National Cancer Institute®
Last Modified: July 1, 2002
UI - 10094000
AU - Eisinger F; Geller G; Burke W; Holtzman NA
TI - Cultural basis for differences between US and French clinical recommendations for women at increased risk of breast and ovarian cancer.
SO - Lancet 1999 Mar 13;353(9156):919-20
AD - Department of Cancer Control and INSERM CRI 9703, Paoli-Calmettes Institute, Marseille, France.
UI - 10371567
AU - Alexander FE; Anderson TJ; Brown HK; Forrest AP; Hepburn W; Kirkpatrick
TI - AE; Muir BB; Prescott RJ; Smith A 14 years of follow-up from the Edinburgh randomised trial of breast-cancer screening.
SO - Lancet 1999 Jun 5;353(9168):1903-8
AD - Department of Community Health Sciences, University of Edinburgh, UK. firstname.lastname@example.org
BACKGROUND: The Edinburgh randomised trial of breast-cancer screening recruited women aged 45-64 years from 1978 to 1981 (cohort 1), and those aged 45-49 years during 1982-85 (cohorts 2 and 3). Results based on 14 years of follow-up and 270,000 woman-years of observation are reported. METHODS: Breast-cancer mortality rates in the intervention group (28,628 women offered screening) were compared with those in the control group (26,026) with adjustment for socioeconomic status (SES) of general medical practices. Rate ratios were derived by means of logistic regression for the total trial population and for women first offered screening while younger than 50 years. Analyses were by intention to treat. FINDINGS: Initial unadjusted results showed a difference of just 13% in breast-cancer mortality rates between the intervention and control groups (156 deaths [5.18 per 10,000] vs 167 [6.04 per 10,000]; rate ratio 0.87 [95% CI 0.70-1.06]), but the results were influenced by differences in SES by trial group. After adjustment for SES, the rate ratio was 0.79 (95% CI 0.60-1.02). When deaths after diagnosis more than 3 years after the end of the study were censored the rate ratio became 0.71 (0.53-0.95). There was no evidence of heterogeneity by age at entry and no evidence that younger entrants had smaller or delayed benefit (rate ratio 0.70 [0.41-1.20]). No breast-cancer mortality benefit was observed for women whose breast cancers were diagnosed when they were younger than 50 years. Other-cause mortality rates did not differ by trial group when adjusted for SES. INTERPRETATION: Our findings confirm results from randomised trials in Sweden and the USA that screening for breast cancer lowers breast-cancer mortality. Similar results are reported by the UK geographical comparison, UK Trial of Early Detection of Breast Cancer. The results for younger women suggest benefit from introduction of screening before 50 years of age.
UI - 11535704
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. email@example.com
Risk-reduction mastectomy (RRM), also known as bilateral prophylactic mastectomy, is a controversial clinical option for women who are at increased risk of breast cancer. High-risk women, including women with a strong family history of breast cancer and BRCA1/2 mutation carriers, have several clinical options: risk-reduction surgery (bilateral mastectomy and bilateral oophorectomy), surveillance (mammography, clinical breast examination, and breast self-examination), and chemoprevention (tamoxifen). We review research in a number of areas central to our understanding of RRM, including recent data on 1) the effectiveness of RRM in reducing breast cancer risk, 2) the perception of RRM among women at increased risk and health-care providers, 3) the decision-making process for follow-up care of women at high risk, and 4) satisfaction and psychological status after surgery. We suggest areas of future research to better guide high-risk women and their health-care providers in the decision-making process.
UI - 11784651
AU - Miller AB
TI - Screening for breast cancer with mammography.
SO - Lancet 2001 Dec 22-29;358(9299):2164; discussion 2167-8
UI - 11784653
AU - Thornton H
TI - Screening for breast cancer with mammography.
SO - Lancet 2001 Dec 22-29;358(9299):2165; discussion 2167-8
UI - 11784654
AU - Senn S
TI - Screening for breast cancer with mammography.
SO - Lancet 2001 Dec 22-29;358(9299):2165; discussion 2167-8
UI - 11784657
AU - Dixon-Woods M; Baum M; Kurinczuk JJ
TI - Screening for breast cancer with mammography.
SO - Lancet 2001 Dec 22-29;358(9299):2166-7; discussion 2167-8
UI - 11784655
AU - Duffy SW; Tabar L; Smith RA
TI - Screening for breast cancer with mammography.
SO - Lancet 2001 Dec 22-29;358(9299):2166; discussion 2167-8
UI - 11784656
AU - Vaidya JS
TI - Screening for breast cancer with mammography.
