Download or read book Comparative Effectiveness of Medications To Reduce Risk of Primary Breast Cancer in Women written by and published by . This book was released on 2009 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Comparative Effectiveness of Medications to Reduce Risk of Primary Breast Cancer in Women written by U. S. Department of Health and Human Services and published by Createspace Independent Pub. This book was released on 2013-05-14 with total page 238 pages. Available in PDF, EPUB and Kindle. Book excerpt: Breast cancer is the most frequently diagnosed noncutaneous cancer and the second leading cause of cancer death after lung cancer among women in the United States. In 2008, an estimated 182,460 cases of invasive breast cancer and 67,770 cases of in situ breast cancer were diagnosed, and 40,480 women died of breast cancer in the United States. Recent clinical trials have demonstrated the efficacy of three medications—tamoxifen citrate, raloxifene, and tibolone—to reduce the risk of invasive breast cancer in women without pre-existing cancer. This therapy is sometimes referred to as “chemoprevention” in the literature, although this is not a fully accurate representation of the intervention. Tamoxifen and raloxifene are approved by the U.S. Food and Drug Administration for this indication and tibolone is not. Raloxifene is approved for use by postmenopausal women only. Current clinical recommendations, including those from the U.S. Preventive Services Task Force issued in 2002, support tamoxifen use for primary breast cancer prevention in women considered at high risk for breast cancer by the Gail model or other criteria and low risk for adverse events. However, use of risk-reducing medications for breast cancer is believed to be low in the United States. The purpose of this review is to evaluate the comparative effectiveness of tamoxifen citrate, raloxifene, and tibolone to reduce the risk of primary breast cancer; assess the nature and magnitude of harms; and examine how benefits and harms vary by age, breast cancer risk status, and other factors. The review was originally entitled “Comparative Effectiveness of Chemotherapy Agents in the Prevention of Primary Breast Cancer in Women.” Peer review comments suggested that the terms “chemotherapy” and “prevention” were misnomers. The term “medications to reduce risk” is a better representation of the intervention and therefore, all references to “chemoprevention” are edited, including the key questions and report title. The review also examines issues related to clinical effectiveness, such as patient choice, concordance, adherence, and persistence of use, and evaluates methods to appropriately select patients for risk-reducing medications for clinical applications. The target population includes women without pre-existing breast cancer, noninvasive breast cancer, or precursor conditions who are not known carriers of breast cancer susceptibility mutations (BRCA1, BRCA2, or others). Key questions addressed include: Key Question 1. In adult women without pre-existing breast cancer, what is the comparative effectiveness of selective estrogen receptor modulators (SERMs) tamoxifen citrate and raloxifene, and the selective tissue estrogenic activity regulator (STEAR) tibolone, when used to reduce risk for primary breast cancer on improving short-term and long-term outcomes including invasive breast cancer, noninvasive breast cancer, including ductal carcinoma in situ (DCIS), breast cancer mortality, all-cause mortality, and osteoporotic fractures? Key Question 2. What is the evidence for harms of tamoxifen citrate, raloxifene, and tibolone when used to reduce risk for primary breast cancer? Key Question 3. How do outcomes for tamoxifen citrate, raloxifene, and tibolone when used for primary prevention of breast cancer vary by heterogeneity in subpopulations? Key Question 4. What is the evidence that harms or secondary potential benefits listed above affect treatment choice, concordance, adherence, and persistence to treatment with tamoxifen citrate, raloxifene, and tibolone when used for primary prevention of breast cancer? Key Question 5. What methods, such as clinical risk-assessment models, have been used to identify women who could benefit from medications to reduce risk of breast cancer?
Download or read book Comparative Effectiveness of Medications to Reduce Risk of Primary Breast Cancer in Women written by H. D. Nelson and published by . This book was released on 2009 with total page 8 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Comparative Effectiveness of Medications to Reduce Risk of Primary Breast Cancer in Women written by and published by . This book was released on 2009 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Future Research Needs to Reduce the Risk of Primary Breast Cancer in Women written by and published by . This book was released on 2010 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: The 2009 comparative effectiveness review (CER) on the effectiveness of medications to reduce the risk of primary breast cancer in women without preexisting cancer demonstrated the efficacy of two SERMs, tamoxifen citrate (RR, 0.70; 95% CI, 0.59 to 0.82; 4 trials) and raloxifene (RR, 0.44; CI, 0.27 to 0.71; 2 trials). However, the CER also outlined many adverse effects and unknowns about the medications. The objective of this pilot project was to engage stakeholders to develop and prioritize a list of research questions to address the research gaps related to the CER. First, the goal was to provide sufficient detail--including population, intervention, comparator, and outcome (PICO)--for researchers and funders to use in the development of research proposals and solicitations, respectively. Second, this project was intended to identify a feasible and effective approach to identify and prioritize future research from systematic reviews in general.
