Adherence to adjuvant hormonal therapy among breast cancer survivors in clinical practice: a systematic review

Adjuvant hormonal therapy significantly improves long-term survival of breast cancer patients with hormone receptor-positive disease. Despite the proven clinical efficacy of tamoxifen and aromatase inhibitors, many breast cancer survivors either fail to take the correct dosage at the prescribed frequency (adherence) or discontinue therapy (persistence). This systematic review aims to: (1) determine the prevalence of adherence and persistence to adjuvant hormonal therapy among breast cancer survivors in clinical practice, and (2) identify correlates of adherence and persistence. We searched Medline, PubMed, PsycINFO, and CINAHL for studies that measured rates and/or correlates of adherence and/or persistence to adjuvant hormonal therapy. Studies were reviewed in a multi-step process: (1) the lead author screened titles and abstracts of all potentially eligible studies; (2) each coauthor reviewed a random 5 % sample of abstracts; and (3) two sets of coauthors each reviewed half of all "maybe" abstracts. Any disagreements were discussed until consensus was reached. Twenty-nine studies met inclusion criteria. Prevalence of adherence ranged from 41 to 72 % and discontinuation (i.e., nonpersistence) ranged from 31 to 73 %, measured at the end of 5 years of treatment. Extremes of age (older or younger), increasing out-of-pocket costs, follow-up care with a general practitioner (vs. oncologist), higher CYP2D6 activity, switching from one form of therapy to another, and treatment side effects were negatively associated with adherence and/or persistence. Taking more medications at baseline, referral to an oncologist, and earlier year at diagnosis were positively associated with adherence and/or persistence. Adherence and persistence to adjuvant hormonal therapy among breast cancer survivors is suboptimal. Many of the correlates of adherence and persistence studied to date are not modifiable. Our review reveals a critical need for further research on modifiable factors associated with adherence to adjuvant hormonal therapy, and the development of behavioral interventions to improve adherence in this population.     

Pap testing adherence among Vietnamese American women.

OBJECTIVES: Vietnamese American women are five times more likely to be diagnosed with cervical cancer than their White counterparts. Previous research has demonstrated low levels of Papanicolaou (Pap) testing among Vietnamese. Our study objective was to examine factors associated with interval Pap testing adherence. METHODS: A population-based, in-person survey of Vietnamese women aged 18-64 years was conducted. Questionnaire content was guided by the Health Behavior Framework (HBF). The study sample was randomly selected from 1639 south Seattle households. Statistical methods included chi(2) tests and logistic regression. RESULTS: The response rate among eligible households was 82%, and the study included 352 women. Sixty-eight percent of the participants had been screened during the preceding 3 years. The following HBF factors were associated (P < 0.05) with interval Pap testing in bivariate comparisons: believing Pap tests decrease the risk of cervical cancer and believing cervical cancer is curable if detected early (perceived effectiveness); knowing testing is necessary for women who are asymptomatic, sexually inactive, or postmenopausal (knowledge); reporting concern about pain/discomfort as a barrier to screening (barriers); family member(s) and friend(s) had suggested testing (social support); doctor(s) had recommended testing; and had asked doctor(s) for testing (communication with provider). In a multivariate analysis, being married, knowing Pap testing is necessary for asymptomatic women, doctor(s) had recommended testing, and had asked doctor(s) for testing were independently associated (P < 0.05) with screening participation. CONCLUSION: Our results confirm low levels of Pap testing among Vietnamese women and demonstrate the importance of physician-patient communication in increasing screening adherence. Health education efforts should target unmarried women and reinforce the importance of Pap testing for all Vietnamese women.     

Adherence to surveillance care guidelines after breast and colorectal cancer treatment with curative intent

BACKGROUND:

Evidence‐based guidelines recommend routine surveillance, including office visits and testing, to detect new and recurrent disease among survivors of breast and colorectal cancer. The extent to which surveillance practice is consistent with guideline recommendations or may vary by age is not known.

