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NCI CANCERLIT® Search: Screening and Prevention of Breast Cancer - February 2002
National Cancer Institute®
Last Modified: February 1, 2002
Table of Contents
1
UI - 11521793
AU - Olopade OI; Pichert G
TI -
Cancer genetics in oncology practice.
SO - Ann Oncol 2001 Jul;12(7):895-908
AD - University of Chicago Pritzker School of Medicine, Illinois, USA.
folopade@medicine.bsd.uchicago.edu
Cancer is a genetic disease caused by the progressive accumulation of
mutations in critical genes that control cell growth and
differentiation. Completion of the Human Genome Project promises to
revolutionize the practice of Medicine, especially Oncology care. The
tremendous gains in the knowledge of the structure and function of human
genes will surely impact the diagnosis, prognosis and treatment of
cancer. Moreover, it will lead to more effective cancer control through
the use of genetics to quantify individual cancer risks. This article
reviews the current status of genetic testing and counseling for cancer
risk assessment and will suggest a framework for integrating such
counseling into oncology practice.
2
UI - 11815958
AU - Michaelson J; Satija S; Moore R; Weber G; Halpern E; Garland A; Puri D;
TI -
Kopans DB
The pattern of breast cancer screening utilization and its consequences.
SO - Cancer 2002 Jan 1;94(1):37-43
AD - Department of Pathology, Massachusetts General Hospital, Boston,
Massachusetts 02114, USA. michaelj@helix.mgh.harvard.edu
BACKGROUND: The objective of this study was to describe the pattern of
screening utilization and its consequences in terms of tumor size and
time of tumor appearance of invasive breast carcinoma among a population
of women who were examined at a large service screening/diagnostic
program over the last decade. METHODS: Utilization of mammography was
assessed from a population of 59,899 women who received 196,891
mammograms at the Massachusetts General Hospital Breast Imaging Division
from January 1, 1990 to March 1, 1999, among which 604 invasive breast
tumors were found. Two hundred six invasive, clinically detected tumors
also were seen during this period among women who had no record of a
previous mammogram. Additional information was available on screening of
women from March 1, 1999 to June 1, 2001. RESULTS: Fifty percent of the
women who used screening did not begin until the age of 50 years,
although 25% of the invasive breast tumors were found in women age < 50
years. Relatively few of the women who used screening returned promptly
for their annual examinations; by 1.5 years, only 50% had returned.
Approximately 25% of the invasive breast tumors were found in women for
whom there was no record of a previous screening mammogram, and these
tumors were larger (median, 15 mm) than the screen-detected tumors
(median, 10 mm). Approximately 30% of the 604 invasive breast tumors in
the screening population were found on nonmammographic grounds, and they
also were larger (median, 15 mm) than the screen-detected tumors
(median, 10 mm). However, only 3% of these 604 tumors were found by
nonmammographic criteria within 6 months of the previous negative
examination, and only 12% were found within 1 year. By back calculating
the likely size of each of these tumors at the time of the negative
mammogram, it could be seen that most tumors probably emerged as larger,
palpable masses not because they were missed at the previous negative
mammogram, because most were too small then to have been detected, but
because too much time had been allowed to pass. CONCLUSIONS: Far too
many women did not comply with the American Cancer Society
recommendation of prompt annual screening from the age of 40 years.
Consequently, almost 50% of the invasive tumors emerged as larger and,
thus, potentially more lethal, palpable masses. Copyright 2002 American
Cancer Society.
3
UI - 10885351
AU - Meijers-Heijboer EJ; Verhoog LC; Brekelmans CT; Seynaeve C;
TI -
Tilanus-Linthorst MM; Wagner A; Dukel L; Devilee P; van den Ouweland AM;
van Geel AN; Klijn JG
Presymptomatic DNA testing and prophylactic surgery in families with a
BRCA1 or BRCA2 mutation.
SO - Lancet 2000 Jun 10;355(9220):2015-20
AD - Department of Clinical Genetics, Erasmus University, Rotterdam, The
Netherlands.
BACKGROUND: Germline mutations in the BRCA1 and BRCA2 genes highly
predispose to breast and ovarian cancer. In families with BRCA1 or BRCA2
mutations, identification of mutation carriers is clinically relevant in
view of the options for surveillance and prevention. METHODS: We
assessed presymptomatic DNA testing and prophylactic surgery in 53
consecutive families presenting to the Rotterdam Family Cancer Clinic
with a known BRCA1 or BRCA2 mutation. We identified predictors for DNA
testing and prophylactic surgery with univariate and multivariate
analysis. FINDINGS: 682 unaffected individuals with a 50% risk (275
women and 271 men) or with a 25% risk (136 women) for carrying a
mutation were identified and offered a DNA test. Presymptomatic DNA
testing was requested by 48% (198 of 411) of women and 22% (59 of 271)
of men (odds ratio for difference between sexes 3.21 [95% CI 2.27-4.51];
p<0.001). In women, DNA testing was significantly more frequent at young
age, in the presence of children, and at high pre-test genetic risk for
a mutation. Of the unaffected women with an identified mutation who were
eligible for prophylactic surgery, 51% (35 of 68) opted for bilateral
mastectomy and 64% (29 of 45) for oophorectomy. Parenthood was a
predictor for prophylactic mastectomy but not for prophylactic
oophorectomy. Age was significantly associated with prophylactic
oophorectomy, but not with prophylactic mastectomy, although there was a
tendency towards mastectomy at younger ages. INTERPRETATION: In a
clinical setting, we show a high demand for BRCA1 and BRCA2 testing by
unaffected women at risk, and of prophylactic surgery by unaffected
women with the mutation. Young women with children especially opt for
DNA testing and prophylactic mastectomy.
