Butts S.F.,University of Pennsylvania |
Seifer D.B.,Genesis Centre
Fertility and Sterility | Year: 2010
Objective: To review variations in specific reproductive health outcomes by race and ethnicity. A growing number of reports have explored potential gaps in the quality of reproductive health and healthcare across racial and ethnic groups. Diverse results from numerous investigations have made it challenging for practitioners to confirm the significance of these disparities. Method(s): Three specific areas of the reproductive life cycle were examined: pubertal onset, outcomes from treatment with assisted reproductive technologies (ART), and the menopausal transition. These areas were selected as they encompass a continuum of events across the reproductive life span of women. Outcomes were compared in black, white, Asian, and Hispanic women. Medline searches querying on keywords puberty, IVF, ART, menopause, menopausal symptoms, racial disparity, race, Asian, Japanese, Chinese, African American, black, Hispanic, and Latino were performed to isolate relevant publications for review. Result(s): Differences across race and ethnicity were noted in each clinical endpoint. The most notable findings included earlier puberty in blacks and Hispanics compared with whites, significantly lower live birth rates after ART in all racial and ethnic groups compared with whites, and differences in perimenopausal symptomatology and possibly timing in various racial/ethnic groups compared with whites. Additional research is needed to completely unravel the full significance and basic underpinnings of these disparities. Some of the limitations of the current state of the literature in drawing conclusions about the independent effect of race/ethnicity on reproductive disparities include small samples sizes in some studies, inconsistencies in the characterization of racial/ethnic groups, and incomplete control of potential confounding. Conclusion(s): Race and ethnicity appear to be important correlates of outcomes from the initiation of reproduction functioning through to its conclusion. The ultimate goal of identifying racial disparities in reproduction is to isolate the basic determinants of disparities and formulate strategies to improve outcomes for women at risk. The differences demonstrated in this review of the literature could represent environmental, sociocultural, and/or genetic correlates of race that influence these important milestones. © 2010.
Cuzick J.,Queen Mary, University of London |
Sestak I.,Queen Mary, University of London |
Cawthorn S.,Southmead Hospital |
Hamed H.,Guys and St Thomas Hospital |
And 3 more authors.
The Lancet Oncology | Year: 2015
Background: Four previously published randomised clinical trials have shown that tamoxifen can reduce the risk of breast cancer in healthy women at increased risk of breast cancer in the first 10 years of follow-up. We report the long-term follow-up of the IBIS-I trial, in which the participants and investigators remain largely masked to treatment allocation. Methods: In the IBIS-I randomised controlled trial, premenopausal and postmenopausal women 35-70 years of age deemed to be at an increased risk of developing breast cancer were randomly assigned (1:1) to receive oral tamoxifen 20 mg daily or matching placebo for 5 years. Patients were randomly assigned to the two treatment groups by telephone or fax according to a block randomisation schedule (permuted block sizes of six or ten). Patients and investigators were masked to treatment assignment by use of central randomisation and coded drug supply. The primary endpoint was the occurrence of breast cancer (invasive breast cancer and ductal carcinoma in situ), analysed by intention to treat. Cox proportional hazard models were used to assess breast cancer occurrence and mortality. The trial is closed to recruitment and active treatment is completed, but long-term follow-up is ongoing. This trial is registered with controlledtrials.com, number ISRCTN91879928. Findings: Between April 14, 1992, and March 30, 2001, 7154 eligible women recruited from genetics clinics and breast care clinics in eight countries were enrolled into the IBIS-I trial and were randomly allocated to the two treatment groups: 3579 to tamoxifen and 3575 to placebo. After a median follow up of 16·0 years (IQR 14·1-17·6), 601 breast cancers have been reported (251 [7·0%] in 3579 patients in the tamoxifen group vs 350 [9·8%] in 3575 women in the placebo group; hazard ratio [HR] 0·71 [95% CI 0·60-0·83], p<0·0001). The risk of developing breast cancer was similar between years 0-10 (226 [6·3%] in 3575 women in the placebo group vs 163 [4·6%] in 3579 women in the tamoxifen group; hazard ratio [HR] 0·72 [95% CI 0·59-0·88], p=0·001) and after 10 years (124 [3·8%] in 3295 women vs 88 [2·6%] in 3343, respectively; HR 0·69 [0·53-0·91], p=0·009). The greatest reduction in risk was seen in invasive oestrogen receptor-positive breast cancer (HR 0·66 [95% CI 0·54-0·81], p<0·0001) and ductal carcinoma in situ (0·65 [0·43-1·00], p=0·05), but no effect was noted for invasive oestrogen receptor-negative breast cancer (HR 1·05 [95% CI 0·71-1·57], p=0·8). Interpretation: These results show that tamoxifen offers a very long period of protection after treatment cessation, and thus substantially improves the benefit-to-harm ratio of the drug for breast cancer prevention. © 2015 Cuzick et al. Open Access article distributed under the terms of CC BY.
