Predicting the cumulative risk of false-positive mammograms

BACKGROUND: The cumulative risk of a false-positive mammogram can be substantial. We studied which variables affect the chance of a false-positive mammogram and estimated cumulative risks over nine sequential mammograms. METHODS: We used medical records of 2227 randomly selected women who were 40-69 years of age on July 1, 1983, and had at least one screening mammogram. We used a Bayesian discrete hazard regression model developed for this study to test the effect of patient and radiologic variables on a first false-positive screening and to calculate cumulative risks of a false-positive mammogram. RESULTS: Of 9747 screening mammograms, 6. 5% were false-positive; 23.8% of women experienced at least one false-positive result. After nine mammograms, the risk of a false-positive mammogram was 43.1% (95% confidence interval [CI] = 36.6%-53.6%). Risk ratios decreased with increasing age and increased with number of breast biopsies, family history of breast cancer, estrogen use, time between screenings, no comparison with previous mammograms, and the radiologist's tendency to call mammograms abnormal. For a woman with highest-risk variables, the estimated risk for a false-positive mammogram at the first and by the ninth mammogram was 98.1% (95% CI = 69.3%-100%) and 100% (95% CI = 99.9%-100%), respectively. A woman with lowest-risk variables had estimated risks of 0.7% (95% CI = 0.2%-1.9%) and 4.6% (95% CI = 1. 1%-12.5%), respectively. CONCLUSIONS: The cumulative risk of a false-positive mammogram over time varies substantially, depending on a woman's own risk profile and on several factors related to radiologic screening. By the ninth mammogram, the risk can be as low as 5% for women with low-risk variables and as high as 100% for women with multiple high-risk factors.     

Factors associated with the incompliance with mammogram screening among individuals with a family history of breast cancer or ovarian cancer

Objective The national guidelines recommend more intensive screening for breast cancer for women with a family history of breast or ovarian cancer. Using the data from the 2000 National Health Interview Survey (NHIS), we examined factors related to the underuse of mammogram in this population. Method The study subjects were 1,215 women aged 30–79 who had a family history of breast or ovarian cancer in their first-degree relatives. According to the American Cancer Society’s guidelines for breast cancer screening, having no mammogram in last year was used as an outcome for this study. Socio-demographic characteristics, health-related conditions, lifestyle factors, health behaviors, menstrual/reproductive information and health care access and utilization were analyzed to assess their relations to mammogram underuse using unconditional logistic regression method. Results The results showed that younger age, having no place to go when sick (OR = 2.2, 95% CI, 1.2–4.0), having no visits to a general doctor (OR = 1.7, 95% CI, 1.2–2.4) or medical specialist (OR = 2.2, 95% CI, 1.6–3.1) and having no influenza shot in last year (OR = 1.7, 95% CI, 1.2–2.3) increased the risk of underusing mammography screening among women who had a family history of breast or ovarian cancer. Women who had no home care from health professionals in the last year were less likely to underuse mammogram with an OR of 0.3 (95% CI, 0.1–0.6), compared with women who had. Conclusion Medical care-related factors may affect the use of mammography screening in women with a family history of breast or ovarian cancer. The views expressed in this article are those of the author and do not reflect the official policy of the department of Army, Department of Defense, or U.S. Government.     

Effect of false-positives and women��s characteristics on long-term adherence to breast cancer screening

False-positive results may influence adherence to mammography screening. The effectiveness of breast cancer screening is closely related to adequate adherence among the target population. The objective of this study was to evaluate how false-positives and women's characteristics affect the likelihood of reattendance at routine breast cancer screening in a sequence of routine screening invitations. We performed a retrospective cohort study of 1,371,218 women aged 45-69 years, eligible for the next routine screening, who underwent 4,545,346 screening mammograms from 1990 to 2006. We estimated the likelihood of attendance at seven sequential screening mammograms. Multilevel discrete time hazard models were used to estimate the effect of false-positive results on reattendance, and the odds ratios (OR) of non-attendance for the women's personal characteristics studied. The overall reattendance rate at the second screening was 81.7% while at the seventh screening was 95.6%. At the second screening invitation reattendance among women with and without a false-positive mammogram was 79.3 vs. 85.3%, respectively. At the fourth and seventh screenings, these percentages were 86.3 vs. 89.9% and 94.6 vs. 96.0%, respectively. The study variables associated with a higher risk of failing to participate in subsequent screenings were oldest age (OR = 8.48; 95% CI: 8.31-8.65), not attending their first screening invitation (OR = 1.12; 95% CI: 1.11-1.14), and previous invasive procedures (OR = 1.09; 95% CI: 1.07-1.10). The risk of non-attendance was lower in women with a familial history of breast cancer (OR = 0.97; 95% CI: 0.96-0.99), and those using hormone replacement therapy (OR = 0.96; 95% CI: 0.94-0.97). In conclusion, reattendance was lower in women with false-positive mammograms than in those with negative results, although this difference decreased with the number of completed screening participations, suggesting that abnormal results in earlier screenings more strongly influence behavior. These findings may be useful in providing women with accurate information and in improving the effectiveness of screening programs.     