METHODS:

Cohorts of adult patients diagnosed with breast (n = 6205) and colorectal (n = 2297) cancer between 2000 and 2008 and treated with curative intent in 4 geographically diverse managed care environments were identified via tumor registries. Kaplan‐Meier estimates were used to describe time to initial and subsequent receipt of surveillance services. Cox proportional hazards models evaluated the relation between patient characteristics and receipt of metastatic screening.

RESULTS:

Within 18 months of treatment, 87.2% of breast cancer survivors received recommended mammograms, with significantly higher rates noted for patients aged 50 years to 65 years. Among survivors of colorectal cancer, only 55.0% received recommended colon examinations, with significantly lower rates for those aged ≥ 75 years. The majority of breast (64.7%) and colorectal (73.3%) cancer survivors received nonrecommended metastatic disease testing. In patients with breast cancer, factors associated with metastatic disease testing include white race (hazards ratio [HR], 1.13), comorbidities (HR, 1.17), and younger age (HR, 1.13; 1.15; 1.13 for age groups: <50, 50–64, and 65–74 respectively). In those with colorectal cancer, these factors included younger age (HR, 1.31; 1.25 for age groups: <50 and 50–64 respectively) and comorbidities (HR, 1.10).

CONCLUSIONS:

Among an insured population, wide variation regarding the use of surveillance care was found by age and relative to guideline recommendations. Breast cancer survivors were found to have high rates of both guideline‐recommended recurrence testing and non–guideline‐recommended metastatic testing. Only approximately 50% of colorectal cancer survivors received recommended tests but greater than 67% received metastatic testing. Cancer 2012. © 2012 American Cancer Society.     

Association between adherence to National Comprehensive Cancer Network treatment guidelines and improved survival in patients with colon cancer

BACKGROUND:

The objective of the current study was to examine the impact of adherence to guidelines on stage‐specific survival outcomes in patients with stage III and high‐risk stage II colon cancer. The National Comprehensive Cancer Network (NCCN) has established working, expert consensus, and evidence‐based guidelines for organ‐specific cancer care, including care of patients with colon cancer.

METHODS:

Patients who were diagnosed with colon adenocarcinoma between 1998 and 2002 were selected from within the National Cancer Data Base. The cohort was limited to patients who received their first course of treatment at the reporting facility. Pathologic variables, including tumor depth, lymph node status, and evidence of metastatic disease, were used to restage patients, and the patients were divided into low‐risk and high‐risk categories on the basis of criteria defined by the NCCN. Relative survival rates were calculated for the entire cohort, stratified according to adherence versus nonadherence to NCCN treatment guidelines.

RESULTS:

In univariate analysis of treatment adherence patterns for both patient subgroups (high‐risk stage II and stage III), several factors were associated with a higher rate of nonadherence in both groups, including older age (P < .001); Medicaid, Medicare, or uninsured status versus private insurance (P < .001); and subsequent treatment at a facility other than the facility at which the cancer was first diagnosed (P < .001). In multivariate analysis, multiple factors were associated with differences in relative survival, although analyses that included the year of diagnosis did not demonstrate significant differences over time.

CONCLUSIONS:

The current study documented practice patterns in a heterogeneous population of patients with colon cancer and demonstrated a survival benefit for patients with stage III and high‐risk stage II colon cancer who received treatment that adhered to NCCN guidelines. These data validate the current NCCN practice guidelines for colon cancer and support the concept of guideline‐based metrics that can be compared across institutions to assess the quality of cancer care and to compare the quality of cancer care among institutions. Cancer 2013. © 2012 American Cancer Society.     

