Prevalence and risk factors for foot and ankle musculoskeletal disorders experienced by nurses.

BACKGROUND: Nurses are at high risk of musculoskeletal disorders (MSDs). Although the prevalence of MSDs of the lower back, upper limbs, neck and shoulders have been reported previously in nursing, few studies have evaluated MSDs of the foot and ankle. This study evaluated the prevalence of foot and ankle MSDs in nurses and their relation to individual and workplace risk factors. METHODS: A self-administered survey incorporating the Nordic Musculoskeletal Questionnaire (NMQ) was distributed, over a nine-week period, to all eligible nurses (n = 416) working in a paediatric hospital in Brisbane, Australia. The prevalence of MSDs for each of the NMQ body regions was determined. Bivariate and multivariable logistic regression analyses were conducted to examine the relationships between activity-limiting foot/ankle MSDs and risk factors related to the individual (age, body mass index, number of existing foot conditions, smoking history, general physical health [SF36 Physical Component Scale], footwear features) or the workplace (level of nursing position, work location, average hours worked, hours worked in previous week, time since last break from work). RESULTS: A 73% response rate was achieved with 304 nurses completing surveys, of whom 276 were females (91%). Mean age of the nurses was 37 years (±10), younger than the state average of 43 years. Foot/ankle MSDs were the most prevalent conditions experienced by nurses during the preceding seven days (43.8%, 95% CI 38.2-49.4%), the second most prevalent MSDs to impair physical activity (16.7%, 95% CI 13.0-21.3%), and the third most prevalent MSD, after lower-back and neck problems, during the preceding 12 months (55.3%, 95% CI 49.6-60.7%). Of the nurse and work characteristics investigated, obesity, poor general physical health, existing foot conditions and working in the intensive care unit emerged as statistically significant (p < 0.05) independent risk factors for activity-limiting foot/ankle MSDs. CONCLUSIONS: Foot/ankle MSDs are common in paediatric hospital nurses and resulted in physical activity limitations in one out of every six nurses. We recommend targeted education programs regarding the prevention, self-management and treatment strategies for foot/ankle MSDs. Further research is needed into the impact of work location and extended shift durations on foot/ankle MSDs.

Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis.

BACKGROUND: The body of evidence related to breast-cancer-related lymphoedema incidence and risk factors has substantially grown and improved in quality over the past decade. We assessed the incidence of unilateral arm lymphoedema after breast cancer and explored the evidence available for lymphoedema risk factors. METHODS: We searched Academic Search Elite, Cumulative Index to Nursing and Allied Health, Cochrane Central Register of Controlled Trials (clinical trials), and Medline for research articles that assessed the incidence or prevalence of, or risk factors for, arm lymphoedema after breast cancer, published between Jan 1, 2000, and June 30, 2012. We extracted incidence data and calculated corresponding exact binomial 95% CIs. We used random effects models to calculate a pooled overall estimate of lymphoedema incidence, with subgroup analyses to assess the effect of different study designs, countries of study origin, diagnostic methods, time since diagnosis, and extent of axillary surgery. We assessed risk factors and collated them into four levels of evidence, depending on consistency of findings and quality and quantity of studies contributing to findings. FINDINGS: 72 studies met the inclusion criteria for the assessment of lymphoedema incidence, giving a pooled estimate of 16.6% (95% CI 13.6-20.2). Our estimate was 21.4% (14.9-29.8) when restricted to data from prospective cohort studies (30 studies). The incidence of arm lymphoedema seemed to increase up to 2 years after diagnosis or surgery of breast cancer (24 studies with time since diagnosis or surgery of 12 to <24 months; 18.9%, 14.2-24.7), was highest when assessed by more than one diagnostic method (nine studies; 28.2%, 11.8-53.5), and was about four times higher in women who had an axillary-lymph-node dissection (18 studies; 19.9%, 13.5-28.2) than it was in those who had sentinel-node biopsy (18 studies; 5.6%, 6.1-7.9). 29 studies met the inclusion criteria for the assessment of risk factors. Risk factors that had a strong level of evidence were extensive surgery (ie, axillary-lymph-node dissection, greater number of lymph nodes dissected, mastectomy) and being overweight or obese. INTERPRETATION: Our findings suggest that more than one in five women who survive breast cancer will develop arm lymphoedema. A clear need exists for improved understanding of contributing risk factors, as well as of prevention and management strategies to reduce the individual and public health burden of this disabling and distressing disorder. FUNDING: The National Breast Cancer Foundation, Australia.

