Regular Screening Mammograms Research Articles

Abstract PD1-02: Statin use and breast cancer incidence in the Nurses' health study

Abstract Background Statin drugs lower cholesterol and prevent cardiovascular disease. Laboratory and epidemiologic evidence suggests that statins may also have anti-cancer properties. Published associations between statin use and breast cancer incidence are heterogeneous. Few studies have comprehensively addressed confounding by lifestyle and reproductive factors, or detection bias due to potentially higher screening rates among medication users. The most recent study on this topic reported an increased risk of invasive breast cancer among statin users. Methods To improve upon the present evidence base we studied the association between statin use and incident breast cancer among 79,518 postmenopausal women in the Nurses' Health Study cohort. We followed these women from 2000 (the year statin exposure was first ascertained prospectively) until the first of breast cancer diagnosis, death from any cause, or the end of follow-up in 2012. We defined statin exposure as current or former use (both factored with duration) or never use. We fit Cox regression models to estimate associations, encoding statin use and covariates as time-dependent variables updated every two years. We evaluated confounding by adiposity, reproductive history, menopausal hormone therapy, family history of breast cancer, history of benign breast disease and diabetes, alcohol consumption, physical activity, and use of co-medications. We also measured associations among those cohort members who underwent screening mammograms every two years. Results Over 823,086 person-years of follow-up, 3,055 cases of invasive breast cancer were diagnosed (1,078 of which were among statin users). Compared with non-users, statin users were somewhat older, had a higher mean BMI, were more likely to be users of aspirin, beta blockers, calcium channel blockers, digoxin, and ACE inhibitors, had a higher prevalence of diabetes, and were more likely to undergo mammographic screening. Current users of any statin had a similar rate of breast cancer incidence as never users (for current users of ≥8 years' duration, HRadj=1.1, 95% CI: 0.91, 1.3). Analyses of specific statin exposures among new initiators of therapy in 2004 returned similarly null associations (for current use of hydrophilic statins, HRadj=1.0, 95% CI: 0.82, 1.3; for current use of lipophilic statins, HRadj=1.1, 95% CI: 0.95, 1.3). Associations did not vary substantially by duration of statin use or according to breast cancer subtypes defined by histology (invasive ductal vs. invasive lobular disease) or estrogen receptor status. Statin use was not associated with incident breast carcinoma in situ. These results were similar in analyses restricted to women who underwent regular screening mammograms. Conclusions Our results indicate that cholesterol-lowering statin therapy neither increases nor decreases breast cancer incidence rate in postmenopausal women. Considering the latest report indicated an increased breast cancer risk among statin users, our neutral findings should reassure physicians that statin therapy for the prevention of cardiovascular disease is safe with respect to breast cancer risk. Citation Format: Ahern TP, Tamimi RM, Chen WY, Garber JE, Eliassen AH, Borgquist S. Statin use and breast cancer incidence in the Nurses' health study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr PD1-02.

Do Regular Mammograms Save Lives? Maybe Not.

The good news about breast cancer is that fewer women are dying from it. At first, experts thought this decrease was because regular screening mammograms found cancers at early, more-curable stages. But new studies have raised questions about mammography. Perhaps the lower death rate from breast cancer is due to better treatments for the disease rather than the ability of mammograms to find it early. A recent Canadian study in women aged 40 to 59 is the …

Abstract B55: Digoxin use and risk of invasive breast cancer: Evidence from the Nurses' Health Study

