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Abramson Cancer CenterNCI CANCERLIT® Search: Screening and Prevention of Breast Cancer - June 2002
National Cancer Institute®
Last Modified: June 1, 2002
- Use of alternatives to estrogen for treatment of menopause.
- The British Columbia Mammography Screening Program: evaluation of the first 15 months.
- Low-cost mass screening for breast cancer with mammography.
- The comparative value of mammographic screening for women 40-49 years old versus women 50-64 years old.
- Screening mammography in women 40-49 years old.
- Tracking for breast cancer.
- In the pink. Breast cancer is down, but not out.
- Can the rest follow this strong lead?
- [What is the motive of women?]
- [Primary prevention]
- Effects of a mammography decision-making intervention at 12 and 24 months.
- Effect of prevention strategies on survival and quality-adjusted survival of women with BRCA1/2 mutations: an updated decision analysis.
- Breast cancer. UK nurses are key source of information.
- Tamoxifen resistant and refractory breast cancer: the value of aromatase inhibitors.
- Women's perceptions of breast cancer screening and education opportunities in Canada.
- Breast cancer prevention.
- Prevention in the balance.
- The nurse's role in promoting breast awareness.
- Use of preventive services in a population of very low-income women.
- Risk factors and health promotion in families of patients with breast cancer.
- Importance of local tumour control in breast cancer.
- Genetic testing for cancer predisposition--an ongoing debate.
- Influence of delay to diagnosis on prognostic indicators of screen-detected breast carcinoma.
- Humoral immune response induced by the protein core of MUC1 mucin in pregnant and healthy women.
- Effect of low dose tamoxifen on the insulin-like growth factor system in healthy women.
- Tamoxifen for the treatment and prevention of breast cancer: an update.
- Fine needle aspiration cytology in the work-up of mammographic and ultrasonographic findings in breast cancer screening: an attempt at
- Anti-aromatase agents in the treatment and prevention of breast cancer.
- Lifelong vegetarianism and risk of breast cancer: a population-based case-control study among South Asian migrant women living in England.
- Breast and cervical cancer screening in Hispanic women: a literature review using the health belief model.
- Tamoxifen therapy and hepatic steatosis.
- An intervention study on screening for breast cancer among single African-American women aged 65 and older.
- Advances highlighted at US cancer meeting.
- Mammography: what's a woman to do?
- Raloxifene is associated with less side effects than tamoxifen in women with early breast cancer: a questionnaire study from one physician's
- Screening mammography.
- Age-specific accuracy of initial versus subsequent mammography screening: results from the Ghent breast cancer-screening programme.
- BRCAPRO validation, sensitivity of genetic testing of BRCA1/BRCA2, and prevalence of other breast cancer susceptibility genes.
- [Breast cancer screening campaign]
- Chemoprevention of breast cancer. A joint guideline from the Canadian Task Force on Preventive Health Care and the Canadian Breast Cancer
- Give us clear, not convoluted, clinical practice guidelines.
- Give us clear, not convoluted, clinical practice guidelines.
- Natural modulators of estrogen biosynthesis and function as chemopreventive agents.
- Excentric cleavage products of beta-carotene inhibit estrogen receptor positive and negative breast tumor cell growth in vitro and inhibit
- Cancer studies explore targeted therapy, researchers seek new prevention strategies.
- Vitamins for chronic disease prevention in adults: scientific review.
- News media coverage of screening mammography for women in their 40s and tamoxifen for primary prevention of breast cancer.
- The benefits and ethics of screening for breast cancer.
- There may never be a final cure for breast cancer.
- Endocrine manipulation in advanced breast cancer: recent advances with SERM therapies.
- Future use of selective estrogen receptor modulators and aromatase inhibitors.
- Follow-up of the breast cancer prevention trial and the future of breast cancer prevention efforts.
- The potential for aromatase inhibition in breast cancer prevention.
- Breast health--community health.
- ASPO Distinguished Achievement Award Lecture. Studies on the epidemiology and natural history of benign breast disease and breast
- [Results of mammographic screening at the Mammary Center of Debrecen in 1999 and 2000]
- Hormonal control of p53 and chemoprevention.
Table of Contents
1
UI - 11845111
AU - Pinkerton JV; Santen R
TI -
Use of alternatives to estrogen for treatment of menopause.
SO - Minerva Endocrinol 2002 Mar;27(1):21-41
AD - Department of Obstetrics/Gynecology and the Women's Place, and The
Department of Medicine, Division of Endocrinology, University of
Virginia Health System, Charlottesville, Virginia, USA.
Women frequently chose alternatives to hormone replacement therapy (HRT)
for treatment of menopause even though medical indications for estrogens
may be present. Prior breast cancer or fear of breast cancer is a major
consideration. This review of alternatives to estrogen discusses the
evidence linking breast cancer to HRTs and compares potential risks and
benefits of HRT to nonHRT alternatives for relief of vasomotor symptoms,
vaginal atrophy, neurocognitive changes and prevention of heart disease
and osteoporosis. Practical guidelines are suggested for use of
alternatives for each problem.
2
UI - 1307850
AU - Burhenne LJ; Hislop TG; Burhenne HJ
TI -
The British Columbia Mammography Screening Program: evaluation of the
first 15 months.
SO - AJR Am J Roentgenol 1992 Jan;158(1):45-9
AD - Department of Radiology, University of British Columbia, Vancouver,
Canada.
