The efficacy of sertraline for controlling hot flashes in women with or at high risk of developing breast cancer.

The aim of the study is to evaluate the efficacy of sertraline for controlling hot flashes in women with or at high risk of breast cancer. This was a randomized, double-blind, placebo-controlled study. All participants were asked to complete hot flash diaries. Participants reporting weekly hot flash scores >15 during baseline week underwent a 1-week single-blind placebo run-in. Those reporting hot flash score reductions >50% following placebo run-in were excluded. The remaining women received an assigned treatment for 4 weeks. Both groups' demographic and clinical characteristics were similar with a greater decline, but not statistically significant, in hot flash frequencies and scores in the sertraline-treated group compared with the placebo (P = 0.13 and P = 0.15, respectively). Emotional well-being improved significantly in the sertraline group (P = 0.041). The study failed to demonstrate effectiveness of sertraline in attenuating hot flashes in women with or at high risk of developing breast cancer who were not recommended to take hormone replacement therapy.

Tobacco industry use of judicial seminars to influence rulings in products liability litigation.

OBJECTIVES: This paper examines the tobacco industry's efforts to influence litigation by sponsoring judicial seminars. METHODS: Thousands of internal tobacco documents were examined, including memos, reports, presentations, and newsletters. Connections to outside organisations were corroborated by examining tobacco industry financial records, budgets, and letters pledging funds. Facts about outside organisations were triangulated through examining their websites and publicly-filed financial records, and verifying facts through their representatives' statements in newspaper and law review articles. RESULTS: There are direct financial ties between the tobacco industry and groups that organise judicial seminars in an effort to influence jurisprudence, and judges who attend these seminars may be breaching judicial ethics either by not inquiring about the source of funding or by ignoring funding by potential litigants. CONCLUSIONS: The tobacco industry's attempts to clandestinely influence judges' decisions in cases to which they are a party endangers the integrity of the judiciary.

Compliance with fecal occult blood test screening among low-income medical outpatients: a randomized controlled trial using a videotaped intervention.

BACKGROUND: Morbidity and mortality from colorectal cancer (CRC) are heightened among the socioeconomically disadvantaged. METHOD: A randomized controlled trial was conducted to evaluate the efficacy of a videotaped intervention using peer educators as well as a health professional to increase compliance with fecal occult blood test (FOBT) screening. Participants were 160 older individuals attending a medical outpatient clinic. Compliance with FOBT use was the dependent measure. Demographic variables, family history of CRC, viewing the videotape, perceived risk, self-efficacy, physician recommendation, knowledge about CRC screening, and intent to use the FOBT were independent measures. RESULTS: Approximately 41% of participants complied with FOBT screening. Significant relationships were found between intent and family history of CRC, viewing the video, perceived risk, self-efficacy, and CRC knowledge. However, none of these variables was significantly related to compliance with FOBT use. CONCLUSIONS: Although modest compliance rates were shown for both experimental and control groups, their compliance did not differ significantly. Further investigation of the impact of a video as part of an enhanced intervention program should be considered.

Mammography behavior after receiving a negative BRCA1 mutation test result in the Ashkenazim: a community-based study.

PURPOSE: To define the impact of a negative BRCA1 test result on subsequent breast cancer screening behavior in women. METHODS: Longitudinal study of a community-based sample of Ashkenazi Jews offered testing for the 185delAG BRCA1 mutation in 1996. Of 309 participants, 118 women were mutation negative, of average risk (based on family history of cancer), unaffected with breast cancer, and provided complete data at baseline, and Year 1 and Year 2 follow-up questionnaires. RESULTS: Women age 50 and older had 91.7% compliance with mammography for the year prior to entry (baseline), 88.3% during Year 1, 91.7% during Year 2 (no significant change; P = 0.775). Women under age 50 demonstrated an increase in mammography (49.2% at baseline, 62.7% Year 1, and 67.1% Year 2; P = 0.035). Both groups demonstrated significant decreases in breast cancer worry and perceived risk. Logistic regression analysis on having a mammogram at Year 2 showed that age, physician recommendation, worry, and perceived risk were all significant. CONCLUSION: Receipt of negative BRCA1 test results in a cohort of Ashkenazi Jewish women did not have a negative impact on mammography behavior 2 years after genetic testing.

