Fwd: Management of women who have a genetic predisposition for breast cancer.

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From: HubMed - breast cancer <rssfwd@rssfwd.com>
Date: Sun, Aug 3, 2008 at 8:08 AM
Subject: Management of women who have a genetic predisposition for breast cancer.
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[1]Surg Clin North Am. 2008 Aug; 88(4): 845-61
Jatoi I, Anderson WF

The management of women who have a genetic predisposition for breast cancer requires careful planning. Women who have BRCA 1 and BRCA 2 mutations are at increased risk for breast cancer and for other cancers as well, particularly ovarian cancer. Screening, prophlyactic surgery, and chemoprevention are commonly utilized strategies in the management of these patients, and women may choose more than one of these strategies. No randomized prospective trials have assessed the impact of these strategies specifically in mutaiton carriers. All patients should be informed that screening, prophylactic surgery, and chemoprevention have the potential for harm as well as benefit.



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Fwd: Phantom Breast and Other Syndromes After Mastectomy: Eight Breast Cancer Patients Describe Their Experiences Over Time: A 2-Year Follow-up Study.

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From: HubMed - breast cancer <rssfwd@rssfwd.com>
Date: Sun, Aug 3, 2008 at 8:08 AM
Subject: Phantom Breast and Other Syndromes After Mastectomy: Eight Breast Cancer Patients Describe Their Experiences Over Time: A 2-Year Follow-up Study.
To: mesothelioma77@gmail.com


[1]J Pain. 2008 Jul 29;
Björkman B, Arnér S, Hydén LC

Patients often experience hard-to-treat neuropathic pain and other sensations after surgery; consequently, they could develop chronic pain conditions. The phantom limb phenomenon is a well-documented postoperative pain condition. However, phantom phenomena after mastectomies are less documented. The reviews report several views on the prevalence of breast phantoms and coexisting distress. Researchers observed that new methodological approaches might facilitate further research of these issues. This prospective, qualitative study used semistructured interviews to acquire knowledge of if and how phantom breast phenomena appear within the range of other postmastectomy symptoms and sensations. The study revealed that a phantom breast could be difficult to describe and position spatially. The phantom breast phenomenon varied from classic phantom extremity phenomenon and did not seem to cause much distress. However, it proved to be a phenomenon so unknown and different that there is urgent need for more knowledge. This study highlights the importance of further investigation regarding how information and communication related to a phantom breast might be developed. PERSPECTIVE: The phantom breast is only one piece of a complicated puzzle. Because it was relatively unknown for the women in the study, it is important that analyses of this phenomenon, as a part of a postmastectomy syndrome, be conducted in a dialogue with the patients, by scientifically using qualitative methods.



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Fwd: The guardians' perspective on paediatric cancer treatment in Malawi and factors affecting adherence.

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Date: Fri, Aug 1, 2008 at 4:32 PM
Subject: The guardians' perspective on paediatric cancer treatment in Malawi and factors affecting adherence.
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[1]Pediatr Blood Cancer. 2008 Jul 30;
Israëls T, Chirambo C, Caron H, de Kraker J, Molyneux E, Reis R

BACKGROUND: Abandonment of paediatric cancer treatment is a common problem in developing countries. Little is known about the guardians' perspective on cancer treatment in these countries, especially the factors that affect adherence. METHODS: Following a pilot study enquiring into the possible causes of abandonment, a problem analysis diagram was drawn which helped to develop the questionnaires. Semi-structured interviews (n = 83) and focus group discussions (n = 8) were held with the guardians of 25 Burkitt lymphoma patients and 7 Wilms tumour patients at different phases of therapy in Malawi. RESULTS: Parents in Malawi are very motivated to continue treatment if they think that it will cure their child. Financial costs are important concerns. Not all tasks at home are assumed by other household members. The diagnosis of cancer was unknown before being told about it in hospital and caused fear of recurrence and death. Guardians are reluctant to ask the health personnel questions. They worry that taking frequent blood samples will weaken their child. The side effects of the chemotherapy are seen as a proof of efficacy. CONCLUSION: It is important to appreciate the guardians' concerns when offering treatment that requires their sustained commitment. It is necessary to provide not only medical treatment, but also travel allowances and adequate nutritional support during long hospital stays to impoverished families. Information should be given proactively. Pediatr Blood Cancer (c) 2008 Wiley-Liss, Inc.



