Comparative study of lidocaine- saline versus saline as washout for lumpectomy cavity on acute postoperative pain

Purpose

This study aimed to evaluate the impact of lidocaine-saline solution compared to saline alone for washing out the lumpectomy cavity, focusing on its effect on acute postoperative pain-a prevalent and significant concern among patients undergoing breast surgery.

Methods

In this comparative study, 72 patients scheduled for lumpectomy surgery were randomly assigned to either the lidocaine-saline or saline group. The lidocaine-saline group was administered a washout of the lumpectomy cavity with 2 % lidocaine at a dosage of 1.75 mg/kg in 0.9 % normal saline, whereas the saline group received a washout with an equivalent volume of 0.9 % normal saline. We recorded the participants' basic characteristics, heart rate, blood pressure, the incidence and intensity of pain (measured by the visual analogue scale), and the usage of postoperative analgesics.

Results

The two study groups did not differ significantly in their basic characteristics, heart rate and blood pressure. The saline group had significantly higher pain intensity than the lidocaine-saline group at 30 min after surgery (4.61 vs. 2.88, P < 0.0001) and at all other time points (P < 0.001). The saline group also took the first dose of analgesics earlier than the lidocaine-saline (46.66 Vs. 170.55 min, P < 0.001) and used a significantly higher mean dose of meperidine (77.50 mg vs 33.47 mg, P < 0.001).

Conclusion

The use of a lidocaine-saline wash during lumpectomy procedures can significantly reduce postoperative pain and lower the necessity for analgesics in patients who have undergone breast surgery.

Cancer patterns in Iran: a gender-specific spatial modelling of cancer incidence during 2014-2017

BACKGROUND

Cancer is a significant public health concern and the second leading cause of death. This study aims to visualize spatial patterns of top common cancer types and identify high-risk and low-risk counties for these cancers in Iran from 2014 to 2017.

METHODS

In this study, we analyzed 482,229 newly diagnosed cancer cases recorded by the Iranian National Population-Based Cancer Registry from 2014 to 2017. We employed a purely spatial scanning model and local Moran I analysis to explore spatial patterns across Iran.

RESULTS

Approximately 53% of all cases were male. The average age of cancer diagnosis was 62.58 ± 17.42 years for males and 56.11 ± 17.33years for females. Stomach cancer was the most common cancer in men. The northern and northwestern regions of Iran were identified as high-risk areas for stomach cancer in both genders, with a relative risk (RR) ranging from 1.26 to 2.64 in males and 1.19 to 3.32 in females. These areas recognized as high-risk areas for trachea, bronchus, and lung (TBL) cancer specifically in males (RR:1.15-2.02). Central regions of Iran were identified as high-risk areas for non-melanoma skin cancers in both genders, ranking as the second most common cancer (RR:1.18-5.93 in males and 1.24-5.38 in females). Furthermore, bladder cancer in males (RR:1.32-2.77) and thyroid cancer in females (RR:1.88-3.10) showed concentration in the central part of Iran. Breast cancer, being the most common cancer among women (RR:1.23-5.54), exhibited concentration in the northern regions of the country. Also, northern regions of Iran were identified as high-risk clusters for colon cancer (RR:1.31-3.31 in males and 1.33-4.13 in females), and prostate cancer in males (RR:1.22-2.31). Brain, nervous system cancer, ranked sixth among women (RR:1.26-5.25) in central areas.

CONCLUSIONS

The study's revelations on the spatial patterns of common cancer incidence in Iran provide crucial insights into the distribution and trends of these diseases. The identification of high-risk areas equips policymakers with valuable information to tailor targeted screening programs, facilitating early diagnosis and effective disease control strategies.

Long noncoding RNA HOTAIR promotes breast cancer development through the lncRNA HOTAIR/miR-1/GOLPH3 axis

BACKGROUND

The lncRNA HOTAIR is frequently overexpressed in breast cancer tissues and plays an important role in the development of breast cancer. Here, we investigated the effect of the lncRNA HOTAIR on the biological behaviour of breast cancer cells and its molecular mechanism.

METHODS

We investigated the level of HOTAIR in breast cancer and its clinical pathological characteristics by bioinformatic methods. Then, we evaluated the effects of HOTAIR and miRNA-1 expression on the biological behaviour of breast cancer cells by qPCR, Cell Counting Kit-8 (CCK-8) assay, clonogenic assays, Transwell assay and flow cytometry for cell proliferation, invasion migration and apoptosis, and cell cycle analysis. Finally, the target genes of the lncRNA HOTAIR/miR-1/GOLPH3 regulatory axis were validated by luciferase reports.

RESULTS

The expression of HOTAIR in breast cancer tissues was significantly higher than that in normal breast tissues (P < 0.05). Silencing of HOTAIR suppressed cell proliferation, invasion and migration, promoted apoptosis and induced G1 phase block in breast cancer (P < 0.0001). We also verified that miR-1 is a target of HOTAIR and that GOLPH3 is a target of miR-1 by luciferase reporter assays (P < 0.001).

