Patient- and system-related diagnostic delay in breast cancer

Background: Breast cancer patients in developing countries usuallyseek treatment at a more advanced-stage of disease. This workwas aimed at evaluating the avoidable risk factors related todiagnostic delay of breast cancer (patient- and system-related)in Alexandria, Egypt. Methods: Data were collected from 565incidents, histologically confirmed cases of breast cancer,recruited from nine hospitals in Alexandria, reflecting differentpatterns of health care delivery during the period July 1997–June1998. Results: Patient-related delay (interval between firstsymptom and first medical consultation > three months) wasfound in 38.1%, while system-related delay (interval betweenfirst medical consultation and final diagnosis > four weeks)was found in 12.9% of cases. A significant association betweendelay in seeking medical advice and late stage at diagnosiswas detected; in fact, while 26.3% of women with less than threemonths delay were at stage III and IV, the corresponding proportionamong women with more than three months delay was 72.1% (²1=109.6,p<0.0001). Regarding patient-related delay, age >40 years,lower educational level and not conducting breast self examinationwere independent risk factors associated with diagnostic delay.As for the system-related factors, place of first visit (generalpractitioner), absence of a palpable lump and lack of healthinsurance were significant predictors for delay. Conclusion:The patient's role in diagnostic delay of breast cancer is veryimportant in Egypt. Also, Interactive training directed to generalpractitioners to rationalise their approach to cases with breastlumps should be promoted to reduce system-related delay.     

The cognitive structuring of patient delay in breast cancer

The reasons women give for delaying diagnosis of breast cancer symptoms are numerous and striking. Yet none prove reliable as indicators of those who will delay, and most women overcome all barriers to seek immediate diagnosis. This study looks more deeply into the reasoning of symptomatic women sustaining confidence in a decision to delay diagnosis of self-discovered breast symptoms. Using argument and heuristic analysis, we examined the structure and soundness of the reasoning in interviews with 28 women from the San Francisco Bay area monitoring breast symptoms. Fifteen women were sustaining decisions to delay seeking diagnosis. Their arguments' structure and soundness, and their dependence on heuristic strategies, were compared with those of women who did not delay. Prompt diagnosis-seekers used vivid stories of other women with breast cancer to explain their diagnosis seeking, and the others used similar stories to justify on-going decisions to delay. Diagnosis-seekers offered more arguments for doing so than for delay. Delayers offered fewer arguments for seeking diagnosis and many more for delay. Delayers abandoned sound and usually compelling arguments to seek diagnosis, relying instead on false information, poorly reasoned arguments, and self-created dominance structures around decisions to delay. Decisions to delay were resilient, yet required maintenance to sustain. Intervention studies aimed at decreasing patient delay should address the thinking process by questioning reliance on mistaken claims of control over possibly advancing cancer, satisficing (corner-cutting to arrive at a minimally adequate solution to achieve a goal) when scheduling diagnostic visits, simulating a benign diagnosis rather than the prevention of late-staged cancer, prioritizing fear control over protection of life. Interventions might also include challenging mistaken analogies and the too facile abandonment of sound arguments for seeking prompt diagnosis.     

Occupation and breast cancer risk in Polish women: a population-based case-control study

BACKGROUND: The etiology of breast cancer is not well understood and the role of occupational exposures in breast carcinogenesis is still uncertain. METHODS: The population-based case-control study included 2,386 incident breast cancer cases diagnosed in 2000-2003, and 2,502 controls. Lifetime occupational histories and information on other potential breast cancer risk factors were obtained through personal interviews. Conditional logistic regression analyses calculated odds ratios (ORs) associated with various occupations and industries after control for potential confounders. RESULTS: We found statistically significant excesses of breast cancer among engineers (OR=2.0; 95% CI: 1.0-3.8), economists (2.1; 1.1-3.8), sales occupations-retail (1.2; 1.0-1.5), and other sales occupations (1.2; 1.0-1.5). Industries showing significantly elevated risks included special trade contractors (2.2; 1.2-4.3), electronic and electric equipment manufacturers (1.7; 1.1-2.7); and public administration/general government n.e.c. (2.7; 1.3-5.7). Each of these findings was supported by a statistically significant positive trend for duration of employment (P<0.05). A decreased breast cancer risk was observed in janitors and cleaners (0.7; 0.5-0.8). CONCLUSIONS: In this study, we found few associations for breast cancer and occupations or industries. The suggestive findings for the electronic and electric equipment manufacturing industry and for the occupations with potential exposure to magnetic fields deserve further evaluation.     

