Prevention and screening for breast cancer

Breast cancer is the most common cancer among women in both Europe and the U.S. It is the second leading cause of cancer deaths for women in the U.S., but the first in Poland. Age, family history, reproductive factors, proliferative breast disease, and radiation are established risk factors. Diet may account for differences in international incidence rates; however, the majority of women who get breast cancer do not have identifiable risk factors other than age and being female. Primary prevention of breast cancer is unknown. Control relies on secondary prevention aimed at suppression of clinically occult disease, mammographic screening, and early detection of palpable disease through physical examination and breast self-examination. Dietary and medical prevention strategies are being tested in the U.S. Screening mammography has demonstrated effectiveness in reducing mortality in women over 50. The "Partnerships in Healthcare" program aims to enhance the early detection of breast cancer in Poland by providing mammography units, training for technicians and nurses, and incentives to develop multidisciplinary approaches to diagnosis and treatment.     

Cost of breast cancer screening

In a honeybee colony, brood stimulates development of hypopharyngeal glands of nurse bees. A chemical signal, a blend of 10 fatty acid esters, has been identified on larval cuticle. We demonstrate that the blend of 10 esters, ethyl oleate, and methyl palmitate stimulates the protein synthesis of hypopharyngeal glands of nurses. Thus, in Apis mellifera the chemical signal from the brood acts as a primer pheromone in addition to its previously shown role as a releaser pheromone.     

Liability in breast cancer screening

The U.S. breast cancer mortality rate has risen over the past 29 years in women 50 years of age and older. This is surprising in light of the fact that the disease is curable when detected early through mammography together with clinical breast examinations (CBE). One major problem is that many women are not being screened. Only about one-third of women 50 years of age and older are receiving yearly screening mammograms, despite published guidelines. Regarding CBE, more women are receiving them, but there is room for improvement. The main reasons given by women for not having a mammogram are: 1) their physicians did not recommend it; 2) they did not know they needed one; or 3) they did not have any breast problems. These responses reflect a lack of awareness of breast cancer screening recommendations and indicate that women are not being given adequate information about breast cancer from their physicians. This paper will explore the medical malpractice literature in order to discuss the question of whether physicians should be liable for failing to inform their female patients.     

Mammographic screening. A key examination for the early diagnosis of breast cancer

The insufficiency of the tricuspid valve developed due to blunt chest trauma is a rare and an insidiously progressing clinical incident. In this article we present a case which showed tricuspid insufficiency because of the rupture of the anterior papillary muscle due to trauma and which was treated surgically.     

What is the relationship between breast cancer risk and mammography screening? A meta-analytic review.

This meta-analytic review addresses the issue of how a woman's risk of breast cancer relates to the likelihood that she will obtain mammography screenings. Studies that compared women with or without a family history of breast cancer (n?=?19) showed that women with a family history were more likely to have been screened. Studies that measured perceived risk (n?=?19) showed that feeling vulnerable to breast cancer was positively related to having obtained a screening. Studies that compared women who did or did not have a history of breast problems (n?=?10) showed that those with a positive history were more likely to have been screened. Finally, studies that measured worry (n?=?6) showed that greater worry was related to higher screening levels. Taken together, these data suggest that increasing perceptions of personal vulnerability may increase screening behavior for breast cancer. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patterns of inheritance of ovarian cancer. An analysis from an ovarian cancer screening program

BACKGROUND: A variety of inheritance patterns for familial ovarian cancer have been proposed including an autosomal dominant inheritance, a breast-ovary cancer syndrome and Lynch Cancer Family Syndrome (involving breast, bowel, ovary, and endometrial cancers). METHODS: Women participating in an ovarian cancer screening study completed a questionnaire concerning their family history of ovarian and other malignancies (in particular breast, bowel, and endometrial cancer). Confirmation of the diagnosis was sought when there was uncertainty. RESULTS: Two hundred forty women with a first-degree relative with ovarian cancer participated in the study. Nine percent of these women (representing 13 families) gave a definite history of two or more affected first-degree relatives. Two families had a pedigree consistent with an autosomal dominant inheritance. A breast-ovary cancer family and a Lynch cancer family syndrome were suspected in one family each, although 34% of all women gave a history of at least one other first-degree relative with either breast, bowel, or endometrial cancer. CONCLUSIONS: Only a small number of women with a family history of ovarian cancer fit into the recognized hereditary patterns. Difficulty in recognizing the inheritance patterns and the lack of definitive genetic markers poses problems in providing adequate counseling regarding screening and prophylactic oophorectomy.     