CONCLUSIONS

The expression of HOTAIR was significantly elevated in breast cancer tissues. Reducing the expression of HOTAIR inhibited the proliferation, invasion and migration of breast cancer cells and promoted apoptosis, and the mechanism was mainly the effect of the lncRNA HOTAIR/miR-1/GOLPH3 regulatory axis on the biological behaviour of breast cancer cells.

Clinical characteristics of breast cancer patients admitted to academic surgical wards in Tehran, Iran: an analytical cross-sectional study

BACKGROUND

Breast cancer (BC) is the most commonly diagnosed cancer and the leading cause of cancer death among women. Knowledge of the clinical characteristics of BC in a population may be informative for disease prediction or diagnosis and for developing screening and diagnostic guidelines. This study aimed to evaluate the clinical characteristics of female patients with BC who were admitted to academic surgical wards in Tehran, Iran.

METHODS

In this cross-sectional study, demographic information and clinical characteristics of Iranian females with BC who had undergone breast surgery from 2017-2021 in four academic Breast Surgery Units were extracted from medical files and recorded via a pre-designed checklist.

RESULTS

A total of 1476 patients with a mean age of 48.03 (± 11.46) years were enrolled. Among them, 10.4% were aged less than 35. In younger patients, Triple-negative and Her2-enriched subtypes of BC were significantly higher compared to older ones. Overall, 85.7% of tumors were invasive ductal carcinoma, 43.3% were grade 2, 41.4% were located in the UOQ, and 65.2% had presented with mass palpation. The mean pathologic tumor size was 28.94 mm, and the most common subtype was luminal B.

CONCLUSIONS

Many characteristics of breast cancer in this study were similar to other countries and previous studies in Iran. However, a higher proportion of young BC compared with Western countries, and even with older studies in Iran, suggest a trend toward lower age for BC in recent years. These results indicate the need for preventive measures and screening in Iranian women at a younger age.

Design and psychometric evaluation of the breast cancer screening behaviors scale based on the health action model (HAM)

Background

Breast cancer is known as the most common cancer and the first-rank malignancy among women. Screening plays a crucial role in early diagnosis and timely treatment. This paper presents the results of design, evaluation and analysis of a questionnaire based on the health action model to investigate breast cancer screening behaviors and their relevant factors.

Methods

The study is based on using a combination of quantitative and qualitative approaches for optimal design and development of research tools. In order to design the structure of the health action model and screening behaviors related factors, both qualitative methods such as semi-structured interviews and quantitative approaches studied. Psychometric properties of the research tool were investigated through literature review. The research population consisted of 210 30–69 years old females based in Kashan who were selected through simple random sampling. The relative and content validity indexes were calculated to judge the content of the tool. Also, the confirmatory factor analysis was used to evaluate the construct validity. Additionally, intra-class correlation coefficient and Cornbrash’s alpha coefficient were calculated to evaluate the reliability of the instrument. The data were analyzed using the SPSS 22 and AMOS 22 software packages.

Results

The mean age of the participants was 43 ± 9.82 Years old. The final version of the questionnaire was prepared in four sections, namely demographic factors (15 items), knowledge (12 items), constructs of the health action model or the factors related to breast cancer screening behaviors (67 items), and behavior (6 items). Factor analysis confirmed that the health action model fits in measuring breast cancer screening behaviors.

Conclusion

The tool designed for measuring breast cancer screening behaviors showed acceptable psychometric properties amongst females and can be used as a valid tool in conducting research in health studies.

The Fractions of Eryngium thyrsoideum Extract Sensitize Breast Cancer Cells to Apoptosis

Background: Breast cancer (BC) is the most common cancer in women, and its prevalence has increased dramatically in recent years. Many treatments for BC have been proven, one of which is the utilization of natural products and herbal derivatives. Among natural plants, plants of the Apiaceae family like Eryngium have been studied, which entail antioxidant, antimicrobial, and most importantly, anti-cancer properties. Objectives: Considering the cytotoxical effects of different Eryngium species, it seems reasonable to evaluate the cytotoxic activity of E. thyrsoideum fractions on the BC, including MCF-7 and MDA-MB-231 cell lines. Methods: The shoots of E. thyrsoideum were extracted by Soxhlet apparatus with n-Hexane, methanol, and dichloromethane solvents. Methanolic extract (strong extract) on C18 Sep-Pak column with a mobile phase of methanol-water was fractionated. Then, the cytotoxicity of different fractions of the strong extract against normal and BC cells was evaluated for 24 and 48 hours using the 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide (MTT) assay. Induction of apoptosis was assessed by flow cytometry using staining of cells treated with Annexin V/PI. Results: The 80% fraction of the methanolic extract illustrated the strongest cytotoxic effectiveness among the others. This strong fraction specifically prohibited the MCF-7 and MDA-MB-231 growth with minimal effect on normal cells. The prohibition of cell growth had a time- and dose-dependent manner (P < 0.001). In addition, the flow cytometric analysis indicated that the strong fraction exerted its cytotoxic effects by inducing apoptosis on the cancer cell line. Conclusions: According to our results, due to effective secondary metabolites, 80% fraction of methanolic extract prohibited the growth of both types of BC cells by inducing apoptosis and had less toxicity on normal cells.

