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Ismail Jatoi

Publications and source records attributed to Ismail Jatoi.

At least 19 recordsLinked to original sources
PubMed2006

Factors associated with the incompliance with mammogram screening among individuals with a family history of breast cancer or ovarian cancer.

OBJECTIVE: The national guidelines recommend more intensive screening for breast cancer for women with a family history of breast or ovarian cancer. Using the data from the 2000 National Health Interview Survey (NHIS), we examined factors related to the underuse of mammogram in this population. METHOD: The study subjects were 1,215 women aged 30-79 who had a family history of breast or ovarian cancer in their first-degree relatives. According to the American Cancer Society's guidelines for breast cancer screening, having no mammogram in last year was used as an outcome for this study. Socio-demographic characteristics, health-related conditions, lifestyle factors, health behaviors, menstrual/reproductive information and health care access and utilization were analyzed to assess their relations to mammogram underuse using unconditional logistic regression method. RESULTS: The results showed that younger age, having no place to go when sick (OR = 2.2, 95% CI, 1.2-4.0), having no visits to a general doctor (OR = 1.7, 95% CI, 1.2-2.4) or medical specialist (OR = 2.2, 95% CI, 1.6-3.1) and having no influenza shot in last year (OR = 1.7, 95% CI, 1.2-2.3) increased the risk of underusing mammography screening among women who had a family history of breast or ovarian cancer. Women who had no home care from health professionals in the last year were less likely to underuse mammogram with an OR of 0.3 (95% CI, 0.1-0.6), compared with women who had. CONCLUSION: Medical care-related factors may affect the use of mammography screening in women with a family history of breast or ovarian cancer.

Adult↗
PubMed2006

Psychological distress in U.S. women who have experienced false-positive mammograms.

BACKGROUND: In the United States, approximately 10.7% of all screening mammograms lead to a false-positive result, but the overall impact of false-positives on psychological well-being is poorly understood. MATERIALS AND METHODS: Data were analyzed from the 2000 U.S. National Health Interview Survey (NHIS), the most recent national survey that included a cancer control module. Study subjects were 9,755 women who ever had a mammogram, of which 1,450 had experienced a false-positive result. Psychological distress was assessed using the validated K6 questionnaire and logistic regression was used to discern any association with previous false-positive mammograms. RESULTS: In a multivariate analysis, women who had indicated a previous false-positive mammogram were more likely to report feeling sad (OR = 1.18, 95% CI, 1.03-1.35), restless (OR = 1.23, 95% CI, 1.08-1.40), worthless (OR = 1.27, 95% CI, 1.04-1.54), and finding that everything was an effort (OR = 1.27, 95% CI, 1.10-1.47). These women were also more likely to have seen a mental health professional in the 12 months preceding the survey (OR = 1.28, 95% CI, 1.03-1.58) and had a higher composite score on all items of the K6 scale (P < 0.0001), a reflection of increased psychological distress. Analyses by age and race revealed that, among women who had experienced false-positives, younger women were more likely to feel that everything was an effort, and blacks were more likely to feel restless. CONCLUSION: In a random sampling of the U.S. population, women who had previously experienced false-positive mammograms were more likely to report symptoms of anxiety and depression.

Adult↗
PubMed2006

Effects of estrogen receptor expression and histopathology on annual hazard rates of death from breast cancer.

BACKGROUND: Breast cancer incidence rates vary according to estrogen receptor expression (ER) and histopathology. We hypothesized that annual mortality rates from breast cancer after initial diagnosis (hazard rates) might also vary by ER and histopathology. METHODS: We accessioned the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER, 1992-2002) program to estimate hazard rates according to ER (positive and negative) and histopathology (duct, tubular, lobular, medullary, inflammatory, papillary, and mucinous types). We used spline functions to model hazard rates free of strongly parametric assumptions for ER negative and positive cases overall and by histopathology. RESULTS: Hazard rates for ER negative and ER positive cases were distinct and non-proportional. At 17 months, ER negative hazard rates peaked at 7.5% per year (95% CI, 7.3-7.8% per year) then declined, whereas ER positive hazard rates lacked a sharp early peak and were comparatively constant at 1.5-2% per year. Falling ER negative and constant ER positive hazard rates crossed at 7 years; after which, prognosis was better for ER negative cases. Among ER positive and negative cases, there were proportional and non-proportional hazards according to histopathologic type, but the two basic ER-associated patterns were maintained. CONCLUSIONS: Hazard rates differed quantitatively and qualitatively according to ER and histopathology. These large-scale population-based results seem consistent with genomic studies, demonstrating two main classes of breast cancers with distinct prognoses according to ER expression.

