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Biomedical subjects

V G Vogel

Publications and source records attributed to V G Vogel.

At least 37 records · Page 2Linked to original sources
PubMed1993

Clinical management of women at increased risk for breast cancer.

A large number of women in the population are at risk for the development of breast cancer. Methods now exist to accurately assess risk and to provide quantitative estimates of the chance of a woman developing breast cancer in her lifetime. Histologic assessment of premalignant breast pathology aids in the evaluation of risk. The availability of primary chemoprevention clinical trials reduces the number of indications for prophylactic mastectomy. Women at risk for breast cancer and women who have had a malignant lesion at another anatomic site have an increased risk for new cancers at multiple sites. We propose screening strategies based on epidemiologic information about the risks of these diseases and on the predictive value of the available screening tests. The merits and inadequacies of specific management strategies are considered. We review the risks and benefits of estrogen replacement therapy for women at increased risk for breast cancer and consider the ethical implications of both risk assessment and the various interventions.

Adult↗
PubMed1993

The Texas Breast Screening Project: Part I. Mammographic and clinical results.

The 1987 Texas Breast Screening Project was designed to educate women about the benefits and safety of mammographic screening. During the 2-week promotion, 109,339 women called toll-free telephone numbers to inquire about the program, and 64,459 (65%) of 99,650 eligible callers had $50 mammograms at 306 participating community radiology centers. Biopsies were obtained for 1,122 women (1.7% of those screened), and the ratio of benign to malignant biopsy results was 4.2:1. Among the women having biopsies, 214 cancers were found (3.3 cancers per 1,000 women screened). Forty-seven percent of the tumors were not palpable, 80% were smaller than 2 cm, and 72% were clinicopathologic stage 0 or I. These results show that women will respond to an invitation to attend mammographic screening, and that community radiology centers can detect large numbers of early, curable breast cancers.

Adult↗
PubMed1993

The Texas Breast Screening Project: Part II. Demographics, risk profiles, and health practices of participants.

More than 36,000 of the 64,459 women who had $50 mammograms after a media campaign in 1987 completed a demographic and risk factor questionnaire. The screened women were young and well educated with high annual incomes. Only 32% had had mammograms before 1987. Most women reported that high cost and lack of referral for mammography by their physicians were their reasons for not being screened previously. Publicity promoting the project and the lower cost for mammography were the features of the project that attracted participants. Population-based telephone surveys before and after the project showed a change in attitudes about breast cancer screening. The model used for recruitment in this project can improve compliance with recommendations for regular mammographic screening if charges for screening are reduced. Additional efforts are needed to attract minorities and poor or elderly women to regular breast screening.

Adult↗
PubMed1993

Recruiting older women for screening mammography.

We compared health behavior and attitudes of older and younger women toward breast cancer screening by using data from the 1987 Texas Breast Screening Project, a community-based, low-cost screening program sponsored by the American Cancer Society, Texas Division. Because age is an important risk factor for breast cancer, the women were categorized into three age groups: 55 to 64 years old, 65 to 74 years old, and 75 years and older. Approximately 67% of the women 75 years and older, 64% of women in the 65 to 74 age group, and 59% of the younger (55 to 64) women had never had mammography. Moreover, only 14% of the women in both the 65 to 74 and 75+ age groups and 19% of the younger women reported having two or more mammographic examinations. Fewer older women (65 to 74 and 75+ age groups) reported having recent clinical breast examination. There were no differences among the age groups in the factors that attracted the women to participate in this screening program; in the three age groups, the most influential factors to participate were media publicity and lower mammography costs. Women in all age groups reported a lack of physician referral and cost as reasons for not previously participating in mammography screening. This study shows that older women are underscreened. Educational programs about the benefits of early detection should target older women because they are at increased risk for breast cancer.

Age Factors↗
PubMed1993

Epidemiology and etiology of leukemia.

New clinical and epidemiologic studies provide information about the possible causes of human leukemia. Evidence for a viral etiology continues to appear, and the relationship between myelodysplastic syndrome and the leukemias is now linked through molecular genetic studies. Molecular mechanisms of leukemogenesis are being understood through evaluation of preleukemic conditions and predisposing medical illnesses. Epipodophyllotoxins and, to a lesser extent, cisplatin are being linked causally to secondary leukemia. Potential environmental causes of leukemia are being intensively investigated with both positive and negative results. The literature on the epidemiology of leukemia is growing rapidly, and important leads toward a more complete understanding of its etiology are emerging.

Alkylating Agents↗
PubMed1992

Breast cancer screening behaviors and attitudes in three racial/ethnic groups.

