Metformin and other anti-diabetic medication use and breast cancer incidence in the Nurses' Health Studies.

We aimed to examine the association between the use of metformin and other anti-diabetic medications and breast cancer incidence within two large prospective cohort studies. We followed 185,181 women who participated in the Nurses' Health Study (NHS; 1994-2016) and the NHSII (1995-2017), with baseline corresponding to the date metformin was approved for type 2 diabetes (T2D) treatment in the US Information on T2D diagnosis, anti-diabetes medications, and other covariates was self-reported at baseline and repeatedly assessed by follow-up questionnaires every 2 years. Breast cancer cases were self-reported and confirmed by medical record review. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between medication use and breast cancer were estimated using Cox proportional hazards regression models, adjusting for breast cancer risk factors. During 3,324,881 person-years of follow-up, we ascertained 9,192 incident invasive breast cancer cases, of which 451 were among women with T2D. Compared with women without T2D (n = 169,263), neither metformin use (HR = 0.97; 95% CI = 0.81-1.15) nor other anti-diabetic medications use (HR = 1.11; 95% CI = 0.90-1.36) associated with significantly lower breast cancer incidence. Among women with T2D (n = 15,918), compared with metformin never users, metformin ever use was not significantly inversely associated with breast cancer (HR = 0.92; 95% CI = 0.74-1.15). Although we observed that past use of metformin was inversely associated with breast cancer in the T2D population (HR = 0.67; 95% CI = 0.48-0.94), current use (HR = 1.01; 95% CI = 0.80-1.27) and longer duration of metformin use were not associated with breast cancer (each 2-year interval: HR = 1.01; 95% CI = 0.95-1.07). Overall, metformin use was not associated with the risk of developing breast cancer among the overall cohort population or among women with T2D.

Systematic Review on Gender-Affirming Testosterone Therapy and the Risk of Breast Cancer: A Challenge for Physicians Treating Patients from Transgender and Gender-Diverse Populations.

Conflicting evidence exists about the risk of breast cancer in transgender and gender-diverse (TGD) patients treated with testosterone. This review aimed to summarize current knowledge regarding the risk of breast cancer associated with gender-affirming testosterone treatment (GATT). A systematic literature search using the Preferred Reporting Items for Systematic Review and Meta-Analysis checklist was conducted in January 2023 through Ovid, Scopus, and Web of Science databases. English-language, peer-reviewed articles evaluating breast cancer in TGD patients after GATT that met the inclusion criteria were included. This review included 22 articles, with 14 case reports, 4 case series, and 4 retrospective cohort studies. The review identified 26 TGD patients who developed breast cancer post-GATT therapy, with inconclusive evidence on the relationship between testosterone and the risk of breast cancer in TGD patients. This uncertainty in part arises from the mechanisms governing testosterone's effects within breast tissue, with contrasting theories proposing both proliferative and antiproliferative impacts. Considering this ambiguity, it is imperative for healthcare providers to engage in informed discussions with patients prior to initiating hormone therapy to discuss potential adverse effects, including the possibility of breast cancer development in TGD individuals. Patient education and shared decision-making are essential components of responsible care in this context.

Efficacy of Community Health Worker-Delivered Family Health History-Based Breast Cancer Education and Services Among Chinese Americans.

Family health history (FHH) is an evidence-based genomics tool used in cancer prevention and education. Chinese Americans, the largest Asian American group, face unique barriers in FHH collection and communication. This study aimed to evaluate the efficacy of culturally and linguistically appropriate community health worker (CHW)-delivered FHH-based breast cancer (BC) education and services to Chinese Americans. A total of 1129 Chinese Americans received FHH-based BC education and service delivered by our trained Chinese American CHWs. Participants responded to evaluation surveys before, immediately after, and 3 months after the education and service. Participating Chinese Americans showed significant increases in rates of collecting FHH of BC, discussing FHH of BC with family members, informing their primary care physicians of their FHH of BC, and discussing their FHH of BC with their primary care physicians at 3 months post-education and service compared to the baseline data (all Ps < 0.01). Attitudes, intention, and self-efficacy related to FHH of BC communication and collection and FHH of BC knowledge were improved both immediately after and 3 months after the delivery of the education and services (all Ps < 0.01). Within 3 months, ~ 14.3% of participants who had a high risk of BC based on FHH reported visiting geneticists for genetic evaluation. Our Chinese American CHW-delivered FHH-based BC education and services showed initial success in increasing knowledge, collection and communication of BC-related FHH, and genetic service utilization among Chinese American participants. This study can serve as a starting point for conducting more robust studies, such as randomized controlled trials, in the future.