Abstract Background: Digoxin, a cardiac glycoside derived from Digitalis purpurea, has been used for centuries to treat heart failure and atrial fibrillation. Early evidence suggested that digoxin attenuates breast tumor aggressiveness and could become an antineoplastic drug. Two recent Danish studies did not support this hypothesis, showing an approximately 30% increased rate of breast cancer in digoxin users. One of these studies noted a stronger association with incidence of estrogen receptor (ER)-positive breast cancer than with incidence of ER-negative disease. Neither Danish study could account for mammography usage or for potential confounding by lifestyle-related breast cancer risk factors such as adiposity, postmenopausal hormone usage, and reproductive history, all of which hampers a causal interpretation of their findings. To address this evidence gap, we estimated the association between digoxin use and breast cancer incidence in the Nurses' Health Study (NHS) cohort. Methods: The NHS began in 1976 with the enrollment of 121,700 female U.S. registered nurses, who have completed biennial questionnaires to update demographic characteristics, lifestyle, dietary, and pharmaceutical exposures, and newly diagnosed illnesses. The current study followed cancer-free postmenopausal participants from 1994 (the year in which digoxin was first ascertained) until the end of 2010. Incident breast cancers were reported on questionnaires and confirmed by medical record review. We fit multivariable Cox proportional hazards models to estimate associations between time-varying digoxin use and breast cancer incidence. Competing risks models were used to assess heterogeneity of associations by tumor ER status. We conducted a secondary analysis to evaluate possible confounding by indication through use of an alternative reference group, comprised of digoxin-unexposed women who took other cardiac drugs (e.g., beta blockers). Results: Our study included 90,202 postmenopausal women who contributed approximately 1.05 million person-years of observation. There were 4,876 women who reported using digoxin during the follow-up period, among whom 144 cases of invasive breast cancer were diagnosed. Compared with non-users, digoxin users had lower average BMI, were more likely to have undergone regular screening mammograms, and were more likely to take aspirin, beta blockers and lipid lowering drugs. The exposed and unexposed groups were similar with respect to reproductive history, alcohol consumption, and use of postmenopausal hormones. Current digoxin use of greater than four years' duration was associated with a 49% increase in breast cancer incidence compared with never use (HRadj=1.49, 95% CI: 1.16, 1.91). This association was somewhat stronger for ER-positive breast cancer (HRadj=1.52, 95% CI: 1.14, 2.02) than for ER-negative breast cancer (HRadj=1.13, 95% CI: 0.53, 2.41). Current users with four or fewer years of exposure had a 31% higher incidence of ER-positive breast cancer (HRadj=1.31, 95% CI: 1.01, 1.69), and former users had about the same breast cancer risk as never users. The association was robust to adjustment for lifestyle-related breast cancer risk factors and to restriction to women who underwent regular screening mammograms. Furthermore, we saw no evidence of confounding by indication. Conclusions: This study confirms previously reported associations between current digoxin use and the incidence of breast cancer. We demonstrate that this association is not attenuated when lifestyle-related breast cancer risk factors and screening practices are accounted for. The considerable worldwide prevalence of digoxin use and the availability of alternative drugs may present an opportunity for primary prevention of a substantial number of breast cancer cases. Citation Format: Thomas P. Ahern, Rulla M. Tamimi, Bernard A. Rosner, Susan E. Hankinson. Digoxin use and risk of invasive breast cancer: Evidence from the Nurses' Health Study. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr B55.

Locally advanced breast cancers are more likely to present as Interval Cancers: results from the I-SPY 1 TRIAL (CALGB 150007/150012, ACRIN 6657, InterSPORE Trial)

Interval cancers (ICs), defined as cancers detected between regular screening mammograms, have been shown to be of higher grade, larger size, and associated with lower survival, compared with screen-detected cancers (SDCs) and comprise 17% of cancers from population-based screening programs. We sought to determine the frequency of ICs in a study of locally advanced breast cancers, the I-SPY 1 TRIAL. Screening was defined as having a mammogram with 2 years, and the proportion of ICs at 1 and 2 years was calculated for screened patients. Differences in clinical characteristics for ICs versus SDCs and screened versus non-screened cancers were assessed. For the 219 evaluable women, mean tumor size was 6.8 cm. Overall, 80% of women were over 40 and eligible for screening; however, only 31% were getting screened. Among women screened, 85% were ICs, with 68% diagnosed within 1 year of a previously normal mammogram. ICs were of higher grade (49% vs. 10%) than SDCs. Among non-screened women, 28% (43/152) were younger than the recommended screening age of 40. Of the entire cohort, 12% of cancers were mammographically occult (MO); the frequency of MO cancers did not differ between screened (11%) and non-screened (15%). ICs were common in the I-SPY 1 TRIAL suggesting the potential need for new approaches beyond traditional screening to reduce mortality in women who present with larger palpable cancers.

