Psychosocial predictors of survival: Metastatic breast cancer

Background:Research interest in psychosocial predictors of theonset and course of cancer has been active since the 1950s. Recently wereported associations between psychological factors and survival in patientswith metastatic melanoma. We now report a replication of this study in asample of women with metastatic breast cancer. Patients and methods:Ninety-nine patients with metastatic breastcancer completed questionnaires measuring cognitive appraisal of threat,coping, psychological adjustment, perceived aim of treatment, social supportand quality of life, approximately four months after diagnosis. Survival wasmeasured from date of study entry to date of death or censored at the date oflast follow-up for surviving patients. Results:In a multivariate analysis, four factors independentlypredicted outcome. Patients with metastases in the liver, lung or pleurasurvived for a shorter duration (P < 0.001); older patients(P < 0.001) and those with a better appetite (P <0.05) also lived for a shorter time. Patients who minimised the impact ofcancer survived longer (a median of 29.1 vs. 23.9 months after study entry,P < 0.01). Conclusions:Minimisation was also significantly associated withoutcome in patients with metastatic melanoma who participated in anidentically designed study, reported elsewhere. This suggests thatminimisation may have a general impact on cancer progression and deservescloser scrutiny in other cancers.     

Alcohol consumption and breast cancer risk in Denmark

The influence of alcohol consumption on breast cancer risk was evaluated in a population-based case-control study, including 1,486 cases diagnosed over a one-year (1983–84) period in Denmark. Cases were identified from the files of the nationwide clinical trial of the Danish Breast Cancer Cooperative Group and the Danish Cancer Registry. The control group was an age-stratified random sample of 1,336 women from the general population. Data on risk factors were collected by self-administered questionnaires. The association of alcohol consumption with breast cancer risk varied with age and dietary fat intake. Among women aged 50–59 years, with a fat intake in the lowest quartile, the risk of breast cancer increased with increasing consumption of alcohol. A consumption of 24 g or more per day was associated with an 18-fold increased risk compared with abstainers. For women in other age groups, alcohol consumption had no significant association with breast cancer risk.The author is with the Danish Cancer Registry, Institute of Cancer Epidemiology, Danish Cancer Society, Rosenvaengets Hovedvej 35, Box 839 DK-2100 Copenhagen Ø, Denmark. The study was funded by The Danish Cancer Society, the Danish Medical Research Council, and Astrid Thaysen's Legat.     

肺癌发病的社会心理因素研究

目的　探讨与肺癌发病有关的社会心理因素 ,为进一步前瞻性研究打下基础。方法　选 118例经病理确诊 ,卡氏评分≥ 6 0分的肺癌患者为病例组 ,根据 1∶1配对原则 ,即与病例组相同性别、相同民族、相同职业、相同居住地点、年龄相差± 3岁、无身心疾患的健康人作为对照组。使用杨德森、张亚宁编制的“生活事件量表 (LES)”、肖水源编制的“社会支持评定量表”和Bond编制的“防御机制问卷 (DSQ)”分别对两组对象的生活事件、社会支持和防御机制进行问卷调查。结果　单因素分析中病例组吸烟、睡眠不足、饮酒、吃饭常伴烟酒、常吃腌制食品、生活无规律与对照组有统计学差异 (P <0 .0 5 ) ,生活事件评分、社会支持评分与对照组无统计学差异 ,但负性事件总分高于对照组 ,防御方式中不成熟因子与对照组有统计学差异 (P <0 .0 5 ) ;多因素分析中吸烟、睡眠不足进入癌症发病的 1∶1配对多元Logistic模型。结论　社会心理因素与肺癌发病有一定关系 ,防御方式中的不成熟因子为肺癌发病的社会心理因素 ,吸烟、睡眠不足、饮酒、吃饭常伴烟酒、常吃腌制食品、生活无规律为肺癌发病的危险因素。     

Report from a symposium on diet and breast cancer

On 21 September 2001 the Harvard Center for Cancer Prevention and the Cancer Epidemiology Program of the Dana-Farber/Harvard Cancer Center co-sponsored a symposium on diet and breast cancer for members of the Harvard breast cancer research community in Boston, MA. The purpose of the symposium was to review past findings and recent research developments in diet and breast cancer, and to potentially identify new opportunities for study. Presentations addressed research on the associations between phytoestrogens, total dietary fat, types of fat, olive oil, alcohol, folate/folic acid, and intakes of fruits and vegetables, and breast cancer risk. The relations between metabolic factors such as body mass index, weight gain, and breast cancer risk were also highlighted.     

