Risk of contralateral breast cancer. Associations with histologic, clinical, and therapeutic factors

A case-control study was conducted to assess the risk factors associated with the development of a contralateral primary breast cancer among women who had had a first primary breast cancer. Hospital records were reviewed for 292 women with an incident contralateral breast cancer, diagnosed in one of eight hospitals between July 1, 1975 and December 31, 1983, and for a comparison group of 264 surviving unilateral breast cancer patients, previously diagnosed in the same hospitals. All subjects were identified through the records of the Connecticut Tumor Registry. Having an initial tumor containing lobular carcinoma was associated with an almost twofold increased risk of developing a contralateral cancer (aOR = 1.8; 95% CI: 1.0-3.5). Among those for whom a progesterone receptor assay was available, a positive assay was associated with an increased risk of a contralateral primary (aOR = 3.2; 95% CI: 1.0-9.5). AB blood type was also associated with an elevated risk, but this elevation was not statistically significant (aOR = 2.3; 95% CI: 0.7-7.7). Having received radiation treatment was not significantly associated with the risk of a contralateral primary (aOR = 0.9; 95% CI: 0.6-1.4), whereas chemotherapy treatment was associated with a significantly lowered risk (aOR = 0.3; 95% CI: 0.1-0.7). The association with chemotherapy appeared to be modified by body build (ROR = 1.5; 95% CI: 1.0-2.3 for a 2.5-unit differential in Quetelet's index).     

Rome women's screening study: knowledge, attitudes and practices of women regarding screening for breast and cervical cancer

A survey on knowledge, attitudes, and practice regarding breast and cervical cancer screening was conducted in Rome on a sample of women aged 18-64 years. Of the 793 interviewees, 31.9% had undergone at least one breast imaging examination; examinations were more frequent in women over 35 and in those familiar with breast self-examination and female pathophysiology. Seventy percent of the women had had at least one Pap smear. Women were classified as Pap smear underusers (26.0%), appropriate users (28.8%), and overusers (45.2%) as compared to standard screening recommendations, according to their age and their lifetime number of smears. Age over 35 was associated with both underuse and overuse. Such inappropriate screening patterns could be related in part to the fact that the women reported that their physicians recommendations for Pap smear frequency were once a year or more in 62%, and once every two or three years in only 2%.     

Breast cancer risk in symptomatic women spontaneously undergoing clinical breast examination

Breast cancer (BC) is the most common cancer among women. However, few studies consider the possible relationship between the main breast complaints referred to by non-screened patients and cancer onset. The objective of this study was to evaluate the relationship between the principal breast complaints (breast pain, breast lump and nipple discharge) and the risk of BC. A group of 347 symptomatic women (median age 59 years, range 35-83) with confirmed BC (cases) was age-matched with a population-based group of 351 symptomatic women (controls) who were followed-up for at least three years (median 78 months, range 36-146) to exclude the presence of a missed BC. Breast pain was the most common (p < 0.05) complaint in younger patients (50 years or less = 39.0%, 51-60 years = 51.2%), while breast lump was most common in patients aged > 60 years (65.4%). Since the odds ratio (OR) ranged from 0.80 to 1.20 at a 95% confidence interval (CI) of 0.54-1.80, there was no overall significant association between breast complaints and risk of BC. There was some evidence of increased risk among patients with breast lump (OR = 1.20, 95% CI 0.80-1.80), and no risk in those with breast pain (OR = 0.86, 95% CI 0.54-1.36) and nipple discharge (OR = 0.8, 95% CI 0.37-1.74). In conclusion, a relationship between breast complaints and the onset of BC does not seem to exist.     

Breast self-examination and death from breast cancer: a meta-analysis

Breast self-examination (BSE) is widely recommended for breast cancer prevention. Following recent controversy over the efficacy of mammography, it may be seen as an alternative. We present a meta-analysis of the effect of regular BSE on breast cancer mortality. From a search of the medical literature, 20 observational studies and three clinical trials were identified that reported on breast cancer death rates or rates of advanced breast cancer (a marker of death) according to BSE practice. A lower risk of mortality or advanced breast cancer was only found in studies of women with breast cancer who reported practising BSE before diagnosis (mortality: pooled relative risk 0.64, 95% CI 0.56-0.73; advanced cancer, pooled relative risk 0.60, 95% CI 0.46-0.80). The results are probably due to bias and confounding. There was no difference in death rate in studies on women who detected their cancer during an examination (pooled relative risk 0.90, 95% CI 0.72-1.12). None of the trials of BSE training (in which most women reported practising it regularly) showed lower mortality in the BSE group (pooled relative risk 1.01, 95% CI 0.92-1.12). They did show that BSE is associated with considerably more women seeking medical advice and having biopsies. Regular BSE is not an effective method of reducing breast cancer mortality.     