Why I Don’t Get Mammograms

Narrative Matters Health AffairsVol. 29, No. 10: Comparative Effectiveness Research Why I Don’t Get MammogramsVeneta Masson Affiliations Veneta Masson ( [email protected] ) is a nurse practitioner and writer living in Washington, D.C. Her most recent book is a collection of poetry, Clinician’s Guide to the Soul (Sage Femme Press, 2008). PUBLISHED:October 2010No Accesshttps://doi.org/10.1377/hlthaff.2010.0455AboutSectionsView articleView Full TextView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions View articleAbstractA nurse practitioner tells why she and many experts believe that most regular screening mammograms don’t save lives but instead give rise to false fears and unneeded biopsies.TOPICSBreast cancerCancerNurse practitionersPrimary careMediaSurgeryWomen's healthPreventive careAccess to care Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article MetricsCitations: Crossref 1 History Published online 1 October 2010 Information Project HOPE—The People-to-People Health Foundation, Inc. PDF downloadCited ByCorrecting a decade of negative news about mammographyClinical Imaging, Vol. 60, No. 2

Current Practices and Perspectives on Breast Cancer Screening and Treatment in Older Women with Dementia

To explore the nature of breast cancer screening and treatment decisions in older women with dementia. Thematic analysis of semistructured telephone interviews. Alzheimer's Disease Research Center Registry. Twenty-three family caregivers (CGs) of women with dementia (WWD). Semistructured questions regarding CGs' perceptions of current and predementia beliefs held by the WWD about the importance of regular screening mammograms, CGs' views about the importance of obtaining regular screening mammograms for the WWD and whether dementia stage of the WWD influenced these views, and CGs' view of what level of treatment would be appropriate if WWD they were caring for were to be diagnosed with breast cancer. In CGs of women with mild to moderate (but not severe) dementia, mammogram importance ratings reflected perceived predementia importance levels (generally high). Most CGs of women with mild to moderate dementia planned to continue screening regardless of dementia severity of the WWD, but CGs of women with severe dementia at the time of the interview did not generally consider screening important. Physician recommendations were frequently found to influence screening practices. CGs' views on appropriate treatment if the WWD developed breast cancer varied widely except in the case of severe dementia, in which case comfort care was consistently preferred. Breast cancer screening and treatment in dementia are active areas for healthcare decision-making, and supportive interventions involving physicians, CGs, and WWD are needed.

Recreational Physical Activity and Mammographic Breast Density Characteristics

Increased mammographic breast density is considered an intermediate marker of breast cancer risk. Physical activity is believed to reduce breast cancer risk; however, its effect on breast density is not well understood. We studied the association between recreational physical activity and mammographic characteristics of the breast among a population of premenopausal and postmenopausal women enrolled as controls (n = 728) in a case-control study of mammographic breast density and breast cancer. Women were enrolled shortly after obtaining their regular screening mammograms, and participants reported their current and lifetime recreational physical activity history using a self-administered, reliable questionnaire at study enrollment. Linear regression was used to determine associations between physical activity variables and the dense breast area, non-dense area, total breast area, and percent density. Age-adjusted analyses revealed significant inverse associations between physical activity variables and the non-dense area and total area and positive associations with percent breast density. These associations were attenuated and nonsignificant after adjustment for body mass index (BMI). Adjustment for additional factors did not substantially change the results. Physical activity was not associated with the dense breast area before or after adjustment for BMI. Self-reported recreational physical activity was not significantly associated with the mammographic characteristics of the breast after adjustment for BMI in this population. These results suggest that the mechanism by which physical activity reduces breast cancer risk may not involve breast density.

