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Dewi TK, Massar K, Ruiter RAC, Leonardi T. Determinants of breast self-examination practice among women in Surabaya, Indonesia: an application of the health belief model. BMC Public Health 2019; 19:1581. [PMID: 31775697 PMCID: PMC6882356 DOI: 10.1186/s12889-019-7951-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 11/14/2019] [Indexed: 11/10/2022] Open
Abstract
Background Breast cancer has become one of the most common causes of mortality among Indonesian women. Many women in Indonesia present with late-stage breast cancer, negatively affecting prognosis and treatment outcomes. Better prognosis of breast cancer will be achieved if it is diagnosed in an earlier stage, thus efforts to detect breast cancer earlier are important. Breast Self-Examination (BSE) is considered as an important first step to encourage women to actively be responsible for their own health, especially for women in low-and middle-income countries with limited resources and access to other forms of preventive healthcare (e.g., screening programs). The present study aimed to predict BSE practice among women in Surabaya, Indonesia using the Health Belief Model (HBM). Methods This investigation was a cross-sectional survey which was distributed among 1967 women aged 20–60 years. The Indonesian version of Champion’s Health Belief Model Scale (I-CHBMS) was used to explain self-reported BSE practice. Logistic regression analysis was used to examine the association of HBM variables with BSE practice. Results 44.4% of the respondents indicated they had performed BSE. Further, the results indicated that the HBM variables were significantly associated with BSE practice. Specifically, higher perceived benefits and self-efficacy, lower perceived barriers and less cues to action were unique correlates of BSE practice. The result also showed that perceived severity and susceptibility were not associated with BSE practice. Conclusion This study indicated that several HBM constructs significantly associated with BSE practice among Indonesian women, suggesting that BSE health education programs should emphasize the perceived benefits of BSE, focus on increasing women’s self-efficacy to address and overcome perceived barriers in performing BSE, and help them in identifying personally relevant cues to action.
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Affiliation(s)
- Triana Kesuma Dewi
- Department of Clinical Psychology and Mental Health, Faculty of Psychology, Universitas Airlangga, Surabaya, Indonesia. .,Department of Work and Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.
| | - Karlijn Massar
- Department of Clinical Psychology and Mental Health, Faculty of Psychology, Universitas Airlangga, Surabaya, Indonesia.,Department of Work and Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Robert A C Ruiter
- Department of Work and Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Tino Leonardi
- Department of Educational and Developmental Psychology, Faculty of Psychology, Universitas Airlangga, Surabaya, Indonesia
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Elshami M, Abu Kmeil H, Abu-Jazar M, Mahfouz I, Ashour D, Aljamal A, Mohareb N, Elbalaawi R, Dabbour R, Ghaith J, Hasan T, Abdelati M, Saleh E, Shawwa H, Al-Ghazali R, Obaid O, Albarqouni L, Böttcher B. Breast Cancer Awareness and Barriers to Early Presentation in the Gaza-Strip: A Cross-Sectional Study. J Glob Oncol 2019; 4:1-13. [PMID: 30372400 PMCID: PMC7010447 DOI: 10.1200/jgo.18.00095] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Timely detection of breast cancer (BC) is important to reduce its related deaths. Hence, high awareness of its symptoms and risk factors is required. This study aimed to assess the awareness level of BC among females in Gaza. MATERIALS AND METHODS A cross-sectional study was performed during September and October 2017 in Gaza, Palestine. Stratified sampling was used to recruit patients from four hospitals and seven high schools. The validated Breast Cancer Awareness Measure (BCAM) was used to assess confidence and behavior in relation to breast changes, awareness of BC symptoms and risk factors, barriers to seek medical help, and knowledge of BC screening. Women (age ≥ 18 years) visiting or admitted to any of the four hospitals, and female adolescents (age 15 to 17 years) in any of the seven schools, were recruited for face-to-face interviews to complete the BCAM. RESULTS Of 3,055 women approached, 2,774 participants completed the BCAM questionnaire (response rate, 90.8%); 1,588 (57.2%) were adults, and 1,186 (42.8%) were adolescents. Of these, 1,781 (64.2%) rarely (or never) checked their breasts, and 909 (32.8%) were not confident to notice changes. In total, 1,675 (60.4%) were aware of the availability of BC screening programs. The overall mean ± standard deviation score for awareness of BC symptoms was 5.9 ± 2.9 of 11, and that of risk factors 7.5 ± 3.1 of 16. Feeling scared was the most reported barrier to seeking advice reported among women (n = 802; 50.2%), whereas feeling embarrassed was the most reported in adolescents (n = 745; 62.8%). CONCLUSION Awareness of BC symptoms, risk factors, and screening programs is suboptimal in Gaza. Educational interventions are necessary to increase public awareness of BC and to train local female breast surgeons to address barriers to early detection.
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Affiliation(s)
- Mohamedraed Elshami
- Mohamedraed Elshami, Reem Dabbour, Tayseer Hasan, Esraa Saleh, and Haifa Shawwa, Ministry of Health; Hanan Abu Kmeil, Maymona Abu-Jazar, Ibtisam Mahfouz, Dina Ashour, Ansam Aljamal, Nada Mohareb, Reem Elbalaawi, Meral Abdelati, Reem Al-Ghazali, and Bettina Böttcher, Islamic University of Gaza School of Medicine; Jomana Ghaith, Alazhar University School of Medicine, Gaza, Palestine; and Loai Albarqouni, Centre for Research in Evidence-Based Practice, Bond University, Australia
| | - Hanan Abu Kmeil
- Mohamedraed Elshami, Reem Dabbour, Tayseer Hasan, Esraa Saleh, and Haifa Shawwa, Ministry of Health; Hanan Abu Kmeil, Maymona Abu-Jazar, Ibtisam Mahfouz, Dina Ashour, Ansam Aljamal, Nada Mohareb, Reem Elbalaawi, Meral Abdelati, Reem Al-Ghazali, and Bettina Böttcher, Islamic University of Gaza School of Medicine; Jomana Ghaith, Alazhar University School of Medicine, Gaza, Palestine; and Loai Albarqouni, Centre for Research in Evidence-Based Practice, Bond University, Australia
| | - Maymona Abu-Jazar
- Mohamedraed Elshami, Reem Dabbour, Tayseer Hasan, Esraa Saleh, and Haifa Shawwa, Ministry of Health; Hanan Abu Kmeil, Maymona Abu-Jazar, Ibtisam Mahfouz, Dina Ashour, Ansam Aljamal, Nada Mohareb, Reem Elbalaawi, Meral Abdelati, Reem Al-Ghazali, and Bettina Böttcher, Islamic University of Gaza School of Medicine; Jomana Ghaith, Alazhar University School of Medicine, Gaza, Palestine; and Loai Albarqouni, Centre for Research in Evidence-Based Practice, Bond University, Australia
| | - Ibtisam Mahfouz
- Mohamedraed Elshami, Reem Dabbour, Tayseer Hasan, Esraa Saleh, and Haifa Shawwa, Ministry of Health; Hanan Abu Kmeil, Maymona Abu-Jazar, Ibtisam Mahfouz, Dina Ashour, Ansam Aljamal, Nada Mohareb, Reem Elbalaawi, Meral Abdelati, Reem Al-Ghazali, and Bettina Böttcher, Islamic University of Gaza School of Medicine; Jomana Ghaith, Alazhar University School of Medicine, Gaza, Palestine; and Loai Albarqouni, Centre for Research in Evidence-Based Practice, Bond University, Australia
| | - Dina Ashour
- Mohamedraed Elshami, Reem Dabbour, Tayseer Hasan, Esraa Saleh, and Haifa Shawwa, Ministry of Health; Hanan Abu Kmeil, Maymona Abu-Jazar, Ibtisam Mahfouz, Dina Ashour, Ansam Aljamal, Nada Mohareb, Reem Elbalaawi, Meral Abdelati, Reem Al-Ghazali, and Bettina Böttcher, Islamic University of Gaza School of Medicine; Jomana Ghaith, Alazhar University School of Medicine, Gaza, Palestine; and Loai Albarqouni, Centre for Research in Evidence-Based Practice, Bond University, Australia
| | - Ansam Aljamal
- Mohamedraed Elshami, Reem Dabbour, Tayseer Hasan, Esraa Saleh, and Haifa Shawwa, Ministry of Health; Hanan Abu Kmeil, Maymona Abu-Jazar, Ibtisam Mahfouz, Dina Ashour, Ansam Aljamal, Nada Mohareb, Reem Elbalaawi, Meral Abdelati, Reem Al-Ghazali, and Bettina Böttcher, Islamic University of Gaza School of Medicine; Jomana Ghaith, Alazhar University School of Medicine, Gaza, Palestine; and Loai Albarqouni, Centre for Research in Evidence-Based Practice, Bond University, Australia
| | - Nada Mohareb
- Mohamedraed Elshami, Reem Dabbour, Tayseer Hasan, Esraa Saleh, and Haifa Shawwa, Ministry of Health; Hanan Abu Kmeil, Maymona Abu-Jazar, Ibtisam Mahfouz, Dina Ashour, Ansam Aljamal, Nada Mohareb, Reem Elbalaawi, Meral Abdelati, Reem Al-Ghazali, and Bettina Böttcher, Islamic University of Gaza School of Medicine; Jomana Ghaith, Alazhar University School of Medicine, Gaza, Palestine; and Loai Albarqouni, Centre for Research in Evidence-Based Practice, Bond University, Australia
| | - Reem Elbalaawi
- Mohamedraed Elshami, Reem Dabbour, Tayseer Hasan, Esraa Saleh, and Haifa Shawwa, Ministry of Health; Hanan Abu Kmeil, Maymona Abu-Jazar, Ibtisam Mahfouz, Dina Ashour, Ansam Aljamal, Nada Mohareb, Reem Elbalaawi, Meral Abdelati, Reem Al-Ghazali, and Bettina Böttcher, Islamic University of Gaza School of Medicine; Jomana Ghaith, Alazhar University School of Medicine, Gaza, Palestine; and Loai Albarqouni, Centre for Research in Evidence-Based Practice, Bond University, Australia
| | - Reem Dabbour
- Mohamedraed Elshami, Reem Dabbour, Tayseer Hasan, Esraa Saleh, and Haifa Shawwa, Ministry of Health; Hanan Abu Kmeil, Maymona Abu-Jazar, Ibtisam Mahfouz, Dina Ashour, Ansam Aljamal, Nada Mohareb, Reem Elbalaawi, Meral Abdelati, Reem Al-Ghazali, and Bettina Böttcher, Islamic University of Gaza School of Medicine; Jomana Ghaith, Alazhar University School of Medicine, Gaza, Palestine; and Loai Albarqouni, Centre for Research in Evidence-Based Practice, Bond University, Australia
| | - Jomana Ghaith
- Mohamedraed Elshami, Reem Dabbour, Tayseer Hasan, Esraa Saleh, and Haifa Shawwa, Ministry of Health; Hanan Abu Kmeil, Maymona Abu-Jazar, Ibtisam Mahfouz, Dina Ashour, Ansam Aljamal, Nada Mohareb, Reem Elbalaawi, Meral Abdelati, Reem Al-Ghazali, and Bettina Böttcher, Islamic University of Gaza School of Medicine; Jomana Ghaith, Alazhar University School of Medicine, Gaza, Palestine; and Loai Albarqouni, Centre for Research in Evidence-Based Practice, Bond University, Australia
| | - Tayseer Hasan
- Mohamedraed Elshami, Reem Dabbour, Tayseer Hasan, Esraa Saleh, and Haifa Shawwa, Ministry of Health; Hanan Abu Kmeil, Maymona Abu-Jazar, Ibtisam Mahfouz, Dina Ashour, Ansam Aljamal, Nada Mohareb, Reem Elbalaawi, Meral Abdelati, Reem Al-Ghazali, and Bettina Böttcher, Islamic University of Gaza School of Medicine; Jomana Ghaith, Alazhar University School of Medicine, Gaza, Palestine; and Loai Albarqouni, Centre for Research in Evidence-Based Practice, Bond University, Australia
| | - Meral Abdelati
- Mohamedraed Elshami, Reem Dabbour, Tayseer Hasan, Esraa Saleh, and Haifa Shawwa, Ministry of Health; Hanan Abu Kmeil, Maymona Abu-Jazar, Ibtisam Mahfouz, Dina Ashour, Ansam Aljamal, Nada Mohareb, Reem Elbalaawi, Meral Abdelati, Reem Al-Ghazali, and Bettina Böttcher, Islamic University of Gaza School of Medicine; Jomana Ghaith, Alazhar University School of Medicine, Gaza, Palestine; and Loai Albarqouni, Centre for Research in Evidence-Based Practice, Bond University, Australia
| | - Esraa Saleh
- Mohamedraed Elshami, Reem Dabbour, Tayseer Hasan, Esraa Saleh, and Haifa Shawwa, Ministry of Health; Hanan Abu Kmeil, Maymona Abu-Jazar, Ibtisam Mahfouz, Dina Ashour, Ansam Aljamal, Nada Mohareb, Reem Elbalaawi, Meral Abdelati, Reem Al-Ghazali, and Bettina Böttcher, Islamic University of Gaza School of Medicine; Jomana Ghaith, Alazhar University School of Medicine, Gaza, Palestine; and Loai Albarqouni, Centre for Research in Evidence-Based Practice, Bond University, Australia
| | - Haifa Shawwa
- Mohamedraed Elshami, Reem Dabbour, Tayseer Hasan, Esraa Saleh, and Haifa Shawwa, Ministry of Health; Hanan Abu Kmeil, Maymona Abu-Jazar, Ibtisam Mahfouz, Dina Ashour, Ansam Aljamal, Nada Mohareb, Reem Elbalaawi, Meral Abdelati, Reem Al-Ghazali, and Bettina Böttcher, Islamic University of Gaza School of Medicine; Jomana Ghaith, Alazhar University School of Medicine, Gaza, Palestine; and Loai Albarqouni, Centre for Research in Evidence-Based Practice, Bond University, Australia
| | - Reem Al-Ghazali
- Mohamedraed Elshami, Reem Dabbour, Tayseer Hasan, Esraa Saleh, and Haifa Shawwa, Ministry of Health; Hanan Abu Kmeil, Maymona Abu-Jazar, Ibtisam Mahfouz, Dina Ashour, Ansam Aljamal, Nada Mohareb, Reem Elbalaawi, Meral Abdelati, Reem Al-Ghazali, and Bettina Böttcher, Islamic University of Gaza School of Medicine; Jomana Ghaith, Alazhar University School of Medicine, Gaza, Palestine; and Loai Albarqouni, Centre for Research in Evidence-Based Practice, Bond University, Australia
| | - Ola Obaid
- Mohamedraed Elshami, Reem Dabbour, Tayseer Hasan, Esraa Saleh, and Haifa Shawwa, Ministry of Health; Hanan Abu Kmeil, Maymona Abu-Jazar, Ibtisam Mahfouz, Dina Ashour, Ansam Aljamal, Nada Mohareb, Reem Elbalaawi, Meral Abdelati, Reem Al-Ghazali, and Bettina Böttcher, Islamic University of Gaza School of Medicine; Jomana Ghaith, Alazhar University School of Medicine, Gaza, Palestine; and Loai Albarqouni, Centre for Research in Evidence-Based Practice, Bond University, Australia
| | - Loai Albarqouni
- Mohamedraed Elshami, Reem Dabbour, Tayseer Hasan, Esraa Saleh, and Haifa Shawwa, Ministry of Health; Hanan Abu Kmeil, Maymona Abu-Jazar, Ibtisam Mahfouz, Dina Ashour, Ansam Aljamal, Nada Mohareb, Reem Elbalaawi, Meral Abdelati, Reem Al-Ghazali, and Bettina Böttcher, Islamic University of Gaza School of Medicine; Jomana Ghaith, Alazhar University School of Medicine, Gaza, Palestine; and Loai Albarqouni, Centre for Research in Evidence-Based Practice, Bond University, Australia
| | - Bettina Böttcher
- Mohamedraed Elshami, Reem Dabbour, Tayseer Hasan, Esraa Saleh, and Haifa Shawwa, Ministry of Health; Hanan Abu Kmeil, Maymona Abu-Jazar, Ibtisam Mahfouz, Dina Ashour, Ansam Aljamal, Nada Mohareb, Reem Elbalaawi, Meral Abdelati, Reem Al-Ghazali, and Bettina Böttcher, Islamic University of Gaza School of Medicine; Jomana Ghaith, Alazhar University School of Medicine, Gaza, Palestine; and Loai Albarqouni, Centre for Research in Evidence-Based Practice, Bond University, Australia
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Scheel JR, Parker S, Hippe DS, Patrick DL, Nakigudde G, Anderson BO, Gralow JR, Thompson B, Molina Y. Role of Family Obligation Stress on Ugandan Women's Participation in Preventive Breast Health. Oncologist 2019; 24:624-631. [PMID: 30072390 PMCID: PMC6516124 DOI: 10.1634/theoncologist.2017-0553] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 05/08/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The purpose of this study is to determine the role of family obligation stress on Ugandan women's participation in preventive breast health through the receipt of breast cancer education and health check-ups. MATERIALS AND METHODS A validated survey was conducted on a community sample of Ugandan women, providing a multi-item scale to assess preventive breast-health-seeking behaviors and measure family obligation stress (FO; range 6-18). Univariate and multivariate linear regression was used to assess associations between sociodemographic factors and FO. Univariate and multivariate linear regression (used in conjunction with the robust sandwich estimator for standard errors) and probability differences (PDs) were used to evaluate associations between preventive breast-health-seeking behaviors, sociodemographic factors, and FO. RESULTS A total of 401 Ugandan women ages 25-74 participated in the survey. Most had three or more children in the home (60%) and were employed full time (69%). Higher FO was associated with increasing number of children and/or adults in the household (p < .05), full-time employment (p < .001), and being single (p = .003). Women with higher FO were less likely to participate in breast cancer education (PD = -0.02 per 1-point increase, p = .008) and preventive health check-ups (PD = -0.02, p = .018), associations that persisted on multivariate analysis controlling for sociodemographic factors. CONCLUSION Ugandan women with high FO are less likely to participate in preventive breast cancer detection efforts including breast cancer education and preventive health check-ups. Special efforts should be made to reach women with elevated FO, because it may be a risk factor for late-stage presentation among women who develop breast cancer. IMPLICATIONS FOR PRACTICE High family obligation stress (FO) significantly reduces women's participation in preventive health check-ups and breast cancer education. These findings support research in U.S. Latinas showing high FO negatively affects women's health, suggesting that FO is an important factor in women's health-seeking behavior in other cultures. Addressing family obligation stress by including family members involved in decision-making is essential for improving breast cancer outcomes in low- and middle-income countries, such as Uganda.