SO - Lancet 2001 Dec 22-29;358(9299):2166; discussion 2167-8
UI - 11854394
AU - Evans DG; Howell A; Baildam A; Brain A; Lalloo F; Hopwood P
TI - Re: risk-reduction mastectomy: clinical issues and research needs.
SO - J Natl Cancer Inst 2002 Feb 20;94(4):307-8
UI - 12058158
AU - Kinney AY; Emery G; Dudley WN; Croyle RT
TI - Screening behaviors among African American women at high risk for breast cancer: do beliefs about god matter?
SO - Oncol Nurs Forum 2002 Jun;29(5):835-43
AD - College of Nursing, The Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA. firstname.lastname@example.org
PURPOSE/OBJECTIVES: To examine the relationship between beliefs about God as a controlling force in health and adherence to breast cancer screening among high-risk African American women. DESIGN: Cross-sectional cohort. SETTING: In-person interviews in rural, southeastern Louisiana and telephone interviews conducted at the University of Utah. SAMPLE: 52 females who were members of a large kindred with a BRCA1 mutation; no subjects had breast cancer. METHODS: Survey through in-person or telephone interviews. MAIN RESEARCH VARIABLES: Belief in God as a controlling agent over health measured by the God Locus of Health Control (GLHC) scale; screening behaviors measured by self-report. Adherence was based on consensus-approved recommendations for BRCA1 carriers or women at risk of being carriers. FINDINGS: Bivariate analysis indicated that presence of a primary care provider and low GLHC scores were associated with seeking clinical breast examination (CBE) and mammography. With the variable "presence of a primary care provider" excluded, GLHC scores were inversely associated with seeking CBE and mammography. CONCLUSIONS: African American women at increased risk for breast cancer and with high GLHC scores may have a decreased inclination to adhere to CBE and mammography recommendations. IMPLICATIONS FOR NURSING: Assessing religious and spiritual beliefs and incorporating belief systems into education and counseling sessions may improve understanding and acceptance of presented material.
UI - 12058159
AU - Katapodi MC; Facione NC; Miaskowski C; Dodd MJ; Waters C
TI - The influence of social support on breast cancer screening in a multicultural community sample.
SO - Oncol Nurs Forum 2002 Jun;29(5):845-52
AD - Department of Physiological Nursing, University of California, San Francisco, CA, USA. email@example.com
PURPOSE/OBJECTIVES: To examine the relationship between women's reported social support and their adherence to recommended breast cancer screening guidelines. DESIGN: Descriptive, cross-sectional survey. SETTING: Community women's organizations throughout the San Francisco Bay Area. SAMPLE: 833 mostly low-income women with a mean age of 46.2 years from three racial or ethnic groups (i.e., Latina, Caucasian, and African American) who were not breast cancer survivors. METHODS: Social support was measured with a five-item, four-point, Likert scale developed for the study (Cronbach's alpha = 0.7248). Adherence to screening guidelines was measured by asking frequency of performing breast self-examination (BSE) and frequency of obtaining a clinical breast examination (CBE) and a mammogram. Research assistants and leaders of women's organizations conducted the survey in work and community settings. MAIN RESEARCH VARIABLES: Social support, performance of BSE, obtaining a CBE and a mammogram, income, education, spoken language, and level of acculturation. FINDINGS: Higher levels of social support were related to higher income and higher education. Lower levels of social support were associated with being Latina, completing the survey in Spanish, and being born abroad. Women who did not adhere to screening guidelines (for BSE or CBE) reported less social support. CONCLUSIONS: Social support is associated with adherence to breast cancer screening guidelines. IMPLICATIONS FOR NURSING: Nurses should assess women's levels of social support as a factor when evaluating adherence to breast cancer screening guidelines.
UI - 12063676
AU - Hayes DF; Thor AD
TI - c-erbB-2 in breast cancer: development of a clinically useful marker.
SO - Semin Oncol 2002 Jun;29(3):231-45
AD - University of Michigan Comprehensive Cancer Center, Department of Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA.
