 0a 74 75 6d |eral bre|ast..tum|
|00003170| 6f 72 20 28 46 69 67 20 | 32 31 2d 31 29 2e 20 20 |or (Fig |21-1). |
|00003180| 4f 6e 6c 79 20 36 25 20 | 6f 66 20 70 61 74 69 65 |Only 6% |of patie|
|00003190| 6e 74 73 20 77 69 74 68 | 20 70 6f 73 69 74 69 76 |nts with| positiv|
|000031a0| 65 20 61 78 69 6c 6c 61 | 72 79 20 6e 6f 64 65 73 |e axilla|ry nodes|
|000031b0| 20 77 68 6f 0d 0a 72 65 | 63 65 69 76 65 64 20 72 | who..re|ceived r|
|000031c0| 61 64 69 6f 74 68 65 72 | 61 70 79 20 61 6e 64 20 |adiother|apy and |
|000031d0| 63 68 65 6d 6f 74 68 65 | 72 61 70 79 20 68 61 64 |chemothe|rapy had|
|000031e0| 20 61 20 72 65 63 75 72 | 72 65 6e 63 65 20 69 6e | a recur|rence in|
|000031f0| 20 74 68 65 20 73 61 6d | 65 20 62 72 65 61 73 74 | the sam|e breast|
|00003200| 2e 0d 0a 44 65 73 70 69 | 74 65 20 61 20 68 69 67 |...Despi|te a hig|
|00003210| 68 65 72 20 72 61 74 65 | 20 6f 66 20 72 65 63 75 |her rate| of recu|
|00003220| 72 72 65 6e 63 65 20 69 | 6e 20 75 6e 69 72 72 61 |rrence i|n unirra|
|00003230| 64 69 61 74 65 64 20 70 | 61 74 69 65 6e 74 73 2c |diated p|atients,|
|00003240| 20 74 68 65 72 65 20 77 | 61 73 20 6e 6f 0d 0a 73 | there w|as no..s|
|00003250| 69 67 6e 69 66 69 63 61 | 6e 74 20 64 69 66 66 65 |ignifica|nt diffe|
|00003260| 72 65 6e 63 65 20 69 6e | 20 6f 76 65 72 61 6c 6c |rence in| overall|
|00003270| 20 73 75 72 76 69 76 61 | 6c 20 6f 72 20 73 75 72 | surviva|l or sur|
|00003280| 76 69 76 61 6c 20 77 69 | 74 68 6f 75 74 20 6d 65 |vival wi|thout me|
|00003290| 74 61 73 74 61 74 69 63 | 0d 0a 64 69 73 65 61 73 |tastatic|..diseas|
|000032a0| 65 20 61 6d 6f 6e 67 20 | 77 6f 6d 65 6e 20 68 61 |e among |women ha|
|000032b0| 76 69 6e 67 20 6c 75 6d | 70 65 63 74 6f 6d 79 20 |ving lum|pectomy |
|000032c0| 77 69 74 68 20 6f 72 20 | 77 69 74 68 6f 75 74 20 |with or |without |
|000032d0| 69 72 72 61 64 69 61 74 | 69 6f 6e 20 28 46 69 67 |irradiat|ion (Fig|
|000032e0| 20 32 31 2d 32 29 2e 0d | 0a 54 68 65 20 66 69 6e | 21-2)..|.The fin|
|000032f0| 64 69 6e 67 73 20 63 6f | 6e 74 69 6e 75 65 20 74 |dings co|ntinue t|
|00003300| 6f 20 73 75 70 70 6f 72 | 74 20 6c 75 6d 70 65 63 |o suppor|t lumpec|
|00003310| 74 6f 6d 79 20 66 6f 72 | 20 73 74 61 67 65 73 20 |tomy for| stages |
|00003320| 49 20 61 6e 64 20 49 49 | 20 62 72 65 61 73 74 20 |I and II| breast |
|00003330| 63 61 6e 63 65 72 2e 0d | 0a 50 6f 73 74 6f 70 65 |cancer..|.Postope|
|00003340| 72 61 74 69 76 65 20 62 | 72 65 61 73 74 20 69 72 |rative b|reast ir|
|00003350| 72 61 64 69 61 74 69 6f | 6e 20 6c 6f 77 65 72 73 |radiatio|n lowers|
|00003360| 20 74 68 65 20 72 69 73 | 6b 20 6f 66 20 6c 6f 63 | the ris|k of loc|
|00003370| 61 6c 20 72 65 63 75 72 | 72 65 6e 63 65 2e 0d 0a |al recur|rence...|
|00003380| 0d 0a 0d 0a 50 6f 73 74 | 2d 43 6f 6d 6d 65 6e 74 |....Post|-Comment|
|00003390| 0d 0a 0d 0a 20 20 20 20 | 20 54 68 69 73 20 6c 61 |.... | This la|
|000033a0| 6e 64 6d 61 72 6b 20 73 | 74 75 64 79 20 62 79 20 |ndmark s|tudy by |
|000033b0| 70 61 72 74 69 63 69 70 | 61 6e 74 73 20 69 6e 20 |particip|ants in |
|000033c0| 74 68 65 20 4e 61 74 69 | 6f 6e 61 6c 20 53 75 72 |the Nati|onal Sur|
|000033d0| 67 69 63 61 6c 20 41 64 | 6a 75 76 61 6e 74 0d 0a |gical Ad|juvant..|
|000033e0| 42 72 65 61 73 74 20 61 | 6e 64 20 42 6f 77 65 6c |Breast a|nd Bowel|
|000033f0| 20 50 72 6f 6a 65 63 74 | 20 63 6f 6e 74 69 6e 75 | Project| continu|
|00003400| 65 73 20 74 6f 20 62 72 | 69 6e 67 20 67 6f 6f 64 |es to br|ing good|
|00003410| 20 6e 65 77 73 20 74 6f | 20 77 6f 6d 65 6e 20 77 | news to| women w|
|00003420| 69 74 68 20 65 61 72 6c | 79 0d 0a 62 72 65 61 73 |ith earl|y..breas|
|00003430| 74 20 63 61 6e 63 65 72 | 3b 20 74 68 61 74 20 69 |t cancer|; that i|
|00003440| 73 2c 20 6c 75 6d 70 65 | 63 74 6f 6d 79 20 70 6c |s, lumpe|ctomy pl|
|00003450| 75 73 20 72 61 64 69 61 | 74 69 6f 6e 20 69 73 20 |us radia|tion is |
|00003460| 61 73 20 67 6f 6f 64 20 | 6f 72 20 62 65 74 74 65 |as good |or bette|
|00003470| 72 20 74 68 61 6e 0d 0a | 74 6f 74 61 6c 20 6d 61 |r than..|total ma|
|00003480| 73 74 65 63 74 6f 6d 79 | 2e 20 20 42 6f 74 68 20 |stectomy|. Both |
|00003490| 67 72 6f 75 70 73 2c 20 | 6f 66 20 63 6f 75 72 73 |groups, |of cours|
|000034a0| 65 2c 20 75 6e 64 65 72 | 77 65 6e 74 20 61 78 69 |e, under|went axi|
|000034b0| 6c 6c 61 72 79 20 6e 6f | 64 65 20 64 69 73 73 65 |llary no|de disse|
|000034c0| 63 74 69 6f 6e 2e 0d 0a | 55 6e 66 6f 72 74 75 6e |ction...|Unfortun|
|000034d0| 61 74 65 6c 79 2c 20 73 | 6f 6d 65 20 73 75 72 67 |ately, s|ome surg|
|000034e0| 65 6f 6e 73 20 63 6f 6e | 74 69 6e 75 65 20 74 6f |eons con|tinue to|
|000034f0| 20 70 65 72 66 6f 72 6d | 20 6d 61 73 74 65 63 74 | perform| mastect|
|00003500| 6f 6d 79 20 69 6e 20 74 | 68 65 73 65 20 70 61 74 |omy in t|hese pat|
|00003510| 69 65 6e 74 73 2e 0d 0a | 47 79 6e 65 63 6f 6c 6f |ients...|Gynecolo|
|00003520| 67 69 73 74 73 20 73 68 | 6f 75 6c 64 20 72 65 66 |gists sh|ould ref|
|00003530| 65 72 20 74 68 65 69 72 | 20 70 61 74 69 65 6e 74 |er their| patient|
|00003540| 73 20 77 69 74 68 20 62 | 72 65 61 73 74 20 70 72 |s with b|reast pr|
|00003550| 6f 62 6c 65 6d 73 20 74 | 6f 20 73 75 72 67 65 6f |oblems t|o surgeo|
|00003560| 6e 73 20 6f 72 0d 0a 63 | 65 6e 74 65 72 73 20 74 |ns or..c|enters t|
|00003570| 68 61 74 20 70 72 6f 76 | 69 64 65 20 61 64 65 71 |hat prov|ide adeq|
|00003580| 75 61 74 65 20 63 6f 75 | 6e 73 65 6c 69 6e 67 20 |uate cou|nseling |
|00003590| 61 6e 64 20 72 65 63 6f | 6e 73 74 72 75 63 74 69 |and reco|nstructi|
|000035a0| 76 65 20 73 75 72 67 65 | 72 79 20 61 73 20 77 65 |ve surge|ry as we|
|000035b0| 6c 6c 20 61 73 0d 0a 74 | 68 65 20 63 6f 6e 73 65 |ll as..t|he conse|
|000035c0| 72 76 61 74 69 76 65 20 | 61 70 70 72 6f 61 63 68 |rvative |approach|
|000035d0| 20 74 6f 20 62 72 65 61 | 73 74 20 63 61 6e 63 65 | to brea|st cance|
|000035e0| 72 20 74 68 65 72 61 70 | 79 2e 2d 2d 43 2e 50 2e |r therap|y.--C.P.|
|000035f0| 20 4d 6f 72 72 6f 77 2c | 20 4d 2e 44 2e 0d 0a 24 | Morrow,| M.D...$|
|00003600| 55 6e 69 71 75 65 5f 49 | 44 7b 59 52 42 31 31 38 |Unique_I|D{YRB118|
|00003610| 30 34 7d 0d 0a 24 54 69 | 74 6c 65 7b 4d 61 73 74 |04}..$Ti|tle{Mast|
|00003620| 65 63 74 6f 6d 79 20 6f | 72 20 43 6f 6e 73 65 72 |ectomy o|r Conser|
|00003630| 76 61 74 69 6f 6e 3a 20 | 20 54 68 65 20 50 61 74 |vation: | The Pat|
|00003640| 69 65 6e 74 27 73 20 43 | 68 6f 69 63 65 7d 0d 0a |ient's C|hoice}..|
|00003650| 24 41 75 74 68 6f 72 7b | 57 69 6c 73 6f 6e 2c 20 |$Author{|Wilson, |
|00003660| 52 47 0d 0a 48 61 72 74 | 2c 20 41 0d 0a 44 61 77 |RG..Hart|, A..Daw|
|00003670| 65 73 2c 20 50 4a 44 4b | 7d 0d 0a 24 41 66 66 69 |es, PJDK|}..$Affi|
|00003680| 6c 69 61 74 69 6f 6e 7b | 4e 65 77 63 61 73 74 6c |liation{|Newcastl|
|00003690| 65 20 47 65 6e 20 48 6f | 73 70 2c 20 4e 65 77 63 |e Gen Ho|sp, Newc|
|000036a0| 61 73 74 6c 65 20 75 70 | 6f 6e 20 54 79 6e 65 2c |astle up|on Tyne,|
|000036b0| 20 45 6e 67 6c 61 6e 64 | 7d 0d 0a 24 4a 6f 75 72 | England|}..$Jour|
|000036c0| 6e 61 6c 7b 42 72 20 4d | 65 64 20 4a 7d 0d 0a 24 |nal{Br M|ed J}..$|
|000036d0| 56 6f 6c 75 6d 65 7b 32 | 39 37 7d 0d 0a 24 50 61 |Volume{2|97}..$Pa|
|000036e0| 67 65 7b 31 31 36 37 2d | 31 31 36 39 7d 0d 0a 24 |ge{1167-|1169}..$|
|000036f0| 44 61 74 65 7b 4e 6f 76 | 20 35 2c 20 31 39 38 38 |Date{Nov| 5, 1988|
|00003700| 7d 0d 0a 24 59 42 56 6f | 6c 7b 31 39 39 30 20 59 |}..$YBVo|l{1990 Y|
|00003710| 65 61 72 20 42 6f 6f 6b | 20 6f 66 20 4f 62 73 74 |ear Book| of Obst|
|00003720| 65 74 72 69 63 73 20 61 | 6e 64 20 47 79 6e 65 63 |etrics a|nd Gynec|
|00003730| 6f 6c 6f 67 79 7d 0d 0a | 24 43 68 61 70 74 65 72 |ology}..|$Chapter|
|00003740| 7b 32 31 2d 31 36 7d 0d | 0a 24 59 42 45 64 69 74 |{21-16}.|.$YBEdit|
|00003750| 6f 72 7b 44 72 73 2e 20 | 4d 69 73 68 65 6c 6c 2c |or{Drs. |Mishell,|
|00003760| 20 4b 69 72 73 63 68 62 | 61 75 6d 2c 20 61 6e 64 | Kirschb|aum, and|
|00003770| 20 4d 6f 72 72 6f 77 7d | 0d 0a 24 54 61 62 6c 65 | Morrow}|..$Table|
|00003780| 7b 7d 0d 0a 24 43 6f 6d | 6d 65 6e 74 61 74 6f 72 |{}..$Com|mentator|
|00003790| 7b 57 2e 48 2e 20 48 69 | 6e 64 6c 65 2c 20 4d 2e |{W.H. Hi|ndle, M.|
|000037a0| 44 2e 7d 0d 0a 0d 0a 43 | 6f 70 79 72 69 67 68 74 |D.}....C|opyright|