Perinatal factors increase breast cancer risk

Summary Emerging evidence suggests that breast cancer may originate during early life. In particular, offspring of mothers who during pregnancy exhibited behaviors that are associated with increased incidence of breast cancer, may be at risk. These behaviors include intake of high fat diet or alcohol, or stressful life style. We have found that neonatal exposure to handling that leads to improved ability to cope with stress, reduces 7,12-dimethylbenz(a)anthracene (DMBA)-induced mammary tumors in rats. Further, our results indicate that maternal exposure to high fat diet increases the incidence of DMBA-induced mammary tumors in female offspring. High fat diet also increases serum 17-estradiol (E2) levels in pregnant animals. These results support the hypothesis thatin utero concentrations of estrogens play a critical role in the vulnerability to develop breast cancer. The mechanism of estrogen action might be related to its effect on the induction of epithelial hyperplasia and altered breast differentiation. These events then increase the rate of genetic/epigenetic changes that increase the possibility of neoplastic transformation. Increased pregnancy estrogens may also lead to behavioral alterations in the offspring. This could explain the proposed association between certain behavioral patterns and increased tumorigenity. Our results in transgenic mice overexpressing transforming growth factor (TGF) are in accordance with this interpretation. The male TGF mice exhibit elevated serum E2 levels, impaired ability to cope with stress, increased voluntary alcohol intake and high incidence of spontaneous hepatocellular tumors. These findings indicate that animal models offer a unique opportunity to investigate the role of timing of risk behaviors on breast cancer. They are also useful in the attempts to understand the mechanism of early estrogen action on mammary tumorigenesis.     

乳腺癌患者心理社会因素与免疫功能的相关性

免疫系统在肿瘤进展中有重要作用,心理社会因素也会影响肿瘤的发生、发展。乳腺癌相关心理社会因素主要包括应激性生活事件、应对方式、情绪和个性特征以及社会支持。相关免疫应答效应因素包括T淋巴细胞及其亚群等特异性免疫,TNF-a、巨噬细胞、NK细胞等非特异性免疫应答效应因素。探讨乳腺癌患者心理、肿瘤、免疫之间的关系,作为乳腺癌心理治疗的基础,具有重要意义。     

Dietary fat and breast cancer risk in the Swedish women's lifestyle and health cohort

We investigated whether dietary intakes of total fat, monounsaturated fat (MUFA), polyunsaturated fat (PUFA) and saturated fat (SFA) were associated with breast cancer risk in a prospective cohort of 49 261 Swedish women (30-49 years at enrolment), which yielded 974 breast cancer cases by December 2005. Further, we evaluated if associations differed by oestrogen and/or progesterone receptor tumour status. Total fat, MUFA, PUFA or SFA were not associated with risk overall. However, women in the highest MUFA and PUFA quintile intake had a reduced breast cancer risk after age 50 years (hazard ratios: 95% confidence interval=0.45: 0.25-0.99 and 0.54: 0.35-0.85, respectively) compared to women in the lowest quintile. The associations did not differ by oestrogen or progesterone receptor status. Despite the negative findings, type of fat during premenopausal years may have later differential effects on risk.     

A study of diet and breast cancer prevention in Canada: why healthy women participate in controlled trials

Little research has been undertaken to determine why healthy people agree to enroll in randomized controlled trials of cancer prevention. This study describes the beliefs of Canadian women participating in a trial designed to determine the effect of reducing dietary fat on the development of breast cancer. Healthier eating, nutritional counseling, contributing to science, and helping others were the most frequently cited advantages of participation. Weight control and general better health were specifically associated with the dietary regimens. Attending appointments and difficulties when eating out were the main disadvantages of participation. Suggestions that would promote adherence to the trial protocol also were elicited. Responses cited most often included opportunities to meet other participants, more nutritional counseling (particularly psychological tips), updates about the trial, and more recipes. Attention should be paid to these suggestions as they characterize some of the major determinants of adherence behavior.Drs Till and Boyd, and Mss Sutherland, Martin, and Greenberg are with the Division of Epidemiology & Statistics, Ontario Cancer Institute/Princess Margaret Hospital, Toronto, Canada. Ms Carlin and Mr Harper were summer students in the Division. Address correspondence to Ms Sutherland, Division of Epidemiology and Statistics, Ontario Cancer Institute, 500 Sherbourne Street, Toronto, Canada, M4X 1K9. This research was supported by The National Cancer Institute of Canada with funds from the Canadian Cancer Society. Dr Boyd is the recipient of a National Health Scientist award from Health and Welfare, Canada.     

