Intrauterine exposures to environmental factors have been hypothesized to influence the risk of breast cancer in adulthood. The majority of epidemiological studies suggest that dietary folate intake is inversely related to breast cancer, however, the evidence have been inconsistent. An animal study was performed to determine the relationship between in utero and postnatal dietary folate intervention and the risk of breast cancer in the DMBA rodent model. Supplementation of maternal and offspring diet with folic acid (5 mg/kg diet) was observed to significantly increase the risk of mammary tumor development in the offspring compared to controls (2 mg/kg diet). Maternal diet and tumor status were also found to be significant predictors of global DNA methylation. Our data suggests that high intrauterine and postnatal exposures to folic acid increases the risk of breast cancer development. Epigenetic modifications may be an underlying mechanism by which folate mediates mammary tumorigenesis in the offspring.

Ecological studies and results from our low-fat, high-carbohydrate dietary intervention trial suggest that different carbohydrates are associated with breast cancer risk in different ways. We examined the association of diet glycemic index (GI), a ranking of carbohydrate containing foods based on their blood glucose raising potential, with breast cancer risk and phenotype. GI was calculated from multiple food records from subjects in our intervention trial using a nested case-control design (220 cases, 440 controls). GI was not associated with risk of total or estrogen receptor positive breast cancer, tumor size or nodal status. GI was strongly positively associated with hormone negative breast cancer. This finding is potentially important as little is known about the etiology of hormone negative breast cancer, which has a worse prognosis than hormone positive breast cancer. However, this finding is based on a small number of cases and should be replicated in a larger sample.

Ecological studies and results from our low-fat, high-carbohydrate dietary intervention trial suggest that different carbohydrates are associated with breast cancer risk in different ways. We examined the association of diet glycemic index (GI), a ranking of carbohydrate containing foods based on their blood glucose raising potential, with breast cancer risk and phenotype. GI was calculated from multiple food records from subjects in our intervention trial using a nested case-control design (220 cases, 440 controls). GI was not associated with risk of total or estrogen receptor positive breast cancer, tumor size or nodal status. GI was strongly positively associated with hormone negative breast cancer. This finding is potentially important as little is known about the etiology of hormone negative breast cancer, which has a worse prognosis than hormone positive breast cancer. However, this finding is based on a small number of cases and should be replicated in a larger sample.

Background: Breast cancer is a diverse disease. Over the past 3 decades it has been increasingly appreciated that therapy should be targeted to specific patient and tumour characteristics. In recent years the evaluation of tailored therapy has been dominated by the development of new drug therapy which when successful has been marketed at a high price. There have been few successful attempts to optimize currently available therapies. This thesis explores the optimization of currently available therapies in three domains: efficacy, toxicity and supportive care. Methods: Three independent studies were undertaken. First, a prospective cohort study was conducted to assess the impact of re-biopsy of recurrent breast cancer on physician choice of therapy and on patient satisfaction. The second study comprised a systematic review and meta-analysis of randomized trials exploring toxicities associated with different endocrine therapy options for early breast cancer with the aim of identification of patients who may be harmed by certain drugs. Finally, a randomized feasibility study was conducted to evaluate de-escalated intravenous bisphosphonates in women with low-risk metastatic breast cancer to bone. Results: All studies met their objectives in showing that the tailored use of available therapies can be optimized. The prospective study of the impact of re-biopsy showed that treatment decisions were modified in 14% of women. Patient satisfaction with the process of re-biopsy was high. The meta-analysis of toxicities of endocrine therapy identified cardiovascular disease as a statistically significant toxicity of aromatase inhibitors, thereby suggesting that those with established cardiovascular disease or risk factors thereof should reduce their exposure to these drugs. Finally, the randomized feasibility study showed that it is possible to conduct randomized trials of de-escalated bisphosphonates in women with low-risk breast cancer and there was no signal that reducing the frequency of treatment was associated with untoward outcomes. Conclusions: It is possible to optimize the tailored therapy of breast cancer using currently available treatments. This may lead to improved patient outcome while using existing resources. Further studies assessing the optimization of other treatments are warranted.

Intrauterine exposures to environmental factors have been hypothesized to influence the risk of breast cancer in adulthood. The majority of epidemiological studies suggest that dietary folate intake is inversely related to breast cancer, however, the evidence have been inconsistent. An animal study was performed to determine the relationship between in utero and postnatal dietary folate intervention and the risk of breast cancer in the DMBA rodent model. Supplementation of maternal and offspring diet with folic acid (5 mg/kg diet) was observed to significantly increase the risk of mammary tumor development in the offspring compared to controls (2 mg/kg diet). Maternal diet and tumor status were also found to be significant predictors of global DNA methylation. Our data suggests that high intrauterine and postnatal exposures to folic acid increases the risk of breast cancer development. Epigenetic modifications may be an underlying mechanism by which folate mediates mammary tumorigenesis in the offspring.

