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1.
Artigo em Inglês | MEDLINE | ID: mdl-34208878

RESUMO

The coronavirus pandemic (COVID-19) has had multilevel effects on non-COVID-19 health and health care, including deferral of routine cancer prevention and screening and delays in surgical and other procedures. Health and health care use has also been affected by pandemic-related loss of employer-based health insurance, food and housing disruptions, and heightened stress, sleep disruptions and social isolation. These disruptions are projected to contribute to excess non-COVID-19 deaths over the coming decades. At the same time municipalities, health systems and individuals are making changes in response to the pandemic, including modifications in the environmental to promote health, implementation of telehealth platforms, and shifts towards greater self-care and using remote platforms to maintain social connections. We used a multi-level biopsychosocial model to examine the available literature on the relationship between COVID-19-related changes and breast cancer prevention to identify current gaps in knowledge and identify potential opportunities for future research. We found that COVID-19 has impacted several aspects of social and economic life, through a variety of mechanisms, including unemployment, changes in health care delivery, changes in eating and activity, and changes in mental health. Some of these changes should be reduced, while others should be explored and enhanced.


Assuntos
Neoplasias da Mama , COVID-19 , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/prevenção & controle , Atenção à Saúde , Feminino , Promoção da Saúde , Humanos , Pandemias , SARS-CoV-2
2.
Artigo em Inglês | MEDLINE | ID: covidwho-1288883

RESUMO

The coronavirus pandemic (COVID-19) has had multilevel effects on non-COVID-19 health and health care, including deferral of routine cancer prevention and screening and delays in surgical and other procedures. Health and health care use has also been affected by pandemic-related loss of employer-based health insurance, food and housing disruptions, and heightened stress, sleep disruptions and social isolation. These disruptions are projected to contribute to excess non-COVID-19 deaths over the coming decades. At the same time municipalities, health systems and individuals are making changes in response to the pandemic, including modifications in the environmental to promote health, implementation of telehealth platforms, and shifts towards greater self-care and using remote platforms to maintain social connections. We used a multi-level biopsychosocial model to examine the available literature on the relationship between COVID-19-related changes and breast cancer prevention to identify current gaps in knowledge and identify potential opportunities for future research. We found that COVID-19 has impacted several aspects of social and economic life, through a variety of mechanisms, including unemployment, changes in health care delivery, changes in eating and activity, and changes in mental health. Some of these changes should be reduced, while others should be explored and enhanced.


Assuntos
Neoplasias da Mama , COVID-19 , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/prevenção & controle , Atenção à Saúde , Feminino , Promoção da Saúde , Humanos , Pandemias , SARS-CoV-2
3.
BMC Med Inform Decis Mak ; 21(1): 180, 2021 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-34090422

RESUMO

BACKGROUND: Women with pathogenic BRCA1 and BRCA2 mutations possess a high risk of developing breast and ovarian cancer. They face difficult choices when considering preventive options. This study presents the development process of the first decision aids to support this complex decision-making process in the German healthcare system. METHODS: A six-step development process based on the International Patient Decision Aid Standards was used, including a systematic literature review of existing decision aids, a topical medical literature review, preparation of the decision aids, focus group discussions with women with BRCA1/2 mutations, internal and external reviews by clinical and self-help experts, and user tests. All reviews were followed by iterative revisions. RESULTS: No existing decision aids were transferable to the German setting. The medical research revealed a need to develop separate decision aids for women with BRCA1/2 mutations (A) without a history of cancer (previvors) and (B) with a history of unilateral breast cancer (survivors). The focus group discussions confirmed a high level of approval for the decision aids from both target groups. Additionally, previvors requested more information on risk-reducing breast surgery, risk-reducing removal of both ovaries and Fallopian tubes, and psychological aspects; survivors especially wanted more information on breast cancer on the affected side (e.g. biological parameters, treatment, and risk of recurrence). CONCLUSIONS: In a structured process, two target-group-specific DAs for previvors/survivors with BRCA1/2 mutations were developed to support decision-making on risk-adapted preventive options. These patient-oriented tools offer an important addition to existing specialist medical care in Germany.


