ABSTRACT
PURPOSE: Despite the effectiveness of chemoprevention (tamoxifen and raloxifene) in preventing breast cancer among women at high risk for the disease, uptake is low. The objective of this study was to determine the tradeoff preferences for various attributes associated with chemoprevention among women not currently taking the drugs. METHODS: We used rating-based conjoint analysis to evaluate the relative importance of a number of attributes associated with chemoprevention, including risk of side effects, drug effectiveness, time needed to take the drugs, and availability of a blood test to see if the drugs were working in an Internet sample of women. We generated mean importance values and part-worth utilities for all attribute levels associated with taking chemoprevention. We then used multivariable linear regression to examine attribute importance scores controlling for participant age, race, Hispanic ethnicity, educational level, and a family history of breast cancer. RESULTS: Overall interest in taking chemoprevention was low among the 1094 women included in the analytic sample, even for the scenario in which participants would receive the greatest benefit and fewest risks associated with taking the drugs. Time needed to take the pill for it to work and 5-year risk of breast cancer were the most important attributes driving tradeoff preferences between the chemoprevention scenarios. CONCLUSIONS: Interest in taking chemoprevention among this sample of women at average risk was low. Addressing women's concerns about the time needed to take chemoprevention for it to work may help clinicians improve uptake of the drugs among those likely to benefit.
Subject(s)
Breast Neoplasms/psychology , Chemoprevention/psychology , Estrogen Antagonists/standards , Patient Acceptance of Health Care/psychology , Adult , Breast Neoplasms/drug therapy , Breast Neoplasms/prevention & control , Chemoprevention/adverse effects , Chemoprevention/methods , Decision Making , Estrogen Antagonists/administration & dosage , Estrogen Antagonists/adverse effects , Female , Guideline Adherence/statistics & numerical data , Humans , Linear Models , Marketing/methods , Middle Aged , Patient Acceptance of Health Care/statistics & numerical data , Practice Guidelines as Topic , Risk Assessment/methods , Risk Assessment/statistics & numerical data , Time Factors , United StatesABSTRACT
BACKGROUND: The purpose of the present paper was to review the management of men referred to a breast clinic with presumed gynaecomastia. METHODS: A retrospective analysis was carried out of 175 men over the age of 16 years who presented with breast enlargement and/or 'lumps', during a 7-year period to a single-surgeon. All patients had complete biochemical assessment (liver function tests, gamma-glutamyl transferase, prolactin, alpha-fetoprotein, beta-human chorionic gonadotropin), and mammography and/or ultrasound with fine-needle biopsy if indicated. RESULTS: One hundred and seventy-five men, median age 44 years (range: 18-89 years), were assessed. Thirty-nine had bilateral true gynaecomastia and 88 had unilateral gynaecomastia (53% left). Carcinoma of the breast was diagnosed in eight, pseudo-gynaecomastia in 18, 13 had physiological pubertal changes only and nine had other diagnoses. Adverse drug reactions were possibly implicated in the aetiology of 47 patients, alcohol in seven patients, cannabis in one patient, testicular malignancy in four patients and hepatocellular carcinoma in one patient. Five patients were found to have hyperprolactinaemia. Twenty-four per cent of patients were reassured without intervention; 18% failed to attend follow up. Sixteen per cent were treated with danazol, 15% underwent surgery and 28 were referred for management of their cause. Danazol was effective in 81%, and three patients required surgery when danazol was ineffective. One further patient developed testicular cancer 9 months after presentation. CONCLUSION: Men presenting to a breast clinic require clinical assessment to exclude diagnoses other than gynaecomastia. True gynaecomastia can be managed with exclusion of causative factors by non-invasive investigation and examination. Many patients can be reassured as to the idiopathic nature of the condition and many will fail to attend follow up. Danazol is successful in some patients and surgery should be reserved for resistant cases.
Subject(s)
Danazol/standards , Estrogen Antagonists/standards , Gynecomastia/diagnosis , Gynecomastia/therapy , Practice Guidelines as Topic/standards , Practice Patterns, Physicians'/standards , Surgical Procedures, Operative/standards , Adolescent , Adult , Aged , Aged, 80 and over , Danazol/administration & dosage , Danazol/therapeutic use , Estrogen Antagonists/administration & dosage , Estrogen Antagonists/therapeutic use , Gynecomastia/etiology , Humans , Male , Middle Aged , Patient Selection , Retrospective Studies , Risk FactorsABSTRACT
Compound CDRI-85/287: 2-[4-(2-N-piperidinoethoxy) phenyl]-3-phenyl (2H) benzo (b) pyran has been identified as a potent antiimplantation agent in rat. A single oral dose (2.5 mg/kg body weight) of the compound administered on days 1, 2 or 3 of pregnancy or multiple dosing (0.05 mg/kg daily) on days 5-7 postcoitum effectively prevented pregnancy. When administered on days 5-7 postcoitum, it failed to interrupt pregnancy even at 20 mg/kg dose. The compound is a potent antiestrogen, with very weak uterotrophic activity; it does not induce vaginal cornification in immature ovariectomised rat. Also, it is devoid of progestational, antiprogestational, androgenic, antiandrogenic and antigonadotrophic activities. The results suggest that the compound exerts its antiimplantation acivity in rat by virtue of its antiestrogenic activity [corrected].
