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Time to decide about risk-reducing mastectomy: A case series of BRCA1/2 gene mutation carriers
Mary McCullum, Joan L Bottorff, Mary Kelly, Stephanie A Kieffer, Lynda G Balneaves
BMC Women's Health , 2007, DOI: 10.1186/1472-6874-7-3
Abstract: Data was collected in a pilot study that assessed the response of women to an information booklet about RM and decision-making support strategies. A detailed analysis of three women's descriptions of their decision-making processes and outcomes was conducted.All three women were carriers of a BRCA1/2 gene mutation and, although undecided, were leaning towards RM when initially assessed. Each woman reported a different RM decision outcome at last follow-up. Case #1 decided not to have RM, stating that RM was "too radical" and early detection methods were an effective strategy for dealing with breast cancer risk. Case #2 remained undecided about RM and, over time, she became less prepared to make a decision because she felt she did not have sufficient information about surgical effects. Case #3 had undergone RM by the time of her second follow-up interview and reported that she felt "a load off (her) mind now".RM decision making may shift over time and require decision support over an extended period.As testing for BRCA1/2 gene mutations becomes more widely available as a clinical service, increasing numbers of women are being identified at high risk for breast and ovarian cancer. Female BRCA1/2 carriers are told they have an estimated lifetime risk of breast cancer between 50% and 85% [1]. Risk-reducing mastectomy (RM) is one option for breast cancer risk reduction that is offered to women who learn they are carriers of a BRCA1/2 gene mutation. Although reported interest in RM varies by clinic setting and country, up to half of women at high risk for breast cancer express either the intention to have RM or some uncertainty about this decision [2-4]. Our clinical observations indicate that with increased access to BRCA1/2 genetic testing, more high-risk women are considering RM and the majority of these women request additional information and support with this difficult decision.An emerging body of research describes high-risk women's experiences and satisfaction wit
Pathologic Findings in MRI-Guided Needle Core Biopsies of the Breast in Patients with Newly Diagnosed Breast Cancer  [PDF]
K. P. Siziopikou,P. Jokich,M. Cobleigh
International Journal of Breast Cancer , 2011, DOI: 10.4061/2011/613285
Abstract: The role of MRI in the management of breast carcinoma is rapidly evolving from its initial use for specific indications only to a more widespread use on all women with newly diagnosed early stage breast cancer. However, there are many concerns that such widespread use is premature since detailed correlation of MRI findings with the underlying histopathology of the breast lesions is still evolving and clear evidence for improvements in management and overall prognosis of breast cancer patients evaluated by breast MRI after their initial cancer diagnosis is lacking. In this paper, we would like to bring attention to a benign lesion that is frequently present on MRI-guided breast biopsies performed on suspicious MRI findings in the affected breast of patients with a new diagnosis of breast carcinoma. 1. Introduction For patients with newly diagnosed breast carcinoma, evaluation of the extent of the disease in the breast is of paramount importance in planning appropriate surgical therapy. Magnetic resonance imaging (MRI) plays an ever increasing role in the evaluation of additional areas in the affected breast deemed suspicious but indeterminate by other radiologic modalities. Technical developments such as MRI with high spatial resolution, special breast coils, dynamic kinetic imaging techniques, and intravenous contrast agents contribute to enhanced diagnosis of breast abnormalities. While excitement about the role of this modality in improving the planning of surgical treatment of breast cancer patients is increasing [1–6], many areas of uncertainty remain, especially related to the clinical importance of additional lesions that are detected by the use of MRI [7–9]. In this study we evaluated the pathologic findings in MRI-guided needle core biopsies of the breast obtained from other suspicious areas in the affected breast of patients with a new diagnosis of breast carcinoma. 2. Materials and Methods Our study population consisted of 44 MRI-guided needle core breast biopsies performed on 40 patients with newly diagnosed breast carcinoma at Rush University Medical Center, Chicago, IL, USA between May 2007 and July 2008. Histologic findings of these biopsies were reviewed and recorded. Patient age ranged from 36 to 77 years (average: 52 years). 3. Results Overall, 9/44 (20.4%) of our MRI-guided breast biopsies were malignant, 29/44 (66%) were benign, and 6/44 (13.6%) showed atypia (Table 1). Of the 9 malignant cases, 4 were infiltrating ductal carcinomas with tubular features, 2 infiltrating lobular carcinomas, and 3 ductal carcinoma in situ lesions (Table
Knowledge and Practices Related to Breast Cancer Prevention in Iranian Female Population, Multi-Center Study in 2004
Gholamali Godazandeh,H. Khani,A.R. Khalilian,Z. Atarod,A. Montazeri M.A. Firozjaee,M. Ebrahimi,S. Ehteshamie,H. Tayebifard,A. Partovi,K. Rezaie Kalantari
Research Journal of Biological Sciences , 2012,
Abstract: Screening and preventive programs are critical components in reduction of breast cancer morbidity and mortality.A cross-section self-administered questionnaire survey was conducted to explore the knowledge and practices of breast cancer prevention modalities among a large descendant of the Iranian traditional female society. We have collected 400 questionnaires per stratum and 2400 totally. The mean age of the respondents was 25.01 years (SD = 8.78) with a range of 15-78, 46.9% were married, 86.7% had a medium-high educational level, 23.5% were housewives, 54.2% were students and family history of breast cancer was reported by 25.8%. Knowledge about breast cancer prevention was 28.5% accep, 67.3% low and 4.2% poor in the study population. 37% of the women 20 to 40 years and 48.8% of the women older than 40 years performed Breast Self-Examination (BSE) but only 17.1% did it monthly. Approximately 13.12% felt very confident that they could examine their own breasts correctly. 82.6% of the women 20 years and older never underwent a specialist visit. Among women 40 years of age and older, approximately 65.86% underwent a specialist visit once and 47.3% had obtained mammograms in the last 2 years and 61.07% have had at least one mammograms until now.The Iranian female population needs planning health education interventions and population-based specific regular screening programs to improve cancer prevention.
