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Introduction: Although the World Health Organization (WHO) has stated that cancer pain can be controlled in 85-97% of cases with knowledge and technology available today, effective pain control is about 40%. This situation emphasizes the necessity of discussing cancer pain again. Objective: This descriptive study was conducted with the aim of determining prevalence, severity, region and frequency of cancer pain in patients registered to a cancer treatment center. Materials and methods: A total of 256 patients who were treated in the outpatient clinic of a cancer center in Istanbul in 2010 constituted the study population and 99 cancer patients who agreed to participate in the study and could be reached constituted study sample. The study was completedwith 49 (49.5%) patients as 50 (50.5%) out of 99 patients who were reached did not report pain. Results: Of the patients with cancer pain, 30.6% (n=15) had colon/rectum cancer, 24.5% (n=12) had lung cancer and 51% (n=25) had metastasis. Pain was in lower extremities in 34.3% (n=35), 57.1% (n=28) had moderate pain, 24.5% (n=12) had severe pain and pain was constant in 28.6% (n=19). Additionally, 20.4% (n=10) were not receiving pain treatment. Usually opioids, nonsteroidal anti-inflammatory drugs (NSAIDs) and adjuvant analgesics were being used in combination for pain treatment. Conclusion: The fact that 20.4% (n=10) of 49 patients were not receiving pain treatment and half of the cancer patients under control are experiencing pain is bothersome and thought provoking.
Cholangiocarcinoma (CCA), the malignant neoplasm of the biliary epithelium, is usually fatal due to difficulty in early diagnosis and lack of availability of effective therapy. The genetic mechanisms involved in the development of CCA are not well understood and only a few cytogenetic studies have been published. In this study, genomic instability in 30 Thai cases of intrahepatic cholangiocarcinoma (ICC) was assessed using an arbitrarily primedpolymerase chain reaction (AP-PCR) method. Genetic alterations were analyzed as banding pattern changes between tumors and corresponding normal DNA. The abnormal band present at the highest frequency (23/30 cases, 77%) appeared with the AO16 primer. Statistical analysis also showed that DNA alteration from this primer was significantly associated with the moderately to poorly differentiated histological type (P = 0.038). Kaplan-Meier survival curves showed borderline significance for this DNA aberration (P = 0.06 by the log-ranktest). This DNA fragment may thus be of use to predict degree of malignancy of the disease.
Background and aim: In recent years, there has been considerable interest in hether vitamin D inhibits breast cancer development. Experimental studies have shown that vitamin D promotes cell differentiation and retards or terminates proliferation of breast cancer cells. However, there is little evidence supporting the association of vitamin D and prognosis of breast cancer. Methods and Materials: In this analytic-descriptivestudy, 119 female patients with histological proven breast cancer were recruited in Tabriz oncology clinics in a 15-month period of time. History of chemotherapy, radiotherapy or receiving vitamin D/Ca supplements and presence of other malignancies were exclusion criteria. Serum level of 25 hydroxy vitamin D (25(OH)D) was measured in all patients. Results: One hundred and nineteen patients with a mean age of 50.4±12.6 (26-76) years were enrolled in the study. Metastasis was present in 21.8% of the cases. Stage of tumor was I, II, III and IV in 11, 56, 26 and 26 patients, respectively. The Tumor grade was low in 37 cases, intermediate in 46 cases, and high in 36 cases. The P53, Ki-67, HER2, ER and PR were positive in 30.3%, 49.6%, 17.6%, 61.2% and 55.5% of the patients, respectively. The mean serum level of 25(OH)D was 15.7±17.8 (4-122) ng/ml, deficient in 66 cases, insufficient in 36 cases and normal level in 17 cases. The median level of 25(OH)D was lower in the P53+ group in a borderline trend (17.3 vs. 13.6 ng/ml; p=0.07). The median level of 25(OH)D was significantly higher in the patients with metastasis, as well (27.7 vs. 12.0 ng/ml; p=0.03). There was no significant association between the serum level of 25(OH)D and other studied parameters. Conclusion: Based on our findings, there may be an association between the serum level of 25(OH)D and prognosis of breast cancer.
The epidemiology of Hodgkin lymphoma (HL) shows a wide geographic variation with regard to age, gender, histological subtypes and their association with Epstein-Barr virus. The proportion of EBV positive cases appears higher in developing than in developed countries. EBV is a common infection in Pakistan due to poor socioeconomic conditions, but reports regarding HL subtypes have been rather selective. Our aims were to establish the relative frequencies of the five subtypes of Hodgkin lymphoma, to determine their associations with Epstein-Barr virus, and finally to establish whether such association follows patterns seen in developingor developed countries. Among 100 cases, the male: female ratio was 4.5:1, with an age range of 4-82 years and an average of 26.6 years. Similar to the subtype distribution in developing countries, mixed cellularity was the commonest 57%, followed by nodular sclerosis 35%, lymphocyte rich 6% and nodular lymphocyte predominant 2 %. EBV-LMP1 staining was demonstrated in 41/57 (71%) of the mixed cellularity and the 19/35 (54.2%) of nodular sclerosis subtypes. All 6 cases of lymphocyte rich and 2 cases of nodular lymphocyte predominant were negative for EBV-LMP 1. Speculation about prognostic effects of EBV infection on the course of HL are tempting. Thus the EBV-positive HL could in the future prove to be an excellent candidate for targeted cellular immunotherapy.
This paper raises issues about the role of family members in providing support for breast cancer survivors. Data were collected from 400 breast cancer survivors in Peninsular Malaysia through a custom-designed questionnaire fielded at hospitals and support group meetings. The data were analyzed using descriptive statistics. The analyses show that all family members could be supportive, especially in decision making and help with emotional issues. The spouse was the main support provider among the family members (others were children, parents, siblings and more distant relatives). The results also indicated that a significant percentage practiced collaborative decision-making. Breast cancer survivors needed their family members’ support for information on survivorship strategies such as managing emotions, health, life style and dietary practice. The family members’ supportive role may be linked to the Malaysian strong family relationship culture. For family members to contribute more adequately to cancer survivorship, it is suggested that appropriate educational intervention also be provided to them.
Objectives: Early diagnosis and prevention is very important for lung cancer patients. Previous studies have emphasized that the level of coenzyme Q10 (CoQ10), present primarily in mitochondria, decreases with age and is low in patients with chronic diseases. Our goal was to find out if there is any relationship between lung cancerand CoQ10 and lipid peroxidation levels. Design and Methods: Blood samples from lung cancer patients were collected. Total and oxide CoQ10 levels, 8-OHdG (product of DNA damage), and malondialdehyde (MDA) levels (lipid peroxidation) were analyzed with high performance liquid chromatography (HPLC). Results: The MDAlevel (P<0.001) and DNA damage rate (8-OHdG) (P<0.001) was higher in cancer patients than in the control group; in contrast, theCoQ10 enzyme level was ignificantly lower (P<0.001). Conclusion: The results suggest t hat the aforementioned parameters can be useful for lung cancer risk assessment.
Background: The association of hepatitis B virus (HBV) infection and pancreatic cancer is still controversial. The purpose of this study is to determine whether chronic HBV infection increases the risk. Methods: In this case-control study, there were 1,066 patients recruited, with 533 in the study group and 533 controls, frequencymatched for age and sex. Blood samples were collected to detect hepatitis viral infection. Results: Compared to 77 patients (14.4%) in the control group, 80 pancreatic cancer patients (15.0%) were seropositive for HBV surface antigen (not statistically significant, P=0.8). The prevalence of HBV e antigen was higher in study group than that of control group ( P=0.03). Further analysis indicated that HBeAg was a risk factor for pancreatic cancer (OR=2.935, 95% CI: 1.048-8.220). Conclusions: In HBV endemic area of China, there appears to be no significant association between chronic HBV infection and pancreatic cancer, but the role of HBeAg needs further exploration.
