Identifying and communicating a disease diagnosis has historically been the center of the medical encounter. Recent advances in molecular biology and genetics have increased the amount of care devoted to disease screening and risk assessment. In this era of prevention, risk itself has become a ‘problem’ requiring intervention where once such problems were left unidentified. Treating risk as a diagnosis itself allows it be treated in a familiar manner, but marginalizes the patient experience. It is important to understand how adopting a biomedical view of risk and prevention influences participation in care and patient willingness to engage with the medical system, despite a lack of manifest disease. This is a critical gap in knowledge at a time when there is increased emphasis on preventive medicine. This dissertation contains three chapters that seek to characterize how identifying, labeling, and developing interventions for patients 'at risk' affects service provision and use. Study 1, Explanatory Models of Risk: The Role of Social Context in Breast Cancer Risk Perception and Decision-Making, sought to characterize explanatory models of risk among women at risk for developing breast cancer. Qualitative interviews demonstrated the importance of perceptions of risk and control in combination with elements of explanatory models and social context in their decision-making. Study 2, Associations between Breast Cancer Risk and General Health Service Use, considered the possibility that patterns of health service utilization may change following a medical finding that is often perceived as increased risk. Results showed a greater increase in the rate of outpatient visits and referrals in the year following a false positive mammogram, suggesting such utilization is driven by both patients and providers. Study 3, An Assessment of Patient Navigator Activities in Breast Cancer Patient Navigation Programs Using a Nine-Principle Framework, described similarities and differences in the execution of patient navigation programs designed to increase engagement in care among individuals who have been labeled as ‘at risk’ upon having an abnormal mammogram. Activities conducted by navigators where shown to vary according to the local context and population of women that they served.

The term "teachable moment" (TM) has been used to describe a life transition or event which motivates an individual to change a behavior or presents an opportunity to intervene to prompt behavior change. We examined whether receipt of a false positive ovarian cancer (OC) screening result may represent a TM. 403 women participating in an OC screening program completed questionnaires assessing demographic, clinical, behavioral, and psychosocial information. The TM was operationalized as expressed interest in receiving health-related information. We hypothesized that among women receiving a false positive screening test result, those women who had experienced greater personal perceived risk for OC as well as distress would be more interested in receiving health-related information than women receiving a normal result. Analyses revealed that women receiving a false positive screening result were less interested in receiving health-related information than women receiving a normal screening result. For women receiving a false positive result, expressed interest in receipt of health-related information was only modestly related to distress and related even less to perceptions of OC risk. Our data do not support viewing a false positive OC screening result as a TM. Potential explanations for the current findings as well as recommendations for future research investigating the TM are discussed.

Heavy metal contamination of soil and agricultural products is an environmental problem, has an adverse effect on the quality of food crops, and is a danger to food security and public health. The concentration of arsenic (As), cadmium (Cd), lead (Pb), iron (Fe) and zinc (Zn) in surface soils and edible hypocotyls tissues of two ecotypes of Lepidium meyenii Walpers (maca) was evaluated in three districts of the Junín province, Peru. In addition, the risk to human health due to exposure to heavy metals from maca consumption was evaluated. Soil samples and maca hypocotyls were collected in areas influenced by mining and metallurgical activity. The mean concentration of Cd (0.32 ± 0.23 mg/kg) and Pb (0.20 ± 0.12 mg/kg) in maca samples exceeded the values established by the Food and Agriculture Organization and the World Health Organization. The bioconcentration factor was less than 1. The estimated daily intake of each metal was below the oral reference dose. The hazard quotient and hazard index were less than 1, it is unlikely to cause non-cancer adverse health outcome. The cancer risk for As and Cd was higher than the tolerable limit (1 × 10−6) in children and adults. In the district of Ondores, the cancer risk for As in children was higher than the acceptable limit (1 × 10−4). Residents of the Ondores district would be more exposed to As and Cd from consumption of maca hypocotyls. It is very important to carry out continuous monitoring of other toxic metals in different ecotypes of maca (red, black, yellow, purple, creamy white, pink) in order to evaluate the variation in the accumulation of heavy metals and the level of toxicity of each metal between ecotypes. / Revisón por pares

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21299号 / 医博第4388号 / 新制||医||1030(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 妹尾 浩, 教授 中川 一路, 教授 川上 浩司 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Suppression of genes involved in DNA repair, tumor suppression and detoxification through epigenetic modifications has been implicated in the etiology of cancer. As such analysis of promoter methylation patterns in genes frequently down regulated in breast cancer in non-cancerous subjects may serve as an indicator of breast cancer risk. CpG-island hypermethylation of single genes has been detected in cells isolated from nipple aspirate and ductal lavage, yet both isolation methods yield insufficient cells to complete an extensive analysis on any one donor sample. As an alternative we have turned to magnetic separation of human mammary epithelial cells from breast milk. Initial studies with these cells, which are detailed in chapter one, show that a breast milk sample provides sufficient epithelial cells to isolate high quality RNA for gene expression analyses or genomic DNA for methylation analysis of multiple genes. Using quantitative RT-PCR of RNA collected from these samples we detected differences in the mRNA levels for six genes known to be down regulated in breast cancers: BRCA1, p16, CDH1, TMS-1, GSTPi, and SFRP1. Additionally using methyl-specific PCR (MSP) we assayed for a small panel of genes frequently methylated in cancer and found them to be unmethylated in the few breast milk samples examined. However, given the small number of CpG sites which can be assayed by the MSP technique it is not surprising that methylation was not detected in disease-free subjects. With methods for collecting breast milk samples and processing them for genetic material established we turned to a more comprehensive study of DNA methylation in larger population of donors which is detailed in chapter two. Utilizing a highly sensitive and highly quantitative methylation analysis technique known as Pyrosequencing we examined age-related methylation patterns for RASSF1A, TMS-1, CDH1, SFRP1, GSTPi, and CRBP1 in genomic DNA purified from exfoliated epithelial cells magnetically enriched from breast milk (n=111) and whether the protective effects conveyed by early pregnancy could be partly due to decreases in DNA hypermethylation. Although firm answers about early pregnancy were inconclusive based on our sample pool, this body of work lays down a solid foundation for future studies.