c-erbB-2 amplification and/or overexpression occurs in 20% to 30% of breast cancers and appear to be associated with a more aggressive phenotype. Detecting abnormalities in c-erbB-2 might provide important clinical information for breast cancer patients. However, several of the potential clinical uses of c-erbB-2 remain unproven. Many variables influence c-erbB-2 results, including selection and characteristics of test populations and methods of analysis. Current literature suggests two roles for c-erbB-2, either as a pure prognostic factor with no association with therapy or as a factor predictive of benefit from specific types of systemic treatments. c-erbB-2 appears to be only a weak prognostic factor, although some individual studies suggest greater prognostic importance. c-erbB-2 abnormalities appear to predict for relative, but not absolute, resistance to endocrine therapy in estrogen receptor (ER)-positive women. When adjuvant chemotherapy is indicated, some studies have indicated that patients with c-erbB-2-positive cancers (by immunohistochemistry [IHC] or fluoresence in situ hybridization [FISH]) receive more benefit from anthracycline-containing regimens as compared to alkylating agents. c-erbB-2 testing appears critical for selecting patients with metastatic disease who should receive the anti-c-erbB-2 antibody, trastuzumab. Prospective randomized clinical trials of trastuzumab as adjuvant therapy are underway. Well-designed, prospective, randomized clinical trials (designed to test the value of c-erbB-2) or formal meta-analyses will help to better establish the predictive role of c-erbB-2 in breast cancer. Copyright 2002, Elsevier Science (USA). All rights reserved.
UI - 12082787
AU - von Schoultz E
TI - [Can serum estradiol predict the effect of raloxifene on breast cancer risk?]
SO - Lakartidningen 2002 May 2;99(18):2068
AD - Brostenheten, Radiumhemmet, Karolinska sjukhuset, Stockholm. firstname.lastname@example.org
UI - 12027268
AU - McCaul KD; Wold KS
TI - The effects of mailed reminders and tailored messages on mammography screening.
SO - J Community Health 2002 Jun;27(3):181-90
AD - University of Colorado Cancer Center, Division of Cancer Prevention and Control, USA.
A mail campaign to promote mammography screening was tested with 3,887 Medicare recipients in North Dakota who had not had a mammogram in 2 1/2 years. Three types of mailings were compared: (1) a simple reminder message, (2) a reminder accompanied by a persuasive communication emphasizing personal risk, and (3) a reminder accompanied by a message tailored to the participants' chief barrier to having a mammogram. Overall, subsequent mammography rates for women in these conditions did not differ from the rate observed among women who did not receive any mailing. However, post-hoc analyses suggested that women who reported a barrier to having a mammogram were more likely to have a mammogram. Population-wide mail campaigns of the kinds tested here may be generally ineffective for Medicare recipients who are obtaining screenings infrequently. Tailoring messages may be one potentially effective intervention, if investigators can develop ways to increase responses to inquiries about barriers.
UI - 11899367
AU - Mahon SM
TI - Cancer prevention and early detection.
SO - Clin J Oncol Nurs 2001 May-Jun;5(3):105-7
AD - email@example.com
Advances in the area of cancer prevention and early detection are being made constantly. Basic epidemiologic research continues to provide insight into the impact of carcinogen exposure and the development of cancer. It is exciting to note that the study of Tamoxifen and Raloxifene chemoprevention trial is successfully recruiting women, including minority women, to participate. This large chemoprevention trial is providing much insight into how to recruit and retain women to take a chemoprevention agent to ultimately prevent the development of cancer. Advances also are being made in the knowledge base of how to best detect cancer in asymptomatic people. The best screening tool recommendation for the early detection of colorectal cancer remains controversial. Screening for colorectal cancer, however, is the only way to ultimately decrease the morbidity and mortality associated with the disease. Oncology nurses need to accurately risk for colorectal cancer and provide patients with the necessary information to make an informed choice about the most appropriate screening for their situation. Oncology nurses need to be familiar with new research and advances in cancer prevention and early detection so they can share information with patients and their families.
UI - 11899370
AU - Mahon SM
TI - Factors affecting genetic testing and decisions about prophylactic surgery.
SO - Clin J Oncol Nurs 2001 May-Jun;5(3):117-20
AD - St. Louis University, Division of Hematology/Oncology, St. Louis, MO, USA.
Both of the articles reviewed here as well as the references, suggest that very little is actually known about the impact of many aspects of genetic testing. How decision are made about genetic testing in people who do not have cancer, how the results of testing are used used to guide care, and ultimately how people adjust to prophylactic surgery, which is the most effective form of prevention currently available to those who do have a mutation are not completely clear. This has many implications for practice in general. Oncology nurses who build relationships with those diagnosed with cancer and their families may be one of the best groups of professionals to provide the education and counseling individuals and families need prior to making any decision about genetic testing. Just as many responses to cancer exist, so do many responses to finding out the results of mutation status. Oncology nurses are challenged to help facilitate adjustment to learning that one carries a mutation that significantly increases risk of developing cancer. More nursing research needs to be conducted on how to facilitate this adjustment. Dealing with the unknown can be a frightening experience. Little is known about the long-term effectiveness of prophylactic mastectomy and oophorectomy in unaffected mutation-positive individuals. Most of what is known is based on retrospective review. Nurses are challenged to interpret this information, along with its inherent strengths and weaknesses, to individuals so they can make the best possible decisions. The psychosocial needs of those who undergo prophylactic surgery are not clearly understood. Surgery can have many psychological outcomes, and how individuals adjust to these changes is not clear. More nursing research is needed not only to understand these needs but also to design interventions to facilitate and improve adjustment to not only the information that one is mutation positive but also to prophylactic surgery. People who do not have cancer but have a high risk for cancer because of their genetic background need comprehensive and consistent care by knowledgeable healthcare providers. Although these individuals have not been diagnosed with cancer, they have complex psychosocial needs related to their family history and the decisions being made about prevention strategies. Oncology nurses can help fill this gap in care and provide the necessary support these individuals need.
