Patterns and predictors of the breast cancer detection methods in women under 45 years of age (United States)

OBJECTIVES

Few studies have examined methods by which breast cancers are detected, and only one study has been published on predictors of those methods. This study examined patterns and predictors of breast cancer detection methods during 1990-1992 among women age 20-44.

METHODS

In-person interview and medical record data were obtained during a population-based case-control study of 1619 women newly diagnosed with breast cancer in three areas of the United States (US).

RESULTS

Seventy-one percent of the cancers were identified by self-detection, 9% by routine clinical breast exam (CBE), and 20% by routine mammography. Cancers detected by mammography and CBE, but not those detected by breast self-exam, were much more likely to be early-stage. Detection by mammography increased with age, and a history of mammography use was associated with detection by mammography or CBE. Several commonly studied predictors of screening utilization in the US population were associated with CBE detection, but were less clearly related to or unrelated to mammography detection.

CONCLUSION

Findings suggest that, during the 1990s in the US, most breast cancers among women under age 45, including those age 40-44, were self-detected. Few factors other than age and prior screening are verified predictors of method of breast cancer detection.

Breast and cervical carcinoma mortality among women in the Appalachian region of the U.S., 1976-1996

BACKGROUND

Previous studies have shown high cervical carcinoma mortality and increasing breast carcinoma mortality in the Appalachian region of the U.S. (which includes parts of 12 states and all of West Virginia). In the current study the authors report trends in breast and cervical carcinoma death rates among women in Appalachia for 1976-1996.

METHODS

Death rates were calculated from information provided on death certificates and reported to the National Center for Health Statistics for Appalachian women and for women living elsewhere in the U.S. ("other U.S. women"). Trends were examined with joinpoint regression techniques overall and by age and race. Average annual mortality rates were calculated by state for 1992-1996 for each state's Appalachian and non-Appalachian areas.

RESULTS

Overall breast carcinoma mortality was lower among Appalachian women than among other U.S. women throughout the study period; however, after rates decreased among both groups in the 1990s, the difference appears to have narrowed. No such decline was observed for women age >/= 70 years. Overall cervical carcinoma mortality was higher among Appalachian women than among other U.S. women but decreased during the study period to rates closer to those for other U.S. women. No significant decrease was observed among women age < 50 years. Overall, for both black and white women, breast carcinoma mortality was lower and cervical carcinoma mortality higher among women in Appalachia compared with their counterparts elsewhere in the U.S. For both breast and cervical carcinoma, the average annual death rates (1992-1996) varied by geographic areas within the Appalachian states, but most differences were not significant.

CONCLUSIONS

Analysis of mortality trends in breast and cervical carcinoma may provide guidance for prevention and control activities to reduce premature mortality from these diseases.

Knowledge, attitudes, and screening practices among older men regarding prostate cancer

OBJECTIVES

This study determined population-based rates of reported prostate cancer screening and assessed prostate cancer-related knowledge, attitudes, and screening practices among men in New York aged 50 years and older.

METHODS

Two telephone surveys were conducted. One was included in the 1994 and 1995 statewide Behavioral Risk Factor Surveillance System interviews, and the other was a community-level survey that targeted Black men (African-American Men Survey). Prevalence estimates were computed for each survey, and prostate cancer screening practices were assessed with logistic regression models.

RESULTS

Overall, fewer than 10% of the men in each survey perceived their prostate cancer risk to be high; almost 20% perceived no risk of developing the disease. Approximately 60% of the men in each survey reported ever having had a prostate-specific antigen (PSA) test. In both surveys, physician advice was significantly associated with screening with a PSA test or a digital rectal examination. Also, race was significantly associated with screening in the statewide survey.

CONCLUSIONS

Many New York men appear to be unaware of risk factors for prostate cancer. However, a substantial percentage reported having been screened for the disease; physician advice may have been a major determining factor in their decision to be tested.

Breast and cervical cancer screening practices among Asian and Pacific Islander women in the United States, 1994-1997

Recent studies suggest that Asian and Pacific Islander women in the United States may underuse cancer screening tests. We examined the breast and cervical cancer screening practices of 6048 Asian and Pacific Islander women in 49 states from 1994 through 1997 using data from the Behavioral Risk Factor Surveillance System. About 71.7% [95% confidence interval (CI), 66.3-77.0%] of women in this sample aged > or =50 years had a mammogram in the past 2 years, and 69.5% (95% CI, 63.9-75.1%) had a clinical breast exam in the past 2 years. About 73.7% (95% CI, 71.3-76.0%) of women aged > or =18 years who had not undergone a hysterectomy had a Papanicolaou test in the past 3 years. Women with health insurance and those who had seen a physician in the past year were more likely to have been screened. These results underscore the need for continued efforts to ensure that Asian and Pacific Islander women who are medically underserved, including those without health insurance, have access to cancer screening services.

