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Abramson Cancer CenterNCI CANCERLIT® Search: Screening and Prevention of Breast Cancer - April 2002
National Cancer Institute®
Last Modified: April 1, 2002
Table of Contents
1
UI - 11686016
AU - Gradishar WJ; Jordan VC
TI -
The evolving role of endocrine therapy for treatment and prevention of
breast cancer.
SO - Cancer Chemother Biol Response Modif 2001;19():215-36
AD - Robert H. Lurie Comprehensive Cancer Center, Northwestern University
Medical School, 676 North St. Clair Street, Suite 850, Chicago, IL
60611-2927, USA.
2
UI - 11759823
AU - Croce M V; Isla-Larrain M T; Capafons A; Price M R; Segal-Eiras A
TI -
Humoral immune response induced by the protein core of MUC1 mucin in
pregnant and healthy women.
SO - Breast Cancer Res Treat 2001 Sep;69(1):1-11
AD - Comision de Investigaciones Cientificas de la Provincia de Buenos Aires,
Argentina.
Serum levels of MUC1 and antibodies (Abs) against MUC1 (IgG and
IgM-MUC1) were evaluated in healthy women related to pregnancy and
lactation status. A total of 149 serum samples were obtained from:
nulliparous, primiparous pregnant, multiparous pregnant that have
lactated, multiparous pregnant without lactation, multiparous
non-pregnant actual lactating, multiparous non-pregnant that have
lactated and finally, multiparous non-pregnant women without lactation.
In all assays, we included pre- and post-serum samples belonging to a
breast cancer patient vaccinated with a MUC1 derived peptide. CASA test
was employed to measure MUC1 while IgG- and IgM-MUC1 serum Abs were
evaluated with an ELISA using a 100 mer peptide as catcher. In all
groups, mean IgM levels were higher than IgG mean values; when samples
were grouped in pregnants versus non-pregnants, a significant difference
was detected with both Abs, being raised in non-pregnants. When samples
were grouped in lactating versus non-lactating a significant difference
was detected with IgG-MUC1, being raised in lactating women while no
significant difference was found with IgM-MUC1. The evaluation of serum
MUC1 levels confirmed previous results since a significant difference
between pregnant versus non-pregnant groups was found while lactating
versus non-lactating samples did not. CONCLUSIONS: (i) Increased MUC1
serum levels are apparently associated with pregnancy but not with
lactation; (ii) MUC1 Abs are mainly associated with lactation and with
non-pregnant status. These results may be considered a contribution on
studies about protection against breast cancer induced by pregnancy and
lactation.
3
UI - 11759825
AU - Bonanni B; Johansson H; Gandini S; Guerrieri-Gonzaga A; Torrisi R;
TI -
Sandri M T; Cazzaniga M; Mora S; Robertson C; Lien E A; Decensi A
Effect of low dose tamoxifen on the insulin-like growth factor system in
healthy women.
SO - Breast Cancer Res Treat 2001 Sep;69(1):21-7
AD - Division of Chemoprevention, European Institute of Oncology, Milan,
Italy.
The use of tamoxifen as a preventive agent may be limited by the
increased risk of endometrial cancer and venous thromboembolic events
observed in postmenopausal women. We have recently shown a comparable
activity of lower doses of tamoxifen on several surrogate biomarkers of
cardiovascular disease and breast cancer, including Insulin-like Growth
Factor-I (IGF-I). To provide further insight into the effect of
tamoxifen at low doses on the IGF system, we have correlated the drug
serum levels attained after 2 months of either placebo (n = 32),
tamoxifen 20 mg/day (n = 26), 10 mg/day (n = 23) or 10 mg/every other
day (n = 29) with the changes in IGF-I, Insulin-like Growth Factor-II
(IGF-II), Insulin-like Growth Factor Binding Protein-1 (IGFBP-1),
Insulin-like Growth Factor Binding Protein-3 (IGFBP-3), and
IGF-I/IGFBP-3 ratio. Compared with placebo, tamoxifen induced a mean +/-
standard error (SE) reduction of IGF-I of 16.9 +/- 7.8%, p < 0.05, a
non-significant increase of 22.9 +/- 12.2% in IGF-II, an increase in
IGFBP-1 of 49.3 +/- 22.7%, p < 0.05, and a non-significant change of
IGFBP-3 (-4.0% +/- 9.2). No significant concentration-response
relationship was observed between serum tamoxifen concentrations and the
biomarker changes except for the ratio of IGF-I/IGFBP-3, which decreased
by 1.53 +/- 0.68% for any increase by 10 ng/ml of serum tamoxifen
concentration (p = 0.02). Although low tamoxifen concentrations induce a
comparable modulation of the IGF family relative to the conventional
dose, the lower decrements in the IGF-I/IGFBP-3 ratio observed at low
drug concentrations might be associated with a reduced preventive
activity. Further studies on the search of the minimal active dose of
tamoxifen are warranted.
4
UI - 11845096
AU - Myles J; Duffy S; Nixon R; Boggis C; Howell A; Shenton A; Evans G
TI -
Initial results of a study into the effectiveness of breast cancer
screening in a population identified to be at high risk.
