National Cancer Institute®
Last Modified: January 1, 2002
UI - 11275449
AU - Morris CR; Wright WE; Schlag RD
TI - The risk of developing breast cancer within the next 5, 10, or 20 years of a woman's life.
SO - Am J Prev Med 2001 Apr;20(3):214-8
AD - Public Health Institute, California Cancer Registry, Sacramento, California 95815-4402, USA. firstname.lastname@example.org
BACKGROUND: The lifetime risk of developing breast cancer is a frequently misinterpreted statistic. Risk projections over a shorter time period, conditioned on current age, may be less prone to misconceptions and more relevant to populations at different ages. The purpose of this study was to estimate the risk of developing breast cancer within the next 5, 10, or 20 years for women currently aged 30 to 70 years in California's four major race/ethnic groups. METHODS: Life tables were used to obtain risk estimates based on 1993-1997 breast cancer incidence rates from the California Cancer Registry and statewide mortality rates. RESULTS: For women currently aged 50, the estimated risk of developing invasive breast cancer within 5 years varied from 0.8% (1 in 133) among Hispanics to 1.3% (1 in 75) among Caucasians. Risk estimates within 10 years were 2.9% (1 in 34) among Caucasians, 2.3% (1 in 43) among African Americans, 2.0% (1 in 51) among Asian/Pacific Islanders, and 1.6% (1 in 63) among Hispanics. Within 20 years, estimated risks increased to 6.6% (1 in 15) among Caucasians, 5.0% (1 in 20) among African Americans, 3.9% (1 in 26) among Asian/Pacific Islanders, and 3.7% (1 in 27) among Hispanics. Risk estimates were 8% to 20% higher when in situ tumors were included in the calculations. CONCLUSIONS: Based on these estimates, the baseline risk of developing breast cancer in the next 1 or 2 decades of life varies by race/ethnicity and current age, but may be lower than the risk perceived by most women.
UI - 11386037
AU - Thornton H
TI - Pairing accountability with responsibility--the consequences of screening 'promotion'.
SO - Med Sci Monit 2001 May-Jun;7(3):531-3
AD - email@example.com
The chain of accountability, beginning with the inadequate information provision to women being invited for mammographic screening over the last decade, against a background of changing attitudes in women and increased understanding of DCIS, and the consequences and effectiveness of mammographic screening, is explored. In particular, an example is used of family repercussions arising from facile, unjustified extrapolation by insurance brokers of genetic risk by use of the 'breast cancer' label in a case of diagnosis of screen-detected ductal carcinoma in situ (DCIS) to seek to unjustly deny, restrict or withhold. The question posed is: where does the responsibility lie for such a serious, previously unadvised repercussion in a public health programme imposed on 'healthy' women, promoted to them in a coercive manner with unbalanced, inadequate information, and still not revised in the light of recent findings and GMC guidelines?
UI - 11434448
AU - Torrisi R; Decensi A; Formelli F; Camerini T; De Palo G
TI - Chemoprevention of breast cancer with fenretinide.
SO - Drugs 2001;61(7):909-18
AD - Chemoprevention Unit, European Institute of Oncology, Milan, Italy.
Chemoprevention of cancer represents a challenge for oncology during this new millennium. Substantial advances have been accomplished in the last decade, especially for primary and secondary prevention of breast cancer. In addition to tamoxifen, raloxifene and other selective estrogen receptor modulators, retinoids are among the most promising agents, given their ability to inhibit mammary carcinogenesis in preclinical models. Fenretinide, the synthetic amide of retinoic acid, inhibits cell growth mostly through the induction of apoptosis with mechanisms which may partly involve the retinoid receptors. Because it has a favourable toxicological profile, fenretinide has been extensively investigated in clinical trials. A large randomised phase III trial for secondary breast cancer prevention has been recently carried out in Italy. Results showed a reduction of second breast malignancies in premenopausal women. In addition, a significant decrease of circulating insulin-like growth factor (IGF)-1, a known risk factor for premenopausal breast cancer, was observed after 1 year of fenretinide administration in premenopausal women with breast cancer. Ongoing studies on the validation of the circulating IGF-1 as a surrogate endpoint biomarker of fenretinide activity and on the effectiveness of the combination with low dose tamoxifen may provide further insight into the future clinical application of fenretinide.
UI - 11475877
AU - Rutledge DN; Barsevick A; Knobf MT; Bookbinder M
TI - Breast cancer detection: knowledge, attitudes, and behaviors of women from Pennsylvania.
