Increased trend of breast cancer mortality in Iran

14-bp Insertion/Deletion Polymorphism of the HLA-G gene in Breast Cancer among Women from North Western Iran

BACKGROUND

The human leukocyte antigen-G (HLA-G) gene is highly expressed in cancer pathologies and is one strategy used by tumor cells to escape immune surveillance. A 14-bp insertion/deletion (InDel) polymorphism of the HLA-G gene has been suggested to be associated with HLA-G mRNA stability and the expression of HLA-G. The aim of present study was to assess any genetic association between this polymorphism and breast cancer among Iranian-Azeri women.

MATERIALS AND METHODS

In this study 227 women affected with breast cancer, in addition to 255 age-sex and ethnically matched healthy individuals as the control group, participated. Genotyping was performed using polymerase chain reaction and electrophoresis assays. The data were compiled according to the genotype and allele frequencies, compared using the Chi-square test. Statistical significance was set at P<0.05.

RESULTS

In this case-control study, no significant difference was found between the case and control groups at allelic and genotype levels, although there is a slightly higher allele frequency of HLA-G 14bp deletion in breast cancer affected group. However,when the stage I subgroup was compared with stage II plus stage III subgroup of affected breast cancer, a significant difference was seen with the 14 bp deletion allele frequency. The stage II-III subgroup patients had higher frequency of deletion allele (57.4% vs 45.8%) than stage I cases (χ2=4.16, p-value=0.041).

CONCLUSIONS

Our data support a possible action of HLA-G 14bp InDel polymorphism as a potential genetic risk factor for progression of breast cancer. This finding highlights the necessity of future studies of this gene to establish the exact role of HLA-G in progression steps of breast cancer.

Total and Partial Prevalence of Cancer Across Kerman Province, Iran, in 2014, Using an Adapted Generalized Network Scale-Up Method

Due to the lack of nationwide population-based cancer registration, the total cancer prevalence in Iran is unknown. Our previous work in which we used a basic network scale-up (NSU) method, failed to provide plausible estimates of total cancer prevalence in Kerman. The aim of the present study was to estimate total and partial prevalence of cancer in southeastern Iran using an adapted version of the generalized network scale-up method. A survey was conducted in 2014 using multi-stage cluster sampling. A total of 1995 face-to-face gender-matched interviews were performed based on an adapted version of the NSU questionnaire. Interviewees were asked about their family cancer history. Total and partial prevalence were estimated using a generalized NSU estimator. The Monte Carlo method was adopted for the estimation of upper/lower bounds of the uncertainty range of point estimates. One-yr, 2-3 yr, and 4-5 yr prevalence (per 100,000 people) was respectively estimated at 78 (95%CI, 66, 90), 128 (95%CI, 118, 147), and 59 (95%CI, 49, 70) for women, and 48 (95%CI, 38, 58), 78 (95%CI, 66, 91), and 42 (95%CI, 32, 52) for men. The 5-yr prevalence of all cancers was estimated at 0.18 percent for men, and 0.27 percent for women. This study showed that the generalized familial network scale-up method is capable of estimating cancer prevalence, with acceptable precision.

Relationship between erb-B2 mRNA Expression in Blood and Tissue of Invasive Ductal Carcinoma Breast Cancer Patients and Clinicopathological Characteristics of the Tumors

Molecular detection methods such as RT-PCR for detecting breast cancer-associated gene expression in the peripheral blood have the potential to modify breast cancer (BC) staging and therapy. In this regard, we evaluated the potential of erb-B2 molecular marker in BC detection and analyzed the expression of erb-B2 mRNA in the peripheral blood and fresh tissue samples of 50 pretreated female BC patients and 50 healthy females by reverse transcription-PCR (RT-PCR) method. We also assessed the correlation of erb-B2 mRNA marker positivity in peripheral blood and tumor tissue samples with clinical and pathological factors in BC patients in order to evaluate its prognostic value. It was shown that there is a significant difference between healthy females and BC patients with expression of the erb-B2 molecular marker (p<0.01). A significant difference between the expression of erb-B2 in the peripheral blood and tissue samples of BC patients (p<0.01) and the frequency of circulating erb-B2 mRNA expression in peripheral blood and in tissue was detected by RT-PCR. No correlation was found between erb-B2 mRNA expression in blood or tumor tissue samples and lymph node, tumor grade, tumor stage, tumor size, patient's age, ki67, estrogen receptor (ER), progesterone receptor (PGR), P53, and HER-2 status. However, in a small subset of 31 BC patients we found that expression of erb-B2 in peripheral blood or in both peripheral blood and tumor tissue was directly correlated with lympho-vascular invasion and perineural invasion as poor prognostic features. The highest rates of erb-B2 expression in peripheral blood or tumor tissue were in the ER and PR negative and HER-2 positive group. This study suggests that the application of the RT-PCR and immunohistochemical methods for erb-B2 molecular marker detection would provide a higher detection rate, especially in early stage BC.

Survival Rates for Breast Cancer in Iranian Patients: a Meta- Analysis

BACKGROUND

Breast cancer is the most common cancer among Iranian women. Since development of the disease in Iranian women occurs relatively early, the survival rate matters considerably. In different countries, survival of breast cancer patients varies considerably. Therefore, the one-year, three-year, five-year, and ten- year survival rates for breast cancer in Iran were assessed using a meta-analysis.