Mass screening programs for breast cancer in France. Comparative evaluation

OBJECTIVE: The purpose of this work was to comparatively assess the results of mass screening programs for breast cancer implemented in six French departments in 1986, within the scope of the National Fund for Health Prevention, Education and Information of the National Health Insurance Office of Salaried Workers. MATERIAL AND METHODS: The data collected by the screening centres were analyzed by ten assessment teams that were independent from the program promotion staff, all using the same evaluation form. A complementary population study performed in eight French districts then, allowed assessing the frequency of self-referred screening (mammography performed out of program). RESULTS: The rate of participation in screening programs, in relation to the invited population, ranged from 21 to 48%, according to the district (36% in average). This low participation was probably related to the extent of self-referred screening. In fact, 19 to 40% of women, according to the district, had previously had a screening mammographic coverage: rate was around 68% in women aged 50 to 69 years. Positive findings with mammography ranged from 4.5 to 15.8% (10.1% in average), while intervention rates ranged from 0.7 to 1.6% and detection rates from 3.8 to 6.2%. The ratio between benign tumors and cancers ranged from 0.7 to 2.1 according to the district. In order to enlighten the judgement on French results, we propose a comparison with the international standards in force. CONCLUSION: The various experiences with breast cancer screening in France show that this screening is technically feasible on the basis of existing medical structures. However, some criteria are still below the expected values, especially if compared with international standards. This result is probably accounted for by the high rate self-referred screening before age 40 in France. In these conditions, the question is whether extending breast cancer screening programs in France is an appropriate course of action.     

Test sequences in screening for breast cancer

Published data of Stark and Way on the screening of 2,684 women at high risk of breast cancer are analyzed to arrive at a preferred sequence of screening tests. In the practical situation where palpation first signals a problem, the analysis suggests thermography to follow. Women with positive thermograms should then be biopsied, and those with negative thermograms should be mammographed. A positive mammogram calls for biopsy, and a negative one calls for close follow-up. For high-risk women whose breasts appear normal on palpation, a subsequent negative thermogram is not definitive enough to terminate investigation, but a negative mammogram after a negative palpation is enough evidence to waive further investigation for some time. A positive mammogram calls for immediate biopsy in any circumstance.     

Increasing breast and cervical cancer screening in low-income women

Active cytomegalovirus (CMV) retinitis in patients with acquired immunodeficiency syndrome (AIDS) was treated with an intraocular sustained-release ganciclovir implant. A total number of 19 implants were performed in 15 eyes of 9 AIDS patients. The intraocular sustained-release ganciclovir was effective in preventing reactivation of CMV retinitis in 15 of the 19 implants, ineffective in 3, and undetermined in 1. All ineffective cases had been resistant to ganciclovir therapy before the implants. Vision after the therapy was maintained at better than 0.5 except for one eye. There were no serious ocular complications caused by the therapy. Among 5 patients with unilateral CMV retinitis, 2 unaffected eyes developed CMV retinitis during this therapy. In addition, another patient developed presumed CMV infection in other systemic organs. Based on these data, the intraocular sustained-release ganciclovir implant was considered to be useful for the treatment of CMV retinitis in AIDS.     

A nursing rehabilitation program for women with breast cancer receiving adjuvant chemotherapy

PURPOSE/OBJECTIVES: To examine the effects of a comprehensive rehabilitation program on facilitating physical and psychosocial adaptation of women with breast cancer who are receiving adjuvant chemotherapy. DESIGN: Experimental. SETTING: Breast evaluation clinics of two New England medical centers with comprehensive cancer treatment programs. SAMPLE: 14 women (mean age = 44 years) receiving adjuvant chemotherapy for breast cancer (86% stage II) following surgical treatment. METHODS: Subjects were assigned randomly to the experimental group or the usual care group. Experimental group members began a structured exercise program of walking and attended support group meetings. All subjects were tested before beginning chemotherapy, during the course of chemotherapy, and one month following chemotherapy completion. MAIN RESEARCH VARIABLES: Performance status, physical functioning, psychosocial adjustment, self-concept and body image, and 12 symptoms (e.g., fatigue, nausea, anxiety). FINDINGS: Measures of physical performance, psychosocial adjustment, and symptom intensity revealed improved adaptation in subjects who completed the walking/support group program. CONCLUSIONS: Physical and psychosocial benefits from a modest walking exercise program and a support group are possible for patients receiving adjuvant chemotherapy. IMPLICATIONS FOR NURSING PRACTICE: Although more detailed research is necessary to answer some of the questions raised by this study, implementing the walking program and forming a support group are achievable in an outpatient setting.     