SO - Oncol Nurs Forum 2001 Jul;28(6):1032-40
AD - Fox Chase Cancer Center, Philadelphia, PA, USA. firstname.lastname@example.org
PURPOSE/OBJECTIVES: To assess relationships among breast cancer detection behaviors and selected variables in healthy women. DESIGN: Correlational study. SETTING/SAMPLE: A sample of 1,000 women was selected randomly from the 16,500 members of the General Federation of Women's Clubs of Pennsylvania. Respondents (N = 538; 54% response rate) were predominately white, well educated, lived in urban areas, and had an average age of 60 years. METHODS: Mailed packets with a professionally designed, scannable survey instrument that included questions related to detection behaviors, a risk index, health behaviors, attitudes, and knowledge. MAIN RESEARCH VARIABLES: Breast cancer detection behaviors: mammography, clinical breast examination (CBE), breast self-examination (BSE). Structural/demographic variables: age, education, residence, knowledge of breast cancer and detection methods, teaching history, encouragement, and risk index (family/medical history). Predisposing variables: susceptibility, benefits/barriers, confidence, social norms and influence, and general health motivation. FINDINGS: Women reported moderate/high adherence to recommendations for early detection of breast cancer. Mammography behavior was predicted by older age, being encouraged by a doctor or nurse, and greater risk. CBE predictors were greater knowledge and risk along with greater benefits, social norms, and health motivation. BSE behavior was predicted by having had BSE technique checked, greater knowledge, greater risk, decreased barriers to BSE, and higher health motivation. CONCLUSIONS: Common predictors of breast screening behaviors include risk (family/medical history), knowledge, and general health motivation. IMPLICATIONS FOR NURSING PRACTICE: Educational efforts can be designed specifically to influence variables related to compliance with early breast cancer detection behaviors.
UI - 11499690
AU - Srivastava A; McKinnon W; Wood ME
TI - Risk of breast and ovarian cancer in women with strong family histories.
SO - Oncology (Huntingt) 2001 Jul;15(7):889-902; discussion 902, 905-7, 911-13
AD - Division of Hematology and Oncology, University of Vermont College of Medicine, Burlington 05401, USA.
Assessing the risk of breast and ovarian cancer starts with obtaining a complete and accurate family history. This can reveal evidence of inherited cancer risk. The highest risk of cancer is associated with germ-line abnormalities in several genes, including BRCA1, BRCA2, and TP53. Moderate-risk genes associated with syndromes that are inherited in an autosomal dominant pattern (such as Cowden's disease, hereditary non-polyposis colorectal cancer, Muir-Torre syndrome, and Peutz-Jeghers syndrome) exhibit lower penetrance and thus less risk of breast and/or ovarian cancer. Low-risk genes likely require significant environmental exposure, and although they are associated with the lowest risk of cancer, they account for more cancer than high- and moderate-risk genes. Lifetime risks for breast or ovarian cancer can be estimated. The Gail and Claus models, the more widely utilized models for calculation of lifetime breast cancer risk, are discussed. Models are also available for determining the likelihood of finding a BRCA1/2 mutation (the BRCAPRO and Myriad models). Appropriate candidates for testing include affected individuals who are most likely to have a hereditary form of cancer. Testing should proceed only after a thorough discussion of the risks, benefits, and limitations of testing. Risk-reducing options are available to women with a strong family history of breast and ovarian cancer. These options include high-risk screening, chemoprevention, and prophylactic surgery.
UI - 11499144
AU - Kessler M; Schneider P; Sittek H; Reiser M
TI - [Screening lowers breast cancer mortality. Motivate your patients for mammography]
SO - MMW Fortschr Med 2001 Jul 19;143(28-29):32-5
Breast cancer is the most common malignant disease in women under 70, and the most common cause of death in those under 50. Causal prophylaxis is unknown. Only early diagnosis prior to the onset of lymphogenic or hematogenic metastasization improves the prognosis. Since the early nineteen-sixties, large-scale studies have shown that screening mammography can reduce mortality. Furthermore, early diagnosis enables breast-conserving treatment in up to 70% of cases. Disadvantages of screening mammography currently under discussion are the radiation burden, the number of false-positive diagnoses prompting biopsy and incurring costs. In Germany, the cost of screening mammography in women with no relevant history or clinical symptoms is not borne by the state-affiliated health insurance carriers. Currently, ongoing pilot projects are investigating quality-controlled early diagnosis with mammography.
UI - 11508619
AU - Port ER; Montgomery LL; Heerdt AS; Borgen PI
TI - Patient reluctance toward tamoxifen use for breast cancer primary prevention.