Quantification of the effect of mammographic screening on fatal breast cancers: The Florence Programme 1990-96

Breast cancer cases diagnosed in women aged 50-69 since 1990 to 1996 in the City of Florence were partitioned into those who had been invited to screening prior to diagnosis and those who had not. All cases were followed up for vital status until 31 December 1999. The cumulative number of breast cancer deaths among the cases were divided by screening and invitation status, to give the rates of cancers proving fatal within a period of 8 years of observation (incidence-based mortality). We used the incidence-based mortality rates for two periods (1985-86, 1990-96), pre and during screening. The incidence-based mortality ratio comparing 1990-96 and 1985-86 was 0.50 (95% CI : 0.38-0.66), a significant 50% reduction. For noninvited women, compared to 1985-86, there was a 41% significant mortality reduction (RR=0.59, 95% CI : 0.42-0.82). The comparable reduction in those invited was a significant 55% (RR=0.45, 95% CI : 0.32-0.61). The incidence ratio of rates of cancers stage II or worse was close to one when the noninvited in 1990-96 were compared with 1985-86 (RR=0.97, 95% CI : 0.78-1.21). Excluding prevalent cases, the rate of stage II+ breast cancer cases was 42% lower in Screened women compared with the noninvited (RR=0.58, 95% CI : 0.45-0.74). This study confirmed that new treatments and the first rounds of the screening programme contributed to reducing mortality from breast cancer.     

Association of symptoms and breast cancer in population‐based mammography screening in Finland

The study purpose was to assess association of symptoms at screening visits with detection of breast cancer among women aged 50–69 years during the period 2006–2010. Altogether 1.2 million screening visits were made and symptoms (lump, retraction, secretion etc.) were reported either by women or radiographer. Breast cancer risk was calculated for each symptom separately using logistic regression [odds ratio (OR)] and 95% confidence intervals (CIs). Of the 1,198,410 screening visits symptoms were reported in 298,220 (25%) visits. Breast cancer detection rate for women with and without symptoms was 7.8 per 1,000 and 4.7 per 1,000 screening visits, respectively, whereas lump detected 32 cancers per 1,000 screens. Women with lump or retraction had an increased risk of breast cancer, OR = 6.47, 95% CI 5.89?7.09 and OR = 2.19, 95% CI 1.92–2.49, respectively. The sensitivity of symptoms in detecting breast carcinoma was 35.5% overall. Individual symptoms sensitivity and specificity ranged from, 0.66 to 14.8% and 87.4 to 99.7%, respectively. Of 5,541 invasive breast cancers, 1,993 (36%) reported symptoms at screen. Breast cancer risk among women with lump or retraction was higher in large size tumors (OR = 9.20, 95% CI 8.08–10.5) with poorly differentiated grades (OR = 5.91, 95% CI 5.03–6.94) and regional lymph nodes involvement (OR = 6.47, 95% CI 5.67–7.38). This study was done in a setting where breast tumors size is generally small, and symptoms sensitivity and specificity in diagnosing breast tumors were limited. Importance of breast cancer symptoms in the cancer prevention and control strategy needs to be evaluated also in other settings.     