News Article | February 28, 2017
CALGARY, Alberta, Feb. 28, 2017 (GLOBE NEWSWIRE) -- The Taralake Townhomes board of directors has chosen C-Era Property Management & Realty, an Associa company, as their new management partner. C-Era will begin providing its complete line of financial, maintenance, communications and administrative services to the Calgary community on March 1. Comprised of 57 contemporary units, Taralake Townhomes is located on Taralake Way just west of Stoney Trail in northeast Calgary. The fully landscaped community boasts convenient access to city amenities like a large park, Saddleridge Town Centre and the Genesis Centre of Community Wellness, a multi-purpose complex with sports facilities, a library and a YMCA. "I would like to thank the Taralake condominium corporation board of directors for putting their trust in us to deliver unsurpassed service and help them realize their vision," says C-Era President Vicci O'Brien. "This is a small, tight-knit neighbourhood and the residents expect an upscale lifestyle, which we will be most equipped to provide for years to come." Delivering unsurpassed association management services to communities since 1979, Associa leads the industry operating more than 180 branch offices across North America and employing 10,000 team members dedicated to serving nearly five million residents who are part of the Associa family. With unrivaled industry expertise, safeguarded finances and trailblazing innovation, Associa provides solutions designed to help communities achieve their vision. To learn more go to www.associaonline.com. Stay Connected: Facebook: https://www.facebook.com/associa Twitter: https://twitter.com/associa LinkedIn: http://www.linkedin.com/company/associa YouTube: http://www.youtube.com/associamarketing Google+: https://plus.google.com/+Associaonline/
Toner J.P.,Atlanta Center for Reproductive Medicine |
Seifer D.B.,Genesis Centre |
Seifer D.B.,New York University
Fertility and Sterility | Year: 2013
Antimüllerian hormone is the most informative serum marker of ovarian reserve currently available and should be considered an important part of any contemporary reproductive medicine practice. It is both more convenient and informative than basal FSH and can be assessed at any point in the cycle. It is the most useful serum method of determining ovarian reserve, which guides pretreatment counseling, choice of infertility treatment, and avoidance of ovarian hyperstimulation. The future role of basal FSH testing is in doubt. © 2013 American Society for Reproductive Medicine, Published by Elsevier Inc.
