National Cancer Institute®
Last Modified: October 1, 2002
UI - 10750598
AU - Jakes RW; Duffy SW; Ng FC; Gao F; Ng EH
TI - Mammographic parenchymal patterns and risk of breast cancer at and after a prevalence screen in Singaporean women.
SO - Int J Epidemiol 2000 Feb;29(1):11-9
AD - NMRC Clinical Trials & Epidemiology Research Unit, Singapore.
BACKGROUND: The objective of this study was to assess the effect of mammographic parenchymal patterns on risk of breast cancer detected at first screen or in the period following a negative screen. METHODS: The study utilizes a nested case-control design with 132 breast cancer patients detected at first screen (from a total of 29 193 screened) and 42 breast cancer patients detected in the period following the first screen. These patients were matched to 348 screened-negative controls. The mammograms were classified according to Tabar's classification for parenchymal pattern and statistical analysis was done by conditional logistic regression. RESULTS: The risk of breast cancer for women with Tabar pattern IV was significantly high when compared to the remaining patterns (odds ratio 2.59). Risk factors for Tabar pattern IV coincided largely with established risk factors for breast cancer. CONCLUSION: The study confirms the increased risk of breast cancer associated with Tabar pattern IV (approximately Wolfe pattern P2), in an Asian population. This pattern is associated with nulliparity and high educational status and is strongly associated with grade 3 cancers.
UI - 10750599
AU - Wakai K; Dillon DS; Ohno Y; Prihartono J; Budiningsih S; Ramli M; Darwis
TI - I; Tjindarbumi D; Tjahjadi G; Soetrisno E; Roostini ES; Sakamoto G; Herman S; Cornain S Fat intake and breast cancer risk in an area where fat intake is low: a case-control study in Indonesia.
SO - Int J Epidemiol 2000 Feb;29(1):20-8
AD - Department of Preventive Medicine, Nagoya University School of Medicine, Japan.
BACKGROUND: Associations of fat and other macronutrients with breast cancer risk are not clear in areas where fat intake is low. METHODS: We conducted a hospital-based case-control study from 1992 to 1995 in Jakarta, Indonesia. RESULTS: The study, based on 226 cases and 452 age and socioeconomic status matched controls, provided the following findings. (a) In the pre-marriage period, the greater the fat or protein consumption, the larger the risk, whereas decreasing risk with increasing carbohydrate intake was detected. The odds ratio (OR) for the highest quartile of intake relative to the lowest was 8.47 (95% CI: 4.03-17.8) for fat, 2.19 (95% CI: 1.30-3.69) for protein, and 0.16 (95% CI: 0.08-0.31) for carbohydrate. A positive association with fat and a negative one with carbohydrate were also observed for the post-marriage period, but of weaker magnitude compared to the pre-marriage period. (b) The effects of macronutrient intakes were stronger among premenopausal than among postmenopausal women. (c) Most of the associations of protein and carbohydrate were insignificant after adjustment for fat intake. CONCLUSIONS: These findings suggest that fat intake might be an important determinant of breast cancer among populations with a low fat diet in Indonesia.
UI - 11962245
AU - Simon MS; Lababidi S; Djuric Z; Uhley V; Depper J; Kresge C; Klurfeld
TI - DM; Heilbrun LK Comparison of dietary assessment methods in a low-fat dietary intervention program.
SO - Nutr Cancer 2001;40(2):108-17
AD - Division of Hematology and Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI 48201, USA. firstname.lastname@example.org
The food frequency questionnaire (FFQ) is commonly utilized for assessment of dietary fat intake, but its validity among individuals following a low-fat diet is unclear. We evaluated the agreement of nutrient estimates derived from FFQ, 24-h recall, and 3-day food records obtained from 104 participants in a randomized trial of a low-fat dietary intervention for women at elevated breast cancer risk. Comparisons were made for total calories, percent calories from fat, and total fat after 1 yr. Correlation was assessed using standard methods based on a null hypothesis of no agreement between instruments as well as by a methodology based on a null hypothesis that the instruments should be in agreement. With the use of standard methods, FFQ estimates for women on the low-fat diet were significantly correlated to records only for percent calories from fat (r = 0.39), whereas recall and record estimates were significantly correlated for all three dietary variables. Using the new method, we found no significant correlation between FFQ and either recalls or records for women following a low-fat diet but significant correlation between recall and record estimates for total calories (r = 0.67). Traditional correlation testing may overestimate the extent of agreement in dietary instruments among women on a low-fat diet. We found empirical support for the nontraditional method.