MATERIALS AND METHODS

This systematic review and meta-analysis was based on valid Iranian sources including SID, MAGIRAN and IRANMEDEX, along with reliable English databases, namely, PUBMED and SCOPUS. In domestic databases, a search was conducted based on key words of breast cancer and survival rate, and in international databases, with "breast cancer" and the equivalent of "neoplasm" of Mesh Word, "survival rate" and "Iran. " Then all reviewed papers and theses which met the inclusion criteria were selected for investigation. To conduct the analysis STATA 11.2 software and random-effects models were used.

RESULTS

In 24 studies, 22,745 participants were included. The one-year, three-year, five-year and ten-year survival rates were 0.956, 0.808, 0.695 and 0.559, respectively. The minimum and maximum survival rates for 5-years were 0.48 and 0.87. The average age of the onset of the disease was 48.3.

CONCLUSIONS

As in Iran, since the onset of the disease is at low age, in spite of the relatively high survival rate as compared to other cancers, prevention and screening programs at early age for early stage diagnosis seems necessary.

Self-care Concept Analysis in Cancer Patients: An Evolutionary Concept Analysis

Background:

Self-care is a frequently used concept in both the theory and the clinical practice of nursing and is considered an element of nursing theory by Orem. The aim of this paper is to identify the core attributes of the self-care concept in cancer patients.

Materials and Methods:

We used Rodgers’ evolutionary method of concept analysis. The articles published in English language from 1980 to 2015 on nursing and non-nursing disciplines were analyzed. Finally, 85 articles, an MSc thesis, and a PhD thesis were selected, examined, and analyzed in-depth. Two experts checked the process of analysis and monitored and reviewed the articles.

Results:

The analysis showed that self-care concept is determined by four attributes of education, interaction, self-control, and self-reliance. Three types of antecedents in the present study were client-related (self-efficacy, self-esteem), system-related (adequate sources, social networks, and cultural factors), and healthcare professionals-related (participation).

Conclusion:

The self-care concept has considerably evolved among patients with chronic diseases, particularly cancer, over the past 35 years, and nurses have managed to enhance their knowledge about self-care remarkably for the clients so that the nurses in healthcare teams have become highly efficient and able to assume the responsibility for self-care teams.

MMP-7 A-181G Polymorphism in Breast Cancer Patients from Western Iran

BACKGROUND

Matrix metalloproteinases (MMPs) are upregulated in tumors. The MMP-7 A-181G polymorphism is associated with increased expression of the MMP-7 gene. Aim of the present study was to investigate the association between the MMP-7 A-181G polymorphism and susceptibility to breast cancer.

PATIENTS AND METHODS

The MMP-7 A-181G variants were studied in a cohort of 251 subjects consisting of 100 breast cancer patients and 151 healthy controls; all were from Western Iran. The MMP-7 A-181G genotypes were identified using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis.

RESULTS

The frequencies of the MMP-7 AA, AG, and GG genotypes in healthy individuals were 34.4, 50.4, and 15.2%, respectively. In breast cancer patients, the frequencies of AA (34%), AG (52%), and GG (14%) genotypes (p = 0.95) were similar to those in the controls. There was a trend toward an increased frequency of the combined genotype of MMP-7 AG+GG in patients with lymph node metastasis (70.4%) compared to those without metastasis (66.7%). Also, in patients with invasive lobular carcinoma, the frequency of the MMP-7 AG+GG genotype tended to be higher (71.4%) compared to that in patients with invasive ductal carcinoma (66.2%) (p = 0.78).

CONCLUSION

Our findings indicate that the MMP-7 A-181G polymorphism may not be correlated with susceptibility to breast cancer in our population.

Silibinin affects tumor cell growth because of reduction of stemness properties and induction of apoptosis in 2D and 3D models of MDA-MB-468

Silibinin, with a strong antioxidant activity and a weak cytotoxic property, is considered a candidate for cancer prevention. As there is no information on its effect on breast cancer tumor-initiating cells [cancer stem cells (CSCs)] in a 3D culture model, which more closely mimic natural tissues, we carried out this study to determine whether silibinin can target breast CSCs in MDA-MB-468 cells cultured under 3D and 2D conditions. Silibinin was added to culture medium of MDA-MB-468 at a half maximal inhibitory concentration (IC50) dose in 2D and 3D models. Then, stemness properties were assessed using colony and sphere-formation tests. Flow cytometry and real-time PCR were used to determine the different expression levels of stem cell-related marker at protein and mRNA levels under both culture conditions. Our results showed that silibinin inhibits cell growth in a dose-dependent manner by induction of apoptosis, alteration of the cell cycle, reduction of stemness properties and function, and induction of tumoral differentiation. The mechanism of silibinin action and also the response of tumor cells differed when cells were cultured in a 3D model compared with a 2D model. Silibinin may potentially target breast CSCs. Moreover, tumor-initiating cells are more sensitive to silibinin in a 3D culture than in a 2D culture.