174例乳腺癌生存因素分析

目的 分析影响乳腺癌生存率的相关因素。方法 收集174例乳腺癌病人的完整临床资料与病理,随访5年以上,观察其生存时间,制作Kaplan-Meier评价生存曲线,并做比较分析。结果 乳腺癌高发年龄在40~49岁;Ⅰ期、Ⅱ期与Ⅲ期乳腺癌患者总体生存曲线不同;乳腺癌的肿块大小与腋窝淋巴结转移成正相关;绝经后患者5年生存率低于未绝经患者;ER(-)病例平均无病存活时间小于ER(+)病例。结论 必须重视乳腺癌的早期检查、早期诊断和早期系统治疗;全社会应普及乳腺癌的筛查工作。     

Nutrition and lifestyle factors on the risk of developing breast cancer

Aspects of nutrition and lifestyle may be largely responsible for the development of common cancers in Western countries, as indicated by the large differences in breast cancer rates between countries, the striking changes in these rates among migrating populations, and the rapid changes over time within countries. The better informed and increasingly health-conscious population of the present day are intensively seeking to identify and eliminate these putative carcinogenic risk factors and to exploit the preventive effects that have been attributed to certain dietary components. Nutrition and 'lifestyle' may exert its carcinogenic effects indirectly by cell stimulations (alcohol, hormone therapy in postmenopause), inhibition of DNA-repair mechanisms (lack of vitamins), effecting estrogen metabolism (phytoestrogenes), or as promotors to enhance growth of tumours (body mass index). Some 'substances' may act as a carcinogenic itself, for example, aromatic hydrocarbons in tobacco or increased polycyclic aromatic hydrocarbons in well done meat. Individual differences in the effects of nutritional factors on mammary epithelia could be caused by genetic polymorphisms. In this critical review, we focus on current data regarding the effect of nutrition and lifestyle, on the risk of developing breast cancer. A health lifestyle, consisting of 'healthy diet', physical activity, renunciation of stimulants, is recommended from childhood throughout life.     

Psychosocial issues in colorectal cancer survivorship: the top ten questions patients may not be asking

Advances in colorectal cancer screening and treatment have increased survivorship significantly in recent years. This has led to an increased emphasis on the need for continuing patient care long after cancer treatment is completed. Colorectal cancer survivors may face a number of psychosocial issues following treatment, including cancer-related distress, adjustment to physical changes following treatment, and challenges related to returning to work. Although there are many resources available to assist with these challenges, many patients may not seek this information from their providers during follow-up care visits. This article highlights some of the most common patient concerns related to survivorship in colorectal cancer and serves as a reminder to ask about these concerns throughout the course of treatment and follow-up care.     

Analysis of prognostic factors in 568 patients treated for breast cancer by surgery

The Tygerberg Breast Clinic serves a heterogeneous population, and it is therefore possible to analyse prognostic factors influencing survival and to identify any possible differences between these groups. From 1978 to 1985, 568 breast cancer patients (52% white and 48% colored) were treated surgically in Tygerberg Hospital. Stage for stage, all patients received identical treatment. Colored patients were seen at a younger age, with more advanced disease, had lower estrogen receptor values, and more nodes involved. Cox's regression analysis of age, receptor value, stage, nodal involvement, race, menopausal status, treatment, and study period in the evaluation of disease-free survival and overall survival confirmed stage and lymph node status as prognostic factors. Estrogen receptor status, menopausal status, age at presentation, treatment, study period, and race did not enter the regression, except in stage I, where race was a variable. A target group for directing educational intervention is identified.     

