Biomedical subjects

Michelle D Holmes

Publications and source records attributed to Michelle D Holmes.

At least 19 recordsLinked to original sources

PubMed2007

Diet and breast cancer.

Clarification of the role of diet in breast cancer pathogenesis is important in order to identify modifiable risk factors on which to focus prevention efforts. Excess weight and weight gain in adult life are related to higher risk of postmenopausal breast cancer, and weight loss after menopause is associated with substantially reduced risk. Even moderate alcohol consumption contributes considerably to excess breast cancer risk, which can likely be mitigated with adequate folate intake. Diet during early life may play a substantial role in later cancer risk, but data are limited. In addition, physical activity and the prevention of weight gain can improve survival after a breast cancer diagnosis.

Body Mass Index↗

PubMed2006

Dietary fat and risk of postmenopausal breast cancer in a 20-year follow-up.

Dietary fat in midlife has not been associated with breast cancer risk in most studies, but few have followed women beyond one decade. The authors examined the relation of dietary fat, assessed by repeated questionnaires, to incidence of postmenopausal breast cancer in a cohort of 80,375 US women (3,537 new cases) prospectively followed for 20 years between 1980 and 2000. The multivariable relative risk for an increment of 5% of energy from total dietary fat intake was 0.98 (95% confidence interval: 0.95, 1.00). Additionally, specific types of fat were not associated with an increased risk of breast cancer. Furthermore, secondary analyses indicated no differences in breast cancer risk by estrogen receptor or progesterone receptor status. However, stratification by waist circumference indicated a significant decrease in breast cancer risk for participants with a waist circumference of 35 inches (88.9 cm) or greater (p-trend = 0.04). None of the latency intervals investigated were associated with an increased risk of breast cancer. In addition, fat intake before menopause was not related to risk of postmenopausal breast cancer. These results suggest a reduction in breast cancer risk for women with insulin resistance syndrome who consume high-fat diets and no association between specific sources of fat during midlife and risk of postmenopausal breast cancer.

Aged↗

PubMed2006

Correlates of use of different types of complementary and alternative medicine by breast cancer survivors in the nurses' health study.

PURPOSE: Among breast cancer survivors, we identified the prevalence and correlates of use of different types of complementary and alternative medicine (CAM). PATIENTS AND METHODS: We included 2,022 women diagnosed with breast cancer 1998-2003 who responded to a survey about CAM use. We performed logistic regression to determine demographic and disease factors associated with use of different CAM therapies (including relaxation/imagery, spiritual healing, yoga, energy healing, acupuncture, massage, chiropractic, high-dose vitamins, herbs, and homeopathy). We also measured quality of life (QoL) using the SF36 and optimism using LOT-R and fit linear regression models to compare mean scores among CAM users and nonusers. RESULTS: Sixty-two percent of respondents used CAM. Younger age was the most consistent correlate of CAM use, but factors associated with CAM use varied by type of CAM. Chemotherapy was associated with use of relaxation/imagery (OR 1.3 95%CI 1.1-1.7). Radiotherapy was associated with use of high-dose vitamins (OR 1.5 95% CI 1.2-2.0). Tamoxifen or anastrozole treatment was associated with use of homeopathy (OR 0.5 95%CI 0.3-0.9). Users of most types of CAM had worse QoL scores than nonusers, but better QoL was found among users of yoga. The lowest QoL scores were associated with the use of energy healing. Optimism was higher among users of relaxation/imagery. CONCLUSIONS: Factors associated with CAM use varied according to type of CAM. Our finding of worse QoL among women using energy healing and better QoL among women using yoga suggests the need for longitudinal studies to determine the temporal relationships between these therapies and QoL.

Adult↗

PubMed2006

Physical activity and survival after colorectal cancer diagnosis.

