Incidence and mortality of female breast cancer in Jiangsu, China

Nectin-4 promotes lymphangiogenesis and lymphatic metastasis in breast cancer by regulating CXCR4-LYVE-1 axis

Tumor-induced lymphangiogenesis promotes tumor progression by generating new lymphatic vessels that helps in tumor dissemination to regional lymph nodes and distant sites. Recently, the role of Nectin-4 in cancer metastasis and angiogenesis has been studied, but its role in lymphangiogenesis is unknown. Here, we systematically delineated the role of Nectin-4 in lymphangiogenesis and its regulation in invasive duct carcinoma (IDC). Nectin-4 expression positively correlated with occurrence risk factors associated with breast cancer (alcohol, smoke, lifestyle habit, etc), CXCR4 expression, and LYVE-1-lymphatic vessel density (LVD). LVD was significantly higher in axillary lymph node (ALN) than primary tumor. Depleting Nectin-4, VEGF-C or both attenuated the important lymphangiogenic marker LYVE-1 expression, tube formation, and migration of ALN derived primary cells. Nectin-4 stimulated the expressions of CXCR4 and CXCL12 under hypoxic conditions in ALN derived primary cells. Further, Nectin-4 augmented expressions of lymphatic metastatic markers (e.g. eNOS, TGF-β, CD-105) and MMPs. Induced expressions of Nectin-4 along with other representative metastatic markers were noted in lymph and blood circulating tumor cells (LCTCs and BCTCs) of local and distant metastatic samples. Thus, Nectin-4 displayed a predominant role in promoting tumor-induced lymphangiogenesis and lymphatic metastasis by modulating CXCR4/CXCL12-LYVE-1- axis.

A Review of the Epidemiology of Breast Cancer in Asia: Focus on Risk Factors

Background and Aim:

Breast cancer is the most prevalent cancer in women. To date, regional differences in breast cancer risk factors have not been identified. The aim of our review was to gain a better understanding of the role of risk factors in women with breast cancer in Asia.

Methods:

We conducted a PubMed search on 15 March 2016, for journal articles published in English between 2011 and 2016, which reported data for human subjects in Asia with a diagnosis of breast cancer. Search terms included breast neoplasm, epidemiology, Asia, prevalence, incidence, risk and cost of illness. Studies of any design were included, except for review articles and meta-analyses, which were excluded to avoid duplication of data. No exclusions were made based on breast cancer treatment. We reported the results using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.

Results:

A total of 776 abstracts were retrieved. After screening against the eligibility criteria, 562 abstracts were excluded. The remaining 214 abstracts, which were published between 2013 and 2015, were included in this review. Results were summarized and reported under three categories: incidence, prevalence or outcomes for breast cancer in Asia; modifiable risk factors; and non-modifiable risk factors. We found that the increased risk of breast cancer among participants from Asia was associated with older age, family history of breast cancer, early menarche, late menopause, high body mass index, being obese or overweight, exposure to tobacco smoke, and high dietary intake of fats or fatty foods. In contrast, intake of dietary fruits, vegetables, and plant- and soy-based products was associated with a decreased breast cancer risk. While based on limited data, when compared to women from the United States, women from Asia had a decreased risk of breast cancer.

Conclusions:

This review of 214 abstracts of studies in Asia, published between 2013 and 2015, confirmed the relevance of known non-modifiable and modifiable risk factors for women with breast cancer.

SNHG1 Long Noncoding RNA is Potentially Up-Regulated in Colorectal Adenocarcinoma

Colorectal cancer (CRC) is one of the most common types of cancer worldwide. However, the molecular mechanisms involved in CRC initiation and progression is remained to be unknown. It seems that lncRNAs, as the main and lengthy functional transcripts of the genome, have important roles in different cancers such as CRC. CRC-related lncRNAs are reported to be involved in diverse molecular processes such as metastasis, invasion, cell proliferation, and apoptosis. This study was aimed to analyse the expression level of lncRNA SNHG1 in colorectal adenocarcinoma and normal tissues. We performed an in silico analysis on a large cohort and confirmed the results by experimental analysis of clinical samples through real-time PCR. Our findings demonstrated that that SNHG1 is potentially overexpressed in tumor tissues compared with adjacent normal tissues. The expression level of SNHG1 was shown to be potentially associated with clinicopathological features of tumors. The current study suggests the potential role of SNHG1 in colon cancer progression.

