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  • 1
    Electronic Resource
    Electronic Resource
    The Rate of Breast-Conserving Surgery for Early Breast Cancer Is Not Influenced by the Surgical Strategy of Excisional Biopsy Followed by the Definitive Procedure (2001)
    Boston, MA, USA : Blackwell Science Inc
    The @breast journal 7 (2001), S. 0 
    Details
    ISSN: 1524-4741
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract: Increased emphasis on breast conservation and the primacy of the patient's preferences has led to the promotion and increased use of a two-step surgical strategy (definitive operation only after a final tissue diagnosis from a biopsy done on a previous visit) in the treatment of early breast cancer, with the assumption being that this is more conducive to the performance of breast-conserving surgery (BCS). We sought to test this by examining the effect of the surgical strategy (one-step versus two-step) on the operation performed (BCS versus mastectomy). A random sample of women with node-negative breast cancer diagnosed in 1991 in Ontario was drawn from the Ontario Cancer Registry database and matched to the Canadian Institute of Health Information and Ontario Health Insurance Plan databases (n = 643). This provided information on the timing and nature of all surgical procedures performed as well as patient, tumor, hospital, and surgeon characteristics. The surgical strategy was defined as either a one-step procedure (biopsy and definitive surgery performed at the same time) or a two-step procedure (surgical biopsy and pathologic diagnosis, followed by definitive surgery at a later date). The axillary lymph node dissection was used to define the definitive procedure. BCS was employed in 68% of patients, and this did not differ significantly between the one-step and two-step groups (66% versus 70%). Patients with palpable lesions had a significantly lower rate of breast conservation than those with nonpalpable lesions. Other variables associated with a lower rate of BCS were larger tumor size, presence of extensive ductal carcinoma in situ (DCIS), and central or multifocal tumors. The use of a one-step procedure was associated with a patient age of more than 50 years, a palpable mass, tumor size larger than 1 cm, previous fine needle aspiration (FNA) biopsy, absence of extensive DCIS, and surgery in an academic setting. Breast conservation was not affected by the surgical strategy used or the timing of the decision, but was associated with several accepted tumor factors. This study shows that, contrary to the opinion of some, there is a group of breast cancer patients in whom treatment in a one-step manner is appropriate.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1524-4741.2001.007003158.x
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  • 2
    Electronic Resource
    Electronic Resource
    Predictors of Quality of Life in Women with a Bilateral Prophylactic Mastectomy (2005)
    Oxford, UK : Blackwell Science Inc
    The @breast journal 11 (2005), S. 0 
    Details
    ISSN: 1524-4741
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract:  The purpose of this study was to assess the quality of life in women who had previously undergone a bilateral prophylactic mastectomy and to determine what factors predict quality of life in this population. Women in Ontario who had undergone prophylactic mastectomy between 1991 and 2000 were asked to complete several questionnaires that assessed current psychosocial functioning, including the Quality of Life Index (QLI). The mean score for the QLI was 23.34 (range 9.53–30.00). QLI scores were negatively correlated with cancer-related distress, body image difficulties, and psychological distress. Conversely, QLI scores were positively correlated with social support. Significant predictors of quality of life included psychological distress and one subscale of body image (vulnerability). Vulnerability and psychological distress are important predictors of quality of life in women who have previously undergone bilateral prophylactic mastectomy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1075-122X.2005.21546.x
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  • 3
    Electronic Resource
    Electronic Resource
    The rise of tamoxifen: Temporal and geographical trends of tamoxifen use in Ontario (1997)
    Springer
    Breast cancer research and treatment 43 (1997), S. 33-41 
    Details
    ISSN: 1573-7217
    Keywords: breast cancer ; health services research ; small-area analysis ; tamoxifen
