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NCI CANCERLIT^® Search: Screening and Prevention of Breast Cancer - August 2002

National Cancer Institute^®
Last Modified: August 1, 2002

Biology and cost-benefit in mammography screening.
Controversies in screening with mammography.
Breast cancer risks: some clinically useful approaches.
Breast health--introduction and overview.
The controversy over estrogen replacement therapy: an update on clinical trials.
Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50302
Prophylactic bilateral mastectomy: patterns of practice.
The Department of Defense Congressionally Directed Medical Research Program: innovations in the federal funding of biomedical research.
Breast cancer: risk, prevention, & tamoxifen.
Screening mammography.
Ethical issues in contrast-enhanced magnetic resonance imaging screening for breast cancer.
What is the difference between screening and diagnostic tests?
A review of selective estrogen receptor modulators in the treatment of breast and endometrial cancer.
Racial disparities in the quality of care for enrollees in medicare managed care.
Letrozole for the management of breast cancer.
Exemestane: a potent irreversible aromatase inactivator and a promising advance in breast cancer treatment.
Dramatic print ads raise awareness. NorthEast Medical Center's breast health campaign.
The CYP17 MspA1 polymorphism and breast cancer risk: a meta-analysis.
The role of the nurse in cancer genetics.
Health-related behaviors and lifestyle factors of patients with breast cancer.
Questionnaire wording on population-based estimates of mammography prevalence.
Promoting participation in breast cancer screening.
In your own words.
Breast health.
Progress in the control of female breast cancer in Rhode Island, 1987-2000.
Decision analysis of tamoxifen for the prevention of invasive breast cancer.
Update on effects of screening mammography.
Prophylactic mastectomy--evaluation and treatment of high risk patients.
Re: Risk-reduction mastectomy: clinical issues and research needs.
Sociodemographic predictors of non-attendance at invitational mammography screening--a population-based register study (Sweden).
Chemoprevention of breast cancer by targeting cyclooxygenase-2 and peroxisome proliferator-activated receptor-gamma (Review).
Breast cancer screening. First Nations communities in New Brunswick.
[Schematization and forcing of the analysis of mammographic screening effectiveness]
[Personality traits of women participating in a breast cancer prevention trial]
Breast feeding reduces risk of breast cancer, says study.
Current status of screening mammography.
Disparities in adherence to recommended followup on screening mammography: interaction of sociodemographic factors.
Breast cancer.
Postmenopausal hormone replacement therapy: scientific review.

1
UI - 9490081
AU - Rutqvist LE
TI - Biology and cost-benefit in mammography screening.
SO - Acta Oncol 1997;36(7):673-4

2
UI - 9490082
AU - Larsson LG
TI - Controversies in screening with mammography.
SO - Acta Oncol 1997;36(7):675-9
AD - Oncologic Centre, University Hospital, Umea, Sweden.
Screening with mammography in order to detect early curable breast cancer has been widely used during the last 2-3 decades. Especially an overview of 4 randomised trials in Sweden has shown a convincing short-term relative reduction of the breast cancer mortality while the long-term absolute effect on this mortality has been impossible to study due to screening of the control groups after some years. There is, however, rather general consensus about the value of screening in women above 50 years of age whereas screening in the age group 40-49 is still controversial due to the low rate of mammographically demonstrable cancers and the high rate of recalls for supplementary mammography, clinical examinations and biopsies in relation to cancers found. Recent follow-up of the pooled Swedish randomised trials have shown an about 20% almost significant reduction of the breast cancer mortality in women aged 40-49 at randomisation but the design of these trials does not allow an adequate estimation of the extra benefit obtained by starting periodical screening at age 40 instead of at age 50. The author proposes that screening in the age group 40-49 should be regarded as experimental and subject to proper randomised trials of a type on-going in UK and planned within UICC.

3
UI - 12116602
AU - Kelly PT
TI - Breast cancer risks: some clinically useful approaches.
SO - Curr Womens Health Rep 2002 Apr;2(2):128-33
AD - Cancer Risk Assessment, Saint Francis Memorial Hospital, 824 Cragmont Avenue, Berkeley, CA 94708, USA. ptkelly@ptkelly.com
Information about breast cancer risk is often confusing and may even be misleading when presented as a comparison of one risk versus another. Frequently used comparison formats include relative risks, odds ratios, and proportional risk reductions. This paper discusses five areas of breast cancer risk--average risk, prognosis following a breast cancer diagnosis, risk associated with use of hormone replacement therapy at menopause, use of tamoxifen as prevention, and risks associated with BRCA mutations--to show the clarity and clinical usefulness that are obtained when risks are presented not as comparisons, but in absolute terms with a time frame.