Download or read book Future Research Needs to Reduce the Risk of Primary Breast Cancer in Women written by U. S. Department of Health and Human Services and published by Createspace Independent Pub. This book was released on 2013-05-17 with total page 116 pages. Available in PDF, EPUB and Kindle. Book excerpt: Breast cancer is the second most commonly diagnosed cancer in women in the United States, with over 200,000 new cases of invasive breast cancer expected in women in 2010. It is the second most common cause of cancer-related death in women, killing over 40,000 women each year. Tamoxifen was approved by the U.S. Food and Drug Administration (FDA) in 1999 as a preventive strategy for women at high risk of developing breast cancer. Data from the 2000 National Health Interview Survey estimated that 10 million U.S. women ages 35 to 79 years of age were candidates for tamoxifen preventive therapy and for 2.4 million of these women, the benefits would outweigh the harms. However, despite its approval for more than a decade, less than one percent of women use tamoxifen as a preventive therapy. In 2007, the FDA approved the use of raloxifene hydrochloride for reduction in the risk of invasive breast cancer in postmenopausal women with osteoporosis and/or at high risk for invasive breast cancer. In 2008, the Agency for Healthcare Research and Quality (AHRQ) commissioned the Oregon Evidence-based Practice Center (Oregon EPC) to conduct a comparative effectiveness review (CER) on the effectiveness of medications to reduce the risk of primary breast cancer in women. Briefly, the five key questions addressed by the review were: (1) In adult women without preexisting breast cancer, what is the comparative effectiveness of selective estrogen receptor modulators (SERMs) tamoxifen and raloxifene, and the selective tissue estrogenic activity regulator (STEAR) tibolone, when used to reduce risk for primary breast cancer on improving short-term and long-term outcomes? (2) What is the evidence for harms? (3) How do outcomes vary by heterogeneity in subpopulations? (4) What is the evidence that harms or secondary potential benefits affect treatment choice, concordance, adherence, and persistence to treatment? (5) What methods, such as clinical risk-assessment models, have been used to identify women who could benefit from medications to reduce risk of breast cancer?
Download or read book Medication Use for the Risk Reduction of Primary Breast Cancer in Women written by Heidi D. Nelson and published by . This book was released on 2019 with total page 213 pages. Available in PDF, EPUB and Kindle. Book excerpt: BACKGROUND: Medications to reduce breast cancer risk are an effective prevention intervention for women at increased risk, although medications also cause adverse effects. PURPOSE: To update the 2013 U.S. Preventive Services Task Force (USPSTF) systematic review on the use of medications to reduce the risk of primary breast cancer. DATA SOURCES: Searches included the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, EMBASE, and MEDLINE (January 1, 2013 to February 1, 2019); and manual review of reference lists. Studies published before 2013 were identified from prior systematic reviews for the USPSTF. STUDY SELECTION: Discriminatory accuracy studies of breast cancer risk assessment methods; double-blind, placebo-controlled or head-to-head randomized controlled trials (RCT) of tamoxifen, raloxifene, and aromatase inhibitors for primary prevention of breast cancer that enrolled women without preexisting breast cancer; and RCTs and observational studies of harms of medications. DATA EXTRACTION: One investigator abstracted data on study methods; setting; population characteristics; eligibility criteria; interventions; numbers enrolled and lost to followup; method of outcome ascertainment; and results for each outcome and a second investigator checked abstractions for accuracy. Two investigators independently assessed study quality using methods developed by the USPSTF. DATA SYNTHESIS (RESULTS): Eighteen risk models evaluated in 25 studies had generally low discriminatory accuracy in predicting the probability of breast cancer in an individual (c-statistics 0.55 to 0.65). Most models performed only slightly better than age alone as a risk predictor. No studies evaluated