Analysis of breast cancer cases according to county-level poverty status in 3.5 million rural women who participated in a breast cancer screening program of Hunan province, China from 2016 to 2018

The Hunan provincial government has implemented a free breast cancer screening program for rural women aged 35 to 64 years from 2016, under a 2015 policy aimed at of poverty eradication and improving women's health in China. However, there has been no population study of the breast cancer screening program in China to date, especially considering exploring differences related to the area's poverty status. We explored differences in risk factors, clinical examination results, and clinicopathological features among breast cancer patients in poor compared with non-poor counties in rural areas of Hunan province from 2016 to 2018 using χ and Fisher's exact test, and multivariate logistic regression analysis. A total of 3,151,679 women from rural areas participated in the screening program, and the breast cancer prevalence was 37.09/10. Breast cancer prevalence was lower in poor (29.68/10) than in non-poor counties (43.13/10). There were differences between breast cancers in poor and non-poor counties in terms of cysts, margins, internal echo, blood flow in solid masses in the right breast on ultrasound examination, lump structure in mammograms, and clinicopathological staging and grading in pathological examinations. Breast cancer in poor counties was more likely to be diagnosed at later stages as determined by ultrasound, mammography, and pathological examinations. Furthermore, indexes of the breast screening program including early detection, prevalence, pathological examination, and mammography examination were lower in poor compared with non-poor counties. Multivariate logistic regression analysis showed that education, ethnicity, reproductive history and the year 2017 were associated with an increased risk of breast cancer in poor counties (odds ratio >1, P < .05). In conclusion, women in poor areas were more likely to be diagnosed with breast cancer at a later stage compared with women in non-poor areas. Women in poor areas of Hunan province should therefore have better access to diagnostic and clinical services to help rectify this situation.

Association between ultrasound findings, tumor type, grade, and biological markers in patients with breast cancer

Background

This prospective study included 65 female patients with primary breast cancer. Ultrasound was performed for all patients. Ultrasound findings were analyzed according to the ACR BI-RADS lexicon 5th edition and correlated with tumor type, grade, and biological markers (ER, PR, HER-2/neu, and Ki67). The purpose of this study is to assess the association between ultrasound findings, tumor type, grade, and the state of biological markers in patients with breast cancer.

Results

Irregular shape and speculated margins are more frequently associated with invasive duct carcinoma than DCIS (p value < 0.001). There were no association between the ultrasound findings (shape, margin, orientation, echopattern, and posterior features) and the tumor grade (p value 1.0, 0, 0.544, 1.0, and 1.0), respectively. Irregular shape is more frequently seen in ER and PR positive breast cancers (p value = 0.036 and 0.026, respectively). Non-circumscribed margins were frequently seen in PR positive breast cancers (p value = 0.068). No statistically significant difference between US descriptors and HER-2/neu-positive cases.

Conclusion

Irregularly shaped tumors with speculated margins are frequently seen in invasive duct carcinoma and also more frequently seen in ER-, PR-, and Ki67-positive cases. No relation between ultrasound descriptors and the tumor grade of invasive duct carcinoma. Also, there were no relation between ultrasound descriptors and the state of HER-2/neu.

Clinical Studies Investigating the Use of Leuprorelin in Breast Cancer Patients from Asia

Leuprorelin is a synthetic analogue of naturally occurring gonadotropin-releasing hormone. It is currently approved in the United States, Europe and Asia and has indications in advanced prostate cancer, endometriosis, breast cancer and precocious puberty. This review examined clinical trials of leuprorelin in women with breast cancer in Asia.

