No abstract

High insulin levels have been associated with increased risk of breast cancer and poorer survival after a breast cancer diagnosis. Waist-to-hip ratio (WHR) is a marker for insulin resistance and hyperinsulinemia. In this study, the authors tested the hypothesis that elevated WHR is directly related to breast cancer mortality. For identification of modifiable factors affecting survival, data were collected on 603 patients with incident breast cancer who visited the Vancouver Cancer Centre of the British Columbia Cancer Agency (Vancouver, British Columbia, Canada) in 1991-1992, including body measurements and information on demographic, medical, reproductive, and dietary factors. These patients were followed for up to 10 years. Cox proportional hazards regression models were used to relate the variables to breast cancer mortality (n = 112). After adjustment for age, body mass index, family history, estrogen receptor (ER) status, tumor stage at diagnosis, and systemic treatment (chemotherapy or tamoxifen), WHR was directly related to breast cancer mortality in postmenopausal women (for highest quartile vs. lowest, relative risk = 3.3, 95% confidence interval: 1.1, 10.4) but not in premenopausal women (relative risk = 1.2, 95% confidence interval: 0.4, 3.4). Stratification according to ER status showed that the increased mortality was restricted to ER-positive postmenopausal women. Elevated WHR was confirmed as a predictor of breast cancer mortality, with menopausal status and ER status at diagnosis found to be important modifiers of that relation.

No abstract

Chinese Americans are 10 times more likely to be diagnosed with hepatocellular carcinoma (HCC) than their white counterparts. About 80% of HCC's among Asian immigrants are associated with hepatitis B virus (HBV) infection. We used data from in-person interviews of Chinese residents in Seattle to examine factors associated with HBV testing. The survey was completed by 206 men and 236 women (cooperation rate: 58%). Less than one-half (48%) of respondents had been tested for HBV. Factors associated (p < 0.01) with ever having tested in bivariate comparisons included knowing that Chinese are more likely to be infected with HBV than Whites; individuals can be infected with HBV for life; HBV infection can cause liver cancer; not believing that HBV can be prevented by having a positive attitude; having a family member, friend, or medical doctor recommend testing; asking for testing from a medical doctor; and not needing interpreter services. In multiple regression analyses, the following factors were independently associated with testing: believing that Chinese were more likely than Whites to get HBV (p = 0.004), having a doctor recommend testing (p

Introduction: Liver cancer rates are higher in North American Chinese than non-Asian ethnic/racial groups, largely due to chronic hepatitis B virus (HBV) infection. Methods: A community-based survey of Chinese women (n = 147) was completed during 1999 to examine HBV knowledge and practices in Vancouver, British Columbia. Results: Most women had heard of HBV (85%) but smaller proportions knew about some routes of transmission (e.g., sexual intercourse) and sequelae of infection. Knowledge about HBV was significantly associated with education level (p=0.005), English fluency (p<0.001) and household income (p=0.007). Previous serologic testing for HBV infection was significantly associated with education level (p=0.04), English fluency (p=0.01), and level of knowledge about HBV (p<0.001). Conclusions: Efforts to increase knowledge about HBV infection in this community should consider targeting less educated and less acculturated individuals. La traduction du résumé se trouve à la fin de l'article.

Summary Between 1946 and 1976 over 9,000 women with breast cancer were seen within one year of diagnosis at the A. Maxwell Evans Clinic (AMEC) in Vancouver, British Columbia. By 1978, 275 had a subsequent diagnosis of a second primary in the contralateral breast: 100 were diagnosed within 1 year, and 175 after 1 year of the first primary. Two separate comparison groups of AMEC patients with unilateral breast cancer were selected to identify risk factors for bilateral breast cancer and to determine the incidence. The average annual incidence rates for a second primary in the contralateral breast were 5.0, 4.1 and 3.0 per 1,000 women for women less than 45 years, 45-54 years, and over 55 years of age at diagnosis of first primary breast cancer, respectively. These rates remained stable for at least 15 years after the diagnosis of the first primary. Two risk factors were found for bilateral cancer within 1 year of the first primary, histologic diagnosis of lobular carcinoma and absence of pathologic involvement of axillary nodes; one risk factor was found for bilateral breast cancer after 1 year of the first primary, family history of breast cancer.With longer survival rates from breast cancer the risk increases that a woman will develop a second breast malignancy. Information is needed about this likelihood and the characteristics of women at high risk, especially when considering such issues as prophylactic contralateral mastectomy. This study was undertaken to determine factors which influence the incidence of second primary tumours of the contralateral breast. MethodOver 9,000 women had their first histologically confirmed primary breast cancer diagnosed between 1946 and 1976 and were registered for treatment within one year of diagnosis at the A. Maxwell Evans Clinic (AMEC) in Vancouver, British Columbia. Two hundred and seventy-five of these women subsequently had an invasive second primary diagnosed in the contralateral breast prior to November 1978 and they comprised the bilateral cancer group ("cases"). Two comparison groups ("controls") were selected from the remaining women with unilateral breast cancer: one comparison group, the "5% sample", was a randon 5% sample of these women; the second comparison group, the "matched sample", consisted of 275 women individually matched with the cases by age (±2 years), year of diagnosis of the first primary (± 1 year) and survival (required to be greater than the elapsed time between the diagnosis of the first and second primary breast cancers in the case).The medical records of the women in the bilateral cancer group and two comparison groups were reviewed in 1978, restricting the observations on risk factors to those available at the time of referral for the first breast primary. None were lost to follow-up. Information was collected on recognised risk factors for both unilateral and bilateral breast cancer and clinical details of the first primary breast cancer. A case-control study design was then used to identify the risk factors associated with bilateral brea...

In this article we describe the connections between prostate cancer support groups (PCSGs) and men's health literacy and consumer orientation to health care services. The study findings are drawn from participant observations conducted at 16 PCSGs in British Columbia, Canada and 54 individual interviews that focused on men's experiences of attending group meetings. Men's communication and interactions at PCSGs provide important insights for how men talk about and conceptualize health and illness. For example, biomedical language often predominated at group meetings, and men used numbers and measures to engage with risk discourses in linking prostate cancer markers to various treatment options and morbidity and mortality rates. Many groups afforded opportunities for men to interact with health care providers as a means to better understand the language and logic of prostate cancer management. The health literacy skills fostered at PCSGs along with specific group-informed strategies could be mobilized in the men's subsequent clinical consultations. Consumer discourses and strategies to contest power relations with health care professionals underpinned many men's search for prostate cancer information and their commitment to assisting other men. Key were patients' rights, and perhaps responsibility, to compare diverse health products and services in making decisions across the entire trajectory of their prostate cancer. Overall, the study findings reveal PCSGs as having the capacity to contest as well as align with medical expertise and services facilitating men's transition from patient to informed health care consumers. The processes through which this occurs may direct the design of older men's health promotion programs.

Alles im Fluss: Anorganische Materialien wurden durch Phasentrennung zwischen den Nanomaterialien und einer Polymerschmelze sowie durch Einengen der Nanomaterialien auf definierte Bereiche in einer Polymerschmelze strukturiert. Diese Technik lieferte mikro‐ und nanostrukturierte Metall‐ und Halbleitermuster (siehe Bild).