Risk factors of metastasis in women with breast cancer in Isfahan, Iran

Background: Breast cancer is one of the most common malignancies in women and its metastasis plays an important role in mortality, treatment failures and complications. The objective of this study was to evaluate the risk factors of metastatic breast cancer. Methods: In a retrospective cohort study, breast cancer patients in Isfahan, Iran were followed up for ten years. The existence of metastasis was considered as the dependent variable while independent variables included age at diagnosis, hormone receptor status, family history, number of lymph nodes dissected in surgery and involved ones, number of pregnancies, age at first pregnancy and menarche, menstrual status, histopathology and tumor size. All data was collected from patients' profiles and analyzed using logistic regression in SPSS16. Findings: A total of 685 patients with breast cancer were studied during 1999-2009. While 91.4 of cases had no metastasis, distant metastasis was found in 8.6 of subjects. Sites of metastasis according to prevalence were lung (4.7), bone (2.6), other organs (1.1), and liver (0.3). Number of involved lymph nodes (P = 0.043) and number of pregnancies (P = 0.022) had significant relationships with metastasis. Conclusion: We concluded that less pregnancies and more involved lymph nodes indicate a high probability of metastasis occurrence. Therefore, survival improvement might be possible with early diagnosis of breast cancer, using prophylactic treatments, and identifying metastatic cases by diagnostic tests

Coping skills improve quality of life in women with breast cancer and maladaptive coping Style

Background: Breast cancer (BC) is a common malignancy among women. BC is a stressor in life that affects coping strategies and quality of life. This study performed to improve the quality of life in women with maladaptive coping style.  Methods: A randomized clinical trial, held in 2011. Patients with maladaptive coping strategy were included in the study. 62 patients were randomized into two groups. Before and after 8 weeks of coping therapy, the quality of life was measured. General linear model was used for analysis.  Results: The mean age in the intervention and control group was 45.10±7.34, 46.52±6.20 respectively (P-value>0.5). Functional health significantly improved after the intervention (p-value<0.005), but in the control it decreased (p-value=0.029). Symptom health between the two groups demonstrated no difference before and after intervention. General health improved in the intervention group (p-value=0.017). However, in the control group it was not significant (p-value=0.128). Problem-focused coping strategies in the intervention group improved markedly (p-value= 0.003) whereas, the control group did not reveal significant differences (p-value=0.196).  Conclusion: The results showed that the coping skill training program can improve the overall quality of life of breast cancer in women, and indicated that the care of breast cancer should address psychological issues and the finding points to the importance of taking individual coping strategies into account when evaluating the impact of breast cancer on psychosocial well-being

Exploring Factors Related to Metastasis Free Survival in Breast Cancer Patients Using Bayesian Cure Models

