EUROPA DONNA: has strength in its heterogeneity

EUROPA DONNA, a non-profit-making organisation, is a pan-European movement against breast cancer; it is a coalition that is active in 29 countries, each organised into national independent Fora. In each Forum, a postal survey was conducted between 2001 and 2002. A standardised questionnaire was used to collect information about Forum characteristics and activities, and perceptions of the adequacy of the local health service in relation to the prevention, diagnosis and treatment of breast cancer. Twenty-seven Fora (93%) participated in the survey. The results show the heterogeneity between the Fora in the services offered and activities in the different countries. The Fora also perceived a range of deficiencies in the prevention, diagnosis and treatment of breast cancer within their national health systems. These results highlight the importance of a coalition to establish a consensus among the Fora, and the need for coordinated initiatives in different European countries.     

Socio‐demographic predictors of high support needs in newly diagnosed breast cancer patients

GRIESSER A.‐C., VLASTOS G., MOREL L., BEAUME C., SAPPINO A.‐P. & HALLER G. (2010) European Journal of Cancer Care
Socio‐demographic predictors of high support needs in newly diagnosed breast cancer patients This study aimed to identify high support needs and their socio‐demographic predictors to improve supportive care for newly diagnosed breast cancer patients. A cross‐sectional study measured patients' needs and unsatisfied support needs by the supportive care needs survey (SCNS‐34), administered after surgery, chemotherapy or radiotherapy. Socio‐demographic, disease and treatment characteristics completed data collection. A total of 308 questionnaires were completed with a response rate of 88%. The most frequent support needs (73.3% of patients) related to information and the highest unsatisfied support needs to the management of emotions and daily life (36.3–39.6% of patients). Younger age predicted high and dissatisfied support needs (P < 0.05). Patients born outside Switzerland or with a lower level of education had more needs in daily living and psychological domains (P < 0.05). Being born outside Switzerland also predicted dissatisfaction with information provided. Being parent was a predictor of significant needs in the daily living domain after adjusting for disease and treatment characteristics (P= 0.01). Therefore, information, psychological and daily living support for newly diagnosed breast cancer patients should be strongly reinforced, particularly in patients being born outside Switzerland, those with children or being younger. For the latter, support in sexuality domain should also be emphasised.     

The mobile phone as a tool in improving cancer care in Nigeria

Objective: The use of mobile phone as a tool for improving cancer care in a low resource setting. Methods: A total of 1176 oncology patients participated in the study. Majority had breast cancer. 58.4% of the patients had no formal education; 10.7 and 9.5% of patients had college or graduate education respectively. Two out of every three patients lived greater than 200 km from hospital or clinic. One half of patients rented a phone to call. Results: At 24 months, 97.6% (1132 patients) had sustained their follow‐up appointments as against 19.2% (42 patients) who did not receive the phone intervention. 72.8% (14 102 calls) were to discuss illness/treatment. 14% of the calls were rated as emergency by the oncologist. 86.2% of patients found the use of mobile phone convenient/excellent/cheap. 97.6% found the use of the phone worthwhile and preferred the phone to traveling long distance to hospital/clinic. Also the patients felt that they had not been forgotten by their doctors and were been taken care of outside the hospital/clinic. Conclusions: Low resource countries faced with the burden of cancer care, poor patient follow‐up and poor psychosocial support can cash in on this to overcome the persistent problem of poor communication in their healthcare delivery. The potential is enormous to enhance the use of mobile phones in novel ways: developing helpline numbers that can be called for cancer information from prevention to treatment to palliative care. The ability to reach out by mobile phone to a reliable source for medical information about cancer is something that the international community, having experience with helplines, should undertake with colleagues in Africa, who are experimenting with the mobile phone potential. Copyright © 2011 John Wiley & Sons, Ltd.     