PURPOSE: Physically active individuals have a lower risk of developing colorectal cancer but the influence of exercise on cancer survival is unknown. PATIENTS AND METHODS: By a prospective, observational study of 573 women with stage I to III colorectal cancer, we studied colorectal cancer-specific and overall mortality according to predefined physical activity categories before and after diagnosis and by change in activity after diagnosis. To minimize bias by occult recurrences, we excluded women who died within 6 months of their postdiagnosis physical activity assessment. RESULTS: Increasing levels of exercise after diagnosis of nonmetastatic colorectal cancer reduced cancer-specific mortality (P for trend = .008) and overall mortality (P for trend = .003). Compared with women who engaged in less than 3 metabolic equivalent task [MET] -hours per week of physical activity, those engaging in at least 18 MET-hours per week had an adjusted hazard ratio for colorectal cancer-specific mortality of 0.39 (95% CI, 0.18 to 0.82) and an adjusted hazard ratio for overall mortality of 0.43 (95% CI, 0.25 to 0.74). These results remained unchanged even after excluding women who died within 12 and 24 months of activity assessment. Prediagnosis physical activity was not predictive of mortality. Women who increased their activity (when comparing prediagnosis to postdiagnosis values) had a hazard ratio of 0.48 (95% CI, 0.24 to 0.97) for colorectal cancer deaths and a hazard ratio of 0.51 (95% CI, 0.30 to 0.85) for any-cause death, compared with those with no change in activity. CONCLUSION: Recreational physical activity after the diagnosis of stages I to III colorectal cancer may reduce the risk of colorectal cancer-specific and overall mortality.

Aged↗

PubMed2006

Prospective changes in quality of life after ductal carcinoma-in-situ: results from the Nurses' Health Study.

PURPOSE: The incidence of ductal carcinoma-in-situ (DCIS) of the breast has been increasing. However, uncertainties exist about its prognosis, optimal treatment, and effect on women's health-related quality-of-life (HRQoL). Our study assessed the prospective changes in HRQoL in women diagnosed with DCIS. PATIENTS AND METHODS: Between 1992 and 2000, HRQoL was assessed at three 4-year intervals among women enrolled in two Nurses' Health Study cohorts using the Medical Outcomes Survey Short-Form 36 health survey. Using mixed effects and logistic regression modeling, we compared the prospective changes in HRQoL scores among women with and without DCIS. RESULTS: The study included 114,728 women; 510 were diagnosed with DCIS during the study period. During 4 years, women with DCIS had small, but statistically significantly greater declines in the domains of role limitations due to physical problems (-6.74; SE, 1.69), vitality (-2.06; SE, 0.78), and social functioning (-2.40; SE, 0.93) than women without DCIS. Among those with DCIS, clinically significant declines were more often observed within 6 months of the diagnosis in the domains of social functioning (odds ratio, 1.78; 95% CI, 1.03 to 3.07) and mental health (odds ratio, 2.03; 95% CI, 1.09 to 3.79) than after 6 months after diagnosis. CONCLUSION: Women with DCIS experienced small long-term declines in HRQoL, although these declines did not seem to be clinically important. Short-term clinically significant declines in the psychosocial domains were noted. In counseling women with DCIS, clinicians should provide reassurance but prepare them to deal with the short-term sequelae.

Adult↗

PubMed2006

Milk consumption and acne in adolescent girls.

There has been a remarkable paucity of evidence for an association between diet and acne. Our previous studies suggest that there is an association between milk intake and teenage acne. This is a prospective cohort study to evaluate that relationship. We studied 6,094 girls, aged 9-15 years in 1996, who reported dietary intake on up to three food frequency questionnaires from 1996 to 1998. Presence and severity of acne was assessed by questionnaire in 1999. We computed multivariate prevalence ratios (PR) and 95 percent confidence intervals for acne. After accounting for age at baseline, height and energy intake, the multivariate PRs (95 % CI; p-value for test of trend) for acne comparing highest (2 or more servings per day) to lowest (<1 per week) intake categories in 1996, were 1.20 (1.09, 1.31; <0.001) for total milk, 1.19 (1.06, 1.32; <0.001) for whole milk, 1.17 (1.04, 1.31; 0.002) for low fat milk and 1.19 (1.08, 1.31; <0.001) for skim milk. This result did not change appreciably when we excluded girls who reported use of contraceptives and when we restricted our analysis to those younger than 11 years of age at baseline. We found a positive association between intake of milk and acne. This finding supports earlier studies and suggests that the metabolic effects of milk are sufficient to elicit biological responses in consumers.

