Nurse Faculty Scholars - Breast Cancer

Biologic Roles of Estrogen Receptor- β and Insulin-Like Growth Factor-2 in Triple-Negative Breast Cancer.

agurin — Thu, 30 Apr 2015 17:55:35 +0000

Published Date:

Sun, 2015-03-22 (All day)

Triple-negative breast cancer (TNBC) occurs in 10–15% of patients yet accounts for almost half of all breast cancer deaths. TNBCs lack expression of estrogen and progesterone receptors and HER-2 overexpression and cannot be treated with current targeted therapies. TNBCs often occur in African American and younger women. Although initially responsive to some chemotherapies, TNBCs tend to relapse and metastasize. Thus, it is critical to find new therapeutic targets. A second ER gene product, termed ERβ, in the absence of ERα may be such a target.

Spatial equity in facilities providing low- and no-fee screening mammography in Chicago neighborhoods

nfs — Wed, 29 Sep 2010 12:03:13 +0000

Published Date:

Wed, 2006-03-01 (All day)

Recent research suggests living in an economically disadvantaged neighborhood is associated with decreased likelihood of undergoing mammography and increased risk of late-stage breast cancer diagnosis. Long distances and travel times to facilities offering low- or no-fee mammography may be important barriers to adherence to mammography screening recommendations for women living in economically disadvantaged urban neighborhoods, in which African–Americans are disproportionately represented. The purpose of this study was to examine whether the spatial distribution of facilities providing low- or no-fee screening mammography in Chicago, Illinois, is equitable on the basis of neighborhood socioeconomic and racial characteristics. We found that distance and travel times via automobile and public transportation to facilities generally decrease as neighborhood poverty increases. However, we also found that the strength of the association between neighborhood poverty level and two of the spatial accessibility measures—distance and public transportation travel time—is less strong in African–American neighborhoods. Among neighborhoods with the greatest need for facilities (i.e., neighborhoods with the highest proportions of residents in poverty), African–American neighborhoods have longer travel distances and public transportation travel times than neighborhoods with proportionately fewer African–American residents. Thus, it appears that the spatial accessibility of low- and no-fee mammography services is inequitable in Chicago. In view of persistent social disparities in health such as breast cancer outcomes, these findings suggest it is important for researchers to examine the spatial distribution of health resources by both the socioeconomic and racial characteristics of urban neighborhoods.

Why some women have an optimistic or a pessimistic bias about their breast cancer risk: experiences, heuristics, and knowledge of risk factors

nfs — Tue, 28 Sep 2010 12:45:05 +0000

Published Date:

Fri, 2010-01-01 (All day)

Perceived risk to a health problem is formed by inferential rules called heuristics and by comparative judgments that assess how one's risk compares to the risk of others. The purpose of this cross-sectional, community-based survey was to examine how experiences with breast cancer, knowledge of risk factors, and specific heuristics inform risk judgments for oneself, for friends/peers, and comparative judgments for breast cancer (risk friends/peers - risk self). We recruited an English-speaking, multicultural (57% nonwhite) sample of 184 middle-aged (47 + or - 12 years old), well-educated women. Fifty percent of participants perceived that their breast cancer risk was the same as the risk of their friends/peers; 10% were pessimistic (risk friends/peers - risk self < 0), whereas 40% were optimistic (risk friends/peers - risk self > 0). Family history of breast cancer and worry informed risk judgments for oneself. The availability and cultural heuristics specific for black women informed risk judgments for friends/peers. Knowledge of risk factors and interactions of knowledge with the availability, representativeness, and simulation heuristics informed comparative judgments (risk friends/peers - risk self). We discuss cognitive mechanisms with which experiences, knowledge, and heuristics influence comparative breast cancer risk judgments. Risk communication interventions should assess knowledge deficits, contextual variables, and specific heuristics that activate differential information processing mechanisms.

