Mammography screening among Arab American women in metropolitan Detroit

Mammography screening behavior has not been well studied among Middle Eastern immigrant women. We conducted a telephone survey of 365 Arab American women residing in metropolitan Detroit, home to one of the largest populations of Middle Eastern immigrants in the US, to determine prevalence of factors associated with mammography, and attitudes and beliefs regarding mammography screening. Of 365 participants, only five were born in the US. Mean age was 53.2 years (SD 10.8). Two hundred twelve (58.1%) reported having mammogram every 1-2 years; 70% ever had mammogram. Age 50-64 years, having health insurance, married status, being in the US over 10 years, and being Lebanese were associated with mammography every 1-2 years. After adjusting for demographic factors, perceived seriousness of disease, general health motivation, and having fewer barriers were associated with more frequent screening. Appropriate mammography screening is decreased in this group. Targeted outreach regarding screening is appropriate for this population; however, lack of insurance may prevent adequate follow-up.

Spatially resolved characterization of Xe ion irradiated LiF crystals using static field gradient NMR

Spatially resolved (19)F and (7)Li nuclear magnetic resonance (NMR) spin-lattice relaxation rates have been measured in LiF crystals irradiated with 1.44 GeV Xe ions at fluences from 10(10) to 10(12) ions cm(-2). In addition, the F-centre concentration has been measured by optical absorption spectroscopy and the concentration of paramagnetic centres by electron paramagnetic resonance (EPR). Within the ion range, the relaxation rate turns out to increase linearly with the concentration of paramagnetic centres but super-linearly with the F-centre concentration. Beyond the ion range, the relaxation rate is still significantly enhanced compared to non-irradiated LiF.

ADHD and Stroop interference from age 9 to age 41 years: a meta-analysis of developmental effects

BACKGROUND

In this meta-analysis, we investigated whether response inhibition is sensitive to attention deficit hyperactivity disorder (ADHD) status and, if so, what influence maturation has on this attentional symptom of ADHD.

METHOD

We examined 25 studies that reported data on the Stroop color word test in children and adults with ADHD and in age-matched controls; average ages ranged from 9 to 41 years. We utilized a hierarchical approach to analyze the strength of the Stroop effect and whether the effect varies as a function of age. Additionally, we assessed potential differences in maturation rates based on reaction time (RT) of color and color-word conditions.

RESULTS

First, we found that the relationship between color-word and color RT was multiplicative, and the slope of this function (the ratio of color-word RT over color RT) was identical across age groups and ADHD status. Second, we found that although ADHD individuals were on average 1.14 times slower than age-matched controls in both the color and the color-word condition, the maturation rate was identical for both groups.

CONCLUSIONS

The results from this analysis indicate that the Stroop interference effect is not larger in ADHD individuals than in age-matched controls. Further, we did not find evidence for differential maturation rates for persons with ADHD and the control groups. The Stroop interference effect appears to be immune to age, regardless of ADHD status.

Spatially resolved characterization of heavy ion irradiated crystals using static field gradient nuclear magnetic resonance

Static magnetic field gradient NMR has been used for one-dimensional spatial (19)F spin-lattice relaxation profile studies (resolution of the order of 10 µm) in a LiF crystal irradiated with U ions. Technical aspects of the use of large static magnetic field gradients are discussed as well as a special data acquisition mode allowing for effectively measuring spatially resolved spin-lattice relaxation rates as low as 10(-3) s(-1). In addition to the expected enhanced spin-lattice relaxation rate within the ion range, also an enhanced rate beyond the ion range has been found.

Racial differences in cervical cancer survival in the Detroit metropolitan area

BACKGROUND

African-American (AA) women have lower survival rates from cervical cancer compared with white women. The objective of this study was to examine the influence of socioeconomic status (SES) and other variables on racial disparities in overall survival among women with invasive cervical cancer.