Acne Vulgaris↗

PubMed2006

Unopposed estrogen therapy and the risk of invasive breast cancer.

BACKGROUND: Although short-term unopposed estrogen use does not seem to increase breast cancer risk, the effect of longer-term estrogen use remains unclear. We sought to assess the relationship between longer-term use of unopposed estrogen and the risk of invasive breast cancer over an extended follow-up period. METHODS: Within the Nurses' Health Study, a prospective cohort study, we observed 11 508 postmenopausal women who had a hysterectomy and reported information on estrogen use at baseline (1980). The study population was expanded every 2 years to include women who subsequently became postmenopausal and had a hysterectomy, so that 28 835 women were included in the final follow-up period (2000-2002). Estrogen use was assessed from self-reported data on biennial questionnaires. The main outcome was invasive breast cancer. RESULTS: A total of 934 invasive breast cancers were included in the analysis. Breast cancer risk increased with duration of unopposed estrogen use among longer-term users with the highest risk seen in cancers positive for estrogen receptor (ER+) and progesterone receptor (PR+). The multivariate relative risks (RRs) and 95% confidence intervals (CIs) for breast cancer with current use of unopposed estrogen for less than 5 years, 5 to 9.9 years, 10 to 14.9 years, 15 to 19.9 years, and 20 years or longer were, respectively, 0.96 (95% CI, 0.75-1.22), 0.90 (95% CI, 0.73-1.12), 1.06 (95% CI, 0.87-1.30), 1.18 (95% CI, 0.95-1.48), and 1.42 (95% CI, 1.13-1.77) (P for trend <.001). The risk of ER+/PR+ breast cancers was noted to be statistically significant after 15 years of current use (RR, 1.48; 95% CI, 1.05-2.07). CONCLUSION: Users of unopposed estrogen were at increased risk of breast cancer but only after longer-term use.

Aged↗

PubMed2006

Social networks, social support, and survival after breast cancer diagnosis.

PURPOSE: We prospectively examined social ties and survival after breast cancer diagnosis. PATIENTS AND METHODS: Participants included 2,835 women from the Nurses' Health Study who were diagnosed with stages 1 to 4 breast cancer between 1992 and 2002. Of these women, 224 deaths (107 of these related to breast cancer) accrued to the year 2004. Social networks were assessed in 1992, 1996, and 2000 with the Berkman-Syme Social Networks Index. Social support was assessed in 1992 and 2000 as the presence and availability of a confidant. Cox proportional hazards models were used in prospective analyses of social networks and support, both before and following diagnosis, and subsequent survival. RESULTS: In multivariate-adjusted analyses, women who were socially isolated before diagnosis had a subsequent 66% increased risk of all-cause mortality (HR = 1.66; 95% CI, 1.04 to 2.65) and a two-fold increased risk of breast cancer mortality (HR = 2.14; 95% CI, 1.11 to 4.12) compared with women who were socially integrated. Women without close relatives (HR = 2.65; 95% CI, 1.03 to 6.82), friends (HR = 4.06; 95% CI, 1.40 to 11.75), or living children (HR = 5.62; 95% CI, 1.20 to 26.46) had elevated risks of breast cancer mortality and of all-cause mortality compared with those with the most social ties. Neither participation in religious or community activities nor having a confidant was related to outcomes. Effect estimates were similar in analyses of postdiagnosis networks. CONCLUSION: Socially isolated women had an elevated risk of mortality after a diagnosis of breast cancer, likely because of a lack of access to care, specifically beneficial caregiving from friends, relatives, and adult children.

