National Cancer Institute Survey Research Articles

Dietary patterns, cooking methods and breast cancer risk in Mexico: An exploratory case-control study.

Background: Nutrition has an important influence on the risk of developing breast cancer (BC). Dietary patterns can capture the complex interplay of nutrients and cooking methods can contribute to the presence of heterocyclic amines, which are potent mammary carcinogens. Research on dietary patterns, cooking methods, and their association with BC in Mexican women is scarce. Aim: To evaluate the association of dietary patterns and cooking methods with BC risk among women from the Northwest region of Mexico. Methods: This case-control study included 120 women. Eligible cases (n = 60) were diagnosed and biopsy-confirmed in the past 2 years. Control subjects (n = 60) were hospital and population-based. Dietary intake and cooking methods were respectively assessed through a food frequency questionnaire (FFQ) and the National Cancer Institute survey. We obtained dietary patterns from a K-means cluster analysis (CA), and multivariate logistic regression tested the association of dietary patterns and cooking methods with BC risk. Results: Prudent and caloric dietary patterns were identified. The caloric pattern was associated with BC risk (Model 1: ORadj: 5.07, 95%CI:1.44-17.84, p = 0.011; Model 2: ORadj: 4.99 (95%CI:1.39-17.92, p = 0.014). Intense frying, meat grilling and poultry resulted in a significant BC risk (Model 1: ORadj: 5.54,95%CI: 2.13-14.41), p < 0.001; Model 2: ORadj: 5.12, 95%CI: 1.83-14.31, p = 0.002). At Oestrogen exposure of <32 years, there was an association between dietary patterns and BC risk (ORadj: 4.69, 95%CI: 1.01-21.92, p = 0.049). The relationship between BC risk and cooking intensity was found in both strata of exposure to oestrogens: <32 years (ORadj: 3.72, 95%CI:1.04-13.33, p = 0.044), and ≥32 years (ORadj: 6.06, 95%CI:1.34-27.42, p = 0.019). Conclusions: A caloric dietary pattern rich in refined carbohydrates and saturated fat, and intense meat product cooking may increase the risk of BC in Mexican women.

Knowledge and self-efficacy for caring for breast and colon cancer survivors among safety net primary care providers.

Primary care providers (PCPs) are critical to the provision of comprehensive care for cancer survivors, yet there is very little data on the practices and quality of survivorship care occurring in safety net primary care settings. This study aimed to assess the knowledge and attitudes of PCPs and preferences for care models for breast and colon cancer survivors in a safety net health network. A modified National Cancer Institute Survey of Physician Attitudes Regarding the Care of Cancer Survivors was sent electronically to 220 PCPs in 12 primary care clinics in the San Francisco Health Network affiliated with Zuckerberg San Francisco General Hospital and Trauma Center. The response rate was 50% (110/220). About half of PCPs strongly/somewhat agreed (vs. strongly/somewhat disagreed) that PCPs have the knowledge needed to provide follow-up care related to breast (50%) and colon cancer (54%). Most providers (93%) correctly reported recommended frequency of mammography, however, frequency of blood tests and other imaging surveillance were not as well recognized for breast or colon cancer. Recognition of long-term side effects of chemotherapy drugs ranged from 12% for oxaliplatin to 44% for doxorubicin. Only 33% of providers reported receiving any survivorship training. The most preferred model for survivorship care was shared care model (40%). Safety net PCPs prefer a shared care model for care of cancer survivors but are limited by lack of training, poor communication, and poor delineation of roles. Patient-centered survivorship care can be improved through effective oncologist-PCP-patient partnerships and coordination.

Are changes in breast self-exam recommendations and early misperceptions of breast cancer risk increasing women's future risks?

Young women, high school age, are exposed to breast cancer messages targeting adult women that can result in misperceptions, increasing future risks. Changes in breast self-exam screening recommendations may reduce nurse practitioner (NP) time addressing breast health. This study characterized misperceived knowledge of breast cancer risk in younger women. A survey (338 high school students aged 14 to 19) was conducted to assess their perceptions of breast cancer etiologies and risk behaviors. Survey results indicated 20% to 50% of students had misperceptions about breast cancer risk, and the mean knowledge score for all items was 65.47%. There were no differences in students with familial breast cancer histories or those instructed in breast self-exam. Approximately 12% reported being fearful, avoiding public health messages, and approximately 20% thought breastfeeding increased breast cancer risk. The findings suggest that school-based programs are not addressing misperceptions related to breast health effectively. A National Cancer Institute survey found that NPs and other providers are the most trusted sources of health information. Given the low rates of breast cancer in young women and recommendations against teaching breast self-exam, it is important for NPs to be knowledgeable about common misperceptions and address them with their patients.