We report our experiences in the first 15 months of a government-funded
pilot project begun in 1988 to study the feasibility of rapid
throughput, low-cost screening mammography in British Columbia. The
primary goals of the project were (1) to determine the unit cost of
screening mammography within the context of the program; (2) to design
and put into operation a centralized system of data collection,
analysis, and quality control to enable calculations of cancer detection
rates, biopsy rates, biopsy yield ratios, staging, and other specific
cancer characteristics; and (3) to study compliance in the community
where the program was offered. A total of 11,824 women had mammography
at a unit cost of U.S. $32.66. Computerized analysis revealed that (1)
11% of women had known primary risk factors; (2) findings on mammograms
were interpreted as abnormal in 9% of screening examinations; (3) breast
cancers were confirmed in 47 (22%) of 211 patients who had biopsies, and
87% of these were stage 0-1. The overall cancer detection rate was four
per 1000, with five per 1000 for women who had not had mammography in
the preceding 2 years and one per 1000 for women who had had mammography
in the past 2 years. The results show that screening mammography can be
conducted at low cost. Data collection and analysis and compliance were
sufficiently convincing to initiate province-wide expansion.
3
UI - 1727358
AU - Sickles EA
TI -
Low-cost mass screening for breast cancer with mammography.
SO - AJR Am J Roentgenol 1992 Jan;158(1):55-7
AD - Department of Radiology, University of California, School of Medicine,
San Francisco 94143-0628.
4
UI - 7717212
AU - Curpen BN; Sickles EA; Sollitto RA; Ominsky SH; Galvin HB; Frankel SD
TI -
The comparative value of mammographic screening for women 40-49 years
old versus women 50-64 years old.
SO - AJR Am J Roentgenol 1995 May;164(5):1099-103
AD - Department of Radiology, University of California School of Medicine,
San Francisco 94143-0628, USA.
OBJECTIVE. The purpose of our study was to compare the major prognostic
factors (tumor size, axillary lymph node status, and tumor stage) of
breast cancers detected at mammographic screening in women ages 40-49
years old with those in women ages 50-64 years old. MATERIALS AND
METHODS. Study subjects were women ages 40-64 years old who participated
1994. We retrospectively reviewed the clinical and pathology records of
women in whom breast cancer was detected at mammographic screening. All
examinations were performed with dedicated equipment using screen-film
technique. RESULTS. A total of 44,301 screening examinations were done
during the study period. Seventy-five cancers were detected in women
ages 40-49 years old, and 128 cancers were detected in women ages 50-64
years old. The cancer detection rate was 3.0 per 1000 examinations in
the younger age group compared with 5.5 per 1000 examinations in the
older age group. The median size of breast cancers was 10 mm for women
ages 40-49 versus 11 mm for women ages 50-64. Eighty-eight percent of
the patients in both age groups had no evidence of metastasis to
axillary lymph nodes. Nineteen percent of women in the younger age group
had advanced breast cancer (stage II or higher) compared with 26% of
women ages 50-64 (p = .25). No statistically significant differences
were noted between the two age groups in the size, lymph node status, or
stage of breast cancers detected at mammographic screening. However, the
cancers found in younger women had slightly more favorable prognoses.
CONCLUSION. The major prognostic factors of cancers detected with modern
mammographic equipment appear to be at least as favorable for women ages
40-49 years old as for women ages 50-64 years old. As mammographic
screening has already been shown to be beneficial for women ages 50-64
years old, screening should also be beneficial for women ages 40-49
years old.
5
UI - 7717213
AU - Cardenosa G; Eklund GW
TI -
Screening mammography in women 40-49 years old.
SO - AJR Am J Roentgenol 1995 May;164(5):1104-6
AD - Susan G. Komen Breast Center, St. Francis Medical Center, Peoria, IL
61614, USA.
6
UI - 9423607
AU - Berlin L
TI -
Tracking for breast cancer.
SO - AJR Am J Roentgenol 1998 Jan;170(1):93-5
AD - Department of Radiology, Rush North Shore Medical Center, Skokie, IL
60076, USA.
7
UI - 11968631
AU - Coombes R
TI -
In the pink. Breast cancer is down, but not out.
SO - Nurs Times 2000 Oct 5-11;96(40):10-1
8
UI - 11968632
AU - Ryan C
TI -
Can the rest follow this strong lead?
SO - Nurs Times 2000 Oct 5-11;96(40):12
9
UI - 11845499
AU - Longerich B
TI -
[What is the motive of women?]
SO - Krankenpfl Soins Infirm 2002;95(1):61
10
UI - 11845500
AU - Gigandet OG; Schopfer AB
TI -
[Primary prevention]
SO - Krankenpfl Soins Infirm 2002;95(1):62-7
11
UI - 11988381
AU - Rimer BK; Halabi S; Sugg Skinner C; Lipkus IM; Strigo TS; Kaplan EB;
TI -
Samsa GP
Effects of a mammography decision-making intervention at 12 and 24
months.
SO - Am J Prev Med 2002 May;22(4):247-57
AD - Division of Cancer Control and Population Sciences, National Cancer
Institute, Rockville, Maryland 20852, USA. brimer@nih.gov
BACKGROUND: Most women are not getting regular mammograms, and there is
confusion about several mammography-related issues, including the age at
which women should begin screening. Numerous groups have called for
informed decision making about mammography, but few programs have
resulted. Our research is intended to fill this gap. METHODS: We
conducted a randomized controlled trial, which ran from 1997 to 2000.
