National Cancer Institute®
Last Modified: May 1, 2002
UI - 11768605
AU - Aro AR; de Koning HJ; Absetz P; Schreck M
TI - Two distinct groups of non-attenders in an organized mammography screening program.
SO - Breast Cancer Res Treat 2001 Nov;70(2):145-53
AD - Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland. firstname.lastname@example.org
OBJECTIVE: To find out reasons for non-attendance and to study subgroup differences of the non-attenders in an organized mammography screening program. DESIGN: Prospective for background and psychosocial factors, retrospective for reasons of non-attendance. SETTING: Finnish screening based on personal first round invitations, with 89% attendance rate. PARTICIPANTS: Four hundred thirty six women with both pre-screening response to socioeconomic and psychosocial measures, and post-screening response reporting reasons of non-attendance. MAIN RESULTS: Most common single reason for non-attendance was previous recent mammogram (53%), but also reasons related to practical obstacles, worry and fear, knowledge and attitudes, and organization of screening were mentioned. Two distinct groups of non-attenders were found based on the reasons for non-attendance. Those who did not attend because a mammogram taken elsewhere (ELSE, n = 233) were urban, well-to-do women, who took care of their health by own initiation and felt more susceptible to breast cancer, and also expected mammogram to be painful. Other (real) non-attenders (REAL, n = 155) were less compliant with health recommendations and services, more socially isolated, depressed and anxious than ELSE. Level of depression among REAL was clearly higher (10.80) than the mean value (7.91, SD = 7.28) of the age group, and was also slightly above the cut-off score of 10 indicating mild or moderate depression. Trait anxiety was also markedly higher (40.18) than that of the same age group (37.76, SD = 8.95). CONCLUSIONS: Further research should clarify determinants and consequences of depression and anxiety among real non-attenders. Knowledge gaps and attitudinal barriers among non-attenders require more targeted campaigns.
UI - 11850610
AU - Baratelli GM; Allio W; Lanzani A; Valsecchi P; Rotmensz N
TI - How to decrease the non-compliance in a clinical trial.
SO - Minerva Med 2002 Feb;93(1):7-12
AD - Delegazione Alto Lario della Lega Italiana per la Lotta contro i Tumori, Gravedona, Como, Italy. email@example.com
BACKGROUND: A high compliance is an important scientific objective for a multicenter clinical trial and also an ethical responsibility. Some of non-compliance causes can be prevented during the enrollment phase by an accurate selection of subjects (quality of recruitment), other can be controlled after the recruitment, by a good organization of follow-up tests and visits (quality of organization). METHODS: The policy adopted in the Operative Center of the Delegazione Alto Lario della Lega Italiana per la Lotta contro i Tumori di Gravedona (Como) for obtaining a high compliance of women recruited in the Italian Tamoxifen Prevention Study are illustrated. RESULTS: The non-compliance rate of this center is low: 5.6 vs 23.3% of the whole Italian trial. CONCLUSIONS: The low non-compliance demonstrates the efficacy of the policy adopted.
UI - 11873549
AU - Fries MH; Holt C; Carpenter I; Carter CL; Daniels J; Flanagan J; Murphy
TI - K; Hailey BJ; Martin L; Hume R; Hudson G; Cadman M; Weatherly R; Nunes ME Guidelines for evaluation of patients at risk for inherited breast and ovarian cancer: recommendations of the Department of Defense Familial Breast/Ovarian Cancer Research Project.
SO - Mil Med 2002 Feb;167(2):93-8
AD - Air Force Medical Genetics Center, Keesler Air Force Base, MS 39534, USA.
Patients at high risk for inherited breast and/or ovarian cancer are frequently encountered in all medical specialties. Department of Defense, Health Affairs funding as part of the Breast Cancer Education and Awareness Program was used to develop a comprehensive program for the identification, counseling, genetic testing, and long-term follow-up of such high-risk patients. This article reports the recommendations for high-risk patient management based on 4 years of evaluation and care, including discussions of the approach to counseling, indications for genetic testing, post-testing counseling, patient surveillance with examination, imagining, and laboratory testing, and suggested options for surgical and chemoprophylaxis as well as lifestyle modifications.