Effect of Crocin on Cell Cycle Regulators in N-Nitroso-N-Methylurea-Induced Breast Cancer in Rats

We previously showed the anticancer effect of crocin, a saffron carotenoid, in both breast and gastric cancers in animal models, but its mechanism of action is not clearly known, yet. In this study, the effect of crocin on cell cycle regulators is investigated. Female Wistar Albino rats were divided into two groups, with or without N-nitroso-N-methylurea (NMU) injection. After tumor formation, each group of rats was divided into two subgroups, receiving crocin or vehicle only. After 5 weeks, the rats were sacrificed and the tumors were retained for pathologic investigation and determination of the parameters. Before crocin treatment, the tumor volumes were 13.27±3.77 and 12.37±1.88, but at the end of the experiment, they were 23.66±8.82 and 11.91±2.27 in the control and crocin-treated groups, respectively. Pathologic investigation indicated the adenocarcinoma induction by NMU. Reverse transcription-polymerase chain reaction and Western blot analysis showed overexpression of cyclin D1 and p21(Cip1) in the NMU-induced breast tumors; however, the expression of both of them suppressed by crocin treatment. The previous studies indicated that crocin induces apoptosis in tumor tissue. In this study, we show that it also suppresses tumor growth and induces cell cycle arrest by downregulation of cyclin D1. In addition, crocin suppressed p21(Cip1) in a p53-dependent manner.

Application of a Non-Mixture Cure Rate Model for Analyzing Survival of Patients with Breast Cancer

BACKGROUND

As a result of significant progress made in treatment of many types of cancers during the last few decades, there have been an increased number of patients who do not experience mortality. We refer to these observations as cure or immune and models for survival data which include cure fraction are known as cure rate models or long-term survival models.

MATERIALS AND METHODS

In this study we used the data collected from 438 female patients with breast cancer registered in the Cancer Research Center in Shahid Beheshti University of Medical Sciences, Tehran, Iran. The patients had been diagnosed from 1992 to 2012 and were followed up until October 2014. We had to exclude some because of incomplete information. Phone calls were made to confirm whether the patients were still alive or not. Deaths due to breast cancer were regarded as failure. To identify clinical, pathological, and biological characteristics of patients that might have had an effect on survival of the patients we used a non-mixture cure rate model; in addition, a Weibull distribution was proposed for the survival time. Analyses were performed using STATA version 14. The significance level was set at P ≤ 0.05.

RESULTS

A total of 75 patients (17.1%) died due to breast cancer during the study, up to the last follow-up. Numbers of metastatic lymph nodes and histologic grade were significant factors. The cure fraction was estimated to be 58%.

CONCLUSIONS

When a cure fraction is not available, the analysis will be changed to standard approaches of survival analysis; however when the data indicate that the cure fraction is available, we suggest analysis of survival data via cure models.

The relationship of social support concept and repeat mammography among Iranian women

BACKGROUND

Breast cancer ranks as the first most common cancer among the Iranian women. The regular repeat of mammography with 1-2 year intervals leads to the increased efficiency of early detection of breast cancer. The present study examined the predictors of repeat mammography. It was hypothesized that higher social support is connected with mammography repeat.

METHODS

A cross-sectional study was carried out among 400 women 50 years and older in Sanandaj, Iran. Data was collected by the questionnaire including information on socio demographical variables and measuring social support level. Data was analyzed by SPSS16 software. Multiple logistic regression was used to determine the predictive power of demographic variables and dimensions of social support for repeat mammography.

RESULTS

Women aged 50-55 years had three times odds of repeat mammography compared to women aged 56-60 years) OR, 3.02). Married women had greater odds of repeat mammography compared to single women (P < 0.006). The probability of repeat mammography in women with higher social support was 0.93 times greater than the women with lower social support (OR, 0.93; 95 % CI, 0.91-0.95; P < 0.0001).

CONCLUSIONS

Iranian women are less likely repeat mammography than other Asian women. Identifying the associations between perceived social support and repeat mammography may offer detailed information to allow for future study and guide the development of interventions not only for Iranian women but also for similar cultural that received pay too little attention to date in the breast cancer literature.

The impact of international economic sanctions on Iranian cancer healthcare

BACKGROUND

In 2012, Iranian's economy collapsed under strain from sanctions instituted to stop Iran from violating the International Nuclear Non-Proliferation Treaty. Sanctions have indirectly led to serious healthcare concerns, specifically cancer treatment. This is the first report to evaluate Iranian cancer healthcare while under international economic sanctions.

METHODS

Data and information were identified by searches of MEDLINE, PubMed, and references from relevant articles using the search terms: "Iran", "health policy", "sanctions", "ethics", and "cancer". Articles published in the English language between 1966 and present were included, based on relevance to sanctions or the specific case of sanctions in Iran.

RESULTS

The Program of Action for Cancer Therapy evaluated Iran's National Cancer Control Program (NCCP), reporting it has substantial deficits, including prevention, diagnosis/treatment, palliative care, monitoring, and technology, with a serious drug shortage for cancer care. Sanctions have exemptions for medicines and food, but lead to disruption of health services through complications in transportation, transferring currencies or lack of money.

CONCLUSION

There is increasing evidence that sanctions harm vulnerable populations, while blocking globalization and not creating political or social change quickly. Improvement of Iran's NCCP is not feasible, and the health of cancer patients will continue to decline while the sanctions are in effect. The solution is complex, but a modern and innovative approach to diplomacy, which includes human rights, is necessary.

Exploring factors related to metastasis free survival in breast cancer patients using Bayesian cure models

BACKGROUND

Breast cancer is a fatal disease and the most frequently diagnosed cancer in women with an increasing pattern worldwide. The burden is mostly attributed to metastatic cancers that occur in one-third of patients and the treatments are palliative. It is of great interest to determine factors affecting time from cancer diagnosis to secondary metastasis.

