Prevention and screening for breast cancer.

Breast cancer is the most common cancer among women in both Europe and the U.S. It is the second leading cause of cancer deaths for women in the U.S., but the first in Poland. Age, family history, reproductive factors, proliferative breast disease, and radiation are established risk factors. Diet may account for differences in international incidence rates; however, the majority of women who get breast cancer do not have identifiable risk factors other than age and being female. Primary prevention of breast cancer is unknown. Control relies on secondary prevention aimed at suppression of clinically occult disease, mammographic screening, and early detection of palpable disease through physical examination and breast self-examination. Dietary and medical prevention strategies are being tested in the U.S. Screening mammography has demonstrated effectiveness in reducing mortality in women over 50. The Partnerships in Healthcare program aims to enhance the early detection of breast cancer in Poland by providing mammography units, training for technicians and nurses, and incentives to develop multidisciplinary approaches to diagnosis and treatment

Managing the Impact of Advanced Complex Illness on Family Caregiver and Professional Caregiver Stress: A Role for Palliative Care.

With the increasing health care needs of an ageing population and the projected shortfall in the US healthcare workforce, an increasing number of patients with advanced complex illness will require care at home. Up to 90 percent of this care is provided by unpaid family or informal caregivers. Caregiver stress is a challenge for both family caregivers and members of the health care team responsible for medical care. Using clinical cases, the authors describe an innovative health service delivery model that links specialty palliative care services provided by palliative care certified registered nurse practitioners (CRNPs) to the patient\u27s primary and specialty physicians. Optimizing Advanced Complex Illness Support (OACIS) is an interdisciplinary program that provides inpatient, outpatient and home-based palliative care services, and also serves as a platform for the support of both family and professional caregivers

Effect of a Computer-Based Decision Aid on Knowledge, Perceptions, and Intentions about Genetic Testing for Breast Cancer Susceptibility: a Randomized Controlled Trial.

CONTEXT: As the availability of and demand for genetic testing for hereditary cancers increases in primary care and other clinical settings, alternative or adjunct educational methods to traditional genetic counseling will be needed. OBJECTIVE: To compare the effectiveness of a computer-based decision aid with standard genetic counseling for educating women about BRCA1 and BRCA2 genetic testing. DESIGN: Randomized controlled trial conducted from May 2000 to September 2002. SETTING AND PARTICIPANTS: Outpatient clinics offering cancer genetic counseling at 6 US medical centers enrolled 211 women with personal or family histories of breast cancer. INTERVENTIONS: Standard one-on-one genetic counseling (n = 105) or education by a computer program followed by genetic counseling (n = 106). MAIN OUTCOME MEASURES: Participants\u27 knowledge, risk perception, intention to undergo genetic testing, decisional conflict, satisfaction with decision, anxiety, and satisfaction with the intervention. Counselor group measures were administered at baseline and after counseling. Computer group measures were administered at baseline, after computer use, and after counseling. Testing decisions were assessed at 1 and 6 months. Outcomes were analyzed by high vs low risk of carrying a BRCA1 or BRCA2 mutation. RESULTS: Both groups had comparable demographics, prior computer experience, medical literacy, and baseline knowledge of breast cancer and genetic testing, and both counseling and computer use were rated highly. Knowledge scores increased in both groups (P CONCLUSIONS: An interactive computer program was more effective than standard genetic counseling for increasing knowledge of breast cancer and genetic testing among women at low risk of carrying a BRCA1 or BRCA2 mutation. However, genetic counseling was more effective than the computer at reducing women\u27s anxiety and facilitating more accurate risk perceptions. These results suggest that this computer program has the potential to stand alone as an educational intervention for low-risk women but should be used as a supplement to genetic counseling for those at high risk

Increased Incidence of Melanoma in Renal Transplantation Recipients.

BACKGROUND: It is well established that the incidence of nonmelanoma skin carcinoma is increased in renal transplantation recipients. However, existing studies are not in agreement over whether patients who undergo transplantation have an increased risk of melanoma. The objective of this study was to estimate the risk of melanoma among immunosuppressed renal transplantation recipients and to determine whether that risk is associated with patient and transplantation characteristics. METHODS: The authors studied 89,786 patients who underwent renal transplantation between 1988 and 1998 using the United States Renal Data System. Age standardized (to the United States 2000 population) incidence rates for melanoma were computed as diagnoses per 100,000 population and were compared with rates from the Surveillance, Epidemiology, and End Results (SEER) data. Incidence rates also were stratified to examine differences by age and gender. RESULTS: Of the 89,786 patients who underwent transplantation, 246 patients developed melanoma. The age-adjusted incidence rate of melanoma among renal transplantation recipients was 55.9 diagnoses per 100,000 population. This represented an increase in age-adjusted, standardized risk that was 3.6 times greater than the SEER population. Stratified analysis suggested that the risk of melanoma accelerated in male transplantation recipients as age increased, but the risk leveled off with age among female transplantation recipients. Finally, there was a trend for patients who experienced at least 1 acute rejection episode to develop melanoma (odds ratio = 1.34; P = 0.059). CONCLUSIONS: Renal transplantation recipients were nearly 3.6 times more likely to develop melanoma than the general population. Physicians who care for renal transplantation recipients should be vigilant in screening for melanoma