UI - 11883297
AU - Bucholc M; Lepecka-Klusek C; Pilewska A; Kanadys K
TI - [Women's opinion of the risk of breast cancer]
SO - Ginekol Pol 2001 Dec;72(12A):1460-4
AD - Zakladu Pielegniarstwa Polozniczo-Ginekologicznego Wydzialu Pielegniarstwa i Nauk o Zdrowiu AM w Lublinie.
The basic element of preparing primary prophylactic is the designation of factors of the risks. In this connexion it has been decided that we acquaint ourselves with the opinions of women. Regarding the factors of the risks of falling ill with breast cancer, to be found on them. The research has been carried out among 149 women in the period of procreation. In order to obtain the material required for the research we hare used the questionnaire of the poll of their proper ownership. The gathered material was subjected to a statistic and descriptive analysis. Most of surveyed (138, it. 92.6%) has estimated the degree of the risks of falling ill with breast cancer. The women associated this fact with the cases of falling in their families or the changes on their breast. When asked, what increases the risks oh falling ill with breast cancer in their it was connected with women's gynaecological and maternity post. CONCLUSIONS: 1. Over halt of the women (53.6%) has estimated the risks of falling ill with breast cancer giving 1-2 points (within the scale 0-5 points). 2. In the families of the surveyed there were cases of falling ill with malignant breast tumour (3%). 3. The vast majority (78.5%) undertakes the steps in order (wholesome falling in advantageous to their health and controlling their state of health) to protect themselves against tumourous disease. 4. The variables accepted while working did not differentiate the surveyed opinions.
UI - 11850229
AU - Howell A; Howell SJ; Clarke R; Anderson E
TI - Where do selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs) now fit into breast cancer treatment algorithms?
SO - J Steroid Biochem Mol Biol 2001 Dec;79(1-5):227-37
AD - CRC Department of Medical Oncology, Christie Hospital NHS Trust, M20 4BX, Manchester, UK. firstname.lastname@example.org
The agents used for endocrine therapy in patients with breast cancer have changed markedly over the past decade. Tamoxifen remains the anti-oestrogen of choice, but could be replaced by the oestrogen receptor down-regulator ICI 182780 or by the fixed ring triphenylethylene arzoxifene (previously SERM III) soon. Whilst aminoglutethimide and 4-OH androstenedione were the aromatase inhibitors of choice, they have been replaced by non-steroidal (anastrozole and letrozole) and steroidal (exemestane) inhibitors of high potency and low side effect profile. Previously, often used treatments such as progestogens (megestrol acetate and medroxyprogesterone acetate) and androgens are now rarely used or confined to fourth or fifth line treatments. The LHRH agonist, goserelin, remains the treatment of choice for pre-menopausal patients with advanced breast cancer although recent randomised trials indicate a response, time to progression and survival advantage for the combination of goserelin and tamoxifen compared with goserelin alone.The newer treatments have led to questions concerning the optimum sequence of agents to use in advanced breast cancer and as neo-adjuvant and adjuvant therapy in relation to surgery. Two trials of anastrozole compared with tamoxifen and one trial of letrozole compared with tamoxifen indicate that the new triazole aromatase inhibitors have a significant advantage over the anti-oestrogen with respect to time to progression and survival. Similarly, triazole aromatase inhibitors give faster and more complete responses compared with tamoxifen when used in post-menopausal women before surgery.Major research questions remain with respect to the aromatase inhibitors used as adjuvant therapy. Anastrozole is being tested alone or in combination with tamoxifen compared with tamoxifen in the 'so-called' ATAC trial. Over 9000 patients have been randomised to this important study: the results will be available late-2001. A similar study comparing letrozole and tamoxifen started recently under the auspices of the Breast International Group. Importantly, this trial is also comparing the sequence of tamoxifen followed by letrozole (or vice versa). A similar trial of exemestane given after 2-3 years of tamoxifen compared with 5 years of tamoxifen is recruiting well as is a study comparing letrozole (or placebo) for 5 years after 5 years of adjuvant tamoxifen. These studies may show that aromatase inhibitors are superior to tamoxifen or that a sequence is preferable.ICI 182780 causes complete oestrogen receptor down-regulation leading to a the lack of agonist activity of the drug. Two trials of ICI 182780 compared with anastrozole for advanced disease will report later this year and a comparison with tamoxifen next year. Arzoxifene (SERM III) is being tested against tamoxifen. These studies are likely to result in new anti-oestrogens being introduced into the clinic.Most of our endocrine treatments deprived the tumour cell of oestradiol. In vitro experiments with MCF-7 cells indicate that tumour cells can adapt and then grow in response to low oestrogen concentrations in the tissue--culture medium. Importantly, the cells were shown to apoptose in response to high oestrogen concentrations. A recent clinical trial has demonstrated a high response rate to stilboestrol given after a median of four previous oestrogen depriving endocrine therapies. These data and the newer treatments available indicate a need to re-think our general approach to endocrine therapy and endocrine prevention.