The study was embedded in Shanxi Province Cervical Cancer Screening Study II with the aim of examining the association between history of diagnosed tuberculosis or cervical inflammation and oncogenic human papillomavirus (HPV) infection, persistent oncogenic HPV infection, cervical intraepithelial neoplasia grade 3 or cervical cancer (CIN3+) in an isolated rural population of China. A total of 8,798 women were recruited for cervical cancer screening and an interviewer-administered questionnaire. Of the women in the study, 2.7% and 34% reported a diagnosis of tuberculosis and cervical inflammation, respectively. In the model for HPV infection,HPV persistence and CIN3+, we show an increasing magnitude of effect of tuberculosis with increasing severity of disease, as demonstrated by the increasing odds ratios from 1.68 for HPV positivity, to 1.75 for persistent HPV and then 2.08 for CIN3+. Women reporting a diagnosis of tuberculosis, cervical inflammation or both tuberculosis and cervical inflammation were at 75%, 22% and 113% higher odds of persistent HPV infection, respectively. One percent of the study population was diagnosed with tuberculosis and cervical inflammation, placing them at 90% and 113% higher odds of infection with HPV and persistent HPV, respectively. Tuberculosis and oncogenic HPV are identified for the first time as co-infections in rural unscreened women in Shanxi Province, China, highlighting the importance of infection history in assessing an individual’s risk for HPV infection, persistence and CIN3+.
Objective: Since 2000, thyroid cancer has been increasing most rapidly in Korea. Although the cause of the increase is not clear, thyroid cancer screening could be identified as one of its causes. The purpose of this study was to examine the screening rate of thyroid cancer and its related factors using nationwide data. Methods: The study population was derived from the 2009 Korea National Cancer Screening Survey (KNCSS), an annual cross-sectional survey that uses a nationally representative random sampling to investigate cancer screening rates. A total of 2,000 Korean adults participated. The screening method of thyroid cancer was restricted to thyroid ultrasonography. Logistic regression was used to identify factors associated with undergoing thyroid cancer screening. Results: Of all participants, 13.2% (8.4% men and 16.4% women) underwent thyroid ultrasonography. On multiple analyses, age, residence, belief in cancer screening, regular health check-ups, smoking, alcohol drinking, and exercise were associated with thyroid cancer screening. Subjects who underwent other cancer screening, such as gastric, colorectal, breast, or cervical, were more likely to have had a thyroid ultrasonogram that those who did not get screened. Conclusions: We presented the number and characteristics of examinees utilized ultrasonography as a thyroid screening tool in Korea. Although these results revealed that cancer screening might play a major role in the increase of thyroid cancer incidence, further research is needed to determine causes of the rapidly increasing incidence of thyroid cancer in Korea.
Introduction: Neutropenia, defined as a decrease in the absolute neutrophil count lower than the normal that is < 1500 cell/ μl, has a detrimental effect on cancer patients’ quality of life, also possibly resulting in a reduction in the chemotherapy dose which could lead to an increment in the size of a cancer. There are so many causative factors for neutropenia like hematological disorders, autoimmune diseases and infection, drugs reactions and chemotherapy or radiotherapy. So the main aim of this study is to find the association between chemotherapy drug or regimens, schedule of administration used for treatment of solid cancer diseases with neutropenia onset and severity. Methods: This is an observational retrospective study carried out in a general hospital on 117 solid tumor patients who admitted between January 2003 to December 2006. The main statistical tests used were Chisquaretest and Fisher’s Exact test. The significance of the result will be when the P < 0.05, while the confidence interval for this study was 95%. Results: The highest chemotherapeutic regimen was (5-FU + epirubicin + cyclophosphamide) (47, 40.2%) followed by (gemcitabine + cisplatin) (6, 5.1%) and many others. Majority of the patients receive their chemotherapy schedule of administration was one day schedule (90, 76.9%) followed by more than one day schedule (27, 23.1%). Conclusion: The doses of these drugs were not high enough to produce a sufficient pharmacological effect to cause bone marrow suppression and lead to neutropenia. Besides the schedule of administration for each drug was long enough to overcome neutropenia also the high uses of granulocyte colony stimulation factor (G-CSF) which will play a major role in reducing the time and severity of neutropenia. All these factors play an important role in giving non- significant association between neutropenia onset and severity with chemotherapeutics drugs and their schedule of administration.
Introduction: As the second most common cancer in women worldwide, cervical cancer causes major health and economic burdens. Recent introduction of HPV immunization program locally has been encouraging but vaccine uptake remains poor. In addition, no study has been conducted to explore the people’s awareness and knowledge on cervical cancer, HPV and its vaccine in a rural setting in Malaysia after the inception of the HPV vaccination program. Objective: This study was conducted to determine the awareness of cervical cancer, HPV vaccination and its affordability among people in a rural area in Malaysia. Method: A cross-sectional study was conducted among 116 participants in a village in Penang. All consenting female villagers aged 13 years and above, and males who were married were interviewed using a questionnaire. Results: Most participants (88.8%) had heard of cervical cancer, however only 29.3% and 42.2% of them had heard of HPV and HPV vaccination respectively. Only 5.2% knew the actual market price for the vaccine. They were willing to pay an average of RM 96.7 (USD $27.7) for the full course of vaccination if it is not given to them for free, whereas the market price is RM1200 (USD $342.85). Conclusion: Awareness among the Malaysian population in a rural setting on HPV and HPV vaccination is low. Educating the public on the infection can help control the illness. Cost of the HPV vaccine is a serious barrier to the success of the vaccination program in Malaysia.
Background and Aims: Intraoperative consultation of CNS lesions provides accurate diagnosis to neurosurgeons. Some lesions, however, may cause diagnostic difficulty. In this study accuracy of intraoperative consultations of CNS lesions and discrepancies in diagnosis and deferrals were analysed. Methods: All CNS cases from May 1, 2004 to September 20, 2010 in which intraoperative frozen section had been performed, and which were reported in the Section of Histopathology, Aga Khan University Hospital, Karachi Pakistan were retrieved. The diagnoses given on FS were compared with the final diagnosis given on permanent sections (and additional material if received), as indicated in the frozen section and final pathology report. Results: During the study period, 171 CNS cases were received for intraoperative consultation. In all cases, cryostat sections (FS) plus cytology smears were prepared. The ages of the patients ranged from 03 to 77 years. 106 were males and65 were females. Out of these 171 cases, 160 cases (94.1 %) were concordant, 10 cases (5.8 %) were discrepant, and one case was deferred until permanent sections. The diagnostic accuracy of frozen section was 88.9%. The sensitivity and specificity were 94.8% and 87.5% respectively. The positive predictive value was 98.6% andnegative predictive value was 63.6%. All our cases in which intraoperative consultation was requested were sent for primary diagnosis. Adequacy per se was not a criterion for sending cases for intraoperative consultation. Conclusions: Our results show a reasonably high percentage of accuracy in the intraoperative diagnosis of CNS lesions. However, there are limitations and some lesions pose a diagnostic challenge. There is a need to improve our own diagnostic skills and establish better communication with neurosurgeons.