Data from a multiethnic sample of women participating in the American Cancer Society 1987 Texas Breast Screening Project was used to compare attitudes and behaviors related to breast cancer screening for whites, blacks, and Hispanics. In general, similar patterns of association were observed across racial/ethnic groups between a number of demographic and risk factors and prior mammography and recent clinical breast examination (CBE), although the magnitude of the associations varied somewhat across groups. Reasons for not having had prior mammography also were similar across groups, with lack of physician referral and cost cited as the two most important reasons. However, Hispanics were less likely than blacks or whites to report prior breast cancer screening, including mammography, CBE, and breast self-examination (BSE). This study demonstrated that women of different racial/ethnic backgrounds can be successfully recruited to participate in a patient-initiated, community-based program. However, this programmatic approach requires augmentation with other intervention strategies designed to reach low-income women because women with more years of education and higher family income were overrepresented in all three groups.

Adult↗
PubMed1992

Low incidence of familial breast cancer among Hispanic women.

There is a paucity of data on familial patterns of breast cancer among minority populations. This study compared the frequency of cancer in 1,095 first-degree relatives of 50 White, 46 Black, and 49 Hispanic breast-cancer patients referred to The University of Texas M.D. Anderson Cancer Center (United States). Family histories of cancer were derived from a self-administered questionnaire on risk factors. Expected numbers of cancers were calculated from the Connecticut Tumor Registry for White and Black relatives and from the New Mexico Tumor Registry for Hispanic relatives. Family history of a first-degree relative with breast cancer was the most important risk factor for both Black and White patients. Significantly elevated standardized incidence ratios (SIR) for breast cancer were noted among White (SIR = 4.5, 95 percent confidence interval [CI] = 1.2-11.4) and Black (SIR = 4.1, CI = 1.1-10.4) relatives younger than age 45. Despite the small number of Black patients, the combined effect of family history of breast cancer and the relative's age at diagnosis (under 45 years) was associated with an SIR of 7.1 (CI = 1.9-18.1). A deficit of cancer was noted in Hispanic women; only one patient reported having a first-degree relative with breast cancer. These findings, although based on small numbers, suggest that Hispanics have a lower rate of familial breast cancer than Whites and Blacks, and that they may possess protective factors that reduce their risk for breast cancer.

Adult↗
PubMed1992

Early detection, epidemiology, and prevention of breast cancer.

Control of breast cancer will ultimately be achieved through a better understanding of the epidemiology of the disease and application of primary prevention. Until then, use of screening mammography offers the promise of a 30% reduction in breast cancer mortality, which continues to be shown by screening studies with prolonged follow-up. Biologic markers of cancer risk, including nipple aspirates and cyst fluid, suggest that a complete risk profile can be developed using fluid and tissue obtained from the normal breast. Epidemiologic studies of dietary factors and geographic differences in breast cancer risk continue to provide promising leads relating to the etiology of the disease. Increasing evidence suggests that circulating androgens and estrogens affect breast cancer risk, whereas exogenous estrogen therapy does not increase risk except for small subgroups of women at risk. Increasing understanding of the genetics of breast cancer will have an impact on the disease in the near future. The greatest impact in the short term will come from the use of tamoxifen for primary prevention of breast cancer. The retinoids, particularly N-(4-hydroxyphenyl)retinamide, hold great promise as agents for primary prevention.

Biomarkers, Tumor↗
PubMed1992

Design and conduct of a low-cost mammography screening project: experience of the American Cancer Society, Texas Division.

To improve compliance with recommendations for screening mammography, the American Cancer Society (ACS) Texas Division designed and conducted a media-promoted screening project in 1987. The project was planned during a 2-year period by a task force made up of physicians and lay members of ACS division committees. Radiology centers desiring to participate in the project were asked to submit information about the number of patients they could screen and their equipment, along with physics data, to a review committee. Of 306 facilities that responded, 266 (87%) passed the initial review. Thirteen facilities (4%) submitted images from two examinations using a dedicated mammography phantom, and 27 sites (9%) entered the project by agreeing to adhere to the project standards and guidelines without undergoing formal review. All facilities agreed to provide mammograms for $50 to women scheduling appointments during a 2-week media campaign in February 1987. The project generated 64,459 mammographic screening examinations. Our experience indicates that a media campaign can encourage women to have screening mammograms and that screening facilities will agree to screen a large number of women at reduced cost. This strategy, if widely applied, can improve compliance with mammographic screening recommendations and reduce breast cancer mortality.

Adult↗
PubMed1991

High-risk populations as targets for breast cancer prevention trials.

Breast cancer risk factors include age; a family history of the disease in first-degree relatives (particularly if premenopausal with bilateral disease); proliferative benign breast disease with or without atypia; mammographic parenchymal pattern showing glandular, dense, dysplastic, or Wolfe P2 changes; and obesity. Women in these risk groups have annual breast cancer incidence rates 2 to 10 times higher than baseline. Using data from the National Cancer Institute SEER Program, the U.S. 1987 census estimates, and published prevalence and incidence estimates for breast cancer risk factors, estimates were made for the number of women in the white female population who are at increased risk for breast cancer and who might serve as suitable subjects for an antiestrogen chemoprevention intervention trial. More than 30 million white women are older than 50 years. Two million women older than 50 years have at least one first-degree relative with breast cancer. Six million women over age 50 have undergone breast biopsy for benign disease; one-fourth of these women have proliferative changes, and 11% also have a family history of breast cancer. More than 8 million women older than 50 years are obese, and at least a million older women have high-risk mammographic parenchymal patterns. Thus, there are at least 12 million women at increased risk for breast cancer in the United States, and each year 200,000 additional women enter the high-risk pool. These data indicate that sufficient numbers of women at increased risk for breast cancer are present in the population to justify a chemoprevention trial. The optimal recruitment strategy is yet to be identified.

