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Breast cancer is most commonly found in women 65 years or older. The increasing number of women in this age group means an absolute increase in new breast cancer cases. Because studies looking at the efficacy of mammography as a screening test for breast cancer have for the most part included younger women, recommendations for screening mammography in women at or older than age 65 are unclear. The nature of breast cancer in this population and the morbidity associated with treatment influence the potential value of screening. Analyzing cost-effectiveness and considering expected benefits, harms, and costs reduced the value of screening women under age 65, but the analysis of older women has been less clear. The U.S. Preventive Services Task Force (USPSTF) systematically reviewed published cost-analyses that evaluate breast cancer screening in women.
Breast cancer is most commonly found in women 65 years or older. The increasing number of women in this age group means an absolute increase in new breast cancer cases. Because studies looking at the efficacy of mammography as a screening test for breast cancer have for the most part included younger women, recommendations for screening mammography in women at or older than age 65 are unclear. The nature of breast cancer in this population and the morbidity associated with treatment influence the potential value of screening. Analyzing cost-effectiveness and considering expected benefits, harms, and costs reduced the value of screening women under age 65, but the analysis of older women has been less clear. The U.S. Preventive Services Task Force (USPSTF) systematically reviewed published cost-analyses that evaluate breast cancer screening in women.
This USPSTF review suggests that it is cost-effective to screen women 65 years and older for breast cancer every two years. However, screening is more costly among sicker women, who are likely to have a life expectancy similar to that of an 85-year-old woman (about five years).

Further analysis of women’s preferences, clarification of the natural history of tumors in older women, the value of diagnosing ductal carcinomas, potential needless distress from false-positive examinations, and the development of new adjuvant therapies need to be considered before concluding that the benefits of screening outweigh the harms.

American Pharmaceutical Partners Inc., a generic drug manufacturer that recently moved its headquarters to Illinois from Los Angeles, has announced positive results for a long-awaited trial of its proprietary breast cancer drug ABI-007, now called Abraxane. The news sent the stock up $4 a share last week to $43, more than four times higher than its 52-week low of $10.05 …

The New York State Breast and Cervical Cancer Screening Program (NYSBCCSP) is funded in part through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) (1,2). A total of 292 mammography facilities participate in NYSBCCSP. In 1998, NYSBCCSP began reviewing the clinical outcomes of clients screened through the program to identify facilities that might need more intensive assessment of quality assurance and corrections of deficiencies. This report describes the quality assurance process of NYSBCCSP, which provides methods for monitoring and assessing the quality of clinical care by program providers. These outcome-based methods can be useful to other programs and providers of breast cancer screening.
NYSBCCSP routinely compares the proportion of abnormal clinical breast examinations (CBE), abnormal screening mammography outcomes, and positive predictive values of breast cancer biopsies (ppvB) for individual program facilities with overall figures generated by the state and national programs (NYSBCCSP and NBCCEDP, unpublished data, 1995-2003). Facilities with proportions of abnormal mammography * , abnormal CBEs ([dagger]) , or ppvB ([section]) significantly ([paragraph]) different from the lower or upper bounds of expected ranges (i.e., outliers) are identified for further evaluation. The expected ranges for abnormal CBEs are based on the NBCCEDP Data Quality Indicator Guide, a program management tool; the ranges for abnormal mammography and ppvB are commonly accepted parameters in mammography (4).
NYSBCCSP compiles additional patient data for the facilities identified with outlier results, including the age, race/ ethnicity, and previous screening history of clients served; the proportion of abnormal screenings or ppvB over time; and the diagnostic procedures performed after abnormal screening results. The cancer detection rate also is calculated and compared with rates in the state and national programs. In addition, cross tabulations of screening mammography results by CBE results are reviewed.

The facility and local screening project responsible for coordinating screening and related services in a community are contacted to determine potential explanations for the outliers. A random sample of medical records is reviewed to identify data-reporting errors. If data-reporting errors cannot explain the outlier results, the clinical interpretive skills of providers at the facility are assessed. A board-certified radiologist performs the mammography assessment by evaluating the technical and interpretive quality of the mammograms. A clinician performs the CBE assessment by reviewing the position of patients during examinations, areas of breast tissue examined, search pattern used, and quality of documentation and communication skills of providers.

NYSBCCSP collaborates with the facility and local screening project to develop, implement, and evaluate an action plan to correct any deficiencies identified. The following two examples describe this quality assessment process.