Underestimation of breast cancer risk: influence on screening behavior.

nfs — Tue, 28 Sep 2010 12:42:10 +0000

Published Date:

Fri, 2009-05-01 (All day)

DESIGN: Descriptive, correlational, cross-sectional.

SETTING: Community settings in a metropolitan area on the western coast of the United States.

SAMPLE: Multicultural sample of 184 English-speaking women (57% non-Caucasian, X age = 47 +/- 12 years) who have never been diagnosed with cancer.

METHODS: Two perceived risk scales (verbal and comparative) and the Gail model were used to assess perceived and objective breast cancer risk, respectively.

MAIN RESEARCH VARIABLES: Perceived breast cancer risk, objective breast cancer risk, screening behavior.

FINDINGS: Participants reported that they "probably will not" get breast cancer and that their risk was "somewhat lower" than average. Family history of breast cancer was a significant predictor of perceived risk. Demographic characteristics and objective risk factors were not associated with perceived risk. Most women at high risk for breast cancer (89%) underestimated their actual risk; fewer women with low to average risk for breast cancer (9%) overestimated their risk. Age, Gail scores, and health insurance status promoted breast cancer screening; underestimation of risk had the opposite effect.

CONCLUSIONS: Inaccurate perceptions of risk do not promote optimal breast cancer screening. The finding has implications for most women at high risk for developing breast cancer who underestimate their risk.

IMPLICATIONS FOR NURSING: Oncology nurses can use risk assessment tools to provide individualized counseling regarding breast cancer risk factors and screening. Women at high risk who underestimate their risk could benefit from additional screening and from advances in cancer chemoprevention.

PURPOSE/OBJECTIVES: To describe perceived breast cancer risk, identify the percentage of women with inaccurate risk perceptions, and examine the influence of perceived and objective risk on screening behavior.
DESIGN: Descriptive, correlational, cross-sectional.
SETTING: Community settings in a metropolitan area on the western coast of the United States.
SAMPLE: Multicultural sample of 184 English-speaking women (57% non-Caucasian, X age = 47 +/- 12 years) who have never been diagnosed with cancer.

Prospective assessment of fatigue and health status in Greek patients with breast cancer undergoing adjuvant radiotherapy.

nfs — Tue, 28 Sep 2010 12:30:22 +0000

Published Date:

Mon, 2006-05-01 (All day)

PURPOSE/OBJECTIVES: To describe fatigue in women with breast cancer undergoing radiotherapy and to explore the impact of fatigue on their health status.

DESIGN: Prospective, descriptive, repeated measures.

SETTING: A major oncology center, Saint Savvas Cancer Hospital, in Athens, Greece.

SAMPLE: Consecutive sample of 106 women (mean age = 55 + 12), with histologically confirmed diagnosis for stage I or II breast cancer who were receiving adjuvant radiotherapy for approximately six weeks.

METHODS: Data were collected with the Revised Piper Fatigue Scale (PFS) and the Short Form-36 (SF-36) Health Survey Scale in the first two days of radiotherapy (T0), during the third week (T1), and during the last week of treatment (T2).

MAIN RESEARCH VARIABLES: Fatigue, health status.

FINDINGS: Across-subjects analysis revealed that fatigue increased during radiotherapy in patients with breast cancer regardless of stage, type of surgery, or whether they received chemotherapy (p 0.05). Between-subject analysis revealed that no differences existed in the PFS between different groups (chemotherapy versus no chemotherapy, breast conservation versus mastectomy, stage I versus stage II) at each measurement point. A negative correlation was found between the subscales of the PFS and all of the subscales of the SF-36.

CONCLUSIONS: Fatigue intensity increased significantly during the course of radiotherapy, and patients experienced a significant deterioration in their overall health status.

IMPLICATIONS FOR NURSING: Findings contribute to the growing body of evidence regarding fatigue and its impact on health status in Greek patients with breast cancer and provide insights for effective nursing assessment, patient education, and symptom management.

