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PubMed1996

[Biology of solid cancers: breast cancer as an example. First part: genetic systems implicated in carcinogenesis].

There are two main categories of genes involved in cancer: protoconcogenes and tumor suppressor genes. The development of cancer can require the production of several successive gene accidents within a given cell. Most of these alterations appear to be somatic changes. Only one of these two steps would involve germinal processes and only in hereditary tumors. When altered, these genes, implicated in cell proliferation, differentiation and normal cell death, contribute to the initiation and/or the progression of tumors. Other genes have an indirect effect on the malignant transformation and thus complete the action of oncogenes and suppressor genes at certain stages of cancerogenesis. The genes implicated in individual susceptibility to cancer is an example (genes coding for DNA repair enzymes and for proteins which inactivate exogenous cancerogenenic agents. Others are genes coding for growth factors and angiogenic factors, genes involved in metastatic dissemination including those which code for proteases and adherence proteins, and finally genes affecting chemoresistance.

Breast Neoplasms↗
PubMed2003

External breast prosthesis use: experiences and views of women with breast cancer, breast care nurses, and prosthesis fitters.

After mastectomy, the provision of an appropriate breast prosthesis can help to improve body image and quality of life and reduce associated emotional distress. Although up to 90% of women use an external breast prosthesis after mastectomy, little is known about their experiences and satisfaction with breast prosthesis use. Focus groups were conducted with women who had been fitted with an external breast prosthesis, breast care nurses, and prosthesis fitters to explore women's experiences of prosthesis use. Qualitative thematic content analysis of focus group transcripts indicated that whereas women's initial reaction to the prosthesis generally was negative, this improved over time. Provision of adequate information and support, characteristics of the fitter and the fitting experience, and relationships with breast care nurses and prosthesis fitters were important to women's acceptance and satisfaction with their prosthesis. The study results highlighted the key role that breast care nurses play and the underestimation of the prosthesis fitter's role. Common themes concerning the impact of prosthesis use included body image, appearance, and feminine identity. These findings have important implications for professionals involved in the delivery of breast prostheses services.

Adaptation, Psychological↗
PubMed2003

[Value of radiotherapy in breast cancer. Breast preservation rises to 80%].

The indication for radiotherapy for mamma carcinoma is determined in particular by the macroscopic and microscopic tumor findings, the number of lymph nodes identified, receptor status, the surgical report and (neo)adjuvant chemotherapy. Irradiation is applied in particular in conjunction with breast-preserving first-line treatment in the case of ductal in situ carcinomas, and postoperatively following breast conservation in the case of invasive mamma carcinoma. The indication for irradiation following mastectomy is controversial and is determined by tumor size and location, together with further factors (see the Guidelines of the German Society of Senology). The indications applying to the irradiation of regional lymph nodes are determined by the sites of the respective metastases. The combination of radio- and chemotherapy is carried out in close cooperation between oncologists and radiologists.

Breast Neoplasms↗
PubMed1995

[Plastic surgery in the context of surgery for breast cancer. Breast reconstruction using the patient's own tissue].

The breast reconstructions after mastectomies are overviewed. The criteria of a successful operation are discussed. The result of breast reconstruction with latissimus dorsi and rectus abdominis musculocutaneous flaps are presented. The spectrum of 106 breast reconstructions of from 1987 to 1993 is published. The methods of adequate reconstructions mall, middle size and large breasts are discussed. With the reconstruction of large breasts the best results have been achieved by the transfer of rectus abdominis musculocutaneous flap with micro vascular anastomoses. This flap has the best blood supply and this procedure causes the less damage to the donor area. It is stated that the breast reconstructions with living tissues are superior and preferable.

Abdominal Muscles↗
PubMed2005

CYP17 genetic polymorphism, breast cancer, and breast cancer risk factors: Australian Breast Cancer Family Study.