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Affiliation(s)
- John R Scheel
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Radiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Seattle Cancer Care Alliance, Seattle, Washington, USA
| | - Scott Parker
- Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Donald L Patrick
- School of Public Health, University of Washington, Seattle, Washington, USA
| | | | - Benjamin O Anderson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Surgery, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Seattle Cancer Care Alliance, Seattle, Washington, USA
| | - Julie R Gralow
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Medical Oncology, University of Washington, Seattle, Washington, USA
- Seattle Cancer Care Alliance, Seattle, Washington, USA
| | - Beti Thompson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Yamile Molina
- Community Health Sciences Division, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
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104
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Assessing Breast Cancer Knowledge Among Iranian Physicians. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2019. [DOI: 10.5812/ijcm.85822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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105
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The effect of metformin on biomarkers associated with breast cancer outcomes: a systematic review, meta-analysis, and dose-response of randomized clinical trials. Clin Transl Oncol 2019; 22:37-49. [PMID: 31006835 DOI: 10.1007/s12094-019-02108-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/01/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE Breast cancer is a leading cause of cancer mortality in developed countries. We performed a meta-analysis of randomized clinical trials to investigate the effect of metformin on biomarkers associated with breast cancer outcomes and to explore the dose-response relationship. METHODS A systematic search was performed from onset of the database to January 2019 in MEDLINE/PubMed, SCOPUS, and Cochrane library to identify randomized clinical trials investigating the impact of metformin on insulin, glucose, CRP, leptin, body mass indices (BMI), cholesterol, Ki-67, and Homeostatic Model Assessment for Insulin-Resistance (HOMA-IR). Effect sizes were expressed as weighted mean difference (WMD) and 95% confidence intervals (CI) using a random-effects models. RESULTS Nine studies providing 1,363 participants were included in the meta-analysis. Pooled results showed a significant reduction in insulin (WMD: - 0.99 U/ml, 95% CI - 1.66, - 0.33), glucose (WMD: - 1.78 ml/dl, 95% CI - 2.96, - 0.60), CRP (WMD: - 0.60 mg/l, 95% CI - 0.88, - 0.33), HOMA-IR (WMD: - 0.45, 95% CI - 0.77, - 0.11), leptin (WMD: - 2.44 ng/ml, 95% CI - 3.28, - 1.61), BMI (WMD: - 0.55 kg/m2, 95% CI - 1.00, - 0.11), and Ki-67 (WMD: - 4.06, 95% CI - 7.59, - 0.54). Results of the subgroup analyses showed that insulin, glucose, and BMI decreased more significantly when the duration of administering metformin intervention was above 4 weeks. We did not observe non-linear changes in the dose-response relationship between metformin and biomarkers as outcomes. CONCLUSIONS Breast cancer patients receiving metformin as treatment for diabetes showed significant reduction in levels of insulin, fasting glucose, CRP, HOMA, leptin, BMI, and Ki-67.
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Vayr F, Montastruc M, Savall F, Despas F, Judic E, Basso M, Dunet C, Dalenc F, Laurent G, Soulat JM, Herin F. Work adjustments and employment among breast cancer survivors: a French prospective study. Support Care Cancer 2019; 28:185-192. [PMID: 31001691 DOI: 10.1007/s00520-019-04799-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 04/02/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE The objective of our study was to assess the rate of work adjustments 1 year after the diagnosis in a population of female breast cancer (BC) survivors, in the context of the French system of social protection. We also characterised these adjustments and their influence on the reduction of professional exclusion of patients 1 year after the diagnosis. METHODS This observational, prospective study was conducted from February 2015 to April 2016 among female patients with BC. Inclusion criteria were women aged between 18 and 65 years, treated for BC and integrated into the labour market at the time of diagnosis (working or on sick leave). Exclusion criteria were metastatic BC, retired patients and refusal to participate. A 1-year follow-up was scheduled, and data collection was performed with questionnaires. RESULTS In total, 213 patients were included between February 2015 and April 2016. One year after the diagnosis (T1), among 185 BC survivors, 78 (42.2%) patients were working. Among them, 13 patients did not interrupt their occupational activity and 65 returned to work after a period of sick leave. Sixty-four patients returned to work after the end of chemotherapy (after 6 months), and one returned to work before this therapeutic threshold. Sixty-six patients (35.7%) benefited from at least one adjustment of their work conditions to facilitate their return to work (RTW) or maintenance at work: working hours were decreased for 43 patients, and workstation changes were performed for 22 patients. An occupational health physician was involved for some patients; work adjustments were prescribed to 42 patients, 7 patients had medical restrictions for physical reasons and 4 patients had restrictions for psychological reasons. Forty-three patients benefited from part-time work prescribed for therapeutic reasons. CONCLUSIONS Referral to occupational health physicians and work adjustments remain limited in the process of RTW or maintenance at work after BC in France, despite their positive impact.
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Affiliation(s)
- Flora Vayr
- Service des Maladies Professionnelles et Environnementales, CHU Toulouse, F-31000, Toulouse, France
| | - Marion Montastruc
- Service d'Oncologie, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole, F-31000, Toulouse, France
| | - Frédéric Savall
- Service de Médecine Légale, CHU Toulouse, F-31000, Toulouse, France.,Laboratoire d'Anthropologie Moléculaire et Imagerie de Synthèse, CNRS, UMR 5288, Université de Toulouse III, F-31000, Toulouse, France
| | - Fabien Despas
- Service de Pharmacologie Médicale et Clinique, CHU Toulouse, F-31000, Toulouse, France.,Laboratoire de Pharmacologie Médicale et Clinique, Faculté de Médecine, Université Paul Sabatier, F-31000, Toulouse, France.,INSERM UMR 1027, Université de Toulouse III, F-31000, Toulouse, France.,CIC INSERM 1436, Université et CHU Toulouse, F-31000, Toulouse, France
| | - Elodie Judic
- Service des Maladies Professionnelles et Environnementales, CHU Toulouse, F-31000, Toulouse, France
| | - Maud Basso
- Département de la Recherche et de l'Innovation, CHU Toulouse, F-31000, Toulouse, France
| | - Charlotte Dunet
- Département de la Recherche et de l'Innovation, CHU Toulouse, F-31000, Toulouse, France
| | - Florence Dalenc
- Service d'Oncologie, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole, F-31000, Toulouse, France
| | - Guy Laurent
- INSERM UMR 1027, Université de Toulouse III, F-31000, Toulouse, France.,Service d'Hématologie, CHU Toulouse, Institut Universitaire du Cancer de Toulouse - Oncopole, F-31000, Toulouse, France
| | - Jean Marc Soulat
- Service des Maladies Professionnelles et Environnementales, CHU Toulouse, F-31000, Toulouse, France.,INSERM UMR 1027, Université de Toulouse III, F-31000, Toulouse, France
| | - Fabrice Herin
- Service des Maladies Professionnelles et Environnementales, CHU Toulouse, F-31000, Toulouse, France. .,INSERM UMR 1027, Université de Toulouse III, F-31000, Toulouse, France.
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Mainwaring W, Bowers J, Pham N, Pezzi T, Shukla M, Bonnen M, Ludwig M. Stereotactic Radiosurgery Versus Whole Brain Radiation Therapy: A Propensity Score Analysis and Predictors of Care for Patients With Brain Metastases From Breast Cancer. Clin Breast Cancer 2019; 19:e343-e351. [DOI: 10.1016/j.clbc.2018.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/04/2018] [Accepted: 11/02/2018] [Indexed: 10/27/2022]
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108
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Darwito D, Dharmana E, Riwanto I, Budijitno S, Suwardjo S, Purnomo J, Widodo I, Ghozali A, Aryandono T, Anwar SL. Effects of Omega-3 Supplementation on Ki-67 and VEGF Expression Levels and Clinical Outcomes of Locally Advanced
Breast Cancer Patients Treated with Neoadjuvant CAF Chemotherapy: A Randomized Controlled Trial Report. Asian Pac J Cancer Prev 2019; 20:911-916. [PMID: 30912414 PMCID: PMC6825781 DOI: 10.31557/apjcp.2019.20.3.911] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 02/22/2019] [Indexed: 01/09/2023] Open
Abstract
Background: Omega-3 is a polyunsaturated fatty acid with an ability to regulate cell proliferation and apoptosis through interaction with inflammatory mediators. The potential additional beneficial effects of Omega-3 on chemotherapy patients with breast cancer is not yet completely revealed. Methods: A double-blind randomized control trial (RCT) involving a total of 48 locally advanced breast cancer patients was conducted. Ki-67 and VEGF expressions, as well as overall survival of patients receiving neoadjuvant cyclophosphamide-doxorubicin-5’fluorouracyl (CAF) chemotherapy plus Omega-3 (intervention group) or placebo (control group), were compared. Kaplan-Meier curve and Cox-regression tests were used to assess conditional disease-free survival (DFS) and overall survival (OS) between the two groups. Results: Decreased Ki-67 expression was observed in the intervention group compared to control (42.4±4.8 versus 39.2±5.3; T-test p=0.032). Decreased Ki-67 expression was observed in intervention compared to control group (42.4±4.8 versus 39.2±5.3; T-test p=0.032). Decreased VEGF expression was also seen in the intervention group compared to control (32.7±5.2 versus 29.5±5.4; T-test p=0.041). VEGF expression positively correlated with Ki-67 expression (Spearman’s test p<0.001, R2=0.541). Overall survival in the intervention group was significantly longer in comparison to the control group (mean survival: 30.9 ± 3.71 versus 25.9 ± 3.6 weeks, Mantel-Cox test p=0.048; HR=0.411, 95%CI: 0.201-0.840). Disease-free survival was significantly longer in the intervention group compared to the control group (mean survival: 28.5 ± 3.3 versus 23.7 ± 3.6, respectively; Mantel-Cox test p=0.044, HR= 0.439, 95%CI: 0.222-0.869). Conclusion: Omega-3 fatty acid supplementation improved overall survival and progression-free survival of locally advanced breast cancer treated with CAF neoadjuvant chemotherapy and mastectomy.
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Affiliation(s)
- Darwito Darwito
- Department of Surgery, Dr. Kariadi Hospital, Faculty of Medicine, University Diponegoro, Semarang, Indonesia
- Division of Surgical Oncology, Department of Surgery, Dr. Sardjito Hospital, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Edi Dharmana
- Graduate School in Medicine and Health, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
| | - Ignatius Riwanto
- Division of Surgical Oncology, Department of Surgery, Dr. Sardjito Hospital, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Selamat Budijitno
- Department of Surgery, Dr. Kariadi Hospital, Faculty of Medicine, University Diponegoro, Semarang, Indonesia
| | - Suwardjo Suwardjo
- Division of Surgical Oncology, Department of Surgery, Dr. Sardjito Hospital, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Joko Purnomo
- Department of Surgery, Dr. Moewardi Hospital, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Irianiwati Widodo
- Department of Anatomical Pathology, Dr. Sardjito Hospital, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ahmad Ghozali
- Department of Anatomical Pathology, Dr. Sardjito Hospital, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Teguh Aryandono
- Division of Surgical Oncology, Department of Surgery, Dr. Sardjito Hospital, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Sumadi Lukman Anwar
- Division of Surgical Oncology, Department of Surgery, Dr. Sardjito Hospital, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
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Madkhali NA, Santin O, Noble H, Reid J. Breast health awareness in an Arabic culture: A qualitative exploration. J Adv Nurs 2019; 75:1713-1722. [PMID: 30895639 DOI: 10.1111/jan.14003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/27/2018] [Accepted: 02/12/2019] [Indexed: 11/29/2022]
Abstract
AIMS To explore breast health awareness and the early diagnosis and detection methods of breast cancer from the perspective of women and primary healthcare providers in Saudi Arabia. BACKGROUND A high incidence of advanced breast cancer exists in Saudi Arabia, particularly among younger women. This is due to poor awareness of breast cancer and its management, social customs and poor breast health awareness among healthcare providers. DESIGN Qualitative exploratory study. METHODS This qualitative study was conducted in eight states across the Jizan region of Saudi Arabia. Purposive sampling was used to recruit Saudi women (N = 24), general practitioners (N = 20), and nurses (N = 20). Semi-structured interviews were conducted from November 2015-February 2016. Inductive thematic analysis was undertaken. RESULTS Overarching themes centred on culture, religion, and resources. Novel key findings from this study confirm that Saudi women require more health education about breast cancer and breast cancer screening. The study has provided important new knowledge in relation to Islamic concept of preserving health, social barriers, cultural taboos, misconceptions, and myths that currently exist surrounding breast cancer in Saudi Arabia. CONCLUSION This study provides new evidence on the complexity of poor breast health awareness and lack of resources in Saudi Arabia. Additional resources are needed to remove such barriers and provide targeted health education and services. IMPACT This research informs breast cancer service provision for Muslim or Arab women internationally as they share cultural resources or Islamic principles to follow a healthy lifestyle and help promote the uptake of breast cancer screening services.
