Lifestyle Practices and Its Influence on Quality Of Life among Breast Cancer Survivors.

Breast cancer is ranked number one from the ten most frequent cancers in female, Peninsular Malaysia. Various studies provide negative evidence on malignancies and one of the end results is impaired quality of life (QOL). Studies show lifestyle approaches are key factors in enhancing the QOL among cancer survivors. The purpose of this study is to describe the lifestyle practices (LP) among breast cancer survivors (BCS) which consist of dietary intake, exercise habits, and stress management and to determine whether these practices have influence on the QOL among Malaysian BCS. This study adopts a cross-sectional study design using a self-administered questionnaire. A total of 280 BCS from public and private hospitals throughout Peninsular Malaysia had participated. The questionnaire covers QOL and LP items which consist of dietary intake (consumption of high-fat food, high-fibre food, fruits and vegetables), exercise habits, and stress management. Descriptive statistics and one-way ANOVA were used to determine the relationship between LP and QOL. Mean age of the study sample was at 41 (SD=7.37). Majority of them were Malay (74%), 53% were diagnosed with breast cancer between 1 to 2 years whereas 54% were presented with stage 2 at diagnosis. There was a statistically significant difference (p<.05) in the overall quality of life score for the three LP groups (Better, No change, Worse). Malaysians’ BCS reported an improvement in LP and the enhancement in LP may result to better QOL outcomes

Work engagement among breast cancer survivors: are they less engaged in their work?

This study investigates work engagement of employed breast cancer survivors in comparison to unmatched control samples of healthy working women without cancer and any other chronic diseases from the general population. A case-control study design using unmatched controls was adopted in this study. The case comprised of 80 female breast cancer survivors who have returned to full-time employment selected using purposive sampling technique. Meanwhile, controls were 88 healthy female working women in full time paid employment, selected using quota sampling. Questionnaire covering socio-demographic characteristics and self-rated work engagement measured using Utrecht Work Engagement Scale (UWES) was distributed to the cancer survivors through face-to-face meeting during their hospital visits. For the healthy controls the questionnaires were distributed using drop-andcollect method through the human resource personnel of the participating organization.The results revealed, after controlling for age, marital status, ethnic group and tenure with organization, no significant differences in the overall work engagement was found between the breast cancer survivors [mean (SD) =,4.66 (0.92)] and the healthy controls [mean (SD) = 4.75 (0.85)]; F(1, 163) =1.70. In comparison to the work engagement domains, only the Vigor domain was found to be significantly lower for the survivors, survivors [F (1,163) =14.94; p<.001] compared to healthy controls. However, the effect size was small (2= 0.004). No significant difference was found in the mean absorption and dedication domain scores.The findings suggest, except for vigor domain, work engagement of breast cancer survivors who have returned to work do not differ from individuals without cancer

Axillary accessory breast carcinoma masquerading as axillary abscess: a case report

Accessory breast is a frequently seen developmental breast abnormality, commoner among Asians than Caucasians. This ectopic breast tissue shares many similarities as the normal breast tissue, and although subjected to the same pathological processes, accessory breast carcinoma is rare. As locations of the accessory breast may be variable, detection of pathological lesions through clinical examinations and standard diagnostic tools (i.e., mammogram) can be difficult. Staging and management should be tailored-made according to the location of the accessory breast as well as its known pattern of lymphatic drainage. We report a case of an intra-ductal carcinoma occurring in an axillary accessory breast

Axillary accessory breast carcinoma masquerading as axillary abscess: a case report

Accessory breast is a frequently seen developmental breast abnormality, commoner among Asians than Caucasians. This ectopic breast tissue shares many similarities as the normal breast tissue, and although subjected to the same pathological processes, accessory breast carcinoma is rare. As locations of the accessory breast may be variable, detection of pathological lesions through clinical examinations and standard diagnostic tools (i.e., mammogram) can be difficult. Staging and management should be tailored-made according to the location of the accessory breast as well as its known pattern of lymphatic drainage. We report a case of an intra-ductal carcinoma occurring in an axillary accessory breast