Adult↗
PubMed1991

A clinical cancer prevention curriculum in a comprehensive cancer center.

Interns, residents, and medical students who spend one month at a comprehensive cancer center are presented with a strategy to incorporate cancer preventive services into their outpatient practices. This is accomplished through didactic lectures in clinical epidemiology. Terms that are essential to an understanding of disease occurrence are defined including incidence, prevalence, and mortality rate. Odds and probability are explored with the introduction of the odds ratio and the identification of risk factors. Primary and secondary cancer prevention are defined, and parameters related to cancer screening are introduced (sensitivity, specificity, prevalence, and positive predictive value). Risk factors for malignancy are identified where they are known and can be modified. Primary prevention strategies are reviewed by site along with data that support or refute recommendations for site-specific screening. Medical conditions and risk factor profiles that define high-risk groups are reviewed. Trainees are given copies of the US Preventive Services Task Force screening recommendations and a clinical handbook. The impact of this information on clinical practice patterns remains to be evaluated.

Cancer Care Facilities↗
PubMed1990

Mammographic screening of women with increased risk of breast cancer.

Five hundred one women from Dallas County, Texas who participated in the American Cancer Society 1987 Texas Breast Screening Project were selected because of a self-reported family history of breast cancer (cases). They were matched with 501 randomly selected women from the same county with no family history (controls). Although there was a statistically significant trend with age for an increasing proportion of women to report having undergone mammography, there was no significant difference when comparing mammographic histories of cases with controls after controlling for age (31.5% versus 35.1%, P = 0.33). Significantly more cases (79%) perceived their risk for breast cancer to be moderate or greater compared with controls (54%, P less than 0.0001), but mammographic histories were not different when controlling for perceived risk. Both cases and controls cited lack of physician referral and cost as their reasons for not having undergone mammography. Women at increased risk for breast cancer (because of their family history) are not undergoing regular mammographic screening despite their self-awareness of the increase in their risk.

Adult↗
PubMed1990

Inhibition of protein kinase C by the 12-O-tetradecanoylphorbol-13-acetate antagonist glycyrrhetic acid.

Glycyrrhetic acid is an anti-inflammatory agent isolated from licorice root that inhibits 12-O-tetradecanoylphorbol-13-acetate (TPA)-mediated tumor promotion in mouse skin. Although it has been established that glycyrrhetic acid inhibits a number of events induced by the phorbol ester tumor promoter TPA in cultured cells, its mechanisms of action has remained obscure. In this report, we demonstrate that glycyrrhetic acid inhibits the Ca2+-and phospholipid-dependent phosphotransferase activity of protein kinase C (PKC), the phorbol ester tumor promoter receptor. Therefore, inhibition of PKC may play a role in the anti-promoting activity of glycyrrhetic acid.

Glycyrrhetinic Acid↗
PubMed1990

Breast screening compliance following a statewide low-cost mammography project.

Public health educational campaigns can attract large numbers of one-time participants, but the impact on subsequent behavior remains unstudied. The American Cancer Society Texas Division, Inc. sponsored a statewide $50.00 mammography screening project in early 1987. More than 64,000 mammograms were completed at 306 centers; 37,000 screenees answered a 31-item questionnaire. Attitudes toward screening were assessed, and screening history was recorded. Eighteen months after the project, a follow-up questionnaire was sent to 1000 screenees; 411 women returned the questionnaires. In the year following the project, 51% of the women 50 years and older reported having a subsequent mammogram. Among the women in this group who had never had a mammogram prior to 1987, 42% had screening mammography repeated in the following year. These data show that media-based public education projects can be effective mechanisms for improving and maintaining compliance with mammography screening recommendations.

Adult↗
PubMed1989

Elevated protein kinase C expression in human breast tumor biopsies relative to normal breast tissue.

The Ca2+- and phospholipid-dependent protein kinase, protein kinase C (PKC), is a critical enzyme in the regulation of cell growth. In this report, we demonstrate elevated expression of PKC activity in surgical specimens of eight of nine spontaneous human breast tumors, as compared with the expression of PKC activity in normal breast tissue obtained from the same patients. The mean PKC specific activity in histologically normal breast tissue was 166 +/- 63 pmol 32P/min/mg, whereas the mean PKC specific activity in the breast tumors was 460 +/- 182 pmol 32P/min/mg (P = 0.0003; Student's t test). The low interpatient variability among the PKC levels observed in the histologically normal breast tissue specimens and the significant elevation of PKC levels observed in the tumors indicate that elevated expression of PKC activity in breast tissue is a potential marker for malignant disease in the breast.

Biomarkers, Tumor↗