|000037b0| 20 28 63 29 20 59 65 61 | 72 62 6f 6f 6b 20 4d 65 | (c) Yea|rbook Me|
|000037c0| 64 69 63 61 6c 20 50 75 | 62 6c 69 73 68 65 72 73 |dical Pu|blishers|
|000037d0| 2c 20 49 6e 63 2e 2c 20 | 31 39 39 30 0d 0a 0d 0a |, Inc., |1990....|
|000037e0| 31 39 39 30 20 59 65 61 | 72 20 42 6f 6f 6b 20 6f |1990 Yea|r Book o|
|000037f0| 66 20 4f 62 73 74 65 74 | 72 69 63 73 20 61 6e 64 |f Obstet|rics and|
|00003800| 20 47 79 6e 65 63 6f 6c | 6f 67 79 20 28 52 29 0d | Gynecol|ogy (R).|
|00003810| 0a 0d 0a 43 68 61 70 74 | 65 72 20 32 31 2d 2d 42 |...Chapt|er 21--B|
|00003820| 72 65 61 73 74 20 44 69 | 73 65 61 73 65 73 0d 0a |reast Di|seases..|
|00003830| 0d 0a 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |..------|--------|
|00003840| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003850| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003860| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003870| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003880| 0d 0a 4d 61 73 74 65 63 | 74 6f 6d 79 20 6f 72 20 |..Mastec|tomy or |
|00003890| 43 6f 6e 73 65 72 76 61 | 74 69 6f 6e 3a 20 20 54 |Conserva|tion: T|
|000038a0| 68 65 20 50 61 74 69 65 | 6e 74 27 73 20 43 68 6f |he Patie|nt's Cho|
|000038b0| 69 63 65 0d 0a 0d 0a 57 | 69 6c 73 6f 6e 20 52 47 |ice....W|ilson RG|
|000038c0| 2c 20 48 61 72 74 20 41 | 2c 20 44 61 77 65 73 20 |, Hart A|, Dawes |
|000038d0| 50 4a 44 4b 0d 0a 28 4e | 65 77 63 61 73 74 6c 65 |PJDK..(N|ewcastle|
|000038e0| 20 47 65 6e 20 48 6f 73 | 70 2c 20 4e 65 77 63 61 | Gen Hos|p, Newca|
|000038f0| 73 74 6c 65 20 75 70 6f | 6e 20 54 79 6e 65 2c 20 |stle upo|n Tyne, |
|00003900| 45 6e 67 6c 61 6e 64 29 | 0d 0a 42 72 20 4d 65 64 |England)|..Br Med|
|00003910| 20 4a 20 32 39 37 3a 31 | 31 36 37 2d 31 31 36 39 | J 297:1|167-1169|
|00003920| 2c 20 4e 6f 76 20 35 2c | 20 31 39 38 38 0d 0a 2d |, Nov 5,| 1988..-|
|00003930| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003940| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003950| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003960| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003970| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 0d 0a 0d |--------|-----...|
|00003980| 0a 41 62 73 74 72 61 63 | 74 0d 0a 0d 0a 20 20 20 |.Abstrac|t.... |
|00003990| 20 20 43 6f 6e 73 65 72 | 76 61 74 69 6f 6e 20 74 | Conser|vation t|
|000039a0| 72 65 61 74 6d 65 6e 74 | 20 61 73 20 70 72 69 6d |reatment| as prim|
|000039b0| 61 72 79 20 74 68 65 72 | 61 70 79 20 66 6f 72 20 |ary ther|apy for |
|000039c0| 62 72 65 61 73 74 20 63 | 61 6e 63 65 72 20 6f 66 |breast c|ancer of|
|000039d0| 66 65 72 73 20 67 6f 6f | 64 0d 0a 63 6f 73 6d 65 |fers goo|d..cosme|
|000039e0| 74 69 63 20 72 65 73 75 | 6c 74 73 20 61 6e 64 20 |tic resu|lts and |
|000039f0| 61 70 70 61 72 65 6e 74 | 6c 79 20 69 73 20 6e 6f |apparent|ly is no|
|00003a00| 20 6c 65 73 73 20 65 66 | 66 65 63 74 69 76 65 20 | less ef|fective |
|00003a10| 74 68 61 6e 20 6d 61 73 | 74 65 63 74 6f 6d 79 2e |than mas|tectomy.|
|00003a20| 20 20 44 75 72 69 6e 67 | 0d 0a 61 20 39 2d 79 65 | During|..a 9-ye|
|00003a30| 61 72 20 70 65 72 69 6f | 64 2c 20 31 35 33 20 77 |ar perio|d, 153 w|
|00003a40| 6f 6d 65 6e 20 79 6f 75 | 6e 67 65 72 20 74 68 61 |omen you|nger tha|
|00003a50| 6e 20 61 67 65 20 36 35 | 20 79 65 61 72 73 20 77 |n age 65| years w|
|00003a60| 69 74 68 20 54 31 2c 20 | 54 32 2c 20 4e 31 2c 20 |ith T1, |T2, N1, |
|00003a70| 61 6e 64 20 4e 30 0d 0a | 74 75 6d 6f 72 73 20 6f |and N0..|tumors o|
|00003a80| 66 20 74 68 65 20 62 72 | 65 61 73 74 20 77 65 72 |f the br|east wer|
|00003a90| 65 20 67 69 76 65 6e 20 | 61 6e 20 6f 70 74 69 6f |e given |an optio|
|00003aa0| 6e 20 6f 66 20 74 72 65 | 61 74 6d 65 6e 74 2d 2d |n of tre|atment--|
|00003ab0| 63 6f 6e 73 65 72 76 61 | 74 69 6f 6e 20 6f 72 0d |conserva|tion or.|
|00003ac0| 0a 6d 61 73 74 65 63 74 | 6f 6d 79 2d 2d 61 66 74 |.mastect|omy--aft|
|00003ad0| 65 72 20 61 64 65 71 75 | 61 74 65 20 69 6e 66 6f |er adequ|ate info|
|00003ae0| 72 6d 61 74 69 6f 6e 20 | 61 6e 64 20 63 6f 75 6e |rmation |and coun|
|00003af0| 73 65 6c 69 6e 67 2e 20 | 20 43 6f 6e 73 65 72 76 |seling. | Conserv|
|00003b00| 61 74 69 6f 6e 20 74 72 | 65 61 74 6d 65 6e 74 0d |ation tr|eatment.|
|00003b10| 0a 69 6e 63 6c 75 64 65 | 64 20 65 78 63 69 73 69 |.include|d excisi|
|00003b20| 6f 6e 20 6f 66 20 74 68 | 65 20 6c 75 6d 70 2c 20 |on of th|e lump, |
|00003b30| 65 78 74 65 72 6e 61 6c | 20 72 61 64 69 6f 74 68 |external| radioth|
|00003b40| 65 72 61 70 79 2c 20 61 | 6e 64 20 69 72 69 64 69 |erapy, a|nd iridi|
|00003b50| 75 6d 20 77 69 72 65 0d | 0a 69 6d 70 6c 61 6e 74 |um wire.|.implant|
|00003b60| 65 64 20 69 6e 20 74 68 | 65 20 74 75 6d 6f 72 20 |ed in th|e tumor |
|00003b70| 62 65 64 2e 20 20 4d 61 | 73 74 65 63 74 6f 6d 79 |bed. Ma|stectomy|
|00003b80| 20 69 6e 63 6c 75 64 65 | 64 20 6e 6f 64 65 20 73 | include|d node s|
|00003b90| 61 6d 70 6c 69 6e 67 20 | 61 6e 64 20 6c 6f 63 61 |ampling |and loca|
|00003ba0| 6c 0d 0a 72 61 64 69 6f | 74 68 65 72 61 70 79 20 |l..radio|therapy |
|00003bb0| 69 66 20 69 6e 64 69 63 | 61 74 65 64 2e 20 20 49 |if indic|ated. I|
|00003bc0| 6e 20 32 38 20 77 6f 6d | 65 6e 20 69 6e 74 65 72 |n 28 wom|en inter|
|00003bd0| 76 69 65 77 65 64 20 6d | 6f 72 65 20 74 68 61 6e |viewed m|ore than|
|00003be0| 20 32 20 79 65 61 72 73 | 20 61 66 74 65 72 0d 0a | 2 years| after..|
|00003bf0| 74 72 65 61 74 6d 65 6e | 74 2c 20 74 68 65 20 6f |treatmen|t, the o|
|00003c00| 75 74 63 6f 6d 65 20 6f | 66 20 74 68 69 73 20 70 |utcome o|f this p|
|00003c10| 6f 6c 69 63 79 20 69 6e | 20 74 65 72 6d 73 20 6f |olicy in| terms o|
|00003c20| 66 20 70 72 65 66 65 72 | 65 6e 63 65 73 20 61 6e |f prefer|ences an|
|00003c30| 64 20 72 65 73 75 6c 74 | 73 20 6f 66 0d 0a 74 72 |d result|s of..tr|
|00003c40| 65 61 74 6d 65 6e 74 20 | 77 61 73 20 65 76 61 6c |eatment |was eval|
|00003c50| 75 61 74 65 64 2e 0d 0a | 20 20 20 20 20 4e 6f 6e |uated...| Non|
|00003c60| 65 20 6f 66 20 74 68 65 | 20 70 61 74 69 65 6e 74 |e of the| patient|
|00003c70| 73 20 72 65 66 75 73 65 | 64 20 74 6f 20 70 61 72 |s refuse|d to par|
|00003c80| 74 69 63 69 70 61 74 65 | 20 69 6e 20 6d 61 6b 69 |ticipate| in maki|
|00003c90| 6e 67 20 61 20 63 68 6f | 69 63 65 20 69 6e 0d 0a |ng a cho|ice in..|
|00003ca0| 74 72 65 61 74 6d 65 6e | 74 2e 20 20 4f 76 65 72 |treatmen|t. Over|
|00003cb0| 61 6c 6c 2c 20 35 34 20 | 77 6f 6d 65 6e 20 63 68 |all, 54 |women ch|
|00003cc0| 6f 73 65 20 63 6f 6e 73 | 65 72 76 61 74 69 6f 6e |ose cons|ervation|
|00003cd0| 20 74 72 65 61 74 6d 65 | 6e 74 20 61 6e 64 20 39 | treatme|nt and 9|
|00003ce0| 39 20 70 72 65 66 65 72 | 72 65 64 0d 0a 6d 61 73 |9 prefer|red..mas|
|00003cf0| 74 65 63 74 6f 6d 79 2e | 20 20 54 68 65 20 6c 61 |tectomy.| The la|
|00003d00| 74 74 65 72 20 63 68 6f | 69 63 65 20 77 61 73 20 |tter cho|ice was |
|00003d10| 6d 61 64 65 20 62 65 63 | 61 75 73 65 20 6f 66 20 |made bec|ause of |
|00003d20| 61 20 64 65 73 69 72 65 | 20 66 6f 72 20 72 61 70 |a desire| for rap|
|00003d30| 69 64 0d 0a 74 72 65 61 | 74 6d 65 6e 74 20 66 6f |id..trea|tment fo|
|00003d40| 72 20 64 6f 6d 65 73 74 | 69 63 20 6f 72 20 65 6d |r domest|ic or em|
|00003d50| 70 6c 6f 79 6d 65 6e 74 | 20 72 65 61 73 6f 6e 73 |ployment| reasons|
|00003d60| 20 61 6e 64 20 66 65 61 | 72 20 6f 66 20 70 6f 73 | and fea|r of pos|
|00003d70| 73 69 62 69 6c 69 74 79 | 20 6f 66 20 66 75 74 75 |sibility| of futu|
|00003d80| 72 65 0d 0a 6d 61 73 74 | 65 63 74 6f 6d 79 2e 20 |re..mast|ectomy. |
|00003d90| 20 4f 6e 6c 79 20 31 20 | 6f 66 20 74 68 65 20 77 | Only 1 |of the w|
|00003da0| 6f 6d 65 6e 20 63 68 6f | 6f 73 69 6e 67 20 6d 61 |omen cho|osing ma|
|00003db0| 73 74 65 63 74 6f 6d 79 | 20 72 65 67 72 65 74 74 |stectomy| regrett|
|00003dc0| 65 64 20 68 65 72 20 64 | 65 63 69 73 69 6f 6e 2e |ed her d|ecision.|
|00003dd0| 0d 0a 54 68 65 20 35 2d | 79 65 61 72 20 73 75 72 |..The 5-|year sur|
|00003de0| 76 69 76 61 6c 20 72 61 | 74 65 20 77 61 73 20 73 |vival ra|te was s|
|00003df0| 69 6d 69 6c 61 72 20 69 | 6e 20 74 68 65 20 32 20 |imilar i|n the 2 |
|00003e00| 74 72 65 61 74 6d 65 6e | 74 20 67 72 6f 75 70 73 |treatmen|t groups|