Development and evaluation of a teleoncology system for breast cancer during the COVID-19 pandemic

Background: The present study describes the steps of developing a hybrid teleoncology system to provide treatment plans for breast cancer patients. Materials & methods: This research was conducted in four stages, including developing a proposal for experts, identifying and analyzing system requirements, designing a prototype and implementing and evaluating the final version of the hybrid teleoncology system. Results: The results of the usability evaluation showed that the users evaluated the system at a good level and, in practice, the implemented system was perceived to be useful by specialists in providing treatment plans for cancer patients. Conclusion: The hybrid teleoncology system is a practical alternative to traditional methods for providing treatment plans to breast cancer patients.

Determination of the Risk Factors for Breast Cancer Survival using the Bayesian Method, Yazd, Iran

Background:

There are numerous sophisticated studies which have investigated risk factors of breast cancer (BC). The purpose of this paper is to use benefits of Bayesian modeling to involve such prior information in determining factors affecting the survival of women with BC in Yazd city.

Materials and Methods:

The checklist included the characteristics of the patients and the factors studied. Then, from the records of patients referred to Radiotherapy Center of Shahid Ramezanzadeh, who had BC, from April 2005 to March 2012, the survival of 538 persons was recorded in the census. Data were analyzed by R software version 3.4.2, and 0.05 was considered the significance level.

Results:

The mean age of BC diagnosis was 48.03 ± 11016 years. The Bayesian Cox regression showed that surgery (hazard ratio [HR] =1.631 95% PI; 1.102–2.422), ki67 (HR = 3.260. 95% PI; 1.6308–6.372), stage (HR = 5.620, 95% PI; 4.079–7.731), lymph node (HR = 1.765, 95% PI; 1.127–2.790), and ER (HR = 2. 600 95% PI; 2.023–3.354) were significantly related to survival time.

Conclusion:

The parametric and cox models were compared with standard error, and Cox model was selected as an optimal model. Accordingly, stage, ki67, lymph node, ER, and surgery variables had a positive effect on death hazard.

Tendency to Breast Cancer Screening Among Rural Women in Southern Iran: A Structural Equation Modeling (SEM) Analysis of Theory of Planned Behavior

Background:

Early detection of breast cancer is a crucial factor in surviving the disease. This study aimed to investigate the mammography screening based on the theory of planned behavior (TPB) among rural women in Fasa and Shiraz cities, Iran.

Methods:

This study is a cross-sectional study performed on 800 female clients referring to rural health centers in Fasa and Shiraz cities in southern Iran in early 2021. The authors decided to send and distribute the electronic questionnaire form through the WhatsApp application in collaboration with the health staff of rural health centers for the people covered by these centers. Data gathering tools were a questionnaire on demographic characteristics, a questionnaire based on constructs of TPB, and behavior of mammography screening. Using the structural equation model (SEM), the TPB constructs and demographic variables were entered into the model. Data analysis was executed employing SPSS software version 26 and Amos version 24 (IBM Co., Ann Arbor, MI, USA). Analyzing the data was carried out using the 1-way analysis of variance (ANOVA), logistic regression, and structural equation analysis. During data analysis, various model indicators such as the goodness of fit, including comparative fit index (CFI), goodness-of-fit index (GFI), root mean square error of approximation (RMSEA), and chi-square index/df were evaluated. The significance level in all tests was considered 0.05.

Results:

The knowledge, attitude, and perceived behavioral control were the predictors of intention and behavior of mammography screening among the women. Among demographic variables, age, literacy, being menopausal, cancer in family, city, and ethnicity contribute more to the variance variation in TPB constructs. In this study, 7.2% of Persians, 8% of Qashqai Turks, and 4.5% of Arabs are contemplating going to mammography screening. In total, 6.8% (54 people) of all individuals intended to go mammography screening, and 5.4% (43 people) had a history of mammography screening. Goodness-of-fit indices (χ² = 18.45, df = 10, n = 800, χ²/df = 1.845, RMSEA = 0.032, GFI = 0.90, non-normed fit index (NNFI) = 0.91) of conceptual model of this study indicate the suitability of the model.

Conclusions:

The results of the study indicated that the constructs of the TPB can predict mammography screening behaviors in rural women. It has also demonstrated that mammographic behavior can be improved in rural women using education based on the TPB model, emphasizing critical psychological factors of creating or changing behavior.