YAP1 overexpression is associated with poor prognosis of breast cancer patients and induces breast cancer cell growth by inhibiting PTEN

YES‐associated protein 1 (YAP1) plays a key role as a transcriptional coactivator in the Hippo tumor suppressor pathway. YAP1 is overexpressed in a variety of cancers and is considered to be encoded by a proto‐oncogene. However, the role of YAP1 remains debatable, because both gain and loss of YAP1 expression have both been reported in breast cancer (BC). Here, we found that elevated expression of YAP1 mRNA in BC was negatively correlated with relapse‐free, distant metastases‐free and overall survival rates. We then knocked down or overexpressed YAP1 in human BC cells, and examined cell proliferation, apoptosis, and tumorigenic ability in vivo. We identified that YAP1 promotes cell growth and inhibits cell apoptosis of BC through the phosphatase and tensin homolog deleted on chromosome 10–AKT signaling pathway, and thus suggest that YAP1 might serve as a new target for inhibiting BC progression.

Diagnosis and treatment pattern among rural and urban breast cancer patients in Southwest China from 2005 to 2009

The incidence of all cancers in China is generally higher in urban areas; however, the mortality risk for affected patients is considerably higher in rural areas. We present a subanalysis investigating the differences in patient and disease characteristics, treatment patterns, and outcomes between rural and urban patients who were diagnosed with breast cancer at West China Hospital between 2005–2009. Baseline patient and disease characteristics were recorded, and patients were followed up for a minimum of 3 years, or until death. For this subanalysis, patients were stratified by their residential status (rural or urban). Of the 2252 patients in the cohort, 76.3% were from urban areas and 22.1% were from rural areas. Significant differences were observed in the prevalence of luminal A and human epidermal growth factor receptor 2-positive breast cancers among rural and urban patients. Estrogen receptor (ER)-positive patients were less likely to receive anti-ER therapy if they were from rural areas compared with urban areas; the use of aromatase inhibitors was also significantly lower for rural patients than urban patients. Univariate, multivariate, and Kaplan–Meier analyses all demonstrated that overall survival and progression-free survival were significantly lower for rural patients than urban patients.

Design and implementation of a mobile system for lung cancer patient follow-up in China and initial report of the ongoing patient registry

Introduction

Management of lung cancer remains a challenge. Although clinical and biological patient data are crucial for cancer research, these data may be missing from registries and clinical trials. Biobanks provide a source of high-quality biological material for clinical research; however, linking these samples to the corresponding patient and clinical data is technically challenging. We describe the mobile Lung Cancer Care system (mLCCare), a novel tool which integrates biological and clinical patient data into a single resource.

Methods

mLCCare was developed as a mobile device application (app) and an internet website. Data storage is hosted on cloud servers, with the mobile app and website acting as a front-end to the system. mLCCare also facilitates communication with patients to remind them to take their medication and attend follow-up appointments.

Results

Between January 2014 and October 2015, 5,080 patients with lung cancer have been registered with mLCCare. Data validation ensures all the patient information is of consistently high-quality. Patient cohorts can be constructed via user-specified criteria and data exported for statistical analysis by authorized investigators and collaborators. mLCCare forms the basis of establishing an ongoing lung cancer registry and could form the basis of a high-quality multisite patient registry. Integration of mLCCare with SMS messaging and WeChat functionality facilitates communication between physicians and patients.

Conclusion

It is hoped that mLCCare will prove to be a powerful and widely used tool that will enhance both research and clinical practice.

