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Biomedical subjects

R Given-Wilson

Publications and source records attributed to R Given-Wilson.

13 recordsLinked to original sources
PubMed2001

Vitamin D receptor gene polymorphisms are associated with breast cancer risk in a UK Caucasian population.

There is increasing evidence that vitamin D can protect against breast cancer. The actions of vitamin D are mediated via the vitamin D receptor (VDR). We have investigated whether polymorphisms in the VDR gene are associated with altered breast cancer risk in a UK Caucasian population. We recruited 241 women following a negative screening mammogram and 181 women with known breast cancer. The VDR polymorphism Bsm I, an intronic 3' gene variant, was significantly associated with increased breast cancer risk: odds ratio bb vs BB genotype = 2.32 (95% CI, 1.23-4.39). The Bsm I polymorphism was in linkage disequilibrium with a candidate translational control site, the variable length poly (A) sequence in the 3' untranslated region. Thus, the 'L' poly (A) variant was also associated with a similar breast cancer risk. A 5' VDR gene variant, Fok I, was not associated with breast cancer risk. Further investigations into the mechanisms of interactions of the VDR with other environmental and/or genetic influences to alter breast cancer risk may lead to a new understanding of the role of vitamin D in the control of cellular and developmental pathways.

Adult↗
PubMed1997

Impact of follow up letters on non-attenders for breast screening: a general practice based study.

OBJECTIVE: To determine the effectiveness of follow up letters to non-attenders for screening on the breast screening uptake in practices with a low preliminary uptake of screening. DESIGN: Observational study of two groups of general practices. In 40 of these practices, the preliminary uptake of screening was less than 60%. These 40 practices were offered help from a clerical officer to check names and addresses of non-attenders, and to send non-attenders a reminder letter. SETTING: 93 general practices in South West London in 1995-96. MAIN OUTCOME MEASURES: Preliminary and final uptake of breast screening. RESULTS: Breast screening uptake increased by an average of 4.6% in the 40 intervention practices compared with 1.6% in the 53 control practices (difference 3.0%, P < 0.0001). However, the absolute increase in the uptake of screening in the intervention group was small (from 53.8% to 58.5%). The marginal cost for each additional women screened was Pounds 7 (compared with an average cost for each women screened of Pounds 27). CONCLUSIONS: Reminder letters can help increase the uptake of screening in practices with a low preliminary uptake of breast screening. However, they have a limited role in improving the uptake of breast screening in inner city areas, and other methods of increasing uptake therefore need to be developed and evaluated.

Breast Neoplasms↗
PubMed1995

The use of ultrasound for monitoring breast tumour response to pro-adjuvant therapy.

In a prospective study, use of serial ultrasound (US) for monitoring tumour response to pro-adjuvant chemotherapy was assessed in 16 patients. Comparison was made with mammographic and pathological tumour size measurements. Clinical and radiological response to treatment was assessed using UICC (International Union Against Cancer) criteria. Comparison of clinical and US response to treatment showed some agreement in 60% and disagreement in 40%. This was comparable with clinical versus mammographic responses (55% and 45%). Correlation between calliper and pathological measurement was similar to that between US and pathological measurement (r = 0.51, P = 0.05; r = 0.50, P < 0.05). Mammography showed poorer correlation (NS). For assessment of final tumour size, US clinical measurements were comparable and better than mammography. US may be a useful tool in monitoring the response of breast tumours to pro-adjuvant therapy.

Adult↗
PubMed1995

Do general practitioners influence the uptake of breast cancer screening?

OBJECTIVES: To investigate the relative importance of patient and general practice characteristics in explaining variations between practices in the uptake of breast cancer screening. DESIGN: Ecological study examining variations in breast cancer screening rates among 131 general practices using routine data. SETTING: Merton, Sutton, and Wandsworth Family Health Services Authority, which covers parts of inner and outer London. MAIN OUTCOME MEASURE: Percentage of eligible women aged 50-64 who attended for mammography during the first round of screening for breast cancer (1991-1994). RESULTS: Of the 43,063 women eligible for breast cancer screening, 25,826 (60%) attended for a mammogram. Breast cancer screening rates in individual practices varied from 12.5% to 84.5%. The estimated percentage list inflation for the practices was the variable most highly correlated with screening rates (r = -0.69). There were also strong negative correlations between screening rates and variables associated with social deprivation, such as the estimated percentage of the practice population living in households without a car (r = -0.61), and with variables that measured the ethnic make-up of practice populations, such as the estimated percentage of people in non-white ethnic groups (r = -0.60). Screening rates were significantly higher in practices with a computer than in those without (59.5% v 53.9%, difference 5.6%, 95% confidence interval 1.1 to 10.2%). There was no significant difference in screening rates between practices with and without a female partner; with and without a practice nurse; and with and without a practice manager. In a forward stepwise multiple regression model that explained 58% of the variation in breast cancer screening rates, four factors were significant independent predictors (at P = 0.05) of screening rates: list inflation and people living in households without a car were both negative predictors of screening rates, and chronic illness and the number of partners in a practice were both positive predictors of screening rates. The practice with the highest screening rate (84.5%) contacted all women invited for screening to encourage them to attend for their mammogram and achieved a rate 38% higher than predicted from the regression model. Breast cancer screening rates were on average lower than cervical cancer screening rates (mean difference 14.5%, standard deviation 12.0%) and were less strongly associated with practice characteristics. CONCLUSIONS: The strong negative correlation between breast cancer screening rates and list inflation shows the importance of accurate age-sex registers in achieving high breast cancer screening rates. Breast cancer screening units, family health services authorities, and general practitioners need to collaborate to improve the accuracy of the age-sex registers used to generate invitations for breast cancer screening. The success of the practice with the highest screening rate suggests that practices can influence the uptake of breast cancer screening among their patients. Giving general practitioners a greater role in breast cancer screening, either by offering them financial incentives or by giving them clerical support to check prior notification lists and contact nonattenders, may also help to increase breast cancer screening rates.