UI - 12241901
AU - du Bois A
TI - Mammographic screening: no reliable supporting evidence?
SO - Lancet 2002 Aug 31;360(9334):719-20; discussion 720-1
UI - 12241902
AU - Bonneux L
TI - Mammographic screening: no reliable supporting evidence?
SO - Lancet 2002 Aug 31;360(9334):720; discussion 720-1
UI - 12241903
AU - Werth J
TI - Mammographic screening: no reliable supporting evidence?
SO - Lancet 2002 Aug 31;360(9334):720; discussion 720-1
UI - 12243426
AU - Ashkar K; Bulbul M; Sharara A; Hourani M; Hamadeh GN
TI - Cancer screening for the primary care physician.
SO - J Med Liban 2001 Sep-Oct;49(5):298-302
AD - American University of Beirut-Medical Center, Department of Family Medicine, Lebanon. email@example.com
Cancer screening guidelines are developed by numerous agencies. These guidelines are often conflicting leaving the primary care physician in a difficult position. He (she) is requested to choose the best test for his or her patients taking into consideration the principles of screening, the test cost and most importantly the patient's emotional and physical well-being. Screening for some cancers, like lung cancer, has been considered of no benefit. Other cancers, like breast, colon, cervix and prostate, have been the subject of numerous recommendations: For breast cancer, clinical examination and mammography are recommended every 1-2 years for women between 50 to 70 years. For cervical cancer, PAP smear is suggested every 1-3 years and for colorectal cancer, a yearly fecal occult blood, sigmoidoscopy or colonoscopy every 5-10 years. Annual serum prostate specific antigen (PSA) and digital rectal examination screening for prostate cancer are still controversial.
UI - 2187166
AU - Grio R; Piacentino R; Cellura A; Caccuri D; Zaccheo F; Baccarini G;
TI - Marchino GL; Borgarino S; Fuda G [Hormonal contraception using estroprogestins]
SO - Minerva Ginecol 1990 Mar;42(3):49-53
AD - Istituto di Ginecologia e Ostetricia Cattedra A, Universita degli Studi di Torino.
Today the estroprogestagen pill is the most valid method of contraception given that its benefits far outweigh its risks. The paper stresses the importance of a thorough anamnestic, clinical and laboratory examination so as to obtain correct and safe steroid contraception. The efficacy and excellent tolerance of the combined method currently make it the most widespread form of oral contraception.
UI - 2092241
AU - Peterson HB; Lee NC
TI - Long-term health risks and benefits of oral contraceptive use.
SO - Obstet Gynecol Clin North Am 1990 Dec;17(4):775-88
AD - Division of Reproductive Health, Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control, Atlanta, Georgia.
The contraceptive effect of oral contraceptive use provides an important health benefit, particularly in developing countries, where the risks of pregnancy and childbearing are increased. Several important noncontraceptive health benefits of oral contraceptive use include the prevention of endometrial and ovarian cancers. Data are generally reassuring concerning the risks of oral contraceptive use, which include cardiovascular disease and breast and cervical cancer.
UI - 2063386
AU - Vatten LJ
TI - [Can breast cancer be prevented?]
SO - Tidsskr Nor Laegeforen 1991 May 30;111(14):1745-8
AD - Kreftavdelingen Regionsykehuset i Trondheim.
More than six-fold variation in incidence between countries, an increasing incidence among immigrants to high incidence areas, and a general increase in the incidence of breast cancer within countries, are factors which suggest a potential for prevention. Reproductive factors such as early menarche, late age at first full term birth, nulliparity, and late age at menopause increase risk of breast cancer, but manipulation of any one of these factors does not seem to be a realistic preventive tool. Nevertheless, the future possibility of using tamoxifen as a chemopreventive agent against breast cancer is discussed, particularly in relation to women at increased risk due to familial clustering. Alcohol consumption by young women, and overweight among postmenopausal women may also increase the incidence of breast cancer. Consequently, reduced alcohol intake by young women, and weight reduction among overweight women after menopause may reduce the risk of breast cancer.
UI - 1559340
AU - Petitti DB; Porterfield D
TI - Worldwide variations in the lifetime probability of reproductive cancer in women: implications of best-case, worst-case, and likely-case assumptions about the effect of oral contraceptive use.
