Disparities across the breast cancer continuum

Objective: We performed a structured review of the literature to identify areas of greater and lesser knowledge of the nature of disparities across the breast cancer continuum from risk and prevention to treatment and mortality.Methods: We searched OvidMedline and PubMed to identify published studies from January 1990 to March 2004 that address disparities in breast cancer. We read the abstracts of the identified articles and then reviewed the articles if they were in English, were limited to American populations, limited to women, and described quantitative outcomes. We designated the articles as addressing one or more disparities across one or more of the domains of the breast cancer continuum.Results: Substantial research exists on racial disparities in breast cancer screening, diagnosis, treatment, and survival. Disparities in screening and treatment exist across other domains of disparities including age, insurance status, and socioeconomic position. Several gaps were identified including how factors interact.Conclusion: A structured review of breast cancer disparities suggests that research in other domains of social inequality and levels of the cancer continuum may uncover further disparities. A multidisciplinary and multi-pronged approach is needed to translate the knowledge from existing research into interventions to reduce or eliminate disparities.     

个性化健康教育联合心理干预对乳腺癌化疗患者心理健康状况和生活质量的影响

目的 探讨个性化健康教育联合心理干预对乳腺癌化疗患者心理健康状况和生活质量的影响.方法 根据干预方法的不同将194例乳腺癌化疗患者分为对照组和观察组,每组97例,对照组患者给予常规健康教育联合心理干预,观察组患者给予个性化健康教育联合心理干预.两组患者均随访3个月,分别采用抑郁自评量表(SDS)、状态-特质焦虑问卷(S...     

Sexual health issues in Sudanese women before and during hormonal treatment for breast cancer

Objective: Recent Sudanese studies have focused on depression and anxiety in women treated for breast cancer (BrCa). Less is known about whether such women suffer from sexual disturbances due to different cancer treatments. This study compares BrCa patients with a healthy control group and assessed the impact of cancer treatment types. Methods: The BrCa group included women treated for BrCa with mastectomies, chemotherapy and radiotherapy (N=100). Some received hormonal therapy (N=60) and others had not yet received it (N=40). The control group comprised women who had never had BrCa, non‐BrCa (N=100). Outcomes were assessed using the Watts Sexual Function Questionnaire. Results: It was found that many women treated for BrCa suffered from sexual disturbances before hormonal treatment while some regained sexual activity during hormonal treatment. Demographic data show negative correlation (P=0.03) between sexual function and age of the patients, positive correlation (P=0.002) between sexual function and educational level and positive correlation (P=0.031) as well between sexual function and the patient's length of marriage. Conclusion: This study helps to fill the gap in the literature about Sudanese women's sexuality, as many studies indicate the effect of some psychological disturbance (depression and anxiety) and ignoring the effect of sexual function in enhancing patient's quality of life. Copyright © 2008 John Wiley & Sons, Ltd.     

Risk factors for a decline in upper body function following treatment for early stage breast cancer

Purpose: To identify risk factors for a decline in upper body function following treatment for early stage breast cancer.Methods: We conducted a cross-sectional observational study of 213 women 55 years of age newly diagnosed with early stage breast cancer interviewed three to five months following their definitive surgery. Patients were classified as having impaired upper body function related to their breast cancer treatment if: 1) they reported having no difficulty in performing any of three tasks requiring upper body function (pushing or pulling large object; lifting objects weighing more than 10 pounds; and reaching or extending arms above shoulder level) prior to treatment, but reported that any of these tasks were somewhat or very difficult in the four weeks prior to interview, or 2) they reported that performing any of the three tasks requiring upper body function was somewhat difficult prior to treatment, but reported that any of these tasks were very difficult in the four weeks prior to interview.Results: In multiple logistic regression models, both the extent and type of primary tumor therapy and cardiopulmonary comorbidity were significantly associated with a decline in upper body function following breast cancer treatment.Conclusion: Given the critical importance of upper body function in maintaining independent living, clinicians should consider the functional consequences of treatment when they discuss treatment options and post-operative care with older women who have early stage breast cancer.     

Breast cancer awareness among older women

The aim of this study was to elicit the level of breast cancer awareness in older women. A cross-sectional study-specific questionnaire survey of 712 British women aged 67-73 years (response rate 83.8%), assessing knowledge of symptoms and risk and confidence to detect a change, was conducted. Over 85% of respondents were aware that a lump was a symptom of breast cancer but knowledge of non-lump symptoms was limited. Knowledge of risk was poor; 50% believed that the lifetime risk of developing breast cancer was less than 1 in 100 women and 75% were not aware that age is a risk factor. Thirty-one percent of women reported low levels of confidence to detect a breast change and 19% rarely or never checked their breasts. Those with fewer educational qualifications had poorer knowledge of symptoms, less awareness of lifetime and age-related risks, but were more likely to check their breasts than more highly educated women. This national survey demonstrates a significant lack of the prerequisite knowledge and confidence to detect a breast change. Raising breast cancer awareness and promoting early presentation among older women is important, as they are more at risk of breast cancer and more likely to delay seeking help with breast cancer symptoms than younger women.     