Current pesticide profiles in blood serum of adults in Jiangsu Province of China and a comparison with other countries

Although various pesticides were used globally, the pesticides profiles in human blood serum remain largely unknown. We determined pesticide exposure profiles using solid-phase extraction and gas chromatography tandem with triple quadrupole mass spectrometry in 200 human blood serum samples from the adult population in Jiangsu Province, China. A systematic and comprehensive literature review was carried out to identify the articles investigating pesticide exposure and compare exposure data. Of the 88 pesticides, 76 were found in the blood serum of the population in Jiangsu Province. To the best of our knowledge, 58 pesticides were reported in human blood serum for the first time, and among these pesticides, parathion-methyl, pyrimethanil, fluacrypyrim, simazine, cloquintocet-mexyl and barban were debatable in more than half of the samples. By statistical comparison of the blood serum levels of pesticides between this study and other countries, we found the levels of several organochlorine pesticides were significantly higher in the female population of Jiangsu Province. Health risks related to the pesticide profiling were then revealed, which identified higher carcinogenic toxicity and teratogenic toxicity risk in the female adults of Jiangsu Province caused by organochlorine pesticide exposure. This study not only provides a high-throughput pesticide screening method for future studies of the exposome, but also presents the first human data on exposure to a number of pesticides. It may provide a knowledge database for the risk assessment and management of the pesticides.

Increase of Incidence and Mortality of Ovarian Cancer during 2003-2012 in Jiangsu Province, China

PURPOSE

The objective of this study is to investigate and analyze the epidemiologic characteristics and time trends of ovarian cancer incidence and mortality in Jiangsu Province of China during 2003-2012.

METHOD

Data were collected from eligible cancer registries in Jiangsu Province. Crude rates, age-specific rates, truncated age-standardized rate, and proportions of ovarian cancer were calculated. The Segi's World Population was used to calculate age-standardized rates for world (ASW). Poisson distribution was used to analyze the differences between urban and rural areas. Joinpoint regression was performed to estimate the annual percent change (APC) of ovarian cancer incidence/mortality.

RESULTS

A total number of 4,401 new cases and 1,918 deaths were identified during period 2003-2012. The incidence and mortality ASW was 3.64/100,000 and 1.52/100,000, respectively. ASW of incidence was 4.48/100,000 in urban areas, while 3.04/100,000 in rural areas. The mortality of ASW was slight higher in urban areas than in rural areas. Age-specific incidence showed a peak at the age group of 60-64 years, whereas mortality peaked at age group of 65-69 years. A significant increase of incidence was observed from 2003 to 2006, with an APC of 34.0% (95% CI: 9.7, 63.7), the increasing rate declined since 2006 (APC = 3.3%, 95% CI: -3.5, 10.5). The mortality showed a gentle upward trend as compared with incidence, with an APC of 9.9% (95% CI: 7.7, 12.2) per year, continuously from 2003 to 2012. It is apparent that both incidence and mortality presented a rising trend in all areas, but urban were higher than that in rural areas.

CONCLUSION

Ovarian cancer is a highly lethal disease which is becoming a significant public health problem in Chinese women. It is vital to improve the understanding of current status of ovarian cancer. Moreover, prevention and control policies should be formulated to reduce the disease burden of ovarian cancer in China.

Treatment and survival patterns of Chinese patients diagnosed with breast cancer between 2005 and 2009 in Southwest China: An observational, population-based cohort study

Breast cancer is a significant health issue both globally and within China. Here, we present epidemiological data for female patients diagnosed with breast cancer and treated at West China Hospital, Sichuan University, between 2005 and 2009. Patients who were diagnosed with breast cancer between 2005 and 2009 were enrolled. Data cut-off in this analysis was October 2013, allowing a minimum of 3 years' follow-up, or follow-up until death. Data were collected and subject to statistical analyses to assess relationships between patient and cancer characteristics, treatment patterns and long-term outcomes. A total of 2252 women with breast cancer were included in the analyses. Luminal B was the most common subtype of breast cancer and human epidermal growth factor 2 (HER2)-positive (nonluminal) was the least common. Most patients had early-stage disease (stage ≤IIIa) at diagnosis. Patients with luminal A appeared to have the best overall survival (OS), compared with other subtypes. Hormone-receptor positivity was associated with improved prognosis, compared with negativity (OS hazard ratio [HR] 0.5). Late-stage compared with early-stage disease at diagnosis was associated with much poorer OS across all patients and tumor subtypes. Clear differences were apparent between breast cancer subtypes and the response to treatment. The interaction of breast cancer subtypes, treatments and disease stage is complex. One of the most important factors for improved prognosis is diagnosis and treatment at an early-stage of disease. With breast cancer becoming an increasingly important health concern, this highlights the importance of establishing systems and protocols to identify and treat patients with breast cancer as early as possible.