Increasing Mammography Screening Through Inpatient Education

The reasons why women do not undergo regular screening mammograms have not been clearly defined. In this study, we addressed an educational intervention based on Health Belief Model constructs for 3 of the most common reasons why women do not participate in mammography screening: cost, fear, and lack of knowledge. The purpose of the project was to study whether an educational intervention addressing these factors could increase mammography screening among age-appropriate women who had not had a recommended mammogram within the previous 12 months. The educational intervention consisted of providing a tailored brochure addressing either the barrier of (1) cost, (2) fear, or (3) lack of information. Participants were hospital inpatients admitted for noncancer diagnoses. They were followed up approximately 3 months after hospital discharge to ascertain subsequent mammography utilization either before or after leaving the hospital. Of the 272 women originally interviewed, 147 (54%) were reached for follow-up. Although there were no differences related to which mammography barrier was addressed, 42 (28.6%) reported that they had obtained a mammogram after the intervention. These data suggest that a fairly simple, low-cost patient education intervention of brochure distribution can produce substantially increased patient awareness and consequent mammography utilization.

Relationship Between Relative Risk of Developing Breast Cancer and Absolute Risk in a Population of Rural, Older African American Women.

Relative risks computed from known breast cancer risk factors can be used to quantitate a woman's individual risk of developing breast cancer. However, among older women the absolute risk of developing breast cancer over a specified time interval may be more useful in risk-benefit counseling. The objective of this investigation is to characterize the relationships between relative risks and absolute risks of breast cancer among a population of rural, older African American women. Among 224 African American women aged 50-91 years, relative risks were computed from historical information on age at menarche, number of previous biopsies, age at first birth, and number of first-degree relatives with breast cancer. These estimates, combined with the woman's current age, average remaining life expectancy, age-specific mortality, and breast cancer incidence rates, were used to estimate lifetime probabilities of developing breast cancer. Most women in the cohort (72.8%) had weak relative risks of 1.01-1.5 and only 3.5% of the women had relative risks of greater than 3.0. The majority of the women (87.5%) had lifetime probabilities of developing breast cancer that were less than 5%. Although there is a marked increase in age-specific breast cancer incidence with age, the probability of developing breast cancer in this population is low, primarily due to the low relative risks and the effects of competing mortality at older ages. Screening mammography should be directed toward women with high risks who are not receiving regular screening mammograms.

Compliance with mammography screening guidelines: 1995 mammography attitudes and usage study report

T he American Cancer Society (ACS) estimates that there will be approximately 184,300 new cases of breast cancer and 44,300 breastcancer related deaths among women in the United States in 1996.r Because the causes of breast cancer have not been identified, secondary prevention strategies have been developed that rely on early detection through use of screening mammography and clinical breast examination. The ACS recommends that women begin screening mammography by 40 years of age, that they have a mammogram every l-2 years, and that women over the age of 50 have an annual screening mammogram.1 Although some organizations continue to recommend that asymptomatic women in their forties have regular screening mammograms, others agree that regular screening mammography should start at 50 years of age. In 1994, the National Cancer Institute dropped recommendations for screening mammograms for women in their 40s and replaced the guidelines with statements of scientific fact that emphasize the lack of scientific evidence to support screening for women in this age group.’ Between 1987 and 1992, the National Health Interview Survey found that o 19% by The Jacobs Institute there was at least a two-fold increase in the percentage of women of all ages, of Women’s Health regardless of racial or ethnic category, who reported that they had a recent Published by Ekevier Science Inc. mammogram.3 1049-3867/96/$15.00 Despite the documented increase in the proportion of women PII sio49-3867(96)00037-o

Effects of Force, Race, and Coping Style on Pain During Patient-Controlled Mammography

