Contralateral prophylactic mastectomy (CPM), a preventive procedure to remove the unaffected breast in patients with disease in one breast, may only offer a survival benefit to breast cancer patients age 50 and younger, who have early-stage disease and are estrogen receptor (ER) negative, according to researchers at The University of Texas M. D. Anderson Cancer Center.
Published online in the Journal of the National Cancer Institute, it's the first population-based study to find an association between the procedure and survival in any group of breast cancer patients. The findings should offer evidence to both the women making this often agonizing decision and the physicians responsible for their care.
According to Isabelle Bedrosian, M.D., assistant professor in M. D. Anderson's Department of Surgical Oncology, a growing number of breast cancer patients are opting for the procedure; recent statistics have shown that the rate of CPM in women with stage I-III breast cancer increased by 150 percent from 1998 to 2003 in the United States.
"In our clinic, we've seen a dramatic increase in the number of women requesting CPM, and across the breast cancer community, studies have shown that the utilization of the procedure is skyrocketing," said Bedrosian, the study's co-corresponding author. "Until now, we've counseled these patients on a very important, personal decision in a vacuum. With our study, our goal was to understand the implications of the surgery and who may benefit."
For the retrospective, population-based study, the researchers used the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) registry, the premier population-based cancer registry now representing 26 percent of the country's population, to identify 107,106 breast cancer patients who underwent a mastectomy for treatment, as well as a subset of 8,902 women who had CPM. All of the women were treated for stages I - III breast cancer between 1998 and 2003. Patients were stratified for ER status, stage of disease and age. Breast cancer-specific survival served as the study's primary endpoint.
Rigorous analysis was paramount in the design of the study, said George J. Chang, M.D., assistant professor in M. D. Anderson's Department of Surgical Oncology.
"It was important to take a critical eye and look at all the different ways the data could be misinterpreted to ensure that biases were not impacting our findings," said Chang, the study's co-corresponding author. "Using multi-variable analysis as well as risk stratification, we did our analysis in many different ways - through SEER, comparing the survival of these patients to that of the general population, as well as examining non-cancer related versus cancer-specific survival. All alternative analyses resulted in the same conclusion; we found one group for whom this surgery offers a true survival benefit."
The researchers found a clear survival benefit for a select group of women that represents less than 10 percent of the breast cancer population. Those younger than age 50 with stage I or II cancer with ER negative disease had a survival benefit of 4.8 percent at five years. However, both Bedrosian and Chang expect that future research will show increased survival benefit with longer follow-up in the population, as a patient's likelihood of getting a second breast cancer increases with time.
While the findings should serve as a guideline for breast cancer patients and their physicians to have an informed, medically-based discussion about CPM, they do not determine that CPM is medically inappropriate for all others with the disease, said the researchers.
"Our research found that breast cancer patients over the age of 60 can be reassured that they will not benefit from CPM," said Bedrosian. "However, there are other populations - such as women between the age of 50 and 60 - where the findings about the procedure remain less clear. In addition, for young women with early stage, estrogen receptive positive breast cancer who receive Tamoxifen for only five years, we really do not know whether they would derive a life-long protective effective from a second breast cancer event. Therefore, for some additional breast cancer patients, CPM may very well be a medically-appropriate option."
In addition, the researchers note, the study captured neither family history nor BRCA status; it also did not include DCIS, or stage 0 breast cancer patients.
In addition to Bedrosian and Chang, Chung Yuan Hu in the Department of Surgical Oncology, also authored the all-M. D. Anderson study.
About M. D. Anderson
The University of Texas M. D. Anderson Cancer Center in Houston ranks as one of the world's most respected centers focused on cancer patient care, research, education and prevention. M. D. Anderson is one of only 39 Comprehensive Cancer Centers designated by the National Cancer Institute. For six of the past eight years, M. D. Anderson has ranked No. 1 in cancer care in "America's Best Hospitals," a survey published annually in U.S. News and World Report.