Assuntos
Neoplasias da Mama , Técnicas de Apoio para a Decisão , Neoplasias Ovarianas , Proteína BRCA1/genética , Proteína BRCA2/genética , Neoplasias da Mama/genética , Neoplasias da Mama/prevenção & controle , Feminino , Genes BRCA1 , Genes BRCA2 , Predisposição Genética para Doença , Alemanha , Humanos , Mutação , Neoplasias Ovarianas/genética , Neoplasias Ovarianas/prevenção & controle
7.
BMC Health Serv Res ; 21(1): 429, 2021 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-33952277

RESUMO

BACKGROUND: Among all cancers, breast cancer is the most prevalent cancer and the leading cause of mortality among women in developing countries including Palestine. Community pharmacists are trusted and easily accessible healthcare providers who could be engaged in breast cancer health promotion. This study was conducted with the aim of exploring knowledge, attitudes, beliefs, and barriers toward breast cancer health promotion among community pharmacists in the Palestinian territories. METHODS: This study was conducted in a cross-sectional design using a questionnaire among community pharmacists. Knowledge of community pharmacists of breast cancer was tested using a 26-item knowledge test. Attitudes and beliefs of the community pharmacists with regard to breast cancer promotion were explored using 14 items. Barrier to breast cancer health promotion were explored using 9 items. RESULTS: Data were collected from 200 community pharmacists. The median knowledge score was 69.2 % with and IQR of 15.2 %. Of the community pharmacists, 67.5 % scored 50 % and above in the knowledge test. Multivariate logistic regression showed that community pharmacists who were female in gender were more likely to score 50 % and above in the knowledge test compared to the community pharmacists who were male in gender (OR = 4.73, 95 % CI of 2.26-9.89). The community pharmacists had positive attitudes toward breast cancer health promotion. There was a significant moderate positive correlation between knowledge and attitudes scores (Spearman's rho = 0.37, p-value < 0.001). Lack of reimbursement, lack of enough personnel, lack of time, and fear of offending the patients were the main barriers to breast cancer health promotion (percentage of agreement > 60.0 %). CONCLUSIONS: This study shed light on the role of community pharmacists in breast cancer health promotion. Pharmacists had good knowledge of breast cancer and positive attitudes toward promoting the health of patients with breast cancer. Further studies are still needed to determine how to integrate community pharmacists in the team of healthcare providers caring for patients with breast cancer.


Assuntos
Neoplasias da Mama , Serviços Comunitários de Farmácia , Árabes , Atitude do Pessoal de Saúde , Neoplasias da Mama/prevenção & controle , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde , Humanos , Masculino , Farmacêuticos , Inquéritos e Questionários
8.
Chirurgia (Bucur) ; 116(2 Suppl): 73-83, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33963696

RESUMO

Introduction: The rate of contralateral prophylactic mastectomy (CPM) increased within the recent years. The main reasons are: genetic testing, availability of breast reconstruction, more often use of preoperative breast MRI, improvement of postoperative aesthetic results and reimbursement of breast reconstruction. The purpose of this study was to analyze the indication of CPM, it's evolution and the surgical techniques used for this type of surgery. Materials and methods: This prospective study enrolled patients with unilateral breast cancer for which conservative treatment was not an option and underwent CPM concomitant with therapeutic mastectomy, using different techniques, followed by immediate breast reconstruction using alloplastic materials. Results: A total of 45 patients with unilateral breast cancer underwent therapeutic mastectomy and CPM followed by immediate breast reconstruction, between January 2015-December 2020. The mean age was 43.5 years, 64,44% patients had stage I and II breast cancer and 22,22% were triplenegative. The indications for CPM were: pathogenic mutation of BRCA or of other genes associated with high risk of breast cancer, strong family history, suspicious findings on breast MRI, extended micro-calcifications, dense breasts, and extreme anxiety. Conclusions: A growing rate of bilateral mastectomy for unilateral breast cancer was observed. Availability of immediate breast reconstruction and reimbursement plays an important role for patients in choosing CPM. Factors associated with CPM include: young age, pathogenic BRCA mutation, significant family history and triple-negative disease. The rate of immediate postoperative complications was low. CPM is a valid option to reduce the risk of contralateral breast cancer and to achieve a good aesthetic outcome for patients with unilateral breast cancer with high risk of contralateral breast cancer.


