Asunto(s)
Comités Consultivos , Neoplasias de la Mama , Detección Precoz del Cáncer , Mamografía , Tamizaje Masivo , Humanos , Neoplasias de la Mama/prevención & control , Neoplasias de la Mama/diagnóstico , Femenino , Estados Unidos , Adulto , Guías de Práctica Clínica como Asunto , Persona de Mediana EdadAsunto(s)
Comités Consultivos , Neoplasias de la Mama , Detección Precoz del Cáncer , Mamografía , Tamizaje Masivo , Humanos , Neoplasias de la Mama/prevención & control , Neoplasias de la Mama/diagnóstico , Femenino , Estados Unidos , Adulto , Guías de Práctica Clínica como Asunto , Persona de Mediana EdadAsunto(s)
Comités Consultivos , Neoplasias de la Mama , Detección Precoz del Cáncer , Mamografía , Tamizaje Masivo , Humanos , Neoplasias de la Mama/prevención & control , Neoplasias de la Mama/diagnóstico , Femenino , Estados Unidos , Adulto , Guías de Práctica Clínica como Asunto , Persona de Mediana EdadAsunto(s)
Comités Consultivos , Neoplasias de la Mama , Detección Precoz del Cáncer , Mamografía , Tamizaje Masivo , Humanos , Neoplasias de la Mama/prevención & control , Neoplasias de la Mama/diagnóstico , Femenino , Estados Unidos , Adulto , Guías de Práctica Clínica como Asunto , Persona de Mediana EdadAsunto(s)
Comités Consultivos , Neoplasias de la Mama , Detección Precoz del Cáncer , Mamografía , Tamizaje Masivo , Humanos , Neoplasias de la Mama/prevención & control , Neoplasias de la Mama/diagnóstico , Femenino , Estados Unidos , Adulto , Guías de Práctica Clínica como Asunto , Persona de Mediana EdadRESUMEN
BACKGROUND: Breast Cancer (BC) prevention strategies range from lifestyle changes such as increasing physical activity and reducing body weight to preventive drugs like tamoxifen, known to reduce BC incidence in high-risk women. Sex Hormone Binding Globulin (SHBG) is related to BC risk due to its ability to bind circulating estradiol at high affinity and to regulate estradiol action. A study protocol is presented based on the assessment of the effect of different interventions such as tamoxifen at 10 mg every other day (LDT), intermittent caloric restriction (ICR) two days per week, lifestyle intervention (LI, step counter use) and their combination on the modulation of SHBG and several other biomarkers associated to BC. METHODS: A randomized phase II biomarker study will be conducted in 4 Italian centers. Unaffected women aged between 18 and 70 years, carriers of a germline pathogenetic variant (BRCA1, BRCA2, PALB2, or other moderate penetrance genes), or with a >5% BC risk at 10 years (according to the Tyrer-Cuzick or the Breast Cancer Surveillance Consortium Risk models) or with a previous diagnosis of intraepithelial neoplasia will be eligible. A total of 200 participants will be randomized to one of the four arms: LDT; LDT + ICR; LI; LI + ICR. Interventions will span six months, with baseline and follow-up clinic visits and interim phone calls. DISCUSSION: The aim of the study is to verify whether LDT increases circulating SHBG more than LI with or without ICR after 6 months. Secondary objectives include assessing HOMA-index, inflammatory markers, adiponectin/leptin ratio, quality of life (QoL), safety, toxicity, mammographic density, and changes in microbiome composition across groups. The study's innovation lies in its inclusion of diverse BC risk categories and combination of pharmaceutical and behavioral interventions, potentially enhancing intervention efficacy while balancing tamoxifen's side effects on QoL, especially menopausal symptoms. TRIAL REGISTRATION: EuCT number:2023-503994-39-00; Clinical trials.gov NCT06033092.