SO - Rev Epidemiol Sante Publique 2001 Oct;49(5):471-5
AD - Department of Statistics, Mathematics and Epidemiology, Imperial Cancer
Research Fund, 61 Lincoln's Inns Fields, London, WC2A 3PX.
mylesj@icrf.icnet.uk
BACKGROUND: Women are frequently referred to genetic clinics because of
a family history of breast or ovarian cancer, conferring a moderate
increased risk of the disease, but not sufficient in itself to indicate
gene mutation analysis. One possible management strategy is to offer
regular mammographic screening, possibly earlier in life and more
frequently than in the general population. This strategy is used in many
parts of the UK, although it has not been formally evaluated. METHODS:
In this paper we present some early results on the effectiveness of a
programme of mammography in 2,998 women aged 19-71 with a moderate
family history of breast cancer in Manchester. We estimated the test and
programme sensitivity and sojourn time, using different statistical
methods. RESULTS: Fifty breast cancers were diagnosed. The incidence
rate observed was 4.46 per thousand person-years. The incidence expected
from the segregation analysis of Claus et al. was 3.75 per thousand
person-years. Screen-detection rates at first and subsequent screens
were 5.00 and 4.93 per thousand respectively. Interval cancer incidence
in the first year following a negative screen was 0.91 per thousand
person-years. Screening test sensitivity was estimated conservatively as
83%, programme sensitivity as 70%. CONCLUSIONS: Early indications are
that the programme is likely to be effective. Further follow-up,
analysis of tumour size, node status and malignancy grade, and
subsequent mortality from breast cancer is required to confirm this.
5
UI - 11801870
AU - Bentrem DJ; Jordan VC
TI -
Role of antiestrogens and aromatase inhibitors in breast cancer
treatment.
SO - Curr Opin Obstet Gynecol 2002 Feb;14(1):5-12
AD - Department of Surgery, Robert H. Lurie Comprehensive Cancer Center,
Northwestern University Medical School, Chicago, Illinois 60611, USA.
This review explores the recent experience with, and the basis for, the
use of selective estrogen receptor modulators to treat and prevent
breast cancer. As new agents are unveiled, they will continue to be
tested against tamoxifen. A number of new selective estrogen receptor
modulators are in clinical development in an attempt to decrease the
unwanted effects of tamoxifen. Raloxifene holds the promise of treating
osteoporosis with the beneficial side effect of breast cancer
prevention. Additionally, two different classes of hormonal agents, the
aromatase inhibitors and estrogen receptor down-regulators, which have
no estrogen-like properties at any site, appear to be promising new
treatments for advanced breast cancer.
6
UI - 11854547
AU - Powles TJ
TI -
Breast cancer prevention.
SO - Oncologist 2002;7(1):60-4
AD - Royal Marsden NHS Trust, and Institute of Cancer Research, London,
United Kingdom. trevor.powles@rmh.nthames.nhs.uk
Epidemiological, experimental, and clinical data strongly support the
possibility that breast cancer will be prevented by using
anti-estrogenic interventions in healthy women. Three trials involving
over 20,000 women have so far been reported using tamoxifen 20 mg/day or
placebo in healthy women to chemoprevent breast cancer. The American
National Surgical Adjuvant Breast and Bowel P-1 Project randomized over
13,000 women to take tamoxifen or placebo and showed a 49% reduction in
the early incidence of breast cancer. This was associated with a
reduction in osteoporotic fractures but increases in the risks of
endometrial cancer, cataract, and thromboembolism. The Royal Marsden
tamoxifen trial randomized 2,500 women, and the Italian national trial
randomized 5,000 women. Interim analyses from these two trials showed no
effect on the early incidence of breast cancer. These results,
therefore, have not been able to clearly show an overall clinical
benefit of giving tamoxifen to healthy women, nor have they shown which
women are likely to benefit. Another selective anti-estrogen (SERM),
raloxifene, has been used in a clinical trial to prevent osteoporotic
fractures in women with low bone mineral density. Annual mammography in
this trial has shown an approximate 80% reduction in the early incidence
of breast cancer, and further follow-up of this trial continues. New
trials in chemoprevention of breast cancer being started or being
proposed use luteinizing-hormone-releasing hormone analogues, aromatase
inhibitors, and other SERMs.
7
UI - 11338753
AU - Wojtaszek C
TI -
Another reader shares experience with paclitaxel reactions.
SO - Oncol Nurs Forum 2001 Apr;28(3):446
8
UI - 11845940
AU - Valdez A; Banerjee K; Ackerson L; Fernandez M
TI -
A multimedia breast cancer education intervention for low-income
Latinas.
SO - J Community Health 2002 Feb;27(1):33-51
AD - Valdez & Associates, Mountain View, CA 94040, USA.