A High-Quality Biobank Supports Breast Cancer Research in Harbin, China

We established a standard breast cancer biobank at Harbin Medical University Cancer Hospital (HMUCH) in 2009. More than 100,000 biospecimens, including high-quality human breast cancer samples, matched blood samples, and adjacent normal tissues, were collected from patients and healthy donors in HMUCH and were then deposited in the repository. We reported the establishment of a biobank in our hospital and its crucial role in translational medicine research. We stored, processed, and distributed qualified biological specimens in accordance with international standard operating procedures. We also summarized the utilization of this biobank and its influence on research projects over the years since its establishment. Therefore, we can verify specific biomarkers that may aid in the development of targeted breast cancer therapies by using high-quality, well-annotated tissue samples provided by the biobank.

Coevolution between Cancer Activities and Food Structure of Human Being from Southwest China

Yunnan and Tibet are the lowest cancer mortality and the largest producer for anticancer crops (brown rice, barley, buckwheat, tea, walnut, mushrooms, and so forth). Shanghai and Jiangsu province in China have the highest mortality of cancers, which are associated with the sharp decline of barley.

The AURKA gene rs2273535 polymorphism contributes to breast carcinoma risk - meta-analysis of eleven studies

The rs2273535 polymorphism in the AURKA gene had proven to be associated with breast carcinoma susceptibility. Nevertheless, the results of different studies remain contradictory. A meta-analysis covering 28, 789 subjects from eleven different studies was here carried out in order to investigate the association in detail. The random effects model was used to analyze the pooled odds ratios (ORs) and their corresponding 95% confidence intervals (95% CIs). A significant relationship between the rs2273535 polymorphism and breast tumors was found in an allelic genetic model (OR: 1.076, 95% CI: 1.004-1.153, p=0.040, Pheterogeneity=0.002). No significant association was detected in a homozygote model (OR: 1.186, 95% CI: 0.990-1.423, P=0.065, Pheterogeneity=0.002), a heterozygote model (OR: 1.016, 95% CI: 0.959-1.076, p=0.064, Pheterogeneity=0.000), a dominant genetic model (OR: 1.147, 95% CI: 0.992-1.325, p=0.217, Pheterogeneity=0.294) and a recessive genetic model (OR: 1.093, 95% CI: 0.878- 1.361, p=0.425, Pheterogeneity=0.707). A significant relationship between the rs2273535 polymorphism in the AURKA gene and breast tumor in Asian group was found in an allelic genetic model (OR: 1.124, 95% CI: 1.003-1.29, p=0.044, Pheterogeneity=0.034), a homozygote model (OR: 1.229, 95% CI: 1.038-1.455, p=0.016, Pheterogeneity=0.266) and a recessive genetic model (OR: 1.227, 95% CI: 1.001-1.504, p=0.049, Pheterogeneity=0.006). A significant association was thus observed between the rs2273535 polymorphism in the AURKA gene and breast cancer risk. Individuals with the rs2273535 polymorphism in the AURKA gene have a higher risk of breast cancer in Asian populations, but not in Caucasians.