UI - 12090973
AU - Ravdin P
TI - Aromatase inhibitors for the endocrine adjuvant treatment of breast cancer.
SO - Lancet 2002 Jun 22;359(9324):2126-7
AD - Department of Medical Oncology, University of Texas Health Science Center, San Antonio, TX 98284-7884, USA. firstname.lastname@example.org
UI - 12090977
AU - The ATAC Trialists' Group. Arimidex, tamoxifen alone or in combination.
TI - Anastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early breast cancer: first results of the ATAC randomised trial.
SO - Lancet 2002 Jun 22;359(9324):2131-9
BACKGROUND: In the adjuvant setting, tamoxifen is the established treatment for postmenopausal women with hormone-sensitive breast cancer. However, it is associated with several side-effects including endometrial cancer and thromboembolic disorders. We aimed to compare the safety and efficacy outcomes of tamoxifen with those of anastrozole alone and the combination of anastrozole plus tamoxifen for 5 years. METHODS: Participants were postmenopausal patients with invasive operable breast cancer who had completed primary therapy and were eligible to receive adjuvant hormonal therapy. The primary endpoints were disease-free survival and occurrence of adverse events. Analysis for efficacy was by intention to treat. FINDINGS: 9366 patients were recruited, of whom 3125 were randomly assigned anastrozole, 3116 tamoxifen, and 3125 combination. Median follow-up was 33.3 months. 7839 (84%) patients were known to be hormone-receptor-positive. Disease-free survival at 3 years was 89.4% on anastrozole and 87.4% on tamoxifen (hazard ratio 0.83 [95% CI 0.71-0.96], p=0.013). Results with the combination were not significantly different from those with tamoxifen alone (87.2%, 1.02 [0.89-1.18], p=0.8). The improvement in disease-free survival with anastrozole was seen in the subgroup of hormone-receptor-positive patients, but not the receptor-negative patients. Incidence of contralateral breast cancer was significantly lower with anastrozole than with tamoxifen (odds ratio 0.42 [0.22-0.79], p=0.007). Anastrozole was significantly better tolerated than tamoxifen with respect to endometrial cancer (p=0.02), vaginal bleeding and discharge (p<0.0001 for both), cerebrovascular events (p=0.0006), venous thromboembolic events (p=0.0006), and hot flushes (p<0.0001). Tamoxifen was significantly better tolerated than anastrozole with respect to musculoskeletal disorders and fractures (p<0.0001 for both). INTERPRETATION: Anastrozole is an effective and well tolerated endocrine option for the treatment of postmenopausal patients with hormone-sensitive early breast cancer. Longer follow-up is required before a final benefit:risk assessment can be made.
UI - 12093267
AU - Anonymous
TI - Summaries for patients. Using medication to prevent breast cancer: recommendations from the United States Preventive Services Task Force.
SO - Ann Intern Med 2002 Jul 2;137(1):I62
UI - 11850580
AU - Yoo KY; Kang D; Park SK; Kim SU; Kim SU; Shin A; Yoon H; Ahn SH; Noh DY;
TI - Choe KJ Epidemiology of breast cancer in Korea: occurrence, high-risk groups, and prevention.
SO - J Korean Med Sci 2002 Feb;17(1):1-6
AD - Department of Preventive Medicine, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-799, Korea. email@example.com
Breast cancer ranks second or third to uterine cervix cancer and stomach cancer as a cause of death in women, and as a common site of primary cancer. The large difference in its incidence between Westernized and non-Westernized countries is remarkable. There is a linear increase with age that is observed in Western countries, which are high-incidence areas, on the contrary to the inverted V shape curve seen in Asian countries. Epidemiologic studies conducted in Korea have shown that an older age, a family history of breast cancer, early menarche, late menopause, late full-term pregnancy, and never having had a breast-fed child are primary risk factors in the development of breast cancer. The estrogen-augmented-by-progesterone hypothesis explains the roles of these factors to some extent. On the other hand, recent molecular studies have revealed the existence of novel gene environmental interactions. Epidemiological features suggest that the breast cancer incidence rate in Korea will increase, but the age specific curve would not be changed in keeping with what is observed in Western countries. Strategies aimed at controlling breast cancer that include the screening guidelines and the identification of individual predispositions may give us further insights into both the etiology and the prevention of breast cancer.
