A Matched Case-Control Study of Risk Factors for Breast Cancer Risk in Vietnam

Association of microRNA-21 expression with breast cancer subtypes and its potential as an early biomarker

Breast cancer has become the most diagnosed cancer worldwide in 2020 with high morbidity and mortality rates. The alarming increase in breast cancer incidence has sprung many researchers to focus on developing novel screening tests to identify early breast cancer which will allow clinicians to provide timely and effective treatments. With much evidence supporting the notion that the deregulation of miRNAs (a class of non-coding RNA) greatly contributes to cancer initiation and progression, the promising role of miRNAs as cancer biomarkers is gaining traction in the research world. Among the upregulated miRNAs identified in breast carcinogenesis, miR-21 was shown to be significantly expressed in breast cancer tissues and bodily fluids of breast cancer patients. Therein, this review paper aims to provide an overview of breast cancer, the role and significance of miR-21 in breast cancer pathogenesis, and its potential as a breast cancer biomarker. The paper also discusses the current types of tumor biomarkers and their limitations, the presence of miR-21 in extracellular vesicles and plasma, screening methods available for miRNA detection along with some challenges faced in developing diagnostic miR-21 testing for breast cancer to provide readers with a comprehensive outlook based on using miR-21 in clinical settings.

A Cross-Sectional Study on the Epidemiology of Newly Diagnosed Breast Cancer Patients Attending Tertiary Care Hospitals in a Tribal Preponderant State of India: Regression Analysis

INTRODUCTION

Breast cancer (BC) is globally prevalent and the leading cause of death due to cancer in females. Due to changes in risk factor profiles, improved cancer registration, and cancer detection, its incidence and death rates have risen over the past three decades. Both modifiable and immutable risk factors for BC make up a sizable portion of the total risk factors.  Methodology: This was a hospital-based cross-sectional study carried out in the Department of Surgery, Rajendra Institute of Medical Sciences (RIMS), Ranchi. Consecutive sampling was done with a complete enumeration of all newly diagnosed cases of breast cancer >15 years old. Those who consented to participate and those who were extremely ill, deaf, or dumb were excluded from the study.

RESULTS

A total of 88 patients were included. Maximum patients diagnosed with breast cancer belonged to the age group of 40-50 years (37.5%), Hindu by religion (76.1%), non-tribal (80.68%), illiterate (89.8%), married (98.9%), housewives (92%), and of class IV socio-economic status (SES) (65.9%).

CONCLUSION

Regular training of Sahiya (the local name of Accredited Social Health Activist (ASHA) in Jharkhand), empowerment of screening clinics for cancer, and upgraded diagnostic facilities for timely referral should be stressed upon.

Information Needs of Patients With Breast Cancer Undergoing Treatment in Vietnam and Related Determinants

BACKGROUND

Patients with cancer who are not well informed often experience dissatisfaction with care, difficulty coping with their disease, and feelings of helplessness.

PURPOSE

This study was designed to investigate the information needs of women with breast cancer undergoing treatment in Vietnam and the determinants of these needs.

METHODS

One hundred thirty women undergoing chemotherapy for breast cancer in the National Cancer Hospital in Vietnam enrolled as volunteers in this cross-sectional descriptive correlational study. Self-perceived information needs, body functions, and disease symptoms were surveyed using the Toronto Informational Needs Questionnaire and the 23-item Breast Cancer Module of the European Organization for Research and Treatment of Cancer questionnaire, which consists of two (functional and symptom) subscales. Descriptive statistical analyses included t test, analysis of variance, Pearson correlation, and multiple linear regression.

RESULTS

The results revealed participants had high information needs and a negative future perspective. The highest information needs related to potential for recurrence, interpretation of blood test results, treatment side effects, and diet. Future perspective, income level, and educational level were identified as determinants of information needs, explaining 28.2% of the variance in the need for breast cancer information.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

This study was the first to use a validated questionnaire to assess information needs in women with breast cancer in Vietnam. Healthcare professionals may refer to the findings of this study when designing and delivering health education programs designed to meet the self-perceived information needs of women with breast cancer in Vietnam.