UI - 11850205
AU - Chen S; Zhou D; Yang C; Okubo T; Kinoshita Y; Yu B; Kao YC; Itoh T
TI - Modulation of aromatase expression in human breast tissue.
SO - J Steroid Biochem Mol Biol 2001 Dec;79(1-5):35-40
AD - Division of Immunology, Beckman Research Institute of the City of Hope, Duarte, CA 91010, USA. email@example.com
Aromatase plays an important role in breast cancer development through its role in the synthesis of estrogen. Aromatase expression in breast tissue can be regulated by several mechanisms. The major promoter usage for aromatase expression in breast tumors (i.e. cAMP-stimulated promoters I.3 and II) is different from that in normal breast tissue (i.e. glucocorticoid-stimulated promoter I.4). Recent characterization of transcription factors that interact with the two important regulatory elements near promoters I.3 and II, i.e. S1 and CREaro, helps us better understand the mechanism of the switch of promoter usage between normal breast tissue and cancer tissue. It is thought that in normal breast tissue, the function of promoters I.3 and II is suppressed through the binding of EAR-2, COUP-TFI, and EARgamma to S1, and through the binding of Snail/Slug proteins to their binding site that quenchs the CREaro activity. In cancer tissue, the expression levels of EAR-2, COUP-TFI, EARgamma, Snail, and Slug decrease, and aromatase expression is then up regulated through the binding of ERRalpha-1 to S1 and the binding of CREB or related factors to CREaro. Results from this and other laboratories reveal that aromatase activity in aromatase expressing cells can also be modified by treatment with aromatase inhibitors and the antiestrogen ICI 182, 780. While aromatase inhibitors are used to treat breast cancer, the treatment has been found to increase the level of aromatase in the breast tissue of some patients. The enhancement of aromatase activity by aromatase inhibitors is thought to be due to a decrease of aromatase protein degradation by enzyme-inhibitor complex formation, up-regulation of the aromatase gene transcription through a cAMP-mediated mechanism, and an induction of aromatase expression by gonadtropins that are released from the pituitary in response to a reduction of estrogen levels in circulation in premenopausal women. Antiestrogen ICI 182, 780 has been found to suppress aromatase expression, but the mechanism has not yet been determined. In addition, aromatase activity and expression can be affected by environmental chemicals. A detailed structure-function study has revealed that flavones, but not isoflavones, are inhibitors of aromatase. It was found that flavones bind to the active site of aromatase in an orientation in which their rings-A and -C mimic rings-D and -C of the androgen substrate. The modulation of aromatase expression by endocrine disrupting chemicals is exemplified by two organochlorine pesticides (i.e. toxaphene and chlordane) that have been found to be antagonists of ERRalpha-1 orphan receptor. These compounds reduce ERRalpha-1 activity, resulting in a suppression of aromatase expression.
UI - 11347284
AU - Dog TL; Riley D; Carter T
TI - Traditional and alternative therapies for breast cancer.