Breast Neoplasms↗
PubMed1994

Ductal carcinoma in situ presenting as a stellate lesion on mammography.

Ductal carcinoma in situ (DCIS) usually manifests as microcalcification on mammography, but several other unusual forms of presentation on mammography are also described. One such atypical appearance is the stellate mass without calcification. This may occur with DCIS alone or when DCIS is associated with a complex sclerosing lesion (CSL). We retrospectively analysed the histopathological specimens and mammograms of women who were referred for biopsy from two large breast screening programmes, and were found to have DCIS as the dominant histological lesion. Of 677 women referred for surgical biopsy, 86 (13%) showed histological evidence of DCIS as the predominant lesion, and of these, seven (8%) showed a stellate appearance on mammography without associated calcification. In three cases the mammographic appearance was due to DCIS alone, and four were due to a CSL with associated DCIS. Only one case showed microinvasion (< 1 mm), and this was not large enough to account for the stellate lesion. We advocate biopsy of all radial lesions which are not surgical scars, as malignancy associated with benign lesions such as CSLs could be missed by cytological sampling errors.

Aged↗
PubMed1991

Current working practices during pregnancy in British radiologists.

A postal survey was conducted of female radiologists practising in the United Kingdom to assess attitudes to, and working practices during, pregnancy in radiologists. A wide variation was found in both practices and attitudes but with a good general appreciation of the principles of radiation protection. The risk to the fetus of occupational exposure during pregnancy is likely to be small but there is a widespread desire for more guidance on suitable and safe working practices for pregnant radiologists.

Adult↗
PubMed1989

The use of real-time orbital ultrasound in Graves' ophthalmopathy: a comparison with computed tomography.

Evaluation of the severity of orbital involvement and likelihood of the development of optic neuropathy in Graves' disease can be clinically difficult. We describe the use of real-time orbital ultrasound scanning to measure the medial rectus muscle width in 20 patients with Graves' ophthalmopathy and 21 normal individuals. The normal reference interval (to 2 SDs) was 1.75 to 4.07 mm. Significantly (p less than 0.001; Mann Whitney U-test) larger values were observed in the patients compared with controls, and there was good correlation between medial rectus width and a clinical index of disease severity in individual eyes (p less than 0.001; Spearman rank correlation coefficient). Comparison of the medial rectus measurements obtained using orbital computed tomography and ultrasound showed positive correlation at the p less than 0.001 significance level. Computed tomographic medial rectus measurements also correlated with horizontal and vertical muscle indices for that orbit. We suggest that real-time ultrasound of medial rectus width, using widely available equipment, provides an accurate, simple and non-invasive means of evaluating the orbits of patients with Graves' disease. Repeated measurements may be of value in identifying patients at high risk of visual failure, and in following prospectively the orbital response to therapy in patients with Graves' ophthalmopathy.

Adult↗
PubMed1985

Once daily timolol in the prophylaxis of angina pectoris.

The clinical efficacy of timolol given once and twice daily was compared in the management of angina pectoris. Following a 2-week entry period, 16 normotensive male subjects with stable angina and proven myocardial ischaemia received timolol 10 mg twice daily, or 20 mg every morning for 1 month followed by 1 month on crossover therapy. All were exercised on separate days in random order 1 hr after administration of 10 mg, 1 hr after administration of 20 mg, 13 hr after administration of 10 mg and 25 hr after administration of 20 mg. In spite of significant differences in the maximum heart rates, rate pressure products and maximum lateral ST segment depression between the once and twice daily regimes, the maximal walking times were not significantly different (P greater than 0.10) and attack rates for angina and trinitrin consumption were similar (P greater than 0.45; P greater than 0.05). This evidence suggests that timolol is as effective in dosage of 20 mg taken once daily as half the dose taken twice daily in the symptom management of angina pectoris.

Adult↗
PubMedDate not supplied

CT monitoring of therapy for meconium ileus.

Meconium ileus equivalent is a common complication of cystic fibrosis in the postneonatal period. Because of the added risks of surgery in these patients, conservative management is preferred. We describe here a method of monitoring the conservative treatment of this condition using CT and suggest that its application will reduce the need for potentially dangerous surgical intervention.

Adolescent↗