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BackgroundBenign breast disease and high breast density are prevalent, strong risk factors for breast cancer. Women with both risk factors may be at very high risk.MethodsWe included 42818 women participating in the Breast Cancer Surveillance Consortium who had no prior diagnosis of breast cancer and had undergone at least one benign breast biopsy and mammogram; 1359 women developed incident breast cancer in 6.1 years of follow-up (78.1% invasive, 21.9% ductal carcinoma in situ). We calculated hazard ratios (HRs) using Cox regression analysis. The referent group was women with nonproliferative changes and average density. All P values are two-sided.ResultsBenign breast disease and breast density were independently associated with breast cancer. The combination of atypical hyperplasia and very high density was uncommon (0.6% of biopsies) but was associated with the highest risk for breast cancer (HR = 5.34; 95% confidence interval [CI] = 3.52 to 8.09, P < .001). Proliferative disease without atypia (25.6% of biopsies) was associated with elevated risk that varied little across levels of density: average (HR = 1.37; 95% CI = 1.11 to 1.69, P = .003), high (HR = 2.02; 95% CI = 1.68 to 2.44, P < .001), or very high (HR = 2.05; 95% CI = 1.54 to 2.72, P < .001). Low breast density (4.5% of biopsies) was associated with low risk (HRs

Breast implants may make breast cancer diagnosis by mammography more difficult, according to a study of approximately 1 million women. Among women with breast implants, mammography only identified 45% of the women who had breast cancer. Among women without breast implants, mammography identified 67% of those who had breast cancer. Breast implants do not make breast cancer worse.

Background: Few studies have examined the predictors of adherence separately for supervised and unsupervised exercise or in postmenopausal women over an extended time period. Here, we report the predictors of exercise adherence in the Alberta Physical Activity and Breast Cancer Prevention (ALPHA) Trial. Methods: The ALPHA trial randomized 160 postmenopausal women in Calgary and Edmonton, Canada to an exercise intervention that consisted of an average of 200 min/wk of supervised (123 minutes) and unsupervised (77 minutes) exercise over a 1-year period. Baseline data were collected on demographic, health-related fitness, quality of life, and motivational variables from the theory of planned behavior. Results: Participants completed an average of 95% of their supervised exercise and 79% of their unsupervised exercise. In multivariate analyses, 8.1% (P = .001 ) of the variance was explained for supervised exercise by being from Edmonton (β = 0.22; P = .004) and older (β = 0.15; P = .050). For unsupervised exercise, 21.1% (P < .001) of the variance was explained by being from Calgary (β = -0.39; P < .001), having a family history of breast cancer (β = 0.21 ; P = .003), and having higher vitality (β = 0.19; P = .011). Conclusions: Predictors of adherence may differ for supervised and unsupervised exercise, moreover, predicting adherence to supervised exercise may be particularly difficult in well-controlled efficacy trials. [ABSTRACT FROM AUTHOR]

Posttraumatic growth (PTG) after cancer can minimize the emotional impact of disease and treatment; however, the facilitators of PTG, including support seeking, are unclear. The authors examined the role of support seeking on PTG among 604 breast cancer survivors ages 40 to 64 from the Health Eating, Activity, and Lifestyle (HEAL) Study. Multivariable linear regression was used to examine predictors of support seeking (participation in support groups and confiding in health care providers) as well as the relationship between support seeking and PTG. Support program participation was moderate (61.1%) compared to the high rates of confiding in health professionals (88.6%), and African Americans were less likely to report participating than non-Hispanic Whites (odds ratio = .14, confidence intervals [0.08, 0.23]). The mean (SD) PTG score was 48.8 (27.4) (range 0–105). Support program participation (β = 10.4) and confiding in health care providers (β = 12.9) were associated (p < .001) with higher PTG. In analyses stratified by race/ethnicity, PTG was significantly higher in non-Hispanic Whites and African American support program participants (p < .01), but not significantly higher in Hispanics/Latinas. Confiding in a health care provider was only associated with PTG for non-Hispanic Whites (p = .02). Support program experiences and patient–provider encounters should be examined to determine which attributes facilitate PTG in diverse populations. [ABSTRACT FROM PUBLISHER]

