Obesity in breast cancer--what is the risk factor?

Environmental factors influence breast cancer incidence and progression. High body mass index (BMI) is associated with increased risk of post-menopausal breast cancer and with poorer outcome in those with a history of breast cancer. High BMI is generally interpreted as excess adiposity (overweight or obesity) and the World Cancer Research Fund judged that the associations between BMI and incidence of breast cancer were due to body fatness. Although BMI is the most common measure used to characterise body composition, it cannot distinguish lean mass from fat mass, or characterise body fat distribution, and so individuals with the same BMI can have different body composition. In particular, the relation between BMI and lean or fat mass may differ between people with or without disease. The question therefore arises as to what aspect or aspects of body composition are causally linked to the poorer outcome of breast cancer patients with high BMI. This question is not addressed in the literature. Most studies have used BMI, without discussion of its shortcomings as a marker of body composition, leading to potentially important misinterpretation. In this article we review the different measurements used to characterise body composition in the literature, and how they relate to breast cancer risk and prognosis. Further research is required to better characterise the relation of body composition to breast cancer.

Self-hypnosis in chronic pain. A multiple baseline study of five highly hypnotisable subjects.

The efficacy of self-hypnosis in the treatment of chronic pain was evaluated using a multiple baseline design for five patients referred to the Auckland Hospital Pain Clinic. Subjects were selected for high hypnotisability using the Stanford Hypnotic Clinical Scale. Daily records of pain intensity, sleep quality, medication requirements, and self-hypnosis practice were completed. At four research interviews the Health Locus of Control survey, the McGill Pain Questionnaire, and the Illness Self Concept Repertory Grid (ISCRG) were administered. Subjects also reported on daily activities and quality of life. Postal follow-up assessment occurred after 2 years. Two subjects reported overall improvement, two demonstrated little change in condition, although self-hypnosis was effective on some occasions, and one subject experienced deterioration in her condition. The patients showed an increase in personal locus of control and a shift of self-concept away from physical illness on the ISCRG. The results suggest that self-hypnosis can be a highly effective technique for some patients with chronic pain but not for all. Selection criteria and clinical factors other than hypnotisability need to be considered in further research, since even highly hypnotisable subjects may derive limited benefit from self-hypnosis.

Chronic pain and the use of health services.

The range and extent of health consulting by people who have chronic pain attending a specialist clinic was assessed. Forty-two subjects attending Auckland Hospital pain clinic completed a questionnaire about their use of conventional and complementary health services for their pain in the previous 12 months. The general practitioner was the most frequently consulted health professional, visited, on average, 12.9 times per annum; compared with the expected rate of 4.2 consultations per annum. Medical specialists and health professionals had been consulted more frequently than complementary specialists. Twenty-five percent of the sample had been admitted to hospital for investigations relating to their pain in the previous year. On average, these patients spent $1333.63 per annum of their personal funds on health care. The cost of health care for chronic pain is significant both for the individual and the state and highlights the need for intensive pain management programmes.