The incidence of cardiac end points remains low even after longer-term follow-up. The cumulative incidence of any type of cardiac end point increases during the scheduled treatment period of 1 year, but it remains relatively constant thereafter.
Studies conducted in Western countries have reported excess risks for second primary malignancies after breast cancer. However, there is little documentation of ethnic differences in these excess risks. Asian women are characterized by younger age at diagnosis of breast cancer, but very few reports are available on the incidences and risks for second primary cancers in this region. Using population-based data from the Taiwan National Cancer Registry (TNCR) for the period 1979 to 2003, we quantified standardized incidence ratios and cumulative incidence of second cancers among 53,783 women with initial diagnoses of breast cancer. Age-specific incidences showed peaks among women in their 40s, and 1,085 cases (2.02%) developed nonbreast second primary cancers. The risk for second cancers differs significantly according to age at diagnosis of breast cancer. In comparison with women diagnosed when z50 years (standardized incidence ratio, 0.96; 95% confidence interval; 0.89-1.04), there were significantly greater risks for bone, corpus uterine, ovarian, thyroid, esophageal, kidney and lung cancers, nonmelanoma skin cancer, and leukemia or lymphoma in women diagnosed when <50 years (standardized incidence ratio, 1.43; 95% confidence interval, 1.29-1.58). The survival probabilities differed between breast cancer patients with and without second cancers (P < 0.001). After diagnosis of the second cancer, the median survival time was only 2.87 years. In conclusion, we confirmed that young age at diagnosis of breast cancer predicted a subsequently increased risk for second malignancies, and the second cancers indeed worsen survivorship in patients who survived breast cancer. (Cancer Epidemiol Biomarkers Prev 2008;17(10):2647 -55)
AnxietyDiagnostic period Suspected breast cancer Uncertainty A possible diagnosis of breast cancer imposes a huge psychological impact on most women, but few studies have addressed uncertainty and anxiety changes at different diagnostic stages in women with suspected breast cancer. Thus, this longitudinal study examined uncertainty and anxiety and predictive factors for uncertainty in women with suspected breast cancer. Data were collected on uncertainty (Uncertainty in Illness Scale) and anxiety (State Anxiety Inventory) from 127 women at 3 times: upon notice of a breast biopsy, before biopsy, and after diagnosis. The results showed that uncertainty and anxiety levels were significantly higher before than after diagnosis. At the 3 data collection times, uncertainty and anxiety were significantly lower for participants diagnosed with benign tumors than for those with malignant diagnoses.Uncertainty and anxiety were positively, moderately correlated. Uncertainty was predicted by age, marital status, education level, religious status, family history of benign breast tumor, regular breast self-examination, self-perceived probability of receiving a breast cancer diagnosis, and biopsy result. Therefore, nursing professionals should be aware of the uncertainty and anxiety changes and impact of personal attributes on women with suspected breast cancer during the diagnostic period and provide care programs to alleviate their psychological distress. B reast cancer is the most common cancer and fourth leading cause of death among Taiwanese women. 1 Although newly diagnosed breast cancer patients account for only 8.4% of the total female cancer population in Taiwan, the incidence of breast cancer in recent years has become the highest among all cancers. 2 For Taiwanese women, the average onset age for breast cancer is 45 to 49 years, 5 to 10 years earlier than for Westerners. 2 During the
Need levels of women with suspected breast cancer vary during the diagnostic period, are highest before breast biopsy, and related to personal characteristics and cultural context. Therefore, during this period, nursing staff should provide patients and families with culturally sensitive, individualized, supportive care.
This study aims to examine the incidence and risk factors of bilateral breast cancer in area with low incidence rate. A total of 120 and 1902 women with bilateral and unilateral breast cancers were enrolled; various factors, including those concerning their medical history and life style, were extracted. Using Kaplan-Meier method, we calculate the cumulative incidence of contralateral breast cancer. The results show as follows. The cumulative incidences of contralateral breast cancer at 1, 3, 5 years after diagnosis of first breast cancer were 1.15, 1.94, and 2.97%, respectively. The statistically significant risk factors included menopause (Hazard Ratio (HR) =1.56, (1.00-2.42)), invasive lobular carcinoma (HR=2.98, (1.35-6.56)), receiving chemotherapy (HR=2.21, (1.43-3.42)) and/or radiotherapy (HR=3.32, (2.19-5.05) and a protective factor was tamoxifen therapy (HR=0.5 (0.34-0.74). Size of the second occurred tumour (2.97 cm) tended to be smaller than the first one (3.58 cm) with borderline statistical significance (p=0.0731). Comparing to the existing data on Western countries, we find a higher risk for developing contralateral breast cancer in Taiwan where a low incidence of first breast cancer rate with early age diagnosis is noted. It suggests that first primary breast tumour with early age of onset and lobular carcinoma are found more likely to develop bilateral breast cancers.
The postoperative intrahepatic remnant rate is very high; 80% by 5 years after resection. The preoperative serum alpha-fetoprotein level and adequacy of the cut margin significantly influenced the recurrence rate.
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