Participant Evaluation of a Multi-disciplinary Oncology Preceptorship Training Program for Oncology Health Professionals from Kumasi, Ghana.

A critical shortage of skilled healthcare workers is a primary cause of disparate global cancer outcomes. We report participant evaluation of a multidisciplinary preceptorship program. In collaboration with the city of Kumasi, Ghana, Mayo Clinic and the City Cancer Challenge hosted a preceptorship program for comprehensive multidisciplinary breast and cervix cancer training. A total of 14 healthcare workers from Kumasi received two weeks of training at Mayo Clinic in November and December 2021. Each participant and preceptor were requested to complete an anonymous post-participation survey. Of the 14 trainee participants, 10 (71%) completed the survey. All respondents found the program "valuable and applicable to their clinical practice." Ninety percent reported they were able to "review effective and critical elements in the development and expansion of the multidisciplinary team" and able to "solve practical clinical cases as a team". General themes of satisfaction included: (1) organization and administration, (2) clinical observations and demonstrations, (3) guidelines development, and (4) recognizing the central importance of cultivating a team-based approach. Of the 40 preceptors, 16 (40%) completed the survey. All respondents reported they felt the training would meaningfully "influence patient care in Ghana", that participation "added value or joy to their clinical practice," and all wished to "participate in future preceptorship programs". After a focused two-week program, trainees reported high satisfaction, usefulness from observing specialized cancer care, and value in closely observing a multidisciplinary oncology team. Preceptors reported the experience added joy and perspective to their clinical practice and wished to participate in future programs.

Task shifting between physicians and nurses in acute care hospitals: cross-sectional study in nine countries.

BACKGROUND: Countries vary in the extent to which reforms have been implemented expanding nurses' Scopes-of-Practice (SoP). There is limited cross-country research if and how reforms affect clinical practice, particularly in hospitals. This study analyses health professionals' perceptions of role change and of task shifting between the medical and nursing professions in nine European countries. METHODS: Cross-sectional design with surveys completed by 1716 health professionals treating patients with breast cancer (BC) and acute myocardial infarction (AMI) in 161 hospitals across nine countries. Descriptive and bivariate analysis on self-reported staff role changes and levels of independence (with/without physician oversight) by two country groups, with major SoP reforms implemented between 2010 and 2015 (Netherlands, England, Scotland) and without (Czech Republic, Germany, Italy, Norway, Poland, Turkey). Participation in 'medical tasks' was identified using two methods, a data-driven and a conceptual approach. Individual task-related analyses were performed for the medical and nursing professions, and Advanced Practice Nurses/Specialist Nurses (APN/SN). RESULTS: Health professionals from the Netherlands, England and Scotland more frequently reported changes to staff roles over this time period vs. the other six countries (BC 74.0% vs. 38.7%, p < .001; AMI 61.7% vs. 37.3%, p < .001), and higher independence in new roles (BC 58.6% vs. 24.0%, p < .001; AMI 48.9% vs. 29.2%, p < .001). A higher proportion of nurses and APN/SN from these three countries reported to undertake tasks related to BC diagnosis, therapy, prescribing of medicines and information to patients compared to the six countries. Similar cross-country differences existed for AMI on prescribing medications and follow-up care. Tasks related to diagnosis and therapy, however, remained largely within the medical profession's domain. Most tasks were reported to be performed by both professions rather than carried out by one profession only. CONCLUSIONS: Higher levels of changes to staff roles and task shifting were reported in the Netherlands, England and Scotland, suggesting that professional boundaries have shifted, for instance on chemotherapy or prescribing medicines. For most tasks, however, a partial instead of full task shifting is practice.

Nurse-Led Individualized Follow-Up Versus Regular Physician-Led Visits After Early Breast Cancer (MyHealth): A Phase III Randomized, Controlled Trial.