Adult↗

PubMed2006

Diet quality is associated with the risk of estrogen receptor-negative breast cancer in postmenopausal women.

Emerging evidence suggests that diet quality indices may serve as prognostic indicators of disease. However, the ability of these indices to predict breast cancer risk has not been evaluated previously. We assessed the association between several diet quality scores and the risk of breast cancer in postmenopausal women. The indices we used were the Healthy Eating Index (HEI), Alternate Healthy Eating Index (AHEI), Diet Quality Index-Revised (DQI-R), Recommended Food Score (RFS), and the alternate Mediterranean Diet Score (aMed). We calculated diet quality indices from dietary information collected in FFQ administered 5 times between 1984 and 1998 among women in the Nurses' Health Study cohort. Relative risks (RR) were computed using Cox proportional hazards models and adjusted for known risk factors for breast cancer. Separate analyses were conducted for estrogen receptor positive (ER+) and negative (ER-) tumors. Between 1984 and 2002, we documented 3,580 cases of breast cancer, of which 2,367 were ER+, and 575 were ER-. We did not observe any association between the diet quality indices and total or ER+ breast cancer risk. However, for ER- breast cancer, after adjusting for potential confounders, the RR comparing highest to lowest quintiles were 0.78 (95% CI=0.59-1.04, P for trend=0.01) for the AHEI, 0.69 (95% CI=0.51-0.94, P for trend=0.003) for the RFS, and 0.79 (95% CI=0.60-1.03, P for trend=0.03) for the aMed. These observations appeared to be the result of an inverse association (P for trend=0.01) with the vegetable component of the scores. We conclude that women who scored high in AHEI, RFS, and aMed had a lower risk of ER- breast cancer. The HEI and DQI-R appeared to be of limited value in predicting breast cancer risk.

Adult↗

PubMed2005

Dietary patterns and survival after breast cancer diagnosis.

PURPOSE: There is little prior study of major dietary patterns and breast cancer survival. METHODS: Patients included 2,619 Nurses' Health Study participants who were diagnosed with invasive breast cancer between 1982 and 1998 and completed a dietary questionnaire more than 1 year after diagnosis. Participants were followed through 2002 (median = 9 years). During follow-up, 414 patients died of any cause, 242 patients died of breast cancer, and 172 patients died from causes other than breast cancer. Women with in situ or metastatic disease at diagnosis were excluded. We used Cox proportional hazards models to evaluate prospective associations of prudent and Western dietary patterns assessed both before and after diagnosis with time to event after diagnosis. RESULTS: In multivariate-adjusted analyses assessed after diagnosis, the Western and prudent dietary patterns were unrelated to all-cause or breast cancer mortality. However, compared with women with the lowest intake of the prudent dietary pattern, the relative risks (and 95% CIs) of death from causes other than breast cancer were 0.85 (95% CI, 0.53 to 1.35), 0.74 (95% CI, 0.45 to 1.21), 0.70 (95% CI, 0.42 to 1.17), and 0.54 (95% CI, 0.31 to 0.95; P = .03, from lowest to highest quintile of intake). In contrast, the Western dietary pattern was positively associated with this outcome (P = .04). Results for the assessment of dietary patterns before diagnosis were similar, except the prudent dietary pattern was unrelated to mortality. CONCLUSION: A higher intake of the prudent pattern and a lower intake of the Western pattern may protect against mortality from causes unrelated to breast cancer.

Adult↗

PubMed2005

Assessment of a dietary questionnaire in cancer patients receiving cytotoxic chemotherapy.