Knowledge and Practices Related to Breast Cancer Prevention in Iranian Female Population, Multi-Center Study in 2004
Gholamali Godazandeh,H. Khani,A.R. Khalilian,Z. Atarod
Research Journal of Biological Sciences , 2008,
Abstract: Screening and preventive programs are critical components in reduction of breast cancer morbidity and mortality.A cross-section self-administered questionnaire survey was conducted to explore the knowledge and practices of breast cancer prevention modalities among a large descendant of the Iranian traditional female society. We have collected 400 questionnaires per stratum and 2400 totally. The mean age of the respondents was 25.01 years (SD = 8.78) with a range of 15-78, 46.9% were married, 86.7% had a medium-high educational level, 23.5% were housewives, 54.2% were students and family history of breast cancer was reported by 25.8%. Knowledge about breast cancer prevention was 28.5% accep, 67.3% low and 4.2% poor in the study population. 37% of the women 20 to 40 years and 48.8% of the women older than 40 years performed Breast Self-Examination (BSE) but only 17.1% did it monthly. Approximately 13.12% felt very confident that they could examine their own breasts correctly. 82.6% of the women 20 years and older never underwent a specialist visit. Among women 40 years of age and older, approximately 65.86% underwent a specialist visit once and 47.3% had obtained mammograms in the last 2 years and 61.07% have had at least one mammograms until now.The Iranian female population needs planning health education interventions and population-based specific regular screening programs to improve cancer prevention.
Nettfrekvente elektromagnetiske felt og helseeffekter  [cached]
Karl Gerhard Blaasaas,Tore Tynes
Norsk Epidemiologi , 2009,
Abstract: I denne artikkelen oppsummeres epidemiologisk kunnskap om mulige helseeffekter etter eksponering for nettfrekvente (50/60 Hz) elektromagnetiske felt. Vi har basert oss p et flertall av vitenskapelige arbeider publisert i perioden 2001-2004 og konklusjoner i rapporter og oversiktsartikler fra perioden f r 2001. Det er ikke funnet noen etiologisk sammenheng mellom elektromagnetiske felt og kronisk sykdom. Man vet heller ikke sikkert hvilke egenskaper ved de elektromagnetiske feltene som eventuelt kan fremskaffe sykdom. Eventuell latenstid fra eksponering til sykdomsutvikling er ogs ukjent. Eksponering over 0,4 mT fra kraftlinjer ser ut til kunne gi en dobling i risikoen for barneleukemi, og basert p metaanalyser kan ikke resultatene avvises som tilfeldige funn. Holdepunktene for en slik sammenheng er likevel begrenset. Ved vokseneksponering har man i enkeltstudier observert risiko kninger for brystkreft, leukemi, hjernesvulst og amyotrofisk lateralsklerose. Det er ogs gjort isolerte funn av abort blant kvinner eksponert under graviditeten. For alle disse endepunktene er funnene allikevel ikke tilstrekkelige til trekke sikre konklusjoner om sammenheng med eksponering This review is based on epidemiologic literature in the period 2001-2004 and conclusions in reports and review articles before 2001, regarding power frequency (50/60 Hz) electromagnetic fields and health outcomes. Twotimes increased risks for childhood leukaemia have been observed among children exposed to magnetic fields above 0.4 mT from power lines, and based on meta-analyses these results can not be regarded as chance alone. The evidence for an association is however, still limited. Increased risks of breast cancer, leukaemia, brain tumor and amyotrophic lateral sclerosis have been observed in isolated studies. Increased risk of spontaneous abortion among women exposed during pregnancy has also been reported. None of the observations for any of these endpoints are, however, sufficient for any connection to electromagnetic field exposure.