Women aged 40 to 44 and 50 to 54, who were enrolled in Blue Cross Blue
Shield of North Carolina, were randomly assigned to one of three groups:
usual care (UC), tailored print (TP) materials, or TP plus tailored
telephone counseling (TP+TC). We assessed the impact of tailored
interventions on knowledge about breast cancer and mammography, accuracy
of breast cancer risk perceptions, and use of mammography at two time
points after intervention-12 and 24 months. RESULTS: At 12 and 24
months, women who received TP+TC had significantly greater knowledge and
more accurate breast cancer risk perceptions. Compared to UC, they were
40% more likely to have had mammograms (odds ratio=0.9-2.1). The effect
was primarily for women in their 50s. TP had significant effects for
knowledge and accuracy, but women who received TP were less likely to
have had mammography. CONCLUSIONS: Decision-making interventions,
comprised of two tailored print interventions (booklet and newsletter),
delivered a year apart, with or without two tailored telephone calls,
significantly increased knowledge and accuracy of perceived breast
cancer risk at 12 and 24 months post-intervention. The effect on
mammography use was significant in bivariate relationships but had a
much more modest impact in multivariate analyses.
12
UI - 12011131
AU - Grann VR; Jacobson JS; Thomason D; Hershman D; Heitjan DF; Neugut AI
TI -
Effect of prevention strategies on survival and quality-adjusted
survival of women with BRCA1/2 mutations: an updated decision analysis.
SO - J Clin Oncol 2002 May 15;20(10):2520-9
AD - Herbert Irving Comprehensive Cancer Center, Department of Medicine,
College of Physicians and Surgeons, Columbia University, 630 W 168th
Street, New York, NY 10032, USA.
PURPOSE: This study updates findings regarding the effects of
prophylactic surgery, chemoprevention, and surveillance on the survival
and quality-adjusted survival of women who test positive for BRCA1/2
mutations. MATERIALS AND METHODS: Markov modeling of outcomes was
performed in a simulated cohort of 30-year-old women who tested positive
for BRCA1/2 mutations. The model incorporated breast and ovarian cancer
incidence rates from the literature and mortality rates from the
Surveillance, Epidemiology, and End Results Program. Quality adjustment
of survival estimates were obtained from a survey of women aged 33 to 50
years. Sensitivity analyses were performed of varied assumptions
regarding timing and effects of preventive measures on cancer incidence
and adverse effects. RESULTS: A 30-year-old woman could prolong her
survival beyond that associated with surveillance alone by use of
preventive measures: 1.8 years with tamoxifen, 2.6 years with
prophylactic oophorectomy, 4.6 years with both tamoxifen and
prophylactic oophorectomy, 3.5 years with prophylactic mastectomy, and
4.9 years with both surgeries. She could prolong her quality-adjusted
survival by 2.8 years with tamoxifen, 4.4 years with prophylactic
oophorectomy, 6.3 years with tamoxifen and oophorectomy, and 2.6 years
with mastectomy, or with both surgeries. The benefits of all of these
strategies would decrease if they were initiated at later ages.
CONCLUSION: Women who test positive for BRCA1/2 mutations may derive
greater survival and quality adjusted survival benefits than previously
reported from chemoprevention, prophylactic surgery, or a combination.
Observational studies and clinical trials are needed to verify the
results of this analysis of the long-term benefits of preventive
strategies among BRCA1/2-positive women.
13
UI - 11966300
AU - Anonymous
TI -
Breast cancer. UK nurses are key source of information.
SO - Nurs Times 2001 Dec 6-12;97(49):9
14
UI - 11929341
AU - Goss PE; Strasser K
TI -
Tamoxifen resistant and refractory breast cancer: the value of aromatase
inhibitors.
SO - Drugs 2002;62(6):957-66
AD - Breast Cancer Prevention Program, Princess Margaret Hospital, University
Health Network, Toronto, Ontario, Canada. pegoss@interlog.com
Tamoxifen has dominated endocrine treatment of breast cancer for over
two decades. It is useful in metastatic breast cancer, adjuvant therapy,
preoperative treatment, ductal carcinoma-in-situ and chemoprevention.
However, breast cancer may be refractory to tamoxifen or develop
resistance to it with ongoing treatment. This resistance involves
several mechanisms including receptor mutation causing 'estrogen
hypersensitivity' and an increasing agonist effect of tamoxifen.
Megestrol (megestrol acetate), in North America, and aminoglutethimide,
in Europe, have been the traditional second line therapies after
tamoxifen in advanced breast cancer. Aromatase (estrogen synthetase)
inhibitors are a logical alternative to tamoxifen to antagonise the
effects of estrogen on breast cancer. The third-generation non-steroidal
aromatase inhibitors anastrozole, letrozole and vorozole, and the
steroidal inhibitor exemestane, have been studied after tamoxifen versus
either megestrol or aminoglutethimide. They showed enhanced efficacy and
significantly superior toxicity profiles. Compliance with the inhibitors
was also significantly better than with the traditional treatments.
Aromatase inhibitors have most recently been shown to be superior to
tamoxifen as initial therapy and are being extensively tested in the
adjuvant setting after, or instead of, tamoxifen. Pilot studies of
chemoprevention are also being undertaken. The aromatase inhibitors are
an important new addition to the armamentarium of breast cancer therapy.
15
UI - 11868402
AU - Stamler LL; Thomas B; Lafreniere K; Charbonneau-Smith R
TI -
Women's perceptions of breast cancer screening and education
opportunities in Canada.
SO - Can Nurse 2001 Oct;97(9):23-7
AD - Nipissing University, North Bay, Ontario.
16
UI - 11961192
AU - Love RR
TI -
Breast cancer prevention.
SO - Oncologist 2002;7(2):100-2
AD - University of Wisconsin Medical School, Madison, Wisconsin 53705-2397,
USA.
17
UI - 11961193
AU - Vogel VG
TI -
Prevention in the balance.
SO - Oncologist 2002;7(2):103-5
AD - Magee/UPCI Breast Program, Magee-Women's Hospital University of
Pittsburgh Cancer Institute, Pennsylvania 15213, USA. vvogel.magee.edu
18
UI - 11973892
AU - Bailey K
TI -
The nurse's role in promoting breast awareness.