UI - 11965197
AU - Friedenson B
TI - A current perspective on genetic testing for breast and ovarian cancer: the oral contraceptive decision.
SO - MedGenMed 2001 Nov 2;3(6):2
AD - Department of Biochemistry and Molecular Biology at the University of Illinois at Chicago, Chicago, Illinois, USA. molmeddoc@Yahoo.com.
A clinician faces a problem in how best to counsel the woman with a family history of breast or ovarian cancer about her options for pregnancy prevention. The physician must guide her as she makes new and complex decisions. Recent data strongly support an amplified effect of the estrogens in oral contraceptives for the woman with a genetic risk for breast cancer. Nonetheless, a woman's immediate need to prevent pregnancy may be much more important to her than worrying about the long-term risk of breast cancer. Another factor is that oral contraceptives prevent ovarian cancer, so the physician may wish to prescribe them to protect her from ovarian cancer. In some genetic backgrounds, however, oral contraceptives not only do not prevent ovarian cancer, but they may raise the risk of breast cancer so significantly that they should not be taken. With other genetic backgrounds, oral contraceptives will protect the woman from ovarian cancer without much effect on her breast cancer risk. When does each of these cancer risks or benefits become significant? The clinician can provide an important benefit to a woman who must prevent pregnancy yet worries about her cancer risk. The physician can help her evaluate the evidence, with its gaps and uncertainties, in the context of her own preferences. To assist in this evaluation, this decision aid provides base-line estimates of the cancer risk that accompanies each of a woman's options. In some cases, genetic testing is likely to provide valuable information as she makes choices about contraception and the risks vs. benefits of different alternatives available to her.
UI - 12033810
AU - Rimando AM; Cuendet M; Desmarchelier C; Mehta RG; Pezzuto JM; Duke SO
TI - Cancer chemopreventive and antioxidant activities of pterostilbene, a naturally occurring analogue of resveratrol.
SO - J Agric Food Chem 2002 Jun 5;50(12):3453-7
AD - Natural Products Utilization Research Unit, Agricultural Research Service, U.S. Department of Agriculture, P.O. Box 8048, University, Mississippi 38677, USA. firstname.lastname@example.org
Pterostilbene, a natural methoxylated analogue of resveratrol, was evaluated for antioxidative potential. The peroxyl-radical scavenging activity of pterostilbene was the same as that of resveratrol, having total reactive antioxidant potentials of 237 +/- 58 and 253 +/- 53 microM, respectively. Both compounds were found to be more effective than Trolox as free radical scavengers. Using a plant system, pterostilbene also was shown to be as effective as resveratrol in inhibiting electrolyte leakage caused by herbicide-induced oxidative damage, and both compounds had the same activity as alpha-tocopherol. Pterostilbene showed moderate inhibition (IC50 = 19.8 microM) of cyclooxygenase (COX)-1, and was weakly active (IC50 = 83.9 microM) against COX-2, whereas resveratrol strongly inhibited both isoforms of the enzyme with IC50 values of approximately 1 microM. Using a mouse mammary organ culture model, carcinogen-induced preneoplastic lesions were, similarly to resveratrol, significantly inhibited by pterostilbene (ED50 = 4.8 microM), suggesting antioxidant activity plays an important role in this process.
UI - 12089239
AU - De Lemos M
TI - Safety issues of soy phytoestrogens in breast cancer patients.
SO - J Clin Oncol 2002 Jul 1;20(13):3040-1; discussion 3041-2
UI - 12074209
AU - Salih AK; Fentiman IS
TI - 14. Breast cancer prevention.
SO - Int J Clin Pract 2002 May;56(4):267-71
AD - Hedley Atkins Breast Unit, Guy's Hospital London, UK.