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Affiliation(s)
| | - Olinda Santin
- School of Nursing and Midwifery, Queens University Belfast, Belfast, UK
| | - Helen Noble
- School of Nursing and Midwifery, Queens University Belfast, Belfast, UK
| | - Joanne Reid
- School of Nursing and Midwifery, Queens University Belfast, Belfast, UK
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Furtado KS, Budd EL, Armstrong R, Pettman T, Reis R, Sung-Chan P, Wang Z, Brownson RC. A cross-country study of mis-implementation in public health practice. BMC Public Health 2019; 19:270. [PMID: 30841888 PMCID: PMC6404329 DOI: 10.1186/s12889-019-6591-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 02/25/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Mis-implementation (i.e., the premature termination or inappropriate continuation of public health programs) contributes to the misallocation of limited public health resources and the sub-optimal response to the growing global burden of chronic disease. This study seeks to describe the occurrence of mis-implementation in four countries of differing sizes, wealth, and experience with evidence-based chronic disease prevention (EBCDP). METHODS A cross-sectional study of 400 local public health practitioners in Australia, Brazil, China, and the United States was conducted from November 2015 to April 2016. Online survey questions focused on how often mis-termination and mis-continuation occur and the most common reasons programs end and continue. RESULTS We found significant differences in knowledge of EBCDP across countries with upwards of 75% of participants from Australia (n = 91/121) and the United States (n = 83/101) reporting being moderately to extremely knowledgeable compared with roughly 60% (n = 47/76) from Brazil and 20% (n = 21/102) from China (p < 0.05). Far greater proportions of participants from China thought effective programs were never mis-terminated (12.2% (n = 12/102) vs. 1% (n = 2/121) in Australia, 2.6% (n = 2/76) in Brazil, and 1.0% (n = 1/101) in the United States; p < 0.05) or were unable to estimate how frequently this happened (45.9% (n = 47/102) vs. 7.1% (n = 7/101) in the United States, 10.5% (n = 8/76) in Brazil, and 1.7% (n = 2/121) in Australia; p < 0.05). The plurality of participants from Australia (58.0%, n = 70/121) and the United States (36.8%, n = 37/101) reported that programs often mis-continued whereas most participants from Brazil (60.5%, n = 46/76) and one third (n = 37/102) of participants from China believed this happened only sometimes (p < 0.05). The availability of funding and support from political authorities, agency leadership, and the general public were common reasons programs continued and ended across all countries. A program's effectiveness or evidence-base-or lack thereof-were rarely reasons for program continuation and termination. CONCLUSIONS Decisions about continuing or ending a program were often seen as a function of program popularity and funding availability as opposed to effectiveness. Policies and practices pertaining to programmatic decision-making should be improved in light of these findings. Future studies are needed to understand and minimize the individual, organizational, and political-level drivers of mis-implementation.
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Affiliation(s)
- Karishma S. Furtado
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Dr., Campus Box 1196, St. Louis, MO 63130 USA
| | | | - Rebecca Armstrong
- Melbourne School of Population and Global Health, The University of Melbourne, Victoria, 3010 Australia
| | - Tahna Pettman
- Melbourne School of Population and Global Health, The University of Melbourne, Victoria, 3010 Australia
| | - Rodrigo Reis
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Dr., Campus Box 1196, St. Louis, MO 63130 USA
| | - Pauline Sung-Chan
- Hong Kong University of Science & Technology, Clear Water Bay, Kowloon, Hong Kong
| | | | - Ross C. Brownson
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Dr., Campus Box 1196, St. Louis, MO 63130 USA
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine; Washington University in St. Louis, St. Louis, MO 63130 USA
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Soto-Perez-de-Celis E. Global geriatric oncology: One size does not fit all. J Geriatr Oncol 2019; 10:199-201. [DOI: 10.1016/j.jgo.2018.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 11/20/2018] [Indexed: 12/13/2022]
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Birnbaum JK, Duggan C, Anderson BO, Etzioni R. Early detection and treatment strategies for breast cancer in low-income and upper middle-income countries: a modelling study. LANCET GLOBAL HEALTH 2019; 6:e885-e893. [PMID: 30012269 DOI: 10.1016/s2214-109x(18)30257-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 04/23/2018] [Accepted: 05/04/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Poor breast cancer survival in low-income and middle-income countries (LMICs) can be attributed to advanced-stage presentation and poor access to systemic therapy. We aimed to estimate the outcomes of different early detection strategies in combination with systemic chemotherapy and endocrine therapy in LMICs. METHODS We adapted a microsimulation model to project outcomes of three early detection strategies alone or in combination with three systemic treatment programmes beyond standard of care (programme A): programme B was endocrine therapy for all oestrogen-receptor (ER)-positive cases; programme C was programme B plus chemotherapy for ER-negative cases; programme D was programme C plus chemotherapy for advanced ER-positive cases. The main outcomes were reductions in breast cancer-related mortality and lives saved per 100 000 women relative to the standard of care for women aged 30-49 years in a low-income setting (East Africa; using incidence data and life tables from Uganda and data on tumour characteristics from various East African countries) and for women aged 50-69 years in a middle-income setting (Colombia). FINDINGS In the East African setting, relative mortality reductions were 8-41%, corresponding to 23 (95% uncertainty interval -12 to 49) to 114 (80 to 138) lives saved per 100 000 women over 10 years. In Colombia, mortality reductions were 7-25%, corresponding to 32 (-29 to 70) to 105 (61 to 141) lives saved per 100 000 women over 10 years. INTERPRETATION The best projected outcomes were in settings where access to both early detection and adjuvant therapy is improved. Even in the absence of mammographic screening, improvements in detection can provide substantial benefit in settings where advanced-stage presentation is common. FUNDING Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium Cancer Center Support Grant of the US National Institutes of Health.
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Affiliation(s)
- Jeanette K Birnbaum
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Catherine Duggan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Benjamin O Anderson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Surgery, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Ruth Etzioni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Statistics, University of Washington, Seattle, WA, USA.
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Liu PL, Yeo TED. Breast health, risk factors, and cancer screening among lesbian, bisexual, and queer/questioning women in China. Health Care Women Int 2019; 42:947-961. [PMID: 30730783 DOI: 10.1080/07399332.2019.1571062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In this study, we examine the health disparities of sexual minority women by surveying 310 lesbian, bisexual, and queer/questioning women (LBQW) in China about their breast health and cancer screening practices. We found that Chinese LBQW, particularly those identified with a masculine gender role and practice chest binding, are vulnerable to breast cancer given their high rates of behavioral risk factors (e.g., cigarette smoking) and symptoms (e.g., breast lumps) but low rates of self and clinical breast examinations. Salient barrier (stigma) and facilitators (social support availability, self-efficacy, and breast cancer information exposure) of breast cancer screening were also identified.
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Affiliation(s)
- Piper Liping Liu
- School of Communication, Hong Kong Baptist University, Hong Kong
| | - Tien Ee Dominic Yeo
- Department of Communication Studies, Hong Kong Baptist University, Hong Kong
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Jenkins C, Ngan TT, Ngoc NB, Phuong TB, Lohfeld L, Donnelly M, Van Minh H, Murray L. Strengthening breast cancer services in Vietnam: a mixed-methods study. Glob Health Res Policy 2019; 4:2. [PMID: 30723793 PMCID: PMC6352367 DOI: 10.1186/s41256-019-0093-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 01/13/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Incidence of breast cancer has increased in Vietnam over the past two decades, but little data exists to inform policy and planning. This study examined the organisation and delivery of breast cancer services in Vietnam in order to address the lack of data on detection, diagnosis and treatment. METHODS We gathered quantitative and qualitative data using an adapted survey-based Service Availability and Readiness Assessment (SARA) tool and semi-structured interviews from healthcare providers in 69 healthcare facilities about the experience and challenges of delivering breast cancer services. We conducted our study across four levels of the health system in three provinces in Vietnam. RESULTS The analysis of our data show that a number of areas require strengthening particularly in relation to service availability and service readiness. Firstly, healthcare providers across all levels of the health system reported that service provision was constrained by a lack of resources both in relation to health infrastructure and training for healthcare providers. Secondly, access to timely diagnosis and treatment is limited due to services only being available at the top two levels of the health system. Women living outside the immediate vicinity of such facilities tend to find access more costly and time-consuming, and there is a need to investigate the social, economic, geographic and cultural barriers that may prevent women from accessing services. CONCLUSIONS Our study suggests that there is a need to strengthen lower levels of the Vietnamese health system in relation to the detection of breast cancer. Provision of some services such as clinical breast examination, advice on self-examination, and conducting ultrasound tests (supported with appropriate training and capacity-building of healthcare providers) at commune and district levels of the health system may reduce the overcrowding and service-delivery burden experienced in provincial and national-level hospitals. Empowering lower levels of the health system to conduct breast cancer screening, which is currently undertaken on an ad hoc basis through higher-level facilities, is likely to improve access to services for women.
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Affiliation(s)
- Chris Jenkins
- Centre for Public Health, Queen’s University Belfast, Royal Victoria Hospital Site, Institute of Clinical Sciences Block B, Grosvenor Road, Belfast, BT12 6BJ UK
| | - Tran Thu Ngan
- Centre for Population Sciences, Hanoi University of Public Health, Hanoi, Vietnam
| | - Nguyen Bao Ngoc
- Centre for Population Sciences, Hanoi University of Public Health, Hanoi, Vietnam
| | - Tran Bich Phuong
- Centre for Population Sciences, Hanoi University of Public Health, Hanoi, Vietnam
| | - Lynne Lohfeld
- Centre for Public Health, Queen’s University Belfast, Royal Victoria Hospital Site, Institute of Clinical Sciences Block B, Grosvenor Road, Belfast, BT12 6BJ UK
| | - Michael Donnelly
- Centre for Public Health, Queen’s University Belfast, Royal Victoria Hospital Site, Institute of Clinical Sciences Block B, Grosvenor Road, Belfast, BT12 6BJ UK
| | - Hoang Van Minh
- Centre for Population Sciences, Hanoi University of Public Health, Hanoi, Vietnam
| | - Liam Murray
- Centre for Public Health, Queen’s University Belfast, Royal Victoria Hospital Site, Institute of Clinical Sciences Block B, Grosvenor Road, Belfast, BT12 6BJ UK
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Risk of cardiotoxicity induced by adjuvant anthracycline-based chemotherapy and radiotherapy in young and old Asian women with breast cancer. Strahlenther Onkol 2019; 195:629-639. [PMID: 30690687 DOI: 10.1007/s00066-019-01428-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 12/24/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE The risk of cardiotoxicity induced by adjuvant anthracycline-based chemotherapy (CT) and radiotherapy (RT) is yet to be investigated in a large-scale randomized controlled trial with an adequate sample size of young and old women with breast cancer. PATIENTS AND METHODS To compare the occurrence of major heart events (heart failure and coronary artery disease) in patients with breast cancer, 3489 women who underwent surgical resection of the breast tumor were retrospectively selected from the Taiwan National Health Insurance Research Database. The patients were categorized into the following groups based on their treatment modalities: group 1 (n = 1113), no treatment; group 2 (n = 646), adjuvant RT alone; group 3 (n = 705), adjuvant anthracycline-based CT alone; and group 4 (n = 1025), combined adjuvant RT and anthracycline-based CT. RESULTS The mean patient age was 50.35 years. Subsequent coronary artery disease and heart failure were identified in 244 (7.0%) and 206 (5.9%) patients, respectively. All three adjuvant therapies were significant independent prognostic factors of major heart events (adjusted hazard ratio [95% confidence interval]: 1.47 [1.24-1.73]; 1.48 [1.25-1.75], and 1.92 [1.65-2.23] in groups 2, 3, and 4, respectively). In patients aged ≥50 years with breast cancer who underwent surgery, the log-rank p values of groups 2 and 3 after adjustment were 0.537 and 0.001, respectively. CONCLUSION Adjuvant RT can increase cardiotoxicity in patients with breast cancer, particularly when used in combination with anthracycline-based CT. Therefore, it should be offered with optimal heart-sparing techniques, particularly in younger patients with good prognosis and long life expectancy.
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Bademler S, Zirtiloglu A, Sari M, Ucuncu MZ, Dogru EB, Karabulut S. Clinical Significance of Serum Membrane-Bound Mucin-2 Levels in Breast Cancer. Biomolecules 2019; 9:biom9020040. [PMID: 30682816 PMCID: PMC6406351 DOI: 10.3390/biom9020040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 01/17/2019] [Accepted: 01/18/2019] [Indexed: 12/31/2022] Open
Abstract
This study was conducted to investigate the serum levels of membrane-bound mucin 2 (MUC2) in breast cancer (BC) patients and the relationship with tumour progression and known prognostic parameters. We enrolled 127 female patients with histopathologically diagnosed BC who did not receive chemotherapy (CT) or radiotherapy. Serum MUC2 levels were measured by the enzyme-linked immunosorbent assay (ELISA) method and compared with those of 40 age and sex-matched healthy controls. Median age of diagnosis was 50 (range: 26–78). Twenty-eight (22%) patients were metastatic and the most frequent site of metastasis was bone (n = 17, 61%). The median serum MUC2 level of BC patients was significantly higher than that of the controls (198 vs. 54 ng/mL, p < 0.001). There was no significant difference between patients and controls according to known disease-related clinicopathological or laboratory parameters (p > 0.05). Serum MUC2 levels were not associated with survival (p = 0.65). Although serum MUC2 levels might have a diagnostic role, their predictive and prognostic role in survival in BC patients was not detected. Serum levels of MUC2 should be investigated for diagnostic or screening purposes on a larger scale.
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Affiliation(s)
- Suleyman Bademler
- Department of Surgery, Institute of Oncology, Istanbul University, 34093 Istanbul, Turkey.
| | - Alisan Zirtiloglu
- Department of Medical Oncology, Bakırkoy Dr Sadi Konuk Education and Research Hospital, 34147 Istanbul, Turkey.
| | - Murat Sari
- Department of Medical Oncology, Institute of Oncology, Istanbul University, 34093 Istanbul, Turkey.
| | - Muhammed Zubeyr Ucuncu
- Department of Health Science Institute, Istanbul Gelisim University, 34310 Istanbul, Turkey.
| | - Elif Bilgin Dogru
- Department of Basic Oncology, Institute of Oncology, Istanbul University, 34093 Istanbul, Turkey.
| | - Senem Karabulut
- Department of Medical Oncology, Institute of Oncology, Istanbul University, 34093 Istanbul, Turkey.