CEEQUAL är ett klassningssystem utvecklad av ICE, den brittiska Institutionen för Civilingenjörer, för att bättra på anläggningsbranschens sociala, ekonomiska och miljömässiga hållbarhetsarbete. Systemet utvecklades år 2003 och användes fram till år 2011 endast i Storbritannien och Irland. År 2011 utvecklades en internationell version för organisationer som är intresserade av att certifiera projekt i andra delar av världen. Syftet med rapporten är att utvärdera konsekvenser för ett projekt som skall miljöcertifieras. Detta sker med hjälp av tre fallstudier från Skanska Sverige AB: Projekt Skarplöt, exploatering av en åkermark i Västerhaninge. Projekt Folkparksvägen, ombyggnation av en 1500 meter vägsträcka. Projekt Tyresövägen-Simvägen, en avsmalning av Tyresövägen från  motorvägsstandard till stadsväg.           Målet med rapporten är att: Identifiera förbättringsåtgärder för att främja hållbarhet och resurseffektivitet i produktion. Uppskatta vilka resurser förbättringsåtgärderna för certifiering kräver. Resultat från fallstudierna visar att Skanska har väl inarbetade rutiner i företagets ledningssystem, dock finns det förbättringspotential som kan uppnås med integrering av CEEQUALs krav i dagens arbetssätt. Merkostnaden av förbättringsåtgärderna består mestadels av tjänstemannatid för ett utökat samhällsengagemang, planering och bevakning av åtgärder som främjar hållbarhet samt insamling av bevismaterial för certifiering. Ändringar som uppkommer i arbetssättet är projektberoende och belyses i produktionsplaneringsskedet i varje enskilt projekt med hjälp av den extra planeringen som en CEEQUAL certifiering kräver. Rekommendationer för Skanska är att integrera en del av CEEQUALs krav i ledningssystemet och att skapa färdiga mallar som är anpassade till CEEQUALs frågeställningar med avsikt att effektivisera framställning av bevisdokumentationen i varje enskilt projekt. CEEQUAL is an assessment and award scheme developed by ICE, The Institution of Civil Engineers in Great Britain, in order to improve the Civil engineering industry´s social, economic and environmental sustainability. The system was developed in 2003 and it was only used in the UK and Ireland until 2011. Year 2011, was an international version developed for organizations that are interested in certifying projects in other parts of the world. The report aims to evaluate the consequences for a project that is going to be assessed. This is done by using three case studies from Skanska Sverige AB: Project Skarplöt, exploitation of previous farming land in Västerhaninge. Project Folkparksvägen, refurbishment of a 1500 meter stretch of road. Project Tyresövägen - Simvägen, a narrowing of Tyresövägen from motorway standard to a city road with cycle lanes. The objective of this report is to: Identify improvement measures to promote sustainability and resource efficiency under production. Estimate the resources that such improvements and the works associated with the certification requires. Results of case studies show that Skanska has well-established work practices, however, there is potential for improvement that can be achieved with the integration of CEEQUALs requirements in the company’s management system. The additional cost of the improvement measures consist mostly of extra working time needed to administrate, plan and monitor measures that promote sustainability as well as gather evidence for certification. Adjustments to the production process that arises in the planning stages of the sustainability measures cannot be generalised and depend mostly on the project prerequisites. Recommendations to Skanska are to integrate CEEQUALs requirements in their management system and to create pre-designed templates for the required documentation and procedures in order to streamline planning and monitoring in each individual project that is going to be certified

Plasma Level Of miR-21 And miR-451 In Primary And Recurrent Breast Cancer Patients.

PURPOSE: MiR-21 and miR-451 are closely associated with tumor initiation, drug resistance, and recurrence of breast cancer (BC). This study was conducted to evaluate the possible value of the plasma level of miR-21 and miR-451 as potential biomarkers for the detection of primary and recurrent BC. PATIENTS AND METHODS: In this descriptive-analytical study, the plasma level of miR-21 and miR-451 was measured in 23 primary BC patients, 24 recurrent (local/distant metastasis) BC patients, and 24 aged-match women as healthy controls using quantitative reverse transcription-polymerase chain reaction (qRT-PCR). Finally, data were analyzed using SPSS software, and the area under the receiver operating characteristic (ROC) curve of miRNAs was measured. RESULTS: The plasma level of miR-21 was significantly increased in both groups of primary (P<0.001) and recurrent (P<0.001) BC patients in comparison with healthy women. However, the plasma level of miR-451 was not significantly changed in primary (P=0.065) and recurrent (P=0.06) BC patients than healthy controls. The elevation of both miR-21 and miR-451 plasma level was not significantly changed in recurrent patients compared with non-recurrent (primary) patients (P=0.481, and P=1, respectively). Based on the ROC analyses, the areas under the curves (AUC) for miR-21 in discriminating primary BC and recurrent BC patients from healthy controls were 0.828 (95% CI: 0.712 to 0.944) and 0.865 (95% CI: 0.756 to 0.974), respectively. CONCLUSION: These data indicating that plasma miR-21 may be useful as a biomarker for the detection of both primary and recurrent BC. However, plasma miR-451 lacks enough sensitivity in the detection of primary and recurrent BC, and more studies are needed in this area

A Short Communication: Non-acid Nucleic Blood Multi-Factors Panels for Primary Breast Cancer Detection - A Systematic Review and Network Meta-Analysis