This paper discusses the results from the field test of a multimedia
health education intervention, designed to provide breast cancer
education for low income Latinas. The purpose of the field test was to
ascertain whether the intervention produced significant changes in
breast cancer knowledge and attitude, and screening intentions. A total
of 1,197 Latina women participated in the field study at six different
sites. The majority of the participants were under 65 years of age,
foreign-born with less than eight years of education and a weekly
household income that fell in the lowest income quintile for 1998
(<$350.00). Participants were randomly assigned to a control or
intervention condition. The control group was interviewed about their
breast cancer knowledge, attitude and mammography intentions prior to
exposure to the intervention, and served as the baseline group. Women in
the intervention group exhibited higher knowledge scores than the
pretest group (Chi sq., p < .0001). Never-screened women exhibited the
largest differences in knowledge scores relative to the baseline sample.
The intervention also increased the likelihood of women seeking
information about a mammogram.
9
UI - 11902497
AU - Sharma DC
TI -
Delhi launches cancer awareness campaign.
SO - Lancet Oncol 2002 Mar;3(3):133
10
UI - 11899786
AU - Burnside E; Belkora J; Esserman L
TI -
The impact of alternative practices on the cost and quality of
mammographic screening in the United States.
SO - Clin Breast Cancer 2001 Jul;2(2):145-52
AD - Department of Radiology, University of California at San Francisco, San
Francisco, CA, USA.
The decentralized structure of health care in the Unites States hinders
population-based analysis of breast cancer screening. Our objectives are
to model mammography in the United States as a whole, to identify the
variables that most profoundly affect cost and efficacy, and to develop
a strategy to improve mammography screening from a population
perspective. A spreadsheet model was used to represent the variables of
mammography screening in the United States. The population-based
national screening program in Sweden provides a framework for
comparison. The outcome measures are the aggregate cost and the number
of cancers detected by mammography. We used deterministic sensitivity
analysis to calculate the impact of variation in practice. Aggregate
costs of screening in the United States are in the range of $3-$5
billion dollars. The percentage of women screened, cost per mammogram,
cancer to biopsy ratio, recall rate, and cost of recall have the most
profound effect on the quality and cost of a national screening program.
Variance of these high-impact variables, based on the U.S. population,
modifies the aggregate cost of screening by over $2 billion. As
mammography screening in the United States increases to include all
women over age 40, high-impact variables should be optimized to decrease
costs and improve breast cancer detection. Our model establishes which
parameters are most important.
11
UI - 11899377
AU - Sledge GW Jr
TI -
A seat at the table.
SO - Clin Breast Cancer 2001 Apr;2(1):16
12
UI - 11899380
AU - Ross PJ; Powles TJ
TI -
Results and implications of the Royal Marsden and other tamoxifen
chemoprevention trials.
SO - Clin Breast Cancer 2001 Apr;2(1):33-6; discussion 37-40
AD - Breast Unit, Royal Marsden Hospital, Downs Road, Sutton, Surrey, SM2
5PT, UK.
A pilot chemoprevention study from the Royal Marsden Hospital in the
United Kingdom demonstrated that tamoxifen could be administered safely
to healthy women. This led to the establishment of multicenter trials,
including the National Surgical Adjuvant Breast and Bowel Project
(NSABP) P-1 and Italian National Cancer Institute trials. An interim
analysis of the Royal Marsden Hospital trial did not detect a preventive
effect. The Italian trial concurred with the Royal Marsden Hospital
trial. In contrast, the larger NSABP study detected a 49% reduction in
the incidence of breast cancer with tamoxifen chemoprevention. Possible
reasons for the different results are examined and the implications for
tamoxifen chemoprevention are discussed.
13
UI - 11899381
AU - Costantino JP; Vogel VG
TI -
Results and implications of the Royal Marsden and other tamoxifen
chemoprevention trials: an alternative view.
SO - Clin Breast Cancer 2001 Apr;2(1):41-6
AD - University of Pittsburgh, Graduate School of Public Health, 130 DeSoto
Street, Room 316 Parran Hall, Pittsburgh, PA 15261, USA.
costan@nsabp.pitt.edu
At the time of the release of the findings of the Breast Cancer
Prevention Trial (BCPT), early interim results from two smaller European
studies were also released. These smaller studies included one from the
Royal Marsden (RM) Hospital in London, England, and another from the
Italian National Cancer Institute. Since then, there has been much
discussion about the relevance of the interim findings from the European
studies and the likely reason for the failure of these studies to find a
treatment effect. In some instances, the discussion has been incomplete
or inconsistent with the observations from the trial. This has caused
some confusion regarding the likely differences among the three studies
of breast cancer prevention with tamoxifen. Recently, investigators from
the RM study have published their interpretation of the reasons for the
negative findings from the European studies. The discussions of the RM
investigators are reviewed and used as a basis to illustrate some
misconceptions regarding key differences in trial design and
implementation among the BCPT and the European trials. The investigator
discussions are also used to illustrate the significance of performing
an appropriate benefit/risk assessment to identify women who would
likely have a net beneficial effect when using tamoxifen to reduce the
risk of breast cancer occurrence. Differences in terms of the
characteristics of the study populations resulting in inadequate
statistical power is the most likely reason for the failure to detect
treatment differences in the European trials. Possible confounding due
to the use of hormone replacement therapy is another reason that must be
considered. Also, benefit/risk analysis indicates that tamoxifen has
substantial public health potential as an approach to reduce breast
cancer incidence and the physical and mental morbidity associated with
this disease. The drug cannot be used indiscriminately due to the
potential side effects, but benefit/risk assessment methodology can be
used to identify substantial numbers of women in whom treatment would
provide a net beneficial effect.