MATERIALS AND METHODS

Cure rate models assume a Poisson distribution for the number of unobservable metastatic-component cells that are completely deleted from the non-metastasis patient body but some may remain and result in metastasis. Time to metastasis is defined as a function of the number of these cells and the time for each cell to develop a detectable sign of metastasis. Covariates are introduced to the model via the rate of metastatic-component cells. We used non-mixture cure rate models with Weibull and log-logistic distributions in a Bayesian setting to assess the relationship between metastasis free survival and covariates.

RESULTS

The median of metastasis free survival was 76.9 months. Various models showed that from covariates in the study, lymph node involvement ratio and being progesterone receptor positive were significant, with an adverse and a beneficial effect on metastasis free survival, respectively. The estimated fraction of patients cured from metastasis was almost 48%. The Weibull model had a slightly better performance than log-logistic.

CONCLUSIONS

Cure rate models are popular in survival studies and outperform other models under certain conditions. We explored the prognostic factors of metastatic breast cancer from a different viewpoint. In this study, metastasis sites were analyzed all together. Conducting similar studies in a larger sample of cancer patients as well as evaluating the prognostic value of covariates in metastasis to each site separately are recommended.

Lifetime and 5 years risk of breast cancer and attributable risk factor according to Gail model in Iranian women

Introduction:

Breast cancer is the most commonly diagnosed cancers in women worldwide and in Iran. It is expected to account for 29% of all new cancers in women at 2015. This study aimed to assess the 5 years and lifetime risk of breast cancer according to Gail model, and to evaluate the effect of other additional risk factors on the Gail risk.

Materials and Methods:

A cross sectional study conducted on 296 women aged more than 34-year-old in Qom, Center of Iran. Breast Cancer Risk Assessment Tool calculated the Gail risk for each subject. Data were analyzed by paired t-test, independent t-test, and analysis of variance in bivariate approach to evaluate the effect of each factor on Gail risk. Multiple linear regression models with stepwise method were used to predict the effect of each variable on the Gail risk.

Results:

The mean age of the participants was 47.8 ± 8.8-year-old and 47% have Fars ethnicity. The 5 years and lifetime risk was 0.37 ± 0.18 and 4.48 ± 0.925%, respectively. It was lower than the average risk in same race and age women (P < 0.001). Being single, positive family history of breast cancer, positive history of biopsy, and radiotherapy as well as using nonhormonal contraceptives were related to higher lifetime risk (P < 0.05). Moreover, a significant direct correlation observed between lifetime risk and body mass index, age of first live birth, and menarche age. While an inversely correlation observed between lifetimes risk of breast cancer and total month of breast feeding duration and age.

Conclusion:

Based on our results, the 5 years and lifetime risk of breast cancer according to Gail model was lower than the same race and age. Moreover, by comparison with national epidemiologic indicators about morbidity and mortality of breast cancer, it seems that the Gail model overestimate the risk of breast cancer in Iranian women.

Interrelationships Between Ki67, HER2/neu, p53, ER, and PR Status and Their Associations With Tumor Grade and Lymph Node Involvement in Breast Carcinoma Subtypes: Retrospective-Observational Analytical Study

Various predictive and prognostic factors could affect breast carcinoma behavior, but to date no definitive correlation has been established between them and breast carcinoma subtypes. The present study was conducted to examine the interrelationships of these predictive and prognostic factors as well as their effects on breast carcinoma subtypes.The archives of all patients with breast carcinoma (from 2008 to 2014) were studied. Patients' data were extracted using a checklist that included age, histology type, size and grade of tumor, lymph node involvement, estrogen receptor (ER) and progesterone receptor (PR) status, along with the overexpression of human epidermal growth factor receptor (HER2/neu) and the rate of Ki67 and p53 mutations. All data were analyzed by SPSS-17 software with χ and Fisher exact tests, as well as the least significant difference pairwise comparison test.A total of 566 patients' records were included in this study. The mean age of patients was 50 ± 12.9 with an age range of 17 to 98 years. A meaningful correlation was found between age and the type of tumor (P = 0.001). Infiltrating lobular carcinoma had a higher ER positivity between groups (85.7%), whereas noninvasive carcinomas had a higher PR positivity (67%). In addition, a meaningful correlation was detected between the type and grade of tumor (P = 0.001). No meaningful relationship was observed between the type of tumor and HER2/neu overexpression and number of lymph nodes involved. Between the groups, medullary carcinoma had the highest Ki67 index (P = 0.007). Meaningful correlation was found between the grade of tumor and lymph node involvement (P = 0.005) and also with HER2/neu overexpression (P = 0.002). Higher grades had greater positivity in Ki67 index and p53 mutation rates (P = 0.002, P = 0.01). HER2/neu positive tumors had a higher Ki67 index (P = 0.03).Higher Ki67 index tumors showed more HER2/neu overexpression, larger size, and more lymph node involvement compared with other types and maybe considered aggressive. Moreover, in young patients with breast carcinoma, the rates of Ki67 with the overexpression of HER2/neu and p53 mutations are higher, and it shows a more aggressive behavior than other tumors assessed in this age group.

