National Cancer Institute®
Last Modified: February 1, 2002
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. email@example.com
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.
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. firstname.lastname@example.org
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.
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.
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).
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.
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. email@example.com
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.
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. firstname.lastname@example.org
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.
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.
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. email@example.com
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.
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. firstname.lastname@example.org
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.
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. email@example.com
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.
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. firstname.lastname@example.org
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.
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. email@example.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.
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.
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.
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.
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. firstname.lastname@example.org
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.
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.
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.
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.
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.
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.
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. email@example.com
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.
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. firstname.lastname@example.org
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.
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.
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. email@example.com
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.
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.
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. firstname.lastname@example.org
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.