SO - Altern Ther Health Med 2001 May-Jun;7(3):36-42, 45-7; quiz 48, 149
UI - 11975321
AU - Satge D; Sasco AJ; Pujol H; Rethore MO
TI - [Breast cancer in women with trisomy 21]
SO - Bull Acad Natl Med 2001;185(7):1239-52; discussion 1252-4
AD - Laboratoire d'Anatomie pathologique, Centre hospitalier, 19000 Tulle.
The population with Down's syndrome has a different cancer profile compared to the general population, even after taking into account issues of survival and ageing. Several solid tumours are unusually rare, whereas in contrast leukaemias are increased. In addition, few studies are available on this topic. We therefore decided to conduct a mortality study based on the INSERM national mortality statistics in France comparing over a 24 year period deaths from female breast cancer in the general French population with the cancer deaths in women with Down's syndrome. Only 5 deaths with Down's syndrome could be found compared to 68.98 expected based on national statistics. This clear reduction in risk agrees with other studies available in Down's syndrome patients. This observation could be partly explained by over expression of genes linked to gene dosage effects on chromosome 21, playing a role in cell growth, differentiation, survival and death. An additional protective effect could come from the marked and continued decreased exposure to oestrogens, starting in utero for women with trisomy 21 and lasting all over life.
UI - 11975860
AU - Andejeski Y; Breslau ES; Hart E; Lythcott N; Alexander L; Rich I;
TI - Bisceglio I; Smith HS; Visco FM; U.S. Army Medical Research and Materiel Command Fiscal Year 1995 Breast Cancer Research Program Integration Panel Benefits and drawbacks of including consumer reviewers in the scientific merit review of breast cancer research.
SO - J Womens Health Gend Based Med 2002 Mar;11(2):119-36
AD - Office of Communication, National Cancer Institute, Bethesda, Maryland, USA.
BACKGROUND: This study assessed participant opinions about inclusion of breast cancer survivors as lay representatives in a scientific and technical merit review of proposals for the 1995 Department of Defense Breast Cancer Research Program (DOD BCRP). METHODS: The evaluation employed a prepanel and postpanel survey design, which was intended to elicit feedback about attitudes, perceptions, and beliefs toward collaborative consumer and scientist participation in scientific merit review. Qualitative methods were used to describe the consumers' and scientists' responses, to explore the significance of this interaction, and to gain an understanding of the benefits and disadvantages of bringing these participants together. RESULTS: Both groups were initially troubled about the consumers' lack of scientific background and questioned their qualifications and preparation for participation in a scientific panel. In particular, consumers were concerned that their judgments would not be taken seriously by scientists, a concern somewhat lessened by participation. After the meeting, scientists viewed the consumers as hard-working, dedicated survivors and advocates and endorsed the presence of carefully chosen lay panel members. Scientists were troubled that consumers potentially would have an impact on voting and on the subsequent scoring of proposals, a concern that was not validated by quantitative findings. CONCLUSIONS: As a result of these data, the DOD BCRP continues to embrace clarify the nature of collaborative participation in scientific merit review.
UI - 11973868
AU - Nevanlinna H; Kallioniemi OP
TI - [Susceptibility genes of familiar breast cancer in Finland]
SO - Duodecim 1999;115(21):2365-74
AD - HYKS:n naistenklinikka, tutkimuslaboratorio PL 140, 00029 HYKS. firstname.lastname@example.org
UI - 11979289
AU - Yu MY; Seetoo AD; Qu M
TI - Challenges of identifying asian women for breast cancer screening.
