Comparison of Clinico-Pathological Presentations of Triple-Negative versus Triple-Positive and HER2 Iraqi Breast Cancer Patients

BACKGROUND: Breast cancer remains the most common malignancy among the Iraqi population. Affected patients exhibit different clinical behaviours according to the molecular subtypes of the tumour. AIM: To identify the clinical and pathological presentations of the Iraqi breast cancer subtypes identified by Estrogen receptors (ER), Progesterone receptors (PR) and HER2 expressions. PATIENTS AND METHODS: The present study comprised 486 Iraqi female patients diagnosed with breast cancer. ER, PR and HER2 contents of the primary tumours were assessed through immunohistochemical staining; classifying the patients into five different groups: Triple Negative (ER/PR negative/HER2 negative), Triple Positive (ER/PR positive/HER2 positive), Luminal A (ER/PR positive/HER2 negative), HER2 enriched ((ER/PR negative/HER2 positive) and all other subtypes. RESULTS: The major registered subtype was the Luminal A which was encountered in 230 patients (47.3%), followed by the Triple Negative (14.6%), Triple Positive (13.6%) and HER2 Enriched (11.5%). Patients exhibiting the Triple Negative subtype were significantly younger than the rest of the groups and presented with larger size tumours. A significant difference in the distribution of the breast cancer stages was displayed (p < 0.05); the most advanced were noted among those with HER2 enriched tumours who exhibited the highest frequency of poorly differentiated carcinomas and lymph node involvement. CONCLUSION: The most significant variations in the clinicopathological presentations were observed in the age and clinical stage of the patients at diagnosis. Adoption of breast cancer molecular subtype classification in countries with limited resources could serve as a valuable prognostic marker in the management of aggressive forms of the disease

Correlation between Breast Self-Examination Practices and Demographic Characteristics, Risk Factors and Clinical Stage of Breast Cancer among Iraqi Patients

BACKGROUND: Breast Cancer (BC) is the most common cancer and the leading cause of cancer death among women globally. The disease can be cured with limited resources if detected early. Breast self-examination (BSE) is considered a cost-effective feasible approach for early detection of that cancer in developing countries. AIM: To determine the correlation between BSE performance and demographic characteristics, risk factors and clinical stage of BC among Iraqi patients. METHODS: This retrospective study included a total of 409 female patients diagnosed with BC at the Referral Training Center for Early Detection of Breast Cancer and the National Cancer Research Center in Baghdad. The studied variables included the age of the patient, occupation, marital and educational status, parity, history of lactation, contraceptive pill intake, family history of cancer and the clinical stage of the disease. RESULTS: Our findings revealed that the most important predictors for practicing BSE was family history of BC or any other cancers (OR = 3.87, P = 0.018) followed by being a governmental employee (OR = 1.87, P = 0.024), history of contraceptive use (OR = 1.80, P = 0.011) and the high level of education (OR = 1.73, P = 0.004). On the other hand, there was no significant correlation between the practice of BSE and the BC stage at the time of presentation. CONCLUSION: There is a relatively poor practice of BSE among Iraqi patients diagnosed with BC. It is mandatory to foster the national cancer control strategies that focus on raising the level of awareness among the community through public education as a major approach to the early detection of cancer in Iraq

Iraqi Breast Cancer: A Review on Patients' Demographic Characteristics and Clinico-Pathological Presentation.

Background: Breast Cancer is the commonest type of malignancy in Iraq. The Iraqi Cancer Registry displays an obvious trend for the disease to affect younger women with advanced stages at the time of presentation. This report presents a review on the main demographic characteristics and clinicopathological parameters in Iraqi patients diagnosed with breast cancer. Patients & Methods: The study was carried out on 721 out of a total of 5044 patients (14.3%) who complained of palpable breast lumps that were diagnosed as cancer. The procedure for tumor nuclear DNA Ploidy assessment was performed by means of Image Cytometry. Immuno-cytochemical and  histochemical assays were applied for the determination of Estrogen and Progesterone receptor (ER/PR) contents and Her-2/neu expression of the tumor tissues. Results: Approximately one third of the breast cancer patients were diagnosed in the age period (40- 49 years), 71.9% came from urban areas and 75% were married. History of lactation and hormonal therapy was reported in 63.1% and 29% respectively, while positive family history was recorded in 16.2%. Although the lump was detected by the patient herself in 90.6%, yet only 32% sought medical advice within the first month. Accordingly 47% of these patients presented in advanced stages (III and IV).The main histological type was invasive ductal carcinoma; in which pathological changes of grade II and III were observed in 56.6% and 39.9% respectively. Cytophotometric DNA analysis showed that 80.3% of Iraqi mammary carcinomas were aneuploid. ER and PR positive tumor contents were demonstrated in 65.1% and 45.1% of the examined specimens respectively while Her- 2/neu over expression was displayed in 46.4%. Conclusions: The aforementioned data justifies increasing efforts for establishing comprehensive breast cancer control programs in our country. Further interventional research studies using molecular biomarkers should be promoted to address the factors contributing to the illustrated aggressive tumor behavioral form

