乳腺癌危险因素病例对照研究

为探索海宁地区女性乳腺癌的危险因素，对１９９０～１９９６年间确诊的女性乳腺癌存活病例及其正常人对照进行了１∶１配对的病例对照研究。结果显示：当地居民经常食用的羊肉、鸭肉是乳腺癌的危险因素，锌、锰摄入量及饮用河水、池塘水、溪沟水的年数病例组明显高于对照组，并存在明显的剂量－反应关系，而轻体力劳动和水果是保护因子。     

Screening Mammography and Late-Stage Breast Cancer: A Population-Based Study

BACKGROUND: Among 50- to 69-year-old women, randomized clinical trials show breast cancer mortality reductions from screening mammography. However, few studies examine the long-term health effects and outcomes from screening mammography in community practice. The purpose of this study was to evaluate one approach for determining the effectiveness of screening mammography, as it is practiced in community settings, and to measure the prevalence of prior screening mammography among women with incident breast cancer. METHODS: This study was a population-based survey of the general community. Participants were 406 women with breast cancer diagnosed in 1993. The main outcome measure was breast cancer, late stage at diagnosis or fatal within 2 to 3 years of diagnosis. RESULTS: Sixty-four (57.7%) of 111 women with late-stage and 123 (42.1%) of 292 women with early-stage breast cancer did not have a screening mammogram in the 4 calendar years (1989-1992) before diagnosis. Relative to women with early-stage breast cancer, mammography nonuse in 1989-1992 was significantly more frequent among women with late-stage breast cancer (age-adjusted odds ratio 2.3, 95% confidence interval 1.3-4.3). Prior mammography was particularly infrequent among 42 women with breast cancer incident in 1993 and fatal before January 1996. CONCLUSIONS: Prior mammography among women with late-stage or fatal breast cancer was relatively infrequent. Late-stage or fatal breast cancer lacking prior mammography constitutes a missed public health opportunity. Also, this population-based study showed the expected association between prior mammography and late-stage or fatal breast cancer. These results are consistent with the effective practice of mammography in a community setting. The results illustrate and validate a public health approach that uses prior mammography histories among women with incident breast cancer to evaluate mammography penetration and quality in defined communities.     

Breast Cancer Screening in Rural Populations: A Pilot Study

This report describes the development and implementation of a pilot intervention project designed to determine the economic, logistic, behavioral, and attitudinal variables that influence rural women's participation in a community-based breast cancer screening program. This paper reports on survey responses of women who registered for this pilot breast cancer screening program. It includes information on all women who registered for the project--both those who received breast cancer screening and those who did not. The study is a pilot intervention project, the overall goal of which was to develop a network of community providers, organizations, and volunteers to facilitate breast cancer screening among rural women. Of the 159 women registered for this pilot program, 101 (63.5%) were screened (receiving both a clinical breast examination and mammogram). The attitudes of women surveyed through the project confirm the importance of a physician recommendation for breast cancer screening. More than 90 percent of both the screened and unscreened groups of women stated that a doctor's recommendation to have breast cancer screening is important. Further, nearly 42 percent of the unscreened group had never had a physician recommend breast cancer screening. Despite existing barriers to screening, this pilot study demonstrated that health care professionals and regional organizations that have not traditionally been associated with delivering health care in this particular community setting can successfully work together to implement breast cancer screening programs.     

Physical Activity and Reduced Breast Cancer Risk: A Multinational Study

We evaluated the association between physical activity and breast cancer risk among 1,463 breast cancer cases and 4,862 controls in a multinational study. All subjects were asked how many times and for how long they exercised or engaged in strenuous physical labor per week. We used multivariate logistic regression to assess the association between physical activity and breast cancer risk. For all subjects combined, the multivariate-adjusted odds ratio was 50% lower (95% confidence interval = 0.4–0.6) for women who reported physical activity once per week or more after adjusting for age, race, body mass index, and pack years of smoking compared to those who reported physical activity less than once per week. Women who reported physical activity 3 times/wk or more did not gain any additional reduced risk. The amount of time spent in physical activity per session was also significantly associated with reduced risk. All ethnic groups examined including Caucasian-Americans, African-Americans, Hispanic-Americans, Tunisian-Arabs, and Polish-Caucasians were at 35% or greater reduced risk for breast cancer if they were physically active for more than 30 minutes per week. Our study shows that physical activity may reduce breast cancer risk regardless of race, weight category, or family history of breast cancer.     

