Barriers to colorectal cancer screening in the Eastern Mediterranean Region: a scoping review using the theoretical domains framework.

Background: Colorectal cancer screening plays a key role in mitigating morbidity and mortality associated with the disease. Regions such as the Eastern Mediterranean Region experience a particularly large burden of colorectal cancer. While trends have been described at the country level within the region, it is important to understand what barriers exist to colorectal cancer screening, so that more effective interventions can be conceptualized and implemented. Methods: A scoping review was conducted by applying the Theoretical Domains Framework. The search strategy was conceptualized and implemented by searching two online databases (Scopus and PubMed) that identified papers published between 2000 and 2021 that were available in English and related to colorectal cancer screening in the Eastern Mediterranean Region. Duplicates were removed both automatically by EndNote and manually for those that remained by two members of the research team. Two data collection matrices, constructed according to the Theoretical Domains Framework, were used to extract data on multi-level barriers to screening as perceived by the at-risk population and providers. Results: Barriers related to colorectal cancer screening were evident at the individual, public, provider, and health system levels. The most noted barriers among both matrices pertained to the domains of knowledge, emotion, environmental context and resources, and beliefs about consequences. At the individual level, knowledge was the most-cited barrier. At the provider and health system levels, knowledge and environmental context and resources were the most-cited barriers, respectively. Conclusions: In understanding barriers at the individual, provider, and health system levels, more effective interventions can be developed to promote screening and early detection for colorectal cancer.

Risk Stratification of Prostatic Adenocarcinoma Metastatic to the Lymph Nodes.

CONTEXT.­: The pathologic nodal staging of prostatic adenocarcinoma is binary for regional lymph nodes. Stages pN0 and pN1 indicate the absence or presence of regional nodal metastasis, respectively, whereas patients with metastasis to nonregional lymph nodes are staged as pM1a. OBJECTIVE.­: To determine the risk of recurrence of pN1 prostatic adenocarcinoma patients based on the extent of nodal tumor burden. DESIGN.­: We retrospectively reviewed pN1 patients with prostatic adenocarcinoma managed with radical prostatectomy seen between 2011 and 2019. Kaplan-Meier and Cox regression analyses were performed to compare disease-free survival. RESULTS.­: Ninety-six patients were included (median [interquartile range] age, 62 years [57-67 years]; 70 of 96 [73%] White). On univariate analysis, age >65 years (P = .008), ≥2 positive regional lymph nodes (P < .001), and a maximum size of the tumor deposit ≥2 mm (P = .004) were significantly associated with an unfavorable outcome. Controlling for age, stage, metastatic deposit size, margin status, and the presence of extranodal extension, patients with ≥2 positive regional lymph nodes were 3.03 times more likely (95% confidence interval, 1.39-6.60; P = .005) to have an unfavorable outcome. Patients with pN1M1a stage showed a disease-free survival similar to that of pN1M0 patients, after controlling for the number of positive regional lymph nodes (P = .36). CONCLUSIONS.­: Overall, pN1 patients with ≥2 positive regional lymph nodes are 3 times more likely to have an unfavorable outcome. The results suggest a benefit in further stratifying patients with metastatic prostatic adenocarcinoma to the lymph nodes into prognostically significant risk categories that could help the treating clinicians tailor subsequent patient follow-up and therapy.

Energy drinks consumption and perceptions among University Students in Beirut, Lebanon: A mixed methods approach.