Increased risk of breast cancer may result from potentially modifiable causes such as endogenous hormone levels, obesity, HRT, and non-lactation, or non-modifiable factors including genetic susceptibility and increasing age. The Gail model, based on known factors, may be useful for estimating lifetime risk in some individuals, but those risk factors that are easier to modify may have a limited impact on the totality of breast cancer. Tamoxifen prevention still remains contentious, with a significant reduction in risk of breast cancer in women given tamoxifen in the NSABP P1 study but no effect in the Italian and Royal Marsden trials. Raloxifene, tested in the MORE trial, reduced the incidence of breast cancer by 65% but this was restricted to oestrogen receptor positive tumours. Lifestyle factors such as diet, obesity, exercise and age at first full term pregnancy and number of pregnancies have a mild to moderate impact on risk, so may have little effect on the incidence of breast cancer. Reduction of alcohol intake could lead to a modest reduction in the risk of breast cancer but possibly adversely affect other diseases. Fat reduction and GnRH analogue reduce mammographic density but have not yet been shown to affect risk. For women with BRCA1/2 mutation, options include unproven surveillance and prophylactic mastectomy with an unquantified risk reduction. Interesting new candidates for chemoprevention include aromatase inhibitors, new generation SERMs, demethylating agents, non-selective COX inhibitors, tyrosine kinase inhibitors and polyamine synthetic inhibitors.
UI - 12093250
AU - Kinsinger LS; Harris R; Woolf SH; Sox HC; Lohr KN
TI - Chemoprevention of breast cancer: a summary of the evidence for the U.S. Preventive Services Task Force.
SO - Ann Intern Med 2002 Jul 2;137(1):59-69
AD - Cecil G. Sheps Center for Health Services Research, Program on Prevention, CB# 7508, Wing D, Room 383, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7508, USA.
PURPOSE: Chemoprevention offers promise as a strategy for reducing morbidity and mortality from breast cancer in women. This review examined the evidence for the effectiveness of chemoprevention in women without a history of breast cancer. DATA SOURCES: MEDLINE (1966 to controlled trials (RCTs) of chemoprevention of breast cancer in women without a previous diagnosis of breast cancer were examined, and 4 relevant trials, 3 involving tamoxifen and 1 involving raloxifene, were selected. Trials that provided data on the harms of tamoxifen or raloxifene, studies of the costs of chemoprevention, and studies of risk assessment were also reviewed. DATA EXTRACTION: Four reviewers independently abstracted data on key variables, including study population, sample size, randomization, treatment, and outcomes. DATA SYNTHESIS: The largest of the RCTs of tamoxifen reported a 49% reduction in relative risk (0.51 [95% CI, 0.39 to 0.66]) for invasive cancer among women with an estimated 5-year breast cancer risk of at least 1.66%. The other tamoxifen trials did not observe a statistically significant benefit, but only a few women in each trial took tamoxifen during the entire study period. The raloxifene study of postmenopausal women with osteoporosis found a 76% reduction in relative risk (0.24 [CI, 0.13 to 0.44]) for invasive breast cancer. Tamoxifen and raloxifene were effective only against estrogen receptor-positive tumors. Both drugs increased risk for venous thromboembolic disease and hot flashes; tamoxifen increased risk for endometrial cancer and stroke. CONCLUSIONS: Tamoxifen and raloxifene reduce the incidence of estrogen receptor-positive breast cancer in women. The relative risk reduction seems similar across all breast cancer risk groups. The absolute risk reduction varies by risk factors for breast cancer, however, and must be balanced against the potential harms to judge the appropriateness of treatment for individual women.
UI - 11902020
AU - Adams ML; Becker H; Colbert A
TI - African-American women's perceptions of mammography screening.
SO - J Natl Black Nurses Assoc 2001 Dec;12(2):44-8
AD - University of Texas at Austin, School of Nursing, 1700 Red River, Austin, TX 78701, USA.
While mammography has been shown to decrease breast cancer mortality, many African-American women are not receiving annual screenings. African-American women's reasons for not having mammograms are not well understood. This study therefore surveyed 164 African-American women concerning barriers to mammography screening. Outreach coordinators in two urban and one rural site in Texas asked African-American women to complete a checklist about the barriers to mammography screening. The 23-item Mammography Barriers Checklist, which was developed based upon one of the author's clinical experience and the research literature, included both internal and external barriers to screening. Women in all three geographic areas identified fear of finding cancer and mammography cost as the most important reasons for not having mammograms. These results suggest that outreach strategies that address fears related to mammography screening and help women find low-cost mammography resources may be more effective than those focusing strictly on providing information.
UI - 12095949
AU - Chen S; Zhou D; Okubo T; Kao YC; Eng ET; Grube B; Kwon A; Yang C; Yu B
TI - Prevention and treatment of breast cancer by suppressing aromatase activity and expression.
SO - Ann N Y Acad Sci 2002 Jun;963():229-38
AD - Division of Immunology, Beckman Research Institute of the City of Hope, Duarte, California 91010, USA. email@example.com.