SO - Ann Surg Oncol 2001 Aug;8(7):580-5
AD - Breast Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
BACKGROUND: The National Surgical Adjuvant Breast and Bowel Project (NSABP) P-1 trial demonstrated that tamoxifen reduces the incidence of new breast cancers by 49% in women at increased risk for breast cancer development. Tamoxifen does have side effects, however, including marginally increased risks of endometrial cancer and thromboembolic events. In this study, women at increased risk for breast cancer development were offered tamoxifen. Their knowledge of tamoxifen as a chemopreventive agent was assessed, and factors influencing their acceptance of tamoxifen and willingness to take it were determined. METHODS: Forty-three patients were identified who qualified to take tamoxifen for primary prevention. Patients qualified by having at least a 1.7% 5-year risk of developing breast cancer, the criteria for entry into the NSABP P-1 trial. Patients initially completed questionnaires designed to assess their knowledge of tamoxifen and its associated risks and benefits. Patients were then provided neutral educational sessions and literature delineating the actual risks and benefits of tamoxifen. Subsequently, patients' decisions regarding taking tamoxifen were reassessed. RESULTS: Mean patient age was 52.8 years, with a range of 39 to 74 years. Ten patients (23.2%) qualified based on the presence of lobular carcinoma in situ (LCIS), seven patients (16.3%) qualified based on increased risk secondary to age >60 years, and 26 patients (60.5%) age range 35 to 59 qualified based on risk profiles demonstrating significantly increased risk. Of the total 43 patients, two (4.7%) elected to start taking tamoxifen. Fifteen patients (34.8%) declined immediately, and 26 patients (60.5%) were undecided initially but ultimately declined. Educational sessions did not influence patients' decisions. Fear of side effects, including endometrial cancer, thromboembolic events, and menopausal symptoms, was the most commonly cited reason for declining to take tamoxifen. CONCLUSIONS: In this study, the vast majority of patients at increased risk for breast cancer perceived that the risks of taking tamoxifen outweighed the benefits and declined to take it.
UI - 11525592
AU - Tymchuk CN; Tessler SB; Barnard RJ
TI - Changes in sex hormone-binding globulin, insulin, and serum lipids in postmenopausal women on a low-fat, high-fiber diet combined with exercise.
SO - Nutr Cancer 2000;38(2):158-62
AD - Department of Physiological Science, University of California, Los Angeles 90095, USA.
Dietary factors including fat and fiber have been reported to play a role in the development of breast cancer, possibly mediated by changes in estradiol. Diet and exercise have been shown to affect levels of sex hormone-binding globulin (SHBG), which in turn regulate the bioavailability of estradiol. Diet and exercise also affect insulin levels, which play a role in the synthesis of SHBG, and the hormone itself is a potent mitogen for many cancer cell lines. This study was designed to measure the effects of a low-fat, high-fiber diet, combined with regular aerobic exercise, on the levels of SHBG, insulin, and serum lipids in postmenopausal women with or without hormone replacement therapy (HRT). Two groups of postmenopausal women, 11 on HRT and 11 not on HRT, underwent a low-fat (1O% fat calories), high-fiber (65-70 g/day) diet-and-exercise intervention for three weeks. Serum SHBG, insulin, and lipids were measured before and after the regimen. After the intervention, SHBG levels were significantly increased for the women on HRT (44.5 +/- 3.4 vs. 62 +/- 6.4 nmol/l) and the women not on HRT (32.1 +/- 4.6 vs. 45.5 +/- 6.1 nmol/l, both changes p < 0.01). Also after the intervention, insulin levels were significantly reduced for the women on HRT (196 +/- 44.4 vs. 119.8 +/- 28.7 pmol/l) and the women not on HRT (144.2 +/- 17.9 vs. 115.5 +/- 20.8 pmol/l, both changes p < 0.01). Body mass index and total cholesterol were significantly reduced for both groups of women (all changes p < 0.01). Although the exact mechanism for the change in SHBG is not known, the increases in SHBG and reductions in insulin as a result of this lifestyle intervention should reduce the risk for breast cancer in postmenopausal women.
UI - 11525602
AU - Collins-Burow BM; Burow ME; Duong BN; McLachlan JA
TI - Estrogenic and antiestrogenic activities of flavonoid phytochemicals through estrogen receptor binding-dependent and -independent mechanisms.
