Purpose: To assess the false-positive rate of breast cancer surveillance by magnetic resonance imaging (MRI) in BRCA mutation carriers and the impact of an abnormal mammography or breast MRI on the ...patients’ decision for prophylactic mastectomy. Patients and methods: A total of 196 BRCA mutation carriers were included with a median follow-up of 2 years (range 1–9) with annual mammography and MRI. Preference for prophylactic mastectomy was registered at first surveillance after the mutation carriership was revealed. Results: In all, 41% (81 of 196) of the women had at least one positive MRI or mammography. Malignancy was detected in 17 women: 11 at surveillance, 4 at an intended prophylactic mastectomy and 2 had an interval cancer. Imaging by mammography and MRI had a sensitivity of 71% and a specificity of 90%. The probability that a positive MRI result is false positive was 83%. In the group with a prior preference for mastectomy with and without a false–positive imaging, prophylactic mastectomy was carried out in 89% and 66%, respectively (P = 0.06), in the group with prior preference for surveillance these percentages were 15% and 11%, respectively (P = 0.47). Conclusion: Although the rate of false-positive MRI results is high, the impact on the choice for prophylactic mastectomy is limited and is determined by the woman’s preference before the establishment of a BRCA mutation.
My purpose in this essay is to consider some views about death and dying presented in two recent books. One book is Death by philosopher Shelly Kagan and the second is Being Mortal by medical doctor ...Atul Gawande. I focus on their different views about when it does and does not make sense to die given the quality of one's life. In addition to what we can learn from examining the arguments in each book separately, I hope it will be enlightening to see how prominent figures in two different professional areas deal with the same problem. As background to discussing these views, I briefly present some views about death to help situate my discussion.
Abstract Purpose Severe fatigue after treatment of ductal carcinoma in situ (DCIS) has not been studied before. The current study examined (i) the prevalence of severe fatigue in DCIS patients versus ...breast cancer survivors (BCS) and healthy controls (HC), (ii) quality of life and functioning of severely versus non-severely fatigued DCIS patients and BCS, and (iii) the association of fatigue with psychosocial and behavioral factors in DCIS patients. Methods 89 patients treated for DCIS were matched on age and gender to 67 BCS and 178 HC (ratio 1:1:2). Fatigue was measured with the Fatigue Severity subscale of the Checklist Individual Strength. Results 23% of DCIS patients, 25% of BCS, and 6% of HC were severely fatigued (DCIS versus HC: p < 0.001). Severely fatigued DCIS patients had a lower quality of life and were more impaired in all domains of functioning than non-severely fatigued DCIS patients. Sleep problems, dysfunctional cognitions regarding fatigue, avoidance of activities, all-or-nothing behavior, perceived lack of social support, DCIS-related coping problems, and fear of future cancer occurrence were related to fatigue. Conclusions The prevalence of severe fatigue in DCIS patients was similar to BCS, but higher than in HC. Severely fatigued DCIS patients had a lower quality of life and more functional impairments. The psychosocial and behavioral fatigue-related factors in DCIS patients are known to perpetuate fatigue in BCS. These factors can be targeted in interventions for cancer-related fatigue. Our findings suggest that the same treatment elements might be applicable to severely fatigued DCIS patients.
This book collects work on bioethics, which have appeared over the last twenty-five years and which have made the author among the most influential philosophers in this area. The author is known for ...intricate, sophisticated, and painstaking philosophical analyses of moral problems generally and of bioethical issues in particular. This volume showcases this work—revised to eliminate redundancies—as parts of a coherent whole. An introduction identifies important themes than run through the chapters. Sections cover topics such as death and dying; early life (on conception and use of embryos, abortion, and childhood); genetics and other such enhancements (on cloning and other genetic technologies); allocating scarce resources; and methodology (on the relation of moral theory and practical ethics).
Kamm raises a number of concerns about the traditional theory of the just war, focusing largely on the doctrine of double effect and the distinction between combatants and noncombatants. She argues ...that relying on these two views leads one wrongly to label some permissible acts as impermissible and other impermissible acts as permissible. The mortality of war is often considerably more complicated than advocates of just war theory have acknowledged, especially once one introduces political considerations that in many cases may justify a state's giving priority to protecting its own constituents.
Periodic and aperiodic two‐dimensional nanostructures with hierarchical order have been prepared by a combined top–down/bottom–up approach. This method allows 7 nm nanoparticles to be positioned with ...a accuracy of 10 nm or less, with a separation distance of several micrometers. The Figure is an optical dark field microscopy image of a square arrangement of Au dots on a Si wafer.
This book presents a new argument attacking the view that if the foetus has the moral standing of a person it has a right to life and abortion is impermissible. Most discussion of abortion has ...assumed that this premise is correct, and so has focused on the question of the personhood of the foetus. Frances Kamm, however, argues that abortion can be moral even if the foetus is indeed a person.
Terrorism and Intending Evil KAMM, F. M.
Philosophy & public affairs,
04/2008, Volume:
36, Issue:
2
Journal Article
Peer reviewed
Kamm examines some distinctions that may bear on the morality and the conceptual characterization of terrorism. Standard Terrorism (ST) is not meant to be a set of necessary and sufficient ...conditions, but only characteristics that many people tend to associate with current terrorism. The victim in ST is typically a random noncombatant civilian (NC) and someone who is not otherwise shortly to die. The bad that is done to the NCs in ST is death or grave injury to some; and terror in other NCs, who are afraid of death or grave injury to themselves or others. The terrorist is a nonstate agent, not engaged in standard war between nation-states. This agent intends rather than merely foresees the harm and terror to his victims, either as a means or as an end in itself. His actions are also thought through rather than impulsive. The further aims of the terrorist could be political or religious; otherwise, he might simply be aiming to show the mighty that they are vulnerable.
This article examines arguments concerning enhancement of human persons recently presented by
Michael Sandel (2004)
. In the first section, I briefly describe some of his arguments. In section two, I ...consider whether, as Sandel claims, the desire for mastery motivates enhancement and whether such a desire could be grounds for its impermissibility. Section three considers how Sandel draws the distinction between treatment and enhancement, and the relation to nature that he thinks each expresses. The fourth section examines Sandel's views about parent/child relations and also how enhancement would affect distributive justice and the duty to aid. In conclusion, I briefly offer an alternative suggestion as to why enhancement may be troubling and consider what we could safely enhance.
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