SO - Oncol Nurs Forum 2002 Apr;29(3):585-7
AD - School of Nursing, University of Michigan, Ann Arbor, MI, USA. email@example.com
PURPOSE/OBJECTIVES: To emphasize the need for multiple data sources to develop a comprehensive list of potential respondents for a study of breast cancer screening behavior among Asian American women. DESIGN: Descriptive, pilot. SETTING: An urban Michigan county. SAMPLE: 616 Chinese women age 40 and older. METHODS: Comparison of multiple data sources, including lists from membership directories of local Chinese organizations, a commercial survey company, health promotion events, and brief telephone interviews. FINDINGS: Of the 616 eligible women, 32% were identified through the membership directories of local Chinese organizations, 28% from a list obtained from the survey company, 22% from telephone directories, 10% from the attendance lists of health promotion events, and 8% from more than one source. CONCLUSIONS: Multiple sources are required to obtain a comprehensive list for specialized populations. Every data source has its advantages and disadvantages. The use of diverse sources helps to offset the limitations of each individual one. IMPLICATIONS FOR NURSING: Identifying potential participants from specialized populations represents a major issue for clinicians and researchers in nursing and other health-related disciplines. Strategies exist to facilitate the process.
UI - 11814067
AU - Smith RA; Cokkinides V; von Eschenbach AC; Levin B; Cohen C; Runowicz
TI - CD; Sener S; Saslow D; Eyre HJ; American Cancer Society American Cancer Society guidelines for the early detection of cancer.
SO - CA Cancer J Clin 2002 Jan-Feb;52(1):8-22
AD - Cancer Control Department, American Cancer Society, Atlanta, GA, USA.
Each year the American Cancer Society publishes a summary of existing recommendations for early cancer detection, including updates, and/or emerging issues that are relevant to screening for cancer. In last year's article, the guidelines regarding screening for the early detection of prostate, colorectal, and endometrial cancers were updated, as was the narrative pertaining to testing for early lung cancer detection. Although none of the ACS's guidelines were updated in 2001, work is proceeding on an update of screening recommendations for breast and cervical cancer and an update of these guidelines will be announced review recommendations for the "cancer-related check-up," in which clinical encounters provide case-finding and health counseling opportunities. Finally, we provide an update of the most recent data pertaining to participation rates in cancer screening by age, gender, and ethnicity from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System (BRFSS) and National Health Interview Survey (NHIS).
UI - 11977534
AU - Miyoshi Y; Noguchi S
TI - [Genetic test and prophylactic treatment in breast cancer families]
SO - Gan To Kagaku Ryoho 2002 Apr;29(4):512-22
AD - Dept. of Surgical Oncology, Osaka University Graduate School of Medicine.
Fifteen (13.3%) and 21 (18.6%) deleterious germline mutations were identified in BRCA1, and BRCA2 genes among 113 Japanese breast cancer families. We found a BRCA1 codon 63 (nucleotide 307) nonsense mutation and a 4-bp deletion at codon 1858 (nucleotide 5802) of BRCA2 in 4 and 7 independent families, respectively. Haplotype analysis has revealed that these two mutations were founder mutations. Lifetime risk of breast cancer in BRCA1 or BRCA2 mutation carriers was estimated at nearly 80%, and that of ovarian cancer in BRCA1 mutation carriers was about 40%. A questionnaire survey as to the genetic testing (BRCA1 and BRCA2) and prevention was carried out with 146 healthy women (hospital workers or medical students) and 84 breast cancer patients. About 80% of healthy women as well as breast cancer patients responded positively to the genetic testing, based on the assumption their's was a breast cancer family, and about 20% of each group answered that they would opt for prophylactic mastectomy and oophorectomy if they were found to be germline mutation carriers. These results indicate that genetic testing and prophylactic surgery would be acceptable among a considerable number of Japanese women, and seem to support the establishment an infrastructure for genetic testing in Japan.
UI - 11732640
AU - Kellen JA
TI - Raloxifene.
