The Edinburgh Randomized Trial of Breast Cancer Screening

This article presents additional follow-up analysis of women aged 45-49 from the Edinburgh Randomized Trial of Breast Cancer Screening. The screening protocol included four mammographic examinations at two-year intervals and seven annual clinical examinations. Altogether, 21,774 women aged 45-49 were recruited from 1978 to 1985 using cluster randomization. After 10-14 years of follow-up, breast cancer mortality has been reduced by 12% to 18% (rate ratios, with and without adjustment for socio-economic status, are 0.88 and 0.82 respectively, with 95% confidence intervals [CIs] of 0.55-1.41 and 0.51-1.32). These benefits are smaller than that reported previously with shorter follow-up. This article also presents data from an observational study that compared survival beyond baseline (50-52 years) of women first offered screening before and after age 50. Based on six-year data, the results suggest that earlier screening confers follow-up benefit (hazard ratio for later screening = 1.60; 95% CI: 0.96-2.67), but these findings are not statistically significant. The trial is too small to yield statistically significant results by itself, but can make useful contributions to overview and meta-analyses.     

Occupational Risk Factors for Breast Cancer among Nurses

This study examined the relationship between coping and depression in multiple sclerosis patients, and how that relationship varies at different levels of physical impairment. One-hundred and one patients with clinically definite MS were assessed using the Kurtzke Expanded Disability Status Scale (EDSS), the Ways of Coping Inventory (WCI) with three sub-scales developed by Wineman et al, and the Beck Depression Inventory (BDI). Depression was significantly higher at more advanced levels of neurologic impairment than at lower levels. Escape-Avoidance and Emotional Respite were positively related to level of depression. Planful Problem-Solving and Cognitive Reframing were negatively related to depression. An interaction between coping, depression, and level of neurologic impairment was observed in which Planful Problem-Solving and Cognitive Reframing were more strongly related to depression at higher levels of impairment. The interaction effect for Escape-Avoidance and Emotional Respite with depression and level of impairment did not reach significance. It was concluded that there is a significant interaction between level of neurologic impairment, coping behaviors, and depression in patients with MS.     

Couple-Focused Group Intervention for Women With Early Stage Breast Cancer.

This study examined the efficacy of a couple-focused group intervention on psychological adaptation of women with early stage breast cancer and evaluated whether perceived partner unsupportive behavior or patient functional impairment moderated intervention effects. Two hundred thirty-eight women were randomly assigned to receive either 6 sessions of a couple-focused group intervention or usual care. Intent-to-treat growth curve analyses indicated that participants assigned to the couples' group reported lower depressive symptoms. Women rating their partners as more unsupportive benefited more from the intervention than did women with less unsupportive partners, and women with more physical impairment benefited more from the intervention group than did women with less impairment. Subgroup analyses comparing women attending the couple-focused group intervention with women not attending groups and with usual care participants indicated that women attending sessions reported significantly less distress than did women receiving usual care and women who dropped out of the intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Breast cancer screening programmes in 22 countries: current policies, administration and guidelines. International Breast Cancer Screening Network (IBSN) and the European Network of Pilot Projects for Breast Cancer Screening

BACKGROUND: Currently there are at least 22 countries worldwide where national, regional or pilot population-based breast cancer screening programmes have been established. A collaborative effort has been undertaken by the International Breast Cancer Screening Network (IBSN), an international voluntary collaborative effort administered from the National Cancer Institute in the US for the purposes of producing international data on the policies, funding and administration, and results of population-based breast cancer screening. METHODS: Two surveys conducted by the IBSN in 1990 and 1995 describe the status of population-based breast cancer screening in countries which had or planned to establish breast cancer screening programmes in their countries. The 1990 survey was sent to ten countries in the IBSN and was completed by nine countries. The 1995 survey was sent to and completed by the 13 countries in the organization at that time and an additional nine countries in the European Network. RESULTS: The programmes vary in how they have been organized and have changed from 1990 to 1995. The most notable change is the increase in the number of countries that have established or plan to establish organized breast cancer screening programmes. A second major change is in guidelines for the lower age limit for mammography screening and the use of the clinical breast examination and breast self-examination as additional detection methods. CONCLUSION: As high quality population-based breast cancer screening programmes are implemented in more countries, they will offer an unprecedented opportunity to assess the level of coverage of the population for initial and repeat screening, evaluation of performance, and, in the longer term, outcome of screening in terms of reduction in the incidence of late-stage disease and in mortality.     

