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Breast Cancer in Iran: An Epidemiological Review
The Breast Journal
Abstract
Breast cancer is one of the most frequent malignancies among Iranian women, however; the epidemiological aspects of breast cancer among Iranian patients are uncertain. A literature review of the published articles from January 1998 to December 2005 was conducted using different search engines: MEDLINE, Scientific information data base of Academic Center for Education, Culture and Research, and over 2000 issues of 94 Persian medical journals. The headings "Breast Cancer,"Breast Tumor,"Breast Malignancy," and "Breast Carcinoma" were combined with the word "Iran" to execute the search. In all, 85 full papers were reviewed. These findings showed that participants ranged from 15 to 84 years old, with those 40-49 being the most prevalent. The incidence of breast cancer in women was 22 per 100,000. The prevalence in this same population was 120 per 100,000. Stage I was diagnosed in 18%, stage II in 57% and stage III in 25% of the cases. About 72% of the patients were diagnosed with a tumor over 2 cm. Sixty-three percent of the patients had lymph node involvement at the diagnostic time. Infiltrative ductal carcinoma was found to be the most common at 77% and lobular carcinoma the least at 5%. This review indicates that the epidemiological aspects of breast cancer in Iran are relatively well-studied. Shortcomings in study of its clinical aspects are evident and need to be a central part of upcoming investigations.
... Based on reports from WHO in 2020, half a million women in low-and middle-income countries pass away because of breast cancer, accounting for almost 75% of worldwide deaths from the disease (6). In Iranian populations, breast cancer is one of the most common cancers, with the incidence of ranging 22-120 per 100,000 women (7). Age-standardized Years of Life Lost rate (ASYR) had an increase from 85.1 (65.6 to 110.4) per 100,000 people in 1990 to 196.1 (156.5 to 245.7) per 100,000 people in 2010, followed by an insignificant decline of 20%, which reached to 151.1 (119.7 to 190.6) per 100,000 people in 2015 (8). ...
... In addition, the trend of YLL rate due to premature mortality in ovary cancer was increasing: average annual percent change (AAPC) was 19.0% (Fig. 2). This decrease postulated the role of generalized use of mammography and improvement of breast cancer treatment in US. (2). in this respect, in Iran, only 18% of breast cancer patients are estimated to detect in stage 1 (7). More than 80% of these patients initially diagnose with stage II in Iran (18). ...
Background: There is an increase in the incidence of breast and gynecologic cancers in Iran during the last three decades. Literature is inadequate about the Years of Life Lost (YLL) attributed to these cancers in Iran.
Methods: Mortality data due to these cancers amongst females aged >20 yr from 2004 to 2019 was acquired from “Electronic Death Registry System”, Fars Province, Iran. Using local health centers’ databases and national census reports from 1996 to 2016, the age-standardized incidence rate (ASR) per 100,000 people were estimated. YLLs were calculated using the WHO’s 2015 “YLL template”.
Results: During 2004–2019, 1886 and 829 deaths occurred due to breast and gynecologic cancers, respectively. The ASR due to breast and gynecologic cancers showed a significant increasing trend (P<0.001 for each). The total YLL due to breast, cervical/uterine/vaginal/vulvar, and ovary cancers’ deaths in the 16-year period were 33,077, 7,172 and 6,584 yr, respectively. The highest YLLs were observed in 50-59-year-old females, followed by 40-49- and 60-69-year-old females. The 16- year trend of YLL rate due to premature mortality in breast cancer, ovary cancer and cervix cancer was increasing: annual percent change (APC) was 7.6% (95% CI: 5.5-9.7, P<0.001), 19.0% (95% CI: 12.2-26.1, P<0.001) and 9.2% (95% CI: -9.2 to 31.3, P>0.05, respectively.
Conclusion: Mortality rate and YLLs due to breast and gynecologic cancers have been increased in southern Iran during the last twenty years. Early detection programs and allocating treatments at early stages should be prioritized.
Keywords: Years of life lost; Mortality; Breast cancer; Gynecologic cancer; Cervical cancer; Ovarian cancer; Iran.
... Moreover, the Iranian Ministry of Health and Medical Education has recently reported that breast cancer accounts for 16 % of cancer cases (10). Previous studies have shown that 23 % of breast cancer cases in Iran have been diagnosed in patients less than 40 years of age, of which 70 % have been recognized in the advanced stage of the disease (11,12). The incidence of breast cancer can be reduced by early detection through effective measures (13,14). ...
... The important aims of the current system are to improve Iranian people's health and access to healthcare, and control the spending patterns of health services (18). Early detection of breast cancer is critical, especially in the early stages, to reduce its mortality rate (11,12). ...
Background: Breast cancer screening programs are one of the most important methods for the early detection of breast cancer in women. Several studies have been conducted to identify factors affecting breast cancer screening behaviors among Iranian women. This study is conducted to systematically review the factors influencing women’s participation in breast cancer screening programs in Iran.
Methods: Papers were collected by using the keywords breast, mammary, screening, early detection, diagnosis*, examination, testing, and Iran from various English-language databases, including PubMed, Scopus, Web of Science, and databases in Persian language including SID and Magiran. The search was limited to the title and abstract of papers published between January 1, 2000, and May 1, 2021. A narrative synthesis was performed to summarize findings of the obtained papers.
Results: In this study, 1345 papers were initially found and, after screening the title, abstract, and full-text, 39 papers were selected. Most of them were cross-sectional (n= 28). Results indicated that socioeconomic factors, individual characteristics, recommendation of health workers, knowledge, Islamic beliefs, support by family, and activities of the Iranian government are frequently mentioned as contributing factors and can be applied to increase participation of Iranian women in breast cancer screening.
Conclusion: The results demonstrate that lack of knowledge and a positive attitude towards breast cancer screening is a major problem regarding Iranian women's non-participation in the screening programs. Therefore, the need for regular implementation of the national screening program in the country, providing appropriate educational methods to increase women's awareness, removing barriers and improving women's access to health care providers should be the priorities of the Iranian health system to prevent breast cancer.
... Breast cancer is recognized as one of the most important women's health problems and the most common cancer worldwide. Breast cancer is the second most common cause of cancer deaths (Mousavi et al., 2007;Segovia-Mendoza & Morales-Montor, 2019). The 5-year survival rate for women diagnosed with breast cancer in early stages is around 98%. ...
... The 5-year survival rate for women diagnosed with breast cancer in early stages is around 98%. The average incidence of breast cancer in all races is about 124 cases per 100,000 women, which varies from race to race (Mousavi et al., 2007). Alterations in the expression of microRNAs cause the expression of genes that are contributed to the cell proliferation or survival, which can eventually lead to tumor formation. ...
The tumor microenvironment (TME) is well-defined target for understanding tumor progression and various cell types. Major elements of the tumor microenvironment are the followings: endothelial cells, fibroblasts, signaling molecules, extracellular matrix, and infiltrating immune cells. MicroRNAs (miRNAs) are a group of small noncoding RNAs with major functions in the gene expression regulation at post-transcriptional level that have also appeared to exerts key functions in the cancer initiation/progression in diverse biological processes and the tumor microenvironment. This study summarized various roles of miRNAs in the complex interactions between the tumor and normal cells in their microenvironment.
... Notably, the prevalence of breast cancer in Iran is on the rise, with patients often diagnosed at advanced stages. Moreover, Iranian women diagnosed with breast cancer are typically ten years younger than their Western counterparts [5,6]. ...
Breast cancer is one of the leading causes of cancer-related deaths, yet it can be effectively treated if detected early. Various studies investigating the prevalence of breast self-examination (BSE) among women in Iran have yielded varying findings. Thus, this systematic review and meta-analysis aimed to determine the pooled prevalence of BSE practice in Iran.
Scopus, PubMed, EMBASE, Web of Science, Google Scholar, Scientific Information Database (SID), and MagIran databases were systematically searched from June 2023. Two independent authors screened, extracted data, and assessed the quality of articles. Discrepancies were resolved through discussion or consultation with a third reviewer. Heterogeneity was evaluated with the I2 index and Cochran Q test. Subgroup analysis was conducted by separating the target population and the region of the country, and meta-regression was performed to explore the relationship between the prevalence of BSE, the year of publication of articles, and the age of women. Meta-regression was used to assess trends over time and age. Publication bias was assessed using a funnel plot and Egger’s test. The random effects meta-analysis was conducted using STATA 17 software.
Eighty-eight studies with 76,453 participants were included to estimate the pooled prevalence of BSE practice. The pooled prevalence of ever and regular BSE practice was 43.4% (95% confidence interval [CI]: 38.6–48.1) and 16.5% (95% CI: 13–20), respectively. The highest prevalence of ever BSE was observed among healthcare workers (57.6%), while the lowest was among women attending health centers (37.1%). Similarly, the highest prevalence of regular BSE was reported among students (21.2%), whereas the lowest prevalence was among women attending health centers (13.7%). From 2000 to 2022, the pooled prevalence of ever BSE practice showed an increasing trend, as determined through meta-regression (p = 0.018). Additionally, there was a significant upward trend in the prevalence of regular BSE practice with the increasing age of women (p = 0.022). Publication bias was insignificant for the ever BSE (p = 0.413).
Despite nearly half (43.4%) of Iranian women reporting ever practicing BSE, the prevalence of regular BSE practice was only 16.5%, which is insufficient given the importance of regular self-examinations in the early detection of breast cancer. These findings highlight the need for implementing programs to enhance awareness about breast cancer and encouraging women to adopt regular BSE as a preventive measure against breast cancer.
... This discrepancy might be due to the differences in French and Iranian populations, such as smoking habits, alcohol consumption, and lower UPF consumption in Iran (8.5%) [35] (in the present study in the case group: 11.3% and in the control group: 9.6% energy from UPFs) compared with the total consumption of UPFs in France (18.7%) [18]. On the other hand, studies showed that the mean age of patients with breast cancer in Iran is 10-15 years lower than in developed countries [36,37], and 23% of diagnosed cases are younger than 40 years [39]. Additionally, in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort [34], low-fat and high-fiber intake was associated with a reduction in breast cancer risk in premenopausal women, suggesting that lower fat intake reduces sex hormone concentrations and bioavailability and contributes to a lower risk of breast cancer [40,41]. ...
Background
Results from studies investigating the association between ultra-processed foods (UPFs) and breast cancer are scarce and, in some cases, contradictory. Therefore, we aimed to evaluate the association between the intake of processed foods (PFs) and UPFs with the risk of breast cancer in Iranian women.
Methods
The present case (n = 133) - control (n = 266) study was carried out at two general hospitals in Tehran, Iran. A 168-item semi-quantitative food frequency questionnaire was used to assess the participants’ dietary intake. Also, the NOVA classification was used to identify PFs and UPFs. The association between PFs and UPFs with the odds of breast cancer was analyzed using logistic regression models.
Results
According to Model 1 of conditional logistic regression, the odds of breast cancer were higher in the last tertile of UPFs than in the first tertile (odds ratio (OR) = 1.930; 95% confidence interval (CI): 1.080–3.449). In Model 2, no significant association was observed between the second and last tertiles of PFs and UPFs with the odds of breast cancer compared to the reference tertile. Also based on menopause status, the odds of breast cancer increased in the last tertile only among premenopausal women in Model 2 (OR = 3.656; 95% CI: 1.326–10.079).
Conclusions
This study demonstrated that higher consumption of UPFs is associated with higher odds of breast cancer in premenopausal women.
... The incidence of breast cancer has increased in all countries, especially in developing countries with an aging population (1). Iran's epidemiological model of breast cancer is similar to that of the East Mediterranean and developing countries (2). It is estimated that the onset of breast cancer in Iran is over 40 years, compared to 50 years in other countries (3,4). ...
Background: Breast cancer is the most common female cancer and the second leading cause of death worldwide. The gold standard tool for screening breast cancer, mammography has limitations in some instances, such as patients with dense breast tissue. This study evaluates the correlation of Ultrasound (US) to mammography in breast lesions in BI-RADS. Methods: This prospective cross-sectional study was conducted at a tertiary hospital during 2019-2021. Women who referred to the radiology department for mammography with abnormalities appearing in their mammograms, with a minimum age of 40 and older, underwent ultrasonography. The results of mammography and US evaluations compared according to BI-RADS category. Statistical software SPSS was used to analyze the form data. Results: In this study, 156 women with a mean age of 48/9 years registered. The US reports were equivalent to mammographic BI-RADS category 2 in 23 cases. All the 26 patients with mammographic BI-RADS category were categorized into BI-RADS 2 by US. Among 43 lesions with BI-RADS category 4 and 21 with BI-RADS category 5, 90/6% and 95/2% of sonography reports were similar to mammography findings. Based on the Pearson correlation coefficient of 0/68, there is a correlation between the results of US and mammography in this study. Conclusion: This study reveals that US can be an excellent complement to mammography, particularly in identifying early-stage breast cancer in mammographic BI-RADS category 0 lesions. The mammographic-sonographic correlation should lead to more accurate diagnoses and better patient care.