4
UI - 12116605
AU - Hindle WH
TI - Breast health--introduction and overview.
SO - Curr Womens Health Rep 2002 Apr;2(2):73
AD - Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine, WOH L1009 HSC, Los Angeles, CA 90033, USA. whindle@goldstate.net

5
UI - 12116607
AU - Gnatuk CL
TI - The controversy over estrogen replacement therapy: an update on clinical trials.
SO - Curr Womens Health Rep 2002 Apr;2(2):89-94
AD - Penn State University College of Medicine, Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA. cgnatuk@psu.edu
This is a review and presentation of recent clinical trials designed to ascertain the effects of estrogen or estrogen plus progesterone on the risks of heart disease. The framework of the epidemiologic evidence that estrogen is cardioprotective is reviewed and the impact of these data on apparent findings from clinical trials discussed. The Heart and Estrogen/Progestin Replacement Study is examined in detail, and the most frequent criticisms of its findings are presented. Findings from other clinical trials are presented and the clinical implications from the data discussed in relation to the larger body of literature pertaining to hormone replacement therapy and heart disease.

6
UI - 12133652
AU - Collaborative Group on Hormonal Factors in Breast Cancer.
TI - Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50302 women with breast cancer and 96973 women without the disease.
SO - Lancet 2002 Jul 20;360(9328):187-95
BACKGROUND: Although childbearing is known to protect against breast cancer, whether or not breastfeeding contributes to this protective effect is unclear. METHODS: Individual data from 47 epidemiological studies in 30 countries that included information on breastfeeding patterns and other aspects of childbearing were collected, checked, and analysed centrally, for 50302 women with invasive breast cancer and 96973 controls. Estimates of the relative risk for breast cancer associated with breastfeeding in parous women were obtained after stratification by fine divisions of age, parity, and women's ages when their first child was born, as well as by study and menopausal status. FINDINGS: Women with breast cancer had, on average, fewer births than did controls (2.2 vs 2.6). Furthermore, fewer parous women with cancer than parous controls had ever breastfed (71% vs 79%), and their average lifetime duration of breastfeeding was shorter (9.8 vs 15.6 months). The relative risk of breast cancer decreased by 4.3% (95% CI 2.9-5.8; p<0.0001) for every 12 months of breastfeeding in addition to a decrease of 7.0% (5.0-9.0; p<0.0001) for each birth. The size of the decline in the relative risk of breast cancer associated with breastfeeding did not differ significantly for women in developed and developing countries, and did not vary significantly by age, menopausal status, ethnic origin, the number of births a woman had, her age when her first child was born, or any of nine other personal characteristics examined. It is estimated that the cumulative incidence of breast cancer in developed countries would be reduced by more than half, from 6.3 to 2.7 per 100 women by age 70, if women had the average number of births and lifetime duration of breastfeeding that had been prevalent in developing countries until recently. Breastfeeding could account for almost two-thirds of this estimated reduction in breast cancer incidence. INTERPRETATION: The longer women breast feed the more they are protected against breast cancer. The lack of or short lifetime duration of breastfeeding typical of women in developed countries makes a major contribution to the high incidence of breast cancer in these countries.

7
UI - 12124821
AU - Metcalfe KA; Goel V; Lickley L; Semple J; Narod SA
TI - Prophylactic bilateral mastectomy: patterns of practice.
SO - Cancer 2002 Jul 15;95(2):236-42
AD - The Centre for Research in Women's Health, Toronto, Ontario, Canada.
BACKGROUND: Many women who are at an elevated risk of developing breast carcinoma choose prophylactic mastectomy to decrease their risk. We conducted a population-based study to review the indications for, and patterns of practice of prophylactic mastectomy in Ontario, Canada, since 1991. METHODS: A medical chart review was conducted at 33 hospitals that were identified as having conducted at least one prophylactic mastectomy. All bilateral mastectomy patients with no diagnosis of invasive or in situ breast carcinoma were eligible. RESULTS: The number of prophylactic bilateral mastectomies performed varied from 6 to 19. The mean age of women undergoing prophylactic mastectomy was 43.5 years. Eighty percent of the women had prophylactic mastectomy performed because of a family history of breast carcinoma (89 of 99) or because of a known BRCA1 or BRCA2 mutation (10 of 99). Twenty percent of the women had no family history, but had the surgery for other benign breast conditions. Women with a family history of breast carcinoma were much more likely to have a total mastectomy (89%) than a subcutaneous mastectomy (11%). Sixty percent of the women had reconstructive surgery following mastectomy. CONCLUSIONS: Prophylactic mastectomy is not performed on a large scale. The introduction of genetic testing for BRCA1 and BRCA2 has the potential to change the patterns of practice for prophylactic mastectomy. Copyright 2002 American Cancer Society.DOI 10.1002/cncr.10680