SO - Curr Drug Targets 2001 Dec;2(4):423-5
AD - firstname.lastname@example.org
Efforts to interfere with the initiation and promotion of breast and other cancers by endocrine manipulation are not new. It is of obvious benefit to cancer patients to administer substances that combine minimal general toxicity with maximal oestrogen inhibition. Raloxifene is a relatively recent addition to a group of compounds loosely designated as antioestrogens, which implies their ability to antagonize oestrogen effects via competitive binding to the various receptors. This is a reductionist simplification, since their effect varies and ranges from interaction with lipid transduction cascades, covalent binding to proteins and DNA, regulation of growth factors, erbB2, mdr1 and probably p53 expression, complexing with E-cadherin/catenin to active induction of apoptosis and many other effects on the genome. Also, the action of most antioestrogens is not solely antagonistic and different compounds do exert some agonistic effects in various tissues. Apart from some "pure" antioestrogens, the benzothiophene derivative Raloxifene has been found to combine a high degree of selective oestrogen suppression with several other desirable characteristics, such as reduction of bone demineralisation and antiatherogenic effects without endometrial stimulation. It is well tolerated, has been successfully tested as a chemopreventive agent for breast cancer in certain groups of the population and does not prevent ovulation in women with normal menstrual cycles. Certainly, Raloxifene is only another forerunner of upcoming "designer" oestrogen modulators, but it represents a welcome addition to the therapeutic choices available for the control of some menopausal problems as well as for the prevention and treatment of breast cancer, as outlined in the following brief review.
UI - 11769967
AU - Bevers TB
TI - Breast cancer chemoprevention: current clinical practice and future direction.
SO - Biomed Pharmacother 2001 Nov;55(9-10):559-64
AD - The University of Texas M. D. Anderson Cancer Center Clinical Cancer Prevention, Houston 77030, USA. email@example.com
With the unblinding of the Breast Cancer Prevention Trial (BCPT) in 1998, the clinical management of breast cancer prevention patients has expanded from the time-honored triad of breast cancer screening to include breast cancer risk assessment and risk reduction. With a proven 49% reduction in the incidence of breast cancer, tamoxifen is now the gold standard in chemoprevention for breast cancer risk reduction for women at increased risk of the disease. The suggested 74% reduction in the incidence of breast cancer seen with raloxifene in the Multiple Outcomes of Raloxifene Evaluation (MORE) trial is the basis of the now ongoing Study of Tamoxifen and Raloxifene (STAR) for the Prevention of Breast Cancer. Findings are anticipated in 2006.
UI - 11893879
AU - Strobel ES; Fritschka E
TI - Hereditary premenopausal breast cancer.
SO - Onkologie 2002 Feb;25(1):24-7
AD - Paracelsus-Klinik, Bad Elster, Germany.
Less than 1% of breast cancers occur between the age of 20 and 30 years, but more than 50% of breast cancers under the age of 30 years are hereditary. Breast cancer mainly occurs sporadically, however, in 5 to maximally 10% of cases a genetic predisposition is present. Mutations in the already sequenced tumor suppressor genes BRCA1 and BRCA2 account for 60-70% of these hereditary breast cancers. The chromosomal location of BRCA1 is 17q21 and that of BRCA2 is 13q12-13. Screening procedures and possible prevention strategies for women with mutations in the BRCA1 and BRCA2 genes are discussed. They include the use of tamoxifen. Copyright 2002 S. Karger GmbH, Freiburg
UI - 11942076
AU - Pelikan V; Kreuter B; Schmid K; Kniewallner K
TI - [Breast carcinoma. A topic that affects us women! Because cases of breast carcinoma occurred in our family circle, we became interested in information regarding risk factors, prevention, mass screening and counseling facilities. School project in nursing research curriculum]
SO - Osterreichische Pflegezeitschrift 2001 May;54(5):24-5
UI - 11984562
AU - Pharoah PD; Antoniou A; Bobrow M; Zimmern RL; Easton DF; Ponder BA
TI - Polygenic susceptibility to breast cancer and implications for prevention.
