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Abramson Cancer CenterNCI CANCERLIT® Search: Screening and Prevention of Breast Cancer - October 2001
National Cancer Institute®
Last Modified: November 21, 2001
Table of Contents
1
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?
2
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.
3
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.
4
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. agoldhrisch@sakk.ch
5
UI - 21462048
AU - Anonymous
TI -
Phytoestrogens--plant-based alternative to HRT?
SO - Mayo Clin Health Lett 2001 Oct;19(10):4
6
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.
7
UI - 21468593
AU - Saul H
TI -
'No benefit' from mammography.
SO - Eur J Cancer 2000 Dec;36(18):2277-8
8
UI - 21468594
AU - Saul H
TI -
Doubts raised over tamoxifen as preventive agent.
SO - Eur J Cancer 2000 Dec;36(18):2281
9
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.
10
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
11
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. 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.
12
UI - 21453494
AU - Anonymous
TI -
Recruitment of women to clinical trials.
SO - Lancet 2001 Sep 15;358(9285):853
13
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.
14
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.
vvogel@mail.magee.edu
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.
15
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.
16
UI - 20487065
AU - Piver MS
TI -
Insurance policies for prophylactic mastectomy: to cover or not to
cover?
SO - Ann Surg Oncol 2000 Oct;7(9):714
17
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.
18
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. mfoxall@unmc.edu
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.
19
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.
20
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.
raf-vanhoeyweghen@azbrugge.be
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.
21
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. abadawi@unmc.edu
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.
22
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. karen_chalmers@umanitoba.ca
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.
23
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.
24
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. negbert@kent.edu
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.
25
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. petron@ju.edu.jo
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.
26
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.
27
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.
etpisano@med.unc.edu
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.
28
UI - 21454917
AU - Anonymous
TI -
Breast cancer.
SO - N C Med J 2001 Sep-Oct;62(5):275-6
29
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
30
UI - 21461768
AU - Sontheimer DL
TI -
Additional comments on screening mammography.
SO - Am Fam Physician 2001 Sep 15;64(6):922; discussion 924, 927
31
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. riitta.luoto@uta.fi
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.
32
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.
33
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<
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