METHODS

One thousand thirty-six women (705 white women and 331 AA women) who were diagnosed with primary invasive cancer of the cervix between 1988 and 1992 were identified through the Metropolitan Detroit Cancer Surveillance System (MDCSS), a registry in the Surveillance, Epidemiology, and End Results (SEER) database. Pathology, treatment, and survival data were obtained through SEER. SES was categorized by using occupation, poverty, and educational status at the census tract level. Cox proportional hazards models were used to compare overall survival between AA women and white women adjusting for sociodemographics, clinical presentation, and treatment.

RESULTS

AA women were more likely to present at an older age (P<.001), with later stage disease (P<.001), and with squamous histology (P=.01), and they were more likely to reside in a census tract categorized as Working Poor (WP) (P<.001). After multivariate adjustment, race no longer had a significant impact on survival. Women who resided in a WP census tract had a higher risk of death than women from a Professional census tract (P=.05). There was a significant interaction between disease stage and time with the effect of stage on survival attenuated after 6 years.

CONCLUSIONS

In this study, factors that affected access to medical care appeared to have a more important influence than race on the long-term survival of women with invasive cervical cancer.

Conflicts in decision-making for breast cancer surgery

BACKGROUND

Little is known about the interaction among surgeons, patients, and other physicians in selecting breast cancer surgery.

METHODS

We contacted attending surgeons (n = 456) of a population-based sample of 2645 breast cancer patients diagnosed in Detroit and Los Angeles from December 2001 to January 2003. Eighty percent completed a written survey with clinical scenarios.

RESULTS

The mean surgeon age was 50 years, 50% practiced in a community hospital, and breast cancer averaged 31% of practice volume. The mean number of years in practice was 17.2. Female surgeons made up 14.4% of the sample and 35% of the high-volume surgeons. Conflict with patients and other providers was reported by 58% and 32% of surgeons, respectively. When the patient preferred mastectomy and the surgeon favored BCS, conflict was reported by 49.9% of surgeons. Compared with low-volume surgeons, high-volume surgeons were significantly more likely to report conflict in this scenario (44% vs 62%; P = .047). When another provider preferred mastectomy and the respondent surgeon favored BCS, conflict was reported by 34% of surgeons and was more common for high-volume surgeons (P < .001). In a logistic regression model, surgeon volume and practice setting were strongly associated with conflict in this scenario.

CONCLUSION

High-volume surgeons and those in cancer centers more frequently endorse current clinical guidelines that favor BCS over mastectomy, resulting in greater conflict with patients. These findings support patient reports that patient choice is a key factor in continued mastectomy use.

Disentangling the effects of race on breast cancer treatment

BACKGROUND

African Americans (AA) have higher mortality from breast cancer compared with white Americans (WA). Studies using population-based cancer registries have attributed this to disparities in treatment after normalizing the AA and WA populations for differences in disease stage. However, those studies were hampered by lack of comorbidity data and limited information about systemic treatments. The objective of the current study was to investigate racial disparities in breast cancer treatment by conducting a comprehensive medical records review of women who were diagnosed with breast cancer at the Karmanos Cancer Institute (KCI) in Detroit, Michigan.

METHODS

The study cohort consisted of 651 women who were diagnosed with primary breast cancer between 1990 and 1996 at KCI. Multivariable logistic regression analysis controlling for sociodemographic factors, tumor characteristics, comorbidities, and health insurance status was used to assess whether there were differences between WA and AA in the receipt of breast-conserving surgery (BCS), radiation, tamoxifen, and chemotherapy.

RESULTS

There was no significant difference between WA and AA in the receipt of BCS versus mastectomy. Patients with local-stage disease who were enrolled in government insurance plans underwent mastectomy more often (vs BCS plus radiation) compared with patients who were enrolled in nongovernment plans. The rates of receipt of tamoxifen and chemotherapy were similar for local-stage WA and local-stage AA. However, WA were more likely to receive tamoxifen and/or chemotherapy for regional-stage disease. Married women with regional disease were more likely to receive chemotherapy than nonmarried women.

