Hormonal replacement therapy and breast cancer]

Hormonal replacement therapy is prescribed more and more frequently to increase quality of life and decrease the symptomatic and organic consequences of the menopausal status. The different studies which analyzed the risk of breast cancer for women under hormonal replacement therapy show opposed conclusion. We reviewed articles published between 1980 and 1997 to try to conclude about the consequences of the action of this treatment in the risk of breast cancer from the characteristic of the hormonal replacement therapy and from known risk of breast cancer. Hormonal replacement therapy increases the incidence of breast cancer. Risk increase with the treatment duration and a low estrogen dose would be sufficient to palliate to the hormonal lack (< 0.625 mg/j). The risk of breast cancer becomes the same that this of women without hormonal replacement treatment when treatment interrupted. The association of estrogen and progestin should not be protective of breast cancer. But the hormonal treatment seems to be synergistic for the risk of breast cancer with late menopause, late age at the birth of first child. Hormonal treatment could increase the estrogenic period and should increased the risk of breast cancer in women with late age at menarche, late age at menopause and late age at first child. It should not increase the risk of breast cancer in women with benign breast disease, with family history of breast cancer and in nulliparous women. For women who undergone a bilateral oophorectomy before hormonal replacement treatment the risk would be the same than for women with natural menopause and without hormonal replacement treatment. However breast cancer should be diagnosed earlier in women with hormonal treatment because mammographies were made more frequently. Overall survival should not different between the women who were under hormonal therapy and theses were not.     

Alterations in eighteen-carbon saturated, monounsaturated and polyunsaturated fatty acid peroxisomal oxidation in mouse brain during development and aging

PURPOSE/OBJECTIVES: To provide an update on the breast cancer genes BRCA1 and BRCA2 and to review available primary preventive options. DATA SOURCES: Published articles, abstracts, and clinical experience. DATA SYNTHESIS: While genetic testing will help identify a cadre of women at high risk for breast cancer development, it also will raise many psychosocial and ethical issues, including if and when to be tested and what patients and healthcare professional should do with the information. CONCLUSIONS: The only currently available putative form of primary prevention is prophylactic mastectomy. Diet and the use of tamoxifen remain areas for future research. IMPLICATIONS FOR NURSING PRACTICE: Nurses can play an important role in educating patients who face difficult decisions surrounding genetic testing and primary prevention modalities. Nurses also can design and conduct much needed research in these areas.     

Breast cancer risk: protective effect of an early first full-term pregnancy versus increased risk of induced abortion

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.     

Negative affect and barriers to exercise among early stage breast cancer patients.

Objective: To assess the relative frequency of and barriers to exercise among women with breast cancer while controlling for cancer-relevant and demographic factors. Design: The present study employed concurrent samples, correlational research design. Main Outcome Measures: Exercise frequency and its association with negative affect and barriers to exercise, independent of cancer treatment, among women (N = 176) with Stage I or II breast cancer who were 3, 6, and 12 months postsurgery. Results: After accounting for cancer-relevant and control variables, degree of negative affect and frequency of perceived barriers were significantly inversely associated with exercise. Conclusion: These findings suggest that attention to both emotional factors and psychosocial barriers to exercise may be warranted to further understand exercise among women with early stage breast cancer. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual functioning and intimacy in African American and white breast cancer survivors: a descriptive study

This study examines ethnic differences in sexual socialization and attitudes, sexual history and current practices, and the effects of treatment in 147 African American and White breast cancer survivors. Sex-related research in younger healthy populations has shown that cultural values associated with ethnicity influence sexual functioning, but small numbers of African American participants in previous research in breast cancer survivors has limited what we know about that population. In this study, there were few differences between the 2 ethnic groups in a predominantly well-educated, high-income, highly functional sample. However, African American women were significantly less likely to be comfortable with and to practice oral sex, self-touching, and masturbatory behaviors. White women were more likely to report that breast cancer had a negative impact on their sex lives. These differences in sexual repertoire and functioning should be noted by health care practitioners treating the sexual sequelae of breast cancer treatment.     