4
UI - 11814067
AU - Smith RA; Cokkinides V; von E; Levin B; Cohen C; Runowicz CD; Sener S;
TI -
Saslow D; Eyre HJ; American Cancer Society
American Cancer Society guidelines for the early detection of cancer.
SO - CA Cancer J Clin 2002 Jan-Feb;52(1):8-22
AD - Cancer Control Department, American Cancer Society, Atlanta, GA, USA.
Each year the American Cancer Society publishes a summary of existing
recommendations for early cancer detection, including updates, and/or
emerging issues that are relevant to screening for cancer. In last
year's article, the guidelines regarding screening for the early
detection of prostate, colorectal, and endometrial cancers were updated,
as was the narrative pertaining to testing for early lung cancer
detection. Although none of the ACS's guidelines were updated in 2001,
work is proceeding on an update of screening recommendations for breast
and cervical cancer and an update of these guidelines will be announced
review recommendations for the "cancer-related check-up," in which
clinical encounters provide case-finding and health counseling
opportunities. Finally, we provide an update of the most recent data
pertaining to participation rates in cancer screening by age, gender,
and ethnicity from the Centers for Disease Control and Prevention's
Behavioral Risk Factor Surveillance System (BRFSS) and National Health
Interview Survey (NHIS).
5
UI - 11209384
AU - Martin H
TI -
Time is of the essence. It took a 'pushy' woman a month to secure a
mammograph privately.
SO - Nurs Stand 2000 Jan 26-Feb 1;14(19):22
6
UI - 11341348
AU - Matson S; Andersson I; Berglund G; Janzon L; Manjer J
TI -
Nonattendance in mammographic 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.
7
UI - 11826460
AU - Levin T; Reichelt J; Heimdal K; Moller P
TI -
[Information to families with hereditary breast and ovarian cancer]
SO - Tidsskr Nor Laegeforen 2001 Nov 20;121(28):3292-4
AD - Seksjon for genetisk veiledning Avdeling for kreftgenetikk Det Norske
Radiumhospital 0310 Oslo. pal.moller@klinmed.uio.no
BACKGROUND: Under Norwegian legislation, persons at risk should make the
initial contact with the proper health personnel, and not vice versa. It
may be argued that the physician should be allowed to make contact with
persons at risk of preventable or curable disorders. MATERIAL AND
METHODS: We identified all first-degree relatives of all 75 BRCA1
mutation carriers diagnosed within a given period of time and asked them
whether or not they had been informed by their relatives. RESULTS: After
two years, 60/63 (95%) adult sisters and daughters had made contact with
us; the remaining three (5%) had been informed. In comparison, 18/45
(40%) adult brothers and sons had contacted us. INTERPRETATION: The
legislation constituted no barrier to offering health services to the
target group. Information on our services had reached all close
relatives who could benefit from them. This may be representative for
curable inherited disorders. We examined inherited cancer limited to
females; similar studies on inherited cancers in males and on other
curable inherited disorders should be performed. Outside the framework
of the present study, we are aware of rare examples of distant cousins
who have not been properly informed through their families. One legally
acceptable way of identifying mutation carrier families is to test all
patients with breast or ovarian cancer for causative mutations. Health
services should be monitored to make future decisions based on empirical
evidence.
8
UI - 11831084
AU - Lynge E
TI -
[Recommendations on cancer screening in the European Union. Advisory
Committee on Cancer Prevention]
SO - Ugeskr Laeger 2002 Jan 7;164(2):176-8
AD - Kobenhavns Universitet, Institut for Folkesundhedsvidenskab.
elsebeth@pubhealth.ku.dk
9
UI - 11831089
AU - Holk IK; Rosdahl N; Pedersen KL
TI -
[Acceptance of mammographic screening by immigrant women]
SO - Ugeskr Laeger 2002 Jan 7;164(2):195-200
AD - Embedslaegeinstitutionen for Kobenhavns, Frederiksberg Kommuner, Henrik
Pontoppidansvej 8, DK-2200 Kobenhavn N.
BACKGROUND: The aim was to investigate compliance by ethnic groups to
the mammography screening programme in the City of Copenhagen over six
years and to look at developments over time. MATERIAL AND METHODS:
charge to all women between 50 and 69 years of age in the City of
Copenhagen. Data on women born in Poland, Turkey, Yugoslavia, and
Pakistan divided into five-year groups were compared to that of women
born in Denmark and all other foreign-born women. Data from 1991 to 1997
were grouped according to the mammography performed, the offer refused,
or non-appearance. RESULTS: Whereas 71% of Danish-born women accepted
mammography, compliance by foreign-born women was significantly lower.