14
UI - 11895838
AU - Thornton H
TI -
Breast screening seems driven by belief rather than evidence.
SO - BMJ 2002 Mar 16;324(7338):677
15
UI - 11761347
AU - Lindberg NM; Wellisch D
TI -
Anxiety and compliance among women at high risk for breast cancer.
SO - Ann Behav Med 2001 Fall;23(4):298-303
AD - Department of Psychiatry, UCLA School of Medicine, Los Angeles, CA
90024-1759, USA. nlindberg@mediaone.net
The aim of this study was to investigate the association between
symptoms of depression and general anxiety, patient's feelings of
vulnerability to cancer, the anxiety experienced specifically in
relation to various cancer-screeningprocedures, and compliance with
these procedures among women atfamilial risk for breast cancer The data
were obtained from 430 patients from the High Risk Clinic at the UCLA
Revlon Breast Center who completed the State-Trait Anxiety Inventory and
answered questions about their perceived vulnerability to breast cancer;
the anxiety they experienced regarding undergoing pap smear tests,
mammograms, and breast self-examinations (BSEs); and their compliance
with these cancer-screening procedures. Correlations were used to
estimate the association between feelings of anxiety and compliance. We
found that women attending programs targeting those at familial risk for
breast cancer suffer from significant symptoms of general anxiety.
General anxiety was found to be related to anxiety regarding specific
screening practices but not to women's perceived vulnerability to cancer
In general, neither general nor screening-specific anxiety were found to
be related to patients 'compliance with screening practices; however,
significant associations were found between patient's feelings of
anxiety regarding BSEs and their actual performing them. BSE appears to
be the only procedure for which compliance is negatively associated with
procedure-specific anxiety. We offer possible explanations for this
relation and discuss the possible psychological impact that
recommendations regarding BSEs may have on highly anxious at-risk women.
16
UI - 11845768
AU - Petersen WO; Trapp MA; Vierkant RA; Sellers TA; Kottke TE; de Groen PC;
TI -
Nicometo AM; Kaur JS
Outcomes of training nurses to conduct breast and cervical cancer
screening of Native American women.
SO - Holist Nurs Pract 2002 Jan;16(2):58-79
AD - Department of Health Sciences Research, Mayo Clinic Comprehensive Cancer
Center, Rochester, Minnesota, USA.
Native WEB (Women Enjoying the Benefit) is a unique training program for
nurses employed by the Indian Health Service (IHS), tribal clinics, and
other clinics with large, underserved populations. It teaches nurses
breast and cervix cancer screening techniques and trains them to
administer and maintain high-quality screening programs that include
patient outreach, education, and training. We review American Indian
(AI)/Alaska Native (AN) women's need for screening services, identify
some of the obstacles to screening, and present our evaluation of the
Native WEB's impact on clinics, nurses, and patients. Findings show that
Native WEB training is associated with increased screening activity at
all three levels.
17
UI - 11870156
AU - DeMichele A; Weber BL
TI -
Risk management in BRCA1 and BRCA2 mutation carriers: lessons learned,
challenges posed.
SO - J Clin Oncol 2002 Mar 1;20(5):1164-6
18
UI - 11902495
AU - Anonymous
TI -
Confusion over mammography screening intensifies.
SO - Lancet Oncol 2002 Mar;3(3):127
19
UI - 11919047
AU - Jones LA; Chilton JA
TI -
Impact of breast cancer on African American women: priority areas for
research in the next decade.
SO - Am J Public Health 2002 Apr;92(4):539-42
AD - Department of Gynecologic Oncology, University of Texas M. D. Anderson
Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
Despite all the gains that have been made in the area of breast cancer
research, African American women suffer disproportionately from the
effects of the disease. Breast cancer is the second leading cause of
cancer death among African American women, exceeded only by lung cancer.
Improvements in cancer incidence, mortality, and survival rates among
populations are undoubtedly the outcome of quality research. Therefore,
there is a need to identify and discuss issues regarding breast cancer
among African American women and to determine whether these issues
should be a part of the nation's breast cancer research agenda. This
commentary summarizes the results of the Summit Meeting Evaluating
Research on Breast Cancer in African American Women, which was held
September 8-11, 2000, in Washington, DC. Listed are priority areas and
some of the questions that fueled this 2-day discussion among 130
participants, including health advocates, cancer survivors, and experts
representing various areas of cancer research.
20
UI - 11408508
AU - Lippman ME; Krueger KA; Eckert S; Sashegyi A; Walls EL; Jamal S; Cauley
TI -
JA; Cummings SR
Indicators of lifetime estrogen exposure: effect on breast cancer
incidence and interaction with raloxifene therapy in the multiple
outcomes of raloxifene evaluation study participants.
