Limiting comorbid conditions and breast cancer stage at diagnosis.

BACKGROUND: Contrasting hypotheses exist regarding the relationship between comorbidity and breast cancer stage at diagnosis. One suggestion is that disabling comorbid conditions would result in a later stage diagnosis of breast cancer because such conditions would limit mobility and thus access to medical care. This article examines this hypothesis by building a comorbidity summary measure of functionally limiting comorbid conditions and by testing the effectiveness of this measure in predicting the stage at which breast cancer is diagnosed. METHODS: Cases with newly diagnosed breast cancer were identified through the population-based Metropolitan Detroit Cancer Surveillance System, a participant of the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute. Of 1191 eligible cases, 1011 (85%) were interviewed 2-4 months following diagnosis. The analyses for this study were limited to 731 cases for which there were complete data on all variables. Five individual comorbid conditions that predicted functional limitation were combined into a comorbidity summary measure: arthritis, eye conditions, gastrointestinal conditions, kidney conditions, and respiratory conditions. Breast cancer stage was categorized in relation to whether women had local or advanced (regional or remote) disease. RESULTS: Women with two or more of these five functionally limiting conditions were about half as likely as those with none of these conditions to receive an advanced stage diagnosis of breast cancer (odds ratio [OR] = 0.49, 95% confidence interval [CI] 0.28-0.86, p = .01). CONCLUSIONS: These findings do not support the suggestion that the presence of disabling comorbid conditions results in later stage breast cancer. The five conditions summarized by this measure, although functionally limiting, may also require greater medical monitoring due to associated symptoms and/or treatment requirements and thus lead to increased opportunities for cancer screening.

Coverage of beverage alcohol issues in the print media in the United States, 1985-1991.

OBJECTIVES: This study assessed the portrayal of alcohol-related issues in the print media in the United States during the 7-year period bracketing implementation of the US alcohol warning label act in November 1988. METHODS: All articles that appeared from 1985 to 1991 in 5 national newspapers and that were indexed as dealing with beverage alcohol were identified. Content analysis of a 15% sample of these articles allowed an in-depth assessment of the conceptualization of alcohol in the US print media. RESULTS: A slight decrease in articles related to alcoholism was offset by an increase in articles about the more general health-related effects of alcohol. The warning label act received little attention. Most articles portrayed alcohol neutrally or negatively, using information from government sources. CONCLUSIONS: Portrayal of alcohol in the US print media has changed in recent decades. A general shift noted as early as the 1960s has increasingly emphasized public health issues and deemphasized clinical aspects of alcoholism. This has been accompanied by a continuing shift away from a biopsychological definition of alcohol-related behavior to a definition stressing external environmental factors.

Alcohol consumption and breast cancer stage at diagnosis.

The stage at which breast cancer is diagnosed is an important determinant of prognosis. In contrast to the many investigations of the relationship between alcohol consumption and the risk of developing breast cancer, few have examined how alcohol consumption may affect the stage of this cancer at diagnosis. This article examines the relationship between alcohol intake and breast cancer stage and assesses consumption in relation to the volume of drinks consumed per week and the patterns of consumption 1 year prior to the breast cancer diagnosis. A total of 1191 women, aged 40 to 84 years, with newly diagnosed breast cancer were identified through the population-based Metropolitan Detroit Cancer Surveillance System, a participant of the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute. Of these, 1011 (85%) were interviewed 2 to 4 months following diagnosis. The analyses for this article were limited to 920 cases with local and regional stage disease. The bivariate analysis showed that frequent drinkers were more likely than abstainers or infrequent drinkers to present with regional disease. Logistic regression showed that frequent drinkers were 1.45 times more likely than infrequent drinkers to be diagnosed with later stage breast cancer (95% CI: 1.01-2.10; p = 05). The association between alcohol consumption and disease stage may be due to the relationship between heavy consumption and other unhealthy behaviors. In addition, women who drink more frequently may have less awareness of and access to cancer screening services. Heavy exposure to alcohol may also contribute to accelerated tumor growth once breast cancer is present.

Examining the link between provider roles and program development: Findings from a process evaluation of a community-based drug prevention program.

This paper presents data from a process/formative evaluation of the Real Alternatives Project (RAP), a community-based substance abuse prevention program for "high-risk" adolescents. The challenge of integrating diverse services for a multi-cultural population required the establishment of an innovative provider role-that of the community case counselor. This paper describes the process of role identity among these case counselors within the context of a developing program. Their role evolved from simple case managers to that of generalists. Serving as case managers, counselors, mentors, role models, and advocates, they met clients' multiple needs. Organizational needs were met through their role in implementing and integrating services and their participation in decision making. The evaluation documented and legitimized this process of role and program evolution. The importance of incorporating process evaluation as an equal partner in program development and implementation is discussed.

Women's knowledge about breast cancer. Dimensions of knowledge and scale development.

Evidence suggests that knowledge about breast cancer may influence secondary prevention, care-seeking behavior, and participation in treatment decision-making. Yet few standardized measures of breast cancer knowledge are in existence. Using factor analysis, this paper describes the structure of women's knowledge about breast cancer and uses that structure to develop a measurement scale. Principal axis factoring and varimax rotation yielded a nine factor solution, which accounted for 59.3% of the common variance. Interpretation of the conceptual structure of these factors suggests that knowledge is organized around breast cancer treatment, misconceptions, risk factors, symptoms, menstruation, and prevalence. Considering only those items with factor loadings of .35 and greater, and including only those factors containing three or more items, a 16-item scale, which included four factor-based subscales covering knowledge about breast cancer treatment, misconceptions, risks, and symptoms was developed. Internal consistency reliability of the total scale and of the four subscales was high (alphas = .76-.95). Using chi square analysis, it was found that levels of knowledge on the total scale and on the treatment and symptom subscales are associated with age, education, income, and history of breast cancer. Knowledge on the misconceptions subscale was associated with age, education, and income. Knowledge on the risks subscale was associated with age and education. Issues of reliability and validity of the scale as well as directions for future research in this area are discussed.

The perineal field in the external irradiation of cancer of the prostate: a modified Regato technique. First Annual del Regato Distinguished Lecture.

(1) 50 consecutive patients with cancer of the prostate, stages A2 through C2 received external irradiation. The whole pelvis was treated using 4-MV photons, and a prostate boost was given through the perineum using a cesium-137 teletherapy unit. (2) The treatment technique was easily duplicated daily and was well tolerated. There were no grade 2, 3 or 4 complications. (3) Local control was excellent: 96% of all cases. (4) Disease-free survival was high. (5) Potency was maintained in the majority of this elderly population. Considering that American males have an increasing longevity and thus a greater likelihood of developing cancer of the prostate, external-beam radiation therapy should be utilized in the future even more so than today. We must continue to refine radiation therapy techniques in order to further increase disease-free survival and reduce radiation morbidity.