The Breast RSS feed: Current Issue. The Breast is an international, multidisciplinary journal for clinicians, which focuses on translational and clinical research for the advancement of breast cancer prevention and therapy. The Editors welcome the submission of original research articles, systematic reviews, viewpoint and debate articles, and correspondence on all areas of pre-malignant and malignant breast disease, including: • Surgery • Medical oncology and translational medicine • Radiation oncology • Breast endocrinology • Epidemiology and prevention • Gynecology • Imaging, screening and early diagnosis • Pathology • Psycho-oncology and quality of life • Advocacy • Supportive and palliative care • Nursing • Research and management in countries with limited resources The Breast is a valuable source of information for surgeons, medical oncologists, gynecologists, radiation oncologists, endocrinologists, epidemiologists, radiologists, pathologists, breast care nurses, breast cancer advocates, psychologists and all those with a special interest in breast cancer.http://www.thebreastonline.com/?rss=yesElsevier Inc.en © 2010 Elsevier Ltd. All rights reserved. The Breast0960-9776194August 2010 © 2010 Elsevier Ltd. All rights reserved. healthpermissions@elsevier.comhttp://www.thebreastonline.com/article/PIIS0960977610000743/abstract?rss=yesAs we prepare to submit this special edition of The Breast to Elsevier, the Winter Olympics in Vancouver, Canada are creating excitement and showcasing athletic accomplishments that highlight the top tier of talent from countries around the world. It occurred to us that if gold medals were awarded for exemplary standards in breast care, both EUSOMA and the American Society of Breast Disease would earn the coveted prize for developing and promoting best practices to reduce mortality from breast cancer.A quest for quality and economic effectiveness throughout the continuum of breast careMarie M. La Fargue, Cathy Coleman10.1016/j.breast.2010.03.020The Breast 19, 4 (2010)2010-04-14The Breast2010-04-14194S0960-9776(10)X0005-4251252http://www.thebreastonline.com/article/PIIS0960977610000731/abstract?rss=yesAbstract: This article focuses on the value and benefit of a Breast Center to an organization by identifying the best ways to maximize their contribution in order to create and sustain a financially viable, clinically respected and community-oriented Breast Center. The goal of the Breast Center is to ultimately benefit the community and the hospital’s Comprehensive Cancer Program as a whole. The value propositions are divided into three areas that have positive impacts to the program and hospital, collectively. These value propositions are:Maximizing the value of a breast centerMickey Goldman, Dan Chang10.1016/j.breast.2010.03.019The Breast 19, 4 (2010)2010-04-20The Breast2010-04-20194S0960-9776(10)X0005-4253259http://www.thebreastonline.com/article/PIIS0960977610000676/abstract?rss=yesAbstract: Recent suggestions by the United States Preventive Task Force to change the longstanding guidelines for screening mammography have raised the issue of cost-effectiveness in regards to breast cancer detection. Given the enormous number of women who have had, or who will be diagnosed with breast cancer, it is essential to maintain the quality of care that has been achieved here in the United States while utilizing a cost-effective approach. The following review attempts a close examination of current methods available for risk assessment, screening and prevention programs. These programs must be carefully considered and analyzed prior to implementing cost-saving changes to current clinical standards that have proven successful in decreasing the mortality from breast cancer throughout the world.Risk assessment, screening and prevention of breast cancer: A look at cost-effectivenessGail S. Lebovic, Alan Hollingsworth, Stephen A. Feig10.1016/j.breast.2010.03.013The Breast 19, 4 (2010)2010-04-20The Breast2010-04-20194S0960-9776(10)X0005-4260267http://www.thebreastonline.com/article/PIIS0960977610000718/abstract?rss=yesAbstract: Mammographic screening is a proven method for reducing breast cancer mortality for women 40 years of age and older, but the best method for implementation of mammographic screening, particularly in the age group 40–49, remains controversial. The author, in an invited review, summarizes the data and offers guidance based on the best information available for women at risk for breast cancer, and their care providers, with particular emphasis on costs and benefits.Mammographic screening for breast cancer: An invited review of the benefits and costsJon M. Greif10.1016/j.breast.2010.03.017The Breast 19, 4 (2010)2010-04-05The Breast2010-04-05194S0960-9776(10)X0005-4268272http://www.thebreastonline.com/article/PIIS096097761000072X/abstract?rss=yesAbstract: As a former general radiologist and current full time clinical breast radiologist, I have observed and experienced both good and suboptimal practice patterns, operations, and economics. Proper organization of a high quality, efficient breast center requires basic infrastructure including functional space, quality imaging equipment, data reporting systems, as well as a highly motivated, dedicated, and focused team. People on the breast care team need to share the same passion and commitment to provide superior care for patients and families. Each member of this interdisciplinary team provides an important role that contributes to best practices and patient satisfaction. Efficiency and quality are essential for the long-term survival of clinical breast radiology, a highly regulated and scrutinized medical subspecialty. This paper reflects personal perspectives and perceptions about how to make a good breast care practice great by incorporating strategies such as the simple hedgehog concept used in other successful businesses.A radiologist’s perspective on efficiency and economics in a quality breast centerRichard O. Wagner10.1016/j.breast.2010.03.018The Breast 19, 4 (2010)2010-04-14The Breast2010-04-14194S0960-9776(10)X0005-4273279http://www.thebreastonline.com/article/PIIS0960977610000706/abstract?rss=yesAbstract: My personal journey into breast cancer advocacy resulted from a diagnosis of low grade