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose: To describe the change in use oftamoxifen over time and across countries in Ontario.Methods: Data from the Ontario Drug Benefit (ODB)plan, Census Canada, and the Ontario Cancer Registry(OCR) were combined and analysed to determine ratesof tamoxifen use for females over 65 foreach county and the province overall, by year.Rates were analyzed by repeated measures ANOVA todetermine significance of changes over time. Consistency oftamoxifen use across counties was determined by theSpearman rank correlation coefficient, and overall variation betweencounties was described using three statistical techniques: Chi-squareanalysis, the extremal quotient (EQ), and the systematiccomponent of variation (SCV). Results: The number ofone-month tamoxifen prescriptions per incident case of breastcancer rose significantly from 13.51 in 1985 to20.54 in 1990 (p 〈 0.001) and to34.06 in 1992 (p=0.001). Viewed differently,the number of women over 65 receiving tamoxifenprescriptions per incident case of breast cancer changedfrom 1.91 in 1985 to 3.14 in 1990to 4.54 in 1992. Statistically significant variation inthe rate of tamoxifen prescribing was demonstrated betweenOntario counties in all three years by ChiSquared analysis (p 〈 0.0001). Both the EQand the SCV declined from 1985 to 1990,suggesting more uniform prescribing across the province. Littlechange in overall variation was seen between 1990and 1992. All counties over time tended toprescribe generic preparations more often and shifted from10 mg to 20 mg formulations. Conclusions: Thesignificant increase in the rate of tamoxifen useand trend towards more uniform prescribing across Ontariobetween 1985 and 1990 coincided with the publicationof two important documents outlining the benefits oftamoxifen in early breast cancer. Despite this trend,variation in tamoxifen use between counties remains. Therehas been little change in uniformity of prescribingsince 1990.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1005736325626
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  • 4
    Electronic Resource
    Electronic Resource
    Utilization of Professional Supportive Care Services by Women with Breast Cancer (2000)
    Springer
    Breast cancer research and treatment 64 (2000), S. 253-258 
    Details
    ISSN: 1573-7217
    Keywords: breast cancer ; psychosocial ; supportive care ; utilization
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This paper reports on the results of a survey of utilization of professional supportive care services by women with breast cancer, and on patterns of differential service utilization by sub-groups of patients. Study participants were women with invasive breast cancer diagnosed 23–36 months prior to contact about the study, and randomly selected from the Ontario Cancer Registry. From among 1,119 eligible women sent survey questionnaires, 731 returned completed questionnaires (65%). A total of 31% of respondents reported accessing one or more of the following professionals: social worker, psychologist, psychiatrist, dietitian, physiotherapist. Among those who responded to a question about whether they would have liked specific services, 34% reported that there was at least one professional supportive care service they would have liked to use, but were unable to access. Factors shown to be related to greater utilization of services included: younger age, higher household income, employed or student status, private health insurance coverage, and having received chemotherapy. Overall, there was a surprisingly low utilization of professional specialized supportive care services among women with breast cancer. Policy implications include finding strategies to better inform cancer patients about existing services, and ensuring that a core set of services are available to all patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1026548320063
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    Paper (German National Licenses)
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  • 5
    Electronic Resource
    Electronic Resource
    Development of a knowledge scale about breast cancer and heredity (BCHK) (1999)
    Springer
    Breast cancer research and treatment 53 (1999), S. 69-75 
    Details
    ISSN: 1573-7217
    Keywords: family history ; hereditary breast cancer ; knowledge
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract An 11‐item questionnaire, the Breast Cancer and Heredity Knowledge Scale (BCHK), was developed to test general knowledge about breast cancer and hereditary breast cancer (HBC) among women at low to moderate risk of HBC. The BCHK measures knowledge about breast cancer incidence and prognosis, risk factors, screening, disease presentation and treatment, and HBC. Scale items were generated from focus group interviews, previously published breast cancer knowledge scales, and consulation with a multidisciplinary research team, including health professionals and women with breast cancer or a family history of breast cancer. A 27‐item draft scale was tested on 36 breast clinic patients and 17 women from the general public. Results were used to develop the final 11‐item scale. Development of the scale and its potential uses are discussed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1006114710328
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