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Caglevic C, Anabalón J, Soza C, Milla E, Gaete F, Carrasco AM, Panay S, Gallardo C, Mahave M. Triple-negative breast cancer: the reality in Chile and in Latin America. Ecancermedicalscience 2019; 13:893. [PMID: 30792810 PMCID: PMC6372297 DOI: 10.3332/ecancer.2019.893] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Indexed: 12/21/2022] Open
Abstract
Breast cancer is the leading cause of cancer death among women worldwide. While triple-negative breast cancer is less common among various sub-types of breast cancer, it tends to affect younger women and is more aggressive, having a higher rate of early recurrence and mortality compared to other sub-types. We know about the association between triple-negative breast cancer and BRCA mutations, which are highly prevalent in founding populations of European origin, but the true prevalence of these mutations in Latin American populations is unknown. There is also very little information about the demographic and epidemiological aspects of triple-negative breast cancer in Latin America, which we will try to summarise in this article. In addition, we will try to provide a brief introduction to the most common recommendations for treating this histological class in Latin America.
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Affiliation(s)
- Christian Caglevic
- Medical Oncology Department, Clinica Alemana Santiago; Faculty of Medicine, Universidad del Desarrollo, Santiago 456, Chile
| | - Jaime Anabalón
- Oncology Institute Arturo López Pérez Foundation, Santiago 878, Chile
| | - Cristian Soza
- School of Biochemistry, Faculty of Science, San Sebastián University, Santiago 1457, Chile.,Oncoloop Foundation, Faculty of Medicine, Andrés Bello University, Santiago 890, Chile
| | - Elizabeth Milla
- Oncology Institute Arturo López Pérez Foundation, Santiago 878, Chile
| | - Fancy Gaete
- Hospital Santiago Oriente Dr Luis Tisné, Santiago 5150, Chile
| | | | - Sergio Panay
- Oncology Institute Arturo López Pérez Foundation, Santiago 878, Chile
| | - Carlos Gallardo
- Oncology Institute Arturo López Pérez Foundation, Santiago 878, Chile
| | - Mauricio Mahave
- Oncology Institute Arturo López Pérez Foundation, Santiago 878, Chile
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Olasehinde O, Alatise OI, Arowolo OA, Mango VL, Olajide OS, Omisore AD, Boutin-Foster C, Kingham TP. Barriers to mammography screening in Nigeria: A survey of two communities with different access to screening facilities. Eur J Cancer Care (Engl) 2019; 28:e12986. [PMID: 30614109 DOI: 10.1111/ecc.12986] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 10/16/2018] [Accepted: 12/11/2018] [Indexed: 11/27/2022]
Abstract
Delayed presentation of breast cancer is a common theme in most low- and middle-income countries. This study evaluates barriers to mammography screening in two Nigerian communities with different geographic access to screening facilities. A 35 item questionnaire was administered to women, 40 years and older, 1,169 (52.6%) in Ife Central Local Government where mammography services are offered and 1,053 (47.4%) in Iwo Local Government where there are no mammography units. Information on breast cancer screening practices and barriers to mammography screening were compared between the two communities. Most women had heard of breast cancer (Ife 94%, Iwo 97%), but few were aware of mammography (Ife 11.8%, Iwo 11.4%). Mammography uptake in Ife Central was 2.8% and 1.8% in Iwo, despite the former offering mammography services. Knowledge and practice of mammography were not statistically different between the two communities (p = 0.74, 0.1). Lack of awareness was the commonest reason cited for not having mammography in both communities. Others include lack of perceived need and cost. Awareness creation to ensure optimal utilisation of existing facilities, as well as innovative measures to address the barrier of cost, is required to improve breast cancer screening uptake in Nigeria.
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Affiliation(s)
| | | | | | - Victoria L Mango
- Department of Radiology, Memorial Sloan-Kettering Cancer center, New York, New York
| | | | - Adeleye D Omisore
- Department of Radiology, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - Thomas P Kingham
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
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Azemfac K, Christie SA, Carvalho MM, Nana T, Fonje AN, Halle-Ekane G, Dicker R, Chichom-Mefire A, Juillard C. A Community-Based Assessment of Knowledge and Practice of Breast Self-Examination and Prevalence of Breast Disease in Southwest Cameroon. J Cancer Epidemiol 2019; 2019:2928901. [PMID: 30713554 PMCID: PMC6333001 DOI: 10.1155/2019/2928901] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/15/2018] [Accepted: 12/05/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Despite the rising trend in breast cancer incidence and mortality across Sub-Saharan Africa, there remains a critical knowledge gap about the burden and patterns of breast disease and breast cancer screening practices at the population level. This study aimed to identify socioeconomic factors associated with knowledge and practice of breast self-examination (BSE) as well as assess the prevalence of breast disease symptoms among a mixed urban-rural population of women in the Southwest region of Cameroon. METHODS We conducted a household-level community-based study in Southwest Cameroon between January and March 2017, using a three-stage cluster sampling framework. We surveyed 1287 households and collected self-reported data on 4208 female subjects, 790 of whom were household representatives. Each household representative provided information on behalf of all female household members about any ongoing breast disease symptoms. Moreover, female household representatives were questioned about their own knowledge and practice of BSE. RESULTS Women demonstrated low frequency of knowledge of BSE, as 25% (n=201) of household representatives reported any knowledge of BSE; and among these only 15% (n=30) practiced BSE on a monthly basis. Age (aOR: 1.04), usage of Liquid Petroleum Gas fuel, a marker of higher socioeconomic status (aOR: 1.86), and speaking English as a primary language in the household (aOR: 1.59) were significant predictors of knowledge of BSE. Eleven women reported ongoing breast disease symptoms resulting in an overall prevalence of 2.3 cases of breast disease symptoms per 1000 women. CONCLUSIONS Socioeconomic disparities in access to health education may be a determinant of knowledge of BSE. Community-based strategies are needed to improve dissemination of breast cancer screening methods, particularly for women who face barriers to accessing care.
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Affiliation(s)
- Kareen Azemfac
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - S. Ariane Christie
- Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Melissa M. Carvalho
- Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Theophile Nana
- Department of Surgery, Regional Hospital Limbe, Limbe, Southwest Region, Cameroon
| | - Ahmed N. Fonje
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | | | - Rochelle Dicker
- Department of Surgical Critical Care, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Catherine Juillard
- Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
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Shankar S, Boyanagari M, Boyanagari VK, Shankar M, Ayyanar RS. Profile of breast cancer patients receiving government sponsored free treatment and the associated economic costs. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2018. [DOI: 10.1016/j.cegh.2018.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Multi-parametric dynamic contrast enhanced MRI, diffusion-weighted MRI and proton-MRS in differentiation of benign and malignant breast lesions: Imaging interpretation and radiology-pathology correlation. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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122
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Figueroa-Padilla J, Soto-Perez-de-Celis E, Maciel-Miranda A, Vargas-Salas D, Santamaria E, Esparza-Arias N, Gutiérrez-Zacarías LM, Cabrera-Galeana P, Bargalló-Rocha E. Implementation of a microsurgical breast reconstruction program in Mexico. Microsurgery 2018; 38:831-833. [PMID: 30462855 DOI: 10.1002/micr.30383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/10/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Johnatan Figueroa-Padilla
- Post-Mastectomy Program, Department of Breast Tumors, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Enrique Soto-Perez-de-Celis
- Post-Mastectomy Program, Department of Breast Tumors, Instituto Nacional de Cancerología, Mexico City, Mexico.,Department of Geriatrics, Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Alejandro Maciel-Miranda
- Post-Mastectomy Program, Department of Breast Tumors, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Daniela Vargas-Salas
- Post-Mastectomy Program, Department of Breast Tumors, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Eric Santamaria
- Post-Mastectomy Program, Department of Breast Tumors, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Nereida Esparza-Arias
- Post-Mastectomy Program, Department of Breast Tumors, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Luz M Gutiérrez-Zacarías
- Post-Mastectomy Program, Department of Breast Tumors, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Paula Cabrera-Galeana
- Post-Mastectomy Program, Department of Breast Tumors, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Enrique Bargalló-Rocha
- Post-Mastectomy Program, Department of Breast Tumors, Instituto Nacional de Cancerología, Mexico City, Mexico
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Wu TY, Lee J. Promoting Breast Cancer Awareness and Screening Practices for Early Detection in Low-Resource Settings. Eur J Breast Health 2018; 15:18-25. [PMID: 30816360 DOI: 10.5152/ejbh.2018.4305] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 09/14/2018] [Indexed: 12/12/2022]
Abstract
Objective Breast cancer is the most common type of cancer among women in the Philippines. Philippines has one of the highest breast cancer mortality rate and the lowest mortality-to-incidence ratio in Asia. This study has three objectives: 1) explore Filipino women's knowledge, attitudes toward, and practices of breast cancer and cancer screening, 2) examine if an educational program increases women's intention to seek future breast cancer screening, and 3) examine associations between demographic variables and breast cancer screening practices. Materials and Methods A total of 944 women from two urban areas (Calasciao and Tacloban City) and one rural area (Sogood) of the Philippines participated in this cross-sectional study. Study participants attended an educational program and completed study questionnaires regarding demographics, knowledge about, and practices of breast self-exams, clinical breast exams and mammography as well as reported barriers toward future screening. Results The results showed a disparity between knowledge of routine breast cancer screening and actuals screening behaviors. Following breast health education and screening programs, participants reported greater intention to adhere to recommended breast cancer screening guidelines. The multivariate analyses showed that education level is a significant predictor for CBE and mammography uptake in current study. Conclusion This study has implications for breast cancer control among women in low-resources settings. Designing and implementing effective educational programs that increase women's awareness about breast cancer and promote screening uptake are important steps to reduce the burden affected by breast cancer among women in the Philippines and other South Asian low- to middle-income countries.
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Affiliation(s)
- Tsu-Yin Wu
- Department of Nursing, Eastern Michigan University School of Nursing, MI, USA
| | - Joohyun Lee
- Department of Mental Health Behavioral Sciences, James A. Haley VA Medical Center, Tempa, FL
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Fernandes A, Pesci-Feltri A, García-Fleury I, López M, Guida V, De Macedo M, Correnti M. Lymphocyte subsets predictive value and possible involvement of human papilloma virus infection on breast cancer molecular subtypes. World J Clin Oncol 2018; 9:123-132. [PMID: 30425937 PMCID: PMC6230918 DOI: 10.5306/wjco.v9.i7.123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 08/26/2018] [Accepted: 10/24/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To detect human papilloma virus (HPV) presence and to characterize cellular immune response in breast cancer patients.
METHODS A total of 74 women were included, of which 48 samples were from patients diagnosed with breast cancer and 26 patients with benign pathology of the breast. Molecular subtype classification was performed based on the immunohistochemical reports of the tumor piece. HPV genome detection and genotyping from fresh breast biopsies was performed using the INNO-LIPA HPV Genotyping Extra test (Innogenetics, Ghent, Belgium). CD3+, CD4+, CD8+ and natural killer (NK)+ cells levels from peripheral blood samples from patients with breast cancer and benign pathology were measured by flow cytometry.
RESULTS Luminal A was the most frequent breast cancer molecular subtype (33.33%). HPV was detected in 25% of the breast cancer patients, and genotype 18 was the most frequent in the studied population. The mean of CD3+, CD4+ and CD8+ subpopulations were decreased in patients with breast cancer, in relation to those with benign pathology, with a statistically significant difference in CD8+ values (P = 0.048). The mean of NK+ cells was increased in the benign pathology group. The average level of CD3+, CD4+, CD8+ and NK+ cells decreased as the disease progressed. HER2+ and Luminal B HER2+ tumors had the lowest counts of cell subsets. HPV breast cancer patients had elevated counts of cellular subsets.
CONCLUSION Determining level changes in cellular subsets in breast cancer patients is a useful tool to evaluate treatment response.
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Affiliation(s)
| | | | | | - Marco López
- University Hospital of Caracas, Caracas 1050, Venezuela
| | - Vincent Guida
- University Hospital of Caracas, Caracas 1050, Venezuela
| | | | - María Correnti
- Oncology and Hematology Institute, Caracas 1050, Venezuela
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125
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Rzepecki AK, Wang J, Urman A, Amin B, McLellan B. Nummular eczema of the breast following surgery and reconstruction in breast cancer patients. Acta Oncol 2018; 57:1586-1588. [PMID: 30014750 DOI: 10.1080/0284186x.2018.1489145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Alexandra K. Rzepecki
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
- Montefiore Medical Center, Department of Medicine, Division of Dermatology, Bronx, NY, USA
| | - Jenny Wang
- Department of Dermatology, New York University School of Medicine, New York, NY, USA
| | - Alexandra Urman
- Department of Oncology, Montefiore Medical Center, Bronx, NY, USA
| | - Bijal Amin
- Montefiore Medical Center, Department of Medicine, Division of Dermatology, Bronx, NY, USA
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Beth McLellan
- Montefiore Medical Center, Department of Medicine, Division of Dermatology, Bronx, NY, USA
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Jenkins C, Minh LN, Anh TT, Ngan TT, Tuan NT, Giang KB, Hoat LN, Lohfeld L, Donnelly M, Van Minh H, Murray L. Breast cancer services in Vietnam: a scoping review. Glob Health Action 2018; 11:1435344. [PMID: 29473488 PMCID: PMC5827719 DOI: 10.1080/16549716.2018.1435344] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Breast cancer incidence has been increasing consistently in Vietnam. Thus far, there have been no analytical reviews of research produced within this area. OBJECTIVES We sought to analyse the nature andextent of empirical studies about breast cancer in Vietnam, identifying areas for future research and systemsstrengthening. METHODS We undertook a scoping study using a five-stage framework to review published and grey literature in English and Vietnamese on breast cancer detection, diagnosis and treatment. We focused specifically on research discussing the health system and service provision. RESULTS Our results show that breast cancer screening is limited, with no permanent or integrated national screening activities. There is a lack of information on screening processes and on the integration of screening services with other areas of the health system. Treatment is largely centralised, and across all services there is a lack of evaluation and data collection that would be informative for recommendations seeking to improve accessibility and quality of breast cancer services. CONCLUSIONS This paper is the first scoping review of breast cancer services in Vietnam. It outlines areas for future focus for policy makers and researchers with the objective of strengthening service provision to women with breast cancer across the country while also providing a methodological example for how to conduct a collaborative scoping review.