Relationship of Catastrophizing to Fatigue Among Women Receiving Treatment for Breast Cancer.

This study examined the relationship of catastrophizing to fatigue in 80 women receiving chemotherapy (CT) or radiotherapy (RT) for treatment of early stage breast cancer. Findings revealed expected relationships between catastrophizing and fatigue among women receiving RT but not CT. Among RT patients, those high in catastrophizing reported significantly greater fatigue than was reported by those low in catastrophizing; among CT patients, differences in fatigue based on level of catastrophizing were not significant. Likewise, catastrophizing was found to account for significant variability in subsequent reports of fatigue among RT patients but not CT patients. These findings extend research on catastrophizing beyond previously studied relationships with pain and are consistent with the view that, as the inherent symptom-producing potential of treatment decreases, psychological factors play a greater role in patients' experience of symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The breast cancer screening controversy and the National Institutes of Health Consensus Development Conference on Breast Cancer Screening for Women Ages 40-49

PURPOSE: Unaccustomed exercise is associated with an elevated plasma creatine kinase (CK), myofibrillar inflammation, and delayed onset muscle soreness (DOMS). Nonsteroidal antiinflammatory drugs (NSAID) may attenuate DOMS and indirect indices of inflammation in humans. METHODS: We studied the effects of an NSAID (naproxen sodium (500 mg, 2 times a day for 48 h)) taken before and after resistance exercise in eight healthy, moderately trained men in a randomized, double-blind trial. The exercise consisted of unilateral knee concentric/eccentric weight lifting with 6 sets x 10 repetitions at 80-85% of the 1 repetition maximal contraction. Muscle biopsies of each vastus lateralis (EX = exercised/REST = control) were taken 24 h after exercise for immunohistochemical staining of inflammatory cells (leukocyte common antigen). At 24 and 48 h postexercise, we also determined DOMS, plasma CK activity, and knee extensor muscle torque. RESULTS: Exercise resulted in an increased CK activity at +24 and +48 h (vs preexercise: P < 0.01), with no treatment effect. There were no treatment effects for any of the measured variables except for a return of voluntary knee extension torque to baseline by +48 h postexercise for NSAID treatment (P < 0.05). CONCLUSIONS: NSAID administration did not alter CK rise, muscle force deficit at 24 h postexercise, nor perceived muscle pain. In addition, the increased CK at 24 h postexercise was not associated with an acute myofibrillar inflammatory cell infiltrate in moderately trained men after resistance exercise.     

Optimism, Perceived Risk of Breast Cancer, and Cancer Worry Among a Community-Based Sample of Women.

Optimism is frequently inversely associated with distress; however, less is known about the mechanisms underlying this relationship. Optimism can be defined as having a generalized positive expectancy about the future. The authors hypothesized that a specific expectancy might mediate the relationship between optimism and distress. That model was tested using perceived risk of breast cancer as a specific measure of expectancy and cancer worry as a measure of distress in a community-based sample of 1,366 women. It was hypothesized that optimism would be inversely associated with cancer worry and that perceived risk of breast cancer would mediate the relationship between optimism and cancer worry. Multiple regression analyses revealed that perceived risk partially mediated the relationship between optimism and cancer worry. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Racial and Body Image Differences in Coping for Women Diagnosed With Breast Cancer.

Although more White women develop breast cancer, African American women more frequently die of the disease (American Cancer Society, 2003). Despite higher morbidity among African American women, few studies have included racially diverse samples. The purposes of this study were to explore racial and body image differences in coping and self-efficacy in coping and racial differences in body image perceptions among breast cancer patients. The 92 participants ranged in age from 28 to 86 years (M=57.64, SD=12.48). Participants with higher body image perceptions had significantly higher self-efficacy in coping compared with participants with lower body image perceptions. There were no significant racial or ethnic differences in coping, self-efficacy in coping, or body image perceptions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Repression and High Anxiety Are Associated With Aberrant Diurnal Cortisol Rhythms in Women With Metastatic Breast Cancer.

