Options for early breast cancer follow-up in primary and secondary care : a systematic review

Background Both incidence of breast cancer and survival have increased in recent years and there is a need to review follow up strategies. This study aims to assess the evidence for benefits of follow-up in different settings for women who have had treatment for early breast cancer. Method A systematic review to identify key criteria for follow up and then address research questions. Key criteria were: 1) Risk of second breast cancer over time - incidence compared to general population. 2) Incidence and method of detection of local recurrence and second ipsi and contra-lateral breast cancer. 3) Level 1–4 evidence of the benefits of hospital or alternative setting follow-up for survival and well-being. Data sources to identify criteria were MEDLINE, EMBASE, AMED, CINAHL, PSYCHINFO, ZETOC, Health Management Information Consortium, Science Direct. For the systematic review to address research questions searches were performed using MEDLINE (2011). Studies included were population studies using cancer registry data for incidence of new cancers, cohort studies with long term follow up for recurrence and detection of new primaries and RCTs not restricted to special populations for trials of alternative follow up and lifestyle interventions. Results Women who have had breast cancer have an increased risk of a second primary breast cancer for at least 20 years compared to the general population. Mammographically detected local recurrences or those detected by women themselves gave better survival than those detected by clinical examination. Follow up in alternative settings to the specialist clinic is acceptable to women but trials are underpowered for survival. Conclusions Long term support, surveillance mammography and fast access to medical treatment at point of need may be better than hospital based surveillance limited to five years but further large, randomised controlled trials are needed

Breast and cervical cancer screening in Great Britain: Dynamic interrelated processes.

No previous analysis has investigated the determinants of screening uptake for breast and cervical cancer screening for possible spillover effects from one type of screening examination to the other type of screening examination with a dynamic bivariate panel probit model. For our analysis, we used a dynamic random effects bivariate panel probit model with initial conditions (Wooldridge-type estimator) and dependent variables were the participation of breast and cervical cancer screening in the recent year. The balanced panel sample consisted of 844 women from the British Household Panel Survey (BHPS) from the time period 1992 to 2008. Our analysis showed the high relevance of past screening behaviour and the importance of state dependency for the same and the other type of cancer screening examinations even after controlling for covariates and unobserved heterogeneity. The uptake for breast and cervical cancer screening was higher when the same screening examination was done one or three years earlier. This result is in accordance with the medical screening programmes in Great Britain. With regard to breast and cervical cancer screening positive spillover effects existed between screening examinations in the third order lags. Women with a previous visit to a general practitioner and individuals in the recommended age groups had a higher uptake for breast and cervical cancer screening. Other socioeconomic and health related variables had non-uniform results in both screening examinations. Promoting the uptake of one female prevention activity could also enhance the uptake of the other prevention activity

Effect of Whole-Body Periodic Acceleration on Exercise-Induced Muscle Damage after Eccentric Exercise

To examine the effects of whole-body periodic acceleration (pGz) on exercise-induced-muscle-damage (EIMD) -related symptoms induced by unaccustomed eccentric arm exercise.Seventeen active young men (23.4 ± 4.6 y) made 6 visits to the research facility over a 2-wk period. On day 1, subjects performed a 1-repetition-maximum (1RM) elbow-flexion test and were randomly assigned to the pGz (n = 8) or control group (n = 9). Criterion measurements were taken on day 2, before and immediately after performance of the eccentric-exercise protocol (10 sets, 10 repetitions using 120% 1RM) and after the recovery period. During subsequent sessions (24, 48, 72, and 96 h) these data were collected before pGz or passive recovery. Measurements included isometric strength (maximal voluntary contraction [MVC]), blood markers (creatine kinase, myoglobin, IL-6, TNF-α, TBARS, PGF2α, protein carbonyls, uric acid, and nitrites), soreness, pain, circumference, and range of motion (ROM).Significantly higher MVC values were seen for pGz throughout the recovery period. Within-group differences were seen in myoglobin, IL-6, IL-10, protein carbonyls, soreness, pain, circumference, and ROM showing small negative responses and rapid recovery for the pGz condition.Our results demonstrate that pGz can be an effective tool for the reduction of EIMD and may contribute to the training-adaptation cycle by speeding up the recovery of the body due to its performance-loss-lessening effect

Cycling time to failure is better maintained by cold than contrast or thermoneutral lower-body water immersion in normothermia

PurposeTo examine the effects of four commonly used recovery treatments applied between two bouts of intense endurance cycling on the performance of the second bout in normothermia (~21 °C).MethodsNine trained men completed two submaximal exhaustive cycling bouts (Ex1 and Ex2: 5 min at ~50 % V˙O2 peak, followed by 5 min at ~60 % V˙O2 peak and then ~80 % V˙O2 peak to failure) separated by 30 min of (a) cold water immersion at 15 °C (C15), (b) contrast water therapy alternating 2.5 min at 8 °C and 2.5 min at 40 °C (CT), (c) thermoneutral water immersion at 34 °C (T34) and (d) cycling at ~40 % V˙O2 peak (AR).ResultsExercise performance, cardiovascular and metabolic responses during Ex1 were similar among all trials. However, time to failure (~80 % V˙O2 peak bout) during Ex2 was significantly (P < 0.05) longer in C15 (18.0 ± 1.6) than in CT (14.5 ± 1.5), T34 (12.4 ± 1.4) and AR (10.6 ± 1.0); and it was also longer (P < 0.05) in CT than AR. Core temperature and heart rate were significantly (P < 0.05) lower during the initial ~15 min of Ex2 during C15 compared with all other conditions but they reached similar levels at the end of Ex2.ConclusionsA 30 min period of C15 was more beneficial in maintaining intense submaximal cycling performance than CT, T34 and AR; and CT was also more beneficial than T34 and AR. These effects were not mediated by the effect of water immersion per se, but by the continuous (C15) or intermittent (CT) temperature stimulus (cold) applied throughout the recovery

Post-exercise cold water immersion: Effect on core temperature and melatonin responses

To study the effect of post-exercise cold water immersion (CWI) on core temperature and melatonin responses, 10 male cyclists completed two evening (~1800 hours) cycling trials followed by a 15-min CWI (14 C) or warm water immersion (WWI; 34 C), and were then monitored for 90 min post-immersion. The exercise trial involved 15 min at 75 % peak power, followed by a 15 min time trial. Core (rectal) temperature was not different between the two conditions pre-exercise (~37.4 C), post-exercise (~39 C) or immediately post-immersion (~37.7 C), but was significantly (p < 0.05) below pre-exercise levels at 60 and 90 min post-immersion in both conditions. Core temperature was significantly lower after CWI than WWI at 30 min (36.84 ± 0.24 vs. 37.42 ± 0.40 C, p < 0.05) and 90 min (36.64 ± 0.24 vs. 36.95 ± 0.43 C, p < 0.05) post-immersion. Salivary melatonin levels significantly increased (p < 0.05) from post-exercise (~5 pM) to 90 min post-immersion (~8.3 pM), but were not different between conditions. At 30 and 90 min post-immersion heart rate was significantly lower (~5-10 bpm, p < 0.01) after CWI than WWI. These results show that undertaking either CWI or WWI post-exercise in the evening lowers core temperature below baseline for at least 90 min; however, the magnitude of decrease is significantly greater following CWI. The usual evening increase in melatonin is unaffected by exercise or post-exercise water immersion undertaken between ~1800 and ~2000 hours. © 2012 Springer-Verlag