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Affiliation(s)
- Chris Jenkins
- a Centre for Public Health , Queen's University , Belfast , UK
| | - Luu Ngoc Minh
- b Institute of Preventive Medicine and Public Health , Hanoi Medical University , Hanoi , Vietnam
| | - Tran Tuan Anh
- c Centre for Population Health Sciences , Hanoi University of Public Health , Hanoi , Vietnam
| | - Tran Thu Ngan
- c Centre for Population Health Sciences , Hanoi University of Public Health , Hanoi , Vietnam
| | - Ngo Tri Tuan
- b Institute of Preventive Medicine and Public Health , Hanoi Medical University , Hanoi , Vietnam
| | - Kim Bao Giang
- b Institute of Preventive Medicine and Public Health , Hanoi Medical University , Hanoi , Vietnam
| | - Luu Ngoc Hoat
- b Institute of Preventive Medicine and Public Health , Hanoi Medical University , Hanoi , Vietnam
| | - Lynne Lohfeld
- a Centre for Public Health , Queen's University , Belfast , UK
| | - Michael Donnelly
- a Centre for Public Health , Queen's University , Belfast , UK.,d UKCRC Centre of Excellence for Public Health , Belfast , UK
| | - Hoang Van Minh
- c Centre for Population Health Sciences , Hanoi University of Public Health , Hanoi , Vietnam
| | - Liam Murray
- a Centre for Public Health , Queen's University , Belfast , UK
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López-Pineda A, Rodríguez-Moran MF, Álvarez-Aguilar C, Fuentes Valle SM, Acosta-Rosales R, Bhatt AS, Sheth SN, Bustamante CD. Data mining of digitized health records in a resource-constrained setting reveals that timely immunophenotyping is associated with improved breast cancer outcomes. BMC Cancer 2018; 18:933. [PMID: 30261931 PMCID: PMC6161369 DOI: 10.1186/s12885-018-4833-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 09/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Organizations that issue guidance on breast cancer recommend the use of immunohistochemistry (IHC) for providing appropriate and precise care. However, little focus has been directed to the identification of maximum allowable turnaround times for IHC, which is necessary given the diversity of hospital settings in the world. Much less effort has been committed to the development of digital tools that allow hospital administrators to monitor service utilization histories of their patients. METHODS In this retrospective cohort study, we reviewed electronic and paper medical records of all suspected breast cancer patients treated at one secondary-care hospital of the Mexican Institute of Social Security (IMSS), located in western Mexico. We then followed three years of medical history of those patients with IHC testing. RESULTS In 2014, there were 402 breast cancer patients, of which 30 (7.4% of total) were tested for some IHC biomarker (ER, PR, HER2). The subtyping allowed doctors to adjust (56.7%) or confirm (43.3%) the initial therapeutic regimen. The average turnaround time was 56 days. Opportune IHC testing was found to be beneficial when it was available before or during the first rounds of chemotherapy. CONCLUSIONS The use of data mining tools applied to health record data revealed that there is an association between timely immunohistochemistry and improved outcomes in breast cancer patients. Based on this finding, inclusion of turnaround time in clinical guidelines is recommended. As much of the health data in the country becomes digitized, our visualization tools allow a digital dashboard of the hospital service utilization histories.
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Affiliation(s)
- Arturo López-Pineda
- Department of Biomedical Data Science, School of Medicine, Stanford University, 1265 Welch Road, Stanford, California 94305 USA
| | - Mario F Rodríguez-Moran
- Facultad de Ciencias Médicas y Biológicas “Dr. Ignacio Chávez”, Universidad Michoacana de San Nicolás de Hidalgo, Av. Dr. Rafael Carrillo S/N, Esq. Dr. Salvador González Herrejón, Morelia, 58020 Michoacán Mexico
| | - Cleto Álvarez-Aguilar
- Facultad de Ciencias Médicas y Biológicas “Dr. Ignacio Chávez”, Universidad Michoacana de San Nicolás de Hidalgo, Av. Dr. Rafael Carrillo S/N, Esq. Dr. Salvador González Herrejón, Morelia, 58020 Michoacán Mexico
- Coordinación de Investigación en Salud, Delegación Michoacán, Instituto Mexicano del Seguro Social, Av. Madero Poniente No. 1200, Morelia, 58000 Michoacán Mexico
| | - Sarah M Fuentes Valle
- Hospital General Regional No. 1, Servicio de Ginecobstetricia, Instituto Mexicano del Seguro Social, Bosques de los Olivos No. 101, Charo, 61303 Michoacán Mexico
| | - Román Acosta-Rosales
- Delegación Michoacán, Instituto Mexicano del Seguro Social, Av. Madero Poniente No. 1200, Morelia, 58000 Michoacán Mexico
| | - Ami S Bhatt
- Department of Genetics, School of Medicine, Stanford University, 300 Pasteur Drive, Stanford, 94305 California USA
- Department of Medicine (Hematology), School of Medicine, Stanford University, 875 Blake Wilbur Drive, Stanford, 94305 California USA
| | - Shruti N Sheth
- Department of Medicine (Oncology), School of Medicine, Stanford University, 875 Blake Wilbur Drive, Stanford, 94305 California USA
| | - Carlos D Bustamante
- Department of Biomedical Data Science, School of Medicine, Stanford University, 1265 Welch Road, Stanford, California 94305 USA
- Department of Genetics, School of Medicine, Stanford University, 300 Pasteur Drive, Stanford, 94305 California USA
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Gyedu A, Gaskill CE, Agbedinu K, Salazar DR, Kingham TP. Surgical oncology at a major referral center in Ghana: Burden, staging, and outcomes. J Surg Oncol 2018; 118:581-587. [PMID: 30095201 PMCID: PMC6160332 DOI: 10.1002/jso.25168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 06/27/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Outcome data after surgery for cancer in Sub-Saharan Africa are insufficient. We aimed to describe the presentation and outcomes of patients with solid cancers managed at a tertiary hospital in Ghana. METHODS Records of cancer patients admitted to Komfo Anokye Teaching Hospital general surgery wards from 2013 to 2016 were reviewed for data on presentation, staging, management, and mortality. Patients discharged alive were followed-up by biannual telephone calls to establish their postdischarge status. Survival analysis was performed for patients with pathologic or radiologic confirmation of cancer and adequate staging. RESULTS A total of 343 patients were included. Of these, 76% were female. The most common diagnoses were breast 136 (40%), foregut 70 (20%), and colorectal 63 (18%) cancers. Cancer diagnosis was confirmed by pathology or radiology in 281 (82%) patients, but only 112 (40%) had adequate staging. Seventy-four (66%) patients were stage IV. Two-year overall survival for all 343 patients was 22% to 69%, depending on cancer site. Among those with adequate staging who were alive after postoperative 90 days, 3-year survival was similar for curative compared with palliative operations (P = 0.64). CONCLUSIONS Improved capacity for both therapeutic and palliative cancer care is needed to achieve better outcomes by more appropriate allocation of surgery with respect to the goal of treatment.
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Affiliation(s)
- Adam Gyedu
- Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; University Hospital, KNUST, Kumasi, Ghana,
| | | | | | | | - T. Peter Kingham
- Division of Hepatopancreatobiliary Surgery, Dept. of Surgery, Memorial Sloan-Kettering Hospital, New York, USA,
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130
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The Role of Quality Measures in Improving Breast Cancer Care in Low-Income Countries. CURRENT BREAST CANCER REPORTS 2018. [DOI: 10.1007/s12609-018-0288-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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131
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Plichta JK, Campbell BM, Mittendorf EA, Hwang ES. Anatomy and Breast Cancer Staging: Is It Still Relevant? Surg Oncol Clin N Am 2018; 27:51-67. [PMID: 29132565 DOI: 10.1016/j.soc.2017.07.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Breast cancer staging concisely summarizes disease status, creating a framework for assessing and relaying prognostic information. The fundamental concepts and components of breast cancer staging are reviewed. The AJCC Cancer Staging Manual, which includes traditional anatomic factors, now includes additional tumor characteristics: tumor grade, estrogen receptor status, progesterone receptor status, human epidermal growth factor receptor 2 status, and (when available) multigene panel testing from the primary tumor. With these updates, staging provides the most reliable system for accurately predicting patient outcome. When the AJCC 8th edition guidelines are adopted, they will more closely reflect tumor biology.
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Affiliation(s)
- Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, DUMC 3513, Durham, NC 27710, USA
| | - Brittany M Campbell
- Department of Surgery, Duke University Medical Center, DUMC 3513, Durham, NC 27710, USA
| | - Elizabeth A Mittendorf
- Department of Breast Surgical Oncology, University of Texas, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, DUMC 3513, Durham, NC 27710, USA.
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132
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Mohan S, Patel S, Greenstein I, Ng C, Frazier K, Nguyen G, Harding L, Barlow D. Metabolic relevance for N-hydroxy L-arginine reduction in estrogen-negative breast cancer cells. Amino Acids 2018; 50:1629-1636. [PMID: 29922922 DOI: 10.1007/s00726-018-2603-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 06/09/2018] [Indexed: 02/06/2023]
Abstract
We had shown Nw-hydroxy-L-arginine (NOHA) as a promising blood-based biomarker for estrogen-receptor-negative (ER-) breast cancer (BC) that differentiates ER- BC based on grade and molecular phenotype. In this in vitro study, we assessed the metabolic relevance for ER- BC-specific NOHA modulation and correlated them with NOHA regulatory responses. This study aids future NOHA clinical utility in ER- BC diagnosis and therapy management and would prove useful for potential drug discovery and development process.
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Affiliation(s)
- Srinidi Mohan
- Department of Pharmaceutical Sciences, College of Pharmacy, University of New England, Portland, ME, 04103, USA.
| | - Seema Patel
- Department of Pharmaceutical Sciences, College of Pharmacy, University of New England, Portland, ME, 04103, USA
| | - Ian Greenstein
- Department of Pharmaceutical Sciences, College of Pharmacy, University of New England, Portland, ME, 04103, USA
| | - Cathy Ng
- Department of Pharmaceutical Sciences, College of Pharmacy, University of New England, Portland, ME, 04103, USA
| | - Kelly Frazier
- Department of Pharmaceutical Sciences, College of Pharmacy, University of New England, Portland, ME, 04103, USA
| | - Giang Nguyen
- Department of Pharmaceutical Sciences, College of Pharmacy, University of New England, Portland, ME, 04103, USA
| | - Lisa Harding
- Department of Pharmaceutical Sciences, College of Pharmacy, University of New England, Portland, ME, 04103, USA
| | - David Barlow
- Department of Pharmaceutical Sciences, College of Pharmacy, University of New England, Portland, ME, 04103, USA
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Zhang Q, Ding L, Liang X, Wang Y, Jiao J, Lu W, Guo X. Comparison of pathological characteristics between self-detected and screen-detected invasive breast cancers in Chinese women: a retrospective study. PeerJ 2018; 6:e4567. [PMID: 29713563 PMCID: PMC5924684 DOI: 10.7717/peerj.4567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/13/2018] [Indexed: 11/20/2022] Open
Abstract
Background In China, there is insufficient evidence to support that screening programs can detect breast cancer earlier and improve outcomes compared with patient self-reporting. Therefore, we compared the pathological characteristics at diagnosis between self-detected and screen-detected cases of invasive breast cancer at our institution and determined whether these characteristics were different after the program's introduction (vs. prior to). Methods Three databases were selected (breast cancer diagnosed in 1995-2000, 2010, and 2015), which provided a total of 3,014 female patients with invasive breast cancer. The cases were divided into self-detected and screen-detected groups. The pathological characteristics were compared between the two groups and multiple imputation and complete randomized imputation were used to deal with missing data. Results Compared with patient self-reporting, screening was associated with the following factors: a higher percentage of stage T1 tumors (75.0% vs 17.1%, P = 0.109 in 1995-2000; 66.7% vs 40.4%, P < 0.001 in 2010; 67.8% vs 35.7%, P < 0.001 in 2015); a higher percentage of tumors with stage N0 lymph node status (67.3% vs. 48.4%, P = 0.007 in 2010); and a higher percentage of histologic grade I tumors (22.9% vs 13.9%, P = 0.017 in 2010). Conclusion Screen-detected breast cancer was associated with a greater number of favorable pathological characteristics. However, although screening had a beneficial role in early detection in China, we found fewer patients were detected by screening in this study compared with those in Western and Asian developed countries.
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Affiliation(s)
- Qi Zhang
- Department of Breast Pathology and Lab, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Lanjun Ding
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China.,Collaborative Innovation Center of Chronic Disease Prevention and Control, Tianjin Medical University, Tianjin, China
| | - Xuan Liang
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China.,Collaborative Innovation Center of Chronic Disease Prevention and Control, Tianjin Medical University, Tianjin, China
| | - Yuan Wang
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China.,Collaborative Innovation Center of Chronic Disease Prevention and Control, Tianjin Medical University, Tianjin, China
| | - Jiao Jiao
- Department of Breast Pathology and Lab, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Wenli Lu
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China.,Collaborative Innovation Center of Chronic Disease Prevention and Control, Tianjin Medical University, Tianjin, China
| | - Xiaojing Guo
- Department of Breast Pathology and Lab, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
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134
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Antioxidant Supplements and Breast Cancer: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2018. [DOI: 10.5812/ijcm.10082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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135
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Unger-Saldaña K, Ventosa-Santaulària D, Miranda A, Verduzco-Bustos G. Barriers and Explanatory Mechanisms of Delays in the Patient and Diagnosis Intervals of Care for Breast Cancer in Mexico. Oncologist 2018; 23:440-453. [PMID: 29284758 PMCID: PMC5896704 DOI: 10.1634/theoncologist.2017-0431] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/02/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Most breast cancer patients in low- and middle-income settings are diagnosed at advanced stages due to lengthy intervals of care. This study aimed to understand the mechanisms through which delays occur in the patient interval and diagnosis interval of care. MATERIALS AND METHODS We conducted a cross-sectional survey including 886 patients referred to four major public cancer hospitals in Mexico City. Based in a conceptual model of help-seeking behavior, a path analysis strategy was used to identify the relationships between explanatory factors of patient delay and diagnosis delay. RESULTS The patient and the diagnosis intervals were greater than 3 months in 20% and 65% of participants, respectively. We present explanatory models for each interval and the interrelationship between the associated factors. The patient interval was longer among women who were single, interpreted their symptoms as not worrisome, concealed symptoms, and perceived a lack of financial resources and the difficulty of missing a day of work as barriers to seek care. These barriers were more commonly perceived among patients who were younger, had lower socioeconomic status, and lived outside of Mexico City. The diagnosis interval was longer among those who used several different health services prior to the cancer hospital and perceived medical errors in these services. More health services were used among those who perceived errors and long waiting times for appointments, and who first consulted private services. CONCLUSION Our findings support the relevance of strengthening early cancer diagnosis strategies, especially the improvement of quality of primary care and expedited referral routes to cancer services. IMPLICATIONS FOR PRACTICE This study's findings suggest that policy in low- and middle-income countries (LMICs) should be directed toward reducing delays in diagnosis, before the implementation of mammography screening programs. The results suggest several factors susceptible to early diagnosis interventions. To reduce patient delays, the usually proposed intervention of awareness promotion could better work in LMIC contexts if the message goes beyond the advertising of screening mammography to encourage the recognition of potential cancer symptoms and sharing of symptoms with significant others. To reduce diagnosis delay, efforts should focus on strengthening the quality of public primary care services and improving referral routes to cancer care centers.