SO - Nurs Stand 2000 Apr 12-18;14(30):34-6
AD - Tenovus Cancer Information Centre, Splott, Cardiff.
BACKGROUND: Breast cancer affects up to one in 12 women in the UK.
Breast awareness, which is advocated in place of routine breast
examination, involves women becoming more familiar with their bodies.
CONCLUSION: Nurses have a vital role to play in encouraging women to
become more breast aware. Their health promotion activities in this area
can have an important impact on the uptake of breast screening
initiatives.
19
UI - 12017906
AU - Diamant AL; Brook RH; Fink A; Gelberg L
TI -
Use of preventive services in a population of very low-income women.
SO - J Health Care Poor Underserved 2002 May;13(2):151-63
AD - Division of General Medicine and Health Services Research, University of
California, Los Angeles, USA.
20
UI - 11889682
AU - Conto SI; Myers JS
TI -
Risk factors and health promotion in families of patients with breast
cancer.
SO - Clin J Oncol Nurs 2002 Mar-Apr;6(2):83-7
AD - smanley@chartertn.net
Women with a family history of breast cancer have an increased risk of
developing the disease. Women identified as "high risk" for developing
breast cancer have been shown to exhibit increased levels of
psychological distress and anxiety related to breast cancer. Oncology
nurses can address this barrier and others, such as altered risk
perception and lack of physician recommendation for screening. Oncology
nurses also can identify high-risk families that may be candidates for
genetic testing for breast cancer susceptibility, provide comprehensive
teaching about breast self-examination (BSE), and clarify misconceptions
about early detection. Primary prevention measures for hereditary breast
cancer include prophylactic mastectomy and oophorectomy and
chemopreventative agents. Secondary prevention measures include
screening and early detection with mammography, clinical breast
examinations, and BSE. Nurses have a responsibility to educate families
of patients with breast cancer about risk factors, primary and secondary
preventive measures, genetic testing, and screening recommendations.
21
UI - 11905613
AU - Wong JS; Harris JR
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.
22
UI - 11905664
AU - Muller H; Eeles RA; Wildsmith T; McGleenan T; Friedman S
TI -
Genetic testing for cancer predisposition--an ongoing debate.
SO - Lancet Oncol 2000 Oct;1():118-24
AD - Division of Medical Genetics UKBB, Department of Clinical-Biological
Sciences, Basel, Switzerland. Hansjakob.Mueller@unibas.ch
23
UI - 12001110
AU - Olivotto IA; Gomi A; Bancej C; Brisson J; Tonita J; Kan L; Mah Z;
TI -
Harrison M; Shumak R
Influence of delay to diagnosis on prognostic indicators of
screen-detected breast carcinoma.
SO - Cancer 2002 Apr 15;94(8):2143-50
AD - Screening Mammography Program of British Columbia, British Columbia
Cancer Agency, Vancouver British Columbia, Canada.
BACKGROUND: Although delay to diagnosis after a breast screening
abnormality causes anxiety, its effect on prognosis is unknown. METHODS:
Using pooled data from five Canadian organized breast cancer screening
programs, the authors used unconditional logistic regression to evaluate
the effect of delay to diagnosis on prognostic indicators among 4465
women with invasive breast carcinoma diagnosed in the ipsilateral breast
within 3 years of an abnormal screen performed during 1990-1996.
RESULTS: Women with high-suspicion screens (n = 1569) compared with
those without (n = 2896) were more promptly investigated (median days
from screen to diagnosis, 31 vs. 47; P < or = 0.0001), had larger tumors
(79.4% vs. 55.9% > 10 mm; P < or = 0.0001), and were more likely to be
lymph node positive (33.9% vs. 17.3%; P < or = 0.0001). For delays
beyond > 12 to < or = 20 weeks, a linear trend of increased tumor size
and lymph node positivity began to emerge. Controlling for suspicion,
the authors found that odds ratios for tumor size greater than 10 mm
were 0.9 (95% CI, 0.66-1.17), 1.2 (95% confidence interval [CI],
0.88-1.56), 1.5 (95% CI, 1.05-2.16), and 2.1 (95% CI, 1.15-3.86) for
delays of > 12 to < or = 20, > 20 to < or = 52, > 52 to < or = 104, and
> 104 < or = 156 weeks, respectively (p(trend) < or = 0.0001), compared
with delays of > 4 to < or = 12 weeks. Similarly, odds ratios for lymph
node metastasis were 1.0 (95% CI, 0.67-1.42), 1.2 (95% CI, 0.84-1.69),
2.2 (95% CI, 1.48-3.15), and 3.2 (95% CI, 1.84-5.55) for the same time
intervals (p(trend) = 0.0033). CONCLUSIONS: The authors' findings
suggest that delays to diagnosis of asymptomatic breast carcinoma of 6
to 12 months are associated with progression of breast carcinoma as
measured by increasing risk of lymph node metastases and larger tumor
size. A policy of early recall rather than biopsy for low suspicion
mammographic abnormalities may introduce delays of this magnitude. The
tendency to more expediently investigate women with high-suspicion,
worse prognosis screens (suspicion bias) obscures whether delays shorter
than 20 weeks also worsen prognostic indicators. Suspicion bias should
be considered when interpreting the effect of delay on prognosis.
Copyright 2002 American Cancer Society.
24
UI - 11759823
AU - Croce MV; Isla-Larrain MT; Capafons A; Price MR; Segal-Eiras A
TI -
Humoral immune response induced by the protein core of MUC1 mucin in
pregnant and healthy women.
SO - Breast Cancer Res Treat 2001 Sep;69(1):1-11
AD - Comision de Investigaciones Cientificas de la Provincia de Buenos Aires,
Argentina.