BACKGROUND: Energy drinks (ED) are caffeine- and sugar-rich beverages with other ingredients that are marketed for their energy-boosting and performance-enhancing effects. The consumption of these drinks, with and without alcohol, is dramatically increasing worldwide, despite the reported side effects and potential harms to consumers. Few studies, to date, have explored the perceptions and experiences of young adults towards these beverages. OBJECTIVE: The present study aimed to explore the consumption patterns and correlates of ED consumption, as well as the perceptions and experiences of university students in Lebanon towards these beverages. METHODS: A sequential explanatory mixed-methods approach was adopted. Data collection was conducted in two private universities in Beirut, Lebanon. A self-administered 36-item quantitative survey was first used to explore the prevalence and correlates of ED consumption among a convenience sample of university students (n = 226). The survey included questions related to socio-demographic characteristics, anthropometric measurements, and other lifestyle behaviors, including physical activity of university students. The subsequent qualitative phase consisted of focus group discussions (FGD) conducted to further examine the perceptions and experiences of university students towards ED. Descriptive statistics and logistic regression analyses were conducted using survey data, whereas the transcribed FGD were analyzed thematically. RESULTS: A total of 226 university students completed the survey. Results showed that 45% of survey respondents consumed ED at least once in their life (ever consumers), among which 30% reported consumption of ED mixed with alcohol (AmED). Adjusting for socio-demographic and anthropometric characteristics, coffee and sports drinks consumption were significantly associated with ED (OR = 2.45, 95% CI = 1.20, 5.00, and OR = 4.88, 95%CI = 2.41, 9.88, respectively). In addition, physically active participants were 1.89 times (95%CI = 1.01, 3.51) more likely to consume ED compared to their inactive counterparts. During the qualitative phase, a total of six FGD were conducted with 29 university students, who reported consuming ED at least once per month. Three main themes were derived reflecting individual-, interpersonal/social- and environmental-level factors affecting ED consumption among university students. These themes were further supported by eight subthemes, including: perceived benefits of ED, experienced side effects, misinformation about content of ED, peer pressure and social image, as well as affordability and accessibility of ED. CONCLUSION: Findings highlight the need for public health policies and programs to curb the growing public health phenomenon of ED consumption amongst university students. Such programs should consider the multi-level factors affecting ED consumption at the individual, interpersonal/social, and environmental levels, including educational campaigns on ED potential harms, regulating ED content and labeling, as well as restricting sales and marketing of these beverages, especially among young consumers.

Factors Affecting Smoking Initiation and Cessation Among Saudi Women Attending Smoking Cessation Clinics.

OBJECTIVES: Smoking is one of the most adaptable risk behaviours associated with increased mortality rates, yet over one billion individuals worldwide are smokers. This study aimed to examine self-reported reasons for starting and quitting smoking among women attending smoking cessation clinics in Saudi Arabia. METHODS: This cross-sectional study took place between January 2014 and January 2017 in Saudi Arabia using previously collected data. A survey was distributed to 3,000 female smokers attending smoking cessation programmes in 18 clinics from different regions in Saudi Arabia to determine self-reported reasons for smoking initiation and willingness/unwillingness to quit. RESULTS: A total of 2,190 women participated in the study (response rate = 73%). Overall, the most common reason for starting to smoke was friends (31.1%), while the predominant reason for willingness to quit was health concerns (45.5%). The most frequent reason for being unwilling to quit smoking was a fear of mood changes (28%). CONCLUSION: Most Saudi women are socially-driven to start smoking, while the most common reason for quitting is health concerns. The latter finding is promising in that it shows that smokers are gaining awareness of the adverse effects of smoking.

An overview of mortality & predictors of small-cell and non-small cell lung cancer among Saudi patients.

Lung cancer ranks as the top cancer worldwide in terms of incidence and constitutes a major health problem. About 90% of lung cancer cases are diagnosed at advance stage where treatment is not available. Despite evidence that lung cancer screening improves survival, guidelines for lung cancer screening are still a subject for debate. In Saudi Arabia, only 14% of lung cancers are diagnosed at early stage and researches on survival and its predictors are lacking. This overview analysis was conducted on predictors of lung cancer mortality according to the two major cancer types, small-cell lung cancers (SCLCs) and non-small cell lung cancers (NSCLCs) in Saudi Arabia. A secondary data analysis was performed on small-cell lung cancers (SCLCs) and Non-small cell lung cancers (NSCLCs) registered in the Saudi Cancer Registry (SCR) for the period 2009-2013 to estimate predictors of mortality for both lung cancer types. A total of 404 cases (197 SCLC and 207 NSCLC) were included in the analysis, all Saudi nationals. A total of 213 (52.75%) deaths occurred among lung cancer patients, 108 (54.82%) among SCLCs and 105 (50.72%) among NCSLCs. Three quarter of patients are diagnosis with advance stage for both SCLC & NSCLC. Univariate analysis revealed higher mean age at diagnosis in dead patients compared to alive patients for SCLCs (p=0.04); but not NSCLCs, a lower mortality for NSCLCs diagnosed in 2013 (p=0.025) and a significant difference in stage of tumor (p=0.006) and (p=0.035) for both SCLC and NSCLC respectively. In multiple logistic regression, stage of tumor was a strong predictor of mortality, where distant metastasis increased morality by 6-fold (OR=5.87, 95% CI: 2.01 - 17.19) in SCLC and by 3-fold (OR=3.29, 95% CI: 1.22 - 8.85) in NSCLC, compared to localized tumors. Those with NSCLC who were diagnosed in 2013 were less likely to die by 64% compared to NSCLC diagnosed in 2009 (OR=0.36, 95% CI: 0.14 - 0.93). Age, sex, topography and laterality were not associated with mortality for both types of lung cancer. We observed that the stage of the tumor is the strongest predictor of mortality for both SCLCs and NSCLs. This confirms the impact of diagnostic stage on survival. However, establishing Saudi-specific lung cancer screening guidelines will require further research on the benefits and harms of screening modalities in the Saudi population.

