National Cancer Institute®
Last Modified: November 21, 2001
UI - 21267892
AU - Bush T
TI - Beyond HERS: some (not so) random thoughts on randomized clinical trials.
SO - Int J Fertil Womens Med 2001 Mar-Apr;46(2):55-9
AD - University of Maryland College Park, USA.
Science is the process of discovering truth, and "truth" is sampled each time we do a study. The results from all of our studies will be distributed around the truth, and different study designs give different amounts and different qualities of sampled material. Truth is ascertained only when sufficient numbers of appropriate studies are conducted, and no one study or one study design has a monopoly on truth. Currently, the randomized clinical trial is considered the penultimate study design and the ultimate test of the hypothesis, but only if it is double-blinded, placebo-controlled, and analyzed by an intention-to-treat protocol. The study design most similar to the randomized controlled trial is the prospective cohort study. In this observational approach, a cohort (group of individuals) is assembled and followed in real time while end points (e.g. breast cancers, heart attacks, fractures) accrue. This is contrasted to the randomized controlled trial, where a group of individuals is assembled, intervened upon, and followed in real time while end points accrue. The major advantage of the randomized controlled trial over an observational study is that the randomization process should eliminate any "bias" in the exposure of interest. However, the randomized controlled trial, like all study designs, has other limitations. Major limitations of the randomized controlled trial include significant financial and other costs, problems with external generalizability, the placebo effect, external monitoring, multi-center differences, and the (frequently problematic) intention-to-treat analysis rule. Many of these limitations do not occur in prospective cohort studies. For example, since a placebo is not administered in an observational study, there is no placebo effect, and since the study is not monitored by a data and safety monitoring board, abrupt truncation of the study duration is not usually seen in observational cohort studies. These limitations of randomized controlled trials are discussed, with specific references to several recently published randomized controlled trials in women (HERS, NSABP P-1, and the Royal Marsden Hospital trials). The HERS trial is significant because despite overwhelming observational evidence that menopausal estrogen therapy prevents heart disease, HERS found no overall difference in heart disease events in women assigned to an estrogen-plus-progestin intervention. The NSABP P-1 and the Royal Marsden Hospital trials are significant in that they were testing the same hypothesis (whether tamoxifen can prevent breast cancer), but came to entirely different conclusions. Two major questions will be posed from this specific review: One: Given conflicting evidence by study design (observational vs. randomized clinical trial), does menopausal estrogen therapy protect against heart disease? Two: Given conflicting evidence within study design (conflicting randomized clinical trials), does tamoxifen prevent breast cancer?
UI - 21406152
AU - Unnithan J; Macklis RM
TI - Contralateral breast cancer risk.
SO - Radiother Oncol 2001 Sep;60(3):239-46
AD - Department of Radiation Oncology, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
The use of breast-conserving treatment approaches for breast cancer has now become a standard option for early stage disease. Numerous randomized studies have shown medical equivalence when mastectomy is compared to lumpectomy followed by radiotherapy for the local management of this common problem. With an increased emphasis on patient involvement in the therapeutic decision making process, it is important to identify and quantify any unforeseen risks of the conservation approach. One concern that has been raised is the question of radiation- related contralateral breast cancer after breast radiotherapy. Although most studies do not show statistically significant evidence that patients treated with breast radiotherapy are at increased risk of developing contralateral breast cancer when compared to control groups treated with mastectomy alone, there are clear data showing the amount of scattered radiation absorbed by the contralateral breast during a routine course of breast radiotherapy is considerable (several Gy) and is therefore within the range where one might be concerned about radiogenic contralateral tumors. While radiation related risks of contralateral breast cancer appear to be small enough to be statistically insignificant for the majority of patients, there may exist a smaller subset which, for genetic or environmental reasons, is at special risk for scatter related second tumors. If such a group could be predicted, it would seem appropriate to offer either special counseling or special prevention procedures aimed at mitigating this second tumor risk. The use of genetic testing, detailed analysis of breast cancer family history, and the identification of patients who acquired their first breast cancer at a very early age may all be candidate screening procedures useful in identifying such at- risk groups. Since some risk mitigation strategies are convenient and easy to utilize, it makes sense to follow the classic 'ALARA' (as low as reasonably achievable) principles and to minimize scattered radiation for these special risk groups and perhaps for all patients undergoing breast radiotherapy. This paper reviews the literature on the risk of radiation- related second contralateral breast cancers.
