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Background.--Randomised trials of tamoxifen versus placebo indicate that tamoxifen reduces breast cancer risk by approximately 33%, yet uptake is low. Approximately 10% of women in our clinic entered the IBIS-I prevention trial. We assess the uptake of tamoxifen in a consecutive series of premenopausal women not in a trial and explore the reasons for uptake through interviews. Methods.--All eligible women between 33 and 46 years at ⩾17% lifetime risk of breast cancer and undergoing annual mammography in our service were invited to take a 5-year course of tamoxifen. Reasons for accepting (n = 15) or declining (n=15) were explored using semistructured interviews. Results.--Of 1279 eligible women, 136 (10.6%) decided to take tamoxifen. Women >40 years (74 out of 553 (13.4%)) and those at higher non- BRCA-associated risk were more likely to accept tamoxifen (129 out of 1109 (11.6%)). Interviews highlighted four themes surrounding decision making: perceived impact of side effects, the impact of others' experience on beliefs about tamoxifen, tamoxifen as a 'cancer drug', and daily reminder of cancer risk. Conclusions.--Tamoxifen uptake was similar to previously ascertained uptake in a randomised controlled trial (IBIS-I). Concerns were similar in women who did or did not accept tamoxifen. Decision making appeared to be embedded in the experience of significant others. [ABSTRACT FROM AUTHOR]

Background.--Adjuvant treatment with tamoxifen reduces the risk of contralateral breast cancer in hormone-responsive postmenopausal patients, whereas the effect in premenopausal women has not been fully elucidated. We have therefore studied the effect of tamoxifen on contralateral breast cancer in premenopausal women in a controlled randomised trial. Patients and Methods.--Premenopausal women (564) with stage II breast cancers were randomised to 2 years of tamoxifen versus control irrespective of oestrogen receptor (ER) and progesterone receptor (PgR) status. The median follow-up for patients not developing a contralateral cancer was 14 years. Results.--In the control group 35 women, and in the tamoxifen group 17 women, developed a contralateral breast cancer as a primary event. Tamoxifen significantly reduced the risk of contralateral breast cancer in all women regardless of age (hazard ratio (HR) 0.5, p = 0.02). In subgroup analysis the risk reduction was most pronounced in patients <40 years of age (HR 0.09, p = 0.02). A risk reduction was also seen in women 40-49 years of age or ≤50 years of age, although in these subgroups this did not reach statistical significance. The reduced risk of contralateral breast cancer was persistent during the whole follow-up time. Conclusion.--In this randomised trial, adjuvant treatment using tamoxifen for 2 years reduced the incidence of contralateral breast cancer by 50% in all premenopausal women, and by 90% in women <40 years of age. The effect of tamoxifen was not significantly dependent on time. [ABSTRACT FROM AUTHOR]

The article discusses research being done on the risks and benefits of stopping randomized treatment with estrogen and progestin in women. It references a study by G. Heiss and colleagues, published in the 2008 issue of the "Journal of the American Medical Association." The study reports the health outcomes three years after withdrawing estrogen and progestin treatment. Cardiovascular risks in the patients were analyzed, along with other fatal and nonfatal malignancies.

Purpose.--Exemestane, a steroidal aromatase inhibitor, reduced invasive breast cancer incidence by 65% among 4,560 postmenopausal women randomly assigned to exemestane (25 mg per day) compared with placebo in the National Cancer Institute of Canada (NCIC) Clinical Trials Group MAP.3 (Mammary Prevention 3) trial, but effects on quality of life (QOL) were not fully described. Patients and Methods.--Menopause-specific and health-related QOL were assessed by using the four Menopause-Specific Quality of Life Questionnaire (MENQOL) domains and the eight Medical Outcomes Study Short Form Health Survey (SF-36) scales at baseline, 6 months, and yearly thereafter. MENQOL questionnaire completion was high (88% to 98%) in both groups at each follow-up visit. Change scores for each MENQOL and SF-36 scale, calculated at each assessment time relative to baseline, were compared by using the Wilcoxon rank-sum test. Clinically important worsened QOL was defined as a MENQOL change score increase of more than 0.5 (of 8) points and an SF-36 change score decrease of more than 5 (of 100) points from baseline. Results.--Exemestane had small negative effects on women's self-reported vasomotor symptoms, sexual symptoms, and pain, which occurred mainly in the first 6 months to 2 years after random assignment. However, these changes represented only a small excess number of women being given exemestane with clinically important worsening of QOL at one time or another; specifically, 8% more in the vasomotor domain and 4% more each in the sexual domain and for pain. No other between-group differences were observed. Overall, slightly more women in the exemestane arm (32%) than in the placebo arm (28%) discontinued assigned treatment. Conclusion.--Exemestane given for prevention has limited negative impact on menopause-specific and health-related QOL in healthy postmenopausal women at risk for breast cancer. [ABSTRACT FROM AUTHOR]

