Breast Cancer Incidence Patterns in the Saudi Female Population: A 17-Year Retrospective Analysis

Integrating pharmacogenomics in three Middle Eastern countries' healthcare (Lebanon, Qatar, and Saudi Arabia): Current insights, challenges, and strategic directions

BACKGROUND AND OBJECTIVES

Pharmacogenomics (PGx) leverages genomic information to tailor drug therapies, enhancing precision medicine. Despite global advancements, its implementation in Lebanon, Qatar, and Saudi Arabia faces unique challenges in clinical integration. This study aimed to investigate PGx attitudes, knowledge implementation, associated challenges, forecast future educational needs, and compare findings across the three countries.

METHODS

This cross-sectional study utilized an anonymous, self-administered online survey distributed to healthcare professionals, academics, and clinicians in Lebanon, Qatar, and Saudi Arabia. The survey comprised 18 questions to assess participants' familiarity with PGx, current implementation practices, perceived obstacles, potential integration strategies, and future educational needs.

RESULTS

The survey yielded 337 responses from healthcare professionals across the three countries. Data revealed significant variations in PGx familiarity and educational involvement. Qatar and Saudi Arabia participants were more familiar with PGx compared to Lebanon (83%, 75%, and 67%, respectively). Participation in PGx-related talks was most prevalent in Saudi Arabia (96%), followed by Qatar (53%) and Lebanon (35%). Key challenges identified included test cost and reimbursement, insufficient physician knowledge, and lack of infrastructure. Lebanon reported the highest concern for test costs (16%), compared to the lowest in Saudi Arabia (5%). Despite these challenges, a strong consensus emerged on PGx's potential to improve patient outcomes, with over 86% of respondents in all three countries expressing this belief. Educational interest areas varied by country, with strong interest in PGx for cancer chemotherapy in Saudi Arabia and Lebanon and for diabetes mellitus in Qatar.

CONCLUSION

This study highlights the significant influence of varied educational backgrounds and infrastructural limitations on PGx implementation across Lebanon, Qatar, and Saudi Arabia. The findings emphasize the need for targeted strategies in each country to address these distinct barriers. Integrating PGx education into healthcare training programs and clinical workflows could unlock PGx's potential to optimize patient care.

Differences in Clinical, Epidemiological, and Pathological Features of Breast Cancer in the Saudi Population: An Analytical Cross-Sectional Single Institution Study

Background: In Saudi Arabia, breast cancer is the most common malignancy among women, significantly impacting cancer-related morbidity and mortality. The country's unique demographics and rapid socioeconomic development contribute to distinct breast cancer patterns. Objective: To analyze demographic and pathological characteristics of breast cancer with an emphasis on associations between the Ki67 proliferation index, tumor stages, and molecular subtypes. Materials and Methods: An analytical cross-sectional study was conducted on 294 breast cancer patients from 2013 to 2019, recruited from the Comprehensive Cancer Center at King Fahad Medical City, Riyadh, Saudi Arabia. A one-way ANOVA and logistic regression were used to identify risk factors associated with elevated Ki67 levels. Significance was set at a 95% confidence level. Results: The mean age of patients was 51.58. Among them, 67% were overweight/obese, 21.1% were diabetic, and 17% were hypertensive. Approximately 28.9% of all tumors were classified as T3, 46.9% as Grade III, and 40% as Stage IV. Invasive ductal carcinomas (83.9%) were the most common. ER, PR, and HER2 expression were positive in 63.4%, 54.3%, and 34.9% of patients, respectively, with a high Ki67 index in 50.7%. As compared to Grade I cancer, grade II cancer increased the likelihood of elevated Ki67 by 41 times (p = 0.001), Grade III cancer by 7.43 times (p = 0.001), and Stage IV cancer by 2.26 times (p = 0.03). Conversely, invasive lobular carcinomas and other cancer types were significantly less likely to have high Ki67 levels (p < 0.05). Conclusions: Elevated Ki67 appeared to predict higher tumor grades and certain molecular subtypes cancer.

Deciphering the prognostic impact of aberrant DNA methylation on ANGPT1 gene in breast cancer

Breast cancer (BC) is a multifaceted disease distinguished by a range of molecular subtypes and varying clinical prognoses. The involvement of DNA methylation in the dysregulation of gene expression has been linked to the development and progression of BC. Therefore, this study aimed to investigate the association between ANGPT1 gene expression and DNA methylation in BC patients. Eight Saudi female blood samples were used to undergo for whole genome bisulfite sequencing (WGBS) and RNA sequencing for the identification of novel DNA methylation targets. Several public domain BC datasets including the METABRIC cohort, TCGA, and Kaplan Meier Plotter datasets, were used to explore the prognostic significance of ANGPT1 gene. Then, the demethylation agent 5-aza-2'-deoxycytidine was used to examine the potential association between DNA methylation and ANGPT1 expression. Finally, the validation was conducted on blood samples from 49 Saudi females using methylight techniques. Our results shows that upregulation of ANGPT1 gene expression exhibited hypomethylation pattern in BC samples. these results were confirmed by MCF7 cell line experiments. Demethylating using 5-aza in MCF7 and MCF10A showed a high expression of ANGPT1 in both cell lines. ANGPT1 mRNA expression was found to poor prognostic biomarker and lower Breast Cancer-Specific Survival (BCSS) in BC patients. The potential importance of abnormal DNA methylation in the development and advancement of BC is significant. ANGPT1 may act as an oncogene and could be extensively studied further to behave as a predictive biomarker for breast cancer.