Dysplasia severity, but not experiences during colposcopy, predicts adherence to follow-up colposcopy

Objective: Patient adherence with treatment recommendations is an essential factor for the effectiveness of cervical cancer screening programs. Psychological factors may play a role in patient adherence to cervical cancer screening. The present study aimed to extend knowledge of women's adherence to follow‐up colposcopy, by examining possible predictive biopsychosocial variables measured at colposcopy and objective attendance rates from patients' medical files. Methods: Baseline data on psychosocial factors (e.g. demographic variables, state anxiety, and pain) were collected from 141 women prior to undergoing colposcopy for the first time (M age = 29.63, SD = 8.39). Experiences of colposcopy and adherence to follow‐up (within two years) were assessed subsequently. Results: There were no associations between adherence and demographic variables. Women with severe dysplasia were more likely to adhere to follow‐up colposcopy than women with other histology grades. Women who did not attend for follow‐up reported significantly greater state anxiety and pain unpleasantness following colposcopy than women who did attend. A multivariate logistic regression analysis revealed that the psychological experiences of colposcopy did not predict adherence status. However, dysplasia severity made a significant contribution to the model. The odds of adhering to colposcopy for patients with severe dysplasia were 3.57 times higher than for patients with normal histology, and 4.35 times higher than for patients with moderate dysplasia (p = 0.005). Conclusions: Colposcopy‐related experiences do not appear to be strong predictors of adherence, but women with dysplasia grades other than ‘severe’ should be targeted for follow‐up recommendations and advice. Copyright © 2010 John Wiley & Sons, Ltd.     

Influence of Income on Cancer Incidence and Death among Patients in Aomori,Japan

Background: Aomori Prefecture has experienced the highest cancer-related mortality rates since the 2000s in Japan.In addition, income of residents in Aomori Prefecture is lower than that of a countrywide average. Aims of this studywere to examine the relationships of the incidence and mortality rates of common cancers (stomach, colorectal, liver,lung, breast, cervical, and prostate) with the income levels of residential income area and clarify the factors contributingto the high mortality rates in Aomori prefecture.Methods: We included data on all patients diagnosed with stomach,colorectal, liver, lung, breast, cervical, or prostate cancer in the Aomori cancer registry database between 2010 and2012. Age-standardized incidence rates and incidence rate ratios were calculated. Risk of cancer mortality related toeconomic disparities was determined via multivariable Cox regression analysis and adjusted for age, sex, and stage atdiagnosis in the multivariable model. Results: We identified 21,240 eligible cancer patients. There were no differencesin AIRs and IRRs among patients with stomach, colorectal, or lung cancer according to income. Contrarily, AIRs andIRRs were higher in higher-income areas than in lower-income areas among patients with breast, cervical, or prostatecancer. There were no significant differences in HRs according to income for any cancer type. Conclusions:Patientswith higher income were diagnosed with early-stage disease more frequently, and they had higher AIRs for breast,cervical, and prostate cancers than those with middle and low incomes. However, there were no significant differencesin hazard ratios.     

Aetiology of Cancer in Asia

Cancer has become the leading cause of death in many Asian countries. There is an increasing trend inbreast, prostate and colon cancers, which are considered as typical of economically developed countries. Althoughbreast and prostate cancer rates are still lower than in western countries, they are particularly rapidly increasing.In this paper, we review recently published literature to identify important etiologic factors affecting the cancerrisk in Asian populations. Infectious agents such as Helicobacter pylori, hepatitis B and C viruses, , and humanpapillomavirus were shown to be associated with elevated risks of stomach, liver and cervical cancer, respectively.Tobacco smoking was shown to be significantly associated with higher lung cancer risk and moderately increasedall cancer risk. Excessive alcohol drinking appeared to increase the risk of colorectal cancer in Japanese andbreast cancer in the Korean population. Betel nut chewing was associated with higher risk of oral and esophagealcancer. In terms of diet, various studies have demonstrated that high caloric and fat intake was associated withbreast cancer risk, salted food intake with stomach cancer, aflatoxin B1 with liver cancer, and low fruits andvegetables intake with breast and lung cancer. Environmental exposure to indoor and outdoor air pollution,arsenic, radon, asbestos and second hand smoke was shown to increase the lung cancer risk. Reproductivefactors such as late age at first childbirth, early menarche, late menopause, oral contraceptive intake, and shortduration of lifetime lactation were shown to be associated with breast and/or colorectal cancer. Cancer hasclearly become an emerging health threat in Asia and cancer control programs should be actively implementedand evaluated in this region. Various strategies for cancer control have been developed in some Asian countries,including the set-up of national cancer registries, cancer screening programs, education programs for healthbehavior change, eradication of Helicobacter pylori and vaccination for hepatitis B and C viruses, and humanpapilloma virus high risk forms. However, more attention should also be paid to low- and medium-resourceAsian countries where cancer incidence rates are high, but neither intensive research on cancer for planningeffective cancer control programs, nor easy implementation of such programs are available, due to limitedfinancial resources.     