8
UI - 11948100
AU - Young-McCaughan S; Rich IM; Lindsay GC; Bertram KA
TI - The Department of Defense Congressionally Directed Medical Research Program: innovations in the federal funding of biomedical research.
SO - Clin Cancer Res 2002 Apr;8(4):957-62
AD - United States Army Medical Research and Materiel Command, Congressionally Directed Medical Research Programs, Fort Detrick, Maryland 21702-5024, USA.
In response to the lobbying efforts of the women's advocacy movement, in 1993 Congress authorized funds for a substantial increase in support of new and promising research aimed at the eradication of breast cancer. This appropriation resulted in a major expansion of the United States Army Medical Research and Materiel Command, Department of Defense Breast Cancer Research Program. The Office of Congressionally Directed Medical Research Programs was established within the United States Army Medical Research and Materiel Command to facilitate the management of the expanded extramural research program. Since that time, the programs have grown to include not just breast cancer but also prostate cancer, ovarian cancer, and neurofibromatosis. The unique appropriations to the Office of Congressionally Directed Medical Research Programs has resulted in a number of programmatic innovations. These include development of unique mechanisms of grant support, inclusion of consumer advocates on peer and programmatic review panels, and the introduction of criteria-based evaluation and scoring in peer review. This article describes these novel scientific management strategies and outlines their success in meeting program visions and goals.

9
UI - 11301680
AU - Machia J
TI - Breast cancer: risk, prevention, & tamoxifen.
SO - Am J Nurs 2001 Apr;101(4):26-35; quiz 36
AD - Fred Hutchinson Cancer Research Center, Seattle, WA, USA.

10
UI - 12020568
AU - van Veen WA; Knottnerus JA
TI - Screening mammography.
SO - Lancet 2002 May 11;359(9318):1701

11
UI - 12055452
AU - Plevritis SK; Ikeda DM
TI - Ethical issues in contrast-enhanced magnetic resonance imaging screening for breast cancer.
SO - Top Magn Reson Imaging 2002 Apr;13(2):79-84
AD - Department of Radiology, Stanford University, Stanford, California, USA. sylvia.plevritis@stanford.edu
Breast magnetic resonance imaging (MRI) screening has been shown to detect early breast cancer. The main challenge ahead for breast MRI screening is to prove its effectiveness in reducing breast cancer mortality. While this challenge is commonly viewed as a scientific, technological, and clinical one, it also carries ethical components. This article is concerned with the risks and benefits of MRI screening that should be explained to screening participants and discusses the evidence needed by policy makers who ultimately will determine a just allocation of health care resources to MRI breast cancer screening.

12
UI - 12154802
AU - Anonymous
TI - What is the difference between screening and diagnostic tests?
SO - Johns Hopkins Med Lett Health After 50 2002 Jul;14(5):8

13
UI - 12138407
AU - Chan S
TI - A review of selective estrogen receptor modulators in the treatment of breast and endometrial cancer.
SO - Semin Oncol 2002 Jun;29(3 Suppl 11):129-33
AD - Nottingham City Hospital, Nottingham, United Kingdom.
The understanding of how estrogen affects different body tissues by selective actions on the two subtypes of estrogen receptors (alpha and beta) has created the possibility of targeted therapy by the manufacturing of a group of compounds known as selective estrogen receptor modulators. The goal of an ideal selective estrogen receptor modulator that has all the beneficial effects of estrogen receptor modulation without adverse side effects seems increasingly achievable with improving drug design. The clinical findings for the new selective estrogen receptor modulator, arzoxifene, which has been shown to be highly active in the treatment of advanced breast cancer as well as advanced endometrial cancer, has confirmed the value of selective targeting of the estrogen receptors, and may herald a new era in endocrine therapy in clinical oncology. Copyright 2002, Elsevier Science (USA). All rights reserved.

14
UI - 11886320
AU - Schneider EC; Zaslavsky AM; Epstein AM
TI - Racial disparities in the quality of care for enrollees in medicare managed care.
SO - JAMA 2002 Mar 13;287(10):1288-94
AD - Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115,USA. eschneid@hsph.harvard.edu
CONTEXT: Substantial racial disparities in the use of some health services exist; however, much less is known about racial disparities in the quality of care. OBJECTIVE: To assess racial disparities in the quality of care for enrollees in Medicare managed care health plans. DESIGN AND SETTING: Observational study, using the 1998 Health Plan Employer Data and Information Set (HEDIS), which summarized performance in calendar year 1997 for 4 measures of quality of care (breast cancer screening, eye examinations for patients with diabetes, beta-blocker use after myocardial infarction, and follow-up after hospitalization for mental illness). PARTICIPANTS: A total of 305 574 (7.7%) beneficiaries who were enrolled in Medicare managed care health plans had data for at least 1 of the 4 HEDIS measures and were aged 65 years or older. MAIN OUTCOME MEASURES: Rates of breast cancer screening, eye examinations for patients with diabetes, beta-blocker use after myocardial infarction, and follow-up after hospitalization for mental illness. RESULTS: Blacks were less likely than whites to receive breast cancer screening (62.9% vs 70.9%; P<.001), eye examinations for patients with diabetes (43.6% vs 50.4%; P =.02), beta-blocker medication after myocardial infarction (64.1% vs 73.8%; P<.005), and follow-up after hospitalization for mental illness (33.2 vs 54.0%; P<.001). After adjustment for potential confounding factors, racial disparities were still statistically significant for eye examinations for patients with diabetes, beta-blocker use after myocardial infarction, and follow-up after hospitalization for mental illness. CONCLUSION: Among Medicare beneficiaries enrolled in managed care health plans, blacks received poorer quality of care than whites.

