• The privatization of risk.

• Breast and ovarian cancer screening practices in healthy women with a strong family history of breast or ovarian cancer.

• [Primary and secondary breast cancer prevention. Knowledge, assessment and participation among the female population of Schleswig-Holstein]

• Comments on E. Giovannucci, "Insulin, insulin-like growth factors and colon cancer: a review of the evidence".

• Interim assessment of a community intervention to improve breast and cervical cancer screening among Korean American women.

• The breast is close to the heart.

• The breast cancer screening controversy continues.

• Evaluation of a cancer prevention and detection curriculum for medical students.

• Costs and cost-effectiveness of a clinical intervention to increase mammography utilization in an inner city public health hospital.

• Mammographic parenchymal patterns and self-reported soy intake in Singapore Chinese women.

• Effects of the aromatase inhibitor letrozole on normal breast epithelial cell proliferation and metabolic indices in postmenopausal women: a

• Correspondence re: Cotterchio et al., Nonsteroidal anti-inflammatory drug use and breast cancer risk. Cancer Epidemiol. Biomark. Prev., 10:

• Nutrition and survival after the diagnosis of breast cancer: a review of the evidence.

• American Society of Clinical Oncology technology assessment of pharmacologic interventions for breast cancer risk reduction including

• The breast cancer screening controversy continues.

• Effect of transdermal estradiol and oral conjugated estrogen on C-reactive protein in retinoid-placebo trial in healthy women.

• Prophylactic mastectomy: an unnecessary procedure.

• Rationale for elective contralateral mastectomy with immediate bilateral reconstruction.

• Phytoestrogen therapy for menopausal symptoms?

• Risk-reduction mastectomy: clinical issues and research needs.

• The introduction of mammographical screening has had little effect on the trend in breast-conserving surgery: a population-based study in

• Impact of screening on breast cancer detection. Retrospective comparative study of two periods ten years apart.

• Strategies for the modification of risk factors in gynecological cancers.

• [WHO and The Lancet: yes to mammographic screening]

• Making good decisions about breast cancer chemoprevention.

• Summaries for patients. Using medication to prevent breast cancer: recommendations from the United States Preventive Services Task Force.

• Pregnancy related protection against breast cancer depends on length of gestation.

• Tamoxifen for breast cancer prevention: safety warning.

• The Canadian National Breast Screening Study-1: breast cancer mortality after 11 to 16 years of follow-up. A randomized screening trial of

• Screening for breast cancer: recommendations and rationale.

• Breast cancer screening: a summary of the evidence for the U.S. Preventive Services Task Force.

• Screening mammography for younger women: back to basics.

• The mammography dilemma: a crisis for evidence-based medicine?

• Summaries for patients. Mammograms in women age 40 to 49: results of the Canadian Breast Cancer Screening study.

• Summaries for patients. Screening for breast cancer: recommendations from the U.S. Preventive Services Task Force.

• Hormonal manipulations and breast cancer.

• Mammography and evidence-based decision making.

• Breast screening: time for a rethink?

• Breast screening.

• Women's perceptions of the risks of age-related diseases, including breast cancer: reports from a 3-year research study.

• Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study.

• Effect of participant motivation on rapid dietary changes in an intervention trial.

• Breast cancer chemoprevention: current challenges and a look toward the future.

• The study of tamoxifen and raloxifene: preliminary enrollment data from a randomized breast cancer risk reduction trial.

• Association between acetaminophen or nonsteroidal antiinflammatory drugs and risk of developing ovarian, breast, or colon cancer.

• [Breast cancer: selected risk factors, primary prevention]

• Concerning the relationship between benefit and radiation risk, and cancers detected and induced, in a breast screening programme.

• Sociodemographic variations in breast cancer screening behavior among Australian women: results from the 1995 National Health Survey.

• Dual effects of phytoestrogens result in u-shaped dose-response curves.

• Women's views on the introduction of Annual Screening Mammography to those aged 40-49 years (a pilot study).

• The screening mammography: the continuous dilemma.

• Breast self-examination: knowledge, attitudes, and practices among female health care workers in Tehran, Iran.

• Regular mammograms can save lives.

• Breast cancer risk assessment in patients seen in a gynecologic oncology clinic.

• Only one quarter of women with learning disability in Exeter have cervical screening.

• Breast cancer susceptibility-A new look at an old model.

• Risk estimation for breast cancer development; a clinical perspective.

• Expression of multiple cancer/testis (CT) antigens in breast cancer and melanoma: basis for polyvalent CT vaccine strategies.

• Diet and the prevention of cancer.

• Diet and prevention of cancer. Consumption of oily fish should be encouraged.

• Meeting highlights: International Consensus Panel on the Treatment of Primary Breast Cancer. Seventh International Conference on Adjuvant

• [Information on mammography screening--from deception to insight]

• [Breast conserving surgery for mammary cancer]

• [Screening of breast cancer]

• Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized

• Tailoring communication in consultations with women from high risk breast cancer families.

• Breast cancer after prophylactic bilateral mastectomy in women with a BRCA1 or BRCA2 mutation.

• Risk-reducing salpingo-oophorectomy in women with a BRCA1 or BRCA2 mutation.

• Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations.

• A guest editorial: do SERMS prevent breast cancer? A patient's need to know versus ambiguous data.

• Oophorectomy in carriers of BRCA mutations.

• Oophorectomy in carriers of BRCA mutations.

• Oophorectomy in carriers of BRCA mutations.