Case Reports

Case l. During 1996-1999, facility A, a medium-sized hospital (300-400 inpatient beds), provided mammography screening to 544 NYSBCCSP-enrolled women. A total of 73 (13.4%) of the 544 mammograms performed at facility A were classified as Breast Imaging Reporting and Data System (BI-RADS [R]) category 4 (i.e., suspicious abnormalities that indicating biopsy should be considered), whereas 3,750 (1.5%) of an estimated 250,000 mammograms performed at other Facilities in NYSBCCSP during the same period were classified as category 4. Five (3.0%) of 166 women at facility A with abnormal mammograms underwent additional imaging, compared with 13,500 (45.0%) of approximately 30,000 women with abnormal mammograms screened at other NYSBCCSP facilities. In addition, the 166 women at facility A with abnormal mammograms were more than three times as likely to receive a breast biopsy as women at other facilities (52.0% versus 15.0%, respectively). The ppvB for detecting breast cancer from imaging at facility A was 6.9%, compared with 23.9% at other facilities.

On the basis of review of medical records and independent review of mammograms at Facility A, two staff radiologists had higher biopsy recommendation rates and use of stereotactic biopsy than those of three other readers at the facility. Facility A agreed to the following corrective plan of action: 1) conduct in-service training for all five radiologists on the use of the BI-RADS [R] reporting system; 2) obtain a second reading by a different radiologist of all mammograms reported as a BI-RADS [R] category 4 for 6 months, with final resolutions by the chief of radiology; and 3) obtain facility accreditation for its stereotactic biopsy program.

During January 2001-December2002 (approximately 4-28 months after completion of the action plan), the proportion of mammograms reported at facility A classified as BI-RADS [R] category 4 decreased from 13.4% to 4.3%, the proportion of women with abnormal mammograms receiving additional imaging increased from 3.0% to 7.0%, the proportion of women undergoing breast biopsies decreased from 52.0% to 28.0%, and the ppvB increased from 6.9% to 19.0%.

In a recent Breast Cancer Action Newsletter (February/March 2004), Musa Mayer expresses her doubts about new genetic research presented at the 26th San Antonio Breast Cancer Symposium. [Abstracts are available at www.sabcs.org, by clicking on ‘Abstract Online 2003′ and logging in as a guest.] Mayer says that the hope that genetic analysis of a person’s cancer would lead to individualized prognosis and treatment recommendations is not living up to expectations. Researchers are developing new drugs that target specific proteins in a cancer cell, but these targeted therapies only work in specific cancers. For example, Herceptin[R], which received FDA approval five years ago, is a monoclonal antibody that targets cancer cells that make too much HER-2, a protein found on the surface of about 25-30% of breast cancer cells. Genentech, the drug’s manufacturer, developed a test to identify which tumors might respond to Herceptin. Without targeting a specific population, the drug would not show a benefit in breast cancer trials. Genentech has developed another drug called Avastin[R] that targets VEGF, a gene responsible for angiogenesis, but has not yet found a way to identify patients who might benefit from it. Like many of these drugs, it does not show any significant effect among the general population in clinical trials.
The test was credited with predicting outcome better than any other single prognostic factor except for tumor grade. The test was not 100% accurate. One observer at the San Antonio Symposium noted that 10% of the patients in the low-risk group were misclassified. Dr. Soonmyung Paik, director of pathology, the National Surgical Adjuvant Breast and Bowel Project, worked with Genomic Health on this study. He admitted that it may never be possible to predict whether cancer will recur in an individual patient. Statistician Donald Berry of the MD Anderson Cancer Center concurred, noting that the complexity of genetic analysis, difficulties with uniform data collection and pathology, and other methodological and statistical issues make interpretation of genetic tests problematic.