Potential biomarkers through genome-wide expression analysis of breast cancer samples from Malaysian patients

Breast cancer is a serious health concern and still a leading cause of death among women in the world. To explore the complexity of this cancer, we performed microarray analysis on highly selective cancer and normal breast tissues. The aim of this study was to identify differentially expressed genes between both tissues and to elucidate further molecular pathways involved in breast cancer carcinogenesis. Genome-wide expression profiling was performed on fifteen cancer and five normal breast tissues using the Affymetrix GeneChip® Human Gene 1.0 ST array. Supervised hierarchical cluster analysis using filtering parameters of -1.5 to 1.5 fold-change and p-value with False Discovery Rate < 0.05 revealed 404 up-regulated and 463 down-regulated genes. Pathway analysis revealed the significant genes were involved in cell cycle regulation, DNA repair, Hedgehog pathway, histone phosphorylation, TRRAP/Tip60 chromatin remodelling and apoptosis regulation. Among the top 10 significantly overexpressed genes were CENPF, DTL and MK167 and these were related to cell cycle regulation. Among the top 10 significant down-regulated genes, HOXA5 and NRG1 were found to be associated with Wnt signalling pathway and ErbB signalling pathway respectively. Aberrations in these genes are likely to promote breast cancer carcinogenesis. Our current findings highlighted the importance of differentially expressed genes in breast cancer and their molecular pathways that linked these genes. Further studies are required to validate our findings using larger sample size

Low prevalence of CHEK2 gene mutations in multiethnic cohorts of breast cancer patients in Malaysia.

CHEK2 is a protein kinase that is involved in cell-cycle checkpoint control after DNA damage. Germline mutations in CHEK2 gene have been associated with increase in breast cancer risk. The aim of this study is to identify the CHEK2 gene germline mutations among high-risk breast cancer patients and its contribution to the multiethnic population in Malaysia. We screened the entire coding region of CHEK2 gene on 59 high-risk breast cancer patients who tested negative for BRCA1/2 germline mutations from UKM Medical Centre (UKMMC), Hospital Kuala Lumpur (HKL) and Hospital Putrajaya (HPJ). Sequence variants identified were screened further in case-control cohorts consisting of 878 unselected invasive breast cancer patients (180 Malays, 526 Chinese and 172 Indian) and 270 healthy individuals (90 Malays, 90 Chinese and 90 Indian). By screening the entire coding region of the CHEK2 gene, two missense mutations, c.480A>G (p.I160M) and c.538C>T (p.R180C) were identified in two unrelated patients (3.4%). Further screening of these missense mutations on the case-control cohorts unveiled the variant p.I160M in 2/172 (1.1%) Indian cases and 1/90 (1.1%) Indian control, variant p.R180C in 2/526 (0.38%) Chinese cases and 0/90 Chinese control, and in 2/180 (1.1%) of Malay cases and 1/90 (1.1%) of Malay control. The results of this study suggest that CHEK2 mutations are rare among high-risk breast cancer patients and may play a minor contributing role in breast carcinogenesis among Malaysian population

