Lactation in Australian women : the effect of oral contraceptives on the vitamin and trace element content of breast milk

The aim of this project was to investigate the effects of oral contraceptives on the nutrient composition of breast milk. The design of the study also allowed the effects of stage of lactation and maternal diet on milk composition to be observed. A prospective study was designed to measure maternal dietary intake and vitamin and trace element concentration in milk and plasma. Vitamin A, ascorbic acid and iron, copper, zinc, manganese, selenium, cobalt, chromium, rubidium and caesium were measured. Two groups of women participated, oral contraceptive users and controls. Fasting milk and blood samples and 24-hour food records were collected from the women once a week for 20 weeks commencing 3-8 weeks post-partum, and 1-2 weeks before they began to take oral contraceptives. Fifteen women participated in the study; 5 took progestogen-only oral contraceptives, 1 took an oestrogen-progestogen oral contraceptive and 9 acted as controls. Progestogen-only oral contraceptives did not affect the milk or plasma concentration of the vitamins and trace elements measured. As only 1 subject took an oestrogen-progestogen preparation no conclusion could be drawn as to its effect. The mean milk and plasma concentration of all nutrients studied did not change significantly with the progression of lactation, with the exception of iron and zinc. The mean milk iron concentration was significantly higher at 16 weeks post-partum than at 8 and 23 weeks post-partum. The mean milk zinc concentration was significantly lower at 23 weeks post-partum than at 8 and 16 weeks post-partum. The infants1 mean estimated daily intakes of ascorbic acid and vitamin A from breast milk were above the U.S. and British Recommended Dietary Allowance for those vitamins. However, their mean estimated intakes of iron, zinc, copper, manganese and selenium were well below the U.S. recommendations. Effects of the maternal dietary intake on milk and plasma composition were variable. Implications of these findings have been discussed.

Analytical relationship between family history and genetic and environmental risks, with application to female breast cancer

It is well established in genetic epidemiology that family history is an important indicator of familial aggregation of disease in a family. A strong genetic risk factor or an environmental risk factor with high familial correlation can result in a strong family history. In this paper, family history refers to the number of first-degree relatives affected with the disease. Cui and Hopper (Journal of Epidemiology and Biostatistics 2001; 6: 331-342) proposed an analytical relationship between family history and relevant genetic parameters. In this paper we expand the relationship to both genetic and environmental risk factors. We established a closed-form formula for family history as a function of genetic and environmental parameters which include genetic and environmental relative risks, genotype frequency, prevalence and familial correlation of the environmental risk factor. The relationship is illustrated by an example of female breast cancer in Australia. For genetic and environmental relative risks less than 10, most of the female breast cancer cases occur between the age of 40 and 60 years. A higher genetic or environmental relative risk will move the peak of the distribution to a younger age. A more common disease allele or more prevalent environmental risk factor will move the peak to an older age. For a proband with breast cancer, it is most likely (with probability ge80%) that none of her first-degree relatives is affected with the disease. To enable the probability of having a positive family history to reach 50%, the environmental relative risks must be extremely as high as 100, the familial correlation as high as 0.8 and the prevalence as low as 0.1. For genetic risk alone, even the relative risk is as high as 100, the probability of having a positive family history can only reach about 30%. This suggests that the environmental risk factor seems to play a more important role in determining a strong family history than the genetic risk factor.

Regressive logistic and proportional hazards disease models for within-family analyses of measured genotypes, with application to a CYP17 polymorphism and breast cancer

Various statistical methods have been proposed to evaluate associations between measured genetic variants and disease, including some using family designs. For breast cancer and rare variants, we applied a modified segregation analysis method that uses the population cancer incidence and population-based case families in which a mutation is known to be segregating. Here we extend the method to a common polymorphism, and use a regressive logistic approach to model familial aggregation by conditioning each individual on their mother's breast cancer history. We considered three models: 1) class A regressive logistic model; 2) age-of-onset regressive logistic model; and 3) proportional hazards familial model. Maximum likelihood estimates were calculated using the software MENDEL. We applied these methods to data from the Australian Breast Cancer Family Study on the CYP17 5UTR TC MspA1 polymorphism measured for 1,447 case probands, 787 controls, and 213 relatives of case probands found to have the CC genotype. Breast cancer data for first- and second-degree relatives of case probands were used. The three methods gave consistent estimates. The best-fitting model involved a recessive inheritance, with homozygotes being at an increased risk of 47% (95% CI, 28-68%). The cumulative risk of the disease up to age 70 years was estimated to be 10% or 22% for a CYP17 homozygote whose mother was unaffected or affected, respectively. This analytical approach is well-suited to the data that arise from population-based case-control-family studies, in which cases, controls and relatives are studied, and genotype is measured for some but not all subjects.

Genome - wide association study identifies novel breast cancer susceptibility loci

Breast cancer exhibits familial aggregation, consistent with variation in genetic susceptibility to the disease. Known susceptibility genes account for less than 25% of the familial risk of breast cancer, and the residual genetic variance is likely to be due to variants conferring more moderate risks. To identify further susceptibility alleles, we conducted a two-stage genome-wide association study in 4,398 breast cancer cases and 4,316 controls, followed by a third stage in which 30 single nucleotide polymorphisms (SNPs) were tested for confirmation in 21,860 cases and 22,578 controls from 22 studies. We used 227,876 SNPs that were estimated to correlate with 77% of known common SNPs in Europeans at r² > 0.5. SNPs in five novel independent loci exhibited strong and consistent evidence of association with breast cancer (P < 10^-7). Four of these contain plausible causative genes (FGFR2, TNRC9, MAP3K1 and LSP1). At the second stage, 1,792 SNPs were significant at the P < 0.05 level compared with an estimated 1,343 that would be expected by chance, indicating that many additional common susceptibility alleles may be identifiable by this approach.