Genetic landscape and personalized tracking of tumor mutations in Vietnamese women with breast cancer

Breast cancer is the leading cause of cancer death in Vietnamese women, but its mutational landscape and actionable alterations for targeted therapies remain unknown. After treatment, a sensitive biomarker to complement conventional imaging to monitor patients is also lacking. In this prospective multi-center study, 134 early-stage breast cancer patients eligible for curative-intent surgery were recruited. Genomic DNA from tumor tissues and paired white blood cells were sequenced to profile all tumor-derived mutations in 95 cancer-associated genes. Our bioinformatic algorithm was then utilized to identify top mutations for individual patients. Serial plasma samples were collected before surgery and at scheduled visits after surgery. Personalized assay tracking the selected mutations were performed to detect circulating tumor DNA (ctDNA) in the plasma. We found that the mutational landscape of the Vietnamese was largely similar to other Asian cohorts, showing higher TP53 mutation frequency than in Caucasians. Alterations in PIK3CA and PI3K signaling were dominant, particularly in our triple-negative subgroup. Using top-ranked mutations, we detected ctDNA in pre-operative plasma in 24.6-43.5% of the hormone-receptor-positive groups and 76.9-80.8% of the hormone-receptor-negative groups. The detection rate was associated with breast cancer subtypes and clinicopathological features that increased the risk of relapse. Interim analysis after a 15-month follow-up revealed post-operative detection of ctDNA in all three patients that had recurrence, with a lead time of 7-13 months ahead of clinical diagnosis. Our personalized assay is streamlined and affordable with promising clinical utility in residual cancer surveillance. We also generated the first somatic variant dataset for Vietnamese breast cancer women that could lay the foundation for precision cancer medicine in Vietnam.

Menstrual and Reproductive Factors in Association With Breast Cancer Risk in Vietnamese Women: A Case-Control Study

OBJECTIVES

Though menstrual and reproductive factors have been associated with the risk of breast cancer in many populations, very few studies have been conducted among Vietnamese women. This study aimed to assess the association between menstrual and reproductive factors and the risk of breast cancer in Vietnamese women.

METHODS

A retrospective case-control study of 490 breast cancer cases and 468 controls was conducted in Northern Vietnam. Unconditional logistic regression models adjusting for confounders were used to estimate odds ratios (ORs) and their 95% confidence intervals (CIs) for the associations of menstrual and reproductive factors with the risk of breast cancer; overall and by cancer subtype.

RESULTS

Among breast cancer patients, the luminal B subtype was the most frequent (48.6%), followed by HER2-overexpressing (24.5%), luminal A (16.7%), and triple-negative breast cancer (TNBC; 10.2%). Among menopausal women, menopausal age at 50 years or older (OR = 1.71, 95% CI: 1.15-2.57 vs. <50 y) was associated with an increased risk of breast cancer. Earlier age at menarche (<13 y) was associated with a significantly increased risk of breast cancer (OR = 2.66, 95% CI: 1.08-7.51) among premenopausal women only and the luminal A subtype of breast cancer (OR = 3.06, 95% CI: 1.04-8.16). Having more than two children was associated with a reduced risk of premenopausal (OR = .42, 95%CI: .21-.83), luminal B (OR = .43, 95% CI: .24-.79), and TNBC (OR = .34, 95% CI: .14-.89). Later menopause was positively associated with the risk of breast cancer with HER2 overexpression (OR = 2.19, 95% CI: 1.14-4.23).

CONCLUSION

Associations of menstrual and reproductive factors with breast cancer among Vietnamese women, particularly for among premenopausal women and for the luminal A subtype, are generally consistent with those reported from other countries. These findings suggest that changes in menstrual and reproductive patterns among young Vietnamese women may contribute to the recent rising incidence of breast cancer in Vietnam.

