The psychosocial burden of caring for some Nigerian women with breast cancer and cervical cancer.

In Nigeria, the rising incidence of cancer and the paucity of institutional facilities and specialist man-power implies that the burden of care rests largely on relatives. We assessed the severity of indices of psycho-social and economic burden among relatives of women with breast and cervical cancer; and its relationship with patients' psychosocial distress. Using a burden questionnaire, relatives of 73 women with cancer (41 cervical and 32 breast, mean age of caregivers 35.6 years) were interviewed, in out-patient clinics. While the caregivers admitted high frequency of all indices of 'objective' burden, emotional ties at home and social relationships in the neighbourhood seemed intact, indicating tolerance and lack of social stigma. The financial burden was more problematic than the effect of caring on family routines; and these two factors significantly predicted global rating of burden. The severity of patient's worries and psychopathological symptoms were not significantly correlated with care-giver global rating of burden. The tolerance shown by this group of relatives implies that they have strong potentials for playing useful roles in community care of patients.     

Occupations and breast cancer risk among Chinese women in urban Shanghai

BACKGROUND: Although, an elevated risk of breast cancer has been suggested for a number of occupations, many earlier studies were limited by selection biases, the incomplete assessment of job histories, and the inability to control for confounding. METHODS: We examined the relationship between occupational history and breast cancer risk using data from a population-based case-control study of 1,458 cases and 1,556 age-matched controls (90% response rate) conducted in Shanghai, China. Unconditional logistic regression models were used to derive odds ratios (ORs) and 95% confidence intervals (95% CIs) of breast cancer risk associated with occupations and duration of employment adjusting for non-occupational risk factors. RESULTS: The following occupations were found to be associated with an increased risk of breast cancer: laboratory technicians (OR 9.94, 95% CI 1.20-82.37), telephone and telegraph operators (OR 4.63, 95% CI 1.85-11.59), leather and fur processors (OR 3.25, 95% CI 1.11-9.53), and glass-manufacturing workers (OR 2.08, 95% CI 1.14-3.82). A dose-response pattern for years of employment was observed for leather and fur processors (P = 0.02) and glass-manufacturing workers (P = 0.01). Stratified analyses also revealed dose-response relationships between the risk of breast cancer and years of employment as inspector and product analysts among pre-menopausal women (P = 0.02), and as farmers among post-menopausal women (P = 0.04). CONCLUSIONS: This study found that several occupations are associated with an increased risk of breast cancer among women. Studies examining various occupational exposures in these high-risk occupations are warranted to identify carcinogens that may play a role in the increased breast cancer risk.     

Street foods and dietary intakes of Nigerian urban market women

The food and nutrient intake of 197 market women aged 19-66 years (mean 41 years) have been determined using questionnaire and 24-hour dietary recall. The contributions of street foods (SF) to total intake of food and nutrients were determined in order to quantify the importance of SF as a source of food and nutrients for these women. Eighty-three of the women were of child-bearing age (<49 years), Group I, while 114 were not (> 49 years). Overall, SF provided 63% of the weight of total food consumed. The mean energy intake was 11.5 MJ with the older women Group II consuming significantly (P < 0.05) higher than the younger age group (Group I). The contribution of SF to energy intake was similar (59%) for both groups. The older women (Group II) also consumed significantly (P < 0.05) more total protein than the younger women (110 vs 80 g) although SF contributed similar percentages (58 vs 59%). Mean calcium intake was high for the subjects (618 mg) but no significant differences were found between the two age cohorts. The proportion of calcium intake supplied by SF was 79% for Group I and 81% for Group II. There was a wide variation (8.1-16.5 mg) in total daily iron intake. Overall SF provided 57% of the pooled mean intake (12 mg). Mean iron intake for Group II was significantly (P < 0.05) higher than that of Group I. The contribution of SF to the intakes of vitamins was above 50% except for thiamin (47%) in the younger age cohort and vitamin A (46%) in the older age group. The results suggest therefore that street foods constitute the major sources of dietary energy and other nutrients for market women in Nigeria.     