SO - J Clin Oncol 2001 Jun 15;19(12):3111-6
AD - Osteoporosis Research Program, Women's College Hospital, Toronto,
Ontario, Canada. lippmanm@umich.edu
PURPOSE: To test the hypothesis that risk factors related to lifetime
estrogen exposure predict breast cancer incidence and to test if any
subgroups experience enhanced benefit from raloxifene. PATIENTS AND
METHODS: Postmenopausal women with osteoporosis (N = 7,705), enrolled
onto the Multiple Outcomes of Raloxifene Evaluation (MORE) trial, were
randomly assigned to receive placebo, raloxifene 60 mg/d, or raloxifene
120 mg/d for 4 years. Breast cancer risk was analyzed by the following
baseline characteristics indicative of estrogen exposure: previous
hormone replacement therapy, prevalent vertebral fractures, family
history of breast cancer, estradiol level, bone mineral density (BMD),
body mass index, and age at menopause. Therapy-by-subgroup interactions
were assessed using a logistic regression model. RESULTS: Overall, women
with the highest one-third estradiol levels (> or = 12 pmol/L) had a
2.07-fold increased invasive breast cancer risk compared with women with
lower levels. Raloxifene significantly reduced breast cancer risk in
both the low- and high-estrogen subgroups for all risk factors examined
(P <.05 for each comparison). The women with the highest BMD and those
with a family history of breast cancer experienced a significantly
greater therapy benefit with raloxifene, compared with the two thirds of
patients with lower BMD or those without a family history, respectively;
the subgroup-by-therapy interactions were significant (P =.005 and P
=.015, respectively). CONCLUSION: The MORE trial confirms that increased
lifetime estrogen exposure increases breast cancer risk. Raloxifene
therapy reduces breast cancer risk in postmenopausal osteoporotic women
regardless of lifetime estrogen exposure, but the reduction is greater
in those with higher lifetime exposure to estrogen.
21
UI - 11911752
AU - McKiernan F; Wiley C
TI -
Measurement of serum estradiol.
SO - JAMA 2002 Mar 27;287(12):1528
22
UI - 11759305
AU - Meade CD; Calvo A
TI -
Developing community-academic partnerships to enhance breast health
among rural and Hispanic migrant and seasonal farmworker women.
SO - Oncol Nurs Forum 2001 Nov-Dec;28(10):1577-84
AD - Interdisciplinary Oncology Program, University of South Florida, USA.
cdmeade@moffitt.usf.edu
PURPOSE/OBJECTIVES: To examine effective strategies for building
community-academic partnerships for the promotion of breast cancer
education and outreach among rural and Hispanic migrant and seasonal
farmworker women, mostly from Mexican descent. DATA SOURCES: Published
research and education articles and books, community-education models,
personal experiences, and community key informant feedback. DATA
SYNTHESIS: Effective community partnerships for enhanced education and
outreach include a framework based on a network of partners with common
goals, communication processes based on trust, and bilingual/bicultural
and culturally competent staff. CONCLUSIONS: A sustainable community
partnership can be achieved through systematic but flexible approaches
to community planning. Involvement of community members in the
development and implementation of education and screening activities
helps ensure that community needs are met. Relationships based on mutual
respect are key. IMPLICATIONS FOR NURSING PRACTICE: Nurses can act as
catalysts through community capacity building to create
community-academic partnerships to reach medically underserved
populations with cancer screening, outreach, and education through the
delivery of strategies that are based on common goals.
23
UI - 11715787
AU - Thoresen SO
TI -
[Mammography screening saves life]
SO - Tidsskr Nor Laegeforen 2001 Oct 20;121(25):2995
24
UI - 11910853
AU - Anonymous
TI -
Hormone may be key to raloxifene's breast cancer benefits.
SO - Health News 2002 Mar;8(3):8
25
UI - 11912627
AU - Anonymous
TI -
[Breast cancer diagnostics. Finnish Breast Cancer Group]
SO - Duodecim 1999;115(13):1426-31
26
UI - 11917742
AU - Gifford DS
TI -
The controversy over screening mammography.
SO - Med Health R I 2002 Mar;85(3):101-2
AD - ripro.dgifford1@sdps.org
27
UI - 11480666
AU - Wu AH
TI -
Soy and risk of hormone-related and other cancers.
SO - Adv Exp Med Biol 2001;492():19-28
AD - University of Southern California, Department of Preventive Medicine,
Los Angeles 90089, USA.
28
UI - 11898176
AU - Anonymous
TI -
Older women unaware of increased breast cancer risk.
SO - Cancer Pract 2000 Mar-Apr;8(2):57
29
UI - 11920488
AU - Kumar NB; Cantor A; Allen K; Riccardi D; Cox CE
TI -
The specific role of isoflavones on estrogen metabolism in premenopausal
women.
