Alcohol consumption and mortality from all-cause and cancers among 1.34 million Koreans: the results from the Korea national health insurance corporation’s health examinee cohort in 2000

Background  

The relationship between alcohol and cancer death has not been well established in Asian population, particularly among women.     

Breast MRI increases the number of mastectomies for ductal cancers,but decreases them for lobular cancers

Purpose

Mammographic density is a measurable and modifiable biomarker that is strongly and independently associated with breast cancer risk. Paradoxically, although Asian women have lower risk of breast cancer, studies of minority Asian women in predominantly Caucasian populations have found that Asian women have higher percent density. In this cross-sectional study, we compared the distribution of mammographic density for a matched cohort of Asian women from Malaysia and Caucasian women from Sweden, and determined if variations in mammographic density could be attributed to population differences in breast cancer risk factors.

Methods

Volumetric mammographic density was compared for 1501 Malaysian and 4501 Swedish healthy women, matched on age and body mass index. We used multivariable log-linear regression to determine the risk factors associated with mammographic density and mediation analysis to identify factors that account for differences in mammographic density between the two cohorts.

Results

Compared to Caucasian women, percent density was 2.0% higher among Asian women (p < 0.001), and dense volume was 5.7 cm³ higher among pre-menopausal Asian women (p < 0.001). Dense volume was 3.0 cm³ lower among post-menopausal Asian women (p = 0.009) compared to post-menopausal Caucasian women, and this difference was attributed to population differences in height, weight, and parity (p < 0.001).

Conclusions

Our analysis suggests that among post-menopausal women, population differences in mammographic density and risk to breast cancer may be accounted for by height, weight, and parity. Given that pre-menopausal Asian and Caucasian women have similar population risk to breast cancer but different dense volume, development of more appropriate biomarkers of risk in pre-menopausal women is required.

     

Associations among family history of cancer, cancer screening and lifestyle behaviors: a population-based study

Purpose

Some cancers are largely preventable through modification of certain behavioral risk factors and preventive screening, even among those with a family history of cancer. This study examined the associations between (1) family cancer history and cancer screening, (2) family history and cancer preventive lifestyle behaviors, and (3) cancer screening and lifestyle behaviors.

Methods

Data were from the 2009 California Health Interview Survey (n = 12,603). Outcomes included screening for breast cancer (BC) and colorectal cancer (CRC) and six cancer preventive lifestyle behaviors, based on World Cancer Research Fund recommendations. Multivariate logistic regression analyses, stratified by gender and race–ethnicity, examined associations. Predicted probabilities of cancer screening by family cancer history, race–ethnicity, and sex were computed.

Results

Family history of site-specific cancer—CRC for men and women, and BC for women—was associated with higher probability of cancer screening for most groups, especially for CRC, but was largely unrelated to other lifestyle behaviors. In the few cases in which family history was significantly associated with lifestyle—for example, physical activity among White and Latino males, smoking among White and Asian females—individuals with a family history had lower odds of adherence to recommendations than those with no family history. Greater overall adherence to lifestyle recommendations was associated with higher odds of up-to-date CRC screening among White and Asian males, and lower odds among Asian females (no significant association with BC screening); this relationship did not vary by family cancer history.

Conclusion

The fact that family history of cancer is not associated with better lifestyle behaviors may reflect shared behavioral risks within families, or the lack of knowledge about how certain lifestyle behaviors impact personal cancer risk. Findings can inform interventions aimed at lifestyle behavioral modification for individuals at increased cancer risk due to family history.     

Breast and cervical cancer screening among Asian subgroups in the USA: estimates from the National Health Interview Survey, 2008, 2010, and 2013

Purpose

This study describes variations in mammography and Pap test use across and within subgroups of Asian women in the USA.

Methods

Using data from the National Health Interview Survey (2008, 2010, and 2013), we calculated weighted proportions for selected Asian subgroups (Asian Indian, Chinese, Filipino, Other Asian) of women reporting mammography and Pap test use.