|00003e10| 2c 20 62 75 74 20 6d 6f | 72 74 61 6c 69 74 79 0d |, but mo|rtality.|
|00003e20| 0a 69 6e 20 70 61 74 69 | 65 6e 74 73 20 77 69 74 |.in pati|ents wit|
|00003e30| 68 20 6c 6f 62 75 6c 61 | 72 20 63 61 6e 63 65 72 |h lobula|r cancer|
|00003e40| 20 77 61 73 20 68 69 67 | 68 65 72 20 69 6e 20 74 | was hig|her in t|
|00003e50| 68 65 20 63 6f 6e 73 65 | 72 76 61 74 69 6f 6e 20 |he conse|rvation |
|00003e60| 67 72 6f 75 70 2e 0d 0a | 20 20 20 20 20 50 61 74 |group...| Pat|
|00003e70| 69 65 6e 74 73 20 77 69 | 74 68 20 62 72 65 61 73 |ients wi|th breas|
|00003e80| 74 20 63 61 6e 63 65 72 | 20 73 68 6f 75 6c 64 20 |t cancer| should |
|00003e90| 70 6c 61 79 20 61 20 70 | 61 72 74 20 69 6e 20 64 |play a p|art in d|
|00003ea0| 65 63 69 64 69 6e 67 20 | 77 68 69 63 68 0d 0a 74 |eciding |which..t|
|00003eb0| 72 65 61 74 6d 65 6e 74 | 20 74 6f 20 68 61 76 65 |reatment| to have|
|00003ec0| 2e 20 20 44 65 73 70 69 | 74 65 20 74 68 65 20 61 |. Despi|te the a|
|00003ed0| 70 70 61 72 65 6e 74 20 | 63 6f 73 6d 65 74 69 63 |pparent |cosmetic|
|00003ee0| 20 61 6e 64 20 70 73 79 | 63 68 6f 6c 6f 67 69 63 | and psy|chologic|
|00003ef0| 61 6c 20 61 64 76 61 6e | 74 61 67 65 73 0d 0a 6f |al advan|tages..o|
|00003f00| 66 20 72 65 74 61 69 6e | 69 6e 67 20 74 68 65 20 |f retain|ing the |
|00003f10| 62 72 65 61 73 74 2c 20 | 6d 6f 73 74 20 70 61 74 |breast, |most pat|
|00003f20| 69 65 6e 74 73 20 73 65 | 6c 65 63 74 20 6d 61 73 |ients se|lect mas|
|00003f30| 74 65 63 74 6f 6d 79 2e | 20 20 50 61 74 69 65 6e |tectomy.| Patien|
|00003f40| 74 73 20 77 69 74 68 0d | 0a 6c 6f 62 75 6c 61 72 |ts with.|.lobular|
|00003f50| 20 63 61 6e 63 65 72 73 | 20 73 68 6f 75 6c 64 20 | cancers| should |
|00003f60| 6e 6f 74 20 62 65 20 6f | 66 66 65 72 65 64 20 63 |not be o|ffered c|
|00003f70| 6f 6e 73 65 72 76 61 74 | 69 6f 6e 20 74 72 65 61 |onservat|ion trea|
|00003f80| 74 6d 65 6e 74 2e 0d 0a | 0d 0a 50 6f 73 74 2d 43 |tment...|..Post-C|
|00003f90| 6f 6d 6d 65 6e 74 0d 0a | 0d 0a 20 20 20 20 20 49 |omment..|.. I|
|00003fa0| 6e 66 6f 72 6d 65 64 20 | 63 6f 6e 73 65 6e 74 20 |nformed |consent |
|00003fb0| 66 6f 72 20 73 75 72 67 | 65 72 79 20 69 73 20 6d |for surg|ery is m|
|00003fc0| 61 6e 64 61 74 6f 72 79 | 2c 20 70 61 72 74 69 63 |andatory|, partic|
|00003fd0| 75 6c 61 72 6c 79 20 66 | 6f 72 20 74 68 65 20 74 |ularly f|or the t|
|00003fe0| 72 65 61 74 6d 65 6e 74 | 0d 0a 6f 70 74 69 6f 6e |reatment|..option|
|00003ff0| 73 20 6f 66 20 73 74 61 | 67 65 73 20 49 20 61 6e |s of sta|ges I an|
|00004000| 64 20 49 49 20 62 72 65 | 61 73 74 20 63 61 6e 63 |d II bre|ast canc|
|00004010| 65 72 2e 20 20 49 6e 20 | 6d 6f 72 65 20 74 68 61 |er. In |more tha|
|00004020| 6e 20 61 20 64 6f 7a 65 | 6e 20 73 74 61 74 65 73 |n a doze|n states|
|00004030| 20 73 75 63 68 0d 0a 69 | 6e 66 6f 72 6d 65 64 20 | such..i|nformed |
|00004040| 63 6f 6e 73 65 6e 74 20 | 63 6f 76 65 72 69 6e 67 |consent |covering|
|00004050| 20 61 6c 6c 20 74 72 65 | 61 74 6d 65 6e 74 20 6f | all tre|atment o|
|00004060| 70 74 69 6f 6e 73 20 69 | 73 20 72 65 71 75 69 72 |ptions i|s requir|
|00004070| 65 64 20 62 79 20 6c 61 | 77 2e 20 20 42 65 63 61 |ed by la|w. Beca|
|00004080| 75 73 65 0d 0a 74 68 65 | 72 65 20 69 73 20 6e 6f |use..the|re is no|
|00004090| 74 20 61 20 73 69 6e 67 | 6c 65 20 22 62 65 73 74 |t a sing|le "best|
|000040a0| 22 20 74 72 65 61 74 6d | 65 6e 74 2c 20 61 20 73 |" treatm|ent, a s|
|000040b0| 68 61 72 65 64 20 63 6f | 6f 70 65 72 61 74 69 76 |hared co|operativ|
|000040c0| 65 20 64 65 63 69 73 69 | 6f 6e 20 61 73 20 74 6f |e decisi|on as to|
|000040d0| 0d 0a 69 6e 64 69 76 69 | 64 75 61 6c 20 74 72 65 |..indivi|dual tre|
|000040e0| 61 74 6d 65 6e 74 20 6f | 66 20 73 74 61 67 65 73 |atment o|f stages|
|000040f0| 20 49 20 61 6e 64 20 49 | 49 20 62 72 65 61 73 74 | I and I|I breast|
|00004100| 20 63 61 6e 63 65 72 20 | 69 73 20 65 73 73 65 6e | cancer |is essen|
|00004110| 74 69 61 6c 2e 20 20 54 | 65 6e 2d 79 65 61 72 0d |tial. T|en-year.|
|00004120| 0a 66 6f 6c 6c 6f 77 2d | 75 70 20 73 74 75 64 69 |.follow-|up studi|
|00004130| 65 73 20 64 65 6d 6f 6e | 73 74 72 61 74 65 20 74 |es demon|strate t|
|00004140| 68 61 74 20 62 72 65 61 | 73 74 2d 63 6f 6e 73 65 |hat brea|st-conse|
|00004150| 72 76 69 6e 67 20 73 75 | 72 67 65 72 79 20 77 69 |rving su|rgery wi|
|00004160| 74 68 20 6c 75 6d 70 65 | 63 74 6f 6d 79 2c 0d 0a |th lumpe|ctomy,..|
|00004170| 61 78 69 6c 6c 61 72 79 | 20 6c 79 6d 70 68 20 6e |axillary| lymph n|
|00004180| 6f 64 65 20 64 69 73 73 | 65 63 74 69 6f 6e 2c 20 |ode diss|ection, |
|00004190| 61 6e 64 20 6c 6f 63 61 | 6c 20 72 61 64 69 61 74 |and loca|l radiat|
|000041a0| 69 6f 6e 20 74 68 65 72 | 61 70 79 20 61 63 68 69 |ion ther|apy achi|
|000041b0| 65 76 65 73 0d 0a 64 69 | 73 65 61 73 65 2d 66 72 |eves..di|sease-fr|
|000041c0| 65 65 20 73 75 72 76 69 | 76 61 6c 20 72 65 73 75 |ee survi|val resu|
|000041d0| 6c 74 73 20 65 71 75 61 | 6c 20 74 6f 20 74 68 6f |lts equa|l to tho|
|000041e0| 73 65 20 6f 66 20 6d 6f | 64 69 66 69 65 64 20 72 |se of mo|dified r|
|000041f0| 61 64 69 63 61 6c 20 6d | 61 73 74 65 63 74 6f 6d |adical m|astectom|
|00004200| 79 0d 0a 61 6e 64 20 61 | 78 69 6c 6c 61 72 79 20 |y..and a|xillary |
|00004210| 6c 79 6d 70 68 20 6e 6f | 64 65 20 64 69 73 73 65 |lymph no|de disse|
|00004220| 63 74 69 6f 6e 20 69 6e | 20 73 74 61 67 65 73 20 |ction in| stages |
|00004230| 49 20 61 6e 64 20 49 49 | 20 64 69 73 65 61 73 65 |I and II| disease|
|00004240| 2e 20 20 43 65 72 74 61 | 69 6e 6c 79 2c 20 74 68 |. Certa|inly, th|
|00004250| 65 0d 0a 69 6e 64 69 76 | 69 64 75 61 6c 20 70 61 |e..indiv|idual pa|
|00004260| 74 69 65 6e 74 20 73 68 | 6f 75 6c 64 20 62 65 20 |tient sh|ould be |
|00004270| 74 6f 74 61 6c 6c 79 20 | 69 6e 66 6f 72 6d 65 64 |totally |informed|
|00004280| 20 61 6e 64 20 69 6e 76 | 6f 6c 76 65 64 20 69 6e | and inv|olved in|
|00004290| 20 74 72 65 61 74 6d 65 | 6e 74 0d 0a 64 65 63 69 | treatme|nt..deci|
|000042a0| 73 69 6f 6e 73 2e 2d 2d | 57 2e 48 2e 20 48 69 6e |sions.--|W.H. Hin|
|000042b0| 64 6c 65 2c 20 4d 2e 44 | 2e 0d 0a 24 55 6e 69 71 |dle, M.D|...$Uniq|
|000042c0| 75 65 5f 49 44 7b 59 52 | 42 31 31 38 30 35 7d 0d |ue_ID{YR|B11805}.|
|000042d0| 0a 24 54 69 74 6c 65 7b | 45 66 66 65 63 74 73 20 |.$Title{|Effects |
|000042e0| 6f 66 20 41 64 6a 75 76 | 61 6e 74 20 54 61 6d 6f |of Adjuv|ant Tamo|
|000042f0| 78 69 66 65 6e 20 61 6e | 64 20 6f 66 20 43 79 74 |xifen an|d of Cyt|
|00004300| 6f 74 6f 78 69 63 20 54 | 68 65 72 61 70 79 20 6f |otoxic T|herapy o|
|00004310| 6e 20 4d 6f 72 74 61 6c | 69 74 79 20 69 6e 20 45 |n Mortal|ity in E|
|00004320| 61 72 6c 79 20 42 72 65 | 61 73 74 20 43 61 6e 63 |arly Bre|ast Canc|
|00004330| 65 72 3a 20 20 41 6e 20 | 4f 76 65 72 76 69 65 77 |er: An |Overview|
|00004340| 20 6f 66 20 36 31 20 52 | 61 6e 64 6f 6d 69 7a 65 | of 61 R|andomize|
|00004350| 64 20 54 72 69 61 6c 73 | 20 41 6d 6f 6e 67 20 32 |d Trials| Among 2|
|00004360| 38 2c 38 39 36 20 57 6f | 6d 65 6e 7d 0d 0a 24 41 |8,896 Wo|men}..$A|
|00004370| 75 74 68 6f 72 7b 45 61 | 72 6c 79 20 42 72 65 61 |uthor{Ea|rly Brea|
|00004380| 73 74 20 43 61 6e 63 65 | 72 20 54 72 69 61 6c 69 |st Cance|r Triali|
|00004390| 73 74 73 27 20 43 6f 6c | 6c 61 62 6f 72 61 74 69 |sts' Col|laborati|
|000043a0| 76 65 20 47 72 6f 75 70 | 7d 0d 0a 24 41 66 66 69 |ve Group|}..$Affi|
|000043b0| 6c 69 61 74 69 6f 6e 7b | 52 61 64 63 6c 69 66 66 |liation{|Radcliff|
|000043c0| 65 20 49 6e 66 69 72 6d | 61 72 79 2c 20 4f 78 66 |e Infirm|ary, Oxf|
|000043d0| 6f 72 64 2c 20 45 6e 67 | 6c 61 6e 64 7d 0d 0a 24 |ord, Eng|land}..$|
|000043e0| 4a 6f 75 72 6e 61 6c 7b | 4e 20 45 6e 67 6c 20 4a |Journal{|N Engl J|
|000043f0| 20 4d 65 64 7d 0d 0a 24 | 56 6f 6c 75 6d 65 7b 33 | Med}..$|Volume{3|
|00004400| 31 39 7d 0d 0a 24 50 61 | 67 65 7b 31 36 38 31 2d |19}..$Pa|ge{1681-|
|00004410| 31 36 39 32 7d 0d 0a 24 | 44 61 74 65 7b 44 65 63 |1692}..$|Date{Dec|
|00004420| 20 32 39 2c 20 31 39 38 | 38 7d 0d 0a 24 59 42 56 | 29, 198|8}..$YBV|
|00004430| 6f 6c 7b 31 39 39 30 20 | 59 65 61 72 20 42 6f 6f |ol{1990 |Year Boo|
|00004440| 6b 20 6f 66 20 4f 62 73 | 74 65 74 72 69 63 73 20 |k of Obs|tetrics |
|00004450| 61 6e 64 20 47 79 6e 65 | 63 6f 6c 6f 67 79 7d 0d |and Gyne|cology}.|