UI - 21436642
AU - Coulson AS; Glasspool DW; Fox J; Emery J
TI - RAGs: A novel approach to computerized genetic risk assessment and decision support from pedigrees.
SO - Methods Inf Med 2001;40(4):315-22
AD - Advanced Computation Laboratory, Imperial Cancer Research Fund, London, United Kingdom.
OBJECTIVES: To assist general practitioners in evaluating patients' genetic risk of cancer on the basis of family history data. METHODS: A new computer application, RAGs (Risk Assessment in Genetics), has been developed to help doctors create graphical family trees and assess the genetic risk of breast and colorectal cancer. RAGs possesses two features that distinguish it from similar software: (i) a user-centred design, which takes into account the requirements of the doctor-patient encounter; (ii) effective and accessible risk reporting by employing qualitative evidence for or against increased risk, which is more easily understood than numerical probabilities. The system allows any rule-based genetic risk guideline to be implemented, and may be readily modified to cater for the varying degrees of information required by different specialists. RESULTS: RAGs permits fast, accurate data entry, and results in more appropriate management decisions than those made via other techniques. In addition, RAGs enables both the clinician and the patient to understand how it arrives at its conclusions, since the use of qualitative evidence allows the program to provide explanations for its reasoning. CONCLUSIONS: The RAGs system promises to help practitioners be more effective gatekeepers to genetic services. It may empower doctors both to make an informed choice when deciding to refer patients who are at increased genetic risk of breast or colorectal cancer, and to reassure those who are at low risk.
UI - 21443823
AU - Goldhirsch A; Glick JH; Gelber RD; Coates AS; Senn HJ
TI - Meeting highlights: International Consensus Panel on the Treatment of Primary Breast Cancer. Seventh International Conference on Adjuvant Therapy of Primary Breast Cancer.
SO - J Clin Oncol 2001 Sep 15;19(18):3817-27
AD - International Breast Cancer Study Group, Oncology Institute of Southern Switzerland, Lugano, Switzerland. email@example.com
UI - 21455259
AU - Menck HR; Mills PK
TI - The influence of urbanization, age, ethnicity, and income on the early diagnosis of breast carcinoma: opportunity fo screening improvement.
SO - Cancer 2001 Sep 1;92(5):1299-304
AD - Cancer Registry of Central California and the University of California, San Francisco, USA.
BACKGROUND: Because most risk factors for breast carcinoma are not readily amenable to primary prevention, and early diagnosis is a powerful prognostic determinant, screening for the disease is crucial. Consequently, assessment of the progress and comprehensiveness of screening and other breast carcinoma early detection activities is important. The relative frequency of early diagnosis may provide a useful indicator of such activities. Nationwide, time trends in the early diagnosis of breast carcinoma have been improving for decades, but not all population subgroups may have benefited equally. METHODS: Using 1994-1997 data from the California Cancer Registry (CCR), a review of diagnostic patterns of in situ and local stage breast carcinoma was undertaken. For analytic purposes, the CCR includes 10 regional registries and 36 county reporting groups. Three early diagnostic measures were designated, including in situ breast carcinoma with tumor size < 10 mm in greatest dimension, in situ breast carcinoma, and localized breast carcinoma with tumor size < 21 mm in greatest dimension. These are referred to hereinafter as early diagnosis breast carcinomas. RESULTS: The percentage of early diagnosis breast carcinomas differed markedly by age, ethnicity, diagnosis year, and county of residence. Lower percentages of early diagnosis breast carcinomas were diagnosed in older women age >/= 85 years. Hispanic women were diagnosed with lower levels of in situ breast carcinoma. Hispanic and black women were diagnosed with less localized breast tumors of small size. There was an increase in the percentage of early diagnosis breast carcinomas over the 4-year observation period. Lower percentages of early diagnosis breast carcinomas were reported for the nonurban county/county groups, which were characterized by greater distances, lower population density, and lower household incomes. CONCLUSIONS: The authors conclude that elderly women, Hispanic and black women, and women who reside in nonurban areas should be targeted as high-priority subpopulations for mammographic screening. Copyright 2001 American Cancer Society.