Are primary care providers prepared to care for survivors of breast cancer in the safety net?

With the growing number of survivors of breast cancer outpacing the capacity of oncology providers, there is pressure to transition patients back to primary care. Primary care providers (PCPs) working in safety-net settings may have less experience treating survivors, and little is known about their knowledge and views on survivorship care. The current study was performed to determine the knowledge, attitudes, and confidence of PCPs in the safety net at delivering care to survivors of breast cancer. A modified version of the National Cancer Institute's Survey of Physician Attitudes Regarding Care of Cancer Survivors was given to providers at 2 county hospitals and 5 associated clinics (59 providers). Focus groups were held to understand barriers to survivorship care. Although the majority of providers believed PCPs have the skills necessary to provide cancer-related follow-up, the vast majority were not comfortable providing these services themselves. Providers were adherent to American Society of Clinical Oncology recommendations for mammography (98%) and physical examination (87%); less than one-third were guideline-concordant for laboratory testing and only 6 providers (10%) met all recommendations. PCPs universally requested additional training on clinical guidelines and the provision of written survivorship care plans before transfer. Concerns voiced in qualitative sessions included unfamiliarity with the management of endocrine therapy and confusion regarding who would be responsible for certain aspects of care. Safety-net providers currently lack knowledge of and confidence in providing survivorship care to patients with breast cancer. Opportunities exist for additional training in evidence-based guidelines and improved coordination of care between PCPs and oncology specialists.

Tightening tobacco restrictions on teens may impact adult smoking

States with more stringent limits on teens purchasing tobacco have lower adult smoking rates, especially among women, according to a study by researchers at the Washington University School of Medicine in St. Louis, Missouri.1 Investigators also found that, compared with states that have fewer restrictions, the stricter states also tended to have fewer adult heavy smokers. Researchers evaluated data from an ongoing National Cancer Institute survey that monitors smoking behavior in all 50 states. They reviewed data from 1998 to 2007 on 105,519 people aged 18 to 34 years. They considered whether people had ever smoked, were currently smoking, and, if they did smoke, whether they smoked more than 10 cigarettes per day. Researchers also examined the specific smoking restrictions that were in place when the participants were aged 17 years. Although it has been illegal for many years in most states to sell cigarettes to people aged younger than 18 years, few provisions are in place to prevent such sales, according to the study's first author, Richard Grucza, PhD, associate professor of psychiatry at Washington University. Dr. Grucza and his colleagues focused on 9 smoking-related policies and found that in states with enforcement policies, 17-year-olds not only had more difficulty purchasing cigarettes but were less likely to smoke in their 20s or 30s. They estimated that if all states had such policies in place, the prevalence of smoking could be reduced by approximately 14%, whereas the rates of heavy smoking would decline by 29%. The most effective restrictions were those on cigarette vending machines, in which the machines were either eliminated or housed in locations inaccessible to people aged younger than 18 years; identification requirements for purchasing cigarettes; restrictions on repackaging cigarettes so that 5 or 10 can be sold at a time versus an entire 20-pack; and prohibiting the distribution of free cigarettes at public events. Many of the more restrictive policies have been in place nationally since the FDA started regulating cigarettes in 2009, which may lead to a decline in future adult smoking rates, Dr. Grucza notes. He and his colleagues found that restrictive policies on youth access had a big impact on women but did not make much of difference with regard to smoking rates in men. They theorized that underage women in the past have had an easier time getting alcohol and tobacco and that new policies such as checking identification may have made it more difficult for underage women to buy cigarettes. The last year of available data on states for the study was 2006. At that time, only 4 states required a photo identification and only 20 had any kind of identification requirements. As more states around the country adopt stricter policies, smoking rates are likely to decline, Dr. Grucza says.

Abstract A51: Understanding community-based primary care providers' attitudes toward caring for breast cancer survivors.