Breast cancer screening among ethnically diverse low-income women in a general hospital psychiatry clinic.

Most low-income minority women do not obtain screening mammography on a regular basis. Compliance with recommended breast cancer screening guidelines may be even lower in women with psychiatric illnesses. We investigated compliance with breast cancer screening guidelines among 121 ethnically diverse low-income women recruited from a general hospital psychiatry clinic. Mammography and clinical breast examination (CBE) had been obtained in the previous year by 59% and 70% of the patients 40 years of age and older, respectively. Among patients 20 years of age and older, 42% reported monthly breast self-examination (BSE). Physician recommendation of mammography was the strongest predictor of having obtained both a mammogram and a CBE within the previous year. There was an inverse relationship between breast cancer knowledge and screening mammography. Patients who were Hispanic, more educated, more confident in performing BSE, and whose physicians recommended monthly BSE were more likely to perform BSE monthly. These results highlight the importance of physician recommendation of compliance with screening guidelines for early detection of breast cancer. Because psychiatric patients typically are treated by psychiatrists on a regular and frequent basis, psychiatrists are in a unique position not only to encourage cancer screening but also to monitor patient compliance with their recommendations.

Psychological and behavioral factors associated with colorectal cancer screening among Ashkenazim.

BACKGROUND: Psychological and behavioral factors related to annual colorectal cancer (CRC) screening were examined in a sample of Ashkenazi Jewish individuals. Identification of factors related to regular CRC screening in this population is important because of the possibility of a heightened incidence of CRC. METHODS: Eligible participants were 171 Ashkenazi Jewish adults 40 years or older attending an educational program about breast cancer genetics. Compliance with recommended guidelines for digital rectal examination and fecal occult blood test in the past year were dependent measures. Demographic variables, family history of CRC, perceived risk, physician recommendation, and worry about cancer were independent measures. RESULTS: Digital rectal examinations and fecal occult blood tests had been obtained in the past year by 46 and 31% of the participants, respectively. A logistic regression showed that physician recommendation was related significantly to obtaining digital rectal examinations. Physician recommendation and education were related significantly to obtaining fecal occult blood tests. Although participants with family histories of CRC perceived themselves as being at increased risk of developing CRC, and were more worried about developing colon cancer, they were no more likely to adhere to CRC screening guidelines than those without such histories. CONCLUSIONS: Overall, compliance with recommended CRC screening was low even among high-risk individuals. Physicians play a key role in motivating people to comply with CRC screening. Physicians need to en courage all asymptomatic patients 50 years and older to be screened for CRC.

Psychological impact of receiving negative BRCA1 mutation test results in Ashkenazim.

PURPOSE: Most DNA test results for breast/ovarian cancer susceptibility are negative. Because negative test results might be interpreted incorrectly and may have serious psychological and behavioral implications, determining the psychological impact of such results is important. METHODS: A community-based sample of 289 Ashkenazim was tested for 185delAG. The 199 mutation-negatives provided data at baseline and follow-up. Increased risk participants included those who received negative test results but remained at increased risk because positive family and/or personal histories of breast or ovarian cancer made the results uninformative. Average risk meant those who tested negative and had negative family and personal histories of breast or ovarian cancer. Using a logistic regression analysis, both groups' psychological distress levels were compared at baseline and at 1 and 6 months after notification of DNA test results. RESULTS: A logistic regression analysis showed significant but small differences in cancer-specific distress after 6 months between increased and average risk participants (P < 0.006). Increased risk participants reported more distress than average risk. General distress declined among all participants after 1 month. Although baseline and follow-up differences in cancer-specific distress obtained by the increased and average risk participants were statistically significant, none of the absolute levels observed reflected especially high degrees of stress. CONCLUSIONS: Receipt of negative DNA test results does not have a deleterious psychological impact, whether results are informative or uninformative.