The article discusses research on the escalation in the number of breast cancer with estrogen receptor (ER)-positive status in Great Britain as a result of the rise in diagnosis through screening. It references the study "Is the Biology of Breast Cancer Changing? A Study of Hormone Receptor Status 1984-1986 and 1996-1997," by S. B. F. Mallon et al., published in an issue of "British Journal of Cancer." Researchers noted several factors that contribute to better survival rates in such patients.

Numerous observational studies conducted to evaluate the association between NSAIDs and breast cancer risk have produced inconsistent results, although the majority of evidence suggests that NSAID use is associated with a reduction in risk. However, the only randomized trial of NSAIDs as a breast cancer chemopreventive agent, the Women's Health Study (WHS), did not identify any effect of low-dose aspirin (100 mg) taken every other day on breast cancer incidence in an average of 10 years of follow-up in nearly 40,000 women. Although the Women's Health Initiative (WHI) cohort study of nearly 81,000 women similarly found no effect of low-dose aspirin (81 mg) on breast cancer incidence among women, reductions with higher doses and other formulations of NSAIDS and some evidence of the benefit of longer duration of use were seen. One interesting finding from the WHS was the suggestion of an increased risk of breast cancer among nonsmokers with low-dose aspirin use while past smokers had a reduced risk of breast cancer. The case-control study reported in this article was done to help reconcile the discordance between the wealth of reported observational studies and the WHS randomized controlled trial.3 On the basis of a hypothesis that proinflammatory processes such as tobacco carcinogens and arthritis potentially increase the effectiveness of NSAIDs for chemoprevention, this study stratified for smokers and women with arthritis to determine whether differential effects would be observed. Additionally, because of the effect of NSAIDs on estrogen production as a result of regulation of the cycloogenase pathway, their effects on ER/PR-positive and ER/PR-negative cancers were assessed. Breast cancer risk was reduced with the use of NSAIDs, and this effect was apparently unaffected by smoking status or history of arthritis. Additionally, no significant difference was seen among ER/PR-positive and ER/PR-negative breast cancers. This latter finding supports results from the WHS. Similar to the WHI, the benefit of NSAIDs in the WHS was greater with increased duration of use. It is important to note that the study by Kirsh and colleagues was not restricted to any specific NSAID formulation or dose and that women who used NSAIDs for fewer than 2 months were considered nonusers. Given the accumulating evidence, continued investigation of other doses and formulations of NSAIDs is worthwhile. The findings of this study provide further support for such research. [ABSTRACT FROM AUTHOR]

The article presents abstracts on topics related to breast cancer including "Breast Cancer Risk Assessment and Prevention: A Framework for Shared Decision-Making Consultations," "The Roles of Teaching Hospitals, Insurance Status and Race/Ethnicity in Receipt of Adjuvant Therapy for Regional-Stage Breast Cancer in Florida" and "High Risk of Contralateral Breast Carcinoma in Women With Hereditary/Familial Non-BRCA1/BRCA2 Breast Carcinoma."

The article discusses research study on whether mammographic density can show the association between family history of breast cancer and the risk of developing the disease. It references a study by L. J. Martin and colleagues published in a 2010 issue of "Cancer Epidemiology, Biomarkers & Prevention." Compared with women with no affected first-degree relatives, the researchers found that percent mammographic density for women with one affected relative was 3.1% more.