Benefit of screening mammography in reducing the rate of late-stage breast cancer diagnoses (United States)

Objective We studied the benefit of modern mammography screening in community settings, evaluating age-related differences in rates of late-stage breast cancer detection. Methods Our multicenter population-based case–control study included 931 black and white women with incident breast cancer (American Joint Commission on Cancer Stage IIB or higher) diagnosed 1994–1998 and 4,016 randomly sampled controls never diagnosed with breast cancer. Adjusted odds ratios (ORs) estimated the relative rate of late-stage diagnosis in screened and non-screened women. Results Women aged 50–64 at diagnosis with at least one screening mammogram in the previous 2 years were significantly less likely to have late-stage diagnosis (OR = 0.41, 95% CI 0.33–0.52). Results for women aged 40–49 were consistent with a screening benefit, although the confidence interval marginally overlapped the null (OR = 0.81, 95% CI 0.64–1.02). Mammography screening was associated with lower rates of late-stage breast cancer among both premenopausal (OR = 0.64, 95% CI 0.50–0.81) and postmenopausal (OR = 0.44, 95% CI 0.35–0.56) women. Conclusions With modern mammography in the community, rates of late-stage breast cancer diagnoses are lower in screened compared to non-screened women ages 40 and older, but age-related differences persist. The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.     

Surveillance mammography and the risk of death among elderly breast cancer patients

Purpose To examine the benefits of mammography for elderly breast cancer survivors in community settings. Methods Using the 1991–1999 linked SEER-Medicare data, we examined if mammography reduced the risk of breast-cancer-specific and all-cause mortality among women age 66 or older who were diagnosed with first primary breast cancer (FPBC) at stages 0–III and survived at least 30 months. To analyze the influence of mammography (both within one year and within two years prior to death/censoring) on the risk of breast-cancer-specific mortality, we compared women who died of breast cancer (cases) with women who died of other causes or were censored (controls). For an analysis of all-cause mortality, we compared women who died from any cause (cases) with women who were censored (controls). Propensity scores were used to adjust for tumor-related, treatment-related, and sociodemographic confounders. Results Among 1351 breast cancer deaths (cases) and 5,262 controls, women who had a mammogram during a one or two-year time interval were less likely to die from breast cancer than women who did not have any mammograms during this time period in propensity-score-adjusted analysis (within one year odds ratio [OR]: 0.83, 95% confidence interval [CI]: 0.72–0.95; within two years OR: 0.80, 95% CI: 0.70–0.92). Similarly, risk of all-cause mortality was reduced among women who had mammograms during one- or two-year intervals. Conclusions In community settings, mammography use during a one- or two-year time interval was associated with a small-reduced risk of breast-cancer-specific and all-cause mortality among elderly breast cancer survivors.     

On-schedule mammography rescreening in the National Breast and Cervical Cancer Early Detection Program.

