NCI CANCERLIT^® Search: Screening and Prevention of Breast Cancer - September 2001

Last Modified: November 1, 2001

[Breast cancer screening: a current topic]
Update in general internal medicine.
Too early to say that pregnancy has an antitumor effect on breast cancer.
Waiting times from abnormal breast screen to diagnosis in 7 Canadian provinces.
Breast cancer diagnosis: what are we waiting for?
Another reader shares experience with paclitaxel reactions.
Breast cancer screening among American Samoan women.
Mammography screening in single older African-American women: a study of related factors.
Screening and early detection among racial and ethnic minority women.
Low national breast and cervical cancer-screening rates in American Indian and Alaska Native women with diabetes.
Cancer screening rates.
Educational review: role of the surgeon in hereditary breast cancer.
Hard choices when breast cancer threatens.
Role of population-based studies in assessing genetic cancer risk.
Phytoestrogen therapy for menopausal symptoms?
Impact of educational print materials on knowledge, attitudes, and interest in BRCA1/BRCA2: testing among Ashkenazi Jewish women.
Women's attitudes toward preventive strategies for hereditary breast or ovarian carcinoma differ from one country to another: differences among English, French, and Canadian women.
How can we increase utilization of preventive services?
Preventive health program aims to reduce cost, incidence of breast cancer.
Cancer screening among community health center women: eliminating the gaps.
'Controversy'. Propaganda versus evidence based health promotion: the case of breast screening.
Short-term breast cancer prediction by random periareolar fine-needle aspiration cytology and the Gail risk model.
Insurance policies for prophylactic mastectomy: to cover or not to cover?
Insurance policies for prophylactic surgery: to cover or not to cover?
Nonattendance in mammorgraphic screening: a study of intraurban differences in Malmo, Sweden, 1990-1994.
Early indicators of the effect of a breast cancer screening program for low-income women.
A meta-analysis of mammography screening promotion.
How does menopause alter the primary care of women?
What we still don't know about soy.
[Screening for cancer: from guidelines to practice]
[Medical management of women with inherited predisposition to breast cancer: indications and procedures for mammographic screening]
[Recommendations on cancer screening in the European Union]
Design and methods of the Raloxifene Use for The Heart (RUTH) study.
Physical activity and cancer prevention -- is 'no pain, no gain' passe?
Oral contraceptives, cancer and vascular disease.
Relation between intensity of physical activity and breast cancer risk reduction.
Study of radiation induced cancers in a breast screening programme.
Mammography screening in Norway: results from the first screening round in four counties and cost-effectiveness of a modeled nationwide screening.

CancerMail from the National Cancer Institute

1
UI - 21342213
AU - Gilles R; Dilhuydy M
TI - [Breast cancer screening: a current topic]
SO - J Radiol 2001 Jun;82(6 Pt 1):619-20

2
UI - 21402297
AU - Mincey BA
TI - Update in general internal medicine.
SO - Ann Intern Med 2001 Aug 21;135(4):300-1

3
UI - 21396221
AU - Surbone A
TI - Too early to say that pregnancy has an antitumor effect on breast cancer.
SO - J Clin Oncol 2001 Aug 15;19(16):3707-8

4
UI - 21409450
AU - Olivotto IA; Bancej C; Goel V; Snider J; McAuley RG; Irvine B; Kan L; Mirsky D; Sabine MJ; McGilly R; Caines JS
TI - Waiting times from abnormal breast screen to diagnosis in 7 Canadian provinces.
SO - CMAJ 2001 Aug 7;165(3):277-83
AD - Division of Radiation Oncology, University of British Columbia, Vancouver, BC.
BACKGROUND: Delay to breast cancer diagnosis following an abnormal screening result is associated with anxiety and personal disruption. We assessed the patterns and timeliness of diagnostic follow-up after breast cancer screening for women with abnormal results who attended organized screening programs in 7 provinces. METHODS: Using data from the Canadian Breast Cancer Screening Database, we identified 203,141 women aged 50-69 years who underwent screening in 1996 through provincially organized breast cancer screening programs in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Nova Scotia and Newfoundland. We prospectively followed women with an abnormal screening result through to the completion of the assessment process. We evaluated the waiting times from screening examination to first assessment, from screening examination to first imaging, from screening examination to diagnosis and from first assessment to diagnosis for 13,958 women, stratified according to screening program, mode of detection, whether a biopsy was performed and whether cancer was diagnosed. RESULTS: We observed considerable variations between and within programs in the time to diagnosis. The median time from screening examination to first assessment was 2.6 weeks. The median time from screening examination to diagnosis was 3.7 weeks; this time increased to 6.9 weeks for women undergoing biopsy. Even when no biopsy was performed, 10% of the women waited 9.6 weeks or longer for a diagnosis, as compared with 15.0 weeks or longer for 10% of the women undergoing biopsy. Among the women who had a biopsy, the use of core biopsy was associated with a shorter median time to diagnosis than was open biopsy, and those found to have cancer had shorter waiting times than women with benign biopsy findings. INTERPRETATION: Women undergoing assessment of an abnormal breast cancer screening result waited many weeks for a diagnosis, especially when a biopsy was performed. To ensure that targets for timeliness, adopted nationally in 1999, are realized, improved models of care or dissemination of existing efficient techniques to reach a diagnosis will be needed.