Background: C-reactive protein (CRP) and Serum amyloid A protein (SAA) increases with systemic inflammation and are related to worse survival for breast cancer survivors. This study examines the association between percent body fat and SAA and CRP and the potential interaction with NSAID use and weight change.Methods: Participants included 134 non-Hispanic white and Hispanic breast cancer survivors from the Health,Eating, Activity, and Lifestyle Study. Body fat percentage, measured with Dual Energy X-ray Absorptiometer (DEXA),and circulating levels of CRP and SAA were obtained 30 months after breast cancer diagnosis.Results: Circulating concentrations of CRP and SAA were associated with increased adiposity as measured by DEXA after adjustment for age at 24-months, race/ethnicity, dietary energy intake, weight change, and NSAID use.Survivors with higher body fat ≥35% had significantly higher concentrations of CRP (2.01 mg/l vs. 0.85 mg/l) and SAA (6.21 mg/l vs. 4.21 mg/l) compared to non-obese (body fat < 35%). Women who had gained more than 5% of their body weight since breast cancer diagnosis had non-statistically significant higher geometric mean levels of CRP and SAA. Mean levels of CRP and SAA were higher among obese women who were non-users of NSAID compared to current users; the association with SAA reached statistical significance (Mean SAA = 7.24, 95%CI6.13-8.56 for non-NSAID; vs. 4.87; 95%CI 3.95-6.0 for NSAID users respectively).Conclusions: Breast cancer survivors with higher body fat had higher mean concentrations of CRP and SAA than women with lower body fat. Further assessment of NSAID use and weight control in reducing circulatinginflammatory markers among survivors may be worthwhile to investigate in randomized intervention trials as higher inflammatory markers are associated with worse survival. [ABSTRACT FROM AUTHOR]

The goal of this study was to estimate prevalence of HER-2 positive tumors in a population-based sample of 1026 women diagnosed in 2005 with early stage breast cancer. We modeled the relationship between patient and tumor characteristics and HER-2. HER-2 positive estimates were 19% for women aged ≤49 years and 15% aged ≥50 years. HER-2 varied by tumor grade and size in women aged ≤49 years but was not significant in multivariate analysis. Tumor grade and race were associated with HER-2 for women aged ≥50 years after controlling for other variables. HER-2 varies by age and by race and tumor in older women. [ABSTRACT FROM AUTHOR]

This study examined the relationship between race, religiosity, and posttraumatic growth as well as the association between growth and physical and mental health-related quality of life (HRQOL) in breast cancer survivors (N = 802; M age = 57.2). Multivariate analyses revealed that African American breast cancer survivors reported higher levels of posttraumatic growth than White women. However, this relationship was mediated by religiosity. We found an inverse association with growth and mental HRQOL which might be explained by the fact that growth cooccurs with distress and perhaps women in this sample are still struggling with their disease. [ABSTRACT FROM AUTHOR]

Substantial observational epidemiological evidence exists that physical activity and weight control are associated with decreased risk of postmenopausal breast cancer. Uncertainty remains regarding several aspects of these associations, including the effect of possible confounding factors on these associations. We present the rationale and design for two randomized controlled trials that can help resolve this uncertainty. In a 5-year prevention trial conducted among women at high risk of breast cancer, the primary endpoint would be breast cancer incidence. For a comparable survivorship trial, the primary endpoint would be the disease-free interval and secondary endpoints would be breast cancer recurrence-free interval, second primary breast cancer, and total invasive plus in situ breast cancer. A set of inclusion and exclusion criteria is proposed for both trials. Intervention goals are the same for both trials. Goals for the weight control intervention would be, for women whose body mass index (BMI) is greater than 25 kg/m², to lose 10% of body weight and,for women whose BMI is less than or equal to 25 kg/m², to avoid weight gain. The goal for the physical activity intervention would be to achieve and maintain regular participation in a moderate- intensity physical activity program for a total of 150-225 minutes over at least 5 days per week. Sample size calculations are based on alternative assumptions about hazard ratio, adherence, follow-up duration, and power and are presented for the primary prevention and survivorship trials. Although both studies could enhance our understanding of breast cancer etiology and benefit public health, practical considerations, including smaller sample size, ease of recruitment, and reduced likelihood of early termination, favor the survivorship trial at this time. [ABSTRACT FROM AUTHOR]