Development and validation of a breast cancer risk prediction model for Thai women: a cross-sectional study

BACKGROUND

Breast cancer risk prediction models are widely used in clinical practice. They should be useful in identifying high risk women for screening in limited-resource countries. However, previous models showed poor performance in derived and validated settings. Therefore, we aimed to develop and validate a breast cancer risk prediction model for Thai women.

MATERIALS AND METHODS

This cross-sectional study consisted of derived and validation phases. Data collected at Ramathibodi and other two hospitals were used for deriving and externally validating models, respectively. Multiple logistic regression was applied to construct the model. Calibration and discrimination performances were assessed using the observed/expected ratio and concordance statistic (C-statistic), respectively. A bootstrap with 200 repetitions was applied for internal validation.

RESULTS

Age, menopausal status, body mass index, and use of oral contraceptives were significantly associated with breast cancer and were included in the model. Observed/expected ratio and C-statistic were 1.00 (95% CI: 0.82, 1.21) and 0.651 (95% CI: 0.595, 0.707), respectively. Internal validation showed good performance with a bias of 0.010 (95% CI: 0.002, 0.018) and C-statistic of 0.646(95% CI: 0.642, 0.650). The observed/expected ratio and C-statistic from external validation were 0.97 (95% CI: 0.68, 1.35) and 0.609 (95% CI: 0.511, 0.706), respectively. Risk scores were created and was stratified as low (0-0.86), low-intermediate (0.87-1.14), intermediate-high (1.15-1.52), and high-risk (1.53-3.40) groups.

CONCLUSIONS

A Thai breast cancer risk prediction model was created with good calibration and fair discrimination performance. Risk stratification should aid to prioritize high risk women to receive an organized breast cancer screening program in Thailand and other limited-resource countries.

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

BACKGROUND

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Breast Cancer Challenges and Screening in China: Lessons From Current Registry Data and Population Screening Studies

BACKGROUND

As one of its responses to the increasing global burden of breast cancer (BC), China has deployed a national registration and BC screening campaign. The present report describes these programs and the initial results of these national BC control strategies, highlighting the challenges to be considered.

MATERIALS AND METHODS

The primary BC incidence and prevalence data were obtained from the Chinese National Central Cancer Registry. MapInfo software was used to map the geographic distribution and variation. The time trends were estimated by the annual percentage of change from 2003 to 2009. The description of the screening plans and preliminary results were provided by the Ministry of Health.

RESULTS

Chinese cancer registries were primarily developed and activated in the East and Coastal regions of China, with only 12.5% of the registries located in West China. Geographic variation was noted, with the incidence of BC higher in North China than in South China and in urban areas compared with rural areas. Of great interest, these registries reported that the overall BC incidence has been increasing in China, with an earlier age of onset compared with Western countries and a peak incidence rate at age 50. In response to this increasing incidence and early age of onset, BC screening programs assessed 1.46 million women aged 35-59 years, using clinical breast examinations and ultrasound as primary screening tools between 2009 and 2011. The diagnostic rate for this screening program was only 48.0/10(5) with 440 cases of early stage BC. Early stage BC was detected in nearly 70% of screened patients. Subsequently, a second-generation screening program was conducted that included older women aged 35-64 years and an additional 6 million women were screened.

CONCLUSION

The cancer registration system in China has been uneven, with a greater focus on East rather than West China. The data from these registries demonstrate regional variation, an increasing BC incidence, and an early age of onset. The 2009 to 2011 BC screening program targeting women aged 35-59 years had a low detection rate that resulted in a second-generation screening program that extended the cohort size and ages screened to 35-64 years.

IMPLICATIONS FOR PRACTICE

Cancer registration has been active in China for decades; however, a national survey of registries has not been routinely reported. This study used MapInfo to describe the reported data and found asymmetric registration activities, geographic variations in breast cancer (BC) burdens, and an increasing incidence with a peak at age 50. The initial Chinese BC screening programs focused on a relatively young population of women aged 35-59 years and had a low detection rate, but 69.7% of patients had early stage BC. Older women were included in the second-generation screening programs, and an additional 6 million women were screened. Consideration of regional variations and age is necessary to optimize the efficiency and utility of BC screening in China, with the ultimate goal to reduce BC mortality.