5
UI - 21409455
AU - Rasuli P
TI - Breast cancer diagnosis: what are we waiting for?
SO - CMAJ 2001 Aug 7;165(3):303-4
AD - Department of Radiology, Ottawa Hospital-General Campus, 501 Smyth Rd., Ottawa, ON K1H 8L6. prasuli@ottawahospital.on.ca

6
UI - 21237427
AU - Wojtaszek C
TI - Another reader shares experience with paclitaxel reactions.
SO - Oncol Nurs Forum 2001 Apr;28(3):446

7
UI - 21376775
AU - Mishra SI; Luce PH; Hubbell FA
TI - Breast cancer screening among American Samoan women.
SO - Prev Med 2001 Jul;33(1):9-17
AD - Center for Health Policy and Research, Chao Family Comprehensive Cancer Center, Irvine, California 92697-5800, USA. simishra@uci.edu
BACKGROUND: Little is known about breast cancer screening practices or predictors of age-specific screening for Samoan women. METHODS: Through systematic, random sampling procedures, we identified and interviewed 720 adult (> or =30 years) Samoan women residing in American Samoa, Hawaii, and Los Angeles. Multivariate logistic regressions were performed to determine independent predictors for recent age-specific screening. RESULTS: Only 55.6% of women (> or =30 years) had ever had a CBE and 32.9% of women (> or =40 years) had ever had a mammogram. Furthermore, only 24.4 and 22.4% of Samoan women (> or =40 years) residing in Hawaii and Los Angeles, respectively, had an age-specific mammogram within the prior year. Independent predictors of age-specific CBE screening included age, education, health insurance, ambulatory visit, and being a resident of Hawaii or Los Angeles; those for mammography included ambulatory visit and awareness of screening guidelines. CONCLUSION: Population-based estimates of age-specific breast cancer screening among Samoan women are lower than the national objectives and those reported for other minorities. Targeted efforts that address doctor-patient communication on preventive behavior, improved access to health care services (especially in American Samoa), and focused educational awareness programs are needed to improve the dismal screening rates observed in this indigenous population. Copyright 2001 American Health Foundation and Academic Press.

8
UI - 20560306
AU - Zhu K; Hunter S; Bernard LJ; Payne-Wilks K; Roland CL; Levine RS
TI - Mammography screening in single older African-American women: a study of related factors.
SO - Ethn Dis 2000 Autumn;10(3):395-405
AD - Department of Occupational and Preventive Medicine of Meharry Medical College, Nashville, TN, USA.
OBJECTIVE: Using baseline data from an intervention study, we examined cognitive, psychological, social and medical care factors in relation to the use of a mammogram in the preceding year among single African-American women aged 65 and older. METHODS: Study subjects were 325 African-American women aged 65 and older who were divorced, widowed, separated or never-married, and lived in ten public housing complexes in Nashville, Tennessee. In-person interviews were conducted to collect information on breast screening behavior, knowledge and attitude, social network and activities, emotional and psychological symptoms and signs, and medical care use. RESULTS: Compared with those who had not had a mammogram in the preceding year, women who had had a mammogram in the preceding year were three times more likely to have a regular doctor (95% confidence interval [CI] 1.4-5.0) and about six times more likely to have a doctor's recommendation for a mammogram (95%CI 3.4-11.1). In addition, they were more likely to: (a) have attended a meeting on breast health or received educational materials on breast cancer; (b) agree that a woman needs a mammogram even though she has no breast problem; (c) agree that a woman can have breast cancer without having symptoms; (d) have living children and grandchildren; and (e) attend social activities more frequently. CONCLUSIONS: While access to regular medical care and receiving a physician's recommendation are strongly associated with mammography among these older, single African-American women, education on breast health and social networks also appear to be influential.