Results

The proportion of women aged 50–74 years who reported a mammogram within the past 2 years did not differ significantly across Asian subgroups. The proportion of women aged 21–65 years who received a Pap test within the past 3 years differed significantly across Asian subgroups, with lower proportions among Asian Indian, Chinese, and Other Asian women. Recent immigrants, those without a usual source of care, and women with public or no health insurance had lower proportions of breast and cervical cancer screening test use.

Conclusions

Patterns of mammography and Pap test use vary among subgroups of Asian women, by length of residency in the USA, insurance status, usual source of care, and type of cancer screening test. These findings highlight certain Asian subgroups continue to face significant barriers to cancer screening test use.

     

Explaining disparities in colorectal cancer screening among five Asian ethnic groups: A population-based study in California

Background  

Data from the California Health Interview Survey (CHIS) indicate that levels and temporal trends in colorectal cancer (CRC) screening prevalence vary among Asian American groups; however, the reasons for these differences have not been fully investigated.     

Self-reported history of Pap-smear in HIV-positive women in Northern Italy: a cross-sectional study

Background  

The incidence of invasive cervical cancer in HIV-positive women is higher than in the general population. There is evidence that HIV-positive women do not participate sufficiently in cervical cancer screening in Italy, where cervical cancer is more than 10-fold higher in women with AIDS than in the general population. The aim of the present study was to evaluate the history of Pap-smear in HIV-positive women in Italy in recent years. We also examined the sociodemographic, clinical, and organizational factors associated with adherence to cervical cancer screening.     

Factors associated with use of breast cancer screening services by women aged ≥ 40 years in Korea: The Third Korea National Health and Nutrition Examination Survey 2005 (KNHANES III)

Background  

Despite evidence that breast cancer screening reduces morbidity and mortality, until recently most women have not undergone regular mammogram examinations in Korea. We aimed to identify factors associated with use of breast cancer screening services.     

Quality of life among Latina breast cancer patients: a systematic review of the literature

Introduction  

The Latino population is the most rapidly growing ethnic minority in the United States and Latinas have higher rates of advanced breast cancer and more rigorous treatments than White women. However, the literature lacks reviews on quality of life among this population of breast cancer patients.     

Papillary thyroid cancer incidence rates vary significantly by birthplace in Asian American women

Objective  

To investigate how birthplace influences the incidence of papillary thyroid cancer among Asian American women.     

Comparative analysis of clinicopathologic features, treatment, and survival of Asian women with a breast cancer diagnosis residing in the United States

BACKGROUND:

It has been established that disparities by ethnicity in the rates of breast cancer diagnoses and disease‐specific survival (DSS) exist in the United States. However, few studies have assessed differences specifically between Asians and other ethnic groups or among Asian subgroups.

METHODS:

The authors used the Surveillance, Epidemiology, and End Results database to identify patients who were diagnosed with invasive breast cancer between 1988 and 2008. Clinicopathologic features, treatment, and DSS rates were compared among broad ethnic groups and among Asian subgroups.

RESULTS:

In total, there were 658,691 patients in the study, including 511,701 non‐Hispanic white (NHW) women (77.7%), 57,890 black women (8.8%), 45,461 Hispanic white (HW) women (6.9%), and 43,639 Asian women (6.6%). The Asian cohort was divided into the following subgroups: Filipino, Chinese, Japanese, Indian/Pakistani, Korean, Vietnamese, Hawaiian/Pacific Islander, and other. Patients in all the Asian subgroups, except Japanese, were younger at diagnosis than NHW patients. After adjustment for disease stage, Japanese patients diagnosed with stage I through III disease had better DSS rates than patients in the NHW group or in the other Asian subgroups. Hawaiian/Pacific Islander patients with stage III or IV disease had worse DSS rates than NHW patients and patients in the other Asian subgroups. All other Asian subgroups had DSS rates similar to the DSS rate in the NHW group.