Red and processed meat,nitrite, and heme iron intakes and postmenopausal breast cancer risk in the NIH‐AARP Diet and Health Study

Previous studies have shown inconsistent associations between red and processed meat intake and breast cancer risk. N‐nitroso compounds and heme iron have been hypothesized as contributing factors. We followed 193,742 postmenopausal women in the NIH‐AARP Diet and Health Study and identified 9,305 incident breast cancers (1995–2006). Dietary intake was assessed using a food frequency questionnaire at baseline. We adjusted daily intakes of meat, nitrite and heme iron for energy intake using the nutrient density method. We estimated multivariable‐adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) by quintiles of dietary exposures for all breast cancer, by stage (in‐situ, localized, regional/distant) and by estrogen/progesterone receptor (ER/PR) status using Cox proportional hazards regression. Total red meat intake was positively associated with risk of regional/distant cancer (p‐trend = 0.02). The risk was 25% higher in the highest vs. lowest intake quintile (95% CI = 1.03–1.52). Higher processed red meat intake (Q5 vs. Q1) was associated with 27% higher risk of localized breast cancer (95% CI = 1.01–1.27, p‐trend = 0.03) and a 19% higher risk of regional/distant cancer (95% CI = 0.98–1.44, p‐trend = 0.10). In addition, higher nitrite intake from processed red meat was positively associated with localized cancer (HR for Q5 vs. Q1 = 1.23, 95% CI = 1.09–1.39, p‐trend < 0.0001). Heme iron intake was positively associated with breast cancer risk overall and all cancer stages (p‐trend = 0.02–0.05). No heterogeneity was observed in risk associations by hormone receptor status. Our findings suggest that high consumption of red meat and processed meat may increase risk of postmenopausal breast cancer. Added nitrite and heme iron may partly contribute to these observed associations.     

Loss,uncertainty, or acceptance: subjective experience of changes to fertility after breast cancer

This qualitative study examines the subjective experience of infertility in a large sample of Australian women with breast cancer. Participants were 1830 women, average age 54, who responded to an email invitation to complete an online survey on sexual well‐being and fertility concerns after breast cancer. 24.6% (n = 452) reported that cancer had affected their fertility; 21.3% (n = 391) did not know their fertility status. In thematic analysis of open‐ended responses provided by 381 women about changes to fertility status, reactions to infertility, and experiences of information and interventions to assist fertility, five themes were identified: ‘Negative responses to infertility and early menopause’; ‘Sexual changes associated with menopause and infertility’; ‘Uncertainty and anxiety about fertility status’; ‘Information and fertility preservation’; ‘Acceptance of the end of fertility’. These findings confirm previous reports that infertility and premature menopause are a significant cause of anxiety for many women with breast cancer. However, some women closer to natural menopause, or who had completed their families, reported acceptance of changed fertility status. Accounts of deficits in information provision and fertility counselling suggest an urgent need for accessible and comprehensive information about fertility and cancer to be developed and evaluated, as well as education and training of health professionals in addressing fertility concerns following cancer.     

Interest in a group psychotherapy program among Philippine breast cancer patients and its associated factors

Objective: A wide variety of psychosocial interventions are available for cancer patients, among which group psychotherapy (GPT) programs have made improvements in cancer patients' quality of life, coping abilities, and emotional distress. Few research data are available describing Philippine breast cancer patients' interest in GPT. This study aimed at enumerating the factors that determine Philippine breast cancer patients' interest in a GPT program. Methods: Patients recruited from the University of Santo Tomas Hospital Benavides Cancer Institute were asked to answer a survey questionnaire about their demographic, clinical, and psychosocial status, as well as whether they would be interested in joining GPT and why. Results: Of 135 patients approached, 123 patients completed the survey. 104 (85%) women indicated interest in GPT. Patients were mostly interested because they wanted to learn coping skills (79%) and gain knowledge or information in dealing with cancer (69%). Patients said they were ‘very interested’ in learning about cancer recurrence (96%) and treatments (94%). Bivariate analysis showed that compared to the uninterested group, interested patients were younger, more likely to be married, and were more likely to have used complementary therapy for breast cancer. Logistic regression showed that married women were more likely to be interested in GPT (OR 3.30, CI 1.07–10.20). Conclusion: There is a potentially high interest in GPT among Philippine breast cancer patients. The attributes of Philippine patients interested in GPT are similar to and yet unique, compared to other populations. Copyright © 2010 John Wiley & Sons, Ltd.     

Exploring Knowledge,Attitudes, and Practices Related to Breast and Cervical Cancers in Mongolia: A National Population‐Based Survey

Background.