UI - 21022873
AU - Torres-Sanchez L; Lopez-Carrillo L; Lopez-Cervantes M; Rueda-Neria C;
TI - Wolff MS Food sources of phytoestrogens and breast cancer risk in Mexican women.
SO - Nutr Cancer 2000;37(2):134-9
AD - Center for Research on Health Services, National Institute of Public Health, Mexico, CP 62508, Cuernavaca, Morelos, Mexico.
We analyzed the intake of selected foods that contain phytoestrogens in relation to breast cancer (BC) risk using data from a hospital-based case-control study performed in Mexico City from 1994 to 1995. A total of 198 women with BC, aged 21-79 years, were individually age matched to an identical number of women with no breast disease. By a direct interview, information on socioeconomic characteristics and diet was obtained. A semiquantitative questionnaire was used to estimate the frequency of consumption of 95 foods. The effect of selected foods that contain phytoestrogens on BC risk was estimated using logistic regression models. The adjusted odds ratio for the consumption of more than one slice of onion per day and BC was 0.27 (95% confidence interval = 0.16-0.47), with a statistically significant trend (p < 0.001). This protective effect remained after adjustment for known risk factors of BC. Among premenopausal women, there was also a protective and significant effect due to the intake of lettuce and spinach and nonsignificant protective effects for the consumption of apples and herbal tea. Additional studies aimed at evaluating the potential protective effect of particular phytoestrogens on BC risk are needed.
UI - 21427140
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. firstname.lastname@example.org
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.
UI - 21453507
AU - Evans D; Lalloo F; Shenton A; Boggis C; Howell A
TI - Uptake of screening and prevention in women at very high risk of breast cancer.
SO - Lancet 2001 Sep 15;358(9285):889-90
Management of women at high lifetime risk of familial breast cancer is hampered because of limited data concerning the appropriateness of treatment options. Over the past 8 years women at very high (>40%) lifetime risk of breast cancer have had the option of entering two chemoprevention treatment trials, a magnetic resonance imaging (MRI) breast screening study, or a risk-reducing mastectomy (RRM) study. Only 10% of eligible women have entered one of the chemotherapy trials with a similar proportion opting for RRM (>50% in mutation carriers) compared with 60% opting for MRI screening. Future chemotherapy trials will have to be designed to address this poor recruitment.
UI - 21445115
AU - Vogel VG
TI - Reducing the risk of breast cancer with tamoxifen in women at increased risk.
SO - J Clin Oncol 2001 Sep 15;19(18 Suppl):87S-92S
AD - Magee-Women's Hospital, University of Pittsburgh Cancer Institute Breast Program, University of Pittsburgh, Pittsburgh, PA 15213, USA. email@example.com
Validated quantitative models are available that permit the accurate estimation of a woman's risk of developing invasive breast cancer during a specified period of time. Data from the National Surgical Adjuvant Breast and Bowel Project Breast Cancer Prevention Trial indicate that tamoxifen can reduce the risk of developing breast cancer by at least 49% in women who are at increased risk. All premenopausal women whose 5-year risk of developing breast cancer is 1.67% or greater derive a net benefit from taking tamoxifen for risk reduction. Women who have either lobular carcinoma-in-situ or atypical ductal or lobular hyperplasia derive an even greater net benefit. Women who carry mutations in either the BRCA1 or BRCA2 gene will also experience reduced incidence of breast cancer with tamoxifen. Although postmenopausal women derive a net benefit from tamoxifen through the reduction of both breast cancer and bone fracture event rates, the risks of both invasive endometrial cancer and thromboembolic events must be balanced in older women. Physicians should identify appropriate candidates with whom to discuss the possible benefits of tamoxifen for reducing the risk of breast cancer.
UI - 21463149
AU - McDonnell SK; Schaid DJ; Myers JL; Grant CS; Donohue JH; Woods JE; Frost
TI - MH; Johnson JL; Sitta DL; Slezak JM; Crotty TB; Jenkins RB; Sellers TA; Hartmann LC Efficacy of contralateral prophylactic mastectomy in women with a personal and family history of breast cancer.