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Neoplasias de la Mama , Estilo de Vida , Tamoxifeno , Humanos , Femenino , Neoplasias de la Mama/prevención & control , Tamoxifeno/uso terapéutico , Adulto , Persona de Mediana Edad , Anciano , Adolescente , Globulina de Unión a Hormona Sexual/análisis , Globulina de Unión a Hormona Sexual/metabolismo , Adulto Joven , Biomarcadores de Tumor/sangre , Restricción Calórica/métodos , Antineoplásicos Hormonales/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
BACKGROUND: Identifying women aged 30-39 years at increased risk of developing breast cancer would allow them to receive screening and prevention offers. For this to be feasible, the practicalities of organising risk assessment and primary prevention must be acceptable to the healthcare professionals who would be responsible for delivery. It has been proposed that primary care providers are best placed to deliver a breast cancer risk assessment and primary prevention pathway. The present study aimed to investigate a range of primary care provider's views on the development and implementation of a breast cancer risk assessment and primary prevention pathway within primary care for women aged 30-39 years. METHODS: Twenty-five primary care providers working at general practices in either Greater Manchester or Cambridgeshire and Peterborough participated in five focus groups (n = 18) and seven individual interviews. Data were analysed thematically and organised using a framework approach. RESULTS: Three themes were developed. Challenges with delivering a breast cancer risk assessment and primary prevention pathway within primary care highlights that primary care are willing to facilitate but not lead delivery of such a pathway given the challenges with existing workload pressures and concerns about ensuring effective clinical governance. Primary care's preferred level of involvement describes the aspects of the pathway participants thought primary care could be involved in, namely co-ordinating data collection for risk assessment and calculating and communicating risk. Requirements for primary care involvement captures the need to provide a training and education package to address deficits in knowledge prior to involvement. Additionally, the reservations primary care have about being involved in the management of women identified as being at increased risk are discussed and suggestions are provided for facilitating primary care to take on this role. CONCLUSIONS: Despite optimism that primary care might lead a breast cancer risk assessment and primary prevention pathway, participants had a range of concerns that should be considered when developing such a pathway.
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Neoplasias de la Mama , Atención Primaria de Salud , Prevención Primaria , Humanos , Femenino , Neoplasias de la Mama/prevención & control , Neoplasias de la Mama/diagnóstico , Adulto , Medición de Riesgo , Reino Unido/epidemiología , Prevención Primaria/métodos , Grupos Focales , Personal de SaludRESUMEN
BACKGROUND: Taiwan implemented the Cancer Screening Quality Improvement Program (CAQIP) in 2010. The program sought to enhance mass breast cancer screening accessibility. This study aimed to examine socioeconomic disparities in outreach screening utilization pre-CAQIP (2005-2009) and post-CAQIP (2010-2014). METHOD: We conducted a nationwide population-based observational study in Taiwan, analyzing four population databases to evaluate socioeconomic disparities among women aged 50 to 69 years undergoing their first mammography screening pre-CAQIP. Multivariate logistic regression was used to examine changes in utilization of outreach screening pre- and post-CAQIP implementation, and to estimate the Slope Index of Inequity (SII) and Relative Index of Inequity (RII) values. RESULTS: Utilization of outreach screening through mobile mammography units (MMUs) increased from 6.12 to 32.87% between the two periods. Following CAQIP, a higher proportion of screened women were older, less educated, and from suburban or rural areas. The SII and RII for age, income, and urbanization levels decreased post-CAQIP. However, regarding education level, SII was - 0.592 and RII was 0.392 in the pre-CAQIP period, increasing to -0.173 and 0.804 post-CAQIP, respectively. CONCLUSIONS: Our study observed that utilization of outreach screening through MMUs increased after CAQIP. The MMUs made outreach screening services more accessible in Taiwan. Expanding outreach screening services and educational programs to promote mammography uptake in local communities could help reduce the potential effect of socioeconomic disparities, and thus may enhance early detection of breast cancer. Further study could focus on the accessibility of outreach screening and breast cancer outcomes.