The offer was accepted by 36% of Pakistanis, 45% of Yugoslavians, 53% of
Turks, and 64% of Poles. Compliance fell in all ethnic groups with
advancing age. Of the Danish women, 16% failed to keep the appointment.
The corresponding percentages were 52 for Pakistanis, 48 for
Yugoslavians, 41 for Turks, and 23 for Poles. The proportion of women
who actively refused the offer was similar in all groups. The number of
invited women fell during the period. CONCLUSIONS: The lower
participation of women from the countries under study might have various
explanations: among them the language barrier, procedure-related
factors, and a lower incidence of breast cancer in the countries of
origin.
10
UI - 11795435
AU - Gorin SS; Jacobson J
TI -
Diet and breast cancer surveillance behaviors among Harlem women.
SO - Ann N Y Acad Sci 2001 Dec;952():153-60
AD - Department of Sociomedical Sciences, Mailman School of Public Health of
Columbia University, New York, New York 10032, USA.
The consumption of green, yellow, and other vegetables, fruits and fruit
juices may be protective against breast cancer, and, alongside regular
breast cancer screening, may contribute to ethnic and racial differences
in breast cancer rates. The purpose of this study is to assess the
dietary and sociodemographic predictors of surveillance among Harlem
women, using a population-based household survey. One half of the Harlem
women in this sample consumed no or one fruit or vegetable per day.
Logistic regression analyses revealed that women who consumed more
fruits and vegetables had received more recent mammography, and that
women who were unemployed were less likely to receive recent breast
cancer screening than were those who worked full- or part-time. The high
response rate and the representativeness of the sample are study
strengths. Owing to the small sample size for women between 40-65, the
ages for which screening mammography and clinical breast exam are
recommended, subgroup analyses were limited. Therefore, additional study
of age-adjusted dietary patterns and screening among African American
women is suggested.
11
UI - 11795442
AU - Narod SA
TI -
Hormonal prevention of hereditary breast cancer.
SO - Ann N Y Acad Sci 2001 Dec;952():36-43
AD - The Centre for Research on Women's Health, Women's College Hospital,
University of Toronto, Ontario, Canada. steven.narod@swchsc.on.ca
Women who carry a mutation in the BRCA1 or BRCA2 genes face a lifetime
risk of developing breast cancer that approaches 80%. Among women with
predisposing BRCA mutations, the risk of breast cancer is influenced by
environmental factors and by modifying genes. Through the study of
cohorts of female BRCA1 and BRCA2 carriers, several modifying factors
have been identified. The risk of breast cancer is increased by early
parity and is decreased by breast feeding, by oophorectomy, and by
cigarette smoking. Many of the stragegies for breast cancer prevention
involve estrogen deprivation and it is important to consider the acute
and long-term effects of induced menopause in young women at high risk
for breast cancer. There are no data so far on whether hormonal
replacement therapy is hazardous in carriers of BRCA mutations.
12
UI - 11795443
AU - Fabian CJ; Kimler BF
TI -
Beyond tamoxifen new endpoints for breast cancer chemoprevention, new
drugs for breast cancer prevention.
SO - Ann N Y Acad Sci 2001 Dec;952():44-59
AD - University of Kansas Medical Center, Kansas City 66160-7320, USA.
cfabian@kumc.edu
Although tamoxifen appears to markedly reduce breast cancer risk in
women with a prior diagnosis of atypical hyperplasia or in situ
carcinoma, it is not clear what other groups of women receive
substantial benefit. Major breast chemoprevention priorities are to (1)
develop new agents that (a) have fewer side effects, (b) are effective
in ER--as well as tamoxifen-resistant precancerous tissue, and (c) are
compatible with hormone therapy; and (2) develop efficient clinical
strategies including prognostic and predictive morphologic and molecular
biomarkers. Breast tissue may be repeatedly sampled for evidence of
intraepithelial neoplasia by fine needle aspiration, ductal lavage, or
needle biopsy to select candidates at highest short-term risk as well as
to monitor response in small proof of principle studies prior to a large
cancer incidence trial. Molecular marker expression may also be used to
select a cohort most likely to respond to a particular agent. A large
number of new agents are attractive as potential prevention agents and
some are already in clinical prevention testing. Compounds which should
be effective in ER + precancerous tissue but may have a better
side-effect profile include new selective estrogen receptor modulators
which lack uterine estrogen agonist activity, isoflavones, aromatase
inactivators/inhibitors for postmenopausal women, and
gonadotropin-releasing hormone regimens for premenopausal women.
Retinoids, rexinoids, and deltanoids may be efficacious in ER+ tissue
resistant to tamoxifen. Agents which should theoretically have activity
in ER- or ER+ precancerous tissue include polyamine synthesis
inhibitors, tyrosine kinase inhibitors, combined demethylating agents
and histone deacetylase inhibitors, as well as metalloprotease and
angiogenesis inhibitors. Sample Phase I and Phase II clinical trial
designs are reviewed using modulation of molecular markers and breast
intraepithelial neoplasia as the major endpoints.