SO - Cancer 2002 Feb 15;94(4):1166-74
AD - Department of Nutrition, H. Lee Moffitt Cancer Center and Research
Institute, University of South Florida, Tampa, Florida 33612, USA.
kumar@moffitt.usf.edu
BACKGROUND: There is increasing evidence that dietary factors may play a
role in the production, metabolism, and bioavailability of sex hormones
and their impact on target tissues. The specific objective of this study
was to evaluate the effectiveness of supplementing a group of
premenopausal women who were free of breast carcinoma with a dietary
supplement of isoflavones (40 mg per day) in producing a change in
steroid hormones and menstrual cycle length. METHODS: Sixty-eight
consecutively recruited, premenopausal, omnivorous women of all races
and ethnicities between the ages of 25 years and 55 years were admitted
to the study and randomized to an experimental group supplemented with
soy (40 mg genistein per day) or to a control group that consumed a
placebo for a 12-week period. Changes in their anthropometric,
nutritional, and hormonal biomarkers from early follicular phase were
analyzed at baseline and post-intervention. RESULTS: Serum-free
estradiol and estrone levels decreased moderately in the experimental
group. Serum hormone-binding globulin levels increased in 41.4% of women
in the experimental group compared with 37.5% of women in the placebo
group. Free estradiol decreased in 53.85% of women in the experimental
group compared with 37.5% of women in the placebo group. Estrone
decreased in 55.56% of women in the experimental group compared with
42.86% in the placebo group. Those women in the experimental group who
were consuming soy had their mean menstrual cycle length increased by
3.52 days compared with a mean decrease of 0.06 days for women in the
placebo group (P = 0.04) from baseline to the third menstrual cycle. In
addition, women who were taking soy had their mean follicular phase
increase by 1.46 days compared with a mean increase of 0.14 days for
women who were taking the placebo (P = 0.08). CONCLUSIONS: These data
suggest that increased isoflavone intake affects estrogen metabolism by
altering the steroid hormone concentrations and menstrual cycle length,
thereby demonstrating a potential to reduce the risk for breast
carcinoma. Copyright 2002 American Cancer Society. DOI
10.1002/cncr.10320
30
UI - 11929006
AU - Duffy SW; Tabar L; Smith RA
TI -
The mammographic screening trials: commentary on the recent work by
Olsen and Gotzsche.
SO - CA Cancer J Clin 2002 Mar-Apr;52(2):68-71
31
UI - 9615508
AU - Freedman TG
TI -
The Breast Cancer Prevention Trial: nurses' observations.
SO - Cancer Nurs 1998 Jun;21(3):178-86
AD - University of Pennsylvania, Philadelphia 19104-6096, USA.
The Breast Cancer Prevention Trial (BCPT), a case study of a clinical
prevention trial, offered a unique opportunity to examine the
multifaceted and complex role of the nurse. The primary aims of this
study were (a) to identify the self-descriptions of a sample of nurses
involved in the day-to-day management of the BCPT, (b) to determine the
nurses' perceptions of their own role and the role of the women who
joined the BCPT, (c) to understand the role of the nurse in the larger
context of a clinical prevention trial, and (d) to expand the knowledge
base regarding some of the social and ethical underpinnings of clinical
prevention trials with healthy participants. The research design was
qualitative, descriptive, and exploratory. The methods used were the
telephone interview and the focus group. Fifty BCPT nurses were
interviewed. This included 30 telephone interviews and 20 additional
BCPT nurses who participated in four national and international focus
groups. After analysis of the data using ethnographic methods, a view of
the multi-faceted role of the BCPT nurse emerged. On a broader scale,
the inquiry raised a number of critical ethical and social issues that
are relevant to future clinical prevention trials with volunteer human
participants.
32
UI - 11377596
AU - Narod SA; Sun P; Ghadirian P; Lynch H; Isaacs C; Garber J; Weber B;
TI -
Karlan B; Fishman D; Rosen B; Tung N; Neuhausen SL
Tubal ligation and risk of ovarian cancer in carriers of BRCA1 or BRCA2
mutations: a case-control study.
SO - Lancet 2001 May 12;357(9267):1467-70
AD - Centre for Research on Women's Health, University of Toronto, 790 Bay
Street, Room 750, M5G 1N8, Ontario, Canada. steven.narod@swchsc.on.ca
BACKGROUND: In several case-control and prospective studies, tubal
ligation has been associated with a decreased risk of invasive
epithelial ovarian cancer. We aimed to assess the potential of tubal
ligation in reducing the risk of ovarian cancer in women who carry
predisposing mutations in the BRCA1 or BRCA2 genes. METHODS: We did a
matched case-control study among women from Canada, the USA, and the UK
who had undergone genetic testing and who carried a pathogenic mutation
in BRCA1 or BRCA2. Cases were 232 women with a history of invasive
ovarian cancer, and controls were 232 women without ovarian cancer, and
who had both ovaries intact. Cases and controls were matched for year of
birth, country of residence, and mutation (BRCA1 or BRCA2). The odds
ratio for developing ovarian cancer was estimated for tubal ligation,
adjusting for oral contraceptive use, parity, history of breast cancer,
and ethnic group. FINDINGS: In an unadjusted analysis among BRCA1
carriers, significantly fewer cases than controls had ever had tubal
ligation (30 of 173 [18%] vs 60 of 173 [35%], odds ratio 0.37 [95% CI
0.21-0.63]; p=0.0003). After adjustment for oral contraceptive use,
parity, history of breast cancer and ethnic group, the odds ratio was
0.39 (p=0.002). Combination of tubal ligation and past use of an oral
contraceptive was associated with an odds ratio of 0.28 (0.15-0.52). No
protective effect of tubal ligation was seen among carriers of the BRCA2
mutation. INTERPRETATION: Tubal ligation is a feasible option to reduce
the risk of ovarian cancer in women with BRCA1 mutations who have
completed childbearing.