警惕下肢动脉也会硬化

日常生活中，我们常听说心脏动脉硬化、脑动脉硬化，很少有人知道下肢动脉硬化性闭塞症这个名词。在人们的印象中，下肢那么粗的动脉血管怎么也会发生硬化阻塞呢？事实上，由于人们饮食结构的改变，脂类食品含量加大，加上一些家族遗传或代谢方面的一些因素，使得人们印象中较为粗大的动脉血管也不可避免地发生了硬化。当您下肢的动脉硬化了，可要小心了。否则它带来的麻烦可就大了。[编者按]     

Delayed presentation in breast cancer: a study in Iranian women

Background  

A cross sectional study was conducted in Tehran Iran to examine the extent of patient delay and associated factors in the presentation of breast cancer.     

Pilot study of an information aid for women with a family history of breast cancer

Objective

To develop and pilot study an information aid for women with a family history of breast cancer.

Design, setting and participants

The information aid, consisting of a booklet and audiotape, was developed by a multi-disciplinary team of health care professionals, breast cancer survivors and their relatives. Women with no personal history of breast cancer, on the waiting list for a familial breast cancer clinic at either of two centres, who could read English, were eligible for the pilot study which consisted of three sets of mailed questionnaires.

Main outcome measures

The baseline questionnaires included: demographic information: the Breast Cancer and Heredity Knowledge Scale (BCHK); psychological measures (the State-Trait Anxiety Inventory [STAI], Centre for Epidemiologic Studies Depression Scale [CES-D] and an item about breast cancer worry), and an item about breast cancer risk perception. Immediately after reviewing the information aid, participants completed a satisfaction survey, the risk perception and cancer worry items and a checklist about their personal family history. The third set of questionnaires, completed 2–4 weeks after reviewing the aid, was identical to the first. Patients then attended their scheduled clinic visit and an objective hereditary breast cancer risk assessment was made by the genetic counselling team.

Results and conclusions

Of 97 eligible women who were contacted, 67 completed all three sets of questionnaires. Overall, women were very satisfied with the aid and 96% would recommend it to other women. There was a highly significant improvement in their knowledge scores after they reviewed the aid. Anxiety and depression did not change and there was a decline in breast cancer worry. Risk perception did not change significantly. Ninety per cent of women completed their personal family history checklist accurately. Several important improvements have been made in the information aid and it will now be evaluated in the community.

     

吉西他滨联合顺铂治疗晚期乳腺癌疗效观察

目的 观察吉西他滨联合顺铂与长春瑞滨联合顺铂治疗晚期乳腺癌的临床疗效.方法 将符合病例入选标准的乳腺癌患者160例患者采用随机数字表法分为治疗组和对照组,每组80例.观察组予吉西他滨1 000 mg/m2,静脉滴注30 min,d1,8;顺铂25 mg/m2静脉滴注,d 3～5.对照组予长春瑞滨25 mg/m2,d1,8,溶于生理盐水100 ml中,快速静脉滴注,顺铂25 mg/m静脉滴注,d 3～5.2组均以治疗21 d为1个周期.观察2组患者的生活质量、临床疗效及不良反应.结果 CR观察组为37.50％,对照组为35.00％,2组相比差异无统计学意义(P＞0.05).总有效率观察组为60.00％,对照组为57.50％,2组相比较差异无统计学意义(P＞0.05).2组治疗后均出现了不同程度的中性粒细胞减少、贫血、恶心呕吐、脱发、发热、肝功能损害、肾功能损害,但总体而言Ⅱ-Ⅴ级发生率两组相比差异无统计学意义(P＞0.05).结论 吉西他滨联合顺铂与长春瑞滨联合顺铂治疗晚期乳腺癌的临床疗效相当,不良反应相当.     

''Nothing fit me'': nationwide consultations with young women with breast cancer

OBJECTIVE: There exists little research about the experience of breast cancer for young women in Canada. To address this gap, the Canadian Breast Cancer Network (CBCN) and the Ontario Breast Cancer Community Research Initiative undertook a research project to explore the information and support experiences, needs and recommendations of geographically diverse Canadian young women with breast cancer. SETTING AND PARTICIPANTS: We consulted with 65 young women in 10 focus groups held across Canada. All women had been diagnosed with breast cancer at, or before, 45 years of age. During the consultations the women were asked to discuss their information and support experiences and needs, as well as resource recommendations related to their diagnosis, treatment and survivorship. MAIN RESULTS: The overarching theme, 'Nothing Fit Me', revealed that accessed information, support and programmes/services did not 'fit' or match the women's age or life stage. When we asked for their recommendations the young women suggested that information and support match their age and life stage and that health-care providers create and implement several topical workshops concerning, for example, sexuality, lymphedema and reconstruction. CONCLUSION: The findings will be used by the CBCN as a general platform from which to conduct further research and/or action strategies. The CBCN will also implement the recommendations from this groundbreaking work as this network formulates a national strategy for young women with breast cancer.     