SO - J Clin Oncol 2001 Oct 1;19(19):3938-43
AD - Division of Medical Oncology, Mayo Clinic Cancer Center, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
PURPOSE: To estimate the efficacy of contralateral prophylactic mastectomy in women with a personal and family history of breast cancer. PATIENTS AND METHODS: We followed the course of 745 women with a first breast cancer and a family history of breast and/or ovarian cancer who underwent contralateral prophylactic mastectomy at the Mayo Clinic between 1960 and 1993. Family history information and cancer follow-up information were obtained from the medical record, a study-specific questionnaire, and telephone follow-up. Life-tables for contralateral breast cancers, which consider age at first breast cancer, current age, and type of family history, were used to calculate the number of breast cancers expected in our cohort had they not had a prophylactic mastectomy. RESULTS: Of the 745 women in our cohort, 388 were premenopausal (age < 50 years) and 357 were post- menopausal. Eight women developed a contralateral breast cancer. Six events were observed among the premenopausal women, compared with 106.2 predicted, resulting in a risk reduction of 94.4% (95% confidence interval [CI], 87.7% to 97.9%). For the 357 postmenopausal women, 50.3 contralateral breast cancers were predicted, whereas only two were observed, representing a 96.0% risk reduction (95% CI, 85.6% to 99.5%). CONCLUSION: The incidence of contralateral breast cancer seems to be reduced significantly after contralateral prophylactic mastectomy in women with a personal and family history of breast cancer.
UI - 21277671
AU - Schaefer KM; Ladd E; Gergits MA; Gyauch L
TI - Backing and forthing: the process of decision making by women considering participation in a breast cancer prevention trial.
SO - Oncol Nurs Forum 2001 May;28(4):703-9
AD - Department of Nursing, College of Allied Health, Temple University, Philadelphia, PA, USA.
PURPOSE/OBJECTIVES: To describe the process of decision making by women considering participation in a breast cancer prevention trial (BCPT). DESIGN: Qualitative. SETTING/SAMPLE: Twenty-six women considering participation in a BCPT in the Northeastern United States. METHODS: Women were interviewed one or two times over a period of one year, with each interview averaging 40 minutes in length. The grounded theory method was used to collect and analyze the data. In-depth interviews were conducted with each participant. Data were analyzed using the constant comparative method. MAIN RESEARCH CONCEPTS: Context, decision making, meaning. FINDINGS: The core variable of backing and forthing is a nonlinear complex process of decision making that includes reviewing life, wanting to be sure, chancing and deciding within the contexts of fear, view of self in the world, transgenerational issues, and social support. CONCLUSIONS: The process of decision making for women considering participation in a BCPT is complex. Women tend to make decisions based on what is in their heads and hearts. They often are concerned more about others than they are about themselves. IMPLICATIONS FOR NURSING PRACTICE: Trust in the provider and active involvement in the process is critical to women making a decision to participate in a BCPT. Decision making is unique for each woman; however, understanding the context, the core variables, and the process will help healthcare providers to support decision making.
UI - 21277673
AU - Foxall MJ; Barron CR; Houfek JF
TI - Ethnic influences on body awareness, trait anxiety, perceived risk, and breast and gynecologic cancer screening practices.
SO - Oncol Nurs Forum 2001 May;28(4):727-38
AD - Science Department, College of Nursing, University of Nebraska Medical Center, Omaha, USA. firstname.lastname@example.org
PURPOSE/OBJECTIVES: To examine ethnic influences on body awareness, trait anxiety, perceived risk, and breast and gynecologic cancer screening practices. DESIGN: Descriptive, correlational secondary analysis. SETTING: Urban and rural home and community populations. SAMPLE: 233 women: 138 (59%) Caucasian, 37 (17%) African American, 29 (12%) Hispanic, and 29 (12%) American Indian women (X = 46.86 years) were recruited through mailings, churches, and community organizations. METHODS: Structured questionnaires. MAIN RESEARCH VARIABLES: Body awareness, trait anxiety, perceived risk, and breast and gynecologic cancer screening practices. FINDINGS: Ethnicity predicted breast and gynecologic cancer screening practices (except clinical breast examination), body awareness, trait anxiety, and perceived risk. Hispanic and American Indian women reported greater breast self-examination frequency than Caucasian and African American women. Caucasian and African American women reported more mammogram use than Hispanic and American Indian women. Increased body awareness was related to fewer gynecologic exams for American Indian women. CONCLUSIONS: Women of different ethnic backgrounds respond differently to breast and gynecologic cancer screening practices. The influence of psychosocial variables on these practices varied with different groups. IMPLICATIONS FOR NURSING PRACTICE: Nursing interventions to increase breast and gynecologic cancer screening should be ethnic-specific, with particular attention to the meaning of body awareness to American Indian women and trait anxiety and perceived risk to African American women.