Age-related differences in mammography use and in breast cancer knowledge, attitudes, and behaviors.

BACKGROUND: This study examined age differences in breast cancer knowledge, attitudes, and early-detection behaviors in a multi-ethnic sample of economically disadvantaged women participating in a breast-cancer education outreach program. METHODS: Age differences in breast cancer knowledge, perceptions of risk of breast cancer, barriers to mammography, recommendations of mammography by health professionals, health promotion behaviors, and mammography use and intention were investigated. The subjects were 139 women aged 30 or older who were categorized in one of three age groups: 30 to 39, 40 to 49, and 50 years old or older. RESULTS: One fourth of the women between the ages of 30 and 39 reported both that they had had mammography in the past and that they intended to have it in the next year. Fifty percent of those in their forties reported mammography use at some time in the past, and 56% intended to obtain it in the coming year. Fifty percent of those 50 or older reported that they had had mammography in the past year. Women aged 40 or older were more likely than those in their thirties to report that their healthcare providers had encouraged them to get mammograms. No significant age differences were observed in breast cancer knowledge or perceptions of personal risk of breast cancer. CONCLUSION: The fact that the three age groups were similar in their perceptions of personal risk of breast cancer suggests that older women may not be accurately assessing their risk and thus may be obtaining screening mammography at less-than-optimal levels.

Screening for 185delAG in the Ashkenazim.

A study was initiated to assess interest, educational effectiveness, and implications of genetic testing for the common BRCA1 mutation, 185delAG, in the Ashkenazim. Of 333 individuals who attended group sessions, 309 (92%) participated in the study. Participants were categorized as having negative family history (67%), positive family history (defined, by a relaxed criterion, as one first-degree relative or two second-degree relatives with breast [premenopausal] or ovarian cancer) (22%), positive personal history (7%), and both positive personal history and positive family history (4%). Group education was effective, as shown by the improvement in participant scores from pre- to posteducation tests. For the 289 individuals (94%) who requested testing, the major reasons included concern for their own risk, concern for the risk of their children, and desire to learn about surveillance options. The most common reason given by participants who declined testing was concern about health insurance. Six participants found to be heterozygous for the 185delAG mutation received results and were offered genetic counseling. Participants had consented for additional testing without receiving results and were screened for the 6174delT mutation in BRCA2, and seven were found to be positive. All identified carriers reported at least one first- or second-degree relative with a history of breast or ovarian cancer, although they did not all meet our study criteria for positive family history. Given these outcomes, we conclude that screening for breast and ovarian cancer susceptibility is most appropriate for individuals with a positive personal or positive family cancer history. We propose a guideline for future studies designed to identify individuals who may benefit from genetic testing for inherited breast and ovarian cancer.

Cancer genetics--survey of primary care physicians' attitudes and practices.

BACKGROUND: Genetic testing for susceptibility to cancer often involves complex medical, ethical, legal, and psychological issues that present a challenge for physicians in clinical practice. METHODS: This study is based on survey data from 101 primary care physicians throughout Texas, measuring their interest in and attitudes about cancer genetics. RESULTS: The majority of physicians surveyed reported that they would consider genetic screening for at least one of seven genetic disorders that predispose to cancer, and almost 20% had made one or more referrals for genetic evaluation and DNA testing. Overall, they wanted to see a variety of continuing education programs and educational materials on DNA testing for cancer susceptibility developed. Although most of the physicians accurately perceived a number of major obstacles to referring patients for genetic testing, barriers such as difficulty in interpreting test results, potential for false-positive and false-negative results, and concern about patients'reactions to test results were reported less frequently. CONCLUSIONS: The results support other evidence for a need to provide continuing education to physicians about genetic testing for susceptibility to cancer.

Demographic, psychosocial, and objective risk factors related to perceived risk of skin cancer.