Patterns, correlates, and prognostic significance of quality of life following breast cancer.

OBJECTIVE: To describe quality of life (QOL) over a 12-month period among women with breast cancer, consider the association between QOL and overall survival (OS), and explore characteristics associated with QOL declines. METHODS: A population-based sample of Australian women (n=287) with invasive, unilateral breast cancer (Stage I+) was observed prospectively for a median of 6.6 years. QOL was assessed at 6, 12, and 18 months post-diagnosis, using the Functional Assessment of Cancer Therapy, Breast (FACT-B+4) questionnaire. Raw scores for the FACT-B+4 and subscales were computed and individuals were categorized according to whether QOL declined, remained stable or improved between 6 and 18 months. Kaplan-Meier and Cox proportional hazards survival methods were used to estimate OS and its associations with QOL. Logistic regression models identified factors associated with QOL decline. RESULTS: Within FACT-B+4 subscales, between 10% and 23% of women showed declines in QOL. Following adjustment for established prognostic factors, emotional well-being and FACT-B+4 scores at 6 months post-diagnosis were associated with OS (p<0.05). Declines in physical (p<0.01) or functional (p=0.02) well-being between 6 and 18 months post-diagnosis were also associated significantly with OS. Receiving multiple forms of adjuvant treatment, a perception of not handling stress well and reporting one or more other major life events at 6 months post-diagnosis were factors associated with declines in QOL in multivariable analyses. CONCLUSIONS: Interventions targeted at preventing QOL declines may ultimately improve quantity as well as quality of life following breast cancer.

Upper-body morbidity following breast cancer treatment is common, may persist longer-term and adversely influences quality of life.

BACKGROUND: Impairments in upper-body function (UBF) are common following breast cancer. However, the relationship between arm morbidity and quality of life (QoL) remains unclear. This investigation uses longitudinal data to describe UBF in a population-based sample of women with breast cancer and examines its relationship with QoL. METHODS: Australian women (n=287) with unilateral breast cancer were assessed at three-monthly intervals, from six- to 18-months post-surgery (PS). Strength, endurance and flexibility were used to assess objective UBF, while the Disability of the Arm, Shoulder and Hand questionnaire and the Functional Assessment of Cancer Therapy-Breast questionnaire were used to assess self-reported UBF and QoL, respectively. RESULTS: Although mean UBF improved over time, up to 41% of women revealed declines in UBF between six- and 18-months PS. Older age, lower socioeconomic position, treatment on the dominant side, mastectomy, more extensive lymph node removal and having lymphoedema each increased odds of declines in UBF by at least two-fold (p<0.05). Lower baseline and declines in perceived UBF between six- and 18-months PS were each associated with poorer QoL at 18-months PS (p<0.05). CONCLUSIONS: Significant upper-body morbidity is experienced by many following breast cancer treatment, persisting longer term, and adversely influencing the QoL of breast cancer survivors.

Repeat participation in colorectal cancer screening utilizing fecal occult blood testing: a community-based project in a rural setting.

BACKGROUND AND AIM: To investigate participation in a second round of colorectal cancer screening using a fecal occult blood test (FOBT) in an Australian rural community, and to assess the demographic characteristics and individual perspectives associated with repeat screening. METHODS: Potential participants from round 1 (50-74 years of age) were sent an intervention package and asked to return a completed FOBT (n = 3406). Doctors of participants testing positive referred to colonoscopy as appropriate. Following screening, 119 participants completed qualitative telephone interviews. Multivariable logistic regression models evaluated the association between round-2 participation and other variables. RESULTS: Round-2 participation was 34.7%; the strongest predictor was participation in round 1. Repeat participants were more likely to be female; inconsistent screeners were more likely to be younger (aged 50-59 years). The proportion of positive FOBT was 12.7%, that of colonoscopy compliance was 98.6%, and the positive predictive value for cancer or adenoma of advanced pathology was 23.9%. Reasons for participation included testing as a precautionary measure or having family history/friends with colorectal cancer; reasons for non-participation included apathy or doctors' advice against screening. CONCLUSION: Participation was relatively low and consistent across rounds. Unless suitable strategies are identified to overcome behavioral trends and/or to screen out ineligible participants, little change in overall participation rates can be expected across rounds.