... reast cancer stands as the most prevalent cancer among women globally, with approximately 1 in 8 women facing a breast cancer diagnosis in their lifetime (1,2). In Iran, it ranks as the second most common cancer after skin cancer, yet claims the top spot among women, with an annual increase of 7000 cases (3). Amidst the heterogeneous nature of this disease, recent decades have witnessed the development of targeted therapies, including hormone therapy for estrogen receptor (ER) expression and the use of trastuzumab to inhibit HER2 signalling (4). ...
Introduction and Aim: Breast cancer ranks among the leading causes of death in women worldwide. Ginger has shown potential efficacy against certain cancer types, surpassing conventional therapies such as chemotherapy and radiation. However, its molecular mechanisms remain less understood.
Materials and Methods: In this study, MCF-7 cancer cells were cultured and treated with various concentrations of aqueous ginger extract (20, 30, 45, 65 μg/mL) for 12, 48, and 72 hours. The effects were assessed through gene expression analysis and cell vitality assays (MTT).
Results: The cell vitality test revealed a direct correlation between cytotoxicity and extract concentration. Concentrations exceeding 30 μg/mL exhibited significant cell death (IC50 of 104.03 μg/mL). Gene expression analysis demonstrated an increase in Patched-1 and a decrease in Gli1 expression with rising extract concentrations. The maximum Patched-1 expression occurred at 65 μg/mL after 72 hours. Patched-1 (oncogene) and Gli1 (tumor suppressor) are pivotal genes in the hedgehog (Hh) signalling pathway associated with breast cancer.
Conclusion: It appears that ginger compounds play a substantial role in regulating cancer progression by influencing key components of the hedgehog signalling pathway.
... Breast cancer is one of the most common malignancies in women, with over 1 million new cases diagnosed annually. Recent research indicates a growing prevalence of breast cancer among Iranian women, particularly at a younger age, which raises concerns [37,38]. Although our knowledge of breast cancer is still evolving, we have identified various genetic risk factors associated with the disease [10]. ...
Introduction
Breast cancer is a prevalent and significant contributor to cancer-related mortality among women worldwide. Its increasing incidence, especially in regions like North-West Iran, necessitates a deeper understanding of genetic factors contributing to its development. Genetic alterations, particularly single nucleotide polymorphisms (SNPs), are implicated in breast cancer susceptibility, making investigation in this context crucial. This study explores the role of CYP1A2-rs17861162 and ADSL-rs3788579 SNPs in breast cancer risk among Iranian women.
Methods
This study involved 200 female breast cancer patients and 200 healthy controls in North-West Iran. DNA was extracted from blood samples, and PCR–RFLP was used for genotyping the CYP1A2 and ADSL genes.
Results
The CYP1A2-rs17861162 SNP exhibited a shift from the C allele to the G allele in breast cancer patients, resulting in a 21.7% decrease in CC genotype frequency and a 21.6% and 77.8% increase in CG and GG genotypes, respectively, compared to controls. In ADSL-rs3788579 SNP, breast cancer patients had a significantly higher prevalence of the T allele, with a 28.5% increase compared to controls. In healthy participants, CC was most common, while in the breast cancer group, TT was most common.
Conclusion
This study highlights significant genetic alterations in CYP1A2-rs17861162 and ADSL-rs3788579 SNPs among breast cancer patients in North-West Iran, suggesting their potential as diagnostic and prognostic biomarkers. Further research is warranted to elucidate the precise mechanisms underlying their contributions to breast cancer susceptibility in this population.
... In Iran, BC ranks as the third leading cause of death among women, with a ten-year survival rate of 58.1% [2, 3]. BC impacts 8,000 Iranian women annually, and one-third of cases occur in women under 30 years old [4]. While early diagnosis of BC can improve the treatment process, its metastatic and multifactorial nature makes it difficult to treat effectively [5]. ...
Background
Evidence from recent studies suggested that variation in the quantity and quality of macronutrients in the diet may potentially play a role in predicting the risk of breast cancer (BC). In the current study, we aimed to assess the association of different high-protein diet scores and replacing fats and carbohydrate (CHO) with protein in the diet with the BC risk among Iranian women.
Methods
The current hospital-based case-control study was conducted on 401 participants, aged ≥ 30 years old, including 134 women in the case group who had been diagnosed with histologically confirmed BC and 267 women in the control group. Dietary intake data was collected using a validated food frequency questionnaire, and high protein diet scores were determined. Logistic regression models were used to determine the odds ratios (OR) and 95% confidence interval (CI) of BC across tertiles of high protein diet scores. Also, we assessed how substituting protein with other macronutrients affected BC odds while adjusting for the various confounding variables.
Results
Participants’ mean ± SD of age and body mass index were 47.9 ± 10.3 years and 29.4 ± 5.5 kg/m², respectively. The scores of high-protein-low-CHO and fat diet, high-protein and CHO-low-fat diet, and high-protein and fat-low-CHO diet in participants were 16.5 ± 3.8, 16.5 ± 6.7, and 16.4 ± 5.9, respectively. In the multivariable model, individuals in the highest tertile of high-protein-low-CHO and fat diet score (OR:0.71;95%CI:0.56–0.90) and high-protein and CHO-low-fat diet (OR:0.76;95%CI:0.60–0.97) had lower odds of BC compared to those in the lowest tertile (P < 0.05). However, no significant association was found between high-protein and fat-low-CHO diet and BC risk. Our results showed that replacing fat by protein (ORdifferences:-0.40;95%CI:-0.73,-0.07) and also replacing refined-CHO by plant protein (ORdifferences:-0.66;95%CI:-1.26,-0.07) in the diet are associated inversely with risk of BC(P < 0.05).
Conclusions
The results of our study suggested that higher adherence to a high-protein-low-CHO and fat diet, characterized by a higher intake of plant proteins and a lower intake of refined grains and saturated fat can play a protective role against the odds of BC.
... Breast cancer (BC) is known as the second most common cancer with two million new cases in women reported in 2020. BC incidence has been increased over the past three decades 1,2 . Patients with BC can be diagnosed in the early stages. ...
The misregulation of long non-coding RNAs (lncRNAs) is related to the progressive evolution of various human cancers, such as Breast cancer (BC). The role of lncRNA B4GALT1-AS1 has been investigated in some human cancers. Therefore, studying B4GALT1-AS1 expression was aimed for the first time in the tumor and marginal tissues of BC in this study. The cancer genome atlas (TCGA) database was utilized to evaluate the relative expression of B4GALT1-AS1 in BC and other cancers. RNA was extracted from twenty-eight paired BC and marginal tissues, and cDNA was synthesized. The quantitative expression level of B4GALT1-AS1 was evaluated using real-time PCR. The bioinformatics analyses were performed to identify co-expression genes and related pathways. B4GALT1-AS1 was significantly downregulated in BC specimens compared to tumor marginal samples. The TCGA data analysis confirmed the downregulation of B4GALT1-AS1 in BC. The bioinformatics analysis discovered the correlation between 700 genes and B4GALT1-AS1 and identified GNAI1 as the high degree gene which was positively correlated with B4GALT1-AS1 expression. It seems B4GALT1-AS1 provides its function, at least partly, in association with one of the hippo pathway components, YAP, in other cancers. This protein has the opposite role in BC and its loss of function can result in poor survival in BC. Further research is needed to investigate the interaction between B4GALT1‐AS1 and YAP in various subtypes of BC.
... Breast cancer (BC) is one of the most common cancers and health problems in women under the age of 40, with a number of about 244 000 cases per year (1)(2)(3)(4). In such a way that it constitutes more than 30% of important cancers in women (150 times more than men). ...
Background: Breast cancer (BC) is one of the most common cancers and health problems in women under the age of 40. Objectives: This systematic study investigates the presence of human papilloma virus (HPV) in Iranian women with BC by searching various international and Iranian databases using standardized keywords. Methods: The inclusion and exclusion criteria were applied to select 22 articles with a total of 2445 BC samples for data extraction and analysis using Statistical Package for the Social Sciences (SPSS) software. Results: The results show that 21.10% of BC samples were HPV positive with Khuzestan, Shahrekord, Mashhad, and Karaj having the highest number of HPV-positive cases among women with BC. Polymerase chain reaction (PCR) was the most used method for detecting HPV in the studies. The distribution of BC samples was highest in Karaj, Tehran, and Golestan. Conclusions: This study provides valuable information about the prevalence of HPV in Iranian women with BC and the geographical distribution of positive cases.
... Moreover, 70% of Iranian women die after a late diagnosis of breast cancer (14). Mousavi et al (15) reported that 82% of women with breast cancer are diagnosed in advanced stages (18% in stage 2 and 77% in stage 3). In addition to mortality, breast cancer has a significant impact on a woman's life (16). ...
Background: The early diagnosis of breast cancer through mammography is effective in reducing death. Therefore, this study aimed to determine the effect of an educational program based on the protection motivation theory (PMT) on mammography adherence among women in Yazd, Iran. Methods: In this experimental study, 144 women referring to the clinic were randomly assigned to test and control groups. The data collection tool was a valid and reliable researcher-made questionnaire with 56 items and 8 dimensions. The educational program was held in the form of 6 sessions for the test group, which included PMT–based essays, infographics, and videos. The 12-week follow-up period continued as telephone consultation, and then the data were collected and analyzed by SPSS software version 21 with a 95% confidence interval. Results: The results showed that in the pre-training phase, the Mann-Whitney U statistical test did not reveal a significant difference between the two groups of women in terms of the mean mammography intention score (Z=2523.000, P value=0.775). Based on the results of the Wilcoxon test before and after the intervention, the protection motivation of women for mammography for the next month showed a significant difference in the test group. Furthermore, none of the women in the two groups were referred for mammography three months after the implementation of the training. In addition, the McNemar test results did not indicate a significant difference regarding mammography behavior in the two groups before and after the educational intervention. Conclusion: According to the results, the protection motivation of the majority of the women in the test group was in the stages of possible and definitive referral for mammography after the educational intervention, which indicates the effectiveness of the tailored educational program. In this study, all the constructs of the PMT act as interconnected building blocks with logical action and interaction to promote mammography adherence in women in Yazd.
... However, the global survey reveals an elevation in the incidence of breast cancer, but a faster rise in developing countries (13). According to the previous studies, the incidence of breast cancer in Iranian women occurs 10 years earlier than the western women (14). Data indicate that 70% of breast cancer patients in Iran die early due to delay in the diagnosis and being in the advanced stages of the disease (15). ...
Background: Breast cancer is the most common type of cancer among Iranian women with more than 10 000 cases per year. Objectives: This study aimed at determining out-of-pocket (OOP) payments among women with breast cancer at health care centers affiliated to Iran University of Medical Sciences. Methods: This descriptive cross-sectional and applied study was done among 336 women with breast cancer referring to hospitals affiliated to Iran University of Medical Sciences. The data on inpatient expenses were obtained from the cost bills and the outpatient was collected, using a researcher-made questionnaire. Finally, the data were analyzed, using SPSS V2 software. Results: The average monthly OOP payment for direct hospitalization costs in inpatient breast cancer patients was estimated 146 ± 47.98 dollars and the average OOP payment for direct costs of treatment in outpatients was 69 ± 102.99 dollars, and the average OOP payment for non-medical direct cost per month 34.88 ± 31.12 dollars. The results of this study showed the average OOP payment included drug costs with the rate of 37.99 ± 45.31 dollars imposed the highest medical direct costs. Among the non-medical direct costs of OOP payment for transportation, the average of 30.65 ± 103.23 dollars imposed the highest OOP payment on breast cancer patients. Conclusions: These findings show that individuals with breast cancer endure high OOP payments that could adversely affect their quality of life; hence, decision-makers should pay more attention to implementing proper policies.
... Statistics show that each year there are over 1.1 million newly diagnosed women with breast cancer worldwide and 410,000 women die from the disease [5]. Breast cancer constitutes 25% of all cancer cases in women In Iran [6]. Some diseases, particularly cancer development, lead to reduced quality of life of afflicted patients due to their mental and physical effects [7][8][9]. ...
Background
Breast cancer may negatively affect people’s quality of life. We investigated the predictors of quality of life in women with breast cancer with the mediating role of resilience.
Method
In a cross-sectional design, 218 patients completed a survey referring to the Valiasr International Hospital Oncology Center in Tabriz, Iran. Four validated self-report measures assessed HRQoL as measured by the SF-12, Resilience, Hope, and Perceived Social Support (MSPs). The mediating roles of resilience between HRQoL and the fitness of the proposed model were investigated using path analysis. SPSS version 24 software and Lisrel 8.8 software were used for data analysis.
Results
The results of path analysis showed that the final model had a good fit to the data (Chi-Square/ degrees of freedom (Normed Chi2) = 2.08, RMSEA = 0.014, goodness fit index = 0.99, both comparative fit index = 0.99 both CFI = 0.99 and IFI = 1). In this model, age and psychosocial factors predicted health-related quality of life.
Conclusions
Age and psychosocial factors especially social support are important components in predicting health-related quality of life among those suffering from breast cancer.