CONCLUSIONS

The results from this study may be used to target educational interventions to improve the use of adjuvant therapies among AA women who have regional-stage disease.

Factors associated with patient involvement in surgical treatment decision making for breast cancer

OBJECTIVE

To evaluate factors associated with women's reported level of involvement in breast cancer surgical treatment decision making, and the factors associated with the match between actual and preferred involvement in this decision.

METHODS

Survey data from breast cancer patients in Detroit and Los Angeles was merged with surgeon data for an analytic dataset of 1101 patients and 277 surgeons. Decisional involvement and the match between actual and preferred amount of involvement were analyzed as three-level dependent variables using multinomial logistic regression controlling for clustering within surgeons. Independent variables included patient demographic and clinical factors, surgeon demographic and practice factors, cancer program designation, and two measures of patient-surgeon communication.

RESULTS

We found variation in women's actual decisional involvement and match between actual and preferred involvement. Women with a surgeon-based or patient-based (versus shared) decision were significantly (p < or = 0.05) younger. Women who had too little decisional involvement (versus the right amount) were younger, while women with too much involvement had less education. Patient-surgeon communication variables were significantly associated with both involvement and match, and higher surgeon volume as associated with too little involvement.

CONCLUSION

Patient factors and patient-surgeon communication influence women's perception of their involvement in breast cancer surgical treatment decision making.

PRACTICE IMPLICATIONS

Decision tools are needed across surgeons and practice settings to elicit patients' preferences for involvement in treatment decisions for breast cancer.

Patterns and Correlates of Patient Referral to Surgeons for Treatment of Breast Cancer

Purpose

Characteristics of surgeons and their hospitals have been associated with cancer treatments and outcomes. However, little is known about factors that are associated with referral pathways.

Methods

We analyzed tumor registry and survey data from women with breast cancer diagnosed in 2002 and reported to the Detroit and Los Angeles Surveillance, Epidemiology, and End Results registries (n = 1,844; response rate, 77.4%) and their attending surgeons (n = 365; response rate 80.0%).

Results

About half of the patients (54.3%) reported that they were referred to the surgeon by another provider or health plan; 20.3% reported that they selected the surgeon; and 21.9% reported that they both were referred and were involved in selecting the surgeon. Patients who selected the surgeon based on reputation were more likely to have received treatment from a high-volume surgeon (adjusted odds ratio [OR], 2.2; 95% CI, 1.5 to 3.4) and more likely to have been treated in an American College of Surgeons–approved cancer program or a National Cancer Institute (NCI) –designated cancer center (adjusted OR, 2.0; 95% CI, 1.3 to 3.1; adjusted OR, 3.4; 95% CI, 1.9 to 6.2, respectively). Patients who were referred to the surgeon were less likely to be treated in an NCI-designated cancer center (adjusted OR, 0.5; 95% CI, 0.3 to 0.9).

Conclusion

Women with breast cancer who actively participate in the surgeon selection process are more likely to be treated by more experienced surgeons and in hospitals with cancer programs. Patients should be aware that provider or health plan–based referral may not connect them with the most experienced surgeon or comprehensive practice setting in their community.

An informed decision? Breast cancer patients and their knowledge about treatment

OBJECTIVE

Although involving women in breast cancer treatment decisions is advocated, there is little understanding of whether women have the information they need to make informed decisions. The objective of the current study was to evaluate women's knowledge of survival and recurrence rates for mastectomy and breast conserving surgery (BCS) and the factors associated with this knowledge.

METHODS

We used a population-based sample of women diagnosed with breast cancer in metropolitan Los Angeles and Detroit between December 2001 and January 2003. All women with ductal carcinoma in situ and a random sample of women with invasive disease were selected (N=2382), of which 1844 participated (77.4%). All participants were mailed surveys. The main outcome measures were knowledge of survival and recurrence rates by surgical treatment type.