Glycation accelerates the oxidation of low density lipoprotein by copper ions

The American Cancer Society recommends periodic mammography, clinical breast examination and breast self-examination beginning at age 40 years for asymptomatic women at average risk of breast cancer. Although there is substantial evidence from meta-analyses and non-randomized studies to support these recommendations, individual randomized clinical trials of breast cancer screening have not demonstrated mortality reduction in women aged 40-49 years. The opportunity to study this issue further in the United States has been diminished by the high prevalence of screening already being conducted in that population of younger women. The International Union Against Cancer, the American Cancer Society and the National Cancer Institute of the United States have convened a series of workshops and planning meetings to consider the available data and outline plans for future research. Plans are being developed to conduct a randomized trial of mammography in women younger than 50 years in multiple European sites. Successful completion of this trial may provide critical data on efficacy of breast cancer screening in younger women.     

The social construction of breast loss and reconstruction

Reconstructing the breasts of women with breast cancer is standard medical care. An exploratory, qualitative study of women with breast cancer demonstrates that breast reconstruction is not essential to the resolution of a breast cancer crisis. This article reveals that today's culture creates a social context in which breast loss appears to have dire consequences for women and then provides the medical care to redress the loss it has helped create. Interviews were held with 29 women to explore the psychosocial consequences of breast cancer on their health and lives. This study demonstrates that breast reconstruction fails to meet the expectations of these women with breast cancer because the women identify disjunctures between social expectation and their own interests in health and well-being.     

Is there a basis for prevention of breast cancer with drugs?

The anti-oestrogen drug tamoxifen has led to one of the most important improvements in therapy for breast cancer patients achieved during the last decades. Tamoxifen reduces risk of relapse and improves survival in women with breast cancer. In addition, tamoxifen has favourable effects on the lipoprotein metabolism, reduces morbidity and death from myocardial infarction, and stabilizes bone density in women after menopause. Owing to the good therapeutic results in breast cancer patients and the additional favourable effects of tamoxifen, studies were started among healthy women with elevated risk of breast cancer. The intention was to examine whether tamoxifen could reduce the risk of breast cancer development in healthy women. Recent studies, however, have demonstrated higher risk of endometrium cancer in breast cancer patients treated with tamoxifen, and higher risk of histological abnormalities in the endometrium in healthy women. Prevention trials, when tamoxifen is given to healthy women, are disputed, owing to the apparent carcinogenic effect of tamoxifen.     

Psychological disease adjustment in breast cancer patients

In a prospective follow-up study, attention was focused on adjustment to disease in breast cancer patients one year after diagnosis. Prebioptic data was collected in the original patient group consisting of 95 women with mammary tissue findings that required clarification. Twenty-nine women with histological confirmation of breast cancer and 37 patients of the control group with benign histological findings were recontacted after an interval of one year. Data was collected by means of psychological test questionnaires (STAI, SVF, FPI, CIP-DS), the patients with breast cancer were given an additional problem-oriented questionnaire about coping with disease, compiled by the author. Most denied having disease-related fears-progression of the disease, premature death; instead, marked sleep disturbances, regularly, recurring nightmares, and depressed states of mind characterized the psychosomatic correlate of the mental burden. The psychological consequences of cancer are related to some extent to the stage of tumour growth at the time of diagnosis; the process of social reintegration appears to be facilitated in women whose biopsy operation did not involve removal of a breast. An clear characterization of breast cancer patients could not be established using psychological testing procedures one year after diagnosis of the disease.     

Breast cancer arising in surgical scars

Twelve women who developed breast cancer at the site of old surgical scars in the breast are presented. Six had had former breast biopsies, 3 drainage of breast abscesses, and 3 developed breast cancer in old thoracotomy scars transversing the breast. The combination of trauma as an oncogen and scar tissue as a functional and immunological locus minoris resistentia seems to play a major role in the development of breast cancer in this group of patients. The associaton of breast cancer, scar, and trauma would not be coincidental. Increased attention drawn to this entity may lead to a rise in the number of cases diagnosed among patients with breast scars after biopsies, abscesses, trauma, or foreign body implantation.     

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.     