Mongolia bears the second-highest cancer burden in the world (5,214 disability-adjusted life years per 100,000 people, age standardized). To determine drivers of the growing burden of noncommunicable diseases, including breast and cervical cancers, a national knowledge, attitudes, and practices (KAP) survey was implemented in 2010.

Methods.

This paper analyzed the results of the 2010 KAP survey, which sampled 3,450 households nationally. Reflecting Mongolian screening policies, women aged 30 and older were included in analyses of questions regarding breast and cervical cancer (n = 1,193). Univariate and multivariate odds ratios (MORs) were derived through logistic regression to determine associations between demographic covariables (residence, age, education, employment) and survey responses.

Results.

This study found that 25.7% (95% confidence interval [CI]: 23.3–28.3) and 22.1% (95% CI: 19.8–24.5) of female participants aged 30 years or older self-rated their knowledge of breast and cervical cancers, respectively, as “none.” Employment and education were associated with greater awareness of both cancers and participation in screening examinations (p < .05). Clinical breast examinations were more common among rural than urban participants (MOR: 1.492; 95% CI: 1.125–1.979). Of all female participants, 17% (95% CI: 15.3–18.5) knew that cervical cancer is vaccine preventable.

Conclusion.

Our results suggest that cancer control in Mongolia should emphasize health education, particularly among lower-educated, rural, and unemployed women. The health infrastructure should be strengthened to reflect rural to urban migration. Finally, although there is awareness that early detection improves outcomes, a significant proportion of women do not engage in screening. These trends warrant further research on barriers and solutions.

Implications for Practice:

The rising burden of breast and cervical cancers, particularly in low- and middle-income countries, necessitates the development of effective strategies for cancer control. This paper examines barriers to health service use in Mongolia, a country with a high cancer burden. The 2010 national knowledge, attitude and practices survey data indicate that cancer control efforts should focus on improving health education among lower-educated, rural, and unemployed populations, who display the least knowledge of breast and cervical cancers. Moreover, the findings support the need to emphasize individual risk for disease in cancer education and ensure that the health-care infrastructure reflects Mongolia’s urbanization.     

Knowledge About Genomic Recurrence Risk Testing Among Breast Cancer Survivors

Genomic expression profiling of tumors is used to individualize early-stage breast cancer treatment. However, very little is known about patients’ understanding of and desired information about these tests, such as Oncotype DX. We addressed these issues via a survey mailed to 130 early-stage breast cancer patients who received an Oncotype DX test result. The survey assessed understanding (14 items), information desired about genomic expression profiling tests, and if and where they sought information about Oncotype DX. Sixty-four surveys were returned. Overall, 54% of the knowledge items were answered correctly. Patients wanted education about genomic tests in many areas. Overall, 62% sought information about the test, primarily from the Internet (48%) and doctor or health care provider (31%). In sum, patients’ misunderstanding of genomic tests abound, necessitating better educational efforts on behalf of health care systems to meet their needs for varied information through different communication channels.     

Health professionals' provision of lifestyle advice in the oncology context in the United Kingdom

A healthy lifestyle following a cancer diagnosis is linked with better long‐term outcomes. Health professionals can play an important role in promoting healthy lifestyles after cancer, but little is known about the factors that influence whether or not they give lifestyle advice. We conducted an online survey to examine levels of, and predictors of, health professionals' provision of lifestyle advice to cancer patients in the United Kingdom. The survey included questions on awareness of lifestyle guidelines for cancer survivors, current practices with regard to giving advice on smoking, diet, exercise, weight and alcohol, and perceived barriers to giving advice. Nurses, surgeons and physicians (N = 460) responded to the survey. Many (36%) were not aware of any lifestyle guidelines for cancer survivors, but 87% reported giving some lifestyle advice; although this was lower for individual behaviours and often to <50% of patients. Respondents who were aware of lifestyle guidelines were more likely to give lifestyle advice on all behaviours (all OR's > 1.76, all P's < 0.05). Not believing lifestyle would affect outcomes was associated with lower odds of giving lifestyle advice (all OR's < 0.48, all P's < 0.05). Improved survivorship education for health professionals may increase the number of patients receiving lifestyle advice, and improve their long‐term outcomes.     