PURPOSE: Few studies have examined the influence of diet on survival and chemotherapy-associated toxicities in patients with cancer. Although several comprehensive dietary questionnaires have been validated and calibrated in healthy populations, similar studies have not been performed among cancer patients. METHODS: Two hundred patients with colorectal, breast, or neuroendocrine cancer undergoing treatment with cytotoxic chemotherapy completed a self-administered, 131-item, semiquantitative food frequency questionnaire. Using the questionnaire, we calculated dietary intakes of carotenoids, tocopherols, and fatty acids, and correlated these values with relevant biomarkers measured in simultaneously collected plasma specimens. RESULTS: The Pearson correlation coefficients for various carotenoids as measured by the questionnaire, with the corresponding measurements in plasma specimens, ranged from 0.33 to 0.44 (all P < .001), adjusted for total energy intake, body mass index, age, sex, smoking status, and total plasma cholesterol. Similarly, the adjusted correlation between self-reported total vitamin E intake and plasma alpha-tocopherol was 0.34 (P < .001). Correlations between questionnaire and plasma measurements of trans-fat, eicosapentaenoic acid, and docosahexaenoic acid were 0.55, 0.29, and 0.42 (all P < .001), respectively. These levels of correlation are consistent with those reported in similar studies of self-reported diet in otherwise healthy populations. CONCLUSION: Among patients with cancer receiving cytotoxic chemotherapy, questionnaire-based measurements of various micronutrients and dietary factors appeared to predict meaningful differences in the corresponding measurements in plasma specimens. This dietary questionnaire could offer an informative and practical means for assessing the influence of diet in cancer patients receiving chemotherapy.

Adult↗

PubMed2005

Depressive symptoms and prospective incidence of colorectal cancer in women.

The authors examined depressive symptoms and prospective incidence of colorectal cancer and distal colorectal adenomas in 81,612 women without prior cancer from the Nurses' Health Study; 400 cases of colorectal cancer and 680 distal colorectal adenomas accrued between 1992 and the year 2000. Depressive symptoms were assessed in 1992 and 1996 with the five-question Mental Health Index (MHI-5), a subscale of the Short-Form 36 health status survey. Scores ranged from 0 to 100, and women with scores between 0 and 52 were defined as having significant depressive symptomatology. The authors also created four categories across the range of Mental Health Index scores: 0-52, 53-75, 76-85, and 86-100 (referent). Cox proportional hazards models were used to analyze the extent of depressive symptoms and colorectal events. Analyses were stratified by body mass index. In multivariate analyses with updated exposure, women with the highest levels of depressive symptoms had an elevated risk of incident colorectal cancer (hazard ratio = 1.43, 95% confidence interval: 0.97, 2.11) compared with women with the lowest levels of symptoms (p(trend) = 0.04). Associations appeared stronger in overweight women. However, depressive symptoms were unrelated to risk of colorectal adenomas. Associations are consistent with a possible role in late promotion of the disease.

Adenoma↗

PubMed2005

Dietary patterns and the risk of postmenopausal breast cancer.

The association between individual foods and breast cancer has been inconsistent. Therefore, we examined the association between diet and risk of postmenopausal breast cancer by the alternative approach of dietary patterns. Dietary patterns were identified with factor analysis from food consumption data collected from a food frequency questionnaire in 1984. Relative risks were computed using proportional hazard models and adjusted for known risk factors for breast cancer. Between 1984 and 2000, we ascertained 3,026 incident cases of postmenopausal breast cancer. We identified 2 major dietary patterns. The prudent pattern is characterized by higher intake of fruits, vegetables, whole grains, low-fat dairy products, fish and poultry, while the Western pattern is characterized by higher intake of red and processed meats, refined grains, sweets and desserts and high-fat dairy products. Neither of the patterns was associated with overall risk of postmenopausal breast cancer. However, a positive association between the Western pattern score was observed among smokers at baseline (relative risk = 1.44, comparing top to bottom quintiles; 95% CI = 1.02-2.03; p for trend = 0.03). An inverse association was observed between the prudent pattern and estrogen receptor-negative cancer (relative risk = 0.62; 95% CI = 0.45-0.88; p for trend = 0.006). Among the major food groups, higher consumptions of fruits (relative risk for 1 serving/day increase = 0.88; 95% CI = 0.80-0.97; p = 0.009) and vegetables (relative risk = 0.94; 95% CI = 0.88-0.99; p = 0.03) were significantly associated with decreased risk for ER(-) breast cancer. In conclusion, we did not observe an overall association between the prudent or Western pattern and overall breast cancer risk. However, a Western-type diet may elevate risk of breast cancer among smokers, and a prudent diet may protect against estrogen receptive-negative tumors.