Adenocarcinoma↗
PubMed2006

Assessing the impact of screening mammography: Breast cancer incidence and mortality rates in Connecticut (1943-2002).

BACKGROUND: Randomized controlled studies demonstrate that early detection and intervention reduce breast cancer mortality by approximately 25%. Though the ultimate goal of screening is to reduce breast cancer deaths, the immediate goal is to detect and treat early-stage tumors before they pose a threat to life. MATERIALS AND METHODS: To assess the impact of early detection and intervention in the general population, we analyzed breast cancer incidence and mortality rates in the NCI's Historical Connecticut Tumor Registry (1943-2002). RESULTS: Though breast cancer rates increased for the entire study period, overall incidence rates rose faster than previously following the initiation of mammography screening in the early 1980s in the United States. Of note, stage-specific incidence rates increased 152% (53.2-133.9 per 100,000 woman-years) for early-stage tumors and fell 16% (56.1-47.2 per 100,000 woman-years) for late-stage breast cancers. Period- and cohort-age-specific incidence rates rose dramatically for early-stage tumors among women targeted for screening (ages 40-80 years), whereas rates for regional and distant stages declined modestly among women ages >50 years. Breast cancer mortality rates fell 31.6%. CONCLUSIONS: Along with increases in incidence rates for early-stage tumors, rates for late-stage disease and breast cancer mortality declined following widespread screening mammography, consistent with effective early detection and improved treatment over time. However, the disparity between the dramatic rise in early-stage tumors compared to the more modest declines in late-stage disease and mortality suggests that many mammography-derived early-stage lesions may never progress to late-stage cancers and pose a threat to life.

Adult↗
PubMed2006

Meta-analysis of survival in African American and white American patients with breast cancer: ethnicity compared with socioeconomic status.

PURPOSE: The extent to which socioeconomic disadvantages and inadequate health care access account for the disproportionately elevated mortality hazard observed in African American compared with white American patients with breast cancer is poorly defined. METHODS: We identified 20 studies reported between January 1980 and June 2005 that provided survival analyses in patients with breast cancer after adjusting for ethnicity and some measurement of socioeconomic status. These studies also adjusted for age and stage of disease at time of diagnosis. RESULTS: The pooled outcome data yielded estimates for the mortality hazard in 14,013 African American and 76,111 white American patients with breast cancer. Studies varied in their methods for assigning socioeconomic status, with most relying on area-wide measures such as census tract and census block data. The combined analysis (adjusted for age, stage, and socioeconomic status) revealed that African American ethnicity was associated with a statistically significant excess mortality risk in overall survival (mortality hazard, 1.27; 95% CI, 1.18 to 1.38) and in breast cancer-specific survival (mortality hazard, 1.19; 95% CI, 1.10 to 1.29). CONCLUSION: Our pooled analysis demonstrated that African American ethnicity is a significant and independent predictor of poor outcome from breast cancer, even after accounting for socioeconomic status by conventional measures. These findings support the need for further investigation of the biologic, genetic, and sociocultural factors that may influence survival in African American patients with breast cancer.

Black People↗
PubMed2006

Body mass index and use of mammography screening in the United States.

BACKGROUND: Obese and underweight women may be less likely to seek cancer screening because of health status, self-perception, and body image related to non-desirable weight. This study examined the relationship between body mass index (BMI) and mammography screening, using the data from the year 2000 United States National Health Interview Survey. METHODS: This study included 7692 white and 1496 black female participants aged 40-80, who were randomly selected. Body mass index (kg/m2), based on self-reported weight and height, was compared between women with and without a mammogram in the past 2 years using logistic regression. RESULTS: Compared to women with normal body mass index, underweight and extremely obese women were more likely to have no screening mammograms in the past 2 years (odds ratio (OR) = 1.8, 95% confidence interval (CI), 1.2-2.6 for underweight women; odds ratio = 1.3, 95% confidence interval, 1.0-1.8 for extremely obese women). When data were analyzed by race, the odds ratio estimates were 1.8 for underweight white women (95% confidence interval, 1.3-2.7) and 1.4 for extremely obese white women (95% confidence interval, 1.0-1.9). The corresponding odds ratio estimates were close to 1.0 for black women. CONCLUSIONS: Underweight and extreme obesity may increase the risk of underusing screening mammography. The association between body mass index especially underweight and underuse of mammography might exist primarily in white women.