• Oophorectomy in carriers of BRCA mutations.

• Cancer prevention clinical trials.

1
UI - 11236399
AU - Rockhill B
TI - The privatization of risk.
SO - Am J Public Health 2001 Mar;91(3):365-8
AD - Channing Laboratory, Harvard Medical School and Brigham and Women's Hospital, Boston, Mass., USA. beverly.rockhill@channing.harvard.edu
The privatization, or individualization, of risk factor knowledge has been largely responsible for a rising tide of criticism of epidemiology. The current debate seems polarized into 2 sides, those who support and those who attack "risk factor" epidemiology. This commentary aims to reinvigorate some of Geoffrey Rose's central arguments and show that this debate may miss a key point: a risk factor is a probabilistic concept that applies to an aggregate of individuals, not to a specific individual. Risk factor knowledge compels those in public health to seek actions that shift population distributions of these factors and, to do so, to understand their social, economic, and political determinants. The author links Rose's qualitative distinction between the causes of cases and the causes of incidence to an examination of the conceptual and quantitative limits of "individual risk" estimation. The attempt to predict individuals' futures on the basis of risk factor profile is especially prominent now with breast cancer. The author suggests reasons why a policy promoting private decision making about risk, while likely ineffective from a population standpoint, is viewed as the only feasible primary prevention option against this disease.

2
UI - 11881908
AU - Isaacs C; Peshkin BN; Schwartz M; Demarco TA; Main D; Lerman C
TI - Breast and ovarian cancer screening practices in healthy women with a strong family history of breast or ovarian cancer.
SO - Breast Cancer Res Treat 2002 Jan;71(2):103-12
AD - Department of Medical Oncology, Lombardi Cancer Center, Georgetown University, Washington, DC 20007-2197, USA. isaacsc@georgetown.edu
Studies in women with a family history of cancer demonstrate a wide variability in the uptake of cancer screening measures. Little data exist regarding the breast and ovarian cancer screening practices of women who are members of hereditary breast cancer families. In order to address this issue, we examined the screening behaviors and the determinants of screening in a clinic based group of 216 women with a strong family history of breast or ovarian cancer who were participating in a free genetic counseling and testing research program. At baseline, prior to obtaining genetic counseling or testing, 50% of women ages 30-39, 83% of those age 40-49, 69% of those 50-64, and 53% of those >65 reported having a mammogram in the prior year. Adherence to mammography recommendations was correlated with age, number of relatives with breast cancer, and income. Twenty percent of participants had at least one CA- 125 performed and 31 % had ever obtained a screening ultrasound. Having at least one relative with ovarian cancer was very strongly associated with ovarian cancer screening [OR = 12.3, 95% CI = 4.6-33 for CA-125; OR=4.9, 95% CI=2.4, 10.1 for ultrasound]. No association between cancer worries/distress and either breast or ovarian cancer screening was found. In conclusion, the breast and ovarian screening uptake in healthy women from hereditary breast cancer families is suboptimal, even for women over age 50, for whom annual mammography is clearly indicated. These findings indicate a need for better education about screening guidelines for high-risk women.

3
UI - 12080482
AU - Schleider SA; Schwarz-Boeger U; Jonat W; Kiechle M
TI - [Primary and secondary breast cancer prevention. Knowledge, assessment and participation among the female population of Schleswig-Holstein]
SO - Zentralbl Gynakol 2002 Apr;124(4):207-12
AD - Universitatsfrauenklinik der Christian-Albrechts-Universitat Kiel, Germany.
OBJECTIVE: The intention was to find out to what extend women in Schleswig-Holstein were informed about primary and secondary preventive measures concerning breast cancer, how they assess their efficiency and 2000 1 520 women in Schleswig-Holsteins were asked to complete a questionnaire about breast cancer prevention. There was a representative opinion poll of the market research company "Institut fur Gesundheitsforschung Munchen (Infratest)". RESULTS: Most of the women (90.6 %) believed in the efficiency of early recognition of breast cancer at the gynaecologist, only 79.3 % of them stated that they took the chance of taking part in the annual examination. According to the doctors Union "Kassenarztliche Vereinigung", only 50.4 % of the female members of health insurance schemes took part in examinations concerning the early recognition of breast cancer in 1999. The degree of knowledge about and participation in preventive measures depend on the age of the women. The gynaecologist was named as the most important source of information and counselling. CONCLUSION: In future the population needs more information and instruction concerning breast cancer preventive measures.

4
UI - 12163683
AU - Grant WB
TI - Comments on E. Giovannucci, "Insulin, insulin-like growth factors and colon cancer: a review of the evidence".
SO - J Nutr 2002 Aug;132(8):2324; discussion 2325

5
UI - 12174401
AU - Wismer BA; Moskowitz JM; Min K; Chen AM; Ahn Y; Cho S; Jun S; Lew A; Pak
TI - YM; Wong JM; Tager IB Interim assessment of a community intervention to improve breast and cervical cancer screening among Korean American women.
SO - J Public Health Manag Pract 2001 Mar;7(2):61-70
AD - Center for Family and Community Health, School of Public Health, University of California, Berkeley, California, USA.
Breast and cervical cancer screening practices are suboptimal among Korean American women. A community intervention program was launched in 1996 to improve breast and cervical cancer screening among Korean American women in Alameda County, California. After 18 months, interim program assessment revealed that mammograms improved, but Pap smears, breast self-examinations, and clinical breast examinations did not change significantly. However, results were similar for the control county probably because the program was not implemented fully. Several strategies for improving program implementation are discussed including recommendations for researchers planning community intervention projects.