13
UI - 11807889
AU - Hughes C; Lerman C; Schwartz M; Peshkin BN; Wenzel L; Narod S; Corio C;
TI -
Tercyak KP; Hanna D; Isaacs C; Main D
All in the family: evaluation of the process and content of sisters'
communication about BRCA1 and BRCA2 genetic test results.
SO - Am J Med Genet 2002 Jan 15;107(2):143-50
AD - Department of Psychiatry, University of Pennsylvania, Philadelphia,
Pennsylvania 19104, USA. chanita@mail.med.upenn.edu
Despite the potential importance of family communication, little is
known about the process and content of communicating BRCA1/2 test
results to relatives. The objectives of this observational study were to
describe the process and content of communicating BRCA1/2 test results
to sisters, and to evaluate whether the proband's carrier status
influenced communication outcomes. Participants were 43 women who were
the first family member to have genetic testing (probands). Probands
reported on communication outcomes for 81 sisters. Process and content
variables were evaluated 1-month after receipt of BRCA1/2 test results
using the Family Communication Questionnaire (FCQ). Overall, BRCA1/2
test results were communicated to 85% of sisters, and carriers
communicated their results to significantly more sisters compared to
uninformative (96% vs. 76%, FET = 0.02). The most important reason for
communicating results was to provide genetic risk information; however,
compared to uninformatives, carriers communicated their results to
significantly more sisters to obtain emotional support (74%) and to get
advice about medical decisions (42%) (FET = 0.001). Carriers also
discussed the possibility of discrimination and recommendations for
cancer management with significantly more sisters. Among sisters to whom
BRCA1/2 test results were not communicated, the most important reason
for not sharing test results was because of emotionally distant
relationships. The results of this study suggest that probands are
likely to quickly communicate their BRCA1/2 test results to relatives
and that although needs for social support may motivate family
communication, emotionally distant relationships may be a barrier to
communication with relatives. Copyright 2001 Wiley-Liss, Inc.
14
UI - 11582606
AU - Lostao L; Joiner TE; Pettit JW; Chorot P; Sandin B
TI -
Health beliefs and illness attitudes as predictors of breast cancer
screening attendance.
SO - Eur J Public Health 2001 Sep;11(3):274-9
AD - Departamento de Sociologia, Sociologia de la Salud, Universidad Publica
de Navarra, Campus de Arrosadia s/n, 31006 Pamplona-Navarra, Spain.
llostao@unavarra.es
BACKGROUND: This paper considers the breast cancer screening programme
in the autonomous community of Navarre, Northern Spain. Women from
different areas of Northern, Central and Southern Navarre are involved.
METHODS: A sample of 512 women participants and 196 non-participants was
taken from a total of 60,908 women between 45 and 65 years of age who
received an invitation to attend the breast cancer screening programme.
The participants were asked to fill in an individual structured
questionnaire in their local Health Centre and the non-participants in
their homes. This was done retrospectively. RESULTS: The response rate
was 100% for participants and 83.9% for non-participants. This study
investigates the attitude profiles of the women attending mammography
mass screening, with non-attending women (matched in educational and
occupational levels) as controls. Subjects were assessed on dimensions
such as attitudes towards health and illness. The results support
Rosenstock's 1974 model that perceived severity of breast cancer and
perceived susceptibility to breast cancer are related to participation
in screening. Furthermore, results demonstrated that hypochondriacal
beliefs, disease phobia and feared effects of symptoms were related to
decreased participation levels. CONCLUSION: This study has explored the
implication of health belief attitudes and the attitudes toward illness
variables with women's participation in a breast cancer screening
programme. It assesses the relative contribution of these variables to
levels of participation, and the results of the study indicate that
belief sets and attitudes are important components of women's cancer
prevention behaviours.
15
UI - 11682322
AU - Surbone A
TI -
Ethical implications of genetic testing for breast cancer
susceptibility.
SO - Crit Rev Oncol Hematol 2001 Nov;40(2):149-57
AD - Department of Medicine, Memorial Sloan-Kettering Cancer Center, New
York, NY, USA. surbonea@aol.com
The identification of gene mutations involved in hereditary breast
cancer is a major recent scientific discovery, enabling us to identify
women at very high risk, and also providing the means to understand the
biology of breast cancer and to explore novel preventive strategies.
Yet, it carries medical, psychological, ethical and social implications.
This paper is a review of all the ethical implications of genetic
testing for breast cancer predisposition, as well as an attempt to
discuss the more philosophical questions of women facing BRCA testing.
To what extent does the individual benefit from genetic knowledge? Some
women look with trepidation upon the potential of planning their life in
view of a risk, while others believe that only through knowledge and
awareness we can improve control of our life. The risk of breast cancer
may be qualitatively so important to justify all the potential risks of
finding out about it.
16
UI - 11720196
AU - Keith LG; Oleszczuk JJ; Laguens M
TI -
Circadian rhythm chaos: a new breast cancer marker.
