Explaining Perceived Priorities in Women with Breast Cancer: A Qualitative Study

Objective:

Cancer is a stressful event in life, and the dreadful impact and problems created for patients and families by cancer negatively affect their quality of life. Therefore, regarding the increasing number of cancer patients and the nature of this disease, the need to recognize and understand the priorities and problems of patients after the diagnosis of cancer is of high importance. This study was designed and implemented with the aim of identifying the perceived priorities of women with breast cancer.

Methods:

This study is a qualitative research of content analysis type. To collect data, purposeful sampling and deep semi-structured individual interviews were used. The subjects were women with breast cancer who visited the Breast Disease Research Center of Shahid Motahari Clinic in Shiraz, and the data were saturated after 15 interviews. The four criteria presented by Lincken and Guba were used to evaluate the validity and reliability. To analyze the qualitative data, conventional qualitative data analysis and MAXQDA10 software were used. Two themes were obtained in the assessment of interviews and analysis of data: 1) Supportive relief; 2) Therapeutic support.

Results:

Some of the participants highlighted the role of social and family support in coping with the disease, and considered social communication and continued support in the form of empathic relationship as a turning point in their lives. The absence of a fertility specialist in the cancer treatment system was the main complaint of most participants. The results showed that receiving support from family and the healthcare system is the most important perceived priorities in breast cancer patients.

Conclusion:

The results of this study show the importance of social support as a perceived priority in breast cancer patients to improve their quality of life. Development and reinforcement of the supportive network seem to be essential to provide the best possible help to these patients.

Effect of yoga exercise on the quality of life and upper extremity volume among women with breast cancer related lymphedema: A pilot study

PURPOSE

This pilot study aimed to evaluate the effect of an 8-weeks-yoga intervention on quality of life and upper extremity edema volume in women with breast cancer related lymphedema.

METHODS

This was a controlled trial with pre-post design. A total of 40 women with breast cancer related lymphedema were randomly assigned into an intervention or control groups. The intervention group participated in a yoga exercise class for 8 weeks, in a twice a week instructor-led practice and once a week home practice. Outcomes were EORTC QLQ_C30 to measure quality of life, and water displacement volume-meter to measure upper extremity edema volume. The outcomes were evaluated at baseline, 4th and 8th week. Data were analyzed using SPSS.

RESULTS

Four weeks after the intervention, a significant difference was observed between the groups with respect to role functioning of quality of life (P = 0.03). Eight weeks after the intervention, a significant difference was observed between groups concerning physical and emotional functioning of quality of life (P < 0.05). The changing trend in physical, role, emotional, and cognitive functioning had increased, and in some scales such as fatigue, pain, insomnia, and financial difficulties the scores were reduced in the intervention group. Regarding edema volume, no significant difference was found between both groups on the 4th and 8th week after the intervention (P > 0.05).

CONCLUSION

As yoga exercise might improve physical, role, and emotional functioning of quality of life as well as reduce fatigue, pain, and insomnia, using this intervention can be suggested amongst women with breast cancer related lymphedema.

Importance of CD45RO+ tumor-infiltrating lymphocytes in post-operative survival of breast cancer patients

PURPOSE

In recent years, the prognostic/predictive significance of tumor infiltrating lymphocytes (TILs) has become a topic of interest. Here, we aimed to evaluate the prognostic significance of CD3+, CD8+, CD45RO+ and Foxp3+ TILs in breast cancer, as well as the relation of these markers to other clinicopathological features of this disease.

METHODS

FFPE tumor samples from 94 females with invasive ductal carcinoma of the breast were retrospectively selected and immunohistochemically assessed for CD3, CD8, CD45RO and Foxp3 expression. Digital photos were acquired from the center (CT) and invasive margins (IM) of the tumors, after which positive cells were counted using ImageJ software.