Adult↗
PubMed2006

Clinical trial results applied to management of the individual cancer patient.

The application of clinical trial results to the management of the individual cancer patient is not always straightforward. The results of a clinical trial indicate the "average" effect of an intervention, often expressed in terms of an absolute risk reduction, which is an estimate of the likelihood of benefit for a particular patient. However, within any clinical trial, there might be differences between groups of patients in underlying pathology, genetics, or biology, and some patients might benefit more from a new treatment than others. Thus, within a clinical trial, it might also be useful to group together patients with similar characteristics, and test for subgroup interaction. The test for interaction will indicate whether the magnitude of benefit differs from one prognostic subgroup to the next (a quantitative interaction). Much less common are qualitative interactions, in which a new treatment is beneficial in one subgroup but harmful in another. If the test for subgroup interaction is significant, then the effects of treatment may indeed differ between subgroups of patients, but this should be confirmed in other trials before a treatment is implemented in clinical practice.

Data Interpretation, Statistical↗
PubMed2005

Breast cancer trends among black and white women in the United States.

PURPOSE: Overall US breast cancer mortality rates are higher among black women than white women, and the disparity is widening. To investigate this disparity, we examined incidence data and changes in mortality trends according to age, year of death (calendar period), and date of birth (birth cohort). Calendar period mortality trends reflect the effects of new medical interventions, whereas birth cohort mortality trends reflect alterations in risk factors. PATIENTS AND METHODS: Incidence data were obtained from the Connecticut and National Cancer Institute Surveillance, Epidemiology, and End Results registries and mortality data were obtained from the National Center for Health Statistics. Changes in age, period, and cohort mortality trends were analyzed with Poisson regression. RESULTS: For both races, breast cancer incidence rates for localized and regional disease diverged in the late 1970s. Almost concurrently, overall mortality rates diverged among blacks and whites. For both races, mortality increases with age, but blacks have higher mortality at age younger than 57. The calendar period curves revealed declining mortality for whites over the entire study period. For blacks, calendar period mortality declined until the late 1970s, and then sharply increased. After 1994, calendar period mortality declined for both. For women born between 1872 and 1950, trends in mortality were similar for blacks and whites. For women born after 1950, mortality decreased more rapidly for blacks. CONCLUSION: The widening racial disparity in breast cancer mortality seems attributable to calendar period rather than birth cohort effects. Thus, differences in response or access to newer medical interventions may largely account for these trends.

Adult↗
PubMed2005

Hazard rates of recurrence following diagnosis of primary breast cancer.

We calculated hazard rates for recurrence in patients with primary breast cancer (stage I, II; no adjuvant therapy). Previous publications have indicated a peak in hazard rates for recurrence (or death) at approximately 2-3 years after diagnosis of primary breast cancer. However, there have been conflicting reports concerning the presence of a second peak at 5-7 years after diagnosis. In this study, we estimated hazard functions by the Nelson-Aalen method and fit by cubic-linear and cubic-cubic-linear models to test for the presence of one or two peaks, respectively. We identified two peaks in hazard of recurrence, one at 2 years and another at 5 years. The 5-year peak, though statistically significant, represents very small differences in patient outcome. This additional peak may be an artifact of interval censoring due to a tendency to follow-up patients at specific bench-mark time points.

Adult↗
PubMed2005

Distinct breast cancer incidence and prognostic patterns in the NCI's SEER program: suggesting a possible link between etiology and outcome.