Menopausal symptoms are a concern for peri- and postmenopausal women, and for women who have been treated for breast cancer. Changes in memory are a commonly reported menopausal symptom which can interfere with daily activities, occurring in women who experience natural menopause as well as in women who have an abrupt onset of menopause following treatment for breast cancer. Menopause hormone therapy may be contraindicated or unacceptable for many women, reinforcing the need for well-tolerated, non-hormonal treatments for menopausal symptoms. The purpose of this study was to examine the efficacy of acupuncture to improve the menopausal symptom of memory changes in breast cancer survivors, and was a secondary analysis of a placebo-controlled, randomized clinical trial. The Framework for Interactions between the Individual and the Environment was the conceptual framework that guided the study.<br>Subjects in the parent study were randomized to either the experimental group (symptom-specific acupuncture), control group (non-symptom-specific acupuncture), or enhanced usual care group (instruction on health-related topics). Each group received twelve intervention sessions over an 8-week period. Sixty subjects indicating a positive response to memory items on instruments at baseline were selected for this secondary analysis. The Daily Symptom Diary, Kupperman Index, and Menopause-Specific Quality of Life Questionnaire (MENQOL) measured frequency or severity of perceived memory changes at baseline, midpoint, and end of treatment.<br>Frequency distributions were used to summarize the data. There were no statistically significant results from the Daily Symptom Diary. Improvement in the enhanced usual care group compared to the acupuncture groups was seen on the Kupperman Index, and validity concerns for this instrument were reviewed. Analysis of the MENQOL data revealed more positive change in the acupuncture groups in improvement of memory than in the enhanced usual care group. These findings support the need for further exploration of targeted interventions such as acupuncture to improve memory difficulties for menopausal women and breast cancer survivors, particularly as advances are made in the understanding of the mechanisms of cognitive change. Acupuncture remains promising as a non-hormonal treatment for menopausal symptoms and merits further investigation. / School of Nursing; / Nursing / PhD; / Dissertation;

Ethnodrama has been identified as an effective and innovative qualitative research method and dissemination tool which aims to improve and inform society through theatrical performances. Researchers are increasingly utilizing ethnodrama in their work; however it is relatively new and remains unexplored. The lived experiences of this method have not been extensively documented in prior research.<p> Specifically, I focus on a project which involved ethnodrama workshops for women experiencing arm problems after breast cancer. The ethnodrama workshops revealed that women were feeling: 1) there is a lack of support, 2) a sense of isolation, and 3) a need to heal after breast cancer. The workshops began to break that isolation, provide support, and start a journey of healing. They also provided an unexpected finding that yoga is an effective and sought after method of healing for women after breast cancer. This finding moved the workshops into the creation of healing yoga program for women after breast cancer, instead of a research based theatrical performance (ethnodrama). <p> Phenomenological interviews took place with a yoga teacher, dramatists, and researchers who had lived experiences of ethnodrama. The researchers spoke of the challenges involved in ethnodrama creation including time, funding, participant recruitment, and data collection. I also focus on the themes of emotional connectivity, building trust, healing, breaking isolation, and social change as they were found to resonate across all their experiences with the method.<p> I also use the methodology of autoethnography to connect the common themes across the experiences of ethnodrama with my own experience. My participation in an ethnodrama project allows me to connect my participant and researcher involvement with this method.<p> Ethnodrama is an effective knowledge translation strategy for audiences; however I have found that it is also a method which emotionally connects researchers and participants. There are challenges to this method, but I learned they did not outweigh the benefits. The themes of healing, breaking isolation, building trust, and social change show that ethnodrama is a method which positively impacts researchers and participants involved.

No description available.

published_or_final_version / Clinical Psychology / Master / Master of Social Sciences

Background: Breast cancer is the most frequent female cancer in both developed and developing world which comprising 16% of all female cancer according to WHO GLOBOCAN 2008. The statistic from Hong Kong Cancer Registry reported that breast cancer is the third commonest cause of female death in Hong Kong. Breast cancer incidence varies remarkably among developed countries. The high dietary consumption of soy isoflavones has been hypothesized to explain the lower breast cancer incidence among women in Asian countries in observational studies, but whether soy isoflavones exert estrogenic or anti-estrogenic in breast tissue remains uncertain. Objective: This systematic review was to assess the effects of isoflavone-rich soy consumption on breast cancer risk in pre- and post-menopausal women Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines for conducting and reporting randomized controlled trials were followed. Data sources: A systematic review of randomized controlled trials was conducted through searching databases: MEDLINE, PubMed and Cochrane Library (2002 until March 2012). Keywords for electronic searches included: [(soy OR isoflavones) AND (breast cancer OR breast neoplasms)] limited study types to human & randomized controlled studies. Study selection: RCTs of the effects of isoflavones or supplement versus placebo or control diet among pre- and post-menopausal participants who were currently free from breast cancer. Outcome measurements: serum sex hormones and IGF profile, mammographic density and menstruation cycle length Results: 15 RCTs (1527 women) compared isoflavones with placebo or control diet for study duration ranged from 2 months to 2 years. No significant effect was found on serum sex hormones, IGF profile, mammographic density or menstrual cycle length. The effect of menstrual cycle on mammographic densities was noticed. Conclusion: The results of the systematic review did not support the hypothesis that short-term isoflavones exposure has an effect on modulating breast cancer risk. The effect of menstrual cycle on mammographic densities probably reflects the effect of hormonal changes. Null results did not necessarily contradict the inverse association between soy intake and breast cancer risk from the results of epidemiologic studies. The absence of conclusive data on the effects might be attributable to the insufficient exposure duration in the RCTs. Longer duration of soy exposure and early life exposure might be a scope for future research. / published_or_final_version / Public Health / Master / Master of Public Health