Street foods and dietary intakes of Nigerian urban market women

The food and nutrient intake of 197 market women aged 19-66 years (mean 41 years) have been determined using questionnaire and 24-hour dietary recall. The contributions of street foods (SF) to total intake of food and nutrients were determined in order to quantify the importance of SF as a source of food and nutrients for these women. Eighty-three of the women were of child-bearing age (< 49 years), Group I, while 114 were not (> 49 years). Overall, SF provided 63% of the weight of total food consumed. The mean energy intake was 11.5 MJ with the older women Group II consuming significantly (P < 0.05) higher than the younger age group (Group I). The contribution of SF to energy intake was similar (59%) for both groups. The older women (Group II) also consumed significantly (P < 0.05) more total protein than the younger women (110 vs 80 g) although SF contributed similar percentages (58 vs 59%). Mean calcium intake was high for the subjects (618 mg) but no significant differences were found between the two age cohorts. The proportion of calcium intake supplied by SF was 79% for Group I and 81% for Group II. There was a wide variation (8.1-16.5 mg) in total daily iron intake. Overall SF provided 57% of the pooled mean intake (12 mg). Mean iron intake for Group II was significantly (P < 0.05) higher than that of Group I. The contribution of SF to the intakes of vitamins was above 50% except for thiamin (47%) in the younger age cohort and vitamin A (46%) in the older age group. The results suggest therefore that street foods constitute the major sources of dietary energy and other nutrients for market women in Nigeria.     

Perceived needs of women diagnosed with breast cancer: rural versus urban location

OBJECTIVE: To assess the prevalence and predictors of perceived unmet needs among women diagnosed with breast cancer, with a particular focus on the impact of location (rural/urban). METHOD: A random sample of women in NSW diagnosed with breast cancer was surveyed during 1995-96. The Breast Cancer Patients' Needs Questionnaire (BR-CPNQ) explores patients' perceived needs across five domains: psychological, health information, physical/daily living, patient care/support and interpersonal communication. Items assessing breast cancer specific needs and access to services and resources were included. Of 235 eligible rural women, 134 (57%) consented to participate and 129 (55%) returned completed surveys. Of 196 eligible urban women, 102 (52%) consented to participate and 100 (51%) returned completed surveys. RESULTS: For 12 of the 52 items, at least one-third of the sample reported ever having a moderate/high need for help. Of the 15 highest moderate or high unmet needs, 10 related to health information and three to psychological needs. There were few differences in the prevalence of needs reported by rural and urban women. Only in the physical/daily living domain were rural women more likely than urban women to report some need for help (OR = 2.59, 95% CI 1.21-5.52). CONCLUSIONS: Unmet needs, particularly in the information and psycho-social domains, are reported by both rural and urban women with breast cancer, with sub-groups experiencing different types of needs. IMPLICATIONS: There is a need to develop and trial targeted and innovative strategies to meet the health information and psychological needs of women with breast cancer, and the physical/daily living needs of rural women diagnosed with breast cancer.     

中国城市居民乳腺癌危险因素的研究

目的 乳腺癌是全世界妇女中最多发的肿瘤。我国城市女性乳腺癌危险因素的筛查及其探索监测方法研究（并有相关的论文陆续发表）,对乳腺癌的预防和控制十分重要。方法 在我国选择北京、天津、上海、重庆、武汉、广州六大城市作为监测地区,采用以人群为基础的１：１配对的病例对照研究方法,共抽取２１００对病例与对照,进行问卷调查。应用ＳＡＳ６．１２软件进行单因素、多因素条件ｌｏｇｉｓｔｉｃ回归分析,并对六城市分别做指     

Hip fractures in women with breast cancer

The authors investigated whether the incidence of first hip fracture, an indicator of osteoporosis, is lower in breast cancer patients, who are assumed to have higher levels of endogenous estrogens, than in other women. A population-based Swedish cohort comprising 9,673 women with invasive breast cancer diagnosed from 1958 through 1983 was followed up with respect to the occurrence of a first hip fracture during the period 1965-1983. Overall, the number of observed acute fractures (n = 387) was slightly higher than expected (n = 348.6) (standardized incidence ratio (SIR) = 1.1, 95% confidence interval (CI) 1.0-1.2). Risk for trochanteric fractures was slightly higher than expected (SIR = 1.2, 95% CI 1.0-1.4), but risk for cervical fractures was not (SIR = 1.0, 95% CI 0.9-1.1). Risk for trochanteric fracture decreased with increasing age at breast cancer diagnosis, reaching standardized incidence ratios close to unity after the age of 70 years. Duration of follow-up appeared to be unrelated to the risk of either type of fracture. The authors conclude that the incidence of first hip fracture is not lower in breast cancer patients than in other women.     