Expression and Function of C1orf132 Long-Noncoding RNA in Breast Cancer Cell Lines and Tissues

miR-29b2 and miR-29c play a suppressive role in breast cancer progression. C1orf132 (also named MIR29B2CHG) is the host gene for generating both microRNAs. However, the region also expresses longer transcripts with unknown functions. We employed bioinformatics and experimental approaches to decipher C1orf132 expression and function in breast cancer tissues. We also used the CRISPR/Cas9 technique to excise a predicted C1orf132 distal promoter and followed the behavior of the edited cells by real-time PCR, flow cytometry, migration assay, and RNA-seq techniques. We observed that C1orf132 long transcript is significantly downregulated in triple-negative breast cancer. We also identified a promoter for the longer transcripts of C1orf132 whose functionality was demonstrated by transfecting MCF7 cells with a C1orf132 promoter-GFP construct. Knocking-out the promoter by means of CRISPR/Cas9 revealed no alterations in the expression of the neighboring genes CD46 and CD34, while the expression of miR-29c was reduced by half. Furthermore, the promoter knockout elevated the migration ability of the edited cells. RNA sequencing revealed many up- and downregulated genes involved in various cellular pathways, including epithelial to mesenchymal transition and mammary gland development pathways. Altogether, we are reporting here the existence of an additional/distal promoter with an enhancer effect on miR-29 generation and an inhibitory effect on cell migration.

The Impact of COVID-19 Outbreak on Emotional and Cognitive Vulnerability in Iranian Women With Breast Cancer

The psychological cost on emotional well-being due to the collateral damage brought about by COVID-19 in accessing oncological services for breast cancer diagnosis and treatment has been documented by recent studies in the United Kingdom. The current study set out to examine the effect of delays to scheduled oncology services on emotional and cognitive vulnerability in women with a breast cancer diagnosis in Iran, one of the very first countries to be heavily impacted by COVID-19. One hundred thirty-nine women with a diagnosis of primary breast cancer answered a series of online questionnaires to assess the current state of rumination, worry, and cognitive vulnerability as well as the emotional impact of COVID-19 on their mental health. Results indicated that delays in accessing oncology services significantly increased COVID related emotional vulnerability. Regression analyses revealed that after controlling for the effects of sociodemographic and clinical variables, women’s COVID related emotional vulnerability explained higher levels of ruminative response and chronic worry as well as poorer cognitive function. This study is the first in Iran to demonstrate that the effects of COVID-19 on emotional health amongst women affected by breast cancer can exaggerate anxiety and depressive related symptoms increasing risks for clinical levels of these disorders. Our findings call for an urgent need to address these risks using targeted interventions exercising resilience.

Dietary Insulin Index and Insulin Load in Relation to Breast Cancer: Findings from a Case-Control Study

BACKGROUND

No data are available on the association between dietary insulin index (DII) and dietary insulin load (DIL) and the risk of breast cancer (BC).

PATIENTS AND METHODS

This hospital-based case-control study enrolled 150 newly diagnosed cases of BC and 150 age-matched controls. All cases were patients with pathologically confirmed BC, with no history of any type of other pathologically confirmed cancers. Controls were selected from visitors, relatives, and friends of non-cancer patients in other wards who had no family relationships with the cases. We assessed the dietary intakes of study participants using a validated 147-item semiquantitative food frequency questionnaire. DII and DIL were obtained from previously published data.

RESULTS

A significant positive association was found between DII and BC (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.02-3.25), such that after considering energy intake and age, participants in the highest tertile of DII had 1.86 times greater risk of BC than those in the lowest tertile (OR, 1.86; 95% CI, 1.03-3.35). However, this association became non-significant after controlling for further potential risk factors (OR, 3.26; 95% CI, 0.9-11.7). Furthermore, we observed a significant positive association between DIL and BC (OR, 1.9; 95% CI, 1.06-3.40). The association remained significant even after controlling for age and energy intake. Further controlling for other potential confounders resulted in the disappearance of the association (OR, 3.06; 95% CI, 0.87-10.6).

CONCLUSION

Adherence to a diet with high DII and DIL was not associated with odds of BC after controlling for potential confounders.

Prediction of Breast Cancer Survival by Machine Learning Methods: An Application of Multiple Imputation

Background:

The low breast cancer survival rates in less developed countries are critical. The machine learning techniques predict cancers survival with high accuracy. Missing data are the most important limitation for using the highest potential of these techniques to predict cancers survival. Multiple imputation (MI) was implemented and analyzed in detail to impute the missing data of a breast cancer dataset.

Methods:

The dataset was from The Omid Treatment and Research Center Urmia, Iran between Jan 2006 and Dec 2012 and had information from 856 women. The algorithms such as C5 and repeated incremental pruning to produce error reduction were applied on the imputed versions of the original dataset and the non-imputed dataset to predict and extract clinical rules, respectively.

Results:

The findings showed the performance of C5 in all the evaluation criteria including accuracy (84.42%), sensitivity (92.21%), specificity (64%), Kappa statistic (59.06%), and the area under the receiver operator characteristic (ROC) curve (0.84), was improved after imputation.

Conclusion:

The dataset of the present study met the requirements for using the multiple imputation method. The extracted rules after the application of MI were more comprehensive and contained knowledge that is more clinical. However, the clinical value of the extracted rules after filling in the missing data did not noticeably increase.

Application of additive hazards models for analyzing survival of breast cancer patients

BACKGROUND

Survival rates for breast cancer (BC) are often based on the outcomes of this disease. The aim of this study was to compare the performance of three survival models, namely Cox regression, Aalen's, and Lin and Ying's additive hazards (AH) models for identifying the prognostic factors regarding the survival time of BC patients.