Changes in chronic medication adherence in older adults with cancer versus matched cancer-free cohorts

ObjectivesA cancer diagnosis can influence medication adherence for chronic conditions by shifting care priorities or reinforcing disease prevention. This study describes changes in adherence to medications for treating three common chronic conditions – diabetes, hyperlipidemia, and hypertension – among older adults newly diagnosed with non-metastatic breast, colorectal, lung, or prostate cancer.MethodsWe identified Medicare beneficiaries aged ≥66 years newly diagnosed with cancer and using medication for at least one chronic condition, and similar cohorts of matched individuals without cancer. To assess medication adherence, proportion of days covered (PDC) was measured in six-month windows starting six-months before through 24 months following cancer diagnosis or matched index date. Generalized estimating equations were used to estimate difference-in-differences (DID) comparing changes in PDCs across cohorts using the pre-diagnosis window as the referent. Analyses were run separately for each cancer type-chronic condition combination.ResultsAcross cancer types and non-cancer cohorts, adherence was highest for anti-hypertensives (90–92%) and lowest for statins (77–79%). In older adults with colorectal and lung cancer, adherence to anti-diabetics and statins declined post-diagnosis compared with the matched non-cancer cohorts, with estimates ranging from a DID of ?2 to ?4%. In older adults with breast and prostate cancer cohorts, changes in adherence for all medications were similar to non-cancer cohorts.ConclusionOur findings highlight variation in medication adherence by cancer type and chronic condition. As many older adults with early stage cancer eventually die from non-cancer causes, it is imperative that cancer survivorship interventions emphasize medication adherence for other chronic conditions.     

Cancer incidence, mortality, and associated risk factors among Asian Americans of Chinese, Filipino, Vietnamese, Korean, and Japanese ethnicities

Many studies demonstrate that cancer incidence and mortality patterns among Asian Americans are heterogeneous, but national statistics on cancer for Asian ethnic groups are not routinely available. This article summarizes data on cancer incidence, mortality, risk factors, and screening for 5 of the largest Asian American ethnic groups in California. California has the largest Asian American population of any state and makes special efforts to collect health information for ethnic minority populations. We restricted our analysis to the 4 most common cancers (prostate, breast, lung, colon/rectum) and for the 3 sites known to be more common in Asian Americans (stomach, liver, cervix). Cancer incidence and mortality were summarized for 5 Asian American ethnic groups in California in order of population size (Chinese, Filipino, Vietnamese, Korean, and Japanese). Chinese Americans had among the lowest incidence and death rate from all cancer combined; however, Chinese women had the highest lung cancer death rate. Filipinos had the highest incidence and death rate from prostate cancer and the highest death rate from female breast cancer. Vietnamese had among the highest incidence and death rates from liver, lung, and cervical cancer. Korean men and women had by far the highest incidence and mortality rates from stomach cancer. Japanese experienced the highest incidence and death rates from colorectal cancer and among the highest death rates from breast and prostate cancer. Variations in cancer risk factors were also observed and were for the most part consistent with variations in cancer incidence and mortality. Differences in cancer burden among Asian American ethnic groups should be considered in the clinical setting and in cancer control planning.     