Source: University of Texas M. D. Anderson Cancer Center
суббота, 28 января 2012 г.
суббота, 21 января 2012 г.
Violence Against Women: Stories You Rarely Hear About
Every day, women all over the world are abducted into forced marriage; subjected to harmful traditional practices; married, while still children, to far older men; and injured through gang rape and rape with foreign objects - usually during conflict. In Guatemala, the death toll of murdered and mutilated women has already reached more than 500 for this year alone and has climbed steadily during the last five years. In 2005, 665 women were found murdered, compared to 494 in 2004. For a small country of 12 millions, these numbers are alarming and by far surpass those of the better-known homicides of young women in Ciudad Juarez, Mexico.
Every year, the plight of these women is too often ignored, consigned to the back pages of newspapers or relegated to no more than a passing mention in mainstream broadcast media-if at all.
To kick off the annual 16 Days of Activism Against Gender-Based Violence, UNFPA, the United Nations Population Fund, is highlighting five under-reported stories relating to gender-based violence for 2006.
These stories are as hidden as they are diverse. They include:
The rising tide of 'bridenapping'-the abduction, rape and forced marriage of young women throughout Central Asia;
Breast-ironing, a traditional practice in a number of West African countries that involves crushing the breasts of young girls in order to deter male attention;
The epidemic of traumatic fistula in Africa, which is caused by gang rape and often the forced insertion of foreign objects into the rape victim. This results in the tearing of the delicate tissues separating the birth canal from the bowel and/or the bladder. Seriously injured and psychologically traumatized, the victim is left incontinent, leaking faeces, urine, or both. Too often, her family and community rejects her, to live out the remainder of her life as a pariah - doubly stigmatized - both by the rape itself and its terrible consequences.
The ongoing femicide of women in the Central American country of Guatemala. Unlike the killings of young women in Ciudad Juarez, on the El Paso/Mexico border, the wholesale murder and mutilation of Guatemala's women continues to be enacted under a cloak of media silence and official neglect.
Child marriage - the forced marriage of girl children - most often against their will, to (usually) older men. Most of these marriages take place in the world's poorest nations and mean girls are unable to complete their education; are at greater risk of being exploited, of contracting sexually transmitted infections, including HIV, and of dying or being injured in childbirth owing to the fact that their bodies are too immature to withstand the rigours of birth.
To learn more about five under reported stories on gender-based violence, please visit unfpa.
The United Nations Population Fund is an international development agency that promotes the right of every woman, man and child to enjoy a life of health and equal opportunity. UNFPA supports countries in using population data for policies and programmes to reduce poverty and to ensure that every pregnancy is wanted, every birth is safe, every young person is free of HIV/AIDS, and every girl and woman is treated with dignity and respect.
For more information please go to:
The United Nations Population Fund
Every year, the plight of these women is too often ignored, consigned to the back pages of newspapers or relegated to no more than a passing mention in mainstream broadcast media-if at all.
To kick off the annual 16 Days of Activism Against Gender-Based Violence, UNFPA, the United Nations Population Fund, is highlighting five under-reported stories relating to gender-based violence for 2006.
These stories are as hidden as they are diverse. They include:
The rising tide of 'bridenapping'-the abduction, rape and forced marriage of young women throughout Central Asia;
Breast-ironing, a traditional practice in a number of West African countries that involves crushing the breasts of young girls in order to deter male attention;
The epidemic of traumatic fistula in Africa, which is caused by gang rape and often the forced insertion of foreign objects into the rape victim. This results in the tearing of the delicate tissues separating the birth canal from the bowel and/or the bladder. Seriously injured and psychologically traumatized, the victim is left incontinent, leaking faeces, urine, or both. Too often, her family and community rejects her, to live out the remainder of her life as a pariah - doubly stigmatized - both by the rape itself and its terrible consequences.