9
UI - 21415206
AU - Smith ED; Phillips JM; Price MM
TI - Screening and early detection among racial and ethnic minority women.
SO - Semin Oncol Nurs 2001 Aug;17(3):159-70
AD - University of Illinois, Chicago College of Nursing, Chicago, IL, USA.
OBJECTIVES: To highlight sociocultural factors reported to influence and strategies to promote breast and cervical cancer screening and early detection behaviors of racial and ethnic minority women. DATA SOURCES: Published articles, book chapters, and reports. CONCLUSIONS: The most successful strategies for promoting screening and early detection among racial and ethnic minority women are collaborative and include approaches that are culturally sensitive and appropriate. NURSING IMPLICATIONS: Intercultural and intracultural differences in racial and ethnic minority women challenge nurses to explore strategies that focus on the health care provider, the health care delivery system, and the individual woman within the context of the woman's culture.

10
UI - 20386418
AU - Giroux J; Welty TK; Oliver FK; Kaur JS; Leonardson G; Cobb N
TI - Low national breast and cervical cancer-screening rates in American Indian and Alaska Native women with diabetes.
SO - J Am Board Fam Pract 2000 Jul-Aug;13(4):239-45
AD - Epidemiology Program, Aberdeen Indian Health Service Area, Rapid City, SD, USA.
BACKGROUND: The cervical cancer mortality rate for American Indian and Alaska Native women is twice that of all races in the United States. To date the only published national breast and cervical cancer-screening rates for American Indian and Alaska Native women are based on self-reported data. When the Indian Health Service (IHS) conducts an annual audit on patients with diabetes, it includes cancer screening. This observational study presents national breast and cervical cancer-screening rates for American Indian and Alaska Native women with diabetes. METHODS: Cancer-screening rates were extracted from the 1995 diabetic audit for the 12 IHS areas. These rates were compared with rates for women without diabetes of the same age, 50 to 69 years, by chart review, at four IHS hospitals in the Aberdeen IHS area. RESULTS: Screening rates for women with diabetes in the 12 areas varied: mammogram (ever) 35% to 78%; clinical breast examination (last year) 28% to 70%, and Papanicolaou smear (last year) 26% to 69%. The Aberdeen IHS area women with diabetes had 51% more clinic visits per year than women without diabetes, but the groups had similar screening rates. CONCLUSION: Cancer-screening rates for American Indian and Alaska Native women vary by region. In the Aberdeen IHS area, women with diabetes had more visits (missed opportunities) but similar screening rates as women without diabetes. The diabetic audit could be used to monitor national IHS cancer-screening trends for women with diabetes and in the Aberdeen IHS area for all women aged 50 to 69 years.

11
UI - 21003411
AU - Samuelson P
TI - Cancer screening rates.
SO - J Am Board Fam Pract 2000 Nov-Dec;13(6):468-9

12
UI - 21249655
AU - Newman LA; Kuerer HM; Hunt KK; Vlastos G; Ames FC; Ross MI; Singletary SE
TI - Educational review: role of the surgeon in hereditary breast cancer.
SO - Ann Surg Oncol 2001 May;8(4):368-78
AD - Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
Up to 10% of the breast cancers detected in the United States are related to an inherited germline mutation, usually in the BRCA1 or BRCA2 genes, and the majority of these patients will at some point require surgical evaluation and/or treatment. Women who harbor a genetic predisposition for breast cancer face an increased risk for early onset disease, bilateral tumors, and other non-breast malignancies, such as ovarian cancer. These issues raise questions regarding the appropriate surveillance regimen, and the potential efficacy of risk reduction strategies that should be considered. Once a breast cancer diagnosis has been established, the prognosis appears to be similar to stage-controlled sporadic breast cancer, despite an increased prevalence of adverse primary tumor features. However, the role of breast conservation therapy for these patients and the optimal means of addressing the substantially increased risk for contralateral tumors is not yet defined. The reported literature in this area, including a discussion of the value of genetic counseling and genetic testing, is reviewed.