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Affiliation(s)
- Karla Unger-Saldaña
- National Council of Science and Technology (CONACYT) - Mexican National Cancer Institute, Epidemiology Unit, Mexico City, Mexico
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136
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Ishola F, Omole O. A vision for improved cancer screening in Nigeria. LANCET GLOBAL HEALTH 2018; 4:e359-60. [PMID: 27198833 DOI: 10.1016/s2214-109x(16)30062-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 04/13/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Foluso Ishola
- Atlas Service Corps, Washington, DC 20001, USA; Department of Global Strategy and Programs, Susan G Komen, Dallas, TX 75244, USA
| | - Oluwatosin Omole
- Howard University Hospital, Community and Family Medicine, Washington, DC 20001, USA.
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137
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Yang L, Wang J, Cheng J, Wang Y, Lu W. Quality assurance target for community-based breast cancer screening in China: a model simulation. BMC Cancer 2018. [PMID: 29514679 PMCID: PMC5840933 DOI: 10.1186/s12885-018-4168-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background We aimed to clarify the feasibility of a community-based screening strategy for breast cancer in Tianjin, China; to identify the factors that most significantly influenced its feasibility; and to identify the reference range for quality control. Methods A state-transition Markov model simulated a hypothetical cohort of 100,000 healthy women, the start aged was set at 35 years and the time horizon was set to 50 years. The primary outcome for the model was the incremental cost-utility ratio (ICUR), defined as the program’s cost per quality-adjusted life year (QALY) gained. Three screening strategies providing by community health service for women aged 35 to 69 years was compared regarding to different intervals. Result The probability of the ICUR being below 20 272USD (i.e., triple the annual gross domestic product [3 GDPs]) per QALY saved was 100% for annual screening strategy and screening every three years. Only when the attendance rate was > 50%, the probability for annual screening would be cost effective > 95%. The probability for the annual screening strategy being cost effective could reach to 95% for a willingness-to-pay (WTP) of 2 GDPs when the compliance rate for transfer was > 80%. When 10% stage I tumors were detected by screening, the probability of the annual screening strategy being cost effective would be up to 95% for a WTP > 3 GDPs. Conclusion Annual community-based breast cancer screening was cost effective for a WTP of 3 GDP based on the incidence of breast cancer in Tianjin, China. Measures are needed to ensure performance indicators to a desirable level for the cost-effectiveness of breast cancer screening. Electronic supplementary material The online version of this article (10.1186/s12885-018-4168-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lan Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China.,Tianjin Binhai New Area Tanggu Center for Disease Control and Prevention, Tianjin, 300451, China
| | - Jing Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Juan Cheng
- Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Yuan Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China.,Collaborative Innovation Center of Chronic disease prevention and control, Tianjin Medical University, Tianjin, 300070, China
| | - Wenli Lu
- Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China. .,Collaborative Innovation Center of Chronic disease prevention and control, Tianjin Medical University, Tianjin, 300070, China.
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138
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Anwar SL, Tampubolon G, Van Hemelrijck M, Hutajulu SH, Watkins J, Wulaningsih W. Determinants of cancer screening awareness and participation among Indonesian women. BMC Cancer 2018; 18:208. [PMID: 29506486 PMCID: PMC5838961 DOI: 10.1186/s12885-018-4125-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 02/12/2018] [Indexed: 02/07/2023] Open
Abstract
Background Cancer screening awareness and participation may be lower in low- and middle-income countries that lack established national screening programmes compared with those that do. We evaluated potential determinants of awareness about and participation in breast and cervical cancer screening, and breast self-examination (BSE) in women using survey data from Indonesia. Methods From the fifth Indonesian Family Life Survey (2014–2015), a total of 5397 women aged 40 and older without any history of cancer who responded to questionnaires concerning Pap smears, mammography, and BSE were included. Multilevel modelling was used to assess potential determinants in relation to awareness about Pap smears and mammography, and participation in Pap smears and BSE practice. Multivariable analyses were performed to identify independent predictors of cancer screening. Results Of the 5397 respondents, 1058 (20%) women were aware of Pap smears, of which 297 had never had the procedure. Only 251 (5%) participants were aware of mammography. A total of 605 (12%) of women reported they performed BSE. Higher education and household expenditure were consistently associated with higher odds of awareness about Pap smears and mammography (e.g. odds ratio [OR] of being aware of Pap smear and mammography: 7.82 (95% CI: 6.30–9.70) and 7.70 (6.19–9.58), respectively, for high school graduates compared to women with less educational attainment in the multivariable models), and participation in Pap smears and BSE. We also identified enabling factors linked with greater cancer screening awareness and participation, including health insurance, shorter distance to health services, and social participation. Conclusion There are socioeconomic disparities in cancer screening awareness and participation among Indonesian women. Our findings may help inform targeted health promotion and screening for cancer in the presence of limited resources. Electronic supplementary material The online version of this article (10.1186/s12885-018-4125-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sumadi L Anwar
- Division of Surgical Oncology Department of Surgery, Faculty of Medicine Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia.,PILAR Research and Education, 20 Station Road, Cambridge, CB1 2JD, UK
| | - Gindo Tampubolon
- Cathie Marsh Institute for Social Research, University of Manchester, M13 9PL, Manchester, UK
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research, King's College London, London, SE1 9RT, UK
| | - Susanna H Hutajulu
- Division of Medical Haematology and Oncology Department of Internal Medicine, Faculty of Medicine Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Johnathan Watkins
- PILAR Research and Education, 20 Station Road, Cambridge, CB1 2JD, UK
| | - Wahyu Wulaningsih
- PILAR Research and Education, 20 Station Road, Cambridge, CB1 2JD, UK. .,MRC Unit for Lifelong Health and Ageing, University College London, Place London WC1B 5JU, Bedford, 33, UK.
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139
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Eber-Schulz P, Tariku W, Reibold C, Addissie A, Wickenhauser C, Fathke C, Hauptmann S, Jemal A, Thomssen C, Kantelhardt EJ. Survival of breast cancer patients in rural Ethiopia. Breast Cancer Res Treat 2018; 170:111-118. [PMID: 29479644 DOI: 10.1007/s10549-018-4724-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 02/16/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To describe the histopathological characteristics and survival of female breast cancer (BC) patients in a rural setting with limited access to adjuvant treatment. METHODS A prospective study of 107 histologically confirmed BC patients treated with surgery from 2010 to 2016 from rural parts of western Ethiopia. Referral pathology was performed, and active follow-up was conducted. Adjusted cox regression analysis (hazard ratio [HR]) was performed. RESULTS The median age at diagnosis was 45 (16-83) years; 57% of the patients presented with cT3/4 tumors, 71% with clinically positive lymph nodes, 21% with HER2-overexpression (Dako3+) and 68% with grade 3 tumors. Estrogen and/or progesterone receptor expressions were present in 66% and triple-negative disease in 25%. The estimated 1- and 2-year overall survival probability rates were 78 and 53%, respectively. The 2-year survival for patients with clinically positive lymph nodes was 44% compared to 73% for patients with lymph node-negative disease (HR 2.44; 95% confidence interval [95% CI] 1.19-5.02). The corresponding 2-year survival for patients with cT4 tumors was 25% versus 68% for patients with cT1-2 tumors (cT1-3 vs. cT4 HR 3.86; 95% CI 1.82-13.63). The 2-year survival for patients with hormone receptor-negative disease was 40% compared to 59% for patients with hormone receptor-positive disease (HR 1.92; 95% CI 1.06-3.47). CONCLUSION The majority of breast cancer patients treated with surgery in rural parts of western Ethiopia are diagnosed at advanced stage and have hormone receptor-positive disease. Nearly half of the patients die within 2 years. These findings underscore the need for provision of adjuvant hormonal therapy and for the establishment of pathology service including hormone receptor testing.
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Affiliation(s)
- Pia Eber-Schulz
- Department of Gynecology, Martin-Luther-University, Halle, Germany
| | - Wakuma Tariku
- Ethiopian Evangelical Church of Mekane Yesus EECMY Aira Hospital, Aira, Ethiopia
| | | | - Adamu Addissie
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Christine Fathke
- Department of Pathology, Martin-Luther-University, Halle, Germany
| | | | | | | | - Eva Johanna Kantelhardt
- Department of Gynecology, Martin-Luther-University, Halle, Germany. .,Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Saale, Halle, Germany.
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140
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Tan D, Lee JH, Chen W, Shimizu K, Hou J, Suzuki K, Nawarawong W, Huang SY, Sang Chim C, Kim K, Kumar L, Malhotra P, Chng WJ, Durie B. Recent advances in the management of multiple myeloma: clinical impact based on resource-stratification. Consensus statement of the Asian Myeloma Network at the 16th international myeloma workshop. Leuk Lymphoma 2018; 59:2305-2317. [PMID: 29390932 DOI: 10.1080/10428194.2018.1427858] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Predicated on our improved understanding of the disease biology, we have seen remarkable advances in the management of multiple myeloma over the past few years. Recently approved drugs have radically transformed the treatment paradigm and improved survivals of myeloma patients. The progress has necessitated revision of the diagnostic criteria, risk-stratification and response definition. The huge disparities in economy, healthcare infrastructure and access to novel drugs among different Asian countries will hinder the delivery of optimum myeloma care to patients managed in resource-constrained environments. In the light of the tremendous recent changes and evolution in myeloma management, it is timely that the resource-stratified guidelines from the Asian Myeloma Network be revised to provide updated recommendations for Asia physicians practicing under various healthcare reimbursement systems. This review will highlight the most recent advances and our recommendations on how they could be integrated in both resource-abundant and resource-constrained facilities.
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Affiliation(s)
- Daryl Tan
- a Raffles Cancer Center , Raffles Hospital , Singapore.,b Department of Hematology , Singapore General Hospital , Singapore
| | - Jae Hoon Lee
- c Gil Hospital, Gachon University , Incheon , South Korea
| | - Wenming Chen
- d Beijing Chaoyang Hospital, Capital Medical University , Beijing , China
| | - Kazuyuki Shimizu
- e Higashi Nagoya National Hospital , National Hospital Organization , Nagoya , Japan
| | - Jian Hou
- f Department of Haematology , Changzheng Hospital, The Second Military Medical University , Shanghai , China
| | - Kenshi Suzuki
- g Department of Hematology , Japanese Red Cross Medical Center , Tokyo , Japan
| | | | | | - Chor Sang Chim
- j Queen Mary Hospital, University of Hong Kong , Hong Kong , China
| | - Kihyun Kim
- k Samsung Medical Center , Sungkyunkwan University , Seoul , South Korea
| | - Lalit Kumar
- l Department of Medical Oncology , Institute Rotary Cancer Hospital, All India Institute of Medical Sciences , New Delhi , India
| | - Pankaj Malhotra
- m Department of Internal Medicine , Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Wee Joo Chng
- n Cancer Science Institute of Singapore , National University of Singapore , Singapore.,o Department of Haematology-Oncology , National University Cancer Institute of Singapore National University Health System , Singapore
| | - Brian Durie
- p Cedars-Sinai Comprehensive Cancer Center , Los Angeles , CA , USA
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Galal SA, Khairat SHM, Ali HI, Shouman SA, Attia YM, Ali MM, Mahmoud AE, Abdel-Halim AH, Fyiad AA, Tabll A, El-Shenawy R, El Abd YS, Ramdan R, El Diwani HI. Part II: New candidates of pyrazole-benzimidazole conjugates as checkpoint kinase 2 (Chk2) inhibitors. Eur J Med Chem 2018; 144:859-873. [PMID: 29316526 DOI: 10.1016/j.ejmech.2017.12.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 10/12/2017] [Accepted: 12/06/2017] [Indexed: 02/07/2023]
Abstract
The development of checkpoint kinase 2 (Chk2) inhibitors for the treatment of cancer has been an ongoing and attractive objective in drug discovery. In this study, twenty-one feasible pyrazole-benzimidazole conjugates were synthesized to study their effect against Chk2 activity using Checkpoint Kinase Assay. The antitumor activity of these compounds was investigated using SRB assay. A potentiation effect of the synthesized Chk2 inhibitors was also investigated using the genotoxic anticancer drugs cisplatin and doxorubicin on breast carcinoma, (ER+) cell line (MCF-7). In vivo Chk2 and antitumor activities of 8d as a single-agent, and in combination with doxorubicin, were evaluated in breast cancer bearing animals induced by N-methylnitrosourea. The effect of 8d alone and in combination with doxorubicin was also studied on cell-cycle phases of MCF-7 cells using flow cytometry analysis. The results revealed their potencies as Chk2 inhibitors with IC50 ranges from 9.95 to 65.07 nM. Generally the effect of cisplatin or doxorubicin was potentiated by the effect of most of the compounds that were studied. The in vivo results indicated that the combination of 8d and doxorubicin inhibited checkpoint kinase activity more than either doxorubicin or 8d alone. There was a positive correlation between checkpoint kinase inhibition and the improvement observed in histopathological features. Single dose treatment with doxorubicin or 8d produced S phase cell cycle arrest whereas their combination created cell cycle arrest at G2/M from 8% in case of doxorubicin to 51% in combination. Gold molecular modelling studies displayed a high correlation to the biological results.
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Affiliation(s)
- Shadia A Galal
- Department of Chemistry of Natural and Microbial Products, Division of Pharmaceutical and Drug Industries, National Research Centre, Cairo, 12622, Egypt.
| | - Sarah H M Khairat
- Department of Chemistry of Natural and Microbial Products, Division of Pharmaceutical and Drug Industries, National Research Centre, Cairo, 12622, Egypt
| | - Hamed I Ali
- Department of Pharmaceutical Sciences, Texas A&M University Irma Lerma Rangel College of Pharmacy Kingsville, TX 78363, United States; Department of Pharmaceutical Chemistry, College of Pharmacy, Helwan University, Cairo, Egypt
| | - Samia A Shouman
- Department of Cancer Biology, National Cancer Institute, Cairo University, Egypt
| | - Yasmin M Attia
- Department of Cancer Biology, National Cancer Institute, Cairo University, Egypt
| | - Mamdouh M Ali
- Department of Biochemistry, Division of Genetic Engineering and Biotechnology, National Research Centre, 12622, Cairo, Egypt
| | - Abeer E Mahmoud
- Department of Biochemistry, Division of Genetic Engineering and Biotechnology, National Research Centre, 12622, Cairo, Egypt
| | - Abeer H Abdel-Halim
- Department of Biochemistry, Division of Genetic Engineering and Biotechnology, National Research Centre, 12622, Cairo, Egypt
| | - Amal A Fyiad
- Department of Biochemistry, Division of Genetic Engineering and Biotechnology, National Research Centre, 12622, Cairo, Egypt
| | - Ashraf Tabll
- Department of Microbial Biotechnology, Division of Genetic Engineering & Biotechnology, National Research Centre, 12622, Cairo, Egypt
| | - Reem El-Shenawy
- Department of Microbial Biotechnology, Division of Genetic Engineering & Biotechnology, National Research Centre, 12622, Cairo, Egypt
| | - Yasmine S El Abd
- Department of Microbial Biotechnology, Division of Genetic Engineering & Biotechnology, National Research Centre, 12622, Cairo, Egypt
| | - Raghda Ramdan
- Radiobiology Unit, Belgian Nuclear Research Center (SCK•CEN), Mol, Belgium; Department of Basic Medical Sciences, Physiology Group, Ghent University, Ghent, Belgium
| | - Hoda I El Diwani
- Department of Chemistry of Natural and Microbial Products, Division of Pharmaceutical and Drug Industries, National Research Centre, Cairo, 12622, Egypt
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142
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Al-Sukhun S, de Lima Lopes G, Gospodarowicz M, Ginsburg O, Yu PP. Global Health Initiatives of the International Oncology Community. Am Soc Clin Oncol Educ Book 2017; 37:395-402. [PMID: 28561641 DOI: 10.1200/edbk_100008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cancer has become one of the leading causes of morbidity and mortality in low- and middle-income countries (LMICs), where 60% of the world's total new cases are diagnosed. The challenge for effective control of cancer is multifaceted. It mandates integration of effective cancer prevention, encouraging early detection, and utilization of resource-adapted therapeutic and supportive interventions. In the resource-constrained setting, it becomes challenging to deliver each service optimally, and efficient allocation of resources is the best way to improve the outcome. This concept was translated into action through development of resource-stratified guidelines, pioneered by the Breast Health Global Initiative (BHGI), and later adopted by most oncology societies in an attempt to help physicians deliver the best possible care in a limited-resource setting. Improving outcome entails collaboration between key stakeholders, including the pharmaceutical industry, local and national health authorities, the World Health Organization (WHO), and other nonprofit, patient-oriented organizations. Therefore, we started to observe global health initiatives-led by ASCO, the Union for International Cancer Control (UICC), and the WHO-to address these challenges at the international level. This article discusses some of these initiatives.