Abstract Background: Of the 13.7 million cancer survivors in the United States, 22% are breast cancer survivors. By 2050, this number is expected to double. The 2005 Institute of Medicine's Report “From Cancer Patient to Cancer Survivor: Lost in Transition,” identified 4 essential components of survivorship care. Central to this includes the coordination between specialists and primary care providers. Primary Care Providers (PCPs) often play a critical role in the follow-up care for patients with chronic diseases. Cancer survivorship can now be viewed as a chronic disease however PCPs have little access to training and education in survivorship care. By offering culturally appropriate and trusted care in a setting that is familiar and accessible to their patients, PCPs in the community setting are in a unique position to impact cancer follow-up care for their patients. Thus greater involvement by community PCPs is likely to impact cancer survivorship disparities. We sought to survey PCP attitudes regarding cancer survivorship care delivery. Methods: The Illinois Breast and Cervical Cancer Program (IBCCP) is part of the Center for Disease Control's National Breast and Cervical Cancer Early Detection Program. This program provides access to breast and cervical cancer screening services to underserved women. Illinois has 36 lead agencies. A 10-question survey based on the National Cancer Institute's Survey of Physician Attitudes Regarding the Care of Cancer Survivors (SPARCCS) was given to IBCCP providers. Providers were surveyed about their attitudes and self-efficacy as well as preferences for breast cancer care delivery. The SPARCCS surveyed over 1000 PCPs on their knowledge and attitudes on breast cancer survivorship care. 83% of SPARCCS PCPs work in either private practice or as part of a large healthcare system. Results: 110 PCPs completed the IBCCP survey. 54% (n=59) were physicians, 28% (n= 31) nurse practitioners, and 17% (n= 19) identified as other. 94.5% (n= 104) of the respondents reported having patients with a breast cancer history. Compared to PCPs in the original SPARCCS survey, 37% IBCCP providers' preferred oncologists take primary responsibility (SPARCCS 25%, p=0.0057) and 13% IBCCP providers' preferred survivorship care be delivered in specialized survivorship clinics led by a clinician other than a physician (SPARCCS 4%, p=0.0002). The other survivorship care model preference differences were not statistically significant. Overall, community-PCPs surveyed preferred follow-up care be delivered through specialized clinics and/or by cancer specialists. Conclusions: Limited information exists regarding the role of community PCPs in breast cancer survivorship follow-up care for the underserved. Most providers in our survey stated they preferred follow-up care be delivered by the cancer specialist or through specialized survivorship clinics. The role to which improving provider knowledge, attitudes, and self-efficacy can impact preferences for care delivery needs to be explored. Citation Format: Zakiya Moton, Danielle Weston, Rebecca McFarland, Tamara Hamlish, Daniel Johnson, Maureen Mencarni, Shannon Lightner, Jean Becker, Funmi Olopade, Susan Hong. Understanding community-based primary care providers' attitudes toward caring for breast cancer survivors. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A51.

Adrenal Carcinoma - A Case Report

DOI: http://dx.doi.org/10.3329/bjch.v35i1.10371 BJCH 2011; 35(1): 32-35

Biorepository and Biospecimen Science: A New Focus for CEBP

In January 2006, Cancer Epidemiology, Biomarkers & Prevention ( CEBP ) introduced the new subject area of Biorepository and Biospecimen Science. In creating this new category, the journal is recognizing what many investigators, including molecular epidemiologists, have known for years: that the

Cutting Cost and Increasing Access to Colorectal Cancer Screening: Another Approach to Following the Guidelines

Through medical decision making, physicians in the U.S. influence the spending of >$1.3 trillion or 15% of the gross domestic product. U.S. physicians are challenged to identify areas of clinical practice to improve while cutting cost and increasing access. Primary screening for colorectal cancer is a good example to illustrate this point. To apply a population-based method of medical decision making in the area of primary screening for colorectal cancer in order to illustrate a reduction in health care costs while increasing access and maintaining quality of care. We used a combination of (a) census population data, (b) National Cancer Institute Survey data on screening rates, and (c) charge data to estimate the current costs of colorectal cancer screening. We also estimated cost and capacity increases that would occur under various other screening scenarios. These included all currently screened subjects receiving annual fecal occult blood testing (FOBT), all currently unscreened individuals undergoing either colonoscopy every decade or annual FOBT, and all eligible subjects undergoing annual FOBT. Cost and access differences between current screening activity and other potential scenarios compliant with guidelines. Screening for colorectal cancer with yearly, six-window, rehydrated FOBT for all normal-risk individuals over the age of 50 has the potential to screen 3,813,095 more Americans for colon cancer yearly than are currently being screened, while costing $8.7 billion less per decade than what is currently being spent on screening a fraction of the population. Looking into the future, it is possible to increase screening rates from 50% to 100%, while saving almost $10 billion per decade by using FOBT for all eligible Americans. In practice, some proportion of these benefits would be realized as the calculations assume a 100% patient compliance rate. Considering a population-based approach and the balance among quality, accessibility, and cost parameters, we recommend primary screening for colorectal cancer to be based on yearly six-window, rehydrated FOBT. Colonoscopy due to cost and access issues should be relegated to secondary screening and case finding.

