JAMA Internal Medicine: Oncology Topic Collection

Outcomes of Screening Mammography by Frequency, Breast Density, and Postmenopausal Hormone Therapy Outcomes of Screening Mammography

Kerlikowske K, Zhu W, Hubbard RA, et al. — Mon, 13 May 2013 00:00:00 GMT

Importance

Controversy exists about the frequency women should undergo screening mammography and whether screening interval should vary according to risk factors beyond age.

Objective

To compare the benefits and harms of screening mammography frequencies according to age, breast density, and postmenopausal hormone therapy (HT) use.

Design

Prospective cohort.

Setting

Data collected January 1994 to December 2008 from mammography facilities in community practice that participate in the Breast Cancer Surveillance Consortium (BCSC) mammography registries.

Participants

Data were collected prospectively on 11 474 women with breast cancer and 922 624 without breast cancer who underwent mammography at facilities that participate in the BCSC.

Main Outcomes and Measures

We used logistic regression to calculate the odds of advanced stage (IIb, III, or IV) and large tumors (>20 mm in diameter) and 10-year cumulative probability of a false-positive mammography result by screening frequency, age, breast density, and HT use. The main predictor was screening mammography interval.

Results

Mammography biennially vs annually for women aged 50 to 74 years does not increase risk of tumors with advanced stage or large size regardless of women's breast density or HT use. Among women aged 40 to 49 years with extremely dense breasts, biennial mammography vs annual is associated with increased risk of advanced-stage cancer (odds ratio [OR], 1.89; 95% CI, 1.06-3.39) and large tumors (OR, 2.39; 95% CI, 1.37-4.18). Cumulative probability of a false-positive mammography result was high among women undergoing annual mammography with extremely dense breasts who were either aged 40 to 49 years (65.5%) or used estrogen plus progestogen (65.8%) and was lower among women aged 50 to 74 years who underwent biennial or triennial mammography with scattered fibroglandular densities (30.7% and 21.9%, respectively) or fatty breasts (17.4% and 12.1%, respectively).

Conclusions and Relevance

Women aged 50 to 74 years, even those with high breast density or HT use, who undergo biennial screening mammography have similar risk of advanced-stage disease and lower cumulative risk of false-positive results than those who undergo annual mammography. When deciding whether to undergo mammography, women aged 40 to 49 years who have extremely dense breasts should be informed that annual mammography may minimize their risk of advanced-stage disease but the cumulative risk of false-positive results is high.

Not Just Words Caring for the Patient by Caring About Language

Epstein AS. — Mon, 13 May 2013 00:00:00 GMT

Creative Arts Therapies Defined Comment on “Effects of Creative Arts Therapies on Psychological Symptoms and Quality of Life in Patients with Cancer”

Bradt J, Goodill S. — Mon, 13 May 2013 00:00:00 GMT

A diagnosis of cancer and subsequent treatments may result in significant emotional, physical, and social suffering, placing cancer survivors at greater risk for mental health issues. Therefore, the care of cancer patients should incorporate services that help meet patients' psychological, social, and spiritual needs. Creative arts therapies (CATs), such as dance/movement, music, art, poetry, drama, and psychodrama, are increasingly used to aid in the care of cancer patients and in their recovery. The results of several systematic reviews, as referenced in the study by Puetz et al have reported small to moderate effects of music, art, and dance/movement therapies on a variety of psychological outcomes in cancer patients. The systematic review by Puetz and colleagues aims to expand the existing evidence base by identifying potential moderators of the efficacy of CATs during and after cancer treatment.

Effects of Creative Arts Therapies on Psychological Symptoms and Quality of Life in Patients With Cancer Creative Arts Therapies in Cancer Patients

Puetz TW, Morley CA, Herring MP. — Mon, 13 May 2013 00:00:00 GMT

Importance

Creative arts therapies (CATs) can reduce anxiety, depression, pain, and fatigue and increase quality of life (QOL) in patients with cancer. However, no systematic review of randomized clinical trials (RCTs) examining the effects of CAT on psychological symptoms among cancer patients has been conducted.

Objectives

To estimate the effect of CAT on psychological symptoms and QOL in cancer patients during treatment and follow-up and to determine whether the effect varied according to patient, intervention, and design characteristics.

Evidence Review

We searched ERIC, Google Scholar, MEDLINE, PsycInfo, PubMed, and Web of Science from database inception to January 2012. Studies included RCTs in which cancer patients were randomized to a CAT or control condition and anxiety, depression, pain, fatigue and/or QOL were measured pre- and post-intervention. Twenty-seven studies involving 1576 patients were included. We extracted data on effect sizes, moderators, and study quality. Hedges d effect sizes were computed, and random-effects models were used to estimate sampling error and population variance.

Findings

During treatment, CAT significantly reduced anxiety (Δ = 0.28 [95% CI, 0.11-0.44]), depression (Δ = 0.23 [0.05-0.40]), and pain (Δ = 0.54 [0.33-0.75]) and increased QOL (Δ = 0.50 [0.25-0.74]). Pain was significantly reduced during follow-up (Δ = 0.59 [95% CI, 0.42-0.77]). Anxiety reductions were strongest for studies in which (1) a non-CAT therapist administered the intervention compared with studies that used a creative arts therapist and (2) a waiting-list or usual-care comparison was used. Pain reductions were largest during inpatient treatment and for homogeneous cancer groups in outpatient settings; significantly smaller reductions occurred in heterogeneous groups in outpatient settings.

Conclusions and Relevance

Exposure to CAT can improve anxiety, depression, and pain symptoms and QOL among cancer patients, but this effect is reduced during follow-up.