Long-term effects of amyloid enhancing factor: clinical and experimental implications

The aim of our study was to assess Polish women's attitudes and possible acceptance of genetic tests for breast cancer susceptibility. The research was carried out in 1995-1996 and enrolled 200 women of different age, education and professional status who were asked to answer the questions included in a questionnaire. We estimate the percentage of women presenting different attitudes towards breast cancer genetic testing: 77% of women accepted genetic tests for breast cancer (BRCA) and 48% of women accepted informing their close relatives of the genetic tests results.     

Women''s experiences of non-invasive breast cancer: literature review and study report

A review of the post-1990 literature on breast cancer has identified a large body of psychosocial research focusing on coping styles, quality of life and women's participation in choice of treatment. However, numerous methodological problems were found, including a variety of different diagnoses included in samples both within studies and between studies, making comparisons difficult. In particular, no article was traced which focused on non-invasive breast cancer, or ductal carcinoma in situ (DCIS). Therefore a small exploratory study was conducted using qualitative methods to explore women's experience of DCIS, in an attempt to begin exploration of possible similarities or differences in the way women experience invasive and non-invasive breast cancer. A convenience sample of 10 women treated at two hospitals in an Australian state capital city was interviewed, and three themes which emerged from these interviews are discussed in this article. These are discovering the problem, reaction to the diagnosis, and information. Most women unexpectedly reacted in a calm and accepting way to receiving the diagnosis of DCIS, and this may be because they had had no signs of disease but been recalled for further tests after routine screening. They felt well and had no cause to assume a poor prognosis. It is possible also that their reactions were affected by a television health education campaign at the time, which gave a very optimistic picture of the benefits of early detection of breast cancer. Information-giving, as reported by the women, seemed deficient. None of them knew that they had had a non-invasive condition, one thought her disease had been benign, and another that hers was "evasive'. Findings are discussed in relation to the literature on information-giving and on the role of the nurse in this area, and suggestions are made for further research to systematically compare women's reactions to having invasive and non-invasive breast cancer in order that nurses may be aware of their possibly different needs and respond to them appropriately.     

From ethnography to intervention: developing a breast cancer control program for Latinas

Latinas are less likely than Anglo women to have appropriate breast cancer screening for reasons that may include culturally based beliefs as well as socioeconomic factors. This study employed ethnographic methods to explore breast cancer-related knowledge, attitudes, and behaviors among Latinas, Anglo women, and physicians, tested the generalizability of the findings in a telephone survey of randomly selected women, and used the results to design a culturally sensitive breast cancer control intervention in Orange County, Calif. Respondents for the ethnographic interviews included 28 Salvadoran immigrants, 39 Mexican immigrants, 27 Chicanas (U.S.-born Latinas of Mexican heritage), 27 Anglo women, and 30 physicians selected through organization-based network sampling. Latinas had very different beliefs about risk factors for breast cancer and held more fatalistic attitudes about the disease. For example, they believed that trauma to the breast was among the most important risk factors. Results of a telephone survey of 1225 randomly selected women (269 U.S.-born Latinas, 425 Mexican immigrants, 109 other Latina immigrants, and 422 Anglo women) generally confirmed the dissimilar beliefs among Latinas and Anglo women. The findings influenced our decision to design and pilot-test a breast cancer control intervention based on Bandura's self-efficacy theory and Freire's empowerment pedagogy. The methodology and findings of this study have important implications for future cancer control research and interventions.     

The effects of health beliefs on screening mammography utilization among a diverse sample of older women

Screening mammography is particularly effective in detecting breast cancer in elderly women. Yet, although half of all breast cancers are diagnosed in older women, statistics show that women aged 65 and over tend to underutilize screening mammography. Prior research has used the constructs of the Health Belief Model to explore attitudes and beliefs relative to breast cancer screening. Prior studies have also identified health beliefs and concerns relative to screening mammography and race/ethnicity as some of the patient-related predictors of screening mammography utilization among younger women. This study uses the theoretical framework of the Health Belief Model to explore the effects of these variables on utilization in a multiracial, multiethnic, random sample of 1011 women, aged 65 and over. Race/ethnicity, belief that mammograms detect cancer, ease the mind, and provide accurate results; concern over the radiation, pain, and cost associated with receiving a mammogram; and other independent variables were tested as predictors of screening mammography utilization. Regression analysis identified that the belief that having a mammogram eases recipients minds was the most significant predictor of screening mammography utilization. None of the other health beliefs or health concerns were significant predictors. Race/ethnicity had no direct effects on utilization nor was it a confounder in the relationship between health beliefs, concerns and utilization. These results indicate that, along with emphasizing the importance of mammograms in early detection of breast cancer, stressing the reassurance that mammography brings recipients may be an effective health education strategy for elderly women of different racial/ethnic backgrounds.     

