Trends of breast cancer and its management in the last twenty years in Aden and adjacent governorates, Yemen

Breast Cancer in Asia: Incidence, Mortality, Early Detection, Mammography Programs, and Risk-Based Screening Initiatives

Simple Summary

Nearly all breast cancer patients survive for more than five years when the tumor is found early and in the localized stage. Regular clinical breast examinations, mammograms, and monthly self-exams of the breasts all contribute to early detection. However, late-stage breast cancers are common in many Asian countries. Low-income countries suffer from a lack of resources for breast cancer screening. High-income countries, on the other hand, are not benefiting fully from national breast screening programs due to an underutilization of the preventive healthcare services available. Existing reviews on Asian breast cancers are heavily focused on risk factors. The question of whether we should adopt or adapt the knowledge generated from non-Asian breast cancers would benefit from an extension into screening guidelines. In addition, several Asian countries are piloting studies that move away from the age-based screening paradigm.

Abstract

Close to half (45.4%) of the 2.3 million breast cancers (BC) diagnosed in 2020 were from Asia. While the burden of breast cancer has been examined at the level of broad geographic regions, literature on more in-depth coverage of the individual countries and subregions of the Asian continent is lacking. This narrative review examines the breast cancer burden in 47 Asian countries. Breast cancer screening guidelines and risk-based screening initiatives are discussed.

Factor structure and internal reliability of breast cancer screening Champion's Health Belief Model Scale in Yemeni women in Malaysia: a cross-sectional study

BACKGROUND

The reliability and validity of the Champion's Health Belief Model Scale (CHBMS) used in assessing the belief of women regarding breast cancer (BC) and breast cancer screening (BCS) have been examined on various populations. However, the use of this tool has not been adequately assessed for its validity in ethnic minorities. This study assessed the validity and reliability of CHBMS by analyzing the factor structure and internal reliability of the factors among Yemeni women in Malaysia.

METHODS

A survey was conducted among 103 female teachers from 10 schools. SPSS version 22.0 was utilized in analyzing the data. Descriptive statistics were computed for the socio-demographic characteristics. The Cronbach's alpha coefficients were used in assessing the internal reliability. The Exploratory Factor Analysis (EFA) was used to analyze the factor structure of the translated items. Parallel analysis was performed to determine the number of factors accurately.

RESULTS

The alpha coefficients of the factors had acceptable values ranging between 0.76 and 0.87. The factor analysis yielded six and five factors for breast self-examination (BSE) and mammography (MMG), with a total explained variance of 47.69% and 52.63%, respectively. The Kaiser-Meyer-Olkin (KMO) index values of 0.64 and 0.72, and the Bartlett's Test of Sphericity (P = 0.0001) for BSE and MMG, respectively, verified the normality distribution and the adequacy of the sample size for EFA. All the items on each factor were from the same construct that were consistent with the number of factors obtained in the scale development study. The items achieved adequate factor loadings that ranged between 0.47 and 0.88.

CONCLUSIONS

The translated version of the CHBMS is a validated scale used in assessing the beliefs related to BC and BCS among Yemeni women living in Malaysia. Healthcare workers could use the scales to assess women's beliefs on BC and BCS. This instrument could be used to test the effectiveness of the intervention programs.

Survival and Predictors of Mortality among Breast Cancer Patients in Northwest Ethiopia: A Retrospective Cohort Study

BACKGROUND

Breast cancer is the most common malignant tumor and the leading cause of cancer death in over 100 countries. Despite the high burden of difficulty, the survival status and the predictors for mortality are not yet determined in Ethiopia. Studies related to this area are scarce. Therefore, we aimed to estimate the survival status and predictors of mortality among breast cancer patients in Northwest Ethiopia.

METHODS

A retrospective cohort study design was carried out from September 2015 to August 2020 among 482 women who had breast cancer in Northwest Ethiopia. A systematic sampling technique was employed to select the required representative sample. The Cox regression model was used to identify the predictors of mortality among breast cancer patients.