RESULTS

We found that greater infiltrations of target lymphocyte subpopulations were associated with TNM stage III, lymph node metastasis, high histological grade, ER negativity and HER2 positivity. The ratios of CD8+ cytotoxic T cells to CD3+, CD45RO+ and Foxp3+ TILs were found to be relatively higher in tumors exhibiting the aforementioned characteristics. In univariate survival analyses, CD8+ TILs in the IM and total CD45RO+ TILs were found to be significantly associated with overall survival (OS). Infiltration of CD45RO+ TILs in the CT and lymph node status were variables that significantly correlated with disease-free survival (DFS). Multiple Cox regression analyses revealed independent significant prognostic effects of total CD45RO+ TILs and lymph node status (HR of 3.24 and 3.19, respectively) in predicting OS. Infiltration of CD45RO+ TILs in the CT (HR 3.12) and lymph node status (HR 3.15) also exhibited significant prognostic effects on DFS.

CONCLUSION

From our data we conclude that CD45RO+ TILs serve as prognostic factors for predicting OS and DFS of breast cancer patients.

Moderating Role of Self-compassion in Relation to Psychopathological Symptoms and God Attachment in Women With Breast Cancer

Background: In many of past studies, the role of God as an attachment figure in reducing psychopathological symptoms has strongly been confirmed. In an effort to account for the effectiveness of attachment to God in mitigating psychopathological symptoms in healthy people we came upon self-compassion as a potential mediating variable in this process. Hence, in the current research, we studied this relation in Iranian Muslim women diagnosed with breast cancer. Methods: A total of 360 Muslim women diagnosed with breast cancer were asked to fill the Attachment to God Inventory, Self-Compassion Scale, and Depression, Anxiety, and Stress Scale. Data were analyzed using path analysis method with AMOS 22. Results: The anxiety dimension of attachment to God was significantly correlated with the severity of anxiety, but the avoidance dimension had no direct effect on any of the symptoms. Also, the anxiety dimension was found to be positively correlated with depression and stress indirectly via self-compassion.  However, in the case of the avoidance dimension, no such relationship was observed. As a result, attachment anxiety causes a decrease in self-compassion in this group of women, and this, in turn, results in more severe psychopathological symptoms like anxiety, stress, and depression. Conclusion: Considering the results of this study, we conclude that improvements in the mental health of Muslim women diagnosed with breast cancer are not exclusively achieved by attachment to material symbols. Rather, attachment to God as a spiritual symbol can have a great impact on the mental health of these women. In fact, secure attachment to God can help improve mental health through positive effects on self-compassion and should be considered as a treatment in psychological interventions.

Comparison of Liquid-based and Conventional Cytology in Diagnosis of Breast Mass

Background:

Among all diagnostic techniques for breast lesions, fine-needle aspiration (FNA) is the simplest, most reliable and cheapest one.

Aim:

To compare liquid-based and conventional cytology in diagnosis of breast mass.

Materials and Methods:

About 101 patients with breast mass were enrolled. The aspirated materials were divided into two parts. One was poured into a liquid medium and the other part was directly spread on clean glass slides. Conventional and liquid-based preparations were compared using several criteria including adequacy (presence of the epithelial cluster or myoepithelial cells), overall cellularity, presence of single epithelial cells, presence of myoepithelial cells, epithelial architecture, nuclear detail, nuclear atypia and inflammatory/proteinaceous background and final diagnosis.

Results:

Among 101 cases, 85 (84.1%) were malignant and 16 (15.9%) were benign. Conventional and liquid-based cytology were similar according to adequacy (P = 0.65), cellularity (P = 0.13), epithelial architecture (P = 0.15), presence of myoepithelial cells (P = 0.61), nuclear detail (P = 0.57) and nuclear atypia (P = 0.44), while there were a significant difference between the two methods according to the presence of single epithelial cells (P < 0.001) and background (P < 0.001).

Conclusion:

Liquid-based cytology of breast specimens is an accurate diagnostic tool with high diagnostic yield in benign and malignant lesions.

The effect of vitamin D and E vaginal suppositories on tamoxifen-induced vaginal atrophy in women with breast cancer

PURPOSE

Vaginal atrophy is one of the most common side effects of using tamoxifen in women with breast cancer. Hormone therapy for vaginal atrophy is prohibited in these women. The present study was conducted to investigate the effect of vitamin D and E vaginal suppositories on vaginal atrophy in women with breast cancer receiving tamoxifen.