≪ Regards croisés 2009 ≫: enquête menée auprès de patients atteints de cancer et de professionnels de santé sur la perception de la fatigue et de l’anémie chimio-induite

? Regards croisés ? survey was conducted in 2009 among cancer patients and health professionals to evaluate and compare their perceptions of the management of fatigue and chemotherapy-induced anemia. The 300 included patients had a diagnosis of breast, lung or colorectal cancer, or non myeloid malignant hemopathy, were undergoing ambulatory chemotherapy, and presented or had presented with anemia (Hb < 11 g/dl) during chemotherapy. All patients completed an auto questionnaire given by their physician. The 359 health professionals included were in charge of cancer patients (250 physicians: oncologists, hematologists, pneumologists, and gastroenterologists; 109 nurses) and were interviewed by phone. Fatigue was the most common symptom reported by 77% of the patients. As in previous surveys, fatigue was described as the main problem affecting daily life (37% of the cases).Regarding fatigue, health professionals’ perceptions were close to those patients. This means that the perception of professionals has changed. They are now convinced that fatigue and its causes must be considered in the management of patients undergoing chemotherapy. All results from the study will be published in following articles.     

The evolution of worry after breast cancer risk assessment: 6‐year follow‐up of the TRACE study cohort

Objectives: There is little evidence regarding the long‐term psychological implications of breast cancer risk assessment for women at moderate genetic risk. A follow‐up study of a trial cohort was conducted to evaluate psychological outcomes and their predictors at 6‐year follow‐up. A further aim was to examine threshold scores for high cancer worry. Methods: Questionnaires were sent to 384 women assessed as moderate risk during a UK trial of genetic assessment (TRACE). Measures included cancer worry, perceived risk, health behaviours, general anxiety, psychological morbidity, optimism, and background variables assessed during TRACE and at 6‐year follow‐up. Results: Reductions from baseline cancer worry and breast self‐examination (BrSE) frequency were maintained 6 years after risk assessment, with relatively consistent levels over short‐ and long‐term follow‐up. Provision of risk information led to short‐term reductions in perceived risk. During the 6‐year period, 43% of women reported having made lifestyle changes and 27% had requested a mammogram. Baseline and post‐risk cancer worry were the only significant predictors of long‐term cancer worry. Greater worry at baseline predicted more frequent BrSE and higher perceived risk, but not lifestyle change or mammogram requests, at 6 years. Eighteen percent of women reported cancer worry above a threshold of 12.5 at long‐term follow‐up, compared with 30% at baseline. Conclusions: Overall reductions in cancer worry following moderate risk assessment were maintained in the long term. However, women at risk of sustained high cancer worry should be identified at an early stage in the risk assessment process for more intensive psycho‐educational intervention. Copyright © 2010 John Wiley & Sons, Ltd.     

Using the theory of planned behavior to understand health professionals' attitudes and intentions to refer cancer patients for psychosocial support

Objective: To describe oncology professionals' patterns of referral to existing community and psychosocial support services, including complementary therapies utilizing the theory of planned behavior (TPB). Methods: An exploratory cross‐sectional survey of 72 oncology professionals including nurses (73.6%), medical practitioners (19.4%) and allied health professionals (6.9%) from health institutions in South Australia assessed past referral patterns, perceived attitudes of peers, control over and attitudes toward, referral, past referral practices and how these impact on intention to refer. Results: Referral to support services such as a cancer helpline, allied health or complementary services was infrequent. A hierarchical regression entering awareness, past referral and the TPB variables (attitude, subjective norm and perceived control) explained 51% of the variance on the outcome ‘intention to refer’. Barriers to referral for support included lack of local services for remote patients, and financial considerations. Conclusion: Interventions with health professionals should focus on the development of a culture, which recognizes the importance of addressing a breadth of patient needs across the cancer trajectory. Education and support for health professionals is required to ensure that they feel comfortable discussing support needs and referring to appropriate support services. Copyright © 2010 John Wiley & Sons, Ltd.     

