Correlation of breast cancer risk factors with HER-2/neu protein overexpression according to menopausal and estrogen receptor status

BACKGROUND: Several researchers have claimed that classification of tumours on the basis of HER-2/neu overexpression or amplification may define a subset of breast cancer in which the net effect of a risk factor could be rather more obvious and its impact on breast cancer development more clear. We decided to investigate, in a group of patients from a geographical area with a low incidence of breast cancer, whether HER-2/neu positive tumours are correlated with established or suspected risk factors for breast cancer and thus to identify distinct subgroups of high risk women. METHODS: This study analysed data from patients who attended the Breast Unit at the University Hospital of Heraklion, Crete, Greece between 1996 and 2002. 384 women with primary invasive breast cancer were compared with 566 screened women who were referred to the Unit and had not developed breast neoplasm by the time the data were analysed. Risk factor data were obtained from each subject by personal interviews using a structured questionnaire. The detection and scoring of the HER-2/neu protein, estrogen and progesterone receptor expression were performed using immunochemistry. Odds ratios and 95% confidence intervals were determined by chi-square test and logistic regression analysis. Case-case odds ratios were calculated in order to measure the risk heterogeneity between HER-2/neu+ and HER-2/neu-tumours. Separate analyses were performed for premenopausal and postmenopausal women and according to estrogen receptor status. RESULTS: In multivariate analysis without HER-2/neu stratification, an increased breast cancer risk was associated with only four of the factors examined: use of oral contraceptives (OR = 4.40, 95%C.I: 1.46–13.28), use of HRT (OR = 7.34, 95%C.I: 2.03–26.53), an age at first full pregnancy more than 23 years (OR = 1.91, 95%C.I: 1.29–2.83) and body mass index more than 29 kg/m(2 )(OR = 3.13, 95%C.I: 2.02–4.84). Additionally, a history of abortion or miscarriage (OR = 0.56, 95%C.I: 0.38–0.82) was correlated with a decreased risk of breast cancer. In the case to case comparison only BMI >29 kg/m(2 )revealed a relative connection that was stronger with positive than with negative HER-2/neu tumours (ratio of OR's = 2.23, 95%C.I: 1.20–4.15, p = 0.011). This may indicate evidence of heterogeneity of a rather significant degree for this factor. In the ER negative group an age at first full pregnancy >23 years and a BMI >29 kg/m(2 )were associated with an increased risk in both HER-2/neu groups, but the association was significantly stronger for the latter factor in the positive HER-2/neu tumours (ratio of OR's = 2.46, 95%CI: 0.97–6.21). CONCLUSIONS: Our study did not confirm that the established or putative hormonal breast cancer risk factors differ regarding their relations with HER-2/neu+ versus HER-2/neu-breast tumours, with the exception of increased BMI. Further innovative studies with larger sample sizes are needed to examine how the status of these potentially modifiable breast cancer risk factors interacts with biological markers such as HER-2/neu oncoprotein

Differences in avoidable mortality between migrants and the native Dutch in the Netherlands

BACKGROUND: The quality of the healthcare system and its role in influencing mortality of migrant groups can be explored by examining ethnic variations in 'avoidable' mortality. This study investigates the association between the level of mortality from 'avoidable' causes and ethnic origin in the Netherlands and identifies social factors that contribute to this association. METHODS: Data were obtained from cause of death and population registries in the period 1995–2000. We compared mortality rates for selected 'avoidable' conditions for Turkish, Moroccan, Surinamese and Antillean/Aruban groups to native Dutch. RESULTS: We found slightly elevated risk in total 'avoidable' mortality for migrant populations (RR = 1.13). Higher risks of death among migrants were observed from almost all infectious diseases (most RR > 3.00) and several chronic conditions including asthma, diabetes and cerebro-vascular disorders (most RR > 1.70). Migrant women experienced a higher risk of death from maternity-related conditions (RR = 3.37). Surinamese and Antillean/Aruban population had a higher mortality risk (RR = 1.65 and 1.31 respectively), while Turkish and Moroccans experienced a lower risk of death (RR = 0.93 and 0.77 respectively) from all 'avoidable' conditions compared to native Dutch. Control for demographic and socioeconomic factors explained a substantial part of ethnic differences in 'avoidable' mortality. CONCLUSION: Compared to the native Dutch population, total 'avoidable' mortality was slightly elevated for all migrants combined. Mortality risks varied greatly by cause of death and ethnic origin. The substantial differences in mortality for a few 'avoidable' conditions suggest opportunities for quality improvement within specific areas of the healthcare system targeted to disadvantaged groups