Serum levels of MUC1 and antibodies (Abs) against MUC1 (IgG and
IgM-MUC1) were evaluated in healthy women related to pregnancy and
lactation status. A total of 149 serum samples were obtained from:
nulliparous, primiparous pregnant, multiparous pregnant that have
lactated, multiparous pregnant without lactation, multiparous
non-pregnant actual lactating, multiparous non-pregnant that have
lactated and finally, multiparous non-pregnant women without lactation.
In all assays, we included pre- and post-serum samples belonging to a
breast cancer patient vaccinated with a MUC1 derived peptide. CASA test
was employed to measure MUC1 while IgG- and IgM-MUC1 serum Abs were
evaluated with an ELISA using a 100 mer peptide as catcher. In all
groups, mean IgM levels were higher than IgG mean values; when samples
were grouped in pregnants versus non-pregnants, a significant difference
was detected with both Abs, being raised in non-pregnants. When samples
were grouped in lactating versus non-lactating a significant difference
was detected with IgG-MUC1, being raised in lactating women while no
significant difference was found with IgM-MUC1. The evaluation of serum
MUC1 levels confirmed previous results since a significant difference
between pregnant versus non-pregnant groups was found while lactating
versus non-lactating samples did not. CONCLUSIONS: (i) Increased MUC1
serum levels are apparently associated with pregnancy but not with
lactation; (ii) MUC1 Abs are mainly associated with lactation and with
non-pregnant status. These results may be considered a contribution on
studies about protection against breast cancer induced by pregnancy and
lactation.
25
UI - 11759825
AU - Bonanni B; Johansson H; Gandini S; Guerrieri-Gonzaga A; Torrisi R;
TI -
Sandri MT; Cazzaniga M; Mora S; Robertson C; Lien EA; Decensi A
Effect of low dose tamoxifen on the insulin-like growth factor system in
healthy women.
SO - Breast Cancer Res Treat 2001 Sep;69(1):21-7
AD - Division of Chemoprevention, European Institute of Oncology, Milan,
Italy.
The use of tamoxifen as a preventive agent may be limited by the
increased risk of endometrial cancer and venous thromboembolic events
observed in postmenopausal women. We have recently shown a comparable
activity of lower doses of tamoxifen on several surrogate biomarkers of
cardiovascular disease and breast cancer, including Insulin-like Growth
Factor-I (IGF-I). To provide further insight into the effect of
tamoxifen at low doses on the IGF system, we have correlated the drug
serum levels attained after 2 months of either placebo (n = 32),
tamoxifen 20 mg/day (n = 26), 10 mg/day (n = 23) or 10 mg/every other
day (n = 29) with the changes in IGF-I, Insulin-like Growth Factor-II
(IGF-II), Insulin-like Growth Factor Binding Protein-1 (IGFBP-1),
Insulin-like Growth Factor Binding Protein-3 (IGFBP-3), and
IGF-I/IGFBP-3 ratio. Compared with placebo, tamoxifen induced a mean +/-
standard error (SE) reduction of IGF-I of 16.9 +/- 7.8%, p < 0.05, a
non-significant increase of 22.9 +/- 12.2% in IGF-II, an increase in
IGFBP-1 of 49.3 +/- 22.7%, p < 0.05, and a non-significant change of
IGFBP-3 (-4.0% +/- 9.2). No significant concentration-response
relationship was observed between serum tamoxifen concentrations and the
biomarker changes except for the ratio of IGF-I/IGFBP-3, which decreased
by 1.53 +/- 0.68% for any increase by 10 ng/ml of serum tamoxifen
concentration (p = 0.02). Although low tamoxifen concentrations induce a
comparable modulation of the IGF family relative to the conventional
dose, the lower decrements in the IGF-I/IGFBP-3 ratio observed at low
drug concentrations might be associated with a reduced preventive
activity. Further studies on the search of the minimal active dose of
tamoxifen are warranted.
26
UI - 12025059
AU - Afflitto L
TI -
Tamoxifen for the treatment and prevention of breast cancer: an update.
SO - Plast Surg Nurs 2000 Winter;20(4):234-6
27
UI - 11952748
AU - Sauer T; Young K; Thoresen SO
TI -
Fine needle aspiration cytology in the work-up of mammographic and
ultrasonographic findings in breast cancer screening: an attempt at
differentiating in situ and invasive carcinoma.
SO - Cytopathology 2002 Apr;13(2):101-10
AD - Department of Pathology, Ullevaal University Hospital, N-0407 Oslo,
Norway. torill.sauer@ulleval.no
This study evaluated the results of fine needle aspiration cytology
(FNAC) from the first four years of organized mammography screening for
breast cancer in Oslo, particularly our policy in differentiating in
situ and invasive carcinoma. Lesions were aspirated directly, ultrasound
guided, by stereotaxic device or biopsy localization plate. All lesions
were aspirated by cytopathologists working with the radiologists at the
breast diagnostic centre. Smears were evaluated immediately for
assessment of adequacy and a preliminary diagnosis was given to the
surgeon. When FNAC revealed malignancy, diagnostic terms were as
follows: (1) invasive carcinoma; (2) ductal carcinoma in situ of comedo
type (high nuclear grade), cannot evaluate infiltration; (3) ductal
carcinoma in situ of low nuclear grade and (4) papillary tumour, cannot
evaluate infiltration. There were 953 cases, 70% of which were
nonpalpable. Insufficient material was obtained in 5.8%. Absolute and
complete sensitivity were 81% and 91%, respectively. Specificity was
85%. There were 448 histologically proven carcinomas. 383 of these were
invasive. 362 carcinomas (in situ and invasive) (80.8%) were diagnosed
directly on FNAC. Distinction between invasive and in situ carcinoma was
possible in 294 of 320 directly diagnosed invasive carcinomas (91.8%).