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Neoplasias de la Mama , Detección Precoz del Cáncer , Accesibilidad a los Servicios de Salud , Disparidades en Atención de Salud , Mamografía , Factores Socioeconómicos , Humanos , Mamografía/estadística & datos numéricos , Femenino , Taiwán , Persona de Mediana Edad , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/prevención & control , Neoplasias de la Mama/diagnóstico por imagen , Anciano , Detección Precoz del Cáncer/estadística & datos numéricos , Mejoramiento de la Calidad , Política de Salud , Relaciones Comunidad-Institución , Tamizaje Masivo/estadística & datos numéricosRESUMEN
OBJECTIVES: Gut microbiota dysbiosis is among the risk factors for breast cancer development, together with genetic background and dietary habits. However, caloric restriction has been shown to remodel the gut microbiota and slow tumor growth. Here, we investigated whether the gut microbiota mediates the preventive effects of long-term chronic or intermittent caloric restriction on breast cancer predisposition. METHODS: 10-week-old transgenic breast cancer-prone mice were randomly assigned to dietary groups (ad libitum, chronic caloric restriction, and intermittent caloric restriction groups) and fed up to week 81. Stool samples were collected at weeks 10 (baseline), 17 (young), 49 (adult), and 81 (old). 16S rRNA gene sequencing was performed to identify the gut microbiota profile of the different groups. In order to investigate the breast cancer gut microbiota profile within genetically predisposed individuals regardless of diet, mammary tumor-bearing mice and mammary tumor-free but genetically prone mice were selected from the ad libitum group (n = 6). RESULTS: Intermittent caloric restriction increased the microbial diversity of adult mice and modified age-related compositional changes. A total of 13 genera were differentially abundant over time. Pathogenic Mycoplasma was enriched in the re-feeding period of the old intermittent caloric restriction group compared with baseline. Furthermore, mammary tumor-free mice showed shared gut microbiota characteristics with mammary tumor-bearing mice, suggesting an early link between genetic predisposition, gut microbiota, and breast cancer development. CONCLUSIONS: Our study revealed the role of gut microbes in the preventive effects of caloric restriction against breast cancer development, implying the significance of diet and microbiome interplay.
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Neoplasias de la Mama , Restricción Calórica , Microbioma Gastrointestinal , Animales , Restricción Calórica/métodos , Ratones , Femenino , Neoplasias de la Mama/microbiología , Neoplasias de la Mama/prevención & control , Ratones Transgénicos , Predisposición Genética a la Enfermedad , Heces/microbiología , Disbiosis/microbiología , ARN Ribosómico 16SRESUMEN
BACKGROUND: Dietary flavonoids may have potential effects on hormone-related cancers (HRCs) due to their anti-cancer properties via regulating hormones and suppressing inflammation and oxidative stress. We aimed to examine the association of flavonoid intake with risks of HRCs and whether this association was mediated by blood biomarkers involved in biological mechanisms. METHODS: This prospective cohort study from UK Biobank included 187,350 participants free of cancer when the last dietary recall was completed. The dietary intakes of flavonoids and subclasses were assessed using 24-hour dietary recalls. Venous blood was collected at baseline and assayed for biomarkers of inflammation, hormones, and oxidative stress. Hazard ratios (HR) and 95 % confidential intervals (CI) for the associations between flavonoid intake and HRCs risk were estimated by the cause-specific Cox proportional hazards model. The role of blood biomarkers in the flavonoids-HRCs association was investigated through mediation analysis. RESULTS: Over a median follow-up of 9.5 years, 3,392 female breast cancer, 417 ovarian cancer, 516 endometrial cancer, 4,305 prostate cancer, 45 testicular cancer, and 146 thyroid cancer cases were documented. Compared to the lowest quintile, multivariable-adjusted HRs (95 % CIs) in the highest quintile of total flavonoid intake were 0.89 (0.80-0.99) for breast cancer, 0.68 (0.50-0.92) for ovarian cancer, and 0.88 (0.80-0.98) for female-specific cancers. For subclasses, intakes of flavonols and anthocyanidins were inversely associated with the risk of female-specific cancers (Ptrend <0.05). Anthocyanidin intake was positively related to prostate cancer risk, whereas isoflavone intake was inversely linked to thyroid cancer risk (Ptrend <0.05). Additionally, certain biomarkers of inflammation, hormones and oxidative stress jointly mediated the association of flavonoid intake with the risk of female-specific cancers and prostate cancer. CONCLUSIONS: Our findings highlighted the importance of dietary flavonoids for the prevention of HRCs in the general population, providing epidemiological evidence for dietary guidelines.