PURPOSE/OBJECTIVES: To describe fatigue in women with breast cancer undergoing radiotherapy and to explore the impact of fatigue on their health status.
DESIGN: Prospective, descriptive, repeated measures.
SETTING: A major oncology center, Saint Savvas Cancer Hospital, in Athens, Greece.
SAMPLE: Consecutive sample of 106 women (mean age = 55 + 12), with histologically confirmed diagnosis for stage I or II breast cancer who were receiving adjuvant radiotherapy for approximately six weeks.

Do women in the community recognize hereditary and sporadic breast cancer risk factors?

nfs — Tue, 28 Sep 2010 12:25:41 +0000

Published Date:

Sun, 2005-05-01 (All day)

PURPOSE/OBJECTIVES: To describe knowledge of hereditary, familial, and sporadic breast cancer risk factors among women in the community and to identify characteristics associated with this knowledge.

DESIGN: Descriptive, cross-sectional.

SETTING: Community settings in the San Francisco Bay Area.

SAMPLE: 184 women who had never been diagnosed with cancer, were 30-85 years old (mean = 47 + 12), and agreed to complete a questionnaire in English. Participants were from diverse racial and cultural backgrounds (i.e., 43% European descent, 27% African descent, 16% Asian descent, and 14% Hispanic descent). Many (49%) were college graduates, and 24% had a median annual family income of $30,000-$50,000.

METHODS: Survey.

MAIN RESEARCH VARIABLES: Knowledge of hereditary, familial, and sporadic breast cancer risk factors and characteristics associated with this knowledge.

FINDINGS: Although most women recognized heredity as a risk factor, some did not understand the impact of paternal family history on risk. Some women did not recognize the relationship between breast and ovarian cancer, risk factors associated with the Gail model, and that aging increases risk. Education level was the most important characteristic associated with knowledge of risk factors.

CONCLUSIONS: Although age and family history are independent predictors of sporadic, hereditary, and familial breast cancer risk, women in the community could not distinguish between the three forms of the disease. Although the sample included a large number of educated women, their knowledge of breast cancer risk factors appeared incomplete.

IMPLICATIONS FOR NURSING: Advanced practice nurses should provide individualized risk assessment and education regarding breast cancer risk factors.

PURPOSE/OBJECTIVES: To describe knowledge of hereditary, familial, and sporadic breast cancer risk factors among women in the community and to identify characteristics associated with this knowledge.
DESIGN: Descriptive, cross-sectional.
SETTING: Community settings in the San Francisco Bay Area.

Perceived breast cancer risk: heuristic reasoning and search for a dominance structure.

nfs — Tue, 28 Sep 2010 12:22:23 +0000

Published Date:

Sat, 2005-01-01 (All day)

Studies suggest that people construct their risk perceptions by using inferential rules called heuristics. The purpose of this study was to identify heuristics that influence perceived breast cancer risk. We examined 11 interviews from women of diverse ethnic/cultural backgrounds who were recruited from community settings. Narratives in which women elaborated about their own breast cancer risk were analyzed with Argument and Heuristic Reasoning Analysis methodology, which is based on applied logic. The availability, simulation, representativeness, affect, and perceived control heuristics, and search for a dominance structure were commonly used for making risk assessments. Risk assessments were based on experiences with an abnormal breast symptom, experiences with affected family members and friends, beliefs about living a healthy lifestyle, and trust in health providers. Assessment of the potential threat of a breast symptom was facilitated by the search for a dominance structure. Experiences with family members and friends were incorporated into risk assessments through the availability, simulation, representativeness, and affect heuristics. Mistrust in health providers led to an inappropriate dependence on the perceived control heuristic. Identified heuristics appear to create predictable biases and suggest that perceived breast cancer risk is based on common cognitive patterns.

Predictors of perceived breast cancer risk and the relation between perceived risk and breast cancer screening: a meta-analytic review.

nfs — Tue, 28 Sep 2010 12:12:28 +0000

Published Date:

Thu, 2004-04-01 (All day)

BACKGROUND: Perceived risk is a principal variable in theoretical models that attempt to predict the adoption of health-protective behaviors.