... Unfortunately, breast cancer is a leading cause of death among women aged 40-50, with mortality rates steadily increasing each year (Isfahani et al., 2020). In Iran, breast cancer comprises 25% of all cancer cases in women, and it is distressing to note that Iranian women are diagnosed with breast cancer a decade earlier than women in other advanced countries (Mousavi et al., 2007). A review of data from various countries reported the highest and lowest breast cancer prevalence rates to be in Iran (57.1%) and England (8.9%), respectively (Isfahani et al., 2020). ...
Objectives
Breast cancer is the most challenging disease, and the level of resilience in patients determines their ability to cope with the arising stress. There is relatively limited information on the resilience of patients in clinical settings. Our study aims were to evaluate the extent of resilience and identify factors that predict resilience in women with breast cancer.
Patients and methods
A cross-sectional study was conducted with the participation of 218 women with breast cancer who were referred to the Oncology clinic in 2022. The participants completed three scales, namely the Conner-Davidson Resilience, Schneider’s Life Expectancy, and the Multidimensional Scale of Perceived Social Support, along with sociodemographic information. Descriptive statistics, bivariate, and multiple linear regression were used to explore the predictors of resilience.
Result
The mean (SD) scores for resilience, social support, and hope were 59.22 (17.25), 38.53 (6.19), and 59.37 (16.68), respectively. Based on analysis 50.8% of the variations in resilience could be explained by 6 variables including social support, hope, women’s age, employment, and income status as well as the stage of illness (R ² adj = 0.508, P < 0.001). Employment status and disease stage did not show a significant relationship with resilience and social support was the factor with the highest impact on resilience (β = 0.516, P < 0.001).
Conclusion
Our study showed social support, hope, age, and income level predict significant resilience in women with breast cancer. The findings emphasize the importance of fostering strong support networks, cultivating a hopeful mindset, embracing life’s transitions, and addressing financial considerations in the pursuit of enhanced resilience.
... Studies conducted in Pakistan revealed a very low percentage of people being aware of breast cancer and breast self-examination. According to a study only 20.9% identified the correct year to start the breast cancer self-examination [13] . ...
BACKGROUND & OBJECTIVE: A good knowledge of the predictive and precepting factors can reduce the risk of breast cancer. This study aimed to assess female patients' knowledge of breast cancer, self-examination techniques, and other screening methods. METHODOLOGY: A cross-sectional descriptive study was carried out at the territory care hospital Khurrianwala Faisalabad, including 500 women attending the outpatient department from June 2022 to November 2022 after taking informed consent. Data collected by filling out a validated questionnaire was analyzed through SPSS software version 22.0. Relationships between categorical variables were tested by using the chi-square test, and a p<0.05 is considered highly significant. RESULTS: Out of 500 study participants, 304(60.8 %) know about breast cancer, of which 64(12.8 %) have a positive family history, 436(87.2 %) have no history of breast cancer, and 196(39.2%) were unaware of breast cancer. Out of the total participants, 60.8 % were aware of Breast self-examination, while 39.2% did not know. There is a significant association for the practice of breast self-examination in the population above higher education p-value≤0.001. Similarly, occupation p-value≤0.001, marital status p-value=0.040, and education p-value≤0.001 have significant associations with BSE. CONCLUSION: The current study showed that knowledge of breast cancer and the practice of BSE and mammography were very poor. A health education program involving the local and governing bodies should be organized to reduce the prevalence and create awareness.
... Liposarcoma (LS) is a common type of soft tissue sarcoma [6,7]. In addition, breast cancer is one of the most important and common malignancies in Iranian women [8]. The type of cancer and the rate of its progression will determine the treatment methods. ...
Background
The genus Artemisia of the Asteraceae family has different species that are used in the treatment of a wide range of diseases, including cancers due to the presence of valuable compounds and important medicinal properties. Various studies on the anti-tumor effect of different species of Artemisia have proven the cytotoxic properties of these plants in cancer treatment, and several anti-cancer compounds of this genus have been purified.
Objective
The objective of this study was to investigate the cytotoxicity and related mortality mechanisms of Artemisia marschalliana essential oil and extracts.
Methods
The essential oil and various extracts of Artemisia marschalliana were elicited using a Soxhlet extractor. Anti-cancer to anti-proliferative activity as MTT assay is measuring cancerous and non-cancerous cell viability. In the next step, the strongest extract fractions were obtained by using the vacuum liquid chromatography method. Flow cytometry was applied to identify the mechanism of cell death, and a Real-time polymerase chain reaction test of apoptosis genes, which encode apoptosis-regulating proteins, was measured to confirm the flow cytometry results.
Results
The strongest extract belonged to dichloromethane extract 60% fraction of the extract on breast cancer cells and 80% fraction on liposarcoma cancer cells showed the most cytotoxicity within 48 h, while, the fractions did not notable cytotoxicity of non-cancerous cells cell. Flow cytometry analysis illustrated the mentioned extract and its fractions kill cancer cell lines through the apoptosis mechanism. Our findings confirmed the flow cytometry results. In addition, the essential oil of Artemisia marschalliana showed a considerable cytotoxic property.
Conclusion
Dichloromethane extract of Artemisia marschalliana shoot and its 60 and 80% fraction selectively inhibited the growth of cancer cells by inducing the apoptosis mechanism. Regarding obtained results, 60 and 80% fractions of dichloromethane extract can be a good candidate for future studies in the field of identification and separation of pure cytotoxic compounds.
... Breast cancer is the most common type of cancer across the world, and the most frequent cause of cancer death in women [1]. In Iran also, breast cancer is the more frequent female malignancy and constitutes one fourth of all cancers in the country [2,3]. The mean age of breast cancer is lower in Iran than in western countries, and has been shown to be around 46 years of age [4]. ...
Background
Breast cancer is the most common cancer among females, and early diagnosis is possible in case the patients seek medical attention on time. For this to come true, they must know about the existence and risks of the disease and be aware of the appropriate attitude and actions toward prevention or early diagnosis. However, we see that women have unanswered questions about these issues. In this study, we sought to investigate healthy women’s information needs about breast cancer from their own perspective.
Methods
This prospective study was carried out by using the maximum variation sampling, and theoretical saturation to reach sample saturation. Women who came to different clinics of Arash Women’s Hospital (except the Breast Clinic) during two months were entered in the study. Participants were asked to write down all the questions and subjects they would like to be explained in a breast cancer educational program. The questions were reviewed and categorized after every fifteen consecutive forms were filled until there was not even one new question. Afterwards, all the questions were reviewed and matched based on their similarity and repeated items were eliminated. Finally, questions were organized according to their common topics and the range of details they comprised.
Results
Sixty patients were included in the study, and 194 questions were gathered and categorized according to common scientific terms, resulting in 63 questions in 5 categories.
Conclusions
Many studies have been conducted on breast cancer education, but none have addressed healthy women's personal queries. This study outlines the questions of unaffected women about breast cancer that need to be addressed in educational programs. The results can be used for development of educational material at community level.
Trial registration: This study was conducted as the preliminary phase of a study approved in Tehran University of Medical Sciences (Approval Code 99-1-101-46,455) and by the Ethics Committee of the University (Ethical Code IR.TUMS.MEDICINE.REC.1399.105).
... Breast cancer occurs in young Iranian women and the age of diagnosis is about one decade earlier than in western countries [6]. On the other hand, the use of cosmetic products is increasing in Iran [7] and Iran is the third biggest consumer in Middle East countries [8]. ...
Background
Since breast cancer is increasing worldwide and previous risk factors cannot justify such an increasing trend, investigating new environmental factors is necessary for each population. Mammographic breast density (MBD) is a strong risk factor for breast cancer as well as a biomarker for the effect of chemicals on breast tissue.
Objective
Given limited data about the association between breast density and cosmetic products containing endocrine-disrupting chemicals (EDCs), the purpose of this study was to evaluate the effects of cosmetic products on MBD in Iranian women.
Methods
In this cross-sectional study, women who attended two university hospitals for breast screening mammography and who had been living in the capital city of Iran for the last 3 years or more were recruited. We asked women to fill out a questionnaire containing two parts; the first part was about the women's characteristics and medical history and the second part consisted of cosmetic use. The frequency of cosmetic use was measured using the Likert scale in four scales. One expert radiologist in each center reported the MBD on a four-category scale.
Results
The mean age of 813 participants was 50.16 ± 7.65. Three hundred-seven (37.8%) women had low breast density and 506 (62.2%) had high breast density. Based on our results, heavy use of moisturizers, sunscreen, nail polish, eye products, makeup products, and lipstick was associated with increased breast density. In multivariable analysis after adjusting for menopause, excessive use of nail polish, sunscreen, and moisturizing cream was associated with increased MBD.
Conclusion
Our study shows a probability of an increased MBD with the excessive use of cosmetic products. Since a small increase in the risk of breast cancer may lead to a considerable public health impact, thus further studies are needed to find new prevention strategies.
... 6,7 One of the specific characteristics of Iranian breast cancer patients is that the agegroup 40-49 are the group with most incident cases and is emphasized that they are one decade younger than their western counterparts. [8][9][10] However, the rate of BCS in Iranian breast cancer is low compared with mastectomy. 11,12 A systematic review study reported that young women with breast cancer have conventionally been more likely to treat with BCS, compared to mastectomy, but concerns regarding recurrence may affect their choice. ...
Background: Survival after breast conserving surgery (BCS) vs. modified radical mastectomy (MRM) is a controversial issue. In this study, we want to compare the disease-free survival (DFS) of women who underwent BCS with those treated by MRM. Method: In this historical cohort study, a total of 1097 women who were diagnosed with breast cancer between 2001 and 2007 and received modified MRM or BCS were entered into the study and followed up to March 2017. Kaplan-Meier estimator and extended cox model, and Cox proportional hazards model with propensity score weighting were implemented to compare overall survival between two groups. Results: A total of 283 women with a maximum follow-up of 11.1 years and age 47.17 ± 11.278 were met the inclusion criteria. The results of the extended cox model did not show any difference between the survival of two groups (P = 0.35). After implementing the Cox model with propensity score weighting, the inferences remained unchanged (P = 0.67). Conclusion: The patients treated with BCS tend to have the same DFS rate as those who underwent a mastectomy in a randomized controlled trial-like setting using propensity score weighting.
... Research in Iran has shown that delay in seeing a doctor for symptom evaluation is the most critical delay stage in diagnosis. Among the factors that affect health, social factors, or in other words, the conditions in which people are born, grow up, live, and work, have the most significant impact (2). Because of the increase in the incidence of breast cancer among Iranian women, the study of social determinants of delayed diagnosis of breast cancer seems necessary. ...
... Researchers are interested in chemotherapies that use nanoparticles. When gold nanoparticles (AuNPs) are used to treat cancer, the results have been very positive (Mousavi et al., 2007;Shreyash et al., 2021). Not only do these particles stop the growth of cancers Safdar et al., 2019) other than normal cells, but they induce apoptosis that is the main goal of cancer drugs (López-Barrera et al., 2021), and you can easily see how they work by looking at caspases. ...
The aim of this study was to make de novo gold nanoparticles (Au(0)NPs) that turn on p53 and turn off NF-kB signaling in SKBR3 breast cancer cells. The chemical method was used to make the erythromycin-based Au(0)NPs. Authentic techniques were used to figure out what these Au(0)NPs were like. In the end, relative gene expression studies were used to treat SKBR3 breast cancer cells with these Au(0)NPs as a nanomedicine. When Au(0)NPs were present, the levels of caspases 3, 8, and 9 changed, p53 was turned on, and NF-kB was turned off at the same time. Compared to normal breast cells, the number of breast cancer cells (SKBR3) that could live was cut down (CRL-4010). Gene expressions of caspases also showed that the data were correct. When AuNPs were used to treat breast cancer cells, it was found that p53 and NF-kB had the opposite relationship. The study laid out a first step for using newly made AuNPs as a chemotherapeutic agent to treat SKBR3 cells.
... Breast cancer is recognized at the forefront of other cancers in incidence and mortality [2]. Every 3 min, a woman in the United States is affected by breast cancer [3], which is diagnosed in 12% of US women during their lifetime [4]. However, due to the recent advances in early diagnosis and treatment of BC, mortality from the disease has steadily declined since 1990 [5]. ...
Background
Breast cancer is one of the most common challenges for women's health. Until now, neoadjuvant chemotherapy is a standard approach in locally advanced breast cancer (LABC), as it increases the probability of breast-conserving surgery (BCS). This study aimed to compare the survival rate in neoadjuvant and adjuvant groups to suggest a better treatment strategy for locally advanced breast cancer.
Methods
The study was conducted between 2009 and 2019 on 845 LABC patients at the Cancer Research Center of Shahid Beheshti University of Medical Sciences in Iran. All patients with LABC at stages 3A, 3B, and two were evaluated for treatment with adjuvants (n = 520 female patients) and neoadjuvant (n = 320 female patients) treatment strategies. Patients were followed up for at least 120 months. The Kaplan-Meier method calculated the survival rate using SPSS version 23 software.
Result
The 5 and 10 years survival rates of neoadjuvant and adjuvant groups were 87 ± 0.04, 80 ± 0.07% and 87 ± 0.02, 83 ± 0.03%, respectively. Statistical analysis results with the mentioned treatment strategies did not show any significant difference in overall survival.
