Predictors of mammography adherence among Icelandic women

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjective: In Iceland, breast cancer is a second only to lung cancer as a cause of women s cancer related deaths. Despite the widely-recognized utility of mammography for detecting breast cancer at early stages when it is most curable, many Icelandic women do not adhere to mammography screening recommendations. The aim of the present population-based study was to identify factors that facilitate and hinder women s adherence to mammography screening in Iceland. Material and methods: A randomly selected sample of Icelandic women between the ages of 40-69 years, not previously diagnosed with breast cancer (n=1000), were recruited to the study by mail. Participants (n=619) completed questionnaires assessing: demopgraphic variables, knowledge of screening guidelines, possible facilitators (e.g., physician recommendation) and barriers (e.g. concern about radiation) to adherence, as well as stages of mammography screening adoption (precontemplation, contemplation, action and maintenance). Results: Women in the precontemplation stage were more afraid of radiation than women on other stages. They as well as women on contemplation stage were more afraid that mammography would be painful, and less satisfied with previous service at the mammography screening center. Doctors recommendations, as well as women s knowledge about mammography screening guidelines, were positively related to mammography adherence. Conclusions: These findings suggest that physicians may have an important role in motivating women to follow mammography screening recommendations. Educating women about mammography screening guidelines and addressing their concern about radiation and pain may increase mammography adherence further. Service at the mammography screening center may also improve adherence.Tilgangur: Brjóstakrabbamein, ásamt lungnakrabbameini, er langalgengasta dánarorsök íslenskra kvenna á miðjum aldri. Þrátt fyrir alþjóðlegan árangur reglubundinnar brjóstamyndatöku við að finna brjóstakrabbamein á for- eða byrjunarstigi, þegar mestar líkur eru á lækningu, mæta íslenskra konur ekki nægilega vel í myndatöku. Tilgangur þessarar rannsóknar var að kanna hvaða þættir hvetja eða letja íslenskar konur til að mæta í myndatöku. Efniviður og aðferðir: Konur á Stór-Reykjavíkursvæðinu, 40-69 ára, sem ekki höfðu greinst með brjóstakrabbamein, voru valdar af handahófi (n=1000) og var þeim sendur spurningalisti í pósti. Þátttakendur (n=619) fengur spurningalista um: lýðfræðilegar breytur, þekkingu á brjóstamyndatöku, mögulega hvetjandi þætti (til dæmis hvatningu frá lækni) og hindranir (til dæmis ótta við geislun) sem tengdust mætingu, ásamt aðlögunarstigum að mætingu í brjóstamyndatöku, það er foríhugun (precontemplation), íhugun (contemplation), framkvæmd (action) og viðhald (maintenance). Niðurstöður: Konur á foríhugunarstigi voru hræddari við geislun en konur á öðrun stigum. Þær ásamt konum á íhugunarstigi óttuðust meira sársauka frá myndavél og voru óánægðari með þjónustu leitarstöðvar Krabbameinsfélagsins. Hvatning frá einkalækni og þekking á því hvenær fara á í myndatöku tengdust einnig jákvætt mætingu. Ályktanir: Þessar niðurstöður gefa til kynna að læknar geti gegnt mikilvægu hlutverki í að hvetja konur til að mæta í brjóstamyndatöku. Með því að upplýsa konur um gildi myndatökunnar og að ræða við þær um áhyggjur þeirra af geislun og sársauka væri hugsanlega hægt að auka þátttöku. Þjónusta á leitarstöðinni virðist einnig geta haft áhrif á það hvort konur halda áfram að mæta í myndatöku

Synergistic induction of cancer-related immunosuppression by β2-adrenergic stress mediators and P38MAPK inflammatory pathway

Psychological stress has been implicated in promoting cancer recurrence and progression, but the magnitude of this effect and underlying mechanism remain unclear. In attempt to address this controversy, we have evaluated the impact of stress on molecular and cellular components of cancer Immune-surveillance and tested the hypothesis that the impact of stress in promoting tumor-associated immune suppression is context-dependent