The ongoing femicide of women in the Central American country of Guatemala. Unlike the killings of young women in Ciudad Juarez, on the El Paso/Mexico border, the wholesale murder and mutilation of Guatemala's women continues to be enacted under a cloak of media silence and official neglect.
Child marriage - the forced marriage of girl children - most often against their will, to (usually) older men. Most of these marriages take place in the world's poorest nations and mean girls are unable to complete their education; are at greater risk of being exploited, of contracting sexually transmitted infections, including HIV, and of dying or being injured in childbirth owing to the fact that their bodies are too immature to withstand the rigours of birth.
To learn more about five under reported stories on gender-based violence, please visit unfpa.
The United Nations Population Fund is an international development agency that promotes the right of every woman, man and child to enjoy a life of health and equal opportunity. UNFPA supports countries in using population data for policies and programmes to reduce poverty and to ensure that every pregnancy is wanted, every birth is safe, every young person is free of HIV/AIDS, and every girl and woman is treated with dignity and respect.
For more information please go to:
The United Nations Population Fund
суббота, 14 января 2012 г.
ASPS Studies Re-Evaluate Psychological Benefits And Health Concerns Of Silicone Breast Implants
Plastic surgeons are re-evaluating past scientific findings and developing new knowledge about the effects of silicone breast implants. A recent supplement to Plastic and Reconstructive Surgery® (PRS), the official medical journal of the American Society of Plastic Surgeons (ASPS), sheds new light on the psychological impact and health concerns of silicone breast implants.
Body Image
One review of important recent studies refuted a common perception - women who want breast augmentation do not suffer from lower overall body image than other women.
"Breast augmentation patients do not have a poorer overall self-image, nor are they more self-critical and preoccupied with their appearance than other women," said Mary McGrath, MD, ASPS Member Surgeon and study author. "It appears it is their significant dissatisfaction with their breasts that serves as the motivation for surgery, not a poor overall body image."
The positive effect of breast augmentation on women's thoughts and feelings is also limited to their breasts. After surgery, they report being less embarrassed about their breasts and spending less time feeling upset about and camouflaging their breasts.
Cancer Risk
While some studies have raised concerns about the potential link between silicone breast implants and breast cancer, others have suggested the implants could cause other types of cancer (cervical, vulvar, lung, etc). A National Cancer Institute (NCI) review of past epidemiologic studies showed little support for an increased risk of cancer among breast implant patients.
"At present, there is no convincing evidence that breast implants alter the risk of cancer," said Louise Brinton, Ph.D., NCI, and study author. "The few increases in risk that have been noted in studies appear to be largely attributable to lifestyle characteristics of the women, such as smoking, rather than the implants."
Effect on Breast-feeding
Despite the overwhelming advantages of breast-feeding, some women with silicone breast implants may fear silicone could be passed on to their child, possibly affecting growth and development. However, according to a study, that measured silicon as an indicator of silicone, the levels of silicon found in lactating mothers with implants, as compared to lactating mothers without implants, was not significantly different.
"Our findings suggest there is no difference in silicone levels in the breast milk of women with silicone breast implants than in the breast milk of women without implants," said John Semple, MD, ASPS Member Surgeon and study author.
More than 329,000 breast augmentations were performed in 2006, according to the ASPS. For the first time since ASPS began collecting statistics in 1992, breast augmentation was the top cosmetic surgical procedure performed.
Visit plasticsurgery for referrals to ASPS Member Surgeons and to learn more about cosmetic and reconstructive plastic surgery.
The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. With more than 6,000 members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 90 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.
American Society of Plastic Surgeons
Body Image
One review of important recent studies refuted a common perception - women who want breast augmentation do not suffer from lower overall body image than other women.
"Breast augmentation patients do not have a poorer overall self-image, nor are they more self-critical and preoccupied with their appearance than other women," said Mary McGrath, MD, ASPS Member Surgeon and study author. "It appears it is their significant dissatisfaction with their breasts that serves as the motivation for surgery, not a poor overall body image."