CONCLUSIONS:

The current results indicated that disparities exist for Asian women with breast cancer who reside in the United States compared with NHW groups and among Asian subgroups. Differences in presenting clinicopathologic features may affect DSS rates, suggesting that further investigation of these disparities is warranted to increase early detection and treatment for specific subgroups. Cancer 2012. © 2012 American Cancer Society.     

Factors Associated with Underscreening for Cervical Cancer among Women in Canada

Background: Cervical cancer is the second most common cancer among women worldwide. Failure toprevent cervical cancer is partly due to non-participation in regular screening. It is important to plan anddevelop screening programs directed towards underscreened women. In order to identify the factors associatedwith underscreening for cervical cancer among women, this study examined Pap test participation and factorsassociated with not having a time-appropriate (within 3 years) Pap test among a representative sample ofwomen in Ontario, Canada using Canadian Community Health Survey (CCHS) data. Materials and Methods:Univariate analyses, cross-tabulations, and logistic regression modeling were conducted using cross-sectionaldata from the 2007-2008 CCHS. Analyses were restricted to 13,549 sexually active women aged 18-69 years oldliving in Ontario, with no history of hysterectomy. Results: Almost 17% of women reported they had not hada time-appropriate Pap test. Not having a time-appropriate Pap test was associated with being 40-69 years old,single, having low education and income, not having a regular doctor, being of Asian (Chinese, South Asian,other Asian) cultural background, less than excellent health, and being a recent immigrant. Conclusions: Resultsindicate that disparities still exist in terms of who is participating in cervical cancer screening. It is crucial todevelop and implement cervical cancer screening programs that not only target the general population, but alsothose who are less likely to obtain a Pap tests.     

Understanding cervical screening non-attendance among ethnic minority women in England

Background:

Women from Black, Asian and Minority Ethnic (BAME) backgrounds are less likely to attend cervical screening than White British women. This study explored sociodemographic and attitudinal correlates of cervical screening non-attendance among BAME women.

Methods:

Women (30–60 years) were recruited from Indian, Pakistani, Bangladeshi, Caribbean, African and White British backgrounds (n=720). Participants completed structured interviews.

Results:

BAME women were more likely to be non-attenders than white British women (44–71% vs 12%) and fell into two groups: the disengaged and the overdue. Migrating to the United Kingdom, speaking a language other than English and low education level were associated with being disengaged. Being overdue was associated with older age. Three attitudinal barriers were associated with being overdue for screening among BAME women: low perceived risk of cervical cancer due to sexual inactivity, belief that screening is unnecessary without symptoms and difficulty finding an appointment that fits in with other commitments.

Conclusions:

BAME non-attenders appear to fall into two groups, and interventions for these groups may need to be targeted and tailored accordingly. It is important to ensure that BAME women understand cancer screening is intended for asymptomatic women and those who have ceased sexual activity may still be at risk.     

Generational risks for cancers not related to tobacco,screening, or treatment in the United States

BACKGROUND:

To assess trends in cancer, the authors evaluated the risk of 1 generation compared with that 25 years earlier (generational risk) for 3 groupings of cancers: those related to tobacco; those that reflect advances in screening or treatment; and a residual category of all other cancers.

METHODS:

In individuals ages 20 years to 84 years, age‐period‐cohort models were used to summarize time trends in terms of generational risk and average annual percentage change for US cancer incidence (1975‐2004) and mortality (1970‐2004) rates associated with these 3 cancer groupings.

RESULTS:

Adult white men today developed 16% fewer tobacco‐related cancers and had 21% fewer deaths because of those cancers than their fathers' generation, whereas adult white women experienced increases of 28% and 19%, respectively, relative to their mothers. The incidence of commonly screened cancers rose 74% in men and 10% in women, whereas mortality fell 25% in men and 31% in women. For cancers that have not been linked chiefly to tobacco or screening, the incidence was 34% and 23% higher in white men and white women, respectively, than in their parents' generation 25 years earlier. Mortality in this residual category decreased 14% in men and 18% in women. Results among blacks were qualitatively similar to those among whites.