Synergistic induction of cancer-related immunosuppression by β2-adrenergic stress mediators and P38MAPK inflammatory pathway

Psychological stress has been implicated in promoting cancer recurrence and progression, but the magnitude of this effect and underlying mechanism remain unclear. In attempt to address this controversy, we have evaluated the impact of stress on molecular and cellular components of cancer Immune-surveillance and tested the hypothesis that the impact of stress in promoting tumor-associated immune suppression is context-dependent

A survey of breast cancer physicians regarding patient involvement in breast cancer treatment decisions

Purpose: Shared breast cancer treatment decision-making between patients and physicians increases patient treatment satisfaction and compliance and is influenced by physician-related factors. Attitudes and behaviors about patient involvement in breast cancer treatment decisions and treatment-related communication were assessed by specialty among breast cancer physicians of women enrolled in the Breast Cancer Quality of Care Study (BQUAL). Results: Of 275 BQUAL physicians identified, 50.0% responded to the survey. Most physicians spend 46-60 min with the patient during the initial consult visit and 51.5% report that the treatment decision is made in one visit. Oncologists spend more time with new breast cancer patients during the initial consult (p = 0.021), and find it more difficult to handle their own feelings than breast surgeons (p = less than 0.001). Conclusion: Breast surgeons and oncologists share similar attitudes and behaviors related to patient involvement in treatment decision-making, yet oncologists report more difficulty managing their own feelings during the decision-making process

CAG Repeat Variants in the POLG1 Gene Encoding mtDNA Polymerase-Gamma and Risk of Breast Cancer in African-American Women

The DNA polymerase-gamma (POLG) gene, which encodes the catalytic subunit of enzyme responsible for directing mitochondrial DNA replication in humans, contains a polyglutamine tract encoded by CAG repeats of varying length. The length of the CAG repeat has been associated with the risk of testicular cancer, and other genomic variants that impact mitochondrial function have been linked to breast cancer risk in African-American (AA) women. We evaluated the potential role of germline POLG-CAG repeat variants in breast cancer risk in a sample of AA women (100 cases and 100 age-matched controls) who participated in the Women's Circle of Health Study, an ongoing multi-institutional, case-control study of breast cancer. Genotyping was done by fragment analysis in a blinded manner. Results from this small study suggest the possibility of an increased risk of breast cancer in women with minor CAG repeat variants of POLG, but no statistically significant differences in CAG repeat length were observed between cases and controls (multivariate-adjusted odds ratio 1.74; 95% CI, 0.49–6.21). Our study suggests that POLG-CAG repeat length is a potential risk factor for breast cancer that needs to be explored in larger population-based studies

Conducting Molecular Epidemiological Research in the Age of HIPAA: A Multi-Institutional Case-Control Study of Breast Cancer in African-American and European-American Women

Breast cancer in African-American (AA) women occurs at an earlier age than in European-American (EA) women and is more likely to have aggressive features associated with poorer prognosis, such as high-grade and negative estrogen receptor (ER) status. The mechanisms underlying these differences are unknown. To address this, we conducted a case-control study to evaluate risk factors for high-grade ER- disease in both AA and EA women. With the onset of the Health Insurance Portability and Accountability Act of 1996, creative measures were needed to adapt case ascertainment and contact procedures to this new environment of patient privacy. In this paper, we report on our approach to establishing a multicenter study of breast cancer in New York and New Jersey, provide preliminary distributions of demographic and pathologic characteristics among case and control participants by race, and contrast participation rates by approaches to case ascertainment, with discussion of strengths and weaknesses