SO - Contraception 1992 Feb;45(2):93-104
AD - Department of Family and Community Medicine, University of California, San Francisco School of Medicine 94143.
Cancer incidence in countries representative of three patterns of reproductive cancer and age-specific mortality was used to estimate the effect of oral contraceptive use on the lifetime probability of reproductive cancer under three sets of assumptions about the effects of oral contraceptives. Under the set of assumptions considered likely, oral contraceptives were estimated to reduce or increase only slightly the lifetime probability of any reproductive cancer in each setting. Under worst-case assumptions, oral contraceptives were estimated to increase the lifetime probability of reproductive cancer only modestly in settings with low cancer rates and in settings with high rates of breast, ovarian, and endometrial cancer, but it might have a large impact on lifetime probability of reproductive cancer in settings with high cervical cancer rates. Under best-case assumptions, oral contraceptives were estimated to decrease the lifetime probability of reproductive cancer in each setting; this reduction was estimated to be greatest in settings where endometrial and ovarian cancer incidence are high.
UI - 1622631
AU - Spicer DV; Pike MC
TI - The prevention of breast cancer through reduced ovarian steroid exposure.
SO - Acta Oncol 1992;31(2):167-74
AD - University of Southern California School of Medicine, Department of Preventive Medicine, Los Angeles 90033-9987.
Analysis of epidemiologic data on cancers of the breast, ovary and endometrium; the effects of endogenous hormones on cell proliferation; and current carcinogenesis concepts, suggest that hormonal contraceptives can be developed that will reduce lifetime risk of all 3 cancers. The 'unopposed-estrogen hypothesis' accounts for endometrial cancer risk factors. Ovarian cancer risk is closely related to the total frequency of ovulation. The risk of breast cancer can be explained by an 'estrogen-plus-progestogen hypothesis'. On the basis of this analysis an hormonal contraceptive regimen has been developed consisting of a gonadotropin-releasing hormone agonist (GnRHA) plus continuous low-dose add-back estrogen and a short course of progestogen every fourth month. The total dose of add-back estrogen is estimated to be approximately 38% that in present-day low-dose combination-type oral contraceptives (COCs). The total dose of progestogen is approximately 15% that in COCs. This regimen prevents ovulation and should thus reduce ovarian cancer risk. It also reduces the exposure of the endometrium to unopposed estrogen, and the exposure of the breast to estrogen-plus-progestogen. It is estimated that use of such a regimen for 10 years will only reduce lifetime risk of endometrial cancer by one-sixth, but lifetime risk of ovarian cancer is estimated to be reduced by two-thirds, and lifetime risk of breast cancer is estimated to be reduced by one-half.
UI - 8435564
AU - Gili AF; Poonja Z; Kalra BB
TI - Breast cancer screening for women younger than 40.
SO - Can Fam Physician 1993 Jan;39():65-72
AD - University of Alberta Hospital.
The charts of 661 women aged 15 to 39 revealed that almost 50% of teenage patients had had breast screening examinations. Most of the physicians and residents involved began performing and teaching breast examination to patients in their teens. Concerned that it might do more harm than good, the Canadian guidelines do not advocate early screening.
UI - 8390340
AU - Spicer DV; Pike MC; Pike A; Rude R; Shoupe D; Richardson J
TI - Pilot trial of a gonadotropin hormone agonist with replacement hormones as a prototype contraceptive to prevent breast cancer.
SO - Contraception 1993 May;47(5):427-44
AD - Department of Medicine, University of Southern California School of Medicine, Los Angeles.