Obesity/Weight Gain and Breast Cancer Risk: Findings From the Japan Collaborative Cohort Study for the Evaluation of Cancer Risk

Background

We analyzed data from the Japan Collaborative Cohort Study (36 164 women aged 40–79 years at baseline in 1988–1990 with no previous diagnosis of breast cancer and available information on weight and height) to examine the association between baseline body mass index (BMI)/weight gain from age 20 years and breast cancer risk in a non-Western population.

Methods

The participants were followed prospectively from enrollment until 1999–2003 (median follow-up: 12.3 years). During follow-up, breast cancer incidence was mainly confirmed through record linkage to population-based cancer registries. A Cox proportional hazards model was used to calculate hazard ratios (HRs) and 95% CIs for the association between breast cancer risk and body size.

Results

In 397 644.1 person-years of follow-up, we identified 234 breast cancer cases. Among postmenopausal women, the adjusted HR increased with BMI, with a significant linear trend (P < 0.0001). Risk was significantly increased among women with a BMI of 24 or higher (HR: 1.50, 95% CI: 1.09–2.08 for BMI of 24–28.9, and 2.13, 1.09–4.16 for BMI ≥ 29) as compared with women with a BMI of 20 to 23.9. Weight gain after age 20 years and consequent overweight/obesity were combined risk factors for postmenopausal breast cancer risk. This combined effect was stronger among women aged 60 years or older. However, the HRs were not significant in premenopausal women.

Conclusions

Our findings support the hypothesis that weight gain and consequent overweight/obesity are combined risk factors for breast cancer among postmenopausal women, particularly those aged 60 years or older.Key words: breast cancer, obesity, weight gain, cohort study     

Nutrient Pathways and Breast Cancer Risk: The Long Island Breast Cancer Study Project

The relative importance of biochemical pathways has not been previously examined when considering the influence of diet on breast cancer risk. To address this issue, we used interview data from a population-based sample of 1463 breast cancer cases and 1500 controls. Dietary intake was assessed shortly after diagnosis using a 101-item food frequency questionnaire. Age- and energy-adjusted odds ratios (ORs) for individual micro- and macronutrients were estimated with logistic regression. Hierarchical modeling was used to account for biologically plausible nutrient pathways (1-carbon metabolism, oxidative stress, glycemic control, and phytoestrogens). Effect estimates from hierarchical modeling were more precise and plausible compared to those from multivariable models. The strongest relationship observed was for the glycemic control pathway, but confidence intervals (CI) were wide [OR (95% CI): 0.86 (0.62, 1.21)]. Little or no effect was observed for the 1-carbon metabolism, oxidative stress, and phytoestrogen pathways. Associations were similar when stratified by supplement use. Our approach that emphasizes biochemical pathways, rather than individual nutrients, revealed that breast cancer risk may be more strongly associated with glycemic control factors than those from other pathways considered. Our study emphasizes the importance of accounting for multiple nutrient pathways when examining associations between dietary intake and breast cancer.     