Breast Neoplasms↗

PubMed2005

Physical activity and survival after breast cancer diagnosis.

CONTEXT: Physical activity has been shown to decrease the incidence of breast cancer, but the effect on recurrence or survival after a breast cancer diagnosis is not known. OBJECTIVE: To determine whether physical activity among women with breast cancer decreases their risk of death from breast cancer compared with more sedentary women. DESIGN, SETTING, AND PARTICIPANTS: Prospective observational study based on responses from 2987 female registered nurses in the Nurses' Health Study who were diagnosed with stage I, II, or III breast cancer between 1984 and 1998 and who were followed up until death or June 2002, whichever came first. MAIN OUTCOME MEASURE: Breast cancer mortality risk according to physical activity category (<3, 3-8.9, 9-14.9, 15-23.9, or > or =24 metabolic equivalent task [MET] hours per week). RESULTS: Compared with women who engaged in less than 3 MET-hours per week of physical activity, the adjusted relative risk (RR) of death from breast cancer was 0.80 (95% confidence interval [CI], 0.60-1.06) for 3 to 8.9 MET-hours per week; 0.50 (95% CI, 0.31-0.82) for 9 to 14.9 MET-hours per week; 0.56 (95% CI, 0.38-0.84) for 15 to 23.9 MET-hours per week; and 0.60 (95% CI, 0.40-0.89) for 24 or more MET-hours per week (P for trend = .004). Three MET-hours is equivalent to walking at average pace of 2 to 2.9 mph for 1 hour. The benefit of physical activity was particularly apparent among women with hormone-responsive tumors. The RR of breast cancer death for women with hormone-responsive tumors who engaged in 9 or more MET-hours per week of activity compared with women with hormone-responsive tumors who engaged in less than 9 MET-hours per week was 0.50 (95% CI, 0.34-0.74). Compared with women who engaged in less than 3 MET-hours per week of activity, the absolute unadjusted mortality risk reduction was 6% at 10 years for women who engaged in 9 or more MET-hours per week. CONCLUSIONS: Physical activity after a breast cancer diagnosis may reduce the risk of death from this disease. The greatest benefit occurred in women who performed the equivalent of walking 3 to 5 hours per week at an average pace, with little evidence of a correlation between increased benefit and greater energy expenditure. Women with breast cancer who follow US physical activity recommendations may improve their survival.

Breast Neoplasms↗

PubMed2005

Dietary flavonols and flavonol-rich foods intake and the risk of breast cancer.