The positive effect of breast augmentation on women's thoughts and feelings is also limited to their breasts. After surgery, they report being less embarrassed about their breasts and spending less time feeling upset about and camouflaging their breasts.
Cancer Risk
While some studies have raised concerns about the potential link between silicone breast implants and breast cancer, others have suggested the implants could cause other types of cancer (cervical, vulvar, lung, etc). A National Cancer Institute (NCI) review of past epidemiologic studies showed little support for an increased risk of cancer among breast implant patients.
"At present, there is no convincing evidence that breast implants alter the risk of cancer," said Louise Brinton, Ph.D., NCI, and study author. "The few increases in risk that have been noted in studies appear to be largely attributable to lifestyle characteristics of the women, such as smoking, rather than the implants."
Effect on Breast-feeding
Despite the overwhelming advantages of breast-feeding, some women with silicone breast implants may fear silicone could be passed on to their child, possibly affecting growth and development. However, according to a study, that measured silicon as an indicator of silicone, the levels of silicon found in lactating mothers with implants, as compared to lactating mothers without implants, was not significantly different.
"Our findings suggest there is no difference in silicone levels in the breast milk of women with silicone breast implants than in the breast milk of women without implants," said John Semple, MD, ASPS Member Surgeon and study author.
More than 329,000 breast augmentations were performed in 2006, according to the ASPS. For the first time since ASPS began collecting statistics in 1992, breast augmentation was the top cosmetic surgical procedure performed.
Visit plasticsurgery for referrals to ASPS Member Surgeons and to learn more about cosmetic and reconstructive plastic surgery.
The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. With more than 6,000 members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 90 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.
American Society of Plastic Surgeons
суббота, 7 января 2012 г.
Population-Based Breast-Cancer Screening Not Best Use Of Limited Health-Care Resources In Low And Middle-Income Countries
There is increasing pressure from national and international advocacy groups on low-income and middle-income countries (LMICs) to implement population-based mammography screening. But according to a Personal View published Online First in The Lancet Oncology, this "one-size-fits-all" approach although proven to be effective in high-income countries would be impractical in most LMCs and an ineffective use of limited health-care resources. A better solution might be to raise awareness and encourage more women with breast symptoms to seek and receive timely treatment.
Globally, breast cancer is the most common female cancer accounting for an estimated 1.4 million cases each year, with more than half of the 400 000 breast-cancer deaths occurring in LMICs. Breast-cancer screening programmes are regularly used in high-income countries where the incidence of breast cancer is highest. However, the value and practicality of such screening programmes in LMICs is less clear. Women in LMICs have a lower risk of breast cancer but tend to be diagnosed at a later stage when curative treatments are less likely to work.
Because rates of breast cancer are generally lower in LMICs, screening programmes aimed at early detection in women without symptoms would have a lower yield and substantially more women would have to be screened to find a case of breast cancer, explains Joe Harford from The National Cancer Institute, Bethesda, USA.
Indeed, he adds, for screening to be effective a high level of compliance is necessary, not only with initial screening but also with treatment in those found to have breast cancer.
The WHO suggests that participation of at least 70% is needed for screening to substantially reduce the number of deaths. But evidence from LMICs suggests this might be difficult. For example, a screening trial involving clinical breast exam in the Philippines was stopped because of the reluctance of women to participate in follow-up and obtain a definitive diagnosis and treatment. Additionally, in the first attempt at screening mammography in Egypt, 2.1% of women were recalled, but more than half were lost to follow up.
In many LMICs the cost of setting up and running screening programmes is high compared with total health spending. A recent analysis concluded that breast screening in India is not cost effective because of the lower incidence and therefore lower yield from screening, and the lack of health-care resources in a country where total health spending per capita is about the same cost as a single mammogram screen in the USA.