Age-specific norms and determinants of anxiety and depression in 731 women with breast cancer recruited through a population-based cancer registry

The aim of this study was to determine population norms and determinants of anxiety and depression in a population-based sample of 731 women with breast cancer (aged 23–60 years) with the Hospital Anxiety and Depression scale (HADS). The prevalence of ‘probable’ psychological morbidity due to anxiety was 23% and due to depression was 3%. When the women identified as ‘possible’ cases were included, the respective proportions were 45 and 12%. Higher anxiety was present in younger, less educated women not born in Australia. There was no clear pattern of risk factors for depression. These population-based findings highlight the need for clinicians to be aware that age, education and country of birth may identify a particularly vulnerable subgroup. While brief scales such as the HADS are limited in their ability to accurately predict a clinical diagnosis, high scores identify those who may warrant referral for clinical evaluation.

Exploring barriers to uptake of breast cancer screening in South East London : a study of women's views.

Research on both sides of the Atlantic demonstrates that achieving high uptake of breast cancer screening remains an important area of public heath concern. UK government targets for breast screening uptake are 70%, however, much lower figures are found in many parts of the country, including South East London. This paper reports the findings of a study carried out to explore the views of women aged 50 to 64 (the age group covered by the free National Health Service screening programme) in order to: · establish in what way women who do not attend for screening are different from women who do attend · ascertain the views of the non-attenders with a view to making recommendations to the service which may help address the low uptake locally.

305 women were recruited through a variety of different community sources across the study area. Using a structured questionnaire/interview, women gave their views on their health concerns generally, as well as on breast screening in particular. The analysis (being undertaken now, to be completed by May 2005) will explore the influence of candidacy (women's assessment of the personal risk to them of their disease) on women's screening behaviour and the differences, if any, between the major ethnic groups in the area, indigenous white, black African and black Caribbean.

Learning Objectives:
# At the conclusion of the session, participants will be able to

* 1. Describe the factors associated with women’s screening behaviour
* 2. Evaluate the relevance of candidacy in understanding screening behaviour
* 3. Assess the relevance of UK findings for screening programmes elsewhere.

Psychological impact of breast and prostate cancer on patients and partners

Aims to identify and describe the psychological experiences of breast and prostate cancer patients and their partners, in terms of adjustment, coping and support issues.

Breast cancer : the embodied transfer of uncertainty and risk

The thesis highlights how women reconstruct themselves after mammography, following a positive diagnosis of cancer, and post mastectomy. It juxtaposes women's experiences of breast cancer with doctors' perceptions of their role in treating patients, allowing an understanding of how risk and uncertainty are transferred between the private and public spheres.

Risk perception, risk communication and message framing : breast cancer and family history

Examines the relationships between risk perception, risk communication, and health protective behaviour in relation to breast cancer and family history. Qualitative research was conducted to develop a printed community resource. Theoretical and practical implications for health behaviour theory and risk communication are identified.

Hormonal breast and prostate cancer cytotoxic agents

Details 13 novel hormone compounds, designed and synthesised for the purpose of aiding the detection and treatment of breast and prostate cancers. Cellular and electromechanical studies of 3 of these synthesised hormones indicate a potential for human application.

Early breast cancer identification : Which way to go? Microarray or image based computer aided diagnosis!

The goal of this research is to develop a computer aided diagnostic (CAD) system that can detect breast cancer in the early stage by using microarray and image data. We verified the performance of six well known classification algorithms with various performance matrices. Although we do not suggest a unique classifier algorithm for a CAD system, we do identify a number of algorithms whose performance is very promising. The algorithms performance was validated by 3 images dataset; two have been used for the first time in this experiment. Multidimensional image filtering is adopted for the final data extraction. The image data classification performance is compared with microarray data. Results suggest the most effective means of breast cancer identification in the early stage is a hybrid approach.

Does multidisciplinary care enhance the management of advanced breast cancer? : evaluation of advanced breast cancer multidisciplinary team meetings

Purpose: To assess the contribution of the advanced breast cancer (ABC) multidisciplinary team meetings (MDMs) to patient care and clinical outcomes.

Methods: Members of ABC MDMs at two health services completed questionnaires in November 2007. The questionnaire asked about the performance of the MDMs and their contribution to improvement in patient care in five domains: medical management, psychosocial care, palliative care, care in the community, and benefits for team members. A final section covered the perceived value and importance of the MDM in patient management. Descriptive statistics (frequencies, mean, and standard deviation) were used to summarize the performance, improvement, and importance scores.

Results: A total of 27 multidisciplinary team members (73%) completed the questionnaire. The MDM performed best in medical management (mean performance score out of 5 [M] = 3.78) and palliative care (M = 3.77). These were also the areas that were most improved through the MDM. Benefits to team members and care in the community (both M = 3.05) ranked lowest by both measures. The MDM provided the most benefit for patient management in the areas of "awareness of services available" (M = 4.32), "efficiency of referrals" (M = 4.27) and "supportive care for patients" (M=4.27). "Awareness of services available," "psychological care for patients," and "continuity of care" were considered the most important (M = 4.64).

Conclusion: The study provides evidence that MDMs make an important contribution to the logistical and medical management of patients with advanced breast cancer.