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Roman R.,Institute Municipal Dinvestigacio Medica Parc Of Salut Mar | Roman R.,Consortium for Biomedical Research in Epidemiology and Public Health | Sala M.,Institute Municipal Dinvestigacio Medica Parc Of Salut Mar | Sala M.,Consortium for Biomedical Research in Epidemiology and Public Health | And 13 more authors.
Breast Cancer Research and Treatment

False-positive results may influence adherence to mammography screening. The effectiveness of breast cancer screening is closely related to adequate adherence among the target population. The objective of this study was to evaluate how false-positives and women's characteristics affect the likelihood of reattendance at routine breast cancer screening in a sequence of routine screening invitations. We performed a retrospective cohort study of 1,371,218 women aged 45-69 years, eligible for the next routine screening, who underwent 4,545,346 screening mammograms from 1990 to 2006. We estimated the likelihood of attendance at seven sequential screening mammograms. Multilevel discrete time hazard models were used to estimate the effect of false-positive results on reattendance, and the odds ratios (OR) of non-attendance for the women's personal characteristics studied. The overall reattendance rate at the second screening was 81.7% while at the seventh screening was 95.6%. At the second screening invitation reattendance among women with and without a false-positive mammogram was 79.3 vs. 85.3%, respectively. At the fourth and seventh screenings, these percentages were 86.3 vs. 89.9% and 94.6 vs. 96.0%, respectively. The study variables associated with a higher risk of failing to participate in subsequent screenings were oldest age (OR = 8.48; 95% CI: 8.31-8.65), not attending their first screening invitation (OR = 1.12; 95% CI: 1.11-1.14), and previous invasive procedures (OR = 1.09; 95% CI: 1.07-1.10). The risk of non-attendance was lower in women with a familial history of breast cancer (OR = 0.97; 95% CI: 0.96-0.99), and those using hormone replacement therapy (OR = 0.96; 95% CI: 0.94-0.97). In conclusion, reattendance was lower in women with false-positive mammograms than in those with negative results, although this difference decreased with the number of completed screening participations, suggesting that abnormal results in earlier screenings more strongly influence behavior. These findings may be useful in providing women with accurate information and in improving the effectiveness of screening programs. © Springer Science+Business Media, LLC. 2011. Source

Peiro-Perez R.,Cancer and Public Health Area | Peiro-Perez R.,CIBER ISCIII | Salas D.,Cancer and Public Health Area | Valles G.,Cancer and Public Health Area | And 17 more authors.
European Journal of Public Health

Background: The aim is to analyse physical activity (PA), the fulfilment recommendation of at least 150 min of moderate PA, through walking/biking (W&B), sport, both types of PA and the factors associated with inactivity by Spanish women who attended breast cancer screening programmes. Methods: The DDM-Spain is a multicentre cross-sectional study involving 3584 women, aged 45-68, attending screening in seven Spanish cities. Data were collected using a questionnaire, including age, socio-demographic and lifestyle characteristics, family burden and PA. PA was converted into metabolic equivalent of task (METs), categorized as low ≤600 METs min per week (m/w), moderate 600-3000 METs m/w and high ≥3000 METs m/w. A multivariate logistic regression was performed to identify variables associated with inactivity for each type of PA. Results: No women achieved a high level of PA through sport. 79.2% achieved a high or moderate level of PA by W&B. Lack of sport was associated with being overweight (odds ratio OR = 1.31; 95% confidence interval CI: 1.06 to 1.62), body mass index (BMI) ≥30 (OR = 1.85; 95% CI: 1.44 to 2.38), smoking (OR = 1.56; 95% CI: 1.22 to 2.00) and living with a disabled person (OR = 1.64; 95% CI: 1.0 to 2.81), whereas enough sport practice was associated with higher educational or socio-economic level (SEL). Regarding W&B, inactivity was associated with BMI ≥ 30 (OR = 1.91; 95% CI: 1.49 to 2.45) and living with someone >74 (OR = 1.96; 95% CI: 1.48 to 2.58). Inactivity for both types of exercise was associated with a BMI ≥30 (OR = 2.13; 95% CI: 1.63 to 2.8), smoking (OR = 1.41; 95% CI: 1.09 to 1.81) and living with someone >74 (OR = 1.69; 95% CI: 1.24 to 2.28). Conclusions: Family burden and BMI ≥30 are inversely associated with both types of PA. W&B is the most common type of PA regardless of educational and SEL. © 2015 The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. Source

Fernandez-Navarro P.,Carlos III Institute of Health | Fernandez-Navarro P.,Consortium for Biomedical Research in Epidemiology and Public Health | Pita G.,Human Genotyping Unit CeGen | Santamarina C.,Galicia Breast Cancer Screening Programme | And 14 more authors.
European Journal of Cancer