Attachment experiences in women with breast cancer

Research into relational experiences of cancer patients suggests possible links between attachment processes and cancer. Women with and without breast cancer were assessed regarding attachment history and early loss, closeness to parents, and adult attachment. Women with breast cancer reported significantly higher incidences of insecure histories and early loss, and scored significantly higher on avoidant attachment than women without cancer. The women in the cancer group also scored significantly lower on closeness to parents than women in the noncancer group. These findings are preliminary and indicate that more research is needed to understand the role that attachment may play in a multidimensional, biopsychosocial model of cancer.     

Health behaviors and breast cancer: experiences of urban African American women.

Breast-cancer survival rates are lower among African American women compared to White women. Obesity may contribute to this disparity. More than 77% of African American women are overweight or obese. Adopting health behaviors that promote a healthy weight status may be beneficial because obesity increases risk for recurrence. Studies among White breast-cancer survivors indicate that many make health behavior changes after diagnosis. This cross-sectional pilot study collected quantitative and qualitative data on the attitudes, beliefs, barriers, and facilitators related to health behavior changes in 27 overweight/obese African American breast-cancer survivors. Results indicated that most participants reported making dietary changes since their diagnosis, and some had increased their physical activity. Focus groups provided rich details on the barriers and facilitators for behavior change. These results begin to address the significant gap in our knowledge of African American breast-cancer survivors' health behaviors and underscore the need for culturally competent health behavior interventions.     

Activity pattern, energy intake and obesity among Nigerian urban market women

Activity pattern, energy intake and body mass index (BMI) were studied in a group of 232 women aged 19-65 years. The subjects were selected from five major markets in Abeokuta Township using a systematic random sampling technique. With the aid of a structured questionnaire and 24-h diet recall, information was collected on socio-demographic characteristics and the food and nutrient intake of the subjects. Information on the activity pattern was collected by recall and random spot observation methods. The result indicated that the majority (61%) of the respondents spent a total of 16 h on both domestic and market activities. An average of 11.5 h was spent in the market on predominantly sedentary activities. The mean energy intake of the women was 3701 kcal (15.4 MJ), which constituted about 164% of the recommended dietary allowance. Roots and tubers, cereals and legume form the major source of nutrients; while fried foods featured prominently in the menu. Eighty-nine women (38.4%) have a BMI within the healthy range of 18.5-25, while a total of 136, representing 58.6%, have a BMI greater than 25. A total of 66 women, representing 48.5% of the 136 women whose BMI was above 25, have a BMI in excess of 30 and are classified as obese. Both the energy intake and activity pattern of the respondents correlated positively with the BMI. This study has established a high risk of obesity among urban market women in Nigeria.     

Determinants of the use of breast cancer screening among women workers in urban Mexico

Introduction

This case-control study aimed to determine critical factors influencing the use of clinical breast examination and mammography among women workers in Monterrey, Mexico.

Methods

We determined case and control status from survey results. Cases were defined in accordance with the guidelines of the Official Mexican Standard as lack of at least one clinical breast examination during the past year by surveyed women. For women older than 40 years, cases were further defined as lack of at least one mammogram in the previous 2 years and, for women older than 50, lack of a mammogram in the previous year. Controls were defined as adherence by surveyed women to these guidelines. Participants (N = 306 clerks aged 18–60) provided information about their practices, knowledge, and perceptions regarding breast cancer screening. Factors identified by odds ratio analysis as significantly different between cases and controls were analyzed by multivariate logistic regression.

Results

Survey participants'' knowledge about the utility of breast self-examination (odds ratio, 6.0; 95% confidence interval, 1.0–33.9), perception that the health care system has enough equipment and personnel for clinical breast examination (odds ratio, 4.7; 95% confidence interval, 1.7–13.2), and perception that they have enough time to wait for and receive clinical breast examinations (odds ratio, 2.5; 95% confidence interval, 1.1–5.8) significantly predisposed women to use screening services independent of years of formal education, number of pregnancies, number of living children, hours worked per week, and monthly family income.