RESULTS

Only 16% of women knew that recurrence rates were different for mastectomy and BCS, and 48% knew that the survival rates were equivalent across treatment. Knowledge about survival and recurrence was improved by exposure to the Internet and health pamphlets (p<0.01). Women who had a female (versus male) surgeon, and/or a surgeon who explained both treatments (rather than just one treatment) demonstrated higher survival knowledge (p<0.01). The majority of women had inadequate knowledge with which to make informed decisions about breast cancer surgical treatment.

CONCLUSION

Previous explanations for poor knowledge, such as irrelevance of knowledge to decision making and lack of access to information, were not shown to be plausible explanations for the low levels of knowledge observed in this sample.

PRACTICE IMPLICATIONS

These results suggest a need for fundamental changes in patient education to ensure that women are able to make informed decisions about their breast cancer treatment. These changes may include an increase in the use of decision aids and in decreasing the speed at which treatment decisions are made.

The influence of race, ethnicity, and individual socioeconomic factors on breast cancer stage at diagnosis

OBJECTIVES

Previous research has generally found that racial/ethnic differences in breast cancer stage at diagnosis attenuate when measures of socioeconomic status are included in the analysis, although most previous research measured socioeconomic status at the contextual level. This study investigated the relation between race/ethnicity, individual socioeconomic status, and breast cancer stage at diagnosis.

METHODS

Women with stage 0 to III breast cancer were identified from population-based data from the Surveillance, Epidemiology, and End Results tumor registries in the Detroit and Los Angeles metropolitan areas. These data were combined with data from a mailed survey in a sample of White, Black, and Hispanic women (n=1700). Logistic regression identified factors associated with early-stage diagnosis.

RESULTS

Black and Hispanic women were less likely to be diagnosed with early-stage breast cancer than were White women (P< .001). After control for study site, age, and individual socioeconomic factors, the odds of early detection were still significantly less for Hispanic women (odds ratio [OR]=0.45) and Black women (OR = 0.72) than for White women. After control for the method of disease detection, the White/Black disparity attenuated to insignificance; the decreased likelihood of early detection among Hispanic women remained significant (OR=0.59).

CONCLUSION

The way in which racial/ethnic minority status and socioeconomic characteristics produce disparities in women's experiences with breast cancer deserves further research and policy attention.

[Diagnostic value of a two-dimensional echocardiographic score for left ventricular hypertrophy validated by the Imatron CT scan in familial hypertrophic cardiomyopathy]

The aim of this study was to validate a two-dimensional echocardiographic score for left ventricular hypertrophy in familial hypertrophic cardiomyopathy (HCM) by fast CT scan and to study the diagnostic value by an indexed threshold value in affected and genotyped families in comparison with the classical diagnostic method of maximal wall thickness (E max). The study was performed successively in two patient groups with HCM. The echo/CT scan population comprised 26 patients. They underwent echocardiography and Imatron CT scanning. The E max and 2D echo score (sum of the thickness of 4 segments) were measured by echocardiography and compared to the left ventricular mass obtained by the CT method. The 2D echo score was closely correlated to the CT left ventricular mass (r = 0.85) with a higher correlation coefficient than the E max (r = 0.78). The echo/generic population comprised 109 genotyped adults with an identified mutation. The E max and 2D echo score were measured. The genotype was the reference for diagnosis. A theoretical value of the 2D echo score was determined in healthy individuals by a multiple linear regression model of ages, sex and body surface area. A threshold value for abnormality was established after analysis of the ROC. The sensitivity and specificity were 63% and 100% respectively for E max and 73% and 96% respectively for the indexed 2D echo score. The improvement in sensitivity was marked in young adults (< 50 years) with 69% for the indexed 2D echo score versus 54% for E max, p < 0.04. The authors conclude that the indexed 2D score has been validated as an index of hypertrophy by the Imatron CT and has a better diagnostic value than E max, especially in young adults. This echocardiographic criterion could be proposed as an alternative diagnostic sign for screening families.