13
UI - 21414907
AU - Mayes JR
TI - Hard choices when breast cancer threatens.
SO - JAAPA 2001 Mar;14(3):6, 9

14
UI - 21396251
AU - Berry DA
TI - Role of population-based studies in assessing genetic cancer risk.
SO - J Natl Cancer Inst 2001 Aug 15;93(16):1188-9

15
UI - 21400271
AU - Davis SR
TI - Phytoestrogen therapy for menopausal symptoms?
SO - BMJ 2001 Aug 18;323(7309):354-5

16
UI - 21433656
AU - Schwartz MD; Benkendorf J; Lerman C; Isaacs C; Ryan-Robertson A; Johnson L
TI - Impact of educational print materials on knowledge, attitudes, and interest in BRCA1/BRCA2: testing among Ashkenazi Jewish women.
SO - Cancer 2001 Aug 15;92(4):932-40
AD - Department of Oncology, Georgetown University, 2233 Wisconsin Avenue NW, Washington, DC 20007, USA. schwartm@georgetown.edu
BACKGROUND: The recent identification of several BRCA1/BRCA2 founder mutations among Ashkenazi Jewish individuals has led to increased salience of BRCA1/BRCA2 testing for Jewish individuals. Little is known about interest in BRCA1/BRCA2 testing among Ashkenazi Jews from the general population. Furthermore, previous research has not generally evaluated the impact of education on interest in testing among individuals from the general population. The goal of the current study was to examine whether a brief educational booklet regarding BRCA1/BRCA2 testing would influence knowledge, attitudes, and interest in testing among Ashkenazi Jewish women from the general population. METHODS: After a baseline telephone interview, participants were randomized to receive either genetic testing educational print materials (n = 195 women) or general breast cancer education control materials (n = 196 women). One month after receiving these materials, the authors reassessed knowledge, attitudes, and interest in BRCA1/BRCA2 gene testing. RESULTS: Relative to the breast cancer education control materials, the genetic testing education materials led to increased knowledge, increased perception of the risks and limitations of testing, and decreased interest in obtaining a BRCA1/BRCA2 mutation test. CONCLUSIONS: These data indicate that preliminary print education can be used to educate low-risk individuals about BRCA1/BRCA2 genetic testing. This approach may be used to educate low-risk individuals about the benefits and risks/limitations of BRCA1/BRCA2 testing, so that they can make informed decisions about whether to pursue genetic counseling. Copyright 2001 American Cancer Society.

17
UI - 21433659
AU - Julian-Reynier CM; Bouchard LJ; Evans DG; Eisinger FA; Foulkes WD; Kerr B; Blancquaert IR; Moatti JP; Sobol HH
TI - Women's attitudes toward preventive strategies for hereditary breast or ovarian carcinoma differ from one country to another: differences among English, French, and Canadian women.
SO - Cancer 2001 Aug 15;92(4):959-68
AD - INSERM U379, Epidemiology and Social Sciences Applied to Medical Innovation, Paoli-Calmettes Institute, 232 Boulevard Sainte Marguerite, 13273 Marseilles cedex 9, France. julian@marseille.inserm.fr
BACKGROUND: The authors investigated the acceptability to women of the preventive strategies available for dealing with hereditary breast/ovarian carcinoma in France, the United Kingdom, and Canada, countries selected because of their cultural differences. The authors aimed to discover the existence of specific factors that may affect acceptability of these preventative measures. METHODS: A cross-sectional, multicenter survey was conducted in Marseilles, France (n = 141), in Manchester, England (n = 130), and in Montreal, Quebec (n = 84). All of the women attending cancer genetic clinics for the first time because of a family history of breast-ovarian carcinoma completed a self-administered questionnaire before their clinic consultation. RESULTS: Variations in responses to different preventative options presented on the questionnaire were seen within the sample of patients considered as a whole. The highest levels of acceptability were obtained for mammographic screening (87%) and chemoprevention (58%). In contrast, prophylactic oophorectomy and prophylactic mastectomy were thought to be acceptable at an early age (before 35 years), an age associated with the highest prophylactic efficacy, by only 19% and 16% of the respondents, respectively. After multivariate adjustment, the statistical data showed that the British respondents were more in favor of oophorectomy (P < 0.0001) and more in favor of chemoprevention than the French (P < 0.001) and the Canadian respondents (P < 0.001). The British (overall adjusted response [OR(adj)] = 3.9; P < 0.001) and Canadian respondents (OR(adj) = 3; P < 0.01) were more in favor of prophylactic mastectomy than the French. The cumulated acceptability of mammography before the age of 40 years was found to be greater in the French (OR(adj) = 2.8; P < 0.01) and Canadian (OR(adj) = 3.1; P < 0.05) samples than in the British sample. CONCLUSION: These results demonstrated the existence of international variations in the acceptability of the preventive strategies available for women at risk for hereditary breast/ovarian carcinoma. Therefore, these results suggested that when establishing medical recommendations or planning public health interventions, physicians must integrate the population's perception of advantages and drawbacks with the patient's individual decision making. Copyright 2001 American Cancer Society.