PURPOSE: Follow-up after breast cancer with regular visits has failed to detect recurrences, be cost-effective, and address patient needs. METHODS: MyHealth is a phase III randomized controlled trial (ClinicalTrials.gov identifier: NCT02949167). Patients, who recently completed primary treatment for stage I-II breast cancer, were randomly assigned in variable block sizes and stratified by age and human epidermal growth factor receptor 2 status to intervention or control follow-up. The nurse-led intervention comprised three to five individual self-management sessions, regular reporting of symptoms, and navigation to health care services. The control follow-up comprised regular outpatient visits with the physician. The primary outcome was breast cancer-specific quality of life (QoL) measured by the Trial Outcome Index-Physical/Functional/Breast summary score of the Functional Assessment of Cancer Therapy-Breast 2 years after random assignment. Secondary outcomes were fear of recurrence, anxiety, depression, and health care utilization. Analyses were intention-to-treat and P values were two-sided with 95% confidence level set at 0.005 because of multiple comparisons. RESULTS: Among 1,101 eligible patients, 875 were invited and 503 were randomly assigned to control (n = 252) or intervention (n = 251) follow-up. At 2 years, patients in the intervention group reported a significantly and clinically relevant higher QoL (mean, 75.69 [standard deviation [SD], 12.27]) than patients in the control group (71.26 [SD, 14.08]), with a mean difference of 5.05 (95% CI, 3.30 to 6.79; P < .001). The intervention group reported significantly less fear of recurrence, anxiety, and depression; they had fewer physician consultations but more nurse contacts and an unchanged diagnostic imaging pattern. The effect on all outcomes was stable through a 3-year follow-up. CONCLUSION: The MyHealth study suggested a new strategy for follow-up after early breast cancer as it provided significant improvements in QoL.

Approach to the care process by nurse case managers in a breast unit.

OBJECTIVE: Breast units led by nurse case managers are being implemented to provide comprehensive care in the detection and treatment of breast cancer. However, their implementation is heterogeneous and the results of the care process with this professional have not been studied. The aim of the study is to describe the management in time and the approach of the process by a nurse case manager in the breast unit of women with suspected breast cancer pathology, derived from the breast cancer screening program. METHODS: Descriptive, cross-sectional, retrospective study carried out in 2021. Women treated in a breast unit managed by a nurse case manager in a hospital in southern Spain were included. Sociodemographic, clinical and care process characteristics were analysed RESULTS: A total of 118 women of Spanish nationality (92%) participated, with a mean age of 59 years. The diagnosis of malignancy was made in 74.6% of them. Seventy-nine percent of the women had their first visit within 3 days. The mean time to diagnosis was 3.98 days (SD: ±3.93), 4.2 weeks (SD: ±1.84) to initiate treatment and a total in-hospital time of 33 days (SD: ±13.45). CONCLUSIONS: The management of nurse case managers in breast units contributes to improving or speeding up times, in accordance with international guidelines, helping this approach in the continuity of the care process for women referred after screening for breast cancer detection.

Efficient management of new patient referrals to a breast service: the safe introduction of an advanced nurse practitioner-led telephone breast pain service.

INTRODUCTION: There has been an almost 100% increase in referrals to breast cancer diagnostic clinics in the past decade. Breaching of the two-week cancer referral target is now commonplace, potentially delaying diagnoses of breast malignancy in many women. Almost one in five of these referrals are women with mastalgia, not a symptom linked to breast cancer. The objective of the study was the safe introduction of an advanced nurse practitioner-led telephone service for women with mastalgia to improve the service for women and create capacity for those with "red flag" breast symptoms. METHODS: Referrals to clinic were triaged, women with mastalgia only were directed to a telephone-based assessment clinic and symptoms evaluated using a multidisciplinary created proforma. RESULTS: Within 23 months, 1,427 women were assessed in the breast pain telephone assessment clinic: 863 (61%) were aged over 40 and 564 (39%) aged under 40. A total of 1,238 underwent telephone assessment. Reassurance and discharge only was needed for 365 (26%). The aetiology of pain was identified as musculoskeletal in 1,104/1,238 (89%) of patients, with only 39/1,238 (3.2%) identified as having true breast pain. Additional symptoms were mentioned by 264 women (18%) during the consultation; all immediately redirected back to a diagnostic clinic. Mammography was undertaken in 609 women (43%). Seven women (0.6%) were diagnosed with a breast malignancy. Patient survey indicated that 93% of patients were satisfied with the care received and 97% said they would recommend the service to a family member or friend. CONCLUSIONS: Although face-to-face assessments for breast pain remain the standard practice in many breast units, data indicating the safety of a telephone assessment clinic, along with high levels of patient satisfaction, question whether services can be delivered differently.