BACKGROUND: Breast cancer is a heterogeneous and chronic disease with relapses and death occurring 25 years or more after primary diagnosis. Standard tumor characteristics are used to predict initial relapse or death, but their ability to estimate long-term patterns of failure may be limited. METHODS: To further evaluate the significance of standard tumor features, we compared incidence and prognostic patterns in the National Cancer Institute's (NCI's) large-scale population-based Surveillance, Epidemiology, and End Results (SEER) program for high-risk versus low-risk breast cancers, i.e., size > 2.0 versus < or = 2.0 cm, lymph node positive versus negative, high versus low histologic grade, and hormone receptor negative versus positive expression, respectively. Data were stratified by age 50 years to approximate menopause. RESULTS: High-risk versus low-risk breast cancers demonstrated two very different incidence and prognostic patterns. Age-specific incidence rates among women with high-risk tumors increased until age 50 years then flattened, whereas rates among women with low-risk tumors increased continuously with aging. Hazard rates for breast cancer death spiked sharply two years following primary breast cancer diagnosis among women with high-risk but not with low-risk tumors. Paradoxically, hazard function crossed over 6-8 years following breast cancer diagnosis, with hazard rates lower for high-risk than for low-risk breast cancers. CONCLUSION: Distinct incidence and prognostic patterns among high-risk and low-risk breast cancers suggest a possible link between breast cancer etiology and outcome. These epidemiologic results appear to complement emerging molecular genetic techniques, showing distinct genotypes for high-risk and low-risk breast cancer phenotypes.

Aged↗
PubMed2005

Cancer screening.

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Age Factors↗
PubMed2005

Randomized trials of breast-conserving therapy versus mastectomy for primary breast cancer: a pooled analysis of updated results.

We have undertaken a pooled analysis of the 6 major randomized trials comparing mastectomy (MT) and breast-conserving therapy (BCT) in the treatment of primary breast cancer. Specifically, these trials compared the 2 most widely used options in local treatment: mastectomy and axillary dissection (MT) versus breast-conserving surgery, axillary dissection, and breast radiotherapy (BCT). The early results of these 6 trials formed the basis for a 1990 National Institutes of Health Consensus statement. However, most of these trials have recently published long-term follow-up results, and this pooled analysis incorporates the updated results of these 6 trials. For each of these trials, the observed number of treatment events was compared with that expected under the null hypothesis, given the number of patients per arm and the total number of events. Approximate odds ratios were computed using the observed and expected number of events, and the variance of the observed number of events. These were then pooled across trials to give overall odds ratios for the risk of locoregional recurrence, total recurrence, and death. Four of the 6 trials show that MT significantly reduces the risk of locoregional recurrence when compared with BCT, and the pooled odds ratio also shows a significant benefit for MT (odds ratio [OR], 1.561; 95% confidence interval [CI], 1.289-1.890; P < 0.001). However, only 1 trial shows a statistically significant benefit for MT in reducing mortality, and the pooled odds ratio shows no significant difference between MT and BCT (OR, 1.070; 95% CI, 0.935-1.224; P = 0.33). This pooled analysis confirms that MT and BCT have comparable effects on mortality, even after long-term follow up. However, BCT is associated with a significantly greater risk of locoregional recurrence.

Adult↗
PubMed2005

Operation Iraqi Freedom: surgical experience of the 212th Mobile Army Surgical Hospital.

Seven hundred one patients were treated at and 394 were admitted to the 212th Mobile Army Surgical Hospital in Central Iraq during the combat phase of Operation Iraqi Freedom. Ninety of those patients underwent 100 operations, with 187 procedures in 19 days. At the peak of hostilities, 48 patients were admitted, 15 operations were performed, and 56 patients were medically evacuated during different 24-hour periods. Thirty-three patients required the surgical expertise of a general or thoracic surgeon. Although 82% of injuries and 70% of the procedures were orthopedic in nature, orthopedic operating room utilization was only 60% of total operating room time (156 hours). The general and thoracic injuries were labor-intensive, frequently requiring two surgeons. Although orthopedic injury remains the predominant reason for surgical intervention on the battlefield, there remains a need to forward-deploy general and thoracic surgeons, because of the presence and complexity of nonorthopedic trauma.

Emergency Service, Hospital↗
PubMed2005

The mobile Army surgical hospital (MASH): a military and surgical legacy.

Operation Iraqi Freedom was perhaps the last military campaign that will ever utilize the services of a mobile Army surgical hospital (MASH). The Army has now essentially replaced the MASH with combat surgical hospitals (CSH) and forward surgical teams (FST). MASH units were designed as mobile, flexible, forward-deployed military hospitals, providing care for the wounded near the frontlines of the battlefield. These hospitals not only saved thousands of lives during war but also greatly influenced the delivery of trauma and critical care in civilian hospitals. The MASH was made popular by the television series of the 1970s, depicting the 4077th during the Korean War. Although a comical series, these television episodes provided viewers with a glimpse of life in a MASH during time of war. This article chronicles the history of the MASH from its inception during World War II to recent experiences in Operation Iraqi Freedom.