UI - 21279943
AU - Silverman E; Woloshin S; Schwartz LM; Byram SJ; Welch HG; Fischhoff B
TI - Women's views on breast cancer risk and screening mammography: a qualitative interview study.
SO - Med Decis Making 2001 May-Jun;21(3):231-40
AD - VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vermont 05009, USA.
BACKGROUND: To promote informed decision making about mammography, clinicians are urged to present women with complete, relevant information about breast cancer and screening. Understanding women's current beliefs may help guide such efforts by uncovering misunderstandings, conceptual gaps, and areas of concern. OBJECTIVE: The authors sought to learn how women view breast cancer, their personal risk of breast cancer, and how screening mammography affects that risk. METHODS: Forty-one open-ended semistructured telephone interviews with women selected from a national database by quota sampling to ensure a wide range in demographics of the participants. RESULTS: Almost all respondents viewed breast cancer as a uniformly progressive disease that begins in a silent curable form (typically found by mammograms) and, unless treated early, invariably grows, spreads, and kills. Some women felt that any abnormality found must be treated, even if it was not malignant. None had heard of potentially nonprogressive cancers, and when informed, most felt that the uncertain prognosis of such lesions reinforced the need to find and treat disease as soon as possible. Women expressed a wide range of views about their personal risk of breast cancer. Although some saw breast cancer as a central threat to their health, many others cited heart disease, other cancers, violence, and trauma as greater concerns. Most recognized the importance of "uncontrollable" factors for breast cancer such as age, sex, family history, and genetics. However, other "controllable" factors with little or no demonstrated link to breast cancer (e.g., smoking, diet, toxic exposures, "bad attitudes") were given equal or greater prominence, suggesting that many women feel considerable personal responsibility for their level of breast cancer risk. Similarly, although women recognized that mammography was not perfect, almost all believed that failure to have mammograms put one at risk for premature and preventable death. When asked how mammography worked, almost all repeated the message that "early detection saves lives," suggesting that advanced cancer (and perhaps most cancer deaths) reflected a failure of early detection. The belief in the benefit of early detection was so strong that some women advocated scaring other women into getting mammograms because it is "better to be safe than sorry." CONCLUSIONS: Women view breast cancer as a uniformly progressive disease rarely curable unless caught early. The exaggerated importance many attribute to a variety of controllable factors in modifying personal risk and the "danger" seen in failing to have mammograms may lead women diagnosed with breast cancer to blame themselves.
UI - 21380946
AU - Van Hoeyweghen RJ
TI - Secondary prevention of breast cancer in older women.
SO - Z Gerontol Geriatr 2001 Jun;34(3):192-5
AD - Algemeen Ziekenhuis Sint-Jan A.V. Ruddershove 10 8000 Brugge, Belgium. email@example.com
Periodic mammography is well studied and widely applied as a screening programme to reduce breast cancer-related mortality and morbidity in women aged 50 to 69 years. Despite the fact that age is a major risk factor for breast cancer, no evidence-based data are available on survival benefit of screening in women older than 69 years. The most commonly cited guidelines for screening in breast cancer disagree on the upper age limit of the target population. This age limit is a matter of cost-effectiveness and is influenced by active life expectancy, risk for breast cancer, comorbidity and functional status. Benefit of screening also depends on adherence rate of elderly women in screening programmes and optimal treatment of identified tumours. In a selected population of elderly women, screening for breast cancer might be cost-effective.
UI - 21354727
AU - Badawi AF; El-Sohemy A
TI - Non-steroidal anti-inflammatory drugs in chemoprevention of breast and prostate cancer.