Progress in understanding breast cancer: Epidemiological and biological interactions

Summary Little progress has been made recently in our understanding of the epidemiology of breast cancer. While results from epidemiologic studies regarding reproductive factors remain fairly reproducible from one study to another, other associations such as that between breast cancer risk and dietary fat intake, although biologically plausible, are not consistently found in direct study of humans, while yet other associations, which appear less plausible biologically, become stronger (such as the increased risk associated with modest levels of alcohol consumption). In this paper we attempt to review the epidemiology and biology of breast cancer jointly and describe possible mechanisms of breast cancer induction, the cellular composition of the breast, the epidemiology of breast cancer, and salient biological features, and attempt to reconcile the biology and epidemiology. It becomes obvious that future progress depends on better biological thinking by epidemiologists, and vice-versa. Areas of further research are suggested and discussed, concluding that the ability to measure diet with greater precision could have an important role to play in clarifying our understanding of breast cancer.     

Dietary fat and breast cancer metastasis by human tumor xenografts

Human breast cancer cell lines growing as xenografts in athymic nude mice have been used to examine the effects of dietary fat and fatty acids on tumor progression. The estrogen independent MDA-MB-435 cell line has the advantage that it metastasizes consistently to the lungs and forms quantifiable secondary nodules when injected into the mammary fat pads. With these breast cancer cells, the stimulating effects of polyunsaturated omega-6 fatty acids on both primary tumor growth and metastasis were demonstrated; in contrast, the long-chain omega-3 fatty acids were inhibitory. The model can also be adapted to examine dietary fatty acids, and inhibitors of their metabolism, as experimental adjuvant therapy after surgical excision of the primary tumors. Unfortunately, estrogen dependent human breast cancer cells do not metastasize, or do so rarely, in nude mice; in consequence, it is not possible to use the model to study estrogen-fatty acid interactions on the metastatic process. In addition to metastasis from a primary location, intravenous injection of MDA-MB-435 cells into the nude mouse host, particularly when combined with studies using Matrigel-based in vitro invasion assays, permits further dissection of the steps in the metastatic cascade which are influenced by dietary fatty acids. The results obtained by these several approaches have demonstrated distinct roles for the cyclooxygenase and lipoxygenase-mediated products of omega-6 fatty acid metabolism, and suggest new approaches to experimental breast cancer therapy.     

Dietary habits and mammographic patterns in patients with breast cancer

Summary Between 1983 and 1986, dietary history interviews were conducted with 238 women aged 50–65 years who had surgery for stage I–II breast cancer. Diagnostic mammograms were coded in line with Wolfe's criteria in N1, P1, P2, and Dy patterns. Women with Dy pattern reported significantly higher intake of total fat, monounsaturated fatty acids (FA), polyunsaturated FA, n-3 FA, n-6 FA in per cent of energy (E%), and -tocopherol in mg/10 MJ. Fat intake was lowest in women with N1 pattern and highest in those having Dy pattern. Patients having ER-rich cancers and Dy pattern reported significantly higher intake of total fat, monounsaturated FA, polyunsaturated FA, n-6 FA (E%), and -tocopherol (mg/10 MJ), as well as significantly lower intake of carbohydrate (E%) and calcium (g/10 MJ). In the stepwise multivariate analysis, the multivariate-odds ratio (OR) for having P2 + Dy patterns was 1.06 (95% confidence interval (CI), 1.02–1.12) for each increment in E% of total fat. In women with ER-rich tumors this OR was 1.09 (95% CI, 1.02–1.16). The highest self-reported body mass index (BMI) was observed in women with N1 + P1 patterns. OR for having P2 + Dy patterns was 0.91 (95% CI, 0.83–0.98) for each increment in 1 kg/m² of BMI. The results suggest that dietary habits affect the mammographic parenchymal pattern in women with breast cancer and that a high fat intake is associated with a higher proportion of mammograms with Dy pattern in such patients.     

Psychosocial screening for patients with prostate cancer: The development and validation of the psychosocial distress questionnaire-prostate cancer

ABSTRACT

We describe the psychosocial distress questionnaire-prostate cancer (PDQ-PC), a psychosocial screening list developed and validated specifically for prostate cancer patients. An existing screening list, the psychosocial distress questionnaire-breast cancer (PDQ-BC), was used as a starting point. Two focus groups were then implemented to investigate which items of the PDQ-BC were relevant for the PDQ-PC and which new items were needed. Validity and reliability of the questionnaire were assessed on 278 prostate cancer patients. Factor analysis showed that the 36-item PDQ-PC comprises eight subscales, for which the internal consistency ranged from α = 0.48–0.88. Moreover, moderate to high convergent validity was found.