optimal ages or frequencies of risk assessment. In placebo-controlled trials, tamoxifen (risk ratio [RR] 0.69; 95% confidence interval [CI], 0.59 to 0.84; 7 fewer cases per 1000 women over 5 years of use [95% CI, 4 to 12]; 4 trials), raloxifene (RR 0.44; 95% CI, 0.24 to 0.80; 9 fewer cases [95% CI, 3 to 15]; 2 trials), and the aromatase inhibitors exemestane and anastrozole (RR 0.45; 95% CI, 0.26 to 0.70; 16 fewer cases [95% CI, 8 to 24]; 2 trials) reduced invasive breast cancer. Risk for invasive breast cancer was higher for raloxifene than tamoxifen in the Study of Tamoxifen And Raloxifene (STAR) head-to-head trial (RR, 1.24; 95% CI, 1.05 to 1.47) after long-term followup. Effects did not differ by age of initiation or duration of use (3 to 5 years), although these effects were not directly compared. Risk reduction persisted at least 8 years after discontinuation in tamoxifen trials with long-term followup. All medications reduced estrogen receptor positive, but not estrogen receptor negative invasive breast cancer; tamoxifen reduced noninvasive cancer in two trials; and breast-cancer specific and all-cause mortality were not reduced. In placebo-controlled trials, raloxifene (RR 0.61; 95% CI, 0.53 to 0.73; 2 trials) reduced vertebral fractures; tamoxifen reduced nonvertebral fractures in the National Surgical Adjuvant Breast and Bowel Project (NSABP P-1) trial (RR 0.66; 95% CI, 0.45 to 0.98); while the aromatase inhibitors had no effect on fractures. Tamoxifen and raloxifene had similar effects on reducing fractures at multiple vertebral and nonvertebral sites in the STAR head-to-head trial. In placebo-controlled trials, tamoxifen (RR 1.93; 95% CI, 1.33 to 2.68; 4 trials) and raloxifene (RR 1.56; 95% CI, 1.11 to 2.60; 2 trials) increased thromboembolic events, while aromatase inhibitors did not. Raloxifene caused fewer thromboembolic events (RR 0.75; 95% CI, 0.60 to 0.93) than tamoxifen in the STAR head-to-head trial. Tamoxifen, raloxifene, and aromatase inhibitors did not increase coronary heart disease events or strokes. In placebo-controlled trials, tamoxifen increased endometrial cancer (RR 2.25; 95% CI, 1.17 to 4.41; 3 trials), while raloxifene and aromatase inhibitors did not. In the STAR head-to-head trial, raloxifene caused fewer cases of endometrial cancer (RR 0.55; 95% CI, 0.36 to 0.83) and endometrial hyperplasia (RR 0.19; 95% CI, 0.12 to 0.29), and fewer hysterectomies (RR 0.45; 95% CI, 0.37 to 0.54) than tamoxifen. Tamoxifen increased cataracts (RR 1.22; 95% CI, 1.08 to 1.48; 3 trials) and cataract surgery compared with placebo, while raloxifene and aromatase inhibitors did not. Risks for thromboembolic events and endometrial cancer with tamoxifen were higher for older compared with younger women and returned to normal after discontinuation. All medications caused adverse effects, such as vasomotor or musculoskeletal symptoms, that varied by medication. Risks for invasive cancer were generally reduced in all population subgroups evaluated based on menopausal status (pre and postmenopausal); family history of breast cancer; body mass index categories; modified Gail model risk categories; and age at menarche, parity, or age at first live birth, although results varied. Tamoxifen and anastrozole had larger effects in reducing invasive breast cancer in women with previous breast lesions (lobular carcinoma in situ, atypical ductal hyperplasia, or atypical lobular hyperplasia). LIMITATIONS: Trials were limited by clinical heterogeneity related to different medications, exposure durations, eligibility criteria, adherence, and ascertainment of outcomes. No trials compared timing and duration directly. Long-term followup data were lacking from most trials, and followup was particularly short for the aromatase inhibitors. Trials were not designed for subgroup comparisons and analysis of differences may be underpowered. CONCLUSIONS: Tamoxifen, raloxifene, and the aromatase inhibitors exemestane and anastrozole reduce invasive breast cancer in women without preexisting breast cancer, but also cause adverse effects that vary by medication. Tamoxifen and raloxifene increase thromboembolic events and tamoxifen increases endometrial cancer and cataracts. Identifying candidates for therapy is complicated by risk stratification methods that demonstrate low accuracy.