Previous research has provided evidence of autonomic, endocrine, and immunological dysregulation in repressers and a possible association with cancer incidence and progression. Recently published data from the authors' laboratory demonstrated that flatter diurnal cortisol slopes were a risk factor for early mortality in women with metastatic breast cancer. In the current analysis of this same sample (N=91), the authors tested differences at baseline between groups scored using the Weinberger Adjustment Inventory on diurnal cortisol slope and mean cortisol levels. When compared with self-assured and nonextreme groups, the represser and high-anxious groups had a significantly flatter diurnal slope. Diurnal slope was similar for repressers and high-anxious groups. Groups did not differ on mean cortisol levels, nor did they differ on intercept (morning) values. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Couples' Support-Related Communication, Psychological Distress, and Relationship Satisfaction Among Women With Early Stage Breast Cancer.

This study examined associations between couple communication about cancer and psychological distress and relationship satisfaction of women diagnosed with early stage breast cancer. One hundred forty-eight couples completed a videotaped discussion of a cancer-related issue and a general issue. Patients completed measures of psychological distress and relationship satisfaction. Videotapes were coded with the Rapid Marital Interaction Coding System (R. E. Heyman & D. Vivian, 1997). Analyses focused on partner responses to patient self-disclosures. During cancer-issue discussions, patients reported less distress when partners responded to disclosures with reciprocal self-disclosure and humor and when partners were less likely to propose solutions. Fewer links between partner responses to patient self-disclosures and distress were found in general-issue discussions. Results suggest partner responses play a role in women's adaptation to breast cancer. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is Finding Something Good in the Bad Always Good? Benefit Finding Among Women With Breast Cancer.

The correlates and consequences of benefit finding on quality of life were examined for 364 women (93% Caucasian, 6% African American, and 1% Hispanic) diagnosed with Stage I, II, and III breast cancer. Benefit finding and quality of life were measured 4 months postdiagnosis (Tl), 3 months after Tl (T2), and 6 months after T2 (T3). Women with lower socioeconomic status, minorities, and those with more severe disease perceived more benefits at baseline. Benefit finding was associated with more negative affect at baseline and also interacted with stage of disease, such that negative relations to quality of life across time were limited to those with more severe disease. Findings suggest there are qualifiers as to whether "finding something good in the bad" is good or bad. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship of Social Support and Social Burden to Repeated Breast Cancer Screening in the Women's Health Initiative.

Direct and interactive effects of social support, social burden (caregiving, negative life events, and social strain), education, and income on repeated use of breast cancer screening among a large (N=55,278), national sample of postmenopausal women participating in the Women's Health Initiative observational study were examined. Repeated screening decreased as emotional/informational support and positive social interactions decreased (ps     

The Gothenburg Breast Cancer Screening Trial: preliminary results on breast cancer mortality for women aged 39-49

We carried out a randomized trial of invitation to screening mammography in the city of Gothenburg, Sweden, to estimate the effect of screening on breast cancer mortality in women under age 50 years. A total of 11,724 women aged 39-49 were randomized to the study group, which was invited to mammographic screening every 18 months; 14,217 women in the same age range were randomized to a control group, which was not invited to screening until the fifth screen of the study group. Breast cancers diagnosed in both groups between randomization and immediately after the first screen of the control group were followed up for death from breast cancer to the end of December 1994. There was a significant 44% reduction in mortality from breast cancer in the study group compared to the control group (relative risk [RR] = 0.56, P = 0.042, 95% confidence interval [CI]: 0.32-0.98). A conservative estimate based on removal of the cancers detected at the first screen of the control group gave an RR = 0.59 (P = 0.069, 95% CI: 0.33-1.05). The true answer is likely to lie between the two estimates. These data suggest that mammographic screening can reduce breast cancer mortality in women under age 50, particularly if high-quality mammography is used and a short interscreening interval is adhered to.     

Excessive breast self-examination among first-degree relatives of newly diagnosed breast cancer patients. High-Risk Breast Cancer Consortium