SO - Nutr Cancer 2000;38(2):229-44
AD - Tulane-Xavier Center for Bioenvironmental Research, Department of Pharmacology, Tulane University Medical Center, New Orleans, LA 70112, USA.
Members of the flavonoid class of phytochemicals have previously been demonstrated to possess estrogenic activity in a number of hormonally responsive systems. We have performed the present study to characterize the estrogenic and antiestrogenic activity of flavonoids in the estrogen receptor (ER)-positive MCF-7 human breast cancer cell line. Using an ER-dependent reporter gene assay and an ER competition binding assay, we have identified phytochemicals possessing estrogenic and antiestrogenic activities, which appeared to correlate directly with their capacity to displace [3H]estradiol from ER. Several flavonoids, including kaempferide, apigenin, and flavone, were distinct, in that their antiestrogenic activity did not appear to correlate with binding to ER, and therefore their suppression of estrogen-mediated gene transactivation and proliferation may occur independent of direct antagonism of the receptor. Further examination in HEK-293 cells transfected with ERalpha or ERbeta demonstrated potent antagonism with kaempferide and apigenin, while flavone was weakly antagonistic only toward ERP. These results suggest that the receptor binding-independent antiestrogenic chemicals may function through alternate signaling pathways as indirect ER modulators in a receptor- and cell type-specific manner. We conclude that antiestrogenic activities of flavonoid phytochemicals may occur through ER binding-dependent and -independent mechanisms and that the binding-independent antiestrogen activity of certain flavonoids is biologically significant in regulation of breast cancer cell proliferation.
UI - 11527106
AU - Jirojwong S; Manderson L
TI - Beliefs and behaviors about Pap and breast self-examination among Thai immigrant women in Brisbane, Australia.
SO - Women Health 2001;33(3-4):47-66
AD - School of Nursing and Health Studies, Faculty of Arts, Health and Sciences, Central Queensland University, Rockhampton, Australia. email@example.com
Regular screening is an important preventive method in reducing morbidity and mortality from cervical and breast cancer. In 1998, a cross-sectional study was conducted in Brisbane, Australia, among 145 Thai immigrant women, to explore cultural and social factors related to their use of Pap smear tests and breast self-examination (BSE). The study aimed at describing women's beliefs and perceptions about the body, breast and cervical cancer, and their perceptions of the causes of the diseases. It explored the women's perception of the severity and the effects of both cancers on aspects of patients' lives, and their chance of developing both cancers. The Thai immigrant women explained the causes of breast and cervical cancer using both traditional beliefs and medical knowledge. They perceived that both cancers affect a patient's health and her daily activities. Some women believed that they would develop cervical cancer if their perineum or vulva was "dirty." Some believed that they would have breast cancer because they had a history of benign tumor or cyst of a breast. Forty-four percent of the women had biennial Pap smears in the past five years and only 25% conducted BSE monthly in the past two years. Information relating to perceived barriers to undertake regular cervical cancer and breast cancer screenings and other health beliefs can be applied by health care personnel to increase Thai immigrant women's preventive health behaviors.
UI - 11556021
AU - Milaat WA
TI - Knowledge of secondary-school female students on breast cancer and breast self-examination in Jeddah, Saudi Arabia.
SO - East Mediterr Health J 2000 Mar-May;6(2-3):338-44
AD - Department of Community Medicine, College of Medicine, King Abdul Aziz University, Jeddah, Saudi Arabia.
A self-administered questionnaire was given to 6380 female secondary-school students (mean age = 18.1 years) in Jeddah to identify their knowledge of breast cancer and attitude towards breast self-examination (BSE). Knowledge of risk factors and presentation was very low. Over 80% of students failed to answer 50% of the questions correctly. A higher knowledge level was associated with older age, marriage and having children. Also students who had undergone mammography, had been exposed to breast surgery or had a positive family history of breast cancer showed significantly higher knowledge levels. Only 39.6% reported ever hearing of BSE and only 14.4% and 7.1% respectively knew the correct frequency and timing. However, 82.4% had a positive attitude towards learning BSE.
UI - 11553422
AU - Meiser B; Butow PN; Barratt AL; Schnieden V; Gattas M; Kirk J; Gaff C;
TI - Suthers G; Tucker K; The Psychological Impact Collaborative Group Long-term outcomes of genetic counseling in women at increased risk of developing hereditary breast cancer.
SO - Patient Educ Couns 2001 Sep;44(3):215-25
AD - Department of Psychological Medicine, Block 4, Level 5, Royal North Shore Hospital, St. Leonards, NSW 2065, Sydney, Australia.