胸苷磷酸化酶在癌组织中表达的研究

目的　研究胸苷磷酸化酶 (TP)在不同种类癌组织中的表达 ,探讨TP与癌组织血管生成的关系。方法　采用免疫组织化学方法检测 2 5 1例癌组织和相对应的 92例正常组织TP和微血管密度 (MVD)的表达。癌组织包括 :胃癌 4 8例 ,大肠癌 5 3例 ,乳腺癌 4 7例 ,宫颈癌 5 6例 ,肺癌 4 7例 ;正常组织包括 :胃 2 5例 ,大肠 2 5例 ,宫颈 17例 ,肺 2 5例。分析癌组织和正常组织TP表达差异 ,及癌组织TP表达与癌组织MVD的关系。结果　胃癌、大肠癌、乳腺癌、宫颈癌和肺癌的TP表达阳性率分别为6 4 .6 %、6 7.9%、80 .9%、82 .1%和 6 3.8%。癌组织的TP表达阳性率显著高于正常组织 (P =0 .0 0 0 0 )。癌组织TP表达与胃癌、大肠癌、乳腺癌、宫颈癌的MVD值关系密切 (P <0 .0 0 1)。结论　TP在胃癌、大肠癌、乳腺癌、宫颈癌和肺癌组织中过度表达 ,并对胃癌、大肠癌、乳腺癌和宫颈癌的血管生成有明显促进作用。     

The isolation of colon cancer organ specific neoantigen by the use of the leukocyte adherence inhibition assay and monoclonal antibodies

The LAI reactivity of a colon organ specific neoantigen (OSN) was recovered from the urine of advanced colon cancer patients. In this study three physico-chemical steps were employed; precipitation by 80% ammonium sulfate, ion exchange, and molecular sieve chromatography. Each isolate was tested for activity and specificity by the direct tube leukocyte adherence inhibition (LAI) assay employing leukocytes from colon and breast cancer patients. The OSN enriched isolate was then used to generate monoclonal antibodies (Mab). Hybridomas were screened by ELISA. One hybridoma designated Bac 18.1 reacted preferentially with colon OSN and not with the urine from normals or patients with breast cancer. Affinity purification of colon OSN was achieved and it was shown to consist of a single band in SDS-PAGE with an apparent molecular weight of 30,000. The eluted polypeptide was specifically reactive in ELISA as well as in the LAI assay.     

Adherence to cancer prevention guidelines and risk of breast cancer

Healthy eating patterns and keeping physically active are potentially more important for chronic disease prevention than intake or exclusion of specific food items or nutrients. To this end, many health organizations routinely publish dietary and lifestyle recommendations aimed at preventing chronic disease. Using data from the Canadian National Breast Screening Study, we investigated the association between breast cancer risk and adherence to two sets of guidelines specific for cancer prevention, namely the American Cancer Society (ACS) Guidelines and the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Recommendations. At baseline, 49,613 women completed dietary and lifestyle questionnaires and height and weight measurements were taken. During a mean follow‐up of 16.6 years, 2,503 incident cases of breast cancer were ascertained. Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association of meeting each guideline, and number of guidelines met, with breast cancer risk. The two sets of guidelines yielded similar results. Specifically, adherence to all six ACS guidelines was associated with a 31% reduction in breast cancer risk when compared to subjects adhering to at most one guideline (HR = 0.69; 95% CI = 0.49–0.97); similarly, adherence to six or seven of the WCRF/AICR guidelines was also associated with a 31% reduction in breast cancer risk (HR = 0.69; 95% CI = 0.47–1.00). Under either classification, meeting each additional guideline was associated with a 4–6% reduction in breast cancer risk. These results suggest that adherence to cancer prevention guidelines is associated with a reduced risk of breast cancer.     

Health Information Seeking and Cancer Screening Adherence Rates

Effective screening tools are available for many of the top cancer killers in the USA. Searching for health information has previously been found to be associated with adhering to cancer screening guidelines, but Internet information seeking has not been examined separately. The current study examines the relationship between health and cancer Internet information seeking and adherence to cancer screening guidelines for breast, cervical, and colorectal cancer in a large nationally representative dataset. The current study was conducted using data from the Health Information National Trends Survey from 2003 and 2007. The study examined age-stratified models which correlated health and cancer information seeking with getting breast, cervical, and colorectal cancer screening on schedule, while controlling for several key variables. Internet health and cancer information seeking was positively associated with getting Pap screening on schedule, while information seeking from any sources was positively associated with getting colorectal screening on schedule. People who look for health or cancer information are more likely to get screened on schedule. Some groups of people, however, do not exhibit this relationship and, thus, may be more vulnerable to under-screening. These groups may benefit more from targeted interventions that attempt to engage people in their health care more actively.     

