Introduction Relatively few studies of breast cancer survivors have included nonwhite women or women who do not speak English. Methods We administered a survey to patients who were ≥3 months post-completion of their adjuvant treatment for stage 0–III breast cancer at Columbia University Medical Center in order to assess the prevalence of 16 physical and emotional symptoms and identify sociodemographic factors associated with these symptoms. Univariate analysis, factor analysis, ANOVA, and multiple linear regression analysis were performed. Results Of 139 patients surveyed, 58 were white, 63 Hispanic, and 18 black. The symptom most commonly reported was fatigue(76%), and the most common severe symptom was muscle aches(40%). Most patients(70%) complained of ≥6 symptoms. Hispanic women were more likely to report >10 symptoms (p<0.05). Factor analysis reduced the 16 symptoms to 4 underlying symptom clusters that we categorized as ‘depression’, ‘chemotherapy’, ‘hormone’, and ‘pain’-related. In the multiple linear regression models, Hispanic women were more likely to report chemotherapy-related symptoms (p<0.05) and pain-related symptoms (p<0.05). Unemployed women were more likely to report chemotherapy-related symptoms (p<0.05). Women <45 years old were less likely to report chemotherapy (p<0.05) and pain-related symptoms (p<0.05). Conclusions The majority of women in this study, particularly those who were Hispanic, elderly, or unemployed, experienced persistent symptoms, most commonly fatigue and muscle aches. Implications for cancer survivors Because Hispanic, elderly, or unemployed women experience greater symptom burden, efforts should made to address their unique needs.

In vitro, Type I receptors have high and equivalent affinity for aldosterone, corticosterone and cortisol: in vivo, physiological mineralocorticoid target tissues (kidney, colon, parotid) are highly aldosterone-selective, in contrast with hippocampus and heart. In the present study we show that the mesenteric vascular arcade is similarly highly aldosterone-selective in vivo, and in vitro shows considerable levels of 11 beta OH steroid dehydrogenase activity, previously postulated as the mechanism whereby glucocorticoids are excluded from physiological mineralocorticoid receptors.

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Chemoprevention with the antiestrogens, tamoxifen, raloxifene, and aromatase inhibitors, reduce breast cancer incidence in high-risk women; however, uptake has been poor (<5%) in the prevention setting. We assessed use of antiestrogens for breast cancer prevention, among high-risk women seen at an academic breast center, to observe how uptake rates compare in this setting. We collected data on demographics, breast cancer risk factors, and health behaviors via self-administered questionnaires and medical chart abstraction. Women eligible for chemoprevention with antiestrogens had a 5-year predicted breast cancer risk according to the Gail model of ≥1.67%, history of lobular or ductal carcinoma in situ (LCIS/DCIS), and/or BRCA mutation. We dichotomized antiestrogen use as ever or never. Predictors of use were evaluated using multivariable log-binomial regression. Of 412 high-risk women enrolled, 316 (77%) were eligible for chemoprevention. Among eligible women, 55% were non-Hispanic white, 29% Hispanic, 8% non-Hispanic black, and 7% Asian. Women were grouped based upon their highest category of breast cancer risk (in descending order): BRCA mutation carriers (3%), DCIS (40%), LCIS (22%), and 5-year Gail risk ≥1.67% (36%). Among those eligible for chemoprevention, 162 (51%) had ever initiated antiestrogen therapy (71% tamoxifen, 23% raloxifene, 5% aromatase inhibitor). Antiestrogen use was highest among women with DCIS (73%). In multivariable analysis, women with a 5-year Gail risk ≥1.67% had approximately a 20% lower likelihood of antiestrogen use compared to women with DCIS (p=0.01). In the primary prevention setting, excluding women diagnosed with DCIS, antiestrogen use was 37%. Multivariable analysis showed differences in uptake by education and potentially by race/ethnicity. Among high-risk women seen at a breast center, antiestrogen use for chemoprevention was relatively high as compared to the published literature. Clinicians can support high-risk women by effectively communicating breast cancer risk and enhancing knowledge about the risks and benefits of chemoprevention.