Oral Contraceptive Use and Breast Cancer Risk Assessment: A Systematic Review and Meta-Analysis of Case-Control Studies, 2009-2020

To perform a meta-analysis of case-control studies that addressed the association between oral contraceptive pills (OC) use and breast cancer (BrCa), PubMED (MEDLINE), Embase, and the Cochrane Library were searched to identify case-control studies of OC and BrCa published between 2009 and 2020. We used the DerSimonian-Laird method to compute pooled odds ratios (ORs) and confidence intervals (CIs), and the Mantel-Haenszel test to assess the association between OC use and cancer. Forty-two studies were identified that met the inclusion criteria and we included a total of 110,580 women (30,778 into the BrCa group and 79,802 into the control group, of which 15,722 and 38,334 were using OC, respectively). The conducted meta-analysis showed that the use of OC was associated with a significantly increased risk of BrCa in general, OR = 1.15, 95% CI: 1.01 to 1.31, p = 0.0358. Regarding other risk factors for BrCa, we found that increased risk was associated significantly with early menarche, nulliparous, non-breastfeeding, older age at first parity, postmenopause, obesity, smoking, and family history of BrCa. Despite our conclusion that birth control pills increase the cancer risk being supported by extensive previous studies and meta-analyzes, further confirmation is required.

Reproductive factors and breast cancer risk in Palestine: A case control study

BACKGROUND

Early age at menarche, late age at menopause, and late age at first full-term pregnancy are linked to a modest increase in the risk of developing breast cancer (breast ca). This study aims to investigate the reproductive determinants of breast cancer among women in the West Bank of Palestine. A structured questionnaire was used to collect data in a case-control study (237 registered cases and 237 controls). A multivariate analysis model was used to adjust for the association between women's reproductive factors and breast ca risk. This study was approved by Al Quds University Ethical Research Committee and the Ministry of Health research unit.

RESULTS

In the multivariate analysis, menarche after 13 years of age, use of oral contraceptives for more than two months, and hormonal contraceptives use significantly doubled the risk for breast ca (Adjusted Odds Ratio (AOR) = 2.03, 95 % CI: 1.21-4.37, p < 0.011 and AOR = 2.2, 95 % CI: 1.24-4.01, p = 0.008, respectively). Women who used hormone replacement therapy (HRT) were significantly associated with higher odds (5 folds) of having breast ca versus those who did not use them (AOR 5.02, 95 % CI: 1.93-13.06, p = 0.001). Similarly, nulliparous women showed 6 times the odds of breast ca compared with women with one or more children (p = 0.005). Also, parental consanguinity marriage (AOR 2.59, 95 % CI: 1.53-4.36, p = 0.001) and positive family history (AOR 3.88, 95 % CI: 2.19-6.87, p = 0.001) of the condition can be strong determinants for breast ca in this study.

CONCLUSION

This study provides clear evidence that the use of reproductive hormones, whether as a birth control tool or for therapeutic purposes, must be rationalized worldwide and in Palestine in particular.

Identifying Risk Factors of Breast Cancer Among Women Attending Selected Hospitals of Addis Ababa City: Hospital-Based Unmatched Case-Control Study

Background

Breast cancer, one of the chronic diseases, is the most common cancer among women in the world. In Ethiopia, late-stage breast cancer is widely diagnosed and women have very little access to adequate medication, pain relief, or palliative care. In addition, there are few research on risk factors for breast cancer in Ethiopia. A safer way out of this is to concentrate on prevention; one of the prevention methods is to recognize risk factors sooner. The study therefore aimed to establish risk factors for breast cancer among women in hospitals in the city of Addis Ababa.

Methods

Hospital-based, unmatched case-control research conducted in selected Addis Ababa hospitals from April to September 2017 (Case=110 and Control=110). Data were collected by standardized questionnaires for both cases and controls. Cases were initially detected by mammography screening accompanied by histopathological examinations, while controls were those women who were negative by mammogram testing, stress levels were assessed by perceived stress scale (PSS) and body mass index measured by WHO norm. Summary statistics Computed and binary logistic regression analysis to classify risk factors for breast cancer modified odds ratio (AOR) with 95% confidence interval (CI) calculated.

Results

The participants’ mean age of was 43.80 years (SD ±12.63) and 39.64 years (SD ±12.91) for cases and controls, respectively. Physical activity (AOR=0.2, 95% CI: 0.10, 0.41) was correlated with lower probability of breast cancer, while never breastfeed (AOR=3.4, 95% CI: 1.21, 9.67); menopausal state (AOR=6.8, 95% CI: 1.92, 24.16), and body mass index above 25. 1 kg/m² (AOR=5.9, 95% CI: 2.16, 16.48) were factors risk factors for breast cancer.