6
UI - 1309185
AU - Fletcher SW; Fletcher RH
TI - The breast is close to the heart.
SO - Ann Intern Med 1992 Dec 1;117(11):969-71

7
UI - 8460867
AU - Giliberti JJ
TI - The breast cancer screening controversy continues.
SO - Ann Intern Med 1993 May 1;118(9):748; discussion 748-9

8
UI - 12079444
AU - Geller AC; Prout MN; Miller DR; Siegel B; Sun T; Ockene J; Koh HK
TI - Evaluation of a cancer prevention and detection curriculum for medical students.
SO - Prev Med 2002 Jul;35(1):78-86
AD - Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts 02118, USA. ageller@bu.edu
BACKGROUND: Undergraduate medical education needs revision to ensure that medical students graduate with the skills necessary to assist their patients in cancer prevention and detection. We sought to implement and incorporate a cancer education curriculum into the students' core curriculum and to assess their skill levels prior to (1996), during (1997), and at the peak (1998-1999) of the incorporation of new hours. METHODS: We conducted pretest and posttest surveys of students at Boston University School of Medicine (medical student years 1-4) enrolled in each of the four study years (1996-1999). A total of 1,956 surveys (response rate, 82%) were completed. The primary outcome measure was the student's self-reported skill level (with responses ranging from 1 (very unskilled) to 5 (very skilled)) for counseling for tobacco cessation, tobacco prevention, and sun protection and for the early detection of breast, skin, and cervical cancer. Mean scores were computed for each chronological year of the study and medical school year. Differences and trends over time in mean scores of students in each medical school year were evaluated using multiple regression analysis. RESULTS: The number of hours of cancer education increased from 6 in 1996 to 15 in 1999. Strong improvements in self-rated skill levels were recorded for four of the six measures. In particular, tobacco cessation counseling skill rose from 2.16 (1996) to 3.13 (1999) for second year students (P < 0.001) and from 3.27 (1996) to 4.17 (1999) for fourth year students (P < 0.001). Among fourth year students, the percentage reporting that cancer prevention was given too little emphasis declined from 62% (1996) to 26% (1999) (P < 0.001), suggesting that the expanded curriculum reflected the students' preferences. CONCLUSIONS: Cancer education can be interwoven into the existing medical school curriculum and produce improvements in students' skill levels for counseling and examinations. Strategies to enhance prevention teaching can use this model.

9
UI - 12079445
AU - Thompson B; Thompson LA; Andersen MR; Hager S; Taylor V; Urban N
TI - Costs and cost-effectiveness of a clinical intervention to increase mammography utilization in an inner city public health hospital.
SO - Prev Med 2002 Jul;35(1):87-96
AD - Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, MP-702, Seattle, Washington 98109-1024, USA. bthompso@fhcrc.org
BACKGROUND: Studies have demonstrated the cost-effectiveness of screening women for breast cancer; however, the cost-effectiveness of strategies to motivate women to receive breast cancer screening has been less well studied. METHODS: A total of 196 women, aged 50 to 74, who were enrolled in a public health hospital clinic, were noncompliant with mammography screening, and had at least one routine clinic appointment during the study period (15 months) were entered into a randomized, controlled trial of a motivational intervention to increase mammography rates. Costs were captured via a modified Delphi technique, accounting records, sampling of staff time logs, and an estimation of miscellaneous and overhead costs. Summary costs were calculated using Excel spread sheets. RESULTS: Overall, 49% of women who received the intervention had a mammogram within 8 weeks of an index visit compared with 22% of control women. Calculation of the cost-effectiveness of the project showed an additional cost of $151 (1996 U.S.$) for each woman receiving the intervention and $559 for each additional woman motivated to receive a mammogram. CONCLUSIONS: Cost tracking and cost-effectiveness analysis can be done when intervening in a clinical setting, thereby allowing clinics to make informed decisions about implementing programs to increase motivation of their patients to receive screening.

10
UI - 12101107
AU - Jakes RW; Duffy SW; Ng FC; Gao F; Ng EH; Seow A; Lee HP; Yu MC
TI - Mammographic parenchymal patterns and self-reported soy intake in Singapore Chinese women.
SO - Cancer Epidemiol Biomarkers Prev 2002 Jul;11(7):608-13
AD - National Medical Research Council Clinical Trials and Epidemiology Research Unit, Singapore 169039.
The study aimed to investigate whether self-reported dietary variables were associated with mammographic parenchymal patterns, which have been shown to predict risk of breast cancer. Among the 3,421 women, ages 45-74 years, common to two independent population-based cohorts, mammographic parenchymal patterns and current dietary habits were assessed for 406 randomly chosen participants. Logistic regression methods were used to compare dietary and other lifestyle profiles between subjects classified as displaying high (cases) and low risk (controls) parenchymal patterns. After adjustment for energy intake and other potential confounders, dietary soy protein intake was inversely related to risk of high-risk parenchymal pattern (odds ratio, 0.41; 95% confidence interval, 0.18-0.94, highest versus lowest quartile of intake). Similarly, the highest versus lowest quartile of dietary soy isoflavone intake was significantly related to low-risk parenchymal patterns (odds ratio, 0.44; 95% confidence interval, 0.20-0.98). The association between high soy intake and a reduced risk of mammographic parenchymal patterns that are associated with high breast cancer risk may have important implications in breast cancer prevention.