Does quality of life among breast cancer survivors one year after diagnosis differ depending on urban and non-urban residence? A comparative study.

BACKGROUND: This study examined the quality of life (QOL), measured by the Functional Assessment of Cancer Therapy (FACT) questionnaire, among urban (n = 277) and non-urban (n = 323) breast cancer survivors and women from the general population (n = 1140) in Queensland, Australia. METHODS: Population-based samples of breast cancer survivors aged < 75 years who were 12 months post-diagnosis and similarly-aged women from the general population were recruited between 2002 and 2007. RESULTS: Age-adjusted QOL among urban and non-urban breast cancer survivors was similar, although QOL related to breast cancer concerns was the weakest domain and was lower among non-urban survivors than their urban counterparts (36.8 versus 40.4, P < 0.01). Irrespective of residence, breast cancer survivors, on average, reported comparable scores on most QOL scales as their general population peers, although physical well-being was significantly lower among non-urban survivors (versus the general population, P < 0.01). Overall, around 20%-33% of survivors experienced lower QOL than peers without the disease. The odds of reporting QOL below normative levels were increased more than two-fold for those who experienced complications following surgery, reported upper-body problems, had higher perceived stress levels and/or a poor perception of handling stress (P < 0.01 for all). CONCLUSIONS: Results can be used to identify subgroups of women at risk of low QOL and to inform components of tailored recovery interventions to optimize QOL for these women following cancer treatment.

The population approach to falls injury prevention in older people: findings of a two community trial.

BACKGROUND: There is a sound rationale for the population-based approach to falls injury prevention but there is currently insufficient evidence to advise governments and communities on how they can use population-based strategies to achieve desired reductions in the burden of falls-related injury. The aim of the study was to quantify the effectiveness of a streamlined (and thus potentially sustainable and cost-effective), population-based, multi-factorial falls injury prevention program for people over 60 years of age. METHODS: Population-based falls-prevention interventions were conducted at two geographically-defined and separate Australian sites: Wide Bay, Queensland, and Northern Rivers, NSW. Changes in the prevalence of key risk factors and changes in rates of injury outcomes within each community were compared before and after program implementation and changes in rates of injury outcomes in each community were also compared with the rates in their respective States. RESULTS: The interventions in neither community substantially decreased the rate of falls-related injury among people aged 60 years or older, although there was some evidence of reductions in occurrence of multiple falls reported by women. In addition, there was some indication of improvements in fall-related risk factors, but the magnitudes were generally modest. CONCLUSIONS: The evidence suggests that low intensity population-based falls prevention programs may not be as effective as those that are intensively implemented.

Level of physical activity and characteristics associated with change following breast cancer diagnosis and treatment.

OBJECTIVE: While the physical and psychosocial benefits of participating in physical activity (PA) during and following breast cancer treatment are well understood, less is known about rates and uptake of PA following diagnosis. This paper explores the levels and patterns of PA among women recently diagnosed with breast cancer and the factors associated with change in activity levels. METHODS: Using a population-based recruitment approach, PA levels of 287 breast cancer patients were assessed at 6, 12 and 18 months post-diagnosis using the Behavioral Risk Factor Surveillance System, and then converted to MET (metabolic equivalent task)-hours/week. Regression analyses were used to explore the correlates associated with change between 6 and 18 months post-diagnosis. RESULTS: Although more than 80% of women participated in PA at each testing phases, more than 50% were considered insufficiently active or sedentary according to national recommendations and less than one-third reported engagement in vigorous or strength activities. Mean change in total MET-hours/week between 6 and 18 months post-diagnosis was minor (mean=0.10, median=0.0), however individual changes were substantial (ranging from -100 to +174 MET-hours/week). Results are more encouraging for the lower threshold of 3+ MET-hours/week, which may be most relevant specifically for breast cancer outcomes. CONCLUSIONS: Since the majority of women report insufficient levels of PA, there is a clear need for exercise interventions during and following breast cancer treatment. Few characteristics predict declines or improvements in PA levels, hence for optimal benefit, interventions should target the entire breast cancer population.