SO - Int J Fertil Womens Med 2001 Sep-Oct;46(5):238-47
AD - Department of Obstetrics and Gynecology, Northwestern University Medical
School, Chicago, Illinois, USA.
The most disappointing aspect of breast cancer treatment as a public
health issue has been the failure of screening to improve mortality
figures. Since treatment of late-stage cancer has indeed advanced,
mortality can only be decreased by improving the rate of early
diagnosis. From the mid-1950s to the mid-1970s, it was expected that
thermography would hold the key to breast cancer detection, as surface
temperature increases overlying malignant tumors had been demonstrated
by thermographic imaging. Unfortunately, detection of the 1-3 degrees C
thermal differences failed to bear out its promise in early
identification of cancer. In the intervening two-and-a-half decades,
three new factors have emerged: it is now apparent that breast cancer
has a lengthy genesis; a long-established tumor-even one of a certain
minimum size-induces increased arterial/capillary vascularity in its
vicinity; and thermal variations that characterize tissue metabolism are
circadian ("about 24 hours") in periodicity. This paper reviews the
evidence for a connection between disturbances of circadian rhythms and
breast cancer. Furthermore, a scheme is proposed in which circadian
rhythm "chaos" is taken as a signal of high risk for breast cancer even
in the absence of mammographic evidence of neoplasm or a palpable tumor.
Recent studies along this line suggest that an abnormal thermal sign, in
the light of our present knowledge of breast cancer, is ten times as
important an indication as is family history data.
17
UI - 10660790
AU - Han RK; Pimlott N; Heisey R
TI -
Does raloxifene reduce postmenopausal women's risk of breast cancer?
SO - Can Fam Physician 2000 Jan;46():77-80
AD - University of Toronto, Ontario.
18
UI - 10547391
AU - Veronesi U; De Palo G; Marubini E; Costa A; Formelli F; Mariani L;
TI -
Decensi A; Camerini T; Del Turco MR; Di Mauro MG; Muraca MG; Del Vecchio
M; Pinto C; D'Aiuto G; Boni C; Campa T; Magni A; Miceli R; Perloff M;
Malone WF; Sporn MB
Randomized trial of fenretinide to prevent second breast malignancy in
women with early breast cancer.
SO - J Natl Cancer Inst 1999 Nov 3;91(21):1847-56
AD - U. Veronesi, A. Costa, A. Decensi, Istituto Europeo di Oncologia, Milan,
Italy.
BACKGROUND: Fenretinide, a vitamin A analogue, has been shown to inhibit
breast carcinogenesis in preclinical studies. We determined the efficacy
of fenretinide in preventing a second breast malignancy in women with
breast cancer. METHODS: We randomly assigned 2972 women, aged 30-70
years, with surgically removed stage I breast cancer or ductal carcinoma
in situ to receive for 5 years either fenretinide orally (200 mg/day) or
no treatment. The primary end point was the incidence of contralateral
breast cancer or ipsilateral breast cancer 7 years after randomization.
Other end points considered post hoc were the same outcomes stratified
by menopausal status, incidence of distant metastases, overall
mortality, and tumors in other organs. The hazards of breast cancer
occurrence were determined by Cox proportional hazards regression
analysis. Statistical tests were two-sided. RESULTS: At a median
observation time of 97 months, there were no statistically significant
differences in the occurrence of contralateral breast cancer (P =.642)
or ipsilateral breast cancer (P =.177) between the two arms. However, an
interaction was detected between fenretinide treatment and menopausal
status in both outcomes (P for interaction in both outcomes =.045), with
a possible beneficial effect in premenopausal women (contralateral
breast cancer: adjusted hazard ratio [HR] = 0.66, and 95% confidence
interval [CI] = 0.41-1.07; ipsilateral breast cancer: adjusted HR =
0.65, and 95% CI = 0.46-0. 92) and an opposite effect in postmenopausal
women (contralateral breast cancer: adjusted HR = 1.32, and 95% CI =
0.82-2.15; ipsilateral breast cancer: adjusted HR = 1.19, and 95% CI =
0.75-1. 89). There were no statistically significant differences between
the two arms in tumors in other organs, incidence of distant metastasis,
and all-cause mortality. CONCLUSIONS: Fenretinide treatment of women
with breast cancer for 5 years appears to have no statistically
significant effect on the incidence of second breast malignancies
overall, although a possible benefit was detected in premenopausal
women. These studies, particularly the post hoc analyses, are considered
exploratory and need to be confirmed.
19
UI - 10856067
AU - Langman MJ; Cheng KK; Gilman EA; Lancashire RJ
TI -
Effect of anti-inflammatory drugs on overall risk of common cancer:
case-control study in general practice research database.
SO - BMJ 2000 Jun 17;320(7250):1642-6
AD - Department of Medicine University of Birmingham, Birmingham, B15 2TT.
m.j.langman@bham.ac.uk
OBJECTIVE: To examine whether anti-inflammatory drug treatment protects
against the commoner cancers in the United Kingdom. DESIGN: Case-control
study using the general practice research database. SETTING: Practices
throughout United Kingdom providing data to the database. SUBJECTS:
Patients who had a first diagnosis of five gastrointestinal (oesophagus,
stomach, colon, rectum, and pancreas) cancers and four
non-gastrointestinal (bladder, breast, lung, and prostate) cancers in
1993-5 for whom prescription data were available for the at least the
previous 36 months. Each case was matched for age, sex, and general
practice with three controls. MAIN OUTCOME MEASURE: Risk of cancer.