Indiana University-Purdue University Indianapolis (IUPUI) / Perfluorooctanoic acid (PFOA) is a synthetic organic chemical that consists of an 8 carbon alkyl chain with a terminal carboxyl group in which the carbon-hydrogen bonds have been replaced with carbon-fluorine bonds except at the terminal carboxyl end. This perfluoralkyl carboxylate is a contemporary synthetic chemical that does not occur naturally in the environment and has only seen widespread use within the last 50 years. PFOA is environmentally persistent and is ubiquitously found in human serum. PFOA has been shown to induce a tumor triad consisting of liver adenomas, Leydig cell adenomas and pancreatic acinar cell tumors in male Spraque-Dawley rats. The ability of PFOA to produce tumors in rodents compounded by the fact that PFOA is accumulating not only in those occupationally exposed, but also in the general population, justifies concern about the carcinogenic potential of PFOA in humans. This paper reviews the data from current published research and reveals that some carcinogenic pathways identified in the tumors produced by PFOA in experimental animals may provide a plausible mode of action for human carcinogenesis.

Indiana University-Purdue University Indianapolis (IUPUI) / Hispanics are more likely to die from breast cancer compared to non - Hispanic whites matched on stage and age at diagnosis. Higher mortality rates among Hispanics are attributed to cancer - related disparities across the cancer continuum including later - stage detection. While research has shown that socioeconomic factors play a significant role in the development and maintenance of cancer - related disparities, differences persist when these factors are controlled. Thus far, research on cultural factors and cognitions surrounding cancer is limited. The current study investigated illness representations of cancer and their determinants among Hispanic men and women (N = 120) using a cross - sectional survey approach. The study sample was comprised of predominantly first generation, employed Hispanic women in their early - thirties from Mexico. Most had not resided in the U.S. for more than 5 - 9 years. Half of the sample reported an annual income of $20,001 - $30,000 and completing at least a middle school education. While the majority indicated that they did not have health insurance, most indicated that they did have a regular source of health care. Additionally, while most had not been diagnosed with cancer, nearly half of the sample knew of someone diagnosed with cancer. Descriptive data regarding illness identity, illness coherence, timeline, causes, consequences, and controllability are provided. Results suggest that demographic factors (i.e. acculturation, education, and income), cultural constructs (i.e. fatalism and familism), intrapersonal factors (state and trait anxiety), and previous experience with cancer were associated with illness representations of breast cancer. The study adds to theliterature by systematically investigate illness representations of breast cancer and their determinants among a diverse sample of Hispanic men and women. This is a significant first step that can be used to guide and develop effective and culturally appropriate interventions that ultimately reduce disparities across the cancer continuum.

Cancer, an aggressive chronic disease, impacts the lives of millions of people every day. There are numerous proposed triggers related to the diagnosis and much remains to be learned about the causes. Associated with this disease's variability is the challenge to identify a single causative agent that lead to its prevention. Specific topics that need additional evidence relate to environmental factors and lifestyle behaviors in the development, treatment and, in some instances, even suppression of disease progression. Specifically, a diet that excludes animal-based products but consists of a variety of fruits and vegetables (i.e., plant-based vegan diet) is reported to retard disease progression among some individuals diagnosed with cancer. The purpose of this thesis was to examine the effects of a plant-based vegan diet as a treatment approach with individuals who have been diagnosed with cancer. The methodology included a systematic review of literature focusing on use of a plant-based vegan diet on cancer risks in research articles published in peer reviewed journals from 2006 to 2018. Consistent findings include evidence that a diet high in fruits, vegetables, whole grains, and minimal amounts of animal products showed a decrease risk of the development of various types of cancer. Recommendations for nursing education, practice, policy and research are discussed.

No description available.

Human health risk assessments are used by environmental regulatory agencies to determine risk from Hazardous Air Pollutants (HAPs). In this study, the Human Exposure Model (HEM-3) was used to compare the cancer and non-cancer inhalation health effects of a single organic chemical manufacturing facility in Geismar, Louisiana prior to and after Maximum Achievable Control Technologies (MACT) were implemented. The results indicate significant reductions in both cancer risk and non-cancer hazards. The analysis also indicated that the equivalent cancer risk reduction could have been achieved by addressing MACT in only one production process and one single pollutant (ethylene dichloride) within that process. This demonstrates the value that these risk assessments have at evaluating emissions at the facility level, and how they could be used in the control strategy decision making process.