Background and Aims: Intraoperative consultation of CNS lesions provides accurate diagnosis toneurosurgeons. Some lesions, however, may cause diagnostic difficulty. In this study accuracy of intraoperativeconsultations of CNS lesions and discrepancies in diagnosis and deferrals were analysed. Methods: All CNScases from May 1, 2004 to September 20, 2010 in which intraoperative frozen section had been performed, andwhich were reported in the Section of Histopathology, Aga Khan University Hospital, Karachi Pakistan wereretrieved. The diagnoses given on FS were compared with the final diagnosis given on permanent sections (andadditional material if received), as indicated in the frozen section and final pathology report. Results: Duringthe study period, 171 CNS cases were received for intraoperative consultation. In all cases, cryostat sections (FS)plus cytology smears were prepared. The ages of the patients ranged from 03 to 77 years. 106 were males and65 were females. Out of these 171 cases, 160 cases (94.1 %) were concordant, 10 cases (5.8 %) were discrepant,and one case was deferred until permanent sections. The diagnostic accuracy of frozen section was 88.9%. Thesensitivity and specificity were 94.8% and 87.5% respectively. The positive predictive value was 98.6% andnegative predictive value was 63.6%. All our cases in which intraoperative consultation was requested were sentfor primary diagnosis. Adequacy per se was not a criterion for sending cases for intraoperative consultation.Conclusions: Our results show a reasonably high percentage of accuracy in the intraoperative diagnosis of CNSlesions. However, there are limitations and some lesions pose a diagnostic challenge. There is a need to improveour own diagnostic skills and establish better communication with neurosurgeons.
The transtheoretical model (TTM) has been used as one of the major constructs in developing effective cognitive behavioural interventions for smoking cessation and relapse prevention, in Western societies. This study aimed to examine the reliability and construct validity of the translated Bahasa Malaysia version of TTM questionnaire among adult smokers in Klang Valley, Malaysia. The sample consisted of 40 smokers from four different worksites in Klang Valley. A 26-item TTM questionnaire was administered, and a similar set one week later. The questionnaire consisted of three measures; decisional balance, temptations and impact of smoking. Construct validity was measured by factor analysis and the reliability by Cronbach’s alpha (internal consistency) and test-retest correlation. Results revealed that Cronbach’s alpha coefficients for the items were: decisional balance (0.84; 0.74) and temptations (0.89; 0.54; 0.85). The values for test retest correlation were all above 0.4. In addition, factor analysis suggested two meaningful common factors for decisional balance and three for temptations. This is consistent with the original construct of the TTM questionnaire. Overall results demonstrated that construct validity and reliability were acceptable for all items. In conclusion, the BahasaMalaysia version of TTM questionnaire is a reliable and valid tool in ass
Objective. To assess the effect of telephone reminders on repeat screening mammogram completion among women who have already had one or more mammograms. Methods. Seven hundred and forty women whose turn came for further mammography and who could be reached by telephone out of 1,372 women registered at a Cancer Screening and Education Center (CSEC) were studied in Erzurum, Turkey, from January to June 2008. Results. Before reminders with the telephone, of the 740 women, while only 29 (3.9%) had mammograms, after telephone reminders, approximately half of the women (46.4%) received mammograms by coming to the CSEC. Level of awareness of risk of breast cancer, intention, marital status, perceived mammography barriers were factors impacting on behavior. Conclusion: It was found that reminding women registered at the mammography center of their appointments was effective in reinforcing behavior. Health professionals can, through reminder and guidance, reduce the level of perceived barriers related to having a mammography and secure continuityin mammography check-ups.
Background: A common polymorphism of the AluYb8 insertion in the MUTYH gene (AluYb8MUTYH), which led to the increase of oxidative DNA damage and acceleration of chronic diseases, was previously detected. Considering the relationship between carcinogenesis and oxidative stress, an investigation was held on whether the common variant of the MUTYH gene increases the risk for gastric and breast cancers. Methods: The AluYb8MUTYH allele frequencies of 545 breast cancer patients and 762 gastric cancer patients were analyzed and compared with that of the healthy control group using the Chi-square test. The binary logistic regression model was used to examine the association between the polymorphism genotypes and cancer risk. Genomic DNA specimens from the investigated population were tested by polymerase chain reaction in agarose gel electrophoresis. According to the insertion absence or presence of the variant segment, the patterns for the AluYb8MUTYH genotypes were classified as a homozygous of absence/absence (A/A) and presence/presence (P/P) or a heterozygous of absence/presence (A/P). Results: The variant allele frequency (insertion present, P) was inclined to be enhanced in breast cancer patients as compared with the normal female controls (46.8% versus 43.3%), and also, in gastric cancer patients, as compared with the general normal controls (45.1% versus 43.9%). However, a significantly different P allele frequency was only detected between the early-onset breast cancerpatients (<55 years old) and their counterpart female controls (46.6% versus 40.9%, p=0.042; OR=1.26, 95% CI, 1.01–1.56), as well as between the early-onset gastric cancer patients and their respective controls (49.2% versus 41.3%, p=0.042; OR, 1.37; 95% CI, 1.02–1.85). Comparisons on the genotypes of AluYb8MUTYH show that this variation of MUTYH has also a significantly higher prevalence in the early-onset cancer patients, either in breast or gastric cancer patients, than that in their counterpart controls. Conclusions: The AluYb8MUTYH allele frequency can be associated with the early-onset breast and gastric cancer in the Chinese population.Probably, there is importance in screening the carriers with the susceptibility alleles to evaluate their risk of breast and gastric cancer for further research.
Purpose: Cervical cancer is the 6th most common cancer among Korean women, and the prevalence of cervical cancer was 21.9 (per 100,000) in 2008. This study was designed to identify factors associated with Korean women’s participation by age group in cervical cancer screening. Methods: Based on the 2007-2009 Korea Health and Nutrition Examination Survey, we studied 6,964 women who were 30 years or older without a history of cervical cancer and completed a health questionnaire, physical examination, and nutrition examination. Information about their participation in cervical cancer screening examination was collected using a self-administeredquestionnaire. Multiple logistic regression was performed to identify factors associated with their participation in cervical cancer screening over the last 2 years. Results: Approximately 51.9% of women had been screened for cervical cancer over the previous 2 years. Women aged 65 years or older were less likely to undergo the screening than women aged 30-64 years. In the multiple logistic regression analysis, private health insurance, smoking, and body mass index were significantly associated with participation of women aged 30-44 years old in cervical cancer screening examination. Education, health insurance type, private health insurance, and smoking were significantly associated with the participation rate for women aged 45-64 years old. Participation of women aged 65 years or older was associated with private health insurance, body mass index, oral contraceptives, hormone replacement therapy, age at first birth, and number of pregnancies. Conclusion: Indicators of socio-demographic factors, health behavioral factors and reproductive factors seem to have varying impacts on Korean women’s participation in cervical cancer screening according to age group. These results demonstrate the need for more aggressive and age-based interventions and policy programs to improve the cervical cancer screening rate.
In order to determine to the effect of benzo[a]pyrene (BaP) on breast cancer risk we conducted a case-control study in the time period 1996-2004. The study included 1,098 participants (460 cases and 638 controls). All the patients were drawn from the four major hospitals in Montevideo, Uruguay. Statistical analysis was performedusing unconditional multiple logistic regression and the models included age, residence, urban/rural status, education, monthly income, body mass index, menopausal status, age at menarche, parity, smoking index, alcohol drinking, mate consumption, total energy, total vegetables and fruits, and BaP intake. The highest vs. the lowest quartile of BaP intake (OR 2.0, 95 % CI 1.2-3.3) was significantly associated with breast cancer risk. Alcohol drinking was also directly associated with breast cancer risk (OR 1.63, 95 % CI 1.19-2.23) and the joint effect of BaP and alcohol drinking showed an elevated risk of the disease (OR 3.32, 95 % CI 2.17-5.06). The present study suggests that elevated consumption of BaP could play an important role in the etiology of breast cancer. This effect is enhanced by the intake of alcohol.