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Dieta , Flavonoides , Humanos , Femenino , Flavonoides/administración & dosificación , Estudios Prospectivos , Masculino , Persona de Mediana Edad , Anciano , Neoplasias de la Próstata/prevención & control , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/epidemiología , Adulto , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/prevención & control , Neoplasias de la Mama/sangre , Modelos de Riesgos Proporcionales , Neoplasias Ováricas/prevención & control , Neoplasias Ováricas/epidemiología , Neoplasias Ováricas/sangre , Estrés Oxidativo/efectos de los fármacos , Neoplasias de la Tiroides/epidemiología , Neoplasias de la Tiroides/prevención & control , Neoplasias de la Tiroides/sangre , Neoplasias/prevención & control , Neoplasias/epidemiología , Reino Unido/epidemiología , Factores de RiesgoRESUMEN
INTRODUCTION: Established personal and familial risk factors contribute collectively to a woman's risk of breast or ovarian cancer. Existing clinical services offer genetic testing for pathogenic variants in high-risk genes to investigate these risks but recent information on the role of common genomic variants, in the form of a Polygenic Risk Score (PRS), has provided the potential to further personalise breast and ovarian cancer risk assessment. Data from cohort studies support the potential of an integrated risk assessment to improve targeted risk management but experience of this approach in clinical practice is limited. METHODS AND ANALYSIS: The polygenic risk modification trial is an Australian multicentre prospective randomised controlled trial of integrated risk assessment including personal and family risk factors with inclusion of breast and ovarian PRS vs standard care. The study will enrol women, unaffected by cancer, undergoing predictive testing at a familial cancer clinic for a pathogenic variant in a known breast cancer (BC) or ovarian cancer (OC) predisposition gene (BRCA1, BRCA2, PALB2, CHEK2, ATM, RAD51C, RAD51D). Array-based genotyping will be used to generate breast cancer (313 SNP) and ovarian cancer (36 SNP) PRS. A suite of materials has been developed for the trial including an online portal for patient consent and questionnaires, and a clinician education programme to train healthcare providers in the use of integrated risk assessment. Long-term follow-up will evaluate differences in the assessed risk and management advice, patient risk management intentions and adherence, patient-reported experience and outcomes, and the health service implications of personalised risk assessment. ETHICS AND DISSEMINATION: This study has been approved by the Human Research Ethics Committee of Peter MacCallum Cancer Centre and at all participating centres. Study findings will be disseminated via peer-reviewed publications and conference presentations, and directly to participants. TRIAL REGISTRATION NUMBER: ACTRN12621000009819.