METHODS: This meta-analysis synthesizes findings from 42 studies, identified in PubMed and PsycInfo from 1985 onward. Studies examined demographic and psychological variables as predictors of perceived breast cancer risk and the relationship between perceived risk and breast cancer screening. Statistical relationships, weighted for sample size, were transformed to effect sizes and 95% CIs.

RESULTS: Women do not have accurate perceptions of their breast cancer risk (N = 5561, g = 1.10). Overall, they have an optimistic bias about their personal risk (g = 0.99). However, having a positive family history (N = 70660, g = 0.88), recruitment site, and measurement error confounded these results. Perceived risk is weakly influenced by age (N = 38000, g = 0.13) and education (N = 1979, g = 0.16), and is moderately affected by race/culture (N = 2192, g = 0.38) and worry (N = 6090, g = 0.49). There is an association between perceived risk and mammography screening (N = 52766, g = 0.19). It is not clear whether perceived risk influences adherence to breast self-examination. Women who perceived a higher breast cancer risk were more likely to pursue genetic testing or undergo prophylactic mastectomy.

CONCLUSION: Perceived breast cancer risk depends on psychological and cognitive variables and influences adherence to mammography screening guidelines.

BACKGROUND: Perceived risk is a principal variable in theoretical models that attempt to predict the adoption of health-protective behaviors.
METHODS: This meta-analysis synthesizes findings from 42 studies, identified in PubMed and PsycInfo from 1985 onward. Studies examined demographic and psychological variables as predictors of perceived breast cancer risk and the relationship between perceived risk and breast cancer screening. Statistical relationships, weighted for sample size, were transformed to effect sizes and 95% CIs.

The Influence of Social Support on Breast Cancer Screening in a Multicultural Community Sample

nfs — Tue, 28 Sep 2010 12:07:04 +0000

Published Date:

Thu, 2002-08-01 (All day)

Purpose/Objectives: To examine the relationship between women’s reported social support and their adherence to recommended breast cancer screening guidelines. Design: Descriptive, cross-sectional survey. Setting: Community women’s organizations throughout the San Francisco Bay Area. Sample: 833 mostly low-income women with a mean age of 46.2 years from three racial or ethnic groups (i.e., Latina, Caucasian, and African American) who were not breast cancer survivors. Methods: Social support was measured with a five-item, four-point, Likert scale developed for the study (Cronbach’s alpha = 0.7248). Adherence to screening guidelines was measured by asking frequency of performing breast self-examination (BSE) and frequency of obtaining a clinical breast examination (CBE) and a mammogram. Research assistants and leaders of women’s organizations conducted the survey in work and community settings. Main Research Variables: Social support, performance of BSE, obtaining a CBE and a mammogram, income, education, spoken language, and level of acculturation. Findings: Higher levels of social support were related to higher income and higher education. Lower levels of social support were associated with being Latina, completing the survey in Spanish, and being born abroad. Women who did not adhere to screening guidelines (for BSE or CBE) reported less social support. Conclusions: Social support is associated with adherence to breast cancer screening guidelines. Implications for Nursing: Nurses should assess women’s levels of social support as a factor when evaluating adherence to breast cancer screening guidelines.

Culture as an influence on breast cancer screening and early detection

nfs — Tue, 28 Sep 2010 11:59:56 +0000

Published Date:

Tue, 2000-08-01 (All day)

Objectives: To explore how culture may play a part in breast cancer screening, early detection, and efforts to decrease breast mortality. Data Sources: Journal articles published in the past 20 years on cultural aspects of cancer prevention and control. Conclusions: Research seems directed more at discovering cultural differences than at identifying similarities on how culture influences breast cancer screening and early detection. The influences of poverty and lack of educational opportunities account for much of what is termed cultural difference. Implications for Nursing Practice: Improving practice through an informed understanding of culture calls for considerable self-education and a fundamental refinement of care delivery.