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Affiliation(s)
- Sana Al-Sukhun
- From the Al-Hayat Medical Center, Amman, Jordan; Sylvester Comprehensive Cancer Center and Miller School of Medicine, University of Miami, Miami, FL; University of Toronto, Cancer Care Ontario, Princess Margaret Cancer Centre, and University Health Network, Toronto, Canada; Laura and Isaac Perlmutter Cancer Center at NYU Langone Medical Center, New York, NY; Hartford Healthcare, Hartford, CT
| | - Gilberto de Lima Lopes
- From the Al-Hayat Medical Center, Amman, Jordan; Sylvester Comprehensive Cancer Center and Miller School of Medicine, University of Miami, Miami, FL; University of Toronto, Cancer Care Ontario, Princess Margaret Cancer Centre, and University Health Network, Toronto, Canada; Laura and Isaac Perlmutter Cancer Center at NYU Langone Medical Center, New York, NY; Hartford Healthcare, Hartford, CT
| | - Mary Gospodarowicz
- From the Al-Hayat Medical Center, Amman, Jordan; Sylvester Comprehensive Cancer Center and Miller School of Medicine, University of Miami, Miami, FL; University of Toronto, Cancer Care Ontario, Princess Margaret Cancer Centre, and University Health Network, Toronto, Canada; Laura and Isaac Perlmutter Cancer Center at NYU Langone Medical Center, New York, NY; Hartford Healthcare, Hartford, CT
| | - Ophira Ginsburg
- From the Al-Hayat Medical Center, Amman, Jordan; Sylvester Comprehensive Cancer Center and Miller School of Medicine, University of Miami, Miami, FL; University of Toronto, Cancer Care Ontario, Princess Margaret Cancer Centre, and University Health Network, Toronto, Canada; Laura and Isaac Perlmutter Cancer Center at NYU Langone Medical Center, New York, NY; Hartford Healthcare, Hartford, CT
| | - Peter Paul Yu
- From the Al-Hayat Medical Center, Amman, Jordan; Sylvester Comprehensive Cancer Center and Miller School of Medicine, University of Miami, Miami, FL; University of Toronto, Cancer Care Ontario, Princess Margaret Cancer Centre, and University Health Network, Toronto, Canada; Laura and Isaac Perlmutter Cancer Center at NYU Langone Medical Center, New York, NY; Hartford Healthcare, Hartford, CT
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143
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Romanoff A, Constant TH, Johnson KM, Guadiamos MC, Vega AMB, Zunt J, Anderson BO. Association of Previous Clinical Breast Examination With Reduced Delays and Earlier-Stage Breast Cancer Diagnosis Among Women in Peru. JAMA Oncol 2017; 3:1563-1567. [PMID: 28542677 DOI: 10.1001/jamaoncol.2017.1023] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Mammographic screening is impractical in most of the world where breast cancers are first identified based on clinical signs and symptoms. Clinical breast examination may improve early diagnosis directly by finding breast cancers at earlier stages or indirectly by heightening women's awareness of breast health concerns. Objective To investigate factors that influence time to presentation and stage at diagnosis among patients with breast cancer to determine whether history of previous clinical breast examination is associated with earlier presentation and/or earlier cancer stage at diagnosis. Design, Setting, and Participants In this cross-sectional analysis of individual patient interviews using a validated Breast Cancer Delay Questionnaire, 113 (71.1%) of 159 women with breast cancer treated at a federally funded tertiary care referral cancer center in Trujillo, Peru, from February 1 through May 31, 2015, were studied. Main Outcomes and Measures Method of breast cancer detection and factors that influence time to and stage at diagnosis. Results Of 113 women with diagnosed cancer (mean [SD] age, 54 [10.8] years; age range, 32-82 years), 105 (92.9%) had self-detected disease. Of the 93 women for whom stage was documented, 45 (48.4%) were diagnosed with early-stage disease (American Joint Committee on Cancer [AJCC] stage 0, I, or II), and 48 (51.6%) were diagnosed with late-stage disease (AJCC stage III or IV). Mean (SD) total delay from symptom onset to initiation of treatment was 407 (665) days because of patient (mean [SD], 198 [449] days) and health care system (mean [SD], 241 [556] days) delay. Fifty-two women (46.0%) had a history of clinical breast examination, and 23 (20.4%) had undergone previous mammography. Women who underwent a previous clinical breast examination were more likely to have shorter delays from symptom development to presentation compared with women who had never undergone a previous clinical breast examination (odds ratio, 2.92; 95% CI, 1.30-6.60; P = .01). Women diagnosed with shorter patient delay were more likely to be diagnosed with early-stage disease (AJCC stage 0, I, or II) than those with longer patient delay (31 [58.5%] vs 11 [30.6%], P = .01). Women who underwent a previous clinical breast examination were more likely to be diagnosed with early-stage disease compared with women who had never undergone previous clinical breast examination; this relationship remained significant after controlling for insurance and household income (odds ratio, 2.44; 95% CI, 1.01-5.95; P = .048). Conclusions and Relevance In a population in which most breast cancers are self-detected, previous clinical breast examination was associated with shorter patient delay and earlier stage at breast cancer diagnosis. In regions of the world that lack mammographic screening, the routine use of clinical breast examination may provide a resource-appropriate strategy for improving breast cancer early diagnosis.
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Affiliation(s)
- Anya Romanoff
- Department of Global Health, University of Washington, Seattle.,Department of Surgery, Mount Sinai Hospital, New York, New York
| | | | - Kay M Johnson
- Department of Medicine, University of Washington, Seattle.,Hospital and Specialty Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Manuel Cedano Guadiamos
- Department of Surgery, Instituto Regional de Enfermedades Neoplásicas del Norte, Trujillo, Peru
| | - Ana María Burga Vega
- Department of Epidemiology and Statistics, Instituto Regional de Enfermedades Neoplásicas del Norte, Trujillo, Peru
| | - Joseph Zunt
- Department of Global Health, University of Washington, Seattle
| | - Benjamin O Anderson
- Department of Global Health, University of Washington, Seattle.,Department of Surgery, University of Washington, Seattle.,Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
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Zujewski JA, Dvaladze AL, Ilbawi A, Anderson BO, Luciani S, Stevens L, Torode J. Knowledge Summaries for Comprehensive Breast Cancer Control. J Glob Oncol 2017; 4:1-7. [PMID: 30241140 PMCID: PMC6180786 DOI: 10.1200/jgo.17.00141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Breast cancer is the most common cancer in women worldwide, affecting > 1.6
million women each year, projected to increase to 2.2 million cases annually by
2025. A disproportionate number of the > 500,000 women who die as a result of
breast cancer each year reside in low-resource settings. Breast cancer control
is an important component of cancer control planning and women’s health
programs, and tools are needed across the care continuum to reduce the cancer
burden, especially in low-resource settings. Cancer control planning is complex
and multifaceted. Evidence shows that outcomes are improved when prevention,
early diagnosis, treatment, and palliation are integrated and synchronously
developed within a country/region’s health plan. The Knowledge Summaries
for Comprehensive Breast Cancer Control are the product of a multiyear
collaboration led by the Union for International Cancer Control, Breast Health
Global Initiative, Pan American Health Organization, and Center for Global
Health of the US National Cancer Institute. Fourteen knowledge summaries
distilled from evidence-based, resource-stratified guidelines, and aligned with
WHO guidance on breast cancer control, build a framework for resource
prioritization pathways and delivery systems for breast cancer control at four
levels of available resources: basic, limited, enhanced, and maximal. Each
summary contains relevant content to inform breast cancer policy, clinical care,
and advocacy, aiding in the development and implementation of policies and
programs. These tools provide a common platform for stakeholders, including
policymakers, administrators, clinicians, and advocates to engage in decision
making appropriate to their local setting. The goal is to facilitate
evidence-based policy actions and urgently advance implementation of an
integrated approach to reduce breast cancer mortality and improve quality of
life.
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Affiliation(s)
- Jo Anne Zujewski
- Jo Anne Zujewski, Consultant for Leidos Biomedical Research, Frederick; Lisa Stevens, National Cancer Institute, Bethesda, MD, Benjamin O. Anderson, Fred Hutchinson Cancer Research Center; Allison L. Dvaladze, University of Washington, Seattle, WA, Andre M. Ilbawi, World Health Organization European Observatory on Health Systems and Policies, Brussels, Belgium; Silvana Luciani, Pan American Health Organization, Washington, DC; and Julie Torode, Union for International Cancer Control, Geneva, Switzerland
| | - Allison L Dvaladze
- Jo Anne Zujewski, Consultant for Leidos Biomedical Research, Frederick; Lisa Stevens, National Cancer Institute, Bethesda, MD, Benjamin O. Anderson, Fred Hutchinson Cancer Research Center; Allison L. Dvaladze, University of Washington, Seattle, WA, Andre M. Ilbawi, World Health Organization European Observatory on Health Systems and Policies, Brussels, Belgium; Silvana Luciani, Pan American Health Organization, Washington, DC; and Julie Torode, Union for International Cancer Control, Geneva, Switzerland
| | - Andre Ilbawi
- Jo Anne Zujewski, Consultant for Leidos Biomedical Research, Frederick; Lisa Stevens, National Cancer Institute, Bethesda, MD, Benjamin O. Anderson, Fred Hutchinson Cancer Research Center; Allison L. Dvaladze, University of Washington, Seattle, WA, Andre M. Ilbawi, World Health Organization European Observatory on Health Systems and Policies, Brussels, Belgium; Silvana Luciani, Pan American Health Organization, Washington, DC; and Julie Torode, Union for International Cancer Control, Geneva, Switzerland
| | - Benjamin O Anderson
- Jo Anne Zujewski, Consultant for Leidos Biomedical Research, Frederick; Lisa Stevens, National Cancer Institute, Bethesda, MD, Benjamin O. Anderson, Fred Hutchinson Cancer Research Center; Allison L. Dvaladze, University of Washington, Seattle, WA, Andre M. Ilbawi, World Health Organization European Observatory on Health Systems and Policies, Brussels, Belgium; Silvana Luciani, Pan American Health Organization, Washington, DC; and Julie Torode, Union for International Cancer Control, Geneva, Switzerland
| | - Silvana Luciani
- Jo Anne Zujewski, Consultant for Leidos Biomedical Research, Frederick; Lisa Stevens, National Cancer Institute, Bethesda, MD, Benjamin O. Anderson, Fred Hutchinson Cancer Research Center; Allison L. Dvaladze, University of Washington, Seattle, WA, Andre M. Ilbawi, World Health Organization European Observatory on Health Systems and Policies, Brussels, Belgium; Silvana Luciani, Pan American Health Organization, Washington, DC; and Julie Torode, Union for International Cancer Control, Geneva, Switzerland
| | - Lisa Stevens
- Jo Anne Zujewski, Consultant for Leidos Biomedical Research, Frederick; Lisa Stevens, National Cancer Institute, Bethesda, MD, Benjamin O. Anderson, Fred Hutchinson Cancer Research Center; Allison L. Dvaladze, University of Washington, Seattle, WA, Andre M. Ilbawi, World Health Organization European Observatory on Health Systems and Policies, Brussels, Belgium; Silvana Luciani, Pan American Health Organization, Washington, DC; and Julie Torode, Union for International Cancer Control, Geneva, Switzerland
| | - Julie Torode
- Jo Anne Zujewski, Consultant for Leidos Biomedical Research, Frederick; Lisa Stevens, National Cancer Institute, Bethesda, MD, Benjamin O. Anderson, Fred Hutchinson Cancer Research Center; Allison L. Dvaladze, University of Washington, Seattle, WA, Andre M. Ilbawi, World Health Organization European Observatory on Health Systems and Policies, Brussels, Belgium; Silvana Luciani, Pan American Health Organization, Washington, DC; and Julie Torode, Union for International Cancer Control, Geneva, Switzerland
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145
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Wang X, Ji Z, Yang S, Xing D. Morphological-adaptive photoacoustic tomography with flexible transducer and flexible orientation light. OPTICS LETTERS 2017; 42:4486-4489. [PMID: 29088194 DOI: 10.1364/ol.42.004486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 10/03/2017] [Indexed: 06/07/2023]
Abstract
Although conventional photoacoustic tomography (PAT) provides high optical contrast and high ultrasound resolution in depth, its fixed-energy-distribution laser and unchangeable-shaped detector hinder its implementations on clinical routine breast screening. In this Letter, for the first time, to the best of our knowledge, we present a fully flexible photoacoustic coupling system (FPACS) that integrates optical fiber bundles and a flexible ultrasonic transducer for morphological-adaptive breast detection. The experimental results show that the system has better resolution and higher energy utilization than traditional PAT systems, even at the edge of the imaging region. Moreover, the system can achieve morphological adaption, suggesting that the FPACS provides the potential for clinical routine breast screening.
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146
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Akram M, Iqbal M, Daniyal M, Khan AU. Awareness and current knowledge of breast cancer. Biol Res 2017; 50:33. [PMID: 28969709 PMCID: PMC5625777 DOI: 10.1186/s40659-017-0140-9] [Citation(s) in RCA: 609] [Impact Index Per Article: 87.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 09/22/2017] [Indexed: 02/01/2023] Open
Abstract
Breast cancer remains a worldwide public health dilemma and is currently the most common tumour in the globe. Awareness of breast cancer, public attentiveness, and advancement in breast imaging has made a positive impact on recognition and screening of breast cancer. Breast cancer is life-threatening disease in females and the leading cause of mortality among women population. For the previous two decades, studies related to the breast cancer has guided to astonishing advancement in our understanding of the breast cancer, resulting in further proficient treatments. Amongst all the malignant diseases, breast cancer is considered as one of the leading cause of death in post menopausal women accounting for 23% of all cancer deaths. It is a global issue now, but still it is diagnosed in their advanced stages due to the negligence of women regarding the self inspection and clinical examination of the breast. This review addresses anatomy of the breast, risk factors, epidemiology of breast cancer, pathogenesis of breast cancer, stages of breast cancer, diagnostic investigations and treatment including chemotherapy, surgery, targeted therapies, hormone replacement therapy, radiation therapy, complementary therapies, gene therapy and stem-cell therapy etc for breast cancer.