|00004460| 0a 24 43 68 61 70 74 65 | 72 7b 32 31 2d 31 37 7d |.$Chapte|r{21-17}|
|00004470| 0d 0a 24 59 42 45 64 69 | 74 6f 72 7b 44 72 73 2e |..$YBEdi|tor{Drs.|
|00004480| 20 4d 69 73 68 65 6c 6c | 2c 20 4b 69 72 73 63 68 | Mishell|, Kirsch|
|00004490| 62 61 75 6d 2c 20 61 6e | 64 20 4d 6f 72 72 6f 77 |baum, an|d Morrow|
|000044a0| 7d 0d 0a 24 54 61 62 6c | 65 7b 7d 0d 0a 24 43 6f |}..$Tabl|e{}..$Co|
|000044b0| 6d 6d 65 6e 74 61 74 6f | 72 7b 57 2e 48 2e 20 48 |mmentato|r{W.H. H|
|000044c0| 69 6e 64 6c 65 2c 20 4d | 2e 44 2e 7d 0d 0a 0d 0a |indle, M|.D.}....|
|000044d0| 43 6f 70 79 72 69 67 68 | 74 20 28 63 29 20 59 65 |Copyrigh|t (c) Ye|
|000044e0| 61 72 62 6f 6f 6b 20 4d | 65 64 69 63 61 6c 20 50 |arbook M|edical P|
|000044f0| 75 62 6c 69 73 68 65 72 | 73 2c 20 49 6e 63 2e 2c |ublisher|s, Inc.,|
|00004500| 20 31 39 39 30 0d 0a 0d | 0a 31 39 39 30 20 59 65 | 1990...|.1990 Ye|
|00004510| 61 72 20 42 6f 6f 6b 20 | 6f 66 20 4f 62 73 74 65 |ar Book |of Obste|
|00004520| 74 72 69 63 73 20 61 6e | 64 20 47 79 6e 65 63 6f |trics an|d Gyneco|
|00004530| 6c 6f 67 79 20 28 52 29 | 0d 0a 0d 0a 43 68 61 70 |logy (R)|....Chap|
|00004540| 74 65 72 20 32 31 2d 2d | 42 72 65 61 73 74 20 44 |ter 21--|Breast D|
|00004550| 69 73 65 61 73 65 73 0d | 0a 0d 0a 2d 2d 2d 2d 2d |iseases.|...-----|
|00004560| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004570| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004580| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004590| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000045a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 0d 0a 45 66 66 65 63 |--------|-..Effec|
|000045b0| 74 73 20 6f 66 20 41 64 | 6a 75 76 61 6e 74 20 54 |ts of Ad|juvant T|
|000045c0| 61 6d 6f 78 69 66 65 6e | 20 61 6e 64 20 6f 66 20 |amoxifen| and of |
|000045d0| 43 79 74 6f 74 6f 78 69 | 63 20 54 68 65 72 61 70 |Cytotoxi|c Therap|
|000045e0| 79 20 6f 6e 20 4d 6f 72 | 74 61 6c 69 74 79 20 69 |y on Mor|tality i|
|000045f0| 6e 20 45 61 72 6c 79 0d | 0a 42 72 65 61 73 74 20 |n Early.|.Breast |
|00004600| 43 61 6e 63 65 72 3a 20 | 20 41 6e 20 4f 76 65 72 |Cancer: | An Over|
|00004610| 76 69 65 77 20 6f 66 20 | 36 31 20 52 61 6e 64 6f |view of |61 Rando|
|00004620| 6d 69 7a 65 64 20 54 72 | 69 61 6c 73 20 41 6d 6f |mized Tr|ials Amo|
|00004630| 6e 67 20 32 38 2c 38 39 | 36 20 57 6f 6d 65 6e 0d |ng 28,89|6 Women.|
|00004640| 0a 0d 0a 45 61 72 6c 79 | 20 42 72 65 61 73 74 20 |...Early| Breast |
|00004650| 43 61 6e 63 65 72 20 54 | 72 69 61 6c 69 73 74 73 |Cancer T|rialists|
|00004660| 27 20 43 6f 6c 6c 61 62 | 6f 72 61 74 69 76 65 20 |' Collab|orative |
|00004670| 47 72 6f 75 70 0d 0a 28 | 52 61 64 63 6c 69 66 66 |Group..(|Radcliff|
|00004680| 65 20 49 6e 66 69 72 6d | 61 72 79 2c 20 4f 78 66 |e Infirm|ary, Oxf|
|00004690| 6f 72 64 2c 20 45 6e 67 | 6c 61 6e 64 29 0d 0a 4e |ord, Eng|land)..N|
|000046a0| 20 45 6e 67 6c 20 4a 20 | 4d 65 64 20 33 31 39 3a | Engl J |Med 319:|
|000046b0| 31 36 38 31 2d 31 36 39 | 32 2c 20 44 65 63 20 32 |1681-169|2, Dec 2|
|000046c0| 39 2c 20 31 39 38 38 0d | 0a 2d 2d 2d 2d 2d 2d 2d |9, 1988.|.-------|
|000046d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000046e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000046f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004700| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004710| 2d 2d 2d 2d 2d 2d 2d 0d | 0a 0d 0a 41 62 73 74 72 |-------.|...Abstr|
|00004720| 61 63 74 0d 0a 0d 0a 20 | 20 20 20 20 42 65 66 6f |act.... | Befo|
|00004730| 72 65 20 31 39 38 35 2c | 20 32 38 2c 38 39 36 20 |re 1985,| 28,896 |
|00004740| 77 6f 6d 65 6e 20 77 69 | 74 68 20 65 61 72 6c 79 |women wi|th early|
|00004750| 20 62 72 65 61 73 74 20 | 63 61 6e 63 65 72 2c 20 | breast |cancer, |
|00004760| 77 69 74 68 20 6f 72 20 | 77 69 74 68 6f 75 74 0d |with or |without.|
|00004770| 0a 72 65 67 69 6f 6e 61 | 6c 20 6c 79 6d 70 68 20 |.regiona|l lymph |
|00004780| 6e 6f 64 65 20 69 6e 76 | 6f 6c 76 65 6d 65 6e 74 |node inv|olvement|
|00004790| 2c 20 77 65 72 65 20 69 | 6e 63 6c 75 64 65 64 20 |, were i|ncluded |
|000047a0| 69 6e 20 36 31 20 72 61 | 6e 64 6f 6d 69 7a 65 64 |in 61 ra|ndomized|
|000047b0| 20 74 72 69 61 6c 73 0d | 0a 77 6f 72 6c 64 77 69 | trials.|.worldwi|
|000047c0| 64 65 20 6f 6e 20 74 68 | 65 20 65 66 66 69 63 61 |de on th|e effica|
|000047d0| 63 79 20 6f 66 20 61 64 | 6a 75 76 61 6e 74 20 74 |cy of ad|juvant t|
|000047e0| 61 6d 6f 78 69 66 65 6e | 20 61 6e 64 20 63 68 65 |amoxifen| and che|
|000047f0| 6d 6f 74 68 65 72 61 70 | 79 20 69 6e 20 65 61 72 |motherap|y in ear|
|00004800| 6c 79 0d 0a 62 72 65 61 | 73 74 20 63 61 6e 63 65 |ly..brea|st cance|
|00004810| 72 2e 20 20 49 6e 20 32 | 38 20 74 72 69 61 6c 73 |r. In 2|8 trials|
|00004820| 20 6f 66 20 74 61 6d 6f | 78 69 66 65 6e 2c 20 33 | of tamo|xifen, 3|
|00004830| 2c 37 38 32 20 6f 66 20 | 31 36 2c 35 31 33 20 77 |,782 of |16,513 w|
|00004840| 6f 6d 65 6e 20 68 61 64 | 20 64 69 65 64 20 61 6e |omen had| died an|
|00004850| 64 0d 0a 69 6e 20 34 30 | 20 63 68 65 6d 6f 74 68 |d..in 40| chemoth|
|00004860| 65 72 61 70 79 20 74 72 | 69 61 6c 73 2c 20 34 2c |erapy tr|ials, 4,|
|00004870| 35 30 33 20 6f 66 20 31 | 33 2c 34 34 32 20 61 6c |503 of 1|3,442 al|
|00004880| 73 6f 20 64 69 65 64 2e | 20 20 54 68 65 20 64 65 |so died.| The de|
|00004890| 61 74 68 73 20 77 65 72 | 65 0d 0a 61 70 70 72 6f |aths wer|e..appro|
|000048a0| 78 69 6d 61 74 65 6c 79 | 20 64 69 73 74 72 69 62 |ximately| distrib|
|000048b0| 75 74 65 64 20 6f 76 65 | 72 20 79 65 61 72 73 20 |uted ove|r years |
|000048c0| 31 2c 20 32 2c 20 33 2c | 20 34 2c 20 61 6e 64 20 |1, 2, 3,| 4, and |
|000048d0| 35 2b 20 6f 66 20 66 6f | 6c 6c 6f 77 2d 75 70 2c |5+ of fo|llow-up,|
|000048e0| 20 77 69 74 68 0d 0a 6c | 69 74 74 6c 65 20 75 73 | with..l|ittle us|
|000048f0| 65 66 75 6c 20 69 6e 66 | 6f 72 6d 61 74 69 6f 6e |eful inf|ormation|
|00004900| 20 62 65 79 6f 6e 64 20 | 74 68 65 20 66 69 66 74 | beyond |the fift|
|00004910| 68 20 79 65 61 72 2e 0d | 0a 20 20 20 20 20 4d 6f |h year..|. Mo|
|00004920| 72 74 61 6c 69 74 79 20 | 77 61 73 20 73 69 67 6e |rtality |was sign|
|00004930| 69 66 69 63 61 6e 74 6c | 79 20 72 65 64 75 63 65 |ificantl|y reduce|
|00004940| 64 20 64 75 72 69 6e 67 | 20 74 72 65 61 74 6d 65 |d during| treatme|
|00004950| 6e 74 20 77 69 74 68 20 | 74 61 6d 6f 78 69 66 65 |nt with |tamoxife|
|00004960| 6e 20 61 73 0d 0a 63 6f | 6d 70 61 72 65 64 20 77 |n as..co|mpared w|
|00004970| 69 74 68 20 6e 6f 20 74 | 61 6d 6f 78 69 66 65 6e |ith no t|amoxifen|
|00004980| 2c 20 61 6e 79 20 63 68 | 65 6d 6f 74 68 65 72 61 |, any ch|emothera|
|00004990| 70 79 20 76 73 2e 20 6e | 6f 20 63 68 65 6d 6f 74 |py vs. n|o chemot|
|000049a0| 68 65 72 61 70 79 2c 20 | 61 6e 64 0d 0a 70 6f 6c |herapy, |and..pol|
|000049b0| 79 63 68 65 6d 6f 74 68 | 65 72 61 70 79 20 63 6f |ychemoth|erapy co|
|000049c0| 6d 70 61 72 65 64 20 77 | 69 74 68 20 73 69 6e 67 |mpared w|ith sing|
|000049d0| 6c 65 2d 61 67 65 6e 74 | 20 63 68 65 6d 6f 74 68 |le-agent| chemoth|
|000049e0| 65 72 61 70 79 2e 20 20 | 54 68 65 20 6d 6f 72 74 |erapy. |The mort|
|000049f0| 61 6c 69 74 79 0d 0a 72 | 65 64 75 63 74 69 6f 6e |ality..r|eduction|
|00004a00| 20 70 72 6f 64 75 63 65 | 64 20 62 79 20 74 61 6d | produce|d by tam|
|00004a10| 6f 78 69 66 65 6e 20 77 | 61 73 20 6d 6f 73 74 20 |oxifen w|as most |
|00004a20| 63 65 72 74 61 69 6e 20 | 6f 6e 6c 79 20 61 6d 6f |certain |only amo|
|00004a30| 6e 67 20 77 6f 6d 65 6e | 2c 20 61 67 65 64 20 35 |ng women|, aged 5|
|00004a40| 30 0d 0a 79 65 61 72 73 | 20 6f 72 20 6f 6c 64 65 |0..years| or olde|
|00004a50| 72 2c 20 77 69 74 68 20 | 74 68 65 20 61 6e 6e 75 |r, with |the annu|
|00004a60| 61 6c 20 6f 64 64 73 20 | 6f 66 20 64 65 61 74 68 |al odds |of death|
|00004a70| 20 64 75 72 69 6e 67 20 | 74 68 65 20 66 69 72 73 | during |the firs|
|00004a80| 74 20 35 20 79 65 61 72 | 73 20 72 65 64 75 63 65 |t 5 year|s reduce|
|00004a90| 64 0d 0a 62 79 20 32 30 | 25 2e 20 20 49 6e 20 63 |d..by 20|%. In c|
|00004aa0| 6f 6e 74 72 61 73 74 2c | 20 74 68 65 20 65 66 66 |ontrast,| the eff|
|00004ab0| 65 63 74 73 20 6f 66 20 | 63 68 65 6d 6f 74 68 65 |ects of |chemothe|