Conclusion

This research shows the importance of physical exercise, breastfeeding, menopausal status, and nutritional status in the occurrence of breast cancer. Actions aimed at increasing physical activity, breastfeeding habits and keeping a balanced diet will help to minimize the incidence of breast cancer.

Risk Factors Associated with Breast Cancer among Women in Addis Ababa, Ethiopia: Unmatched Case-Control Study

BACKGROUND

Breast cancer is a common public health problem and the main cause of cancer-related death worldwide. There is a paucity of evidence on the risk factors of breast cancer in Ethiopia. Therefore, we aimed to identify the risk factors of breast cancer among women in Addis Ababa, Ethiopia.

METHODS

We conducted an institutional-based unmatched case-control study with a sample of 348 women (116 cases and 232 controls). Participants were selected by a systematic random sampling technique. Data were collected using an interviewer-administered questionnaire. Data were entered using EpiData version 4.6 and analyzed using SPSS version 25. Multivariable analysis was carried out using the adjusted odds ratio (AOR) with a 95% confidence interval (CI). P-value of less than 0.05 was considered statistically significant.

RESULTS

The mean age (+SD) of the participants was 42.7 (±11.3) and 40.7 (±14.6) for the cases and controls, respectively. Early onset of menarche (AOR= 4.10; 95% CI: 1.84, 9.15), rural women (AOR= 3.64; 95% CI:1.38, 9.57), utilization of packed foods or drinks (AOR= 2.80; 95% CI:1.52, 5.15), and smoke-dried meat (AOR= 2.41; 95% CI:1.36, 4.27), family history of cancer (AOR= 2.11; 95% CI:1.04, 4.26), overweight and/or obesity (AOR= 2.38; 95% CI:1.31, 4.31), and women with one or less children (AOR= 1.86; 95% CI:1.01, 3.41) were associated factors with breast cancer risk.

CONCLUSION

In this study, early onset of menarche, rural women, utilization of packed foods or drinks and smoke-dried meat, family history of cancer, overweight and/or obesity, and women with one or fewer children were factors that increased breast cancer risk. Therefore, focusing on modifiable risk factors and increasing awareness of the community such as a healthy diet, promotion of breast self-examination, and creation of programs to increase women's knowledge is important to reduce the increasing burden of breast cancer.

Association of Overweight and Obesity with Breast Cancer During Premenopausal Period in Asia: A Meta-Analysis

Background:

The association of overweight and obesity with breast cancer risk in premenopausal women and in different ethnicities remains in debate, especially among Asian women. The aim of this systematic review and meta-analysis was to determine the association of overweight and obesity with breast cancer during premenopausal period in Asian women.

Methods:

We performed a meta-analysis of research articles on the association of overweight and obesity with breast cancer during premenopausal period in Asian women published from January 2000 to July 2018 in article databases of EBSCO, PubMed, and ProQuest. Pooled odds ratios (ORs) were calculated by fixed and random-effect models. Publication bias was visually evaluated using funnel plots, and then statistically assessed using Egger's and Begg's tests. Review Manager 5.3 (RevMan 5.3) and Stata version 14.2 (Stata Corporation) were used to process the data. We reviewed 886 articles.

Results:

We found 15 studies conducted systematic review continued by meta-analysis of relevant data with 22,362 patients. There was significant association of obesity [OR = 1.36 (95% confidence interval (CI) 1.26–1.47, P < 0.00001)] and overweight [OR = 1.17 (95% CI 1.10–1.25, P < 0.00001)] with breast cancer during premenopausal period in Asian women. In this study, there was no significant publication bias for studies included in overweight and obesity with breast cancer during premenopausal in Asian women.

Conclusions:

This study suggested association of overweight and obesity with breast cancer during premenopausal period in Asian women.

Epidemiological characteristics of and risk factors for breast cancer in the world

AIM

Breast cancer is the most common cancer among women and one of the most important causes of death among them. This review aimed to investigate the incidence and mortality rates of breast cancer and to identify the risk factors for breast cancer in the world.