Combination oral contraceptive (COC) users have reduced risks of ovarian and endometrial cancer, but COCs have not reduced breast cancer risk. We have previously argued that a hormonal contraceptive with substantially lower doses of sex-steroids should reduce breast cancer risk by decreasing the breast epithelial cell proliferation below usual premenopausal levels. We report here the preliminary results of a pilot trial with such a prototype contraceptive consisting of an agonist of gonadotropin releasing hormone (GnRHA) administered with low doses of an oral estrogen (0.625 mg of conjugated estrogen, CE, for 6 days every week) and intermittent oral progestogen (10 mg of medroxyprogesterone acetate, MPA, for 13 days every 4 months). Eighteen subjects at five-fold or greater increased breast cancer risk were entered and randomized -12 to the contraceptive arm and 6 to a control arm. The principal endpoints included tolerance of the regimen, vaginal bleeding patterns, and the regimen's effect on the endometrium, bone metabolism, and lipids. A symptom questionnaire was used to assess tolerance; the contraceptive subjects had fewer symptoms following initiation of the regimen. This results from the elimination of symptoms associated with the luteal phase of the menstrual cycle, commonly referred to collectively as premenstrual syndrome, PMS. The few occurrences of hot flushes or vaginal dryness that did occur were eliminated by small increases in estrogen dose (0.9 mg CE). Scheduled vaginal bleeding occurred associated with most periods of progestogen administration. Unscheduled bleeding or spotting was infrequent and decreased with time on the regimen. A beneficial rise in high-density lipoprotein cholesterol was evident in the contraceptive subjects. Despite the use of an estrogen dose which is known to prevent loss of bone mineral density in normal postmenopausal women, an annualized loss of 1.9% was seen in contraceptive subjects. It is hypothesized that this is secondary to inhibition of ovarian androgen production by the GnRHA, which may additionally account for changes in libido occasionally reported with GnRHA. The study continues with the addition of a small dose of androgen to replace that lost by the action of the GnRHA.
UI - 8253093
AU - Pinotti JA; Barros AC; Hegg R; Zeferino LC
TI - Breast cancer control programme in developing countries.
SO - Eur J Gynaecol Oncol 1993;14(5):355-62
AD - Gynecologic Clinic, Hospital das Clinicas, Medical School, Sao Paulo University.
Breast cancer is a very important health problem in developing countries, where its incidence has increased in the last decades. Mortality rates due to breast cancer have also increased, and the main reason for this is late diagnosis. The authors demonstrate that organizing programmes for early breast cancer detection is possible by making use of simple resources. A set of tiered interventions is proposed, stratified in levels of complexity: Level 1--Identification of abnormal breast by health professionals; Level 2--Medical assistance to women whose breast is considered abnormal, in order to diagnose and treat benign diseases and recognize suspect cases of cancer; Level 3--Management of the women with suspected or diagnosed breast cancer by a multidisciplinary team. Therefore, a proposal for wide action for breast cancer control in developing countries is presented.
UI - 7839882
AU - Anim JT
TI - Breast cancer in sub-Saharan African women.
SO - Afr J Med Med Sci 1993 Mar;22(1):5-10
AD - College of Medicine, King Faisal University, Dammam, Saudi Arabia.
The literature on breast cancer in sub-Saharan women is reviewed. In general, breast cancer is the second most common malignancy of women in the region, after cancer of the uterine cervix. Available reports indicate that data on the disease are incomplete and mostly, of epidemiological or clinical nature. Breast cancer is less common in sub-Saharan Africa compared to the Western countries (USA or Europe), occurs in younger individuals with peak incidences about a decade younger and the majority present late, with advanced, sometimes terminal disease. Absence of health educational programmes on cancer as well as lack of screening facilities in nearly all countries in the region are contributory factors to the late presentation of the cases. The need for more in-depth studies of the disease in the black African population has been highlighted.
UI - 3455923
AU - Miller AB; Bulbrook RD
TI - UICC Multidisciplinary Project on Breast Cancer: the epidemiology, aetiology and prevention of breast cancer.
SO - Int J Cancer 1986 Feb 15;37(2):173-7
UI - 3955285
AU - Drife J; Guillebaud J
TI - Hormonal contraception and cancer.
SO - Br J Hosp Med 1986 Jan;35(1):25-9
The natural menstrual cycle can influence the development of some cancers. Combined oral contraceptives, which replace normal hormonal fluctuations with steadier levels of artificial sex hormones, appear to protect against cancers of the endometrium and ovary, but their effect on carcinomas of the breast and cervix remains uncertain.
UI - 7232306
AU - Wenderlein JM
TI - [Psychometry in gynecological research (author's transl)]
SO - Schweiz Rundsch Med Prax 1981 Mar 24;70(13):554-60
UI - 3369418
AU - Irwin KL; Lee NC; Peterson HB; Rubin GL; Wingo PA; Mandel MG
TI - Hysterectomy, tubal sterilization, and the risk of breast cancer.
SO - Am J Epidemiol 1988 Jun;127(6):1192-201
AD - Division of Reproductive Health, Center for Health Promotion and Education, Centers for Disease Control, Atlanta, GA 30333.
