Comprehensive diagnostic program for medically underserved women with abnormal breast screening evaluations in an urban population.

Objective: To institute a patient navigator program for underinsured women to eliminate delays in diagnostic resolution of abnormal screening mammograms, provide services for abnormalities noted during breast cancer screening, describe demographic and clinical characteristics of enrollees, and assess postscreening follow-up care.

Patients And Methods: Coordinators from area health departments worked with a navigator nurse at Mayo Clinic Cancer Center in Jacksonville, FL, to refer patients for additional diagnostic services, including diagnostic mammography, ultrasonography, ultrasonography-guided biopsy, stereotactic biopsy, breast magnetic resonance imaging, and biopsy guided by magnetic resonance imaging. Women with abnormal screening mammograms (Breast Imaging Reporting and Data System [BI-RADS] category 4 or 5) or palpable suspect breast masses were eligible.

Immediate versus delayed zoledronic acid for prevention of bone loss in postmenopausal women with breast cancer starting letrozole after tamoxifen-N03CC.

Postmenopausal women with breast cancer (BC) are at increased risk for bone loss. Bisphosphonates improve bone mineral density (BMD) in normal postmenopausal women. The purpose of this study was to determine if immediate treatment with zoledronic acid preserves BMD in postmenopausal women with BC starting letrozole after tamoxifen.

Phase III randomized, placebo-controlled, double-blind trial of risedronate for the prevention of bone loss in premenopausal women undergoing chemotherapy for primary breast cancer.

Purpose: Risedronate prevents bone loss in postmenopausal women. The purpose of this study was to determine whether risedronate prevents bone loss in premenopausal women undergoing chemotherapy for breast cancer.

Patients And Methods: Premenopausal women undergoing chemotherapy for breast cancer were treated with oral calcium 600 mg and vitamin D 400 U daily and randomly assigned to receive oral risedronate 35 mg weekly or placebo, with all these therapies beginning within a month of the start of chemotherapy.

The management of bone loss in patients with breast or prostate cancer.

Osteoporosis is a disease that is associated with significant morbidity and mortality, much of which can be prevented with available therapy. The risk for osteoporosis is increased in individuals with some types of cancer, especially in women with breast cancer and men with prostate cancer. This is caused by several factors, including premature ovarian failure and systemic antihormonal therapy in women, androgen ablation therapy in men, and potential direct effects of chemotherapy and of cancer on bone metabolism.

Predicting BRCA1 and BRCA2 gene mutation carriers: comparison of LAMBDA, BRCAPRO, Myriad II, and modified Couch models.

Context: Models have been developed to predict the probability that a person carries a detectable germline mutation in the BRCA1 or BRCA2 genes. Their relative performance in a clinical setting is unclear.

Objective: To compare the performance characteristics of four BRCA1/BRCA2 gene mutation prediction models: LAMBDA, based on a checklist and scores developed from data on Ashkenazi Jewish (AJ) women; BRCAPRO, a Bayesian computer program; modified Couch tables based on regression analyses; and Myriad II tables collated by Myriad Genetics Laboratories.

Risk of cancer treatment-associated bone loss and fractures among women with breast cancer receiving aromatase inhibitors.

Background: Aromatase inhibitors (AIs) are a novel hormonal therapy for patients with breast cancer. However, AIs can cause bone loss by blocking estrogen production. This study aims to assess the association between AIs and treatment-related bone loss in a large managed-care population of women with breast cancer.

Pilot evaluation of citalopram for the treatment of hot flashes in women with inadequate benefit from venlafaxine.

Background: While newer antidepressants, such as venlafaxine and paroxetine, substantially decrease hot flashes, there is no published information with regards to whether a different antidepressant will be effective when one antidepressant does not adequately relieve hot flashes.

Objective: The objective of this trial was to provide pilot information with regards to whether citalopram would effectively reduce hot flashes in patients who did not receive adequate enough hot flash reduction with venlafaxine.

Design: This was a prospective pilot trial.

Advances in screening, diagnosis, and treatment of breast cancer.

Breast cancer is the most common cancer in women in the United States; this year, approximately 215,900 new cases will be diagnosed. Mammography remains the cornerstone of screening, with technologies such as ultrasonography and magnetic resonance imaging having an increasingly defined role. Improved risk assessment and prevention strategies have been implemented, and current research in these areas includes better identification of patients at risk, the use of aromatase inhibitors and other agents to reduce risk, and the use of surrogate markers.

The role of positron emission tomographic imaging in breast cancer.

Studies have shown that deoxy-2-fluorodeoxyglucose ((18)FDG) positron emission tomography (PET) has limited value in detecting primary tumors and axillary lymph node involvement in breast cancer. PET is most successful when it is used to evaluate locally advanced breast tumors. Identification of smaller, earlier-stage tumors and noninvasive or lobular tumors has been suboptimal.

Genetics and the management of women at high risk for breast cancer.

It is estimated that 5%-10% of all breast cancers in women are associated with hereditary susceptibility due to mutations in autosomal dominant genes, such as BRCA1 and BRCA2, p53, pTEN, and STK11/LKB1. Another 15%-20% of female breast cancers occur in women with a family history but without an apparent autosomal dominant inheritance pattern, and are probably due to other genetic factors with environmental influence. Approximately 7%-10% of ovarian cancers occur in women with hereditary susceptibility, primarily secondary to mutations in BRCA1 and BRCA2, with smaller contributions from mutations in mismatch repair genes associated with the hereditary nonpolyposis colorectal cancer and other, as yet undiscovered, genes.

Inclusion body myositis associated with celiac sprue and idiopathic thrombocytopenic purpura.

We report an unusual case of a 51-year-old woman with inclusion body myositis associated with celiac sprue and idiopathic thrombocytopenic purpura. We propose that the presence of all three disorders together suggests that they may share an interrelated immune mechanism.

Osteoporosis in women with breast cancer.

Osteoporosis is a disease that causes substantial morbidity and mortality for which preventive therapy is available. Women with breast cancer are at increased risk for osteoporosis for several reasons, including premature ovarian failure as a result of treatment, direct effects of chemotherapy, and effects of the breast cancer itself. As the incidence of breast cancer continues to increase and survival rates continue to improve, the importance of appropriate screening for and management of osteoporosis becomes more apparent.

Adjuvant therapy for breast cancer: recommendations for management based on consensus review and recent clinical trials.

Determining the optimal individual adjuvant systemic therapy for breast cancer patients is a challenging undertaking because it requires translating data from clinical trials that have involved thousands of patients into a highly individualized, risk-adjusted approach for the patient at hand. Choosing adjuvant therapy for women with breast cancer includes consideration of four issues: A) evaluation of risk of relapse; B) extrapolation of results from clinical trials; C) therapeutic ratio, and D) the patient's preferences following a thorough discussion with her physician. Data from recently completed phase III adjuvant trials and worldwide consensus conferences document the benefits of adjuvant therapy in improving disease-free survival and overall survival for patients diagnosed with invasive breast cancer >1.