Background & Objectives: The aim of this study was to determine the prognostic factors of Iranian colorectal cancer (CRC) patients and their importance using an artificial neural network (ANN) model. Methods: This study was a historical cohort study and the data gathered from 1,219 registered CRC patients between January2002 and October 2007 at the Research Center for Gastroenterology and Liver Disease of Shahid Beheshti University of Medical Sciences, Tehran, Iran. For determining the risk factors and survival prediction of patients, neural network (NN) and Cox regression models were used, utilizing R 2.12.0 software. Results: One, three and five-year estimated survival probability in colon patients were 0.92, 0.71, and 0.48 and for rectum patients were 0.86, 0.71, and 0.42, respectively. By the ANN model, pathologic distant metastasis, pathologic regional lymph nodes, tumor grade, high risk behavior, pathologic primary tumor, familial history and tumor size variables were determined as ordered important factors for colon cancer. Tumor grade, pathologic stage, age at diagnosis, tumor size, high risk behavior, pathologic distant metastasis and first treatment variables were ordered important factors for rectum cancer. The ANN model lead to more accurate predictions compared to the Cox model (true prediction of 89.0% vs. 78.6% for colon and 82.7% vs. 70.7% for rectum cancer patients). Conclusion: This study showed that ANN model is a more powerful tool in survival prediction and influential factors of the CRC patients compared to the Cox regression model. Therefore, this model is recommended for predicting and determining of risk factors of these patients.
This study was undertaken to compare the survival rates of stage IB 1 versus stage IB 2 cervical cancer patients and to evaluate the prognostic factors after treatment primarily with radical hysterectomy and pelvic lymphadenectomy (RHPL). Patients with stage IB cervical cancer undergoing primary RHPL at Chiang Mai University Hospital between January 2002 and December 2009 were evaluated for survival and recurrence. Clinicopathological variables were analyzed to identify the prognostic factors affecting the survival of the patients. During the study period, RHPL was performed on 570 stage IB 1 and 110 stage IB 2 cervical cancer patients. With a median follow-up of 48 months, the 5-year disease-free survivals were 98.1% and 82.8% respectively (p < 0.001). Multivariate analysis identified four significant prognostic factors affecting survival including substaging,non-squamous cell carcinoma histology, lymph node metastasis and the presence of lymph-vascular space invasion. In conclusion, with a primary radical hysterectomy, stage IB 1 cervical cancer patients have a significantly better survival rate than those with stage IB 2. Significant prognostic factors for stage IB cervical cancer include tumor histology, nodal status, and the presence of lymph-vascular space invasion.
Objective: This study was designed to detect the protein expression of VEGF, EGFR and MMP-9, to investigate the potential roles they might play in the pathogenesis of NSCLC and to discuss their relationship and their clinical significance. Methods: For 136 cases who were diagnosed of NSCLC, immunohistochemistry was used to detect protein expression of VEGF, EGFR and MMP-9 tumour and normal lung tissue specimens. Statistical analysis was performed on the relationship between protein expression of VEGF, EGFR and MMP-9 and clinico-pathological parameters and prognosis. Results: Expression of VEGF and MMMP-9 was mostly in the cytoplasm, while EGFR wasfound in both cytoplasm and membranes. In NSCLCs, the positive rate of VEGF protein was 79.4% (108/136), for EGFR was 75.0% (102/136) and for MMP-9 was 68.4% (93/136), significantly greater than the normal tissue values of 16.0% (8/50), 12.0% (6/50) and 8.0% (4/50), respectively (P<0.01). Expression of VEGF, EGFR and MMP-9 was related to pathology grading, lymph node metastasis and clinical staging in NSCLC (P<0.01), while being independent of other clinicopathologic parameters (P>0.05). There was an obvious positive correlation among the expression of VEGF and EGFR (r=0.25; P<0.01), VEGF and MMP-9 (r=0.28; P<0.01), EGFR and MMP-9 (r=0.19; P<0.05) in NSCLCs. Conclusions: Protein expression of VEGF, EGFR and MMP-9 is elevated higher in NSCLC, correlating with progression.
While there has been much research in identifying risk factors and prognostic factor for breast cancer for breast cancer survival, the research specific to South Indian population is limited: Most of the association studies between breast cancer and risk factor have been widely studied in developed countries. This study attempts to explore the survival experience of breast cancer patients treated under adjuvant and neo-adjuvant therapy. The data were obtained from a Government Cancer Hospital, Tamil Nadu, South India and included 522 women diagnosed and treated with adjuvant and neo-adjuvant therapy between January2000 to December 2008 andfollow up to May 2010. The survival experiences under two treatments are presented using Kaplan-Meier survival curves. The important prognostic variables for response to treatment survival were identified using Cox regression with and without time-dependent covariates. Of the 522 cases, 248(47.5%) were of stage2 (A&B),249(47.7%) were of stage3 (A&B). About 90% received neo-adjuvant therapy. About 94% of the patients had response to treatment. The Cox model showed that apart from the chemotherapy, number of children, child birth status and stage3B and 4 turn out to be significant predictors for response to treatment survival. This is the first study to evaluate adjuvant therapy effects under hospital setup in South India. The results show that response to treatment survival is related poor in advanced stage patients under treatment.
Background: There are discrepancies in data of genome-wide microarray-based comparative genomic hybridization (CGH) in squamous cell carcinoma of the head and neck (SCCHN). Variations in ethnic background, life style, presence of chemotherapy, and regions of SCCHN may explain the results. Methods: Considering the variations, we performed CGH in Korean laryngeal SCC (LSCC) tissues (N=16). Results: We found gains of amplification at 7q35 and 8q24 and losses at 1p21, 2q21, 17q12, and 3p22-26 in 40-50 % of the cases. The regions of losses at 3p22-26 contain no known tumor suppressor gene. However, XPC, a key genein DNA repair pathway, is identified at 3p22-25. Conclusion: Our finding strongly suggests that chromosome 3 p22-p26 region harbor critical gene(s) including XPC associated with risk for LSCC.
Background: Many cancer survivors are still not active enough to reap the benefits of physical activity. This study aimed to explore the correlation between perceived barriers and participation in exercise among multiethnic Malaysian women with breast cancer. Methods: A cross-sectional study using a pre-post questionnaireand a media-clip as a cancer control strategy was conducted on a random sample of women with breast cancer. The tools were structured questionnaires to collect socio-medical demographic and physical activity data (e.g. barriers, exercise self-efficacy). Results: A statistically significant relationship between level of physical activity before and after diagnosis of breast cancer (n=51, χ2=70.14, p<0.01) was found, whereby participants who rated more hours of physical activity before diagnosis were likely to persevere with exercise after diagnosis, r(49)=0.73,p<.01. Some 76.5% of women engaged in low level activity and 23.5% of the participants engaged in moderate level of physical activity. Conclusions: Despite the many benefits of physical activity, the majority of survivors in this study were not found to be physically active, and did not even consciously think of exercise participation. Lack of time is the main barrier amongst those survivors who are predominantly 40-50 year old housewives juggling with household chores, childcare and/or job commitments. Public health messages stressing that short bouts of exercise or some exercise are better than no exercise needs to be emphasised consistently.
Background: Increasing survivorship warrants evidence-based intervention to help women manage living effectively with breast cancer. Breast cancer survivors may have many medical and psychosocial issues in the posttreatment period. Qualitative research was carried out to assess survivors’ overall experience and if interventionhelps in survivorship care. This paper reports exploration of benefit-findings from participation in an earlier 4-week self management intervention. Methods: We used a grounded theory approach to analyze three focus groups conducted between May and August 2010 in Kuala Lumpur. We used random sampling to recruit theinformants (n=21), all of whom had earlier participated in the 4 week self-management program held two years previously. Findings: The women reported positive experience and growth with the self management program. Self-efficacy appears as an important underlying theme for successful experiences. The lack of proactive plans to provide bereavement support to surviving women was a key negative experience. Conclusion: The intervention successfully brought women together to work in close partnership with health professionals on ways to selfmanage the medical, emotional and role task as they live indefinitely with breast cancer, a new chronic illness. The beneficial effect from the 4 week intervention was expressed by women even at 2 years after the program. Having successfully developed a tightly knitted group, a major oversight was the lack of professional support o n bereavement for grieving members when close friends passed away.