|00004ac0| 72 61 70 79 20 72 65 67 | 69 6d 65 6e 73 20 77 65 |rapy reg|imens we|
|00004ad0| 72 65 20 6d 6f 73 74 20 | 63 65 72 74 61 69 6e 0d |re most |certain.|
|00004ae0| 0a 61 6d 6f 6e 67 20 77 | 6f 6d 65 6e 20 79 6f 75 |.among w|omen you|
|00004af0| 6e 67 65 72 20 74 68 61 | 6e 20 61 67 65 20 35 30 |nger tha|n age 50|
|00004b00| 20 79 65 61 72 73 2c 20 | 77 69 74 68 20 74 68 65 | years, |with the|
|00004b10| 20 61 6e 6e 75 61 6c 20 | 6f 64 64 73 20 6f 66 20 | annual |odds of |
|00004b20| 64 65 61 74 68 20 64 75 | 72 69 6e 67 0d 0a 74 68 |death du|ring..th|
|00004b30| 65 20 66 69 72 73 74 20 | 35 20 79 65 61 72 73 20 |e first |5 years |
|00004b40| 72 65 64 75 63 65 64 20 | 62 79 20 32 32 25 2e 20 |reduced |by 22%. |
|00004b50| 20 54 68 65 20 6d 6f 73 | 74 20 65 78 74 65 6e 73 | The mos|t extens|
|00004b60| 69 76 65 6c 79 20 73 74 | 75 64 69 65 64 20 63 68 |ively st|udied ch|
|00004b70| 65 6d 6f 74 68 65 72 61 | 70 79 0d 0a 72 65 67 69 |emothera|py..regi|
|00004b80| 6d 65 6e 20 63 6f 6e 73 | 69 73 74 65 64 20 6f 66 |men cons|isted of|
|00004b90| 20 63 79 63 6c 6f 70 68 | 6f 73 70 68 61 6d 69 64 | cycloph|osphamid|
|00004ba0| 65 2c 20 6d 65 74 68 6f | 74 72 65 78 61 74 65 2c |e, metho|trexate,|
|00004bb0| 20 61 6e 64 20 66 6c 75 | 6f 72 6f 75 72 61 63 69 | and flu|orouraci|
|00004bc0| 6c 2e 20 20 44 69 72 65 | 63 74 0d 0a 63 6f 6d 70 |l. Dire|ct..comp|
|00004bd0| 61 72 69 73 6f 6e 73 20 | 73 68 6f 77 65 64 20 74 |arisons |showed t|
|00004be0| 68 61 74 20 63 6f 6d 62 | 69 6e 61 74 69 6f 6e 20 |hat comb|ination |
|00004bf0| 63 68 65 6d 6f 74 68 65 | 72 61 70 79 20 77 61 73 |chemothe|rapy was|
|00004c00| 20 6d 6f 72 65 20 65 66 | 66 65 63 74 69 76 65 20 | more ef|fective |
|00004c10| 74 68 61 6e 0d 0a 73 69 | 6e 67 6c 65 20 63 68 65 |than..si|ngle che|
|00004c20| 6d 6f 74 68 65 72 61 70 | 79 2c 20 62 75 74 20 70 |motherap|y, but p|
|00004c30| 72 6f 6c 6f 6e 67 65 64 | 20 63 68 65 6d 6f 74 68 |rolonged| chemoth|
|00004c40| 65 72 61 70 79 20 28 38 | 2d 32 34 20 6d 6f 6e 74 |erapy (8|-24 mont|
|00004c50| 68 73 29 20 6f 66 66 65 | 72 65 64 20 6e 6f 0d 0a |hs) offe|red no..|
|00004c60| 73 75 72 76 69 76 61 6c | 20 61 64 76 61 6e 74 61 |survival| advanta|
|00004c70| 67 65 20 6f 76 65 72 20 | 6c 65 73 73 20 70 72 6f |ge over |less pro|
|00004c80| 6c 6f 6e 67 65 64 20 74 | 72 65 61 74 6d 65 6e 74 |longed t|reatment|
|00004c90| 20 28 34 2d 36 20 6d 6f | 6e 74 68 73 29 2e 20 20 | (4-6 mo|nths). |
|00004ca0| 42 6f 74 68 20 74 61 6d | 6f 78 69 66 65 6e 0d 0a |Both tam|oxifen..|
|00004cb0| 61 6e 64 20 63 68 65 6d | 6f 74 68 65 72 61 70 79 |and chem|otherapy|
|00004cc0| 20 63 61 6e 20 72 65 64 | 75 63 65 20 35 2d 79 65 | can red|uce 5-ye|
|00004cd0| 61 72 20 6d 6f 72 74 61 | 6c 69 74 79 20 69 6e 20 |ar morta|lity in |
|00004ce0| 77 6f 6d 65 6e 20 77 69 | 74 68 20 65 61 72 6c 79 |women wi|th early|
|00004cf0| 20 62 72 65 61 73 74 0d | 0a 63 61 6e 63 65 72 2e | breast.|.cancer.|
|00004d00| 0d 0a 0d 0a 50 6f 73 74 | 2d 43 6f 6d 6d 65 6e 74 |....Post|-Comment|
|00004d10| 0d 0a 0d 0a 20 20 20 20 | 20 54 68 69 73 20 6c 61 |.... | This la|
|00004d20| 72 67 65 20 67 6c 6f 62 | 61 6c 20 63 6f 6c 6c 61 |rge glob|al colla|
|00004d30| 62 6f 72 61 74 69 76 65 | 20 73 74 75 64 79 20 6f |borative| study o|
|00004d40| 66 20 72 61 6e 64 6f 6d | 69 7a 65 64 20 63 6c 69 |f random|ized cli|
|00004d50| 6e 69 63 61 6c 20 74 72 | 69 61 6c 73 20 6f 66 0d |nical tr|ials of.|
|00004d60| 0a 77 6f 6d 65 6e 20 77 | 69 74 68 20 65 61 72 6c |.women w|ith earl|
|00004d70| 79 20 62 72 65 61 73 74 | 20 63 61 6e 63 65 72 20 |y breast| cancer |
|00004d80| 28 65 2e 67 2e 2c 20 73 | 74 61 67 65 73 20 49 20 |(e.g., s|tages I |
|00004d90| 61 6e 64 20 49 49 29 20 | 69 6e 64 69 63 61 74 65 |and II) |indicate|
|00004da0| 73 20 74 68 61 74 20 61 | 64 6a 75 76 61 6e 74 0d |s that a|djuvant.|
|00004db0| 0a 74 68 65 72 61 70 79 | 20 28 74 61 6d 6f 78 69 |.therapy| (tamoxi|
|00004dc0| 66 65 6e 20 6f 72 20 63 | 68 65 6d 6f 74 68 65 72 |fen or c|hemother|
|00004dd0| 61 70 79 29 20 73 69 67 | 6e 69 66 69 63 61 6e 74 |apy) sig|nificant|
|00004de0| 6c 79 20 69 6e 63 72 65 | 61 73 65 73 20 74 68 65 |ly incre|ases the|
|00004df0| 20 35 2d 79 65 61 72 0d | 0a 73 75 72 76 69 76 61 | 5-year.|.surviva|
|00004e00| 6c 20 72 61 74 65 73 2e | 20 20 54 68 65 73 65 20 |l rates.| These |
|00004e10| 64 61 74 61 20 61 6e 64 | 20 73 69 6d 69 6c 61 72 |data and| similar|
|00004e20| 20 72 65 70 6f 72 74 73 | 20 69 6e 64 69 63 61 74 | reports| indicat|
|00004e30| 65 20 74 68 61 74 20 61 | 64 6a 75 76 61 6e 74 20 |e that a|djuvant |
|00004e40| 74 68 65 72 61 70 79 0d | 0a 73 68 6f 75 6c 64 20 |therapy.|.should |
|00004e50| 70 72 6f 62 61 62 6c 79 | 20 62 65 20 6f 66 66 65 |probably| be offe|
|00004e60| 72 65 64 20 6f 6e 20 61 | 6e 20 69 6e 64 69 76 69 |red on a|n indivi|
|00004e70| 64 75 61 6c 20 63 61 73 | 65 2d 62 79 2d 63 61 73 |dual cas|e-by-cas|
|00004e80| 65 20 62 61 73 69 73 20 | 74 6f 20 61 6c 6c 20 77 |e basis |to all w|
|00004e90| 6f 6d 65 6e 0d 0a 77 69 | 74 68 20 73 74 61 67 65 |omen..wi|th stage|
|00004ea0| 73 20 49 20 61 6e 64 20 | 49 49 20 62 72 65 61 73 |s I and |II breas|
|00004eb0| 74 20 63 61 6e 63 65 72 | 2e 2d 2d 57 2e 48 2e 20 |t cancer|.--W.H. |
|00004ec0| 48 69 6e 64 6c 65 2c 20 | 4d 2e 44 2e 0d 0a 24 55 |Hindle, |M.D...$U|
|00004ed0| 6e 69 71 75 65 5f 49 44 | 7b 59 52 42 31 31 38 35 |nique_ID|{YRB1185|
|00004ee0| 30 7d 0d 0a 24 54 69 74 | 6c 65 7b 45 66 66 65 63 |0}..$Tit|le{Effec|
|00004ef0| 74 73 20 6f 66 20 4d 61 | 74 65 72 6e 61 6c 20 4d |ts of Ma|ternal M|
|00004f00| 61 72 69 6a 75 61 6e 61 | 20 61 6e 64 20 43 6f 63 |arijuana| and Coc|
|00004f10| 61 69 6e 65 20 55 73 65 | 20 6f 6e 20 46 65 74 61 |aine Use| on Feta|
|00004f20| 6c 20 47 72 6f 77 74 68 | 7d 0d 0a 24 41 75 74 68 |l Growth|}..$Auth|
|00004f30| 6f 72 7b 5a 75 63 6b 65 | 72 6d 61 6e 2c 20 42 0d |or{Zucke|rman, B.|
|00004f40| 0a 46 72 61 6e 6b 2c 20 | 44 41 0d 0a 48 69 6e 67 |.Frank, |DA..Hing|
|00004f50| 73 6f 6e 2c 20 52 0d 0a | 41 6d 61 72 6f 2c 20 48 |son, R..|Amaro, H|
|00004f60| 0d 0a 4c 65 76 65 6e 73 | 6f 6e 2c 20 53 4d 0d 0a |..Levens|on, SM..|
|00004f70| 4b 61 79 6e 65 2c 20 48 | 0d 0a 50 61 72 6b 65 72 |Kayne, H|..Parker|
|00004f80| 2c 20 53 0d 0a 56 69 6e | 63 69 2c 20 52 0d 0a 41 |, S..Vin|ci, R..A|
|00004f90| 62 6f 61 67 79 65 2c 20 | 4b 0d 0a 46 72 69 65 64 |boagye, |K..Fried|
|00004fa0| 2c 20 4c 45 0d 0a 43 61 | 62 72 61 6c 2c 20 48 0d |, LE..Ca|bral, H.|
|00004fb0| 0a 54 69 6d 70 65 72 69 | 2c 20 52 0d 0a 42 61 75 |.Timperi|, R..Bau|
|00004fc0| 63 68 6e 65 72 2c 20 48 | 7d 0d 0a 24 41 66 66 69 |chner, H|}..$Affi|
|00004fd0| 6c 69 61 74 69 6f 6e 7b | 42 6f 73 74 6f 6e 20 43 |liation{|Boston C|
|00004fe0| 69 74 79 20 48 6f 73 70 | 3b 20 42 6f 73 74 6f 6e |ity Hosp|; Boston|
|00004ff0| 20 55 6e 69 76 7d 0d 0a | 24 4a 6f 75 72 6e 61 6c | Univ}..|$Journal|
|00005000| 7b 4e 20 45 6e 67 6c 20 | 4a 20 4d 65 64 7d 0d 0a |{N Engl |J Med}..|
|00005010| 24 56 6f 6c 75 6d 65 7b | 33 32 30 7d 0d 0a 24 50 |$Volume{|320}..$P|
|00005020| 61 67 65 7b 37 36 32 2d | 37 36 38 7d 0d 0a 24 44 |age{762-|768}..$D|
|00005030| 61 74 65 7b 4d 61 72 63 | 68 20 32 33 2c 20 31 39 |ate{Marc|h 23, 19|
|00005040| 38 39 7d 0d 0a 24 59 42 | 56 6f 6c 7b 31 39 39 30 |89}..$YB|Vol{1990|
|00005050| 20 59 65 61 72 20 42 6f | 6f 6b 20 6f 66 20 50 65 | Year Bo|ok of Pe|
|00005060| 64 69 61 74 72 69 63 73 | 7d 0d 0a 24 43 68 61 70 |diatrics|}..$Chap|
|00005070| 74 65 72 7b 31 2d 31 7d | 0d 0a 24 59 42 45 64 69 |ter{1-1}|..$YBEdi|
|00005080| 74 6f 72 7b 44 72 73 2e | 20 4f 73 6b 69 20 61 6e |tor{Drs.| Oski an|
|00005090| 64 20 53 74 6f 63 6b 6d | 61 6e 7d 0d 0a 24 54 61 |d Stockm|an}..$Ta|
|000050a0| 62 6c 65 7b 7d 0d 0a 24 | 43 6f 6d 6d 65 6e 74 61 |ble{}..$|Commenta|
|000050b0| 74 6f 72 7b 46 2e 41 2e | 20 4f 73 6b 69 2c 20 4d |tor{F.A.| Oski, M|
|000050c0| 2e 44 2e 7d 0d 0a 0d 0a | 43 6f 70 79 72 69 67 68 |.D.}....|Copyrigh|
|000050d0| 74 20 28 63 29 20 59 65 | 61 72 62 6f 6f 6b 20 4d |t (c) Ye|arbook M|
|000050e0| 65 64 69 63 61 6c 20 50 | 75 62 6c 69 73 68 65 72 |edical P|ublisher|
|000050f0| 73 2c 20 49 6e 63 2e 2c | 20 31 39 39 30 0d 0a 0d |s, Inc.,| 1990...|
|00005100| 0a 31 39 39 30 20 59 65 | 61 72 20 42 6f 6f 6b 20 |.1990 Ye|ar Book |