Consumer health information: the role of breast cancer associations

Background. Providing information for patients is currently a growth need for health professionals, medical journals, and consumer associations. Despite several patients or consumers associations being active in Italy, scarce evidence is available on the volume and type of activities carried out. A national survey was carried out to investigate the volume and the nature of phone requests for information addressed to associations belonging to the Italian Forum of EUROPA DONNA, an European movement active in 28 countries, working to raise public awareness of breast cancer. Methods. A structured questionnaire was sent to all EUROPA DONNA breast cancer associations to be filled in by the persons in charge for delivering the telephone information. Results. Of the 87 breast cancer associations contacted, 41 (47%) participated to the survey, completing a total of 2383 questionnaires for 4251 kinds of information. Most of the people who called were women and about 57% were breast cancer patients. A wide range of information were required: 29% on prevention, 22% on practical problems of daily life, 23% on services actually offered by breast cancer associations, 10% on psychological counselling, and finally 14% for advice on primary therapy and follow-up. In more than one-third of phone calls, people were looking for opinion from women who personally experienced a breast cancer. Conclusion. This survey shows that breast cancer associations receive daily requests of information and convey a wide range of information. The findings underline the need to create meaningful partnership between health professionals and patient's associations in the complex field of information and communication.     

Evaluation of extension of breast screening to women aged 65�C70 in England using screening performance measures

The objective of this study was to investigate screening performance measures in the English screening units that began inviting women aged 65–70 between 1 April 2001 and 1 April 2004. We analysed results after each unit commenced inviting women aged 65–70. In addition, we analysed data from units that invited this age group for a second time between 1 April 2004 and 31 March 2007. Results for women aged 65–70 were compared to women aged 50–64 and 60–64. Average uptake was 72.8% for women aged 65–70 and 76.7% for women aged 50–64. For women screened within the last 5 years, uptake was 88.7% for older women and 89.1% for younger women. For women previously screened within 5 years the invasive cancer detection rate was 17% higher in the 65–70 age group than in the 60–64 age group. The rates of recall to assessment and PPV were 3.5 and 27.6% in women aged 65–70 and 3.4 and 24.6% in women aged 50–64 respectively. These results suggest that, as in the earlier demonstration studies, uptake rates remain high in older women, and many more older women attend following an invitation than had previously self-referred. The cancer detection rate is higher in this older age group, whereas rates of recall are generally similar to those in younger women; consequently the PPV is also higher in older women.     

家属同步健康教育对乳腺癌患者术后自我效能和功能锻炼依从性的影响

目的 探讨家属同步健康教育对乳腺癌患者术后自我效能和功能锻炼依从性的影响.方法 选取120例行乳腺癌根治术的患者,采用随机数字表法分为同步组和非同步组各60例,两组患者术后均给予功能锻炼指导及健康教育,同步组同时对患者家属给予健康教育.随访3个月后,比较两组患者的锻炼依从性、自我效能(GSES)、肩关节功能评分.结果 出院3个月后,同步组患者的锻炼依从率(93.33%)高于非同步组(78.33%),差异有统计学意义(P﹤0.05);同步组患者的GSES评分明显高于非同步组,差异有统计学意义(P﹤0.001);同步组患者的肩关节功能(疼痛程度、日常生活活动能力、主动活动范围、肌力)评分均明显高于非同步组,差异有统计学意义(P﹤0.001).结论 家属同步健康教育对乳腺癌患者术后自我效能和功能锻炼依从性具有积极的促进作用.     

Biology of primary breast cancer in older women treated by surgery: with correlation with long-term clinical outcome and comparison with their younger counterparts

Background:

As age advances breast cancer appears to change its biological characteristics, however, very limited data are available to define the precise differences between older and younger patients.

Methods:

Over 36 years (1973–2009), 1758 older (⩾70 years) women with early operable primary breast cancer were managed in a dedicated clinic. In all, 813 underwent primary surgery and 575 good quality tumour samples were available for biological analysis. The pattern of biomarkers was analysed using indirect immunohistochemistry on tissue microarrays. Comparison was made with a previously characterised series of younger (<70 years) patients.

Results:

There was high expression of oestrogen receptor (ER), PgR, Bcl2, Muc1, BRCA1 and 2, E-cadherin, luminal cytokeratins, HER3, HER4, MDM2 and 4 and low expression of human epidermal growth factor receptor (HER)-2, Ki67, p53, EGFR and CK17. Oestrogen receptor and axillary stage appeared as independent prognostic factors. Unsupervised partitional clustering showed six biological clusters in older patients, five of which were common in the younger patients, whereas the low ER luminal cluster was distinct in the older series. The luminal phenotype showed better breast cancer-specific survival, whereas basal and HER2-overexpressing tumours were associated with poor outcome.

