viernes, 2 de noviembre de 2012

Cancer Screening and Treatment in Women: Recent Findings: Program Brief

Cancer Screening and Treatment in Women: Recent Findings: Program Brief

Cancer Screening and Treatment in Women: Recent Findings

Program Brief

This program brief summarizes findings from Agency for Healthcare Research and Quality (AHRQ)-supported research projects focused on cancer in women published January 2008 through December 2011.
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AHRQ-Sponsored Research
Breast Cancer
Cervical Cancer
Breast and Cervical/Ovarian Cancer
Other Cancers
Cancer Screening and Diagnosis
More Information


Breast cancer continues to be the most commonly diagnosed cancer among women in the United States. In 2011, an estimated 230,480 women were newly diagnosed with breast cancer, another 57,650 women were diagnosed with noninvasive (in situ) breast cancer, and almost 40,000 women died from the disease. Although more white women than black women are diagnosed with breast cancer, black women are more likely to die from the disease. Based on 2008 data, the 5-year breast cancer survival rate is 78 percent for black women, compared with 90 percent for white women.
The good news is that breast cancer deaths have continued to decline in recent years among U.S. women aged 50 and older. One possible explanation for this is decreased use of hormone replacement therapy following the publication of results in 2002 from the Women’s Health Initiative. Findings from this large study indicated a connection between use of HRT and increased risk for breast cancer.
Worldwide, cervical cancer is the second or third most common cancer among women, and in some developing countries, it is the most common cancer affecting women. According to the National Cancer Institute, an estimated 12,170 new cases of cervical cancer will be diagnosed in U.S. women in 2012, and more than 4,200 women will die from cancer of the cervix.
Cervical cancer most often strikes women younger than age 55, and it affects some population groups more than others. Cervical cancer occurs most often in Hispanic women (11.8 cases per 100,000 women), compared with black women (9.8 cases per 100,000), white women (8.0 cases per 100,000), and Asian/Pacific Islander women (7.2 cases per 100,000). On the other hand, black women are more likely to die of cervical cancer than women of other races (4.3 deaths per 100,000, compared with 3.0 for Hispanic women, 2.2 for white women, and 2.0 for Asian/Pacific Islander women).
Data from the National Cancer Institute indicate that 1 in 72 women born today will be diagnosed with cancer of the ovary at some point in their lives. Ovarian cancer occurs in white women (12.6 cases per 100,000 women) more often than in women of other races (11.2 Hispanic, 9.3 black, 9.2 Asian/Pacific Islander, and 9.0 American Indian/Alaska Native). According to the Centers for Disease Control and Prevention, 21,204 women were diagnosed with ovarian cancer in 2008, and 14,362 women died from the disease. The overall 5-year survival rate for women diagnosed with ovarian cancer was 44 percent in 2008. More than 90 percent of those diagnosed with localized ovarian cancer survived for 5 years or more, compared with just 27 percent of those whose cancer had spread to distant organs.

AHRQ-Sponsored Research

The Agency for Healthcare Research and Quality (AHRQ) supports a vigorous women's health research program, including research focused on breast cancer, cervical cancer, and other cancers in women. AHRQ-supported projects are addressing women's access to quality health care services, accurate diagnoses, appropriate referrals for procedures, and optimal use of proven therapies.
Following are examples of findings from AHRQ-supported research projects focused on cancer in women published January 2008 through December 2011. Select for more detailed information on AHRQ's research programs and funding opportunities.

Breast Cancer

  • No link found between use of chemotherapy for breast cancer in older women and later cognitive impairment.
Description: Researchers examined data on more than 62,500 women aged 65 and older with breast cancer. They compared data on a subset of 9,752 of the women who received chemotherapy with data on an equal number of women who did not receive chemotherapy. They found no significant increase in risk of cognitive impairment associated with chemotherapy use up to 16 years after treatment.