贝伐单抗联合多西他赛和卡培他滨二线治疗转移性三阴性乳腺癌的临床研究

目的：回顾性分析贝伐单抗联合多西他赛和卡培他滨二线治疗三阴性乳腺癌的临床疗效及安全性。方法：转移性三阴性乳腺癌女性患者均经病理证实,患者至少存在一个可行RECIST1.1评估的病灶,既往使用过蒽环类、紫杉醇或吉西他滨等一线化疗,其中接受过紫杉类治疗的间隔一年以上。贝伐单抗15mg/kg,多西他赛75mg/m2,卡培他滨1.5口服2次/d,1~14d,3周重复。每个患者至少接受两个周期的化疗,每个周期后评估毒副反应,每两个周期后评价疗效,按RECIST1.1标准分为完全缓解（RR）,部分缓解（（PR）,稳定（SD）和进展（PD）,其中疾病控制率（DCR）=RR＋PR＋SD。结果：20例三阴性乳腺癌患者入组,没有观察到RR的病例,PR为50%（n=10）,SD为25%（n=5）,PD 25%（n=5）,DCR为75%。主要的毒副反应是骨髓抑制,其中Ⅲ/Ⅳ级中粒细胞减少15例（75%）,粒细胞减少性发热2例（10%）;1级高血压2例,2级高血压1例（15%）;2级蛋白尿1例（5%）;1级口腔黏膜出血1例（5%）,没有观察到消化道穿孔、中枢神经系统出血等严重并发症。结论：贝伐单抗联合多西他赛和卡培他滨二线治疗转移性三阴性乳腺癌可获得较好疗效且毒副反应可耐受。     

A consultation with Canadian rural women with breast cancer

Objective Relatively little research has been carried out on the health and supportive care needs of rural women living with breast cancer. In this study, results from a Canadian focus group study are used to highlight issues of importance to rural women. Setting and participants A total of 276 rural women with breast cancer divided into 17 focus groups participated in the study conducted across Canada. A standardized protocol for discussion was employed. Issues of access to information, support and services were discussed, with women describing their experiences in trying to find appropriate programmes and services. Main results The major theme identified through analysis of qualitative data was ‘becoming aware of and/or gaining access to health care information, support and services.’ Other major themes included: (1) dealing with isolation; (2) having to travel; (3) feeling the financial burden and (4) coping with changing work. Conclusions Rural women with breast cancer have supportive care challenges related to their circumstances. A series of recommendations were generated through the consultation process which are contributing to the development of a national strategy focusing on the development and extension of programmes for rural women with breast cancer. Although the research on the project was not to specified standards, and suffered from less attention than community capacity building and advocacy, it proved to be of worth and revealed potential benefits from collaborations between researchers and community organizations.     

Prone breast forward intensity-modulated radiotherapy for Asian women with early left breast cancer: factors for cardiac sparing and clinical outcomes

Since December 2009, after breast-conserving surgery for Stage 0–I cancer of the left breast, 21 women with relatively pendulous breasts underwent computed tomography prone and supine simulations. The adjuvant radiotherapy was 50 Gy in 25 fractions to the left breast alone. Four plans—conventional wedged tangents and forward intensity-modulated radiotherapy (fIMRT) in supine and prone positions—were generated. fIMRT generated better homogeneity in both positions. Prone position centralized the breast tissue by gravity and also shortened the breast width which led to better conformity in both planning techniques. Prone fIMRT significantly reduced doses to left lung, Level I and Level II axilla. The mean cardiac doses did not differ between positions. Among the four plans, prone fIMRT produced the best target dosimetry and normal organ sparing. In subgroup analysis, patients with absolute breast depth > 7 cm in the prone position or breast depth difference > 3 cm between positions had significant cardiac sparing with prone fIMRT. Sixteen patients with significant cardiac sparing in prone position were treated using prone fIMRT and the others using supine fIMRT. All patients received a supine electron tumor bed boost of 10 Gy in 5 fractions. No patients developed Grade 2 or worse acute or late toxicities. There was no difference in the number of segments or beams, monitor units, treatment time, or positioning reproducibility between prone and supine positions. At a median follow-up time of 26.8 months, no locoregional or distant recurrence or death was noted.     