Conclusion:

Early operable primary breast cancer in older women appears as a distinct biological entity, with existence of a novel cluster. Overall older women showed less aggressive tumour biology and ER appeared as an independent prognostic factor alongside the time-dependent axillary stage. These biological characteristics may explain the differences in clinical outcome and should be considered in making therapeutic decisions.     

Poor physical health predicts time to additional breast cancer events and mortality in breast cancer survivors

Background: Health‐related quality of life has been hypothesized to predict time to additional breast cancer events and all‐cause mortality in breast cancer survivors. Methods: Women with early‐stage breast cancer (n=2967) completed the SF‐36 (mental and physical health‐related quality of life) and standardized psychosocial questionnaires to assess social support, optimism, hostility, and depression prior to randomization into a dietary trial. Cox regression was performed to assess whether these measures of quality of life and psychosocial functioning predicted time to additional breast cancer events and all‐cause mortality; hazard ratios were the measure of association. Results: There were 492 additional breast cancer events and 301 deaths occurred over a median 7.3 years (range: 0.01–10.8 years) of follow‐up. In multivariate models, poorer physical health was associated with both decreased time to additional breast cancer events and all‐cause mortality (p trend=0.005 and 0.004, respectively), while greater hostility predicted additional breast cancer events only (p trend=0.03). None of the other psychosocial variables predicted either outcome. The hazard ratios comparing persons with poor (bottom two quintiles) to better (top three quintiles) physical health were 1.42 (95% CI: 1.16, 1.75) for decreased time to additional breast cancer events and 1.37 (95% CI: 1.08, 1.74) for all‐cause mortality. Potentially modifiable factors associated with poor physical health included higher body mass index, lower physical activity, lower alcohol consumption, and more insomnia (p<0.05 for all). Conclusion: Interventions to improve physical health should be tested as a means to increase time to additional breast cancer events and mortality among breast cancer survivors. Copyright © 2010 John Wiley & Sons, Ltd.     

Routine breast screening for women aged 65-69: results from evaluation of the demonstration sites.

Routine programme data and specially designed surveys from 3 demonstration sites were analysed to determine the implications of extending the NHS Breast Screening Programme (NHSBSP), to include routine invitations for women up to 69 years. All women aged 65-69 and registered with GPs in these areas received routine invitations for breast screening along with those aged 50-64. Overall uptake was 71% in women aged 65-69 compared with 78% in younger women, but was > or = 90% in both groups who had previously attended within 5 years. Recall rates were lower for older women, but with a higher positive predictive value for cancer. The percentages of invasive cancer in different prognostic categories were similar in the 2 age groups. Older women took no longer to screen than younger women. The costs per woman invited or per woman screened were also similar to those for women aged 50-64, whilst the cost per cancer detected was some 34% lower in older women. Breast screening is as cost effective for women aged 65-69 as for those aged 50-64, with a higher cancer detection rate balancing shorter life expectancy. The proposed extension to the national programme will have considerable workforce implications for the NHSBSP and require additional resources.     

Spiritual health locus of control and life satisfaction among African American breast cancer survivors

Abstract

Purpose: To examine the relationships between spiritual health locus of control (SHLOC) and satisfaction with life in African American (AA) breast cancer survivors (BCS).

Methods: A total of 118 AABCS completed a mailed survey. Logistic regression models were used to examine relationships among variables of interest.

Results: Annual income and SHLOC were significantly associated with life satisfaction. In unadjusted analyses, high overall SHLOC increased the odds (odds ratio [OR]?=?2.8) of being satisfied with life. The adjusted relationships between SHLOC and life satisfaction differed by income level. Among survivors with lower incomes, high spiritual life/faith and God’s grace subscale scores increased the odds of life satisfaction, when compared to those with higher incomes.

Conclusions: Our data indicated that high overall SHLOC was significantly related to higher odds of life satisfaction. Further, SHLOC may serve as a resource to bolster life satisfaction, especially in low-income AA BCS.     

Healthy Sisters: A Feasibility study of a health behavior intervention for women of color breast cancer survivors

ABSTRACT

There is strong evidence for the need to educate and empower women of color breast cancer survivors (WCBCS) to adopt healthy lifestyle behaviors. The purpose of this study was to explore feasibility and preliminary efficacy of a culturally grounded lifestyle intervention on functional ability, quality of life, and health behaviors. A community-based sample of WCBCS was recruited from two inner cities, with encouragement to invite a partner. There were 30 WCBCS and 10 partners who participated in the 6-week interactive intervention. Data were collected at baseline, end of intervention and 3 and 6 months. There was significant improvement in healthy lifestyle behaviors (p = 0.041), physical activity (p = 0.003), nutrition (p = 0.007), and stress management (p = 0.010) for WCBCS and, for partners, improvements in healthy lifestyle behaviors (p = 0.041), nutrition (p = 0.007), and health responsibility (p = 0.034).