Breast cancer is the second leading cause of cancer-related deaths in women in most industrialized countries. The incidence of this disease in women in Western countries is approximately five times that in women in developing countries and Japan. In Canada, breast cancer is the most common type of cancer in women, with an age-standardized incidence rate of 103 per 100,000 or 30% of all cancers in women. There is compelling evidence that carotenoids play a role in the etiology of breast cancer. Although research on breast cancer prevention has focused intensively on these micronutrients, the mechanisms involved in their reported cancer-preventing activities are not fully understood. The objective of the current study was to assess the possible association between specific and total carotenoids and breast cancer risk and to evaluate the effect modification by diet-related fatty acids and life-style factors in the development of breast cancer.
A population-based case-control study involving 414 incident cases and 429 controls was conducted in French Canadians in Montreal. Dietary intake was estimated with the use of a validated food-frequency questionnaire in face-to-face interviews. There was no significant association that was apparent between any of the individual or total carotenoids and the risk of breast cancer after adjustment for major underlying determinants of breast cancer. In premenopausal women who ever smoked, an increased risk was related to alpha-carotene. Conversely, a reduced risk was related to beta-carotene in women who never used hormone replacement therapy.
In post-menopausal women, total carotenoids were positively associated with breast cancer risk in those with a high arachidonic acid intake, and inversely associated in those with a high docosahexaenoic acid intake. These findings suggest that the combined high intake of total carotenoids and docosahexaenoic acid, including a diet with a high content of fruit, carotenoid-rich vegetables, and DHA-rich fish may reduce the risk of breast cancer.

In 2002, Dana Mirick and colleagues at Fred Hutchinson Cancer Research Center (Seattle, Washington) published an epidemiological study that included questions on underarm shaving and deodorant use. The study compared 800 women with breast cancer with 800 randomly chosen women of similar age. That study found no link between underarm shaving, deodorant use, and breast cancer. Two new studies publicized on NewScientist.com suggest that the question may need further examination.
The first study, originally published in the Journal of Applied Toxicology (vol. 24, p.5), was led by molecular biologist Philippa Darbre at the University of Reading (United Kingdom). She and her colleagues found high concentrations of para-hydroxybenzoic acids (parabens) in 18 out of the 20 breast tumors that they examined. Other researchers have found that parabens bind to estrogen receptors and have estrogenic effects in yeast cells, animals, and in estrogen-sensitive human cells. Parabens are used as preservatives in cosmetics and some foods. The parabens found in the tumors had ester groups, indicating that they had been absorbed through the skin, not eaten and digested. Ester-bearing parabens mimic estrogen more strongly. Darbre asserts that the application of paraben-containing products to the underarm area may help explain why 60% of all breast tumors are located in the upper-outer quadrant, nearest the underarm, instead of being evenly distributed throughout the breast. Skeptics reply that the upper-outer quadrant has the largest amount of breast tissue. This study did not look at paraben concentrations in other areas of the breast or other body tissues.

According to a Swedish study, post-menopausal women who drink more than 1.5 glasses of wine per day are twice as likely to get breast cancer compared to women with little or no alcohol intake. Women who drink less than 1.5 glasses of wine per day, meanwhile, were found to have a 12 percent lower risk of breast cancer. The American Dietetic Association advises women to reduce breast cancer risk by limiting their alcohol intake.

High dietary fat–long suspected to be a culprit in breast cancer–is also strongly associated with breast cancer, the authors report. Those who consumed the highest amounts of fat saw their risk of getting breast cancer rise by 34 percent.

One day shortly after I had a mastectomy, I was talking with friends about how swimming was helping the range of motion in my arm which had been compromised by the surgery incision. All of a sudden and with great sincerity a women said to me “how do you swim with only one breast”? Knowing full well what she meant I chose to tease her by responding with “Well, I just swim with the one that is left”. What she was really asking was; how do you fill out the other side of your bathing suit with a missing breast? It was/is a really great question and one that is not easily answerable. You see, if one has had a mastectomy and has chosen to wear prosthesis, then one is faced with several new challenges.

For example, the “everyday” prosthesis that I bought cost $300.00 and is not pool friendly. Evidently, the pool chemicals would destroy the “breast”. So, it cost another $100.00 to buy a pool friendly “breast”. That would have been irritating enough but I am here to tell that that sucker must weigh 10 lbs not to mention how weird it looks when I am floating on my back. As nature takes its course with my very-own-god-given-still-attached breast, which only s-e-e-m-e-s to disappear when I am lazily floating on my back, the hard shinning new chemically friendly 10 pound boob sticks straight up for all the world to see. To say that I looked lopsided, while floating on my back, would be a kind understatement. Consequently, I am endeavoring to learn the unique art of face down floating. While I am in training for that feat, I thought that I would share a much simpler solution with those of you who understand the implicit ironies of this situation.