Specific TaqMan allelic discrimination assay for rs1477196 and rs9939609 single nucleotide polymorphisms of FTO gene demonstrated that there is no association between these SNPs and risk of breast cancer in Iranian women

Background:

Breast cancer (BC), is the most common cancer in women, that is the major cause of cancer-related morbidity and mortality in women. Obesity is considered as a major risk factor for BC that increases both the rate and intensity of the disease. Polymorphisms in FTO gene, a known obesity related gene, is shown to be associated with obesity-related traits as well. The aim of this study was to evaluate the association between previously reported single nucleotide polymorphisms (SNPs) of intron 1of FTO gene, rs1477196 and rs9939609 and risk of BC in a subset of Iranian BC patients.

Materials and Methods:

We genotyped 99 cases and 100 controls for the two SNPs of rs9939609 and rs1477196 by TaqMan allelic discrimination assay. For each sample in an allelic discrimination assay, a unique pair of fluorescent dye probe is used. One fluorescent dye probe has a perfect match with the wild type allele and the other fluorescent dye probe is perfectly matched to the mutated allele.

Results:

Our research has shown that the observed differences between case and control groups in the studied SNPs of FTO gene are not statistically significant (P > 0.05).

Conclusions:

Our findings suggest that there is no association between rs9939609 and rs1477196 polymorphisms in FTO gene and increase in risk of BC in the studied Iranian population. These results were inconsistent with that of previously reported case–control studies with BC that means presence of these polymorphisms depends on ethnic group.

Incidence Trend and Epidemiology of Common Cancers in the Center of Iran

INTRODUCTION

Cancer is a major public health problem in Iran and many other parts of the world. The cancer incidence is different in various countries and in country provinces. Geographical differences in the cancer incidence lead to be important to conduct an epidemiological study of the disease. This study aimed to investigate cancer epidemiology and trend in the province of Qom, located in center of Iran.

METHOD

This is an analytical cross-sectional study carried out based on re-analysis cancer registry report and the disease management center of health ministry from 2004 to 2008 in the province of Qom. To describe incidence time trends, we carried out join point regression analysis using the software Join point Regression Program, Version 4.1.1.1.

RESULTS

There were 3,029 registered cases of cancer during 5 years studied. Sex ratio was 1.32 (male to female). Considering the frequency and mean standardized incidence, the most common cancer in women were breast, skin, colorectal, stomach, and esophagus, respectively while in men the most common cancers included skin, stomach, colorectal, bladder, and prostate, respectively. There was an increasing and significant trend, according to the annual percentage change (APC) equal to 8.08% (CI: 5.1-11.1) for all site cancer in women.

CONCLUSION

The incidence trend of all cancers was increasing in this area. Hence, planning for identifying risk factors and performing programs for dealing with the disease are essential.

Risk of cancer with combined oral contraceptive use among Iranian women

Oral contraceptive use is the most common type of contraception. More than 300 million women worldwide take oral contraceptives every day. However, there is a concern about the relationship with the incidence of cancer. This analytical retrospective study aimed to investigate the relationship between the incidence of cervical and breast cancers and oral contraceptive use in 128 Iranian patients with cervical cancer, 235 with breast cancer and equal numbers of controls. Data were collected through interviews with an organized set of questions. Details were also extracted from patient files. Data were analyzed using Student's t-test, chi-square and Fisher's exact tests, and Pearson's correlation analysis. The result revealed correlations between both cervical and breast cancers and history of contraceptive pills use. While cervical cancer significantly correlated with duration of use of pills, breast cancer had significant correlations with the type of oral contraceptive and age at first use. No significant relationships were found between the two types of cancer and age at discontinuation of oral contraceptives, patterns of use, and intervals from the last use. The use of oral contraceptives may triple the incidence of cervical cancer and doubles the incidence of breast cancer. Therefore, performing Pap smears every six months and breast cancer screening are warranted for long-term oral contraceptive users.

Vitamin D Receptor Poly(A) Microsatellite Polymorphism and 25-Hydroxyvitamin D Serum Levels: Association with Susceptibility to Breast Cancer

PURPOSE

According to previous studies, vitamin D exhibits protective effects against breast cancer via the vitamin D receptor (VDR). There is growing evidence that breast cancer incidence is associated with various polymorphisms of the VDR gene. This study investigates the association of VDR poly(A) microsatellite variants with 25-hydroxyvitamin D (25(OH)D) serum levels and breast cancer risk.

METHODS

Polymorphism analysis was performed on a total of 261 blood samples, which were collected from 134 women with breast cancer and 127 controls. Single strand conformation polymorphism was assessed by polymerase chain reaction in combination with sequencing to detect poly(A) lengths for each sample. The vitamin D levels of samples were determined by electrochemiluminescence.

RESULTS

The poly(A) variant L allele frequency was significantly higher in cancer patients than in controls (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.16-2.57; p=0.006). Thus, carriers of the L allele (LS and LL genotypes) have a higher risk for breast cancer (OR, 1.86; 95% CI, 1.13-3.05; p=0.013). A larger increase in the risk for breast cancer was found in individuals with the L carrier genotype and lowered 25(OH)D levels.

CONCLUSION

The results primarily suggest that VDR gene polymorphism in the poly(A) microsatellite is associated with 25(OH)D levels and that it can affect the breast cancer risk in the female population from northern Iran.

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.