Study the correlation between hormonal receptors in Iraqi patient women with Breast Cancer

Breast Cancer is one of common types of cancer in the world and is considered one of the causes of death among Iraqi women . The discovery of the hormone receptors (estrogen and progesterone) a significant impact in the selection of patients for treatment and expected to live after period and to the possibility of recurrence treatment again is because the relationship between tumor grade and the percentage of representation of hormone receptors on the surface cells . The research based on measuring the proportion of ER and PR in tissue and blood serum and note relationship between the level of receptors and the clinical situation in Iraqi women with breast cancer . The study has been started from May 2014 to December 2014 in the Educational Tumor Hospital were selected infected women in the age group (28-68) years as measured by the proportion of their ER and PR in tissue and serum .The results showed that the proportion of women  with a family history of patients is 62.5% and that the patients whose ratio to have a tumor of the second degree is 76.7% and the third degree was 13.3% and that the first degree ratio is 10% and that there is no significant difference in the measurement of the percentage ER and PR in ELISA technique and Immunohistochemistry . Sensitivity and Specifity of Immunohistochemistry study is better than ELISA technique because the value of IHC sensitivity and specifity for  ER and PR are 70%(1.0)ng/ml and 69%(1.0)ng/ml respectively while in ELISA technique are 38%(0.9)ng/ml and 20%(0.95)ng/ml respectively . Keywords: Breast Cancer, Estrogen receptors , Progesterone receptors

Evaluation of CRP, D-Dimer of clinical significance in Iraqi patients with COVID-19 and associated comorbidities

Background: The pandemic of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused an unprecedented global social and economic impact, and high numbers of deaths. Many risk factors have been identified in the progression of COVID-19 into a severe and critical stage, underlying comorbidities such as hypertension, diabetes, obesity, chronic lung diseases, heart, liver and kidney diseases. Aims and Methods: This study was designed to investigate Measurement of serum C-reactive protein( CRP) level, plasma D-dimer level and evaluate the levels of each one of the studied parameters between patients infected by coronavirus COVID-19 and no associated comorbidities and patients infected by coronavirus COVID-19 with associated comorbidity (Diabetes , Hypertension). Results: The mean of CRP was 19.31 ± 8.205 in control, , 96.80 ± 18.33 in HTN, 51.08 ± 16.56 in DM group, while mean of  D-dimer was 560.45 ± 155.13 in control group, , 1178.86 ± 379.12 in HTN group, 1529.51 ± 530.20 in DM group of patients.&nbsp

Impact of inflammation, gene variants, and cigarette smoking on coronary artery disease risk

Background: The role of inflammation in coronary artery disease (CAD) pathogenesis is well recognized. Moreover, smoking inhalation increases the activity of inflammatory mediators through an increase in leukotriene synthesis essential in atherosclerosis pathogenesis.Aim: The aim of this study is to investigate the effect of “selected” genetic variants within the leukotriene (LT) pathway and other variants on the development of CAD.Methods: CAD was detected by cardiac catheterization. Logistic regression was performed to investigate the association of smoking and selected susceptibility variants in the LT pathway including ALOX5AP, LTA4H, LTC4S, PON1, and LTA as well as CYP1A1 on CAD risk while controlling for age, gender, BMI, family history, diabetes, hyperlipidemia, and hypertension.Results: rs4769874 (ALOX5AP), rs854560 (PON1), and rs4646903 (CYP1A1 MspI polymorphism) are significantly associated with an increased risk of CAD with respective odds ratios of 1.53703, 1.67710, and 1.35520; the genetic variant rs9579646 (ALOX5AP) is significantly associated with a decreased risk of CAD (OR 0.76163). Moreover, a significant smoking-gene interaction is determined with CYP1A1 MspI polymorphism rs4646903 and is associated with a decreased risk of CAD in current smokers (OR 0.52137).Conclusion: This study provides further evidence that genetic variation of the LT pathway, PON1, and CYP1A1 can modulate the atherogenic processes and eventually increase the risk of CAD in our study population. Moreover, it also shows the effect of smoking-gene interaction on CAD risk, where the CYP1A1 MspI polymorphism revealed a decreased risk in current smokers