Background: Retrospective studies on oral cancer patient profiles related to risk habits could provide etiologic clues for prevention in specific geographic areas. Objective: To study risk habit characteristics of oral cancer patients. Methods: A cross sectional retrospective case record study of oral cancer patients who reported during 1991-2000 to Karnataka Cancer Therapy and Research Institute, Hubli, India was conducted. Data on socio-demography, histopathology, site of cancer and risk habit profiles of the patients were recorded in a predesigned Performa by one calibrated examiner with internal validity checks. Results: The 1,472 oral cancer patients constituted 11% of total cancer patients. Mean age of the patients was 55 years, ranging from 12-88,with a male: female ratio of 2:1. 1,110 (75%) oral cancer patients had risk habits, 55% were habituated for >10years and 25% were habit free. 751(51%) patients had individual and 359(24%) had combined risk habits. Majority 59% were chewers of betel quid alone (17%) / betel quid with tobacco (42%); smokers were (31%)and alcohol users were (14%) of patients. Chewers of gutkha, khaini were more in <40 years and betel quid in >40 years. Risk habituates were highest (87%) in patients with cancer of buccal mucosa, commonly affected site attributed to chewing habit in (51%) of patients. Conclusions: The prevalence of oral cancer was higheramong elderly males predominantly with risk habits of betel quid/tobacco chewing and smoking for more than 10 years.
Introduction: Today, cancer survivors have an added new role to self manage living with the medical, emotional and role tasks that can affect their quality of life (QOL). The purpose of the study was to evaluate the QOL of women two years after participating in a self-management intervention program. Method: The clinical trial was conducted at University Malaya Medical Centre between 2006 and 2008. The experimental group underwent a 4-week self management program, and the control group underwent usual care. Two years after the intervention, questionnaires were randomly posted out to the participants. Results: A total of 51 questionnaires returned.There were statistically differences between groups in psychological, self-care, mobility and participation aspects in PIPP (p<0.05). The experimental group reported having higher confidence to live with breast cancer compared to control group (p <0.05). There were significant between-group changes in anxiety scores at T2 (immediately after intervention) to T4 (two years later), and the differences in anxiety scores within groups between time point T2 and T4 were significantly different (p<0.05). Conclusion: The SAMA program is potentially capable to serve as a model intervention for successful transition to survivorship following breast cancer treatment. The program needs to be further tested for efficacy in a larger trial involving more diverse populations of women completing breast cancer treatment.
Introduction: Cancer ovary is the third most common malignancy diagnosed in women in Karachi, a moderate to high risk region for the disease. Materials and Methods: Three hundred and thirty seven cases of ovarian cancer registered at the Karachi Cancer Registry for the years 1995-2002 were reviewed. Results: The agestandardized incidence rate (ASR) world per 100,000, crude incidence rate per 100,000 (CIR) and frequency of ovarian malignancies in 1995-1997 were 10.9, 5.9 and 6.2% respectively. Corresponding figures for 1998-2002 were 8.1, 5.1 and 4.8%. The mean age at presentation in 1995-1997 was 45.7 years (95%CI 42.9, 48.4; SD±15.9),range 95 (3 to 98) years and in 1998-2002 it was 45.0 years (95%CI 42.8, 47.3; SD±16.1), range 79 (3 to 82) years. Eleven (3.3%) cases of childhood cancers, 13 (3.9%) adolescent cases, 126 (37.4%) reproductive age (20-44 years) and 187 (55.5%) cases in the 45+ age group were registered. Epithelial malignancies were the most common cancers above the age of 20 years (78.4%), the commonest amongst these was serous adenocarcinoma (33.3%). Germ cell tumors were more common (5.6%) in children and adolescents. Microscopic confirmation was 99.0%. Presentation was of a moderately differentiated (grade 2) malignancy with a regional or distant spread of disease in three fourths of the cases. Conclusions: The incidence of cancer ovary, though stable in Karachi, involves a relatively younger age group with a strong family history in a fourth of the cases. The disease presents at an advanced stage. An ageing population over time may translate into a higher incidence of ovarian cancer. The current incidence of cancer ovary in Karachi is an enigma and belies reproductive protective factors. Studies focused on the genetic risk factors in this population are recommended.
Cholangiocarcinoma (CCA) is a rare but devastating neoplasm that accounts for about 3% of all gastrointestinal cancers and about 15% of all primary liver cancers worldwide. The lack of early detection and limited therapeutic options are major problems in controlling CCA. The current study attempted to identify novel serum markers which can substitute the carbohydrate antigen CA19-9, or can improve, when measured together, the diagnostic accuracy of CA19-9. Differentially expressed proteins in pooled and individual plasma samples obtained from patients with CCA and control subjects (10 each) were identified by using two-dimensional gel electrophoresis (2-DE) and mass spectrometry (MALDI-TOF). Out of a total of 21 protein spots separated and identified, five spots were found to be up-regulated in plasma from CCA patients. The up-regulation of α1-antitrypsin (AP1) was observed in all of the ten samples from CCA patients with protein intensity significantly higher than control subjects. Based on results of binary logistic regression analysis of the three serum biomarkers (CA19-9, AP1 and α-fetoprotein: AFP), serum levels of at least CA19-9 together with AP1 were the minimum requirement to obtain prediction accuracy of greater than 80% in a battery test for diagnosis of CCA. However, in order to obtain high predictability of 100% or approaching, an addition of at least one of the three liver function enzymes (alkaline phosphatase: ALP; aspartase transaminase: AST; alanine trasaminase: ALT) is required. Serum biomarkers may be a useful diagnostic or prognostic monitoring tool for CCA. Further evaluation of larger number samples is needed to support their applicability in a clinical setting as diagnostic and prognostic tools. Determination of clinical utility of these marker models in early diagnosis of CCA requires study in animal models with disease progression.
Introduction: Anemia is one of the most frequent hematological demonstration of malignant diseases, leading to impairment of function in all tissues and organs of cancer patients and associated with serious stress. This major problem may be exacerbated by radiotherapy or chemotherapy. It is characterized by lower hemoglobin (Hb) level or inadequate circulating red blood cells (RBCs). The present study evaluated the effectiveness of treatment guidelines for anemia among solid cancer patients in Penang hospital and to find associations between treatments and anemia onset and severity. Methods: This is a retrospective observational study was conducted on 534 cancer patients with anemia who were admitted to a government hospital on Penang island i.e., Penang General Hospital in the period between 2003 to 2009. Results: Effectiveness of standard anemia treatment guidelines was not sufficient because correction of anemia was just temporary. Conclusion: According to the results, erythropoietin must be used as a cornerstone even for patients who suffer from moderate anemia and blood transfusion should be used just for emergency cases when anemia leads to a critical situation.
Background: The study was to investigate the relationship between diabetes mellitus ( DM), specific cancers, age, and gender. Methods: This was a retrospective study that examined the frequency of different forms of cancer among male and female patients with or without DM admitted to a single hospital in Taiwan between January 2009 and June 2010. Results: Of 101,002 study patients admitted to the hospital, 15,901 (15.74%) were diagnosed with DM and 16,748 (16.58%) with a malignancy. The frequency of DM differed between males and females (17.5% vs 14.2%; P < 0.001), and males had a higher cancer incidence than females (20.2% vs 13.5%; P < 0.001). Patients with DM had a greater frequency of cancer diagnosis than non-DM patients (18.1% vs 16.3%, respectively), with pancreatic, liver, uterine, urinary tract, lung, and secondary cancers being more frequent in DM compared with non-DM patients. In contrast, the proportion of patients with thyroid, esophagus, breast, NPC, and other cancers was lower in DM versus non-DM patients. Conclusions: This study found that DM was associated with the incidence of specific cancers and that males had a higher frequency of cancer than females. The association of DM and cancer depended upon cancer type, gender, and age.