Studies of breast-cancer screening in LMICs also suggest that organised screening of women without symptoms might be impractical: "Cultural and economic barriers to participation are one issue, but the magnitude of effort required to screen a large population is another", says Harford. For example, to screen the projected target population of women aged 40 - 69 years in Egypt in 2025 (an estimated 24 million women) would need a 250-fold increase in government-funded mammography screening capacity.
He adds: "It is difficult to envision that the already stretched Egyptian health-care system could increase from 200 mammograms per day to 50 000 mammograms and 5000 follow-up procedures per day, as well as state-of-the-art treatment, to reduce breast-cancer mortality by around 30% as in high-income countries."
So is there an alternative solution? According to Harford, a more effective approach might be to: "Shift the focus from large asymptomatic populations - who make up most of the participants in a screening programme in LMICs, and most of whom will never have breast cancer - to the much smaller populations of women with breast symptoms."
He points out that key to this approach is the need for more evidence-based research into why women with breast symptoms delay
seeking care and the barriers within health-care systems that prevent earlier diagnosis.
"Raising breast awareness is a laudable goal and one that should be aggressively pursued by advocacy groups and health-care systems in LMICs, without necessarily seeking population-based mammographic screening", concludes Harford.
Link to personal view
Source
The Lancet Oncology
Globally, breast cancer is the most common female cancer accounting for an estimated 1.4 million cases each year, with more than half of the 400 000 breast-cancer deaths occurring in LMICs. Breast-cancer screening programmes are regularly used in high-income countries where the incidence of breast cancer is highest. However, the value and practicality of such screening programmes in LMICs is less clear. Women in LMICs have a lower risk of breast cancer but tend to be diagnosed at a later stage when curative treatments are less likely to work.
Because rates of breast cancer are generally lower in LMICs, screening programmes aimed at early detection in women without symptoms would have a lower yield and substantially more women would have to be screened to find a case of breast cancer, explains Joe Harford from The National Cancer Institute, Bethesda, USA.
Indeed, he adds, for screening to be effective a high level of compliance is necessary, not only with initial screening but also with treatment in those found to have breast cancer.
The WHO suggests that participation of at least 70% is needed for screening to substantially reduce the number of deaths. But evidence from LMICs suggests this might be difficult. For example, a screening trial involving clinical breast exam in the Philippines was stopped because of the reluctance of women to participate in follow-up and obtain a definitive diagnosis and treatment. Additionally, in the first attempt at screening mammography in Egypt, 2.1% of women were recalled, but more than half were lost to follow up.
In many LMICs the cost of setting up and running screening programmes is high compared with total health spending. A recent analysis concluded that breast screening in India is not cost effective because of the lower incidence and therefore lower yield from screening, and the lack of health-care resources in a country where total health spending per capita is about the same cost as a single mammogram screen in the USA.
Studies of breast-cancer screening in LMICs also suggest that organised screening of women without symptoms might be impractical: "Cultural and economic barriers to participation are one issue, but the magnitude of effort required to screen a large population is another", says Harford. For example, to screen the projected target population of women aged 40 - 69 years in Egypt in 2025 (an estimated 24 million women) would need a 250-fold increase in government-funded mammography screening capacity.
He adds: "It is difficult to envision that the already stretched Egyptian health-care system could increase from 200 mammograms per day to 50 000 mammograms and 5000 follow-up procedures per day, as well as state-of-the-art treatment, to reduce breast-cancer mortality by around 30% as in high-income countries."
So is there an alternative solution? According to Harford, a more effective approach might be to: "Shift the focus from large asymptomatic populations - who make up most of the participants in a screening programme in LMICs, and most of whom will never have breast cancer - to the much smaller populations of women with breast symptoms."
He points out that key to this approach is the need for more evidence-based research into why women with breast symptoms delay
seeking care and the barriers within health-care systems that prevent earlier diagnosis.
"Raising breast awareness is a laudable goal and one that should be aggressively pursued by advocacy groups and health-care systems in LMICs, without necessarily seeking population-based mammographic screening", concludes Harford.
Link to personal view
Source
The Lancet Oncology
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