Risk factors for breast cancer in nulliparous women

The relation between hormonal and lifestyle factors and breast cancer risk in nulliparae was investigated using data from two case-control studies conducted in Italy between 1983 and 1994. The study included 1041 nulliparae with histologically confirmed incident breast cancer and 1002 nulliparous controls admitted to hospital for a wide range of acute, non-neoplastic, nonhormone-related diseases. In premenopausal nulliparae, there was an inverse relation with age at menarche [odds ratios (OR) 0.45; 95% confidence intervals (CI) 0.24-0.86 for > or = 15 years vs < 12], while no association emerged in postmenopausal. Breast cancer risk increased with age at menopause, the OR being 1.91 (95% CI 1.26-2.90) for nulliparae reporting age at menopause > or = 53 years compared with < 45. Abortion was not related to breast cancer risk, the OR being 0.92 for any spontaneous, 0.97 for any induced and 0.77 for > or = 2 total abortions compared to none. The OR was 1.75 (95% CI 1.03-2.97) for women reporting their first abortion at age > or = 30 years compared with < 30. Oral contraceptives and hormone replacement therapy in menopause were moderately related to risk. The OR was 2.71 (95% CI 1.85-3.95) in nulliparae with a family history of breast cancer and 1.60 (95% CI 1.20-2.14) in those with a history of benign breast disease. Compared with nulliparae reporting a low physical activity, the OR was 0.79 (95% CI 0.54-1.16) for those reporting intermediate/high activity. Breast cancer risk increased with total energy intake, the OR being 1.65 (95% CI 0.99-2.75) in the highest tertile; beta-carotene was inversely related to risk (OR 0.60, 95% CI 0.38-0.95) for the highest tertile. Thus, most risk factors for breast cancer in nulliparae were similar to those in women generally.     

Cancer Screening Adherence of Asian Women According to Biochemically-verified Smoking Status: Korea National Health and Nutrition Examination Survey

Background: Men and women who smoke tend to show less compliance to screening guidelines than nonsmokers.However, a recent study in Korea showed that self-reported female smokers constituted less than halfof cotinine-verified smokers. Therefore, the aim of this study was to identify hidden smokers using cotinineverifiedmethod and examine cancer screening behavior according to biochemically verified smoking status.Materials and Methods: Among 5,584 women aged 30 years and older who participated in the Fourth and FifthKorea National Health and Nutrition Examination Survey (KNHANES), 372 (6.66%) hidden smokers wereidentified based on interview responses and verified by urinary cotinine levels. We compared cancer-screeningbehavior (cervical, breast, stomach, and colon cancer) of female hidden smokers to that of non-smokers and selfreportedsmokers by cross-sectional analysis. Results: Hidden female smokers had significantly lower adherenceto breast cancer screening compared to non-smokers (aOR (adjusted odds ratio) [95% CI] = 0.71 [0.51–0.98]).Adherence to stomach cancer (aOR [95% CI] = 0.75 [0.54–1.03]) and cervical cancer (aOR [95% CI] = 0.85[0.66–1.10]) screening was also lower among hidden female smokers compared to non-smokers. Self-reported(current) smokers showed lowest adherence to cervical cancer (aOR: 0.64, 95% CI0.47-0.87), breast cancer(0.47 [0.32-0.68]), stomach cancer (0.66[0.46-0.95]), and colon cancer (0.62 [0.38-1.01]) screening compared tonon-smokers, followed by female hidden smokers, then non-smokers. These lower adherence rates of currentsmokers were attenuated after we incorporated hidden smokers into the current smoker group. Conclusions:Cancer screening adherence of female hidden smokers was lower than cotinine-verified non-smokers but higherthan current smokers. Considering the risk of smoking-related cancer among women, identifying hidden smokersis important to encourage appropriate cancer screening.     

Incidence and tumor characteristics of breast cancer diagnosed before and after implementation of a population-based screening-program

Background. Randomized controlled trials and service screening programs have shown that breast cancer screening reduces the mortality from the disease. Several years of monitoring are needed to prove such an effect. In the meantime attention should be paid to early surrogate measures, such as histopathological tumor characteristics. The Norwegian Breast Cancer Screening Program started November 1995. This study compares incidence, prognostic tumor characteristics and surgical treatment in breast cancer cases diagnosed in the pre-screening (1987-1995, n=2 618) and screening period (1996-2004, n=5 417), in women aged 50-69 years, residing in the first four counties implementing the screening program. The screening period is divided into those invited versus those not invited to the screening program, and those exposed (participants) versus those not exposed to the program (non-participants). Results. The incidence of invasive breast cancer rose from 170 per 100 000 women years (wy) in 1987 to 355 per 100 000 wy in 1997. The proportion of DCIS was 5% in the pre-screening period, and 14% in the screening period. Tumors 20 mm or less were diagnosed in 56% of the invasive cases in the pre-screening period, in 74% of the invited, and in 77% of the exposed women. The relative risk of diagnosing breast cancer with metastases was 0.85 (95% CI 0.84-0.87) for invited and 0.82 (95% CI 0.81-0.84) for exposed women, relative to those diagnosed in the pre-screening period. Ablation was performed in 85% of the invasive cases diagnosed in the pre-screening period, and in 45% of the cases in the screening period. Conclusion. Breast cancer diagnosed in the screening period had prognostically favorable tumor characteristics compared to breast cancer diagnosed in the pre-screening period. Implementation of organized population based screening and the time trend are considered possible reasons.     