Cancer risk in women: a possible connection with geographic and certain economic and social factors

The paper deals with mulivariate regression analysis of effects of latitude, economic environment and electricity consumption on breast cancer morbidity in 35 countries (1985-2007). Our data are compared with the influence of the same factors on incidence rates for ovarian carcinoma, endometrial and cervical cancer as well as those of the stomach, liver, colon and lung. It was found that rates of morbidity for breast, endometrial, colonic and lung cancer tend to increase north of the equator while cervical, gastric and hepatic cancer incidence is relatively higher in circumequatorial populations. In 1985, geographic factors made a dramatic contribution to hormone-dependent tumors incidence while economic ones--to that of gastrointestinal neoplasms. In the 2000-ies, climate-related risks of hormone-dependent tumors have gradually slumped down while those of economic and social factors have increased.     

Lesbians and cancer: an overlooked health disparity

Objective  To evaluate the breast, cervical, ovarian, lung, and colorectal cancer literatures using a novel application of the cancer disparities grid to identify disparities along domains of the cancer continuum focusing on lesbians as a minority population. Methods  Computerized databases were searched for articles published from 1981 to present. Cumulative search results identified 51 articles related to lesbians and disparities, which were classified by domain. Results  The majority of articles identified were related to breast and cervical cancer screening. Barriers to adequate screening for both cancers include personal factors, poor patient-provider communication, and health care system factors. Tailored risk counseling has been successful in increasing lesbian’s mammography and Pap screening. Ovarian, lung, and colorectal cancer have been virtually unexplored in this population. An “Adjustment to Illness/Quality of Life” domain was added to capture literature on psychosocial aspects of cancer. Conclusions  This review revealed a lack of research for specific cancers and for specific aspects of the cancer continuum. The limited number of studies identified focused on issues related to screening/prevention in cervical and breast cancers, with almost no attention to incidence, etiology, diagnosis, treatment, survival, morbidity, or mortality. We present implications for social and public health policy, research, and prevention.     

Colon and rectum cancer in Thailand: an overview

Cancers of the colon and rectum are rare in developing countries,in contrast to the high incidence rates in countries of Europe,North America, Australia and Japan. Significant differencesalso exist within continents. Colorectal cancer mortality andincidence rates have decreased in the USA. However, the incidencein Japan and Thailand is rising, probably due to the acquisitionof Western lifestyle. Incidence also increases with age: carcinomasare rare before the age of 40 years except in individuals withgenetic predisposition or predisposing conditions. The incidencerate of colorectal cancer in Thailand is low when compared withother countries. It is the third in frequency in males afterliver and bile duct and lung cancers, and the fifth after cancersof the cervix, breast, liver and bile duct and lung for females.The highest incidence for both sexes is seen in Bangkok. Thenumber of cases of colorectal cancer in both sexes is increasingand will probably exceed that of lung cancer in the next decade.Thus, we are planning to have colorectal cancer screening programme.We should pay more attention on primary and secondary preventionto control colorectal cancer in Asian countries.     

Surgical under-treatment of older adult patients with cancer: A systematic review and meta-analysis