Studies suggest that hysterectomy and tubal sterilization may alter the function of the remaining ovaries. Conceivably, this effect could alter breast cancer risk. To investigate whether these surgeries affect breast cancer risk, the authors analyzed data collected between December 1, 1980, and April 30, 1983, in a population-based, case-control study of women aged 20-54 years, the Cancer and Steroid Hormone Study. Compared with never-sterilized women, women with hysterectomy and no remaining ovaries had a decreased risk of breast cancer (relative risk (RR) = 0.7, 95% confidence interval (CI) = 0.6-0.8). Risk was lowest in women who had their surgery before age 40 years or 15 or more years in the past; surgery at an early age provided greater protection than surgery in the distant past. Hysterectomy with one or two remaining ovaries was also inversely associated with breast cancer risk (RR = 0.8, 95% CI = 0.7-0.9), but no relation was found with age at surgery or time since surgery. Women with tubal sterilization had a slightly increased risk of breast cancer, which was of borderline statistical significance (RR = 1.2, 95% CI = 1.0-1.3). However, no relation was found with age at surgery or time since surgery. The data suggest that hysterectomy with bilateral oophorectomy decreases the breast cancer risk in women aged less than 55 years, possibly by curtailing ovarian function at a critical period. However, neither hysterectomy without bilateral oophorectomy nor tubal sterilization appears to substantially alter breast cancer risk in women of this age.
UI - 8120917
AU - Spicer DV; Ursin G; Parisky YR; Pearce JG; Shoupe D; Pike A; Pike MC
TI - Changes in mammographic densities induced by a hormonal contraceptive designed to reduce breast cancer risk.
SO - J Natl Cancer Inst 1994 Mar 16;86(6):431-6
AD - University of Southern California School of Medicine, Los Angeles 90033-9987.
BACKGROUND: It has been known for some time that oral contraceptives substantially reduce the risk of endometrial and ovarian cancer, but they do not reduce the risk of breast cancer. A hormonal contraceptive regimen has been developed which uses a gonadotropin-releasing hormone against (GnRHA) to suppress ovarian function, and this regimen includes the administration of very low doses of both estrogen and progestogen. This hormonal contraceptive regimen attempts to minimize exposure of the breast epithelium to these steroids and to preserve the maximum beneficial effects of estrogen, while still preventing endometrial hyperplasia. PURPOSE: Our purpose was to determine whether changes occurred in mammographic densities between baseline and 1 year for women on this hormonal contraceptive regimen with reduced estrogen and progestogen levels compared with women in a control group. METHODS: Twenty-one women were randomly assigned in a 2:1 ratio to the GnRHA-based contraceptive group (14 women) or to a control group (seven women). The contraceptive group received the following: 7.5 mg leuprolide acetate depot by intramuscular injection every 28 days; 0.625 mg conjugated estrogen by mouth for 6 days out of 7 every week; and 10 mg medroxyprogesterone acetate orally for 13 days every fourth 28-day cycle. The control group received no medication. Baseline and 1-year follow-up mammograms of contraceptive and control subjects were reviewed in a blinded fashion by two radiologists. RESULTS: Comparison of the changes between the baseline and 1-year mammograms in the two groups of women showed significant (P = .039) reduction in mammographic densities at 1 year for women on the contraceptive regimen. Assessing the reduction in mammographic densities by noting the fineness of fibrous septae showed a highly significant (P = .0048) difference in the contraceptive regimen group. One of the women on the contraceptive regimen was withdrawn from the study because of poor compliance. CONCLUSION: The reduced estrogen and progestogen exposures to the breast that were achieved by the hormonal contraceptive regimen resulted in substantial reductions in follow-up mammographic densities at 1 year compared with baseline. Although there is no direct evidence that such a reduction in densities will lead to a reduced risk of breast cancer, indirect evidence for a protective effect of this regimen is that early menopause reduces breast cancer risk, and that menopause is associated with a reduction in mammographic densities.
UI - 9243587
AU - Canty L
TI - Breast cancer risk: protective effect of an early first full-term pregnancy versus increased risk of induced abortion.
SO - Oncol Nurs Forum 1997 Jul;24(6):1025-31
AD - University of Incarnate Word, San Antonio, TX, USA.
