National Cancer Institute®
Last Modified: June 1, 2002
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.
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.
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.
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.
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.
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. email@example.com
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.
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.
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. firstname.lastname@example.org
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.
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.
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
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.
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.
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 - email@example.com
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.
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. firstname.lastname@example.org
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.
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
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.
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.
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.
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. email@example.com
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.
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. firstname.lastname@example.org
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.
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. email@example.com
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.
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.
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. firstname.lastname@example.org
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.
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. email@example.com
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).
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
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.
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. firstname.lastname@example.org
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.
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. email@example.com
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.
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 - firstname.lastname@example.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