SO - Med Hypotheses 2001 Aug;57(2):167-8
AD - Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE 68198-6805, USA. firstname.lastname@example.org
Despite convincing evidence from animal experiments, epidemiological studies linking the use of non-steroidal anti-inflammatory drugs (NSAIDs) with lower risk of breast and prostate cancer have been equivocal. One explanation for the inconsistencies among epidemiological studies may relate to individual differences in NSAID metabolism due to genetic polymorphisms in enzymes such as N -acetyltransferases and cytochrome P4502C9, which are known to be involved in the metabolic biotransformation of NSAIDs. The exclusion of these molecular biomarkers of individual susceptibility may have contributed to the inconsistent findings on the effects of NSAIDs in breast and prostate cancer. Copyright 2001 Harcourt Publishers Ltd.
UI - 21421258
AU - Chalmers KI; Luker KA; Leinster SJ; Ellis I; Booth K
TI - Information and support needs of women with primary relatives with breast cancer: development of the Information and Support Needs Questionnaire.
SO - J Adv Nurs 2001 Aug;35(4):497-507
AD - Helen Glass Centre for Nursing, University of Manitoba, Winnipeg, Manitoba, Canada R3T 2N2. email@example.com
AIMS OF THE STUDY: The aim was to develop and pilot test a newly developed measure, The Information and Support Needs Questionnaire (ISNQ), for use with women with primary relatives with breast cancer. BACKGROUND/RATIONALE: Breast cancer is a major risk to the health of women in the United Kingdom (UK). Increasingly, research is documenting women's needs for information and support, particularly at the time of diagnosis. However, to date there is little understanding of the information and support needs of women who have a family history of breast cancer. Contributing to the dearth of understanding of female relatives' needs is the lack of valid and reliable instruments for use in descriptive and intervention research with this population. DESIGN/METHODS: The ISNQ and survey items documenting family history, sources of information and support for breast cancer risk, breast self-care practices, and other variables were pilot tested for the acceptability of the measures, appropriateness of the data collection methods, initial psychometric properties of the ISNQ, and time and financial costs of administration. Data were collected from 39 women living in the North-west of England who had primary relatives with breast cancer using mailed questionnaires and follow-up telephone interviews. FINDINGS: The items on the ISNQ were reported to be clear, acceptable to women and to yield relevant data. The psychometric properties of the new measure were satisfactory with a high reliability coefficient alpha. Descriptive findings indicate that women had moderate to high needs for information and support, but reported that these needs were not well met. CONCLUSIONS: The results of this pilot are guiding the development of a larger study in which the information and support needs of women with a family history of breast cancer are explored.
UI - 21414282
AU - Hiatt RA; Pasick RJ; Stewart S; Bloom J; Davis P; Gardiner P; Johnston
TI - M; Luce J; Schorr K; Brunner W; Stroud F Community-based cancer screening for underserved women: design and baseline findings from the Breast and Cervical Cancer Intervention Study.
SO - Prev Med 2001 Sep;33(3):190-203
AD - Northern California Cancer Center, Union City, California 94587, USA.
BACKGROUND: Underutilization of breast and cervical cancer screening has been observed in many ethnic groups and underserved populations. Effective community-based interventions are needed to eliminate disparities in screening rates and thus to improve prospects for survival. METHODS: The Breast and Cervical Cancer Intervention Study was a controlled trial of three interventions in the San Francisco Bay Area from 1993 to 1996: (1) community-based lay health worker outreach; (2) clinic-based provider training and reminder system; and (3) patient navigator for follow-up of abnormal screening results. Study design and a description of the interventions are reported along with baseline results of a household survey conducted in four languages among 1599 women, aged 40-75. RESULTS: Seventy-six percent of women ages 40 and over had had at least one mammogram, and most had had a clinical breast examination (88%) and Pap smear (89%). Rates were significantly lower for non-English-speaking Latinas and Chinese women (56 and 32%, respectively, for mammography), and maintenance screening (three mammograms in the past 5 years) varied from 7% (non-English-speaking Chinese) to 53% (Blacks). Pap smear screening in the past 3 years was low among non-English-speaking Latinas (72%) and markedly lower among non-English-speaking Chinese women (24%). The strongest predictors of screening behavior were having private health insurance and frequent use of medical services. Having a regular clinic and speaking English were also important. Race/ethnicity, education, household income, and employment status were, overall, not significant predictors of screening behavior. CONCLUSIONS: These baseline results support the importance of cancer screening interventions targeted to persons of foreign origin, particularly those less acculturated. Copyright 2001 American Health Foundation and Academic Press.
