Fasting insulin and endogenous hormones in relation to premenopausal breast density (Canada).

PURPOSE: Mammographic breast density (BD) is associated with increased risk of breast cancer. This study asks which circulating metabolic and reproductive biomarkers are associated with BD, particularly dense breast area, in premenopausal women not taking exogenous hormones. METHODS: In a cross-sectional study, 299 premenopausal women aged 40-49 completed questionnaires, provided a fasting blood sample, had height, weight, percentage body fat, waist and hip measurements taken, and attended a screening mammogram. Multivariate linear regression was used to calculate adjusted means for percentage BD, absolute dense and non-dense area, across categories of covariates, adjusted for day of menstrual cycle, age, parity, body mass index, percentage body fat, and ethnicity. RESULTS: Fasting insulin levels were inversely associated, and insulin-like growth factor-binding protein 1 levels directly associated with percentage BD, but lost statistical significance after multivariate adjustment. Sex hormone-binding globulin levels were directly associated with percentage BD, still significant after multivariate adjustment (p = 0.03). A significant inverse dose-response association was observed between progesterone levels and dense area (p < 0.01). CONCLUSIONS: Breast density in premenopausal women seems unrelated or inversely related to insulin resistance, levels of insulin-like growth factor 1 and its binding proteins, and levels of sex steroids; therefore, the mechanism by which radiodensity on a mammogram is related to breast cancer risk remains unclear.

Changing communication needs and preferences across the cancer care trajectory: insights from the patient perspective.

PURPOSE: In this program of research, we sought to expand our understanding of how cancer patients' communication needs and preferences change across the course of their illness trajectory. To address known limitations in the empirical knowledge base, we designed a study capitalizing on representative patient reports as they occurred within time and across experience obtaining care for this disease. METHODS: We used a longitudinal cohort design informed by interpretive description methodology to follow 125 patients over a multi-year period as they reflected on their ongoing experiences with cancer care communication. RESULTS: In relation to each phase of their cancer care trajectory, patients identified tension points and contextual challenges impinging on what they felt constituted helpful and unhelpful patient-provider communication. CONCLUSIONS: Findings from this study create a dynamic portrait of how we can better inform communication approaches and interventions through interpretations of population knowledge and individual experience.

Masculinities, diet and senior Punjabi Sikh immigrant men: food for Western thought?

The high rates of diabetes and cardiovascular disease among Punjabi Sikh (PS) men are often linked to diet. Although some high fat and sugar foods in both traditional and Western foods negatively influence these illnesses, little is known about what underpins PS immigrant men's dietary practices. This article details the connections between masculinities and diet to reveal how varying gendered ideals can inform and influence the practices of senior PS Canadian immigrant men who attended community-based men's groups. Participants' masculine ideals and their alignment to those ideals were deeply rooted in spirituality and traditional cultures, which shaped the use of specific foods and beverages, yet there was also evidence that the availability and affordability of dairy products and alcohol in Canada strongly influenced men's diets. While the men's group leaders educated attendees about diet, ideologies reinforcing ties between femininities and the cooking of meals often prevailed. Linkages between participants' masculine ideals and dietary practices were both similar and discordant with the findings reported in studies of Western men. The findings drawn from this study may direct what, how and where dietary messages are targeted to senior PS Canadian immigrant men.

Health promotion and illness demotion at prostate cancer support groups.

Although health promotion programs can positively influence health practices, men typically react to symptoms, rather than maintain their health, and are more likely to deny than discuss illness-related issues. Prostate cancer support groups (PCSGs) provide an intriguing exception to these practices, in that men routinely discuss ordinarily private illness experiences and engage with self-health. This article draws on individual interview data from 52 men, and participant observations conducted at the meetings of 15 groups in British Columbia, Canada to provide insights to how groups simultaneously facilitate health promotion and illness demotion. The study findings reveal how an environment conducive to men's talk was established to normalize prostate cancer and promote the individual and collective health of group members. From a gendered perspective, men both disrupted and embodied dominant ideals of masculinity in how they engaged with their health at PCSGs.

Comparison of breast cancer survival in two populations: Ardabil, Iran and British Columbia, Canada.