Regulation of BAX/BCL2 gene expression in breast cancer cells by docetaxel-loaded human serum albumin nanoparticles

Today, using nanoparticle-based drug delivery systems has expanded to avoid anticancer side effects. Taxanes are important chemotherapeutic agents in the treatment of metastatic breast cancer. In this study, docetaxel (DTX)-loaded human serum albumin (HSA) nanoparticles (NPs) were prepared and characterized. Drug toxicity of the nanoparticles was measured by MTT assay with different drug concentrations (0.01, 0.1, 0.5, 1 and 5 μM) at different incubation times (24, 48 and 72 h). Expression of BAX/BCL2 mRNA levels was determined by real-time PCR. The size of NPs prepared and used in our study was about 147 nm with surface charge of -29.6 mV. Results obtained from MTT assay showed that 0.5 μM of free drug had 50 % toxicity on MCF-7 cells after 48-h incubation. Real-time PCR results showed an increase in expression of BAX and no change for BCL2. In conclusion, a significant overexpression of BAX gene and changes in BAX/BCL2 ratio were observed for DTX-loaded HSA nanoparticles compared with free DTX and may provide a potential therapy to inhibit anticancer drug resistance.

Relationship of body mass index with prognosis in breast cancer patients treated with adjuvant radiotherapy and chemotherapy

BACKGROUND

The aim of this study was to investigate the relationship of body mass index with overall and progression-free survival as well as other prognostic factors of breast cancer in patients with non-metastatic breast cancer.

MATERIALS AND METHODS

We retrospectively reviewed 456 patients diagnosed with breast cancer in the Radiation Oncology department of Kayseri Teaching Hospital between 2005 and 2013. We investigated relationship of body mass index with prognosis and other prognostic factors.

RESULTS

The study included 456 patients (447 women and 9 men). Mean age at presentation was 55.6 years. Of the cases, 96.9% underwent modified radical mastectomy and 95.0% received chemotherapy, while 82.4% received radiotherapy and 60.0% were given hormone therapy. Body mass index was >25 mg/kg(2) in 343 cases. Five- and 10-years overall survival rates were 77% and 58% whereas progression-free survival rates were 65% and 49%, respectively. In univariate analyses, factors including stage (p=0.046), tumor diameter (p=0.001), lymph node metastasis (p=0.006) and body mass index (p=0.030) were found to be significantly associated with overall survival, while perinodal involvement was found to be significantly associated with progression-free survival (p=0.018). In multivariate analysis, stage (p=0.032; OR: 3.8; 95% CI: 1.1-13), tumor diameter (p<0.000; OR: 0.0; 95% CI: 0.0-0.3), lymph node metastasis (p=0.005; OR: 0.0; 95% CI: 0.0-0.5) and BMI (p=0.027; OR: 0.02; 95% CI: 0.0-0.8) remained as significantly associated with OS.

CONCLUSIONS

In our study, it was seen that overall survival time was shorter in underweight and obese patients when compared to normal weight patients.

The antioxidant and chemical properties of Berberis vulgaris and its cytotoxic effect on human breast carcinoma cells

In this study we evaluated the biological activity of alcoholic and aqueous extracts from the fruit of Berberis vulgaris. The total antioxidant capacity of Berberis was characterized by FRAP, DPPH, Folin-Ciocalteu while the anthocyanins content was measured by pH differential method. Cell viability and apoptotic property were determined by MTT and DNA fragmentation assays, respectively. Alcoholic extract of Berberis was richer in antioxidants and anthocyanins compared to aqueous extract. Although both extracts significantly inhibited proliferation of breast cancer cells (MCF-7); these changes were not observed in normal human breast epithelial cells (MCF10-A). The alcoholic extract was more effective in inducing apoptosis as detected by DNA fragmentation in treated cancer cells. Our results suggest that Berberis has potent antioxidant properties and cytotoxic effects that can induce apoptosis. Therefore, Berberis can potentially be exploited for the development of therapeutics to fight against human breast cancer.

Health-related quality of life and the predictive role of sense of coherence, spirituality and religious coping in a sample of Iranian women with breast cancer: a prospective study with comparative design

Background

There is disagreement among studies of health-related quality of life (HRQoL) changes in breast cancer patients over time. Reportedly, assessment of HRQoL prior to diagnosis may be crucial to provide a clear point of comparison for later measurements. The aims of this study were (1) to investigate changes in HRQoL, sense of coherence (SOC), spirituality and religious coping in a group of women with breast cancer from the pre-diagnosis phase to 6 months later in comparison with a control group, and (2) to explore the predictor role of SOC, spirituality, and religious coping within the breast cancer group at the 6-month follow-up.

Methods

A sample of women with breast cancer (n = 162) and a matched control group (n = 210) responded to the following instruments on both occasions: the European Organization for Research and Treatment of Cancer QLQ-C30, the SOC Scale, the Spiritual Perspective Scale and the Brief Religious Coping Scale. A series of General Linear Model (GLM) Repeated Measures was used to determine changes between the groups over time. Also, Multiple Linear Regression analyses were applied to each of the HRQoL dimensions, as dependent variable at the 6 months follow-up.

Results

Physical and role function, fatigue, and financial difficulties were rated worse by the women with breast cancer during the first 6 months in comparison to the controls, which was both a statistically (p < 0.001) and clinically significant difference. Women had better scores for global quality of life (p < 0.001), and emotional functioning (p < 0.01) during the same period of time. The degree of SOC (p < 0.01) and baseline ratings of several dimensions of HRQoL (p < 0.05) were the most important predictors of HRQoL changes.

Conclusions

Collecting HRQoL data before a final diagnosis of breast cancer is important to identify women at risk of deterioration in HRQoL during and after treatment. Special attention should be paid to physical and role functioning impairment, fatigue, and financial difficulties experienced by these women. These results underscore that the degree of SOC may be more important as a predictor for HRQoL changes in this sample than spirituality and religious coping.