PPV of a diagnosis of invasive carcinoma was 97%. Our data showed that
definitive cytological diagnosis of invasive carcinoma was possible in
more than 90% of fully diagnostic smears and allowed definitive primary
surgery in these women.
28
UI - 11965225
AU - Goss P
TI -
Anti-aromatase agents in the treatment and prevention of breast cancer.
SO - Cancer Control 2002 Mar-Apr;9(2 Suppl):2-8
AD - Breast Cancer Prevention Program at the Princess Margaret Hospital,
Toronto, Ontario, Canada. pegoss@interlog.com
Anti-aromatase agents now have a central role in the management of
breast cancer in postmenopausal women; they are superior to megestrol
acetate as second-line therapy and to tamoxifen for initial therapy of
metastatic disease. They also are highly active as neoadjuvant therapy.
Two classes of anti-aromatase agents are available: steroidal (eg,
exemestane) and nonsteroidal (eg, anastrozole, letrozole). Although both
types of agents act on the aromatase enzyme, they do so by different
mechanisms and have different effects on cellular aromatase activity.
Nonsteroidal agents are associated with increased aromatase enzyme
content and steroidal agents are associated with decreased content. The
increase in aromatase content seen with the nonsteroidal agents may in
part explain the development of resistance with these agents and the
ability of the steroidal agent exemestane to induce a response when
nonsteroidal agents fail. Because the anti-aromatase agents almost
completely eliminate endogenous estrogen production, they not only
affect breast cancer tissues, but also may alter the function of other
estrogen-responsive tissues. However, preclinical data show that the
steroidal agent exemestane may actually improve bone and lipid
metabolism. In addition, no increase in clinical fracture rate has been
noted in women treated with exemestane in metastatic trials; the
fracture risk has not yet been studied following prolonged exposure in
healthy women. Exemestane associated beneficial effects on these end
organs may be due to the steroidal nature of both the parent compound
and its principal metabolite, 17-hydroexemestane. Similar benefits have
not been reported with nonsteroidal antiaromatase agents. Based on their
excellent activity in the metastatic setting, anti-aromatase agents are
now being evaluated in the adjuvant setting and in pilot studies for
chemoprevention. These studies will provide long-term data in healthy
women and will help to differentiate anti-aromatase agents, in terms of
their efficacy in the treatment of breast cancer and their effects on
end organs.
29
UI - 11979439
AU - Dos Santos Silva I; Mangtani P; McCormack V; Bhakta D; Sevak L;
TI -
McMichael AJ
Lifelong vegetarianism and risk of breast cancer: a population-based
case-control study among South Asian migrant women living in England.
SO - Int J Cancer 2002 May 10;99(2):238-44
AD - Department of Epidemiology and Population Health, London School of
Hygiene and Tropical Medicine, London, England. isabel.silva@lshtm.ac.uk
To investigate the role of lifelong vegetarianism on the aetiology of
female breast cancer, we conducted a population-based case-control study
among South Asian migrant women from the Indian subcontinent resident in
England. A total of 240 South Asian breast cancer cases were identified
from 2 cancer registries during 1995-1999. For each case, 2 age-matched
South Asian controls were randomly selected from the age-sex register of
the case practice. Lifelong vegetarians had a slight reduction, although
not statistically significant, in the odds of breast cancer relative to
lifelong meat-eaters, which persisted after adjustment for
socio-demographic and reproductive variables [odds ratio (OR)=0.77; 95%
confidence interval (CI)=0.50-1.18]. Analysis by food group revealed no
linear trend in the odds of breast cancer with increasing consumption of
meat (p=0.10) but the odds were higher for women in the top 75%. In
contrast, there were strong inverse trends in the odds of breast cancer
with increasing intake of vegetables (p=0.005), pulses (p=0.007) and
fibre [non-starch polysaccharides, NSP (p=0.02)], with women in the
highest 25% of intake of these foods having about 50% of the odds of
those in the lowest ones. Adjustment for intake of vegetables and pulses
reverted the odds of breast cancer in lifelong vegetarians relative to
lifelong meat-eaters (OR=1.04; 95% CI=0.65-1.68) and attenuated the
quartile-specific estimates for meat intake, whereas the inverse trends
in the odds of breast cancer with intake of vegetables and pulses
remained after adjustment for type of diet or meat intake. These
findings suggest that lifelong vegetarianism may be associated with a
reduction in the risk of breast cancer through its association with a
higher intake of vegetables and pulses. Although it is not possible to
exclude the possibility that lifelong meat abstention may also play a
role, the findings provide evidence that a diet rich in vegetables and
pulses, such as those typically found in South Asian diets, may be
protective against this cancer. Copyright 2002 Wiley-Liss, Inc.
30
UI - 12015184
AU - Austin LT; Ahmad F; McNally MJ; Stewart DE
TI -
Breast and cervical cancer screening in Hispanic women: a literature
review using the health belief model.
SO - Womens Health Issues 2002 May-Jun;12(3):122-8
AD - University Health Network Women's Health Program, Toronto, Ontario,
Canada.
The aim of this study was to review published studies that examined
factors influencing breast and cervical cancer screening behavior in
Hispanic women, using the Health Belief Model (HBM). MEDLINE and
PsycINFO databases and manual search were used to identify articles.
Cancer screening barriers common among Hispanic women include fear of
cancer, fatalistic views on cancer, linguistic barriers, and culturally
based embarrassment. In addition, Hispanic women commonly feel less
susceptible to cancer, which is an important reason for their lack of
screening. Positive cues to undergo screening include physician
recommendation, community outreach programs with the use of Hispanic lay
health leaders, Spanish print material, and use of culturally specific
media. Critical review of the literature using the theoretical framework
of the Health Belief Model identified several culturally specific
factors influencing cancer screening uptake and compliance among
Hispanic women. Future interventions need to be culturally sensitive and
competent.