|00005110| 6f 66 20 50 65 64 69 61 | 74 72 69 63 73 20 28 52 |of Pedia|trics (R|
|00005120| 29 0d 0a 0d 0a 43 68 61 | 70 74 65 72 20 31 2d 2d |)....Cha|pter 1--|
|00005130| 54 68 65 20 4e 65 77 62 | 6f 72 6e 0d 0a 0d 0a 2d |The Newb|orn....-|
|00005140| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005150| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005160| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005170| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005180| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 0d 0a 45 |--------|-----..E|
|00005190| 66 66 65 63 74 73 20 6f | 66 20 4d 61 74 65 72 6e |ffects o|f Matern|
|000051a0| 61 6c 20 4d 61 72 69 6a | 75 61 6e 61 20 61 6e 64 |al Marij|uana and|
|000051b0| 20 43 6f 63 61 69 6e 65 | 20 55 73 65 20 6f 6e 20 | Cocaine| Use on |
|000051c0| 46 65 74 61 6c 20 47 72 | 6f 77 74 68 0d 0a 0d 0a |Fetal Gr|owth....|
|000051d0| 5a 75 63 6b 65 72 6d 61 | 6e 20 42 2c 20 46 72 61 |Zuckerma|n B, Fra|
|000051e0| 6e 6b 20 44 41 2c 20 48 | 69 6e 67 73 6f 6e 20 52 |nk DA, H|ingson R|
|000051f0| 2c 20 41 6d 61 72 6f 20 | 48 2c 20 4c 65 76 65 6e |, Amaro |H, Leven|
|00005200| 73 6f 6e 20 53 4d 2c 20 | 4b 61 79 6e 65 20 48 2c |son SM, |Kayne H,|
|00005210| 20 50 61 72 6b 65 72 20 | 53 2c 0d 0a 56 69 6e 63 | Parker |S,..Vinc|
|00005220| 69 20 52 2c 20 41 62 6f | 61 67 79 65 20 4b 2c 20 |i R, Abo|agye K, |
|00005230| 46 72 69 65 64 20 4c 45 | 2c 20 43 61 62 72 61 6c |Fried LE|, Cabral|
|00005240| 20 48 2c 20 54 69 6d 70 | 65 72 69 20 52 2c 20 42 | H, Timp|eri R, B|
|00005250| 61 75 63 68 6e 65 72 20 | 48 0d 0a 28 42 6f 73 74 |auchner |H..(Bost|
|00005260| 6f 6e 20 43 69 74 79 20 | 48 6f 73 70 3b 20 42 6f |on City |Hosp; Bo|
|00005270| 73 74 6f 6e 20 55 6e 69 | 76 29 0d 0a 4e 20 45 6e |ston Uni|v)..N En|
|00005280| 67 6c 20 4a 20 4d 65 64 | 20 33 32 30 3a 37 36 32 |gl J Med| 320:762|
|00005290| 2d 37 36 38 2c 20 4d 61 | 72 63 68 20 32 33 2c 20 |-768, Ma|rch 23, |
|000052a0| 31 39 38 39 0d 0a 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |1989..--|--------|
|000052b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000052c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000052d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000052e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000052f0| 2d 2d 2d 2d 0d 0a 0d 0a | 41 62 73 74 72 61 63 74 |----....|Abstract|
|00005300| 0d 0a 0d 0a 20 20 20 20 | 20 54 68 65 20 77 69 64 |.... | The wid|
|00005310| 65 73 70 72 65 61 64 20 | 75 73 65 20 6f 66 20 6d |espread |use of m|
|00005320| 61 72 69 6a 75 61 6e 61 | 20 61 6e 64 20 63 6f 63 |arijuana| and coc|
|00005330| 61 69 6e 65 20 64 75 72 | 69 6e 67 20 70 72 69 6d |aine dur|ing prim|
|00005340| 65 20 72 65 70 72 6f 64 | 75 63 74 69 76 65 0d 0a |e reprod|uctive..|
|00005350| 79 65 61 72 73 20 72 61 | 69 73 65 73 20 71 75 65 |years ra|ises que|
|00005360| 73 74 69 6f 6e 73 20 61 | 62 6f 75 74 20 74 68 65 |stions a|bout the|
|00005370| 20 65 66 66 65 63 74 73 | 20 6f 66 20 74 68 69 73 | effects| of this|
|00005380| 20 73 75 62 73 74 61 6e | 63 65 20 6f 6e 20 66 65 | substan|ce on fe|
|00005390| 74 61 6c 20 67 72 6f 77 | 74 68 20 61 6e 64 0d 0a |tal grow|th and..|
|000053a0| 64 65 76 65 6c 6f 70 6d | 65 6e 74 2e 20 20 54 68 |developm|ent. Th|
|000053b0| 65 20 66 65 77 20 73 74 | 75 64 69 65 73 20 6f 6e |e few st|udies on|
|000053c0| 20 74 68 69 73 20 74 6f | 70 69 63 20 68 61 76 65 | this to|pic have|
|000053d0| 20 79 69 65 6c 64 65 64 | 20 69 6e 63 6f 6e 73 69 | yielded| inconsi|
|000053e0| 73 74 65 6e 74 20 72 65 | 73 75 6c 74 73 2e 0d 0a |stent re|sults...|
|000053f0| 49 6e 76 65 73 74 69 67 | 61 74 69 6f 6e 73 20 6f |Investig|ations o|
|00005400| 66 20 31 2c 32 32 36 20 | 6d 6f 74 68 65 72 73 2c |f 1,226 |mothers,|
|00005410| 20 72 65 63 72 75 69 74 | 65 64 20 66 72 6f 6d 20 | recruit|ed from |
|00005420| 61 20 67 65 6e 65 72 61 | 6c 20 70 72 65 6e 61 74 |a genera|l prenat|
|00005430| 61 6c 20 63 6c 69 6e 69 | 63 2c 0d 0a 69 6e 64 69 |al clini|c,..indi|
|00005440| 63 61 74 65 64 20 74 68 | 61 74 20 32 37 25 20 68 |cated th|at 27% h|
|00005450| 61 64 20 75 73 65 64 20 | 6d 61 72 69 6a 75 61 6e |ad used |marijuan|
|00005460| 61 20 64 75 72 69 6e 67 | 20 70 72 65 67 6e 61 6e |a during| pregnan|
|00005470| 63 79 20 61 6e 64 20 31 | 38 25 20 68 61 64 20 75 |cy and 1|8% had u|
|00005480| 73 65 64 0d 0a 63 6f 63 | 61 69 6e 65 2e 20 20 4f |sed..coc|aine. O|
|00005490| 6e 20 74 68 65 20 62 61 | 73 69 73 20 6f 66 20 70 |n the ba|sis of p|
|000054a0| 6f 73 69 74 69 76 65 20 | 75 72 69 6e 65 20 61 73 |ositive |urine as|
|000054b0| 73 61 79 73 20 61 6c 6f | 6e 65 2c 20 31 36 25 20 |says alo|ne, 16% |
|000054c0| 61 6e 64 20 39 25 20 68 | 61 64 20 75 73 65 64 0d |and 9% h|ad used.|
|000054d0| 0a 6d 61 72 69 6a 75 61 | 6e 61 20 61 6e 64 20 63 |.marijua|na and c|
|000054e0| 6f 63 61 69 6e 65 2c 20 | 72 65 73 70 65 63 74 69 |ocaine, |respecti|
|000054f0| 76 65 6c 79 2e 0d 0a 20 | 20 20 20 20 57 68 65 6e |vely... | When|
|00005500| 20 70 6f 74 65 6e 74 69 | 61 6c 6c 79 20 63 6f 6e | potenti|ally con|
|00005510| 66 6f 75 6e 64 69 6e 67 | 20 76 61 72 69 61 62 6c |founding| variabl|
|00005520| 65 73 20 77 65 72 65 20 | 63 6f 6e 74 72 6f 6c 6c |es were |controll|
|00005530| 65 64 20 66 6f 72 2c 20 | 74 68 65 20 69 6e 66 61 |ed for, |the infa|
|00005540| 6e 74 73 0d 0a 6f 66 20 | 6d 6f 74 68 65 72 73 20 |nts..of |mothers |
|00005550| 77 68 6f 20 68 61 64 20 | 70 6f 73 69 74 69 76 65 |who had |positive|
|00005560| 20 75 72 69 6e 65 20 61 | 73 73 61 79 73 20 66 6f | urine a|ssays fo|
|00005570| 72 20 6d 61 72 69 6a 75 | 61 6e 61 20 77 65 72 65 |r mariju|ana were|
|00005580| 20 37 39 20 67 6d 20 6c | 69 67 68 74 65 72 20 69 | 79 gm l|ighter i|
|00005590| 6e 0d 0a 62 69 72 74 68 | 20 77 65 69 67 68 74 20 |n..birth| weight |
|000055a0| 61 6e 64 20 30 2e 35 20 | 63 6d 20 73 68 6f 72 74 |and 0.5 |cm short|
|000055b0| 65 72 20 74 68 61 6e 20 | 74 68 65 20 69 6e 66 61 |er than |the infa|
|000055c0| 6e 74 73 20 6f 66 20 6d | 6f 74 68 65 72 73 20 77 |nts of m|others w|
|000055d0| 68 6f 20 68 61 64 20 6e | 6f 74 20 75 73 65 64 0d |ho had n|ot used.|
|000055e0| 0a 6d 61 72 69 6a 75 61 | 6e 61 20 64 75 72 69 6e |.marijua|na durin|
|000055f0| 67 20 70 72 65 67 6e 61 | 6e 63 79 2e 20 20 49 6e |g pregna|ncy. In|
|00005600| 66 61 6e 74 73 20 6f 66 | 20 6d 6f 74 68 65 72 73 |fants of| mothers|
|00005610| 20 77 68 6f 20 68 61 64 | 20 75 73 65 64 20 63 6f | who had| used co|
|00005620| 63 61 69 6e 65 20 64 75 | 72 69 6e 67 0d 0a 70 72 |caine du|ring..pr|
|00005630| 65 67 6e 61 6e 63 79 20 | 77 65 72 65 20 39 33 20 |egnancy |were 93 |
|00005640| 67 6d 20 6c 69 67 68 74 | 65 72 20 61 6e 64 20 30 |gm light|er and 0|
|00005650| 2e 37 20 63 6d 20 73 68 | 6f 72 74 65 72 20 74 68 |.7 cm sh|orter th|
|00005660| 61 6e 20 74 68 6f 73 65 | 20 77 68 6f 73 65 20 6d |an those| whose m|
|00005670| 6f 74 68 65 72 73 20 68 | 61 64 0d 0a 6e 6f 74 20 |others h|ad..not |
|00005680| 75 73 65 64 20 63 6f 63 | 61 69 6e 65 20 64 75 72 |used coc|aine dur|
|00005690| 69 6e 67 20 70 72 65 67 | 6e 61 6e 63 79 2e 20 20 |ing preg|nancy. |
|000056a0| 49 6e 20 61 64 64 69 74 | 69 6f 6e 2c 20 69 6e 66 |In addit|ion, inf|
|000056b0| 61 6e 74 73 20 6f 66 20 | 63 6f 63 61 69 6e 65 20 |ants of |cocaine |
|000056c0| 75 73 65 72 73 20 68 61 | 64 0d 0a 61 20 30 2e 34 |users ha|d..a 0.4|
|000056d0| 33 20 63 6d 20 73 6d 61 | 6c 6c 65 72 20 68 65 61 |3 cm sma|ller hea|
|000056e0| 64 20 63 69 72 63 75 6d | 66 65 72 65 6e 63 65 20 |d circum|ference |
|000056f0| 74 68 61 6e 20 69 6e 66 | 61 6e 74 73 20 6f 66 20 |than inf|ants of |
|00005700| 6e 6f 6e 75 73 65 72 73 | 2e 20 20 57 68 65 6e 20 |nonusers|. When |
|00005710| 74 68 65 0d 0a 61 6e 61 | 6c 79 73 69 73 20 77 61 |the..ana|lysis wa|
|00005720| 73 20 72 65 70 65 61 74 | 65 64 20 75 73 69 6e 67 |s repeat|ed using|
|00005730| 20 6f 6e 6c 79 20 73 65 | 6c 66 2d 72 65 70 6f 72 | only se|lf-repor|
|00005740| 74 65 64 20 75 73 65 20 | 6f 66 20 6d 61 72 69 6a |ted use |of marij|
|00005750| 75 61 6e 61 20 61 6e 64 | 20 63 6f 63 61 69 6e 65 |uana and| cocaine|
|00005760| 2c 0d 0a 6e 6f 20 73 69 | 67 6e 69 66 69 63 61 6e |,..no si|gnifican|