Cocaine, but not amphetamine, short term treatment elevates the density of rat brain vesicular monoamine transporter 2

We compared the effect of 5 days D-amphetamine (5 mg/kg/day i.p.) and cocaine (15 mg/kg/day i.p.) administration on the vesicular monoamine transporter 2 (VMAT2) density in rat brain. VMAT2 expression was assessed by [(3)H]dihydrotetrabenazine high affinity binding. Cocaine administration led to significant increases in VMAT2 density in both prefrontal cortex (+40%, p < 0.01) and striatum (+23%, p < 0.05), while amphetamine did not affect VMAT2 expression. The upregulation of VMAT2 may serve as compensatory mechanism aimed to enhance the vesicular monoamine storage capacity.

Elevated platelet vesicular monoamine transporter 2 in former heroin addicts maintained on methadone

The brain vesicular monoamine transporter (VMAT2) is essential for neuronal monoamine storage and regulation of monoaminergic neurotransmission. We demonstrated previously a high degree of similarity between the pharmacodynamic characteristics of platelet and brain VMAT2. Opioids induce increase of dopamine release in limbic structures. In the present study we assessed the VMAT2 pharmacodynamic characteristics using high affinity [(3)H]dihydrotetrabenazine (TBZOH) binding to platelets of former male heroin addicts maintained on methadone (n = 12) compared to age-matched healthy controls (n = 13). A significant increase (19%, p < 0.05) in platelet VMAT2 density (Bmax) was observed in the methadone treated patients compared to controls. There was no significant difference in the affinity of [(3)H]TBZOH to its platelet binding site. The increased VMAT2 density may reflect a compensatory attempt to prevent vesicular depletion due to chronic methadone exposure.

Correlates of Between-Surgeon Variation in Breast Cancer Treatments

BACKGROUND

Determinants of between-surgeon variation in breast cancer treatment utilization are not well understood.

OBJECTIVES

The objectives of this study were to evaluate variation in receipt of surgical treatment (ie, mastectomy or breast-conserving surgery with or without radiation) for women with stage I, II, or III breast cancer and receipt of breast reconstruction attributable to surgeons, and to assess factors associated with this between-surgeon variation.

METHODS

We surveyed all attending surgeons (n = 456) of a population-based sample of patients with breast cancer diagnosed in Detroit and Los Angeles during 2002 (n = 1844). Our analytic dataset linked data from 1477 patients with that of 311 surgeons. We used random-effects modeling to account for the multilevel dataset and evaluated 2 outcomes: 1) primary surgical treatment (mastectomy vs. BCS); and 2) receipt of reconstruction before being surveyed (yes vs. no). Independent variables included patient-related factors (clinical and demographic), surgeon-related factors (breast procedure volume, practice setting, and demographics), surgeon treatment recommendation, and referral propensity.

RESULTS

Surgeons explain some variation in use of both mastectomy and reconstruction (9.9% and 26%, respectively). Patient clinical factors and surgeon volume together explain approximately one-third of the between-surgeon variation in mastectomy. Patient factors and surgeon demographics explain approximately 60% of between-surgeon variation in reconstruction, and surgeon referral propensity explains an additional 15%.

CONCLUSION

Our findings suggest that similar patients may get different treatment depending on their surgeon. Broader dissemination of guidelines coupled with increasing patient access to consultations before definitive surgery may reduce between-surgeon variation. Contributing factors such as patient-physician communication should be explored.