OBJECTIVE: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides free cancer screening to many low-income, underinsured women annually but does not routinely collect all data necessary for precise estimation of mammography rescreening rates among enrollees. MATERIALS AND METHODS: To determine the percentages rescreened and to identify factors that encourage on-schedule rescreening, telephone interview and medical record data were collected from 1685 enrollees in Maryland, New York, Ohio, and Texas at least 30 months after their 1997 index mammogram. RESULTS: Overall, 72.4% [95% confidence interval (95% CI) = 70.1-74.7] were rescreened within 18 months and 81.5% (95% CI = 79.6-83.5) within 30 months. At 30 months, the adjusted odds ratios (ORs) for rescreening were higher among Hispanics (OR = 1.95, 95% CI = 1.15-3.28), women with a history of breast cancer before the index mammogram (OR = 3.36, 95% CI = 1.07-10.53), and those who had used hormone replacement therapy before their index mammogram (OR =1.94, 95% CI = 1.30-2.91). The 30-month adjusted ORs were lower for women who reported poor health status (OR = 0.60, 95% CI = 0.42-0.85), did not have a usual source of care (OR = 0.61, 95% CI = 0.40-0.94), did not know if they could have another free mammogram (OR = 0.28, 95% CI = 0.14-0.51), described their index screen as their first mammogram ever (OR for no prior mammograms versus three or more = 0.40, 95% CI = 0.27-0.60), did not recall receiving a rescreening reminder (OR = 0.35, 95% CI = 0.25-0.48), or did not think they had been encouraged to rescreen by their provider (OR = 0.61, 95% CI = 0.44-0.86). DISCUSSION: Rescreening behavior in this sample of NBCCEDP enrollees was comparable with that observed in other populations. To facilitate routine rescreening among low-income women, ongoing efforts are needed to ensure that they receive annual reminders and encouragements from their medical providers and that they know how to obtain the services they need.     

Are there racial/ethnic disparities among women younger than 40 undergoing mammography?

While the probability of a woman developing invasive breast cancer at age <40 is low (<1%), mammography use reported among younger women (age <40) is substantial, and varies by race/ethnicity. Little detail is known about mammography use among women aged <40, particularly by race/ethnicity. We describe racial/ethnic differences in: (1) mammography indication after considering underlying risk factors (breast symptoms and family history); (2) follow-up recommendations, and (3) mammography outcomes for first mammograms in women aged <40. These 1996–2005 Breast Cancer Surveillance Consortium data are prospectively pooled from seven U.S. mammography registries. Our community-based sample included 99,615 women aged 18–39 who self-reported race/ethnicity and presented for a first mammogram (screening or diagnostic) with no history of breast cancer. Multivariable analyses controlled for registry site, age, family history of breast cancer, symptoms, and exam year. Overall, 73.6% of the women in our sample were seen for a screening mammogram. Following screening mammography, African American (AA) women were more likely than white women to be recommended for additional workup [relative risk (RR): 1.15 (95% CI: 1.07–1.23)]. Following diagnostic mammography, AA [RR: 1.30 (95% CI: 1.17–1.44)] and Asian [RR: 1.44 (95% CI: 1.26–1.64)] women were more likely to be recommended for biopsy, fine-needle aspiration, or surgical consultation. Depending on race/ethnicity, and considering the rate of true positive to total first screening mammograms of younger women, a women has a likelihood of a true positive of 1 in 363–1,122; she has a likelihood of a false positive of 1 in 7–10. This study of community-based practice found racial/ethnic variability in mammography indication, recommendations, and outcomes among women undergoing first mammography before 40. These findings highlight important areas for future research to understand the motivating factors for these practice patterns and the implications of early mammography use.     

Variation in false-positive rates of mammography reading among 1067 radiologists: a population-based assessment

Background The accuracy of mammography reading varies among radiologists. We conducted a population-based assessment on radiologist variation in false- positive rates of screening mammography and its associated radiologist characteristics.Methods About 27,394 screening mammograms interpreted by 1067 radiologists were identified from a 5% non-cancer sample of Medicare claims during 1998–1999. The data were linked to the American Medical Association Masterfile to obtain radiologist characteristics. Multilevel logistic regression models were used to examine the radiologist variation in false-positive rates of screening mammography and the associated radiologist characteristics.Results Radiologists varied substantially in the false-positive rates of screening mammography (ranging from 1.5 to 24.1%, adjusting for patient characteristics). A longer time period since graduation is associated with lower false-positive rates (odds ratio [OR] for every 10 years increase: 0.87, 95% Confidence Interval [CI], 0.81–0.94) and female radiologists had higher false-positive rates than male radiologists (OR = 1.25, 95% CI, 1.05–1.49), adjusting for patient and other radiologist characteristics. The unmeasured factors contributed to about 90% of the between-radiologist variance.Conclusions Radiologists varied greatly in accuracy of mammography reading. Female and more recently trained radiologists had higher false-positive rates. The variation among radiologists was largely due to unmeasured factors, especially unmeasured radiologist factors. If our results are confirmed in further studies, they suggest that system-level interventions would be required to reduce variation in mammography interpretation.     