11
UI - 12101108
AU - Harper-Wynne C; Ross G; Sacks N; Salter J; Nasiri N; Iqbal J; A'Hern R;
TI - Dowsett M Effects of the aromatase inhibitor letrozole on normal breast epithelial cell proliferation and metabolic indices in postmenopausal women: a pilot study for breast cancer prevention.
SO - Cancer Epidemiol Biomarkers Prev 2002 Jul;11(7):614-21
AD - Academic Department of Biochemistry, Royal Marsden Hospital, London SW3 6JJ, United Kingdom.
The aromatase enzyme converts androgens to estrogens and is the therapeutic target for aromatase inhibitors in postmenopausal patients with estrogen receptor-positive metastatic breast cancer. Third-generation inhibitors such as letrozole are being considered as potential prophylactic agents for breast cancer. The rationale for their preventive application would be aided by knowledge of their effects on the normal breast and on other estrogen-dependent processes such as bone and lipid metabolism. Thirty-two women without active breast disease were recruited to 3-month treatment with letrozole (2.5 mg/day). Core-cut biopsies from the breast and blood samples were collected before and at the end of treatment. Plasma estradiol levels were markedly suppressed in all but two patients, who were excluded from the efficacy assessment. There was no significant change in the proliferation marker Ki67 (mean change, -23%; 95% confidence interval, -50% to +23%) or estrogen receptor in breast epithelial cells with treatment. Similarly, there were no significant changes in plasma levels of insulin-like growth factor I or lipid profiles. However, there was a significant increase (25%) in the levels of the bone resorption marker C-telopeptide crosslinks (CTx). We conclude that any prophylactic effect of letrozole is not likely to be dependent on antiproliferative effects on normal breast. Studies in healthy patients will need to recognize the potential for enhanced bone resorption.

12
UI - 12101118
AU - Mokbel K; Singh-Ranger G; Kirkpatrick K
TI - Correspondence re: Cotterchio et al., Nonsteroidal anti-inflammatory drug use and breast cancer risk. Cancer Epidemiol. Biomark. Prev., 10: 1213-1217, 2001.
SO - Cancer Epidemiol Biomarkers Prev 2002 Jul;11(7):674; discussion 674

13
UI - 12149305
AU - Rock CL; Demark-Wahnefried W
TI - Nutrition and survival after the diagnosis of breast cancer: a review of the evidence.
SO - J Clin Oncol 2002 Aug 1;20(15):3302-16
AD - Department of Family and Preventive Medicine, Cancer Prevention and Control Program, Dept. 901, University of California-San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0901, USA. clrock@ucsd.edu
PURPOSE: To review and summarize evidence from clinical and epidemiologic studies that have examined the relationship between nutritional factors, survival, and recurrence after the diagnosis of breast cancer. MATERIALS AND METHODS: Relevant clinical and epidemiologic studies were identified through a MEDLINE search. References of identified reports also were used to identify additional published articles for critical review. RESULTS: Several nutritional factors modify the progression of disease and prognosis after the diagnosis of breast cancer. Overweight or obesity is associated with poorer prognosis in the majority of the studies that have examined this relationship. Treatment-related weight gain also may influence disease-free survival, reduce quality of life, and increase risk for comorbid conditions. Five of 12 studies that examined the relationship between dietary fat and survival found an inverse association, which was not evident on energy adjustment in most of these studies. The majority of the studies that examined intakes of vegetables or nutrients provided by vegetables and fruit found an inverse relationship with survival. Alcohol intake was not associated with survival in the majority of the studies that examined this relationship. CONCLUSION: Much remains to be learned about the role of nutritional factors in survival after the diagnosis of breast cancer. Healthy weight control with an emphasis on exercise to preserve or increase lean muscle mass and a diet that includes nutrient-rich vegetables can be recommended. Diets that have adequate vegetables, fruit, whole grains, and low-fat dairy foods and that are low in saturated fat may help to lower overall disease risk in this population.

14
UI - 12149307
AU - Chlebowski RT; Col N; Winer EP; Collyar DE; Cummings SR; Vogel VG 3rd;
TI - Burstein HJ; Eisen A; Lipkus I; Pfister DG; American Society of Clinical Oncology Breast Cancer Technology Assessment Working Group American Society of Clinical Oncology technology assessment of pharmacologic interventions for breast cancer risk reduction including tamoxifen, raloxifene, and aromatase inhibition.
SO - J Clin Oncol 2002 Aug 1;20(15):3328-43
AD - Health Services Research Department, American Society of Clinical Oncology, 1900 Duke Street, Suite 200, Alexandria, VA 22314, USA. guidelines@asco.org
OBJECTIVE: To update an evidence-based technology assessment of chemoprevention strategies for breast cancer risk reduction. POTENTIAL INTERVENTIONS: Tamoxifen, raloxifene, aromatase inhibition, and fenretinide. OUTCOMES: Outcomes of interest include breast cancer incidence, breast cancer-specific survival, overall survival, and net health benefit. EVIDENCE: A comprehensive, formal literature review was conducted for relevant topics. Testimony was collected from invited experts and interested parties. The American Society of Clinical Oncology (ASCO) prescribed technology assessment procedure was followed. VALUES: More weight was given to published randomized trials. BENEFITS/HARMS: A woman's decision regarding breast cancer risk reduction strategies is complex and will depend on the importance and weight attributed to information regarding both cancer- and noncancer-related risks and benefits. CONCLUSIONS: For women with a defined 5-year projected breast cancer risk of > or= 1.66%, tamoxifen (at 20 mg/d for 5 years) may be offered to reduce their risk. Risk/benefit models suggest that greatest clinical benefit with least side effects is derived from use of tamoxifen in younger (premenopausal) women (who are less likely to have thromboembolic sequelae and uterine cancer), women without a uterus, and women at higher breast cancer risk. Data do not as yet suggest that tamoxifen provides an overall health benefit or increases survival. In all circumstances, tamoxifen use should be discussed as part of an informed decision-making process with careful consideration of individually calculated risks and benefits. Use of tamoxifen combined with hormone replacement therapy or use of raloxifene, any aromatase inhibitor or inactivator, or fenretinide to lower the risk of developing breast cancer is not recommended outside of a clinical trial setting. This technology assessment represents an ongoing process and recommendations will be updated in a timely matter. VALIDATION: The conclusions were endorsed by the ASCO Health Services Research Committee and the ASCO Board of Directors.