MATERIALS AND METHODS

This study was a historical cohort study which used 1025 females' medical records that underwent modified radical mastectomy or breast saving. These patients were admitted to Besat and Chamran Hospitals, Tehran, Iran, during 2010-2015 and followed until 2017. The Aalen's and Lin and Ying's AH models and also traditional Cox model were applied for analysis of time to death of BC patients using R 3.5.1 software.

RESULTS

In Aalen's and also Lin and Ying's AH models, age at diagnosis, history of disease, number of lymph nodes, metastasis, hormonal therapy, and evacuation lymph nodes were prognostic factors for the survival of BC patients (P < 0.05). In addition, in the Lin and Ying's AH model tumor size (P = 0.048) was also identified as a significant factor. According to Aalen's plot, metastasis, age at diagnosis, and number of lymph nodes had a time-varying effect on survival time. These variables had a different slope as the times go on.

CONCLUSION

AH model may yield new insights in prognostic studies of survival time of patients with BC over time. Because of the positive slope of estimated cumulative regression function in Aalen's plot, metastasis, higher age at diagnosis, and high number of lymph nodes are important factors in reducing the survival BC, and then based on these factors, the therapists should consider a special therapeutic protocol for BC patients.

Required Data Elements and Requirements of a Teleoncology System to Provide Treatment Plans for Patients with Breast Cancer

Background: Teleoncology refers to the use of telemedicine for remotely providing multiple specialized services in clinical oncology processes, including screening, diagnosis, treatment planning, consultation, supportive care, pathology, surgery, and follow-up services. Objectives: The aim of this study was to identify the required data elements and elicitation of requirements for developing a telemedicine system that aims at providing treatment plans for patients with breast cancer. Methods: In this study, the required data elements for the teleoncology system were identified through both the investigation of clinical guidelines and review of patients’ medical records. Identified data elements were determined by breast cancer specialists through the questionnaire. Besides, an interview method was applied to elicit the requirements of this system. Results: The identified data elements were categorized into 20 groups (e.g., clinical data, breast physical examinations, pathological results, tests, imaging results, etc.). From the 182 data elements included within the questionnaire, 125 were recognized to be necessary (n = 32, 100%). The lowest mean percentage were observed in magnesium blood test (Mg) (n = 21, 65.63%) and protein test (Pr) (n = 21, 65.63%). Other data elements with a minimum mean of 71.87% and a maximum mean of 100% were recognized necessary. In general, 2 major themes, 9 categories, and 45 related sub-categories were extracted from analyzing the findings of the interviews related to the system requirements. Conclusions: The findings of the present study can be used as a basis for developing teleoncology systems that aim at providing treatment plans for patients with breast cancer.

A Conditional Probability Model to Predict the Mortality in Patients With Breast Cancer: A Bayesian Network Analysis

BACKGROUND

The aim of this study was to compute the event rate of patients with breast cancer (BC) using Bayesian network (BN) structure.

METHOD

Data for 1,154 patients newly diagnosed with BC were recruited in this study during 2007 and 2016 in Iran. The database was linked to the regional death registration system and active follow-up was performed by referring to hospital information system or calling the patients. BN structure with inverse probability of censoring weighting (IPCW) approach was used to assess the relationship between event rate and underlying risk factors.

RESULTS

The median (25th, 75th percentiles) of patients' survival time was 46.8 (32.6, 69.3) months. There were 217 (18.8%) deaths from BC by the end of the study. The optimal BN structure (Akaike Information Criteria = -8743.66 and Bayesian Information Criteria = -8790.80) indicated that being male (conditional probability [CP] = 0.316), age >50 (CP = 0.215), higher grades (CP = 0.301) and lower survival times (CP = 0.566) had higher event rate. Also lobular carcinoma (CP = 0.157) and ductal carcinoma (CP = 0.178) type of morphology had lower event rate while other types (CP = 0.316) had higher.

CONCLUSIONS

The BN structure in which time was as a mediator of predictors-event relationship could be presented as the optimal tool to compute the event rate of BC. The findings could be used to identify the high risk patients and recommend for health policy making, prevention and planning for decrease the mortality in patients with BC.

Parametric survival model to identify the predictors of breast cancer mortality: An accelerated failure time approach

Background:

Breast cancer (BC) was the fifth cause of mortality worldwide in 2015 and second cause of mortality in Iran in 2012. This study aimed to explore factors associated with survival of patients with BC using parametric survival models.

Materials and Methods:

Data of 1154 patients that diagnosed with BC recorded in the East Azerbaijan population-based cancer registry database between March 2007 and March 2016. The parametric survival model with an accelerated failure time (AFT) approach was used to assess the association between sex, age, grade, and morphology with time to death.

