Breast cancer screening.

Screening for breast cancer is receiving increased emphasis with the development of modern technology. Health care providers must inform the public that screening for breast cancer may increase survival. Legislation must be enacted to ensure that a screening examination is affordable and can be readily obtained upon referral. The message to both health care professionals and the public must be positive. Early detection is the best protection in breast cancer.     

Breast cancer screening.

Breast cancer, as the second leading form of cancer death among women, causes significant morbidity and mortality. The primary care physician can help raise the survival rate of women with breast cancer by providing important screening procedures that will lead to early diagnosis and treatment. Screening mammography and regular breast physical examinations are the current screening procedures of choice. Although there is still considerable debate over the age and interval at which women should undergo screening (see Table 1 for recommendations from various organizations), the primary care physician's recommendation is the single most important factor and will certainly lead to a higher screening rate for women in the greater at-risk age groups. Judicious use of these screening procedures should allow primary care physicians to catch more breast cancers at an early, curable stage.     

Breast cancer screening, diagnosis, and treatment.

The incidence of breast cancer in US women remains disturbingly high, and unfortunately primary care physicians still frequently encounter patients in whom the disease is suspected or, even worse, confirmed. Fortunately, however, the body of knowledge surrounding the disease has grown dramatically during the past decade, and major advances have been made in the understanding of breast cancer risk, prevention, diagnosis, and treatment. Controversies persist, particularly those concerning the screening of younger women, but consensus now exists regarding many clinical issues relevant to primary care practice. Although multidisciplinary subspecialty expertise must be made available to all women with known or suspected breast cancer, the primary care physician has an important role to play when dealing with patients with this condition. The following article focuses on what primary care practitioners need to know to expertly contribute to the diagnosis, counseling, and initial treatment of women with this disease.     

Colorectal cancer screening and surveillance with CT colonography: current controversies and obstacles

Computed tomographic (CT) colonography has been advocated as an alternative colorectal screening method because studies in populations with a high prevalence of polyps have demonstrated that sensitivity for patients with large (10 mm) polyps is generally high (90%). In three recent studies in low-prevalence populations, however, these values vary from 55% to 94%.Many questions have been raised as to the cause of this remarkable variability, which hampers the implementation of CT colonography in colorectal cancer screening and surveillance. We provide an overview of some potential causes and discuss the available, often indirect, evidence. In addition, several other obstacles that may influence implementation are discussed. Many differences between the study with high sensitivity (94%) and the two studies with low sensitivity (55% and 64%) exist: the primary method to review the data (two or three dimensional), bowel preparation (with or without oral contrast agents), study design (verification method and analysis of adenomas only), readers experience, and scanning technique (single vs. multislice, thin vs. thick sections). Additional obstacles for implementation in prevention of colorectal cancer may be controversial results concerning patient acceptance, the large-scale use of ionizing radiation, difficulties in detecting flat adenomas, and extracolonic findings.Use of primary three-dimensional review methods, addition of oral contrast agents to bowel preparation, and endoscopic verification of false-positive results on CT colonography are speculated to have a positive influence on sensitivity. Future investigations should demonstrate the influence of these potential factors on sensitivity of CT colonography. Despite a growing body of evidence, it remains uncertain to what extent patient acceptance, radiation issues, flat lesions, and extracolonic findings will be a stumbling block to using CT colonography for colorectal cancer screening.     

Colorectal cancer screening and surveillance with CT colonography: current controversies and obstacles