Conclusion
The result of this study on LABC patients demonstrated that compared to surgery first following adjuvant chemotherapy, the neoadjuvant chemotherapy has several benefits, including downstaging and more BCS, with no statistically significant difference in the overall survival rate of the patients.
... Research in Iran has shown that delay in seeing a doctor for symptom evaluation is the most critical delay stage in diagnosis. Among the factors that affect health, social factors, or in other words, the conditions in which people are born, grow up, live, and work, have the most significant impact (2). Because of the increase in the incidence of breast cancer among Iranian women, the study of social determinants of delayed diagnosis of breast cancer seems necessary. ...
... Various risk factors such as consumption of exogenous hormones (oral contraceptives and menopausal hormone replacement therapy), unhealthy lifestyle, physical inactivity, excess body weight, and genetic predisposition are probably responsible for the increased BC incidence in this age group (25,34). The maximum incidence rate of BC was observed in the age range 40-49 years during 1998-2005 in Iran (35). ...
Background: Breast cancer (BC) is the second most frequent cancer in females worldwide. In recent years, the incidence rates of BC have been increasing among Iranian women. This study aimed to examine the incidence of BC among females in Kermanshah province, west of Iran, based on the data taken from the Kermanshah Population-based Cancer Registry (KPCR) during 2014-2017.
Methods: In this registry study, data were obtained from the KPCR, a high-quality cancer registry that collects data on various cancers using standard protocols all over Kermanshah province. The crude incidence rates (CRs) and age-standardized incidence rates (ASRs) of BC were determined per 105 person-years. Further, temporal trends were assessed using joinpoint regression analysis to describe the average annual percent change (AAPC) and 95% CIs. ArcGIS software was used to map the geographic distribution of BC incidence.
Results: During 2014-2017, 1,177 new cases of BC were detected in Kermanshah province. Most of the females diagnosed with BC (cases/100,000, percentage) lived in Kermanshah county (900, 76%) compared to the other counties (277, 23%). The overall ASR of BC increased by 38.7 cases per 100,000 females-year (AAPC: 2.2; 95%CI 5.1–10.1; P=0.3). The lowest and highest ASRs were observed in 2015 (36.7/100,000) and 2017 (40.7/100,000), respectively. The maximum incidence of BC among females was reported in the age group 45-49 years.
Conclusion: The BC trend for females increased from 2014 to 2017 in Kermanshah province across all age groups, especially in the age group 45-49 years. Thus, it is essential to take a series of effective health measures to prevent and control this cancer.
... type of BC in various countries, including Iran (Mousavi et al., 2007). Because of a series of factors, the incidence rate of BC is increasing significantly in South America, Africa, and Asia (Salman et al., 2017). ...
Background:
According to several studies, there is an association between human papillomavirus (HPV) and breast cancer. Therefore, detection and genotyping of HPV seem important. The present study aimed to investigate the presence of HPV DNA in breast tissues by analyzing the L1 gene.
Materials and methods:
This case-control study was conducted on 63 formalin-fixed paraffin-embedded (FFPE) tissues of invasive ductal carcinoma (IDC) as the case group and 32 FFPE tissues of fibroadenoma as the control group. HPV DNA was detected using the polymerase chain reaction assay. Positive samples were then subjected to genotyping. All statistical analyses were performed in SPSS version 22.0.
Results:
The patients' age ranged from 15 to 92 years, with a mean age of 43.54±16.36 years. HPV DNA was detected in 17/95 (17.89%) samples, including 9/32 (28.12%) fibroadenoma samples and 8/63 (12.69%) IDC samples. No significant difference was observed regarding the presence of HPV DNA between the IDC and fibroadenoma tissues (P=0.08). However, a significant difference was found in the detection of high-risk HPV (HR-HPV) between the case and control groups (P=0.03). In the case group, 87.5% of the detected viruses (7/8 samples) were HR-HPV, while in the control group, 22.22% of positive samples (2/9 samples) were HR-HPV (P=0.03). Based on the results, HR-HPV and low-risk HPV genotypes were detected in 53% (9/17) and 47% (8/17) of positive samples, respectively.
Conclusion:
In this study, 12.69% of IDC samples were positive for HPV genomes, and HR-HPV was detected in 87.5% of these samples. The present results suggest the important role of HR-HPV in the development of breast cancer.
... 1 One of the specific characteristics of Iranian breast cancer patients is that they are one decade younger than their western counterparts. 2,3 The results of randomized clinical trials showed that radiotherapy(RT) following breast-conserving surgery in breast cancer patients is associated with a significantly lower rate of local relapse. 4 There is a consensus on reducing the effectiveness of radiotherapy with an increasing number of clonogenic cancer cells. ...
Background: The impact of initiation time of radiotherapy after breast surgery on disease-free status of patient is a controversial issue. We assessed the relationship between the delay in adjuvant radiotherapy and surgery and relapse or metastasis-free survival in women with breast cancer taking heavy censoring into account. Method: This was a historical cohort study on 284 patients with breast cancer, who underwent surgery between 2001 and 2007 and followed up until March 2017. The association of the duration between radiotherapy and surgery, as well as other demographic and clinical factors with occurrence of local relapse or metastasis of breast cancer was examined through penalized Cox regression modeling. The obtained data were analyzed using R 3.6.3. Results: A total of 284 women with the mean age of 47.2 ± 11.3 years met the inclusion criteria. The maximum follow-up time was 11.1 years and the time between surgery and radiotherapy was 168 ± 84.3 days. About 10% of the patients experienced local relapse and 19% had metastasis. In multiple analysis of factors related to disease-free survival, the stage of disease was significant, while surgery to radiotherapy interval (≤180 days vs >180 days) did not have any significant impact on hazard of failure. Analysis of 3, 4, or 5 months of delay in radiation therapy did not imply any significant affects. Conclusion: In the studied patients, the delay in radiotherapy initiation after surgery did not lead into outcomes of local relapse or metastasis.
... This cancer could also harm women with younger ages [7]. In comparison to other races, Iranian women have a larger breast density [8,9]. According to surveys, 90 percent of females with breast cancer survive; however, for women with advanced disease, the survival rate reduces to 60 percent [10]. ...
Breast cancer will be easier and more effective to treat if detected early. Breast cancer is assessed and detected using imaging as a primary approach. The capacity to diagnose breast cancers is continually improving thanks to developments in imaging technologies. However, some of these enhancements have been linked to delays in the initiation of treatment procedures of breast cancer. Overall, cancer management relies heavily on imaging procedures such as screening and symptomatic disease management. Mammography, which is considered the gold standard, and breast ultrasonography are employed as routine imaging modalities. Previous research has shown that, despite recent developments, no single imaging modality can detect and characterizing majority of breast lesions. Various imaging methods and their uses in diagnosing and caring the breast cancer are discussed in this study.
... Ginger plants including medicinal plants, particularly in Iran, which has been introduced in Iranian traditional medicine as an anti-inflammatory herb [28]. Despite multiple reports of the antitumor effects of this plant, known mechanisms of these effects, reducing inflammation occurs [2][3][4][5][6][7]. Several studies have also shown that the modulation of immune responses capable of exacerbating inflammatory cell extract [3]. ...
The aim of this study was to determine the effect of regular physical activity in water with and without ginger supplementation on adiponectin levels in women with breast cancer. The population of the study, 98 women with a mean age of breast cancer patients (48±8.5), weight (76±9)kg and fat mass (8.41±4) formed that voluntarily participated in this study that 40 people of them were selected as sample. subjects were randomly divided into four groups (Group 1: placebo, Group 2: Selected exercises in water placebo, Group 3 and Group 4 supplementation Ginger: Ginger supplements selected exercises in water) were divided into groups of ginger supplements and exercise The Water Department ginger supplements daily for 6 weeks orally 4 capsules (750mg) were used. Programs supplement group ginger exercise and water exercise group placebo juice containing a combination of increased intensity and distance training, with 50% to 75% heart rate reserve for 60 to 75 minutes in a pool with a width of 15 meters and a depth of 4m, 4 times a week 6 weeks was performed. Fasting blood samples were collected at pre-test and post-test. The result of the study All findings using the statistical software in SPSS23 and evaluated p<0.05. Ginger supplements or exercise in water increase adiponectin was compared to baseline. However, the exercise group in water exercise with ginger showed a much better effect on the inflammatory marker adiponectin and blood, than the exercise group in water with placebo or the ginger group alone. The findings show that a protective effect of non-pharmacological strategies such as exercise in water and plant anti-inflammatory agents such as ginger has been detected in inflammatory and metabolic responses in obese women with breast cancer.
... Radiation therapy has a significant impact on the treatment of BC. Research suggests more than 80% of patients with BC receive it alone or in combination with chemotherapy [36]. Most patients tolerate radiotherapy, but some suffer from radiationrelated complications, such as late pulmonary and cardiac side effects [37][38][39]. ...
Breast cancer (BC) is a highly metastatic multifactorial disease with various histological and molecular subtypes. Due to recent advancements, the mortality rate in BC has improved over the past five decades. Detection and treatment of many cancers are now possible due to the application of nanomedicine in clinical practice. Nanomedicine products such as Doxil® and Abraxane® have already been extensively used for BC adjuvant therapy with favorable clinical
outcomes. However, these products were designed initially for generic anticancer purposes and not specifically for BC treatment. With a better understanding of the molecular biology of BC, several
novel and promising nanotherapeutic strategies and devices have been developed in recent years. In this context, multi-functionalized nanostructures are becoming potential carriers for enhanced
chemotherapy in BC patients. To design these nanostructures, a wide range of materials, such as proteins, lipids, polymers, and hybrid materials, can be used and tailored for specific purposes against BC. Selective targeting of BC cells results in the activation of programmed cell death in BC cells and can be considered a promising strategy for managing triple-negative BC. Currently, conventional BC screening methods such as mammography, digital breast tomosynthesis (DBT),
ultrasonography, and magnetic resonance imaging (MRI) are either costly or expose the user to hazardous radiation that could harm them. Therefore, there is a need for such analytical techniques for detecting BC that are highly selective and sensitive, have a very low detection limit, are durable, biocompatible, and reproducible. In detecting BC biomarkers, nanostructures are used alone or in conjunction with numerous molecules. This review intends to highlight the recent advances in nanomedicine in BC treatment and diagnosis, emphasizing the targeting of BC cells that overexpress receptors of epidermal growth factors. Researchers may gain insight from these strategies to design and develop more tailored nanomedicine for BC to achieve further improvements in cancer specificity, antitumorigenic effects, anti-metastasis effects, and drug resistance reversal effects.
Background: Breast cancer is one of the most important cancers in women. Considering the importance of design for improving physical and mental health, quality of life of vulnerable women, the present study aims to design of humor and laughter programs in women with breast cancer and its effects in promoting their health.
Methods: In this systematic review, in order to access relevant articles used from Persian and English databases SID, Magiran, Cochrane Library, MEDLINE/PubMed, Scopus and Science direct, and the key words "Humor therapy", "Laughter therapy", "Breast Cancer", "Wit and Humor as Topic" and "Breast Neoplasms" using logical operators (AND, OR, NOT) were used. All articles were evaluated between January 2008 and January 2023. To assess the quality of the articles, the "Jadad" scale was used.
Results: Among the 975 articles in the initial search, 525 articles are due to the repetition of the title and 442 articles due to other reasons such as not assigning humor therapy in breast cancer, not implementing the joke and laughter intervention program, the language of the article not being related to English or Farsi, and not Conducting clinical trials were excluded, and finally eight articles that scored higher than 3 were included in the systematic review. The results of the studies showed that laughter therapy had an effective role in improving the quality of life, improving various aspects of mental health, reducing negative emotions such as anxiety, stress, depression, pain intensity, fatigue and strengthening positive emotions such as self-esteem, mood. while There has been a non-significant decrease in the dermatitis caused by radiotherapy and the activity of immune cells and the serum level of cortisol.
Conclusion: Considering the positive effect of laughter therapy in reducing the negative emotions of patients, it is recommended that nursing managers and psychologists use this easy, fun, uncomplicated and accessible intervention to improve the physical, mental and emotional health of women with breast cancer.
Introduction: Socioeconomic status has been considered as an important factor that affects health related behaviors. According to recent studies, patients show different coping strategies against their disease based on their socioeconomic status; so this study was designed to evaluate the effect of this factor on the coping behavior of patients with breast cancer. Methods: This study was performed on 100 breast cancer patients referred to the Clinic of Iranian Center for Breast Cancer for further follow-ups. Demographic characteristics of patients were recorded and their coping behaviors were assessed by CWQ-R questionnaire. The socioeconomic status was identified according to their educational and occupational status, family income and place of residency. The patients were divided into three categories (high, medium and low) with respect to their socioeconomic status .Statistical correlations of coping behavior with socioeconomic status were analyzed by SPSS 14 software using Anova and Kruskal-Wallis tests and by using univariate and multivariate regression analysis.
Objective
Breast cancer is one of the most common cancers in women worldwide. This study aims is to investigate the burden of breast cancer in Iran and its relationship with the Human Development Index (HDI) during 2009 to 2019.