Background: Being overweight or obese is associated with increased breast cancer risk and disease severity among postmenopausal women, but whether extent of mammography use and accuracy modify this association and further contribute to increases in disease severity at diagnosis among overweight and obese women is unclear. Methods: We prospectively collected data during 1996-2005 on 287115 postmenopausal women not using hormone therapy (HT) who underwent 614562 mammography examinations; 4446 women were diagnosed with breast cancer within 12 months of a mammography examination. We calculated rates per 1000 mammography examinations of large (> 15 mm), advanced-stage (IIb, III, or IV), high-grade (3 or 4), estrogen receptor (ER)-positive and -negative, and screen-detected and non-screen-detected breast cancer across body mass index (BMI, kg/m2) groups defined as normal (18.5-24.9), overweight (25.0-29.9), obese class I (30.0-34.9), and obese class II/III (⩾35.0), adjusting for age, race/ethnicity, and mammography registry and use. All statistical tests were two-sided. Results: Adjusted rates per 1000 mammography examinations of overall breast cancer increased across BMI groups (6.6 normal, 7.4 overweight, 7.9 obese I, 8.5 obese II/III; Ptrend < .001), as did rates of advanced disease, including large invasive (2.3 normal, 2.6 overweight, 2.9 obese I, 3.2 obese II/III; Ptrend < .001), advanced-stage (0.8 normal, 0.9 overweight, 1.3 obese I, 1.5 obese II/III; Ptrend < .001), and high nuclear grade (1.5 normal, 1.7 overweight, 1.7 obese I, 1.9 obese II/III; Ptrend = .10) tumors. Rates of ER-positive tumors increased across BMI groups (Ptrend < .001); rates of ER-negative tumors did not. Rates of screen-detected cancers were higher among overweight and obese women than normal and underweight women, but rates of non-screen-detected (false-negative) cancers were similar. Rates of advanced breast cancer increased across BMI groups regardless of extent of mammography use. Conclusions: Patterns of mammography use and mammography accuracy are not the primary reasons for higher rates of advanced breast cancer among overweight and obese postmenopausal women not using HT; thus, biologic differences in breast tumor development and/or progression may be important. [ABSTRACT FROM AUTHOR]

The article discusses a study which explored whether detection by mammography was associated with greater use of guideline-consistent breast cancer treatment among patients with diagnosed breast cancer in the U.S. The study found that patients who were diagnosed by mammography were more to have lower stage disease and to be treated in larger hospitals than patients who were diagnosed by other methods. It concluded that survival among patients with diagnosed breast cancer may inform understanding of factors associated with breast cancer prognosis.

This article presents a study regarding the obesity and adult weight change as risk factors for postmenopausal breast cancer. It examines the relations of adult weight change and adiposity to breast cancer risk among 99,039 postmenopausal women in the National Institute of Health. Current body mass index (BMI), BMI at ages 50 and 35 years, and waist-hip ratio were linked with increased breast cancer risk, specifically in women not using menopausal hormone therapy. Findings shows that weight gain throughout adulthood is linked with increased postmenopausal breast cancer risk in menopausal hormone therapy nonusers.

Background: Although recent trends in the use of recommended breast and cervical cancer screening have been well documented in the USA, little is known about trends in the prevalence of abnormal screening results. Methods: Trends in abnormal screening results for mammography and Papanicolaou (Pap) smear were assessed descriptively using data from the 1987 and 2000 National Health Interview Surveys. Estimates were stratified by sociodemographic characteristics of the populations who reported ever receiving screening. All comparisons were evaluated with two-sided tests of statistical significance. Results: The age-standardized prevalence of abnormal Pap smears increased from 12.9% (95% confidence interval [CI] 12.1–13.8%) of women ever screened in 1987 to 20.3% (95% CI 19.5–21.0%) in 2000, and the age-standardized prevalence of abnormal mammogram results increased from 18.8% (95% CI 17.0–20.7%) to 21.6% (95% CI 20.5–22.7%) of women ever screened over the same period. Among women aged 40 years and older who reported ever receiving both a Pap smear and a mammogram, 29.6% (95% CI: 27.3–32.2%) in 1987 and 35% (95% CI: 33.8–36.2%) in 2000 reported either an abnormal Pap smear or an abnormal mammogram. In 2000, abnormal screening results were positively associated with reported frequency of recent screening (P<0.001). Conclusions: A substantial portion of women in the USA reporting cancer screening also report having had abnormal results, although the magnitude of trends between 1987 and 2000 vary by screening test. Additional research is needed to assess the relative contributions of changes in classification of test results, test characteristics and changes in underlying screening histories to increases in abnormal screening results. [ABSTRACT FROM AUTHOR]