Correlates of patient referral to surgeons for treatment of breast cancer

6032

Background: Characteristics of surgeons and their practice settings have been associated with cancer treatments and outcomes. Yet, there is little information about factors that are associated with referral pathways to surgeons and treatment settings. Methods: We merged and analyzed tumor registry and survey data from all women with DCIS and a 20% random sample of women with invasive breast cancer diagnosed in 2002 and reported to the Detroit and Los Angeles SEER registries (N = 1,844, response rate 77.4%,) and their surgeons (N = 365, response rate 80.0%). Results: About half of the patients (54.2%) reported that they were referred to their surgeon by another provider or health plan; 20.3% reported that they selected their surgeon; 21.9% reported that they both were referred and were involved in selecting their surgeon; and the remaining patients (4.9%) reported that they had a prior relationship with their surgeon primarily through previous surgery. Selecting their surgeon based on reputation was more frequently reported by white patients (36.5% vs 26.5%, p < .001), and more highly educated patients (40.0% and 21.6%, respectively for highest and lowest education categories, p < .001). Patients who selected their surgeon based on reputation were more likely to have received treatment from a high volume surgeon (adjusted odds ratio 2.3; 95% CI 1.7, 3.2) and more likely to have been treated in an American College of Surgeon approved cancer program or NCI-designated cancer center (adjusted odds ratio 1.8; 95% CI 1.1, 2.8; 3.0 95% CI 1.6, 5.3, respectively). Patients who were referred to their surgeon were less likely to be treated in an NCI-designated cancer center (adjusted OR 0.4; 95% CI 0.2, 0.8). Conclusions: Women with breast cancer who actively participate in the surgeon selection process are more likely to be treated by more experienced surgeons and in hospitals with approved cancer programs. Patients should be aware that provider or health plan-based referral may not connect them with the most experienced surgeon or comprehensive practice setting in their community. An active patient role in the surgeon selection process has important implications for both the type of treatment received and where care is delivered.

No significant financial relationships to disclose.

Patient and surgeon correlates of shared decision making for surgical breast cancer treatment

6031

Background: The choice of surgical breast cancer treatment represents an opportunity for shared decision making (SDM), since both mastectomy and breast conserving surgery are viable options. Yet women vary in their desire for involvement in this decision. Correlates of SDM and/or the level of involvement in breast cancer surgical treatment decision-making are not known. Methods: Breast cancer patients of Detroit and Los Angeles SEER registries were mailed a questionnaire shortly after diagnosis in 2002 (N = 1,800, RR: 77%). Their responses were merged with a surgeon survey (N = 456, RR: 80%) for a dataset of 1,547 patients of 318 surgeons. Surgical treatment decision making was categorized into: 1) surgeon-based; 2) shared; or 3) patient-based. The concordance between a woman’s self-reported actual and desired decisional involvement was categorized as having more, less, or the right amount of involvement. Decision making and concordance were each analyzed as three-level dependent variables using multinomial logistic regression controlling for clustering within surgeons. Independent variables included patient clinical, treatment and demographic factors, surgeon demographic and practice-related factors, and a measure of surgeon-patient communication. Results: 37% of women reported the surgery decision was shared, 25% that it was surgeon-based, and 38% that it was patient-based. Two-thirds experienced the right amount of involvement, while 13% had less and 19% had more. Compared to women who reported a shared decision, those with surgeon-based decision were significantly (p < 0.05) more likely to have male surgeons, and those reporting a patient-based decision were more likely to have received mastectomy vs. breast conserving surgery. Women who were less involved in the surgery decision than they wanted were younger and had less education, while those with more involvement (vs. the right amount) more often had male surgeons. Patient-surgeon communication was associated with decisional involvement. Conclusions: Correlates of SDM and decisional involvement relating to surgical breast cancer treatment differ. Determining patients’ desired role in decision making may as important as achieving a shared decision for evaluating perceived quality of care.

No significant financial relationships to disclose.

Recall of age of weaning and other breastfeeding variables

BACKGROUND

Many studies of the impact of breastfeeding on child or maternal health have relied on data reported retrospectively. The goal of this study was to assess recall accuracy among breastfeeding mothers of retrospectively collected data on age of weaning, reasons for cessation, breast pain, lactation mastitis, and pumping.