33
UI - 11906436
AU - Masood S
TI -
Breast cancer prevention: an opportunity for better understanding of
time-challenged risk factors.
SO - Breast J 2001 Sep-Oct;7(5):277
34
UI - 11906441
AU - Fabian CJ; Kimler BF
TI -
Chemoprevention for high-risk women: tamoxifen and beyond.
SO - Breast J 2001 Sep-Oct;7(5):311-20
AD - University of Kansas Medical Center, Kansas City, Kansas 66160, USA.
cfabian@kumc.edu
The demonstration by the National Surgical Adjuvant Breast Project
(NSABP) that 5 years of tamoxifen therapy is associated with an
approximate 50% reduction in breast cancer incidence in high-risk women
was a milestone in breast cancer prevention. Because tamoxifen is
associated with increased risk of side-effects such as hot flashes,
menstrual abnormalities, uterine cancer, and thromboembolic phenomena,
its use will not be advisable or acceptable for all high-risk women.
Women over 50 years of age appear to be at highest risk for serious
adverse events, such as uterine cancer and thromboembolic phenomena.
Individuals in whom tamoxifen-associated breast cancer risk reduction
appears to outweigh risk of serious side-effects include women with
prior in situ or estrogen receptor (ER)-positive invasive cancer,
atypical hyperplasia, and/or women ages 35-49 with a calculated Gail
5-year risk of > or =1.7%, hysterectomized women aged 50 and older with
a 5-year Gail risk of > or =2.5%, and nonhysterectomized women aged 50
and older with a 5-year Gail risk of >5.0%. It is not yet clear whether
tamoxifen can reduce breast cancer incidence in women with BRCA1 and
BRCA2 mutations, although preliminary evidence favors benefit for at
least those with a BRCA2 mutation. Raloxifene is a selective ER
modulator with less uterine estrogen agonist activity than tamoxifen,
and it is hoped that it will result in fewer uterine cancers but will be
equally efficacious in reducing the risk of breast cancer. The NSABP is
currently conducting a randomized study of tamoxifen versus raloxifene
in high-risk postmenopausal women. Approximately one third of invasive
cancers are ER negative. Tamoxifen does not reduce the incidence of
ER-negative cancers, nor does it appear to be effective in preventing
the appearance of one third of ER-positive cancers. Priorities in
prevention research are to develop (a) biomarkers to refine short-term
risk assessments based on epidemiologic models, (b) biomarkers
predictive of response to specific classes of preventive agents, (c)
drugs with fewer side-effects and/or effective in ER-negative or
ER-positive tamoxifen-resistant precancerous disease, and (d) efficient
clinical trial models to assess new agent efficacy. Breast
intraepithelial neoplasia (IEN) may be sampled by minimally invasive
techniques and is an attractive short-term risk biomarker. Molecular
abnormalities observed in IEN may be used to select potential agents for
testing/therapy, and modulation of these abnormalities may be used in
phase I trials to select appropriate doses and in phase II trials to
assess response. Breast density volume and certain serum markers such as
insulin-like growth factor-1 are also being studied as potential risk
and response biomarkers. Reversal or prevention of advanced IEN as well
as modulation of other risk biomarkers in randomized phase II and phase
III trials is being evaluated as a means of more efficiently evaluating
prevention drugs in the future. A number of agents are being developed
that target molecular abnormalities in IEN, have fewer or different side
effects than tamoxifen, and may be effective in ER-negative or
tamoxifen-resistant disease.
35
UI - 11906442
AU - Anderson BO
TI -
Prophylactic surgery to reduce breast cancer risk: a brief literature
review.
SO - Breast J 2001 Sep-Oct;7(5):321-30
AD - Department of Surgery, University of Washington Bio-Clinical Breast Care
Program, University of Washington School of Medicine, Seattle,
Washington 98195, USA. banderso@u.washington.edu
Prophylactic mastectomy reduces the likelihood of developing breast
cancer among women at heightened risk for breast cancer, but at
significant personal cost.Women at increased breast cancer risk on the
basis of hormonal history, family history and/or genetic mutation
carrier status may consider bilateral prophylactic mastectomy with or
without reconstruction to reduce their cancer risk and/or decrease their
chances of cancer mortality. Women having received mastectomy as
treatment for breast cancer may request contralateral mastectomy to
decrease the chances of developing a second breast primary. The
potential oncologic value of these procedures must be weighed carefully
on a case-by-case basis against the operation's physical and
psychological morbidity. The purpose of this literature review is to
provide a practice-oriented summary of recent clinical studies
attempting to address the relative risks and benefits of preventive
surgery for breast cancer. Data are included regarding the psychological
factors surrounding patient selection and quality of life outcomes,
which become the cornerstone of patient satisfaction and acceptance.
Taken together, these data support the Society of Surgical Oncology
position statement regarding the proper application of prophylactic
surgery for breast cancer.
36
UI - 11921176
AU - Platner JH; Bennett LM; Millikan R; Barker MD
TI -
The partnership between breast cancer advocates and scientists.