Distribution of hemoglobinopathy disorders in Saudi Arabia based on data from the premarital screening and genetic counseling program, 2011-2015.

The prevalence rates of ß-thalassemia (ß-thal) and Sickle Cell Disease (SCD) in Saudi Arabia are considered one of the highest compared to surrounding countries in the Middle East (0.05% and 4.50%, respectively). In this study, Secondary data analysis was obtained from the premarital screening and genetic counseling program (PMSGC), and included 12,30,582 individuals from February 2011 to December 2015. Prevalence rates (per 1000 population) for ß-thal and SCD were calculated for carrier status, disease status and their combination. During the 5-year study period, the overall prevalence rate per 1000 population for ß-thal was 13.6 (12.9 for the trait and 0.7 for the disease). The prevalence rate for SCD was 49.6 (45.8 for the trait and 3.8 for the disease). Rates for ß-thal were found to decrease from 24.2 in 2011, to 12 in 2015. However, SCD rates remained rather constant and ranged from 42.3 in 2011 to 49.8 in 2015. The highest rate for both ß-thal and SCD was observed in the Eastern and Southern regions. This result reflects major accomplishment of the PMSGC. This study recommends further improvement in preventive measures in high-risk regions, and enhanced community awareness to provide the highest rate reduction for these disorders.

Validation of a pregnancy planning measure for Arabic-speaking women.

BACKGROUND: The prevalence of unplanned pregnancy in Saudi Arabia has not been thoroughly investigated. OBJECTIVE: To conduct a psychometric evaluation study of the Arabic version of the London Measure of Unplanned Pregnancy (LMUP). METHODS: To evaluate the psychometric properties of the LMUP, we conducted a self-administered online survey among 796 ever-married Saudi women aged 20-49 years, and a re-test survey among 24 women. The psychometric properties evaluated included content validity measured by content validity index (CVI), structural validity assessed by exploratory factor analysis (EFA), substantive validity assessed by hypothesis testing, contextual stability for the test-retest assessed by weighted Kappa, and internal consistency assessed by Cronbach's alpha. RESULTS: The psychometric analysis of the Arabic version of LMUP exhibited valid and reliable properties. The CVIs for individual items and at the scale level were >0.7. EFA confirmed a unidimensional extraction of the scale item. Hypothesis testing confirmed expected associations. The tool was stable with weighted kappa = 0.78 and Cronbach's alpha = 0.88. CONCLUSION AND RECOMMENDATIONS: In this study, the validity and reliability of the Arabic version of the LMUP were confirmed according to well-known psychometric criteria. This LMUP version can be used in research studies among Arabic-speaking women to measure unplanned pregnancy and investigate correlates and outcomes related to unplanned pregnancy.

Cholera outbreak in Homa Bay County, Kenya, 2015.

Cholera is among the re-emerging diseases in Kenya. Beginning in December 2014, a persistent outbreak occurred involving 29 out of the 47 countries. Homa Bay County in Western Kenya was among the first counties to report cholera cases from January to April 2015. This case study is based on an outbreak investigation conducted by FELTP residents in Homa Bay County in February 2015. It simulates an outbreak investigation including laboratory confirmation, active case finding, descriptive epidemiology and implementation of control measures. This case study is designed for the training of basic level field epidemiology trainees or any other health care workers working in public health-related fields. It can be administered in 2-3 hours. Used as adjunct training material, the case study provides the trainees with competencies in investigating an outbreak in preparation for the actual real-life experience of such outbreaks.