SO - Nat Genet 2002 May;31(1):33-6
AD - Cancer Research UK Human Cancer Genetic Group, Department of Oncology, Strangeways Research Laboratories, Worts Causeway, Cambridge, CB1 8RN, UK. firstname.lastname@example.org
The knowledge of human genetic variation that will come from the human genome sequence makes feasible a polygenic approach to disease prevention, in which it will be possible to identify individuals as susceptible by their genotype profile and to prevent disease by targeting interventions to those at risk. There is doubt, however, regarding the magnitude of these genetic effects and thus the potential to apply them to either individuals or populations. We have therefore examined the potential for prediction of risk based on common genetic variation using data from a population-based series of individuals with breast cancer. The data are compatible with a log-normal distribution of genetic risk in the population that is sufficiently wide to provide useful discrimination of high- and low-risk groups. Assuming all of the susceptibility genes could be identified, the half of the population at highest risk would account for 88% of all affected individuals. By contrast, if currently identified risk factors for breast cancer were used to stratify the population, the half of the population at highest risk would account for only 62% of all cases. These results suggest that the construction and use of genetic-risk profiles may provide significant improvements in the efficacy of population-based programs of intervention for cancers and other diseases.
UI - 12023992
AU - Kauff ND; Satagopan JM; Robson ME; Scheuer L; Hensley M; Hudis CA; Ellis
TI - NA; Boyd J; Borgen PI; Barakat RR; Norton L; Castiel M; Nafa K; Offit K Risk-reducing salpingo-oophorectomy in women with a BRCA1 or BRCA2 mutation.
SO - N Engl J Med 2002 May 23;346(21):1609-15
AD - Clinical Genetics Service, Memorial Sloan-Kettering Cancer Center, New York 10021, USA.
BACKGROUND: Risk-reducing salpingo-oophorectomy is often considered by carriers of BRCA mutations who have completed childbearing. However, there are limited data supporting the efficacy of this approach. We prospectively compared the effect of risk-reducing salpingo-oophorectomy with that of surveillance for ovarian cancer on the incidence of subsequent breast cancer and BRCA-related gynecologic cancers in women with BRCA mutations. METHODS: All women with BRCA1 or BRCA2 mutations identified during a six-year period were offered enrollment in a prospective follow-up study. A total of 170 women 35 years of age or older who had not undergone bilateral oophorectomy chose to undergo either surveillance for ovarian cancer or risk-reducing salpingo-oophorectomy. Follow-up involved an annual questionnaire, telephone contact, and reviews of medical records. The time to cancer in the two groups was compared by Kaplan-Meier analysis and a Cox proportional-hazards model. RESULTS: During a mean follow-up of 24.2 months, breast cancer was diagnosed in 3 of the 98 women who chose risk-reducing salpingo-oophorectomy and peritoneal cancer was diagnosed in 1 woman in this group. Among the 72 women who chose surveillance, breast cancer was diagnosed in 8, ovarian cancer in 4, and peritoneal cancer in 1. The time to breast cancer or BRCA-related gynecologic cancer was longer in the salpingo-oophorectomy group, with a hazard ratio for subsequent breast cancer or BRCA-related gynecologic cancer of 0.25 (95 percent confidence interval, 0.08 to 0.74). CONCLUSIONS: Salpingo-oophorectomy in carriers of BRCA mutations can decrease the risk of breast cancer and BRCA-related gynecologic cancer.
UI - 12023993
AU - Rebbeck TR; Lynch HT; Neuhausen SL; Narod SA; Van't Veer L; Garber JE;
TI - Evans G; Isaacs C; Daly MB; Matloff E; Olopade OI; Weber BL; The Prevention and Observation of Surgical End Points Study Group Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations.