Synthesis and Anticancer Evaluation of O-Alkylated (E)-Chalcone Derivatives: A Focus on Estrogen Receptor Inhibition

Cancer remains a leading cause of morbidity and mortality worldwide, highlighting the urgent need for novel therapeutic agents. This study investigated the synthesis and biological evaluation of O-alkyl (E)-chalcone derivatives (4a-4v) as potential anticancer agents. The compounds were synthesized via aldol condensation of substituted aldehydes and acetophenones, with structures confirmed by IR, NMR, and mass spectrometry. In vitro cytotoxicity assays revealed varying effectiveness, with compounds 4a, 4b, 4q, and 4v exhibiting potent activity against MDA-MB-231 and MCF-7, showing IC50 values between 2.08 and 13.58 µM, besides HCT-116 and HeLa cancer cell lines (IC50 values between 6.59 and 22.64 µM). Notably, compound 4b displayed remarkable selectivity, with an IC50 of 54.59 µM against the non-cancerous WI-38 cell line. Additionally, protein kinase inhibition assays indicated that compounds 4b and 4q effectively inhibited EGFR and VEGFR-2, with 4b outperforming the standard inhibitor erlotinib. Molecular docking studies of compound 4q showed strong binding affinities in the ATP-binding pockets of EGFR, HER2, VEGFR2, and CDK2. In silico analyses further highlighted the favorable pharmacokinetic properties of compound 4q, underscoring its potential as a selective tyrosine kinase inhibitor. These findings suggest the therapeutic promise of O-alkyl (E)-chalcone derivatives in cancer treatment.

Acyl Urea Compounds Therapeutics and its Inhibition for Cancers in Women: A Review

Acyl urea compounds have garnered significant attention in cancer therapeutics, particularly for their potential effectiveness against cancers that predominantly affect women, such as breast and ovarian cancers. The paper presents a report on the investigation of acyl urea compounds that are reported to involve a multi-faceted approach, including synthetic chemistry, biological assays, and computational modeling. A wealth of information on acyl urea and its purported effects on cancer affecting women has been gathered from different sources and condensed to provide readers with a broad understanding of the role of acyl urea in combating cancer. Acylureas demonstrate promising results by selectively inhibiting key molecular targets associated with cancer progressions, such as EGFR, ALK, HER2, and the Wnt/β-catenin signaling pathway. Specifically, targeting acyl ureas impedes tumor proliferation and metastasis while minimizing harm to healthy tissues, offering a targeted therapeutic approach with reduced side effects compared to conventional chemotherapy. Continued research and clinical trials are imperative to optimize the efficacy and safety profiles of acylurea-based therapies and broaden their applicability across various cancer types. Acyl urea compounds represent a promising class of therapeutics for the treatment of cancers in women, particularly due to their ability to selectively inhibit key molecular targets involved in tumor growth and progression. The combination of synthetic optimization, biological evaluation, and computational modeling has facilitated the identification of several lead compounds with significant anticancer potential. This abstract explores the therapeutic mechanisms and targeted pathways of acyl ureas in combating these malignancies, which will be useful for future studies.

Effectiveness of TachoSil as Sealant in Lymphatic Leakage of Breast Cancer With Axillary Dissection

Objectives: This study is aimed at evaluating the effectiveness of TachoSil in controlling lymphatic leakage in breast cancer patients undergoing axillary dissection. By examining its ability to reduce postsurgical lymphatic drainage, the study will assess its impact on complications like seroma formation, recovery time, and overall patient outcomes, including quality of life and reduced healthcare costs. Methods: Breast cancer patients treated in the Department of Surgical Oncology at King Abdulaziz Medical City were enrolled to receive either TachoSil or undergo drain placement after axillary dissection. Repeated measures multivariate analysis of variance (MANOVA) was used to observe the difference in lymphatic drainage volume over time considering other covariates, such as age, sex, family history, neoadjuvant chemotherapy (NAC), and stage. Results: The TachoSil group showed significantly lower lymphatic drainage volumes at 24 h (106.5 ± 11.3) than the control group (141.7 ± 13.0) (p < 0.001). There were no significant differences in lymphatic drainage volume at 3 days (p = 0.176) and 7 days (p = 0.091). However, at 10 days, the TachoSil group exhibited significantly lower lymphatic drainage volume (19.9 ± 6.1) than the control group (44.5 ± 9.2) (p < 0.001). Repeated measures MANOVA showed a statistically significant difference in lymphatic drainage over time, with a moderate effect (p < 0.001). Conclusion: The findings suggest that TachoSil sealant effectively reduces early postoperative lymphatic drainage volume and maintains lower drainage rates up to 10 days following axillary dissection in breast cancer patients. The use of TachoSil sealant may have potential benefits in reducing the incidence of complications associated with lymphatic drainage and improving patient outcomes.