MATERIALS AND METHODS

A search was performed in PubMed, Web of Science, and Scopus databases without any time restrictions. The search keywords included the following terms: breast cancer, risk factors, incidence, and mortality and a combination of these terms. Studies published in English that referred to various aspects of breast cancer including epidemiology and risk factors were included in the study. Overall, 142 articles published in English were included in the study.

RESULTS

Based on the published studies, the incidence rate of breast cancer varies greatly with race and ethnicity and is higher in developed countries. Results of this study show that mortality rate of breast cancer is higher in less developed regions. The findings of this study demonstrated that various risk factors including demographic, reproductive, hormonal, hereditary, breast related, and lifestyle contribute to the incidence of breast cancer.

CONCLUSION

The results of this study indicated that incidence and mortality rates of breast cancer is rising, so design and implementation of screening programs and the control of risk factors seem essential.

Strengthening breast cancer services in Vietnam: a mixed-methods study

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.

Predictive Analysis of Palmar Dermatoglyphics in Patients with Breast Cancer for Small Bosnian-Herzegovinian Population

INTRODUCTION

Malignant breast cancer is the most common malignancy in women between 40 and 55 years of age. Dermatoglyphs are polygenetically determined properties, whose appearance and number are determined by a specific gene. They represent the skin reefs that are created by epidermis on the fingers or toes, palms and soles. Palmar dermatoglyphs have been used to estimate the hereditary basis of many diseases.

AIM

The aim of the paper is to determine whether there is a statistically significant difference between the observed qualitative and quantitative parameters of both palms between the experimental and the control group.

MATERIAL AND METHODS

A survey of the qualitative and quantitative properties of the palmar complex was carried out on a total of 100 female respondents. The first group included 50 women with breast cancer. Comparative data were used for the analysis of palmar dermatoglyphs in the second group of respondents, or 50 phenotypic healthy female subjects. The imprints of the palmar complex were taken using the printake ribbons, analyzed, and the data was then statistically processed and displayed in charts. An analysis of the number of reefs between two digital triradius was performed, followed by the determination of the axially triad position, as well as the ATD angle measurement.

RESULTS

Quantitative analysis of ATD-angle showed statistically significant difference between the left and right palms of the analyzed groups. However, the analysis of the number of reefs between triradius A-B, B-C, C-D did not show statistically significant results for both the left and right hand between the analyzed groups.

CONCLUSION

These results indicate that the quantitative palmar parameter, ATD-angle, can play a role in identifying women with increased risk of breast cancer.

Breast cancer services in Vietnam: a scoping review

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.

Breast Cancer Risk From Modifiable and Non-Modifiable Risk Factors among Women in Southeast Asia: A Meta-Analysis

Objective:

The aim of this study was to determine breast cancer risk from modifiable and non-modifiable factors among women in Southeast Asia.

Methods:

This meta-analysis was performed on research articles on breast cancer risk factors in PubMed, ProQuest and EBSCO databases published between 1997 and October 2017. Pooled odds ratios (OR) are calculated using fixed and random-effect models. Data were processed using Review Manager 5.3 (RevMan 5.3).

Results:

From a total of 1,211 articles, 15 studies (1 cohort and 14 case control studies) met the criteria for systematic review. Meta-analysis results showed that of the known modifiable risk factors for breast cancer, parity (nulipara) had the highest odd ratio (OR = 1.85 [95% CI 1.47-2.32]) followed by body mass index (overweight) (OR = 1.61 [95% CI 1.43-1.80]) and use of oral contraceptives (OR = 1.27 [95% CI 1.07-1.51]). Of non-modifiable risk factors, family history of breast cancer had the highest odd ratio (OR = 2.53 [95% CI 1.25-5.09]), followed by age (≥ 40 years) (OR = 1.53 [95% CI 1.34-1.76]) and menopausal status (OR = 1.44 [95% CI 1.26-1.65]).

Conclusion:

This analysis confirmed associations between both modifiable risk factors (parity, body mass index and use of oral contraceptives) and non-modifiable risk factors (family history of breast cancer, age and menopausal status) with breast cancer.