Assuntos
Neoplasias da Mama , Mastectomia Profilática , Adulto , Neoplasias da Mama/prevenção & controle , Neoplasias da Mama/cirurgia , Humanos , Mastectomia , Estudos Prospectivos , Resultado do Tratamento
11.
Recent Results Cancer Res ; 218: 47-66, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34019162

RESUMO

This article is a revised version of our proposal for the establishment of the legal concept of risk-adjusted prevention in the German healthcare system to regulate access to risk-reduction measures for persons at high and moderate genetic cancer risk (Meier et al. Risikoadaptierte Prävention'. Governance Perspective für Leistungsansprüche bei genetischen (Brustkrebs-)Risiken, Springer, Wiesbaden, 2018). The German context specifics are summarized to enable the source text to be used for other country-specific healthcare systems. Establishing such a legal concept is relevant to all universal and free healthcare systems similar to Germany's. Disease risks can be determined with increasing precision using bioinformatics and biostatistical innovations ('big data'), due to the identification of pathogenic germ line mutations in cancer risk genes as well as non-genetic factors and their interactions. These new technologies open up opportunities to adapt therapeutic and preventive measures to the individual risk profile of complex diseases in a way that was previously unknown, enabling not only adequate treatment but in the best case, prevention. Access to risk-reduction measures for carriers of genetic risks is generally not regulated in healthcare systems that guarantee universal and equal access to healthcare benefits. In many countries, including Austria, Denmark, the UK and the US, entitlement to benefits is essentially linked to the treatment of already manifest disease. Issues around claiming benefits for prophylactic measures involve not only evaluation of clinical options (genetic diagnostics, chemoprevention, risk-reduction surgery), but the financial cost and-from a social ethics perspective-the relationship between them. Section 1 of this chapter uses the specific example of hereditary breast cancer to show why from a medical, social-legal, health-economic and socio-ethical perspective, regulated entitlement to benefits is necessary for persons at high and moderate risk of cancer. Section 2 discusses the medical needs of persons with genetic cancer risks and goes on to develop the healthy sick model which is able to integrate the problems of the different disciplines into one scheme and to establish criteria for the legal acknowledgement of persons at high and moderate (breast cancer) risks. In the German context, the social-legal categories of classical therapeutic medicine do not adequately represent preventive measures as a regular service within the healthcare system. We propose risk-adjusted prevention as a new legal concept based on the heuristic healthy sick model. This category can serve as a legal framework for social law regulation in the case of persons with genetic cancer risks. Risk-adjusted prevention can be established in principle in any healthcare system. Criteria are also developed in relation to risk collectives and allocation (Sects. 3, 4, 5).


Assuntos
Neoplasias da Mama , Neoplasias da Mama/genética , Neoplasias da Mama/prevenção & controle , Humanos , Oncogenes
12.
Menopause ; 28(5): 589-600, 2021 04 12.
Artigo em Inglês | MEDLINE | ID: mdl-33857955