RESULTS

For this study, 482 participants had followed for 8824 person-months total analysis time or at-risk time. In our findings, the overall survival of breast cancer patients at the end of two and five years was 54.24% and 25.8%, respectively. In the multivariable Cox regression model, age, stage of BC, menopausal status, and surgical therapy were significant predictors of death.

CONCLUSION

The overall survival after two years was 54.24%, and after five years was 25.8%. This result is lower than the recently published report and indicates that in LMIC, especially in rural cancer centers, the infrastructure and resources for routine screening mammography are often unavailable. Therefore, there is a need to promote early diagnosis of BC at each level of health-care delivery point.

Effectiveness of An Educational Intervention of Breast Cancer Screening Practices Uptake, Knowledge, and Beliefs among Yemeni Female School Teachers in Klang Valley, Malaysia: A Study Protocol for a Cluster-Randomized Controlled Trial

Breast cancer is the most common cancer spread among women worldwide. Whereas many studies have discussed the significance of breast cancer screening among women in various countries, few have attempted to discuss this topic among female school teachers. As teachers educate and communicate with students, this may play an essential role in health education and in promoting healthy behavior, such as breast cancer screening. The primary goal of this study is to develop and implement an educational intervention of breast cancer screening and evaluate its effectiveness among Yemeni female school teachers in Malaysia. This was carried out as per the health belief model. A cluster-randomized controlled trial was conducted among 183 Yemeni female school teachers in twelve schools in Klang Valley, Malaysia. A random assignment of the target schools was made to include them within the intervention or control group. Participants in the intervention group were offered a 90-min session for one-day educational intervention on breast cancer screening. On the other hand, participants in the control group were offered the same educational materials at the end of the study. Relevant data was collected at baseline, one month following the intervention, and then three- and six-months follow-up assessments. Analysis of such data was done via IBM SPSS software 25.0 by generalized estimating equations (GEE) to assess the differential changes over time. A primary outcome embodied in breast cancer screening practice uptake was expected. Secondary outcomes include the target group’s knowledge on and beliefs of breast cancer screening. This study intends to contribute to the credibility and effectiveness of utilizing a theory-based breast cancer screening intervention in order to raise the awareness of women on conducting breast cancer screening.

Incidence data for breast cancer among Yemeni female patients with palpable breast lumps

PURPOSE

To estimate the incidence of breast cancer in Yemeni female patients presenting with a breast mass.

MATERIALS AND METHODS

This retrospective study was carried out with 595 female patients with palpable breast lumps, attending to Alkuwait university hospital, Sana'a, Yemen. Triple assessment, including breast examination, mammography and biopsy (FNAC, core needle, or excision), for all patients were performed.

RESULTS

The incidences of benign and malignant lesions was calculated. Some 160 (26.9%) of 595 patients had malignancies; 213 (35.8%) were fibroadenomas; 12 (2.0%) were fibrocystic change; 143 (24.03%) were inflammatory lesions (including mastitis and ductectasia); 62 (10.4%) were simple cysts, while 5 (0.8%) were phyllodes tumors. The mean age of patients with malignant lumps was 44.3 years.

CONCLUSIONS

Among Yemeni female patients with palpable breast lumps, the rate of breast cancer is high, with occurrence at an earlier age than in Western countries. Improving breast cancer awareness programs and increasing breast cancer screening centers inb different areas of Yemen are needed to establish early diagnosis and offer early and optimal treatment.

Assessment of midwifery student preparation for performing the role of breast cancer educator

PURPOSE

Our research project aimed at presenting midwifery student self-assessment of performing the role of breast cancer prevention educator.

MATERIALS AND METHODS

Investigations were carried out in 2011 at the Medical University of Lublin in Poland, and Katolieke Hogeschool of Kortrijk in Belgium, after obtaining approval of the ethical committee of Polish Midwives Association (III/EC/2011/PMA). The project involved a total of 155 midwifery students, made up of 95 from Poland, and 60 from Belgium. Relations between opposing characteristics were tested with Chi-square (x2) test for independent traits. To assess the dependence relation between the examined variables Pearson's corrected coefficient was used. Data base and statistics were carried out with computer software STATISTICA 9.0 (StatSoftPoland).