BACKGROUND: Patterns in survival can provide information about the burden and severity of cancer, help uncover gaps in systemic policy and program delivery, and support the planning of enhanced cancer control systems. The aim of this paper is to describe the one-year survival rates for breast cancer in two populations using population-based cancer registries: Ardabil, Iran, and British Columbia (BC), Canada. METHODS: All newly diagnosed cases of female breast cancer were identified in the Ardabil cancer registry from 2003 to 2005 and the BC cancer registry for 2003. The International Classification of Disease for Oncology (ICDO) was used for coding cancer morphology and topography. Survival time was determined from cancer diagnosis to death. Age-specific one-year survival rates, relative survival rates and weighted standard errors were calculated using life-tables for each country. RESULTS: Breast cancer patients in BC had greater one-year survival rates than patients in Ardabil overall and for each age group under 60. CONCLUSION: These findings support the need for breast cancer screening programs (including regular clinical breast examinations and mammography), public education and awareness regarding early detection of breast cancer, and education of health care providers.

Time-related communication skills from the cancer patient perspective.

OBJECTIVE: Although it is well recognized that skilled communication is an essential element of effective cancer care, lack of time to communicate is often cited as an explanation for the ongoing cancer care communications problems patients report. In this study, we sought to answer the question: How do cancer patients describe and explain the effects of health care communication upon their experience of time? METHODS: We conducted a qualitative secondary analysis, using interpretive description methodology, on a large data set that comprised transcribed interview data from two studies of cancer communication from the patient perspective. One primary study represented a cross-sectional study of helpful and unhelpful communications (n=200) and the other a longitudinal study of changes in communication needs and preferences over the illness trajectory (n=60). RESULTS: We found time a meaningful and symbolic construct for cancer patients. They describe clinician time-related attitudes and behaviors as significant factors in shaping the impact of clinical encounters on their overall psychosocial cancer experiences. They report a number of ways in which clinician communications have been particularly effective in buffering and manipulating the impact of time pressures and describe a capacity within exceptionally skilled clinicians to manufacture a perception of available time even in the context of such pressures. CONCLUSIONS: We believe that the patient perspective on cancer care communication provides an important angle of vision from which to discern strategies that may assist clinicians to buffer the untoward effects of the time pressure under which most care systems currently operate.

Connecting humor, health, and masculinities at prostate cancer support groups.

OBJECTIVE: Many commentaries about men's health practices and masculinities indicate that men do not typically engage with self-health or acknowledge illness, let alone openly discuss their health concerns with other men. Prostate cancer support groups (PCSGs) appear to run contrary to such ideals, yet the factors that influence men's attendance and engagement at group meetings are poorly understood. As part of a larger PCSG study, we noticed that humor was central to many group interactions and this prompted us to examine the connections between humor, health, and masculinities. METHODS: A qualitative ethnographic design was used to direct fieldwork and conduct participant observations at the meetings of 16 PCSGs in British Columbia, Canada. Individual semi-structured interviews were completed with 54 men who attended PCSGs to better understand their perceptions about the use of humor at group meetings. RESULTS: Four themes, disarming stoicism, marking the boundaries, rekindling and reformulating men's sexuality, and when humor goes south were drawn from the analyses. Overall, humor was used to promote inclusiveness, mark the boundaries for providing and receiving mutual help, and develop masculine group norms around men's sexuality. Although there were many benefits to humor there were also some instances when well-intended banter caused discomfort for attendees. CONCLUSIONS: The importance of group leadership was central to preserving the benefits of humor, and the specificities of how humor is used at PCSGs may provide direction for clinical practice and the design of future community-based men's health promotion programs.

Evaluation of a hepatitis B lay health worker intervention for Chinese Americans and Canadians.

Hepatitis B testing is recommended for immigrants from countries where hepatitis B infection is endemic. However, only about one-half of Chinese in North America have received hepatitis B testing. We conducted a randomized controlled trial to evaluate the effectiveness of a hepatitis B lay health worker intervention for Chinese Americans/Canadians. Four hundred and sixty individuals who had never been tested for hepatitis B were identified from community-based surveys of Chinese conducted in Seattle, Washington, and Vancouver, British Columbia. These individuals were randomly assigned to receive a hepatitis B lay health worker intervention or a direct mailing of physical activity educational materials. Follow-up surveys were completed 6 months after randomization. Self-reported hepatitis B testing was verified through medical records review. A total of 319 individuals responded to the follow-up survey (69% response rate). Medical records data verified hepatitis B testing since randomization for 9 (6%) of the 142 experimental group participants and 3 (2%) of the 177 control group participants (P = 0.04). At follow-up, a higher proportion of individuals in the experimental arm than individuals in the control arm knew that hepatitis B can be spread by razors (P < 0.001) and during sexual intercourse (P = 0.07). Our findings suggest that lay health worker interventions can impact hepatitis B-related knowledge. However, our hepatitis B lay health worker intervention had a very limited impact on hepatitis B testing completion. Future research should evaluate other intervention approaches to improving hepatitis B testing rates among Chinese in North America.