CONCLUSIONS:

Despite declining overall cancer death rates, adults are experiencing increased incidence of cancers that are not associated with tobacco or screening relative to their parents. Future research should examine whether similar patterns are exhibited in other modern nations and should identify population‐wide avoidable risks that could account for unexplained increases in these residual cancers. Cancer 2010. © 2010 American Cancer Society.     

Overexpression of cathepsin f,matrix metalloproteinases 11 and 12 in cervical cancer

Background  

Cervical carcinoma (CC) is one of the most common cancers among women worldwide and the first cause of death among the Mexican female population. CC progression shows a continuum of neoplastic transitions until invasion. Matrix metalloproteinases (MMPs) and cathepsins play a central role on the enhancement of tumor-induced angiogenesis, cell migration, proliferation, apoptosis and connective tissue degradation. MMPs -2 and -9 expression has been widely studied in cervical cancer. Nevertheless, no other metalloproteinases or cathepsins have been yet related with the progression and/or invasion of this type of cancer.     

Knowledge and attitudes of primary health care physicians and nurses with regard to population screening for colorectal cancer in Balearic Islands and Barcelona

Background  

Primary health care (PHC) professionals play a key role in population screening of colorectal cancer. The purposes of the study are: to assess knowledge and attitudes among PHC professionals with regard to colorectal cancer screening, as well as the factors that determine their support for such screening.     

Racial disparities in healthy behaviors and cancer screening among breast cancer survivors and women without cancer: National Health Interview Survey 2005

Purpose

We investigated racial disparities in healthy behaviors and cancer screening in a large sample from the US population.

Methods

This analysis used the data from 2005 National Health Interview Survey and included women at age ≥ 40 years who completed the cancer questionnaires (2,427,075 breast cancer survivors and 57,978,043 women without cancer). Self-reported information on cancer history, healthy behaviors (body mass index, smoking, alcohol use, physical activity, fruit/vegetable consumption, sunscreen use) was collected. We compared distributions of each factor among Caucasian, African American, and Hispanic women with and without breast cancer history.

Results

Caucasian breast cancer survivors as compared to their cancer-free counterparts were less likely to be current smokers (8.3 vs. 16.9 %, p < 0.001) and to have regular mammograms (51.5 vs. 36.9 %, p < 0.05). Differences in associations between cancer survivors and respondents without cancer among African American and Hispanic women did not reach statistical significance.

Conclusions

Certain breast cancer survivor groups can benefit from tailored preventive services that would address concerns related to selected healthy behaviors and screening practices. However, most of the differences are suggestive and do not differ by race.     

The American Cancer Society guidelines for breast screening with magnetic resonance imaging: an argument for genetic testing

BACKGROUND.

The American Cancer Society (ACS) guidelines for screening with breast magnetic resonance imaging (MRI) recommend MRI for women who have a lifetime risk ≥20% of developing breast cancer. Genetic testing for breast cancer gene (BRCA) mutations is offered to women who have a risk ≥10% of carrying a mutation. The objectives of the current study were 1) to identify the number of women in a breast cancer screening population who had ≥20% lifetime breast cancer risk and, thus, were candidates for screening MRI; and 2) to determine the number of women who had ≥10% risk of BRCA mutation yet had <20% lifetime risk of breast cancer and, thus, may not have been identified as candidates for MRI screening.

METHODS.

From 2003 to 2005, women who underwent screening mammography completed a self‐administered questionnaire regarding breast cancer risk factors. For each patient, the lifetime breast cancer risk and the risk of BRCA mutation was determined by using the computerized BRCAPRO breast cancer risk‐assessment model.

RESULTS.

Of 18,190 women, 78 (0.43%) had ≥20% lifetime risk of breast cancer, all of whom had ≥10% risk of carrying a BRCA mutation. An additional 374 women (2.06%) had <20% lifetime breast cancer risk but ≥10% risk of mutation. Overall, there were 183 (1%) predicted mutation carriers, 27 women (0.15%) who had ≥20% lifetime risk of breast cancer, and 62 women (0.34%) who had ≥10% risk of mutation but <20% lifetime breast cancer risk.

CONCLUSIONS.