BACKGROUND AND METHODS: The present study examined the ways in which demographic, psychosocial, and objective risk factors were related to perceived risk of skin cancer among 384 hospital employees who participated in a screening program. It was hypothesized that pyschosocial risk factors would account for a significant portion of the variance in risk perception beyond that accounted for by the other risk factors. RESULTS: The risk factors accounted for approximately 44% of the variance in risk perception. Psychosocial risk factors accounted for a statistically significant portion of the variance in risk perception beyond that accounted for by other risk factors. Worry, family history of skin cancer, and race/ethnicity were most strongly related to perceived risk. CONCLUSIONS: Results are discussed in terms of the need for educational programs that emphasize the relationship between level of risk and skin cancer and provide specific information regarding steps that can be taken to prevent skin cancer.

Breast cancer screening behaviors and intentions among asymptomatic women 50 years of age and older.

We examined predictors of (1) compliance with yearly mammography and clinical breast examination (CBE) and (2) intention to obtain mammography and CBE within the following year. Subjects were 312 asymptomatic female hospital employees, 50 years or older, who had participated in a free worksite breast cancer screening program. Mammograms and CBEs had been obtained by 79% and 76% of the subjects, respectively, during the preceding 12 months. The majority of the subjects indicated that they were very/extremely likely to obtain a mammogram and CBE in the next 12 months (88% and 87%, respectively). Multivariate analyses showed that perceived barriers to and physician recommendation of mammography were the strongest predictors of both breast cancer screening behaviors and intentions. Recency of participation in the educational component of the screening program was related to both compliance with mammography in the past 12 months and intention to obtain CBE in the next year. Having a first-degree female relative with a history of breast cancer was related to compliance with CBE in the past 12 months. Perceived efficacy of mammography was related to intention to obtain both mammography and CBE in the next year, and number of reasons for mammography was related to intention to obtain mammography in the next year. Our results suggest that physicians play a key role in motivating women to comply with breast cancer screening and that reducing barriers to obtaining mammography may increase use further.

Skin cancer prevention and early detection intentions and behavior.

This longitudinal study examined predictors of (1) skin cancer prevention and early detection intentions and (2) compliance with recommendation for medical follow-up for suspicious skin lesions. Subjects were 324 hospital employees who were at increased risk for skin cancer and who participated in a worksite skin cancer screening program. Based on behavioral self-regulation theory and the Health Belief Model, multivariate analyses showed that optimism, perceived risk, reasons for doing skin self-examination (SSE), and SSE frequency prior to screening were the best predictors of intentions to engage in future health promotion behaviors (i.e., monthly SSE, regular sunscreen use, and participation in a skin cancer screening program the following year). Although our results also showed that optimism, reasons for doing SSE, and SSE frequency were the best predictors of compliance with medical follow-up, these three variables accounted for only a small amount of the variance in compliance with recommended follow-up care.

Breast cancer screening: racial/ethnic differences in behaviors and beliefs.

Racial/ethnic differences in breast cancer screening behaviors and beliefs were examined in 259 asymptomatic women, 50 years old or older, who participated in a no-cost worksite breast cancer screening program. Hispanics were more likely than African Americans to report having had mammography in the past year. Caucasians and Hispanics were more likely than African Americans to report having had a clinical breast examination in the past year. African Americans to report having had a clinical breast examination in the past year. African Americans and Hispanics were more likely to practice monthly breast self-examination than were Caucasians. African Americans were more likely to report cancer-related fears and worries as barriers to mammography, whereas Caucasians were more likely to report being too busy, inconvenience, and procrastination as barriers. African Americans also were more likely to evaluate their physicians and other health professionals positively than were Caucasians. These results suggest a need to make a special effort to address cancer-related fears as barriers to screening among African Americans, and time-related barriers to screening among Caucasians.

Dispositional optimism, self-efficacy, and health beliefs as predictors of breast self-examination.