The influence of the primary antibody, the fixative, and the antigen unmasking technique on the method sensitivity of immunohistochemistry as a method for the identification of viral hemorrhagic septicemia (VHS) virus in paraffin-embedded specimens of naturally infected rainbow trout (Oncorhynchus mykiss) was examined. Fish (200-300 g) were collected during an outbreak of VHS. Parallel specimens from liver, spleen, kidney, and brain were fixed by immersion in 10% phosphate-buffered formalin, periodate-lysine-paraformaldehyde (PLP), Bouin's fluid, or absolute ethanol. Virus cultivation was also performed on parallel specimens, and the virus titer (TCID50/ml) was determined. Purified nucleocapsid protein (N-protein) of the virus was incorporated in an artificial antigen substrate polymerized bovine serum albumin), fixed as described above, and embedded in paraffin wax. Microwave unmasking was performed on formalin-, PLP-, and Bouin's fluid-fixed specimens. The presence of virus peptides in situ or N-protein in the artificial antigen substrates was visualized using an immunohistochemical method based on alkaline phosphatase or peroxidase and one polyclonal and five monoclonal polypeptide-specific antibodies. VHS virus was identified in situ in specimens with high virus titers (10(7-8) TCID50/ml) regardless of the fixative and without the need of an unmasking procedure. A pronounced masking effect was observed for the cross-linking formalin and PLP fixatives. Regardless of the primary antibodies used, there was a significantly higher epidemiologic sensitivity (the proportion of virus positive samples that tested positive by immunohistochemistry) using ethanol and Bouin's fluid compared with formalin and PLP (P < 0.05). At 10(5) TCID50/ml, the average sensitivity reached 0.5, and at > or = 10(6) TCID50/ml, sensitivity was 0.9. Unmasking procedures showed a moderate effect and did not result in significantly higher epidemiologic sensitivity (P = 0.17), There was great variation for the different monoclonal antibodies/antigens and fixatives. Sensitivity studies on antigen substrates were in accordance with results of in situ studies that showed the highest sensitivity for ethanol and Bouin's fluid. Virus cultivation was more sensitive than immunohistochemistry. This study showed that the fixative and the primary antibody both influence method sensitivity and that VHS virus antigens concealed during fixation are difficult to reexpose. Immunostaining for VHS virus should be performed with monoclonal antibodies specific for the N-protein, and tissue samples should be fixed in either ethanol or Bouin's fluid. Immunohistochemistry is specific but is less sensitive than virus cultivation. Immunostaining for VHS virus can be a valuable supplement to virus cultivation during acute outbreaks of disease.     

Productivity among American psychologists.

An attempt to answer the question of "whether the aggregate publications of any generation of scientists are made up primarily of the work of the highly productive minority or are composed chiefly of the contributions of the less productive majority." Using data from four groups (different time periods) of American psychologists found that the total output of each of the groups is made up to a large extent of the publications of a relatively small number of productive individuals. Further analysis revealed that the more productive persons had their work cited most often in scholarly works in psychology and are more likely to receive professional recognition and honors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Updated overview of the Swedish Randomized Trials on Breast Cancer Screening with Mammography: age group 40-49 at randomization

The purpose of this overview is to estimate more precisely the long-term effect of mammography screening by adding four more years of follow-up to women aged 40-49 years in the four Swedish trials on mammography screening. Data from the four, trials were merged and linked to the Swedish Cancer and Cause of Death Register for 1958-1993 and 1951-1993 respectively to identify date of breast cancer diagnosis and cause and date of death. The invited and control groups comprised 48,569 and 40,247 women respectively. At the December 1993 follow-up, 602 and 482 breast cancer cases were identified in the two groups respectively, of which 104 and 111 had breast cancer as the underlying cause of death. This corresponds to a relative risk (RR) of 0.77 (95% CI: 0.59-1.01) for the two groups. In the 40-44 age group at randomization, 94% of breast cancer patients in the study and 89% in the control group were diagnosed before the age of 50; however, among breast cancer deaths in this age group, only two in the invited and five in the control group died after age 50. At follow-up of women 40-44 years at randomization 208 women in the invited and 184 in the control group were reported to the Cancer registry with breast cancer. Out of these 195 (94%) and 163 (89%) respectively were reported before the age of 50. Further, the relative risk for the age group 40-44 years at randomization by age at follow-up was 1.11, 0.51 and 0.46 for the age groups 45-49, 50-54, and 55-59 at follow-up. This study shows a 23% reduction in the breast cancer mortality in women 40-49 years at randomization achieved from a median trial time of 7.0 years, a median follow-up time of 12.8 years, and a screening interval of 18-24 months. Almost all of the effect in the 40-44 year age group at randomization was due to screening before the age of 50.     