PURPOSE/OBJECTIVES: To examine the question of whether an early first full-term pregnancy (FFTP) protects against breast cancer and whether interruption of the pregnancy with an induced abortion increases breast cancer risk. DATA SOURCES: Published medical and epidemiology journal articles, books, scientific reports, news interviews of researchers, scientific journals. DATA SYNTHESIS: Continually increasing breast cancer rates cannot be explained by the American Cancer Society risk factors, which account for only 25% of cases. Induced abortion is a newly recognized risk factor and has been prevalent in our society since it was legalized in 1973. CONCLUSIONS: Early FFTP confers protection, while induced abortion confers risk. Most specific and controlled variables studies indicate 150% risk for abortions performed on women younger than 18 years of age. Studies have yet to discover the full impact of induced abortion because women who underwent legalized abortion in 1973 are just reaching ages of highest breast cancer incidence. IMPLICATIONS FOR NURSES: Awareness of a controversial risk factor and its relevance to women allows nurses to include this information when educating and supporting patients. Specifically, nurses need to include questions on this reproductive risk when eliciting a patient's reproductive history. Nurses should further be aware of the emotional impact disclosure may have.
UI - 9647530
AU - Yagel S; Anteby E
TI - A rational approach to prenatal screening and intervention.
SO - Hum Reprod 1998 May;13(5):1126-8
AD - Department of Obstetrics and Gynecology, Hadssah Mt Scopus, Jerusalem, Israel.
UI - 12219430
AU - MacDonald DJ
TI - Women's decisions regarding management of breast cancer risk.
SO - Medsurg Nurs 2002 Aug;11(4):183-6
AD - City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
Twenty-three unaffected women with a family history of breast or ovarian cancer participated in a study to ascertain their cancer-related concerns, beliefs, and preferences for risk management. Their perceptions related to breast cancer risk management options have implications for practicing nurses.
UI - 12243912
AU - Kinsinger LS; Harris R
TI - Chemoprevention of breast cancer: a promising idea with an uncertain future.
SO - Lancet 2002 Sep 14;360(9336):813-4
AD - Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. firstname.lastname@example.org
UI - 12243915
AU - IBIS investigators
TI - First results from the International Breast Cancer Intervention Study (IBIS-I): a randomised prevention trial.
SO - Lancet 2002 Sep 14;360(9336):817-24
BACKGROUND: Three clinical trials on the use of tamoxifen to prevent breast cancer have reported mixed results. The overall evidence supports a reduction in the risk of breast cancer, but whether this benefit outweighs the risks and side-effects associated with tamoxifen is unclear. METHODS: We undertook a double-blind placebo-controlled randomised trial of tamoxifen, 20 mg/day for 5 years, in 7152 women aged 35-70 years, who were at increased risk of breast cancer. The primary outcome measure was the frequency of breast cancer (including ductal carcinoma in situ). Analyses were by intention to treat after exclusion of 13 women found to have breast cancer at baseline mammography. FINDINGS: After median follow-up of 50 months (IQR 32-67), 69 breast cancers had been diagnosed in 3578 women in the tamoxifen group and 101 in 3566 in the placebo group (risk reduction 32% [95% CI 8-50]; p=0.013). Age, degree of risk, and use of hormone-replacement therapy did not affect the reduction. Endometrial cancer was non-significantly increased (11 vs 5; p=0.2) and thromboembolic events were significantly increased with tamoxifen (43 vs 17; odds ratio 2.5 [1.5-4.4], p=0.001), particularly after surgery. There was a significant excess of deaths from all causes in the tamoxifen group (25 vs 11, p=0.028). INTERPRETATION: Prophylactic tamoxifen reduces the risk of breast cancer by about a third. Temporary cessation of tamoxifen should be considered and the use of appropriate antithrombotic measures is recommended during and after major surgery or periods of immobilisation. Prophylactic use of tamoxifen is contraindicated in women at high risk of thromboembolic disease. The combined evidence indicates that mortality from non-breast-cancer causes is not increased by tamoxifen. The overall risk to benefit ratio for the use of tamoxifen in prevention is still unclear, and continued follow-up of the current trials is essential.
UI - 12161681
AU - Carney CP; Allen J; Doebbeling BN
TI - Receipt of clinical preventive medical services among psychiatric patients.