Attitudes of Canadian oncology practitioners toward psychosocial interventions in clinical and research settings in women with breast cancer

The aim of this study was to survey Canadian oncology practitioners' attitudes toward psychosocial concerns and issues in women with breast cancer. Surveys were mailed to 351 medical, radiation and surgical oncologists and 375 oncology nurses. Standard questionnaires assessed attitudes towards psychosocial issues in women with primary and metastatic breast cancer and evaluated the practitioners' willingness to refer women to psychosocial intervention trials in the presence and absence of competing drug trials. Responses were obtained from 74% of those surveyed. Respondents reported being aware of the common occurrence of psychosocial problems in women with metastatic breast cancer, however, physicians were less likely than nurses to offer these women psychosocial support on a prophylactic basis (p < 0.0001) and they expressed greater concern than nurses about scientific validity of (p = 0.0003), and potential psychological damage from (p = 0.005), psychosocial support groups. Nurses were more likely than physicians to favour a study investigating group psychosocial support over competing drug studies (p < or = 0.003) in the metastatic setting. Physicians were less likely than nurses to deal with weight problems prophylactically in women with primary breast cancer (p = 0.0009) and they expressed greater concern over scientific validity of psychosocial interventions addressing weight than nurses (p = 0.0008); nurses were more concerned about excessive expectations of patients regarding potential benefits of such interventions (p < 0.0001). Regardless, nurses were more likely than physicians to favour a psychosocial intervention study focused on weight management over drug studies in pre- (p = 0.0006) and postmenopausal women (p = 0.05) with primary breast cancer. Canadian oncology practitioners are aware of the common occurrence of psychosocial distress in women with breast cancer. Physicians and nurses assigned differing priorities to psychosocial interventions in both clinical and research situations.     

Osteoporosis: a concern for cancer survivors

PURPOSE/OBJECTIVES: To describe the risk factors, prevention, diagnosis, management, and impact of osteoporosis on the lives of women who have survived breast and endometrial cancer. DATA SOURCES: Journal articles, selected textbooks, prescribing information, and conference proceedings. DATA SYNTHESIS: Women who have not been able to have estrogen-replacement therapy (including women who have survived breast and endometrial cancer) are at higher risk for developing osteoporosis. Osteoporosis is associated with significant medical costs and can have a detrimental effect on long-term quality of life (QOL) as well as increased mortality. Recently, significant advances have been made in the ability to detect and manage osteoporosis. CONCLUSIONS: Thorough assessment, appropriate evaluation, and treatment of osteoporosis can reduce the complications of this condition and ultimately improve the QOL for women surviving cancer. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses should include assessment of risk for osteoporosis into their practice. Education about the prevention of osteoporosis should be included with other wellness education. Women at higher risk for the development of osteoporosis should be referred for a diagnostic evaluation. Oncology nurses can provide women with osteoporosis with education about treatment as well as psychosocial support.     

Progressive subretinal fibrosis and blindness in patients with multifocal granulomatous chorioretinitis

Since women with a first-degree relative with breast cancer are at increased risk for breast cancer, it is of special importance that they adhere to early detection programs. In this study, women with (389) and without (3295) a family history of breast cancer were compared with respect to risk perception, breast cancer anxiety, and early detection behavior. Special attention was paid to the role of knowing that family history is a breast cancer risk factor. It was found that 46% of "family history positives" did not know that their risk was increased by their family history. Still, family history positives had increased risk perception; our results suggest that this was partly caused by their knowing they belonged to a risk group and partly by their having experienced the disease at close range. Although family history positives had higher risk perceptions, no differences in early detection behavior were found. This could not be attributed to high anxiety levels. Implications for health education are discussed.