Donnelly L.S.,Genesis Centre
British Journal of Cancer | Year: 2016
Introduction:There are widespread moves to develop risk-stratified approaches to population-based breast screening. The public needs to favour receiving breast cancer risk information, which ideally should produce no detrimental effects. This study investigates risk perception, the proportion wishing to know their 10-year risk and whether subsequent screening attendance is affected.Methods:Fifty thousand women attending the NHS Breast Screening Programme completed a risk assessment questionnaire. Ten-year breast cancer risks were estimated using a validated algorithm (Tyrer-Cuzick) adjusted for visually assessed mammographic density. Women at high risk (⩾8%) and low risk (<1%) were invited for face-to-face or telephone risk feedback and counselling.Results:Of those invited to receive risk feedback, more high-risk women, 500 out of 673 (74.3%), opted to receive a consultation than low-risk women, 106 out of 193 (54.9%) (P<0.001). Women at high risk were significantly more likely to perceive their risk as high (P<0.001) and to attend their subsequent mammogram (94.4%) compared with low-risk women (84.2%; P=0.04) and all attendees (84.3%; ⩽0.0001).Conclusions:Population-based assessment of breast cancer risk is feasible. The majority of women wished to receive risk information. Perception of general population breast cancer risk is poor. There were no apparent adverse effects on screening attendance for high-risk women whose subsequent screening attendance was increased.British Journal of Cancer advance online publication 29 March 2016; doi:10.1038/bjc.2016.56 www.bjcancer.com. © 2016 Cancer Research UK
Harvie M.,Genesis Centre
American Society of Clinical Oncology educational book / ASCO. American Society of Clinical Oncology. Meeting | Year: 2014
Nutritional supplements are widely used among patients with cancer who perceive them to be anticancer and antitoxicity agents. Large-scale, randomized cancer prevention trials have mainly been negative, with some notable adverse and beneficial effects. For example, these trials showed that beta-carotene increases the risk of lung and stomach cancer, vitamin E increases prostate cancer and colorectal adenoma, and selenium reduces gastric and lung cancer in populations with low selenium levels but increase rates in those with higher levels. Both beta-carotene and vitamin E supplementation increase overall mortality. This article reviews phase II and III trials that examine the effects of multivitamins, antioxidants, vitamin D, and n-3 supplements on outcome and toxicity from cancer treatments. Although vitamin E and beta-carotene reduce toxicity from radiotherapy among patients with head and neck cancer, it has been found to increase recurrence, especially among smokers. Antioxidants have mixed effects on chemotherapy toxicity, but there are no data on outcome. Vitamin D deficiency is relatively common among patients with cancer, and ongoing phase III trials are studying the effect of vitamin D on outcome as well as optimum vitamin D and calcium intakes for bone health. Docosahexanoic and eicosopentanoic acid supplements have mixed effects on cachexia and are currently being tested as potential adjuncts to maximize response to chemotherapy. Nutritional supplementation tailored to an individual's background diet, genetics, tumor histology, and treatments may yield benefits in subsets of patients. Clinicians should have an open dialogue with patients about nutritional supplements. Supplement advice needs to be individualized and come from a credible source, and it is best communicated by the physician.
Howell A.,Genesis Centre |
Evans G.D.,Genesis Centre
Recent Results in Cancer Research | Year: 2011
There is evidence that hormone replacement therapy (HRT) may both stimulate and inhibit breast cancers, giving rise to a spectrum of activities, which are frequently hard to understand. Here we summarise the evidence for these paradoxical effects and, given the current data, attempt to give an indication where it may or may not be appropriate to prescribe HRT. It is clear that administration of oestrogen-progestin (E-P) and oestrogen alone (E) HRT is sufficient to stimulate the growth of overt breast tumours in women since withdrawal of HRT results in reduction of proliferation of primary tumours and withdrawal responses in metastatic tumours. E-P, E including tibolone are associated with increased local and distant relapse when given after surgery for breast cancer. For women given HRT who do not have breast cancer the only large randomised trial (WHI) of E-P or E versus placebo has produced some expected and also paradoxical results. E-P increases breast cancer risk as previously shown in observational studies. Risk is increased, particularly in women known to be compliant. Conversely, E either has no effect or reduces breast cancer risk consistent with some but not all observational studies. Two observational studies report a decrease or at least no increase in risk when E-P or E are given after oophorectomy in young women with BRCA1/2 mutations. Early oophorectomy increases death rates from cardiovascular and other conditions and there is evidence that this may be reversed by the use of E post-oophorectomy. HRT may thus reduce the risk of breast cancer and other diseases (e.g., cardiovascular) in young women and increase or decrease them in older women. © 2010 Springer Berlin Heidelberg.