Avoidable mortality across Canada from 1975 to 1999

BACKGROUND: The concept of 'avoidable' mortality (AM) has been proposed as a performance measure of health care systems. In this study we examined mortality in five geographic regions of Canada from 1975 to 1999 for previously defined avoidable disease groups that are amenable to medical care and public health. These trends were compared to mortality from other causes. METHODS: National and regional age-standardized mortality rates for ages less than 65 years were estimated for avoidable and other causes of death for consecutive periods (1975–1979, 1980–1985, 1985–1989, 1990–1994, and 1995–1999). The proportion of all-cause mortality attributable to avoidable causes was also determined. RESULTS: From 1975–1979 to 1995–1999, the AM decrease (46.9%) was more pronounced compared to mortality from other causes (24.9%). There were persistent regional AM differences, with consistently lower AM in Ontario and British Columbia compared to the Atlantic, Quebec, and Prairies regions. This trend was not apparent when mortality from other causes was examined. Injuries, ischaemic heart disease, and lung cancer strongly influenced the overall AM trends. CONCLUSION: The regional differences in mortality for ages less than 65 years was attributable to causes of death amenable to medical care and public health, especially from causes responsive to public health

Can multiple lifestyle behaviours be improved in people with familial hypercholesterolemia? Results of a parallel randomised controlled trial

Objective: To evaluate the efficacy of an individualised tailored lifestyle intervention on physical activity, dietary intake, smoking and compliance to statin therapy in people with Familial Hypercholesterolemia (FH). Methods: Adults with FH (n = 340) were randomly assigned to a usual care control group or an intervention group. The intervention consisted of web-based tailored lifestyle advice and face-to-face counselling. Physical activity, fat, fruit and vegetable intake, smoking and compliance to statin therapy were self-reported at baseline and after 12 months. Regression analyses were conducted to examine between-group differences. Intervention reach, dose and fidelity were assessed. Results: In both groups, non-significant improvements in all lifestyle behaviours were found. Post-hoc analyses showed a significant decrease in saturated fat intake among women in the intervention group (β = -1.03; CI -1.98/-0.03). In the intervention group, 95% received a log on account, of which 49% logged on and completed one module. Nearly all participants received face-to-face counselling and on average, 4.2 telephone booster calls. Intervention fidelity was low. Conclusions: Individually tailored feedback is not superior to no intervention regarding changes in multiple lifestyle behaviours in people with FH. A higher received dose of computer-tailored interventions should be achieved by uplifting the website and reducing the burden of screening questionnaires. Counsellor training should be more extensive. Trial Registration: Dutch Trial Register NTR1899. © 2012 Broekhuizen et al

Selection of diseases and disorders for inclusion in Public Health Status and Forecasts

Een centrale doelstelling van de Volksgezondheid Toekomst Verkenning (VTV) is het beschrijven van de gezondheidstoestand van de bevolking in Nederland aan de hand van de indicator 'aanwezigheid van ziekten en aandoeningen'. De vraag is of de selectie van ziekten en aandoeningen die bij de beschrijving daarvan in VTV-1997 is gehanteerd, voor een volgende VTV aangepast zou moeten worden. Daartoe zijn diverse binnenlandse en buitenlandse documenten op het gebied van de volksgezondheid bestudeerd, zijn suggesties van beleidsmakers en medewerkers aan VTV-1997 geinventariseerd en is een nieuwe analyse van sterftecijfers gedaan. Hieruit wordt geconcludeerd dat de selectie van ziekten en aandoeningen voor VTV-1997 het uitgangspunt moet blijven voor een volgende VTV. Daarnaast zijn er nog belangrijke onderwerpen die nu buiten de selectie vallen, maar kandidaat zijn om toegevoegd te worden. Dit zijn (1) verontrustende infectiezieken en zoonosen, (2) aandoeningen met een hoge sterfte en hoge ernst (o.a. enkele nieuwvormingen, chronische nierziekten) en (3) aandoeningen met grote invloed op de kwaliteit van leven van patient en/of omgeving (o.a. chronisch vermoeidheidsyndroom, persoonlijkheids-stoornissen, decubitus, chronische onbegrepen pijn). Verder wordt voorgesteld (meer) aandacht te besteden aan arbeidsgerelateerde aandoeningen, allergieen en infectieziekten als oorzaak van chronische ziekten. Welke aandoeningen uiteindelijk toegevoegd gaan worden aan de huidige selectie in VTV kan in overleg met beleidsmakers en deskundigen worden vastgesteld.A major goal of RIVM's regularly updated Public Health Status and Forecasts (PHSF) is to describe the health status of the population in the Netherlands on the basis of the health indicator 'presence of diseases and disorders'. The main concern in the preparation of this document was whether or not to change the selection of diseases and disorders used for the 1997 PHSF. We therefore set about examining diseases and disorders that had been included in other public health reports from the Netherlands and abroad, afterwhich we made an inventory of subjects proposed by health policy-makers and others during the production and evaluation of PHSF 1997. We also studied Dutch mortality statistics. The diseases and disorders selected for PHSF 1997 were indeed concluded to be the best point of departure for the following PHSF report. Important subjects now outside the selection of diseases and disorders will, however, also be candidates for adding to the selection. These are (1) worrying, emerging infections and zoonoses, (2) disorders with a high mortality and regarded as serious diseases (some neoplasms and chronic renal diseases) and (3) disorders with a large influence on a patient's quality of life and environment (chronic fatigue syndrome, personality disorders, decubitus and chronic incomprehensible pain). Furthermore, we proposed to pay (more) attention to disorders related to one's occupation, to allergic disorders and to infectious diseases predisposing chronic diseases. Final decisions on additional diseases to be selected can be determined in consultations with policy-makers and experts.VW