Computed tomographic (CT) colonography has been advocated as an alternative colorectal screening method because studies in populations with a high prevalence of polyps have demonstrated that sensitivity for patients with large (> or =10 mm) polyps is generally high (approximately 90%). In three recent studies in low-prevalence populations, however, these values vary from 55% to 94%. Many questions have been raised as to the cause of this remarkable variability, which hampers the implementation of CT colonography in colorectal cancer screening and surveillance. We provide an overview of some potential causes and discuss the available, often indirect, evidence. In addition, several other obstacles that may influence implementation are discussed. Many differences between the study with high sensitivity (94%) and the two studies with low sensitivity (55% and 64%) exist: the primary method to review the data (two or three dimensional), bowel preparation (with or without oral contrast agents), study design (verification method and analysis of adenomas only), reader's experience, and scanning technique (single vs. multislice, thin vs. thick sections). Additional obstacles for implementation in prevention of colorectal cancer may be controversial results concerning patient acceptance, the large-scale use of ionizing radiation, difficulties in detecting flat adenomas, and extracolonic findings. Use of primary three-dimensional review methods, addition of oral contrast agents to bowel preparation, and endoscopic verification of false-positive results on CT colonography are speculated to have a positive influence on sensitivity. Future investigations should demonstrate the influence of these potential factors on sensitivity of CT colonography. Despite a growing body of evidence, it remains uncertain to what extent patient acceptance, radiation issues, flat lesions, and extracolonic findings will be a stumbling block to using CT colonography for colorectal cancer screening.     

Breast cancer: trends, risks, treatments, and effects.

Breast cancer is the most common cancer and the second leading cause of cancer-related death for women in the United States (National Center for Chronic Disease Prevention and Health Promotion, 2006). Despite the plethora of readily available information, women die of this disease every day. Major strides have been made in early detection and treatment of breast cancer in recent years. However, more work remains. One in 8 (12%) U.S. women 90 years or younger will develop breast cancer sometime during her life (overall lifetime risk). Approximately 200,000 U.S. women and 1,500 U.S. men develop breast cancer each year. The three greatest risks for developing breast cancer are "female sex, increasing age, and family history of breast cancer" (Office of Genomics and Disease Prevention, 2006, p. 1).     

Breast cancer: genetics, risks, and strategies

Breast cancer is the most common cause of cancer among women, with 175,000 new cases diagnosed in 1999. The recent discovery of inherited mutations on the BRCA1 and BRCA2 genes and related research has increased our understanding of key risk factors. After identifying those who are at risk, health care providers must counsel women regarding appropriate prevention and early detection strategies. This article reviews the influence of genetics on breast cancer, identifies risk factors, discusses risk factor analysis, and suggests strategies for prevention and early detection of breast cancer.     

Elective hysterectomy. Benefits, risks, and costs

This study evaluated the effect of hysterectomy or hysterectomy and bilateral salpingo-oophorectomy (hysterectomy and oophorectomy) versus alternative medical management on life expectancy, quality of life, and direct medical costs. Using techniques of decision analysis and available data on sequelae, it was found that gains in life expectancy and quality of life can be expected when women ages 30-60 undergo hysterectomy for benign neoplasm, disorders of menstruation, acquired abnormal anatomy, cervical disease, or endometriosis, owing primarily to prevention of reproductive tract cancers, which outweighs the impact of operative mortality. However, women who have relatively high operative risk or low expected cancer risks, beyond thresholds estimated in sensitivity analyses, suffer losses in life expectancy. Women younger than 35 not treated with replacement estrogens following hysterectomy and oophorectomy can expect net losses in life expectancy with surgical intervention due to increased risks of heart disease and osteoporosis. For women in the reproductive years who wish to preserve their potential to bear children, sterilization may be an unacceptable consequence of elective hysterectomy in the quality of life.     

Breast cancer screening

Breast cancer is the most common malignancy among women in the United States; however, recent data demonstrates a decline in the mortality rate, which may be attributed to early detection from screening programs combined with effective therapies for early stage disease. As a result of the prevalence of breast cancer and its association with highly emotional issues, screening recommendations have aroused debate in the scientific, public, and legislative domains. A general consensus supports breast cancer screening among women between the ages of 50 and 70; however, much controversy exists regarding screening for women age 40 to 49 or above age 70. This article explores the issues involved in determining breast cancer screening recommendations among asymptomatic women with average risk in the United States.     

Neonatal circumcision. Benefits, risks, and Family teaching.

Neonatal circumcision is a frequently performed elective surgical procedure, and is one of the oldest known surgical procedures. Neonatal circumcision may be performed for medical, cultural, or religious reasons. This article provides current information from the literature regarding the risks, benefits, and concerns about neonatal circumcision.     