INTRODUCTION: Because CYP17 can influence the degree of exposure of breast tissues to oestrogen, the interaction between polymorphisms in this gene and hormonal risk factors is of particular interest. We attempted to replicate the findings of studies assessing such interactions with the -34T-->C polymorphism. METHODS: Risk factor and CYP17 genotyping data were derived from a large Australian population-based case-control-family study of 1,284 breast cancer cases and 679 controls. Crude and adjusted odds ratio (OR) estimates and 95% confidence intervals (CIs) were calculated by unconditional logistic regression analyses. RESULTS: We found no associations between the CYP17 genotype and breast cancer overall. Premenopausal controls with A2/A2 genotype had a later age at menarche (P < 0.01). The only associations near statistical significance were that postmenopausal women with A1/A1 (wild-type) genotype had an increased risk of breast cancer if they had ever used hormone replacement therapy (OR 2.40, 95% CI 1.0 to 5.7; P = 0.05) and if they had menopause after age 47 years (OR 2.59, 95% CI 1.0 to 7.0; P = 0.06). We found no associations in common with any other studies, and no evidence for interactions. CONCLUSION: We observed no evidence of effect modification of reproductive risk factors by CYP17 genotype, although the experiment did not have sufficient statistical power to detect small main effects and modest effects in subgroups. Associations found only in subgroup analyses based on relatively small numbers require cautious interpretation without confirmation by other studies. This emphasizes the need for replication in multiple and large population-based studies to provide convincing evidence for gene-environment interactions.

Adult↗
PubMed2003

Risk of breast cancer and breast cancer characteristics in women treated with supradiaphragmatic radiation for Hodgkin lymphoma: Mayo Clinic experience.

OBJECTIVE: To evaluate the overall risk of breast cancer and breast cancer characteristics in women given supradiaphragmatic radiation therapy for Hodgkin lymphoma. PATIENTS AND METHODS: Medical records of 653 female patients who received supradiaphragmatic radiation therapy for Hodgkin lymphoma at the Mayo Clinic in Rochester, Minn, between 1950 and 1993 were abstracted, and follow-up questionnaires were mailed. In 4 patients, breast cancer was diagnosed before Hodgkin lymphoma was discovered. RESULTS: The median age of 649 patients at supradiaphragmatic radiation therapy was 31.8 years (range, 2.6-86.5 years). The median duration of follow-up was 8.7 years (range, < 1-47.9 years). In 30 patients, breast cancer developed (bilaterally in 4 patients) after supradiaphragmatic radiation therapy; the median interval was 19.9 years (range, 0.7-423 years). The median age at breast cancer diagnosis was 44.4 years (range, 27.5-70.8 years). The standardized morbidity ratio for breast cancer after supradiaphragmatic radiation therapy was 2.9 (95 % confidence interval [CI], 2.0-4.2) (P < .001). Breast cancer risk significantly increased 15 to 30 years after patients received supradiaphragmatic radiation therapy, and risk was inversely related to age at supradiaphragmatic radiation therapy until age 30 years. The standardized morbidity ratio for patients younger than 30 years at supradiaphragmatic radiation was 8.5 (95% CI, 53-13.1) vs 1.2 (95% CI, 0.5-2.2) for those aged 30 years or older (P < .001). Splenectomy increased breast cancer risk (P = .01). Breast cancer detection was by self-examination in 15 cancers, by mammography in 13, and by clinical examination in 4; in 2 cancers, the mode of detection was unknown. Modified radical mastectomy was used to treat breast cancer. CONCLUSION: The increased risk of breast cancer in survivors of Hodgkin lymphoma given supradiaphragmatic radiation therapy appears to be limited to patients who are younger than 30 years at radiation therapy or to those who have undergone splenectomy.

Adult↗
PubMed2004

Risk of breast cancer and breast cancer characteristics in women after treatment for Hodgkin lymphoma.

Radiotherapy is important in the treatment of Hodgkin lymphoma. Although the risk of recurrent Hodgkin lymphoma decreases in long-term survivors, the incidence of radiation-induced cancers increases with time. Breast cancer is the main long-term concern for women. Risk factors associated with breast cancer development include age at irradiation, time since treatment and radiation dose received. The risk of developing breast cancer appears to be limited to women treated before age 30 years. The median time to breast cancer after radiotherapy is 15 years. Higher radiation doses are associated with higher risks. While the histology of breast cancers occurring after treatment for Hodgkin lymphoma appears similar to that of spontaneously occurring breast cancers, the age at diagnosis in these women is significantly younger, often at an age before regular breast screening is implemented. In this article, we review findings from retrospective studies on Hodgkin lymphoma and breast cancer including the risk factors, breast cancer characteristics, breast cancer management and options for primary and secondary prevention. The treatment goals for young female patients with Hodgkin lymphoma include: 1) manipulation of radiation dose and fields without compromising the outcome of the primary malignancy; 2) possible reversible manipulation of hormonal status without permanent effects on fertility; and 3) development of nonsurgical options for primary prevention of radiation-induced breast cancers. Carefully designed studies addressing these strategies and their interplay are needed.