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Neoplasias de la Mama , Predisposición Genética a la Enfermedad , Pruebas Genéticas , Humanos , Femenino , Neoplasias de la Mama/genética , Neoplasias de la Mama/prevención & control , Medición de Riesgo/métodos , Pruebas Genéticas/métodos , Estudios Prospectivos , Australia , Neoplasias Ováricas/genética , Neoplasias Ováricas/prevención & control , Estudios Multicéntricos como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto , Herencia Multifactorial , Factores de Riesgo , Adulto , Polimorfismo de Nucleótido SimpleRESUMEN
OBJECTIVE: Endogenous and exogenous hormonal factors have been associated with female breast, genital, and colorectal cancer risk. The aim of the present study is to conduct an evidence-based evaluation of the fraction of cancers attributable to and prevented by exogenous hormonal (i.e., combined oral contraceptives [COC] and combined estrogen-progestogen menopausal therapy [CEPMT]) and reproductive factors (i.e., parity and breastfeeding) in Italy. STUDY DESIGN: We calculated the population attributable and prevented fractions combining relative risks and prevalence of exposure in Italian women. Italian cancer incidence and mortality data were extracted from national sources and used to estimate the number of cancer cases and deaths attributable to reproductive factors and exogenous hormones in Italy in 2020. For long-term effects, a 20-year latency period was considered. RESULTS: COC were responsible for 4.4 % of breast and 10.9 % of cervical cancers in women aged 15-44, but also avoided 6.4 % of endometrial, 5.6 % of ovarian, and 2.9 % of colorectal cancers in women of all ages. Overall, COC use prevented 1174 cancer diagnoses and 577 cancer deaths. CEPMT caused 0.4 % of breast cancers at age 45-69. Low parity accounted for 8.1 %, 11.8 % and 15.5 % of breast, endometrial and ovarian cancers, respectively (6267 cases, 1796 deaths). Breastfeeding avoided 6.4 % of breast cancers (3775 cases, 897 deaths). CONCLUSIONS: Our analysis quantified the complex effects of hormonal and reproductive factors on cancer burden in Italian women.
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Neoplasias de la Mama , Humanos , Femenino , Italia/epidemiología , Adulto , Persona de Mediana Edad , Adolescente , Anciano , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/prevención & control , Adulto Joven , Anticonceptivos Orales Combinados , Paridad , Lactancia Materna/estadística & datos numéricos , Neoplasias Endometriales/epidemiología , Neoplasias Endometriales/prevención & control , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/prevención & control , Incidencia , Neoplasias/epidemiología , Neoplasias/prevención & control , Terapia de Reemplazo de Estrógeno/estadística & datos numéricos , Neoplasias Ováricas/epidemiología , Neoplasias Ováricas/prevención & control , Factores de Riesgo , Embarazo , Neoplasias de los Genitales Femeninos/epidemiología , Neoplasias de los Genitales Femeninos/prevención & controlRESUMEN
Breast cancer (BrCa) remains a significant health concern globally, influenced by both nonmodifiable and modifiable risk factors. Limited studies have explored the role of color-specific vegetables and fruits, which are rich in specific phytonutrients, on BrCa risk. We hypothesized that consuming color-specific vegetables and fruits may decrease BrCa risk in Korean women. This case-control study examined the relationship between the intake of different-colored vegetables and fruits and the risk of BrCa, considering menopausal, hormone receptor status, tumor subtypes. We matched 395 patients and 395 controls by age and recruited from the National Cancer Center in Korea. Dietary data was collected via food frequency questionnaire, categorizing by colors: green, orange/yellow, red/purple, and white. Odds ratio (OR) and 95% confidence intervals (CIs) were calculated by logistic regression models, with subgroup analyses for menopausal, hormone receptor status, and tumor subtypes. Results shown BrCa patients consumed less vegetables and fruits than control group. Higher consumption of green, other orange/yellow, and white vegetables and fruits was negatively associated with BrCa risk [OR (95% CIs) of Q4 vs Q1 = 0.59 (0.36-0.94); 0.55 (0.33-0.89); and 0.60 (0.37-0.96), respectively]. Particularly, a greater intake of dark green leafy vegetables was significantly associated with reduced BrCa risk (OR of Q4 vs Q1 = 0.55, 95% CI = 0.34-0.89). Subgroup analysis consistently demonstrated inverse associations between higher intake of green-color vegetables and fruits and BrCa risk. Our findings suggest that a diet rich in green and white-color vegetables and fruits may lower BrCa risk among Korean women.