What is the Most Suitable Time Period to Assess the Time Trends in Cancer Incidence Rates to Make Valid Predictions--an Empirical Approach

Projections of cancer cases are particularly useful in developing countries to plan and prioritize both diagnostic and treatment facilities. In the prediction of cancer cases for the future period say after 5 years or after 10 years, it is imperative to use the knowledge of past time trends in incidence rates as well as in population at risk. In most of the recently published studies the duration for which the time trend was assessed was more than 10 years while in few studies the duration was between 5-7 years. This raises the question as to what is the optimum time period which should be used for assessment of time trends and projections. Thus, the present paper explores the suitability of different time periods to predict the future rates so that the valid projections of cancer burden can be done for India. The cancer incidence data of selected cancer sites of Bangalore, Bhopal, Chennai, Delhi and Mumbai PBCR for the period of 1991-2009 was utilized. The three time periods were selected namely 1991-2005; 1996-2005, 1999-2005 to assess the time trends and projections. For the five selected sites, each for males and females and for each registry, the time trend was assessed and the linear regression equation was obtained to give prediction for the years 2006, 2007, 2008 and 2009. These predictions were compared with actual incidence data. The time period giving the least error in prediction was adjudged as the best. The result of the current analysis suggested that for projections of cancer cases, the 10 years duration data are most appropriate as compared to 7 year or 15 year incidence data.

A systemic analysis on pemetrexed in treating patients with breast cancer

BACKGROUND

This systemic analysis was conducted to evaluate the efficacy and safety of pemetrexed based chemotherapy in treating patients with metastatic breast cancer as first or second line chemotherapy.

METHODS

Clinical studies evaluating the efficacy and safety of pemetrexed based regimens on response and safety for patients with breast cancer were identified using a predefined search strategy. Pooled response rate (RR) of treatment were calculated.

RESULTS

In first line pemetrexed based regimens, 10 clinical studies which including 513 patients with advanced breast cancer were considered eligible for inclusion. For second line pemetrexed based chemotherapy, 5 clinical studies which including 281 patients with advanced breast cancer were considered eligible. Systemic analysis suggested that, in all patients, pooled RR was 32.6% (167/513) in pemetrexed based first line regimens, and 13.9 % (39/281) in pemetrexed based second line regimens. Major adverse effects were neutropenia, leukopenia, fatigue, and anemia in pemetrexed based first line treatment; and lymphopenia, neutropenia, leukopenia, as well as anemia in second line chemotherapy. One treatment related death occurred with pemetrexed based second line treatment.

CONCLUSION

This systemic analysis suggests that pemetrexed based first line regimens are associated with a reasonable response rate and acceptable toxicity, however with low response rate for treating patients with metastatic breast cancer when is used in the second line.

Breast cancer diagnosis by mammography in Kazakhstan - staging results of breast cancer with double reading

While mammography has been used for diagnosis of breast cancer in Kazakhstan for a long period, published data are very limited. Recently stress has been placed on increasing the accuracy by double reading of mammograms. Here we provide an overview of breast cancer screening in the different regions of Kazakhstan with data on the stages of cancers detected. A total 459,816 women aged 50, 52, 54, 56, 58 and 60 years were screened in 2012 and 379,903 in the first 9 months of 2013. Clear differences in levels of detection were noted between urban and rural residents, the latter demonstrating lower rates for both screening and cancer detection. Women aged 50 were more likely to undergo screening than their counterparts aged 60. While there were no clear relationships evident between screening rates and stage or numbers of breast cancers observed, this might be due to a number of complicating factors like geographical variation in risk factors as well as ethnicity. Future analyses should focus on the efficacy of mammography in Kazakhstan to reduce mortality.