Mercury health risk assessment among a young adult Lebanese population.

Mercury (Hg) exposure represents a significant public health concern at a global level. This study aims at assessing Hg exposure and risk among Lebanese young adults based on Hg biomonitoring and seafood intake. A group of 166 young adults were administered a questionnaire to assess Hg exposure and were asked to provide a hair sample. Risk assessment was performed: (1) using the US Environmental Protection Agency Hazard Quotient (HQ) model based on fish intake and previously studied local fish Hg concentrations, and (2) by determining the total hair Hg concentration (THHg) using continuous flow-chemical vapor generation atomic absorption spectrometry. Differences in THHg across demographic and exposure subgroups were tested using t test or ANOVA. Correlations between THHg concentrations, fish consumption, and HQ were determined by computing Pearson's r. Higher THHg correlated with higher consumption of Mediterranean rabbitfish/spinefoots (r = 0.27; p = 0.001) and geographical location (p < 0.001) in the bivariate analysis, and remained significant in the adjusted multivariable linear regression model (geographical location: ß = 0.255, 95%CI 0.121-0.388; rabbitfish/spinefoots consumption: ß = 0.016, 95%CI 0.004-0.027). No significant correlations were found between HQ and THHg. In conclusion, this is the first study examining hair Hg levels and fish consumption in a young adult Lebanese population. Our findings constitute valuable baseline data for a local fish advisory and Hg monitoring.

Use of Lean methodology to improve operating room efficiency in hospitals across the Kingdom of Saudi Arabia.

OBJECTIVE: The objective of this study was to assess whether an intervention on process efficiency using the Lean methodology leads to improved utilization of the operating room (OR), as measured by key performance metrics of OR efficiency. DESIGN: A quasi-experimental design was used to test the impact of the intervention by comparing pre-intervention and post-intervention data on five key performance indicators. SETTING: The ORs of 12 hospitals were selected across regions of the Kingdom of Saudi Arabia (KSA). PARTICIPANTS: The participants were patients treated at these hospitals during the study period. INTERVENTION(S): The intervention comprised the following: (i) creation of visual dashboards that enable starting the first case on time; (ii) use of computerized surgical list management; (iii) optimization of time allocation; (iv) development of an operating model with policies and procedures for the pre-anesthesia clinic; and (iv) creation of a governance structure with policies and procedures for day surgeries. MAIN OUTCOME MEASURE(S): The following were the main outcome measures: on-time start for the first case, room turnover times, percent of overrun cases, average weekly procedure volume and OR utilization. RESULTS: The hospital exhibited statistically significant improvements in the following performance metrics: on-time start for the first case, room turnover times and percent of overrun cases. A statistically significant difference in OR utilization or average weekly procedure volumes was not detected. CONCLUSIONS: The implementation of a Lean-based intervention targeting process efficiency applied in ORs across various KSA hospitals resulted in encouraging results on some metrics at some sites, suggesting that the approach has the potential to produce significant benefit in the future. Copyright © 2016 John Wiley & Sons, Ltd.

Public knowledge, perceptions, and attitudes towards HIV/AIDS in Bahrain: A cross-sectional study.

INTRODUCTION: HIV/AIDS is one of the major health problems worldwide. Despite the low prevalence of HIV in Bahrain, educational and awareness programs remain highly important in controlling and preventing the spread of the disease. This study aimed to assess the public's knowledge, risk perceptions, and attitudes towards HIV/AIDS in Bahrain. METHODOLOGY: A self-administered questionnaire-based survey was administered to and completed by 1,038 Bahraini adults. RESULTS: Although the average general awareness among participants was good (63%), some misconceptions and erroneous beliefs were common, including knowledge of mode of transmission and high risk groups. Participants' attitudes towards HIV/AIDS patients varied but were mostly negative; 60% of respondents agreed to isolating HIV/AIDS patients in workplaces and schools, and 52.4% of them thought that HIV is a divine punishment. The vast majority of the participants (84.4%) believed in the role of religion in limiting the spread of the disease. Though the local media was the least utilized source of information, the general opinion of the participants about the role of Bahraini government agencies and organizations in combating HIV/AIDS was positive. CONCLUSIONS: Though the Bahraini public had good knowledge about HIV/AIDS, there were misconceptions that need to be addressed. A major finding of this study was the negative attitudes towards HIV/AIDS patients. To have successful HIV control programs, negative attitudes towards HIV patients and the disease should be minimized. Existing and newly proposed health education and awareness program in Bahrain should address the issue of negative attitudes towards HIV/AIDS observed in this study.