METHODS

Women under breast cancer management receiving tamoxifen and showing symptoms of vaginal atrophy were randomized triple-blind to an 8-week trial on vaginal suppository vitamin E or vitamin D or placebo administered every night before bedtime. The genitourinary atrophy self-assessment tool was administered, and pH was measured in all three groups before the intervention and at the end of weeks 2, 4, and 8 of the intervention. The Vaginal Maturation Index (VMI) was also measured before the intervention and at the end of the eighth week. Data were analyzed with paired t tests, repeated measures analysis of variance, and chi-square test.

RESULTS

Thirty-two patients were randomized in each group. The results obtained showed an increase in the VMI by the end of the eighth week of the intervention in the groups receiving the vitamin D and E vaginal suppositories compared with the placebo group (P < 0.001). The vaginal pH also reduced in both groups compared with that in the placebo group (P < 0.001). The symptoms of self-reported genitourinary atrophy also improved in the two intervention groups compared with those in the placebo group by the end of the eighth week (P < 0.001).

CONCLUSION

These data support that vitamin D and E vaginal suppositories were beneficial in improving vaginal atrophy in women with breast cancer receiving tamoxifen. Given the prohibition on hormone therapy in these women, the suppositories can be used as an alternative therapy to improve these symptoms.

Conflicts women with breast cancer face with: A qualitative study

Background and Aim:

The prevalence of cancer in women under 50 years of age has been increased in recent years. Cancer treatment methods can lead to infertility in women with cancer. Fertility and childbearing, as the most important conflicts in the life of women with breast cancer, significantly affect their quality of life.

Materials and Methods:

This research is a qualitative study of content analysis type. Purposeful sampling and semi-structured individual interviews were performed for data collection. The participants were women with breast cancer referred to the Breast Disease Research Center of Shahid Motahari Clinic in Shiraz. The data were saturated after 15 interviews. To assess the validity and reliability, we used the four criteria provided by Lincoln and Guba. The conventional qualitative data analysis and MAXQDA10 software were used to analyze the qualitative data.

Results:

Explaining the conflicts which women with breast cancer are faced has led to the extraction of four main categories: (1) paradox of decision-making to childbearing, (2) fear, (3) sinister emotions, and (4) challenges. The results showed that the paradox of decision-making on childbearing is the most important challenge with which the patients with breast cancer are faced, causing a state of fear, anxiety, and the emergence of sinister emotions in them.

Conclusion:

It seems that paying more attention to preserving reproductive capacity before starting the treatment plays an important role in solving the biggest conflict in the life of breast cancer patients.

The Shiraz Breast Cancer Registry (SBCR): study design and primary reports

AIM

This is a description of the largest breast cancer (BC) registry in Iran, termed the Shiraz Breast Cancer Registry (SBCR).

METHODS

Data on baseline and clinical characteristics, socioeconomic status, imaging, physical examination, histopathology, treatment and prognosis have been recorded for each individual.

RESULTS

Overall, 5937 were included in the report. Mean age of first presentation was 49.05 ± 11.69 years. Mean tumor size was 2.78 ± 1.76 cm. Most patients had stage 2 (46.9%) and 3 (25.5%) BCs, respectively. Most common type of BC was invasive ductal carcinoma (83.3%), followed by medullary carcinoma (3.8%). Overall, 12.9% were triple negative (HER2-, ER- and PR-).

CONCLUSION

The study provides an overview on the status of BC's in Iran and a wide opportunity for future studies.

Introducing novel and comprehensive models for predicting recurrence in breast cancer using the group LASSO approach: are estimates of early and late recurrence different?

Background

In here, we constructed personalized models for predicting breast cancer (BC) recurrence according to timing of recurrence (as early and late recurrence).

Methods

An efficient algorithm called group LASSO was used for simultaneous variable selection and risk factor prediction in a logistic regression model.