15
UI - 8379981
AU - Ross JM; Gerber P
TI - The breast cancer screening controversy continues.
SO - Ann Intern Med 1993 May 1;118(9):747; discussion 748-9

16
UI - 12208797
AU - Decensi A; Omodei U; Robertson C; Bonanni B; Guerrieri-Gonzaga A;
TI - Ramazzotto F; Johansson H; Mora S; Sandri MT; Cazzaniga M; Franchi M; Pecorelli S Effect of transdermal estradiol and oral conjugated estrogen on C-reactive protein in retinoid-placebo trial in healthy women.
SO - Circulation 2002 Sep 3;106(10):1224-8
AD - Division of Chemoprevention, European Institute of Oncology, Milan, Italy. andrea.decensi@ieo.it
BACKGROUND: The increase in C-reactive protein (CRP) during oral conjugated equine estrogen (CEE) may explain the initial excess of cardiovascular disease observed in clinical studies. Because the effect of transdermal estradiol (E2) on CRP is unclear, we compared CRP changes after 6 and 12 months of transdermal E2 and oral CEE in a randomized 2x2 retinoid-placebo trial. METHODS AND RESULTS: A total of 189 postmenopausal women were randomized to 50 microg/d transdermal E2 and 100 mg BID of the retinoid fenretinide (n=45), 50 microg/d transdermal E2 and placebo (n=49), 0.625 mg/d oral CEE and 100 mg BID fenretinide (n=46), or 0.625 mg/d oral CEE and placebo (n=49) for 1 year. Sequential medroxyprogesterone acetate was added in each group. Relative to baseline, CRP increased by 10% (95% CI -9% to 33%) and by 48% (95% CI 22% to 78%) after 6 months of transdermal E2 and oral CEE, respectively. The corresponding figures at 12 months were 3% (95% CI -14% to 23%) for transdermal E2 and 64% (95% CI 38% to 96%) for oral CEE. Fenretinide did not change CRP levels at 6 and 12 months relative to placebo. Relative to oral CEE, the mean change in CRP after 12 months of transdermal E2 was -48% (95% CI -85% to -7%, P=0.012), whereas fenretinide was associated with a mean change of -1% (95% CI -34% to 40%, P=0.79) compared with placebo. CONCLUSIONS: In contrast to oral CEE, transdermal E2 does not elevate CRP levels up to 12 months of treatment. The implications for early risk of coronary heart disease require further studies.

17
UI - 7850547
AU - Gardner B
TI - Prophylactic mastectomy: an unnecessary procedure.
SO - Ann Surg Oncol 1994 Nov;1(6):453-4

18
UI - 7850550
AU - Kroll SS; Miller MJ; Schusterman MA; Reece GP; Singletary SE; Ames F
TI - Rationale for elective contralateral mastectomy with immediate bilateral reconstruction.
SO - Ann Surg Oncol 1994 Nov;1(6):457-61
AD - Department of Reconstructive and Plastic Surgery, University of Texas M.D. Anderson Cancer Center, Houston 77030.
BACKGROUND: Women with breast cancer treated by mastectomy with immediate breast reconstruction can get exceptionally good results if the reconstruction is performed with autogenous tissue using the transverse rectus abdominis myocutaneous (TRAM) flap. Bilateral reconstruction with TRAM flaps is also possible, but only if both breasts are reconstructed at the same time. To avoid the possibility of subsequently developing contralateral malignancy and having to undergo assymetrical reconstruction with a different technique, some patients have chosen the alternative of bilateral mastectomy with bilateral immediate reconstruction. This is only reasonable if the incidence of failure in bilateral breast reconstruction is very low. METHODS: We prospectively studied reconstructive outcomes in 100 patients who had breast cancer and who underwent bilateral mastectomy and reconstruction (using implants as well as TRAM flaps). We also reviewed the histologic findings in 88 prophylactically removed high-risk breasts. RESULTS: Successful outcomes were initially achieved in 95 patients; of the 5 failures, two were successfully reconstructed with alternative techniques for an overall success rate of 97%. Of the 63 patients reconstructed with bilateral TRAM flaps, all but one (98%) were successful on the first try. TRAM flap reconstructions were significantly more likely to be successful than were those based on implants (p = 0.05). Previously unsuspected invasive cancer was found in 3 patients (3.4%), whereas carcinoma in situ was found in 5 patients (5.7%) and in another 18 patients (20%) cellular atypia was present. CONCLUSIONS: Bilateral breast reconstruction has a low incidence of failure, particularly if TRAM flaps are used. For selected patients, elective contralateral mastectomy with immediate bilateral reconstruction is a reasonable treatment alternative provided that the necessary expertise is available and the patients clearly understand the risks.