There is a product called Water Push Up Pads which cost approximately $5.56 for a package of two and can be purchased at local stores such at K-Mart or Wal-Mart. They come in sizes A-B or B-C. Not a problem if they are not large enough for you, simply turn one A-B or B-C facing up and one facing down then stitch them together and viola you have a “no-breast” bobble or boobble (Boob + Bobble) that is inexpensive, lasts a long time, is chemical friendly (or at least they do not readily fall apart), may be purchased in any city should you forget yours while away from home and/or buy several at this price.

These inserts look much more natural in a swim suite than does the expensive, not readily available, strange looking ten pounder. See, I keep telling you, it’s not the mastectomy that is problematic; it’s the lack of “no breast bobbles” and information thereof. Oh yes, and please do not attempt the floating face down exercise, it scares the life guards.

Do you fear breast cancer? Many women do because it is such a killer! Surprisingly, men are not immune to this disease either.

If you received a diagnosis of breast cancer just 20 years ago, your chances of being a survivor would have been much less than they are today. That’s because of the marvelous advance of medical research.

There are a lot more options available now for treating malignant tumors than were available a few years ago. And more and more women are breast cancer survivors today.

But you would like to know what your particular risks are for developing breast cancer, wouldn’t you? Although no one knows exactly who is going to get breast cancer, there are risk factors that can be taken into consideration. You can do something about some of these risk factors, and other risk factors there’s not much you can do about. — except to be on your guard.

Here are the risk factors you can control:

1. Obesity

2. Drinking alcoholic beverages

3. Smoking

4. Taking estrogen with progesterone for menopausal symptoms

5. Using birth control pills

6. Lack of exercise

7. Choosing to feed your baby with a bottle instead of breast-feeding.

The following are risk factors over which you have no control:

1. Aging

2. Breast cancer in your immediate family

3. Starting your periods before the age of 12

4. Passing through menopause after the age of 50

So as you can see, there are risks you can do something about and risks that you can’t do anything about. So why not start with what you can do? For example, choose to eat healthy foods instead of junk food. Stay away from alcoholic beverages and smoking. Exercise regularly.

For the risks you can do nothing about, you can use preventative measures. If your mother or and or another close relative had breast cancer, try to remember to schedule a yearly mammogram. And have a doctor examine your breasts once a year. Learn how to do breast exams once a month yourself and be faithful about checking your breasts on a regular basis.

To even more accurately assess your personal risk for developing breast cancer, you can take a test that will let you know if you carry a mutated gene related to breast cancer.

Many women all over the world fear breast cancer. It is a killer! It is one of the leading causes of death for women and even men are not immune.

Not that long ago a diagnosis of breast cancer would have been like receiving a death sentence! That’s because it was often fatal. However, things are different today because of the amazing advances in medical science in the area of breast cancer research.

For example, a lot more treatments are available to you today than were available 20 years ago. And many women are survivors of this dreaded disease.

Do you know your personal risk factor for developing breast cancer?

It’s obvious that just because you’re a woman you are more at risk than a man would be. As you age, your risks increase. But you can’t really change that. Your genetic makeup is another risk factor. If breast cancer claimed your mother, that increases your risks as well. If you had another close family member who developed breast cancer that also increases your risk of developing it yourself. The age that you had your first menstrual period also affects your risk factor. If you started menstruating before the age of 12, your risk increases. If you passed through menopause after the age of 50, that also increases your risk.

There is a test available now that you can take to see if you carry a mutated gene related to breast cancer.

If you have menopausal symptoms and you are taking estrogen with progesterone, that will increase your risk of developing breast cancer by a small percent. Taking birth control pills is another factor in slightly increasing your risk of having this disease. Your risks will increase if you drink alcoholic beverages and smoke. Obesity may lead to breast cancer as well. You will increase your risks if you seldom exercise. Those who have never breast fed their babies have an increased risk too.

Surprisingly, even men can suffer from breast cancer. And no one really knows who will be its next victim.

As you have seen in this article, there are some risks that you have control over, while there are other risks over which you have no control.

Here are some risks that you can control. Choose healthy habits like regular exercise and watching your weight. Avoid alcoholic beverages as much as possible and don’t smoke.

If your genetic background is a risk factor for you, be sure to have regular mammograms and breast examinations by your doctor. You ought to examine your own breasts every month too.

Now that you know a little more about what your own personal risk factors for breast cancer are, you can choose healthy habits to protect yourself. And don’t forget to schedule regular examinations by your doctor and examine your breasts yourself once a month. Be sure to include a yearly mammogram for your protection from breast cancer.