Association of CYP3A4/5 genotypes and expression with the survival of patients with neuroblastoma.

Neuroblastoma (NB) is a rare pediatric disease in Lebanon for which poor prognosis remains a major challenge. Genetic polymorphism of genes coding for drug­metabolizing enzymes may influence the response of a patient to chemotherapy. This study investigates a possible association between CYP3A4/5 polymorphism and expression levels and survival in NB patients. All patients with stage III and IV NB diagnosed between 1993 and 2012 in three major hospitals in Beirut were included (n=27). Demographic information and survival time were obtained from medical records. CYP3A4 and CYP3A5 genotypes and expression levels were determined in archival tumors by polymerase chain reaction (PCR) and restriction fragment length polymorphism and quantitative PCR, respectively. Additionally, MYCN amplification was assessed. A Cox proportional hazards model was used to evaluate potential associations, adjusting for MYCN amplification. A statistically significant increase in the risk of mortality was observed in patients with MYCN amplification [hazard ratio (HR) 4.11, 95% confidence interval (CI) 1.14­14.80]. Patients with CYP3A5 expression levels above the median had a lower risk of mortality (HR 0.61, 95% CI 0.21­1.74) and patients with CYP3A4 expression levels above the median had a higher risk of mortality (HR 2.00, 95% CI 0.67­5.90). CYP3A5*3/*3 homozygote mutants had a 4.3­fold increase in the risk of mortality compared with that of homozygote wild­type or heterozygote mutants (HR 4.30, 95% CI 0.56­33.30). Carriers of the CYP3A4*1B mutant allele had a 52% lower risk of mortality compared with that of non­carriers (HR 0.48, 95% CI 0.06­3.76). Although the results of the present study did not achieve statistical significance, associations were observed, which indicates that CYP3A4 and CYP3A5 may modulate the clinical outcome of NB. Further studies with larger sample sizes are required to characterize the effects of the polymorphism and expression levels of CYP3A4/5 on the survival of patients with NB.

Assessment of Dietary Intake Patterns and Their Correlates among University Students in Lebanon.

INTRODUCTION: Unhealthy dietary habits are major risk factors for chronic diseases, particularly if adopted during early years of adulthood. Limited studies have explored the food consumption patterns among young adults in Lebanon. Our study aimed to examine common dietary patterns and their correlates among a large sample of university student population in Lebanon, focusing on correlation with gender and body mass index (BMI). METHODS: A cross-sectional study was carried out on 3384 students, using a proportionate cluster sample of Lebanese students from both public and private universities. A self-administered food frequency questionnaire was used to assess dietary intake of university students. Factor analysis of food items and groups, cluster analysis of dietary patterns, and multivariate regressions were carried out. RESULTS: Three dietary patterns were identified among university youth namely a vegetarian/low calorie dietary pattern (characterized mainly by consumption of plant-based food while avoiding "western" food, composite dishes, and bread); a mixed dietary pattern (characterized by high consumption of plant-based food, followed by composite dishes, bread, and a low consumption of western type food); and finally, a westernized dietary pattern (characterized by high consumption of white bread and western food, and a strong avoidance of plant food and composite dishes). We observed significant differences between males and females in terms of their reported food intake and dietary patterns. Females were particularly more prone to adopt the vegetarian/low calorie diet than males (ORa = 1.69; p < 0.001), while males were more likely to adopt a westernized diet (ORa = 1.51; p < 0.001), seemingly in private universities (p = 0.053). Students with high income and obese students (BMI ≥ 30 kg/m(2)) were more likely to consume vegetarian/low calorie diets (p < 0.05). CONCLUSION: Male university students reported a higher consumption of the westernized dietary pattern as compared to female university students in Lebanon, while the latter reported a higher adoption of a vegetarian diet. Health promotion programs are needed to address the dietary intakes and lifestyle behaviors of young adults in Lebanon to help prevent obesity and other associated comorbidities.