Study design
The present study is an observational study in Iran during the years 2009 to 2019. Data related to the incidence, mortality, Years of Life with Disability (YLD), Years of Life Lost (YLL) and Disability-Adjusted Life-Years (DALY) of breast cancer in Iran were extracted from the Global Burden of Disease 2019 (GBD-2019) website. Correlation tests are used to check the relationship between these indicators and the human development index.
Results
The highest incidence rate of breast cancer in 2019 is related to the provinces of Gilan (29 per 100,000) and Tehran (28.55 per 100,000) and the highest rate of death from breast cancer is related to the provinces of Gilan (10.71 per 100,000). and Semnan (9.97 in 100,000). The results showed that there is a positive and significant correlation between DALY (r = 0.626, P < 0.0001), YLL (r = 0.611, P < 0.0001) and, YLD (r = 0.773, P < 0.0001) breast cancer with HDI index. There is a positive and significant correlation between the incidence (r = 0.794, P < 0.0001) and mortality (r = 0.503, P = 0.003) of breast cancer with the HDI index.
Conclusions
Considering that a positive correlation was observed between the incidence and burden of breast cancer and the human development index in the country, it is suggested to implement preventive measures such as public education programs to reduce the incidence and burden of breast cancer and the necessity of screening programs in areas with low human development index. It confirms the diagnosis of disease cases.
Breast cancer is common among women worldwide, especially in developed countries, urban areas, and Caucasian women. It is rare among women under 35. We conducted a retrospective cohort study on women under 35 diagnosed with breast cancer.
The study focused on breast cancer in young adults aged 18–35. It recorded clinical and epidemiological information and treatment details for each patient. The patients were monitored for four years to determine their survival rates. A p value less than 0.05 was considered statistically significant.
Of 334 women, 219 patients were between the ages of 31–35. The most common type of breast cancer was hormone receptor (HR) positive and HER2-negative, which accounted for 41.6% of the cases. The report showed that 5% of cases were grade 1; while, grades 2 and 3 were reported in 50.9% and 43.6% of cases, respectively. The study found that 16.9% of patients were in stage I, 44.4% were in stage II, 30.5% were in stage III, and 8.2% had metastatic disease at the time of diagnosis. Among the 68 patients who received neoadjuvant chemotherapy, 29.4% had a complete pathological response. The study had a mean follow-up of 71.5 months (± 26.6), with 4-year disease-free survival and overall survival rates of 66% and 80%, respectively.
Breast cancer cases in very young women account for 9.5%. There was a significant association of subtypes with stage and grade.
Background: Breast cancer, the most prevalent cancer in women and the second leading cause of cancer-related deaths worldwide, is a complex and heterogeneous disease characterized by multiple tumor types with distinct tissue patterns, biological characteristics, and clinical behaviors. Given the critical role of histopathological and molecular characteristics in the treatment and management of breast cancer. Objectives: This study was undertaken to investigate the histopathological characteristics of malignant breast masses in the city of Sanandaj from 2019 to 2021. Methods: In this descriptive-analytical study, out of 1,631 pathology reports from breast tissue samples collected in Sanandaj, a city in northwest Iran, between 2019 and 2021, 597 (36%) malignant cases were examined for their pathological type and molecular characteristics. Data analysis was performed using SPSS 26 software, employing chi-square and Fisher's exact tests. Results: The mean age of the patients at diagnosis was 49.7 ± 11.9 years. The most prevalent molecular subtype was luminal A (56.4%), followed by triple-negative (16.7%), human epidermal growth factor receptor 2 (HER2)-positive/enriched (14.1%), and luminal B (14%). Invasive ductal carcinoma was the predominant histological type, accounting for 82.7% of cases, followed by lobular invasive carcinoma (8.2%). Papillary carcinoma accounted for 5.9% of cases, metaplastic carcinoma for 1.8%, and mucinous carcinoma for 1.3%. Higher grades at the time of diagnosis were associated with the metaplastic subtype (P < 0.001). The only biomarker that showed a significant association with pathological types of breast cancer was Ki-67. The percentage of cases positive for Ki-67 was higher in three types of breast cancer: Infiltrating ductal carcinoma, metaplastic, and papillary (intraductal) carcinoma, compared to the other types (P < 0.001). Conclusions: According to our data, infiltrating ductal and lobular carcinoma are the most prevalent pathological types, and luminal A is the most common molecular subtype among Kurdish women in Iran. It is recommended that future studies examine patient survival based on the pathological and molecular types of tumors, including the evaluation of additional biomarkers. Furthermore, comparing these results with those from other ethnic groups could provide valuable insights into the impact of ethnicity on breast cancer characteristics and outcomes.
Background: Chemotherapy as one of the main methods of cancer treatment has many side effects that one of them is the impact of this treatment on the brain. Objective: The aim of this study was to compare the executive functions in women diagnosed with breast cancer undergoing chemotherapy and healthy counterparts. Methods: In this case-control study, women with breast cancer (n=40) undergoing chemotherapy along with healthy women (n=40) with no history of chronic diseases using available sampling method and were selected from Tehran Shohada Tajrish Hospital (2015-2016). Data was collected using demographic characteristics questionnaire, anxiety and depression test, continuous performance test, and Wisconsin card category collected and was analyzed by the independent t test. Findings: In the continuous performance test, omission and commission errors, with weaknesses in speed tests in patients with breast cancer were higher than those in the control group and this difference was statistically significant. There was a significant difference between the two groups in which reflects the low number of correct answers and cluster with higher preservation in breast cancer patients compared to healthy counterparts. Conclusion: According to the results, deficits in executive functions caused by chemotherapy in cancer patients that require therapeutic measures in this field.
Introduction: Following breast cancer, there are several problems for patients, including changes in the body with surgery, hair loss, burns caused by radiation therapy and reduced sexual attraction that can reduce the quality of life of patients. The aim of this study was to determine the effect of mindfulness-based cognitive therapy on body image and fear of negative evaluation of women with mastectomy breast cancer. Methods: This was a quasi-experimental study with a pretest-posttest design with experimental and control groups. The statistical population of the study included all women with mastectomy breast cancer referred to Shohada-e-Tajrish Hospital in Tehran between 2016-2017. Experiments and controls were assigned. Research data were collected by Body Image Concern (BICI) and Fear of Negative Assessment (FNES-B) questionnaires using descriptive statistics (mean and standard deviation) and inferential statistics (multivariate analysis of covariance) and analysis software. Statistical and SPSS.v.22 data were analyzed. Results: The results of data analysis showed that mindfulness-based cognitive therapy reduced body dissatisfaction, reduced body anxiety and also reduced the fear of negative evaluation in women with mastectomy breast cancer in the experimental group compared to the control group. These findings were statistically significant (P <0.001). Conclusions: Through mindfulness-based cognitive therapy, body image and fear of negative evaluation of mastectomy women can be changed and their quality of life can be improved.
Background and Objectives In recent years, flavonoids such as quercetin have been considered as new anticancer drugs. The mechanisms of action of quercetin include cell cycle arrest, inhabitation of cell proliferation, and induction of apoptosis. This study aims to reduce quercetin’s side effects by increasing MCF-7 breast cancer cells’ sensitivity to this drug and facilitating the cytotoxic effects of quercetin at lower concentrations. Subjects and Methods In this study, the MTT assay was used to determine the concentration that reduced the cell viability by 50% (i.e. lethal concentration 50 or LC50). Then, the expression of the DNA fragmentation factor-45 (DFF45) and some genes in the apoptosis pathway (caspase3, p53, BAX, BCL-2, AIF), the autophagy pathway (LC3, ATG5, Beclin, DRAM) and the AKT/mTOR pathway (AKT1, mTOR, and PTEN), in cells treated with siRNA, quercetin, and quercetin+siRNA using the real-time PCR. Results According to the results of MTT assay, the LC50 value for quercetin was determined 220 μM. The results indicated the initiation of cell death through autophagy pathways. The combined treatment (quercetin+siRNA) increased the mechanism of cancer cell death more than the quercetin treatment alone. Conclusion One of the regulating pathways of apoptosis is forcing the inhibitory effect of DFF45 on DFF40/CAD nuclease. Down regulation of DFF45, along with quercetin administration, can lead to induction of breast cancer cell death which can be a novel technique for the treatment of breast cancer.
The misregulation of long noncoding RNAs (lncRNAs) is related to the progressive evolution of various human cancers, such as Breast cancer (BC). The role of lncRNA B4GALT1-AS1 has been investigated in some human cancers. Therefore, studying B4GALT1-AS1 expression was aimed for the first time in the tumor and marginal tissues of BC in this study. The cancer genome atlas (TCGA) database was utilized to evaluate the relative expression of B4GALT1-AS1 in BC and other cancers. RNA was extracted from twenty-eight paired BC and marginal tissues and cDNA was synthesized. The quantitative expression level of B4GALT1-AS1 was evaluated using real-time PCR. The bioinformatics analyses were performed to identify co-expression genes and related pathways. B4GALT1-AS1 was significantly downregulated in BC specimens compared to tumor marginal samples. The TCGA data analysis confirmed the downregulation of B4GALT1-AS1 in BC. The bioinformatics analysis discovered the correlation between 700 genes and B4GALT1-AS1 and identified GNAI1 as the high degree gene which was positively correlated with B4GALT1-AS1 expression. It seems B4GALT1-AS1 provides its function, at least partly, in associated with one of the hippo pathway components, YAP, in other cancers. This protein has the opposite role in BC and its loss of function can result in the poor survival in BC. Further researches are needed to investigate the interaction between B4GALT1‐AS1 and YAP in various subtypes of BC.
Introduction:
Breast cancer is the most common malignancy among women, and subtypes are mainly defined based on hormone receptors such as estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). The relationship between breast cancer subtypes and imaging features in mammography and sonography has been studied but the results are controversial. The purpose of this study was to determine the relationship between the hormonal receptor status of breast tumors and the radiologic feature of the tumors on mammography and sonography.
Methods:
Eighty patients with breast cancer enrolled in this cross-sectional study. ER, PR, and HER2 determined by immunohistochemistry. Every patient underwent mammography and sonography before the biopsy. We evaluated the relationship between the hormonal receptor status and radiographic features of tumors on breast sonography and mammography.
Results:
The majority of the patients (n=75 (93.8%)) were diagnosed with invasive ductal carcinoma (IDC). The mean and standard deviation of the age was 49 ± 9 years. There was no significant relationship between the hormonal receptor status and the sonographic margin and shape (P>0.05). However, PR (P=0.002) and ER (P=0.001) status were significantly correlated with posterior features on sonography. ER-positive patients were more likely to have indistinct or speculated masses on mammography (P=0.017). Irregular or oval masses on mammography were higher in patients with ER (p=0.032).
Conclusion:
There was a significant correlation between PR and ER status and posterior features on sonography. Positive ER was associated with indistinct or speculated masses on mammography, as well as irregular or oval masses.
Comparing The Effect of Peer Education To Health Care Personnel’s
on Knowledge of Breast Self-Examination and The Obstacles among
Undergraduate Students of Shiraz University of Medical Sciences
Mahdye Zangiabadizade
Abstract
Introduction: Breast self-examination is the only way in access for early diagnosis and control of breast
cancer in its primary levels; although most women do not perform this examination regularly. This study was
performed To compare The effect of education by peers tot hat of health care personnel on knowledge and
obstacles of performing breast self-examination among undergraduate students.
Methods: In this quasi-experimental study, 112 students of Shiraz University of Medical Sciences were
selected randomly and allocated in to two groups. A pre-test and two post-tests were taken from them. Data
gathering tool was a questionnaire made by researcher including general information and demographic data
of modules under investigation, know ledge assessment test, and the test of obstacles to perform breast self�examination. Two to three subjects were selected as peer instructors in peer education group andthenTrained.
Students of two groups were educated by peers and personnel of health group independently. The first post�test was held after the sessions were held and the second was held after 6 weeks. Data was analyzed using
statistical tests of chi2
, paired-test, independent t-test, and Repeated Measures ANOVA.
Results: The mean scores of breast self-examinations knowledge immediately after education in peer
education group was 18/05±1/25 and in personnel of health group was 16/9± 2/1. There was a significant
difference between two groups (P=0.002, t=3.27). The mean scores of breast self-examinations knowledge
six months after education in peer education group was 16/6±1/75 and in personnel of health group was
16/9±2/1. There was a significant difference between two groups (p=./0004,t=2/90). The mean scores for
alterations in anxiety, mentality, and knowledgeable factors in peer education group were higher Than that of
health care personnel group, immediately after education. This significant difference was also applicable
about knowledge.
Conclusion: Since the efficacy of training breast self-examination by peers is higher than the education by
health care personnel, it is recommended to employ this educational method more Than before especially in
youth Trainings.
Keywords: Education, breast self-examination, obstacles, peers, health care personnel.
Introduction:
Angiogenesis involves the development of new blood vessels. Biochemical signals start this process in the body, which is followed by migration, growth, and differentiation of endothelial cells that line the inside wall of blood vessels. This process is vital for the growth of cancer cells and tumors.
Materials and methods:
We started our analysis by composing a list of genes that have a validated impact in humans with respect to angiogenesis-related phenotypes. Here, we have investigated the expression patterns of angiogenesis-related genes in the context of previously published single-cell RNA-Seq data from prostate and breast cancer samples.
