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Abramson Cancer CenterNCI CANCERLIT® Search: Screening and Prevention of Breast Cancer - January 2002
National Cancer Institute®
Last Modified: January 1, 2002
Table of Contents
1
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. cyllene@ccr.ca.gov
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.
2
UI - 11282873
AU - Querci della Rovere G; Warren R
TI -
Detection of breast cancer. Mammography should be available.
SO - BMJ 2001 Mar 31;322(7289):792-3
3
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 - hazelcagct@aol.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?
4
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.
5
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. drutledge1@home.com
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.
6
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.
7
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.
8
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.
9
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.
10
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.
11
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.
s.jirojwong@cqu.edu.au
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.
12
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.
13
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.
14
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.
15
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.
vcjordan@nwu.edu
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.
16
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.
17
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. chamot@cmu.unige.ch
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.
18
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. rachel.kupets@tsrcc.on.ca
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.
19
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. carin@ccr.ca.gov
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.
20
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.
21
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
22
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. orhankonez@hotmail.com
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.
23
UI - 11688074
AU - Anonymous
TI -
Simple solutions: creating an educational movement.
SO - Healthc Benchmarks 2001 Oct;8(10):117-8
24
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.
25
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.
karl.von.smitten@hus.fi
26
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. r.prinz@uni-bonn.de
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.
27
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
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