RESUMO

IMPORTANCE: Findings in this work might provide certain guidance for current clinical work. OBJECTIVE: This study aimed to evaluate the efficacy and safety of these drugs based on the Bayesian network meta-analysis. EVIDENCE REVIEW: Two researchers systematically and comprehensively searched PubMed, Embase, and the central databases of the Cochrane Library from inception to September 15, 2020. The number of specific events and sample size were extracted from each of the included studies. This Bayesian theory-based network meta-analysis included indirect comparisons and mixed treatment analysis. Indirect comparisons compare the efficacy of at least three interventions simultaneously and are mostly used when there are few direct comparison studies. In addition, indirect comparisons are conducted on the basis of direct comparisons through mixed treatment analysis, which can thus improve the accuracy of analysis. FINDINGS: A total of nine randomized controlled trials involving 60,732 participants were included. As a result, compared with placebo in high-risk pre- or postmenopausal women, endocrine therapy (ET) decreased the risks of total breast cancer (TBC, odds ratio [OR] 0.69, 95% confidence interval [CI] 0.56-0.85), invasive breast cancer (IBC, OR 0.69, 95% CI 0.53-0.89), estrogen receptor-positive breast cancer (ER+BC) (OR 0.49, 95% CI 0.38-0.64), and ductal carcinoma in situ (OR 0.74, 95% CI 0.56-0.98), but increased the risks of pulmonary embolism (OR 1.33, 95% CI 1.05-1.69), total venous thrombosis (OR 1.75, 95% CI 1.28-2.38), and endometrial carcinoma (EC, OR 1.84, 95% CI 1.17-2.88). In further network stratification analyses, anastrozole, exemestane, and tamoxifen were found to decrease the risks of TBC, IBC, and ER + BC relative to placebo. Similarly, raloxifene decreased the risk of IBC (OR 0.65, 95% CI 0.48-0.85), while tamoxifen increased the risk of EC (OR 2.42, 95% CI 1.10-7.35). CONCLUSIONS AND RELEVANCE: To sum up, ET decreased the risks of TBC, IBC, ER + BC, and ductal carcinoma in situ, while increasing the risks of pulmonary embolism, total venous thrombosis, and EC in high-risk pre- or postmenopausal women. Meanwhile, anastrozole, exemestane, and tamoxifen possibly exerted potential protective effects on TBC, IBC and ER + BC. Typically, raloxifene might be effective on IBC, while tamoxifen might increase the risk of EC. Therefore, clinicians should fully weigh the benefits and risks of ET to develop a rational individualized treatment.


Assuntos
Inibidores da Aromatase , Neoplasias da Mama , Inibidores da Aromatase/efeitos adversos , Teorema de Bayes , Neoplasias da Mama/prevenção & controle , Feminino , Humanos , Metanálise em Rede , Pós-Menopausa , Ensaios Clínicos Controlados Aleatórios como Assunto , Tamoxifeno/efeitos adversos
13.
BMC Womens Health ; 21(1): 157, 2021 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-33863327

RESUMO

BACKGROUND: Chemoprevention is one of several methods that have been developed to help high-risk women reduce their risk of breast cancer. Reasons for the low uptake of chemoprevention are poorly understood. This paper seeks a deeper understanding of this phenomenon by drawing on women's own narratives about their awareness of chemoprevention and their risk-related experiences. METHODS: This research is based on a parent project that included fifty in-depth, semi-structured interviews with a purposive sample of African American and White women at elevated risk of breast cancer. This specific study draws on the forty-seven interviews conducted with women at high or severe risk of breast cancer, all of whom are eligible to use chemoprevention for breast cancer risk-reduction. Interviews were analyzed using grounded theory methods. RESULTS: Forty-five percent of participants, and only 21% of African American participants, were aware of chemoprevention options. Women who had seen specialists were more likely to be aware, particularly if they had ongoing specialist access. Aware and unaware women relied on different types of sources for prevention-related information. Those whose main source of information was a healthcare provider were more likely to know about chemoprevention. Aware women used more nuanced information gathering strategies and worried more about cancer. Women simultaneously considered all risk-reduction options they knew about. Those who knew about chemoprevention but were reluctant to use it felt this way for multiple reasons, having to do with potential side effects, perceived extreme-ness of the intervention, similarity to chemotherapy, unknown information about chemoprevention, and reluctance to take medications in general. CONCLUSIONS: Lack of chemoprevention awareness is a critical gap in women's ability to make health-protective choices. Future research in this field must consider complexities in both women's perspectives on chemoprevention and the reasons they are reluctant to use it.