Mammographic breast density, dense area, and breast area differences by phase in the menstrual cycle.

BACKGROUND: Mammographic breast density may be greater in the luteal phase (days 15-30) than the follicular phase (days 1-14) of the menstrual cycle; this may have implications for when mammography screening should occur. OBJECTIVE: Examine whether percent breast density, breast area, or dense area differ by menstrual phase. METHODS: We identified 204 premenopausal women with regular periods who were <55 years (mean = 45.0 years) and had two screening mammograms within 9 to 18 months, with one screening between days 9 and 14, and one screening between days 22 and 35 of the menstrual cycle. We measured percent breast density, breast area, and dense area using the Cumulus software. We used linear regression to test for differences in breast density, breast area, and dense area from follicular to luteal phase, adjusting for change in weight and time between exams. RESULTS: The mean (SD) percent breast density was 35.8% (21.3) in the follicular phase and 36.7% (21.3) in the luteal phase. Multivariable analyses showed small but not statistically significant increases in percent density [1.1%; 95% confidence interval (95% CI), -0.2% to 2.3%] and breast area (16.7 cm(2); 95% CI, -2.8 to 36.2) and a statistically significant increase in dense area (13.1 cm(2); 95% CI, 0.1-26.1) in the luteal compared with the follicular phase. CONCLUSIONS: Breast density, breast area, and dense area have small, but probably not clinically meaningful, increases in the luteal phase of the menstrual cycle. However, there are other factors that may differ by menstrual cycle phase that we were unable to assess (e.g., breast compression), which may ultimately influence mammographic sensitivity by menstrual cycle phase.     

A case control study on the effectiveness of breast cancer screening by clinical breast examination in Japan.

A case-control study was conducted in Miyagi and Gunma prefectures, Japan, to evaluate the effectiveness of breast cancer screening by clinical breast examination (CBE) alone in reducing breast cancer mortality. Case subjects, who were female and had died of breast cancer, were collected from residential registry files and medical records. Control subjects matched in sex, age and residence were randomly selected from residential registry files. The screening histories during 5 years prior to the cases having been diagnosed as breast cancer were surveyed using the examinee files of the screening facilities. Finally, the data of 93 cases and 375 controls were analyzed. The odds ratio (OR) of breast cancer death for participating in screening at least once during 5 years was 0.93 (95% confidence interval (95% CI) 0.48-1.79). The cases were more symptomatic than the controls when screened. If the participants who had had symptoms in their breasts were classified as not screened, the OR decreased to 0.56 (95% CI 0.27-1.18). The case control study suggests that the current screening modality (CBE) lacks effectiveness (OR = 0.93), although it might be effective for an asymptomatic population (OR = 0.56). The number of cases was small, and a larger case-control study is desirable to define whether CBE is effective or not. However, it is necessary to consider the introduction of mammographic screening to reduce breast cancer mortality in Japan.     

Awareness and Prevalence of Mammography Screening and its Predictors - A Cross Sectional Study in a Primary Care Clinic in Malaysia