This multicenter study evaluated the impact of genetic counseling in 218 women at risk of developing hereditary breast cancer. Women were assessed prior to counseling and 12-month post-counseling using self-administered, mailed questionnaires. Compared to baseline, breast cancer genetics knowledge was increased significantly at follow-up, and greater increases in knowledge were associated with educational level. Breast cancer anxiety decreased significantly from baseline to follow-up, and these decreases were associated with improvements in perceived risk. A significant decrease in clinical breast examination was observed at the 12-month follow-up. Findings suggest that women with a family history of breast cancer benefit from attending familial cancer clinics as it leads to increases in breast cancer genetics knowledge and decreases in breast cancer anxiety. The lowered rates of clinical breast examination indicate that the content of genetic counseling may need to be reviewed to ensure that women receive and take away the right message.
UI - 11566043
AU - Giercksky KE
TI - COX-2 inhibition and prevention of cancer.
SO - Best Pract Res Clin Gastroenterol 2001 Oct;15(5):821-33
AD - Department of Surgical Oncology, The Norwegian Radium Hospital and Institute of Cancer Research, The University of Oslo, Norway.
The potential for cyclo-oxygenase inhibition in cancer prevention and treatment is founded on epidemiology (reduction of colorectal cancer in aspirin users), animal experiments and molecular genetics. Trials using the NSAID sulindac also reduced the number of polyps in patients with familial adenomatous polyposis, but the well-known gastrointestinal toxic effects of aspirin and NSAIDs have discouraged the exploitation of their antineoplastic potential. The advent of specific COX-2 inhibitors, which do not interfere with the cytoprotective constitutive COX-1 enzyme, and the demonstration of increased COX-2 expression in many common malignancies beside colorectal cancer, has opened up new therapeutic possibilities. Recently a non-cyclo-oxygenase effect of COX-2 inhibitors, which combines the PPARdelta and the APC tumour suppressor activity, was also demonstrated. The selective COX-2 inhibitor celecoxib has been approved by the FDA for adjuvant treatment of familial adenomatous polyposis, and a large number of prevention and treatment trials of colorectal and other common cancers (prostate and breast cancer) have been started. Copyright 2001 Harcourt Publishers Ltd.
UI - 11584060
AU - Jordan VC; Gapstur S; Morrow M
TI - Selective estrogen receptor modulation and reduction in risk of breast cancer, osteoporosis, and coronary heart disease.
SO - J Natl Cancer Inst 2001 Oct 3;93(19):1449-57
AD - Robert H. Lurie Comprehensive Cancer Center, Chicago, IL 60611, USA. firstname.lastname@example.org
The recognition of selective estrogen receptor modulation in the laboratory has resulted in the development of two selective estrogen receptor modulators (SERMs), tamoxifen and raloxifene, for clinical application in healthy women. SERMs are antiestrogenic in the breast but estrogen-like in the bones and reduce circulating cholesterol levels. SERMs also have different degrees of estrogenicity in the uterus. Tamoxifen is used specifically to reduce the incidence of breast cancer in premenopausal and postmenopausal women at risk for the disease. In contrast, raloxifene is used specifically to reduce the risk of osteoporosis in postmenopausal women at high risk for osteoporosis. The study of tamoxifen and raloxifene (STAR) trial is currently comparing the ability of these SERMs to reduce breast cancer incidence in high-risk postmenopausal women. There is intense interest in understanding the molecular mechanism(s) of action of SERMs at target sites in a woman's body. An understanding of the targeted actions of this novel drug group will potentially result in the introduction of new multifunctional medicines with applications as preventive agents or treatments of breast cancer and endometrial cancer, coronary heart disease, and osteoporosis.
UI - 11668903
AU - Friedell GH; Linville LH; Sorrell CL; McKinney MM; Kentucky Breast
TI - Cancer Task Force Breast cancer action plan for Kentucky.
SO - J Ky Med Assoc 2001 Oct;99(10):437-44
AD - Markey Cancer Center, University of Kentucky, 2365 Harrodsburg Rd, Ste A230, Lexington, KY 40504-3381, USA.
In 1998, Governor Paul E. Patton established the Kentucky Breast Cancer Task Force (KBCTF) to assess and make recommendations on the availability, accessibility, utilization, quality, and outcomes of breast cancer services across the spectrum of disease. Over a two-year period, the KBCTF reviewed the state of breast cancer control in Kentucky and made recommendations for reducing breast cancer morbidity and mortality. To achieve the provision of optimal breast cancer care, the KBCTF recommended universal adoption of professionally accepted guidelines for breast cancer treatment, pain management, and distress management. To better coordinate public education on breast cancer, the KBCTF recommended the development of a standardized packet of public education materials for dissemination through regional networks of "cancer control partners." KBCTF members also requested the Kentucky Cancer Program to investigate the feasibility of establishing a centralized mammography registry to gather more complete data on screening mammography programs.