Endoscopic colorectal cancer screening—can supply meet demand?

Endoscopic colorectal cancer screening—can supply meet demand?

Current capacity for endoscopic colorectal cancer screening in the United States: data from the National Cancer Institute Survey of Colorectal Cancer Screening Practices

Purpose There is a national goal in the United States to increase the level of colorectal cancer screening, but there is currently little information on resources for the delivery of endoscopic screening and follow-up diagnostic and surveillance procedures. The purpose of this study was to provide nationally representative data on endoscopic resources at the provider level. Methods A nationally representative survey of primary care physicians, general surgeons, and gastroenterologists that was conducted during 1999 to 2000 provided data from survey responses by 1235 primary care physicians, 349 gastroenterologists, and 316 general surgeons. Results We estimated that 65% of all sigmoidoscopy procedures were performed by primary care physicians, 25% by gastroenterologists, and 10% by general surgeons. Only 30% of all primary care physicians performed any procedures, and average volume among those who did was relatively low (seven per month). Gastroenterologists performed two thirds of all colonoscopy procedures, with most of the remainder performed by general surgeons. Conclusion There is potential to increase the capacity to perform screening sigmoidoscopy procedures through primary care delivery. However, without careful consideration of organizational factors, this could result in increased cost and quality control problems. Increasing the capacity for screening colonoscopy is feasible, but will require attention to other problems, such as avoiding overfrequent (e.g., annual or biennial) procedures in low-risk patients.

Nonmelanoma skin carcinoma in Albuquerque, New Mexico: experience of a major health care provider.

Although nonmelanoma skin carcinomas (NMSC) are increasing nationwide, rates are difficult to measure precisely, because few registries include types of carcinoma. Albuquerque, New Mexico is a high risk site for both melanoma and NMSC. In a National Cancer Institute (NCI) survey conducted between 1977 and 1978, NMSC incidence rates among non-Hispanic white males were the highest of 8 national study sites. Experience with NMSC over 28.5 years at the Lovelace Health Systems in Albuquerque, New Mexico is described. The impact of multiple tumors was emphasized, recent annual incidence rates in members of the Lovelace Health Plan (LHP) were calculated, and trends in incidence rates since the NCI survey were estimated. There were 10,760 tumors among 4958 people between 1964 and mid-1992, with an average of 2.2 lesions per person (range: 1-92 lesions). Basal cell carcinoma (BCC) was 6.6 times more common than squamous cell carcinoma (SCC), and more likely to be multiple. There was an excess of males among persons with each tumor type and among subjects with multiple tumors. Only 46.1% of NMSC were first tumors; multiple or subsequent tumors comprised 53.7%. More than half of the concomitant or subsequent tumors were diagnosed within 1 year of the first, but new tumors were still appearing in the same subjects more than 10 years later. The incidence of NMSC between 1989 and 1991 among LHP members increased with age, and rates were higher for non-Hispanic males than females. Hispanics had much lower rates than non-Hispanic whites (NHW), with no sex differential. Incidence rates of BCC have increased markedly since 1977 and 1978 in NHW males, and to a lesser extent in other groups. Rates of SCC have not changed. The ratio of NMSC to other carcinomas at Lovelace has doubled over the same interval and has increased 10-fold over the last 2 decades. These data confirm the marked effect of age, ethnicity, and sex on NMSC rates. Differences in trends in BCC and SCC highlight their somewhat different etiologies. The increasing rate of BCC since the late 1970s and the large numbers of multiple tumors make a powerful case for intensified efforts at both primary and secondary prevention.

A Switch in Time Saves a Statistical Bind-Reply

In Reply. —It is important to note that the statistics in the article are lifetime prevalence rates rather than annual incidence rates, a point that is easily confused. The American Cancer Society's annual publication, Cancer Facts and Figures , estimates that in 1991 approximately 175 000 women will develop breast cancer. 1 Overall, 1.1 million new cases of cancer will be diagnosed this year, and 514 000 women will die from the disease (1400 women each day). The lifetime risk for women developing breast cancer has recently been determined to increase from one in 10 women to one in nine women, a change reflecting both a rising incidence of breast cancer and an aging population. 1 These results are compiled by the American Cancer Society using data collected through the National Cancer Institute's Survey of Epidemiological End Results, an accumulation of actual incidence rates from 10 US oncologic registries.