Cancer surveillance behaviors and psychosocial factors among long‐term survivors of breast cancer

BACKGROUND:

Little is known about cancer surveillance (mammography, clinical breast examination, and pelvic examination) behaviors in long‐term (9‐16 years) breast cancer survivors. This report describes the relation of these behaviors to demographic and clinical characteristics, psychological symptoms, body satisfaction, and social support.

METHODS:

Survivors who had participated in Cancer and Leukemia Group B treatment Trial 8541 completed a survey that included questions on breast cancer surveillance and pelvic examination, psychological well being, body satisfaction, and social support.

RESULTS:

The participation rate was 78% and included 245 breast cancer survivors. Survivors (n = 107; 44%) reported completing breast cancer surveillance (mammography and clinical breast examination) and completing pelvic examination (n = 162; 68%) within recommended guidelines. There were no significant associations between breast cancer surveillance and breast cancer anxiety, depression, stressful life events, body satisfaction, social support, or demographic characteristics. Survivors within recommended guidelines for pelvic examinations were younger (P = .05), married (P = .003), had health insurance (P = .004), and had lower depression scores (P = .005) than survivors who underused or overused pelvic examination. In addition, survivors within recommended pelvic examination guidelines had significantly lower levels of breast cancer anxiety (P = .03) compared with survivors who underused pelvic examination.

CONCLUSIONS:

Many long‐term breast cancer survivors were not within recommended cancer surveillance guidelines. Private health insurance was associated with following recommendations for pelvic examinations, although such a relation did not exist for breast cancer surveillance. The results of this study have implications for the development of educational programs to improve cancer surveillance among the growing population of long‐term breast cancer survivors. Cancer 2009. © 2009 American Cancer Society.     

Late age at first full term birth is strongly associated with lobular breast cancer

BACKGROUND:

Late age at first full‐term birth and nulliparity are known to increase breast cancer risk. The frequency of these risk factors has increased in recent decades.

METHODS:

The purpose of this population‐based case‐control study was to examine associations between parity, age at first birth (AFB), and specific histological subtypes of breast cancer. Women with breast cancer were identified from cancer registries in Wisconsin, Massachusetts, and New Hampshire. Control subjects were randomly selected from population lists. Interviews collected information on reproductive histories and other risk factors. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of ductal, lobular, and mixed ductal‐lobular breast cancer diagnosis in association with AFB and nulliparity.

RESULTS:

AFB ≥30 years was associated with a 2.4‐fold increase in risk of lobular breast cancer compared with AFB <20 years (OR, 2.4; 95% CI, 1.9‐2.9). The association was less pronounced for ductal breast cancer (OR, 1.3; 95% CI, 1.2‐1.4). Nulliparity was associated with increased risk for all breast cancer subtypes, compared with women with AFB <20 years, but the association was stronger for lobular (OR, 1.7; 95% CI, 1.3‐2.2) than for ductal (OR, 1.2; 95% CI, 1.1‐1.3) subtypes (P = .004). The adverse effects of later AFB was stronger with obesity (P = .03) in lobular, but not ductal, breast cancer.

CONCLUSIONS:

Stronger associations observed for late AFB and nulliparity suggest that these factors preferentially stimulate growth of lobular breast carcinomas. Recent temporal changes in reproductive patterns and rates of obesity may impact the histological presentation of breast cancer. Cancer 2011. © 2010 American Cancer Society.     

Allergy and risk of breast cancer among young women (United States)

Objective: To investigate the relationship between allergy and risk of breast cancer in women 45 years of age and younger. Methods: Data were analyzed from a population-based case–control study of breast cancer in western Washington. Cases were women born after 1944 who were diagnosed with invasive breast cancer (n = 747) between January 1983 and April 1990. Controls (n = 958) were similarly aged women ascertained through random-digit dialing. Cases and controls were interviewed about their history of doctor diagnosed allergies, including detailed information on the specific types of allergies and the age of onset. Using logistic regression we examined the associations between allergy history and breast cancer. Results: A history of allergies was associated with a reduced risk of breast cancer for women older than 35 (odds ratio (OR) = 0.77; 95% confidence interval (CI) = 0.60–0.99), but not for women 35 years or younger (OR = 1.30; 95% CI = 0.94–1.81). There was little difference in effect when age of first allergy onset was examined. No specific type of allergy was associated with breast cancer risk. Conclusion: Our results provide some evidence that a history of allergy may be associated with a reduced risk of breast cancer for women who develop breast cancer between 35 and 45 years of age. Future studies are needed to verify the relationship between immune responses and breast cancer risk.     