Incidence and mortality of female breast cancer in Jiangsu, China

OBJECTIVES

The aim of this study was to describe and analyze the incidence and mortality of female breast cancer in Jiangsu Province of China.

METHODS

Incidence and mortality data for female breast cancer and corresponding population statistics from eligible cancer registries in Jiangsu from 2006 to 2010 were collected and analyzed. Crude rates, age-specific rates and age-standardized rates of incidence and mortality were calculated, and annual present changes (APCs) were estimated to describe the time trends.

RESULTS

From 2006 to 2010, 11,013 new cases and 3,068 deaths of female breast cancer were identified in selected cancer registry areas of Jiangsu. The annual average crude incidence and age-standardized incidence by world population (ASW) were 25.2/ and 17.9/100,000 respectively. The annual average crude and ASW for mortality rates were 7.03/ and 4.81/100,000. The incidence was higher in urban areas than that in rural areas, and this was consistent in all age groups. No significant difference was observed in mortality between urban and rural areas. Two peaks were observed when looking at age-specific rates, one at 50-59 years and another at over 85 years. During the 5 years, incidence and mortality increased with APCs of 4.47% and 6.89%, respectively. Compared to the national level, Jiangsu is an area with relatively low risk of female breast cancer.

CONCLUSION

Breast cancer has become a main public health problem among Chinese females. More prevention and control activities should be conducted to reduce the burden of this disease, even in relatively low risk areas like Jiangsu.

Role of HER2 in brain metastasis of breast cancer: a systematic review and meta-analysis

BACKGROUND

Breast cancer is one of the most common cancers among women worldwide and the HER2 receptor plays an important role in its development and progression. This systematic review aimed to summarize the role of HER2 in brain metastasis in patients with breast cancer.

MATERIALS AND METHODS

We conducted a literature search by advanced search in title field using the Scopus, Pubmed, and Google scholar databases until the end of June 2014. With metastasis, metastatic, HER2, brain, and breast cancer, as terms of search we selected 31 articles, which were reviewed by two independent and blinded expert reviewers. The studies were first selected according to their titles and abstracts. Quality of the studies were then assessed using the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) protocol for observational studies and CONSORT(Consolidation of Standards for Reporting Trials) protocol for clinical trials. For statistical analyses, we used STATA, version 11.0 software. Forest and funnel diagrams were drawn and for heterogeneity, index was also considered. Also we used meta regression analysis.

RESULTS

Finally, we reviewed 10 studies. The prevalence of brain metastasis in HER2- positive breast cancer patients was 24.9%. There was publication bias in the reviewed studies. Meta regression analysis showed that follow up time had no significant effect (p=0.396) on the prevalence of brain metastasis.

CONCLUSIONS

The results showed a high prevalence of brain metastasis in HER2 positive breast cancer patients.

Burden of Breast Cancer in Iranian Women is Increasing

BACKGROUND

Breast cancer (BC) is the leading cause of oncological death for women, in both developed and developing countries. In Iran, breast cancer ranks first among cancers diagnosed in women. The aim of this study was to present the burden of this cancer including incidence, mortality and years life lost (YLL) due to breast cancer in Iranian women.

MATERIALS AND METHODS

National incidence data from the Iranian annual National Cancer Registration reports from 2003 to 2009 and national death statistics reported by the Ministry of Health and Medical Education from 1995 to 2010, stratified by age group, were included in this analysis. Also calculated YLLs provided by the Institute for Health Metrics and Evaluation (IHME) for the years 1990, 1995, 2000, 2005 and 2010 were employed to express the years lost due to BC for Iranian women.

RESULTS

The general mortality rate of breast cancer increased during these years from 0.96 to 4.33 per 100,000 and incidence increased from 16.0 to 28.3 per 100,000 for the years under study. YLLs calculated by IHME showed both increasing and decreasing patterns, with a tendency for stabilization.

CONCLUSIONS

The burden of breast cancer for Iranian women is still increasing. Thus, health education programs to inform women regarding the signs and risk factors, and national screening to facilitate early diagnosis are needed for the female community in Iran.

Trends of breast cancer incidence in Iran during 2004-2008: a Bayesian space-time model

BACKGROUND

Breast cancer is the most frequently diagnosed cancer in women and estimating its relative risks and trends of incidence at the area-level is helpful for health policy makers. However, traditional methods of estimation which do not take spatial heterogeneity into account suffer from drawbacks and their results may be misleading, as the estimated maps of incidence vary dramatically in neighboring areas. Spatial methods have been proposed to overcome drawbacks of traditional methods by including spatial sources of variation in the model to produce smoother maps.

MATERIALS AND METHODS

In this study we analyzed the breast cancer data in Iran during 2004-2008. We used a method proposed to cover spatial and temporal effects simultaneously and their interactions to study trends of breast cancer incidence in Iran.

RESULTS

The results agree with previous studies but provide new information about two main issues regarding the trend of breast cancer in provinces of Iran. First, this model discovered provinces with high relative risks of breast cancer during the 5 years of the study. Second, new information was provided with respect to overall trend trends o. East-Azerbaijan, Golestan, North-Khorasan, and Khorasan-Razavi had the highest increases in rates of breast cancer incidence whilst Tehran, Isfahan, and Yazd had the highest incidence rates during 2004-2008.