Results

For recurrence < 5 years, age (OR 0.96, 95% CI = 0.95–0.97), number of pregnancies (OR 0.94, 95% CI = 0.89–0.99), family history of other cancers (OR 0.73, 95% CI = 0.60–0.89), hormone therapy (OR 0.76, 95% CI = 0.61–0.96), dissected lymph nodes (OR 0.98, 95% CI = 0.97–0.99), right-sided BC (OR 0.87, 95% CI = 0.77–0.99), diabetes (OR 0.77, 95% CI = 0.60–0.98), history of breast operations (OR 0.38, 95% CI = 0.17–0.88), smoking (OR 5.72, 95% CI = 2.11–15.55), history of breast disease (OR 3.32, 95% CI = 1.92–5.76), in situ component (OR 1.58, 95% CI = 1.35–1.84), tumor necrosis (OR 1.87, 95% CI = 1.57–2.22), sentinel lymph node biopsy (SLNB) (OR 2.90, 95% CI = 2.05–4.11) and SLNB+axillary node dissection (OR 3.50, 95% CI = 2.26–5.42), grade 3 (OR 1.79, 95% CI = 1.46–2.21), stage 2 (OR 2.71, 95% CI = 2.18–3.35), stages 3 and 4 (OR 5.01, 95% CI = 3.52–7.13), and mastectomy+radiotherapy (OR 2.97, 95% CI = 2.39–3.68) were predictors of recurrence < 5 years. Moreover, relative to mastectomy without radiotherapy (as reference for comparison), quadrantectomy without radiotherapy had a noticeably higher odds ratio compared to quadranectomy with radiotherapy for recurrence < 5 years. (OR 17.58, 95% CI = 6.70–46.10 vs. OR: 2.50, 95% CI = 2–3.12).

Accuracy, sensitivity, and specificity of the model were 82%, 75.6%, and 74.9%, respectively.

For recurrence > 5 years, stage 2 cancer (OR 1.67, 95% CI = 1.31–2.14) and radiotherapy+mastectomy (OR 2.45, 95% CI = 1.81–3.32) were significant predictors; furthermore, relative to mastectomy without radiotherapy (as reference for comparison), quadranectomy without radiotherapy had a noticeably higher odds ratio compared to quadranectomy with radiotherapy for recurrence > 5 years (OR 7.62, 95% CI = 1.52–38.15 vs. OR 1.75, 95% CI = 1.32–2.32). Accuracy, sensitivity, and specificity of the model were 71%, 78.8%, and 55.8%, respectively.

Conclusion

For the first time, we constructed models for estimating recurrence based on timing of recurrence which are among the most applicable models with excellent accuracy (> 80%).

Electronic supplementary material

The online version of this article (10.1186/s12957-018-1489-0) contains supplementary material, which is available to authorized users.

Do site and type of metastasis in breast cancer show a changing pattern with increased age? A cross comparison of clinicopathological characteristics between age groups

Background

In here, we evaluated pattern of metastasis and cross-compared clinicopathological features between different age groups with breast cancer (BC).

Methods

This study was conducted in the Shiraz Breast Cancer Registry (largest BC registry in Iran). Patients were classified as < 30 years old (group 1), 30–60 years old (group 2), and > 60 years old (group 3). The three age groups were compared regarding clinical and baseline characteristics.

Results

Overall, 564 individuals entered group 1, 4519 group 2, and 670 group 3.

Group 1 had lower rates of tumor necrosis (p < 0.001), higher lymphatic or vascular invasion (p = 0.002), estrogen receptor-negative individuals, and HER2-positive individuals (p ≤ 0.001).

Younger groups had more stage 3 BC (31.1, 25.6, and 19.7% for groups 1, 2, and 3, respectively) (p = 0.016), grade 3 BC (27.4, 20.6, and 16.5% for groups 1, 2, and 3, respectively) (p = 0.001), and grade 3 nucleus (43.1, 34.5, and 27.6% for groups 1, 2, and 3, respectively) (p < 0.001).

Group 1 had higher rates of regional metastasis (4.7 vs. 1.5 and 2.1% for groups 2 and 3, respectively). Younger individuals had higher rates of brain metastasis (13.3, 5.4, and 1.1% for groups 1, 2, and 3, respectively). Moreover, those > 60 years old had more lung metastasis (33 vs. 12.6 and 6.7% for groups 2 and 1, respectively) (p < 0.001).

Younger groups had more < 5-year recurrence (16.3, 11.7, and 8.9%, for groups 1, 2, and 3, respectively) (p = 0.023).

Conclusion

Pattern and site of recurrence changes according to age in BC. This brings up the question whether age is an independent predictor of organ of metastasis or is site of metastasis the result of other clinicopathological determinants which differ between age groups.