The Queensland Cancer Risk Study: general population norms for the Functional Assessment of Cancer Therapy-General (FACT-G).

OBJECTIVE: To derive Australian normative scores for the Functional Assessment of Cancer Therapy-General Population (FACT-GP) and to confirm its factor structure. METHODS: Quality of life (QoL) data (as measured by the FACT-GP) were collected within the Queensland Cancer Risk Study (QCRS) in 2004. The QCRS explored cancer screening and cancer risk behaviours among 9419 English-speaking residents of Queensland aged 20-75 years. Information was collected through computer-assisted telephone interviews and augmented by mailed, Self-Administered Questionnaires (SAQ). A total of 2727 participants largely comparable to the general population of Queensland self-completed the FACT-GP; however, participants were somewhat higher educated, more likely to have had cancer and less likely to be of indigenous heritage. RESULTS: The Queensland population reported a FACT-GP summary score of 85.9 (SD=15.1), with subscale scores (range: 19.2 for social well-being to 25.1 for physical well-being (PWB)). In this study, men and women within different age groups reported similar QoL. QoL was clinically and significantly lower among participants not married, with a body mass index (BMI) deviating from normal weight and with one or more self-reported morbidities. A four-factor solution was confirmed with good goodness-of-fit indices (RSMEA<0.05 for all three age groups). CONCLUSIONS: The reference values from the general population reported here can be used for comparison with the QoL measured in populations of cancer patients, providing a benchmark against which clinicians can evaluate the impact of the disease and/or the treatments on QoL.

Views of supervisors of colonoscopy training on quality issues for the national bowel cancer screening program in Australia.

BACKGROUND AND AIM: To describe the views of supervisors of colonoscopy training in regard to colonoscopy training capacity and quality in Australia. METHODS: Anonymous postal surveys from March to May 2007 were posted to 127 colonoscopy training supervisors (30.2% estimated response rate). The surveys queried colonoscopy training capacity and quality, supervisors' views and opinions on innovative approaches to colonoscopy training, number of colonoscopies and time required by trainees to gain competence in colonoscopy. RESULTS: Approximately 50% of trainers agreed and 27% disagreed that current numbers of training places were adequate to maintain a skilled colonoscopy workforce in preparation for the National Bowel Cancer Screening Program (NBCSP). A collaborative approach with the private sector was seen as beneficial by 65%. Non-gastroenterologists (non-GEs) were more likely than gastroenterologists (GEs) to be of the opinion that simulators are beneficial for colonoscopy training (chi(2)-test = 5.55, P = 0.026). The majority of trainers did not support training either nurses (73%) or general practitioners (GPs) in colonoscopy (71%). Approximately 60% of trainers considered that the current requirements for recognition of training in colonoscopy could be insufficient for trainees to gain competence and 80% of those indicated that > or = 200 colonoscopies were needed. CONCLUSIONS: Colonoscopy training in Australia has traditionally followed the apprenticeship model. Projected increases in demand for colonoscopy with the introduction of the NBCSP may require additional training places and new and innovative approaches to training in order to ensure the provision of high-quality colonoscopy services under the NBCSP.

Why do large breast cancers still present in a population offered screening?

Rates of large breast cancers should decrease in a population that is offered mammography screening, but women continue to present with them. We sought an explanation in a population-based epidemiological study of 1,459 women diagnosed with invasive breast cancer in 2002-2003 in Australia; breast cancers were > or =2 cm in 766 women (53%) and 11-1.9 cm in a comparison group (693, 47%). We interviewed the women about their personal, mammogram and breast histories in the years before diagnosis and collected biological characteristics of tumors and mammogram dates from medical records. The strongest correlate of breast cancer size at diagnosis was the method of detection: the odds of a > or =2 cm breast cancer was substantially lower for detection by a screening mammogram (OR = 0.27, 95% CI 0.21-0.34; p < 0.001) than for detection after a breast symptom. Higher BMI (ORs approximately 1.6 for > or =25 kg/m(2)), higher cancer grade (ORs of 1.6 for moderate, 2.89 for high grade) and lobular type (OR 2.09, 95% CI 1.45-3.0) were also independent correlates (p < 0.001) of a > or =2 cm breast cancer. HRT use strongly reduced the odds but only in cancers detected after a breast symptom (OR = 0.49, 95% CI 0.33-0.74; p = 0.002), not in those detected by a screening mammogram. As assessed from their proportional contribution to > or =2 cm breast cancers in our study population, lack of mammogram detection, BMI > or =25 kg/m(2) and moderate or high grade of the cancer were the most important factors with population attributable fractions of 42%, 11% and 29% respectively; the first 2 are amenable to intervention.