RESULTS: In 12 174 cancer cases and 34 934 controls overall risk of the
nine cancers was not significantly reduced among those who had received
at least seven prescriptions in the 13-36 months before cancer diagnosis
(odds ratio 0.98, 95% confidence interval 0.89 to 1.07). Findings were
nevertheless compatible with protective effects from anti-inflammatory
drugs against cancers of the oesophagus (0.64, 0. 41 to 0.98), stomach
(0.51, 0.33 to 0.79), colon (0.76, 0.58 to 1. 00), and rectum (0.75,
0.49 to 1.14) with dose related trends. The risk of pancreatic cancer
(1.49, 1.02 to 2.18) and prostatic cancer (1.33, 1.07 to1.64) was
increased among patients who had received at least seven prescriptions,
but the trend was dose related for only pancreatic cancer. CONCLUSIONS:
Anti-inflammatory drugs may protect against oesophageal and gastric
cancer as well as colon and rectal cancer. The increased risks of
pancreatic and prostatic cancer could be due to chance or to undetected
biases and warrant further investigation.
20
UI - 11556533
AU - Masood S
TI -
Expanding role of breast cytopathology as a risk predictor.
SO - Adv Anat Pathol 2001 Sep;8(5):255-63
AD - Department of Pathology, University of Florida Health Science
Center/Jacksonville, USA.
21
UI - 11567694
AU - Anonymous
TI -
Recruitment of women to clinical trials.
SO - Lancet 2001 Sep 15;358(9285):853
22
UI - 11567707
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.
23
UI - 11794886
AU - Cortet B
TI -
[What do we think about selective estrogen receptor modulators?]
SO - Rev Med Interne 2001 Dec;22(12):1173-6
24
UI - 11809281
AU - Benson JR
TI -
Recruitment of women into trials.
SO - Lancet 2002 Jan 12;359(9301):164
25
UI - 11809284
AU - Thornton H; Dixon-Woods M
TI -
Recruitment of women into trials.
SO - Lancet 2002 Jan 12;359(9301):164-5
26
UI - 11816234
AU - Barron-Gonzalez A; Arias-Martinez J; Castro-Romero I
TI -
[Antiestrogens: mechanism of action and clinical applications]
SO - Salud Publica Mex 2001 Nov-Dec;43(6):577-84
AD - Departamento de Bioquimica y Biologia Molecular, Instituto Nacional de
Perinatologia, Secretaria de Salud, Mexico, D.F., Mexico.
Antiestrogens are compounds that inhibit estrogen action by competing
for its receptors. Estrogens are involved in the proliferation and
differentiation of target cells and are among the main risk factors for
breast and uterine cancer. Some antiestrogens, such as Tamoxifen, are
used as adjuvant therapy against breast cancer, and have been proposed
to be included in prevention programs for women at high risk of cancer.
Antiestrogens are classified according to their action mechanisms into
Type I or partial (agonistic/antagonistic), and Type II or pure (pure
antagonistic). Advancements in the development of new antiestrogens and
their clinical importance are reviewed in this paper, as well as their
mechanism of action and clinical applications.
27
UI - 11758873
AU - Rowland JH; Varricchio CG; Trimble EL; Gore-Langton RE
TI -
Clinical trials referral resource. Health-Related quality of life in
cancer prevention clinical trials.
SO - Oncology (Huntingt) 2001 Nov;15(11):1455, 1458-9
AD - National Cancer Institute, USA.
28
UI - 11749095
AU - Valanis BG; Glasgow RE; Mullooly J; Vogt TM; Whitlock EP; Boles SM;
TI -
Smith KS; Kimes TM
Screening HMO women overdue for both mammograms and pap tests.
SO - Prev Med 2002 Jan;34(1):40-50
AD - Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
97227, USA. Barbara.Valanis@KPCHR.org
BACKGROUND: Regular screening has the potential to reduce breast and
cervical cancer mortality, but despite health plan programs to encourage
screening, many women remain unscreened. Tailored communications have
been identified as a promising approach to promote mammography and Pap
test screening. METHODS: The study used a four-group randomized design
to compare with Usual Care the separate and combined effects of two
tailored, motivational interventions to increase screening-a clinical
office In-reach intervention and a sequential letter/telephone Outreach
intervention. Subjects were 510 female HMO members ages 52-69 who had
had no mammogram in the past 2 years and no Pap smear in the past 3
years. Primary outcomes were the percentage of women in each condition
who received a mammogram, a Pap smear, or both screening tests during
the 14-month study period. RESULTS: Thirty-two percent of the Combined
group, 39% of the Outreach group, and 26% of the In-reach group obtained
both services versus 19% of Usual Care participants. Overall, compared
with Usual Care, both Outreach (P = 0.006) and Combined (P = 0.05)
screened significantly more women. For subjects ages 65-69, Outreach
rates were lower than those of Usual Care. CONCLUSION: A tailored
letter-telephone Outreach appears to be more effective at screening
women ages 52-64 than a tailored office-based intervention, in large
part because most In-reach women did not have clinic visits at which to
receive the intervention. Copyright 2002 American Health Foundation and
Elsevier Science.