Health Literacy and Breast Cancer Screening among Mexican American Women in South Texas

Breast cancer is the main cause of cancer deaths for Hispanic women. This study analyzes the role of functional health literacy on mammography screening behavior and adherence of Hispanic women. Survey data from 722 Mexican American women age 40 and over residing in the Lower Rio Grande Valley of Texas in 2008 were used to estimate logistic regression models to assess the role of functional health literacy on mammography screening behavior and adherence. About 51% of survey respondents had a functional health literacy level deemed as inadequate or marginally functional. After adjusting for other factors, women with adequate health literacy levels were more likely to report to have ever had a mammogram (odds ratio [OR] = 2.92; 95% confidence interval [CI] = 1.62–5.28), to have had a mammogram within the last 2 years (OR = 1.70; 95% CI = 1.14–2.53) or to have had one within the last year (OR = 2.30; 95% CI = 1.54–3.43), compared to women with inadequate or marginally adequate functional health literacy levels. Inadequate/marginal functional health literacy is strongly associated with lower mammography screening. Large improvements in breast cancer control in this population may come from either basic advances in health literacy or by tailored approaches to help women with low literacy navigate local health care systems.     

Which women aren’t getting mammograms and why? (United States)

Objective This study investigates why women who reported no recent mammogram did not get the test. Methods Using data from the 2000 National Health Interview Survey (NHIS), we examine correlates of mammography use among women 40 years and older (n = 10,212), with particular focus on the 30% (n = 3,188) who reported no recent mammogram. Non-screening is examined in the context of two important correlates of mammography use—access to health care and a physician’s recommendation to get a mammogram. Results In total, 80% of non-screeners who reported having access to healthcare did not receive a recommendation for a mammogram. Women age 65 years and older were more likely than younger women to report not receiving a recommendation (OR 1.77, 95% CI 1.25–2.50). For women who reported having access, non-screening was significantly more likely among younger women (40–49), those with less education, incomes less than $20,000, residence outside Metropolitan Statistical Areas (MSAs) and no family history of breast cancer. Among women with access problems, those who had not visited a primary care provider in the past year were much more likely to be non-screeners (80%) compared with those who had seen a provider (46%). Among women with access, those who reported put it off as the main reason for non-screening were significantly more likely to be younger and to be born in the U.S. than women who said that they didn’t know they needed a mammogram. Conclusions Most non-screeners report not receiving a physician recommendation for mammography. Although a minority reported access problems, the effect of lacking access on utilization was strong and is accentuated when women without access do not see a doctor. These findings confirm the importance of a mammography recommendation and raise questions concerning whether this information is being conveyed by physicians or heard by patients. Funding: Dr. Vernon’s work was supported by a National Cancer Institute grant R01 CA76330 and R01CA97263     

BARD1 and breast cancer in Poland

Purpose To investigate whether or not a genetic variant in BARD1 (Cys557Ser) contributes to early-onset breast cancer in Poland, or modifies the risk of breast cancer in women with an inherited predisposition to breast cancer. Experimental design We studied 3,188 unselected Polish women with breast cancer and 1,038 healthy controls. All women were genotyped for the BARD1 Cys557Ser variant and for known founder mutations in BRCA1 (three mutations), CHEK2 (four mutations), and NBS1 (one mutation). Results A BARD1 variant was seen in 150 of 3,188 breast cancer cases (4.7%) and in 40 of 1,038 controls (3.8%) (OR = 1.2; 95% CI = 0.9–1.7). The risk associated with the BARD1 variant was not significantly greater in women with familial cancer (OR = 1.5; 95% CI = 0.8–2.7), or with an inherited mutation in BRCA1 (OR = 0.9; 95% CI = 0.4–2.2), CHEK2 (OR = 1.0; 95% CI = 0.5–2.1), or NBS1 (OR = 1.3; 95% CI = 0.2–10.2). Modest associations were observed among the subgroups of women with very early onset breast cancer (OR = 2.9; 95% CI = 1.2–7.1) and with medullary breast cancer (OR = 1.8; 95% CI = 0.9–3.7). Conclusion There was no clear association between the presence of the BARD1 Cys557Ser allele and breast cancer in Poland. Furthermore, the BARD1 Cys557Ser allele does not appear to modify the risk of breast cancers among carriers of BRCA1 mutations, or of other predisposing mutations. The allele may predispose to breast cancers of certain histologic subtypes, but further studies are needed to confirm these findings.     