UI - 21435379
AU - Egbert N; Parrott R
TI - Self-efficacy and rural women's performance of breast and cervical cancer detection practices.
SO - J Health Commun 2001 Jul-Sep;6(3):219-33
AD - School of Communication Studies, Kent State University, Kent, Ohio 44242, USA. firstname.lastname@example.org
Self-efficacy has become an important variable in multiple areas of human performance, including health behavior modification (Bandura, 1997). This study explores variables that lead to women's perceived self-efficacy in performing regular detection practices for breast and cervical cancer. A sample of southeastern U.S. farm women (N = 206) completed surveys that assessed their perceived and actual knowledge of women's cancer detection practices, as well as their perceived social norms and perceived barriers related to obtaining these tests. Regression analyses of these data revealed that perceived peer norms and the barriers of time and embarrassment were significant predictors of women's confidence in their ability to follow through with cancer detection practices. Perceived knowledge and perceived family norms significantly predicted women's perceptions of difficulty associated with cancer detection practices as well as women's confidence in their skills to perform breast self-examination (BSE). Time was also a significant barrier to confidence in performing BSE. Implications for health communication campaigns are discussed.
UI - 21444571
AU - Petro-Nustas W
TI - Young Jordanian women's health beliefs about mammography.
SO - J Community Health Nurs 2001 Fall;18(3):177-94
AD - Hashemite University, PO Box 13133, Zarka, Jordan. email@example.com
This descriptive study assesses the beliefs held by a group of young Jordanian women toward mammography utilization as a screening procedure for breast cancer. The Health Belief Model (HBM) is the theoretical framework of this study. Champion's (1993) translated HBM tool was utilized as the self-administered questionnaire that was filled in by all participants in this study. The sample consisted of young (< or = 45 years) Jordanian women chosen out of convenience from among those visiting one of the largest maternal and child health centers in Amman. The overall results indicated favorable beliefs toward the use of mammography, coupled with the majority of women (76%) voicing their agreement with the overall benefits of mammography, and 24% were either not in agreement with or unsure about these benefits. Although about half of the sample (49%) perceived barriers to utilizing mammography, the vast majority (85%), reported an overall agreement with the statements of the health motivation subscale. There were no significant differences in women's beliefs as a function of their subgroups of age, education, or insurance status. Nevertheless, when compared with a group of older women who had undergone mammography, significant differences (in favor of the older group) were reported between the two samples, especially in terms of the responses given to selected preventive statements such as "wanting to discover health problems early" (t = 2.27, p = .024) and "eating a well-balanced meal" (t = 1.92, p = .05). Implications for nursing practice, such as recognizing culturally specific barriers and enhancing health education programs to trigger mammography utilization, were addressed.
UI - 21439441
AU - Scinto JD; Gill TM; Grady JN; Holmboe ES
TI - Screening mammography: Is it suitably targeted to older women who are most likely to benefit?
SO - J Am Geriatr Soc 2001 Aug;49(8):1101-4
AD - Qualidigm (formerly CPRO), Middletown, Connecticut, USA.
OBJECTIVES: To determine whether screening mammography is suitably targeted to older women who are most likely to benefit. DESIGN: Prospective cohort study. SETTING: New Haven County, Connecticut. PARTICIPANTS: Eight hundred forty-four community-dwelling older women were interviewed as part of the 1990 New Haven Established Populations for the Epidemiologic Study of the Elderly (EPESE) program. MEASUREMENTS: Mammography use was ascertained from Medicare Part B claims data. A four-level prognostic mortality index was developed using items previously shown to be predictive of mortality. Mammography use and all-cause mortality were evaluated by prognostic stage over a 5-year period, January 1, 1991, to December 31, 1995. RESULTS: Five-year mortality increased steadily with each prognostic stage (12% to 68%, P = .001), whereas the 5-year mammography use rate declined (48% to 7%, P = .001). Over half the women (53%) in the most favorable prognostic group did not receive a mammogram, whereas 13% in the two worst prognostic groups received at least one mammogram. CONCLUSION: Screening mammography may be underutilized among older women who are the most likely to benefit and overutilized among those who are unlikely to benefit.
UI - 21414317
AU - Pisano ED; Kuzmiak C; Koomen M; Cance W
TI - What every surgical oncologist should know about digital mammography.