CONCLUSIONS

Using spatial methods can provide more accurate and detailed information about the incidence or prevalence of a disease. These models can specify provinces with different health priorities in terms of needs for therapy and drugs or demands for efficient education, screening, and preventive policy into action.

Awareness levels about breast cancer risk factors, early warning signs, and screening and therapeutic approaches among Iranian adult women: a large population based study using latent class analysis

BACKGROUND AND OBJECTIVE

Breast cancer (BC) continues to be a major cause of morbidity and mortality among women throughout the world and in Iran. Lack of awareness and early detection program in developing country is a main reason for escalating the mortality. The present research was conducted to assess the Iranian women's level of knowledge about breast cancer risk factors, early warning signs, and therapeutic and screening approaches, and their correlated determinants.

METHODS

In a cross-sectional study, 2250 women before participating at a community based screening and public educational program in an institute of cancer research in Isfahan, Iran, in 2012 were investigated using a self-administered questionnaire about risk factors, early warning signs, and therapeutic and screening approaches of BC. Latent class regression as a comprehensive statistical method was used for evaluating the level of knowledge and its correlated determinants.

RESULTS

Only 33.2%, 31.9%, 26.7%, and 35.8% of study participants had high awareness levels about screening approaches, risk factors, early warning signs and therapeutic modalities of breast cancer, respectively, and majority had poor to moderate knowledge levels. Most effective predictors of high level of awareness were higher educational qualifications, attending in screening and public educational programs, personal problem, and family history of BC, respectively.

CONCLUSION

Results of current study indicated that the levels of awareness among study population about key elements of BC are low. These findings reenforce the continuing need for more BC education through conducting public and professional programs that are intended to raise awareness among younger, single women and those with low educational attainments and without family history.

Breast cancer incidence and mortality in women under 50 years of age in Brazil

Many countries have reported an increase in breast cancer incidence in young women. The current study's objective was to explore breast cancer distribution in women less than 50 years of age in Brazil. A descriptive study on breast cancer incidence (selected cities) and mortality (Brazil and selected cities) in 2002-2004 was carried out, and the results were compared with those from other countries. The study also analyzed the trend in hospital morbidity and incidence rates for breast cancer. Porto Alegre (Rio Grande do Sul State) showed the highest incidence rates (17.9 and 165.5/100,000 in the 15-39 and 40-49-year age strata, respectively). Regarding mortality, Belo Horizonte (Minas Gerais State) showed the highest rate in the 15-39-year group and Porto Alegre in the 40-49-year group (2.8 and 25.5/100,000). Hospital admissions and incidence rates for breast cancer suggest a change in epidemiological distribution. The results reveal an epidemiological pattern of breast cancer in young Brazilian women with regional distribution characteristics.

Estimation of the cure rate in Iranian breast cancer patients

BACKGROUND

Although the Cox's proportional hazard model is the popular approach for survival analysis to investigate significant risk factors of cancer patient survival, it is not appropriate in the case of log-term disease free survival. Recently, cure rate models have been introduced to distinguish between clinical determinants of cure and variables associated with the time to event of interest. The aim of this study was to use a cure rate model to determine the clinical associated factors for cure rates of patients with breast cancer (BC).

MATERIALS AND METHODS

This prospective cohort study covered 305 patients with BC, admitted at Shahid Faiazbakhsh Hospital, Tehran, during 2006 to 2008 and followed until April 2012. Cases of patient death were confirmed by telephone contact. For data analysis, a non-mixed cure rate model with Poisson distribution and negative binomial distribution were employed. All analyses were carried out using a developed Macro in WinBugs. Deviance information criteria (DIC) were employed to find the best model.

RESULTS

The overall 1-year, 3-year and 5-year relative survival rates were 97%, 89% and 74%. Metastasis and stage of BC were the significant factors, but age was significant only in negative binomial model. The DIC also showed that the negative binomial model had a better fit.

CONCLUSIONS

This study indicated that, metastasis and stage of BC were identified as the clinical criteria for cure rates. There are limited studies on BC survival which employed these cure rate models to identify the clinical factors associated with cure. These models are better than Cox, in the case of long-term survival.

Social disparity in breast and ovarian cancer incidence in iran, 2003-2009: a time trend province-level study

Purpose

This pioneering study aimed to investigate social disparities in breast cancer (BC) and ovarian cancer (OC) incidence rates among women across Iran's provinces from 2003 to 2009.

Methods

Provincial level population distribution data pertaining to women were obtained from the Statistical Centre of Iran. Age-standardized incidence rates of BC and OC were gathered from the National Cancer Registry. Human Development Index was used as the provinces' social rank (SR), and rate ratio and Kunst and Mackenbach relative index of inequality were used to assess social disparities. Annual percentage change (APC) was calculated using joinpoint regression, and Spearman rank correlation was used to examine the association between APC and SR.

Results

It was found that over the study period, annual incidence rates rose by 11.6% and 9.7% for BC and OC, respectively. Social disparities were substantial and stable in favor of provinces with lower SR in Iran, and were more profound for BC than OC. Correlations between APC and SR were small and nonsignificant for both BC and OC.

Conclusion

The results showed that both BC and OC incidence increased in Iran during 2003 to 2009. There were positive associations between BC and OC incidence rates and the provinces' SR. This study's recommendations provide valuable information for health resource allocation pertaining to BC and OC control programs across provinces in Iran.