Results:
Using a protein-protein interaction network, we showed how different modules of angiogenesis-related genes are overexpressed in different cell types. In our results, genes, such as ACKR1, AQP1, and EGR1, showed a strong cell type-dependent overexpression pattern in the two investigated cancer types, which can potentially be helpful in the diagnosis and follow-up of patients with prostate and breast cancer.
Conclusion:
Our work demonstrates how different biological processes in distinct cell types contribute to the angiogenesis process, which can provide clues regarding the potential application of targeted inhibition of the angiogenesis process.
Background
The increasing rate of breast cancer (BC) incidence and mortality in Iran has turned this disease into a challenge. A delay in diagnosis leads to more advanced stages of BC and a lower chance of survival, which makes this cancer even more fatal.
Objectives
The present study was aimed at identifying the predicting factors for delayed BC diagnosis in women in Iran.
Methods
In this study, four machine learning methods, including extreme gradient boosting (XGBoost), random forest (RF), neural networks (NNs), and logistic regression (LR), were applied to analyze the data of 630 women with confirmed BC. Also, different statistical methods, including chi-square, p-value, sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC), were utilized in different steps of the survey.
Results
Thirty percent of patients had a delayed BC diagnosis. Of all the patients with delayed diagnoses, 88.5% were married, 72.1% had an urban residency, and 84.8% had health insurance. The top three important factors in the RF model were urban residency (12.04), breast disease history (11.58), and other comorbidities (10.72). In the XGBoost, urban residency (17.54), having other comorbidities (17.14), and age at first childbirth (>30) (13.13) were the top factors; in the LR model, having other comorbidities (49.41), older age at first childbirth (82.57), and being nulliparous (44.19) were the top factors. Finally, in the NN, it was found that being married (50.05), having a marriage age above 30 (18.03), and having other breast disease history (15.83) were the main predicting factors for a delayed BC diagnosis.
Conclusion
Machine learning techniques suggest that women with an urban residency who got married or had their first child at an age older than 30 and those without children are at a higher risk of diagnosis delay. It is necessary to educate them about BC risk factors, symptoms, and self-breast examination to shorten the delay in diagnosis.
Background: Breast cancer control in a low-income country such a Bangladesh is a challenging endeavor influenced by a myriad of forces. Quality of life is now considered an important endpoint in cancer clinical trials. The study was conducted to determine the quality of life of breast cancer patients. Methods: This cross-sectional study was conducted among 142 breast cancer patients. Data were collected by faceto- face interview using European Organization for Research and Treatment of Cancer questionnaire from respondents once only ensuring the privacy, confidentiality and maintaining ethical issues. The study was conducted during the period from January 2012 to June 2012 in National Institute of Cancer Research and Hospital (NICRH), Mohakhali, Dhaka-1212, Bangladesh. Results: The study revealed that majority of the participants were housewife (76.1%) and the maximum were in the 41-50 age groups. Mean age of the respondents was 42.80(±8.95) years. Maximum respondents (30%) had passed SSC and primary educated were 27%. The average monthly income was Tk. 11,570.70. Better income group (Tk. 15,000.00 monthly) enjoy better quality of life than other group. Quality of life was better in women living in joint family rather than nuclear family. Among 142 respondents who heard the name of breast cancer, majority of the respondents heard it from Neighbors/ Relatives. Adequate monthly income (p=0.006) and small size family (p=0.02) improved the quality of life while treatment specific attributes and duration of disease sufferings worsen the quality of life of breast cancer patients Conclusion: The overall QOL score was considerably poor in this study. Early diagnosis with regular follow-up treatment could be a way of improving quality of life among breast cancer patients. JOPSOM 2020; 39(2): 20-33
High expression of receptor tyrosine-protein kinase erbB-3 (HER3) has been found in several malignancies such as breast cancer. In this study, we designed, produced and evaluated a new affitoxin consisting of a truncated form of diphtheria toxin and a HER3-binding affibody domains. The new affitoxin was expressed in Escherichia coli and purified by affinity chromatography. We evaluated the suitability of affitoxin to kill HER3 positive breast cancer cells with MTT and apoptosis assays. The protein synthesis inhibition was also evaluated. The IC50 value in HER3 negative cells is about 10 times more than HER3 positive cells in new design of affitoxin. The specificity of affitoxin for binding to HER3 positive cells was also investigated with binding assay with flow cytometry. The results show that, the new affitoxin is an anti-cancer molecule with specific binding to HER3 positive cells and may open a new window for the treatment of HER3-positive cancers.
Background
The meaning of angiogenesis is the development of new blood vessels. Chemical signals start this process in the body. This will continue by migration, growth, and differentiation of endothelial cells, which line the inside wall of blood vessels. This process is vital for cancer cells.
Material and methods
Here, we investigated expression pattern of angiogenesis related genes in the context of previously published single-cell RNA-Seq data from prostate and breast cancer samples.
Results
Here we show how different modules of these angiogenesis related genes are over-expressed in different cell types, using protein-protein interaction network.
Conclusion
Our work demonstrates how different biological processes in distinct cell types that collaborate to the angiogenesis process, and can provide clues targeted inhibition of angiogenesis process.
This descriptive study evaluates a newly established national breast cancer information service in Iran and reports data on the impact of contacting the service. Two instruments were used to collect data: a "call record form" and a "user survey" questionnaire. The call record was filled in after each inquiry, and during 1 year 1,000 forms were completed. The questionnaire was filled in 1 week after each inquiry and was completed for a random sample of 400 callers. Thus, the results are presented in two parts. Analysis of the call record forms (part one) showed that 95% of the callers were female, mostly married (82%) and with secondary or higher education (80%). Most callers reported that they had heard about the service through the mass media (69%). Benign breast diseases, mastalgia and breast masses were the most common subjects of the inquiries (28%, 27%, and 18%, respectively). The majority of callers (77%) said that the main reason for contacting the service was that they wanted more information about breast diseases. Examination of the questionnaires (part two) revealed that 97% of respondents described the service as "useful" or "very useful". The vast majority (80%) perceived the information given as "easy" or "very easy" to understand. When respondents were asked to compare their feelings before and after contacting the service, 86% said that they felt "much more" or "a little more cheerful" and 81% said that they felt "much less" or "a little less worried". Practically all (99%) were satisfied with the overall service provided. The findings indicate that the service is effective in providing information and support for patients, relatives and the general public. The real challenge is how to make the service more widely available, especially to breast cancer patients.
Breast cancer is considered a major malignancy among women worldwide. The contribution of genetic elements to the onset of familial breast cancer has already been established. The current study investigate the alfele frequency of HLA-DRB 1 in 36 primary operable female breast cancer patients from southern Iran by polymerase chain reaction using sequence specific primers (PCR-SSP). Results were compared with those of 36 female control subjects. Statistical analysis was performed and P values were determined for each character. Our results indicated that the frequency of HLA-DRB 1*12 allele is significantly higher in the patient group (p<0.03) compared to the control group. In addition, HLA-DRB1*11 appeared to be as the most frequent allele in the control group (29.2%) and had approximately the same distribution among the patient group (22.5%).
A cross-sectional study was conducted to examine the knowledge of breast cancer, attitudes toward breast self-examination (BSE), and practice of BSE among a sample of female health care workers in Tehran, Iran. Using a purposed questionnaire, a total of 410 women from seven health centers completed the questionnaire. The mean age of the respondents was 32.9 years (SD = 9.5), most (58%) were married, and family history of breast cancer was reported by 11%. Seventy-five percent of the women knew about breast cancer prevalence, but only 27% knew that breast pain is not a symptom of breast cancer. Although 73% of women did know that contact with a relative with breast cancer could not lead to development of breast cancer, the respondents' knowledge of risk factors of breast cancer was not satisfactory. With regard to women's attitudes toward BSE, the majority believed that it is not difficult and time consuming or troublesome (63% and 72%, respectively). Sixty-three percent of the respondents claimed that they know how to examine their breasts, but only 6% performed BSE monthly. The practice of BSE was significantly associated with age (p = 0.01), the level of education (p < 0.0001), personal history of breast problems (p < 0.0001), and knowledge of how to examine the breasts (p < 0.0001). The study findings suggest that the knowledge and behaviors of female health care workers concerning breast cancer is relatively poor and it needs to be improved. Considering the role that health care workers may play in communicating health behaviors to the general public, planning health education interventions for this group of females is essential.
Breast cancer is the most common female malignancy and a major cause of death in middle-aged women. So far, germline mutations in the BRCA1 and BRCA2 genes in patients with early-onset breast and/or ovarian cancer have not been identified within the Iranian population.
With the collaboration of two main centres for cancer in Iran, we obtained clinical information, family history and peripheral blood from 83 women under the age of 45 with early-onset breast cancer for scanning of germline mutations in the BRCA1 and BRCA2 genes. We analysed BRCA1 exons 11 and BRCA2 exons 10 and 11 by the protein truncation test, and BRCA1 exons 2, 3, 5, 13 and 20 and BRCA2 exons 9, 17, 18 and 23 with the single-strand conformation polymorphism assay on genomic DNA amplified by polymerase chain reaction.
Ten sequence variants were identified: five frameshifts (putative mutations - four novel); three missense changes of unknown significance and two polymorphisms, one seen commonly in both Iranian and British populations.
Identification of these novel mutations suggests that any given population should develop a mutation database for its programme of breast cancer screening. The pattern of mutations seen in the BRCA genes seems not to differ from other populations studied. Early-onset breast cancer (less than 45 years) and a limited family history is sufficient to justify mutation screening with a detection rate of over 25% in this group, whereas sporadic early-onset breast cancer (detection rate less than 5%) is unlikely to be cost-effective.
Iranian breast cancer patients are relatively younger than their Western counterparts. The objective of the present study was to investigate risk factors for breast cancer in Iranian women.
A case-control study was conducted from April 1997 to April 1998 in Tehran, Iran. Demographical data and risk factor related information were collected using a short structured questionnaire. Odds ratios (ORs) and 95% confidence intervals (CIs) were derived from logistic regression analysis.
In all, 286 women with breast cancer and 249 control women were interviewed. In multivariate analysis, only marital status (never married: OR 4.24, 95% CI 1.70-10.57 [P = 0.002]; widowed/divorced: OR 1.71, 95% CI 1.05-2.68 [P = 0.03]) and family history (positive family history of breast cancer: OR 2.95, 95% CI 1.15-7.59 [P = 0.02]) were associated with significantly increased risk for breast cancer.
The findings of the present study suggest that family history and marital status may have an impact on the incidence of breast cancer in Iranian women.
In order to assess the prognostic value of family history (FH) of malignancies in patients afflicted with breast cancer (BC), we examined FH and histopathologic characteristics of 542 Iranian primary BC patients. Cases with distant metastasis at the time of diagnosis were excluded. Mean age of the studied population was 49 and the most common presenting stage was stage IIA followed by stage IIB. Data on a total of 6089 relatives (1st to 4th generations with the assumption of probands as the 3rd generation) were gathered. FH of BC and other malignancies (OM) was positive in 29 and 54% of cases, respectively. The most common OM's were gastric (67), lung (52) and uterus (47) cancers. We found that a FH of BC does not have any significant correlation with proven prognostic factors but a history of BC among relatives at or before the age of 36 is associated with more aggressive tumours. On the other hand, although FH of OM was associated with an older age of the probands (which is generally associated with a favourable prognosis), tumours of the cases with FH of OM had higher grades, lymphatic invasion being detected more frequently. Also we noted that the younger the age of the relatives diagnosed with cancer, the higher the stage of the probands themselves. All together our study indicates the possibility of a relation between FH of BC and OM, and histopathologic characteristics of the probands' tumours which would put forward FH as a prognostic factor rather than a simple risk factor in BC.
A prospective study was designed to investigate the factors predicting fatigue in breast cancer patients using the Cancer Fatigue Scale (CFS) in addition to the Hospital Anxiety and Depression Scale (HADS) and a questionnaire containing items on demographic and clinical data, and measures of patients' physical symptoms. The CFS measures total fatigue score ranging from 0 (lowest level) to 60 (highest level) and contains three subscales namely: physical, affective and cognitive fatigue. The questionnaires were administered to a consecutive sample of breast cancer patients attending the Iranian Center for Breast Cancer either for their treatment or follow-up examination. In all, 112 patients were studied. The mean age of the respondents was 45.7 years (SD11.0). Most had stage II breast cancer (67%) and had completed their initial treatment (45%). The mean total fatigue score of the patients was 18.7 (SD 13.5) and overall 49% reported experiencing fatigue to some degree (from quite a bit to very much). Severe anxiety and depression was reported by 16% and 32%, respectively. The regression analysis revealed that fatigue was predicted by depression ( P=0.003), pain ( P=0.005), current tamoxifen use ( P=0.001), undergoing mastectomy ( P=0.03) and anxiety ( P=0.04). The other variables studied did not emerge as significant predictors of fatigue in the regression analysis. The study findings suggest that in comparison to treatment factors, physical and psychological symptoms have a more important role in cancer-related fatigue and that fatigue should be recognized and managed even before commencing breast cancer treatment.