Background Whether a change over time in clinically measured mammographic breast density influences breast cancer risk is unknown. Methods From January 1993 to December 2003, data that included American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) breast density categories (1-4 in order of increasing density) were collected prospectively on 301 955 women aged 30 and older who were not using postmenopausal hormone replacement therapy and underwent at least two screening mammography examinations; 2639 of the women were diagnosed with breast cancer within 1 year of the last examination. Women's first and last BI-RADS breast density (average 3.2 years apart) and logistic regression were used to model the odds of having invasive breast cancer or ductal carcinoma in situ diagnosed within 12 months of the last examination by change in BI-RADS category. Rates of breast cancer adjusted for age, mammography registry, and time between screening examinations were estimated from this model. All statistical tests were two-sided. Results The rate (breast cancers per 1000 women) of breast cancer was higher if BI-RADS breast density category increased from 1 to 2 (5.6, 95% confidence interval (CI) = 4.7 to 6.9) or 1 to 3 (9.9, 95% CI = 6.4 to 15.5) compared to when it remained at BI-RADS density of 1 (3.0, 95% CI = 2.3 to 3.9; P<.001 for trend). Similar and statistically significant trends between increased or decreased density and increased or decreased risk of breast cancer, respectively, were observed for women whose breast density category was initially 2 or 3 and changed categories. BI-RADS density of 4 on the first examination was associated with a high rate of breast cancer (range 9.1-13.4) that remained high even if breast density decreased. Conclusion An increase in BI-RADS breast density category within 3 years may be associated with an increase in breast cancer risk and a decrease in density category with a decrease in risk compared to breast cancer risk in women in whom breast density category remains unchanged. Two longitudinal measures of BI-RADS breast density may better predict a woman's risk of breast cancer than a single measure. [ABSTRACT FROM AUTHOR]

Hormone-related symptoms are common in breast cancer survivors and many aspects of these symptoms are currently under study. Reliable and valid assessment tools are needed to successfully study hormone-related symptoms in breast cancer survivors; however, no gold standard currently exists for measuring these symptoms. This study evaluated the psychometric properties of a shortened version of the Breast Cancer Prevention Trial (BCPT) symptom checklist in a sample of 803 breast cancer survivors. Principal factor analysis with Promax oblique rotation revealed a five-factor structure, identifying five separate hormone-related symptoms scales: vasomotor symptoms, urinary incontinence, cognitive/mood changes, vaginal symptoms, and weight gain/appearance concern. Hormone-related symptom scale scores differed by demographic and clinical characteristics according to expectations, suggesting that these five scales from the shortened BCPT checklist are reasonably reliable and valid. Symptom scale scores were only weakly correlated with health-related quality of life scores; however, the pattern of results generally supported the validity of the symptom scales. This study adds to the evidence that breast cancer survivors experience a significant number of hormone-related symptoms. Future clinical trials and quality of life and symptom management intervention studies would benefit from accurate assessment of hormone-related symptoms with the five scales from the shortened BCPT checklist. Copyright © 2006 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Risk prediction models for breast cancer can be improved by the addition of recently identified risk factors, including breast density and use of hormone therapy. We used prospective risk information to predict a diagnosis of breast cancer in a cohort of 1 million women undergoing screening mammography. Methods: There were 2 392 998 eligible screening mammograms from women without previously diagnosed breast cancer who had had a prior mammogram in the pre- ceding 5 years. Within 1 year of the screening mammogram, 11 638 women were diagnosed with breast cancer. Separate logistic regression risk models were constructed for premenopausal and postmenopausal examinations by use of a stringent (P<.0001) criterion for the inclusion of risk factors. Risk models were constructed with 75% of the data and validated with the remaining 25%. Concordance of the predicted with the observed outcomes was assessed by a concordance (c) statistic after logistic regression model fit. All statistical tests were two- sided. Results: Statistically significant risk factors for breast cancer diagnosis among premenopausal women included age, breast density, family history of breast cancer, and a prior breast procedure. For postmenopausal women, the statistically significant factors included age, breast density, race, ethnicity, family history of breast cancer, a prior breast procedure, body mass index, natural menopause, hormone therapy, and a prior false-positive mammogram. The model may identify high-risk women better than the Gail model, although predictive accuracy was only moderate. The c statistics were 0.631 (95% confidence interval [CI] = 0.618 to 0.644) for pre- menopausal women and 0.624 (95% CI = 0.619 to 0.630) for postmenopausal women. Conclusion: Breast density is a strong additional risk factor for breast cancer, although it is unknown whether reduction in breast density would reduce risk. Our risk model may be able to identify women at high risk for breast cancer for preventive interventions or more intensive surveillance. [ABSTRACT FROM AUTHOR]