Background: Enzymes of the glutathione S-transferase (GST) family are encoded by a set of polymorphic genes as an important part of cellular chemical defense. The aim of this study was to investigate the possible effect of GSTM1 deletion on susceptibility to developing clinical outcome of colorectal cancer in a group of CRCpatients from Isfahan province, Iran, in comparison to age and gender matched control group. Methods: DNA was extracted from blood of 140 CRC patients and 90 healthy individuals and a set of sequence specific hybridization probes was used for GSTM1 genotyping by real-time PCR in Light-Cycler instrument. Chi-squared test was used to assess the statistical significance of observed differences between the patient and control subjects of different genders and ages. To estimate the risk for overall and stratified analyses, odds ratios (OR) with 95% confidence intervals (CI) computed with logistic regression. Results: No difference in GSTM1 null genotype frequency was found in CRC patients and controls stratified by gender (p value=0.14). The data were suggested a trend of increasing risk for GSTM1 null genotype in patients over 60 years old compared with controls (p value=0.05). GSTM1 null genotype carried an increase of the odds of developing CRC in patients over 60 years old (OR=2.7; 95% CI: 1.03-7.05). No significant association was found (P> 0.05) between the GSTM1 null genotype with tumor site (right, left, rectum) or tumor differentiation (well, moderately). Conclusion: Our findings suggest that the GSTM1 null genotype may contribute to colorectal cancer development in people over 60 years old.
Objectives: To study the clinico-pathological pattern of nasopharyngeal carcinoma (NPC) with dietary, smoking and tobacco consumption habits in the Northeastern region of India. Methods: This is a retrospective study on 200 patients with nasopharyngeal carcinoma who were registered in Regional Cancer Centre, RegionalInstitute of Medical Sciences, Manipur from July 2004 to July 2009. Results: There were 139 males and 61 females (ratio 2.2:1). with a mean age of 49.7±15.9 years. The commonest presenting symptoms were neck swelling (78.0%) followed by nasal obstruction (35.5%) and epistaxis (27.5%). Histopathologically, undifferentiated carcinoma type (Type III, WHO) was the commonest (75.0%) followed by differentiated non-keratinizing squamous cell carcinoma (15.0%) and keratinizing squamous cell carcinoma (10.0%). 25% of total patients had cranial nerve(CN) involvement, the commonly involved CN being V (28.8%) followed by VI 26.9%) and X (25.0%) . Of the total 200 patients, 88.0% had history of regular intake of smoked meat, 62.0% admitted regular intake of poorly preserved fermented foods, only 19.0% consumed fresh fruits (at least 4 times a month). Majority of patients (47.0%) chewed tobacco in different forms and (51.0%) smoked at least for 15 years. 186 patients(93.0%) lived in poorly ventilated houses with history of exposure to household smoke from burning firewood. Conclusion: High incidence of NPC in Northeastern India is highlighted in this study. Early detection and early treatment to reduce the morbidity and mortality associated with NPC in addition to imparting awareness onhow to prevent the disease to general population is needed in this region.
Breast and cervical cancers impose large costs on society. Performing breast and cervical cancer screening tests (BCCST), considered as a health promotion behavior, is therefore important. This qualitative study based on the “integrated model of planned behavior and self-efficacy (PBSEIM)” was conducted to assess influencing factors. A total of seventy female workers aged between 20-45 years from Tehran suburban factories were recruited by purposeful sampling to participate in ten focus group discussions. Data were analyzed using the conventional content analysis method. The majority had an appropriate attitude toward BCCST, stressing the importance of family’s especially husband’s encouragement as the subjective norm. Low knowledge, depression, fatigue, shyness and fear of examination and diagnosis of cancer, poor quality of services and financial barriers were mentioned as effective negative factors. The majority reported low self efficacy for planning to perform the behavior and had no intention toundergo screening in the next three months. So interventions are necessary to overcome effective barriers and improve women’s health.
Background: Health behaviour models are continuously being developed to investigate patient delay and help seeking behaviour for breast cancer. Their fitness for generalisation to another setting has not been examined and little is known of their appropriateness for use. Methods: The models’ building blocks (theories, concepts,constructs and variables) and settings were systematically examined and compared. Results: Six models of patient delay and help seeking for breast cancer were developed in a period of seven years (2003-2010). Theories of individual and interpersonal health behaviour, and various combinations of concepts and constructs were used to build these models. There is a lack of consensus in the terminology used to define constructs and variables. Constructs and variables together explained some of the variance of patient delay and help seeking. Conclusion: Existing patient delay and help seeking models for breast cancer were tested and yielded some degree of confirmation of their ability in explaining delayed presentation and help seeking behaviour. More models are likely to be developed in the future to account for factors currently missing in the existing models. To ease this process, there is a need for greater consensus and a shared conceptual language, as well as to advance knowledge a nd research in this field.
Cytochrome P450 (CYP) is a super family of mixed-function oxidases that are responsible for the human metabolism of drugs and endogenous compounds, as well as environmental and dietary substances. Many CYP enzymes function in the liver, but presence of CYP2E1 in the brain is demonstrating its role in both nicotine and ethanol metabolism. To examine the association between CYP2E1 polymorphism and the risk of oral cancer, we performed a case-control study on a south Indian population. 157 patients with oral cancer and 132 age and sexmatched controls were recruited. Three SNPs of the CYP2E1 gene [4768G>A (p. V179I, dbSNP rs6413419), CYP2E1_-1295G>C (dbSNP rs3813867) and CYP2E1_-1055C>T (dbSNP rs2031920)] were genotyped using TaqMan allelic discrimination. The V179I locus is monomorphic in the study subjects, whereas rs3813867 and rs2031920 areco-inherited with a minor allele frequency of 0.022. None of the polymorphic sites deviated from HWE in controls. A much lesser frequency of the uncommon c2 allele was seen in our control subjects than in Caucasians and East Asians. There were no significant differences between oral cancer and controls in the distribution of either allelic or genotype frequencies. None of the haplotypes showed a significant association with oral cancer. Our results suggest that CYP2E1 is not a major or independent determinant in the pathogenesis of oral cancer in south Indians.
Background: Breast cancer is the most common female type of cancer in the Middle East. A review of the evidence about the reasons people did not seek medical care has not been conducted for this region. Methods: A systematic review was undertaken to identify the explanatory factors and assess the strength of the evidenceleading to late or delayed presentation for breast cancer in the Middle East. Results: Electronic databases and websites were searched from 1970 to March 2011and yielded approximately 1801 studies and of which, only 10 were relevant. Of these, 6 studies met the inclusion criteria and they were either Egyptian or Iranian. All studiesemployed quantitative methods to investigate late and delayed presentation for breast cancer, and most defined the term delay in number of weeks or months. Older age and lower educational level were found to have strong effects in explaining late presentation. Having no family history of breast cancer was found to have moderatelyeffect on breast cancer late presentation. Conclusion: Our review revealed the need to conduct research in the Middle East and our findings indicated the importance of considering older age, low educational level and a family history of cancer when planning and developing health strategies to reduce the burden of late presentation.
Aim: To find out diagnostic correlation of prostate specific antigen (PSA) and Gleason’s score (GS) with bone metastasis (BM) in newly diagnosed prostate cancer (PC) patients in Pakistan. Materials and Methods: This retrospective study included 204 newly diagnosed PC patients who were referred for BS for staging. Results: The mean age, mean PSA and incidence of BM on BS were 71 ± 09 years, 111.01 ± 58.45 ng/ml and 67/204 (33%), respectively. The mean GS of the studied population was 7 ±1. According to PSA levels, patients were divided into 5 groups: < 10 ng/ml (77/204), > 10 - ≤ 20 ng/ml (42/204), > 20 - ≤ 50 ng/ml (22/204), > 50 - ≤ 100 (25/204) and > 100 ng/ml (38/204). The incidence of positive BS (%) for BM and mean GS (score ± SD) for each group were 14%, 7 ±1; 10%, 6±1; 32%, 7 ±1; 56%, 8 ±1 and 82%, 8 ±1 respectively (significant p value). PSA and GS were statistically significant predictors of BM on BS and their predictive value was additive (p < 0.0001). Age was not a predictive factor (non-significant p value). Sensitivity and specificity of PSA at a cut-off 48 ng/ml were 68.3% and 86.1% respectively, while GS at a cut-off >6 was more sensitive (88.9%) and less specific (56.2%) for diagnosing BM. Conclusions: (1) There is an overall increased incidence of BM in newly diagnosed patients with PC and even at serum PSA level ≤ 20 ng/ml and GS < 8; (2) PSA and GS are independent predictors for BM but age is not; (3) in view of possible aggressive behavior of PC in local population, one must be careful in adopting Western guidelines for using BS in newly diagnosed Asian males with PC having PSA ≤ 20 ng/ml and GS < 8.
