Psychological status at time of diagnosis and patients' ratings of cosmesis following radiation therapy for breast cancer.

This retrospective pilot study examined the relationship between psychological status at the time of breast cancer diagnosis and ratings of cosmetic outcome later. Sixty-three patients completed measures of depression, anxiety, and quality of life at the time of diagnosis. Following lumpectomy and radiation therapy, these patients and their radiation oncologists completed ratings of the quality of the cosmetic outcome (Cosmesis). The results indicated that both psychological distress and quality of life were related to patients' ratings of Cosmesis, while only patients' quality of life was related to physicians' ratings of Cosmesis. We conclude that Cosmesis is a multifaceted construct that incorporates both physical and psychological factors.

The full potential of breast cancer screening use to reduce mortality has not yet been realized in the United States.

OBJECTIVE: Breast cancer mortality has been declining in European countries and the United States since the early 1990s. Based on breast cancer screening programs in western European countries, the reduction in mortality results from a predictable pattern of increasing early-stage and subsequent declining incidence of late-stage cancers. The purpose of this study was to determine whether changes in the incidence of early-stage and late-stage breast cancers has occurred in the United States to suggest that a reduction in breast cancer mortality is the result of screening. METHOD: The analyses are based on women 50-69 years of age using 1990-1998 Surveillance, Epidemiology, and End Results data. Five indicators that are precursors to reductions in mortality are described: in situ breast cancer, T1 tumors (< 2 cm), stage II-IV tumors, lymph node-positive cancers, and locally advanced breast cancers (LABC). RESULTS: The rate of in situ tumors increased from 37.8 to 67.0 per 100,000 population and that of T1 tumors increased from 143.5 to 163.5 per 100,000 population during 1990-1998. The rates of stage II-IV tumors, lymph node-positive cancers, and LABC remained unchanged at about 120 per 100,000, 76 per 100,000, and 17 per 100,000 population, respectively. CONCLUSIONS: Although there has been an increase in early-stage breast cancers (in situ and T1 tumors), the prerequisite decline in late-stage cancers has not yet occurred in the United States--a pattern that was observed in European studies. Possible explanations include the lack of widespread mammography use during the 1980s and, therefore, insufficient elapsed time since mammography use has become more widespread.

Disparities related to socioeconomic status and access to medical care remain in the United States among women who never had a mammogram.

OBJECTIVE: This study examined whether disparities in mammography use between women of differing socioeconomic status (SES; income and education) and varying access to medical care (healthcare insurance and routine medical check-up) remained over time despite overall increased breast cancer screening. METHODS: Analysis of changes over time were made using data from the 1992, 1996, and 2000 Behavioral Risk Factor Surveillance System data from 53,846 women 50-69 years of age. Women who reported that they never had a mammogram were compared with those who ever had a mammogram. Multivariate logistic regression was used to determine whether and to what extent disparities between subgroups of women changed over time. RESULTS: The percentage of women 50-69 years of age who had never had a mammogram declined 65% from 22.1% in 1992 to 7.7% in 2000. Racial and ethnic differences in mammography prevalence disappeared over time. However, disparities among women of differing SES and among those with varying access to medical care remained based on multivariate analysis. CONCLUSIONS: Despite a substantial reduction in the proportion of women who had never had a mammogram among women 50-69 years of age from 1992 to 2000, disparities in use of mammography among the various population subgroups persisted.