UI - 11604435
AU - Chamot E; Perneger TV
TI - Misconceptions about efficacy of mammography screening: a public health dilemma.
SO - J Epidemiol Community Health 2001 Nov;55(11):799-803
AD - Institute of Social and Preventive Medicine, University of Geneva, Switzerland. email@example.com
OBJECTIVE: This study assessed accuracy of women's opinions about reduction in mortality from breast cancer attributable to mammography screening. DESIGN: Cross sectional survey. SETTING: General population of Geneva, Switzerland. PARTICIPANTS: 895 randomly selected women aged 40 to 80 years, free of breast cancer. RESULTS: Women estimated the proportion of deaths from breast cancer that regular mammography screening prevents in women over age 50. Only 19.3% of the respondents assessed screening efficacy realistically (that is, reduction by about one fourth); 52.0% overestimated efficacy; 26.0% "didn't know", and 2.6% stated that screening prevents no death. Women who believed mammography screening to be effective had more positive attitudes toward screening (higher scores of pros and lower scores of cons) and were more likely to plan to have a mammogram (both p<0.001). Lack of opinion about the benefit of mammography screening was more common among women who had not consulted a gynaecologist recently (p=0.02) nor had had a mammogram during the past two years (p=0.009), who had no opinion about their risk of breast cancer (p<0.001), and who were 70 to 80 years old (p=0.04). Compared with women who provided realistic estimates of screening efficacy, those who overestimated efficacy believed to be at higher risk of breast cancer than other women (p=0.04) and were more likely to be Swiss nationals (p=0.001). CONCLUSIONS: Most women overestimated and many were uninformed about the efficacy of mammography screening. Therefore, few women were able to take truly informed decisions about screening mammography.
UI - 11606071
AU - Kupets R; Covens A
TI - Strategies for the implementation of cervical and breast cancer screening of women by primary care physicians.
SO - Gynecol Oncol 2001 Nov;83(2):186-97
AD - Toronto-Sunnybrook Regional Cancer Center, University of Toronto, Toronto, Ontario, M4N 3M5, Canada. firstname.lastname@example.org
OBJECTIVE: While effective screening tests for the prevention and early detection of cervical and breast cancers exist, poor screening rates are evident. The aim of this paper was to determine the most effective strategies for the implementation of breast and cervical cancer screening delivered to women. METHODS: An in-depth search of the literature using Medline and the Cochrane Library was carried out between the years 1966 and 2000. Randomized controlled studies addressing the delivery of both breast and cervical screening were retained for the purposes of this review. Absolute difference (AD) in screening was defined as screening rates in the intervention arm--screening rates in the control arm. Number needed to intervene (NNI) is a new term developed for the purpose of this paper and refers to the number of physicians or physician-patient pairs that must be exposed to the intervention before one screening test is performed. NNI is defined as 1/AD. RESULTS: Strategies for the implementation of screening tests are divided into three categories: physician-only based, physician and patient based, and patient-only based. CONCLUSIONS: Physician-based strategies, especially manual and computer-generated reminders, appear to be the most effective approach in the implementation of breast and cervical cancer delivery to women. Absolute gains in screening rates were as high as 40% with an NNI of 2.5 physicians; therefore, approximately 3 physicians need to be exposed to a reminder notice before 1 physician actually orders the screening tests. Copyright 2001 Academic Press.
UI - 11606876
AU - Perkins CI; Wright WE; Allen M; Samuels SJ; Romano PS
TI - Breast cancer stage at diagnosis in relation to duration of medicaid enrollment.