This study aimed to compare the non-acid nucleic blood multi-factor panels together and with mammography in terms of sensitivity, specificity, and accuracy in primary breast cancer detection (I, II, III, and IV). We systematically reviewed studies assessing non-acid nucleic blood tumor markers panels’ diagnostic value in both healthy women and patients (before any anticancer treatment) for the detection of primary breast cancer. Out of the 2358 titles initially identified, 12 studies and 9 panels were included in the network meta-analysis. Panels I (MSA + B2m) and J (GATA3 + E-cadherin) had the highest sensitivity in all stages of primary breast cancer but had no significant difference with mammography. Panels L (MSA + CA15–3) and B (M-CSF + CA15–3) had the highest specificity in all stages compared to other panels but no remarkable difference with mammography. Panels J (GATA3 + E-cadherin) and I (MSA + B2m) respectively had the highest accuracy in primary breast cancer detection but no considerable difference with mammography in terms of accuracy. Panel J, including GATA3 + E-cadherin, demonstrated a higher diagnostic value for primary breast cancer detection (I, II, III, and IV) than the rest of the panels

Clinical Trial: CYP2D6 Related Dose Escalation of Tamoxifen in Breast Cancer Patients With Iranian Ethnic Background Resulted in Increased Concentrations of Tamoxifen and Its Metabolites

Introduction: The polymorphic enzyme cytochrome P450 2D6 (CYP2D6) catalyzes a major step in the bioactivation of tamoxifen. Genotyping of clinically relevant CYP2D6 alleles and subsequent dose adjustment is a promising approach to individualize breast cancer therapy. The aim of this study was to investigate the relationship between the plasma levels of tamoxifen and its metabolites and different CYP2D6 genotypes under standard (20 mg/day) and dose-adjusted therapy (Registration ID in Iranian Registry of Clinical Trials: IRCT2015082323734N1).Materials and Methods: Using TaqMan® assays common alleles of CYP2D6 (∗1, ∗2, ∗4, ∗5, ∗6, ∗10, ∗17, and ∗41) and gene duplication were identified in 134 breast cancer patients. Based on CYP2D6 genotypes patients with an activity score 1 (n = 15) and 0–0.5 (n = 2) were treated with tamoxifen adjusted dosage of 30 and 40 mg/day, respectively. The concentration of tamoxifen and its metabolites before and after 4 and 8 months of dose adjustment were measured using LC-MS/MS technology.Results: At baseline, (Z)-endoxifen plasma concentrations (33 ± 15.5, 28.1 ± 14, 26.6 ± 23.4, 14.3 ± 8.6, and 10.7 ± 5.5 nmol/l for EM/EM, EM/IM, EM/PM, IM/IM and PM/PM, respectively) and the metabolic ratio (Z)-Endoxifen/N-desmethyltamoxifen (0.0558 ± 0.02, 0.0396 ± 0.0111, 0.0332 ± 0.0222, 0.0149 ± 0.0026, and 0.0169 ± 0.0177 for EM/EM, EM/IM, EM/PM, IM/IM, and PM/PM, respectively) correlated with CYP2D6 genotype (Kruskal–Wallis p = 0.013 and p &lt; 0.0001, respectively). Dose escalation to 30 and 40 mg/day in patients with a CYP2D6 activity score of 1 (n = 15) and 0–0.5 (n = 2) resulted in a significant increase in (Z)-endoxifen plasma levels (22.17 ± 24.42, 34.43 ± 26.54, and 35.77 ± 28.89 nmol/l at baseline, after 4 and 8 months, respectively, Friedman p = 0.0388) along with the plasma concentrations of tamoxifen and its other metabolites. No severe side effects were recorded during dose escalation.Conclusion: For the first time, we show the feasibility of dose escalation of tamoxifen in breast cancer patients with compromised CYP2D6 activity and Iranian ethnic background to increase the plasma concentrations of (Z)-endoxifen

Coping skills improve quality of life in women with breast cancer and maladaptive coping Style