19
UI - 11509412
AU - Davis SR
TI - Phytoestrogen therapy for menopausal symptoms?
SO - BMJ 2001 Aug 18;323(7309):354-5

20
UI - 11535704
AU - Stefanek M; Hartmann L; Nelson W
TI - Risk-reduction mastectomy: clinical issues and research needs.
SO - J Natl Cancer Inst 2001 Sep 5;93(17):1297-306
AD - Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA. ms496r@nih.gov
Risk-reduction mastectomy (RRM), also known as bilateral prophylactic mastectomy, is a controversial clinical option for women who are at increased risk of breast cancer. High-risk women, including women with a strong family history of breast cancer and BRCA1/2 mutation carriers, have several clinical options: risk-reduction surgery (bilateral mastectomy and bilateral oophorectomy), surveillance (mammography, clinical breast examination, and breast self-examination), and chemoprevention (tamoxifen). We review research in a number of areas central to our understanding of RRM, including recent data on 1) the effectiveness of RRM in reducing breast cancer risk, 2) the perception of RRM among women at increased risk and health-care providers, 3) the decision-making process for follow-up care of women at high risk, and 4) satisfaction and psychological status after surgery. We suggest areas of future research to better guide high-risk women and their health-care providers in the decision-making process.

21
UI - 11720840
AU - Ernst MF; Voogd AC; Coebergh JW; Repelaer van Driel OJ; Roukema JA
TI - The introduction of mammographical screening has had little effect on the trend in breast-conserving surgery: a population-based study in Southeast Netherlands.
SO - Eur J Cancer 2001 Dec;37(18):2435-40
AD - Department of Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands.
In addition to reducing breast cancer mortality, breast cancer screening programmes are expected to increase the proportion of patients who can undergo breast-conserving surgery. Trends in the use of breast-conserving surgery (BCS) in Southeast Netherlands between 1990 and 1998 were studied in relation to the gradual introduction of mammographical screening for women 50-69 years of age between 1992 and 1996. The characteristics of the tumours detected by the screening programme or outside of the programme were compared, to see whether this might clarify the observed trends. In the period 1990-1998, 4788 patients were diagnosed with invasive, operable breast cancer, of whom 2341 were 50-69 years of age. Although the screening programme resulted in a larger proportion of patients with small tumours and more favourable tumour characteristics, no increase was observed in the use of BCS for patients 50-69 years of age in the period 1990-1998 (64% in 1990 and 1998). Patients with a screening-detected tumour, however, were more likely to undergo breast conservation compared with those presenting clinically (68% versus 54%; P<0.0001). In conclusion, no increase in the proportion of breast-conserving surgical procedures was observed in Southeast Netherlands among patients 50-69 years of age in the period 1990-1998, during the introduction of mass mammographical screening for this group. Screening, however, resulted in a larger proportion of patients with small tumours with more favourable characteristics, who are better candidates for breast conservation.

22
UI - 11876389
AU - Aubard Y; Genet D; Eyraud JL; Clavere P; Tubiana-Mathieu N; Philippe HJ
TI - Impact of screening on breast cancer detection. Retrospective comparative study of two periods ten years apart.
SO - Eur J Gynaecol Oncol 2002;23(1):37-41
AD - Service de gynecologie-obstetrique, CHU Dupuytren, Limoges, France.
OBJECTIVE: The aim of this study was to evaluate changes in the mode of discovery of breast cancer in the last 15 years. We compared two periods separated by a 10-year interval, during which a mass mammographic screening programme was established in our department. MATERIALS AND METHOD: We made a retrospective comparison of the records of female patients with breast cancer diagnosed in our hospital over the period 1986-1989 (first period) and 1997-1999 (second period). The mass screening programme for breast cancer began in 1995. RESULTS: We collected 372 patients in the first period and 341 in the second. We found a significant change in the mode of the discovery of breast cancer between the two periods: 80.2% versus 51.9%, respectively, of the cases of breast cancer were discovered by breast self-examination, 10.2% versus 13.7% were discovered by a physician, and 4.8% versus 29.1% were discovered by routine mammography as part of an individual or mass screening programme. The mean size of the tumours decreased significantly (2.6 cm versus 2.3 cm: p = 0.019), and the number of tumours with initial metastases or lymph node involvement decreased, almost attaining the level of significance (p = 0.06). It is difficult to compare the survival and disease-free survival curves because of the short follow-up in the second period (median follow-up = 10 months). However, a marked difference appears to be developing (p < 0.0001): patients diagnosed by mammography are showing better survival and disease-free survival compared with the others. DISCUSSION: We observed that more widespread use of mammography screening for breast cancer led to smaller tumours being discovered during the second period, with less lymph node involvement and less initial metastasis. Breast cancer screening is one of the most intensively evaluated health care practices with eight completed randomized trials yet its net benefit has remained controversial. It has been shown that, at least for patients aged 50 to 70, properly organized mass screening for breast cancer led to a reduction in mortality rate. However, individual breast self-exam, physician and mammographic screening can interfere with assessment of mass screening programmes in terms of individual benefit. In addition, introducing a mass screening programme may induce opportunistic screening in non-invited age groups and influence health behaviour in the target and non target populations. A retrospective study was performed to evaluate the mode of discovery, the diagnostic presentation, and prognostic factors in breast cancer in a French department before and after initiation of a mass-screening programme (MSP).