Mitochondrial DNA mutations in Malaysian female breast cancer patients

Cancer development has been ascribed with diverse genetic variations which are identified in both mitochondrial and nuclear genomes. Mitochondrial DNA (mtDNA) alterations have been detected in several tumours which include lung, colorectal, renal, pancreatic and breast cancer. Several studies have explored the breast tumour-specific mtDNA alteration mainly in Western population. This study aims to identify mtDNA alterations of 20 breast cancer patients in Malaysia by next generation sequencing analysis. Twenty matched tumours with corresponding normal breast tissues were obtained from female breast cancer patients who underwent mastectomy. Total DNA was extracted from all samples and the entire mtDNA (16.6kb) was amplified using long range PCR amplification. The amplified PCR products were sequenced using mtDNA next-generation sequencing (NGS) on an Illumina Miseq platform. Sequencing involves the entire mtDNA (16.6kb) from all pairs of samples with high-coverage (~ 9,544 reads per base). MtDNA variants were called and annotated using mtDNA-Server, a web server. A total of 18 of 20 patients had at least one somatic mtDNA mutation in their tumour samples. Overall, 65 somatic mutations were identified, with 30 novel mutations. The majority (59%) of the somatic mutations were in the coding region, whereas only 11% of the mutations occurred in the D-loop. Notably, somatic mutations in protein-coding regions were non-synonymous (49%) in which 15.4% of them are potentially deleterious. A total of 753 germline mutations were identified and four of which were novel mutations. Compared to somatic alterations, less than 1% of germline missense mutations are harmful. The findings of this study may enhance the current knowledge of mtDNA alterations in breast cancer. To date, the catalogue of mutations identified in this study is the first evidence of mtDNA alterations in Malaysian female breast cancer patients

Complementary and alternative medicine (CAM) use and delays in presentation and diagnosis of breast cancer patients in public hospitals in Malaysia

<div><p>Complementary and alternative medicine (CAM) is widely used among the breast cancer patients in Malaysia. Delays in presentation, diagnosis and treatment have been shown to impact the disease prognosis. There is considerable use of CAM amongst breast cancer patients. CAM use has been cited as a cause of delay in diagnosis and treatments in qualitative studies, however there had not been any confirmatory study that confirms its impact on delays. The purpose of this study was to evaluate whether the use of CAM among newly diagnosed breast cancer patients was associated with delays in presentation, diagnosis or treatment of breast cancer. This multi-centre cross-sectional study evaluating the time points of the individual breast cancer patients’ journey from first visit, resolution of diagnosis and treatments was conducted in six public hospitals in Malaysia. All newly diagnosed breast cancer patients from 1st January to 31st December 2012 were recruited. Data were collected through medical records review and patient interview by using a structured questionnaire. Complementary and alternative medicine (CAM) was defined as the use of any methods and products not included in conventional allopathic medicine before commencement of treatments. Presentation delay was defined as time taken from symptom discovery to first presentation of more than 3 months. The time points were categorised to diagnosis delay was defined as time taken from first presentation to diagnosis of more than 1 month and treatment delay was defined as time taken from diagnosis to initial treatment of more than 1 month. Multiple logistic regression was used for analysis. A total number of 340 patients participated in this study. The prevalence of CAM use was 46.5% (n = 158). Malay ethnicity (OR 3.32; 95% CI: 1.85, 5.97) and not interpreting symptom as cancerous (OR 1.79; 95% CI: 1.10, 2.92) were significantly associated with CAM use. The use of CAM was associated with delays in presentation (OR 1.65; 95% CI: 1.05, 2.59), diagnosis (OR 2.42; 95% CI: 1.56, 3.77) and treatment of breast cancer (OR 1.74; 95% CI: 1.11, 2.72) on univariate analyses. However, after adjusting with other covariates, CAM use was associated with delays in presentation (OR 1.71; 95% CI: 1.05, 2.78) and diagnosis (OR 2.58; 95% CI: 1.59, 4.17) but not for treatment of breast cancer (OR 1.58; 95% CI: 0.98, 2.55). The prevalence of CAM use among the breast cancer patients was high. Women of Malay ethnicity and not interpreting symptom as cancerous were significantly associated with CAM use. The use of CAM is significantly associated with delay in presentation and resolution of diagnosis. This study suggests further evaluation of access to breast cancer care is needed as poor access may cause the use of CAM. However, since public hospitals in Malaysia are heavily subsidized and readily available to the population, CAM use may impact delays in presentation and diagnosis.</p></div

Family pedigree of <i>CHEK2</i> p.R180C missense mutation’s carrier (BC254) from sequencing analysis.

<p>Index patients are indicated with an arrow while individuals affected with breast cancer are indicated with filled symbol. Date of birth and age of diagnosis (in bracket) for affected individual are indicated. Deceased individuals are indicated with a slash.</p