SO - Semin Surg Oncol 2001 Apr-May;20(3):181-6
AD - Department of Radiology, UNC-Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599-7510, USA. firstname.lastname@example.org
This article reviews the available information on digital mammography for surgeons who care for patients with breast cancer. The limitations of the current film-based technology and why digital mammography promises to improve breast cancer detection and breast lesion diagnosis are described. The basics of digital imaging technology are reviewed, including a description of image contrast and spatial resolution and its variance from currently available clinical digital mammography systems. The results of clinical trials completed to date are reported. An upcoming large screening trial for digital mammography, sponsored by the National Cancer Institute, is described. Future technological developments, including improvements in softcopy display, image processing, computer-aided detection and diagnosis (CADD), tomosynthesis, and digital subtraction mammography (DSM), are briefly discussed. Copyright 2001 Wiley-Liss, Inc.
UI - 21461769
AU - Vega C
TI - Additional comments on screening mammography.
SO - Am Fam Physician 2001 Sep 15;64(6):922, 924; discussion 924, 927
UI - 21461768
AU - Sontheimer DL
TI - Additional comments on screening mammography.
SO - Am Fam Physician 2001 Sep 15;64(6):922; discussion 924, 927
UI - 21236789
AU - Luoto R; Latikka P; Pukkala E; Hakulinen T; Vihko V
TI - The effect of physical activity on breast cancer risk: a cohort study of 30,548 women.
SO - Eur J Epidemiol 2000;16(10):973-80
AD - National Public Health Institute, Department of Epidemiology and Health Promotion, Helsinki and Tampere School of Public Health, University of Tampere, Finland. email@example.com
BACKGROUND: In epidemiological studies abundant physical activity has been related to decreased breast cancer risk, though the results have been inconsistent. The purpose of this paper was to study the association of physical activity at leisure and commuting to work and incidence of breast cancer. METHODS: The study cohort consisted of 30,548 female participants of the Finnish adult health behaviour survey, based on annual random samples of Finns aged 15-64, collected in 1978-1993. By the end of 1995, 332 breast cancer cases had been diagnosed in the cohort. Relative risks of breast cancer were adjusted for age at survey, body mass index (BMI), education, length of follow-up, parity and age at first birth using Poisson regression models. RESULTS: Compared to women exercising less than once a week, the adjusted relative risk of breast cancer for women exercising once a week was 0.80 (95% confidence interval (CI): 0.58-1.10), for women exercising 2-3 times per week 0.92 (95% CI: 0.78-1.22) and for women exercising daily 1.01 (95% CI: 0.72-1.42). Women who reported commuting, walking or bicycling to work 30 min or more daily had slightly lower adjusted risk of breast cancer (RR: 0.87, 95% CI: 0.62-1.24) than women working at home, being unemployed or driving a car to working place. CONCLUSION: Although a small protective effect of regular physical activity for breast cancer incidence was found in physical activity when commuting to work, the role of the physical activity in breast cancer prevention is still an open question.
UI - 21310743
AU - Gray JA
TI - The evolution of screening.
SO - Pharmacoepidemiol Drug Saf 2001 Jan-Feb;10(1):49-54
AD - UK National Screening Committee, UK.
Botany is usually considered to be the gentlest of sciences with botanists being regarded as people who study relatively safe specimens, compared with, for example, anthropologists or microbiologists. However, botanists have their moments, particularly when collecting new species. The great botanists of the eighteenth and nineteenth centuries risked their lives in collecting and bringing back species, which we now take for granted, and Robert Brown was one of these adventurers, a young Scot who accompanied Sir Joseph Banks to New Holland. It was not, however, for his adventurous lifestyle that Brown is remembered but for his startling observation of the movements of pollen grains on a microscope slide. He noted that the pollen grains were in perpetual agitated motion, without purpose or direction but full of energy. This motion, called Brownian motion, arises from the movement of molecules, and Brownian motion is the term that has been applied to much of healthcare, including many screening programmes, which have in the past been marked more by the amount of energy and activity than by a clear sense of direction or positive achievement.
UI - 21385555
AU - Boetes C; Stoutjesdijk M
TI - MR imaging in screening women at increased risk for breast cancer.
SO - Magn Reson Imaging Clin N Am 2001 May;9(2):357-72, vii<