Nonsteroidal anti‐inflammatory drug use and breast cancer risk in a European prospective cohort study

Experimental studies have shown a protective effect of nonsteroidal anti‐inflammatory drugs (NSAIDs) on breast cancer development. However, results from epidemiological cohort studies are less consistent. Our objective was to assess the association between NSAID use and breast cancer risk within the European Prospective Investigation into Cancer and Nutrition (EPIC). EPIC is a prospective cohort study initiated in 1992 in 10 European countries. Self‐reported information on NSAID use at baseline has been collected in five EPIC countries. Multivariable Cox regression models were used to estimate hazard ratios for the association of NSAID use with breast cancer incidence with adjustment for potential confounders. We also assessed effect modification by breast cancer risk factors and examined the associations within specific breast cancer subtypes. Among the 140,981 women included in the analysis, 7% were regularly using NSAIDs at baseline. During a median follow‐up time period of 13 years, 7,379 incident breast cancer cases were diagnosed (816 in situ and 6,563 invasive). There were no statistically significant associations between NSAID use and breast cancer risk, overall and by subtypes. However, a statistically significant interaction was observed for invasive cases between NSAID use and ever use of menopausal hormonal therapy (MHT) among postmenopausal women [MHT users: HR_{NSAID use} = 0.84 (0.73–0.96); non MHT users: HR_{NSAID use} = 1.08 (0.93–1.25); p_interaction = 0.05]. Our results indicate potential effect modification of MHT use on the association between use of NSAIDs and breast cancer risk which deserves in‐depth investigation in studies with accurate data on both NSAID and MHT use.     

Association between meat consumption and risk of breast cancer: Findings from the Sister Study

Meat consumption has been postulated to increase the risk of breast cancer, but this association has not been consistently seen. We examined the association between consumption of different types of meat, meat mutagens and incident invasive breast cancer. Information on consumption of different meat categories and meat cooking practice behaviors was obtained from 42,012 Sister Study participants who completed a Block 1998 Food Frequency Questionnaire at enrollment (2003–2009) and satisfied eligibility criteria. Exposure to meat type and meat mutagens was calculated, and associations with invasive breast cancer risk were estimated using multivariable Cox proportional hazards regression. During follow-up (mean, 7.6 years), 1,536 invasive breast cancers were diagnosed at least 1 year after enrollment. Increasing consumption of red meat was associated with increased risk of invasive breast cancer (HR_{highest vs. lowest quartile}:1.23, 95% CI: 1.02–1.48, p_trend = 0.01). Conversely, increasing consumption of poultry was associated with decreased invasive breast cancer risk (HR _{highest vs. lowest quartile}: 0.85; 95% CI: 0.72–1.00; p_trend = 0.03). In a substitution model with combined red meat and poultry consumption held constant, substituting poultry for red meat was associated with decreased invasive breast cancer risk (HR _{highest vs. lowest quartile} of poultry consumption: 0.72, 95% CI: 0.58–0.89). No associations were observed for cooking practices, estimated heterocyclic amines or heme iron from red meat consumption with breast cancer risk. Red meat consumption may increase the risk of invasive breast cancer, whereas poultry consumption may be associated with reduced risk. Substituting poultry for red meat could reduce breast cancer risk.     

Progestin‐only and combined oral contraceptives and receptor‐defined premenopausal breast cancer risk: The Norwegian Women and Cancer Study