Age, body mass, usage of exogenous estrogen, and lifestyle factors in relation to circulating sex hormone-binding globulin concentrations in postmenopausal women.

BACKGROUND: Circulating concentrations of sex hormone-binding globulin (SHBG) have been associated with cardiovascular diseases, type 2 diabetes, metabolic syndrome, and hormone-dependent cancers; however, correlates of SHBG concentrations are not well understood. METHODS: We comprehensively investigated correlates of SHBG concentrations among 13 547 women who participated in the Women's Health Initiative and who had SHBG measurements. We estimated study- and ethnicity-specific associations of age, reproductive history, usage of exogenous estrogen, body mass index (BMI), and lifestyle factors such as physical activity, smoking, alcohol consumption, coffee intake, and dietary factors with SHBG concentrations. These estimates were pooled using random-effects models. We also examined potential nonlinear associations using spline analyses. RESULTS: There was no significant ethnic difference in the age-adjusted mean concentrations of SHBG. Age, exogenous estrogen use, physical activity, and regular coffee intake were positively associated with SHBG concentrations, whereas BMI was inversely associated with SHBG concentrations after adjustment for potential confounding factors. Similar patterns were observed among both ever users and never users of exogenous estrogen. The spline analysis indicated nonlinear relations of regular intake of coffee, age, and BMI with SHBG concentrations. Two or more cups/day of regular coffee consumption and age of 60 years or older were associated with higher SHBG concentrations; the inverse BMI-SHBG relation was especially strong among women whose BMI was below 30. CONCLUSIONS: In this large sample of postmenopausal women, age, exogenous estrogen use, physical activity, regular coffee intake, and BMI were significant correlates of SHBG concentrations, presenting potential targets for interventions.

Sex hormone levels and risk of breast cancer with estrogen plus progestin.

BACKGROUND: Although high endogenous sex hormone levels and estrogen plus progestin (E+P) therapy are associated with increased breast cancer risk, it is unknown whether pretreatment levels of sex hormones modify E+P effect on breast cancer. METHODS: We conducted a nested case-control study within the Women's Health Initiative randomized clinical trial of E+P. The trial enrolled 16608 postmenopausal women aged 50 to 79 years with intact uterus and no breast cancer history. During a mean of 5.6 years of follow-up, 348 incident breast cancer case subjects were identified and matched with 348 control subjects. Case and control subjects had their sex hormone levels measured at baseline (estrogens, testosterone, progesterone, and sex hormone-binding globulin [SHBG]) and year 1 (estrogens and SHBG) using sensitive assays. All statistical tests were two-sided. RESULTS: Statistically significant elevations in breast cancer risk were seen with greater pretreatment levels of total estradiol (P trend = .04), bioavailable estradiol (P trend = .03), estrone (P trend = .007), and estrone sulfate (P trend = .007). E+P increased all measured estrogens and SHGB at year 1 (all P < .001). The effect of E+P on breast cancer risk was strongest in women whose pretreatment levels of total estradiol, bioavailable estradiol, and estrone were in the lowest quartiles. For example, the odds ratio for E+P relative to placebo was 2.47 (95% confidence interval [CI] = 1.28 to 4.79) in the lowest total estradiol quartile, compared with 0.96 (95% CI = 0.44 to 2.09) in the highest total estradiol quartile; P interaction = .04). CONCLUSIONS: Women with lower pr-treatment endogenous estrogen levels were at greater risk of breast cancer during E+P therapy compared with those with higher levels. Further studies are warranted to confirm these findings.

The Young Adults' Cigarette Dependence (YACD) score: an improved tool for cigarette dependence assessment in university students.