Download or read book Holland Frei Cancer Medicine written by Robert C. Bast, Jr. and published by John Wiley & Sons. This book was released on 2017-03-10 with total page 2004 pages. Available in PDF, EPUB and Kindle. Book excerpt: Holland-Frei Cancer Medicine, Ninth Edition, offers a balanced view of the most current knowledge of cancer science and clinical oncology practice. This all-new edition is the consummate reference source for medical oncologists, radiation oncologists, internists, surgical oncologists, and others who treat cancer patients. A translational perspective throughout, integrating cancer biology with cancer management providing an in depth understanding of the disease An emphasis on multidisciplinary, research-driven patient care to improve outcomes and optimal use of all appropriate therapies Cutting-edge coverage of personalized cancer care, including molecular diagnostics and therapeutics Concise, readable, clinically relevant text with algorithms, guidelines and insight into the use of both conventional and novel drugs Includes free access to the Wiley Digital Edition providing search across the book, the full reference list with web links, illustrations and photographs, and post-publication updates
Download or read book Initial National Priorities for Comparative Effectiveness Research written by Institute of Medicine and published by National Academies Press. This book was released on 2009-11-14 with total page 252 pages. Available in PDF, EPUB and Kindle. Book excerpt: Clinical research presents health care providers with information on the natural history and clinical presentations of disease as well as diagnostic and treatment options. In today's healthcare system, patients, physicians, clinicians and family caregivers often lack the sufficient scientific data and evidence they need to determine the best course of treatment for the patients' medical conditions. Initial National Priorities for Comparative Effectiveness Research(CER) is designed to fill this knowledge gap by assisting patients and healthcare providers across diverse settings in making more informed decisions. In this 2009 report, the Institute of Medicine's Committee on Comparative Effectiveness Research Prioritization establishes a working definition of CER, develops a priority list of research topics, and identifies the necessary requirements to support a robust and sustainable CER enterprise. As part of the 2009 American Recovery and Reinvestment Act, Congress appropriated $1.1 billion in federal support of CER, reflecting legislators' belief that better decisions about the use of health care could improve the public's health and reduce the cost of care. The Committee on Comparative Effectiveness Research Prioritization was successful in preparing a list 100 top priority CER topics and 10 recommendations for best practices in the field.
Download or read book Delivering Affordable Cancer Care in the 21st Century written by Institute of Medicine and published by National Academies Press. This book was released on 2013-06-20 with total page 95 pages. Available in PDF, EPUB and Kindle. Book excerpt: Rising health care costs are a central fiscal challenge confronting the United States. National spending on health care currently accounts for 18 percent of gross domestic product (GDP), but is anticipated to increase to 25 percent of GDP by 2037. The Bipartisan Policy Center argues that "this rapid growth in health expenditures creates an unsustainable burden on America's economy, with far-reaching consequences". These consequences include crowding out many national priorities, including investments in education, infrastructure, and research; stagnation of employee wages; and decreased international competitiveness.In spite of health care costs that far exceed those of other countries, health outcomes in the United States are not considerably better. With the goal of ensuring that patients have access to high-quality, affordable cancer care, the Institute of Medicine's (IOM's) National Cancer Policy Forum convened a public workshop, Delivering Affordable Cancer Care in the 21st Century, October 8-9, 2012, in Washington, DC. Delivering Affordable Cancer Care in the 21st Century summarizes the workshop.
Download or read book Developing a Protocol for Observational Comparative Effectiveness Research A User s Guide written by Agency for Health Care Research and Quality (U.S.) and published by Government Printing Office. This book was released on 2013-02-21 with total page 204 pages. Available in PDF, EPUB and Kindle. Book excerpt: This User’s Guide is a resource for investigators and stakeholders who develop and review observational comparative effectiveness research protocols. It explains how to (1) identify key considerations and best practices for research design; (2) build a protocol based on these standards and best practices; and (3) judge the adequacy and completeness of a protocol. Eleven chapters cover all aspects of research design, including: developing study objectives, defining and refining study questions, addressing the heterogeneity of treatment effect, characterizing exposure, selecting a comparator, defining and measuring outcomes, and identifying optimal data sources. Checklists of guidance and key considerations for protocols are provided at the end of each chapter. The User’s Guide was created by researchers affiliated with AHRQ’s Effective Health Care Program, particularly those who participated in AHRQ’s DEcIDE (Developing Evidence to Inform Decisions About Effectiveness) program. Chapters were subject to multiple internal and external independent reviews. More more information, please consult the Agency website: www.effectivehealthcare.ahrq.gov)
Download or read book Women s Health Research written by Institute of Medicine and published by National Academies Press. This book was released on 2010-10-27 with total page 439 pages. Available in PDF, EPUB and Kindle. Book excerpt: Even though slightly over half of the U.S. population is female, medical research historically has neglected the health needs of women. However, over the past two decades, there have been major changes in government support of women's health research-in policies, regulations, and the organization of research efforts. To assess the impact of these changes, Congress directed the Department of Health and Human Services (HHS) to ask the IOM to examine what has been learned from that research and how well it has been put into practice as well as communicated to both providers and women. Women's Health Research finds that women's health research has contributed to significant progress over the past 20 years in lessening the burden of disease and reducing deaths from some conditions, while other conditions have seen only moderate change or even little or no change. Gaps remain, both in research areas and in the application of results to benefit women in general and across multiple population groups. Given the many and significant roles women play in our society, maintaining support for women's health research and enhancing its impact are not only in the interest of women, they are in the interest of us all.