31
UI - 12044063
AU - Coskun U; Toruner FB; Gunel N
TI -
Tamoxifen therapy and hepatic steatosis.
SO - Neoplasma 2002;49(1):61-4
AD - Gazi University Medical School, Department of Medical Oncology, Ankara,
Turkey. ugurcos@hotmail.com
Tamoxifen has been used for a long time as a hormonal treatment in
breast cancer. Recent studies in pre and postmenopausal women have shown
that tamoxifen exhibits favorable effects on the lipid profile. In this
study we investigated the effects of tamoxifen on lipid profile and
hepatic steatosis. Fifty two (31 postmenopausal and 21 premenopausal)
women with breast cancer treated with tamoxifen at a dose of 20 mg daily
were included in the study. Serum lipid parameters (total cholesterol,
high and low density lipoprotein cholesterol and triglyceride) were
measured baseline and at the 6th month of tamoxifen treatment. Upper
abdominal ultrasonography was performed before and at the 6th month of
therapy for assessment of liver steatosis. We obtained decreased levels
of serum total cholesterol after 6 months of tamoxifen treatment (p <
0.05). However, we did not detect any changes in triglyceride and
high-density lipoprotein cholesterol levels (p > 0.05). Increased liver
steatosis was observed in 22 patients (42.3%) after tamoxifen treatment.
We could not detect increase in lipid levels in these patients. There
was no significant difference between the lipid levels in the patients
with increased liver steatosis and stable or no liver steatosis. Whether
hepatic steatosis is dependent on lipid changes in tamoxifen use should
be further investigated.
32
UI - 11969355
AU - Zhu K; Hunter S; Bernard LJ; Payne-Wilks K; Roland CL; Elam LC; Feng Z;
TI -
Levine RS
An intervention study on screening for breast cancer among single
African-American women aged 65 and older.
SO - Prev Med 2002 May;34(5):536-45
AD - Pennsylvania State University College of Medicine, Hershey 17033, USA.
kzhu@hes.hmc.psu.edu
BACKGROUND: Older African-American women with single marital status are
least likely to use screening procedures. This study aimed to evaluate a
breast screening intervention program conducted in this population.
METHODS: Ten public housing complexes were randomly assigned to either
the intervention or the control group. African-American women aged 65
and over were recruited into the study if they were widowed, divorced,
separated, or never married and did not have a history of breast cancer
(n = 325). The intervention program was delivered by lay health
educators at the participant's apartment and was designed to increase
knowledge about breast screening, reduce psychological problems, and
increase support from significant others. Breast-screening-related
cognition and behavior were measured at baseline and at 1 and 2 years
postintervention. RESULTS: Comparisons of the preintervention and
postintervention measurements showed that while the proportion of women
who had a clinical breast examination or mammogram in the preceding year
was decreased at 1 year postintervention in the control group, it was
increased in the intervention group. However, the differences did not
reach a significant level. No consistent patterns could be found in
changes of breast self-examination and variables in knowledge,
attitudes, and beliefs. When analyses were restricted to women whose
significant others had provided information or help on breast screening,
results were better, but the differences between the intervention and
control groups still did not reach statistical significance.
CONCLUSIONS: These results did not suggest significant effects of an
intervention program that used lay health educators to promote breast
cancer screening in older single African-American women. (C) 2002
Elsevier Science (USA).
33
UI - 12044383
AU - McCarthy M
TI -
Advances highlighted at US cancer meeting.
SO - Lancet 2002 May 25;359(9320):1835
34
UI - 12066794
AU - Anonymous
TI -
Mammography: what's a woman to do?
SO - Johns Hopkins Med Lett Health After 50 2002 Jun;14(4):4-5
35
UI - 11988138
AU - Rohatgi N; Blau R; Lower EE
TI -
Raloxifene is associated with less side effects than tamoxifen in women
with early breast cancer: a questionnaire study from one physician's
practice.
SO - J Womens Health Gend Based Med 2002 Apr;11(3):291-301
AD - Department of Internal Medicine, Division of Hematology/Oncology,
University of Cincinnati College of Medicine, Cincinnati, Ohio
45267-0562, USA.
OBJECTIVE: Selective estrogen receptor modulators (SERMs) are being used
increasingly for the prevention and treatment of breast cancer. The
currently available SERMs, tamoxifen and raloxifene, are both associated
with antiestrogenic side effects that can be bothersome. However, no
data exist on how they compare in this regard. We conducted a
retrospective, questionnaire-based study to answer this question.
METHODS: Women with early breast cancer in one physician's practice who
had received either or both of these drugs were surveyed using a
self-administered questionnaire. Respondents graded the frequency and
severity of side effects related to estrogen deprivation, such as
vaginal dryness, mood changes, hot flashes, weight gain, and changes in
libido, as well as other side effects, such as vaginal discharge. They
were separated into three groups for analysis (group 1, tamoxifen only;
group 2, raloxifene only; group 3, both drugs). Side effects graded 4 or
5 (or weight gain >10 pounds) were considered severe. RESULTS: Two
hundred sixty-four questionnaires were available for analysis. Women on
raloxifene had a shorter average duration of therapy. In comparing the
tamoxifen and raloxifene groups, vaginal discharge, severe hot flashes,
and weight gain of >10 pounds were significantly more frequent with
tamoxifen. However, weight gain was also related to the duration of
therapy with either drug. CONCLUSIONS: In this observational study,
antiestrogenic side effects were common with either tamoxifen or
raloxifene. Raloxifene is associated with significantly less vaginal
discharge and severe hot flashes than tamoxifen in women with early
breast cancer. Although weight gain of >10 pounds may also occur less
frequently on this drug, this may be confounded by the shorter average
duration of raloxifene therapy.