Estrogen promotes the proliferation of breast cancer cells. Aromatase is the enzyme that converts androgen to estrogen. In tumors, expression of aromatase is upregulated compared to that of surrounding noncancerous tissue. Tumor aromatase is thought to stimulate breast cancer growth in both an autocrine and a paracrine manner. A treatment strategy for breast cancer is to abolish in situ estrogen formation with aromatase inhibitors. In addition, aromatase suppression in postmenapausal women is being evaluated as a potential chemopreventive modality against breast cancer. One area of aromatase research in this laboratory is the identification of foods and dietary compounds that can suppress aromatase activity. In vitro and in vivo studies have found that grapes and mushrooms contain chemicals that can inhibit aromatase. Therefore, a diet that includes grapes and mushrooms would be considered preventative against breast cancer. Another area of our aromatase research is the elucidation of the regulatory mechanism of aromatase expression in breast cancer tissue. Increased aromatase expression in breast tumors is attributed to changes in the transcriptional control of aromatase expression. Whereas promoter I.4 is the main promoter that controls aromatase expression in noncancerous breast tissue, promoters II and I.3 are the dominant promoters that drive aromatase expression in breast cancer tissue. Our recent gene regulation studies revealed that in cancerous versus normal tissue, several positive regulatory proteins (e.g., nuclear receptors and CREB1) are present at higher levels and several negative regulatory proteins (e.g., snail and slug proteins) are present at lower levels. This may explain why the activity of promoters II and I.3 is upregulated in cancerous tissue. In addition, our in vitro transcription/translation analysis using plasmids containing T7 promoter and the human snail gene as a reporter capped with different untranslated exon Is revealed that exon PII-containing transcripts were translated more effectively than were exon I.3-containing transcripts. An understanding of the molecular mechanisms of aromatase expression between noncancerous and cancerous breast tissue, at both transcriptional and translational levels, may help in the design of a therapy based on suppressing aromatase expression in breast cancer tissue.
UI - 12095952
AU - Kaaks R; Lukanova A
TI - Effects of weight control and physical activity in cancer prevention: role of endogenous hormone metabolism.
SO - Ann N Y Acad Sci 2002 Jun;963():268-81
AD - International Agency for Research on Cancer, 69372 Lyon Cedex 08, France. firstname.lastname@example.org
Excess body weight and/or lack of physical activity are increasingly recognized as major risk factors for cancer of the colon, breast, endometrium, and prostate. This paper reviews the effects of excess body weight and physical inactivity on endogenous hormone metabolism (insulin, the IGF-I/IGFBP system, and sex steroids) and of endocrine alterations with risk of cancer of the endometrium, breast, prostate, and colon.
UI - 12095953
AU - Castagnetta L; Granata OM; Cusimano R; Ravazzolo B; Liquori M; Polito L;
TI - Miele M; Di Cristina A; Hamel P; Traina A The Mediet Project.
SO - Ann N Y Acad Sci 2002 Jun;963():282-9
AD - Unit of Experimental Oncology & Palermo Branch of IST-GE, and Cancer Registry, Department of Clinical Oncology, M. Ascoli Cancer Hospital Centre, A.R.N.A.S., Civico, Palermo, Italy. email@example.com
Preliminary evidence from a case control study of healthy postmenopausal women living in Palermo, Sicily, is presented to investigate the potential impact of a traditional Mediterranean diet on the risk of developing breast cancer. Of the 230 women who fulfilled specific eligibility criteria, 115 were enrolled in the study based on serum testosterone values equal to or greater than the median population value (0.14 microg/ml). Women were then individually randomized into a diet intervention (n = 58) and a control (n = 55) group. Women in the intervention group attended a weekly "cooking course" for 1 year, being trained by professional chefs in the correct use of the natural ingredients of the traditional Mediterranean diet, including whole cereals, legumes, seeds, fish, cruciferous vegetables, and many others. The intervention group was subsequently instructed to follow the learned diet at home, while the control group was only advised to increase the consumption of fruits and vegetables, as recommended by WHO. The following measures were taken at the beginning, middle, and end of the study: (a) fasting blood and 12-hour urine samples to assay defined hormonal endpoints; (b) height, weight, and circumference of the waist and hip; and (c) a food frequency and computerized 24-hour dietary recall questionnaire. After 1 year, both the control and the intervention groups showed satisfactory compliance rates (81 and 85%, respectively). In addition, preliminary results so far obtained reveal an unequivocal trend towards weight loss, a strong reduction in cholesterol levels, and a psychophysical feeling of well-being by women adopting the Mediterranean diet. The study is currently ongoing to verify the association of changes in serum and urine hormone levels and breast cancer risk in the intervention group.
UI - 12026751
AU - Puleo E; Zapka J; White MJ; Mouchawar J; Somkin C; Taplin S
TI - Caffeine, cajoling, and other strategies to maximize clinician survey response rates.