Littlechild S.A.,Genesis Centre |
Barr L.,Genesis Centre
Patient Education and Counseling | Year: 2013
Objectives: To identify the proportion of breast cancer patients that used the Internet for breast cancer information; to classify patterns of use based on patient demographics; and to evaluate whether using the Internet for this purpose was beneficial or problematic. Also to recognize whether a specific demographic group was more likely to experience problems when using the Internet for breast cancer information. Methods: A 10-item questionnaire was given to patients who attended the breast unit at the University Hospital of South Manchester between May and June 2011 following breast cancer treatment within the last 5 years. Results: 200 questionnaires were completed. 50.5% of patients had used the Internet for breast cancer information, with younger (p < 0.001) patients with a higher household income (p < 0.001) being most likely to do so. The majority (73%) found it beneficial; however 31% had experienced problems. Ethnicity affected the likelihood of experiencing problems with white patients encountering fewer problems (25%) than non-white patients (64%) (p= 0.008). Conclusion: A significant proportion of breast cancer patients will encounter difficulties when using the Internet for breast cancer information, particularly those from ethnic minorities. Practice implications: Health professionals need to include a discussion about Internet use in consultations with breast cancer patients. © 2013 Elsevier Ireland Ltd.
Evans D.G.,Genesis Centre |
Howell A.,Genesis Centre
Breast Cancer Research | Year: 2015
Breast cancer risk is continuing to increase across all societies with rates in countries with traditionally lower risks catching up with the higher rates in the Western world. Although cure rates from breast cancer have continued to improve such that absolute numbers of breast cancer deaths have dropped in many countries despite rising incidence, only some of this can be ascribed to screening with mammography, and debates over the true value of population-based screening continue. As such, enthusiasm for risk-stratified screening is gaining momentum. Guidelines in a number of countries already suggest more frequent screening in certain higher-risk (particularly, familial) groups, but this could be extended to assessing risks across the population. A number of studies have assessed breast cancer risk by using risk algorithms such as the Gail model, Tyrer-Cuzick, and BOADICEA (Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm), but the real questions are when and where such an assessment should take place. Emerging evidence from the PROCAS (Predicting Risk Of Cancer At Screening) study is showing not only that it is feasible to undertake risk assessment at the population screening appointment but that this assessment could allow reduction of screening in lower-risk groups in many countries to 3-yearly screening by using mammographic density-adjusted breast cancer risk. © 2015 Evans and Howell.
Harvie M.,Genesis Centre |
Howell A.,Genesis Centre
Proceedings of the Nutrition Society | Year: 2012
Energy restriction (ER) to control weight is a potential strategy for breast cancer prevention. The protective effects of habitual continuous energy restriction (CER) and weight loss on breast tumour formation have been conclusively demonstrated in animal studies over the past 100 years, and more recently in women using data from observational studies and bariatric surgery. Intermittent energy restriction (IER) and intermittent fasting (IF) are possible alternative preventative approaches which may be easier for individuals to undertake and possibly more effective than standard CER. Here, we summarise the available data on CER, IER and IF with special emphasis on their potential for breast cancer prevention. In animals, IER is superior or equivalent to CER with the exception of carcinogen-induced tumour models when initiated soon after carcinogen exposure. There are no human data on IER and breast cancer risk, but three studies demonstrated IER and CER to be equivalent for weight loss. IF regimens also reduce mammary tumour formation in animal models and also led to weight loss in human subjects, but have not been directly compared with CER. Animal and some human data suggest that both IER and IF may differ mechanistically compared with CER and may bring about greater reduction in hepatic and visceral fat stores, insulin-like growth factor 1 (IGF-1) levels and cell proliferation, and increased insulin sensitivity and adiponectin levels. Although IER and IF were first studied 65 years ago, we conclude that further studies are required to assess their values compared with CER. © 2012 The Authors.