Medullary Breast Carcinoma and Invasive Ductal Carcinoma: A Review Study

BACKGROUND

Medullary breast carcinoma (MBC) is a unique histological subtype of breast cancer. The present study aimed to evaluate the classic and non-classic characteristics of MBC and its differences with IDC. The present review study incorporates 22 years of practical experience from a breast disease research center-based series of cases.

METHODS

Retrospectively, the medical records of 3,246 patients were reviewed in the Breast Disease Research Center, Shiraz University of Medical Science (Shiraz, Iran), from December 1993 to December 2015. The tumor size, lymph node metastasis, pathologic stage, nuclear and histological grade, hormonal receptor status, recurrence, disease-free, and overall survival were reviewed. Differences between medullary breast carcinoma and invasive ductal carcinoma were analyzed statistically using the Chi-square, Fischer, independent-sample t test, and Kaplan-Meier analysis (SPSS version 19.0). P<0.05 were considered statistically significant.

RESULTS

A total of 179 patients were identified with MBC and 3,067 patients were identified with IDC. The MBC group had a significant association with a higher histological grade (P<0.001) as well as negative estrogen receptor (P<0.001), progesterone receptor (P<0.001), and HER-2 (P=0.004) status. The MBC patients predominantly had triple-negative breast cancer (TNBC) according to the molecular subtype (P<0.001). In local invasion, MBC was less invasive compared to IDC (P<0.001). The disease-free survival (DFS) and overall survival (OS) differed significantly between the MBC and IDC groups (5-year DFS: 94.2% vs. 86.3%, P=0.008; 5-year OS: 98.1% vs. 92.8%, P=0.004).

CONCLUSION

Despite the poor and aggressive pathological features of MBC, its clinical outcome is more favorable compared to IDC. Our findings can be useful in improvement of diagnosis and treatment of less known breast cancer subtypes, such as MBC.

Correlates of Lymphedema in Women with Breast Cancer: a Case Control Study in Shiraz, Southern Iran

Globally, the burden of breast cancer (BC) continues to increase. BC related lymphedema (BCRL) is currently non curable and as a life time risk it affects at least 25% of BC patients. Knowing more about BCRL and appropriate control of its modifiable risk factors can improve quality of life (QOL) of the affected patients. In this case control study to detect factors, 400 women with BCRL (as the case group) and 283 patients with BC without lymphedema (as the control group) that were referred to Shiraz University of Medical Sciences affiliated BC clinic center were assessed. The data were analyzed in SPSS. The mean age of the case group was 52.3±11.0 years and of the control group was 50.1±10.9 years. In patients with BCRL, 203(50.7%) had left (Lt) side BC and in non- lymphedema group 151 (53.3%) had Lt side BC. Out of all BCRL patients, 204 (51%) had lymphedema in all parts of their affected upper extremities, 100 (25%) had swelling in the arm and forearm and 23 (5.7%) had edema in both the upper extremity and trunk. Edema, heaviness, concern about changing body image, pain and paresthesia were the most common signs/symptoms among patients with BCRL. In BCRL patients, the difference of circumference between the affected upper limb and non-affected limb was 4.4±2.5 cm and the difference in volume displacement was 528.7±374.4 milliliters. Multiple variable analysis showed that moderate to severe activity (OR; odds ratio =14, 95% CI: 2.6-73.3 ), invasiveness of BC (OR =13.7, 95% CI: 7.3-25.6), modified radical mastectomy (OR=4.3, 95% CI: 2.3-7.9), BMI =>25 (OR=4.2, 95% CI: 2-8.7), radiotherapy (OR=3.9, 95% CI: 1.8-8.2 ), past history of limb damage (OR=1.7, 95% CI: 0.9-3.1) and the number of excised lymph nodes (OR=1.06, 95% CI: 1.02-1.09) were the significant predictors of lymphedema in women with BC. Modifiable risk factors of BCRL such as non-guided moderate to severe physical activity, high BMI and trauma to the limb should be controlled as early as possible in BC patients to prevent development of BCRL and improve QOL of these patients.