This cross-sectional study examined relationships among predictors of breast self-examination (BSE) derived from the Health Belief Model and behavioral self-regulation theory. Subjects were 427 gynecology outpatients. Although 64% indicated that they had practiced BSE at least once during the past year, only 27% indicated they practiced BSE monthly. The majority of the subjects knew about most of the recommended BSE steps. The most frequently endorsed reasons for completing BSE were early detection, recommendation from a doctor, and peace of mind. The most frequently endorsed barrier was forgetting/being too busy. Multivariate analysis showed that several psychological variables--including reasons for doing BSE, self-efficacy, and barriers to doing BSE--were related to frequency of BSE. Overall, the variables in this model accounted for about 37% of the variance in BSE frequency.

Subtypes of psychosocial adjustment to breast cancer.

By means of cluster analytic techniques, four subtypes of psychosocial adjustment were identified in a sample of 122 breast cancer patients who completed the Psychosocial Adjustment to Illness Scale. Internal consistency and internal validity of the derived typology were suggested by the finding that two different hierarchical agglomerative clustering methods (average linkage between groups, Ward's) produced similar solutions. Three of the derived subtypes reported normal affect levels but different patterns of relative strengths and dysfunctions, while the fourth subtype appeared to be highly distressed and globally maladjusted. External validation was demonstrated by differentiating the subtypes on variables of negative affect, avoidance coping, and fighting spirit. The clinical and heuristic implications of these findings are discussed. The findings highlight the need for comprehensive assessment of psychosocial functioning of cancer patients. They demonstrate that even non-emotionally distressed patients can have very different profiles of adjustment and may benefit from correspondingly individually tailored psychosocial interventions.

Early detection of skin cancer: racial/ethnic differences in behaviors and attitudes.

Data from 384 individuals participating in a worksite skin cancer screening program were used to assess racial/ethnic differences in attitudes toward and practice of prevention and early detection of skin cancer. Caucasians and Hispanics were more likely than African Americans to report having used a sunscreen during the past year. Caucasians performed skin self-examination more frequently than Hispanics, but African Americans did not differ in their frequency of skin self-examination from the other two groups. African Americans and Hispanics reported that they would be less likely than Caucasians to seek immediate follow-up care for suspicious skin lesions. Both similarities and differences were found in a variety of health belief variables across the three groups. These findings suggest a need for intensified efforts at primary and secondary prevention of skin cancer among African Americans.

Anxiety in medical situations and chemotherapy-related problems among cancer patients.

Relationships between anxiety in medical situations and age, gender, duration of illness, and communication problems with friends or relatives were examined in a heterogeneous sample of 117 adult cancer patients. The relationships between the same demographic, medical, and psychosocial variables and chemotherapy-related problems in a subsample of 79 patients receiving chemotherapy also were examined. Results indicated that females and patients who reported more communication problems with friends or relatives reported more anxiety in medical situations. Female patients and patients who reported more communication problems with friends or relatives also reported more chemotherapy-related problems. Duration of illness was not related significantly to either dependent measure. Clinical implications of these results are discussed.

Skin self-examination in a population at increased risk for skin cancer.

This cross-sectional study examined predictors of skin self-examination (SSE) in a population at increased risk for skin cancer. Subjects were 384 hospital employees participating in a worksite skin cancer screening. Although 61% reported that they performed SSE at least once during the past year, only 20% reported monthly SSE. Only a minority of the subjects were knowledgeable about most of the recommended SSE steps. Based on behavioral self-regulation theory, multivariate analysis showed that a variety of psychological factors (including optimism, knowledge about SSE, perceived self-efficacy, and number of reasons for doing SSE) correlated positively with frequency of SSE. Demographic variables accounted for about 6% of the variance in frequency of SSE. Overall, the variables in this model accounted for about 25% of the variance.

Physical and psychosocial needs of cancer patients.

A collaborative multidisciplinary study was conducted to assess both physical and psychosocial needs of 117 adults with various types of cancers. Although these patients functioned adequately in many areas of their lives, they reported that cancer and its treatment had an impact on energy, physical and recreational activities, communication with spouse, sexual and emotional functioning, occupational matters, and treatment-related situations. Younger patients reported more psychosocial, sexual, and treatment-related problems than did older patients. Female patients reported more chemotherapy-related problems than did male patients. Implications for clinicians treating cancer patients were discussed.