Background: Worldwide, over half a million women died of breast cancer in 2011 alone. Mammographyscreening is associated with a reduction of 20 to 35% in breast cancer mortality. The aim of this study was todetermine the awareness and practice of mammography screening and predictors of its uptake in Malaysianwomen attending a primary care clinic. Materials and Methods: A cross-sectional study was carried out amongwomen aged 40 to 74 years attending a primary care clinic in Selangor, Malaysia. An assisted structuredquestionnaire included questions on socio-demography, source of information and level of knowledge. An adaptedversion of the revised Champion Health Belief Model Scale plus other associated factors for mammographyscreening up-take were also included as part of the questionnaire. Predictors for mammography screeninguptake were only determined in those who were aware about mammography screening. Significant predictorswere determined by logistic regression. Results: 447 women were recruited for this study; 99.1% of them (n:411) were aware about breast cancer. Only 50.1% (n: 206) had knowledge about mammography screening.Prevalence of clinical breast-examination (CBE) was 23.3% (n: 104) and mammography screening up-take was13.2% (n: 59). The predictors for the latter were those who have had clinical breast-examination (aOR=17.58,95%CI: 7.68-39.82) and those aged between 50 to 59 years (aOR=3.94, 95%CI: 1.61-9.66) as well as those aged60 years and above (aOR=6.91, 95%CI: 2.28-20.94). Good knowledge and positive beliefs about mammographyscreening were not associated with mammography screening uptake. Conclusions: Half of our Malaysian womenwere aware about mammography screening. However, the uptake of mammography was low. Previous CBE andolder age were significant predictors of mammography screening uptake. Increasing CBE services may increasecompliance with guidelines.     

Impact of reproductive factors and lactation on breast carcinoma in situ risk

Incidence rates for breast carcinoma in situ (CIS) have increased markedly over the past 20 years. Breast CIS, detected primarily on mammography, now represents 30-45% of all screened detected breast cancers. We conducted a large population-based case-control study to evaluate the impact of reproductive factors and lactation on breast CIS risk. Case subjects were newly diagnosed with breast CIS at ages 35-64 years between March 1, 1995 and May 31, 1998 (n = 567), resided in Los Angeles County and were born in the United States. Control subjects (n = 614), identified through random digit dialing, fulfilled the same eligibility criteria and were required to have had at least one screening mammogram in the 2-year period before their interview. Women with a positive family history of breast cancer had a 2-fold increase in breast CIS risk. Parous women were at reduced risk relative to nulligravid women (odds ratio [OR] = 0.67, 95% confidence interval [CI] = 0.46-1.00). Among nulliparous women, pregnancy was unrelated to breast CIS risk. Among parous women, risk declined with each additional term pregnancy (p-trend = 0.003). No associations were found with age at first term pregnancy, induced abortion or miscarriage. Long duration of breast-feeding (> or =24 months) was associated with increased risk (OR = 2.00, 95% CI = 1.11-3.60). The observed effects of family history and pregnancy on breast CIS risk are consistent with those observed for invasive breast cancer. The results for breast-feeding are contrary to what has been observed in studies of invasive breast cancer.     

Family history of breast or ovarian cancer modifies the risk of secondary leukemia after breast cancer: results from a population-based study

We evaluated the impact of a family history of breast/ovarian cancer on the risk of secondary leukemia following breast cancer. At the Geneva cancer registry, we identified 4,397 patients diagnosed with invasive breast cancer between 1990 and 2004. Patients were followed up for leukemia until the end of 2005. Family history was categorized as positive in patients with >or=1 first- or second-degree relative with breast/ovarian cancer. We compared leukemia rates in patients with positive and negative family histories with those expected in the general population, generating standardized incidence ratios (SIRs). With Cox regression analysis, we calculated adjusted risks of secondary leukemia in patients with familial risks compared to those without it. Breast cancer patients had a significantly increased risk of secondary acute leukemia (SIR 3.2, 95% CI: 1.2-6.9) but not of chronic leukemia (SIR 1.6, 95% CI: 0.6-3.5). Among patients with a positive family history (n = 1.125, 25.6%), the SIRs were 5.7 (95% CI: 1.2-16.6) for acute and 5.2 (95% CI: 1.4-13.3) for chronic leukemia. Among breast cancer patients, family history was independently associated with leukemia [adjusted hazard ratio (HR(adj)) of 3.2, 95% CI: 1.1-9.2, among patient with vs. without family history]. The effect of family history was stronger for chronic leukemia (HR(adj): 11.6, 95% CI 1.3-104.7) than for acute leukemia (HR(adj) 1.6, 95% CI: 0.4-6.6). Breast cancer patients with a family history of breast/ovarian have an increased risk of secondary leukemia, both compared to the general population as well as to breast cancer patients without family histories. This excess risk is largely due to the increased risk of secondary chronic leukemia.     