Breast and cervical cancer screening practices among American Indian and Alaska Native women in the United States, 1992-1997

BACKGROUND

Recent studies suggest that American Indian and Alaska Native women have important barriers to cancer screening and underuse cancer screening tests.

METHODS

We examined the breast and cervical cancer screening practices of 4,961 American Indian and Alaska Native women in 47 states from 1992 through 1997 by using data from the Behavioral Risk Factor Surveillance System.

RESULTS

About 65.1% [95% confidence interval (CI) 60.2 to 69.9%] of women in this sample aged 50 years or older had received a mammogram in the past 2 years. About 82.6% (95% CI 80.1 to 85.2%) of women aged 18 years or older who had not undergone a hysterectomy had received a Papanicolaou test in the past 3 years. Older women and those with less education were less likely to be screened. Women who had seen a physician in the past year were much more likely to have been screened.

CONCLUSIONS

These results underscore the need for continued efforts to ensure that American Indian and Alaska Native women who are elderly or medically underserved have access to cancer screening services.

Risk of breast cancer in young women in relation to body size and weight gain in adolescence and early adulthood

Findings have been inconsistent on effects of adolescent body size and adult weight gain on risk of breast cancer in young women. These relations were examined in a population-based case control study of 1590 women less than 45 years of age newly diagnosed with breast cancer during 1990-1992 in three areas of the US and an age-matched control group of 1390 women. Height and weight were measured at interview and participants asked to recall information about earlier body size. Logistic regression was used to estimate the relative risk of breast cancer adjusted for other risk factors. Women who were either much heavier or lighter than average in adolescence or at age 20 were at reduced risk. Weight gain after age 20 resulted in reduced risk, but the effect was confined to early-stage and, more specifically, lower grade breast cancer. Neither the risk reduction nor the variation by breast cancer stage or grade was explained by the method of cancer detection or by prior mammography history. These findings suggest that relations between breast cancer risk in young women and body weight at different ages is complex and that the risk reduction with adult weight gain is confined to less aggressive cancers.

Stage of breast cancer in relation to body mass index and bra cup size

Most studies on women with breast cancer indicate that obesity is positively associated with late-stage disease. Some results have shown a similar relationship between breast size and stage. A recent study found that the association between body mass index (BMI) and stage was limited to cancers that were self-detected, suggesting that the BMI-stage relation may be due to delayed symptom recognition. We examined the relationships between stage and both BMI and breast (bra cup) size, stratified by method of detection, using data from a population-based case-control study of 1,361 women (ages 20-44 years) diagnosed with breast cancer during 1990-1992. Height and weight measurements and information on bra cup size, method of cancer detection and other factors predictive of stage at diagnosis were collected during in-person interviews. A case-case comparison was conducted using logistic regression to estimate odds of regional or distant stage rather than local stage in relation to BMI and bra size. Odds of late-stage disease were increased with higher BMI [adjusted odds ratio (OR) for highest to lowest tertile = 1.46, 95% confidence interval (CI) 1.10-1.93] and larger bra cup size (OR for cup D vs. cup A = 1.61, 95% CI 1.04-2.48). These relationships were not modified by the method of detection. Differences in etiologic effects, rather than differences in detection methods, may explain the relations observed between stage and both BMI and breast size.

Long-term trends in cancer mortality rates for West Virginia

Using data on death certificates, we examined age-adjusted cancer mortality rates for West Virginia men and women from 1980-1994. The leading causes of cancer deaths among men in the state in 1994 were cancers of the lung, prostate, colon, and pancreas, and non-Hodgkin's lymphoma. Among West Virginia women in 1994, cancer deaths were most often due to cancers of the lung, breast, colon, pancreas, and ovary. Based on polynomial regression analyses, many of the leading cancer mortality rates significantly increased during 1980-1994. The most striking increase was a 76% rise in lung cancer mortality among West Virginia women. These mortality data underscore the continuing need for tobacco control and other cancer control practices. Even though barriers to medical care challenge the state's health care professionals, the burden of cancer in West Virginia can be reduced by prevention, early detection, and appropriate treatment.

An unbalanced experimental design for dose response studies

Sixty sets of real data for 15 different pesticides from both sexes of Balb/C mice in two different experimental designs were generated at NCTR. The quantal responses for the dose groups in this data ranged from 1% to 90%. It was shown that the data could be represented equally well by a probit or logit transformation. It was further shown that the investment in terms of 7 times as many animals would greatly increase the confidence in estimating the parameters of the model and in predicting the dose at the low end of the dose response. Most important, it was shown that the estimation of a safe dose for a specified risk was greatly influenced by the choice of experimental design and method of extrapolation. It might be worth the investment in better experimental design to both the consumer and to the chemical industry if higher safe doses could be established which would allow the chemical to better accomplish its purpose and yet improve the assurance of the safety of the consumer.