Receptor‐defined subtypes of breast cancer represent distinct cancer types and have differences in risk factors. Whether the two main hormonal forms of oral contraceptives (OCs); i.e. progestin‐only (POC) and combined oral contraceptives (COC), are differentially associated with these subtypes are not well known. The aim of our study was to assess the effect of POC and COC use on hormone receptor‐defined breast cancer risk in premenopausal women in a prospective population‐based cohort – The Norwegian Women and Cancer Study (NOWAC). Information on OC use was collected from 74,862 premenopausal women at baseline. Updated information was applied when follow‐up information became available. Multiple imputation was performed to handle missing data, and multivariable Cox regression models were used to calculate hazard ratios (HR) for breast cancer. 1,245 incident invasive breast cancer cases occurred. POC use ≥5 years was associated with ER+ (HR = 1.59, 95% CI 1.09– 2.32, p_trend = 0.03) and ER+/PR+ cancer (HR = 1.63, 95% CI 1.07–2.48, p_trend = 0.05), and was not associated with ER? (p_{heterogeneity} = 0.36) or ER?/PR? (p_{heterogeneity} = 0.49) cancer. COC use was associated with ER? and ER?/PR? cancer, but did not increase risk of ER+ and ER+/PR+ cancer. Current COC use gave different estimates for ER/PR‐defined subtypes (p_{heterogeneity} = 0.04). This is the first study to show significant associations between POC use and hormone receptor‐positive breast cancer. The lack of power to distinguish effects of POC use on subtype development calls for the need of larger studies to confirm our finding.     

Meeting breast cancer patients' information needs during radiotherapy: what can we do to improve the information and support that is currently provided?

HALKETT G.K.B., KRISTJANSON L.J., LOBB E., O'DRISCOLL C., TAYLOR M. & SPRY N. (2010) European Journal of Cancer Care
Meeting breast cancer patients' information needs during radiotherapy: what can we do to improve the information and support that is currently provided? Previous research has reported that patients require specific information relating to radiotherapy; however, these studies fail to describe patients' specific information needs over time. The aims of this study were to determine the specific information needs of breast cancer patients who are receiving radiotherapy and identify when patients prefer to receive specific information. Semi‐structured interviews were conducted with 34 early breast cancer patients and 14 health professionals. Seventeen patients were interviewed after treatment completion, and 17 patients were interviewed on at least two occasions during their radiotherapy. Grounded theory and the constant comparative method were used to analyse the data. Three main categories emerged from the data: ‘repertoire of information’, ‘amount of information relating specifically to radiotherapy’ and‘tailoring information to match patients’ radiotherapy journeys'. Patients' information needs were identified, and key messages and strategies to inform patients were described. This paper identifies breast cancer patient's specific information needs during radiotherapy and shows that patients' information needs are highest during their first appointment with their radiation oncologist and at the time of their planning appointment. The findings presented will enable health professionals to develop and refine their approaches to patient education in radiotherapy.     

Polymorphisms in tissue inhibitors of metalloproteinases‐2 and ‐3 and breast cancer susceptibility and survival

Tissue inhibitors of metalloproteinases (TIMPs) are endogenous inhibitors of matrix metalloproteinases which are involved in normal cellular processes and also in cancer development and progression. The purpose of this study was to evaluate polymorphisms in the TIMP‐2 and TIMP‐3 genes for their associations with breast cancer susceptibility and survival. Using data from the Shanghai Breast Cancer Study, 19 SNPs for each gene were evaluated for associations with breast cancer risk among 1,062 cases and 1,069 controls; associations with disease‐free and overall survival were evaluated among the cases. For TIMP‐2, women with the rs7501477 TT genotype were 3 times more likely to be breast cancer cases than women with the CC genotype (OR: 2.9, 95% CI: 1.2–7.0). For TIMP‐3, women with the rs9609643 AA genotype were 60% less likely to be breast cancer cases than women with the GG genotype (OR: 0.4, 95% CI: 0.2–1.0), whereas women with the rs8136803 TT genotype were 5 times more likely to be cases than women with the GG genotype (OR: 5.1, 95% CI: 1.1–24.3). Further, breast cancer cases with rs8136803 TT were almost 4 times more likely to have decreased disease‐free survival (HR: 3.9, 95% CI: 1.4–10.6) and had a trend toward decreased overall survival (HR: 1.9, 95% CI: 0.6–6.1). An important study limitation was that these 3 SNPs (rs7501477, rs9609643, rs8136803) had low minor allele frequencies which resulted in small numbers of homozygote individuals. Genetic variation in the TIMP‐2 and TIMP‐3 genes may contribute to individual differences in breast cancer susceptibility and survival. © 2009 UICC