Assuntos
Neoplasias da Mama , Neoplasias da Mama/prevenção & controle , Quimioprevenção , Feminino , Pessoal de Saúde , Humanos , Masculino , Pesquisa Qualitativa , Comportamento de Redução do Risco
14.
Nursing (Säo Paulo) ; 24(275): 5530-5543, abr.-2021.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1224224

RESUMO

Objetivo: elucidar o uso de tecnologias na educação em saúde para prevenção e rastreamento do Câncer de Mama. Método: Trata-se de uma revisão integrativa realizada nas bases de dados LILACS, MEDLINE, BDENF e PUBMED com temas relacionados ao uso de tecnologia para educação em saúde na prevenção e rastreamento precoce do câncer de mama, utilizando recorte temporal de 2015 à 2019, fontes primárias e avaliação dos níveis de evidência. Resultados: Constatou-se que os estudos apontam o papel fundamental do enfermeiro frente ao educar em saúde na prevenção e rastreamento do câncer de mama, destacando o uso de tecnologias computacionais como ferramentas aliadas ao processo de empoderamento feminino e fortalecimento do seu autocuidado. Conclusão: Evidenciou-se que o uso das tecnologias em saúde é de grande valia no desenvolvimento das estratégias educativas, refletindo no fortalecimento da autonomia da mulher e melhor operacionalização destas ações nos serviços de saúde.(AU)


Objective: to elucidate or use of technologies in education in health for prevention and tracking of Breast Cancer. Methods: It deals with an integrative review carried out in databases LILACS, MEDLINE, BDENF and PUBMED on topics related to the use of technology for education in health in prevention and early tracking of breast cancer, using temporal cut from 2015 to 2019, primary sources and evaluation of evidence levels. Results: I confirm that the studies play the fundamental role of the nurse in the face of or educating in health in the prevention and screening of breast cancer, highlighting the use of computer technologies as allied tools to the process of feminine empowerment and strengthening of self-care. Conclusion: Evidence that I use the technologies in health and of great value, not developing educational strategies, reflecting not strengthening the autonomy of women and the operationalization of these services for health services.(AU)


Objetivo: aclarar el uso de tecnologías en educación para la salud para la prevención y detección del cáncer de mama. Metodo: Se trata de una revisión integradora realizada en las bases de datos LILACS, MEDLINE, BDENF y PUBMED con temas relacionados con el uso de la tecnología para la educación en salud en la prevención y cribado temprano del cáncer de mama, utilizando un marco temporal de 2015 a 2019, fuentes primarias y evaluación de los niveles de evidencia. Resultados: Se encontró que los estudios señalan el papel fundamental del enfermero en la educación para la salud en la prevención y cribado del cáncer de mama, destacando el uso de tecnologías informáticas como herramientas conjugadas con el proceso de empoderamiento femenino y fortalecimiento de su autocuidado. Conclusión: Se evidenció que el uso de tecnologías en salud es de gran valor en el desarrollo de estrategias educativas, reflejando el fortalecimiento de la autonomía de las mujeres y una mejor operacionalización de estas acciones en los servicios de salud.(AU)


Assuntos
Humanos , Feminino , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/prevenção & controle , Programas de Rastreamento , Educação em Saúde , Tecnologia Biomédica , Tecnologia Educacional/métodos , Prevenção de Doenças , Neoplasias/enfermagem
15.
Mayo Clin Proc ; 96(4): 1033-1040, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33814072