36
UI - 12020568
AU - van Veen WA; Knottnerus JA
TI -
Screening mammography.
SO - Lancet 2002 May 11;359(9318):1701
37
UI - 11984132
AU - Van Landeghem P; Bleyen L; De Backer G
TI -
Age-specific accuracy of initial versus subsequent mammography
screening: results from the Ghent breast cancer-screening programme.
SO - Eur J Cancer Prev 2002 Apr;11(2):147-51
AD - Centre for Prevention and Early Detection of Cancer, Faculty of Medicine
and Health Sciences, Department of Public Health, Ghent University, De
Pintelaan 185, B-9000 Ghent, Belgium. paul.vandelandeghem@rug.ac.be
The aim of this study was to determine whether age-related differences
in the accuracy of mammography breast cancer screening decrease with
1999) of the Ghent breast cancer-screening programme were used for
analysis. In total, 28 944 mammography examinations were included. The
referral rate, cancer detection rate, positive predictive value,
sensitivity and specificity were chosen as performance indicators.
Values were calculated for women aged 40-49, 50-59 and 60-69 years, at
initial versus subsequent examinations, respectively. For first
examinations, overall, performance was much lower for the women in their
forties than for the older age groups. On subsequent screening, the
effect of age disappeared, as expected, or was even reversed for the
positive predictive value and sensitivity of the examination. In the
light of the ongoing debate over the eligible age for mammography
screening, these results support a universal recommendation beginning at
the age of 40 years.
38
UI - 12039933
AU - Berry DA; Iversen ES Jr; Gudbjartsson DF; Hiller EH; Garber JE; Peshkin
TI -
BN; Lerman C; Watson P; Lynch HT; Hilsenbeck SG; Rubinstein WS; Hughes
KS; Parmigiani G
BRCAPRO validation, sensitivity of genetic testing of BRCA1/BRCA2, and
prevalence of other breast cancer susceptibility genes.
SO - J Clin Oncol 2002 Jun 1;20(11):2701-12
AD - Department of Biostatistics, University of Texas M.D. Anderson Cancer
Center, Houston, TX 77030-4009, USA. dberry@mdanderson.org
PURPOSE: To compare genetic test results for deleterious mutations of
BRCA1 and BRCA2 with estimated probabilities of carrying such mutations;
to assess sensitivity of genetic testing; and to assess the relevance of
other susceptibility genes in familial breast and ovarian cancer.
PATIENTS AND METHODS: Data analyzed were from six high-risk genetic
counseling clinics and concern individuals from families for which at
least one member was tested for mutations at BRCA1 and BRCA2.
Predictions of genetic predisposition to breast and ovarian cancer for
301 individuals were made using BRCAPRO, a statistical model and
software using Mendelian genetics and Bayesian updating. Model
predictions were compared with the results of genetic testing. RESULTS:
Among the test individuals, 126 were Ashkenazi Jewish, three were male
subjects, 243 had breast cancer, 49 had ovarian cancer, 34 were
unaffected, and 139 tested positive for BRCA1 mutations and 29 for BRCA2
mutations. BRCAPRO performed well: for the 150 probands with the
smallest BRCAPRO carrier probabilities (average, 29.0%), the proportion
testing positive was 32.7%; for the 151 probands with the largest
carrier probabilities (average, 95.2%), 78.8% tested positive. Genetic
testing sensitivity was estimated to be at least 85%, with
false-negatives including mutations of susceptibility genes heretofore
unknown. CONCLUSION: BRCAPRO is an accurate counseling tool for
determining the probability of carrying mutations of BRCA1 and BRCA2.
Genetic testing for BRCA1 and BRCA2 is highly sensitive, missing an
estimated 15% of mutations. In the populations studied, breast cancer
susceptibility genes other than BRCA1 and BRCA2 either do not exist, are
rare, or are associated with low disease penetrance.
39
UI - 11591922
AU - Aucant D
TI -
[Breast cancer screening campaign]
SO - J Radiol 2001 Sep;82(9 Pt 1):965
40
UI - 11450210
AU - Levine M; Moutquin JM; Walton R; Feightner J; Canadian Task Force on
TI -
Preventive Health Care and the Canadian Breast Cancer Initiative's
Steering Committee on Clinical Practice Guidelines for the Care and
Treatment of Breast Cancer
Chemoprevention of breast cancer. A joint guideline from the Canadian
Task Force on Preventive Health Care and the Canadian Breast Cancer
Initiative's Steering Committee on Clinical Practice Guidelines for the
Care and Treatment of Breast Cancer.
SO - CMAJ 2001 Jun 12;164(12):1681-90
AD - ctf@ctfphc.org
OBJECTIVE: To assist women and their physicians in making decisions
regarding the prevention of breast cancer with tamoxifen and raloxifene.
EVIDENCE: Systematic review of English-language literature published
Contents and Cochrane Library. VALUES: The strength of evidence was
evaluated using the methods of the Canadian Task Force on Preventive
Health Care and the Steering Committee on Clinical Practice Guidelines
for the Care and Treatment of Breast Cancer. RECOMMENDATIONS: Women at
low or normal risk of breast cancer (Gail risk assessment index < 1.66%
at 5 years): There is fair evidence to recommend against the use of
tamoxifen to reduce the risk of breast cancer in women at low or normal
risk of the disease (grade D recommendation). Women at higher risk of
breast cancer (Gail index > or = 1.66% at 5 years): Evidence supports
counselling women at high risk on the potential benefits and harms of
breast cancer prevention with tamoxifen (grade B recommendation). The
cutoff for defining high r
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