18
UI - 20479283
AU - Hubbard RB 3rd
TI - How can we increase utilization of preventive services?
SO - GHA Today 1999 Jun;43(6):2

19
UI - 20484654
AU - Anonymous
TI - Preventive health program aims to reduce cost, incidence of breast cancer.
SO - Capitation Manag Rep 2000 Jan;7(1):13-5

20
UI - 20518153
AU - Regan J; Lefkowitz B; Gaston MH
TI - Cancer screening among community health center women: eliminating the gaps.
SO - J Ambulatory Care Manage 1999 Oct;22(4):45-52
AD - Office of Data, Evaluation, Analysis and Research, Health Resources and Services Administration, U.S. Department of Health and Human Services, Bethesda, Maryland, USA.
OBJECTIVE: The elimination of health status gaps among minority and low income populations is part of the mission of community health centers (CHCs). Cervical and breast cancer incidence and mortality are related to both minority and socioeconomic status, and CHCs are in a unique position, by virtue of their target population, to effect positive outcomes through screening and early detection. METHODS: Completed in 1995, the survey described in this article included questions from the 1992 NHIS Cancer Supplement, which collected information on the utilization of cancer-screening services, including Pap smear testing, mammography, and clinical breast examination. RESULTS: CHCs are providing access to Pap smear testing, mammography, and clinical breast examination for women who are at an increased risk for morbidity and mortality associated with cancers of the cervix and breast. A higher proportion of CHC women of most racial and ethnic groups and women below poverty level are up to date on cancer screening than comparison groups. In most cases, CHC women meet or exceed the Healthy People 2000 objectives for the nation.

21
UI - 20518128
AU - Hann A
TI - 'Controversy'. Propaganda versus evidence based health promotion: the case of breast screening.
SO - Int J Health Plann Manage 1999 Oct-Dec;14(4):329-34
AD - Department of Public Policy, De Montfort University, Leicester, UK. ahann@dmu.ac.uk
Breast cancer is a serious problem in the developed world, and the common perception of the risks of developing the disease are communicated to the public via a variety of means. This includes leaflets in doctors' surgeries, health promotion campaigns and invitations from well woman clinics to attend for various forms of screening. The national breast cancer screening programme in the UK has a very high compliance rate (which is vital) and a well oiled media machine. This article examines the way in which the risks of developing breast cancer are communicated to women of all ages in the UK, and speculates as to the reason behind the misleading manner in which health promoters offer this information.

22
UI - 20382806
AU - Fabian CJ; Kimler BF; Zalles CM; Klemp JR; Kamel S; Zeiger S; Mayo MS
TI - Short-term breast cancer prediction by random periareolar fine-needle aspiration cytology and the Gail risk model.
SO - J Natl Cancer Inst 2000 Aug 2;92(15):1217-27
AD - Division of Clinical Oncology, Department of Internal Medicine, University of Kansas Medical Center, Kansas City 66160-7820, USA. cfabian@kumc.edu
BACKGROUND:: Biomarkers are needed to refine short-term breast cancer risk estimates from epidemiologic models and to measure response to prevention interventions. The purpose of our study was to determine whether the cytologic appearance of epithelial cells obtained from breast random periareolar fine-needle aspirates or molecular marker expression in these cells was associated with later breast cancer development. METHODS:: Four hundred eighty women who were eligible on the basis of a family history of breast cancer, prior precancerous biopsy, and/or prior invasive cancer were enrolled in a single-institution, prospective trial. Their risk of breast cancer according to the Gail model was calculated, and random periareolar fine-needle aspiration was performed at study entry. Cells were characterized morphologically and analyzed for DNA aneuploidy by image analysis and for the expression of epidermal growth factor receptor, estrogen receptor, p53 protein, and HER2/NEU protein by immunocytochemistry. All statistical tests are two-sided. RESULTS:: At a median follow-up time of 45 months after initial aspiration, 20 women have developed breast cancer (invasive disease in 13 and ductal carcinoma in situ in seven). With the use of multiple logistic regression and Cox proportional hazards analysis, subsequent cancer was predicted by evidence of hyperplasia with atypia in the initial fine-needle aspirate and a 10-year Gail projected probability of developing breast cancer. Although expression of epidermal growth factor receptor, estrogen receptor, p53, and HER2/NEU was statistically significantly associated with hyperplasia with atypia, it did not predict the development of breast cancer in multivariable analysis. CONCLUSION:: Cytomorphology from breast random periareolar fine-needle aspirates can be used with the Gail risk model to identify a cohort of women at very high short-term risk for developing breast cancer. We recommend that cytomorphology be studied for use as a potential surrogate end point in prevention trials.