Results:

A total of 217 (18.8%) individuals experienced death due to BC by the end of the study. Among the fitted parametric survival models including exponential, Weibull, log logistic, and log-normal models, the log-normal model was the best model with the Akaike information criterion = 1441.47 and Bayesian information criterion = 1486.93 where patients with higher ages (time ratio [TR] =0.693; 95% confidence interval [CI] = [0.531, 0.904]) and higher grades (TR = 0.350; 95% CI = [0.201, 0.608]) had significantly lower survival while the lobular carcinoma type of morphology (TR = 1.975; 95% CI = [1.049, 3.720]) had significantly higher survival.

Conclusion:

Log-normal model showed to be an optimal tool to model the survival of patients with BC in the current study. Age, grade, and morphology showed significant association with time to death in patients with BC using AFT model. This finding could be recommended for planning and health policymaking in patients with BC. However, the impact of the models used for analysis on the significance and magnitude of estimated effects should be acknowledged.

Breast Cancer Survival and Incidence: 10 Years Cancer Registry Data in the Northwest, Iran

Methods

Data were obtained from East Azerbaijan cancer registry database for the 10-year period between 2007 and 2016. Survival analysis was performed to calculate the breast cancer-specific survival proportions and mortality rates. Joinpoint trend analysis was performed to estimate the incidence trend of the cancer.

Results

A total number of 4989 patients were recorded with primary diagnosis of breast cancer. Of them, we collected follow-up data for 1335 (1309 female and 26 male). The 10-year crude mortality rate was 3.34 (per 100,000). The one-, two-, three-, five-, and ten-year breast cancer-specific survival proportions were 0.92 (95% CI 0.91-0.93), 0.88 (95% CI 0.86-0.90), 0.84 (95% CI 0.83-0.86), 0.77 (95% CI 0.74-0.80), and 0.65 (95% CI 0.60-0.70), respectively. Over the study period, the age-standardized incidence rates increased from 21.68 to 36.99 (per 100,000) with an annual percentage change of 5.5 percent. Older individuals and males patients had significantly worse survival, and patients with high-grade tumors had significantly higher risk of mortality.

Conclusion

A relatively better survival for breast cancer in East Azerbaijan, Iran, was observed compared to the overall breast cancer-specific survival proportions and mortality rates in the country. However, it is still poor compared to the developed countries indicating that inappropriate treatment modalities might have played a role on this.

An A10398G mitochondrial DNA alteration is related to increased risk of breast cancer, and associates with Her2 positive receptor

Breast cancer is the most common malignancy and the second leading cause of cancer deaths among women worldwide after lung cancer. Mitochondria play a central role in the regulation of cellular function, metabolism, and cell death in cancer cells. We aim to examine the mitochondrial polymorphisms of complex I in association with breast cancer in an Iranian cohort.This experimental study includes 53 patients with breast cancer and 35 healthy control patients. In addition, tumor-adjacent normal breast tissue was obtained from each patient. The DNA of the tissue cells was extracted and analyzed for complex I mutations using a PCR sequencing method. Our results show 94 mtDNA complex I variants in tumor tissues. A10398G was the most prevalent polymorphism and strongly correlated with Her2 receptor in tumor tissue samples. Mitochondrial DNA (mtDNA) mutations have been widely linked to the etiology of numerous disorders. The mtDNA mutations screening on A10398G along with other mutations might provide insight on the role of mitochondrial mutations in breast cancer.

Genetic and molecular biology of breast cancer among Iranian patients

Abstract

Background, Breast cancer (BC) is one of the leading causes of cancer related deaths in Iran. This high ratio of mortality had a rising trend during the recent years which is probably associated with late diagnosis.

Main body

Therefore it is critical to define a unique panel of genetic markers for the early detection among our population. In present review we summarized all of the reported significant genetic markers among Iranian BC patients for the first time, which are categorized based on their cellular functions.

Conclusions

This review paves the way of introducing a unique ethnic specific panel of diagnostic markers among Iranian BC patients. Indeed, this review can also clarify the genetic and molecular bases of BC progression among Iranians.

Nutrition knowledge, attitudes, and practice towards breast cancer prevention among the female population of Iran University of medical science students

Diet plays a measurable role in breast cancer (BC) prevention. The aims of this study were to assess nutrition-related BC prevention Knowledge, attitudes and practice (KAP) of female university students and to examine the relationship between demographic characteristics of students and their KAP. We conducted a cross-sectional study among 500 female students from Iran University of Medical Science (IUMS). A pretested self-administered questionnaires were used to assess the participants' nutrition-related BC prevention KAP. A total of 500 students completed the survey. Students' knowledge with the mean score of 16.97, significantly varied by age (P= 0.03), the field of study (P= 0.001) and family history of BC (P= 0.01). The mean score of attitudes and practice toward nutrition-related BC prevention factors were 24.86 and 39.39, respectively. A significant relationship was observed between nutrition knowledge and attitude (r = 0.27, P < 0.001). Also, Nutrition-related attitudes were positively correlated with the BC prevention dietary practices (r = 0.23, P < 0.001). Nutrition KAP about BC prevention factors was found to be influenced by individual factors such as age, field of study, familial history of BC, job and residency status. Together, our findings confirm that increasing nutrition knowledge is not sufficient for dietary behavior change, but is necessary.