SO - Med Care 2001 Nov;39(11):1224-33
AD - California Department of Health Services, Cancer Surveillance Section, Sacramento, California 95815-4402, USA. email@example.com
BACKGROUND: Stage at diagnosis has been used to compare the quality of cancer screening services by health insurance type, using membership at diagnosis or treatment. This study evaluates breast cancer stage among women on Medi-Cal, California's Medicaid program, in relation to duration of coverage to assess the impact of including women with recently acquired benefits in the Medi-Cal group. METHODS: Breast cancers diagnosed in 1993 among women ages 30 to 64 were obtained from the statewide, population-based cancer registry and linked to Medi-Cal enrollment files. Women on Medi-Cal when diagnosed were categorized based on months covered during the 12 months preceding diagnosis (12, 1-11, or none), and compared with all other women with breast cancer. Logistic regression models measured the effect of duration of Medi-Cal coverage on the odds of late-stage disease, controlling for demographic, socioeconomic, health access, and tumor characteristics. RESULTS: Among women with Medi-Cal benefits when diagnosed, 18% were not covered during the year preceding diagnosis, and late-stage disease was common among these women. The odds ratio for late-stage disease among all women on Medi-Cal was 1.67 (95% CI 1.41, 1.97), but was reduced by 42% to 1.39 (95% CI 1.15, 1.67) when women without benefits before diagnosis were excluded from the Medi-Cal group. CONCLUSIONS: Women with Medi-Cal benefits before diagnosis were more likely to be diagnosed with late-stage disease than other women with breast cancer. However, the practice of assigning health insurance status based on enrollment at diagnosis underestimates the effect of access to breast cancer screening through Medicaid.
UI - 11673680
AU - Brewster A; Helzlsouer K
TI - Breast cancer epidemiology, prevention, and early detection.
SO - Curr Opin Oncol 2001 Nov;13(6):420-5
AD - Department of Medical Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Breast cancer remains a worldwide public health concern despite the fact that mortality rates have been declining in some countries as a result of improvements in adjuvant therapy and screening for breast cancer. In the prevention arena, advances in our understanding of the effects of tamoxifen have led to the investigations of newer agents that may provide extended options for breast cancer prevention in high-risk women. For women who are carriers of a mutation in the breast cancer susceptibility genes BRCA1 or BRCA2, prophylactic oophorectomy and bilateral mastectomy have emerged as preventative surgical options that can significantly impact breast cancer risk. In addition, the identification of potentially modifiable risk factors for breast cancer such as dietary folate intake, alcohol consumption, physical activity, and certain anthropometric factors provides opportunities for intervening in breast cancer prevention both among women at average and high risk. The challenge remains in overcoming the limitations of mammography and clinical breast examination by developing and evaluating new technologies for breast cancer screening such as digital mammogram and breast magnetic resonance imaging.
UI - 11592766
AU - Lee IM; Cook NR; Rexrode KM; Buring JE
TI - Lifetime physical activity and risk of breast cancer.
SO - Br J Cancer 2001 Sep 28;85(7):962-5
AD - Division Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 900 Commonwealth Avenue East, Boston, MA 02215, USA.
We conducted a case-control study of 394 women with breast cancer and 788 control women (91% response) to investigate the association of lifetime physical activity with mainly menopausal breast cancer risk. After controlling for potential confounders, the odds ratios (95% confidence intervals) for increasing quartiles of lifetime physical activity were 1.00 (referent), 0.91 (0.60-1.37), 0.91 (0.60-1.39), and 1.10 (0.73-1.67), respectively; P, trend = 0.47. We also separately examined physical activity at ages 12-18, 19-34, 35-49 and > or =50 years; no significant trends were observed in any age group. These data do not support a role of physical activity in preventing breast cancer. Copyright 2001 Cancer Research Campaign
UI - 11682285
AU - Konez O; Goyal M; Reaven RE
TI - Can tamoxifen cause a significant mammographic density change in breast parenchyma?
SO - Clin Imaging 2001 Sep-Oct;25(5):303-8
AD - Department of Radiology, Mercy Medical Center, Northeastern Ohio Universities College of Medicine (NEOUCOM), Mercy Dr. NW, Canton, OH 44708, USA. firstname.lastname@example.org
To evaluate tamoxifen-induced glandular tissue density changes in women who are on an adjuvant tamoxifen therapy. We examined serial mammograms of 27 women (average age 67) who had surgery for unilateral breast carcinoma and were on tamoxifen for 5 years. Mammograms obtained at the beginning of treatment, within 2 or 3 years, at the end of 5 years and 1 year after cessation of tamoxifen treatment, were evaluated by two radiologists experienced in reading mammograms. Four 1-cm-diameter circular areas of the glandular tissue and retroglandular fat were sampled by a densitometer and a relative glandular density (glandular tissue/fat density) was used for comparison between serial mammograms. Most cases (79%) did not show tamoxifen-induced change in glandular density. Three patients (13%) showed an early and two (8%) a delayed mild reduction in glandular density as compared to baseline mammograms. No patient was found to have increased glandular density following the cessation of tamoxifen therapy (in subjective evaluation). Densitometer readings showed a mild reduction in glandular densities in 16 cases (60%) during treatment and a minimal increase in 13 cases (48%) following cessation of treatment. There was a slight decrease in breast density during treatment [relative density of 0.012+/-0.006 (standard error) per interval, P value:.06] and the difference between years 5 and 6 was nearly zero [relative density of 0.00042+/-0.01 (standard error), P value:.97]. Long-term use of tamoxifen may cause a mild reduction in breast glandular density, although this, in part, may be attributed to the age-related mammographic density change. Following cessation of tamoxifen, no significant increase in glandular density was observed. Therefore, any increase in mammographic density during or after tamoxifen treatment should be viewed with suspicion and further evaluated.