Background: Breast cancer (BC) is a common malignancy among women. BC is a stressor in life that affects coping strategies and quality of life. This study performed to improve the quality of life in women with maladaptive coping style.  Methods: A randomized clinical trial, held in 2011. Patients with maladaptive coping strategy were included in the study. 62 patients were randomized into two groups. Before and after 8 weeks of coping therapy, the quality of life was measured. General linear model was used for analysis.  Results: The mean age in the intervention and control group was 45.10±7.34, 46.52±6.20 respectively (P-value&gt;0.5). Functional health significantly improved after the intervention (p-value&lt;0.005), but in the control it decreased (p-value=0.029). Symptom health between the two groups demonstrated no difference before and after intervention. General health improved in the intervention group (p-value=0.017). However, in the control group it was not significant (p-value=0.128). Problem-focused coping strategies in the intervention group improved markedly (p-value= 0.003) whereas, the control group did not reveal significant differences (p-value=0.196).  Conclusion: The results showed that the coping skill training program can improve the overall quality of life of breast cancer in women, and indicated that the care of breast cancer should address psychological issues and the finding points to the importance of taking individual coping strategies into account when evaluating the impact of breast cancer on psychosocial well-being.</p

Belonging to a peer support group enhance the quality of life and adherence rate in patients affected by breast cancer: A non-randomized controlled clinical trial*

Background: Breast cancer is the most common cancer in women. It seems that breast cancer patients benefit from meeting someone who had a similar experience. This study evaluated the effect of two kinds of interventions (peer support and educational program) on quality of life in breast cancer patients. Methods: This study was a controlled clinical trial on women with non-metastatic breast cancer. The patients studied in two experimental and control groups. Experimental group took part in peer support program and control group passed a routine educational program during 3 months. The authors administered SF-36 for evaluating the quality of life pre-and post intervention. Also, patient′s adherence was assessed by means of a simple checklist. Results: Two groups were similar with respect of age, age of onset of the disease, duration of having breast cancer, marital status, type of the treatment receiving now, and type of the received surgery. In the control group, there were statistically significant improvements in body pain, role-physical, role-emotional and social functioning. In experimental group, role-physical, vitality, social functioning, role-emotional and mental health showed significant improvement. Vitality score and mental health score in experimental group was significantly higher than that of the control group, both with p < 0.001. Also, it was shown that adherence was in high levels in both groups and no significant difference was seen after the study was done. Conclusions: According to the results of this study, supporting the patients with breast cancer by forming peer groups or by means of educational sessions could improve their life qualities

A Hybrid Computer-aided-diagnosis System for Prediction of Breast Cancer Recurrence (HPBCR) Using Optimized Ensemble Learning

Cancer is a collection of diseases that involves growing abnormal cells with the potential to invade or spread to the body. Breast cancer is the second leading cause of cancer death among women. A method for 5-year breast cancer recurrence prediction is presented in this manuscript. Clinicopathologic characteristics of 579 breast cancer patients (recurrence prevalence of 19.3%) were analyzed and discriminative features were selected using statistical feature selection methods. They were further refined by Particle Swarm Optimization (PSO) as the inputs of the classification system with ensemble learning (Bagged Decision Tree: BDT). The proper combination of selected categorical features and also the weight (importance) of the selected interval-measurement-scale features were identified by the PSO algorithm. The performance of HPBCR (hybrid predictor of breast cancer recurrence) was assessed using the holdout and 4-fold cross-validation. Three other classifiers namely as supported vector machines, DT, and multilayer perceptron neural network were used for comparison. The selected features were diagnosis age, tumor size, lymph node involvement ratio, number of involved axillary lymph nodes, progesterone receptor expression, having hormone therapy and type of surgery. The minimum sensitivity, specificity, precision and accuracy of HPBCR were 77%, 93%, 95% and 85%, respectively in the entire cross-validation folds and the hold-out test fold. HPBCR outperformed the other tested classifiers. It showed excellent agreement with the gold standard (i.e. the oncologist opinion after blood tumor marker and imaging tests, and tissue biopsy). This algorithm is thus a promising online tool for the prediction of breast cancer recurrence. Keywords: Breast cancer, Cancer recurrence, Computer-assisted diagnosis, Machine learning, Prognosi