The ACS guidelines for breast MRI screening may systematically exclude MRI screening for many women who have a substantial risk for BRCA mutation. The current results demonstrated a need for greater awareness of breast cancer risk factors in the screening mammography population, so that high‐risk women can be identified and given access to genetic testing and counseling regarding all risk‐reducing interventions. Cancer 2008. © 2008 American Cancer Society.     

Breast cancer experience and survivorship among Asian Americans: a systematic review

Introduction

Breast cancer is the most common cancer in Asian American women, and the number of Asian American breast cancer survivors is rapidly increasing. Although Asian Americans are one of the fastest growing and most heterogeneous ethnic groups in the United States, limited data exist in regard to their breast cancer experience and survivorship.

Methods

A systematic review of the breast cancer experience literature was conducted and included studies of Asian Americans or their subgroups as a major category of study participants. Of the 125 studies reviewed, 10 qualitative studies, 10 quantitative studies, 5 studies that used a mixed-method approach, and 1 intervention study met the criteria for inclusion.

Results

Qualitatively, Asian Americans reported unmet physical and emotional needs and challenges during survivorship. Quantitative studies consistently found that socioeconomic status, cultural health beliefs, immigration stress, acculturation level, English proficiency, social support, and spirituality associated with Asian American breast cancer patients' health behaviors and health-related quality of life (HRQOL). Studies also revealed significant variation in breast cancer reaction and HRQOL within Asian American subgroups.

Conclusions

Although research on Asian American breast cancer experience and survivorship is sparse, we concluded that Asian Americans experience disrupted HRQOL following breast cancer diagnosis and treatment, interwoven with their cultural and socio-ecological system, and that programs focused on improving cancer survivorship outcomes among this ethnic minority group are limited. Most studies have concentrated on the West coast population, and there is significant underrepresentation of longitudinal and intervention studies. Implications for study design, measurement, and future research areas are also included.

Implications for Cancer Survivors

The results highlight a need to understand ethnic differences and to take into account social, cultural, and linguistic factors in breast cancer survivorship experiences among Asian American subgroups as a means to develop culturally relevant and linguistically appropriate interventions designed to improve HRQOL.     

Cervical Cancer Screening Among Adult Women in China, 2010

Introduction.

Cervical cancer is one of the most commonly diagnosed cancers among women in China. The World Health Organization (WHO) recommends routine screening for cervical cancer, and the WHO Global Monitoring Framework suggests that every nation monitors cervical cancer screening. However, little information is available on cervical cancer screening behavior among women in China.

Methods.

We used data from the 2010 China Chronic Disease and Risk Factor Surveillance System that included 51,989 women aged 18 years and older. We report the proportion of women who reported ever having had a Papanicolaou (Pap) test, stratified by sociodemographic characteristics and geographic region. Multivariable logistic regression modeling was performed to adjust for potential confounders.

Results.

Overall, 21% of 51,989 women reported having ever had a Pap test. The highest proportion was reported among women aged 30–39 years (30.1%, 95% confidence interval, 26.8%–33.4%). In all geographic regions, women in rural areas were consistently less likely than women in urban areas to report having had a Pap test. Among women who reported ever having a Pap test, 82% reported having the most recent test in the past 3 years. Factors associated with reporting ever having a test were being aged 30–49 years, higher education, being married, and having urban health insurance.

Conclusion.

Our results indicate that screening programs need to be strengthened along with a more intense focus on specific demographic groups. National cervical cancer screening guidelines and comprehensive implementation strategies are needed to make screening services available and accessible to all women.

Implications for Practice:

This study is the largest nationwide and population-based assessment of self-reported history of Pap test for cervical cancer screening in China. This article describes cervical cancer screening behavior among women and examines key demographic and geographic factors. Only one fifth of Chinese women reported having ever had a Pap test for cervical cancer screening. The results highlight the urgent need to develop national cervical cancer screening guidelines and strategies that make screening services widely available, accessible, and acceptable to all women, especially to those who reside in rural areas and those with no health insurance.