Download or read book Systematic Reviews to Answer Health Care Questions written by Heidi D. Nelson and published by Lippincott Williams & Wilkins. This book was released on 2024-02-21 with total page 313 pages. Available in PDF, EPUB and Kindle. Book excerpt: Accessible, practical, and student-friendly, Systematic Reviews to Answer Health Care Questions, Second Edition, by Dr. Heidi D. Nelson, uses easy-to-understand, step-by-step instruction and real-world examples to illustrate important concepts and principles of today’s systematic reviews. You’ll learn how to form key questions, select evidence, and perform comprehensive reviews not just in predictable circumstances, but when basic rules don’t apply—honing your ability to think critically and solve problems. Perfect for investigators, medical students and faculty, practitioners, policymakers, and others who need to refine their understanding of or approach to systematic reviews, this powerful text goes beyond merely teaching how to catalog and collect, helping readers learn to evaluate, synthesize, and deliver results that will help shape the practice of health care.
Download or read book Primary Care Medicine written by Allan Goroll and published by Lippincott Williams & Wilkins. This book was released on 2020-09-02 with total page 7089 pages. Available in PDF, EPUB and Kindle. Book excerpt: Long regarded as “the book” in the field for in-depth learning as well as decision support at the point of care, Primary Care Medicine, 8th Edition, continues its tradition as a comprehensive, evidence-based, action-oriented information resource. Presented in companion electronic format updated quarterly, its problem-based orientation spans the full spectrum of problems encountered in adult primary care practice. Chapters address screening, diagnosis, prevention and management, including indications for referral and approaches to patient education and shared decision making. Clear, practical, bulleted recommendations and an extensive annotated bibliography of best references follow detailed discussions of pathophysiology, clinical presentation, differential diagnosis, and strategies for workup and treatment. Now with its 40th-anniversary edition, this exceptional text is a must-have resource for physicians, nurse practitioners, physician assistants, students, and residents- offering the most complete and up-to-date resource available for primary care education and practice.
Download or read book The Breast written by K. I. Bland and published by Saunders. This book was released on 2009 with total page 822 pages. Available in PDF, EPUB and Kindle. Book excerpt: Offering the most comprehensive, up-to-date information on the diagnosis and management of, and rehabilitation following, surgery for benign and malignant diseases of the breast, this surgical reference is now in a new edition available in both print and online for easy, convenient access to the absolute latest advances.
Download or read book Primary Care Medicine written by Allan H. Goroll and published by Lippincott Williams & Wilkins. This book was released on 2014-05-29 with total page 5495 pages. Available in PDF, EPUB and Kindle. Book excerpt: Clinicians and students at all levels and in all primary care disciplines will benefit from the clear, practical, evidence-based writing and recommendations that address the full spectrum of clinical problems encountered in the adult primary care practice. Whether it’s the answer to a screening, prevention, evaluation, or management question or a comprehensive approach to a complex condition, the reader will find a review of best evidence integrated with considerations of affordability, cost-effectiveness, convenience and patient preference. Chapters present actionable, scientifically validated guidance that allows physicians to go beyond standard consensus guidelines and provide highly personalized care. Special consideration is given to team-based approaches of primary care delivery, recognizing its increasing importance to achieving high levels of practice performance. Primary Care Medicine’s digital format and quarterly updates ensure current, point-of-care decision support. New, online resources include a recommended curriculum for trainees and faculty, emphasizing a core knowledge base needed for all members of the primary care team, and access to state-of-the-art, condition-specific decision grids to facilitate patient participation in shared decision-making.
Download or read book Reducing Environmental Cancer Risk written by Suzanne H. Reuben and published by DIANE Publishing. This book was released on 2010-10 with total page 240 pages. Available in PDF, EPUB and Kindle. Book excerpt: Though overall cancer incidence and mortality have continued to decline in recent years, cancer continues to devastate the lives of far too many Americans. In 2009 alone, 1.5 million American men, women, and children were diagnosed with cancer, and 562,000 died from the disease. There is a growing body of evidence linking environmental exposures to cancer. The Pres. Cancer Panel dedicated its 2008¿2009 activities to examining the impact of environmental factors on cancer risk. The Panel considered industrial, occupational, and agricultural exposures as well as exposures related to medical practice, military activities, modern lifestyles, and natural sources. This report presents the Panel¿s recommend. to mitigate or eliminate these barriers. Illus.