SO - N Engl J Med 2002 May 23;346(21):1616-22
AD - Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia 19104-6021, USA. email@example.com
BACKGROUND: Data concerning the efficacy of bilateral prophylactic oophorectomy for reducing the risk of gynecologic cancer in women with BRCA1 or BRCA2 mutations are limited. We investigated whether this procedure reduces the risk of cancers of the coelomic epithelium and breast in women who carry such mutations. METHODS: A total of 551 women with disease-associated germ-line BRCA1 or BRCA2 mutations were identified from registries and studied for the occurrence of ovarian and breast cancer. We determined the incidence of ovarian cancer in 259 women who had undergone bilateral prophylactic oophorectomy and in 292 matched controls who had not undergone the procedure. In a subgroup of 241 women with no history of breast cancer or prophylactic mastectomy, the incidence of breast cancer was determined in 99 women who had undergone bilateral prophylactic oophorectomy and in 142 matched controls. The length of postoperative follow-up for both groups was at least eight years. RESULTS: Six women who underwent prophylactic oophorectomy (2.3 percent) received a diagnosis of stage I ovarian cancer at the time of the procedure; two women (0.8 percent) received a diagnosis of papillary serous peritoneal carcinoma 3.8 and 8.6 years after bilateral prophylactic oophorectomy. Among the controls, 58 women (19.9 percent) received a diagnosis of ovarian cancer, after a mean follow-up of 8.8 years. With the exclusion of the six women whose cancer was diagnosed at surgery, prophylactic oophorectomy significantly reduced the risk of coelomic epithelial cancer (hazard ratio, 0.04; 95 percent confidence interval, 0.01 to 0.16). Of 99 women who underwent bilateral prophylactic oophorectomy and who were studied to determine the risk of breast cancer, breast cancer developed in 21 (21.2 percent), as compared with 60 (42.3 percent) in the control group (hazard ratio, 0.47; 95 percent confidence interval, 0.29 to 0.77). CONCLUSIONS: Bilateral prophylactic oophorectomy reduces the risk of coelomic epithelial cancer and breast cancer in women with BRCA1 or BRCA2 mutations.
UI - 11999259
AU - Barratt AL; Les Irwig M; Glasziou PP; Salkeld GP; Houssami N
TI - Benefits, harms and costs of screening mammography in women 70 years and over: a systematic review.
SO - Med J Aust 2002 Mar 18;176(6):266-71
AD - Department of Public Health and Community Medicine, University of Sydney, NSW. firstname.lastname@example.org
OBJECTIVE: To assess the (i) benefits, (ii) harms and (iii) costs of continuing mammographic screening for women 70 years and over. DATA SOURCES AND SYNTHESIS: (i) We conducted a MEDLINE search (1966 - July 2000) for decision-analytic models estimating life-expectancy gains from screening in older women. The five studies meeting the inclusion criteria were critically appraised using standard criteria. We estimated relative benefit from each model's estimate of effectiveness of screening in older women relative to that in women aged 50-69 years using the same model. (ii) With data from BreastScreen Queensland, we constructed balance sheets of the consequences of screening for women in 10-year age groups (40-49 to 80-89 years), and (iii) we used a validated model to estimate the marginal cost-effectiveness of extending screening to women 70 years and over. RESULTS: For women aged 70-79 years, the relative benefit was estimated as 40%-72%, and 18%-62% with adjustment for the impact of screening on quality of life. For women over 80 years the relative benefit was about a third, and with quality-of-life adjustment only 14%, that in women aged 50-69 years. (ii) Of 10,000 Australian women participating in ongoing screening, about 400 are recalled for further testing, and, depending on age, about 70-112 undergo biopsy and about 19-80 cancers are detected. (iii) Cost-effectiveness estimates for extending the upper age limit for mammographic screening from 69 to 79 years range from $8119 to $27 751 per quality-adjusted life-year saved, which compares favourably with extending screening to women aged 40-49 years (estimated at between $24,000 and $65,000 per life-year saved). CONCLUSIONS: Women 70 years and over, in consultation with their healthcare providers, may want to decide for themselves whether to continue mammographic screening. Decision-support materials are needed for women in this age group.
UI - 11905613
AU - Wong J S; Harris J R
TI - Importance of local tumour control in breast cancer.
SO - Lancet Oncol 2001 Jan;2(1):11-7
AD - Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA 02115, USA. email@example.com
The overall importance of local tumour control in the management of breast cancer, specifically the influence of local control on survival, remains one of the fundamental questions for oncologists. This review addresses the issues surrounding local tumour control, including the evolution of the concept of disease spread, the rationale for local control, the results of studies of radiotherapy after breast-conserving surgery and after mastectomy, and an interpretation of the recent data on post-mastectomy radiotherapy.
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