15
UI - 12113048
AU - Goss PE; Smith RE
TI - Letrozole for the management of breast cancer.
SO - Expert Rev Anticancer Ther 2002 Jun;2(3):249-60
AD - Department of Medical Oncology and Hematology, Princess Margaret Hospital, University Health Network, 610 University Avenue, 5-303, Toronto, Ontario, M5G 2M9, Canada. pegoss@interlog.com
Letrozole, a third-generation aromatase inhibitor, has been the only aromatase inhibitor to date to show unequivocal superiority to tamoxifen as first-line treatment of metastatic postmenopausal breast cancer. The superiority of letrozole compared with tamoxifen was also reflected in the neoadjuvant setting, in both estrogen receptor-positive and estrogen receptor-unknown patients with differing HER-2 status. Currently, studies are being performed in the adjuvant setting, which will provide important data on the long-term safety of letrozole and help determine its suitability as a chemopreventive agent in healthy women at risk of developing breast cancer. Nevertheless, the superior clinical efficacy and survival data of letrozole suggest that it has the potential to displace tamoxifen as the gold standard in breast cancer treatment in the coming years.

16
UI - 12113050
AU - Dixon JM
TI - Exemestane: a potent irreversible aromatase inactivator and a promising advance in breast cancer treatment.
SO - Expert Rev Anticancer Ther 2002 Jun;2(3):267-75
AD - Edinburgh Breast Unit, Western General Hospital, Edinburgh, EH4 2XU Scottland, UK. jmd@wght.demon.co.uk
With the introduction of orally-active, potent and selective third-generation aromatase inhibitors and inactivators--anastrozole, letrozole and exemestane--approaches to the treatment of advanced breast cancer are undergoing re-evaluation. In advanced breast cancer, aromatase inhibitors and inactivators are likely to become established as the primary choice over tamoxifen in postmenopausal female breast cancer patients when hormonal therapy is indicated in the first-line setting. The current evaluation of exemestane, an oral steroidal irreversible aromatase inactivator, for primary and adjuvant therapy and the potential role of potent estrogen-deprivation therapy in prevention of postmenopausal breast cancer may extend the use of antiaromatase therapy as an increasingly valuable palliative treatment option, conferring survival benefit and possible preventive outcomes across several treatment settings in the management of breast cancer.

17
UI - 12134405
AU - Botvin JD
TI - Dramatic print ads raise awareness. NorthEast Medical Center's breast health campaign.
SO - Profiles Healthc Mark 2002 Jul-Aug;18(4):15-9, 3
NorthEast Medical Center, a 457-bed independent hospital in Concord, N.C., found itself increasingly in competition with hospitals in neighboring Charlottesville. It changed from an emphasis on media relations and public relations to an advertising mode, beginning with a multimedia breast health campaign last October for Breast Health Month. The attention-grabbing visuals were adapted from the print ads and used as in-house posters to encourage employee participation in the breast screening program.

18
UI - 11880540
AU - Ye Z; Parry JM
TI - The CYP17 MspA1 polymorphism and breast cancer risk: a meta-analysis.
SO - Mutagenesis 2002 Mar;17(2):119-26
AD - Bioinformatics Group, Centre for Molecular Genetics and Toxicology, School of Biological Sciences, University of Wales Swansea, Singleton Park, Swansea SA2 8PP, UK. bazheye@swansea.ac.uk
Inter-individual differences in susceptibility to breast cancer are partially mediated through the levels of endogenous and exogenous steroid hormones. The CYP17 gene encodes P450c17alpha, an enzyme that is involved in the metabolism of steroid hormones. Increased endogenous steroid hormone levels have been associated with a MspA1 polymorphism in the 5'-promoter region of the CYP17 gene. The CYP17 MspA1 polymorphism has been postulated as being associated with the risk of developing breast cancer. However, the association between the CYP17 MspA1 polymorphism and breast cancer risk has been controversial in the literature. To re-examine this controversy, we have undertaken a meta-analysis of 15 case-control studies, which included a total of 4227 breast cancer cases and 4730 individual controls. The odds ratio (OR) was used to evaluate the risk of breast cancer for each study, using homozygosity of the wild-type allele as the control group. Statistical analysis showed no evidence of heterogeneity within the studies. The pooled ORs of breast cancer associated with the combined variant (A1/A2 + A2/A2) and the homozygous genotype (A2/A2) were 0.98 (95% CI 0.89-1.07) and 1.05 (95% CI 0.87-1.21), respectively. Similarly, the pooled ORs of advanced breast cancer associated with the combined variant and the homozygous genotype were 0.96 (95% CI 0.77-1.20) and 0.88 (95% CI 0.55-1.41), respectively. A pooling of the studies was also conducted for the various ethnic groups, but failed to show an association of CYP17 MspA1 polymorphism with breast cancer risk in the different ethnic groups. In addition, our results show that a possible protective effect for breast cancer risk of a later age at menarche was mainly limited to women with the A1 homozygous genotype. The OR for age at menarche (> or = 13) was 0.87 (95% CI 0.62-1.17). Our results suggest that CYP17 MspA1 polymorphism may be at best a weak modifier of breast cancer risk but is not a significant independent risk factor.