General Surgery↗
PubMed2003

Widening disparity in survival between white and African-American patients with breast carcinoma treated in the U. S. Department of Defense Healthcare system.

BACKGROUND: In the U. S., age-adjusted breast carcinoma mortality rates among white and African-American women have been diverging during the last 20 years. Some investigators speculate that the widening disparity is due to inequalities in access to healthcare, with African Americans having less access to necessary healthcare and improved therapies. Others argue that differences in tumor biology or some extrinsic influences on cancer etiology and behavior may account for the widening disparity. To examine this issue further, the authors compared trends in survival among white and African-American women diagnosed with breast carcinoma in the U. S. Department of Defense (DoD), an equal access healthcare system. METHODS: The medical records of all women diagnosed with primary breast carcinoma between 1980-1999 were retrieved from the U. S. DoD Automated Central Tumor Registry (ACTUR). Variables selected for further analysis were date of diagnosis, date of birth, vital status and date of death if applicable, race (black, white, and others), and stage of tumor. Because the database does not contain causes of death, overall survival was investigated. The effect of year of diagnosis and race on overall survival was analyzed using the Cox proportional hazards model stratified by age at diagnosis (1-year age groups). Calculations were performed separately by disease stage for all stages combined and stratified by stage. Statistical analyses were performed using the statistical software package SAS. RESULTS: After deleting observations with missing or implausible information regarding patient age, gender, and follow-up time, the final dataset was comprised of 23,612 women with primary breast carcinoma. The survival of African-American women compared with white women demonstrated an increasing ratio with calendar period. Although the hazard ratio was 1.269 for women diagnosed with breast carcinoma during the calendar period 1980-1984, it increased to 1.849 for those diagnosed between 1995-1999, which is a ratio of 1.46. For this period, the interaction between race and period was found to be significant (P = 0.04). CONCLUSIONS: The results of the current study demonstrated that breast carcinoma survival rates among white and African-American patients, adjusted for age and stage, are diverging in the U. S. DoD healthcare system. Thus, inequalities in access to healthcare most likely are not solely responsible for the widening racial disparities in outcome reported among women diagnosed with breast carcinoma.

Adult↗
PubMed2003

Screening clinical breast examination.

Evidence suggests that CBE detects most breast cancers found by mammograms, and also some that mammograms miss, particularly in younger women. Recent estimates suggest that screening CBE has a sensitivity of about 54% and a specificity of about 94%. Yet, the impact of screening CBE on breast cancer mortality is still not clear, as there are no trials that have reported results comparing screening CBE alone to no screening. In some countries, the costs of screening mammography are considered too high, and policy makers are considering implementing screening programs based on CBE rather than mammography. In those countries with screening mammography programs already in place, screening CBE should also be included, as this will increase the overall sensitivity of breast cancer screening. Studies have shown that community health workers can be trained to conduct screening CBE, and that trained nurses perform CBE as well as physicians. Physicians should take on the responsibility to ensure that screening CBE is performed properly, however, and that it remains an integral part of all screening mammography programs.

Adult↗
PubMed2003

Why is breast-cancer mortality declining?

Population statistics indicate that age-adjusted breast-cancer mortality rates began to decline during the early 1990s in many developed countries. For several decades before 1990, breast-cancer mortality rates in these countries had been either stable or increasing. Many investigators attribute the decline in mortality to mammography screening. However, randomised prospective trials indicate that there is a delay of 10 years before the effect of such screening can be seen in mortality statistics. In many developed countries, screening programmes were launched in the late 1980s and early 1990s, so the sudden decline in breast-cancer mortality in the early 1990s was much too soon to be attributable to mammography screening. In this review, we argue that although some of the decline in breast-cancer mortality is due to a reduction in breast-cancer risk, most of it can probably be attributed to adjuvant systemic therapy and the earlier detection of palpable tumours. We also explain why advances in the treatment of breast cancer might be outpacing the value of mammography screening. Since age-adjusted mortality rates are the most basic measure of progress in the treatment of breast cancer, we suggest that careful scrutiny of recent trends in breast-cancer mortality may provide important insights into the effectiveness of novel strategies for diagnosis and treatment.

Breast Neoplasms↗