Prevalence and correlates of multiple cancer risk behaviors in an Australian population-based survey: results from the Queensland Cancer Risk Study.

OBJECTIVE: To report on the prevalence, clustering, and correlates of behavioral risk factors for cancer in the Queensland, Australia, population. DESIGN, SETTING, AND PARTICIPANTS: The Queensland Cancer Risk Study was a population-based survey of 9419 Queensland residents aged 20-75 years. Information was collected through anonymous computer-assisted telephone interviews between February and November 2004. MAIN OUTCOME MEASURES: Prevalence of tobacco smoking, alcohol consumption, obesity, physical inactivity, sun exposure, and inadequate fruit and vegetable intake, weighted by age, gender, and geographic region. RESULTS: The majority of respondents reported between two and four cancer risk behaviors (79.4%). Men, those younger than 59 years and those with lower educational attainment had more than twofold increased odds of reporting multiple cancer risk factors. Marital status and geographic region were moderately associated with cancer risk. Smoking, high levels of alcohol consumption, and sun exposure were associated with up to twofold increased odds of engaging in multiple additional risk factors. CONCLUSIONS: This study identified key subgroups of the Queensland population with increased odds of engaging in multiple risk behaviors for cancer, particularly younger men and people with lower educational attainment. Individual behavioral risk factors can also exert a significant impact on the overall risk profile, and this may be a useful consideration for public health campaigns that target key health behaviors.

Self-reported information on the diagnosis of colorectal cancer was reliable but not necessarily valid.

OBJECTIVE: Self-report is commonly used in epidemiologic studies; however, few data exist on the reliability and validity of this method for eliciting information related to the diagnosis of colorectal cancer. We examined the test-retest reliability and validity of colorectal cancer patients reporting on the process of their diagnosis. STUDY DESIGN AND SETTING: One hundred and sixteen participants completed two telephone interviews, 1 month apart, and 95 general practitioners (GPs) completed a written questionnaire, to elicit information relating to key elements of the process of diagnosis of colorectal cancer. RESULTS: Acute symptoms such as rectal bleeding had higher reliability and validity than more general symptoms. Colonoscopy was the most accurately recalled diagnostic test. Recall of diagnosis date, and date of colonoscopy, had high test-retest reliability. There were considerable differences between dates of diagnostic tests given by participants and GPs, but there was no evidence of a bias in a particular direction. Accuracy of recall did not diminish as time from diagnosis increased. CONCLUSION: This study confirms that self-reported symptoms, tests, and dates in the colorectal cancer diagnostic pathway are generally reliable; however, the validity of reported symptoms and tests can be moderate to poor.

Older persons' perception of risk of falling: implications for fall-prevention campaigns.

OBJECTIVES: We examined older people's attitudes about falls and implications for the design of fall-prevention awareness campaigns. METHODS: We assessed data from (1) computer-assisted telephone surveys conducted in 2002 with Australians 60 years and older in Northern Rivers, New South Wales (site of a previous fall-prevention program; n=1601), and Wide Bay, Queensland (comparison community; n=1601), and (2) 8 focus groups (n=73). RESULTS: Participants from the previous intervention site were less likely than were comparison participants to agree that falls are not preventable (odds ratio [OR]=0.76; 95% confidence interval [CI]=0.65, 0.90) and more likely to rate the prevention of falls a high priority (OR=1.31; 95% CI=1.09, 1.57). There was no difference between the groups for self-perceived risk of falls; more than 60% rated their risk as low. Those with a low perceived risk were more likely to be men, younger, partnered, and privately insured, and to report better health and no history of falls. Focus group data indicated that older people preferred messages that emphasized health and independence rather than falls. CONCLUSIONS: Although older people accepted traditional fall-prevention messages, most viewed them as not personally relevant. Messages that promote health and independence may be more effective.

Transitions in work participation after a diagnosis of colorectal cancer.

