Patients with MSI who present with multiple space involvement, a high leukocyte count, and those with diabetes are at higher risk of developing life-threatening complications and need to be closely monitored.

ABSTR AC T Background Invasive lobular carcinoma (ILC) comprisesaround 10-15 % of invasive breast cancers. Few prior studies have demonstrated a unique pattern of metastases between ILC and the more common invasive ductal carcinoma (IDC).To our knowledge, such data is limited to first sites of distant recurrence. We aimed to perform a comparison of the metastatic pattern of ILC and IDC at first distant recurrence as well as over the entire course of metastatic disease.Methods We used a prospectively collated database of patients with metastatic breast cancer. Breast cancer recurrence or metastases were classified into various sites and a descriptive analysis was performed.Results Among 761 patients, 88 (11.6 %) were diagnosed with ILC and 673 (88.4 %) with IDC. Patients with ILC showed more frequent metastases to the bone (56.8 vs. 37.7 %, p = 0.001) and gastrointestinal (GI) tract (5.7 vs. 0.3 %, p < 0.001) as first site of distant recurrence, and less to organs such as lung (5.7 vs. 24.2 %, p < 0.001) and liver (4.6 vs. 11.4 %, p = 0.049). Over the entire course of metastatic disease, more patients with ILC had ovarian (5.7 vs. 2.1 %, p = 0.042) and GI tract metastases (8.0 vs. 0.6 %, p < 0.001), also demonstrating reduced tendency to metastasize to the liver (20.5 vs. 49.0 %, p < 0.001) and lung (23.9 vs. 51.9 %, p < 0.001). All associations but bone held after sensitivity analysis on hormonal status. Although patients presenting with ILC were noted to have more advanced stage at presentation, recurrence-free survival in these patients was increased (4.8 years vs. 3.2 years, p = 0.017). However, overall survival was not (2.5 vs. 2.0 years, p = 0.75).Conclusion After accounting for hormone receptor status, patients with IDC had greater lung/pleura and liver involvement, while patients with ILC had a greater propensity to develop ovarian and GI metastases both at first site and overall. Clinicians can use this information to provide more directed screening for metastases; it also adds to the argument that these two variants of breast cancer should be managed as unique diseases. ZUSAMMENFASSUNGEinleitung Invasiv-lobuläre Karzinome (ILC) machen rund

Objectives To determine whether lifestyle factors measured late in life could compress the disabled period towards the end of life. Design Community-based cohort study of older adults followed from 1989 to 2015. Setting Four US communities. Participants Men and women ages 65 and older (N= 5248, mean age 72.7 ± 5.5 years, 57% women, 15.2% minority) who were living in the community, not wheel-chair dependent and able to give informed consent at baseline. Measurements Multiple lifestyle factors including smoking, alcohol consumption, physical activity, diet, body mass index (BMI), social networks and social support were measured at baseline. Activities of Daily Living (ADL) were assessed at baseline and throughout follow-up. Years of Life (YoL) was defined as years until death. Years of Able Life (YAL) was defined as years without any ADL difficulty. YAL/YoL%, the proportion of life lived able, was used to indicate the relative compression/expansion of the disabled period. Results The average duration of disabled years was 4.5 (out of 15.4 mean YoL) for women and 2.9 (out of 12.4 mean YoL) for men. In a multivariable model, obesity (compared to normal BMI) was associated with 7.3% (95% CI, 5.4–9.2) lower YAL/YoL%. Scores in the lowest quintile of the Alternate Healthy Eating Index (compared to highest) were associated with a 3.7% (95% CI, 1.6–5.9) lower YAL/YoL%. Every 25 blocks walked in a week was associated with 0.5% (95% CI, 0.3–0.8) higher YAL/YoL%. Conclusion The effects of healthy lifestyle factors on the proportion of future life lived free of disability indicate that the disabled period can be compressed, given the right combination of these factors.

Forty-one (16.4%) were invited to take part. Twenty subjects took part in the program while 21 refused. There was a significant reduction in psychiatric morbidity and improvement in quality of life scores at 3 months for subjects who attended the program. The improvement in quality of life persisted after adjusting for gender, socioeconomic status and baseline scores. Costing of the program suggests sustainability.