23
UI - 20487065
AU - Steven Piver M
TI - Insurance policies for prophylactic mastectomy: to cover or not to cover?
SO - Ann Surg Oncol 2000 Oct;7(9):714

24
UI - 20320332
AU - Morrow M
TI - Insurance policies for prophylactic surgery: to cover or not to cover?
SO - Ann Surg Oncol 2000 Jun;7(5):321-2

25
UI - 21238962
AU - Matson S; Andersson I; Berglund G; Janzon L; Manjer J
TI - Nonattendance in mammorgraphic screening: a study of intraurban differences in Malmo, Sweden, 1990-1994.
SO - Cancer Detect Prev 2001;25(2):132-7
AD - Department of Community Medicine, Lund University, Malmo University Hospital, Sweden.
Mammographic screening may reduce breast cancer mortality. Not all women, however, come for examination. The objective in this study from Malmo has been to assess extent to which the rate of nonattendance varies between residential areas with different sociodemographic profiles. The study is based on 32,605 women, 45 to 68 years old and living in 17 areas, who between 1990 and 1994 were invited to screening. Between age groups, the age-specific nonattendance rate ranged from 31% to 35 % (P < .01). The nonattendance rate was highest for women 65 years or older. Between residential areas, age-adjusted nonattendance rates ranged from 23% to 43% (P < .01). A socioeconomic score was developed to express the socioeconomic circumstances in the residential areas and ranged from -7.18 in the most deprived area to 5.01 in the least. Nonattendance covaried in an inverse fashion with the socioeconomic score (r = -0.78; P < .01). One of three women in this urban population did not accept the invitation to mammographic screening. Our conclusion is that women in areas with less favorable circumstances seem to be less willing to participate.

26
UI - 21238963
AU - Schootman M; Fuortes LJ
TI - Early indicators of the effect of a breast cancer screening program for low-income women.
SO - Cancer Detect Prev 2001;25(2):138-46
AD - Department of Internal Medicine, Washington University School of Medicine, St Louis, MO 63108, USA.
The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) was developed to increase screening among low-income women who are uninsured or underinsured. This study reports early indicators of the effectiveness of this breast screening program in Iowa. Using data from the Census Bureau and the Iowa Behavioral Risk Factor Surveillance System, we found that racial and ethnic minorities aged 50 to 64 more likely were screened by the NBCCEDP than were their counterparts. Data collected by the Iowa BCCEDP showed a breast cancer detection rate (7.1 per 1,000 women screened) that was at least three times higher than its historical comparison, an indication of the lead time of the screened over the nonscreened population. Predictive values positive (referral and biopsy) and stage distribution were typically higher than for the national program but lower than in other countries. In conclusion, a breast cancer screening program among low-income women can be implemented successfully, judged by early indicators of program effectiveness.

27
UI - 21238964
AU - Ratner PA; Bottorff JL; Johnson JL; Cook R; Lovato CY
TI - A meta-analysis of mammography screening promotion.
SO - Cancer Detect Prev 2001;25(2):147-60
AD - School of Nursing, University of British of Columbia, Vancouver, Canada.
The purpose of this study was to identify factors that influence the effectiveness of interventions in increasing women's use of mammography screening programs. To this end, we conducted a systematic literature review of studies published between 1966 and 1997. In this review, we recorded data about the year and country in which studies were completed, the study design, the methods for measuring screening rates, various sample characteristics, the nature of the intervention, and the resulting screening rates. The PRECEDE model was used as a framework to make distinctions between the various interventions. To synthesize evidence about the baseline screening rates and the effect of interventions on the incidence of mammography screening, we fit random-effects logistic regression models. These models revealed that more recent studies (those conducted from 1990 to 1996) were associated with higher screening rates (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.2-3.9). Conversely, those designed to target older women (minimum age, 50-65 years) and those set in clinics exhibited smaller screening rates (OR, 0.6, 95% CI, 0.3-1.0, and OR, 0.5; 95% CI, 0.3-0.8, respectively). The meta-analyses also suggested methodologic issues that must be considered before the relative strength of various interventions can be assessed rigorously.