29
UI - 11749101
AU - Stoddard AM; Fox SA; Costanza ME; Lane DS; Andersen MR; Urban N; Lipkus
TI -
I; Rimer BK; NCI Breast Screening Consortium
Effectiveness of telephone counseling for mammography: results from five
randomized trials.
SO - Prev Med 2002 Jan;34(1):90-9
AD - University of Massachusetts, Amherst, Massachusetts 01003, USA.
stoddard@schoolph.umass.edu
BACKGROUND: Women over age 50 continue to be underscreened for breast
cancer. The purpose of this report is to compare the effectiveness of a
barrier-specific telephone counseling intervention across the five study
sites of the Breast Cancer Screening Consortium (BCSC). METHODS: Each of
the BCSC projects was a randomized study of the effectiveness of
telephone counseling (TC) in comparison to a control condition. Eligible
underusers were identified and surveyed by telephone before and after
the implementation of the interventions. Data from a total of 3,461
underusers were analyzed. We tested whether significantly more women
randomized to TC than to control were regular mammography users at the
follow-up survey. Data were analyzed separately by site. RESULTS:
Overall, TC was not significantly more effective than control in
encouraging regular mammography. The pooled consortium-wide odds ratio
was 1.08 (95% confidence interval: 0.91 to 1.27). CONCLUSIONS: TC has
the potential to support maintenance of mammogram use. Modifications are
needed to maximize this potential and additional methods should be used
in conjunction with TC to reach women who are underusers of mammography.
Copyright 2002 American Health Foundation and Elsevier Science.
30
UI - 11795342
AU - Powles TJ
TI -
The Royal Marsden Hospital (RMH) trial: key points and remaining
questions.
SO - Ann N Y Acad Sci 2001 Dec;949():109-12
AD - Royal Marsden Hospital, Sutton Surrey, United Kingdom.
trevor.powles@rmh.nthames.nhs.uk
The reported interim analysis of the Royal Marsden chemoprevention
trial, giving tamoxifen (20 mg/day) for up to 8 years to healthy women
at increased risk of breast cancer because of a family history, has
failed to confirm the 49% reduction in overall early incidence of breast
cancer reported from the National Surgical Adjuvant Breast and Bowel
Project (NSABP) P-1 trial. Although statistically compatible, this
discrepancy in results raises the possibility that the sensitivity to
tamoxifen chemoprevention may depend on the population characteristics
of the participants in the two trials. Younger women who do not have
lobular carcinoma in situ or atypical ductal hyperplasia, or who may be
at high risk of carrying a breast cancer predisposing gene, may be
relatively resistant to tamoxifen chemoprevention. Furthermore, the
clinical benefit of a reduction in the early incidence of breast cancer
by using tamoxifen in healthy women has not been clearly established by
the P-1 trial because of the lack of mortality data. Use of tamoxifen
for risk reduction in healthy women needs to take into account these
factors, and more information needs to be gained from the continuing
placebo-controlled trials that are under way.
31
UI - 11795343
AU - Guerrieri-Gonzaga A; Galli A; Rotmensz N; Decensi A
TI -
The Italian breast cancer prevention trial with tamoxifen: findings and
new perspectives.
SO - Ann N Y Acad Sci 2001 Dec;949():113-22
AD - Division of Chemoprevention, European Institute of Oncology, Milan,
Italy.
The Italian Tamoxifen Prevention Study includes 5408 healthy
hysterectomized women aged 35-70 years who have been randomized to 20
mg/day of tamoxifen or placebo for 5 years. After 46 months median
follow-up, an increased risk of venous vascular events (38 women on
tamoxifen vs. 18 women on placebo, P = 0.0053), mainly consisting of
superficial phlebitis, has been observed and 41 breast cancers have
occurred (19 on tamoxifen vs. 22 on placebo, P = 0.64). However,
subgroup analyses indicated a borderline significant reduction of breast
cancer among women continuously on estrogen replacement therapy (ERT,
mostly transdermal) and receiving tamoxifen, with 8 cases of breast
cancer among 390 ERT users on placebo versus 1 case among 362 ERT users
on tamoxifen (RR = 0.13, 95% CI = 0.02-1.02). Withdrawal rate (mainly
due to menopausal symptoms) differed according to ERT use, with
compliance being 78% and 75% at 3 and 5 years, respectively, for women
who never took ERT, and 92% and 88% at 3 and 5 years, respectively, for
women not on ERT at baseline, but who took ERT at some time during the
trial. Pharmacokinetic and pharmacodynamic (surrogate end point
biomarkers) studies showed that a lower dose of tamoxifen (such as 5
mg/day) does not affect the drug's activity on several biomarkers of
both cardiovascular and breast cancer risk. We are therefore planning a
multicenter placebo-controlled phase III trial in postmenopausal healthy
women on hormone replacement therapy (HRT) to test whether the
combination of HRT and low-dose tamoxifen retains the benefits while
reducing the risks of either agent maintaining a high compliance rate.