The Hospital Anxiety and Depression Scale (HADS) is a widely used instrument to measure psychological morbidity in cancer patients. This study aimed to translate and test the reliability and validity of the Iranian version of the HADS.
The English language version of the HADS was translated into Persian (Iranian language) and was used in this study. The questionnaire was administered to a consecutive sample of 167 breast cancer patients and statistical analysis was performed to test the reliability and validity of the HADS.
In general the Iranian version of the HADS was found to be acceptable to almost all patients (99%). Cronbach's alpha coefficient (to test reliability) has been found to be 0.78 for the HADS anxiety sub-scale and 0.86 for the HADS depression sub-scale. Validity as performed using known groups comparison analysis showed satisfactory results. Both anxiety and depression sub-scales discriminated well between sub-groups of patients differing in clinical status as defined by their disease stage.
This preliminary validation study of the Iranian version of the HADS proved that it is an acceptable, a reliable and valid measure of psychological distress among cancer patients.
A descriptive study was conducted in Tehran, Iran, to investigate the beliefs of Muslim women and their practices regarding screening modalities of breast cancer.
A questionnaire was specially designed and validated to collect data and was completed by 410 Muslim women.
A vast majority of women (90 per cent) said that breast self-examination is not against their religious beliefs. With regard to clinical breast examination, although 58 per cent preferred to be examined by a female physician, 47 per cent said that clinical breast examination by a male physician is not against their Islamic beliefs. However, only 6 per cent of respondents performed breast self-examination on a regular basis (monthly).
The study findings suggest that most Muslim women do not perceive breast self-examination as being against their Islamic beliefs and that they believe clinical breast examination by a male physician does not interfere with their religious beliefs.
A family history (FH) of breast cancer (BC) is a long recognized risk factor for developing the disease. Also, there have been some reports of links between an FH and some other malignancies (mostly uterus, ovary, and prostate cancers), and an increased risk of developing BC. In this paper we present descriptive report of the occurrence pattern of malignancies in families of BC afflicted patients through 4 generations. Patients included 542 Iranian primary BC cases, presenting at an outpatient clinic for treatment and follow-up. Detailed pedigrees were drawn for each patient, and data for a total of 6220 relatives were gathered. Among the probands, 29.9% and 53.9% had a positive FH of BC and other malignancies (OM) respectively. Mean number of breast cancers was nearly double in maternal-lines versus paternal-line relatives. Also, occurrence of brain, uterus, and colorectal cancers was significantly higher in maternal-line relatives, but conversely, liver cancer showed a tendency toward paternal-line relatives (1st degree relatives excluded). The highest frequency of BC involvement was noted in 2nd degree/2nd generation, and 3rd degree/3rd generation relatives. For OMs, although gastric cancer was by far the most frequent OM across pedigrees, uterus cancer, and hematopoeitic system lesions (leukemia) predominated over gastric cancer through the 3rd and 4th generations respectively. We did not find any relation between having a positive FH of BC, and developing early-onset BC. The findings discussed in this paper were partially presented at the 18th UICC International Cancer Congress, Oslo-Norway, 30 June-5 July 2002.
A prospective study was undertaken to examine survival in Iranian breast cancer patients. One hundred and sixty-seven breast cancer patients diagnosed in 1997 were entered into the study and followed up for five years. The mean age of the patients at diagnosis was 47.2 (SD = 13.5), ranging from 24 to 81 years. A total of 39 patients were lost in the follow-up period, leaving 128 for analysis of data. Of these, 79 were alive and 49 were dead after five years. Most patients (61%) presented with advanced disease. Using life table analysis, the overall relative 5-year survival rate was found to be 62% (SE = 0.04). In addition, after adjustment for age at diagnosis, initial treatment (mastectomy, breast conserving surgery, and neo-adjuvant therapy), and disease stage, using Cox's regression model, it was found that receiving neo-adjuvant therapy as the initial treatment was an independent predictor of poorer survival (Hazard ratio = 4.56, 95% CI 2.20-9.44, P<0.0001). The other variables (older age and late stage disease), although associated with high hazards rates, were not significant. The study findings suggest that overall relative survival rate in Iranian breast cancer patients stands between western and eastern European countries and needs to be improved. It seems that early detection and better management using standard guidelines might contribute considerably to improvement of survival in women experiencing breast cancer.
Although controversial, the belief that developing breast cancer may be associated with psychological distress is not uncommon. The present study examined the role of psychological variables in the development of breast cancer in women attending a breast clinic for medical examination in Tehran, Iran. During a three-year period (1997-1999) a trained female nurse interviewed all women attending the Iranian Center for Breast Cancer (ICBC) before a confirmed diagnosis was made (N = 3000). Data were collected on demographic variables (age, education and marital status), known risk factors (age at menarche, age at first time full term pregnancy, family history of breast cancer, menopausal status, and oral contraceptive use), psychological variables, including history of psychiatric medications, depression (depressed mood, hopelessness, and loss of interests and pleasures), anxiety (mental and somatic signs) and two single measures of overall health and quality of life. In all, 243 patients were diagnosed as having breast cancer. A total of 486 patients with benign disease were randomly selected from the original cohort as controls. Univariate and multivariate logistic regression analyses were performed to determine the predictive effect of each factor on the risk of breast cancer. There were no significant differences between cases and controls except for age at menarche (P = 0.007) and family history of breast cancer (P<0.001). With regard to psychological variables studied, the results showed that there were significant differences between cases and controls regarding depression (depressed mood P<0.0001, hopelessness P = 0.001, and loss of interest and pleasures P = 0.001), and anxiety (mental signs P = 0.006). Finally, after performing multiple logistic regression analysis in addition to family history and age at menarche, depressed mood and hopelessness showed significant results (odds ratios of 1.90, and 1.63 respectively). The findings of the present study suggest that in addition to the known risk factors, psychological determinants such as depressed mood may play an important role in etiology of breast cancer and deserve further investigation, especially in different populations.
Seroma formation is the most frequent postoperative complication after breast cancer surgery. We carried out a study to investigate the effect of various demographic, clinical and therapeutic variables on seroma formation.
A retrospective cross sectional study of patients who underwent surgical therapy for breast cancer with either modified radical mastectomy (MRM) or breast preservation (BP) was carried out. The demographic data and clinical information were extracted from case records. Seroma formation was studied in relation to age, type of surgery, tumor size, nodal involvement, preoperative chemotherapy, surgical instrument (electrocautery or scalpel), use of pressure garment, and duration of drainage. The multiple logistic regression analysis was performed to estimate odds ratios.
A total of 158 patients with breast cancer were studied. The mean age of the patients was 46.3 years (SD +/- 11.9). Seventy-three percent underwent modified radical mastectomy and the remaining 27% received breast preservation surgery. Seroma occurred in 35% of patients. In multivariate logistic regression analysis an association of postoperative seroma formation was noted with modified radical mastectomy (OR = 2.83, 95% CI 1.01-7.90, P = 0.04). No other factor studied was found to significantly effect the seroma formation after breast cancer surgery.
The findings suggest that the type of surgery is a predicting factor for seroma formation in breast cancer patients.
There appear to be geographical differences in decisions to perform mastectomy or breast conserving surgery for early-stage breast cancer. This study was carried out to evaluate general surgeons' preferences in breast cancer surgery and to assess the factors predicting cancer practice in Iran.
A structured questionnaire was mailed to 235 general surgeons chosen from the address list of the Iranian Medical Council. The questionnaire elicited information about the general surgeons' characteristics and about their work experience, posts they have held, number of breast cancer operations performed per year, preferences for mastectomy or breast conserving surgery, and the reasons for these preferences.
In all, 83 surgeons returned the completed questionnaire. The results indicated that only 19% of the surgeons routinely performed breast conserving surgery (BCS) and this was significantly associated with their breast cancer case load (P < 0.01). There were no associations between BCS practice and the other variables studied. The most frequent reasons for not performing BCS were uncertainty about conservative therapy results (46%), uncertainty about the quality of available radiotherapy services (32%), and the probability of patients' non-compliance in radiotherapy (32%).
The findings indicate that Iranian surgeons do not routinely perform BCS as the first and the best treatment modality. Further research is recommended to evaluate patients' outcomes after BCS treatment in Iran, with regard to available radiotherapy facilities and cultural factors (patients' compliance).
Germline mutations in either BRCA1 or BRCA2 genes are responsible for the majority of hereditary breast and ovarian cancers. At present, over thousand distinct BRCA1 and BRCA2 mutations have been identified. Specific mutations are found to be common within particular populations, resulting from genetic founder effects. To investigate the contribution of germline mutations in these two genes to inherited breast cancer in Iran, we performed BRCA1/BRCA2 mutation analyses in ten Iranian high risk breast cancer families. This is the first study analysing the complete coding sequences of both genes that concerns the Iranian population.
BRCA1/BRCA2 mutation detection included sequencing of the coding and the 3' and 5' untranslated regions. To detect large genomic rearrangements in the BRCA1 gene semi-quantitative multiplex PCR was performed.
Two pathogenic mutations in the BRCA2 gene were detected: a novel deletion c.4415_4418delAGAA and a previously described insertion c.6033_6034insGT. In addition, one intronic variation g.5075-53C > T and a deletion/insertion g.*381_389del9ins29 in the 3' untranslated region of BRCA1 were found in two of the investigated families. Both sequence alterations were absent in an age matched Iranian control group. The BRCA2 homozygous variation p.N372H, previously associated with an increased risk for developing breast cancer, was not identified in this study. We did not detect large genomic rearrangements in BRCA1 in patients tested negatively for disease causing mutations in both genes by standard sequencing.
At present, the BRCA2 mutations c.4415_4418delAGAA and c.6033_6034insGT have not been identified in any investigated population except the Iranian. Whether both mutations are specific for the Iranian population or a special subgroup remains to be investigated in larger studies. The absence of BRCA1 mutations in the analysed families may suggest that penetrance or prevalence of BRCA1 mutations may be lower in Iran.
Breast cancer is amongst the leading causes of death in women worldwide and the most common cancer amongst Iranian women. Unfortunately, the current clinical and histological criteria can only help 60 percent of women with breast cancer in diagnosis and long-term treatment. Therefore, genetic markers both at single gene and chromosomal level can play an important role in improving the diagnosis and prognosis of breast cancer patients. The aim of this retrospective study was to investigate the role of chromosome 1 and 8 copy number assessed by interphase fluorescence in situ hybridization (FISH), as prognostic parameters in 50 Iranian women, aged 35 to 64 years, with sporadic invasive ductal breast carcinoma. Chromosome 1 and 8 copy numbers were evaluated in relation to established clinicopathological parameters, the immunohistochemical markers ER, PR, P53 and cathepsin D, DNA index by flow cytometry, age and survival status of the patients. FISH using centromeric probes for chromosomes 1 and 8 was applied to interphase cell suspensions prepared from archived, Carnoyfixed tumor cells and selected paraffin-embedded tumor sections. Aneusomy for chromosomes 1 and 8 was present in all 50 patients to different levels. The total abnormality rate for chromosome 1 was 33.92 percent (4.24 percent monosomy and 29.68 percent polysomy), whereas for chromosome 8 this rate was 28.30 percent (6.48 percent monosomy and 21.82 percent polysomy). Statistically significant association (p<0.05) was demonstrated between monosomy 1 and patients' age below 50 years, and between monosomy 1 and poor survival, respectively. Disomy 8 was significantly associated with P53 expression. A borderline significant correlation was demonstrated between polysomy 8 and diploid DNA content, as well as between disomy 1 and disease-free status of the patients. Chromosome 1 and 8 copy numbers may be considered as useful prognostic markers in invasive ductal carcinoma of the breast.
To the Editor.—
We read the article by Ferguson and associates in the Sept 17 issue entitled "Staging of Breast Cancer and Survival Rates" (1982;248:1337). The authors are to be congratulated for providing us with valuable information in this difficult area of evaluating the long-term effects of breast cancer.However, we must question the use of relative survival rates to determine the long-range effects of breast cancer. The relative survival rate at time X is given by the following equation: Probability of Surviving in Study Population to Time X/ Probability of Surviving in Control Population to Time X This ratio is then the proportion of the population escaping the excess (not absolute) risk of death caused by breast cancer if the risk of death by other causes is equal in both the study and the general population. It is known that patients from higher socioeconomic conditions have lower death rates
A retrospective study was carried out in five main General District and Teaching Hospitals in Tehran (18 general surgical wards) to investigate breast cancer in Tehran, Iran. All patients who have had breast pathology during 1985-95 were reviewed. For each patient the following data were extracted from case records sex, age, type of disease (based on ICD-10 and ICD-O), breast cancer pathology, tumor size, lymph node involvement, pathological staging (based on TNM system), type of surgery, mass location and the affected side of breast. In all 3085 records were reviewed. Of these, in 903 cases the final diagnosis was breast cancer. The mean age of breast cancer patients was 47.1 (SD=12.3) y and the age-adjusted analysis showed that the observed number of breast cancer cases in the age group 40-49 was higher than expected (P<0.001). The majority of patients (71%) were patients with infiltrating ductal carcinoma, 70% had advanced disease (Stage III), and in 51% of cases the tumour was more than 5 cm in size. Finally it was found that two-third of patients (76%) underwent modified radical mastectomy. Although this study does not address true incidence, but rather frequency, the findings suggest that the Iranian breast cancer patients are relatively younger than their western counterparts and mostly have locally advanced disease. In terms of breast cancer screening programs, these findings have some implications for public health professionals in Iran.