RESUMO

Breast cancer remains the most common cancer in women in the United States. For certain women at high risk for breast cancer, endocrine therapy (ET) can greatly decrease the risk. Tools such as the Breast Cancer Risk Assessment Tool (or Gail Model) and the International Breast Cancer Intervention Study risk calculator are available to help identify women at increased risk for breast cancer. Physician awareness of family history, reproductive and lifestyle factors, dense breast tissue, and history of benign proliferative breast disease are important when identifying high-risk women. The updated US Preventive Services Task Force and American Society of Clinical Oncology guidelines encourage primary care providers to identify at-risk women and offer risk-reducing medications. Among the various ETs, which include tamoxifen, raloxifene, anastrozole, and exemestane, tamoxifen is the only one available for premenopausal women aged 35 years and older. A shared decision-making process should be used to increase the usage of ET and must be individualized. This individualized approach must account for each woman's medical history and weigh the benefits and risks of ET in combination with the personal values of the patient.


Assuntos
Anastrozol/administração & dosagem , Neoplasias da Mama/prevenção & controle , Antagonistas de Estrogênios/administração & dosagem , Pessoal de Saúde/educação , Medicina Preventiva/educação , Cloridrato de Raloxifeno/administração & dosagem , Moduladores Seletivos de Receptor Estrogênico/administração & dosagem , Tamoxifeno/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/epidemiologia , Currículo , Tomada de Decisão Compartilhada , Educação Médica Continuada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medicina Preventiva/métodos , Medição de Risco , Fatores de Risco , Estados Unidos/epidemiologia
16.
Ann Afr Med ; 20(1): 52-58, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33727513

RESUMO

Background: Early detection of breast cancer is important in reducing mortality, morbidity, and high socioeconomic burden associated with it. Mammography is currently the primary imaging modality used as a screening tool to detect early breast cancer in women experiencing no symptoms as they are most curable in the early stage with availability of breast conservative therapies. Objective: This study aimed at determining the mammographic breast density patterns and outcome in asymptomatic women who presented for mammographic examination in Abuja. Materials and Methods: This descriptive cross-sectional study comprises of 113 asymptomatic women who presented for mammographic examination at the Radiology Department of University of Abuja Teaching Hospital, Gwagwalada from March 2015 to December 2018. Two basic views (craniocaudal and mediolateral views) of the breast were obtained using EXR-650 mammographic machine. Results: The mean age of study population was 40.72 ± 10.45 years with age range of 35 and 65 years. Base on mammographic breast density, breast imaging, reporting, and data system 1 and 2 were the most prevalent. There was a positive correlation between mammographic breast density and age of respondents. This relationship was statistically significant (Pearson correlation = 0.56, P = 0.000). The mammographic outcome among asymptomatic women who had mammographic examination was negative in 69 (61.1%) women and positive in 44 (38.9%). The positive outcome noted in mammograms of women examined was: benign mass in 18 (15.9%) women; 9 (8.0%) had benign calcification; 7 (6.2%) showed architectural distortion; 5 (4.4%) was inconclusive; focal asymmetry in 3 (2.6%); and suspicious mass in 2 (1.8%). Conclusion: In this study, screening of women reveals various benign and malignant breast pathologies which necessitate early interventions.


Assuntos
Densidade da Mama , Neoplasias da Mama/diagnóstico por imagem , Mama/diagnóstico por imagem , Detecção Precoce de Câncer , Mamografia/métodos , Programas de Rastreamento/métodos , Adulto , Distribuição por Idade , Idoso , Neoplasias da Mama/prevenção & controle , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Fatores Socioeconômicos
17.
Breast Cancer Res Treat ; 188(3): 703-712, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33733302

