Asymptomatic breast cancer in non-participants of the national screening programme in Norway: a confounding factor in evaluation?

OBJECTIVE: To evaluate the extent and histopathological characteristics of asymptomatic breast cancer detected outside the Norwegian Breast Cancer Screening Program (NBCSP) in women targeted by the programme. METHODS: Our study included 568 primary breast cancers (523 invasive and 45 ductal carcinoma in situ) diagnosed in 553 women aged 50-70, residing in Møre og Romsdal County, 2002-2008. The cancers were divided into screening-detected cancers in the NBCSP, interval cancers (ICs) and cancers detected in women not participating in the NBCSP (never participated and lapsed attendees), and further into asymptomatic and symptomatic cancers. Nottingham Prognostic Index (NPI) was used for comparisons across the groups and the distributions were compared using chi-square tests for statistical significance. RESULTS: Twenty percent (19/97) of the ICs and 32% (69/213) of the breast cancers in non-participants were asymptomatic, with opportunistic screening as the most frequent detection method (42%, 8/19 for ICs and 54%, 37/69 for non-participants). There were no differences in distribution of NPI prognostic categories across subgroups of asymptomatic invasive cancers (screening-detected cancers in the NBCSP, asymptomatic ICs and asymptomatic cancers in non-participants) or between subgroups of symptomatic invasive cancers (symptomatic ICs and symptomatic cancers in non-participants). Asymptomatic cancers had a significantly more favourable distribution of NPI prognostic categories compared with symptomatic cancers (P < 0.001). The proportion of invasive cancers with excellent/good NPI was 53% (164/310) for all asymptomatic and 25% (52/211) for all symptomatic invasive cancers. CONCLUSIONS: A considerable percentage of breast cancers detected outside the organized screening programme were asymptomatic, with a prognostic profile comparable with screening-detected breast cancers in the NBCSP. Individual data regarding the detection method for all breast cancers are needed for a complete evaluation of the organized screening programme in Norway.

Identification and exploration of herb-drug combinations used by cancer patients.

INTRODUCTION: This survey aims to identify herb-chemotherapeutic drug combinations in a defined group of cancer patients and to explore possible clinical consequences of these combinations. METHODS: Herb-chemotherapeutic drug combinations were identified among adult cancer patients, and clinical consequences of the combinations were explored by literature searches in medical databases on possible mutual effects on similar cytochrome P-450 metabolising enzymes (CYPs) and/or the P-glycoprotein (P-gp) transporter. RESULTS: Among 42 cancer patients using herbal remedies concurrently with chemotherapy, 136 two-agent herb-drug combinations were registered and 47 different potential herb-drug interactions were identified on the level of CYP metabolism and P-gp transport in vitro. Garlic, ginger, green tea and noni juice were the herbal remedies most frequently used in such combinations. For 48 % of the herbal remedies identified no literature data exist on their interaction potentials. Clinical studies were available for four herbal remedies only. Minor clinical potential for CYP interactions in humans was indicated for green tea and Echinacea. P-gp interactions were only investigated for garlic, which showed a significant interaction potential both in vivo and in vitro. CONCLUSION: The large number of in vitro potential herb-drug interactions identified urge for more clinical pharmacokinetic interaction studies in humans.

Herbal use among cancer patients during palliative or curative chemotherapy treatment in Norway.

GOALS OF WORK: This survey aims to explore the differences between cancer patients undergoing chemotherapeutic treatment with palliative or curative intention with respect to concurrent herbal use, experiences of adverse effects, motives of herbal intake, and communication about herbal use with health care providers. MATERIALS AND METHODS: One hundred and twelve adult cancer patients from the west coast of Central Norway, currently undergoing chemotherapeutic treatment, were recruited to a cross-sectional descriptive survey. MAIN RESULTS: Palliative and curative patients used herbal remedies concurrent with chemotherapy equally frequent (37% and 38%). One palliative patient reported adverse effects when doubling the dose of injected mistletoe used. Garlic was only used by palliative patients (p = 0.009) who also tended to have a more frequent everyday herbal use (78% vs 67%, respectively) than curative patients (p = 0.075). Curative patients, however, used herbal remedies more often to counteract adverse reactions (31% vs 3%, respectively; p = 0.026). A bivariate logistic regression, which was adjusted for age, showed that palliative patients used herbal remedies more frequently to improve their immune system (adjusted OR = 7.5, 95% CI = 1.1-49.7). CONCLUSIONS: This is the first survey comparing concurrent herbal use between cancer patients undergoing palliative or curative chemotherapy. Both groups frequently use herbal remedies concurrent with chemotherapy, but with a slightly different intent. The frequent concurrent use emphasizes the need for clinicians to include questions on complementary and alternative medicine in routine history taking and for further studies on possible herb-drug interactions among the cancer patient.

[Should complementary therapies be offered in hospitals?]. / Tilbud om komplementaer behandling i sykehus?

BACKGROUND: This study compares attitudes among oncology professionals to whether complementary therapies should be offered in integrated units affiliated with departments of oncology. MATERIAL AND METHODS: In June 2002 a questionnaire on alternative and complementary medicine was distributed among 156 physicians, 414 nurses, 164 radiation therapists and 94 administrative staff members in the five Norwegian university hospitals responsible for cancer treatment. 61% returned the questionnaire. RESULTS: More than half of the physicians (56%) and most of the other health care workers (85-93%) had a positive attitude to departments of integrative medicine. If the service was provided, about half of the physicians expressed the opinion that the cost of treatment should be covered by the patient. By contrast, more than 80% of nurses, clerks and therapeutic radiographers answered that the cost had to be covered by public funding. Most oncology professionals, including the physicians, felt that the decision on the type of treatment to be offered to patients should be made in collaboration between patients, complementary therapists and oncology health care workers. However, one third of the physicians thought that treatment decisions had to be made by health care workers only. INTERPRETATION: In general, this survey demonstrated a positive attitude towards integrated units offering complementary therapies, also among oncologists. However, major differences among professions were found.

[Should alternative therapists treat cancer--what is the opinion of oncology health personnel?]. / Skal alternative utøvere behandle kreft--hva mener onkologiske helsearbeidere?

BACKGROUND: This study compares attitudes to the proposed new Alternative medicine act that would give Norwegian practitioners of alternative medicine more scope in treating patients with cancer. MATERIAL AND METHODS: In June 2002 a questionnaire on alternative and complementary medicine was distributed among 156 physicians, 414 nurses, 164 radiation therapists and 94 administrative staff members in the five Norwegian university hospitals responsible for cancer treatment. 61% returned the questionnaire. RESULTS: Of all respondents, 29% described themselves as having a positive attitude to alternative medicine. When the health services can offer no healing or palliative treatment to offer, 41% of the physicians and 60% of other health care workers were of the opinion that alternative practitioners could treat cancer. More than 50% of respondents were of the opinion that the patients themselves had the right to determine whether or not to use alternative medicine. When health authorities require communication between practitioners and physicians more than 70% of all health care workers felt that this contact had to be in writing. INTERPRETATION: Most health care workers treating cancer are of the opinion that practitioner of alternative medicine might treat cancer if the health services have no healing or palliative treatment. Required contact between physicians and alternative practitioners must be in writing.