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Neoplasias de la Mama , Dieta , Frutas , Verduras , Humanos , Femenino , Neoplasias de la Mama/prevención & control , Neoplasias de la Mama/epidemiología , Persona de Mediana Edad , República de Corea/epidemiología , Estudios de Casos y Controles , Adulto , Factores de Riesgo , Oportunidad Relativa , Anciano , Encuestas sobre Dietas , BlancoRESUMEN
As breast screening services move towards use of healthcare AI (HCAI) for screen reading, research on public views of HCAI can inform more person-centered implementation. We synthesise reviews of public views of HCAI in general, and review primary studies of women's views of AI in breast screening. People generally appear open to HCAI and its potential benefits, despite a wide range of concerns; similarly, women are open towards AI in breast screening because of the potential benefits, but are concerned about a wide range of risks. Women want radiologists to remain central; oversight, evaluation and performance, care, equity and bias, transparency, and accountability are key issues; women may be less tolerant of AI error than of human error. Using our recent Australian primary study, we illustrate both the value of informing participants before collecting data, and women's views. The 40 screening-age women in this study stipulated four main conditions on breast screening AI implementation: 1) maintaining human control; 2) strong evidence of performance; 3) supporting familiarisation with AI; and 4) providing adequate reasons for introducing AI. Three solutions were offered to support familiarisation: transparency and information; slow and staged implementation; and allowing women to opt-out of AI reading. We provide recommendations to guide both implementation of AI in healthcare and research on public views of HCAI. Breast screening services should be transparent about AI use and share information about breast screening AI with women. Implementation should be slow and staged, providing opt-out options if possible. Screening services should demonstrate strong governance to maintain clinician control, demonstrate excellent AI system performance, assure data protection and bias mitigation, and give good reasons to justify implementation. When these measures are put in place, women are more likely to see HCAI use in breast screening as legitimate and acceptable.
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Inteligencia Artificial , Neoplasias de la Mama , Detección Precoz del Cáncer , Investigación Cualitativa , Humanos , Femenino , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/prevención & control , Detección Precoz del Cáncer/métodos , Australia , Adulto , Persona de Mediana Edad , Mamografía/métodos , Tamizaje Masivo/métodosRESUMEN
BACKGROUND: Raloxifene and bazedoxifene are selective estrogen receptor modulators (SERMs) used to prevent and treat osteoporosis in postmenopausal women. Raloxifene is also known for its preventive effect against invasive breast cancer; however, its effect on other cancer types is unclear. This study investigated the incidence of various cancers in osteoporosis patients receiving SERM therapy to determine its association with the risk of developing specific cancer types. METHODS: This retrospective cohort study examined the association between SERM use and the incidence of cervical, endometrial, ovarian, and colorectal cancers in postmenopausal women using data from the Korean National Health Insurance Service. Propensity score matching ensured group comparability by analyzing 95,513 participants. Cox proportional hazard models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) to assess the cancer risk associated with SERM therapy, differentiating between the effects of raloxifene and bazedoxifene. RESULTS: SERM therapy was associated with a reduced risk of cervical (adjusted HR = 0.47, 95% CI = 0.31-0.71), ovarian (adjusted HR = 0.61, 95% CI = 0.42-0.88), and colorectal cancer (adjusted HR = 0.49, 95% CI = 0.42-0.57). No significant risk reduction was observed for endometrial cancer (adjusted HR = 1.05, 95% CI = 0.70-1.59). A comparison between raloxifene and bazedoxifene revealed no significant differences in their cancer prevention effects. CONCLUSION: SERM therapy administration is associated with a decreased incidence of cervical, ovarian, and colorectal cancers. Notably, the effects of raloxifene and bazedoxifene were consistent. Further investigations are crucial to elucidate the mechanisms underlying these observations and their clinical implications.