Objectives: The increasing number of cancer survivors brings greater attention to the biopsychosocial impact of surviving cancer. Instruments exist that measure quality of life (QOL), symptoms, and specific types of functioning after cancer; however, a reliable and valid assessment of the perceived impact of cancer (IOC) on the life plans and activities of cancer survivors has been missing. This study evaluated the psychometric properties of the 16-item Brief Cancer Impact Assessment (BCIA). Methods: Factor analysis with Promax oblique rotation established the factor structure of the BCIA in 783 ethnically diverse breast cancer survivors, ≥2 years after diagnosis. Construct validity was assessed by comparing factor-based scale means by demographic and treatment characteristics, and correlating scales with psychosocial and health-related QOL scales. Results: Factor analysis revealed four factors measuring the IOC on caregiving and finances, exercise and diet behaviors, social and emotional functioning, and religiosity. Scale scores differed by demographic and treatment characteristics according to expectations, and the pattern of correlations with psychosocial and health-related QOL generally supported the construct validity of the scales. Conclusion: Including the BCIA with measures of QOL, symptoms, and functioning will allow researchers to gain a more comprehensive assessment of the biopsychosocial IOC in survivors. Copyright © 2006 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

To compare the performance of screening mammography in the USA and the UK, a consecutive sample of screening mammograms was obtained in women aged 50 and older from 1996 to 1999 who participated in the Breast Cancer Surveillance Consortium in the USA (n=978,591) and the National Health Service Breast Cancer Screening Program in the UK (n=3.94 million), including 6943 diagnosed with breast cancer within 12 months of screening. Recall rates were defined as the percentage of screening mammograms with a recommendation for further evaluation including diagnostic mammography, ultrasound, clinical examination or biopsy, and cancer detection rates including invasive cancer and ductal carcinoma in situ diagnosed within 12 months of a screening mammogram. All results were stratified by whether examinations were first or subsequent and adjusted to a standard age distribution. Among women who underwent a first screening mammogram, 13.3% of women in the USA versus 7.2% of women in the UK were recalled for further evaluation (relative risk for recall 1.9; 95% CI 1.8–1.9). For subsequent examinations recall rates were approximately 50% lower, but remained twice as high in the USA as in the UK. A similar percentage of women underwent biopsy in each setting, but rates of percutaneous biopsy were lower and rates of open surgical biopsy were higher in the USA. Women undergo screening approximately every 18 months in the USA and every 36 months in the UK. Based on a 20-year period of screening, the estimated percentage of women who would be recalled for additional testing was nearly threefold higher in the USA. The number of cancers detected was also higher in the USA (55 versus 43), and most of the increase was in the detection of small invasive and in situ cancers. The numbers of large cancers detected (>2 cm) were very similar between the two countries. Recall rates are approximately two to three times higher in the USA than in the UK. Importantly, despite less frequent screening in the USA, there are no substantial differences in the rates of detection of large cancers. Efforts to improve mammographic screening in the USA should target lowering the recall rate without reducing the cancer detection rate. [ABSTRACT FROM AUTHOR]