The Effects of Nurse-Led Supportive Care Program on Quality of Life in Women with Breast Cancer Receiving Adjuvant Chemotherapy: A Randomized Controlled Pilot Study.

OBJECTIVES: This study was to evaluate the effects of nurse-led supportive care program on quality of life in women with breast cancer receiving adjuvant chemotherapy. METHODS: The study was carried out a parallel group randomized controlled pilot study with repeated-measures design in general surgery unit of a training and research hospital. Forty-two women with newly diagnosed breast cancer were randomly assigned to the intervention and control groups. The intervention group received nurse-led supportive care program for 8 weeks, 4 weeks in face-to-face sessions and 4 weeks through phone sessions. The control group received only routine treatment. The women in both groups completed the EORTC-QLQ-C30 (version 3.0) Quality of Life questionnaires at baseline and ninth week. RESULTS: There was a significant increase in the mean global health status and functional status scores of the women with breast cancer in the intervention group compared to the women in the control group in the ninth week compared to the baseline. The women in the intervention group had a lower mean symptom status score in the ninth week than the women in the control group and there was a statistically significant difference in the change in the mean scores of the groups over time. CONCLUSIONS: Our nurse-led supportive care program is an effective, safe and acceptable method to support women with BC receiving adjuvant chemotherapy. IMPLICATIONS FOR NURSING PRACTICE: The nurse-led supportive care program can be used as a reliable and effective nursing intervention to increase the quality of life of women breast cancer receiving adjuvant chemotherapy. CLINICAL TRIAL REGISTRATION: NCT05399160.

Effectiveness of a novel consultant nurse-led breast pain clinic in secondary care.

BACKGROUND: Patients with breast pain are usually seen in 'one-stop clinic' (OSC) with breast imaging. In the absence of associated red flag features, the incidence of breast cancer is extremely low. With increase in referrals the OSC capacity is over-stretched. We developed a consultant nurse-led dedicated 'breast pain clinic' in September 2021 without routine breast imaging. After meticulous history and examination, patients obtained detailed counselling and advice regarding breast pain management. If any abnormality was noted then appointment was given for OSC. AIM: To assess the effectiveness of a consultant nurse-led dedicated 'breast pain clinic'. METHODS: A prospective study of all consecutive patients seen in 'breast pain clinic' from September 2021 until September 2022. Feedback was sought from all patients. RESULTS: Altogether 429 patients were seen. The mean age was 48.7 years (range 18-86). 87.6% (n = 376) patients required no breast imaging. Only 12.4% (n = 53) patients needed referral to OSC and subsequently 2 patients (0.46%) were diagnosed with breast cancer. Ninety-eight percent of patients felt reassured and 99.2% patients were extremely likely/likely to recommend this service to family and friends. Out of 376 patients who were discharged from breast pain clinic, 12 patients were referred again over a median follow-up period of 15 months, and 2 out of them were diagnosed with breast cancer. CONCLUSION: A consultant nurse-led 'breast pain clinic' provides service improvement as it eases the pressure on the OSC. Most patients were managed without breast imaging with high level of patient satisfaction and low rereferral rate.

Analysis of nursing care concept: perspective of the person submitted to care

OBJECTIVE: This study aimed to analyze the concept of nursing care to patients with breast cancer on chemotherapy treatment, according to the perspective of the person submitted to care. MATERIAL AND METHODS: The study folowed the conceptual analysis methodology proposed by Walker and Avant according to Waldow, and it was developed through consultation to SCOPUS and CINAHL databases. The selection was carried out by inclusion and exclusion criteria, constituting a sample of 7 articles. RESULTS: There have been identified the main uses of the risk concept, defining attributes, antecedents and consequences of the concept. CONCLUSION: The evaluation of the concept and nursing care to breast cancer patient on chemotherapy treatment allowed a broader understanding of the phenomenon, with emphasis on the skills and competencies in nursing care dispensed to woman on chemotherapy treatment for breast cancer.