Background: Older patients with cancer often have lower surgery rates and survival than younger patients, but this may reflect surgical contraindications of advanced disease, comorbidities, and frailty – and not necessarily under-treatment.Objectives: This review aims to describe variations in surgery rates and observed or net survival among younger (<75) and older (≥75) patients with breast, lung and colorectal cancer, while taking account of pre-existing health factors, in order to understand how under-treatment is defined and estimated in the literature.Method: MEDLINE, EMBASE, Web of Science and PubMed databases were searched for studies reporting surgery rates and observed or net survival among younger and older patients with breast, lung, and colorectal cancer. Study quality was assessed using the Newcastle Ottawa Scale, and random effects meta-analyses were used to combine study results. The I-squared statistic and subgroup analyses were used to assess heterogeneity.Results: Thirty relatively high-quality studies of patients with breast (230,200; 71.9%), lung (77,573; 24.2%), and colorectal (12,407; 3.9%) cancers were identified. Compared to younger patients, older patients were less likely to receive surgical treatment for 1) breast cancer after adjusting for comorbidity, performance status (PS), functional status and patient choice, 2) lung cancer after accounting for stage, comorbidity, PS, and 3) colorectal cancer after adjusting for stage, comorbidity, and gender. The pooled unadjusted analyses showed lower surgery receipt in older patients with breast (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.13—0.78), lung (OR 0.54, 95% CI 0.39—0.75), and colorectal (OR 0.59, 95% CI 0.51—0.68) cancer. In separate analyses, older patients with breast, lung and colorectal cancer had lower observed and net survival, compared to younger patients.Conclusions: Lower surgery rates in older patients may contribute to their poorer survival compared to younger patients. Future research quantifying under-treatment should include necessary clinical factors, patient choice, patient’s quality of life and a statistically-robust approach, which will demonstrate how much of the survival deficit in older patients is due to their receiving lower surgery rates.     

A Review of the Epidemiology of Breast Cancer in Asia: Focus on Risk Factors

Background and Aim: Breast cancer is the most prevalent cancer in women. To date, regional differences in breast cancer risk factors have not been identified. The aim of our review was to gain a better understanding of the role of risk factors in women with breast cancer in Asia. Methods: We conducted a PubMed search on 15 March 2016, for journal articles published in English between 2011 and 2016, which reported data for human subjects in Asia with a diagnosis of breast cancer. Search terms included breast neoplasm, epidemiology, Asia, prevalence, incidence, risk and cost of illness. Studies of any design were included, except for review articles and meta-analyses, which were excluded to avoid duplication of data. No exclusions were made based on breast cancer treatment. We reported the results using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Results: A total of 776 abstracts were retrieved. After screening against the eligibility criteria, 562 abstracts were excluded. The remaining 214 abstracts, which were published between 2013 and 2015, were included in this review. Results were summarized and reported under three categories: incidence, prevalence or outcomes for breast cancer in Asia; modifiable risk factors; and non-modifiable risk factors. We found that the increased risk of breast cancer among participants from Asia was associated with older age, family history of breast cancer, early menarche, late menopause, high body mass index, being obese or overweight, exposure to tobacco smoke, and high dietary intake of fats or fatty foods. In contrast, intake of dietary fruits, vegetables, and plant- and soy-based products was associated with a decreased breast cancer risk. While based on limited data, when compared to women from the United States, women from Asia had a decreased risk of breast cancer. Conclusions: This review of 214 abstracts of studies in Asia, published between 2013 and 2015, confirmed the relevance of known non-modifiable and modifiable risk factors for women with breast cancer.     

A comparison of international breast cancer guidelines - do the national guidelines differ in treatment recommendations?

Aim of the study

Clinical practice guidelines (CPG) are an appropriate method to optimise routine clinical care. Numerous CPGs for the diagnosis and treatment of breast cancer have been developed by national health institutions or medical societies. While a comparison of methodological criteria has been undertaken before, it is unknown whether these CPGs differ in their actual treatment recommendations.

Methods

We included national breast cancer CPGs from the USA, Canada, Australia, the UK, and Germany that satisfy internationally recognised methodological criteria and are in widespread use in daily clinical care. Treatment recommendations for adjuvant invasive breast cancer including surgery, radiation, endocrine therapy, chemotherapy and anti-HER2-therapy were compared.

Results

Recommendations for endocrine therapy show discordances regarding optimal usage of ovarian function suppression for premenopausal patients and aromatase inhibitors for postmenopausal patients. However, most other treatment recommendations exhibit a large degree of congruency. This reflects the fact that they rest on the same evidence base, and that many national guidelines are adopted from other guidelines so that well accepted guidelines are cited within other guidelines.

Concluding statement

Considering that the development of guidelines is a very expensive and resource-intensive task the question arises whether the development of national guidelines in numerous countries is worth the effort since the recommendations differ only marginally.