28
UI - 21395428
AU - Onega T
TI - How does menopause alter the primary care of women?
SO - JAAPA 2000 Apr;13(4):42-4, 47-8, 51-4 passim
AD - Physician Assistant Program, University of Iowa, Iowa City, USA.

29
UI - 21431687
AU - Anonymous
TI - What we still don't know about soy.
SO - Harv Womens Health Watch 2001 Aug;8(12):1-3

30
UI - 21387132
AU - Sasco AJ
TI - [Screening for cancer: from guidelines to practice]
SO - Bull Cancer 2001 Jul;88(7):643-4
AD - Unite d'epidemiologie pour la prevention du cancer, Centre international de recherche, Institut national de la sante et de la recherche medicale, 150, cours Albert-Thomas, 69372 Lyon Cedex 8, France.

31
UI - 21387139
AU - Lassetn C; Bonadona V
TI - [Medical management of women with inherited predisposition to breast cancer: indications and procedures for mammographic screening]
SO - Bull Cancer 2001 Jul;88(7):677-86
AD - Unite de prevention et epidemiologie genetique, Centre Leon-Berard, 28, rue Laennec, 69373 Lyon Cedex 08, France. lasset@lyon.fnclcc.fr
Women identified or suspected as carriers of mutations in BRCA1 or BRCA2 susceptibility genes have a high risk to develop an early breast cancer and thus, require appropriate management. Some consensus guidelines were provided for women at hereditary risk and two possible strategies of prevention are suggested: breast cancer screening and prophylactic surgery. We present the French recommendations for breast cancer surveillance and discuss the justification, indications and modalities of mammographic screening. Screening by annual mammography is recommended from age 30 years in experienced centers, in association with semi-annual clinical breast examination from age 20 years. These recommendations apply to women who were identified as carriers of a cancer-predisposing mutation of BRCA1 or BRCA2 genes. In families for whom any mutation of the two genes could be identified, the same modalities apply also to women with a higher probability than 25% of being a carrier. We present here an illustration of the calculation of such probabilities from two example-pedigrees.

32
UI - 21387140
AU - Micksche M; Lynge E; Diehl V; Estape J; Vertio H; Faivre J; Papamichail M; Daly PA; Veronesi U; Dicato M; Kroes R; Limbert E; Holm LE; Vandenbroucke A; Davies T; Groupe des Experts Cancerologues de l'Union Europeenne
TI - [Recommendations on cancer screening in the European Union]
SO - Bull Cancer 2001 Jul;88(7):687-92

33
UI - 21430593
AU - Mosca L; Barrett-Connor E; Wenger NK; Collins P; Grady D; Kornitzer M; Moscarelli E; Paul S; Wright TJ; Helterbrand JD; Anderson PW
TI - Design and methods of the Raloxifene Use for The Heart (RUTH) study.
SO - Am J Cardiol 2001 Aug 15;88(4):392-5
AD - Preventive Cardiology, New York Presbyterian Hospital, Columbia University, New York, New York 10032, USA. ljm10@columbia.edu
Raloxifene is a selective estrogen receptor modulator that lowers total and low-density lipoprotein (LDL) cholesterol, reduces the risk of vertebral fracture, and is associated with a reduced incidence of invasive breast cancer in postmenopausal women with osteoporosis. The Raloxifene Use for The Heart (RUTH) trial is designed to determine whether raloxifene 60 mg/day compared with placebo: (1) lowers the risk of the coronary events (coronary death, nonfatal myocardial infarction [MI], or hospitalized acute coronary syndromes other than MI); and (2) reduces the risk of invasive breast cancer in women at risk for a major coronary event. RUTH is a double-blind, placebo-controlled, randomized clinical trial of 10,101 postmenopausal women aged > or =55 years from 26 countries. Women are eligible for randomization if they are postmenopausal and have documented coronary heart disease (CHD), peripheral arterial disease, or multiple risk factors for CHD. Use of estrogen within the previous 6 months is an exclusion factor. The study will be terminated after a minimum of 1,670 participants experience a primary coronary end point. Secondary end points include cardiovascular death, myocardial revascularization, noncoronary arterial revascularization, stroke, all-cause hospitalization, all-cause mortality, all breast cancers, clinical fractures, and venous thromboembolic events, in addition to the individual components of the composite primary coronary end point. RUTH will provide important information about the risk-benefit ratio of raloxifene in preventing acute coronary events and invasive breast cancer, as well as information about the natural history of CHD in women at risk of major coronary events.