SO - Psychiatr Serv 2002 Aug;53(8):1028-30
AD - Department of Psychiatry, University of Iowa College of Medicine, Iowa City, 52242, USA. email@example.com
A total of 267 patients who were receiving care for psychiatric and substance use disorders at a university medical center completed a self-report instrument assessing their previous receipt of clinical preventive services. High rates of mammography and Pap tests within the past year were observed (76 and 77 percent). Rates of immunization (hepatitis B and tetanus vaccines) varied from 11 percent to 78 percent. Rates of preventive counseling for sexual practices, diet, and avoidance of alcohol were lower than 25 percent in all groups. Only 6 percent of all patients reported having been screened for gun ownership, despite the high risk of suicide among gun owners.
UI - 12242654
AU - Chen C; Bhalala HV; Qiao H; Dong JT
TI - A possible tumor suppressor role of the KLF5 transcription factor in human breast cancer.
SO - Oncogene 2002 Sep 26;21(43):6567-72
AD - Department of Pathology, University of Virginia Health System, Charlottesville, Virginia, VA 22908, USA.
The 13q21 tumor suppressor locus, as defined by chromosomal deletion, harbors the KLF5 transcription factor which may have tumor suppressor function. To investigate whether KLF5 plays a role in breast cancer, we evaluated all genes and/or expressed sequence tags (ESTs) within a 3.3 Mb common region of deletion at 13q21. Of these, only KLF5 mRNA was expressed at high levels in non-neoplastic breast epithelial cells and in normal human mammary tissue, but at lower levels in various breast cancer cell lines. Using the real time TaqMan PCR assay, hemizygous deletion at KLF5 was detected in 13 out of 30, or 43% of breast cancer cell lines tested, and various degrees of loss of expression were detected in 21 out of 30, or 70% of these cell lines. Each of the cases with hemizygous deletion also exhibited loss of KLF5 expression, suggesting that loss of expression can result from chromosomal deletion, and that KLF5 may undergo haploinsufficiency during carcinogenesis. Only one of the 30 breast cancer cell lines tested exhibited a mutation in KLF5, and neither promoter methylation nor homozygous deletion was detected in any of the cell lines. In contrast, loss of heterozygosity (LOH) was frequently detected at KLF5. Re-expression of wild-type KLF5 in T-47D breast cancer cells significantly inhibited colony formation in these cells. Of the KLF5-transfected clones that did form colonies, none were found to express KLF5 mRNA. These findings suggest that loss of function by deletion and/or loss of expression frequently occurs at KLF5, and KLF5 suppresses tumor cell growth in breast cancer.
UI - 12181496
AU - Madanat H; Merrill RM
TI - Breast cancer risk-factor and screening awareness among women nurses and teachers in Amman, Jordan.
SO - Cancer Nurs 2002 Aug;25(4):276-82
AD - Department of Health Science, College of Health and Human Performance, Brigham Young University, Provo, Utah 84602, USA.
Breast cancer awareness studies of women in Jordan do not exist. This study used data from 163 nurses and 178 teachers surveyed in Amman to determine 2 dimensions of breast cancer awareness: general breast cancer awareness, defined as knowledge of risk factors associated with the disease and breast cancer screening awareness, defined as knowledge of breast self-examination and mammography. The survey instrument was based on 2 previously validated knowledge-based questionnaires in the literature (Breast Cancer Knowledge Test and the Comprehensive Breast Cancer Questionnaire). Analysis of covariance indicated that family history was associated with general breast cancer awareness. Profession, age, and family history significantly influenced breast cancer screening awareness. The average percentage of correct responses to general breast cancer awareness was adjusted for select covariates (adjusted means). The adjusted mean general awareness score for nurses was not significantly different from that of teachers (P =.8470). Nurses were more aware than teachers of the importance of breast cancer screening and its techniques. The adjusted mean screening awareness score for nurses was 88.3%, compared with 73.1% for teachers (P <.0001). These results provide important information about the level of breast cancer awareness among women nurses and teachers in Jordan and may be useful for developing future prevention and screening education programs.
UI - 12195760
AU - Heinig A; Lampe D; Kolbl H; Beck R; Heywang-Kobrunner SH
TI - Suppression of unspecific enhancement on breast magnetic resonance imaging (MRI) by antiestrogen medication.
SO - Tumori 2002 May-Jun;88(3):215-23
AD - Department of Diagnostic Radiology, Martin-Luther-Universitat Halle-Wittenberg, Halle, Germany.