146对女性乳腺癌病例对照研究

应用１∶１配比病例对照研究方法对１４６对女性乳腺癌患者及其对照的危险因素进行了研究。配对Ｌｏｇｉｓｔｉｃ回归分析结果表明：既往有乳腺良性肿瘤史及常吃香肠是乳腺癌发生的主要危险因素；而蔬菜摄入量多及经常服用维生素类药物可明显降低发生乳腺癌的危险。另外，单因素分析结果还提示：腊肉摄入量多和长期被动吸烟等因素亦可明显增加乳腺癌发病的危险；而累积哺乳时间长则对乳腺癌发病有保护作用，Ｌｏｇｉｓｔｉｃ回归分析亦有类似结果。     

Breastfeeding and Risk of Breast Cancer: Case-Control Study

The aim of this study was to investigate a possible association of breast cancer occurrence in women with their breastfeeding experience. A matched case-control study was conducted in Kragujevac, Serbia. A total of 382 women (191 cases with breast cancer and 191 controls) were interviewed, but the data were explored on breastfeeding and breast cancer only among parous women (339 women). Logistic regression was used to calculate odds ratios (ORs) as estimates of the relative risk of breast cancer. Compared with controls, significantly more cases ever breastfed [adjusted OR (OR_adj) = 2.90, 95 percent confidence interval (95 percent CI) 1.02–8.22], breastfed all their children (OR_adj = 2.93; 95 percent CI 1.03–8.29), and had longer lifetime duration of breastfeeding (OR_adj = 3.44, 95 percent CI 1.15–10.24 for 13 or more months). In comparison with controls, significantly more cases breastfed at first birth (OR_adj = 3.17, 95 percent CI 1.36–7.37). Breast cancer risk increased if first breastfeeding occurred at an older age (p for trend = .042) and with longer duration of breastfeeding (p for trend = .037). Our study is one of the few in which breastfeeding was found to be a risk factor for breast cancer.     

灰阶中位数分析用于乳腺癌超声筛查的初步研究

目的：评估灰阶中位数分析（gray-scale median,GSM）用于乳腺癌超声筛查的临床价值。方法：基于计算机辅助程序获得二维超声良性和恶性乳腺结节灰阶中位数,以乳腺结节病理检查结果为金标准,统计灰阶中位数分析用于筛查乳腺癌的敏感性、特异性、阳性预测值、阴性预测值、Youden指数和AUC曲线下面积。结果：乳腺良性结节GSM值（30.33±6.50）,乳腺恶性结节GSM值（20.11±4.70）,乳腺良恶性结节GSM差异具有统计学差异（P<0.05）,最佳临界值25.01相应的筛查乳腺癌的敏感性、特异性、阳性预测值、阴性预测值、Youden指数和AUC曲线下面积分别为78.5%、88.7%、73.6%、92.3%、0.675和0.899。结论：乳腺结节GSM值是一个客观的参数,可作为超声鉴别乳腺良恶性结节的重要参数。     

常用乳腺癌筛查方法诊断价值的应用评价

目的研究ROC曲线分析法评价乳腺临床检查、乳腺超声检查（US）、钼靶X线检查（MAM）及这3项检查综合分级在乳腺癌筛查中的诊断价值,为农村地区开展乳腺癌筛查选择适宜技术。方法采用问卷调查和乳腺临床检查,对乳腺癌高危人群采用乳腺超声和钼靶X线检查进行乳腺癌筛查,利用ROC曲线分析法评价临床检查、超声、钼靶X线检查及各项联合检查（综合检查）在乳腺癌筛查中的灵敏度和特异性。结果在23 910名接受乳腺癌筛查的农村妇女中,病理确诊乳腺癌31例,乳腺癌检出率为129.65/10万。乳腺综合检查的灵敏度、特异性及ROC曲线下面积分别为90.323、94.605和0.954;超声检查的灵敏度、特异性及ROC曲线下面积分别为70.968、90.288和0.814;钼靶X线检查的灵敏度、特异性及ROC曲线下面积分别为74.194、91.727和0.850;临床检查的灵敏度、特异性及ROC曲线下面积分别为41.935、82.734和0.676。其ROC曲线下面积（AUC）比较经Z检验,综合检查F分级评价诊断优于其他各项检查的准确性（P〈0.05）,超声与钼靶X线检查诊断准确性比较差异无统计学意义（P〉0.05）。结论乳腺超声和钼靶X线检查是乳腺癌筛查的有效方法,而综合检查分级评价方法能明显提高乳腺癌的诊断能力。     