Background: Mammography screening may reduce breast cancer mortality by detecting cancers at an earlier stage. However, certain questions remain, including the ideal interval between mammograms. Methods: We conducted an observational study using information collected by seven mammography registries across the United States to investigate whether women diagnosed with breast cancer after having screening mammograms separated by a 2-year interval (n = 2440) are more likely to be diagnosed with late-stage disease (positive lymph nodes or metastases) than women diagnosed with breast cancer after having screening mammograms separated by a 1-year interval (n = 5400). Analyses were stratified by age and breast density to clarify whether groups that have the poorest mammography sensitivity (i.e., women under age 50 years and those with mammographically dense breasts) would benefit most from annual screening. The subjects were women diagnosed with breast cancer between 1996 and 2001 who were 40–89 years old at their index mammographic examination (i.e., the most recent screen at or before breast cancer diagnosis). Data were analyzed by logistic regression, adjusting for race, ethnicity, family history of breast cancer, and mammography registry. Results: Among women age 40–49 years at the index mammogram, those with a 2-year screening interval were more likely to have late-stage disease at diagnosis than those with a 1-year screening interval (28% versus 21%; odds ratio [OR] = 1.35, 95% confidence interval [CI] = 1.01 to 1.81). There was no increase in late-stage disease for women 50 years or older with a 2-year versus a 1-year screening interval (women age 50–59 years at index mammogram: OR = 0.97, 95% CI = 0.75 to 1.25; women age 60–69 years at index mammogram: OR = 0.99, 95% CI = 0.72 to 1.35; women age 70 years or older at index mammogram: OR = 0.88, 95% CI = 0.64 to 1.19). There was no indication that women with dense breasts would benefit more from a 1-year versus 2-year screening interval than women with fatty breasts. Conclusion: These findings may be useful for policy decisions about appropriate screening intervals and for use in statistical models that estimate the costs and benefits of mammography by age and screening interval. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Adult weight gain has been associated with a twofold risk of postmenopausal breast cancer. Data are limited regarding whether weight gain at specific periods of marked changes in estrogen- and insulin-related hormones have different risk associations. This study assesses the relation of adult weight change overall and at specific, hormonally relevant times with diagnosis of a first breast cancer after age 55 (late onset). Methods: Framingham study data were used to assess premenopausal (25-44 yr), perimenopausal (45-55 yr), postmenopausal (after 55 yr), and adult lifetime (from 25 yr) weight change in relation to late-onset breast cancer in 2,873 women followed for up to 48 yr, with 206 late-onset breast cancers. Results: Adult lifetime weight gain was associated with an increased risk of late-onset breast cancer (P trend = 0.046). Weight gain during specific time periods was not associated with breast cancer. Data suggested a possible decreased risk of breast cancer with weight loss from ages 25 to 44 and 45 to 55 yr (relative risk = 0.4 [0.2-1.2] and 0.5 [0.3-0.9], respectively). Conclusion: These data confirm prior reports of an association between adult lifetime weight gain and increased risk of late-onset breast cancer and support current recommendations to avoid adult weight gain. [ABSTRACT FROM AUTHOR]

Context: Screening mammography differs between the United States and the United Kingdom; a direct comparison may suggest methods to improve the practice. Objective: To compare screening mammography performance between the United States and the United Kingdom among similar-aged women. Design, Setting, and Participants: Women aged 50 years or older were identified who underwent 5.5 million mammograms from January 1, 1996, to December 31, 1999, within 3 large-scale mammography registries or screening programs: the Breast Cancer Surveillance Consortium (BCSC, n = 978 591) and National Breast and Cervical Cancer Early Detection Program (NBCCEDP, n = 613 388) in the United States; and the National Health Service Breast Screening Program (NHSBSP, n = 3.94 million) in the United Kingdom. A total of 27 612 women were diagnosed with breast cancer (invasive or ductal carcinoma in situ) within 12 months of screening among the 3 groups. Main Outcome Measures: Recall rates (recommendation for further evaluation including diagnostic imaging, ultrasound, clinical examination, or biopsy) and cancer detection rates were calculated for first and subsequent mammograms, and within 5-year age groups. Results: Recall rates were approximately twice as high in the United States than in the United Kingdom for all age groups; however, cancer rates were similar. Among women aged 50 to 54 years who underwent a first screening mammogram, 14.4% in the BCSC and 12.5% in the NBCCEDP were recalled for further evaluation vs only 7.6% in the NHSBSP. Cancer detection rates per 1000 mammogram screens were 5.8, 5.9, and 6.3, in the BCSC, NBCCEDP, and NHSBSP, respectively. Recall rates were lower for subsequent examinations in all 3 settings but remained twice as high in the United States. A similar percentage of women underwent biopsy in each setting, but rates of percutaneous biopsy were lower and open surgical biopsy higher in the United States. Open surgical biopsies not resulting in a diagnosis of... [ABSTRACT FROM AUTHOR]

