Essay breast cancer factors
Identifying hormonally active substances is complex, in that various models are used to measure hormonal activity and the activity levels detected for a substance may differ depending on the model and dose used. It is important to assess the effectiveness of current testing protocols for hormonally active products in providing indicators of the potential for increased risk of breast cancer, and to develop and validate new testing practices where needed. Recommendation The pharmaceutical industry and other sponsors of research on new hormonally active pharmaceutical products should support the development and validation of better preclinical screening tests that can be used before such products are brought to market to help evaluate their potential for increasing the risk of breast cancer.
A suite of in vitro and in vivo tests will likely be needed to address the different mechanisms of action that may be relevant over the life course in utero, early infancy, pre- and postpuberty, pregnancy, and pre- and postmenopause. If such tests can be developed and validated, FDA should require submission of the results as part of the process for approving the introduction of new hormonal preparations for prescription or over-the-counter use.
These tests may also prove useful in testing environmental chemicals. Rationale: With the demonstration that use of certain hormonally active prescription drugs is associated with an increased risk of breast cancer and other adverse health effects, it is important to investigate whether use of other hormonally active drugs is also associated with increased risk. The Food and Drug Administration Amendments Act of gave FDA the authority to require postmarketing studies or clinical trials for approved drugs when adverse event reporting would not be sufficient to assess a known or suspected serious risk FDA, Because adverse event reporting systems are generally better suited to the detection of adverse events that occur soon after use of a drug than to events such as breast cancer that take years to develop, formally conducted studies appear necessary to assess the potential breast cancer risk.
Recommendation FDA should use its authority under the Food and Drug Adminisration Amendments Act of to engage the pharmaceutical industry and scientific community in postmarketing studies or clinical trials for hormonally active prescription drugs for which the potential impact on breast cancer risk has not been well characterized. Study oversight should be designed to mitigate against bias and conflict of interest of study sponsors. Special attention should be accorded to those products that represent a substantial change in pharmacologic composition or dosage schedule from products currently on the market.
The studies should be adequately powered to quantitatively explore the possible contribution of the products to breast cancer risk, as well as other risks that have been associated with these classes of drugs e. Researchers, health care providers, and the public all have an incomplete picture of the components of breast cancer risk. Further work is needed to clarify the contribution of recognized risk factors to differences and changes in the incidence of breast cancer and to determine the most effective ways to convey information about breast cancer risk.
Rationale: Public health messages about ways to reduce risk should rest on strong science on the attribution of risks to various causal factors.
Systematic modeling approaches are needed to refine the estimates of the proportion of breast cancer in the United States and other countries that can be attributed to known factors, especially modifiable factors. Substantial proportions of the increase in breast cancer incidence rates in the United States over the past century, and of the differences in rates of breast cancer between less developed countries and more affluent countries, are probably due in large part to differences over time and between countries in the prevalence of established breast cancer risk factors e.
Few reliable estimates of these temporal and international differences in risk factor prevalence exist. Developing data on changes in the prevalence of known risk factors, along with changes in breast cancer incidence, should permit statistical modeling of the size of these proportions associated with individual risk factors and combinations of these risk factors.
This information will also help in determining the magnitude of risk associated with other unidentified. Of particular interest are the modifiable risk factors. Risk modeling on both the individual and population levels will benefit greatly from improved understanding of the etiology of breast cancer. As the science improves, risk models can also help guide future research investments and policy decisions for population-level interventions. Recommendation Breast cancer researchers and research funders should support efforts to 1 develop statistical methodology for the estimation of risk of breast cancer for given sets of risk factors and that takes the life course perspective into account, 2 determine the proportion of the total temporal and geographic differences in breast cancer rates that can be plausibly attributed to established risk factors, and 3 develop modeling tools that allow for calculation of breast cancer risk, in both absolute and relative terms, with the goal of assessing potential risk reduction strategies, at both personal and public health levels.
Rationale: Accurate and effective communication of breast cancer risks is important for individuals, the public at large, and policy makers and public health officials. Individuals need to be able to make informed choices regarding risk factors, prevention opportunities, and health care appropriate to their risk circumstances. Research indicates that women may have a poor understanding of their risk of breast cancer, with both over- and underestimates of risk observed Lipkus et al. A systematic review under the auspices of the Cochrane Collaborative found that both health care providers and consumers understood risks of health outcomes better when those risks were presented as frequencies rather than as probabilities Akl et al.
Both thought the risks were lower when presented as absolute risk reduction than as relative risk reduction, and both were more persuaded by relative than absolute risks in terms of potential behavioral change. To allow a fair comparison of risks and benefits, supplementing presentation of relative measures with absolute ones is useful because other disease endpoints may be more or less common than breast cancer.
From a public health policy and practice perspective, it is important to determine where risks lie and the potential for benefit and risk at a population level. Uncertainty is inherent in risk prediction, and it can be difficult or impossible to establish that an exposure is not associated with cancer. However, moderate or large risks can be ruled out with reasonable confidence when studies with robust and appropriate research designs and analyses have been conducted in populations with relevant exposures.
Meaningful differences in risk need to be effectively communicated to the public, health care providers, and policy makers so that limited funds can be invested in the most promising research and intervention strategies. Recommendation Breast cancer researchers and research funders should pursue research to identify the most effective ways of communicating accurate breast cancer risk information and statistics to the general public, health care professionals, and policy makers.
Because people differ in their health literacy, their numeracy ability to understand numerical information , and in their preferred modes of learning, multiple communication strategies, modes, and messaging tactics will be needed to reach diverse communities and stakeholders. Among the topics that should receive attention in this research are. Breast cancer is a leading cause of cancer morbidity among women in the United States and many other countries. Major advances have been made in understanding its biology and diversity, but more needs to be.
Familiar advice about healthful lifestyles appears relevant, but it remains difficult to discern what contribution a diverse array of other environmental factors may be making. Important targets for research are the biologic significance of life stages at which environmental risk factors are encountered, what steps may counter their effects, when preventive actions can be most effective, and whether opportunities for prevention can be found for the variety of forms of breast cancer. Akl, E. Oxman, J. Herrin, G.
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