Laboratory and animal studies suggest that dietary flavonols may reduce breast cancer risk but there are limited epidemiological studies. We computed flavonol intakes from dietary data collected by validated food frequency questionnaires in 1991 and 1995 from 90,630 women in the Nurses Health Study II. Using multivariate relative risks (RR) and 95% confidence intervals (95% CI), we evaluated the association of flavonol intake with breast cancer risk in women who were premenopausal and aged between 26 and 46 years at baseline in 1991. During 8 years of follow-up, we documented 710 cases of invasive breast cancer. The multivariate RR (95% CI), comparing highest to lowest quintiles of cumulative average intake, was 1.05 (0.83, 1.34; p-value for test of trend=0.96) for the sum of flavonols and there were no associations seen between individual flavonols such as kaempferol, quercetin and myricetin and breast cancer risk. The multivariate RR (95% CI), comparing highest to lowest quintiles of cumulative average intake, was 0.94 (0.72, 1.22; p-value for test of trend=0.54) for sum of flavonol-rich foods. Among the major food sources of flavonols, we found a significant inverse association with intake of beans or lentils but not with tea, onions, apples, string beans, broccoli, green pepper and blueberries. The multivariate RR (95% CI), comparing the highest category (2 or more times a week) of cumulative average beans or lentils intake with the lowest category (less than once a month), was 0.76 (0.57, 1.00; p-value for test of trend=0.03). While we found no overall association between intake of flavonols and risk of breast cancer, there was an inverse association with intake of beans or lentils that merits further evaluation.

Adult↗

PubMed2005

Weight, weight gain, and survival after breast cancer diagnosis.

PURPOSE: To determine whether weight prior to diagnosis and weight gain after diagnosis are predictive of breast cancer survival. METHODS: Patients included 5,204 Nurses' Health Study participants diagnosed with incident, invasive, nonmetastatic breast cancer between 1976 and 2000; 860 total deaths, 533 breast cancer deaths, and 681 recurrences (defined as secondary lung, brain, bone, or liver cancer, and death from breast cancer) accrued to 2002. We computed the change in body mass index (BMI) from before to the first BMI reported > or = 12 months after the date of diagnosis. Cox proportional hazards models were used to evaluate associations of categories of BMI before diagnosis and of BMI change with time to event. We stratified by smoking, menopausal status, and breast cancer-related variables. RESULTS: In multivariate-adjusted analyses, weight before diagnosis was positively associated with breast cancer recurrence and death, but this was apparent only in never smokers. Similarly, among never-smoking women, those who gained between 0.5 and 2.0 kg/m(2) (median gain, 6.0 lb; relative risk [RR], 1.35; 95% CI, 0.93 to 1.95) or more than 2.0 kg/m(2) (median gain, 17.0 lb; RR, 1.64; 95% CI, 1.07 to 2.51) after diagnosis had an elevated risk of breast cancer death during follow-up (median, 9 years), compared with women who maintained their weight (test for linear trend, P = .03). Associations with weight were stronger in premenopausal than in postmenopausal women. Similar findings were noted for breast cancer recurrence and all-cause mortality. CONCLUSION: Weight and weight gain were related to higher rates of breast cancer recurrence and mortality, but associations were most apparent in never-smoking women.

Adult↗

PubMed2005

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.

Adult↗

PubMed2005

Dietary patterns and the risk of breast cancer.

PURPOSE: Ecologic, migrant, and secular trend studies suggest an association between the Western diet and the risk of breast cancer. We examined data from the Nurses Health Study II to evaluate the association between major dietary patterns and the risk of breast cancer among pre-menopausal women. METHODS: We derived "Western" and "prudent" dietary patterns from the responses of 90,638 premenopausal women, aged 26 to 46 years at baseline in 1991, who completed validated food frequency questionnaires in 1991 and 1995. These patterns were then evaluated for their associations with risk of breast cancer. RESULTS: During 8 years of follow-up, we documented 710 cases of invasive breast cancer. The multivariate RR (95% CI) comparing highest to lowest quintiles of cumulative average score were 0.90 (0.68-1.18, p-value, test for trend = 0.54) for the prudent dietary pattern and 0.97 (0.71-1.33, p-value, test for trend = 0.97) for the Western dietary pattern. CONCLUSIONS: Our findings suggest that there is no overall association between dietary patterns and risk of breast cancer. However, we found an inverse association between the prudent dietary pattern and breast cancer risk among ever smokers, but the test for interaction was not significant. We suggest that this finding merits further evaluation.

Adult↗