Background: Mammographic density (MD) is regarded as an intermediate phenotype in breast cancer development. This association study investigated the influence of 14 breast cancer susceptibility loci identified through previous genome-wide association studies on MD among the participants in the "Determinants of Density in Mammographies in Spain" (DDM-Spain) study. Methods: Our study covered a total of 3348 Caucasian women aged 45-68 years, recruited from seven Spanish breast cancer screening centres having DNA available. Mammographic density was blindly assessed by a single reader using a semiquantitative scale. Ordinal logistic models, adjusted for age, body mass index and menopausal status, were used to estimate the association between each genotype and MD. Results: Evidence of association with MD was found for variant rs3803662 (TOX3) (Odds Ratio (OR) = 1.13, 95% Confidence Interval (CI) = 1.03-1.25), and marginal evidence of association for susceptibility loci rs3817198 (LSP1) (OR = 1.09, 95% CI = 1.00-1.20) and rs2981582 (FGFR2) (OR = 0.92, 95% CI = 0.84-1.01). Two other loci were associated with MD solely among pre-menopausal women, namely, rs4973768 (SLC4A7) (OR = 0.83, 95% CI = 0.70-1.00) and rs4415084 (MEPS30) (OR = 1.22, 95% CI = 1.00-1.49). Conclusions: Our findings lend some support to the hypothesis which links these susceptibility loci to MD. © 2012 Elsevier Ltd. All rights reserved. Source

Fernandez-Navarro P.,Carlos III Institute of Health | Fernandez-Navarro P.,Consortium for Biomedical Research in Epidemiology and Public Health | Gonzalez-Neira A.,Human Genotyping Unit CeGen | Pita G.,Human Genotyping Unit CeGen | And 21 more authors.
International Journal of Cancer

Mammographic density (MD) is an intermediate phenotype for breast cancer. Previous studies have identified genetic variants associated with MD; however, much of the genetic contribution to MD is unexplained. We conducted a two-stage genome-wide association analysis among the participants in the "Determinants of Density in Mammographies in Spain" study, together with a replication analysis in women from the Australian MD Twins and Sisters Study. Our discovery set covered a total of 3,351 Caucasian women aged 45 to 68 years, recruited from Spanish breast cancer screening centres. MD was blindly assessed by a single reader using Boyd's scale. A two-stage approach was employed, including a feature selection phase exploring 575,374 SNPs in 239 pairs of women with extreme phenotypes and a verification stage for the 183 selected SNPs in the remaining sample (2,873 women). Replication was conducted in 1,786 women aged 40 to 70 years old recruited via the Australian Twin Registry, where MD were measured using Cumulus-3.0, assessing 14 SNPs with a p value <0.10 in stage 2. Finally, two genetic variants in high linkage disequilibrium with our best hit were studied using the whole Spanish sample. Evidence of association with MD was found for variant rs11205277 (OR = 0.74; 95% CI = 0.67-0.81; p = 1.33 × 10-10). In replication analysis, only a marginal association between this SNP and absolute dense area was found. There were also evidence of association between MD and SNPs in high linkage disequilibrium with rs11205277, rs11205303 in gene MTMR11 (OR = 0.73; 95% CI = 0.66-0.80; p = 2.64 × 10-11) and rs67807996 in gene OTUD7B (OR = 0.72; 95% CI = 0.66-0.80; p = 2.03 × 10-11). Our findings provide additional evidence on common genetic variations that may contribute to MD. © 2014 UICC. Source

Cabanes A.,Institute Salud Carlos III | Cabanes A.,CIBER ISCIII | Pastor-Barriuso R.,Institute Salud Carlos III | Pastor-Barriuso R.,CIBER ISCIII | And 20 more authors.
Breast Cancer Research and Treatment

Mammographic density (MD), or the proportion of the breast with respect to its overall area that is composed of dense tissue, is a strong risk factor for breast cancer. Studies support a positive association of mammographic density and alcohol drinking. This was a cross-sectional multicenter study based on 3584 women, aged 45-68 years, recruited from seven screening centers within the Spanish breast cancer screening program network. The association between MD, alcohol consumption and tobacco use was evaluated by using ordinal logistic models with random center-specific intercepts. We found a weak positive association between current alcohol intake and higher MD, with current alcohol consumption increasing the odds of high MD by 13% (OR = 1.13; 95% CI 0.99-1.28) and high daily grams of alcohol being positively associated with increased MD (P for trend = 0.045). There were no statistically significant differences in MD between smokers and non-smokers. Nevertheless, increased number of daily cigarettes and increased number of accumulated lifetime cigarettes were negatively associated with high MD (P for trend 0.017 and 0.021). The effect of alcohol on MD was modified by menopausal status and tobacco smoking: whereas, alcohol consumption and daily grams of alcohol were positively associated with higher MD in postmenopausal women and in women who were not currently smoking, alcohol consumption had no effect on MD in premenopausal women and current smokers. Our results support an association between recent alcohol consumption and high MD, characterized by a modest increase in risk at low levels of current consumption and a decrease in risk among heavier drinkers. Our study also shows how the effects of alcohol in the breast can be modified by other factors, such as smoking. © 2011 Springer Science+Business Media, LLC. Source

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