RESUMO

PURPOSE: Women's worry about developing breast cancer may influence their decision to use preventive therapy. However, the direction of this relationship has been questioned. We prospectively investigated the relationship between breast cancer worry and uptake of preventive therapy. The socio-demographic and clinical factors associated with high breast cancer worry were also investigated. METHODS: Women at increased risk of developing breast cancer were recruited from clinics across England (n = 408). Participants completed a survey on their breast cancer worry, socio-demographic and clinical factors. Uptake of tamoxifen was recorded at 3 months (n = 258 women, 63.2%). Both primary and sensitivity analyses were conducted using different classifications of low, medium and high worry. RESULTS: 39.5% of respondents reported medium breast cancer worry at baseline and 21.2% reported high worry. Ethnic minority women were more likely to report high worry than white women (OR = 3.02, 95%CI 1.02, 8.91, p = 0.046). Women educated below degree level were more likely to report high worry than those with higher education (OR = 2.29, 95%CI 1.28, 4.09, p = 0.005). No statistically significant association was observed between worry and uptake. In the primary analysis, fewer respondents with medium worry at baseline initiated tamoxifen (low worry = 15.5%, medium = 13.5%, high = 15.7%). In the sensitivity analysis, participants with medium worry reported the highest uptake of tamoxifen (19.7%). CONCLUSIONS: No association was observed between worry and uptake, although the relationship was affected by the categorisation of worry. Standardised reporting of the classification of worry is warranted to allow transparent comparisons across cohorts.


Assuntos
Neoplasias da Mama , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/prevenção & controle , Inglaterra/epidemiologia , Grupos Étnicos , Feminino , Humanos , Grupos Minoritários , Estudos Prospectivos , Reino Unido/epidemiologia
18.
JCO Glob Oncol ; 7: 416-424, 2021 03.
Artigo em Inglês | MEDLINE | ID: covidwho-1239918

RESUMO

PURPOSE: The coronavirus-induced pandemic has put great pressure on health systems worldwide. Nonemergency health services, such as cancer screening, have been scaled down or withheld as a result of travel restrictions and resources being redirected to manage the pandemic. The present article discusses the challenges to cancer screening implementation in the pandemic environment, suggesting ways to optimize services for breast, cervical, and colorectal cancer screening. METHODS: The manuscript was drafted by a team of public health specialists with expertise in implementation and monitoring of cancer screening. A scoping review of literature revealed the lack of comprehensive guidance on continuation of cancer screening in the midst of waxing and waning of infection. The recommendations in the present article were based on the advisories issued by different health agencies and professional bodies and the authors' understanding of the best practices to maintain quality-assured cancer screening. RESULTS: A well-coordinated approach is required to ensure that essential health services such as cancer management are maintained and elective services are not threatened, especially because of resource constraints. In the context of cancer screening, a few changes in invitation strategies, screening and management protocols and program governance need to be considered to fit into the new normal situation. Restoring public trust in providing efficient and safe services should be one of the key mandates for screening program reorganization. This may be a good opportunity to introduce innovations (eg, telehealth) and consider de-implementing non-evidence-based practices. It is necessary to consider increased spending on primary health care and incorporating screening services in basic health package. CONCLUSION: The article provides guidance on reorganization of screening policies, governance, implementation, and program monitoring.


Assuntos
COVID-19 , Programas de Rastreamento/organização & administração , Neoplasias/prevenção & controle , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/prevenção & controle , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/prevenção & controle , Atenção à Saúde , Detecção Precoce de Câncer , Feminino , Política de Saúde , Humanos , Programas de Rastreamento/métodos , Neoplasias/diagnóstico , Neoplasias/terapia , Pandemias , Guias de Prática Clínica como Assunto , Telemedicina , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/prevenção & controle
19.
Int J Behav Nutr Phys Act ; 18(1): 34, 2021 03 06.
Artigo em Inglês | MEDLINE | ID: mdl-33676538

