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Abramson Cancer CenterNCI CANCERLIT® Search: Screening and Prevention of Breast Cancer - May 2002
National Cancer Institute®
Last Modified: May 1, 2002
Table of Contents
1
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. arja.aro@ktl.fi
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.
2
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. gm.bar@usa.net
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.
3
UI - 11176825
AU - Mitka M
TI -
Some radiologists want more money up front.
SO - JAMA 2001 Jan 17;285(3):281-2
4
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.
5
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.
6
UI - 11898154
AU - Cockey CD
TI -
More older women getting mammograms.
SO - AWHONN Lifelines 2000 Oct-Nov;4(5):18
7
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. maria.parker@christie-tr.nwest.nhs.uk
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.
8
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. schen@coh.org
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.
9
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
10
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.
11
UI - 11902508
AU - Anonymous
TI -
Poor cancer-screening uptake among ethnic minorities.
SO - Lancet Oncol 2001 Dec;2(12):709
12
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.
13
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.
heli.nevanlinna@huch.fi
14
UI - 11979280
AU - Carroll-Johnson RM
TI -
What's a girl to do?
SO - Oncol Nurs Forum 2002 Apr;29(3):445
15
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.
yujiane@umich.edu
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.
16
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).
17
UI - 11989065
AU - Dige U
TI -
[Mammographic screening in the municipality of Copenhagen]
SO - Ugeskr Laeger 2002 Apr 15;164(16):2177-8
18
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.
19
UI - 11732640
AU - Kellen JA
TI -
Raloxifene.
SO - Curr Drug Targets 2001 Dec;2(4):423-5
AD - eljan@sprint.ca
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.
20
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. tbevers@mdanderson.org
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.
21
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
22
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
23
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. paul.pharoah@srl.cam.ac.uk
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.
24
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.
25
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.
trebbeck@cceb.med.upenn.edu
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.
26
UI - 12024000
AU - Haber D
TI -
Prophylactic oophorectomy to reduce the risk of ovarian and breast
cancer in carriers of BRCA mutations.
SO - N Engl J Med 2002 May 23;346(21):1660-2
27
UI - 11868633
AU - Rotstein DL; Alter DA; Rotstein DL
TI -
Addressing the challenges of queues.
SO - CMAJ 2002 Feb 5;166(3):299-300
28
UI - 11999251
AU - Rodger A
TI -
Is it worth screening women over 70 for breast cancer--or indeed any
women?
SO - Med J Aust 2002 Mar 18;176(6):247-8
29
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. alexb@health.usyd.edu.au
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.
30
UI - 11242406
AU - Vastag B
TI -
Breast cancer prevention study aims to overcome drug bias.
SO - JAMA 2001 Jan 24-31;285(4):399-400
31
UI - 11311092
AU - Plouffe L Jr
TI -
Raloxifene for breast cancer prevention.
SO - JAMA 2001 Apr 25;285(16):2079
32
UI - 9641949
AU - Piachaud J; Rohde J
TI -
Screening for breast cancer is necessary in patients with learning
disability.
SO - BMJ 1998 Jun 27;316(7149):1979-80
33
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. jwong@lroc.harvard.edu
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.
The above citations and abstracts reflect those newly added to CANCERLIT for the month and topic listed in the title. The citations have been retrieved from CANCERLIT using a predefined search strategy of indexed subject terms. Although the search strategy has been refined as best as possible, citations may appear that are not directly related to the topic, and occasionally relevant references may be omitted.
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