Management of breast cancer is entering a phase of dramatic changes based on screening, more sophisticated therapy, and the development of "high technology" solutions through research. Appreciation of basic principles of biological behavior and therapy need current emphasis, however. By 2015 the American Cancer Society goals of 50% reduction in mortality and 25% reduction in incidence should be met and probably exceeded in breast cancer.
Management of breast cancer is entering a phase of dramatic changes based on screening, more sophisticated therapy, and the development of “high technology” solutions through research. Appreciation of basic principles of biological behavior and therapy need current emphasis, however. By 2015 the American Cancer Society goals of 50% reduction in mortality and 25% reduction in incidence should be met and probably exceeded in breast cancer.
A prospective study was conducted to assess the long-term impact of attending a support group on the prevalence of psychological morbidity in patients with breast cancer before and after 1-year participation in the Iranian breast cancer support group. Psychological morbidity was measured using the hospital anxiety and depression scale (HADS). In addition, qualitative data were collected to throw some lights on the topic. All current members of the three Iranian breast cancer support groups (n=56) were interviewed. The mean age of patients was 45.4 (S.D.=9.2) years, most were married (n=46, 82%), and 54% of patients (n=30) were diagnosed as having breast cancer from 1 to 5 years ago. While at baseline 16 patients (29%) scored high on the anxiety sub-scale and eight patients (14%) scored high on the depression sub-scale, at follow-up only two patients (2%) were likely experiencing severe anxiety symptoms and there were no patients with probable severely depressed mood. Comparing anxiety and depression at baseline and follow-up, there was a statistically significant difference between baseline and follow-up anxiety (P=0.03) and depression (P=0.008) scores. Analysis of the qualitative data indicated that the group involvement was the most important factor that contributed to the patients' improved psychological well-being. The findings of this prospective study suggest that participation in cancer support groups could have a long-term effect in reducing anxiety and depression in breast cancer survivors.
A prospective study was conducted to measure anxiety and depression in Iranian breast cancer patients before and after diagnosis using the Hospital Anxiety and Depression Scale (HADS). The HADS was administered at two points in time: before diagnosis and 3 months after. In all, 168 breast cancer patients were interviewed. While 48% of patients had severe symptoms of anxiety at both baseline and follow-up, more than 60% of patients had no symptoms of depressive illness at pre-and post-diagnosis assessments. Comparing anxiety and depression before diagnosis and after 3 months, there were no significant differences between patients' scores on anxiety (P = 0.42) and depression (P = 0.98) subscales. The results showed that patients with advanced disease and a lower performance status were more anxious and experienced more depression. The study findings suggest that severe symptoms of anxiety are the most frequent symptoms in Iranian breast cancer patients. It seems that during the process of diagnosis and 3 months after psychological morbidity persists in patients who suffer from breast cancer.
A descriptive study was carried out to explore the beliefs and behaviours of Iranian teachers toward breast cancer and breast self-examination (BSE). A 10% random sample of 8000 teachers working in four central regions of Tehran was selected. Data on beliefs and behaviours regarding breast cancer and BSE were collected by means of a structured questionnaire. In all, 578 women participated in the study. The mean age of the respondents was 37.3 y (s.d.=8.8), and most were married (83%). The majority of the respondents believed that 'Like every other woman I am at risk of breast cancer' (67%) and that 'Family history of breast cancer is a risk factor for breast cancer' (59%). However, only 6% of them reported that they are performing BSE on a regular basis. The most common reasons for not doing BSE and not going for clinical examination were lack of knowledge and the belief that it was not necessary (34 and 36%, respectively). Doing BSE was more frequent in married (P<0.00001), and older (P<0.00001) women. Except for those with a positive family history of breast cancer, there was no association between breast cancer beliefs and almost all other variables studied. The findings suggest that although the majority of Iranian teachers seem to be quite knowledgeable about breast cancer, they need more education on breast cancer and BSE. Since teachers' beliefs and behaviours may have an impact on young females, planning training courses for this group of women is essential.
For evaluation of clinical features and state of the art in the treatment of breast cancer in Iran, we studied 347 consecutive patients among 1123 hospital admissions (in 14 hospitals in three cities) who had undergone surgery for a mass in their breasts during a 2-year period, 1991 to 1992. Thirty-nine additional patients with breast cancer had been treated in the second year of the study, an increment of 8.9%. The relative frequency of positive biopsies for breast cancer was 31% for the entire series. In Teheran, Babol and Yazd, it was 35%, 24.2% and 18.1%, respectively. The mean age for the entire series was 48 +/- 1 years. The mean age for patients from Yazd was 51 +/- 9, which was higher than the mean age (41.5 +/- 16) of patients from Babol. The pathologic diameter was > 2.1 cm (pT2 and pT3) in 59.36% of the tumors. In 15.56% of the patients, the exact size of the tumor was not available. In 83.45% of the patients, the tumors were reported as infiltrating ductal carcinoma. Of 173 patients in whom regional nodes had been histologically examined, 80% had metastatic involvement (stage II disease). Modified radical mastectomy had been used more than radical mastectomy in this series, but the choice of the operation was not related to the size of tumor.
Breast Cancer is the most common cancer in Iranian women. This study aims to demonstrate the characteristics of breast diseases- and especially breast cancer- according to pathologic records in Tehran, Iran.
In this cross-sectional study, all records of pathologic specimens (biopsy or mastectomy) categorized as "breast diseases" from 1996 to 2000 in five teaching hospitals in Tehran were studied. For each patient, sex, age, breast pathology, pathological staging of malignant lesions, side and location of the tumor and the type of surgery were reviewed by a trained general practitioner. SPSS version 10 was used for statistical analysis.
The mean age of women with breast cancer was 48.8. The highest frequency of malignancies was observed in the 40-49 age group (31.8%). Twenty-three percent of breast cancers were observed in women younger than 40 years. About 83 percent of malignant lesions in women were in T2, T3 or T4 at diagnosis. Only about 4 percent of women with breast cancers had tumors in stage I or in-situ carcinomas. Nearly 70 percent of the cancers were detected only after lymph node involvement. Only 4.3 percent of our female cases had the chance of conservative mastectomy. Twenty-eight percent of specimens from biopsies in women were malignant.
In Iran, breast cancer affects women at least one decade younger than their counterparts in developed countries. A considerable proportion of our cases (96%) were in stage II or III at diagnosis. These results show advanced cases at presentation in Iran which further mandate a national cancer detection program involving more effective public education and encouragement of women for breast self-examination and participation in screening campaigns.
The earlier reports on the association between the Ile to Val polymorphism at codon 655 of HER-2 and susceptibility to breast cancer has not been found to hold true for all ethnic populations. Two hundred and four cases and 138 controls were collected to investigate the association of HER-2 Ile655Val polymorphism with the risk of breast cancer development and progression in Iranian population. This association was not found to be significant in the present study (OR = 1.16, 95% CI: 0.67-2.03). The association between HER-2 genotypes frequency and clinicopathological data was also insignificant, suggesting that the HER-2 polymorphism at codon 655 is unlikely to be a susceptibility locus in Iranian patients with breast cancer.
This was a cross-sectional study to examine the association between anxiety, depression and quality of life and the use of complementary and alternative medicine. Anxiety and depression was measured using the Hospital Anxiety and Depression Scale (HADS), and quality of life was measured using the global quality of life subscale selected from the European Organization for Treatment and Research of Cancer (EORTC) quality of life core questionnaire (QLQ-C30). In all, 177 breast cancer patients were studied, and 32% (n=57) reported that they used or were using complementary medicine. Users and nonusers did not differ significantly in almost all variables studied, with the exception of duration of their diagnosis. The most commonly used complementary medicine was prayer and spiritual healing (n=45, 73.8% of responses). Performing the logistic regression analysis controlling for age, marital status, educational level, knowledge of diagnosis, time since diagnosis, global quality of life, depression, and anxiety scores, the results indicated that the use of complementary medicine among breast cancer patients was associated with sever depression (odds ratio 2.49, 95% CI 1.06-5.89, P 0.04). The other variables studied did not show any significant results. The study findings confirm that the use of complementary medicine is more common among depressed breast cancer patients and might be a marker of greater psychological distress in this group of patients.
Due to the lack of systematic screening programmes for early detection of breast cancer in Iran and the predominance of advanced cases, we aimed to study the extent and determinants of patient delay in women with advanced breast cancer.
In this 1-year cross-sectional study, all consecutive women with advanced breast cancer (stages IIb, III or IV) who initially presented to a university hospital were studied.
Sixty-eight percent (136/200) of cases had delayed their first visit by >1 month and 42.5% by >3 months. The median patient delay was 12 weeks. Delay was associated with: older age, being married, lower income, less education, place of residence (small cities), negative family history of breast cancer, belief in the fatality of breast cancer, lack of access to health care services, lack of knowledge of breast cancer symptoms, and denying the importance of breast self-examination. The main reasons given for the delay were: lack of knowledge regarding the necessity of such a visit, fear, negligence, lack of access to physicians, and poverty.
In contrast to some other studies, this study found that married women and those with a negative family history of breast cancer waited longer than others before seeking care. Public education initiatives focused on encouraging women (especially high-risk groups such as older women, married women, and those living in small cities or villages) to see a doctor promptly for evaluation of breast symptoms can decrease delay and improve patient outcome.
Stromal cell-Derived Factor-1 (SDF-1, CXCL12) is one the ELR- CXC angiogenic chemokines. It contributes to hematopoiesis and lymphocyte trafficking. SDF-1 and its exclusive receptor, CXCR4, are reported to play important roles in tumor growth, angiogenesis and metastasis of different types of tumors such as breast, lung, prostate and pancreatic cancers. SDF-1 gene polymorphism, known as SDF1-3'A, has been investigated in HIV-1 infection and the incidence of breast cancer. This investigation was aimed to study the frequency of SDF1-3'A mutation in Iranian women with breast cancer. Results showed that the frequency of AA and AG genotypes was higher among patients, while the frequency of GG genotype was lower compared to the controls. Thus AA and AG genotypes of SDF-1 may be considered as factors increasing the susceptibility of Iranian women to breast cancer.
Breast cancer is a common malignancy for women in most parts of the world and the incidence in Iranian women is growing. The patients are relatively younger than their western counterparts. The present hospital based case-control study was designed to determine roles of reproductive factors for breast cancer among women in Iran. Conducted at a teaching hospital in Tehran, Iran, in 2004, the study covered a total of 303 cases of breast cancer and 303 healthy controls. Cases were identified through the Oncology Department of a university hospital and controls were collected from other wards or out-patient clinics at the same hospital. Control subjects were matched to patients for age. Informed consent was obtained from all cases and controls then demographic and reproductive factors were ascertained by in-person interview using a constructed questionnaire. Odds ratios and their 95% confidence intervals for breast cancer were derived using logistic regression analysis. The mean +/-SD ages of cases and controls were 48.8 +/- 9.8 and 50.2 +/- 11.1 years, respectively, (range 24-84). The final model for multiple analysis indicated that never married, post menopause, age at first live birth, number of live births, use of oral contraceptive pills, and history of chest X-rays between adolescence and 30 yrs of age, were significantly associated with breast cancer. Variables such as higher education, early age at menarche, abortion, breast feeding and its duration were not significant risk factors.
The effect of hormone replacement therapy on of screening mammography's efficacy in menopauses
- Silanian Tosi
Silanian Tosi F. The effect of hormone replacement therapy on of screening mammography's efficacy in menopauses. Univ Lett J 2004;14:76–83 (Persian).
Prevalence of breast cancer in north west of Tabriz
- S Abbasalizadeh
- F Abbasalizadeh
- F Sahaf
- Navaei
Abbasalizadeh S, Abbasalizadeh F, Sahaf F, Navaei N. Prevalence of breast cancer in north west of Tabriz. Iranian J Obstetr Gyn 2002;5:54–57.
Family history in 100 cases of Breast cancer
- T Kamehshian
- Mazochi
Kamehshian T, Mazochi T. Family history in 100 cases of Breast cancer. Faiz Med J 2003;28:90–94 (Persian).
Clinical and pathologic aspects of Breast mass in Moddares general hospital of Tehran from 1988-2002
- M Tofigh
- Anaraki
Tofigh M, Anaraki P. Clinical and pathologic aspects of Breast mass in Moddares general hospital of Tehran from 1988-2002. Pajouhandeh J Med 2004;39:175–177.
Prognostic Value of HER2 Oncoprotein in premenopausal women with breast cancer and axillary lymphadenopathy
- Sh Mortazavi
- P Azadeh
- Valaei
Mortazavi SH, Azadeh P, Valaei N. Prognostic Value of HER2 Oncoprotein in premenopausal women with breast cancer and axillary lymphadenopathy. Pajouhandeh Med J 2003;8:7–13. (Persian).