RESUMO

BACKGROUND: It is estimated that around 30% of breast cancers in post-menopausal women are related to lifestyle. The breast cancer-pooling project demonstrated that sustained weight loss of 2 to 4.5 kg is associated with an 18% lower risk of breast cancer, highlighting the importance of small changes in body weight. Our study aimed to assess the effectiveness a volunteer-delivered, community based, weight management programme (ActWELL) for women with a BMI > 25 kg/m2 attending NHS Scotland Breast Screening clinics. METHODS: A multicentre, 1:1 parallel group, randomised controlled trial was undertaken in 560 women aged 50 to 70 years with BMI > 25 kg/m2. On completion of baseline measures, all participants received a breast cancer prevention leaflet. Intervention group participants received the ActWELL intervention which focussed on personalised diet advice and pedometer walking plans. The programme was delivered in leisure centres by (the charity) Breast Cancer Now volunteer coaches. Primary outcomes were changes between groups at 12 months in body weight (kg) and physical activity (accelerometer measured step count). RESULTS: Two hundred seventy-nine women were allocated to the intervention group and 281 to the comparison group. Twelve-month data were available from 240 (81%) intervention and 227 (85%) comparison group participants. Coaches delivered 523 coaching sessions and 1915 support calls to 279 intervention participants. Mean weight change was - 2.5 kg (95% CI - 3.1 to - 1.9) in the intervention group and - 1.2 kg (- 1.8 to 0.6) in the comparison group. The adjusted mean difference was - 1.3 kg (95% CI - 2.2 to - 0.4, P = 0.003). The odds ratio for losing 5% weight was 2.20 (95% CI 1.4 to 3.4, p = 0.0005) in favour of the intervention. The adjusted mean difference in step counts between groups was 483 steps/day (95% CI - 635 to 1602) (NS). CONCLUSIONS: A community weight management intervention initiated at breast screening clinics and delivered by volunteer coaches doubled the likelihood of clinically significant weight loss at 12 months (compared with usual care) offering significant potential to decrease breast cancer risk. TRIAL REGISTRATION: Database of registration: ISCRTN. Registration number: 11057518 . Date trial registered:21.07.2017. Date of enrolment of first participant: 01.09.2017.


Assuntos
Neoplasias da Mama/prevenção & controle , Perda de Peso , Acelerometria , Idoso , Neoplasias da Mama/diagnóstico , Serviços de Saúde Comunitária , Exercício Físico , Feminino , Humanos , Estilo de Vida , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Razão de Chances , Escócia , Voluntários , Caminhada
20.
J Prim Care Community Health ; 12: 21501327211000211, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33749348

RESUMO

OBJECTIVE: Alcohol intake is a known risk factor for breast cancer. National organizations recommend that women consume no more than one serving of alcohol per day, if at all; however, many women exceed this recommendation, and some are unwilling to decrease consumption. Our study sought to identify factors associated with women's unwillingness to decrease their alcohol intake to decrease their breast cancer risk. METHODS: 942 women in a screening mammography cohort were asked questions about their demographics, personal and family health history, lifestyle factors, and willingness/unwillingness to decrease alcohol intake to decrease their breast cancer risk. Univariate and multivariate analyzes of their responses were performed. RESULTS: 13.2% of women in our cohort indicated they were unwilling to decrease their alcohol intake to reduce their breast cancer risk. After adjusting for potential confounders, women who were 60 years and older were more than twice as unwilling to decrease their alcohol intake compared to their younger counterparts (P = .0002). Women who had an annual household income of more than $200,000 were 1.75 times more unwilling to decrease their alcohol intake compared to their less affluent counterparts (P = .033). Unwillingness was not significantly associated with race/ethnicity, education, having a first-degree family member with cancer, health perception, breast cancer risk perception, or BMI. CONCLUSIONS: Levels of unwillingness to decrease alcohol intake differed by age and household income. An opportunity is present to potentially decrease breast cancer risk in the community by educating women, especially older and more affluent women, about alcohol as a risk factor for breast cancer and the importance of limiting one's alcohol intake.


Assuntos
Neoplasias da Mama , Mamografia , Consumo de Bebidas Alcoólicas , Mama , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/etiologia , Neoplasias da Mama/prevenção & controle , Detecção Precoce de Câncer , Feminino , Humanos , Fatores de Risco
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