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Fwd: Effectiveness of service screening: a case-control study to assess breast cancer mortality reduction.

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Date: Fri, Aug 1, 2008 at 4:32 PM
Subject: Effectiveness of service screening: a case-control study to assess breast cancer mortality reduction.
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[1]Br J Cancer. 2008 Aug 5; 99(3): 423-7
Puliti D, Miccinesi G, Collina N, De Lisi V, Federico M, Ferretti S, Finarelli AC, Foca F, Mangone L, Naldoni C, Petrella M, Ponti A, Segnan N, Sigona A, Zarcone M, Zorzi M, Zappa M, Paci E

The aim of this study was the evaluation of the impact of service screening programmes on breast cancer mortality in five regions of Italy. We conducted a matched case-control study with four controls for each case. Cases were defined as breast cancer deaths occurred not later than 31 December 2002. Controls were sampled from the local municipality list and matched by date of birth. Screening histories were assessed by the local, computerised, screening database and subjects were classified as either invited or not-yet-invited and as either screened or unscreened. There were a total of 1750 breast cancer deaths within the 50 to 74-year-old breast cancer cases and a total of 7000 controls. The logistic conditional estimate of the cumulative odds ratios comparing invited with not-yet-invited women was 0.75 (95% CI: 0.62-0.92). Restricting the analyses to invited women, the odds ratio of screened to never-respondent women corrected for self-selection bias was 0.55 (95% CI: 0.36-0.85). The introduction of breast cancer screening programmes in Italy is associated with a reduction in breast cancer mortality attributable to the additional impact of service screening over and above the background access to mammography.British Journal of Cancer (2008) 99, 423-427. doi:10.1038/sj.bjc.6604532 www.bjcancer.com.



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Fwd: Return to Work After Early-stage Breast Cancer: A Cohort Study into the Effects of Treatment and Cancer-related Symptoms.

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From: HubMed - breast cancer <rssfwd@rssfwd.com>
Date: Sun, Aug 3, 2008 at 8:08 AM
Subject: Return to Work After Early-stage Breast Cancer: A Cohort Study into the Effects of Treatment and Cancer-related Symptoms.
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[1]J Occup Rehabil. 2008 Aug 1;
Balak F, Roelen CA, Koopmans PC, Ten Berge EE, Groothoff JW

Introduction Earlier diagnosis and better treatment have increased the survival rates of cancer patients. This warrants research on return to work of cancer survivors. What is the return to work rate following early-stage breast cancer? What is the effect of the type of treatment and cancer-related symptoms on return to work? Methods Our occupational health department registers sickness absence of about 50,000 employees. In the period 2001-2005 we counted 154 cases of newly diagnosed breast cancer of which 72 were eligible for analysis. In these women, return to work was followed for 24 months after diagnosis and linked to the type of treatment and cancer-related symptoms. Results The mean duration of absence with early-stage breast cancer was 11.4 +/- 5.5 months; 35% of patients were absent longer than one year and 4 patients did not return to work within two years after diagnosis. The duration of absence depended on the type of treatment and was significantly longer in patients who underwent chemotherapy (hazard rate [HR] = 0.31; 95% confidence interval [CI] = 0.12-0.81) or multimodal treatment (HR = 0.24; 95% CI = 0.10-0.54). Women started working about 4 months after the end of therapy irrespective of the type of treatment. At that moment, reaching above shoulder level was impaired in 11 patients (15%) which significantly delayed partial return to work (HR = 0.48; 95% CI = 0.23-0.98) but not full return to work (HR = 0.63; 95% CI = 0.31-1.26). Fatigue was reported by 9 patients (13%) and neither postponed partial return to work nor full return to work. Conclusions The time taken to return to work after early-stage breast cancer was principally determined by the type of treatment.



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