19
UI - 12040228
AU - Middelton L; Dimond E; Calzone K; Davis J; Jenkins J
TI - The role of the nurse in cancer genetics.
SO - Cancer Nurs 2002 Jun;25(3):196-206
AD - Urology Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md. 20892-1873, USA.
Knowledge gained from the Human Genome Project and related genetic research is already impacting clinical oncology nursing practice. Because cancer is now understood to be a genetic disease, changes in the traditional approaches to prevention, diagnosis, and therapeutic management of cancer are becoming increasingly genetically based. Therefore, to ensure competency in oncology nursing practice at all levels, nurses must incorporate an understanding of the underlying biology of carcinogenesis and the molecular rationale underlying strategies to prevent, diagnose, and treat cancer.

20
UI - 12040230
AU - Petro-Nustas W
TI - Health-related behaviors and lifestyle factors of patients with breast cancer.
SO - Cancer Nurs 2002 Jun;25(3):219-29
AD - Faculty of Nursing, Hashemite University, Zarka-Jordan. wasipn@hu.edu.jo
The purpose of this article is to examine differences in the relationship of selected lifestyle factors and health-related behaviors between two groups of women. The study used part of the data gathered in a national Jordanian case-control survey of 100 women with breast cancer and an equal sample of controls. Controls were selected to match the cases (patients) in terms of their age, education, and place of residence. The Health Belief Model and the basic Epidemiological Model were the theoretical framework used in this study. Data were collected using an interview form that was specifically constructed for the national survey. It contained 6 sections: demographics, history of cancer in the family, reproductive history, environmental factors, lifestyle factors, and health education about breast self-examination. The study revealed that there were no significant differences between the patients and controls with regard to their intake of fat, vegetable oil, beef and lamb meat, and smoked food. Higher proportions of patients were found to consume more of the canned and spicy food and caffeinated drinks. Neither smoking nor living or working with someone who smokes showed any significant differences between the patients and controls. Most of the women with breast cancer were found to have exercised in the last 5 years before diagnosis. Having been exposed to stressful events was a major significant risk factor discriminating patients from controls. Finally, having prior knowledge of breast self-examination was a health-related factor that made these women more attentive to their health.

21
UI - 12144966
AU - Berumen A
TI - Questionnaire wording on population-based estimates of mammography prevalence.
SO - Am J Public Health 2002 Aug;92(8):1212; discussion 1212

22
UI - 8279599
AU - Zapka JG
TI - Promoting participation in breast cancer screening.
SO - Am J Public Health 1994 Jan;84(1):12-3

23
UI - 12056192
AU - Syal M
TI - In your own words.
SO - Nurs Stand 2002 May 22-28;16(36):25

24
UI - 12152555
AU - Feldhusen AE
TI - Breast health.
SO - Midwifery Today Int Midwife 2001 Fall;(59):44-9, 69

25
UI - 12101887
AU - Fulton JP; Chiaverini L; Darcy DM
TI - Progress in the control of female breast cancer in Rhode Island, 1987-2000.
SO - Med Health R I 2002 Jun;85(6):192-3
AD - Division of Disease Prevention and Control, Rhode Island Department of Health, and Clinical Associate Professor of Community Health, Brown Medical School, USA.

26
UI - 10882333
AU - Grann VR; Sundararajan V; Jacobson JS; Whang W; Heitjan DF; Antman KH;
TI - Neugut AI Decision analysis of tamoxifen for the prevention of invasive breast cancer.
SO - Cancer J 2000 May-Jun;6(3):169-78
AD - Herbert Irving Comprehensive Cancer Center, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.
PURPOSE: The recent Breast Cancer Prevention Trial has shown that tamoxifen may prevent invasive breast cancer. We used a Markov model to estimate the long-term effects of chemoprevention with tamoxifen on survival, quality-adjusted survival, and health care costs. METHODS: We used a hypothetical cohort of women with breast-cancer risk similar to that of participants in the Breast Cancer Prevention Trial, and a computer-based decision analysis (Markov model and 500 Monte Carlo simulations) to model the outcomes of interest. Survival calculations were from Surveillance, Epidemiology, and End-Results (SEER) data; preference ratings from a time trade-off questionnaire administered to a group of average-risk women; and cost estimates from the Group Health Cooperative of Puget Sound and the Health Care Financing Administration. We obtained utility measures for quality-adjustment by administering a time trade-off questionnaire to a group of community-based women. RESULTS: Use of tamoxifen prolonged the average survival of cohort members by 69 days (95% probability interval [PI] 27 to 117) for those who started use at age 35 years; 40 days (95% PI 16 to 67) for those who started use at age 50 years; and 27 days (95% PI 14 to 40) for those who started use at age 60 years. Tamoxifen extended quality-adjusted survival by 38 days (95% PI 0.1 to 82) at age 35, 25 days (95% PI 0 to 50) at age 50, and 22 days (95% PI 5 to 39) days at age 60. Chemoprevention with tamoxifen cost $46,619 (95% PI $27,928 to $98,796) per life year life saved for women who started at age 35; for women over age 50, it cost more than $50,000 per life year saved. DISCUSSION: Tamoxifen use may improve long-term survival and quality-adjusted survival among women who are at increased risk of breast cancer, but this benefit diminishes with age. Tamoxifen is cost-effective in comparison with other cancer treatment strategies for younger women only.

