Natl Med J India
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Sentinel lymph node biopsy, axillary dissection and breast cancer: radiation oncologist's viewpoint.
Sentinel lymph node (SLN) identification and biopsy in breast cancer have been carried out successfully since the early 1990s. In early-stage breast cancer, the negative predictive value of a SLN biopsy is as high as 93%-100%. With a negative SLN, no axillary treatment would be required and the breast can be treated by tangential radiation fields. ⋯ Hence, it is now time to plan clinical trials comparing axillary irradiation with axillary dissection in SLN-positive, early-stage breast cancer. These approaches to the axilla, guided by the status of the SLN can reduce arm problems in women with breast cancer and improve their quality of life. Just as the treatment of the primary breast tumour has changed from Halstedian mastectomy to conservation surgery combined with breast irradiation, SLN biopsy may allow a move away from surgical axillary clearance and the associated morbidity in the future.
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Years-of-life-lost (YLL) contribute nearly two-thirds of the disability-adjusted life-years (DALYs) worldwide and are especially Important for India where infant and child mortality is still high. These were estimated for India under the Global Burden of Disease study for the year 1990. No estimates are available for the different states of India. We aimed to prepare state-wise estimates of YLL for different causes of death in rural areas and to determine the causes responsible for a higher burden in different states. ⋯ These results provide a new perspective about the causes of death that need more attention in rural areas of different states of India. These will also help prioritize areas which require more inputs at the state-level and hence will be useful for health policymakers.