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Neoplasias de la Mama , Moduladores Selectivos de los Receptores de Estrógeno , Humanos , Femenino , Moduladores Selectivos de los Receptores de Estrógeno/uso terapéutico , Persona de Mediana Edad , Anciano , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/prevención & control , Estudios Retrospectivos , Clorhidrato de Raloxifeno/uso terapéutico , Incidencia , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/prevención & control , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Ováricas/epidemiología , Neoplasias Ováricas/prevención & control , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Endometriales/epidemiología , Neoplasias Endometriales/prevención & control , Indoles/uso terapéuticoRESUMEN
Importance: Many older women are screened for breast cancer beyond guideline-recommended thresholds. Messaging holds promise to reduce overscreening. Objective: To investigate the effect of a message on older women's support for and intentions of stopping breast cancer screening. Design, Setting, and Participants: A 2-wave randomized clinical online survey trial using a nationally representative online panel was performed from May 12 to June 19, 2023. Women 65 years or older without breast cancer were eligible to participate. Intervention: A pilot-tested breast cancer screening cessation message delivered to a hypothetical older woman with serious illnesses and functional impairment. The message was described as from 1 of 3 sources (clinician, news story, or family member). Participants were randomized into 4 groups: no message (group 1 [control]), a single message from a clinician at wave 1 and no message at wave 2 (group 2), a message from a news story (wave 1) and a clinician (wave 2) (group 3), and a message from a family member (wave 1) and a clinician (wave 2) (group 4). Main Outcomes and Measures: Support for stopping screening in the hypothetical older woman (primary) and screening intentions for oneself (secondary) were assessed on 7-point scales, with higher values indicating stronger support for and intentions to stop screening. Means were compared using analysis of variance. The message effect on screening intentions among participants 75 years or older and those with life expectancy of less than 10 years were also explored. Results: A total of 3051 women participated in wave 1 of the trial. The mean (SD) age was 72.8 (5.9) years; 272 (8.9%) were non-Hispanic Black and 2506 (82.1%) were non-Hispanic White. Of these women, 2796 (91.6%) completed wave 2. Group 2 had significantly higher support for screening cessation in the hypothetical patient at wave 2 (mean score, 3.14 [95% CI, 2.99-3.29]) compared with group 1 (mean score, 2.68 [95% CI, 2.54-2.82]; P < .001). The effect was even stronger in group 3 (mean score, 4.23 [95% CI, 4.09-4.38]) and group 4 (mean score, 4.12 [95% CI, 3.97-4.27]) compared with both groups 1 and 2 (all P < .001). Message effects on self-screening intentions followed a similar pattern, with larger effects among participants 75 years or older or with limited life expectancy. Conclusions and Relevance: In this randomized clinical trial, a breast cancer screening cessation message significantly increased older women's support for and intentions of screening cessation. The strongest effects were observed when the message was delivered over time from multiple sources. Future work needs to engage potential message sources to examine the feasibility and acceptability of multilevel messaging strategies and their effect on screening behavior. Trial Registration: ClinicalTrials.gov Identifier: NCT05821023.
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Neoplasias de la Mama , Detección Precoz del Cáncer , Humanos , Femenino , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/psicología , Neoplasias de la Mama/prevención & control , Anciano , Detección Precoz del Cáncer/métodos , Detección Precoz del Cáncer/psicología , Estados Unidos , Intención , Anciano de 80 o más Años , Encuestas y CuestionariosRESUMEN
PURPOSE: Breast cancer (BC) is a major cause of cancer-related mortality in Nigeria, which is exacerbated by a lack of understanding of how knowledge of BC risk factors influences the lifestyle and dietary patterns of Nigerians across age groups. This study evaluated the influence of knowledge of BC risks on lifestyle and dietary patterns across age groups, aiming to inform early management, prevention, and survival rates. METHODS: A cross-sectional survey was conducted in Ota, Ado-odo, Ogun State, Nigeria, involving participants from six educational institutions. The study assessed knowledge of BC risks factors and lifestyle/dietary habits using questionnaires. Results were analyzed using Epi Info software and SPSS version 20. RESULTS: The participants' age ranged from 13 to 60 years, with a mean of 21 years. The age categories of the participants were 75.24% adolescents (13-19), 18.68% young adults (20-40), and 6.08% middle-aged (41-60). Middle-aged individuals had the least knowledge about smoking (7.58%), alcohol (26.09%), antibiotics (7.25%), and red meat/smoked foods (20.09%), which translated into their poor dietary/lifestyle patterns. Young adults showed profound physical inactivity (71.00%), while adolescents consumed more carbonated drinks (71.53%), which corresponded to lack of knowledge about the effects of physical inactivity (10.85%) and consumption of carbonated drinks (13.70%) on BC risk. CONCLUSION: The study found that understanding BC risk factors directly affects lifestyle and dietary patterns. Age groups with higher knowledge had better lifestyle/dietary patterns. This highlights the need for a tailored intervention on lifestyle and dietary education across all age groups, especially the middle-aged, so as to inform a deliberate adjustment in lifestyle and dietary habits, which play crucial roles in BC incidence, survival, and prevention.