27
UI - 12147397
AU - Gulbrandsen P
TI - Update on effects of screening mammography.
SO - Lancet 2002 Jul 27;360(9329):339; discussion 339-40

28
UI - 12013690
AU - Remmel E; Harder F
TI - Prophylactic mastectomy--evaluation and treatment of high risk patients.
SO - Swiss Surg 2002;8(2):45-52
AD - Department of Surgery, University of Basel, Switzerland. eremmel@uhbs.ch
Prophylactic mastectomy is an aggressive strategy for breast cancer risk reduction. The indications and efficiency of this procedures are not yet clearly defined. Randomized, prospective studies, comparing different surgical procedures with other modalities of breast cancer risk reduction are lacking. The report evaluates the existing controversy, based on Medline search in the following sequence: risk factors, possibilities of risk reduction, effectiveness of risk reduction, technical considerations and recommendations. Patient selection is difficult and needs an interdisciplinary approach. The women have to be well informed about all treatment alternatives and various reconstructive procedures. An appropriate risk reduction strategy should be selected individually for each patient. Up to now, there exist only recommendations from different institutions but no definitive guidelines.

29
UI - 11792752
AU - Swanson GP
TI - Re: Risk-reduction mastectomy: clinical issues and research needs.
SO - J Natl Cancer Inst 2002 Jan 16;94(2):143-4

30
UI - 11899121
AU - Lagerlun M; Maxwell AE; Bastani R; Thurfjell E; Ekbom A; Lambe M
TI - Sociodemographic predictors of non-attendance at invitational mammography screening--a population-based register study (Sweden).
SO - Cancer Causes Control 2002 Feb;13(1):73-82
AD - Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden. Magdalena.Lagerlund@mep.ki.se
OBJECTIVE: To investigate the role of sociodemographic factors in predicting mammography uptake in an outreach screening program. METHODS: Linkage of data from a regional population-based mammography program with four Swedish nationwide registers: the Population and Housing Census of 1990, the Fertility Register, the Cancer Register, and the Cause of Death Register. We computed odds ratios (OR) and 95% confidence intervals (CI) for non-attendance by sociodemographic factors. Non-attendance was defined as failure to attend in response to the two most recent invitations. RESULTS: Multivariate analyses among 4198 non-attenders and 38,972 attenders revealed that both childless and high-parity women were more likely to be non-attenders (OR = 1.8, 95% CI: 1.6-2.0 and OR = 2.2, 95% CI: 1.8-2.7, respectively). Women living without a partner were less likely to attend (OR = 1.7, 95% CI: 1.5-1.9), as were non-employed women (OR = 2.1, 95% CI: 1.9-2.3). Those renting an apartment were more likely to be non-attenders compared with home-owners (OR = 1.8, 95% CI: 1.6-2.0), and immigrants from non-Nordic countries were more than twice as likely to be non-attenders compared with Swedish-born women (OR = 2.4, 95% CI: 2.0-2.8). CONCLUSIONS: There are identifiable subgroups in which mammography utilization can be increased. Special attention should be paid to women who have never attended, childless women, and non-Nordic immigrants.

31
UI - 12011987
AU - Badawi AF; Badr MZ
TI - Chemoprevention of breast cancer by targeting cyclooxygenase-2 and peroxisome proliferator-activated receptor-gamma (Review).
SO - Int J Oncol 2002 Jun;20(6):1109-22
AD - Division of Population Science, Fox Chase Cancer Center, Philadelphia, PA 19111, USA. af_badawi@fccc.edu
Cyclooxygenase-2 (COX-2) and peroxisome proliferator-activated receptor-gamma (PPARgamma) have emerged as candidate molecules that hold great promise for cancer chemoprevention. COX-2 increased expression and PPARgamma inactivation occur during mammary gland carcinogenesis. COX-2 and PPARgamma may contribute to breast cancer induction either directly or via their effects on factors known to influence tumor development, e.g., nuclear factor-kappaB and vascular endothelial growth factor. Inhibition of COX-2 or activation of PPARgamma prevents mammary carcinomas in experimental animals with little toxicity. Combinational treatment with COX-2 inhibitor and PPARgamma agonists may produce synergistic anti-tumorigenic effects without significant toxicity and, therefore, be an effective strategy to prevent human breast cancer. Establishing a relationship between COX-2 and PPARgamma in this malignancy may provide the basis for a novel chemopreventive strategy based on the modulation of both molecules simultaneously. This review evaluates experimental and epidemiological findings suggesting a possible role of COX-2 and PPARgamma in the development of human breast cancer and presents evidence substantiating their coordinated action in carcinogenesis and finally develops a rationale for the simultaneous targeting of both molecules as a potentially effective strategy to prevent breast malignancy.