Source: Du, Xia, and Hardy, Am J Clin Oncol 33(6):533-543, 2010 (AHRQ HS16743).
  • Physicians often rely on untrained individuals to help them discuss breast cancer treatment options with limited English-proficient women.
Description: Researchers surveyed 348 physicians about their use and availability of trained interpreters when counseling limited English-proficient women with breast cancer. Almost all of the physicians had treated patients with limited English proficiency in the preceding 12 months, and fewer than half reported good availability of trained medical interpreters or telephone language interpretation services. Instead, they used bilingual staff not specifically trained in medical interpretation and patients’ family members or friends. This was more likely to be the case for physicians in solo practice or single-specialty medical groups than those working in large HMOs.

Source: Rose, Tisnado, Malin, et al., Health Serv Res 45(1):172-194, 2010 (Interagency agreement AHRQ/NCI).
  • Online support groups for women with metastatic breast cancer appear promising.
Description: This study reports on the development and implementation of pilot peer-to-peer online support groups for women with metastatic breast cancer (MBC). Thirty women with MBC were assigned to either an immediate online support group or a wait-listed control group and were assessed monthly over a 6-month period. Retention rates, assessment completion rates, and support group participation were high; reported satisfaction was also high.
Source: Vilhauer, McClintock, and Matthews. Psychosoc Oncol 28:560-586, 2010. Also see Vilhauer, Women’s Health 49:381-404, 2009 (AHRQ grant HS10565).
  • Booklet provides helpful information about breast biopsy.
Description: This guide for women with breast cancer discusses the different kinds of breast biopsies, including their accuracy and side effects. It can help women who need biopsies talk with their doctors and nurses about the procedure and what to expect.

Source: Having a Breast Biopsy: A Guide for Women and Their Families (AHRQ Publication No. 10-EHC007-A).* See also Core-Needle Biopsy for Breast Abnormalities: Clinician Guide (AHRQ Publication No. 10-EHC-007-3)* and Comparative Effectiveness of Core Needle and Open Surgical Biopsy for the Diagnosis of Breast Lesions, Comparative Effectiveness Review No. 19, Executive Summary (AHRQ Publication No. 10-EHC007-1)* (AHRQ contract 290-02-0019)* (Contract 290-02-0019).
  • Guide for women discusses two drugs used to lower the risk of breast cancer.
Description: Two drugs—tamoxifen and raloxifene— have been approved for the prevention of primary (first occurrence) breast cancer in women who have a higher than average risk of breast cancer. This guide provides information about the drugs’ benefits, side effects, and cost, and can help women talk with their doctors to decide whether one of these drugs would be right for them.

Source: Reducing the Risk of Breast Cancer with Medicine: A Guide for Women (AHRQ Publication No. 09(10)EHC028-A).* See also Medications to Reduce the Risk of Primary Breast Cancer in Women: Clinician Guide (AHRQ Publication No. 09(10)-EHC028-3)* and Comparative Effectiveness of Medications to Reduce Risk of Primary Breast Cancer in Women, Executive Summary No. 17 (AHRQ Publication No. 09-EHC028-1)* (AHRQ contract 290-2007-10057-1). (AHRQ contract 290-2007-10057-1).* (AHRQ contract 290-2007-10057-1).
  • Lack of knowledge and mistrust may partly explain women’s underuse of adjuvant therapy for breast cancer.
Description: Adjuvant therapies (chemotherapy, hormone therapy, and radiotherapy) following breast cancer surgery have been proven effective in women with early-stage breast cancer, yet 32 of 258 women in this study who should have received adjuvant therapy did not get it. According to practice guidelines, 64 of the women should have received chemotherapy, 150 should have received hormone therapy, and 174 should have received radiotherapy. The principal factors associated with lack of adjuvant treatment were age older than 70, coexisting illnesses, and mistrust in the medical delivery system.