32
UI - 11795344
AU - Cuzick J; International Breast Cancer Intervention Study
TI -
A brief review of the International Breast Cancer Intervention Study
(IBIS), the other current breast cancer prevention trials, and proposals
for future trials.
SO - Ann N Y Acad Sci 2001 Dec;949():123-33
AD - Department of Mathematics, Statistics, and Epidemiology, Imperial Cancer
Research Fund, London, United Kingdom. j.cuzick@icrf.icnet.uk
The available results from breast cancer chemoprevention trials are
reviewed. Four trials using tamoxifen have been performed, of which
three have reported efficacy results. A fifth trial using raloxifene has
also been published. The largest tamoxifen trial shows approximately a
50% reduction in breast cancer incidence in the short term, but the two
smaller trials have not found any incidence reduction. Greater agreement
exists for side effects: thromboembolic disease and endometrial cancers
are raised about 2- to 3-fold when tamoxifen is used for 5 years. The
possible reasons for the discrepancy in breast cancer reduction are
explored. A review of trial parameters does not clearly explain this
difference, and a metanalysis indicates that all results are compatible
with a 42% reduction in short-term incidence. Several important
questions remain about the clinical implication of this result,
including the effect on mortality, the appropriate risk groups for
chemoprevention, and the long-term effects on incidence. Continued
follow-up of these trials is crucial for resolving these issues.
33
UI - 11795345
AU - Dickler MN; Norton L
TI -
The MORE trial: multiple outcomes for raloxifene evaluation--breast
cancer as a secondary end point: implications for prevention.
SO - Ann N Y Acad Sci 2001 Dec;949():134-42
AD - Department of Medicine, Memorial Sloan-Kettering Cancer Center, New
York, New York 10021, USA.
Breast cancer is a common disease in the United States and Europe and is
therefore a major target for prevention strategies. Estrogen plays a
central role in its pathogenesis, and treatment with estrogen
deprivation has long been recognized to be an effective therapy.
Tamoxifen is the first selective estrogen receptor modulator (SERM) to
be widely used for the treatment of breast cancer and has been
demonstrated to reduce the risk of breast cancer in high-risk women.
Raloxifene is a second-generation SERM that has estrogenic effects on
bone and lipid metabolism, and antiestrogenic effects on breast tissue.
Unlike tamoxifen, raloxifene displays antiestrogenic effects on the
endometrium and may serve as a safer alternative to tamoxifen in the
prevention setting. The MORE trial is a multicenter randomized
placebo-controlled trial designed to determine whether 3 years of
raloxifene reduces the risk of fracture in postmenopausal women with
osteoporosis. As a secondary end point of the trial, raloxifene was
shown to reduce the risk of both in situ and invasive breast cancer by
65% (RR = 0.35; 95% CI = 0.21-0.58; P < 0.001). The benefits were most
significant in women who developed estrogen receptor (ER)-positive
cancers, with a relative risk of 0.10 (95% CI = 0.04-0.24). This reduced
incidence of breast cancer may be due to an anticarcinogenic effect or
to a slowing of growth of occult ER-positive cancer, with a shift to the
right in the time-to-cancer curve. A second large-scale prevention trial
in breast cancer comparing tamoxifen to raloxifene is presently
enrolling cancer-free, but high-risk postmenopausal women (the STAR
trial). Future directions include combined estrogen blockade of the
breast by the addition of an aromatase inhibitor to a SERM. New trial
designs, including those based on biochemical changes at the tissue
level, will be required to allow future progress in this field with
adequate rapidity.
34
UI - 11795346
AU - Day R; National Surgical Adjuvant Breast and Bowel Projet P-1 study
TI -
(NSABP-1)
Quality of life and tamoxifen in a breast cancer prevention trial: a
summary of findings from the NSABP P-1 study. National Surgical Adjuvant
Breast and Bowel Project.
SO - Ann N Y Acad Sci 2001 Dec;949():143-50
AD - Department of Biostatistics, Graduate School of Public Health,
University of Pittsburgh, Pennsylvania 15213, USA. day@nsabp.pitt.edu
This report contains a brief summary of the health-related quality of
life findings for 11,064 women taking part in the National Surgical
Adjuvant Breast and Bowel Project's P-1 trial. Women taking part in this
trial of tamoxifen versus placebo for breast cancer prevention were > or
= 35 years old and predominantly white, well educated, and middle class,
with a strong professional and technical orientation. Key findings
included a lack of difference between the tamoxifen and placebo arms
with regard to depression, overall physical or mental quality of life,
and weight gain. The tamoxifen arm did show consistent increases in
vasomotor (hot flashes) and gynecological (vaginal discharge) symptoms,
as well as difficulties in certain domains of sexual functioning. It is
concluded that an informed discussion with a woman considering tamoxifen
therapy should include these points in the risk-benefit discussion.
35
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