国产重组人血管内皮抑素联合TCF方案治疗晚期胃癌的临床观察

目的观察国产抗肿瘤血管生成剂重组人血管内皮抑制素(恩度)与联合TCF方案治疗晚期胃癌的临床效果和安全性及生活质量评分。方法 2009年1月～2010年10月,64例晚期胃癌患者随机分为2组,各32例,治疗组应用Taxol+DDP+5-Fu方案化疗同时联合恩度15 mg/d,加入生理盐水500 ml内静滴,连用14 d为1疗程,对照组单用Tax-ol+DDP+5-Fu方案21 d为1个周期,连用2个周期后评价疗效,生活质量改变,不良反应,并记录中位疾病进展时间。结果治疗组和对照组的有效率分别为(62.5%)和(34.38%)(χ2=5.067,P﹤0.05)。治疗组生活质量明显提高(P﹤0.05)。中位疾病进展时间分别为7.2个月及4.1个月(P﹤0.05)。结论恩度联合TCF方案治疗晚期胃癌,能显著提高疗效,提高生活质量,延长中位疾病进展时间,且不增加治疗后不良反应的发生率,值得进一步积累病例和积极开展多中心临床协作研究。     

Duration of breast feeding and risk of developmental delay in Taiwanese children: a nationwide birth cohort study

The purpose of this study was to examine the relationship between duration of breast feeding and four developmental domains: gross motor, fine motor, language, and personal/social skills. This study included 14,621 infants from birth to 18 months of age. In the Taiwan Birth Cohort Study, four developmental screening items adapted from the Denver Development Screening Test were most appropriate for children aged 15 to 18 months. The proportion of young children who had mastered specific milestones increased consistently with longer duration of breast feeding. The adjusted odds ratios of the risk of developmental delay for the longest duration of breast feeding vs. never breast-fed were 0.69 [95% confidence interval (CI) 0.57, 0.83] for gross motor, 0.64 [95% CI 0.53, 0.77] for fine motor, 0.74 [95% CI 0.60, 0.91] for language, and 0.76 [95% CI 0.64, 0.90] for personal/social skills. Regardless of when the mothers returned to work, duration of breast feeding was found to have an inverse association with developmental delay in young children. The protection against developmental delays remained significant for those children who were breast-fed for more than 6 months. Children who were breast-fed for longer than 6 months had a lower risk of developmental delay than those who were never breast-fed. These data support the hypothesis that duration of breast feeding is positively related to young children's neurodevelopment.     

有机氯农药非职业暴露与乳腺癌患病风险的病例-对照研究

目的研究有机氯农药二氯二苯三氯乙烷(DDT)和六氯环乙烷(HCH)类雌激素污染物在非职业暴露人群的内暴露水平及与乳腺癌患病风险的关系。方法采用成组病例对照研究方法,调查90名乳腺癌新确诊患者和136名社区健康女性对照。采用问卷调查表收集病例及对照的乳腺癌相关危险因素信息。采用气相色谱-电子捕获(GC-ECD)方法检测血清中有机氯农药残留物水平。运用logistic回归模型分析8种有机氯农药残留物的血清水平与乳腺癌患病风险的相对危险度(OR)。结果病例和对照血清中均能检出p,p’-DDT、p,p’-DDE、o,p’-DDT、p,p’-DDD以及α、β、γ、δ-HCHs有机氯农药残留物,其中β-HCH、p,p’-DDE及p,p’-DDT的总检出率为91·2%、92·1%和91·2%;各物质检出水平在乳腺癌组和对照组间差异无显著性(P>0·05);控制了混杂因素后,p,p’-DDT、p,p’-DDD及δ-HCH暴露与总乳腺癌患病呈正相关(OR>2,P<0·05)。分层分析中绝经前女性的p,p’-DDT、p,p’-DDD、β-HCH血清水平与乳腺癌呈正相关,调整OR分别为3·59、5·70和3·06(P<0·05)。结论有机氯农药残留物(DDTs和HCHs)可能增加妇女,尤其在绝经前妇女患乳腺癌的风险。     

