Sharon W. W. Chan

Help-seeking patterns in Chinese women with symptoms of breast disease: a qualitative study

BACKGROUND Prompt utilization of health services on detecting breast symptoms can improve breast cancer (BC) survival. Little is known about Chinese womens help-seeking behaviour. Our aim was to determine patterns of self-referral among Hong Kong Chinese women with self-detected breast symptoms. METHODS We recruited 37 women awaiting their first consultation at public hospitals for breast symptoms. Interviews were transcribed and analysed based on the grounded theory approaches. RESULTS A two-stage help-seeking model provided the best interpretation of the data. Symptom recognition was triggered by symptom interpretation, symptom progression and social messages. Painful lumps were seen as symptomatic, but atypical symptoms were often dismissed as benign as they responded to dietary change. Symptom intensification and discussions with someone who had faced BC prompted consultation. Service utilization involved fear of consequences, confirmation need, symptom distress, lay referral, media prompts and opportunistic presentation. Fearing cancer as incurable delayed consultation. Utilization barriers included cost, uncertainty about referral pathways, competing priorities and embarrassment. CONCLUSIONS Atypical and painless presentation was more common among women delaying presentation. Barriers included cost, access, time and embarrassment. Education should emphasize atypical symptoms, the high-cure rate and the need for early presentation. Reduced cost and improved access to clinics would enhance early consultation.

A BRCA2 founder mutation and seven novel deleterious BRCA mutations in southern Chinese women with breast and ovarian cancer

Breast cancer incidence in Asia has doubled over the past 10 years and is one of the highest in Hong Kong [1]. Studies in western populations have found differences in breast cancer epidemiology between Asian and Caucasian populations, potentially due to interactions between different lifestyle and genetic characteristics [2–4]. As the genetic predisposition to breast cancer is increasingly understood, it has been suggested that there are differences in different ethnic populations. To date, only a few investigations on the spectrum of BRCA [5, 6] mutations in Chinese populations have been performed, most of which were performed in single institutions or a small number of medical centers [7–9]. Some studied only the BRCA1 gene [10, 11] and most did not perform mutational screening using conventional full gene sequencing [12, 13]. Between March 2007 and February 2008, patients with breast and/or ovarian cancer were recruited from the Hong Kong Hereditary Breast Cancer Family Registry, which was formed in March 2007. In this Registry, all patients were recruited from 11 government-based hospitals, private hospitals, and clinics that cover all three areas of Hong Kong. Sequence analysis of all exons in BRCA1 and BRCA2 of a total of 119 high-risk female probands were

Introduction of night shift call system for surgical trainees: a prospective self-controlled trial.

Objective  The number of hours worked by specialty trainees has come under scrutiny recently. One approach aimed at decreasing the number of consecutive hours worked is the night shift call system (NSCS). This study aimed to determine the advantages and disadvantages of an NSCS compared with those of the conventional overnight call system (ONCS).

Benefit of Ultrasonography in the Detection of Clinically and Mammographically Occult Breast Cancer

ObjectiveThe purpose of this study was to evaluate the performance of high-resolution ultrasonography in the detection of clinically and mammographically occult breast cancer.Materials and methodsFrom September 2003 to November 2006, a total of 1485 patients were confirmed to have in situ or invasive breast cancer in Hong Kong Sanatorium and Hospital Breast Care Centre. All patients underwent mammography (MMG) and/ or sonography (USG) evaluation. Patients’ age and size of tumor detected by USG alone were compared with those detected by MMG.ResultsAltogether, 222 patients (17%) had positive imaging findings on USG only, among which 22 (13%) patients had nonpalpable tumors. Performing USG increased the cancer detection rate among clinically and mammographically occult breast lesions by 14.3%. The mean size of the tumors detected only by USG was 1.98 cm, which was not significantly different from the mean size of tumor detected by MMG (1.46) (p = 0.23). This remains true in the group of patients with nonpalpable tumors (1.36 vs. 1.46 cm, p = 0.88). The sensitivity of USG is 91%, which is significantly higher than that of MMG (78%) (p = 0.001). This remains true in patients age <40 or ≥40, tumor grading I toIII, and LVI +/− cases. However, MMG had higher sensitivity in the group of patients with nonpalpable tumors (73% vs. 62%, p = 0.01) and noninvasive cancers (72% vs. 69%, p = 0.01).ConclusionsThe use of high-resolution USG may lead to detection of a significant number of occult cancers that are no different in size from nonpalpable mammographically detected lesions.

Waiting to see the doctor: understanding appraisal and utilization components of consultation delay for new breast symptoms in Chinese women

Delayed consultation for potential cancer symptoms influences treatment outcomes and remains problematic. Delay components (Appraisal versus Utilization) and respective associations are poorly understood.

Intracranial chloroma in hypereosinophilic myelofibrosis

BACKGROUND Chloroma, also called granulocytic sarcoma, is a localized extramedullary tumor composed of leukemic myeloid cells. It is a rare tumor that can occur in various locations. The association of chloroma with leukemic disease or myeloproliferative disorders is limited to isolated case reports. CASE DESCRIPTION We report a case of intracranial chloroma in an elderly man with myelofibrosis and progressive hypereosinophilia. The presence of leukemic cells within his pleural aspirate suggested an incipient acute leukemic state. CONCLUSION We report the first case of intracranial chloroma associated with hypereosinophilia developing in the course of myelofibrosis. The significance of hypereosinophilia in predicting the likelihood of development of central nervous system chloroma and acute leukemia in a patient with myelofibrosis needs further evaluation.

TRIAGING REFERRAL TO A SPECIALIST BREAST CLINIC

Background:  The aim of this study was to determine the effectiveness of a triage system in predicting patients with malignancy among those referred to a specialist breast clinic.

Women surgeons in Hong Kong

Objective:  To survey Hong Kong women surgeons current situation: their ability to balance career, personal and family life, and to look into some gender‐specific issues.

Postmastectomy reconstruction with extended latissimus dorsi myocutaneous flap for Hong Kong Chinese

Objective:  Because of the smaller breast size of Chinese women, postmastectomy reconstruction without prosthesis by extended latissimus dorsi (LD) flap is potentially more applicable in the Chinese population.

Mesh erosion to urinary bladder causing fistulation to abdominal wall resulting in necrotizing fasciitis: A case report of late complication of incisional hernia

Highlights • Incisional hernia is not an uncommon complication after abdominal operation.• Mesh migration and erosion causing vesico-cutaneous fistula and subsequent necrotizing fasciitis is uncommon.• We hereby report a case of abdominal wall necrotizing fasciitis 21 months after laparoscopic incisional hernia repair in lower midline with dual mesh, due to mesh migration and erosion into urinary bladder, resulting in fistulation between bladder and abdominal wall.• Mesh erosion to viscera can cause severe complication. Its risk should be balanced and discussed with patient with full consent.