An overview of the breast cancer screening controversy

Randomized controlled studies show that screening mammograms are as important for women aged 40-49 as for women 50 years old and above. It was the improper use of retrospective, unplanned, sub-group analysis to advise women and their physicians that caused the controversy over mammograms for women under 50. Furthermore, arbitrarily grouping women into two groups leads to the incorrect conclusion that the age of 50 is a significant break point when it is not. The data demonstrates that none of the parameters of screening change abruptly at age 50. The recall rates (an abnormal mammogram) and the rate at which biopsies are recommended are virtually the same, regardless of age. Breast cancer is not a trivial problem for women in their forties. More than 30% of the years of life lost to breast cancer are from women diagnosed while in their forties. Because of changing demographics, in 1995 and 1996, there were actually more women diagnosed with breast cancer in their forties than for women in their fifties. The data clearly show that screening women for breast cancer, on an annual basis, beginning by age 40, can reduce the death rate by approximately 24%. It is important to separate medical and scientific analyses from the economic considerations. "Society" may decide that it is too expensive to screen women for breast cancer, but women should be provided with the scientific and medical information so that they can participate in the discussion of whether screening is "worthwhile" and decide whether or not to avail themselves of its benefit. The economics should not be used to influence the scientific and medical analysis of benefit.     

Appraisals, coping, and stress in breast cancer screening: A longitudinal investigation of causal structure.

The cognitive-appraisal model of R. S. Lazarus and S. Folkman (1984) is one of the most prominent theories of stress. As integral elements in this model, appraisal and coping have both been proposed as mediators of the stress response. The purpose of this study was to test the predictive power of the theoretical model based on 2 competing formulations using structural equation modeling techniques. One conceptual model proposed that coping influences stress through appraisal; the other proposed that appraisals impact on stress via coping. 506 women (aged 50+ yrs) undergoing breast cancer screening completed measures of appraisal, coping, and stress. Support was found for both hypothesized causal structures. The implications of these findings are discussed in terms of Lazarus's theoretical perspective. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Enhancing breast cancer screening in the university setting

Mammography, physical examination by a health care professional, and breast self-examination (BSE) may increase the probability of detection of breast cancer at an early stage and thus increase long-term survivor rates. The purpose of this study was to investigate the effectiveness of supportive coaching as an intervention to enhance compliance with these breast cancer screening guidelines. The following research questions were identified: (a) what are the attitudes of women toward breast cancer screening? (b) what are the barriers to compliance identified by women in breast cancer screening? and (c) what are the effects of supportive interventions by a professional nurse and of compliance with breast cancer screening in women? A quasi-experimental design was used to study the research questions. The population chosen for the study included female employees in a state university setting. Participants were randomly assigned to one of two groups. All participants were asked to complete a prestudy questionnaire measuring attitudes and beliefs, gathering demographic and health information, and surveying breast cancer screening practices. The experimental group then received coaching and supportive interventions over the course of the academic year. The remainder of the sample served as a control group. A poststudy questionnaire was then sent to the entire sample to identify behaviors related to breast cancer screening. A variety of beliefs and attitudes were observed in the groups. No significant difference was found between the experimental and control groups on compliance with mammography and the clinical breast examination. A difference was noted on compliance with BSE by the experimental group evidencing more compliance.     

A review on family history of breast cancer: screening and counseling proposals for women with familial (non-hereditary) breast cancer

In a neural model of olfactory bulb processing, we demonstrate the putative role of the modulation of two types of inhibition, inspired by electrophysiological data on the effect of acetylcholine and noradrenaline on olfactory bulb synaptic transmission. Feedback regulation of modulation based on bulbar activity serves to 'normalize' the activity of output neurons in response to different levels of input activities. This mechanism also decreases the overlap between pairs of output patterns (Mitral cell activities), enhancing the discrimination between overlapping olfactory input patterns. The effect of the modulation at the two levels of interneurons is complementary: while an increase in periglomerular inhibition decreases the number of responding output neurons, a decrease in granule cell inhibition increases the firing frequencies of these neurons.     

Cervical and breast cancer screening rates in Sioux Indian women

We cloned a novel human beta-defensin gene and determined its full-length cDNA sequence. The entire gene spanned more than 7 kb and included a large 6962-bp intron. The 362-bp cDNA encoded a prepropeptide that corresponded precisely to the recently identified human beta-defensin HBD-1, an antimicrobial peptide implicated in the resistance of epithelial surfaces to microbial colonization. By two-color fluorescence in situ hybridization on both metaphase chromosome and released chromatin fiber, HBD-1 gene (DEFB1 in HUGO/GDB nomenclature) mapped to chromosomal region 8p23.1-p23.2 in close proximity (within 100-150 kb) to the gene for the human neutrophil alpha-defensin HNP-1 (DEFA1). Thus, despite a complete lack of DNA sequence similarity and despite differences in their disulfide-pairing pattern, the alpha- and beta-families appear to have evolved from a common premammalian defensin gene.