Lack of Prognostic Impact of Adjuvant Radiation on Oncologic Outcomes in Elderly Women with Breast Cancer

BACKGROUND

Radiotherapy plays an important role as adjuvant treatment in locally advanced breast cancer and in those patients who have undergone breast-conserving surgery. This study aimed to investigate the prognostic impact of adjuvant radiation on oncologic outcomes in elderly women with breast cancer.

MATERIALS AND METHODS

In this retrospective study, we reviewed and analyzed the characteristics, treatment outcome and survival of elderly women (aged ≥ 60 years) with breast cancer who were treated and followed-up between 1993 and 2014. The median follow up for the surviving patients was 38 (range 3-207) months.

RESULTS

One hundred and seventy-eight patients with a median age of 74 (range 60-95) years were enrolled in the study. Of the total, 60 patients received postoperative adjuvant radiation (radiation group) and the remaining 118 did not (control group). Patients in the radiation group were significantly younger than those in the control group (P value=0.004). In addition, patients in radiation group had higher node stage (P value<0.001) and disease stage (P=0.003) and tended to have higher tumor grade (P=0.031) and received more frequent (P value <0.001) adjuvant and neoadjuvant chemotherapy compared to those in the control group. There was no statistically significant difference between two groups regarding the local control, disease-free survival and overall survival rates.

CONCLUSIONS

In this study, we did not find a prognostic impact for adjuvant radiation on oncologic outcomes in elderly women with breast cancer.

Effect of arginine and threonine administered in ovo on digestive organ developments and subsequent growth performance of broiler chickens

This trial was conducted to investigate the effect of arginine (Arg), threonine (Thr) and Arg + Thr administered in ovo on growth performance, digestive organs and intestinal morphology in broiler chickens. On day 14 of incubation, 400 fertile eggs were randomly allotted to five experimental treatments through injection in the amniotic fluid including: (i) control (none injected), (ii) sham (0.5 ml of 0.5% saline), (iii) Arg (35 mg/egg), (iv) Thr (25 mg/egg) and (v) Arg + Thr (35 + 25 mg/egg). After hatching, chicks were given a commercial corn-soya bean diet up to 42 days of age. Daily feed intake (FI) and body weight (BW) of chicks were measured during different periods of the trial. Digestive organs were measured for their relative weight and intestinal length on days 11 and 42 of age. Intestinal morphometric traits were evaluated on day 11 of the experiment. Supplementing amino acids affected the performance of broiler chicks as Thr significantly increased FI and BW across starter, grower and finisher periods compared with sham and control (p < 0.05). Furthermore, Arg + Thr injection increased jejunal weight compared with control on day 42 (p < 0.05). Moreover, Arg inclusion led to the greatest villus height and crypt depth among treatments in duodenum (p > 0.05); however, amino acid supplemented groups had lower villus height than control in jejunum (p < 0.05). Negative correlations found between digestive organs related to day 11 of age containing pancreas (r = -0.484; p = 0.030), duodenal (r = -0.577; p = 0.007) as well as ileal lengths (r = -0.471; p = 0.035) and FI of entire period. Otherwise, positive relationships were observed between duodenum (r = 0.580; p = 0.007) and ileum (r = 0.582; p = 0.007) weights on day 42 and FI of chickens across the entire phase. In conclusion, Arg and particularly Thr injection into amnion can improve FI and post-hatch growth performance of chickens which may be mediated by the development of digestive organs.

Breast cancer risk factors in women participating in a breast screening program: a study on 11,850 Iranian females

The incidence rate of breast cancer in developed countries is almost three-fold higher than in developing countries. Iran has had one of the lowest incidence rates for breast cancer in the world, but during the recent decades a marked increase has been seen. The purpose of this study was to investigate some established risk factors of breast cancer in Iranian women. A study of 11,850 women participating in abreast screening program was conducted. The 197 women diagnosed with breast cancer and 11,653 healthy women were compared. Logistic regression was performed to investigate associations of reproductive and anthropometric factors with breast cancer risk. Family history of breast cancer (OR=1.94 , 95%CI=1.35-2.78), occupation (OR= 1.65,95%CI=1.20- 2.25), education level (OR=0.50,95%CI=0.28-0.91), parity (OR=0.27, 95%CI=0.12-0.59), menopausal status (OR=3.15, 95%CI=2.35-4.21), age at menarche (OR=0.33, 95%CI=0.15-0.70), and age at the first pregnancy (OR=4.10 , 95%CI=1.13-14.77) were related to the risk of breast cancer. Decrease in parity may to some extent explain the rising trend of incidence of breast cancer incidence in Iranian women.

