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Am Fam Physician. 2001;63(9):1854

Update on Breast Cancer Risk

(Great Britain—The Practitioner, October 2000, p. 884.) Although mortality rates are falling, the continuing rise in the incidence of breast cancer makes understanding the risk factors increasingly important. While the etiology of most types of breast cancer is multifactorial, certain factors have been identified as especially significant. In British women, the risk of breast cancer doubles with every 10 years of age to about 250 per 100,000 by the onset of menopause. Rates remain stable until after 65 years of age when they again rise steeply. Women who have early menarche and late menopause are at increased risk, as are nulliparous women and those who delay childbearing. Women who give birth to their first child after 35 years of age have an even higher risk of breast cancer than do nulliparous women. Use of oral contraceptives and hormone replacement therapy is associated with an increased risk of breast cancer; however, in these women, breast cancer is usually detected at an early stage. Smoking has not been associated with breast cancer risk and the role of diet is controversial. While population-based studies relate risk to increased fat intake, no strong correlations can be made for individual women. Silicone breast implants have not been linked to the development of breast cancer. Family history of early and bilateral breast cancer and of a combination of breast and other specific cancers (e.g., ovary, colon, prostate) is strongly linked to the risk of developing breast cancer. This risk is particularly strong in women who have severe atypical hyperplasia, compared with women who do not have these changes within their breasts.

Factors Associated with Sustained Breast-Feeding

(Great Britain—British Journal of General Practice, November 2000, p. 888.) Approximately 80 percent of British mothers who initiate breast-feeding are still feeding after two weeks. At six weeks, the rate has dropped to 65 percent and at four months, only 42 percent of those who begin breast-feeding are continuing. A study of more than 270 new mothers attending three general practices in London found that maternal age and degree of social support were key determinants in sustained breast-feeding. Younger mothers and those with moderate to poor emotional support were less likely to be breast-feeding at three months. Level of completed education was predictive for white women, but not for those in other ethnic groups. White women with low levels of completed education were not likely to be breast-feeding at three months. Also, the mother's assessment of her own emotional health was not associated with breast-feeding prevalence at three months.

British Patients Prefer Counseling to Medication for Depression

(Great Britain—British Journal of General Practice, November 2000, p. 905.) Nearly 900 adult patients (mean age: 40 years) attending 20 general practices in England were asked to complete questionnaires about depression. Researchers found that most of those surveyed considered depression to be a serious illness and were aware that it was very common. About 30 percent of those surveyed reported personal experience in the treatment of depression. Approximately one half believed that depression is related to external factors. Patients expressed preference for counseling (51 percent) as a treatment for depression, compared with medication (15 percent). Preference for counseling was associated with female gender, previous experience with counseling and the belief that antidepressants are addictive. Age and severity of depressive symptoms were not associated with a preference for counseling.

Common Noninfectious Conditions of the Nails

(Great Britain—The Practitioner, October 2000, p. 873.) Fingernails grow approximately 3 mm per month and require six months to fully regrow. Toenails do not grow as quickly and take two to three times as long to regrow completely. Any systemic illness can cause arrested nail growth, resulting in deep transverse grooves (Beau's lines) that take months to grow out. Median grooves in the nails may result from habit tics or be the self-limiting dystrophy of Heller. Up to 40 percent of patients with psoriasis show pitting and discoloration of the nails. Active psoriasis under the nail causes detachment of the nailplate (onycholysis), which may appear as a “spot of oil” on the nail. Onycholysis also occurs in patients with eczema, lichen planus, blistering skin disorders and systemic conditions such as iron deficiency, thyroid disease and certain connective tissue disorders. Lichen planus of the nails may also cause thinning, brittleness and exaggerated longitudinal ridges. In severe cases, pterygium formation can occur and the nail may be lost permanently.

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Copyright © 2001 by the American Academy of Family Physicians.

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