23
UI - 11876392
AU - Benedet JL; Cabero-Roura L
TI - Strategies for the modification of risk factors in gynecological cancers.
SO - Eur J Gynaecol Oncol 2002;23(1):5-10
AD - Department of Obstetrics & Gynecology, University of British Columbia, BC Cancer Agency, Vancouver, Canada.
Strategies to modify risk for female or gynecological cancers will vary with our knowledge of the epidemiology, etiology, and specific molecular mechanisms for each individual cancer. In general, cancer preventive strategies have been divided into primary and secondary prevention with primary prevention directed toward the causative factors for a disease. Secondary prevention is classically used in cervical cancer cytology screening programs and is essentially an attempt to identify individuals in a population with preclinical phases of the disease where intervention will impact mortality the most. A vast literature has evolved regarding the epidemiology of most of the common cancers in women. While the specific molecular mechanisms are not completely understood at this time knowledge of contributing factors for many of these tumors is well known. The association of cigarette smoking with lung cancer has been well established and the increasing rates of lung cancer, particularly in women, are directly linked to the increasing number of female smokers in the population. Indeed in many western countries lung cancer deaths have overtaken breast cancer as the most common cause of death from malignant disease in women. Excessive sun exposure without adequate skin protection is another lifestyle activity that is related to the high incidence of skin cancer in certain areas. Epidemiologically, cervical cancer has been studied extensively with the current data indicating a causal role of exposure to human papillomavirus (HPV), particularly at an early age in this disease. Hereditary breast and ovarian cancer syndromes are well understood and as more information on human genomics becomes available a clear understanding of the underlying molecular mechanisms of these diseases will be possible and hopefully will result in effective strategies for their control. Unfortunately, in spite of the vast knowledge that is available regarding risk factors for many of these malignancies we have been unable to influence effective lifestyle changes that could substantially reduce the risk of these malignancies in our population. Increased efforts in education, research, and commitment--both financial and educational--are required by governments and other social organizations.

24
UI - 12082868
AU - Garne JP; Hessov I
TI - [WHO and The Lancet: yes to mammographic screening]
SO - Ugeskr Laeger 2002 Jun 3;164(23):3081-2; discussion 3082-3

25
UI - 12093247
AU - Mulley AG; Sepucha K
TI - Making good decisions about breast cancer chemoprevention.
SO - Ann Intern Med 2002 Jul 2;137(1):52-4

26
UI - 12093267
AU - Anonymous
TI - Summaries for patients. Using medication to prevent breast cancer: recommendations from the United States Preventive Services Task Force.
SO - Ann Intern Med 2002 Jul 2;137(1):I62

27
UI - 12177796
AU - Vatten LJ; Romundstad PR; Trichopoulos D; Skjaerven R
TI - Pregnancy related protection against breast cancer depends on length of gestation.
SO - Br J Cancer 2002 Jul 29;87(3):289-90
AD - Department of Community Medicine and General Practice, The Norwegian University of Science and Technology, Trondheim, Norway. Lars.Vatten@medisin.ntnu.no
In a prospective study of 694 657 parous women in Norway, 5474 developed breast cancer after their first birth. If the first pregnancy lasted less than 32 weeks, the risk was 22% (95% confidence interval, -3% to 53%) less than after a pregnancy of 40 weeks or more, with a significant declining trend in risk (P for trend=0.02). Copyright 2002 Cancer Research UK

28
UI - 12197698
AU - Wooltorton E
TI - Tamoxifen for breast cancer prevention: safety warning.
SO - CMAJ 2002 Aug 20;167(4):378-9

29
UI - 12204013
AU - Miller AB; To T; Baines CJ; Wall C
TI - The Canadian National Breast Screening Study-1: breast cancer mortality after 11 to 16 years of follow-up. A randomized screening trial of mammography in women age 40 to 49 years.
SO - Ann Intern Med 2002 Sep 3;137(5 Part 1):305-12
AD - University of Toronto, Toronto, Canada. a.miller@dkfz-heidelberg.de
BACKGROUND: The efficacy of breast cancer screening in women age 40 to 49 years remains controversial. OBJECTIVE: To compare breast cancer mortality in 40- to 49-year-old women who received either 1) screening with annual mammography, breast physical examination, and instruction on breast self-examination on 4 or 5 occasions or 2) community care after a single breast physical examination and instruction on breast self-examination. DESIGN: Individually randomized, controlled trial. SETTING: 15 Canadian centers. PARTICIPANTS: 50 430 volunteers age 40 to pregnant, had no previous breast cancer diagnosis, and had not had mammography in the preceding 12 months. INTERVENTIONS: Breast physical examination and instruction on breast self-examination preceded random assignment of 25 214 women to receive mammography and annual mammography, breast physical examination, and breast self-examination and 25 216 women to receive usual community care with annual follow-up. MEASUREMENTS: Verified breast cancer incidence and cohort mortality 1996. RESULTS: The 105 breast cancer deaths in the mammography group and 108 breast cancer deaths in the usual care group yielded a cumulative rate ratio, adjusted for mammography done outside the study, of 1.06 (95% CI, 0.80 to 1.40). A total of 592 cases of invasive breast cancer in the mammography group compared with 552 and 29 cases, respectively, in the usual care group. The expected proportions of nonpalpable and small invasive tumors were detected on mammography. CONCLUSION: After 11 to 16 years of follow-up, four or five annual screenings with mammography, breast physical examination, and breast self-examination had not reduced breast cancer mortality compared with usual community care after a single breast physical examination and instruction on breast self-examination. The study data show that true effects of 20% or greater are unlikely.