Patient real-time and 12-month retrospective perceptions of difficult communications in the cancer diagnostic period.

Communication is a notoriously complex challenge in the cancer care context. Our program of research involves exploration of patient-provider communications across the cancer trajectory from the patient perspective.Toward this end, we have been following a cohort of 60 cancer patients, representing a range of tumor sites, from immediately after diagnosis through to recovery, chronic, or advanced disease. Drawing on interpretive description analytic techniques, we documented patterns and themes related to various components of the cancer journey. In this article, we report on findings pertaining to poor communication during the initial diagnostic period, as described by patients at the time of diagnosis and 1 year later.These findings illuminate the dynamics of communication problems during that complex period, and depict the mechanisms by which patients sought to confront these challenges to optimize their cancer care experience. On the basis of these findings, considered in the context of the body of available evidence, suggestions are proposed as to appropriate directions for system-level solutions to the complex communication challenges within cancer care.

Sources of health information among Chinese immigrants to the Pacific Northwest.

BACKGROUND: Chinese immigrants to North America experience cancer-related health disparities and underutilize preventive care. Little is known about Chinese immigrants' sources of health information. METHODS: A population-based survey of Chinese immigrants was conducted in Vancouver, British Columbia, Canada and Seattle, Washington. RESULTS: The study group included 899 individuals. Less than three fourths of the respondents reported receiving health information from health care providers, and only a minority used the Internet as a source of health information. We found significant differences between the sources of health information in Seattle and Vancouver. CONCLUSIONS: Health educators should consider available media outlets as well as the characteristics of a target community when planning intervention programs for Chinese immigrants.

Cancer care communication: the power to harm and the power to heal?

OBJECTIVE: This study was designed to examine the belief held by many cancer patients that communication with their care providers has a meaningful part to play in shaping their disease outcomes. METHODS: From a large qualitative interview data set in which cancer patients described their perceptions of helpful and unhelpful heath care communication; we extracted the accounts of 69 patients and 13 focus group participants who specifically articulated a perceived relationship between communication and cancer outcomes. Through secondary analysis of that subset, we generated an interpretive description of patterns and themes within their accounts of a relationship between communication and cancer survivorship. RESULTS: Our findings document patient perceptions of the mechanisms involved in indirect and, some instances, direct relationships between communication encounters and cancer outcomes. CONCLUSION: Some cancer patients believe that, by virtue of its influence upon comfort, inclusion, clarity and hope, communication can influence cancer outcomes. PRACTICE IMPLICATIONS: While competing discourses exist within the patient population with regard to such associations, the perception that communication may influence clinical outcomes seems sufficiently pervasive and persistent that it warrants serious attention within care systems and by the psychosocial cancer research community.

Three-year follow-up study of women who participated in a cervical cancer screening intervention while in prison.

OBJECTIVE: This study describes rescreening following a prison cervical cancer screening intervention: the numbers of women who received rescreening during the three-year follow-up period; their timing of rescreening in relationship to intervention follow-up recommendations; and socio-demographic factors associated with rescreening. METHODS: Socio-demographic information was collected from Corrections Branch records. Clinical and risk factor information was obtained by a self-administered questionnaire. Pap screening histories were collected from Cervical Cancer Screening Program (CCSP) client records using the client ID number for Pap smears taken during the intervention period, during the three-year follow-up period, and during the 30-month period preceding the intervention period. Results were entered in Excel and responses summarized with frequency tables; bivariate analysis of categoric variables was done using chi-square tests of independence. RESULTS: During the three-year follow-up period, only 28 (21%) of 138 women who participated in a prison cervical cancer screening intervention were rescreened within 6 months of the recommendation received at intervention Pap test. Women with fewer than 5 multiple names (aliases) were more likely to be rescreened (p = 0.02). Educational level approached statistical significance (p = 0.05), with women with least education receiving highest rescreening. There was no relationship between rescreening and ethnicity, injection drug use, having borne children and current methadone treatment. CONCLUSION: Only 50% of women who participated in a specifically designed prison screening intervention were rescreened during the subsequent three years. Further work is needed to design, implement and evaluate follow-up initiatives of community cervical cancer screening programs for women who are at higher risk of developing cervical dysplasia.