Introduction: Advanced presentation of breast cancer and the problem of late diagnosis is well documented. Patient delay beyond three months has been shown to reduce survival. This paper aims to explore the experience of Malaysian women presenting with advanced breast cancer with regards to their interpretation of breastsymptoms. Method: Purposive sampling of 19 breast cancer patients presenting with delayed treatment and/or advanced cancer diagnosed within two years at the University Malaya Medical Centre, Kuala Lumpur were carried out. In-depth interviews were conducted using a self-devised interview guide. The interview guide covered the journey of the patient from discovering of symptoms to their present state. The audiotaped interviews were transcribed verbatim. NVivo 8 qualitative software was utilised for data management. Grounded theory with thematic analysis was utilised. Results: Nine women delayed seeking diagnosis although recognizing the symptom, five did not recognize symptom, three delayed treatment and two did not delay health attention. Themes that emerged with regards to triggering help seeking behavior were: a) poor symptom knowledge and recognition; b) importance of knowledge of the disease and its’ outcomes; c) role of coping mechanisms and affect; and lastly d) role of significant others in appraising a breast symptom. Conclusion: Symptom recognition remains an important public health issue in Malaysia. Educating women, their significant others and primary health andprimary care providers in detecting early staged breast cancer are needed. Supporting and sanctioning women with breast symptoms are important. The psycho-social-cultural model of symptom appraisal may serve as an important addition to the fight against cancer in countries that do not have the resources for population based screening mammogram programmes.
Purpose: For cervical carcinoma, postoperative radiation therapy (PORT) following radical hysterectomy (RH) is indicated for certain adverse pathological factors. Simple hysterectomy (SH) is considered inadequate treatment for invasive cervical carcinoma and PORT is required for all such cases. Clinical outcome of patientsreceiving PORT following SH and RH may be different. The aim of our retrospective study is to compare the results of PORT following inadvertent SH or RH in cervical carcinoma. Materials and Methods: During year s2003-2005, we treated 83 patients with cervical carcinoma with PORT following either SH (Group SH, 33 patients) or RH (Group RH, 50 patients). All patients were treated with pelvic external beam radiation therapy (EBRT) followed by intravaginal brachytherapy (IVBT). The endpoints of the study were local control, recurrence free survival (RFS) and delayed complications. Results: Median follow period up was 34 months (range 2-75 months). Local control rate observed in Gp SH and RH was 70% and 88% respectively with a p value of <0.05. Cumulative 5-year overall survival (OS) for combined group was 62%. Group RH patients had significantly better 5-year RFS than Group SH patients (72% and 49% respectively; p value 0.04). The frequency of Grade III-IV toxicity (bladder, rectum, and bowel) in Group SH versus Group RH was 6% vs 8% respectively (p value 0.1). The pedal lymph edema was higher in Group RH patients (10% vs 3%, p value <0.05). Conclusion: PORT provides greater clinical benefit in patients who had undergone RH than SH for early stage invasive cervical carcinoma.
Objective: In this study, written educational materials related to breast cancer used for the education of patients were evaluated for their quality and suitability. Methods. In this descriptive study carried out between November 2010-March 2011, 17 examples of written educational materials used at 20 hospitals and outpatientclinics were evaluated using a Suitability of Written Materials form. Findings: It was determined that educational materials received average scores (12.5 ± 5.4) for their suitability, 58.8% not being considered written at a readable level. Cultural suitability of the materials scored as 0.9 ± 0.8, which was found to be moderate for Turkishpopulation. Conclusions. Most of the written patient education materials used for patient education related to breast cancer need some modification in their literacy, plans and graphic parts. More materials related to care after mastectomy appear necessary. Future research needs to focus on patients’ understanding of the contentand their satisfaction with written educational materials.
Background: There has been an increased recognition of the importance of socio-cultural factors affecting late presentation in breast cancer. Socio-culturally mediated symbolic meanings, attached to “breasts” might importantly affect understandings of breast cancer in connection with late presentation. Objective: To explore symbolic meanings of “breasts” which might affect late presentation, as observed by the practitioners of complementary, alternative and religious (CAM) healing who worked with women with breast cancer in the Boston area, USA. Method: We conducted semi-structured interviews with 46 CAM practitioners who worked with approximately 70 CAM modalities. The interviews were entered into the database and analysed using thematic approach. Results: The CAM practitioners observed that late presentation is related to two symbolic meanings of “breasts”. Firstly, “breasts” are a symbol of maternity and consequently some women delayed seeking medical help because such understanding affected their perceived capacity to take care of their families. Secondly, among White American women “breasts” are related to the culturally highly relevant concept of “beauty”, but among African American women “beauty” is equated with “health”. Such understandings lead to very different reasons for late presentation, different illness experiences and require different psycho-socialintervention to support women. Discussion and conclusion: In planning and designing effective health promotion strategies and appropriate supportive care strategies for women coming from different cultural and sub-cultural backgrounds it is important to carefully examine concepts affecting late presentation in all their different socialand (sub-)cultural settings
Background: Breast cancer has been increased in South East Asia countries, but there are limited data for breast cancer risk factors in these countries. To clarify the risk for breast cancer among the Malaysian women, a matched case-control study was conducted. Method: Between October 2009 and April 2010, a survey wasprospectively conducted among women admitted to clinics of Penang General Hospital for examination and/or treatment by using a questionnaire. Therefore, characteristics of patients diagnosed with breast cancer (n = 150) were compared with control cases (n = 150) admitted to hospital for non-neoplastic, non-hormone related diseases. Results: Family history of a distant relative with breast cancer (OR= 2.84), history of first-degree relatives with breast cancer (OR= 2.95), history of benign breast disease (OR= 2.43), menstrual irregularity (OR= 4.24), and use of oral contraceptive pills (OCP) (OR= 2.15) were found to be significant risk factors for breast cancer in our population. Furthermore, education more than 11 years (OR= 0.40), breastfeeding (OR= 0.50), being employed (OR= 0.45) and practicing low fat diet (OR= 0.53) were strongly protective against breast cancer development. Conclusion: The results emphasize the importance of conducting a series of awareness campaigns that highlightsthe protective role of longer breastfeeding period against breast cancer and the negative relationships betweenOCP use and high fat diet with this disease.
Background: The objective of this study was to bridge the knowledge gap and improve our understanding of the late presentation and management of breast cancer among South Asian women of non-oriental origin (SA) living in the United Kingdom. Methods: Retrospective review of the breast cancer waiting list data-base held at Calderdale and Huddersfield NHS trust was undertaken to identify SA women diagnosed with breast cancer from January 2000 to August 2007. Results: We identified 41 (2.5%) SA women among 1,630 patients diagnosed with breast cancer during this period and 36 were included (median age = 53.5 years, range= 32-84). Only 19% (n=7) were screen detected and 81% (n=29) presented thorough symptomatic breast clinic. In the latter, 66% (n=19) were in the screening age group and 45% (n= 13) presented beyond 8 weeks (late presentation). In ourcohort, 91% (n=29) patients had advanced disease (TNM stage 2 and 3) resulting in a high mastectomy rate of 61% (n=22). 19% (n=7) died as a direct result of cancer and the remaining 78% (n=28) remains disease free following treatment thus far. Conclusion: The delay in presentation and poor national breast screening programmeuptake among the SA women resulted in advanced disease at diagnosis. There is need for increasing the breast cancer awareness as well as encouraging breast screening among SA women in the UK.