Relationship between mammographic density and breast cancer death in the breast cancer surveillance consortium

Background Women with elevated mammographic density have an increased risk of developing breast cancer. However, among women diagnosed with breast cancer, it is unclear whether higher density portends reduced survival, independent of other factors. Methods We evaluated relationships between mammographic density and risk of death from breast cancer and all causes within the US Breast Cancer Surveillance Consortium. We studied 9232 women diagnosed with primary invasive breast carcinoma during 1996-2005, with a mean follow-up of 6.6 years. Mammographic density was assessed using the Breast Imaging Reporting and Data System (BI-RADS) density classification. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by Cox proportional hazards regression; women with scattered fibroglandular densities (BI-RADS 2) were the referent group. All statistical tests were two-sided. Results A total of 1795 women died, of whom 889 died of breast cancer. In multivariable analyses (adjusted for site, age at and year of diagnosis, American Joint Committee on Cancer stage, body mass index, mode of detection, treatment, and income), high density (BI-RADS 4) was not related to risk of death from breast cancer (HR = 0.92, 95% CI = 0.71 to 1.19) or death from all causes (HR = 0.83, 95% CI = 0.68 to 1.02). Analyses stratified by stage and other prognostic factors yielded similar results, except for an increased risk of breast cancer death among women with low density (BI-RADS 1) who were either obese (HR = 2.02, 95% CI = 1.37 to 2.97) or had tumors of at least 2.0cm (HR = 1.55, 95% CI = 1.14 to 2.09). Conclusions High mammographic breast density was not associated with risk of death from breast cancer or death from any cause after accounting for other patient and tumor characteristics. Thus, risk factors for the development of breast cancer may not necessarily be the same as factors influencing the risk of death after breast cancer has developed.     

Differences in Breast and Cervical Cancer Screening Rates in Jordan among Women from Different Socioeconomic Strata: Analysis of the 2012 Population-Based Household Survey

Background: The burden of breast and cervical cancer is changing over time in developing countries. Regularscreening is very important for early detection and treatment. In this study, we assessed inequalities in breastand cervical cancer screening rates in women according to household wealth status, and analyzed the potentialpredictors associated with a low cancer screening rate in Jordan. Materials and Methods: A nationwide populationbasedcross-sectional survey collected information on different variables at the national level. All ever-marriedwomen (the phrase is used throughout the text to refer to women who had ever married) aged 15–49 years wereincluded in the survey. Analysis of breast self-examination (BSE) and clinical breast examination (CBE) at leastonce in the previous year was carried out in 11,068 women, while lifetime Pap-smear testing was carried outin 8,333 women, aged 20-49 years. Results: Over 39% and 19% of ever-married Jordanian women reportedhaving undergone a breast examination during the previous year and Pap smear examination at least once intheir lifetime, respectively. The rate of BSE in the previous year was 31.5%, that of CBE in the previous yearwas 19.3%, and that of Pap smear examination at least once in life was 25.5%. The adjusted OR was higher forperforming BSE (aOR 1.22, 95% CI 1.04–1.43), undergoing CBE (aOR 1.31, 95% CI 1.08–1.60) and undergoingPap smear examination (aOR 2.38, 95% CI 1.92–2.93) among women in the highest wealth-index quintile ascompared to those in the lowest quintile. The concentration index was 0.11 for BSE, 0.01 for CBE, and 0.27for Pap smear examination. Women in their twenties, living in rural or the southern region of Jordan, with anelementary school education or less, who listened to the radio or read the newspaper not more than a few times ayear, and nulliparous women were less likely to undergo breast and cervical cancer screening. Conclusions: Therates of breast and cervical cancer screening are low in Jordan. Reducing the sociodemographic and economicinequalities in breast and cervical cancer screenings requires concerted outreach activities for women livingunder socially deprived conditions.     

The organization of breast self-examination among women in the Estonian SSR

Patients with breast cancer and healthy females (150 in each group) aged 40-64 years were examined to assess the extent of breast self-examination development in Estonia. Breast cancer was detected by self-examination in 82.0% of cases. The occurrence of stage I tumors detected by the physician was comparable to that in the self-examination group. Breast self-examination was practised by 69.3% of healthy females and 42.7% of patients. Most of them had read about the method in the literature. Early detection of breast cancer can be assured provided breast self-examination is performed regularly.     

Changes in mammographic breast density and concomitant changes in breast cancer risk.