|00005770| 74 20 61 73 73 6f 63 69 | 61 74 69 6f 6e 73 20 62 |t associ|ations b|
|00005780| 65 74 77 65 65 6e 20 73 | 75 63 68 20 75 73 65 20 |etween s|uch use |
|00005790| 61 6e 64 20 61 6e 79 20 | 6d 65 61 73 75 72 65 73 |and any |measures|
|000057a0| 20 6f 66 20 6f 75 74 63 | 6f 6d 65 20 77 65 72 65 | of outc|ome were|
|000057b0| 0d 0a 66 6f 75 6e 64 2e | 0d 0a 20 20 20 20 20 54 |..found.|.. T|
|000057c0| 68 65 20 75 73 65 20 6f | 66 20 6d 61 72 69 6a 75 |he use o|f mariju|
|000057d0| 61 6e 61 20 6f 72 20 63 | 6f 63 61 69 6e 65 20 64 |ana or c|ocaine d|
|000057e0| 75 72 69 6e 67 20 70 72 | 65 67 6e 61 6e 63 79 20 |uring pr|egnancy |
|000057f0| 61 70 70 65 61 72 73 20 | 74 6f 20 62 65 20 61 73 |appears |to be as|
|00005800| 73 6f 63 69 61 74 65 64 | 0d 0a 77 69 74 68 20 69 |sociated|..with i|
|00005810| 6d 70 61 69 72 65 64 20 | 66 65 74 61 6c 20 67 72 |mpaired |fetal gr|
|00005820| 6f 77 74 68 2e 20 20 4d | 65 61 73 75 72 69 6e 67 |owth. M|easuring|
|00005830| 20 61 20 62 69 6f 6c 6f | 67 69 63 20 6d 61 72 6b | a biolo|gic mark|
|00005840| 65 72 20 6f 66 20 73 75 | 63 68 20 75 73 65 2c 20 |er of su|ch use, |
|00005850| 72 61 74 68 65 72 0d 0a | 74 68 61 6e 20 72 65 6c |rather..|than rel|
|00005860| 79 69 6e 67 20 6f 6e 20 | 73 65 6c 66 2d 72 65 70 |ying on |self-rep|
|00005870| 6f 72 74 73 2c 20 69 73 | 20 69 6d 70 6f 72 74 61 |orts, is| importa|
|00005880| 6e 74 20 69 6e 20 64 65 | 6d 6f 6e 73 74 72 61 74 |nt in de|monstrat|
|00005890| 69 6e 67 20 74 68 69 73 | 20 61 73 73 6f 63 69 61 |ing this| associa|
|000058a0| 74 69 6f 6e 2e 0d 0a 0d | 0a 50 6f 73 74 2d 43 6f |tion....|.Post-Co|
|000058b0| 6d 6d 65 6e 74 0d 0a 0d | 0a 20 20 20 20 20 54 68 |mment...|. Th|
|000058c0| 69 73 20 70 72 6f 62 6c | 65 6d 20 69 73 20 6f 6e |is probl|em is on|
|000058d0| 65 20 6f 66 20 74 68 65 | 20 6d 61 6a 6f 72 20 63 |e of the| major c|
|000058e0| 68 61 6c 6c 65 6e 67 65 | 73 20 69 6e 20 6f 75 72 |hallenge|s in our|
|000058f0| 20 73 6f 63 69 65 74 79 | 20 61 74 20 70 72 65 73 | society| at pres|
|00005900| 65 6e 74 0d 0a 74 69 6d | 65 2e 20 20 57 68 61 74 |ent..tim|e. What|
|00005910| 20 61 20 73 68 61 6d 65 | 20 74 68 61 74 20 77 65 | a shame| that we|
|00005920| 20 68 61 76 65 20 74 6f | 20 64 65 76 6f 74 65 20 | have to| devote |
|00005930| 73 6f 20 6d 75 63 68 20 | 74 69 6d 65 20 61 6e 64 |so much |time and|
|00005940| 20 6d 6f 6e 65 79 20 74 | 6f 20 74 72 65 61 74 20 | money t|o treat |
|00005950| 74 68 65 0d 0a 72 61 76 | 61 67 65 73 20 6f 66 20 |the..rav|ages of |
|00005960| 74 68 69 73 20 63 6f 6e | 64 69 74 69 6f 6e 20 77 |this con|dition w|
|00005970| 68 65 6e 20 74 68 65 20 | 73 61 6d 65 20 65 6e 65 |hen the |same ene|
|00005980| 72 67 79 20 61 6e 64 20 | 72 65 73 6f 75 72 63 65 |rgy and |resource|
|00005990| 73 20 63 6f 75 6c 64 20 | 62 65 20 69 6e 76 65 73 |s could |be inves|
|000059a0| 74 65 64 0d 0a 69 6e 20 | 69 6d 70 72 6f 76 69 6e |ted..in |improvin|
|000059b0| 67 20 74 68 65 20 6c 6f | 74 20 6f 66 20 74 68 65 |g the lo|t of the|
|000059c0| 20 6c 65 73 73 20 66 6f | 72 74 75 6e 61 74 65 20 | less fo|rtunate |
|000059d0| 6d 65 6d 62 65 72 73 20 | 6f 66 20 73 6f 63 69 65 |members |of socie|
|000059e0| 74 79 2e 20 20 46 6f 72 | 20 6d 6f 72 65 20 6f 6e |ty. For| more on|
|000059f0| 0d 0a 63 6f 63 61 69 6e | 65 20 61 62 75 73 65 20 |..cocain|e abuse |
|00005a00| 61 6e 64 20 69 74 73 20 | 66 65 74 61 6c 20 63 6f |and its |fetal co|
|00005a10| 6e 73 65 71 75 65 6e 63 | 65 73 20 70 6c 65 61 73 |nsequenc|es pleas|
|00005a20| 65 20 72 65 66 65 72 20 | 74 6f 20 41 62 73 74 72 |e refer |to Abstr|
|00005a30| 61 63 74 20 37 2d 31 20 | 61 6e 64 20 74 68 65 0d |act 7-1 |and the.|
|00005a40| 0a 61 63 63 6f 6d 70 61 | 6e 79 69 6e 67 20 63 6f |.accompa|nying co|
|00005a50| 6d 6d 65 6e 74 61 72 79 | 2e 20 20 49 6e 20 61 64 |mmentary|. In ad|
|00005a60| 64 69 74 69 6f 6e 20 74 | 6f 20 74 68 65 20 6f 62 |dition t|o the ob|
|00005a70| 73 65 72 76 61 74 69 6f | 6e 73 20 6f 66 20 5a 75 |servatio|ns of Zu|
|00005a80| 63 6b 65 72 6d 61 6e 20 | 61 6e 64 0d 0a 61 73 73 |ckerman |and..ass|
|00005a90| 6f 63 69 61 74 65 73 20 | 64 65 73 63 72 69 62 65 |ociates |describe|
|00005aa0| 64 20 61 62 6f 76 65 2c | 20 4c 69 74 74 6c 65 20 |d above,| Little |
|00005ab0| 61 6e 64 20 63 6f 6c 6c | 65 61 67 75 65 73 20 66 |and coll|eagues f|
|00005ac0| 72 6f 6d 20 44 61 6c 6c | 61 73 20 72 65 70 6f 72 |rom Dall|as repor|
|00005ad0| 74 20 74 68 61 74 0d 0a | 69 6e 66 61 6e 74 73 20 |t that..|infants |
|00005ae0| 62 6f 72 6e 20 74 6f 20 | 63 6f 63 61 69 6e 65 20 |born to |cocaine |
|00005af0| 61 62 75 73 65 72 73 20 | 68 61 64 20 73 69 67 6e |abusers |had sign|
|00005b00| 69 66 69 63 61 6e 74 6c | 79 20 6d 6f 72 65 20 63 |ificantl|y more c|
|00005b10| 6f 6d 70 6c 69 63 61 74 | 69 6f 6e 73 20 61 74 20 |omplicat|ions at |
|00005b20| 62 69 72 74 68 0d 0a 73 | 75 63 68 20 61 73 20 6d |birth..s|uch as m|
|00005b30| 65 63 6f 6e 69 75 6d 20 | 61 6e 64 20 74 61 63 68 |econium |and tach|
|00005b40| 79 63 61 72 64 69 61 2c | 20 6c 6f 77 65 72 20 62 |ycardia,| lower b|
|00005b50| 69 72 74 68 20 77 65 69 | 67 68 74 2c 20 61 6e 64 |irth wei|ght, and|
|00005b60| 20 61 6e 20 65 78 63 65 | 73 73 20 6f 66 0d 0a 63 | an exce|ss of..c|
|00005b70| 6f 6e 67 65 6e 69 74 61 | 6c 20 63 61 72 64 69 61 |ongenita|l cardia|
|00005b80| 63 20 61 6e 6f 6d 61 6c | 69 65 73 20 28 31 29 2e |c anomal|ies (1).|
|00005b90| 20 20 43 68 6f 75 74 65 | 61 75 20 61 6e 64 20 63 | Choute|au and c|
|00005ba0| 6f 2d 77 6f 72 6b 65 72 | 73 2c 20 69 6e 20 61 20 |o-worker|s, in a |
|00005bb0| 72 65 74 72 6f 73 70 65 | 63 74 69 76 65 0d 0a 73 |retrospe|ctive..s|
|00005bc0| 74 75 64 79 20 66 72 6f | 6d 20 4e 65 77 20 59 6f |tudy fro|m New Yo|
|00005bd0| 72 6b 20 43 69 74 79 2c | 20 66 6f 75 6e 64 20 63 |rk City,| found c|
|00005be0| 6f 63 61 69 6e 65 20 61 | 62 75 73 65 20 74 6f 20 |ocaine a|buse to |
|00005bf0| 62 65 20 61 20 73 69 67 | 6e 69 66 69 63 61 6e 74 |be a sig|nificant|
|00005c00| 20 70 72 65 64 69 63 74 | 6f 72 20 6f 66 0d 0a 6c | predict|or of..l|
|00005c10| 6f 77 20 62 69 72 74 68 | 20 77 65 69 67 68 74 20 |ow birth| weight |
|00005c20| 61 6e 64 20 65 61 72 6c | 79 20 67 65 73 74 61 74 |and earl|y gestat|
|00005c30| 69 6f 6e 61 6c 20 61 67 | 65 20 61 74 20 64 65 6c |ional ag|e at del|
|00005c40| 69 76 65 72 79 20 28 32 | 29 2e 20 20 46 75 72 74 |ivery (2|). Furt|
|00005c50| 68 65 72 2c 20 54 65 6c | 73 65 79 0d 0a 65 74 20 |her, Tel|sey..et |
|00005c60| 61 6c 20 28 33 29 20 72 | 65 70 6f 72 74 20 74 68 |al (3) r|eport th|
|00005c70| 65 20 75 6e 75 73 75 61 | 6c 20 6f 63 63 75 72 72 |e unusua|l occurr|
|00005c80| 65 6e 63 65 20 6f 66 20 | 61 20 74 65 72 6d 20 69 |ence of |a term i|
|00005c90| 6e 66 61 6e 74 20 65 78 | 70 6f 73 65 64 20 74 6f |nfant ex|posed to|
|00005ca0| 20 63 6f 63 61 69 6e 65 | 0d 0a 61 6e 74 65 6e 61 | cocaine|..antena|
|00005cb0| 74 61 6c 6c 79 20 77 68 | 6f 20 77 61 73 20 66 6f |tally wh|o was fo|
|00005cc0| 75 6e 64 20 74 6f 20 68 | 61 76 65 20 6e 65 63 72 |und to h|ave necr|
|00005cd0| 6f 74 69 7a 69 6e 67 20 | 65 6e 74 65 72 6f 63 6f |otizing |enteroco|
|00005ce0| 6c 69 74 69 73 20 61 74 | 20 62 69 72 74 68 2e 20 |litis at| birth. |
|00005cf0| 20 57 68 65 72 65 2c 0d | 0a 61 6e 64 20 77 68 65 | Where,.|.and whe|
|00005d00| 6e 2c 20 77 69 6c 6c 20 | 69 74 20 61 6c 6c 20 65 |n, will |it all e|
|00005d10| 6e 64 3f 2d 2d 46 2e 41 | 2e 20 4f 73 6b 69 2c 20 |nd?--F.A|. Oski, |
|00005d20| 4d 2e 44 2e 0d 0a 24 55 | 6e 69 71 75 65 5f 49 44 |M.D...$U|nique_ID|
|00005d30| 7b 59 52 42 31 31 38 35 | 31 7d 0d 0a 24 54 69 74 |{YRB1185|1}..$Tit|
|00005d40| 6c 65 7b 41 73 73 6f 63 | 69 61 74 69 6f 6e 20 6f |le{Assoc|iation o|
|00005d50| 66 20 55 72 65 61 70 6c | 61 73 6d 61 20 75 72 65 |f Ureapl|asma ure|
|00005d60| 61 6c 79 74 69 63 75 6d | 20 49 6e 66 65 63 74 69 |alyticum| Infecti|
|00005d70| 6f 6e 20 6f 66 20 74 68 | 65 20 4c 6f 77 65 72 20 |on of th|e Lower |
|00005d80| 52 65 73 70 69 72 61 74 | 6f 72 79 20 54 72 61 63 |Respirat|ory Trac|
|00005d90| 74 20 57 69 74 68 20 43 | 68 72 6f 6e 69 63 20 4c |t With C|hronic L|
|00005da0| 75 6e 67 20 44 69 73 65 | 61 73 65 20 61 6e 64 20 |ung Dise|ase and |
