Disease-free survival by treatment after a DCIS diagnosis in a population-based cohort study.

Randomized trials have demonstrated the efficacy of radiation and tamoxifen in reducing risk of second events after breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS), but the comparative effectiveness of mastectomy, BCS, and adjuvant treatments have not been established in community practice. We examined disease-free survival (DFS) among 1,676 DCIS cases diagnosed during 1995-2006 in the population-based Wisconsin In Situ Cohort study. Information on patient and tumor characteristics, treatments, and second breast cancer events were collected via a comprehensive review of data from patient interviews, the statewide cancer registry, and pathology reports. Breast cancer DFS was evaluated according to treatment while adjusting for patient and tumor characteristics. After an average of 7.1 years of follow-up, 143 second breast cancer events occurred. Overall 5-year DFS was similar among women treated with ipsilateral mastectomy (95.6 %; 95 % CI 93.5-97.0) compared to women treated with BCS and radiation (94.8 %; 95 % CI 92.8-96.1), though women receiving BCS without radiation experienced poorer overall DFS (87.0 %; 95 % CI 80.6-91.5). Women treated with tamoxifen in addition to BCS and radiation had a similar risk of a second breast event, although the hazard ratio (HR) suggested a potential benefit (0.70, 95% CI 0.41-1.19). Women treated with BCS, radiation, and tamoxifen had comparable risk of a second event as those treated with ipsilateral mastectomy (HR = 1.20; 95 % CI 0.71-2.02). In this population-based sample, the use of BCS with radiation and tamoxifen resulted in high DFS rates comparable to those achieved by ipsilateral mastectomy.

Components of metabolic syndrome and risk of breast cancer by prognostic features in the study of osteoporotic fractures cohort.

PURPOSE: Metabolic syndrome (MetS) and most of its components have been previously associated with increased breast cancer risk. We hypothesized that increasing number of MetS components would be positively associated with breast cancer risk. METHODS: Data were obtained from the Study of Osteoporotic Fractures, a prospective cohort of women aged ≥65 enrolled between 1986 and 1988 and still being followed prospectively (n = 8,956). MetS components evaluated at baseline were elevated waist circumference, hypertension, and diabetes. Data were not available on hyperlipidemia. Incident breast cancers were confirmed by pathology report. We compared women with 0, 1, and 2 or 3 MetS components. We used Cox proportional hazards regression to calculate associations for breast cancer overall and classified by prognostic features. RESULTS: At baseline, 28.8 % of participants had 2 or 3 MetS components. Over an average follow-up of 14.4 years, 551 breast cancer cases were identified. Compared to those with no components, women with 2 or 3 components had increased breast cancer risk (hazard ratio (HR), 1.30; 95 % confidence interval (CI), 1.01-1.68) and increased risk of ER+ (HR, 1.48; 95 % CI, 1.09-2.03) and PR+ (HR, 1.56; 95 % CI, 1.10-2.20) cancer, adjusting for age, hormone use, and family history of breast cancer. These results became attenuated and not statistically significant when additionally adjusted for body mass index. CONCLUSIONS: MetS is associated with increased postmenopausal breast cancer risk, especially for ER+ and PR+ cancers, though this effect may not be independent of the effect of body mass index. Managing the components of MetS could be efficacious for breast cancer risk reduction.

Practical nurses' health and safety in nursing homes.

PURPOSE: Practical nurses (PNs) rated their general and emotional health and their employers' attention to their health and safety. These components were examined in relationship to work setting and intention to leave for the purpose of exploring workforce issues involving these important care providers of frail elders. DESIGN/METHODS: A relicensure survey mailed to all PNs in one rural state included the Minimum Data Set for nurse workforce supply plus questions from the Health and Retirement Survey. Data were analyzed using Kruskal-Wallis nonparametric ANOVA, t-test, and chi-square tests. RESULTS: Of the state's working PNs, 813 responded, (71%) and 34% (n=269) reported nursing home employment. Overall, age and work role were not significantly associated with self-rated general health (p=0.14 and p=0.12). Males reported poorer general (p=0.09) and emotional (p=0.004) health. PNs working in nursing homes rated their general and emotional health lower than PNs in other settings (p<0.001). Of the PNs in nursing homes, 28% reported they were likely to leave their position within one year, versus 19% in other work settings (p=0.003). PNs with higher evaluations of their employer safety practices were less likely to leave. IMPLICATIONS: Understanding PNs perceived general/emotional health and perceptions of workplace health/safety efforts can inform interventions to reduce turnover.

Lifestyle factors and the risk of a second breast cancer after ductal carcinoma in situ.

BACKGROUND: Little information exists on lifestyle factors that affect prognosis after treatment for ductal carcinoma in situ (DCIS) breast cancer. Improved understanding of the role of lifestyle factors is important to survivors wishing to reduce their risk of a second breast cancer diagnosis. METHODS: We examined the association between body mass index (BMI), physical activity, and alcohol intake, and risk of a second breast cancer diagnosis among 1,925 DCIS survivors in the Wisconsin In Situ Cohort. Exposures were self-reported during biennial patient interviews. Second breast cancer diagnoses were validated via pathology report. Cox proportional hazards regression was used to estimate the association between prediagnosis, postdiagnosis, and change in exposure levels and the risk of a second diagnosis, with adjustment for patient, tumor, and treatment factors. RESULTS: Over a mean of 6.7 years of follow-up, 162 second breast cancer diagnoses were reported, including 57 invasive events, 60 in situ events, and 45 diagnoses of unknown stage. A significant trend of increasing risk of a second diagnosis was found over increasing categories of postdiagnosis alcohol intake (Ptrend = 0.02). Among premenopausal women, increased prediagnosis BMI was associated with a reduced risk of a second diagnosis (HR = 0.93; 95% confidence interval, 0.88-0.99). CONCLUSION: DCIS survivors may reduce their risk of a second diagnosis by reducing postdiagnosis alcohol consumption. IMPACT: The population of DCIS survivors is projected to surpass one million by the year 2016. Our results suggest that these women may be able to reduce their risk of a second diagnosis through moderation of alcohol consumption.

Fatty acid consumption and the risk of osteoporotic fracture.

Osteoporosis is a disease characterized by low bone mass and the structural deterioration of bone tissue. It is estimated that 44 million Americans and 55% of those over 50 years of age are currently affected by this disease. Among other risk factors for osteoporotic fracture, dietary fat in general and essential fatty acids (EFA) in particular have recently been investigated because of their suspected impact on the bone remodeling process. This article reviews the growing body of literature concerning EFA and bone health. In particular, two recent large prospective cohort studies evaluating the association between multiple types of EFA and risk of osteoporotic fracture are highlighted. The results of these studies are placed in context with the existing literature, and recommendations for future investigation are presented.