The Prevention of Hereditary Breast and Ovarian Cancer: A Personal View
Steven Narod
Hereditary Cancer in Clinical Practice , 2004, DOI: 10.1186/1897-4287-2-1-5
Abstract: It is nearly ten years since the BRCA1 gene was identified and genetic testing for breast cancer susceptibility is now widespread. During the last ten years we have come to accept that genetic testing can be done outside of research settings, that most women wish to have - and are capable of understanding - personal information about the risks and benefits of genetic testing and that routine pre-test psychological counselling is not mandatory. As a group, women do not suffer unduly from anxiety or depression following the receipt of a positive test result [1] (although we all know of exceptions to this rule). There is still uncertainty about the best estimate to give a carrier for her risks of breast and ovarian cancer. Some argue that different carriers should be given different risks depending on their family history, but this individualized approach to counselling is really too complicated to be practical. But we all agree that the risks are unacceptably high and that something needs to be done to lower them.It was a relatively straightforward task to establish that prophylactic mastectomy is effective. This has been shown in a small prospective study [2], and in historical cohort studies of primary [3] and contralateral [4] breast cancers. Here the data is consistent. Meijers-Heijboer and colleagues observed no case of breast cancer among 76 women who underwent prophylactic mastectomy after a mean follow-up of three years [2]. Metcalfe and colleagues studied 491 women treated for hereditary breast cancer [4]. Only one contralateral breast cancer was observed among 146 women who had undergone a contralateral mastectomy, versus 42 expected (p < 0.0001). Some debate remains about the optimal age of prophylactic mastectomy and about the best techniques for mastectomy and for reconstruction, but there are few who would argue against the effectiveness of the procedure. But our aim is to replace prophylactic mastectomy with something better. This will either come from
Development and evaluation of a web-based breast cancer cultural competency course for primary healthcare providers
Richard C Palmer, Raquel Samson, Maria Triantis, Irene D Mullan
BMC Medical Education , 2011, DOI: 10.1186/1472-6920-11-59
Abstract: An interactive web-based CME course was developed and contained information about breast cancer disparities, the role of culture in healthcare decision making, and demonstrated a model of cross-cultural communication. A single group pre-/post-test design was used to assess knowledge changes. Data on user satisfaction was also collected.In all, 132 participants registered for the CME with 103 completing both assessments. Differences between pre-/post-test show a significant increase in knowledge (70% vs. 94%; p < .001). Ninety-five percent of participants agreed that the web based training was an appropriate tool to train healthcare providers about cultural competency and health disparities.There was an overall high level of satisfaction among all users. Users felt that learning objectives were met and the web-based format was appropriate and easy to use and suggests that web-based CME formats are an appropriate tool to teach cultural competency skills. However, more information is needed to understand how the CME impacted practice behaviors.Mammography screening has been found to be effective in reducing deaths from breast cancer [1], yet underserved woman are more likely to die from this disease [2,3]. Underserved women are less likely to be screened, which results in later stage diagnosis and decreased survival rates [1]. Imperative to decreasing and eliminating breast cancer disparities is ensuring timely and regular mammography screening for underserved women to ensure early detection [1-3].Breast cancer disparities research has attributed factors such as access to care, socioeconomic status, genetics, and tumor biology as possible causes of this inequity [1,4]. However, it is not well known how these factors, singularly or in combination, contribute to the disparity seen for breast cancer. An additional factor, culture, has been hypothesized as a possible mediator of health disparities in general and for breast cancer [5]. Although the exact contribution that c
The use of complementary and alternative medicines among patients with locally advanced breast cancer – a descriptive study
Lucy K Helyer, Stephen Chin, Betty K Chui, Barbara Fitzgerald, Sunil Verma, Eileen Rakovitch, George Dranitsaris, Mark Clemons
BMC Cancer , 2006, DOI: 10.1186/1471-2407-6-39
Abstract: Women with LABC attending a specialist clinic at a single Canadian cancer centre were identified and approached. Participants completed a self-administered survey regarding CAM usage, beliefs associated with CAM usage, views of their risks of developing recurrent cancer and of dying of breast cancer. Responses were scored and compared between CAM users and non-users.Thirty-six patients were approached, 32 completed the questionnaire (response rate 89%). Forty-seven percent of LABC patients were identified as CAM users. CAM users were more likely to be younger, married, in a higher socioeconomic class and of Asian ethnicity than non-users. CAM users were likely to use multiple modalities simultaneously (median 4) with vitamins being the most popular (60%). Motivation for CAM therapy was described as, "assisting their body to heal" (75%), to 'boost the