|00005db0| 44 65 61 74 68 20 69 6e | 20 56 65 72 79 2d 4c 6f |Death in| Very-Lo|
|00005dc0| 77 2d 42 69 72 74 68 2d | 57 65 69 67 68 74 20 49 |w-Birth-|Weight I|
|00005dd0| 6e 66 61 6e 74 73 7d 0d | 0a 24 41 75 74 68 6f 72 |nfants}.|.$Author|
|00005de0| 7b 43 61 73 73 65 6c 6c | 2c 20 47 48 0d 0a 57 61 |{Cassell|, GH..Wa|
|00005df0| 69 74 65 73 2c 20 4b 42 | 0d 0a 43 72 6f 75 73 65 |ites, KB|..Crouse|
|00005e00| 2c 20 44 54 0d 0a 52 75 | 64 64 2c 20 50 54 0d 0a |, DT..Ru|dd, PT..|
|00005e10| 43 61 6e 75 70 70 2c 20 | 4b 43 0d 0a 53 74 61 67 |Canupp, |KC..Stag|
|00005e20| 6e 6f 2c 20 53 0d 0a 43 | 75 74 74 65 72 2c 20 47 |no, S..C|utter, G|
|00005e30| 52 7d 0d 0a 24 41 66 66 | 69 6c 69 61 74 69 6f 6e |R}..$Aff|iliation|
|00005e40| 7b 55 6e 69 76 20 6f 66 | 20 41 6c 61 62 61 6d 61 |{Univ of| Alabama|
|00005e50| 2c 20 42 69 72 6d 69 6e | 67 68 61 6d 3b 20 55 6e |, Birmin|gham; Un|
|00005e60| 69 76 20 6f 66 20 43 61 | 6d 62 72 69 64 67 65 2c |iv of Ca|mbridge,|
|00005e70| 20 45 6e 67 6c 61 6e 64 | 7d 0d 0a 24 4a 6f 75 72 | England|}..$Jour|
|00005e80| 6e 61 6c 7b 4c 61 6e 63 | 65 74 7d 0d 0a 24 56 6f |nal{Lanc|et}..$Vo|
|00005e90| 6c 75 6d 65 7b 32 7d 0d | 0a 24 50 61 67 65 7b 32 |lume{2}.|.$Page{2|
|00005ea0| 34 30 2d 32 34 35 7d 0d | 0a 24 44 61 74 65 7b 4a |40-245}.|.$Date{J|
|00005eb0| 75 6c 79 20 33 30 2c 20 | 31 39 38 38 7d 0d 0a 24 |uly 30, |1988}..$|
|00005ec0| 59 42 56 6f 6c 7b 31 39 | 39 30 20 59 65 61 72 20 |YBVol{19|90 Year |
|00005ed0| 42 6f 6f 6b 20 6f 66 20 | 50 65 64 69 61 74 72 69 |Book of |Pediatri|
|00005ee0| 63 73 7d 0d 0a 24 43 68 | 61 70 74 65 72 7b 31 2d |cs}..$Ch|apter{1-|
|00005ef0| 32 7d 0d 0a 24 59 42 45 | 64 69 74 6f 72 7b 44 72 |2}..$YBE|ditor{Dr|
|00005f00| 73 2e 20 4f 73 6b 69 20 | 61 6e 64 20 53 74 6f 63 |s. Oski |and Stoc|
|00005f10| 6b 6d 61 6e 7d 0d 0a 24 | 54 61 62 6c 65 7b 54 61 |kman}..$|Table{Ta|
|00005f20| 62 6c 65 20 4f 6d 69 74 | 74 65 64 7d 0d 0a 24 43 |ble Omit|ted}..$C|
|00005f30| 6f 6d 6d 65 6e 74 61 74 | 6f 72 7b 46 2e 41 2e 20 |ommentat|or{F.A. |
|00005f40| 4f 73 6b 69 2c 20 4d 2e | 44 2e 7d 0d 0a 0d 0a 43 |Oski, M.|D.}....C|
|00005f50| 6f 70 79 72 69 67 68 74 | 20 28 63 29 20 59 65 61 |opyright| (c) Yea|
|00005f60| 72 62 6f 6f 6b 20 4d 65 | 64 69 63 61 6c 20 50 75 |rbook Me|dical Pu|
|00005f70| 62 6c 69 73 68 65 72 73 | 2c 20 49 6e 63 2e 2c 20 |blishers|, Inc., |
|00005f80| 31 39 39 30 0d 0a 0d 0a | 31 39 39 30 20 59 65 61 |1990....|1990 Yea|
|00005f90| 72 20 42 6f 6f 6b 20 6f | 66 20 50 65 64 69 61 74 |r Book o|f Pediat|
|00005fa0| 72 69 63 73 20 28 52 29 | 0d 0a 0d 0a 43 68 61 70 |rics (R)|....Chap|
|00005fb0| 74 65 72 20 31 2d 2d 54 | 68 65 20 4e 65 77 62 6f |ter 1--T|he Newbo|
|00005fc0| 72 6e 0d 0a 0d 0a 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |rn....--|--------|
|00005fd0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005fe0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005ff0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00006000| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00006010| 2d 2d 2d 2d 0d 0a 41 73 | 73 6f 63 69 61 74 69 6f |----..As|sociatio|
|00006020| 6e 20 6f 66 20 55 72 65 | 61 70 6c 61 73 6d 61 20 |n of Ure|aplasma |
|00006030| 75 72 65 61 6c 79 74 69 | 63 75 6d 20 49 6e 66 65 |urealyti|cum Infe|
|00006040| 63 74 69 6f 6e 20 6f 66 | 20 74 68 65 20 4c 6f 77 |ction of| the Low|
|00006050| 65 72 20 52 65 73 70 69 | 72 61 74 6f 72 79 20 54 |er Respi|ratory T|
|00006060| 72 61 63 74 0d 0a 57 69 | 74 68 20 43 68 72 6f 6e |ract..Wi|th Chron|
|00006070| 69 63 20 4c 75 6e 67 20 | 44 69 73 65 61 73 65 20 |ic Lung |Disease |
|00006080| 61 6e 64 20 44 65 61 74 | 68 20 69 6e 20 56 65 72 |and Deat|h in Ver|
|00006090| 79 2d 4c 6f 77 2d 42 69 | 72 74 68 2d 57 65 69 67 |y-Low-Bi|rth-Weig|
|000060a0| 68 74 20 49 6e 66 61 6e | 74 73 0d 0a 0d 0a 43 61 |ht Infan|ts....Ca|
|000060b0| 73 73 65 6c 6c 20 47 48 | 2c 20 57 61 69 74 65 73 |ssell GH|, Waites|
|000060c0| 20 4b 42 2c 20 43 72 6f | 75 73 65 20 44 54 2c 20 | KB, Cro|use DT, |
|000060d0| 52 75 64 64 20 50 54 2c | 20 43 61 6e 75 70 70 20 |Rudd PT,| Canupp |
|000060e0| 4b 43 2c 20 53 74 61 67 | 6e 6f 20 53 2c 20 43 75 |KC, Stag|no S, Cu|
|000060f0| 74 74 65 72 20 47 52 0d | 0a 28 55 6e 69 76 20 6f |tter GR.|.(Univ o|
|00006100| 66 20 41 6c 61 62 61 6d | 61 2c 20 42 69 72 6d 69 |f Alabam|a, Birmi|
|00006110| 6e 67 68 61 6d 3b 20 55 | 6e 69 76 20 6f 66 20 43 |ngham; U|niv of C|
|00006120| 61 6d 62 72 69 64 67 65 | 2c 20 45 6e 67 6c 61 6e |ambridge|, Englan|
|00006130| 64 29 0d 0a 4c 61 6e 63 | 65 74 20 32 3a 32 34 30 |d)..Lanc|et 2:240|
|00006140| 2d 32 34 35 2c 20 4a 75 | 6c 79 20 33 30 2c 20 31 |-245, Ju|ly 30, 1|
|00006150| 39 38 38 0d 0a 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |988..---|--------|
|00006160| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00006170| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00006180| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00006190| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000061a0| 2d 2d 2d 0d 0a 0d 0a 41 | 62 73 74 72 61 63 74 0d |---....A|bstract.|
|000061b0| 0a 0d 0a 20 20 20 20 20 | 56 65 72 79 2d 6c 6f 77 |... |Very-low|
|000061c0| 2d 62 69 72 74 68 2d 77 | 65 69 67 68 74 20 69 6e |-birth-w|eight in|
|000061d0| 66 61 6e 74 73 20 61 72 | 65 20 6d 6f 72 65 20 6c |fants ar|e more l|
|000061e0| 69 6b 65 6c 79 20 74 6f | 20 64 69 65 20 6f 66 0d |ikely to| die of.|
|000061f0| 0a 72 65 73 70 69 72 61 | 74 6f 72 79 2d 72 65 6c |.respira|tory-rel|
|00006200| 61 74 65 64 20 70 72 6f | 62 6c 65 6d 73 20 77 69 |ated pro|blems wi|
|00006210| 74 68 69 6e 20 74 68 65 | 20 66 69 72 73 74 20 66 |thin the| first f|
|00006220| 65 77 20 64 61 79 73 20 | 6f 66 20 6c 69 66 65 2c |ew days |of life,|
|00006230| 20 61 6e 64 20 74 68 6f | 73 65 20 77 68 6f 0d 0a | and tho|se who..|
|00006240| 73 75 72 76 69 76 65 20 | 61 72 65 20 61 74 20 69 |survive |are at i|
|00006250| 6e 63 72 65 61 73 65 64 | 20 72 69 73 6b 20 6f 66 |ncreased| risk of|
|00006260| 20 63 68 72 6f 6e 69 63 | 20 6c 75 6e 67 20 64 69 | chronic| lung di|
|00006270| 73 65 61 73 65 2e 20 20 | 48 6f 77 65 76 65 72 2c |sease. |However,|
|00006280| 20 74 68 65 20 74 72 75 | 65 0d 0a 69 6e 63 69 64 | the tru|e..incid|
|00006290| 65 6e 63 65 20 6f 66 20 | 6c 6f 77 65 72 20 72 65 |ence of |lower re|
|000062a0| 73 70 69 72 61 74 6f 72 | 79 20 74 72 61 63 74 20 |spirator|y tract |
|000062b0| 69 6e 66 65 63 74 69 6f | 6e 20 61 6e 64 20 69 74 |infectio|n and it|
|000062c0| 73 20 63 6f 6e 74 72 69 | 62 75 74 69 6f 6e 20 74 |s contri|bution t|
|000062d0| 6f 20 64 65 61 74 68 0d | 0a 6f 72 20 64 65 76 65 |o death.|.or deve|
|000062e0| 6c 6f 70 6d 65 6e 74 20 | 6f 66 20 63 68 72 6f 6e |lopment |of chron|
|000062f0| 69 63 20 6c 75 6e 67 20 | 64 69 73 65 61 73 65 20 |ic lung |disease |
|00006300| 61 72 65 20 75 6e 6b 6e | 6f 77 6e 2e 20 20 45 6e |are unkn|own. En|
|00006310| 64 6f 74 72 61 63 68 65 | 61 6c 20 61 73 70 69 72 |dotrache|al aspir|
|00006320| 61 74 65 73 0d 0a 77 65 | 72 65 20 63 75 6c 74 75 |ates..we|re cultu|
|00006330| 72 65 64 20 77 69 74 68 | 69 6e 20 32 34 20 68 6f |red with|in 24 ho|
|00006340| 75 72 73 20 6f 66 20 62 | 69 72 74 68 20 66 72 6f |urs of b|irth fro|
|00006350| 6d 20 32 30 30 20 69 6e | 66 61 6e 74 73 20 77 68 |m 200 in|fants wh|
|00006360| 6f 20 77 65 69 67 68 65 | 64 20 6e 6f 20 6d 6f 72 |o weighe|d no mor|
|00006370| 65 0d 0a 74 68 61 6e 20 | 32 2c 35 30 30 20 67 6d |e..than |2,500 gm|
|00006380| 20 61 6e 64 20 68 61 64 | 20 65 76 69 64 65 6e 63 | and had| evidenc|
|00006390| 65 20 6f 66 20 72 65 73 | 70 69 72 61 74 6f 72 79 |e of res|piratory|
|000063a0| 20 64 69 73 65 61 73 65 | 2e 20 20 41 73 70 69 72 | disease|. Aspir|
|000063b0| 61 74 65 73 20 77 65 72 | 65 0d 0a 63 75 6c 74 75 |ates wer|e..cultu|
|000063c0| 72 65 64 20 66 6f 72 20 | 6d 79 63 6f 70 6c 61 73 |red for |mycoplas|
|000063d0| 6d 61 73 2c 20 63 68 6c | 61 6d 79 64 69 61 65 2c |mas, chl|amydiae,|
|000063e0| 20 76 69 72 75 73 65 73 | 2c 20 61 6e 64 20 62 61 | viruses|, and ba|
|000063f0| 63 74 65 72 69 61 2e 0d | 0a 20 20 20 20 20 54 68 |cteria..|. Th|
+--------+-------------------------+-------------------------+--------+--------+
Only 25.0 KB of data is shown above.
