Addressing women's breast cancer risk and perceptions of control in medical settings

Many women with family histories of breast cancer deal with two distinct but related issues: their objective physical risk and the emotions this risk engenders. Studies indicate that approximately 70% of African American and white women are concerned about their chances of developing breast cancer someday and perceive themselves to be at risk. Health care providers, including psychologists, need to be aware of the special needs and psychosocial concerns of high-risk women with family histories of breast cancer, since perceptions of breast cancer risk influence screening practices. Providers need training in understanding the significance of specific family patterns of breast cancer, screening guidelines appropriate for women at risk, and the benefits and risks of available prevention options, including genetic screening. Delivering accurate information about both established risk factors known to elevate personal risk, such as age and family history, and factors which women associate with breast cancer, such as bumping and bruising a breast, smoking, and oral contraceptive use, is essential for promoting accurate risk perceptions and appropriate screening schedules.

A Culturally-Specific Dietary Plan To Manage Weight Gain among African American Breast Cancer Survivors: A Feasibility Study

Background. African American (AA) women are less likely to survive for five years after a breast cancer diagnosis than Caucasian women. The higher prevalence of obesity in AA women may contribute to this disparity. Weight gain following breast cancer treatment is one of the few modifiable risk factors for breast cancer recurrence and mortality. AA breast cancer survivors face unique cultural and economic barriers to adopting diets which reduce the likelihood of weight gain.Objective. To determine the feasibility of adopting and maintaining a culturally-specific low-fat eating plan in a population of low to middle income AA breast cancer survivors.Participants. AA women recruited through urban medical centers who were between 30 to 75 years old, had a confirmed diagnosis of stage 0, I, II, III, or IIIA primary breast cancer, and had incomes < $50,000 per year.Methods. A culturally-specific dietary intervention was developed, based on the Women's Intervention Nutrition Study (WINS), to reduce consumption of dietary fat to 25% of total calories, while increasing fruits and vegetables.Eligible participants were enrolled in a one-year feasibility study. Participants received the Culturally-Specific WINS Low-Fat Eating Plan (WLEP) and 8 individual nutritional counseling sessions with a trained diet technician, to help reduce and maintain their fat intake to 25% of total calories. The intervention also included bi-monthly educational group meetings and follow-up telephone contacts with diet technicians.Study Measures. Dietary patterns were assessed with 3-day food records at baseline and follow-up. Compliance with the Culturally-Specific WLEP was defined as 1) dietary fat intake ≤ 25% of total calories; and 2) at least 6 to 7 servings of fruits and vegetables per day. Psychosocial factors and dietary biomarkers were also measured at baseline and follow-up to examine their association with study outcomes. Psychosocial factors included perceived susceptibility to recurrence, quality of life, and social support. Dietary biomarkers included weight, height, waist-hip circumference, blood pressure, lipids, serum fatty acid concentrations, insulin and insulin-like growth factors, glucose, and levels of sex hormone-binding globulins.Results. A total of 9 AA breast cancer survivors are enrolled and receiving the intervention. Baseline and six-month follow-up results for the psychosocial factors and dietary biomarkers associated with dietary compliance and weight maintenance will be reported in October 2009.Conclusions. A population of low to middle income AA breast cancer survivors with limited education and resources demonstrated compliance with the Culturally-Specific WLEP, thereby reducing their risk of cancer recurrence through diet. Procedures and data from this feasibility study will be used in a multi-center clinical trial of the Culturally-Specific WLEP.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1053.

Tumor biology and prognosis in black breast cancer patients: a review

American black women have a risk of developing breast cancer lower than that of American white women. but they have a worse prognosis when they do develop the disease. A major factor responsible for this discrepancy is a relatively high poverty level in the black population, with the consequent likelihood of delayed diagnosis and presentation with more advanced disease. However, breast cancer in black women also occurs at a younger age, more often is estrogen receptor-negative, and more frequently exhibits aggressive biological behavior as judged by histopathologic grade, high tumor cell proliferation rate, and altered p53 expression. Obesity, known to be associated with a poor prognosis primarily as a consequence of increased estrogen production and bioavailability, is more common in black than in white breast cancer patients. An additional factor may be an earlier age at first completed pregnancy for black women, which is associated with a reduced breast cancer risk but also a poorer prognosis. Both the epidemiologic features and the tumor biology of breast cancer in black women serve to stress the particular importance of developing effective, specifically tailored strategies for early diagnosis in this ethnic group.

Mammography screening under 50: a limited perspective on a multifaceted issue

Navarro and Kaplan's article on the cost-effectiveness of mammography screening for women under 50 offers a limited perspective on a complex and rapidly evolving issue. They suggest that eliminating mammography benefits for younger women will result in the delivery of other important women's health services, but they provide no data on the cost-effectiveness of these programs compared to mammography. Four other areas of omission significantly limit this article's scope and potential impact. Navarro and Kaplan do not discuss: 1) increasing breast cancer incidence in women under 50, particularly in African-American women; 2) the importance of breast cancer risk in relation to mammography screening; 3) the relevance of meta-analyses of randomized clinical trials done by other investigators; and 4) the heterogeneity of mammography screening recommendations in clinical practice.

Health behaviors of psychotherapists

Examined the health behaviors practiced by psychotherapists (N = 86) themselves and the extent to which they focus on these behaviors with their clients during the course of psychotherapy. The specific health behaviors investigated were dietary habits, physical exercise, relaxation practices, sleeping, alcohol consumption, and smoking. Results indicate that psychotherapists are at this time actively engaged in both evaluating and making recommendations to their clients in the areas of diet, physical exercise, and relaxation practice. In addition, 51% of those who participated in this study evaluate health practices of their clients and make recommendations with regard to their physical health. While only 47% agreed that it is important for the psychotherapist to assess the typical client's physical health status, 72% of this group frequently inquire about chronic illness during an intake session.