Use of CAM results in delay in seeking medical advice for breast cancer

Cancer patients in developing countries often delay seeking medical advice. It can adversely influence the clinicopathological behavior and outcome of the disease process. This study was undertaken to obtain information about initial perceptions of patients presenting with breast lump, subsequent efforts to seek medical advice, frequency and reasons for delay in seeking medical advice and its possible impact on clinicopathological characteristics. We prospectively gathered data from 138 recently diagnosed (3 months) breast cancer patients who had initially presented with a breast lump and were referred to the medical oncology service for further treatment. Delay in seeking medical advice was defined as time period of 1 month between initial perception of lump and first physician visit. The study was conducted at the National Cancer Institute, Karachi, Pakistan. Most (85%) patients discovered the lump accidentally. In other cases, lump was discovered by the family physician or by the patient as part of regular self-examination. Etiologic perceptions included malignancy (17%), benign growth (26%), milk clot (19%), trauma (23%) and infection (10%). On average, patients took 8.7 weeks to inform the family and 17.2 weeks to first physician visit. Fifty three percent delayed seeking medical advice. Common reasons were; antecedent use of complimentary/alternative therapies (34%), lack of significance attached to the lump (23%), fear of surgery (22%), conflicting personal commitments (7%), fear of cancer (5%), and others (8%). Twenty nine percent practiced CAM before visiting any physician. Common methods used were homeopathy (70%), spiritual therapy (15%) and Ayurvedic medicine (13%). CAM use was associated with delay in seeking medical advice (OR: 5.6; 95% CI: 2.3, 13.3) and presentation at an advanced stage of disease (OR: 2.2; 95% CI: 1.01, 4.6). Patients who delayed seeking medical advice more often had positive axillary nodes and stage III/IV disease. Breast cancer patients in Pakistan frequently (53%) delay seeking medical advice. Antecedent practice of CAM is widespread and a common underlying reason. The delay results in significant worsening of the disease process.     

Occupations and breast cancer risk among Chinese women in urban Shanghai

BACKGROUND: Although, an elevated risk of breast cancer has been suggested for a number of occupations, many earlier studies were limited by selection biases, the incomplete assessment of job histories, and the inability to control for confounding. METHODS: We examined the relationship between occupational history and breast cancer risk using data from a population-based case-control study of 1,458 cases and 1,556 age-matched controls (90% response rate) conducted in Shanghai, China. Unconditional logistic regression models were used to derive odds ratios (ORs) and 95% confidence intervals (95% CIs) of breast cancer risk associated with occupations and duration of employment adjusting for non-occupational risk factors. RESULTS: The following occupations were found to be associated with an increased risk of breast cancer: laboratory technicians (OR 9.94, 95% CI 1.20-82.37), telephone and telegraph operators (OR 4.63, 95% CI 1.85-11.59), leather and fur processors (OR 3.25, 95% CI 1.11-9.53), and glass-manufacturing workers (OR 2.08, 95% CI 1.14-3.82). A dose-response pattern for years of employment was observed for leather and fur processors (P = 0.02) and glass-manufacturing workers (P = 0.01). Stratified analyses also revealed dose-response relationships between the risk of breast cancer and years of employment as inspector and product analysts among pre-menopausal women (P = 0.02), and as farmers among post-menopausal women (P = 0.04). CONCLUSIONS: This study found that several occupations are associated with an increased risk of breast cancer among women. Studies examining various occupational exposures in these high-risk occupations are warranted to identify carcinogens that may play a role in the increased breast cancer risk.     

Occupation and breast cancer risk among Shanghai women in a population-based cohort study

INTRODUCTION: A total of 74,942 female subjects were recruited in a population-based cohort study in Shanghai, China between 1997 and 2000. We examined the relationship between occupation and breast cancer risk. METHODS: Cases were 586 women previously diagnosed with breast cancer at baseline and 438 women newly diagnosed with breast cancer during follow-up through December 2004. Eight controls were randomly selected for each case from cancer-free cohort members and frequency-matched to the cases by year of birth and age at diagnosis. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of breast cancer risk associated with occupations, adjusting for established breast cancer risk factors. RESULTS: In the prevalent breast cancer data analysis, increased risks of breast cancer were associated with technicians in engineering/agriculture/forestry (OR = 1.6, CI: 1.0-2.4), teaching personnel (OR = 1.5, CI:1.1-2.0), tailoring/sewing workers (OR = 1.6, CI:1.0-2.7), and examiners/measurers/testers (OR = 1.5, CI:1.1-2.1) among those who started the jobs at least 20 years ago. Among incident breast cancer cases, significantly increased risks were associated with medical/health care workers (OR = 1.4, CI:1.0-2.0), administrative clerical workers (OR = 1.5, CI:1.0-2.4), postal/telecommunication workers (OR = 2.2, CI:1.0-5.5), and odd-job workers (OR = 1.7, CI:1.1-2.8) among those who started the jobs at least 20 years ago. The excess risks were found in both prevalent and incident cases for postal/telecommunication workers and purchasing/marketing personnel, although ORs reached only marginal significance. CONCLUSIONS: This study suggests that white-collar professionals and several production occupations may be associated with an increased risk of breast cancer.