Background: The Breast Cancer Prevention Trial demonstrated that tamoxifen treatment produced a 49% reduction in the risk of invasive breast cancer among women at elevated risk for the disease. The U.S. Food and Drug Administration (FDA) subsequently approved tamoxifen for women aged 35 years or older with a 5-year breast cancer risk of 1.67% or higher for breast cancer chemoprevention. However, tamoxifen use has been associated with adverse outcomes, and not all eligible women have a positive benefit/risk ratio. Methods: We used weighted data from the year 2000 National Health Interview Survey Cancer Control Module to estimate the total number of U.S. women, aged 35-79 years, who were eligible for tamoxifen chemoprevention based on the FDA eligibility criteria. We also estimated the numbers of white and black women who would benefit from tamoxifen chemoprevention on the basis of a positive benefit/risk index developed by Gail et al. Results: Of the 65826074 women aged 35-79 years without reported breast cancer in the United States in 2000, 10232816 women (15.5%, 95% confidence interval [CI] = 14.7% to 16.3%) would be eligible for tamoxifen chemoprevention. The percentage of U.S. women who would be eligible varied dramatically by race, with 18.7% (95% CI = 17.8% to 19.7%) of white women, 5.7% (95% CI = 4.3% to 7.5%) of black women, and 2.9% (95% CI = 2.1% to 3.9%) of Hispanic women being eligible. Of the 50104 829 white U.S. women aged 3579 years, 2431911 (4.9%, 95% CI = 4.3% to 5.4%) would have a positive benefit/risk index for tamoxifen chemoprevention. Of the 7481779 black U.S. women aged 35-79 years, only 42768 (0.6%, 95% CI = 0.2% to 1.3%) would have a positive benefit/risk index. Among white women, 28 492 (95 % CI = 24 693 to 32 292) breast cancers would be prevented or deferred if those women who have a positive net benefit index took tamoxifen over the next 5 years. Conclusion: A substantial percentage of U.S. women would be eligible for tamoxifen... [ABSTRACT FROM AUTHOR]

Compares the performance of screening mammography in women with a first-degree family history of breast cancer and women with similar age without the history in the U.S. Risk factors for breast cancer; Positive predictive value and sensitivity of screening mammography; Rate of cancer; Breast biopsies.

The convenience of fast computers and the Internet have encouraged large collaborative research efforts by allowing transfers of data from multiple sites to a single data repository; however, standards for managing data security are needed to protect the confidentiality of participants. Through Dartmouth Medical School, in 1996–1998, the authors conducted a medicolegal analysis of federal laws, state statutes, and institutional policies in eight states and three different types of health care settings, which are part of a breast cancer surveillance consortium contributing data electronically to a centralized data repository. They learned that a variety of state and federal laws are available to protect confidentiality of professional and lay research participants. The strongest protection available is the Federal Certificate of Confidentiality, which supersedes state statutory protection, has been tested in court, and extends protection from forced disclosure (in litigation) to health care providers as well as patients. This paper describes the careful planning necessary to ensure adequate legal protection and data security, which must include a comprehensive understanding of state and federal protections applicable to medical research. Researchers must also develop rules or guidelines to ensure appropriate collection, use, and sharing of data. Finally, systems for the storage of both paper and electronic records must be as secure as possible. Am J Epidemiol 2000;152:371–8. [ABSTRACT FROM PUBLISHER]

Presents three perspectives on the integration of experimental and epidemiologic research on diet, anthropometry and breast cancer. Role of energy and fat in mammary carcinogenesis; Relationship of diet to cancer; Limitations and synergy of epidemiologic and experimental approaches.