Family histories of breast cancer, coping styles, and psychological adjustment

Although women with family histories of breast cancer (FHBC+) have been reported to have higher levels of cancer-specific and general distress than have women without such histories (FHBC-), there has been considerable variability in levels of distress found. This study examined individual differences in the use of coping strategies as likely moderators of the relationship between FHBC and psychological outcomes. One hundred and sixteen healthy women (47 FHBC+ and 69 FHBC-) participated. Results revealed that passive coping style was associated with higher levels of cancer-specific distress among FHBC+, but not among FHBC-. This interaction was not found for negative or positive affect. The passive coping style was associated with higher levels of negative affect across both groups. These results suggest that passive coping has negative implications for FHBC+ women and imply that individualized coping training programs targeting this coping strategy may prove useful for these women

Investigación empírica del modelo binario de Albert Ellis sobre malestar emocional

En la literatura actual, el malestar emocional suele describirse mediante un modelo unitario: los niveles altos de malestar emocional se conceptualizan como niveles altos de afecto, mientras que los niveles bajos de malestar emocional suelen conceptualizarse como niveles bajos de afecto. Sin embargo, recientemente, Albert Ellis (1994) y algunos de sus colegas que trabajan con terapias racionalemotivas y cognitivoconductuales han descrito el malestar emocional como un constructo binario compuesto por dos componentes distintos: sentimientos negativos funcionales (p. ej. tristeza) y sentimientos negativos disfuncionales (p. ej. sentirse inútil). En dos estudios con 55 pacientes estadounidenses con cáncer de mama y 45 pacientes rumanas con cáncer de mama, respectivamente, hemos comparado las hipótesis derivadas de los modelos de malestar emocional unitario y binario. Los resultados han revelado que en una situación de estrés (p. ej. inminente cirugía mamaria) los niveles elevados de pensamientos irracionales se asociaban con un mayor nivel de sentimientos negativos tanto funcionales como disfuncionales, mientras que los niveles bajos de pensamientos irracionales se asociaban con bajos niveles de sentimientos negativos funcionales pero con niveles altos de sentimientos negativos disfuncionales. Este aspecto que pudo observarse tanto en la muestra estadounidense como en la rumana y que apoya la teoría del modelo binario del malestar emocional, sugiere que los resultados obtenidos son sólidos y generalizables. En este estudio analizaremos las implicaciones teóricas y prácticas de esto

Depression and Anxiety Disorders among Hospitalized Women with Breast Cancer.

To document the prevalence of depression and anxiety disorders, and their associations with mortality among hospitalized breast cancer patients.We examined the associations between breast cancer diagnosis and the diagnoses of anxiety or depression among 4,164 hospitalized breast cancer cases matched with 4,164 non-breast cancer controls using 2006-2009 inpatient data obtained from the Nationwide Inpatient Sample database. Conditional logistic regression models were used to compute odds ratios (ORs) and 95% confidence intervals (CI) for the associations between breast cancer diagnosis and diagnoses of anxiety or depression. We also used binary logistic regression models to examine the association between diagnoses of depression or anxiety, and in-hospital mortality among breast cancer patients.We observed that breast cancer cases were less likely to have a diagnosis of depression (OR=0.63, 95% CI: 0.52-0.77), and less likely to have a diagnosis of anxiety (OR=0.68, 95% CI: 0.52-0.90) compared with controls. This association remained after controlling for race/ethnicity, residential income, insurance and residential region. Breast cancer patients with a depression diagnosis also had lower mortality (OR=0.69, 95% CI: 0.52-0.89) compared with those without a depression diagnosis, but there was no significant difference in mortality among those with and without anxiety diagnoses.Diagnoses of depression and anxiety in breast cancer patients were less prevalent than expected based on our analysis of hospitalized breast cancer patients and matched non-breast cancer controls identified in the NIS dataset using ICD-9 diagnostic codes. Results suggest that under-diagnosis of mental health problems may be common among hospitalized women with a primary diagnosis of breast cancer. Future work may fruitfully explore reasons for, and consequences of, inappropriate identification of the mental health needs of breast cancer patients