METHODS

Women in Michigan and Nebraska, U.S.A. were interviewed by telephone every 3 weeks during the first 3 months after the birth of their child, and mailed a questionnaire at 6 months. A subset was interviewed again by telephone approximately 1-3.5 years after the birth. The results for the three recall periods, collected 1994-1998, were compared using correlation, linear and Cox regression analysis, and sensitivity and specificity estimates.

RESULTS

The 184 participants were aged 18-42, mostly white (95%) and 63% had an older child. The age of weaning tended to be overestimated in interviews 1-3.5 years after birth compared to those within 3 weeks of the event, by approximately one month for 1-3.5 year recall and two weeks for 6-month recall (p < 0.001 in both cases). Recall accuracy of reasons for weaning varied greatly by reason, with mastitis and return to work having the most recall validity. The sensitivity of 1-3.5 year recall of mastitis was 80%, but was only 54% for nipple cracks or sores.

CONCLUSION

Breastfeeding duration among short-term breastfeeders tended to be somewhat overestimated when measured at 1-3.5 years post-partum. Reporting of other breastfeeding characteristics had variable reliability. Studies employing retrospective breastfeeding data should consider the possibility of such errors.

Correlates of breast reconstruction: results from a population-based study

BACKGROUND

Immediate or early postmastectomy breast reconstruction is performed infrequently. To the authors' knowledge, little is known regarding surgeon or patient perspectives on reconstruction treatment decisions. The purpose of the current study was to identify patient attitudes and preferences associated with breast reconstruction, and whether these differed by race.

METHODS

A sample of women age < or = 79 years who were diagnosed with ductal carcinoma in situ and invasive breast carcinoma between December 2001 and January 2003 was identified from the Surveillance, Epidemiology, and End Results (SEER) registries of Detroit and Los Angeles. Eligible subjects completed a questionnaire at a mean of 7 months after diagnosis. The Wald chi-square test and logistic regression were used for data analysis.

RESULTS

Of the 1844 respondents, 646 underwent a mastectomy (35.0% of the total sample) and 245 of these patients received breast reconstruction (38.0%; of the mastectomy group). On multivariate analysis, younger patient age, higher educational levels, and earlier stage of disease were found to be significantly associated with breast reconstruction. Although 78.2% of women reported that breast reconstruction was discussed, only 11.2% correctly answered 3 basic knowledge questions regarding the procedure. The desire to avoid more surgery was the most common reason for not undergoing breast reconstruction.

CONCLUSIONS

The results of the current study found that the majority of women were aware of breast reconstruction but choose not to undergo the procedure. Lack of knowledge and a greater perception of barriers to the procedure were more common among African-American patients and women with a lower education level, suggesting a need for improved educational strategies.

Response rates in a case-control study: effect of disclosure of biologic sample collection in the initial contact letter

PURPOSE

Participants in epidemiology studies are often asked to complete an interview and to provide biospecimens. In a population-based case-control study of kidney cancer involving an interview and optional biospecimens, we examined whether mentioning the biospecimens in the initial contact letter adversely affects willingness to be interviewed.

METHODS

Eligible cases (n = 434) and controls (n = 775) in Detroit were alternately assigned to receive one of two versions of the contact letter. Both explained that the study involves an interview with 100 dollars compensation plus an optional component with additional compensation; only one disclosed that the optional component involved biospecimens.

RESULTS

There were no meaningful differences between the groups in willingness to be interviewed. However, among 303 cases and 351 controls already interviewed, the proportion providing biospecimens was higher in the fully informed group: for blood, the differences were 10.8 (95% CI, 2.0, 19.5) for cases and 6.7% (95% CI, -1.7, 15.1) for controls. Findings were similar for saliva.

CONCLUSIONS

In a study involving an interview and optional biospecimens, informing people about the samples in the contact letter seems preferable to a non-specific reference to a second study component. Both approaches yielded similar interview participation rates, but biospecimen participation rates were higher among those informed about the samples in the contact letter.