Asian-Islamic Women and Breast Cancer Screening: A Socio-Cultural Analysis

ABSTRACT

This article explores religious and socio-cultural issues relevant to breast cancer screening practices among older immigrant Asian-Islamic women in the U.S. Some of the Islamic tenets that facilitate breast cancer screening include cleanliness, prevention and individual responsibility in health promotion, diet and eating habits, and exercise, and those that hinder screening practice include gender and modesty considerations and patriarchal marital beliefs. Socio-cultural barriers include patient-physician communication and beliefs about cancer and cancer prevention. Recommendations to increase knowledge and practice of breast cancer screening within a religious and socio-cultural context are provided.     

Breast Cancer Screening Among Korean Americans: A Systematic Review

Cancer is the leading cause of death for Korean Americans (KAs). Breast cancer (BC) is the most commonly occurring cancer among KA women, and its rate has been rapidly increasing. Low BC screening rates for KAs puts them at greater risk for late-stage breast cancer. We conducted a systematic review of the published literature on cancer screening among KAs, and identified 38 eligible studies. Despite significant increases in mammogram utilization over the past two decades, KAs have consistently lower rates of mammogram screening than other American populations. KA women also report lower rates of clinical breast examination and breast self-examination. Screening rates are higher among adults with higher socioeconomic status, greater acculturation to the United States, more cancer knowledge, higher perceived susceptibility to BC, more social support, and better access to health services. However, fear of finding something wrong, fear of embarrassment or lack of modesty, not knowing where to go for screening, believing that mammography is only necessary when symptoms are present, and perceived time and cost difficulties in accessing mammography were reported as barriers to mammogram screening. Coordinated efforts from clinicians, public health workers, KA cultural and religious organizations, and the broader breast cancer advocacy and awareness community are necessary for improving BC screening among KAs.     

北京市乳腺癌危险因素病例对照研究

目的：探索北京地区乳腺癌的主要危险因素。方法：采用１：１配对的病例对照研究方法，共押取３５０对样本，进行了多变量的筛检分析。结果：精神、心理因素和良性乳腺疾病史是生物效应较强的主要危险因素，而产后哺乳及常吃玉米为乳腺癌的保护因子。结论：此次研究结果与因内其它城市相关研究结果基本一致，但亦存在一定的地区性差异。     

福州市妇女乳腺癌危险因素的病例对照研究

「目的」探讨福州市妇性乳腺癌的危险因素。「方法」对近２年在福州市各大医院进行手术并经病理确诊为乳腺癌的１４５名患者开展１：１配对的病例对照研究。资料使用Ｅｐｉ－Ｉｎｆｏ软件和ＳＡＳ６．０４版软件进行统计分析。「结果」采因素分析,达到统计学显著性水平的危险因素有乳腺良性疾病史、ＢＭＩ指数高、初潮年龄早、肿瘤家庭史、初产年龄大、流产次数多、未产年龄大和行经时乳房涨痛。哺乳和饮用井水是保护因素。条件Ｌｏ     

煤矿区居民女性乳腺癌发病危险因素的研究

为研究煤矿区居民女性乳腺癌的发病危险因素，１９９１年至１９９４年间，在河南省平顶山矿区开展一次１：２配比的病例对照病因研究。对研究因素进行了单因素与多因素的统计分析。多元条件Ｌｏｇｉｓｔｉｃ回归分析表明该人群主要的发病危险因素为：乳腺良性疾病史、生育胎数少、月经紊乱及乳腺癌家族史。它们相应的调整人群归因危险度分别为０．１４８７、０．４７８１、０．１２８２、０．０７９１，四因素综合人群归因危险度为０．６９５２．