Among participants of the biennial Nijmegen breast cancer screening programme, we examined whether diminution of mammographic breast density lowered breast cancer risk. Post-menopausal breast cancer cases (n = 108), who had to have participated in all the five screening rounds prior to their diagnosis, were matched to 400 controls on year of birth and screening history. Controls had to be free of breast cancer at the time of the case's diagnosis. Changes in breast density were measured over a 10-year period, by a fully computerized method. Women in whom 5-25% or >25% of the breast was composed of fibro-glandular density showed a threefold increased 10-year risk compared to women with <5% density. In women with 5-25% density initially, we observed a trend of decreasing risk with diminishing density: when women with <5% density throughout the whole period formed the reference category, the odds ratio (OR) for those who decreased from 5-25% to <5% density was 1.9 [95% confidence interval (CI) = 0.6-6.1] in contrast to the OR of 5.7 (95% CI = 2.2-15.2) for those with persisting 5-25% density. In women who increased from 5-25% density to >25% density the OR was 6.9 (95% CI = 2.1-22.9). In women with >25% density initially, diminishing density was not clearly associated with lowering risk, which may be partly explained by the low number of women who decreased to <5% (n = 12). Due to the limited size of the study these results have to be interpreted with caution. Although the results are not conclusive, they could indicate a trend of decreasing risk with diminishing breast density. Should this effect be real, it may have great implications for the primary prevention of breast cancer or for the identification of high-risk groups who would benefit by more frequent screening. Therefore, large-scale, long-term follow-up studies on the effects of changes in breast density are needed.     

Do Subjective Norms Predict the Screening of Cancer Patients’ First-Degree Relatives? A Systematic Review and Meta-Analysis

Background: Early detection and preventive measures can reduce the risk of cancer among first degree relatives (FDRs) of cancer patients.Several studies investigated the effect of subjective norm in relation to FDRs’ tendency to conduct preventive behaviors. Therefore, the purpose of this study was to systematically evaluate the effect of subjective norms on cancer patients’ FDRs as well as their willingness for screening. Methods: PubMed and Scopus were studied to investigate the effect of subjective norms on preventive measures such as breast cancer self-examination, colonoscopy, PSA testing, skin examination, and genetic testing. Odds Ratio (OR), correlation was and confidence intervals were extracted for meta-analysis. After reviewing the studies, only 16 studies met the criteria to be included in this systematic review. Results: The meta- analysis and OR showed that Physician Recommendation (OR=6.98, 95% CI; 2.55–19.09, P<0.001), Health Care Provider (HCP) (OR=2.79, 95% CI; 1.26-6.16; P=0.011), family and friends (OR=1.82, 95% CI; 1.33–2.50, P <0.001) significantly enhanced the likelihood of referring for screening and preventive measures. Conclusions: The results of the current study indicated that subjective norms can significantly increase willingness to screening.     

A case-control study of the impact of the East Anglian breast screening programme on breast cancer mortality

Although breast cancer screening has been shown to work in randomised trials, there is a need to evaluate service screening programmes to ensure that they are delivering the benefit indicated by the trials. We carried out a case-control study to investigate the effect of mammography service screening, in the NHS breast screening programme, on breast cancer mortality in the East Anglian region of the UK. Cases were deaths from breast cancer in women diagnosed between the ages of 50 and 70 years, following the instigation of the East Anglia Breast Screening Programme in 1989. The controls were women (two per case) who had not died of breast cancer, from the same area, matched by date of birth to the cases. Each control was known to be alive at the time of death of her matched case. All women were known to the breast screening programme and were invited, at least once, to be screened. There were 284 cases and 568 controls. The odds ratio (OR) for risk of death from breast cancer in women who attended at least one routine screen compared to those who did not attend was 0.35 (CI: 0.24, 0.50). Adjusting for self-selection bias gave an estimate of the breast cancer mortality reduction associated with invitation to screening of 35% (OR=0.65, 95% CI: 0.48, 0.88). The effect of actually being screened was a 48% breast cancer mortality reduction (OR=0.52, 95% CI: 0.32, 0.84). The results suggest that the National Breast Screening Programme in East Anglia is achieving a reduction in breast cancer deaths, which is at least consistent with the results from the randomised controlled trials of mammographic screening.