A strong association between body fat mass and protein profiles in nipple aspirate fluid of healthy premenopausal non-lactating women

Fluid can be aspirated from the nipples of most non-lactating women. This nipple aspirate fluid (NAF) is a potential source for the discovery of new breast cancer biomarkers. NAF has two distinct protein profiles. Type I NAF is similar to the fluid associated with cystic disease of the breast, whereas type II NAF is enriched in milk-associated proteins. The prevalence of these two profiles differs in healthy women and in breast cancer patients. This study investigated the relationship of these two NAF profiles to reproductive history, body composition, diet, and levels of lipids, steroids and thyroid hormones in healthy premenopausal women (age 30–40 years) who had regular menstrual cycles and normal mammograms and were not taking contraceptive medications. On average, women with the type I NAF profile were older, had more years since last childbirth, were less likely to have breastfed their babies and had higher dietary saturated fat intake, body mass index, body fat mass, and levels of plasma low density lipoproteins than women with the type II profile (P <0.05). Using multiple logistic regression, type I NAF was predicted independently (P <0.05) by higher body fat mass [Odds Ratio (OR) = 3.0; 95% Confidence Interval (CI): 1.5–6.1], more years since last childbirth (OR = 2.6; 95% CI: 1.3–5.2) and a higher percentage of calories from saturated fat (OR = 4.1; 95% CI: 1.1–14.6). These results suggest that protein profiles of NAF might be influenced by amounts or types of dietary and body fat, but further study of the relationship of the two profiles to breast cancer risk is needed. Grant support: U.S. Army MRMC under DAMD17-01-1-0417, NIH NCRR GCRC M01 RR00073, NIH R01 CA95545, U.S. Army MRMC under W81XWH-04-1-0345, NIH 2 P30 ES06676, 1 R24 CA88317, AICR grant 01B110, and USPHS CA65628.     

Evaluating organized breast cancer screening implementation: the prevention of late-stage disease?

The objective of our study was to evaluate organized breast cancer screening implementation by measuring the association between screening program enrollment and late-stage disease. Our setting was a health plan using mailed mammography reminders to women ages > or = 40. We conducted yearly cross-sectional summaries of mammography experience and late-stage (regional or distant Surveillance Epidemiology and End Results Reporting (SEER) stage) breast cancer occurrence for all of the health-plan women ages > or = 40 (1986-1998). We estimated the odds of late-stage breast cancer among health-plan and surrounding community women because it was too early to compare changes in mortality. We also estimated the odds of late-stage disease (1995-1998) associated with program enrollment and mammography screening among health-plan women. We found that mammography-within-two-years increased within the health plan from 25.9% to 51.2% among women ages 40-49 and from 32.9% to 74.7% among women ages> or = 50. Health-plan late-stage rates were lower than those in the surrounding community [ages 40-49: odds ratio (OR), 0.87; 95% confidence interval (CI), 0.77-0.99; ages 50-79: OR, 0.86; 95% CI, 0.80-0.92] and declined parallel to the community. Among health-plan cancer cases, women ages > or = 43 who were enrolled in the screening program and who had at least one program mammogram were less likely to have late-stage disease compared with the women not enrolled in the program (OR, 0.31; 95% CI, 0.16-0.61) but the odds of late-stage was also reduced among program-enrolled women not receiving program mammograms (OR, 0.45; 95% CI, 0.21-0.95). We concluded that enrollment in organized screening is associated with increased likelihood of mammography and reduced odds of late-stage breast cancer. Addressing the concerns of un-enrolled women and those without mammograms offers an opportunity for further late-stage disease reduction.     