UI - 11679785
AU - Friedenreich CM; Courneya KS; Bryant HE
TI - Influence of physical activity in different age and life periods on the risk of breast cancer.
SO - Epidemiology 2001 Nov;12(6):604-12
AD - Division of Epidemiology, Prevention and Screening, Alberta Cancer Board, Edmonton, Alberta, Canada.
We conducted a population-based case-control study of 1,237 incident breast cancer cases and 1,241 controls in Alberta between 1995 and 1997 to examine the effect of physical activity performed at different ages and life periods on breast cancer risk. In this study, we measured all types of physical activity done throughout life with a questionnaire developed and tested specifically for this study. We found that breast cancer risk was most associated with a risk reduction for activity done later in life, particularly between menopause and the reference year, for which we observed an odds ratio of 0.70 (95% confidence interval = 0.52-0.95). We also stratified the study participants into four categories according to their patterns of physical activity performed before and after menopause. For the women who sustained physical activity throughout life vs those who were never active, we found an odds ratio of 0.58 (95% confidence interval = 0.41-0.83). This study suggests that sustained activity throughout life and particularly activity done later in life may have the most benefit in reducing breast cancer risk.
UI - 11693810
AU - von Smitten K
TI - Prophylactic breast surgery for women with BRCA1 and BRCA2 germline mutations.
SO - Tumori 2001 Jul-Aug;87(4):S13-5
AD - Breast Surgery Unit, Helsinki University Central Hospital, Hus, Finland. email@example.com
UI - 11697447
AU - Prinz-Langenohl R; Fohr I; Pietrzik K
TI - Beneficial role for folate in the prevention of colorectal and breast cancer.
SO - Eur J Nutr 2001 Jun;40(3):98-105
AD - Institute of Nutritional Science, Dept of Pathophysiology of Human Nutrition, University of Bonn, Germany. firstname.lastname@example.org
Folate is involved in the synthesis of nucleotides and amino acid metabolism such as methylation of homocysteine to methionine. Methionine is activated by adenosine triphosphate (ATP) to produce S-adenosylmethionine (SAM), the primary intracellular methyl donor. Thus, folate is essential for the synthesis, methylation, and repair of DNA. With regard to its biochemical function it has been hypothesized that a diminished folate status may contribute to carcinogenesis by alteration of gene expression and increased DNA damage. Animal and human studies support this hypothesis, particularly with respect to colorectal cancer. Epidemiological evidence for the association between folate status and cancer was first observed among ulcerative colitis patients. Several case-control studies demonstrated reduction in colorectal cancer risk with better folate status. Two large, prospective cohort studies support the concept that high folate intake is protective against colon cancer. In contrast to colorectal cancer, the potential association of folate status and risk has been less investigated in breast cancer. Recently, convincing epidemiological data establishing a positive effect of folate status on breast cancer risk were published. This review summarizes the epidemiological evidence for the association between folate status and colorectal and breast cancer risk. In addition, a short overview is given on the discussed mechanism(s) by which folate might be involved in carcinogenesis.
UI - 11695073
AU - Fentiman IS
TI - Fixed and modifiable risk factors for breast cancer.
SO - Int J Clin Pract 2001 Oct;55(8):527-30
AD - Hedley Atkins Breast Unit, Guy's Hospital, London.
Likely pathogenesis of breast cancer is in two phases, initiation and promotion. Initiating factors include ionising irradiation, dietary factors and possibly alcohol consumption causing DNA mutations uncorrected by repair mechanisms. Subsequent promotional factors include exposure to oestrogens, reduced by late menarche, early pregnancy and lactation and increased by nulliparity, oral contraceptive use and hormone replacement therapy. Only 5% of breast cancers result from inherited genetic mutations of BRCA1 and BRCA2, but individuals wit