Age Factors↗
PubMed2006

Korean immigrant women's meanings of breast, breast cancer, and breast cancer screenings.

PURPOSE: Koreans are one of the fastest growing Asian populations in the U.S. since 1960s. In Korean immigrant women (KIW), breast cancer was reported as the most frequently diagnosed cancer. However, their screening rates for breast cancer are lower than national guidelines; it is assumed that underlying cultural schemas of breast, breast cancer, and its screening modalities exist and need to be studied. This study was aimed to investigate cultural meanings of breast, breast cancer, and breast cancer screenings in KIW. METHODS: Using cultural models theory from cognitive anthropology, naturalistic qualitative methodology was utilized. Three focus group interviews with fifteen KIW were conducted. Thematic analysis with constant comparison technique was performed eliciting units of meaning, categories, and themes. RESULTS: The cultural schema of the meaning of breast is "mother who is breast-feeding her baby," with two themes of "balance in size," and "shyness." Regarding breast cancer, three themes, i.e., "indifference," "fear," and "uncertainty" are emerged. "Lack of information about screening modalities" is the overarching schema with reference to breast cancer screenings. CONCLUSIONS: The findings of this study demonstrate unique cultural models of KIW related to breast cancer and its screenings, which are critical to understand and penetrate their barriers to breast cancer screening.

Adult↗
PubMed1994

Economically disadvantaged females' perceptions of breast cancer and breast cancer screening.

This study examined 500 economically disadvantaged females' perceptions and screening practices regarding breast cancer. The vast majority of respondents did not identify themselves, or economically disadvantaged women in general, as more susceptible to breast cancer. Those who were the most knowledgeable about breast cancer were significantly more likely than the least knowledgeable to perceive themselves as more susceptible to breast cancer, to perceive breast cancer as less severe, to perceive fewer barriers, and to perceive more benefits to screening for breast cancer. Fifty-four percent of the women claimed they had previously had a mammogram. A series of t-tests were conducted to see if breast cancer knowledge or health beliefs would discriminate between those who had and those who had not had a mammogram. The only difference between the two groups was that those who had a mammogram were more likely to perceive greater benefits of mammography screening. The results of this survey indicate that there is considerable room for improvement in knowledge, perceptions, and practices of economically disadvantaged women regarding breast cancer.

Adult↗
PubMed1996

Family History of Breast Cancer and Breast Cancer Risk in Japan.

We studied 132 families with a family history of breast cancer (familial aggregation cases, FA cases) to assess the breast cancer risk presented by such a family history. For comparison with these FA cases, we randomly selected 132 control families of sporadic cases (SP controls) by adjusting for the age of the proband at surgery. Information on family history was collected for all first-degree female relatives and maternal and paternal grandmothers. Japanese women with a first-degree relative affected by breast cancer were found to have an increased risk of the disease. The odds ratio (OR) for women with a family history of breast cancer was 1.99 (95% confidence interval [ CI ], 1.48-2.66). The OR for FA-case doughters of women with breast cancer was 1.54 (95% CI, 0.91-2.63). A higher risk was not observed if a woman's mother had breast cancer. If the proband had a sister with breast cancer, a slightly increased risk of other cancers of the proband was observed (OR, 1.85 [ 0.87-3.92]). These results suggest that a family history of breast cancer in Japanese women may affect their risk of developing cancer of the breast and other organs.

Journal Article↗
PubMed1994

Psychological and psychosocial aspects of breast cancer and breast cancer treatment. A literature review.