32
UI - 12113195
AU - Tatemichi S; Miedema B; Leighton S
TI - Breast cancer screening. First Nations communities in New Brunswick.
SO - Can Fam Physician 2002 Jun;48():1084-9
AD - Department of Family Medicine, Dalhousie University, Fredericton, NB.
OBJECTIVE: To determine use of breast cancer screening and barriers to screening among women in First Nations communities (FNCs). DESIGN: Structured, administered survey. SETTING: Five FNCs in New Brunswick. PARTICIPANTS: One hundred thirty-three (96%) of 138 eligible women between the ages of 50 and 69 years. INTERVENTIONS: After project objectives, methods, and expected outcomes were discussed with community health representatives, we administered a 32-item questionnaire on many aspects of breast cancer screening. MAIN OUTCOME MEASURES: Rate of use of mammography and other breast cancer screening methods, and barriers to screening. RESULTS: Some 65% of participants had had mammography screening within the previous 2 years. Having mammography at recommended intervals and clinical breast examinations (CBEs) yearly were significantly associated with having had a physician recommend the procedures (P < .001). A family history of breast cancer increased the odds of having a mammogram 2.6-fold (P < .05, 95% confidence interval [CI] 1.03 to 6.54). Rates of screening differed sharply by whether a family physician was physically practising in the community or not (P < .05, odds ratio 2.68, 95% CI 1.14 to 6.29). CONCLUSION: Women in FNCs in one health region in New Brunswick have mammography with the same frequency as off-reserve women. A family physician practising part time in the FNCs was instrumental in encouraging women to participate in breast cancer screening.

33
UI - 12125384
AU - Liberati A
TI - [Schematization and forcing of the analysis of mammographic screening effectiveness]
SO - Epidemiol Prev 2002 Mar-Apr;26(2):53-4

34
UI - 12125390
AU - Martino G; Bellati C; Cola A; Galperti G; Krogh V; Luci S; Raimondi M
TI - [Personality traits of women participating in a breast cancer prevention trial]
SO - Epidemiol Prev 2002 Mar-Apr;26(2):82-6
AD - METIS, Centro studi di oncologia, formazione, terapia, Milano.
We have evaluated the psycho-social factors in women--during menopause with different biological characteristics--who participated in two extensive trials of breast cancer prevention: Diana1 and Tamoxifen. Through the use of a recognized personality test (MMPI, Minnesota Multiphasic Personality Inventory), we observed 500 healthy women who agreed to or refused the health care proposal. The findings show that the women who accept chemical preparations or to modify their dietary habits present different personality traits from those who refuse to adhere. One should ask oneself if the lack of homogeneity of the samples with a different concentration of psycho-social factors can alter the efficacy of a cancer prevention program. During chemoprevention studies, in which a high compliance could bring about a redundancy of experience of sickness, in coherence with our goal of health protection, we think it is necessary to supply psycho-social support which tempers any experience of physical, psychological and inter-personal discomfort in the healthy women. The cognitive model of the personality traits could be programmed also for the compliance of mammographical screening. This model requires the training of health care professionals.

35
UI - 12143855
AU - Woodman I
TI - Breast feeding reduces risk of breast cancer, says study.
SO - BMJ 2002 Jul 27;325(7357):184

36
UI - 11892862
AU - Feig SA
TI - Current status of screening mammography.
SO - Obstet Gynecol Clin North Am 2002 Mar;29(1):123-36
AD - Mount Sinai School of Medicine, Department of Radiology, The Mount Sinai Hospital, New York, New York 10029-6574, USA. stephen.feig@mountsinai.org
The results of RCTs conducted around the world indicate that screening mammography can substantially reduce death rates from breast cancer among women aged 40 years and over. Compelling evidence suggests that annual screening should be more effective than screening offered every 1 to 2 years. Annual screening beginning at age 40 years is now recommended by the American Cancer Society, the American Medical Association, and the American College of Radiology* Based on Swedish studies, it is likely that screening mammography can reduce breast cancer deaths by at least 50%. Screening mammography is highly cost-effective and can be performed at acceptable levels of radiation risk and rates of false-positive biopsies. By recommending screening mammography to their patients, the primary care physician can have a pivotal role in reducing the death rate from a major disease of women, similar to the effectiveness of screening for carcinoma of the cervix.