Translation and Psychometric Testing Persian Version of Breast Cancer Screening Belief Questionnaire (BCSBQ) in Iranian Women

Introduction: Women's screening beliefs play an important role in their performance. Since a short form questionnaire is necessary in the assessment of screening beliefs in Iranian society, this study was conducted with the aim of psychometric evaluation of the Breast Cancer Screening Beliefs Questionnaire (BCSBQ) among Iranian women.

Methods: In this cross-sectional methodological study, 300 Iranian women who were aged 18 years or older, and who were attending healthcare centers of Shahid Beheshti University of Medical Sciences, were selected in 2017-18. After a backward-forward translation procedure of BCSBQ was carried out, the face, content and construct validity of breast cancer-screening beliefs questionnaire were evaluated. In addition, the reliability was measured using the Cronbach's alpha and intra class correlation coefficients.

Results: The results of the exploratory and confirmatory factor analysis were used to extract three distinct factors, including: attitude, knowledge, and barriers to screening. The three-factor model fit was accepted for all factors based on standard indices (RMSEA = 0.12, χ² = 2.832, GFI = 0.87, AGFI = 0.8, CFI = 0.94, NFI = 0.92). In addition, the instrument’s reliability was measured using the Cronbach's alpha coefficient. The instrument had an appropriate Cronbach alpha (0.78). The interclass correlation coefficient was obtained to be 0.93 within a range of 0.83-0.97.

Conclusion: The three-factor structure of the BCSBQ-12 had appropriate validity and reliability among Iranian women. Considering its appropriate psychometric properties, this instrument can be employed in subsequent studies to measure women's breast cancer screening beliefs in Iran.

Reconstruction of feminine identity: the strategies of women with breast cancer to cope with body image altered

Background

Body image altered is the most important psychosocial concern associated with breast cancer. Yet, there is a paucity of information regarding strategies for coping with this problem. This study aimed to explore Iranian breast cancer women’s strategies for coping with body image altered.

Methods

This qualitative study was conducted in 2016–2017. A purposive sample of 36 women with breast cancer was selected with maximum variation from three health care centers in Alborz Province, Iran. Data were collected by semi-structured interviews and analyzed by performing conventional qualitative content analysis.

Results

The main theme of the study was “reconstruction of feminine identity” with the six main categories of physical appearance improvement, active information seeking, self-care for managing limits, psychological self-empowerment, maintaining maternal role, and maintaining wife role.

Conclusion

Iranian breast cancer women’s strategies for coping with body image altered are multidimensional and are mainly based on personal resources. Breast cancer women use these strategies to reconstruction of their feminine identity. Health policy-makers can use the findings of the present study to develop interventions and programs for improving breast cancer women’s body image care.

An infodemiology study on breast cancer in Iran

Purpose

According to the studies conducted in Iran, the breast cancer is the most frequent type of cancer among women. This study aimed to explore the state of health information supply and demand on breast cancer among Iranian medical researchers and Iranian Web users from 2011 to 2015.

Design/methodology/approach

A mixed method research is conducted in this study. In qualitative part, a focus group interview is applied to the users to identify their selected keywords searched for breast cancer in Google. The collected data are analyzed using Open Code software. In quantitative part, data are synthesized using the R software in two parts. First, users’ internet information-seeking behavior (ISB) is analyzed using the Google Trends outputs from 2011 to 2015. Second, the scientific publication behavior of Iranian breast cancer specialists are surveyed using PubMed during the period of the study.

Findings

The results show that the search volume index of preferred keywords on breast cancer has increased from 4,119 in 2011 to 4,772 in 2015. Also, the findings reveal that Iranian scholars had 873 scientific papers on breast cancer in PubMed from 2011 to 2015. There was a significant and positive relationship between Iranian ISB in the Google Trends and SPB of Iranian scholars on breast cancer in PubMed.

Research limitations/implications

This study investigates only the state of health information supply and demand in PubMed and Google Trends and not additional databases often used for medical studies and treatment.

Originality/value

This study provides a road map for health policymakers in Iran to direct the breast cancer studies.

A Survey on the Relationship between Religiosity and Quality of Life in Patients with Breast Cancer: A Study in Iranian Muslims

OBJECTIVE

This study aimed to assess the relationship between religiosity and quality of life (QoL) in patients with breast cancer in a Muslim population.

METHODS

This descriptive-correlational study was conducted in 84 Muslim patients with breast cancer who were admitted to Ahvaz Shafa Hospital, Iran, during 2015. QoL and religiosity were measured with the Short Form-36 questionnaire and Muslim Religiosity questionnaire based on the Glock and Stark model, respectively. Data were analyzed using a software program for descriptive statistics, the Chi-square test, Pearson's correlation, and an independent sample t-test.

RESULTS

Most patients had high religiosity (69%) and moderate QoL (46.5%) scores. Total scores and all subscales scores for QoL were significantly higher in patients with high religiosity than patients with moderate religiosity (P < 0.0001). Moreover, a direct correlation was found between religiosity (total and all subscales) and QoL (total and all subscales) (P < 0.0001).