'Weighing in' on screening mammography

Background Obesity is associated with increased post-menopausal breast cancer risk. Overweight and obese women also tend to have a poorer prognosis when diagnosed with breast cancer compared with their matched normal weight peers. In previous studies obesity was associated with decreased utilization of screening mammography. We present a study examining the association between Body Mass Index (BMI) and compliance with recommended mammographic screening using data from the 2004 Behavioral Risk Factor Surveillance Survey (BRFSS). Patients and methods We included 130,185 female participants, aged 40 and older, who were randomly selected to participate in the world largest telephone survey. After weighted analysis, this is representative of 56,226,220 non-institutionalized US women. The primary outcome was the proportion of women who underwent screening mammography within the last 2 years preceding the survey stratified by BMI. The mammography screening behavior of normal weight women (BMI 18.5–24.99) was compared with underweight (<18.5), overweight (25–29.99), and women with obesity class I (30–34.99), class II (35–39.99), and class III (≥40) using logistic regression analysis and weighted to provide estimates of women in the United States (US). Results Our sample included 1.91% underweight, 37.91% normal weight, 30.15% overweight and 14.36%, 5.44%, and 3.49% women with obesity classes’ I–III respectively. Approximately 7% of women age 40 and older had insufficient information to calculate their BMI. Adjusting for age, race, smoking status, general health perception, level of education, and income level, underweight women had lower odds of complying with regular screening mammography (OR 0.57; 95% CI, 0.48–0.68). Women with obesity class III (OR 0.97; 95% CI, 0.84–1.13) showed a trend towards underutilization of screening mammograms which was not clinically significant. In contrary, in overweight women a significantly higher association with appropriate mammography utilization was identified OR 1.08 (95% CI, 1.01–1.15). Although not statistically significant, women with class I and II obesity showed a trend towards a higher utilization 1.08 (95% CI, 0.99–1.18) and 1.10 (95% CI, 0.98–1.25) respectively, when compared to women at desired weight. Conclusion We present a weighted analysis of the BRFSS, evaluating the association of BMI and appropriate screening mammography among women 40 years and older. These results are generalizable to the US population of women in this age range. Underweight women had significantly lower odds of utilizing screening mammography appropriately when compared with women at desired weight. Results from previous studies reporting underutilization of screening mammography in high risk, obese, and overweighed women were not confirmed in this largest population based analysis performed to date.     

Stage of Breast Cancer Diagnosis Among Medically Underserved Women in California Receiving Mammography Through a State Screening Program

OBJECTIVE: This study describes breast cancer stage at diagnosis among California women receiving mammograms through a state-administered screening program in comparison to other California women. METHOD: Linked data from California-administered screening programs and the California Cancer Registry were used to identify participants diagnosed with breast cancer between 1994 and 2000. Logistic regression was used to compare the adjusted likelihood of late stage disease among program participants (categorized into four subgroups based on the timing and frequency of mammograms) to non-participants in California diagnosed during the same time period. RESULTS: Program participants were significantly more likely than non-participants to be diagnosed at late stage (adjusted OR 1.2; 95% CI 1.1, 1.3), with the highest risk occurring among those diagnosed 0-1 months after initial mammogram (adjusted OR 1.8; 95% CI 1.6, 2.1). The stage distribution among regularly screened participants was similar to non-participants (adjusted OR of late stage disease 0.9; 95% CI 0.7, 1.1). CONCLUSIONS: Although program participants were more likely to be diagnosed at late stage than non-participants, their stage distribution was distinctly different according to their pattern of mammography utilization. This likely reflects differential utilization of program diagnostic and screening services, which should be taken into account in program evaluation.     

Consumption of Alcoholic Beverages and Risk of Lung Cancer: Results from Two Case–control Studies in Montreal, Canada

Objective To investigate the association between consumption of alcoholic beverages and lung cancer risk. Methods Data were collected in two population-based case–control studies, conducted in Montreal (Study I – mid-1980s and Study II – mid-1990s). Study I included 699 cases and 507 controls, all males; Study II included 1094 cases and 1468 controls, males and females. In each study group (Study I men, Study II men and Study II women) odds ratios (OR) were estimated for the associations between beer, wine or spirits consumption and lung cancer, while carefully adjusting for smoking and other covariates. The reference category included abstainers and occasional drinkers. Results For Study I men, lung cancer risk increased with the average number of beers/week consumed (for 1–6 beers/week: OR=1.2, 95% confidence interval (CI): 0.9–1.7; for ≥7 beers/week: OR=1.5, 95% CI: 1.1–2.1). For Study II men, beer consumption appeared harmful only among subjects with low fruit and vegetable consumption. In Study II, wine consumers had low lung cancer risk, particularly those reporting 1–6 glasses/week (women: OR=0.3, 95% CI: 0.2–0.4; men: OR=0.6, 95% CI: 0.4–0.8). Conclusions Beer consumption increased lung cancer risk, particularly so among men who had relatively low fruit and vegetable consumption. Moderate wine drinkers had decreased lung cancer risk.     