BACKGROUND: How cancer adversely affects an individual's work role is an understudied survivorship issue. There are no Australian studies quantifying work participation after cancer or the potential barriers to work continuance. Using a large, population-based cohort of working adults with colorectal cancer, we assessed changes in work participation separately for men (n=621) and women (n=354). METHODS: Telephone survey methods collected data on colorectal cancer survivors identified through the Queensland Cancer Registry. Status at baseline and one-year post-diagnosis were described, and logistic regression models assessed correlates of work cessation. RESULTS: Among working adults who were diagnosed with colorectal cancer, 33% of men and 40% of women were not working at one-year post-diagnosis. Radiation therapy among men (OR=2.55, 95%CI: 1.35-4.83) and chemotherapy among women (OR=2.49, 95% Cl: 1.23-5.04) were associated with a higher prevalence of work cessation. Having private health insurance was linked with resuming work for both men and women. CONCLUSION: A large proportion of working men and women leave the workforce by 12 months following a diagnosis of colorectal cancer. Factors correlated with work cessation after colorectal cancer appear different for men and women. IMPLICATIONS: A better understanding of how cancer affects working adults and contributes to unwanted work cessation is required to identify individuals who may benefit from occupational rehabilitation programs.

Rating access to health care: Are there differences according to geographical region?

OBJECTIVE: To report on satisfaction with access to health care in Queensland focussing on regional differences. METHODS: A sub-sample of 4440 respondents with no history of cancer from the Queensland Cancer Risk Study who completed a self-administered questionnaire was used for this study. MAIN OUTCOME MEASURES: Perceptions of overall difficulty gaining access to health care and ratings of access to various health care services by region. RESULTS: Queenslanders living outside major cities reported less satisfaction with access to various aspects of health care services. Age was associated with more favourable ratings of health care access. CONCLUSIONS: Despite public health efforts to increase service provision throughout Queensland, health care access is still rated relatively less favourably by Queenslanders in regional and remote parts of the state. IMPLICATIONS: Identifying which services are difficult to access and why will assist public health policy makers in improving health service accessibility.

Multimedia campaign on a shoestring: promoting 'Stay Active - Stay Independent' among seniors.

ISSUE ADDRESSED: This paper describes a multimedia campaign implemented in rural New South Wales on a budget smaller than that typical of many published campaigns. The 'To Be Young at Heart - Stay Active Stay Independent' (SASI) campaign was one arm of a multi-strategic program to reduce falls among seniors by promoting physical activity. METHODS: This 18-month campaign used social marketing techniques. Central to this campaign was strong formative research, significant use of corporate, community and media partnerships and a detailed, strategic distribution plan. Campaign reach was evaluated by a community intercept survey. RESULTS: A variety of high-quality information, education and communication (IEC) resources were developed. Overall, the campaign cost was calculated at USD 191,000. The actual cost of USD 42,000 (excluding staff time) was used to generate almost double this amount in sponsorship (USD 82,000). In the mid-campaign reach survey, 36% recognised the campaign and attributed this to television (58%), newspaper (33%), poster (13%) and bus-back advertising (8%). Of these respondents, 21% reported seeking information about physical activity, 33% reported increased intention to be more active, and 22% reported becoming more active as a result of the campaign. CONCLUSIONS: It is possible to develop and deliver a well-designed, multi-media campaign on a limited budget by using sound formative research and engaging community and corporate partners to generate sponsorship. An effective distribution strategy is crucial and may require additional partnerships at State or national level.

Risk factors for breast cancer characterized by the estrogen receptor alpha A908G (K303R) mutation.