Selection of diseases and disorders for inclusion in Public Health Status and Forecasts

A major goal of RIVM's regularly updated Public Health Status and Forecasts (PHSF) is to describe the health status of the population in the Netherlands on the basis of the health indicator 'presence of diseases and disorders'. The main concern in the preparation of this document was whether or not to change the selection of diseases and disorders used for the 1997 PHSF. We therefore set about examining diseases and disorders that had been included in other public health reports from the Netherlands and abroad, afterwhich we made an inventory of subjects proposed by health policy-makers and others during the production and evaluation of PHSF 1997. We also studied Dutch mortality statistics. The diseases and disorders selected for PHSF 1997 were indeed concluded to be the best point of departure for the following PHSF report. Important subjects now outside the selection of diseases and disorders will, however, also be candidates for adding to the selection. These are (1) worrying, emerging infections and zoonoses, (2) disorders with a high mortality and regarded as serious diseases (some neoplasms and chronic renal diseases) and (3) disorders with a large influence on a patient's quality of life and environment (chronic fatigue syndrome, personality disorders, decubitus and chronic incomprehensible pain). Furthermore, we proposed to pay (more) attention to disorders related to one's occupation, to allergic disorders and to infectious diseases predisposing chronic diseases. Final decisions on additional diseases to be selected can be determined in consultations with policy-makers and experts.Een centrale doelstelling van de Volksgezondheid Toekomst Verkenning (VTV) is het beschrijven van de gezondheidstoestand van de bevolking in Nederland aan de hand van de indicator 'aanwezigheid van ziekten en aandoeningen'. De vraag is of de selectie van ziekten en aandoeningen die bij de beschrijving daarvan in VTV-1997 is gehanteerd, voor een volgende VTV aangepast zou moeten worden. Daartoe zijn diverse binnenlandse en buitenlandse documenten op het gebied van de volksgezondheid bestudeerd, zijn suggesties van beleidsmakers en medewerkers aan VTV-1997 geinventariseerd en is een nieuwe analyse van sterftecijfers gedaan. Hieruit wordt geconcludeerd dat de selectie van ziekten en aandoeningen voor VTV-1997 het uitgangspunt moet blijven voor een volgende VTV. Daarnaast zijn er nog belangrijke onderwerpen die nu buiten de selectie vallen, maar kandidaat zijn om toegevoegd te worden. Dit zijn (1) verontrustende infectiezieken en zoonosen, (2) aandoeningen met een hoge sterfte en hoge ernst (o.a. enkele nieuwvormingen, chronische nierziekten) en (3) aandoeningen met grote invloed op de kwaliteit van leven van patient en/of omgeving (o.a. chronisch vermoeidheidsyndroom, persoonlijkheids-stoornissen, decubitus, chronische onbegrepen pijn). Verder wordt voorgesteld (meer) aandacht te besteden aan arbeidsgerelateerde aandoeningen, allergieen en infectieziekten als oorzaak van chronische ziekten. Welke aandoeningen uiteindelijk toegevoegd gaan worden aan de huidige selectie in VTV kan in overleg met beleidsmakers en deskundigen worden vastgesteld