Knowledge and behaviour regarding heart disease prevention in Chinese Canadian immigrants.

OBJECTIVE: Although Chinese are one of the fastest growing minorities in Canada, there is little information about heart disease prevention behaviour in Chinese immigrants. Our objective was to examine the knowledge and practices of Chinese immigrants regarding heart disease prevention. METHODS: 504 randomly selected Chinese adult immigrants participated in a community-based, in-person survey in Vancouver during 2005. The survey included questions on heart disease prevention knowledge and practices. RESULTS: Although respondents were quite knowledgeable about heart disease risk factors, their behaviours to reduce heart disease risk were generally low. Thirteen percent of respondents consumed five or more servings of fruit/vegetables per day; 37% engaged in regular physical activity; 54% never used tobacco; 81% had received a blood pressure check in the past 2 years; and 54% had received a cholesterol test in the past 5 years. Differences were found in these behaviours by gender, age, English fluency, birth country and duration of residence in North America. The associations are presented between these demographic variables and heart disease prevention behaviours. CONCLUSION: Heart disease prevention programs are needed in Chinese immigrant populations, especially aimed at increasing fruit/vegetable consumption and regular physical activity. Efforts are also needed to decrease tobacco use and to increase cholesterol testing.

New hope for an oral cancer solution: together we can make a difference.

Oral cancer is associated with high mortality and morbidity rates, largely as a result of late diagnosis. Although dental practitioners are trained to identify premalignant and malignant lesions, an organized system is needed to offer guidance and to improve access to experts in diagnosis and management of these lesions. In this article, we describe the many ways in which the British Columbia Oral Cancer Prevention Program (BC OCPP) is addressing this challenge: by linking community dental practices and referral centres, by creating partnerships between scientists and clinicians that already have resulted in new technologies to enhance early diagnosis, by involving a broad range of stakeholders to ensure population-based screening and by engaging in provincial, national and international outreach.

Treatment decision making among Chinese women with DCIS.

One result of the widespread screening mammography is a 200% increase in the rates of breast ductal carcinoma in situ (DCIS). Treatment decision making among Chinese women diagnosed with DCIS remains understudied. This study examined Chinese-Canadian women's experiences (N = 26): (1) with treatment decision making (mastectomy or breast conserving surgery) and (2) their reflections on the decision-making process. Interviews in Cantonese, Mandarin, or English were transcribed and translated, and a content analysis conducted. Women's treatment decisions reflected a lack of understanding of DCIS, the desire to rid themselves of breast cancer forever, and the influence of significant others. English as a second language and use of medical jargon impeded their ability to make informed treatment decisions. Women's reflections on the decision-making process provided insights into how to improve information and support treatment decision making in ways that are accessible to them.

Opinions from ESL instructors and students about curricula on hepatitis B for use in immigrant communities.

BACKGROUND: Chinese immigrants in Canada have a disproportionately high risk for hepatitis B compared with non-Hispanic Whites. Hepatitis B is the leading cause of hepatocellular carcinoma among Asian immigrants to North America. English-as-a-second-language (ESL) classes are an effective way of reaching newly immigrated individuals and are a potential channel for delivering health messages. METHODS: Using data from 6 focus groups among ESL instructors and students, we characterized perceptions about activities that are successfully used in ESL classrooms and strategies for delivering hepatitis B information. RESULTS. Instructors and students generally reported that activities that focused on speaking and listening skills and that addressed content relevant to students' daily lives were successful in the classroom. Instructors generally avoided material that was irrelevant or too difficult to understand. Focus group participants offered strategies for delivering hepatitis B information in ESL classrooms; these strategies included addressing symptoms and prevention and not singling out a specific population subgroup to avoid stigmatization. CONCLUSIONS: These findings might assist efforts to develop ESL curricula that target immigrant populations.

Hepatitis B knowledge, testing and vaccination levels in Chinese immigrants to British Columbia, Canada.