Clinical and biomarker predictors of side effects from tamoxifen

Tamoxifen decreases breast cancer recurrence, mortality, and breast cancer risk in high-risk women. Despite these proven benefits, tamoxifen use is often limited due to side effects. We identified predictors of tamoxifen-induced side effects based on clinical variables and serum tamoxifen metabolite biomarkers in a cross-sectional study of patients taking tamoxifen. We enrolled 241 women and collected data on demographics, tamoxifen use and side effects, as well as potential clinical and serum predictors. We used logistic regression models and adjusted for age, body mass index, ethnicity, education, prior post-menopausal hormone therapy (HT), tamoxifen duration, and endoxifen levels to identify factors associated with side effects. Common tamoxifen attributed side effects were hot flashes (64%), vaginal dryness (35%), sleep problems (36%), weight gain (6%), and depression, irritability or mood swings (6%). In multi-variate models, tamoxifen duration, age, prior post-menopausal HT, and endoxifen levels all predicted side effects. Women who had been on tamoxifen for >12 months were less likely to report side effects (OR 0.15, 95% CI 0.04–0.58) or severe side effects (OR 0.05, 95% CI 0.005–0.58) compared to women on tamoxifen for <12 months. Compared to women younger than 50, women who were age 60–70 and older than 70 were less likely to report side effects (OR 0.22, 95% CI 0.03–1.35; OR 0.13, 95% CI 0.01–0.99; respectively). Women who previously took post-menopausal HT were more likely to report severe side effects. Women with higher endoxifen levels were more likely to report side effects (OR 1.67, 95% CI 1.01–2.77 per standard deviation increase in endoxifen). Clinicians should consider closely monitoring adherence in women taking tamoxifen, especially in younger women, and women who previously took HT. The association between endoxifen levels and side effects is consistent with the data that suggest that endoxifen is the most highly active metabolite of tamoxifen.     

Breast carcinoma screening and risk perception among women at increased risk for breast carcinoma: results from a national survey

BACKGROUND: The Gail model is validated to estimate breast carcinoma risk. The authors assessed the association of Gail risk scores with screening and cancer risk perception. METHODS: Using the 2000 National Health Interview Survey, the authors studied women ages 41-70 without a cancer history. Gail scores > or = 1.66% defined increased risk. The authors used logistic regression to assess associations between breast carcinoma risk and previous and recent (< or = 1 year) mammography and clinical breast examination (CBE). RESULTS: Of 6410 women, 15.7% had increased risk. High-risk women more frequently reported previous mammograms (94% vs. 85%; P < 0.0001), previous CBE (93% vs. 88%; P < 0.0001), recent mammograms (70% vs. 54%; P < 0.0001), recent CBE (71% vs. 61%; P < 0.0001), and high cancer risk perception (20% vs. 9%; P < 0.0001). However, 30% of high-risk women had not received a recent mammogram. After adjustment for sociodemographic factors, access to care factors, and cancer risk perception, high-risk women remained more likely to have received recent mammography (adjusted odds ratio [OR], 1.45, 95% confidence interval [95% CI], 1.19-1.77), recent CBE (OR, 1.32; 95% CI, 1.08-1.61]), and previous mammography than average-risk women. The authors observed an interaction between risk and age, with women ages 41-49 years more frequently reporting previous mammography (OR, 4.79; 95% CI, 1.55-4.81) than average-risk, same-age women. For women age > or = 50 years, the odds of previous mammography were similar regardless of risk. CONCLUSIONS: In a nationally representative sample, 15.7% of women had increased breast carcinoma risk using the Gail model. High-risk women perceived higher cancer risk and more often received screening. However, nearly one in three high-risk women did not receive recent screening and most of these women did not perceive increased risk.