Source: Bickell, Weidmann, Fei, et al., J Clin Oncol 27(31):5160-5167, 2009 (AHRQ grant HS10859).
  • Tracking system helps to ensure women with breast cancer see oncologists and receive followup care.
Description: Some women diagnosed with breast cancer, especially blacks and Latinos, do not follow through with their referrals to an oncologist. To address this problem, researchers developed a tracking system to facilitate followup with breast cancer patients. They compared the treatment of 639 women with early stage breast cancer who were seen at six New York City hospitals between January 1999 and December 2000 with 300 women who were seen between September 2004 and March 2006, after the tracking system began. Rates of oncology consultations, chemotherapy, and hormone therapy were higher for all women once the system was in place, and the racial disparities in use of care that had existed were eliminated.

Source: Bickell, Shastri, Fei, et al., J Natl Cancer Inst 100(23):1717-1723, 2008 (AHRQ grant HS10859).
  • Poverty may explain racial disparities in receipt of chemotherapy for breast cancer in older women.
Description: According to this study of nearly 14,500 older women with stage II or IIIA breast cancer with positive lymph nodes, black women were less likely than white women to receive chemotherapy within 6 months of diagnosis (56 percent vs. 66 percent, respectively). When the results were adjusted to include socioeconomic status for women aged 65 to 69, poverty appeared to be at the root of the disparity. Despite Medicare coverage, out-of-pocket costs—including copayments, transportation, and so on—may be overwhelming for women in the lowest income groups.

Source: Bhargava and Du, Cancer 115(13):2999-3008, 2009 (AHRQ grant HS16743).
  • Behavioral health carve-outs limit access to mental health services for women with breast cancer.
Description: Up to 40 percent of women with breast cancer suffer significant psychological distress, but only about 30 percent of them receive treatment for it, according to this study. Researchers analyzed insurance claims, enrollment data, and insurance benefit design data from 1998-2002 on women 63 years of age or younger with newly diagnosed breast cancer. They found that women enrolled in insurance plans with behavioral health carve-outs were 32 percent less likely to receive mental health services compared with women in plans that had integrated behavioral health services.

Source: Azzone, Frank, Pakes, et al., J Clin Oncol 27(5):706-712, 2009 (AHRQ grant HS10803)
  • Journal Supplement focuses on guidelines for international implementation of breast health and breast cancer control initiatives.
Description: This journal supplement presents a series of 15 articles authored by a group of breast cancer experts and advocates and presented at the Global Summit on International Breast Health Implementation held in Budapest, Hungary, in October 2007. The articles focus on guideline implementation for early detection, diagnosis, and treatment; breast cancer prevention; chemotherapy; and other breast health topics.

Source: Cancer 113, Supplement 8, 2008 (AHRQ grant HS17218).
  • Breast desmoid tumors are rare and often mistaken for cancer.
Description: A review over 25 years (1982-2006) at one institution identified 32 patients with pathologically confirmed breast desmoids. Their median age was 45; eight patients had a prior history of breast cancer, and 14 had undergone breast surgery, with desmoids diagnosed an average of 24 months postoperatively. All patients presented with physical findings; MRI was more accurate in visualizing the mass than mammography or ultrasound. All patients had their tumors surgically removed, and eight patients had recurring tumors at a median of 15 months. The researchers recommend that clinical judgment be used before extensive and potentially deforming breast resections are performed.

Source: Neuman, Brogi, Ebrahim, et al., Ann Surg Oncol 15(1):274-280, 2008 (AHRQ grant T32 HS00066).
  • More attention is needed to quality of life for breast cancer survivors.
Description: Researchers examined quality of life among women with (114 women) and without (2,527 women) breast cancer. Women with breast cancer reported lower scores on physical function, general health, vitality, and social function compared with women who did not have breast cancer. There was no difference in mental health scores between the two groups of women.