Breast cancer screening: first round in the population-based program in Valencia, Spain. Collaborative Group of Readers of the Breast Cancer Screening Program of the Valencia Community

PURPOSE: To analyze the results of round 1 of the population-based Valencia Breast Cancer Screening Program. MATERIALS AND METHODS: In this program, 78,224 (72.98%) of the 107,178 women invited (aged 45-65 years) underwent screening. Complementary views were obtained in 5,771 women (7.38%). Among the total population studied, 3,502 (4.48%) underwent short-term mammographic follow-up studies; 3,898 (4.98%) underwent additional studies and treatment at hospitals. Five hundred eighty-seven women (0.75%) underwent biopsy. RESULTS: Cancer was detected in 334 patients (4.27 cancers per 1,000 women [3.24 per 1,000 women aged 45-49 years, 6.30 per 1,000 women aged 60-65 years]; six patients with lobular carcinoma in situ excluded). The estimated sensitivity was 89%; specificity, 99%. The positive predictive value of mammography was 8.56%; of mammography with additional examinations, 26.82%; and of biopsy, 56.89%. Forty-one patients (12.28%) had ductal carcinoma in situ; 284 (85.03%) had infiltrating carcinoma. In 73 (25.70%) of the 284 patients, infiltrating carcinomas were smaller than 1 cm. Two hundred twenty-five patients (76.27%) had no lymph node involvement. One hundred seventy-nine (61.09%) had stage 0 or 1 cancer. CONCLUSION: Results are consistent with other published results; differences are due to methods and patient population characteristics.     

The Impact of Breast Cancer on the Lives of Middle-Aged Women: Results From the Australian Longitudinal Study of Women's Health.

This article investigated the impact of breast cancer (BC) in middle-aged Australian women (45-50 years). Two waves of data collected 2 years apart from a longitudinal survey of 12,177 women identified 3 groups: (a) 11,933 (98%) who reported never having had BC, (b) 181 (1.5%) who reported a diagnosis of BC at Time 1, and (c) 63 (0.5%) who reported onset of BC between Time 1 and Time 2. Repeated measures analysis of variance was used to compare the 3 groups. Women with recent onset of BC experienced significant changes across a range of functioning compared with the other 2 groups. Compared with women with no BC, women with longer established onset of BC had significantly worse health and social outcomes, but these were associated with small effect sizes. Both groups of women with BC reported less impact on mental and emotional health than on other areas of functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Canadian National Breast Screening Study: a Canadian critique

The Canadian National Breast Screening Study (CNBSS) was the first study designed to determine the efficacy of screening for breast carcinoma in women 40-49 years old. Women were randomized to undergo either annual mammography and physical examination or usual care after an initial physical examination [1]. Women 50-59 years old were randomized to undergo either annual mammography and physical examination or annual physical examination only [2]. This study, published by epidemiologists on the efficacy of a radiologic examination, therefore, invites evaluation by radiologists.     

The North Carolina Breast Cancer Screening Program: foundations and design of a model for reaching older, minority, rural women

Breast cancer screening programs do not reach all women at the same rate. Screening mammography use varies according to sociodemographic characteristics; mammography utilization is highest among women in their fifties but then decreases with age. In North Carolina, breast cancer is a particular burden for Black and lower-income women. Black women are more likely to be diagnosed with late stage disease, and their rate of breast cancer mortality is higher than it is for White women even though the incidence in White women is greater. Older, Black, and low-income women are less likely to obtain screening by mammography and clinical breast examination. The Black-White gap is even more pronounced among rural women, in part because they are more likely to be poor. The North Carolina Breast Cancer Screening Program (NC-BCSP) was established to increase the rate of regular mammography screening by an absolute 20% in 3 years among older Black women ages 50 and older in five rural counties in the eastern part of the state. In this paper, we describe the genesis of this comprehensive community intervention model, highlighting the behavioral science constructs, health education principles, and theories of behavioral and organizational change that form its conceptual foundation. NC-BCSP's theoretical foundations include the social ecological perspective, the PRECEDE model of health promotion, the Health Belief Model of individual change, and the "stages of change" transtheoretical model. We also review the experiences and lessons learned from two previous outreach initiatives in North Carolina that provided valuable "lessons" in the development of the NC-BCSP intervention model. In the second half of the paper, we describe the actual NC-BCSP interventions, activities, and evaluation tools, citing specific examples of how the underlying theories are implemented. NC-BCSP's goal goes beyond individual behavior change to raise low mammography screening rates among Black women in rural North Carolina. Its ultimate objective is to create linkages across agencies, and between agencies and communities, that will endure after the research project ends.