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Affiliation(s)
- Muhammad Akram
- Department of Eastern Medicine and Surgery, Directorate of Medical Sciences, GC University Faisalabad, Old Campus, Allam Iqbal Road, Faisalabad, 38000 Pakistan
| | - Mehwish Iqbal
- Faculty of Eastern Medicine, Hamdard University Karachi, Main Campus, Sharea Madinat al-Hikmah, Mohammad Bin Qasim Avenue, Karachi, 74600 Sindh Pakistan
| | - Muhammad Daniyal
- Faculty of Eastern Medicine, Hamdard University Karachi, Main Campus, Sharea Madinat al-Hikmah, Mohammad Bin Qasim Avenue, Karachi, 74600 Sindh Pakistan
| | - Asmat Ullah Khan
- Laboratory of Neuroanatomy & Neuropsychobiology, Department of Pharmacology, RibeirãoPreto Medical School of the University of São Paulo, AV. Bandeirantes, 3900, RibeirãoPreto, 14049-900 São Paulo, Brazil
- Department of Eastern Medicine and Surgery, School of Medical and Health Sciences, University of Poonch Rawalakot, Hajira Road, Shamsabad, Rawalakot, 12350 Azad Jammu and Kashmir Pakistan
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147
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Preoperative pregabalin or gabapentin for acute and chronic postoperative pain among patients undergoing breast cancer surgery: A systematic review and meta-analysis of randomized controlled trials. J Plast Reconstr Aesthet Surg 2017; 70:1317-1328. [DOI: 10.1016/j.bjps.2017.05.054] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 05/19/2017] [Accepted: 05/28/2017] [Indexed: 01/28/2023]
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148
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Sama CB, Dzekem B, Kehbila J, Ekabe CJ, Vofo B, Abua NL, Dingana TN, Angwafo F. Awareness of breast cancer and breast self-examination among female undergraduate students in a higher teachers training college in Cameroon. Pan Afr Med J 2017; 28:91. [PMID: 29255561 PMCID: PMC5724944 DOI: 10.11604/pamj.2017.28.91.10986] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 09/16/2017] [Indexed: 12/25/2022] Open
Abstract
Introduction The incidence of breast cancer (BCa) in Cameroon is on the rise and accounts for a leading cause of mortality. An understanding of the knowledge and practices on breast cancer and breast self-examination (BSE) among teachers are important first steps which will guide the designing of interventions aimed at raising awareness across the general population. Methods We conducted a cross-sectional study in April 2016 involving 345 consenting female undergraduate students in the Higher Teachers Training College, Bambili, Cameroon. Data was collected using a pretested self-administered questionnaire and analysed using descriptive methods. Results The mean age of the respondents was 22.5±3.2years and a vast majority (n = 304, 88.1%) had heard about BCa primarily from the television/radio (n=196, 64.5%). Overall, less than a quarter (n=65, 21.4%) of respondents who had heard about BCa had sufficient knowledge on its risk factors and signs/symptoms. A plurality (53.3%) thought BCa can be prevented via vaccination while over a third (38.7%) opined that BCa can be treated spiritually. Less than half (47%) of respondents who had heard about BCa had heard about BSE amongst which only 55 (38.5%) had ever practiced it. Conclusion Though most students are aware of the existence of breast cancer, their overall knowledge on its risk factors and clinical presentation is insufficient with a concomitant low practice of BSE. These highlighted gaps warrants intensification of sensitization campaigns and educational programmes in order to raise knowledge levels and enhance prevention strategies that would aid in reducing the burden of breast cancer in Cameroon.
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Affiliation(s)
- Carlson-Babila Sama
- Bambalang Sub-Divisional Hospital, Northwest Region, Cameroon.,Galactic Corps Research Group (GCRG), Cameroon and Faculty of Health Sciences, University of Buea, Cameroon
| | - Bonaventure Dzekem
- Galactic Corps Research Group (GCRG), Cameroon and Faculty of Health Sciences, University of Buea, Cameroon.,Clinical Research Education, Networking and Consultancy (CRENC), Douala, Cameroon and Health Services Partner Cameroon
| | - Jules Kehbila
- Galactic Corps Research Group (GCRG), Cameroon and Faculty of Health Sciences, University of Buea, Cameroon.,Grace Community Health and Development Association (GRACHADA), Kumba, Cameroon
| | - Cyril Jabea Ekabe
- Galactic Corps Research Group (GCRG), Cameroon and Faculty of Health Sciences, University of Buea, Cameroon.,Grace Community Health and Development Association (GRACHADA), Kumba, Cameroon
| | - Brice Vofo
- Galactic Corps Research Group (GCRG), Cameroon and Faculty of Health Sciences, University of Buea, Cameroon.,Ntam Medicalised Health Centre, Kumba, Cameroon
| | - Naomi Liteba Abua
- Galactic Corps Research Group (GCRG), Cameroon and Faculty of Health Sciences, University of Buea, Cameroon
| | - Therence Nwana Dingana
- Galactic Corps Research Group (GCRG), Cameroon and Faculty of Health Sciences, University of Buea, Cameroon.,Catholic General Hospital, Njinikom, Northwest Region, Cameroon
| | - Fru Angwafo
- Gynaeco-Obstetric and Paediatric Hospital and Department of Surgery, University Teaching Hospital, Yaoundé, Cameroon
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149
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Diaconu K, Chen YF, Cummins C, Jimenez Moyao G, Manaseki-Holland S, Lilford R. Methods for medical device and equipment procurement and prioritization within low- and middle-income countries: findings of a systematic literature review. Global Health 2017; 13:59. [PMID: 28821280 PMCID: PMC5563028 DOI: 10.1186/s12992-017-0280-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 07/27/2017] [Indexed: 08/05/2024] Open
Abstract
Background Forty to 70 % of medical devices and equipment in low- and middle-income countries are broken, unused or unfit for purpose; this impairs service delivery to patients and results in lost resources. Undiscerning procurement processes are at the heart of this issue. We conducted a systematic review of the literature to August 2013 with no time or language restrictions to identify what product selection or prioritization methods are recommended or used for medical device and equipment procurement planning within low- and middle-income countries. We explore the factors/evidence-base proposed for consideration within such methods and identify prioritization criteria. Results We included 217 documents (corresponding to 250 texts) in the narrative synthesis. Of these 111 featured in the meta-summary. We identify experience and needs-based methods used to reach procurement decisions. Equipment costs (including maintenance) and health needs are the dominant issues considered. Extracted data suggest that procurement officials should prioritize devices with low- and middle-income country appropriate technical specifications – i.e. devices and equipment that can be used given available human resources, infrastructure and maintenance capacity. Conclusion Suboptimal device use is directly linked to incomplete costing and inadequate consideration of maintenance services and user training during procurement planning. Accurate estimation of life-cycle costing and careful consideration of device servicing are of crucial importance. Electronic supplementary material The online version of this article (doi:10.1186/s12992-017-0280-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karin Diaconu
- Institute for Applied Health Research, University of Birmingham, B15 2TT, Edgbaston, West Midlands, UK. .,Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU, UK.
| | - Yen-Fu Chen
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, CV4 7AL, UK
| | - Carole Cummins
- Institute for Applied Health Research, University of Birmingham, B15 2TT, Edgbaston, West Midlands, UK.
| | - Gabriela Jimenez Moyao
- Medicins Sans Frontieres, Artsen Zonder Grenzen, Rue de l'Arbre Benit 46, 1050, Bruxelles, Belgium
| | - Semira Manaseki-Holland
- Institute for Applied Health Research, University of Birmingham, B15 2TT, Edgbaston, West Midlands, UK
| | - Richard Lilford
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, CV4 7AL, UK
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150
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Hortobagyi GN, Pyle D, Cazap EL, El Saghir NS, Shulman LN, Lyman GH, Schnipper LE, Adebamowo CA, Gandara DR, Vose J, Wong SL, Yu P. American Society of Clinical Oncology's Global Oncology Leadership Task Force: Findings and Actions. J Glob Oncol 2017; 4:1-8. [PMID: 30241187 PMCID: PMC6180769 DOI: 10.1200/jgo.17.00060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
In response to rising cancer incidence and mortality rates in low- and
middle-income countries and the increasingly global profile of ASCO’s
membership, the ASCO Board of Directors appointed the Global Oncology Leadership
Task Force (Task Force) to provide recommendations on ASCO’s engagement
in global oncology. To accomplish its work, the Task Force convened meetings of
global oncology experts, conducted focus group discussions with member groups,
did site visits to South America and India, and met regularly to analyze the
findings and develop recommendations. Task Force findings included global
concerns, such as access to care, and specific concerns of middle- and
low-resource settings. The need to strengthen health systems and the importance
of alliances with a range of international cancer stakeholders were emphasized.
Task Force recommendations to the ASCO Board of Directors were based on a
three-part global oncology strategy of professional development, improvement of
access to quality care, and acceleration of global oncology research. Specific
areas of focus within each of these strategic pillars are provided along with an
update on areas of ASCO activity as these recommendations are implemented.
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Affiliation(s)
- Gabriel N Hortobagyi
- Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe de Oncología Médica, Buenos Aires, Argentina; Nagi S. El Saghir, American University of Beirut Medical Center, Beirut, Lebanon; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Boston, MA; Clement Adebayo Adebamowo, Institute of Human Virology, Baltimore, MD; David R. Gandara, University of California Davis Comprehensive Cancer Center, Sacramento, CA; Julie Vose, University of Nebraska Medical Center, Omaha, NE; Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and Peter Yu, Hartford HealthCare, Hartford, CT
| | - Doug Pyle
- Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe de Oncología Médica, Buenos Aires, Argentina; Nagi S. El Saghir, American University of Beirut Medical Center, Beirut, Lebanon; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Boston, MA; Clement Adebayo Adebamowo, Institute of Human Virology, Baltimore, MD; David R. Gandara, University of California Davis Comprehensive Cancer Center, Sacramento, CA; Julie Vose, University of Nebraska Medical Center, Omaha, NE; Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and Peter Yu, Hartford HealthCare, Hartford, CT
| | - Eduardo L Cazap
- Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe de Oncología Médica, Buenos Aires, Argentina; Nagi S. El Saghir, American University of Beirut Medical Center, Beirut, Lebanon; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Boston, MA; Clement Adebayo Adebamowo, Institute of Human Virology, Baltimore, MD; David R. Gandara, University of California Davis Comprehensive Cancer Center, Sacramento, CA; Julie Vose, University of Nebraska Medical Center, Omaha, NE; Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and Peter Yu, Hartford HealthCare, Hartford, CT
| | - Nagi S El Saghir
- Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe de Oncología Médica, Buenos Aires, Argentina; Nagi S. El Saghir, American University of Beirut Medical Center, Beirut, Lebanon; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Boston, MA; Clement Adebayo Adebamowo, Institute of Human Virology, Baltimore, MD; David R. Gandara, University of California Davis Comprehensive Cancer Center, Sacramento, CA; Julie Vose, University of Nebraska Medical Center, Omaha, NE; Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and Peter Yu, Hartford HealthCare, Hartford, CT
| | - Lawrence N Shulman
- Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe de Oncología Médica, Buenos Aires, Argentina; Nagi S. El Saghir, American University of Beirut Medical Center, Beirut, Lebanon; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Boston, MA; Clement Adebayo Adebamowo, Institute of Human Virology, Baltimore, MD; David R. Gandara, University of California Davis Comprehensive Cancer Center, Sacramento, CA; Julie Vose, University of Nebraska Medical Center, Omaha, NE; Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and Peter Yu, Hartford HealthCare, Hartford, CT
| | - Gary H Lyman
- Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe de Oncología Médica, Buenos Aires, Argentina; Nagi S. El Saghir, American University of Beirut Medical Center, Beirut, Lebanon; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Boston, MA; Clement Adebayo Adebamowo, Institute of Human Virology, Baltimore, MD; David R. Gandara, University of California Davis Comprehensive Cancer Center, Sacramento, CA; Julie Vose, University of Nebraska Medical Center, Omaha, NE; Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and Peter Yu, Hartford HealthCare, Hartford, CT
| | - Lowell E Schnipper
- Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe de Oncología Médica, Buenos Aires, Argentina; Nagi S. El Saghir, American University of Beirut Medical Center, Beirut, Lebanon; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Boston, MA; Clement Adebayo Adebamowo, Institute of Human Virology, Baltimore, MD; David R. Gandara, University of California Davis Comprehensive Cancer Center, Sacramento, CA; Julie Vose, University of Nebraska Medical Center, Omaha, NE; Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and Peter Yu, Hartford HealthCare, Hartford, CT
| | - Clement Adebayo Adebamowo
- Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe de Oncología Médica, Buenos Aires, Argentina; Nagi S. El Saghir, American University of Beirut Medical Center, Beirut, Lebanon; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Boston, MA; Clement Adebayo Adebamowo, Institute of Human Virology, Baltimore, MD; David R. Gandara, University of California Davis Comprehensive Cancer Center, Sacramento, CA; Julie Vose, University of Nebraska Medical Center, Omaha, NE; Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and Peter Yu, Hartford HealthCare, Hartford, CT
| | - David R Gandara
- Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe de Oncología Médica, Buenos Aires, Argentina; Nagi S. El Saghir, American University of Beirut Medical Center, Beirut, Lebanon; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Boston, MA; Clement Adebayo Adebamowo, Institute of Human Virology, Baltimore, MD; David R. Gandara, University of California Davis Comprehensive Cancer Center, Sacramento, CA; Julie Vose, University of Nebraska Medical Center, Omaha, NE; Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and Peter Yu, Hartford HealthCare, Hartford, CT
| | - Julie Vose
- Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe de Oncología Médica, Buenos Aires, Argentina; Nagi S. El Saghir, American University of Beirut Medical Center, Beirut, Lebanon; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Boston, MA; Clement Adebayo Adebamowo, Institute of Human Virology, Baltimore, MD; David R. Gandara, University of California Davis Comprehensive Cancer Center, Sacramento, CA; Julie Vose, University of Nebraska Medical Center, Omaha, NE; Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and Peter Yu, Hartford HealthCare, Hartford, CT
| | - Sandra L Wong
- Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe de Oncología Médica, Buenos Aires, Argentina; Nagi S. El Saghir, American University of Beirut Medical Center, Beirut, Lebanon; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Boston, MA; Clement Adebayo Adebamowo, Institute of Human Virology, Baltimore, MD; David R. Gandara, University of California Davis Comprehensive Cancer Center, Sacramento, CA; Julie Vose, University of Nebraska Medical Center, Omaha, NE; Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and Peter Yu, Hartford HealthCare, Hartford, CT
| | - Peter Yu
- Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe de Oncología Médica, Buenos Aires, Argentina; Nagi S. El Saghir, American University of Beirut Medical Center, Beirut, Lebanon; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Boston, MA; Clement Adebayo Adebamowo, Institute of Human Virology, Baltimore, MD; David R. Gandara, University of California Davis Comprehensive Cancer Center, Sacramento, CA; Julie Vose, University of Nebraska Medical Center, Omaha, NE; Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and Peter Yu, Hartford HealthCare, Hartford, CT
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