immune system' (56%) and to "give a feeling of control with respect to their treatment" (56%). CAM therapy was used concurrently with conventional treatment in 88% of cases, however, 12% of patients felt that CAM could replace their conventional therapy. Psychological evaluation suggests CAM users perceived their risk of dying of breast cancer was similar to that of the non-Cam group (33% vs. 35%), however the CAM group had less severe anxiety and depression.The motivation, objectives and benefits of CAM therapy in a selected population of women with LABC are similar to those reported for women diagnosed with early stage breast cancer. CAM users display less anxiety and depression and are less likely to believe they will die of their breast cancer. However the actual benefit to overall and disease free survival has yet to be demonstrated, as well as the possible interactions with conventional therapy. Consequently more research is needed in this ever-growing field.Cancer patients take a wide range of complementary and alternative medicines (CAM). These include ingested therapies such as herbs, and vitamins, homeopathic
Breast conserving surgery versus mastectomy: cancer practice by general surgeons in Iran
Massoome Najafi, Mandana Ebrahimi, Ahmad Kaviani, Esmat Hashemi, Ali Montazeri
BMC Cancer , 2005, DOI: 10.1186/1471-2407-5-35
Abstract: A structured questionnaire was mailed to 235 general surgeons chosen from the address list of the Iranian Medical Council. The questionnaire elicited information about the general surgeons' characteristics and about their work experience, posts they have held, number of breast cancer operations performed per year, preferences for mastectomy or breast conserving surgery, and the reasons for these preferences.In all, 83 surgeons returned the completed questionnaire. The results indicated that only 19% of the surgeons routinely performed breast conserving surgery (BCS) and this was significantly associated with their breast cancer case load (P < 0.01). There were no associations between BCS practice and the other variables studied. The most frequent reasons for not performing BCS were uncertainty about conservative therapy results (46%), uncertainty about the quality of available radiotherapy services (32%), and the probability of patients' non-compliance in radiotherapy (32%).The findings indicate that Iranian surgeons do not routinely perform BCS as the first and the best treatment modality. Further research is recommended to evaluate patients' outcomes after BCS treatment in Iran, with regard to available radiotherapy facilities and cultural factors (patients' compliance).Many randomized clinical trials have demonstrated that patient survival rates are similar after treatment by mastectomy or by conservative surgery and radiotherapy [1-4]. However, the National Institute of Health Consensus Conference concluded that for most women with early-stage breast cancers (stages I and II), breast conservation surgery (BCS) is an appropriate method of treatment [5]. Despite these findings, mastectomy remains the most prevalent surgical treatment for early-stage breast cancer in many parts of the world. In Iran, BCS is an uncommon modality for this condition. For example, in one study in Isfahan University of Medical Sciences, 386 breast cancer patients were reviewed and maste
Endocrinology and hormone therapy in breast cancer: Endocrine therapy in premenopausal women
Kathleen Pritchard
Breast Cancer Research , 2005, DOI: 10.1186/bcr1002
Abstract: Endocrine therapy, developed over a century ago [1,2], remains the most effective and the most clearly targeted form of systemic therapy for breast cancer. Endocrine treatments work best in women whose tumours are positive for oestrogen receptor (ER) and/or progesterone receptor (PgR). As we continue to search for newer targeted therapies that will shrink cancers effectively with few undesired side effects, and carry out complex statistical analyses to identify predictive factors, we should not forget the first targeted cancer therapy, namely ovarian ablation (OA) for breast cancer, and the first predictive factor for treatment of any cancer, the ER.For many years adjuvant OA was used and felt to be helpful, but randomized trials were not done. Subsequently, a few small randomized trials were conducted in the 1960s and 1970s. Before the first Early Breast Cancer Trialists Collaborative Group (EBCTCG) or Oxford overview was published in 1984 [3], it was generally believed that these trials showed no benefit for OA. When the meta-analytic techniques used in the EBCTCG overview were applied to these small trials, however, it became apparent that OA was associated with a reasonably large positive effect on both disease-free survival (DFS) and overall survival (OS) in node-positive and node-negative premenopausal women [3-5].The most recent EBCTCG overview http://www.ctsu.ox.ac.uk/projects/ebctcg webcite, carried out in September 2000, included updated information on 4900 women aged under 50 years included in 15 trials of OA. Only about 1300 of these women were in trials of OA in the absence of chemotherapy, whereas more than 3500 were in trials of OA in the presence of chemotherapy. In this updated analysis there was a clear separation between the trials of OA versus no treatment in the absence of chemotherapy and trials of OA plus chemotherapy versus the same chemotherapy. In the former trials large and highly significant positive effects of OA persisted at 15 years in
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