Conclusion

Perception of organizational and structural factors played a significant role in screening use. Our findings have implications for the general population, provider practices, community interventions, and future development of strategies to increase use of screening services in similar locales.     

Fatty acid composition of breast milk from Nigerian and Japanese women.

The fatty acid composition of samples of breast milk obtained from well-nourished Nigerian and Japanese women was determined by gas chromatography. The cultural differences in dietary intake was reflected in the fatty acid composition of breast milk samples. The milk of Nigerian women contained a significantly higher percentage of saturated fatty acids (48.75%) than that of Japanese women (46.65%). Nigerian milks were also richer in arachidonic (20:4 n-6), eicosatrienoic (20:3 n-6), and docosatetraenoic (22:4 n-6) acids. Conversely, the milk of Japanese woman contained significantly higher percentages of monoun-saturates as palmitoleic, heptadecenoic, oleic, and polyunsaturates of n-3 series as alpha-linolenic, eicosapentaenoic, and docosahexaenoic acid.     

Sexual function and chemotherapy in postmenopausal women with breast cancer

ABSTRACT: BACKGROUND: This cross-sectional, nested cohort study assessed Female Sexual Function Index (FSFI) scores in postmenopausal women with breast cancer receiving primary chemotherapy. METHODS: The FSFI questionnaire was administered to 24 postmenopausal women one month after diagnosis of breast cancer (post-diagnosis group) and one month after completion of the first cycle of primary anthracyclin-based chemotherapy (post-chemotherapy group). Scores were compared to those of 24 healthy postmenopausal women seeking routine gynecological care (control group). All patients were sexually active at the time of enrollment. Mean age was 57.29 +/- 11.82 years in the breast cancer group and 52.58 +/- 7.19 years in the control group. RESULTS: Scores in all domains of the FSFI instrument were significantly lower in the post-diagnosis group than in controls (-41.3%, p < 0.001). A further major reduction in FSFI scores was evident on completion of one cycle of primary chemotherapy (down 46.7% from post-diagnosis scores, p < 0.003), again in all domains. Six patients (25%) ceased all sexual relations, in a significant change from baseline (p < 0.001). After one chemotherapy cycle, a further five patients ceased sexual activity, for a total of 11 (45.8%) participants -- a borderline significant difference (p = 0.063). CONCLUSION: The present study shows that female sexual function as assessed by the FSFI declines significantly at two distinct points in time: upon diagnosis of breast cancer and after administration of systemic chemotherapy.     

Factors associated with delays to diagnosis and treatment of breast cancer in women in a Louisiana urban safety net hospital

Only lung cancer surpasses breast cancer as a cause of death from cancer. However, the burden of cancer is not borne equally across racial and ethnic groups. In the United States, African American women have significantly higher mortality rates from breast cancer than white women. Delayed follow-up of breast abnormalities and delays from diagnosis to treatment may contribute to higher mortality. This study examined factors associated with delays to diagnosis and treatment of breast cancer in a group of white and African American women. Identified from tumor registry records were 247 women with pathology-confirmed first primary in situ and invasive breast carcinomas with no known previous cancer diagnosis. Factors associated with delays from provider recognition of abnormality to breast cancer diagnosis (diagnostic delays) and from diagnosis to treatment (treatment delays) were determined using chi-square tests and logistic regression. Factors that were considered included age, race, stage of disease at diagnosis, tumor size, type of abnormality, type of medical service at presentation, and prior mammogram within the past two years. The proportion of women experiencing diagnostic delays was high, with more African American women experiencing delays than white women (34% versus 17%, respectively). African American and white women did not differ in distribution of stage of cancer at diagnosis. Significantly smaller tumor sizes were found in women experiencing diagnostic delays compared to those not experiencing delays. Conversely, women experiencing treatment delays were significantly older and had larger tumor sizes compared to those not experiencing delays. More African American women experienced delays in diagnosis; however these delays did not appear to affect outcomes. Older age as a significant factor in treatment delays suggests that comorbidities as well as other possible barriers to treatment warrant further investigation in older women. The reasons for racial disparities in breast cancer outcomes remain and call for further study.