INTRODUCTION: Estrogen is important in the development of breast cancer, and its biological effects are mediated primarily through the two estrogen receptors alpha and beta. A point mutation in the estrogen receptor alpha gene, ESR1, referred to as A908G or K303R, was originally identified in breast hyperplasias and was reported to be hypersensitive to estrogen. We recently detected this mutation at a low frequency of 6% in invasive breast tumors of the Carolina Breast Cancer Study (CBCS). METHODS: In this report, we evaluated risk factors for invasive breast cancer classified according to the presence or absence of the ESR1 A908G mutation in the CBCS, a population-based case-control study of breast cancer among younger and older white and African-American women in North Carolina. Of the 653 breast tumors evaluated, 37 were ESR1 A908G mutation-positive and 616 were mutation-negative. RESULTS: ESR1 A908G mutation-positive breast cancer was significantly associated with a first-degree family history of breast cancer (odds ratio [OR] = 2.69, 95% confidence interval [CI] = 1.15 to 6.28), whereas mutation-negative breast cancer was not. Comparison of the two case subgroups supported this finding (OR = 2.65, 95% CI = 1.15 to 6.09). There was also the suggestion that longer duration of oral contraceptive (OC) use (OR = 3.73, 95% CI = 1.16 to 12.03; Ptrend = 0.02 for use of more than 10 years) and recent use of OCs (OR = 3.63, 95% CI = 0.80 to 16.45; Ptrend = 0.10 for use within 10 years) were associated with ESR1 A908G mutation-positive breast cancer; however, ORs for comparison of the two case subgroups were not statistically significant. Hormone replacement therapy use was inversely correlated with mutation-negative breast cancer, but the effect on mutation-positive cancer was unclear due to the small number of postmenopausal cases whose tumors carried the mutation. Mutation-negative breast cancer was associated with several reproductive factors, including younger age at menarche (OR = 1.46, 95% CI = 1.09 to 1.94) and greater total estimated years of ovarian function (OR = 1.82, 95% CI = 1.21 to 2.74). CONCLUSION: These preliminary results suggest that OCs may interact with the ESR1 A908G mutant receptor to drive the development of some breast tumors.

Reliability of a measure of prediagnosis physical activity for cancer survivors.

PURPOSE: This study was conducted to examine the test-retest reliability of a measure of prediagnosis physical activity participation administered to colorectal cancer survivors recruited from a population-based state cancer registry. METHODS: A total of 112 participants completed two telephone interviews, 1 month apart, reporting usual weekly physical activity in the year before their cancer diagnosis. Intraclass correlation coefficients (ICC) and standard error of measurement (SEM) were used to describe the test-retest reliability of the measure across the sample; the Bland-Altman approach was used to describe reliability at the individual level. The test-retest reliability for categorized total physical activity (active, insufficiently active, sedentary) was assessed using the kappa statistic. RESULTS: When the complete sample was considered, the ICC ranged from 0.40 (95% CI: 0.24, 0.55) for vigorous gardening to 0.77 (95% CI: 0.68, 0.84) for moderate physical activity. The SEM, however, were large, indicating high measurement error. The Bland-Altman plots indicated that the reproducibility of data decreases as the amount of physical activity reported each week increases. The kappa coefficient for the categorized data was 0.62 (95% CI: 0.48, 0.76). CONCLUSION: Overall, the results indicated low levels of repeatability for this measure of historical physical activity. Categorizing participants as active, insufficiently active, or sedentary provides a higher level of test-retest reliability.

The Queensland Cancer Risk Study: behavioural risk factor results.

OBJECTIVE: To describe the population prevalence of key cancer risk behaviours in Queensland. METHODS: The Queensland Cancer Risk Study was a population-based survey of 9,419 Queensland residents aged 20-75 years. Information was collected through an anonymous, computer-assisted telephone interview between February and November 2004. Outcome measures included tobacco smoking, alcohol consumption, sun-tanning and sunburn, obesity, physical inactivity and poor diet, weighted by age, gender and geographic region. RESULTS: Prevalence of current smoking was 25.2% for males and 20.8% for females and was highest in the 20-39 year age group and in rural/remote areas. Two-thirds of participants regularly drank alcohol; of these, 63% consumed excessive amounts of alcohol. Excessive sun exposure is still a problem; 70% of Queenslanders reported an episode of sunburn and 12% reported attempting to get a suntan in the past year. More than half of the respondents (53.9%) were above the healthy weight range, and 17.1% of males and 18.4% of females were obese. Just over 40% of Queensland adults reported having insufficient levels of physical activity. Fewer than half of the participants met recommended levels of fruit or vegetable consumption. CONCLUSIONS AND IMPLICATIONS: The majority of Queensland adults exhibit known, modifiable cancer risk behaviours. These results suggest that continuing efforts to reduce the prevalence of these risk factors are warranted. Specifically, significant gains could be made by targeting behaviour change programs at younger Queenslanders (aged 20-39 years), men, and those living in remote/ very remote areas of Queensland.