37
UI - 11913611
AU - Strzelczyk JJ; Dignan MB
TI - Disparities in adherence to recommended followup on screening mammography: interaction of sociodemographic factors.
SO - Ethn Dis 2002 Winter;12(1):77-86
AD - Department of Radiology, University of Colorado, Health Sciences Center, School of Medicine, Denver 80262, USA. jodi.strzelczyk@uchsc.edu
OBJECTIVE: The objective of this study was to examine disparities in adherence to screening mammography and, specifically, to investigate whether race/ethnicity, education, age, health insurance, and family history of breast cancer (FHBC), as unique factors and in interactions, influence adherence to recommended follow up on screening mammography. DESIGN: The study involved retrieval and analyses of data collected by the Colorado Mammography Project (CMAP) for 167,232 diverse (82.8% White, 3.4% Black, 11% Hispanic, 1.6% Asian, 0.6% Native American, and 0.6% "other") screening participants during the 1990-1997 study period. METHODS: Subjects' first mammograms captured by CMAP were tracked in the database to identify women who received follow-up recommendations, women who adhered within 12 months and those that did not. Analyses included comparisons of adherence rates among women with various sociodemographic characteristics. RESULTS: Of the 17,358 women who received follow-up recommendations, 80.7% adhered. Overall, non-White women in each of the racial/ethnic groups were less likely to adhere to recommendations than were White women (P<.05). Also less likely to adhere were the younger, less educated, uninsured/underinsured, and women who reported not having FHBC. CONCLUSION: Race/ethnicity appeared to interact with age, education, health insurance, and FHBC to influence the probability of adherence, suggesting the need to explore further cultural, psychosocial, and situational factors.

38
UI - 11913652
AU - Jackson ME
TI - Breast cancer.
SO - Ethn Dis 2002 Winter;12(1):S2-68-70

39
UI - 12186605
AU - Nelson HD; Humphrey LL; Nygren P; Teutsch SM; Allan JD
TI - Postmenopausal hormone replacement therapy: scientific review.
SO - JAMA 2002 Aug 21;288(7):872-81
AD - Oregon Health and Science University, Mail Code BICC 504, 3181 SW Sam Jackson Park Rd, Portland, OR 97201, USA. nelsonh@ohsu.edu
CONTEXT: Although postmenopausal hormone replacement therapy (HRT) is widely used in the United States, new evidence about its benefits and harms requires reconsideration of its use for the primary prevention of chronic conditions. OBJECTIVE: To assess the benefits and harms of HRT for the primary prevention of cardiovascular disease, thromboembolism, osteoporosis, cancer, dementia, and cholecystitis by reviewing the literature, conducting meta-analyses, and calculating outcome rates. DATA SOURCES: All relevant English-language studies were identified in MEDLINE (1966-2001), HealthSTAR (1975-2001), Cochrane Library databases, and reference lists of key articles. Recent results of the Women's Health Initiative (WHI) and the Heart and Estrogen/progestin Replacement Study (HERS) are included for reported outcomes. STUDY SELECTION AND DATA EXTRACTION: We used all published studies of HRT if they contained a comparison group of HRT nonusers and reported data relating to HRT use and clinical outcomes of interest. Studies were excluded if the population was selected according to prior events or presence of conditions associated with higher risks for targeted outcomes. DATA SYNTHESIS: Meta-analyses of observational studies indicated summary relative risks (RRs) for coronary heart disease (CHD) incidence and mortality that were significantly reduced among current HRT users only, although risk for incidence was not reduced when only studies that controlled for socioeconomic status were included. The WHI reported increased CHD events (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.02-1.63). Stroke incidence but not mortality was significantly increased among HRT users in the meta-analysis and the WHI. The meta-analysis indicated that risk was significantly elevated for thromboembolic stroke (RR, 1.20; 95% CI, 1.01-1.40) but not subarachnoid or intracerebral stroke. Risk of venous thromboembolism among current HRT users was increased overall (RR, 2.14; 95% CI, 1.64-2.81) and was highest during the first year of use (RR, 3.49; 95% CI, 2.33-5.59) according to a meta-analysis of 12 studies. Protection against osteoporotic fractures is supported by a meta-analysis of 22 estrogen trials, cohort studies, results of the WHI, and trials with bone density outcomes. Current estrogen users have an increased risk of breast cancer that increases with duration of use. Endometrial cancer incidence, but not mortality, is increased with unopposed estrogen use but not with estrogen with progestin. A meta-analysis of 18 observational studies showed a 20% reduction in colon cancer incidence among women who had ever used HRT (RR, 0.80; 95% CI, 0.74-0.86), a finding supported by the WHI. Women symptomatic from menopause had improvement in certain aspects of cognition. Current studies of estrogen and dementia are not definitive. In a cohort study, current HRT users had an age-adjusted RR for cholecystitis of 1.8 (95% CI, 1.6-2.0), increasing to 2.5 (95% CI, 2.0-2.9) after 5 years of use. CONCLUSIONS: Benefits of HRT include prevention of osteoporotic fractures and colorectal cancer, while prevention of dementia is uncertain. Harms include CHD, stroke, thromboembolic events, breast cancer with 5 or more years of use, and cholecystitis.

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