CONCLUSIONS

Student knowledge on prevention against breast cancer was unsatisfactory.The students place of residence determined their self-estimation of personal knowledge of breast cancer prevention and diagnosing methods to assess the incidence of the disease, this knowledge being better with the students of Lublin. Better self-estimation in the students of Lublin of their personal knowledge on factors rising the risk of breast cancer, such as alimentation method, application of oral contraceptives and breast feeding was found than in Belgian students.

Trends in incidence of breast cancer among women under 40 in Asia

BACKGROUND

The aim of this study was to evaluate trends in incidence of breast cancer in women less than 40 years in Asia.

MATERIALS AND METHODS

Registered cases of female breast cancer age less than 40 years and corresponding person years were ascertained from the CI5plus for 10 registries in Asia for the duration of 1970- 2002. Cases were categorized into three age groups: 16-40, 16-29, and 30-40. The 16-40 age group was adjusted to world age population structure. Joinpoint regression analysis was conducted to determine the annual percent of change (APC) and the average annual percent of change (AAPC) for each age group.

RESULTS

A total of 23,661 cases of breast cancer occurred in the 10 registries during the 32 years (1970-2002) of follow-up. The overall age adjusted (16-40 group) breast cancer incidence rate increased from 2.28-4.26 cases per 100,000 population corresponding to an AAPC of 2.6% (95%CI 2.1, 3.0). The trend in incidence for the age group 16-29 increased from 0.45-1.07 corresponding to an AAPC of 2.8% (95%CI 1.9, 3.7). In age group 30 to 40, the incidence ranged from 13.3 in year 1970 to 24.8 in year 2002 corresponding to an AAPC of 2.7% (95% CI 2.3, 3.1). There were two statistically significant changing points in the regression line for the age groups 30-40 and 16-40: one point in the year 1975 with an APC of 6.1 (5.1, 7.1), and the other in 1985 with an APC of 0.4% (0.01, 0.8).

CONCLUSIONS

Our study proved that: 1) the incidence of breast cancer in young women has increased in Asian population during the study period; 2) the rate of increase was very high during the period of 1980-1990.

Curcumin inhibits TGF-β1-induced MMP-9 and invasion through ERK and Smad signaling in breast cancer MDA- MB-231 cells

OBJECTIVE

To evaluate the effects of curcumin on matrixmetalloproteinase-9 (MMP-9) and invasion ability induced by transforming growth factor-β1 (TGF-β1) in MDA-MB-231 cells and potential mechanisms.

METHODS

Human breast cancer MDA- MB-231 cells were used with the CCK-8 assay to measure the cytotoxicity of curcumin. After treatment with 10 ng/ml TGF-β1, with or without curcumin (≤10 μM), cell invasion was checked by transwell chamber. The effects of curcumin on TGF-β1-stimulated MMP-9 and phosphorylation of Smad2, extracellular-regulated kinase (ERK), and p38 mitogen activated protein kinases (p38MAPK) were examined by Western blotting. Supernatant liquid were collected to analyze the activity of MMP-9 via zymography. Following treatment with PD98059, a specific inhibitor of ERK, and SB203580, a specific inhibitor of p38MAPK, Western blotting and zymography were employed to examine MMP-9 expression and activity, respectively.

RESULTS

Low dose curcumin (≤10 μM) did not show any obvious toxicity to the cells, while 0~10 μmol/L caused a concentration-dependent reduction in cell invasion provoked by TGF-β1. Curcumin also markedly inhibited TGF-β1-regulated MMP-9 and activation of Smad2, ERK1/2 and p38 in a dose- and time-dependent manner. Additionally, PD98059, but not SB203580, showed a similar pattern of inhibition of MMP-9 expression.

CONCLUSION

Curcumin inhibited TGF-β1-stimulated MMP-9 and the invasive phenotype in MDA-MB-231 cells, possibly associated with TGF-β/Smad and TGF-β/ERK signaling.