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Neoplasias de la Mama , Patrones Dietéticos , Conocimientos, Actitudes y Práctica en Salud , Estilo de Vida , Adolescente , Adulto , Femenino , Humanos , Persona de Mediana Edad , Adulto Joven , Factores de Edad , Neoplasias de la Mama/prevención & control , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/etiología , Estudios Transversales , Nigeria/epidemiología , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
BACKGROUND: Breast cancer remains a leading cause of cancer morbidity and mortality worldwide. In the United States, Black women face significant disparities in screening mammograms, experience higher rates of breast cancer at advanced stages, and are more likely to die from the disease. AIMS: This study aimed to develop and beta-test a virtual health navigation program to enhance breast cancer care within the Black community. We identified barriers to utilizing virtual patient navigators and factors impacting the adoption of virtual navigation for breast cancer information among Black women. METHODS: The vCONET (Virtual Community Oncology Navigation and Engagement) intervention was delivered through the Second Life virtual platform. The informational content was collaboratively developed with community members. Participants engaged in an informational session on risk factors, mammography information, and preventive behaviors. Surveys (n = 18) and focus groups (n = 9) assessed knowledge and insights into perceptions. RESULTS: Findings revealed a positive impact of the intervention, with participants expressing increased knowledge and willingness to seek further information about breast cancer prevention, and highlighted the engaging nature of the virtual environment, while acknowledging potential technological challenges. CONCLUSION: Virtual health navigation shows promise in addressing breast cancer disparities by promoting awareness among Black women. Future efforts should optimize virtual navigation approaches through collaborative engagement for lasting impact, enhancing breast cancer care and equity in communities of color.
Asunto(s)
Negro o Afroamericano , Neoplasias de la Mama , Navegación de Pacientes , Humanos , Femenino , Neoplasias de la Mama/prevención & control , Navegación de Pacientes/organización & administración , Persona de Mediana Edad , Adulto , Estados Unidos , Anciano , Mamografía/métodos , Disparidades en Atención de Salud , Grupos FocalesRESUMEN
OBJECTIVES: Adherence to healthy lifestyle recommendations has been reported to improve health-related quality of life (HRQL) in breast cancer (BC) patients, but the influence of long-term behavioral changes remains unknown. We evaluated the association between adherence to the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations and HRQL both, at BC diagnosis and the change 7-12 years later. DESIGN: Prospective cohort study. SETTINGS AND PARTICIPANTS: A total of 406 breast cancer survivors, from the EpiGEICAM study, were recruited in 16 Spanish hospitals. MEASUREMENTS: Epidemiological, clinical, dietary, physical activity and HRQL information was collected both at recruitment and 7-12 years later. A 7-item score to measure compliance with recommendations was assessed according to the 2018 WCRF/AICR scoring criteria. HRQL was evaluated using SF-36 questionnaire. Linear mixed models for longitudinal data were used to assess the cross-sectional and longitudinal association between adherence score and the physical and mental component summary scores. RESULTS: At diagnosis, for each unit increase in WCRF/AICR score adherence, the HRQL physical domain increased 0.78 points (95%CI: -0.04 to 1.60; P trend:0.06). The mean change in physical HRQL from diagnosis to follow-up per unit increase in within-subject adherence score was 0.73 points (95%CI: -0.18 to 1.65; P trend: 0.12). For the mental domain, no association was observed with compliance with the recommendations at diagnosis, nor with changes in adherence over time. CONCLUSIONS: Our results suggest that Increased adherence to WCRF/AICR cancer prevention recommendations over time could contribute to slightly improved long-term physical HRQoL in BC survivors.