Source: Trentham-Dietz, Sprague, Klein, et al., Breast Cancer Res 109:379-387, 2008 (AHRQ grant HS06941).
  • Study underway to develop computer-based tools to improve use of genetic breast cancer tests.
Description: AHRQ has funded a new project to develop, implement, and evaluate four computer-based decision-support tools that will help clinicians and patients better use genetic tests to identify, evaluate, and treated breast cancer. The first pair of tools will assess whether a woman with a family history of cancer should be tested for BRCA1 and BRCA2 gene mutations. The second pair of tools, for women already diagnosed with breast cancer, will help determine which patients are suitable for a gene expression profiling test that can evaluate the risk of cancer recurrence and whether they should have chemotherapy.

Source: More information is available online at (AHRQ contract 290-200-50036I).
  • Report discusses impact of several gene expression profiling tests for breast cancer patients.
Description: Breast cancer treatment today often involves a multi-modality approach, including surgery, radiation therapy, endocrine therapy, and/or chemotherapy. Gene expression profiling has been proposed as an approach to assess women's risk of distant disease recurrence. This report discusses the available evidence on three breast cancer gene expression assays: the Oncotype DX™ Breast Cancer Assay, the MammaPrint® Test, and the Breast Cancer Profiling Test. Tests that improve such estimates of risk potentially can affect clinical outcome in breast cancer patients by either avoiding unnecessary chemotherapy or employing it where it otherwise might not have been used.

Source: Impact of Gene Expression Profiling Tests on Breast Cancer Outcomes, Evidence Report/Technology Assessment No. 160 (AHRQ Publication No. 08-E002)* (AHRQ contract 290-02-0018).
  • Race, age, and other factors affect degree of pain among women with breast cancer.
Description: Researchers studied 1,124 women with stage IV breast cancer over the course of a year and found that minority women who had advanced breast cancer suffered more pain than white women. In addition, women who were inactive and younger women also reported more severe pain.

Source: Castel, Saville, DePuy, et al., Cancer 112(1):162-170, 2008 (AHRQ grant T32 HS00032).

Cervical Cancer

  • Some Latinas have higher rates of cervical cancer than white women.
Description: According to this study, women of Mexican descent born in the United States are at higher risk for contracting the human papilloma virus (HPV) that causes cervical cancer than white women and foreign-born Latinas. Indeed, those who have acculturated—i.e., they think, speak, and read English at home or with friends—are more likely than less acculturated Latinas to contract HPV and cervical cancer. The researchers note that rates of HPV in U.S.-born Mexican women may be a result of increased sexual behavior, since more acculturated U.S.-born Mexican women also had higher rates of chlamydia, gonorrhea, and herpes II.

Source: Kepka, Coronado, Rodriguez, and Thompson, Prev Med 51(2):182-184, 2010 (AHRQ HS13853).
  • Study identifies barriers to followup of an abnormal Pap test in Latinas.
Description: This study found four primary barriers to women having colposcopy as a followup to an abnormal Pap smear result: (1) anxiety or fear of the test, (2) difficulty scheduling the test around work or child care commitments, (3) poor doctor-patient communication, and (4) concern about pain. The study involved 40 Latinas, of whom 75 percent spoke only Spanish.

Source: Percac-Lima, Aldrich, Gamba, et al., J Gen Intern Med 25(11):1198-1204, 2011 (AHRQ grant HS19161).
  • Many young women have not received the HPV vaccine.
Description: This survey found that more than 60 percent of 1,011 young women aged 13 to 26 years knew about Gardasil®, the vaccine against human papilloma virus (HPV) that causes cervical cancer. However, only 30 percent of those aged 13 to 17 and 9 percent of those aged 18-26 had received the vaccine. Because the vaccine is most beneficial when given before young women become sexually active, the authors urge practitioners and parents to step up efforts to educate young women about the importance of receiving the vaccine early.

Source: Caskey, Lindau, and Alexander, J Adolesc Health 45(5):453-462, 2009 (AHRQ grant HS15699).

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