34
UI - 21426769
AU - Vainio H; Bianchini F
TI - Physical activity and cancer prevention -- is 'no pain, no gain' passe?
SO - Eur J Cancer Prev 2001 Aug;10(4):301-2

35
UI - 21426770
AU - La Vecchia C
TI - Oral contraceptives, cancer and vascular disease.
SO - Eur J Cancer Prev 2001 Aug;10(4):303-5

36
UI - 21419584
AU - Friedenreich CM; Courneya KS; Bryant HE
TI - Relation between intensity of physical activity and breast cancer risk reduction.
SO - Med Sci Sports Exerc 2001 Sep;33(9):1538-45
AD - Division of Epidemiology, Prevention and Screening, Alberta Cancer Board, Calgary, Alberta, Canada. chrisf@cancerboard.ab.ca
PURPOSE: To examine the influence of frequency, duration, and intensity of physical activity on risk of breast cancer and to compare breast cancer risks associated with self-reported versus assigned intensity levels of activity. METHODS: A population-based case-control study of 1233 incident breast cancer cases and 1241 controls was conducted in Alberta between 1995 and 1997. The frequency, duration and intensity of occupational, household, and recreational activities were measured throughout lifetime using the Lifetime Total Physical Activity Questionnaire and cognitive interviewing methods. Unconditional logistic regression analyses were used to estimate odds ratios and a full assessment of confounding and effect modification was undertaken. Odds ratios for self-reported and compendium-based assigned levels of activity were compared for lifetime total activity and by type of activity. RESULTS: Breast cancer risk reductions were comparable when self-reported and assigned intensity values were used, although the results and trends were more evident with the assigned intensity data. Moderate-intensity occupational and household activities decreased breast cancer risk, whereas recreational activity, at any intensity level, did not contribute to a breast cancer risk reduction. CONCLUSION: This study found that moderate-intensity activities were the major contributors to the decrease in breast cancer risk found in this study and that risk reductions were more evident when the frequency and duration of activity alone were modeled. Of the three types of activity considered, the greatest risk reductions observed were for occupational and household activities.

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UI - 21432991
AU - Leon A; Verdu G; Cuevas MD; Salas MD; Villaescusa JI; Bueno F
TI - Study of radiation induced cancers in a breast screening programme.
SO - Radiat Prot Dosimetry 2001;93(1):19-30
AD - Dpto. Ingenieria Quimica y Nuclear, Universidad Politecnica de Valencia Aptdo. 22012 Valencia 46071, Spain.
It is demonstrated that screening mammography programmes reduce breast cancer mortality considerably. Nevertheless, radiology techniques have an intrinsic risk, the most important being the late somatic effect of the induction of cancer. This study was carried out in order to evaluate the risk to the population produced by the Comunidad Valenciana Breast Screening Programme. All the calculations are carried out for two risk models, UNSCEAR 94 and NRPB 93. On the one hand, screening series detriments are investigated as a function of doses delivered and other parameters related to population structure and X ray equipment. On the other hand the radiation induced cancer probability for a woman who starts at 45 years and remains in the programme until 65 years old is calculated as a function of mammography units' doses and average compression breast thickness. Finally, risk comparison between a screening programme starting at 45 years old and another one starting at 50 years old is made.

38
UI - 21118883
AU - Wang H; Karesen R; Hervik A; Thoresen SO
TI - Mammography screening in Norway: results from the first screening round in four counties and cost-effectiveness of a modeled nationwide screening.
SO - Cancer Causes Control 2001 Jan;12(1):39-45
AD - Cancer Registry of Norway, Montebello, Oslo. hw@kreftreg.no
OBJECTIVE: To evaluate whether the results of the first screening round in the Norwegian Breast Cancer Screening Program predict future mortality reduction and to explore the cost-effectiveness of the program. METHODS: The results of surrogate measures were calculated and compared with the targets. A cost-effectiveness analysis was performed assuming a nationwide program starting in 1996 with an attendance rate of 80% and a mortality reduction of 30%. RESULTS: The attendance rate was 79.5% and the detection rate was 0.67%. The proportion of invasive tumors smaller than 15 mm was 53.1%, and 21.7% of the patients who underwent axillary surgery had lymphatic metastasis. The C/E ratios were found to be 3750 US dollars (USD) per year of life saved and 86,045 USD per life saved. CONCLUSION: The results of the first screening round will lead to a mortality reduction of at least 30%. The cost-effectiveness analysis shows that it is possible to run a highly cost-efficient screening program in Norway.