Background: Little is known about the influence of culture and beliefs about breast cancer, and its implications on preventive health behaviour among South Asian people in the UK. Methods: Using a qualitative approach, 24 South Asian breast cancer patients and their significant others were interviewed. Results: Most patients were unfamiliar with the subject of cancer; they expressed lack of knowledge of cancer as a disease and its symptoms. They identified a painless lump in the breast as sign of abnormality, but not cancer. They also did not know any non-lump breast symptoms. Over half participated in breast screening after encouragement from daughters or relatives. Most did not practise breast self-examination. Perceptions of cancer and health behaviour were influenced by cultural beliefs. Common themes were cancer is a taboo subject and cancer is a stigma. Patients also expressed misunderstandings about the cause of cancer. Cancer in the family had ramifications on children’s marriage prospects and may cause marital breakdown. Terminology used also caused communication problems with healthcare professionals and within the family: the use of ‘chest’ to substitute ‘breast’ changed the meaning of the message conveyed. Conclusions: Cultural beliefs and practices accentuate difficulties in understanding breast cancer, breast screening and breast self-examination, and can prevent South Asian women from adopting preventive health practices.
Dietary phytochemicals have a variety of antitumor properties. In the present study, the antitumor activity of methanolic extract of lemon fruit (lemon extract; LE) (LE) on the MCF-7 breast cancer cell line was investigated in vitro. Apoptotic cell death was analyzed using the TUNEL assay. In addition, the apoptosis mediated by LE extract in the MCF-7 cells was associated with the increased expression of the tumor suppressor p53 and caspase-3. Additionally, the expression of a pro-apoptotic gene, bax, was increased, and the expression of an anti-apoptotic gene, bcl-2, was decreased by LE extract treatment, resulting in a shift in the Bax:Bcl-2 ratio toone that favored apoptosis. The expression of a major apoptotic gene, caspase-3, was increased by LE extract treatment. In light of the above results, we concluded that LE extract can induce the apoptosis of MCF-7 breast cancer cells via Bax-related caspase-3 activation. This study provides experimental data that are relevant to the possible future clinical use of LE to treat breast cancer.
Background: Her-2/neu is the most frequently studied molecular target in gastric cancer but its prognostic impact is still equivocal. We therefore conducted a meta-analysis to more precisely estimate its prognostic significance. Methods: Published studies that investigated between Her-2/neu status and survival were identified.Meta-analysis was performed by Dersimonian-Laird model. Pooled hazard ratio (HR) and its 95% confidence interval (95%CI) were calculated to evaluate the risk of disease. Results: A total of 19 studies were analyzed by meta-analysis method, cumulative 4342 cases were included. Pooled data of 15 studies using univariate analysis showed worse survival of patient with her-2/neu (+) (pooled HR=1.59, 95%CI: 1.20-2.12), which maintained in 7 studies of multivariate analysis (pooled HR=1.58, 95%CI: 1.18-2.12). The Q statistic test for 15 studies of univariate analysis and for 7 studies of multivariate analysis showed they had heterogeneity (Q=26.98, p=0.019,Q=17.76, p=0.007, respectively). Conclusion: HER-2/neu over-expression is related to poor prognosis of gastric cancer but has a modest effect on survival in gastric cancer as an independent prognosis factor.
Breast cancer is the most common cancer in Singaporean women and the rate of increase in incidence is one of the highest in the world. In view of the significant contribution of delayed presentation to the disease burden in South East Asia, we reviewed the incidence of late presentation of breast cancer and the contributing factors in Singapore. Disease presentation was analysed using studies based on the Singapore Cancer Registry 2004- 2008 and with data from women with breast cancer at the National University Hospital (NUH) in Singapore 1990-2007. Available literature from Singapore on factors contributing to delayed presentation was reviewed and presented here. The overall age-standardized 5-year relative survival for Singaporean women was 70% with only half diagnosed with localized cancer. Of all women diagnosed at NUH close to 20% presented at Stages III and IV. Given the magnitude of the problem of women presenting with more advanced stages of breast cancer,the National University of Singapore has joined a collaborative team with the University of Leeds (UK), the University of Malaya, and University of UAE to set up the UK-SEA-ME Psychosocial-Cultural Cancer Research Network to better understand late presentation.
Clinical and public health research depends on factors including national systems, socio-cultural influences, and access to organisations and individuals. As a ‘new’ country, the United Arab Emirates (UAE) has yet to develop strong support for population research. However, there is interest in research. The challenges for quantitative and qualitative research include the varied composition and mobility of the UAE population, with limited health records and disease registries. Long-term follow-up of patients, and tracing foreign workers who may only be in the UAE for a few years, are two major obstacles for longitudinal studies. There can also be a reluctance shown by parts of the population to participate in studies, especially those that require responding to what is perceived was sensitive questions. Successful execution of population research in the UAE requires an understanding of socio-cultural aspects of the study population, and good communication between researchers and participants.
Psychosocial and cultural factors influencing cancer health behaviour have not been systematically investigated outside the western culture, and qualitative research is the best approach for this type of social research. The research methods employed to study health problems in Asia predominantly are quantitative techniques. The setup of the first psychosocial cancer research network in Asia marks the beginning of a collaboration to promote and spearhead applied qualitative healthcare research in cancer in the UK, Southeast Asia and the Middle East. This paper sets out the rationale, objectives and mission for the UK-SEA-ME Psychosocial-Cultural CancerResearch Network. The UK-SEA-ME network is made up of collaborators from the University of Leeds (UK), the University of Malaya (Malaysia), the National University of Singapore (Singapore) and the University of United Arab Emirates (UAE). The network promotes applied qualitative research to investigate the psychosocialand cultural factors influencing delayed and late presentation and diagnosis for cancer (breast cancer) in partner countries, as well as advocating the use of the mixed-methods research approach. The network also offers knowledge transfer for capacity building within network universities. The mission of the network is to improve public awareness about the importance of early management and prevention of cancer through research in Asia.
Breast cancer is the most common cancer in Malaysian females. The National Cancer Registry in 2003 and 2006 reported that the age standardized incidence of breast cancer was 46.2 and 39.3 per 100,000 populations, respectively. With the cumulative risk at 5.0; a woman in Malaysia had a 1 in 20 chance of developing breast cancer in her lifetime. The incidence of cancer in general, and for breast cancer specifically was highest in the Chinese, followed by Indians and Malays. Most of the patients with breast cancers presented at late stages (stage I: 15.45%, stage II: 46.9%, stage III: 22.2% and stage IV: 15.5%). The Healthy Lifestyles Campaign which started in the early nineties had created awareness on breast cancer and after a decade the effort was enhanced with the Breast Health Awareness program to promote breast self examination (BSE) to all women, to perform annual clinical breast examination (CBE) on women above 40 and mammogram on women above 50. The National Health Morbidity Survey in 2006 showed that the prevalence rate of 70.35% by any of three methods of breast screening; 57.1% by BSE, 51.8% by CBE and 7.6% by mammogram. The current screening policy for breast cancer focuses on CBE whereby all women at the age of 20 years and above must undergo breast examination by trained health care providers every 3 years for age between 20-39 years, and annually for age 40 and above. Several breast cancer preventive programs had been developed by various ministries in Malaysia; among whichare the RM50 subsidy for mammogram by the Ministry of Women, Family and Community Development and the SIPPS program (a call-recall system for women to do PAP smear and CBE) by the Ministry of Health. Measures to increase uptake of breast cancer screening and factors as to why women with breast cancer presentlate should be studied to assist in more development of policy on the prevention of breast cancer in Malaysia.