ABSTRACT Breast cancer is a major killer of American women, with 182,000 new cases and 46,000 deaths expected in 1993. If women over age 50 were to get regular screening mammograms, mortality from this disease could be reduced by about 30%. Although concern about pain is not the most important barrier to mammography utilization, it appears to be a significant concern, especially for minority women. We hypothesized that giving women control over compression during mammography would decrease their self-rated pain, and that a woman's coping style would affect perceived pain. We also investigated the relationship of self- versus technologist compression, amount of force, race, coping style, and pain. Data were collected on 109 women from three sources—a 30-item patient questionnaire prior to the exam, 12 additional patient items completed after the exam, a technologist assessment, and radiologists' ratings of mammogram quality. Of the 48 women who rated technologist-applied compression and patient-controlled ...

Mammography usage and the health belief model.

Regular screening mammograms for asymptomatic women are the most effective method for early detection of breast cancer. This study assessed the relative influence of Health Belief Model (HBM) constructs on prior mammography usage and the intention to obtain mammograms with data from a sample of 1,057 women over the age of 35 years residing in an urban community in the United States. Covariance structure analysis with latent variables was used initially to perform a confirmatory factor analysis of indicators of Socioeconomic Status (SES), Perceived Susceptibility, Perceived Barriers, Perceived Benefits, Cues to Action, Prior Mammography, and Future Intentions. Once a plausible factor structure was confirmed, a predictive path model was tested with Future Intentions and Prior Mammography as the outcome variables. Cues to Action, operationalized as a physician influence variable, particularly impacted Prior Mammography, and Perceived Susceptibility was the most powerful predictor of Future Intentions. SES only related significantly to Perceived Barriers, and Cues to Action, and did not directly influence Prior Mammography and Future Intentions. HBM predictor variables alone accounted for the relationship between previous mammography experience and intentions to obtain mammograms in the future. Health education implications and an applied outreach program are discussed.

Breast screening practices among primary physicians: reality and potential.

Increased use of regular screening mammograms and clinical breast examinations (CBE) among women aged 40 years and more could have a dramatic impact on mortality from breast cancer, but patient and physician barriers to mammography impede its acceptance. We conducted a survey of 300 primary care physicians to assess their knowledge, attitudes, beliefs, and breast screening practices. Our results show that only 71 percent of the respondents ordered mammograms for all women aged 50 to 75 years, which is the recommendation by the National Cancer Institute and American Cancer Society. Approximately 46 percent of respondents performed CBE on all women patients aged 50 to 75 years. Inadequate patient insurance coverage, equivocal radiology reports, patient reluctance or worry, and patient embarrassment all appear to be barriers to physicians' utilization of breast screening.

Promoting physician preventive practices: needs assessment for CME in breast cancer detection.

Needs assessment for a continuing medical education (CME) intervention directed at increasing breast cancer screening of women 50 years of age and older included a survey of target primary care physicians (n = 370) to explore areas of interest for CME in breast cancer detection and to establish baseline screening practices. The survey was completed at community hospital department meetings or by mail with a response rate of 87% (n = 323). Strategies for enhancing response rate and participation in planning included involvement of local physician organizations, use of a focus group of physicians, and attendance at community hospital department meetings. Survey results indicated that the topics of greatest interest for CME included improving patient compliance, risk factors, and patient education. A total of 48% of physician respondents reported referring all their asymptomatic female patients 50 years of age and older for regular screening mammograms; 63% indicated that they perform breast examinations on all such women regularly. Physician concerns that were reported to influence physical breast examination or referral for mammography are discussed, as well as current use of related office systems (e.g., for recall reminders and/or breast self-examination instruction). The results of a survey of women in the target age group residing in the same community are also reviewed in terms of mammography utilization (e.g., the proportion who had a screening mammogram within the last year was 19%) and specific concerns about mammography. The lack of a doctor's recommendation was the most common reason given (45%) for never having had a mammogram. The uses of the data from both surveys for CME program planning are discussed, including the content and design of the programs, along with organizational aspects and strategies for enhancing attendance.