SO - Environ Mol Mutagen 2002;39(2-3):102-7
AD - National Breast Cancer Coalition, Washington, DC 20036, USA.
jplatner@natlbcc.org
The National Breast Cancer Coalition (NBCC) is a grassroots organization
that represents breast cancer advocates and is committed to eradicating
breast cancer. NBCC defines a breast cancer advocate as someone who has
been personally affected by the disease (e.g., a breast cancer survivor,
family member, or friend), represents a constituency, and is motivated
to join the fight against the disease. One of the organization's goals
is to ensure that breast cancer advocates have a seat at the table when
decisions are made about breast cancer research and policy. To
accomplish this goal, NBCC educates advocates so that they can
participate in and make meaningful contributions to legislative,
scientific, and regulatory decision-making bodies. In addition to
creating educational opportunities for advocates, NBCC has spearheaded
several initiatives designed to directly increase the quality and
quantity of breast cancer research. NBCC has also played a major role in
making funding available to breast cancer researchers. Two of NBCC's
most notable programs include Project LEAD, an intensive
science-training course for breast cancer advocates, and the
Environmental Initiative, a collection of activities designed to improve
research into the relationship between breast cancer and the
environment. Breast cancer advocates trained by NBCC have partnered with
the scientific community and individual scientists to improve the peer
review, design, and implementation of breast cancer research. Copyright
2002 Wiley-Liss, Inc.
37
UI - 11921177
AU - Spears PA
TI -
Breast cancer prevention through the eyes of a survivor.
SO - Environ Mol Mutagen 2002;39(2-3):108-11
AD - Department of Anatomy, Physiological Sciences, and Radiology, College of
Veterinary Medicine, North Carolina State University, Raleigh, North
Carolina 27606, USA. paspears@unity.ncsu.edu
38
UI - 11921197
AU - Zujewski J
TI -
Selective estrogen receptor modulators (SERMs) and retinoids in breast
cancer chemoprevention.
SO - Environ Mol Mutagen 2002;39(2-3):264-70
AD - Medical Oncology Clinical Research Unit, Center for Cancer Research,
National Cancer Institute, Bethesda, Maryland 20892, USA.
zujewski@nih.gov
Tamoxifen has been shown to decrease the risk of invasive breast cancer
by 49% and noninvasive breast cancer by 50%. Tamoxifen is also
associated with a threefold increased risk of endometrial cancer.
Raloxifene, a second-generation selective estrogen receptor modulator
(SERM), has not been associated with endometrial cancer risk, and is
currently under study in a large, multi-institutional, randomized Study
of Tamoxifen and Raloxifene (STAR) for breast cancer prevention in
postmenopausal women. A pilot trial of raloxifene in premenopausal women
to assess the safety, tolerability, effects on bone mineral density,
mammographic density, and other biological endpoints is ongoing. The
retinoids have been shown to decrease mammary tumors in rodent
carcinogenesis models. The Italian trial of fenretinide (4-HPR) in women
with stage I breast cancer randomized women to fenretinide or no
intervention. This study did not show an overall effect of decreasing
the risk of contralateral breast cancer. However, a protective effect
was suggested in premenopausal women. It has been suggested that this
effect may be related to insulin-like growth factor 1 (IGF-1), which has
been shown to be modulated by fenretinide in premenopausal but not
postmenopausal women. Pilot studies of SERMs alone and in combination
with retinoids or other agents provide a model for testing the safety
and tolerability, pharmacokinetics and pharmacodynamics, and biomarker
modulation in high-risk women. These studies can provide information as
to both the pathophysiology of carcinogenesis and the mechanism of
action of chemopreventive agents, and help select agents and doses for
testing in large randomized studies.
39
UI - 11236399
AU - Rockhill B
TI -
The privatization of risk.
SO - Am J Public Health 2001 Mar;91(3):365-8
AD - Channing Laboratory, Harvard Medical School and Brigham and Women's
Hospital, Boston, Mass., USA. beverly.rockhill@channing.harvard.edu
The privatization, or individualization, of risk factor knowledge has
been largely responsible for a rising tide of criticism of epidemiology.
The current debate seems polarized into 2 sides, those who support and
those who attack "risk factor" epidemiology. This commentary aims to
reinvigorate some of Geoffrey Rose's central arguments and show that
this debate may miss a key point: a risk factor is a probabilistic
concept that applies to an aggregate of individuals, not to a specific
individual. Risk factor knowledge compels those in public health to seek
actions that shift population distributions of these factors and, to do
so, to understand their social, economic, and political determinants.
The author links Rose's qualitative distinction between the causes of
cases and the causes of incidence to an examination of the conceptual
and quantitative limits of "individual risk" estimation. The attempt to
predict individuals' futures on the basis of risk factor profile is
especially prominent now with breast cancer. The author suggests reasons
why a policy promoting private decision making about risk, while likely
ineffective from a population standpoint, is viewed as the only feasible
primary prevention option against this disease.
40
UI - 11855048
AU - Nakamura K
TI -
Secondary prevention of breast cancer in female Japanese citizens
residing in the USA.
SO - J Cult Divers 2001 Summer;8(2):41-4
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