BACKGROUND: Cigarette smoking induces dependence in young smokers. PURPOSE: The primary objective of this work was to validate the use of the Fagerström Test for Nicotine Dependence (FTND) in young Lebanese university students, and to improve it eventually by adding new items covering DSM-IV and ICD-10 dependence components. METHODS: We used data from a cross-sectional study on university students. A standardized questionnaire was administered, with items related to cigarette dependence: the FTND and the new Young Adults' Cigarette Dependence (YACD) scale. For both tools, factor and reliability analyses were performed. RESULTS: Although the FTND test showed satisfactory psychometric properties, the YACD showed better construct validity and reliability, covered dependence concept better and discriminated better between those who wanted to stop smoking and those who did not. CONCLUSIONS: FTND could be used in university students' population; however, the YACD scale could be more useful.

Relationship between mammographic density and breast cancer death in the Breast Cancer Surveillance Consortium.

BACKGROUND: Women with elevated mammographic density have an increased risk of developing breast cancer. However, among women diagnosed with breast cancer, it is unclear whether higher density portends reduced survival, independent of other factors. METHODS: We evaluated relationships between mammographic density and risk of death from breast cancer and all causes within the US Breast Cancer Surveillance Consortium. We studied 9232 women diagnosed with primary invasive breast carcinoma during 1996-2005, with a mean follow-up of 6.6 years. Mammographic density was assessed using the Breast Imaging Reporting and Data System (BI-RADS) density classification. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by Cox proportional hazards regression; women with scattered fibroglandular densities (BI-RADS 2) were the referent group. All statistical tests were two-sided. RESULTS: A total of 1795 women died, of whom 889 died of breast cancer. In multivariable analyses (adjusted for site, age at and year of diagnosis, American Joint Committee on Cancer stage, body mass index, mode of detection, treatment, and income), high density (BI-RADS 4) was not related to risk of death from breast cancer (HR = 0.92, 95% CI = 0.71 to 1.19) or death from all causes (HR = 0.83, 95% CI = 0.68 to 1.02). Analyses stratified by stage and other prognostic factors yielded similar results, except for an increased risk of breast cancer death among women with low density (BI-RADS 1) who were either obese (HR = 2.02, 95% CI = 1.37 to 2.97) or had tumors of at least 2.0 cm (HR = 1.55, 95% CI = 1.14 to 2.09). CONCLUSIONS: High mammographic breast density was not associated with risk of death from breast cancer or death from any cause after accounting for other patient and tumor characteristics. Thus, risk factors for the development of breast cancer may not necessarily be the same as factors influencing the risk of death after breast cancer has developed.

The association of menopause status with physical function: the Study of Women's Health Across the Nation.

OBJECTIVE: The aim of this study was to determine whether postmenopause status is associated with self-reported limitations in physical function. METHODS: The Study of Women's Health Across the Nation is a multisite, multiethnic, longitudinal study of midlife women. Women aged 45 to 57 years (N = 2,566) completed the physical function scale of the Medical Outcomes Study Short-Form 36 on visit 4 (2000-2001). Scores created a three-category variable of physical function limitations: none (86-100), moderate (51-85), and substantial (0-50). In the Study of Women's Health Across the Nation, menopause status is a five-category list variable based on menstrual bleeding patterns and gynecological surgery. Premenopausal and perimenopausal women using hormones (n = 284) or missing physical function scores (n = 46) were excluded. Multinomial logistic regression was used to relate physical function and menopause status after adjustment for age, ethnicity, site, education, body mass index (BMI), and self-reported diabetes, hypertension, arthritis, depressive symptoms, smoking, and hormone use among postmenopausal women. RESULTS: Of 2,236 women, 8% were premenopausal, 51% were early perimenopausal, 12% were late perimenopausal, 24% were naturally postmenopausal, and 5% were surgically postmenopausal. In the full model, substantial limitations in physical function were higher in postmenopausal women, whether naturally postmenopausal (odds ratio, 3.82; 95% CI, 1.46-10.0) or surgically postmenopausal (odds ratio, 3.54; 95% CI, 1.15-10.84), than in premenopausal women. These associations were attenuated by higher BMI and depressive symptoms but remained significant. Moderate limitations in physical function were not significantly related to menopause status. CONCLUSIONS: Women experiencing surgical or naturally occurring postmenopause report greater limitations in physical function compared with premenopausal women, independent of age and only partly explained by higher BMI and depressive symptoms. This suggests that physiological changes in menopause could contribute directly to limitations in physical function.