CONCLUSIONS

A significant relationship was found between religiosity and QoL in patients with breast cancer. Accordingly, care team members, especially midwifery and nursing staff, should pay more attention to religious beliefs among these patients to improve their QoL.

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

BACKGROUND

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

High expression of CEACAM19, a new member of carcinoembryonic antigen gene family, in patients with breast cancer

Carcinoembryonic antigen (CEA) family members play important roles in malignancies and are introduced as biomarkers in different types of cancers. Among them CEACAM19 (CEAL1) gene, a new member of the CEA family, remains to be fully elucidated. The aim of this study was investigating the mRNA expression level of CEACAM19 in tumor samples of breast cancer patients compared to breast tissue of normal individuals. We evaluated the expression level of this gene in 75 breast tumors by using real-time quantitative PCR. Also, we studied the correlation between CEACAM19 expression and clinicopathological features and hormone receptors status, including estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 of patients. Out of the enrolled patients, six of them (7.9%) showed low expression, ten (13.2%) showed normal expression and 59 (77.6%) showed high expression of CEACAM19. There was a significant correlation between high expression of CEACAM19 gene in tumor samples compared to normal tissues (P = 0.039). No significant correlation was seen between clinicopathological factors and disease-free survival with mRNA levels of CEACAM19 in tumor samples, while the difference between the expression of CEACAM19 in ER/PR-positive and ER/PR-negative breast cancer patients was statistically significant (P = 0.046). In conclusion, CEACAM19 showed high expression in tumor samples compared to normal mammary tissue. In addition, CEACAM19 may represent as a novel therapeutic target in certain subgroups of breast cancer patients such as ER/PR-negative. Critical roles of CEA proteins in tumor progression may nominate them as robust potential targets for therapeutic intervention in near future.

Assessment of Breast Cancer Risk in an Iranian Female Population Using Bayesian Networks with Varying Node Number

Objective:

As a source of information, medical data can feature hidden relationships. However, the high volume of datasets and complexity of decision-making in medicine introduce difficulties for analysis and interpretation and processing steps may be needed before the data can be used by clinicians in their work. This study focused on the use of Bayesian models with different numbers of nodes to aid clinicians in breast cancer risk estimation.

Methods:

Bayesian networks (BNs) with a retrospectively collected dataset including mammographic details, risk factor exposure, and clinical findings was assessed for prediction of the probability of breast cancer in individual patients. Area under the receiver-operating characteristic curve (AUC), accuracy, sensitivity, specificity, and positive and negative predictive values were used to evaluate discriminative performance.

Result:

A network incorporating selected features performed better (AUC = 0.94) than that incorporating all the features (AUC = 0.93). The results revealed no significant difference among 3 models regarding performance indices at the 5% significance level.

Conclusion:

BNs could effectively discriminate malignant from benign abnormalities and accurately predict the risk of breast cancer in individuals. Moreover, the overall performance of the 9-node BN was better, and due to the lower number of nodes it might be more readily be applied in clinical settings.

Comparative Investigation of Single Voxel Magnetic Resonance Spectroscopy and Dynamic Contrast Enhancement MR Imaging in Differentiation of Benign and Malignant Breast Lesions in a Sample of Iranian Women

PURPOSE

To make a comparison of single voxel magnetic resonance spectroscopy (SV-MRS) and dynamic contrast enhancement (DCE) MRI for differentiation of benign and malignant breast lesions in a sample of Iranian women.

MATERIALS AND METHODS

A total of 30 women with abnormal breast lesions detected in mammography, ultrasound, or clinical breast exam were examined with DCE and SV-MRS. tCho (total choline) resonance in MRS spectra was qualitatively evaluated and detection of a visible tCho peak at 3.2 ppm was defined as a positive finding for malignancy. Different types of DCE curves were persistent (type 1), plateau (type 2), and washout (type 3). At first, lesions were classified according to choline findings and types of DCE curve, finally being compared to pathological results as the standard reference.

RESULTS

this study included 19 patients with malignant lesions and 11 patients with benign ones. While 63.6 % of benign lesions (7 of 11) showed type 1 DCE curves and 36.4% (4 of 11) showed type 2, 57.9% (11of 19) of malignant lesions were type 3 and 42.1% (8 of 19) type 2. Choline peaks were detected in 18 of 19 malignant lesions and in 3 of 11 benign counterparts. 1 malignant and 8 benign cases did not show any visible resonance at 3.2 ppm so SV-MRS featured 94.7% sensitivity, 72.7 % specificity and 86.7% accuracy.

CONCLUSIONS

The present findings indicate that a combined approach using MRS and DCE MRI can improve the specificity of MRI for differentiation of benign and malignant breast lesions.

RETRACTED: MicroRNA-138 modulates metastasis and EMT in breast cancer cells by targeting vimentin

This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the Editor-in-Chief. Concerns were raised in the public domain and also reported by the authors to the journal regarding the similarity between panels from Figures 3A and 4C. In addition to the institutional investigation, the journal requested the authors to provide the raw data. However, the authors have not fulfilled this request, and therefore the Editor-in-Chief decided to retract the article.