Prediction of breast cancer risk among women of the Mariana Islands: the BRISK retrospective case-control study.

OBJECTIVES: To develop a breast cancer risk prediction model for Chamorro and Filipino women of the Mariana Islands and compare its performance to that of the Breast Cancer Risk Assessment Tool (BCRAT). DESIGN: Case-control study. SETTING: Clinics/facilities and other community-based settings on Guam and Saipan (Northern Mariana Islands). PARTICIPANTS: 245 women (87 breast cancer cases and 158 controls) of Chamorro or Filipino ethnicity, age 25-80 years, with no prior history of cancer (other than skin cancer), residing on Guam or Saipan for at least 5 years. PRIMARY AND SECONDARY OUTCOME MEASURES: Breast cancer risk models were constructed using combinations of exposures previously identified to affect breast cancer risk in this population, population breast cancer incidence rates and all-cause mortality rates for Guam. RESULTS: Models using ethnic-specific relative risks performed better than those with relative risks estimated from all women. The model with the best performance among both ethnicities (the Breast Cancer Risk Model (BRISK) model; area under the receiver operating characteristic curve (AUC): 0.64 and 0.67 among Chamorros and Filipinos, respectively) included age at menarche, age at first live birth, number of relatives with breast cancer and waist circumference. The 10-year breast cancer risk predicted by the BRISK model was 1.28% for Chamorros and 0.89% for Filipinos. Performance of the BCRAT was modest among both Chamorros (AUC: 0.60) and Filipinos (AUC: 0.55), possibly due to incomplete information on BCRAT risk factors. CONCLUSIONS: The ability to develop breast cancer risk models for Mariana Islands women is constrained by the small population size and limited availability of health services and data. Nonetheless, we have demonstrated that breast cancer risk prediction models with adequate discriminatory performance can be built for small populations such as in the Mariana Islands. Anthropometry, in particular waist circumference, was important for estimating breast cancer risk in this population.

Risk factors for breast cancer in the breast cancer risk model study of Guam and Saipan.

BACKGROUND: Chamorro Pacific Islanders in the Mariana Islands have breast cancer incidence rates similar to, but mortality rates higher than, those of U.S. women. As breast cancer risk factors of women of the Mariana Islands may be unique because of ethnic and cultural differences, we studied established and suspected risk factors for breast cancer in this unstudied population. METHODS: From 2010-2013, we conducted retrospective case-control study of female breast cancer (104 cases and 185 controls) among women in the Mariana Islands. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for each of various lifestyle-related factors from logistic regression of breast cancer, in all women and in pre- and postmenopausal women separately. Tests for interaction of risk factors with ethnicity were based on the Wald statistics for cross-product terms. RESULTS: Of the medical and reproductive factors considered - age at menarche, breastfeeding, number of live births, age at first live birth, hormone use, and menopause - only age at first live birth was confirmed. Age at first live birth, among parous women, was higher among cases (mean 24.9 years) than controls (mean 23.2 years); with increased breast cancer risk (OR=2.53; 95% CI, 1.04-6.19 for age≥30y compared to <20y, P for trend=0.01). Of the lifestyle factors -body mass index, waist circumference, physical activity, alcohol and betel-nut intake, and education - only waist circumference (OR=1.65; 95% CI 0.87-3.14 for the highest tertile group compared to the lowest, P for trend=0.04) was significantly associated with breast cancer risk and only in Filipino women. The association with many other established risk factors, such as BMI, hormone use and physical activity, were in the expected direction but were not significant. Associations for family history of breast cancer and alcohol intake were not evident CONCLUSIONS: The results provide a basis for cancer prevention guidance for women in the Mariana Islands.

Can summits lead to curricula change? An evaluation of emergency preparedness summits for schools of nursing in Georgia.

The Emory University Center for Public Health Preparedness held two summits for nurses that were evaluated by survey. Participants cited multiple deficiencies and challenges with integrating emergency preparedness into nursing curricula. The summits and the related materials were reported as highly useful by survey respondents. More than three fourths of respondents reported incorporating emergency preparedness education into their curricula after summit attendance. Nursing professionals could use summits to encourage active practitioners to pursue continuing education and to initiate efforts to incorporate emergency preparedness and related health care issues into the curricula of schools of nursing.

Logic model use in developing a survey instrument for program evaluation: emergency preparedness summits for schools of nursing in Georgia.

The objective of this paper is to describe a method for using a logic model to guide program evaluation by detailing the steps used, providing diagrams that visually depict the process, and giving an example based on the evaluation of emergency preparedness nursing summits in Georgia. Developing a logic model is an ideal way to visually depict the inputs, activities, outputs, and outcomes of a program, thus providing a clear framework of the workings and functions of the program. In planning a comprehensive evaluation, being able to view all the elements in a program and how they interrelate makes it easier to determine the areas that should be addressed. When a survey is part of a program evaluation, determining that the goals, objectives, research questions, logic model, and survey questions maintain consistency in the way they relate and lead to each other can help document the completeness and symmetry of the assessment. By showing these linkages, the utility of the logic model is maximized and the stakeholders in the assessment of the program have clear evidence that their expectations and needs have been met for a valuable, useful evaluation product.