Pathological profile of patients with breast diseases in Shiraz

BACKGROUND

Around 200,000 breast disorders are annually diagnosed all over the world. Fibrocystic changes are the most common breast disorder and fibroadenoma is the most prevalent benign breast tumor. The present study aimed to determine the spectrum, type and prevalence of breast masses in women referred to Shiraz University of Medical Sciences between 2004 and 2012 .

MATERIALS AND METHODS

A cross-sectional study was conducted on the diagnostic reports data.

RESULTS

A total of 640 samples were studied. Most 57.3% of masses were detected in the left breast, 65%, 28.2% and 6.1% of cases presenting with benign, malignant, and inflammatory lesions, respectively. Among all the samples the most prevalent diagnosis (37.7%) was fibroadenoma and fibrocystic lesions (17%). 174 samples (96% of the malignant cases) were invasive. 6.5% of the benign, and 37% of the malignant cases occurred in post menopause women and the differences were statistically significant. Among those with malignant tumors lymph nodes were involved in 25.6% of menopausal women and 44.2% of non-menopausal ones, and the difference was statistically significant.

CONCLUSIONS

Regular clinical breast examination beside mammographic follow-ups, especially during menopause, should be carried out as a priority and a national organized program should be designed for screening breast disorders.

HIGHLIGHTS IN THE DIAGNOSIS OF BREAST NEOPLASMS

Breast malignancies are one of the most prevalent and major causes of morbidity and mortality among women worldwide. According to the available data, neoplastic lesions of the breast are one of the main causes leading to heavy costs for both the healthcare system and the society. Based on these realities and the fact that different aspects of these malignancies remain unknown to date, and are essential to be determined, these issues make a vast area of research in medicine. Just like the present time, breast neoplasms were under the focus of scientists lived in the past, from all over the world. Accordingly, these malignancies are a group of disease with a long-standing historical background. As a result, it can be claimed that modern-day knowledge of these matters has burgeoned on the extraordinary discoveries and the development of diagnostic and therapeutic methods made through the ages, especially those of the post-medieval era. Recognizing the previous efforts that have been made in this regard will show our future way for us. For this reason, in this paper, we will review the key milestones and vital discoveries in the field of breast neoplasms and some other diseases involving this body organ.

The Effects of Intravenous Acetaminophen on Pain and Clinical Findings of Patients with Acute Appendicitis; A Randomized Clinical Trial

OBJECTIVE

To determine the effects of intravenous Acetaminophen (Apotel®)  on pain severity and clinical findings of peritonitis in patients with acute appendicitis.

METHODS

This randomized  cross-over clinical trial was carried out duringa 6-month  period from August 2012 to February 2013 and comprised 107 patients diagnosed with acute appendicitis. Patients were randomly assigned to received placebo (n=54) or Apotel® (n=53). Patients were evaluated before, 30 minutes, 1 hour and 4 hours after administration  of Apotel®  or placebo,and were told to fill in two forms. The first form required patientsto measure their painintensityaccording to visual analogue scale (VAS). The second form was filled by a surgeon who examined the patients and recorded his or her findings using Alvarado score criteria for diagnosis of acute appendicitis at foregoing time points.

RESULTS

Of 72 patients, 37 (51.4%) were men and 35 (48.6%) were women. The mean age of the patients was 34.1±13.5 years. The mean pain score in 107 patients included in this study was 7.96±2.3. Those who received Apotel®  had significantly lower pain scores when compared to placebo at 30 minutes (p<0.001), 1 hour (p<0.001) and 4 hours of administration. There was no significant difference between two study groups regarding the frequency of Alvarado score; however the frequency of fever was significantly lower in those who received Apotel® (p<0.001). We found that Apotel® was not associated with resolved physical findings of acute appendicitis in different time intervals.

CONCLUSION

Apotel® does not affect the clinical findings of acute appendicitis and dos not interfere with the accurate diagnosis. Therefore, it could safely be used as a reliable pain relieving agent, in patients with acute appendicitis.