DCIS. I joined with others throughout the world in turning adversity into advocacy to support endeavors which further public and professional education, political change and scientific research. This path took me from a mere one woman networking effort to addressing national panels of experts in Washington, D.C. charged with improving quality of breast care. It often became more than a full time job but the rewards were worth it. My family also supported my mission and the potential impact that advocacy could make on both a personal and community level. So I follow in the footsteps of other tenacious advocates and always keep in mind the singular focus of improving standards for quality breast care now and in the future. This paper describes the ever-changing face of advocacy from my viewpoint as a breast cancer survivor.The ever-changing face of breast advocacyJudith A. Wagner10.1016/j.breast.2010.03.016The Breast 19, 4 (2010)2010-04-14The Breast2010-04-14194S0960-9776(10)X0005-4280283http://www.thebreastonline.com/article/PIIS096097761000069X/abstract?rss=yesAbstract: Large-format histopathology allows correct documentation of tumor size, lesion distribution, disease extent, and surgical margins, and facilitates better understanding of the complex morphology of breast carcinoma. Large-format histology slides are optimal tools for radiology–pathology correlations. Adapted to the needs of diagnostic routine, this method has the advantages of the conventional small block techniques while being able to analyze large contiguous pieces of breast tissue. The costs connected to implementing and utilizing this technique, analyzed in detail in this paper, exceed those of conventional histopathology only if the conventional sampling is limited and specimen work-up is insufficient. Documenting equally large tissue surfaces with thorough conventional sampling is much more expensive and laborious than when using large-format sections. Thus, large-format histopathology is the only cost-effective histotechnology method that meets the needs of modern multidisciplinary diagnostic breast care.Cost-benefit analysis of using large-format histology sections in routine diagnostic breast careTibor Tot10.1016/j.breast.2010.03.015The Breast 19, 4 (2010)2010-04-12The Breast2010-04-12194S0960-9776(10)X0005-4284288http://www.thebreastonline.com/article/PIIS0960977610000688/abstract?rss=yesAbstract: The relationship between quality and cost of care for breast cancer surgery was investigated by literature review. The guidelines, policy statements, quality measures (QM) and target goals for performance described by professional organizations were also reviewed. After review, the relationship between quality and cost of care for the components of perioperative care were assigned an inverse, direct or uncertain relationship. Identification of processes of care with an inverse relationship between quality and cost, such as performing a needle biopsy to diagnose cancer compared to an open surgical biopsy, provide opportunity to concurrently lower cost and improve quality. Other components of care, such as post-mastectomy reconstruction, demonstrate a direct relationship between quality and cost. Recognition of the variability of performance of QM’s with an inverse quality and cost relationship has the potential to lower breast cancer population healthcare expenditures, if average performance for those QM can be improved.The relationship between quality and cost during the perioperative breast cancer episode of careJeffrey Landercasper, Lorraine Tafra10.1016/j.breast.2010.03.014The Breast 19, 4 (2010)2010-04-12The Breast2010-04-12194S0960-9776(10)X0005-4289296http://www.thebreastonline.com/article/PIIS0960977610000664/abstract?rss=yesAbstract: The role of the breast cancer surgeon has changed from one with performance of one operation, to a position in which the surgeon is the patient’s initial contact, leader of a multidisciplinary team, the clinical leader who ensures that the patient receives the most appropriate breast cancer treatment and then also receives follow up and surveillance services. Breast conservation rates, patient satisfaction rates, clear margins, use of oncoplastic surgical techniques, appropriate referral to other consultants, clinical trial referral, and survival rates are all higher when patients are cared for by breast-focused surgeons. This new role requires greater time both before and after surgery to provide the proper planning and care for these patients. Women with breast cancer should have access to these dedicated breast-focused surgeons. Recognition of this expanding responsibility and reimbursement for this time and expertise is needed so that women with breast cancer can be offered the highest quality of care.Challenges and economics of private breast cancer surgery practiceLisa Bailey10.1016/j.breast.2010.03.012The Breast 19, 4 (2010)2010-04-14The Breast2010-04-14194S0960-9776(10)X0005-4297302http://www.thebreastonline.com/article/PIIS0960977610000652/abstract?rss=yesAbstract: If breast cancer were viewed among siblings as a family of diseases, it might be easily identified as the favorite child. Policy, advocacy, and funding initiatives have supported this disease in such abundance that the “pink ribbon” has become almost synonymous in America with the terms “motherhood and apple pie”. So, why have we still not found a cure after the launch of the war on cancer in the 1970s? This article delves deeply into the translational breast cancer research maze to capture thoughtful insights through interviews with noted researchers and by exploring the vision and strategies of major funders who invest in translational research. Common barriers within the United States systems are explored and compared to European models. Innovations that offer new paradigm shifts in the delivery of more timely, cost-effective, patient-centered, accountable, transparent, and collaborative research focused on responding to public health priorities and access are urgently needed to find the cure.Policy and advocacy in the quest for effective translational breast care researchMarie M. La Fargue10.1016/j.breast.2010.03.011The Breast 19, 4 (2010)2010-04-16The Breast2010-04-16194S0960-9776(10)X0005-4303306