30
UI - 12204019
AU - U.S. Preventive Services Task Force
TI - Screening for breast cancer: recommendations and rationale.
SO - Ann Intern Med 2002 Sep 3;137(5 Part 1):344-6

31
UI - 12204020
AU - Humphrey LL; Helfand M; Chan BK; Woolf SH
TI - Breast cancer screening: a summary of the evidence for the U.S. Preventive Services Task Force.
SO - Ann Intern Med 2002 Sep 3;137(5 Part 1):347-60
AD - Oregon Health & Science University and Portland Veterans Affairs Medical Center, Mailcode BICC, 3181 SW Sam Jackson Park Road, Portland, OR 97201-3098, USA.
PURPOSE: To synthesize new data on breast cancer screening for the U.S. Preventive Services Task Force. DATA SOURCES: MEDLINE; the Cochrane Controlled Trials Registry; and reference lists of reviews, editorials, and original studies. STUDY SELECTION: Eight randomized, controlled trials of mammography and 2 trials evaluating breast self-examination were included. One hundred fifty-four publications of the results of these trials, as well as selected articles about the test characteristics and harms associated with screening, were examined. DATA EXTRACTION: Predefined criteria were used to assess the quality of each study. Meta-analyses using a Bayesian random-effects model were conducted to provide summary relative risk estimates and credible intervals (CrIs) for the effectiveness of screening with mammography in reducing death from breast cancer. DATA SYNTHESIS: For studies of fair quality or better, the summary relative risk was 0.84 (95% CrI, 0.77 to 0.91) and the number needed to screen to prevent one death from breast cancer after approximately 14 years of observation was 1224 (CrI, 665 to 2564). Among women younger than 50 years of age, the summary relative risk associated with mammography was 0.85 (CrI, 0.73 to 0.99) and the number needed to screen to prevent one death from breast cancer after 14 years of observation was 1792 (CrI, 764 to 10 540). For clinical breast examination and breast self-examination, evidence from randomized trials is inconclusive. CONCLUSIONS: In the randomized, controlled trials, mammography reduced breast cancer mortality rates among women 40 to 74 years of age. Greater absolute risk reduction was seen among older women. Because these results incorporate several rounds of screening, the actual number of mammograms needed to prevent one death from breast cancer is higher. In addition, each screening has associated risks and costs.

32
UI - 12204022
AU - Sox H
TI - Screening mammography for younger women: back to basics.
SO - Ann Intern Med 2002 Sep 3;137(5 Part 1):361-2

33
UI - 12204023
AU - Goodman SN
TI - The mammography dilemma: a crisis for evidence-based medicine?
SO - Ann Intern Med 2002 Sep 3;137(5 Part 1):363-5

34
UI - 12204045
AU - Anonymous
TI - Summaries for patients. Mammograms in women age 40 to 49: results of the Canadian Breast Cancer Screening study.
SO - Ann Intern Med 2002 Sep 3;137(5 Part 1):I28

35
UI - 12204048
AU - Anonymous
TI - Summaries for patients. Screening for breast cancer: recommendations from the U.S. Preventive Services Task Force.
SO - Ann Intern Med 2002 Sep 3;137(5 Part 1):I47

36
UI - 11997678
AU - Benshushan A; Brzezinski A
TI - Hormonal manipulations and breast cancer.
SO - Obstet Gynecol Surv 2002 May;57(5):314-23
AD - Lecturer in Obstetrics and Gynecology, Department of Obstetrics and Gynecology, The Hebrew University, Hadassah Medical School, Jerusalem, Israel. benshushan@netscape.net
Breast cancer is the most common cancer among women and the leading cause of death in women, 40 to 55 years of age. The lifetime odds of developing breast cancer are apparently up to 1 in 8 women in North America and 1 in 12 in Western Europe. According to the American Cancer Society, some 200,000 women (and 1,500 men) will be diagnosed with breast cancer this year. Although the incidence of breast cancer in women has been rising since the mid-1940s, the mortality has dropped modestly over the past decade, probably due to earlier and improved diagnosis and treatment.Evidence from both epidemiological and experimental studies points to an important role of reproductive variables in the development and promotion of human breast neoplasia. Hormonal manipulations, in the form of contraceptives, hormone replacement therapy, or antiestrogens, affect the incidence and course of breast cancer and may be useful in prevention and treatment of the tumor. In this review we summarize the current status of the use of hormones and antihormones in regard to breast cancer and outline possible areas of additional development and investigation. TARGET AUDIENCE: Obstetricians and Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader will be able to summarize the effects of estrogen and progestogens on the breast and to list the effects of other hormonal modulators on the breast.

37
UI - 12192832
AU - Kole LA
TI - Mammography and evidence-based decision making.
SO - JAAPA 2002 Jul;15(7):7-8, 13

38
UI - 2513031
AU - Roberts MM
TI - Breast screening: time for a rethink?
SO - BMJ 1989 Nov 4;299(6708):1153-5

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