AIMS AND BACKGROUND: The value of breast MRI may be impaired by unspecific enhancement. This may leave patients with difficult-to-assess breast tissue with an uncertain diagnosis. We examined whether this unspecific enhancement (which is mostly due to proliferative or hyperplastic changes of benign breast tissue) may be suppressed by antiestrogen medication. METHODS: In a trial of treatment, 10 peri- or postmenopausal patients who exhibited diffuse and/or focal enhancement on breast MRI before tamoxifen medication agreed to undergo a short-term tamoxifen treatment. MRI monitoring was performed 2, 4 and 8 weeks after onset of antiestrogen therapy (tamoxifen, 30 mg per day). RESULTS: Six patients showed a significant decrease of enhancement. Unchanged (n = 3) or increased (n = 1) enhancement was seen in 4 patients. One of the three patients with unchanged enhancement proved to have diffuse lobular carcinoma in situ. CONCLUSIONS: Part of the unspecific enhancement seen on breast MRI can probably be suppressed by short-term antiestrogen medication.
UI - 12222134
AU - Haimov-Kochman R; Lavy Y; Hochner-Celinkier D
TI - [Review of risk factors for breast cancer--what's new?]
SO - Harefuah 2002 Aug;141(8):702-8, 761
AD - Center for Education and Advancement of Women's Health in Menopause, Hadassah University Hospital, Mt. Scopus, Hebrew University, Jerusalem.
Breast cancer is the most common malignancy in women and constitutes 18% of all cancers in women. Female gender, age and country of birth are the strongest determinants of disease risk. Family history and mutations in tumor suppressor genes BRCA1 and BRCA2 are important correlates of lifetime risk. Genetic polymorphisms associated with estrogen synthesis and metabolism are viewed as major factors in breast cancer prevalence in specific populations. Atypical hyperplasia and ductal/lobular carcinoma in situ although uncommon, are considered as pre-malignant conditions as well as markers for invasive breast cancer. Lately, increased bone density and high breast tissue density on mammogram in postmenopausal women have been reported in association with increased risk of breast carcinoma, probably attributable to increased levels of endogenous estrogen. Serum estrogen levels are higher in breast cancer cases as compared with controls. Current use of oral contraceptives and prolonged, current or recent use of postmenopausal hormonal replacement therapy are also considered as risk factors for breast cancer. Tamoxifen and raloxifene, selective estrogen receptor modulators, were shown to reduce breast cancer risk among high-risk women. Various nutrients were evaluated for their possible effect on breast cancer risk but further studies are needed. High socioeconomic status is found to be associated with increased risk of breast malignancy for as yet unestablished reasons. Studying breast cancer risk factors and further research into the molecular etiology of the disease will enable early diagnosis and detection of high-risk women and ultimately improve prognosis.
UI - 12355995
AU - Tremollieres F; Lopes P
TI - [Specific estrogen receptor modulators (SERMs)]
SO - Presse Med 2002 Sep 7;31(28):1323-8
AD - Unite de menopause et maladies osseuses metaboliques, service d'endocrinologie, CHU Rangueil, Toulouse (31).
PRINCIPLE CHARACTERISTICS: Specific estrogen receptor modulators (SERMs) are non-steroid molecules that maintain some of the agonist properties of estrogens on bone tissue and cardiovascular system, but not their stimulating effects on the gynecological sphere. OLD AND NEW MOLECULES: SERMs were formerly known as "antiestrogens" in reference to their primary inhibition of breast tumor growth. Hence, tamoxifen has been used for many years as adjuvant treatment of breast cancer. However, its long-term use is limited by the risk of endometrial hyperplasia, which has led to the development of new molecules devoid of this side effect. Among these molecules, raloxifen, more specifically reserved for the prevention of osteoporosis in menopausal women, has been the subject of major pre-clinical and clinical developments. THE EFFECTS OF RALOXIFEN: In the prevention of postmenopausal bone loss and vertebral fractures, the effects of raloxifen have been established in several randomized, double-blind studies against placebo, which were the basis of its current marketing authorization. Moreover, raloxifen has a favorable effect on lipid profile and, contrary to oral estrogens, does not increase the C-Reactive protein. Endometrial tolerance is good and it is associated with a significant reduction in the incidence of breast cancer in elderly osteoporotic women. ITS PLACE IN THERAPY: Raloxifen's properties raise the question of its place, together with hormone replacement therapy (HRT), in the management of menopausal women. Its absence of efficacy in the control of the climacteric syndrome does not a priori make it a treatment of choice at the beginning of postmenopausal phase. How