SO - Eval Health Prof 2002 Jun;25(2):169-84
AD - University of Massachusetts, USA.
An ongoing objective in health services research is to increase response rates to clinician surveys to ensure generalizability of findings. Three HMOs in the Cancer Research Network participated in a primary care clinician survey to better understand organizational characteristics affecting adoption and implementation of breast and cervical cancer screening guidelines. A four-stage data collection strategy was implemented to maximize response. This included careful attention to survey design and layout, extensive piloting, choice of token incentive, use of "local champions," and denominator management. An overall response rate of 91% was attained, ranging from 83 to 100% among the plans (N = 621). Although the response rate after the second stage of data collection met commonly used standards, the authors argue for the four-stage method due to the possibility of differences when comparing early and late responders. This is important when multiple plans with differing structure and internal characteristics are surveyed.
UI - 12108453
AU - Rollins G
TI - IOM says: X-ray mammography remains the gold standard in breast cancer screening technology.
SO - Rep Med Guidel Outcomes Res 2001 Apr 19;12(8):1-2, 5
UI - 12043758
AU - Cummings DM; Whetstone LM; Earp JA; Mayne L
TI - Disparities in mammography screening in rural areas: analysis of county differences in North Carolina.
SO - J Rural Health 2002 Winter;18(1):77-83
AD - Department of Family Medicine, Brody School of Medicine, Greenville, NC 27858, USA. firstname.lastname@example.org
The extent to which targeted mammography programs have impacted women in rural areas is not well defined. We investigated mammography screening rates among 843 women age 50 and over from a population-based sample in four predominantly rural eastern North Carolina counties. We examined age, race, education level, county of residence, health insurance, and the self-reported completion of mammography in the past year using contingency tables and logistic regression. African American females aged 65 years or older had the lowest reported mammography rates (42%), while white females aged 50 to 64 had the highest rates (58%). Uninsured women and those with less education were less likely to have received a mammogram. Logistic regression demonstrated that age, education, and health insurance were significant predictors of mammography completion. A county-level analysis revealed that three counties had similar rates and one county had substantially lower rates. A higher-than-expected rate of screening-mammography completion among African American women was noted in one predominantly rural county served by a breast cancer screening program. Logistic regression analysis confirmed that county was a significant predictor for mammography completion. In separate regressions run by race, county remained a significant predictor for African American women but not for white women. Differences in mammography screening appear to persist in some predominantly rural areas and are related to age, race, education, and health insurance. Programs that target hard-to-reach women with efforts tailored specifically to their needs may be effective in reducing persistent racial differences.
UI - 12091685
AU - Helvie MA; Bailey JE; Roubidoux MA; Pass HA; Chang AE; Pierce LJ;
TI - Wilkins EG Mammographic screening of TRAM flap breast reconstructions for detection of nonpalpable recurrent cancer.
SO - Radiology 2002 Jul;224(1):211-6
AD - Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr, Taubman Center 2910N, Ann Arbor, MI 48109-0326, USA.
PURPOSE: To evaluate findings from routine mammographic screenings in patients with transverse rectus abdominis musculocutaneous (TRAM) flap reconstructions. MATERIALS AND METHODS: During a 25-month study period, 214 consecutive screening mammograms in 113 asymptomatic women (mean age, 51 years) with TRAM flap reconstructions were obtained. Mastectomies were performed for cancer in 106 (94%) of the 113 women and for prophylaxis in seven (6%). Prospectively, a Breast Imaging Reporting and Data System (BI-RADS) assessment category 1-5 was assigned to each mammogram. Surgical, medical, pathologic, and radiographic records were retrospectively reviewed. CIs were determined by the normal approximation to the binomial distribution. RESULTS: Seven (3%) of 214 examinations were BI-RADS category 4 or 5. Six (86%) of seven patients underwent biopsy. Two (33%) of these six biopsies demonstrated invasive ductal carcinoma. Cancer detection rate for mammography was 1.9% (two of 106) (95% CI: 0.33%, 7.32%) for women with reconstruction for breast cancer during the 2-year period. One (6%) of 16 BI-RADS category 3 examinations later proved to be invasive ductal carcinoma at follow-up. No interval cancer was discovered in 171 cases of BI-RADS category 1 or 2 examinations with 1-year follow-up. No cancers occurred in women who underwent prophylactic mastectomy. A biopsy positive predictive value of 33% (95% CI: 6%, 76%) was observed. CONCLUSION: Screening mammography of TRAM flap-reconstructed breasts enables detection of nonpalpable cancer before clinical examination.