BACKGROUND: Little is known about hepatitis B (HBV) and liver cancer control in Chinese in Canada. Liver cancer, a significant health problem in Asia, is preventable and can be controlled through HBV blood testing, vaccination, and community education about HBV. OBJECTIVE: The overall goal was to increase HBV testing and vaccination in Chinese adult Canadians. The objective was to present findings on HBV testing, vaccination and knowledge in Chinese immigrants. METHODS: 504 randomly selected Chinese adult immigrants residing in Vancouver responded to the survey which examined HBV blood testing and vaccination practices, HBV knowledge levels and socio-demographic characteristics. Face-to-face interviews were conducted in Cantonese, Mandarin, or English. RESULTS: 57% of participants reported that they had received HBV blood testing, 38% had been vaccinated, and 6% were known HBV carriers. There were gender differences, with lower rates of testing and vaccination, and higher chronic carrier rates, among men. Over 80% knew that HBV can be spread by asymptomatic persons and can cause cirrhosis and liver cancer. However, confusion existed about the routes of HBV transmission. INTERPRETATION: A sizeable proportion of Chinese adult immigrants in Vancouver have not been tested or vaccinated for HBV. Knowledge level, especially about routes of HBV transmission, was low. This is a concern, given that chronic HBV infection is the most common cause of liver cancer in Asian North Americans. To improve knowledge, reduce risk of infection and the burden of chronic infection and its sequelae in immigrant populations, continuing educational efforts are needed.

Predisposing, reinforcing and enabling factors associated with hepatitis B testing in Chinese Canadians in British Columbia.

BACKGROUND: Liver cancer, a significant health problem in Chinese, can be controlled through HBV blood testing, vaccination, and community education about HBV. The PRECEDE framework has been very helpful in identifying factors associated with health practices. OBJECTIVES: The objective was to identify factors associated with HBV testing in Chinese Canadians, using the PRECEDE framework. METHODS: Five hundred and thirty-three randomly selected Chinese Canadian adults were interviewed about HBV blood testing practices. Factors were grouped as predisposing, reinforcing and enabling. RESULTS: Fifty-five percent had received HBV blood testing. Several predisposing factors, all reinforcing factors and one enabling factor were associated with HBV testing in bivariate analysis. A physician's recommendation for testing was the strongest factor associated with testing in multiple logistic regression analysis (OR=4.4, p<0.0001). INTERPRETATION: Many Chinese Canadian adults in Vancouver have not been tested for HBV. Continuing educational efforts are needed and the PRECEDE framework can inform the development of health education interventions.

Women's responses to information on mammographic breast density.

The objective of this study was to determine the negative and positive outcomes of providing mammographic breast density (MBD) information to participants of a screening program. A randomized experiment was conducted with a sample of 618 women 50 years or older with MBD greater than 50% of breast volume. The intervention consisted of reporting the presence of MBD in the screening mammography results letter that was sent along with an information pamphlet. Compared to the controls, more women in the intervention group described the term breast density correctly and recognized it as a risk factor for breast cancer. Although at the 4-week follow-up the intervention group indicated that they were "very likely" to have an annual clinical breast examination more frequently than controls, no differences were detected at 6 months. There were no significant differences on other behavioural or psychological measures, although at the 4-week follow-up the control group perceived their risk for breast cancer, relative to other women their age, as "a lot lower" than did women in the intervention group. The results demonstrate a feasible and non-threatening way to provide women with important personalized information about breast cancer risk.

Levels of commitment: exploring complementary therapy use by women with breast cancer.

OBJECTIVES: Previous research on complementary therapy use in populations of patients with breast cancer has failed to differentiate among the different types of therapies and utilization patterns, resulting in wide discrepancies in prevalence rates. The purpose of this study was to develop more refined and rigorous estimates of the prevalence of complementary therapy use in women with breast cancer and their level of commitment to complementary therapy. DESIGN AND SAMPLE/SETTING: Using a cross-sectional, retrospective survey design, a random sample of 334 women with breast cancer was drawn from a Canadian provincial cancer registry. Using an intensive therapy inventory, women were asked to indicate the therapies and practices they had used since cancer diagnosis, frequency of use, amount of effort associated with using each therapy, and financial cost of therapy use. RESULTS: A substantial proportion of women with breast cancer were found to be using complementary therapies, with between 19.5% (most conservative estimate) and 79.9% (liberal estimate) of the women reporting the use of at least one complementary therapy following diagnosis. While the majority of therapies were used on a daily basis, a minimal amount of effort and finances was expended on complementary therapy use. Using two-way cluster analysis, two homogenous groups of complementary therapy users were identified based on level of commitment to complementary therapy use. Women with a low commitment to complementary therapy use comprised 73.9% of the sample and were more likely to be older and report less education than women with a moderate-to-high commitment to complementary therapy use. CONCLUSIONS: The use of complementary therapies by women with breast cancer warrants more precise measurement to accurately capture the types of complementary therapies used and the level of commitment to complementary therapy use. The findings of this study point to the value of the concept of commitment in identifying individuals willing to commit substantial time, energy and financial resources to complementary therapy use.