Breast cancer diagnosis and screening

Approximately 180,000 new cases of breast cancer are diagnosed annually, accounting for about 48,000 deaths per year in the United States. The screening guidelines for the diagnosis of breast cancer are continually changing. Because of increased awareness of the signs and symptoms of breast cancer and the use of screening mammograms, breast cancers are increasingly being diagnosed at earlier stages. Annual mammograms and clinical breast examinations are recommended for women older than 40 years. Women older than 20 years should be encouraged to do monthly breast self-examinations, and women between 20 and 39 years of age should have a clinical breast examination every three years. These guidelines are modified for women with risk factors, particularly those with a strong family history of breast cancer. Ultrasonographic studies are most useful to evaluate cystic breast masses. For solid masses, diagnostic biopsy techniques include fine-needle aspiration, core biopsy and excisional biopsy.     

Breast cancer: risk factors, screening, and prevention

OBJECTIVES: To provide a review of the major and minor risk factors for the development of breast cancer and the options for prevention and treatment in women at high risk for breast cancer. DATA SOURCES: Clinical and research articles and textbooks. CONCLUSIONS: Breast cancer is the leading cancer found in women in the United States. For high-risk women, understanding their risk, appropriate screening recommendations, and possible prevention strategies is paramount. IMPLICATIONS FOR NURSING PRACTICE: Through education and psychosocial support, the nurse can assist with decision-making regarding risk reduction and current prevention and treatment options.     

Benefits and risks of elimination diets.

Elimination diets have been used for the prevention or treatment of allergic disease with the diet of the pregnant or breastfeeding mother or the child, or both, being modulated as deemed appropriate. Evidence from studies published so far suggests that dietary restrictions are in fact effective only in the treatment of specific food allergies, not in allergy prevention. An elimination diet of a child or a breastfeeding mother entails a risk to normal nutrition and growth of the child. Although studies are lacking, dietary restrictions during lactation may well be harmful also to the mother's health. Substitution of nutritionally important foods and professional guidance are necessary for the successful treatment of food allergies.     

Breast, stomach and colorectal cancer screening in Korea

Some issues and activities in cancer screening in Korea are briefly described, in particular those in stomach, breast and colorectal screening. There is randomized trial evidence for the efficacy of screening for breast cancer and colorectal neoplasia. Stomach cancer screening is as yet unproven, but the disease is very common in Korea and one of the leading causes of death. There are major related issues to be addressed by the country in the near future. These include improving uptake and coverage rates, quality control and evaluation. Colorectal cancer will be a major concern as its incidence and mortality rates have been increasing rapidly in recent years.     

Exercise for patients with diabetes. Benefits, risks, precautions.

Exercise is beneficial in both prevention and control of non-insulin-dependent (type II) diabetes. Whether a patient has insulin-dependent or type II diabetes, a regular exercise program can produce positive changes in the lipid profile, reduce blood pressure and weight, and improve other cardiovascular risk factors. The risks of an exercise program include precipitation of cardiovascular events, damage to the soft tissue and joints of the feet, visual loss, early and delayed hypoglycemia, and hyperglycemia and ketosis. Consequently, a comprehensive clinical assessment to identify potentially harmful diabetic complications and to determine the patient's fitness level is needed before a suitable exercise program can be prescribed. With careful manipulation of insulin doses and home monitoring of blood glucose levels, exercise need not adversely affect glycemic control. Moreover, the metabolic and cardiovascular benefits that result from a sensible exercise program can greatly improve the quality of life for most diabetic patients.     

Breast cancer screening barriers and disability

There is evidence that early detection from breast cancer screening is an effective means to reduce overall mortality from breast cancer. Findings from multiple research studies suggest that women with chronic disabling conditions are less likely to participate in breast cancer screening due to the multiple barriers they face. Barriers include those related to finances, environment, physical limitations, health carers' attitudes and lack of knowledge, and psychosocial issues. The purpose of this article is to provide an overview of the existing evidence of the barriers to breast cancer screening experienced by women with physical disabilities. Rehabilitation nurses that work with women who have chronic disabling conditions can be instrumental in eliminating these barriers to breast cancer screening through their efforts to promote health which is consistent with the philosophy of maximizing the health potential and quality of life of these women whose needs are often overlooked.