The aim of the investigation was to study psychological and psychosocial aspects of breast cancer. A literature search was done covering the period 1989-1992. The following research areas were studied: the relationship between psychological characteristics and breast cancer, and between psychosocial interventions and breast cancer; quality of life after breast cancer surgery and treatment; and the relationship between social support and breast cancer. The results showed that the medical community is divided into "believers" and "nonbelievers" with respect to whether or not psychosocial factors influence breast cancer outcomes. One of the best predictors of a women's postcancer adjustment is her psychological state before the breast cancer. The results also showed that the difference in psychological outcome between mastectomy and breast-conserving surgery was small and nonsignificant. Another finding was that the social context and social support from partner, family, friends, relatives and medical professions are important for survival. In conclusion, methodological problems were common in studying psychological and psychosocial aspects of breast cancer.

Breast Neoplasms↗
PubMed1996

Prospective study of relative weight and risk of breast cancer: the Breast Cancer Detection Demonstration Project follow-up study, 1979 to 1987-1989.

Despite extensive research on obesity and breast cancer in recent decades, inconsistencies in the literature exist. The authors examined prospectively the relation between adult relative weight (weight (kg)/height (m)1.5) and breast cancer risk in a cohort of 54,896 women aged 31-89 years who had previously participated in the Breast Cancer Detection Demonstration Project. During a mean follow-up period of 7 years, 226 of the premenopausal women and 1,198 of the postmenopausal women developed breast cancer. Analysis was performed using Cox proportional hazards regression methods with age as the underlying time variable and adjusted for the effects of potential confounders. Among postmenopausal women, the risk of breast cancer increased with increasing relative weight (p < 0.05 for trend); relative risk for the highest compared with the lowest quintile for relative weight was 1.3 (95% confidence interval (CI) 1.1-1.6). This association was modified by age at diagnosis, with relative risks of 1.1 (95% CI 0.8-1.4), 1.2 (95% CI 0.8-1.7), and 1.8 (95% CI 1.3-2.5), respectively, for women aged < 60, 60-64, and > or = 65 years. The higher risk of breast cancer among the older and overweight women was largely confined to women whose weights were measured during the postmenopausal but not the premenopausal period. This risk pattern was observed among the naturally menopausal women, but was also apparent in the smaller group of women with bilateral oophorectomy or hysterectomy with one ovary retained. Among premenopausal women, adult relative weight was not associated with breast cancer risk. These findings suggest that the inconsistencies in the literature on obesity and breast cancer may be due in part to the differing age distributions of the populations studied. The authors conclude that prevention of obesity throughout adulthood, particularly after menopause, may help reduce breast cancer among older women.

Adult↗
PubMed1985

Non-protein bound oestradiol, sex hormone binding globulin, breast cancer and breast cancer risk.

It has recently been found by various authors that despite a normal serum concentration of oestradiol (E2), the percentage of non-protein-bound or free E2 is abnormally high in breast cancer patients. Since it is the free E2 which is considered to be biologically active, confirmation of this finding would be most relevant to the pathogenesis of breast cancer. Using Hammond's centrifugal ultrafiltration dialysis method we have measured free E2 in heparinized plasma from 68 premenopausal women (a) at high familial risk of breast cancer (n = 18), (b) with benign breast disease (n = 17), (c) cured of T1N0M0 breast cancer at least 6 months previously (n = 17) and (d) normal controls matched for age, parity and Quetelet index (n = 16). Sex hormone binding globulin (SHBG) was measured as [3H]-dihydrotestosterone binding capacity. Free E2 and SHBG were also measured in the serum of (e) postmenopausal patients having breast cancer (n = 38) and (f) matched control cancer patients (n = 67). We confirmed a very good inverse correlation between log free E2 per cent and log SHBG (P less than 0.0001). The regression lines for groups (a)-(d) were not statistically different. The regression lines for groups (e) and (f) were identical and ran nearly parallel to those for groups (a)-(d) though somewhat lower. This small difference may be ascribed to menopausal status. Therefore, we found no difference in free E2 percentage, calculated free E2 concentration or SHBG between premenopausal women at risk, women with benign breast disease, patients cured for early breast cancer or having breast cancer and matched controls. However, postmenopausal breast cancer patients had a significantly higher total serum E2 concentration and, by consequence a higher calculated free E2 concentration compared to the carefully matched control group.

Adult↗