The authors reflects on the relation between breast cancer and dietary fat taken from contributions from a survival trial. The authors reflect that medical hypotheses correlating dietary fat to incidents of breast cancer show inconsistent results. They focus on the result on a low-fat intervention trial on women with breast cancer. They suggest that the result is controversial and does not provide strong direct association, but agrees on the necessity and the contributions made by the trials

Abstract: Objective: To profile and compare the content and presentation of written communications related to informed decision-making about mammography. Methods: Materials from 16 screening programs organized at the national or regional level were analyzed according to five major information domains suggested by the international literature. Results: A majority of countries provided information on the program (interval, cost and quality). There was considerable variability in comprehensiveness of elements in the domains, e.g., test characteristics (false positive/negative) and pros and cons of screening. The majority noted the likelihood of recall for further tests, few commented on the risks of additional tests or finding unimportant tumors. The audit also found variation in presentation (words and pictures). Conclusions: Presentation of comprehensive, but balanced information on screening benefits and risks is complex and daunting. Issues such as framing effects, coupled with debate about screening efficacy are challenging to the design of effective information tools. The objective of increasing screening prevalence at the population level must be balanced with objectively presenting complete and clear information. Additional research is needed on how information (and mode of presentation) impact screening decisions. Practice implications: Public health officials need to articulate their objectives and review written communication according to important decision-making domains. [Copyright &y& Elsevier]

Background and Objective: We evaluated patient acceptance of an electronic questionnaire to collect breast cancer risk-factor data in a mammography setting. Methods: We developed an electronic questionnaire on a tablet computer incorporating prefilled answers and skip patterns. Using a randomized controlled study design, we tested the survey in a mammography clinic that administers a paper risk-factor questionnaire to every woman at her screening mammogram. We randomized 160 women to use the electronic survey (experimental group, n = 86) or paper survey (control group, n = 74). We evaluated patient acceptance and data completeness. Results: Overall, 70.4% of the experimental group women thought the survey was very easy to use, compared to 55.6% of women in the control group. Ninety percent of experimental group women preferred using the tablet, compared to the paper questionnaire. Preference for the tablet did not differ by age; however, women > or = 60 years did not find the tablet as easy to use as did women < 60 years. The proportion of missing data was significantly lower on the tablet compared to the paper questionnaire (4.6% vs. 6.2%, P = .04). Conclusion: Electronic questionnaires are feasible to use in a mammography setting, can improve data quality, and are preferred by women regardless of age. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To quantify change in intake of kilocalories, macronutrients, and fruit and vegetable servings after diagnosis of breast cancer, and to correlate these changes with subject characteristics and with self-reported global change in dietary patterns. Design: Food frequency questionnaires were completed by women newly diagnosed with breast cancer shortly after diagnosis. They were asked to recall intake 1 year before diagnosis. Two years after the initial interview another food frequency questionnaire was completed recalling intake during the previous year. At the 2-year follow-up interview women were also asked if they had changed their intake of fruit, vegetables, and fat since diagnosis. Subjects/Setting: Two hundred sixty New Mexico women with newly diagnosed breast cancer between July 1997 and March 1999. Analysis: Two-year change scores for kilocalories, macronutrients, and fruit and vegetable servings were calculated and tested for difference from zero using paired t tests or Wilcoxon signed rank tests. Subjects’ characteristics were related to change in kilocalories and linear regression was used to determine the relative importance of these characteristics. Amount of change in fruit and vegetable servings and fat intake were calculated using food frequency data for women who reported increasing their intake of fruits and vegetables or decreasing their intake of fat after diagnosis. Results: Small but significant decreases in intake of total energy and macronutrients were found 2 years postdiagnosis, with younger women reporting the greatest decreases. Fat as a percentage of diet increased over this period. There was no change in mean intake of fruit and vegetable servings. There is agreement between change as measured by food frequency questionnaire and change reported by more global questions on dietary habits; however, the amount of change measured was small. Women reporting an increase in fruit and vegetable intake postdiagnosis described an increase of one-quarter serving of fruit and one-third serving of vegetables per day. Conclusions: Breast cancer diagnosis results in modest dietary changes. Small changes in fruit and vegetable consumption suggest that efforts are needed to encourage increased consumption of these foods. [Copyright &y& Elsevier]