The clinicopathological significance of BRI3BP in women with invasive breast cancer

Background

Invasive breast cancer (BC) is a highly life-threatening disease affecting women world-wide. While its early identification may benefit the provision of more effective therapies, several BC-associated factors may influence BC patients' therapeutic outcomes. Therefore, identifying novel prognostic and therapeutic targets for invasive BC can help with accurate prognosis and therapy-related decisions. The BRI3 binding protein (BRI3BP) gene was found to be a principal gene in invasive BC cohorts using artificial neural network (ANN) techniques. Thus, this study aimed to evaluate the clinicopathological significance of BRI3BP at the transcriptomic and proteomic levels in invasive BC.

Methods

Two transcriptomic BC cohorts, the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC; n=1,980) and The Cancer Genome Atlas (TCGA; n=854), were used to evaluate BRI3BP expression at the mRNA level. Formalin-fixed paraffin-embedded (FFPE) tissues from an invasive BC cohort (n=100) were also used to evaluate BRI3BP expression at the protein level via immunohistochemistry. The association between BRI3BP expression, clinicopathological characteristics, and patient outcomes was evaluated.

Results

In both METABRIC and TCGA cohorts, high expression of BRI3BP was significantly associated with aggressive tumor features such as high histological grade, large tumor size, and lymph vascular invasion (LVI) positivity. At the protein level, high BRI3BP expression was associated with high histological grade, hormone receptor negativity, high expression of Ki67, and poor outcome.

Conclusions

This study revealed the prognostic significance of BRI3BP in invasive BC patients. Further functional assessment is needed to confirm the biological role of BRI3BP in BC.

Drug Repurposing for Cancer Treatment: A Comprehensive Review

Cancer ranks among the primary contributors to global mortality. In 2022, the global incidence of new cancer cases reached about 20 million, while the number of cancer-related fatalities reached 9.7 million. In Saudi Arabia, there were 13,399 deaths caused by cancer and 28,113 newly diagnosed cases of cancer. Drug repurposing is a drug discovery strategy that has gained special attention and implementation to enhance the process of drug development due to its time- and money-saving effect. It involves repositioning existing medications to new clinical applications. Cancer treatment is a therapeutic area where drug repurposing has shown the most prominent impact. This review presents a compilation of medications that have been repurposed for the treatment of various types of cancers. It describes the initial therapeutic and pharmacological classes of the repurposed drugs and their new applications and mechanisms of action in cancer treatment. The review reports on drugs from various pharmacological classes that have been successfully repurposed for cancer treatment, including approved ones and those in clinical trials and preclinical development. It stratifies drugs based on their anticancer repurpose as multi-type, type-specific, and mechanism-directed, and according to their pharmacological classes. The review also reflects on the future potential that drug repurposing has in the clinical development of novel anticancer therapies.

Cetuximab-conjugated sodium selenite nanoparticles for doxorubicin targeted delivery against MCF-7 breast cancer cells

Aim: To develop and characterize doxorubicin-loaded sodium selenite nanoparticles (SSNP-DOX) and their surface attachment with cetuximab (mAb-SSNP-DOX).Methods: SSNP-DOX was formulated by gelation and then conjugated with cetuximab to form mAb-SSNP-DOX. Characterization included DLS, SEM, TEM, DSC, Raman spectroscopy and XRD. In vitro, the kinetics of doxorubicin release and cytotoxicity in MCF-7 breast cancer cells were investigated.Results: The zeta potential for SSNP-DOX and mAb-SSNP-DOX was -14.4 ± 10.1 mV and -27.5 ± 7.28 mV, with particle sizes of 181.3 nm and 227.5 nm, respectively. The formulation intensity was 89.7% for SSNP-DOX and 100% for mAb-SSNP-DOX, with PDI values of 0.419 and 0.251, respectively. SEM and TEM showed that mAb-SSNP-DOX was smooth and spherical. The DSC analysis revealed exothermic peaks at 102.44°C for SSNP-DOX and 144.21°C for mAb-SSNP-DOX, along with endothermic peaks at 269.19°C and 241.6°C, respectively. Raman spectroscopy showed a higher intensity for mAb-SSNP-DOX. The XRD study showed different peaks for each formulation. Both followed zero order kinetics for doxorubicin release. Cytotoxicity studies showed significant effects and high apoptosis in MCF-7 cells for both formulations.Conclusion: The mAb-SSNP-DOX showed promising properties, more effective doxorubicin release and higher cytotoxicity against breast cancer cells compared with SSNP-DOX.

Barriers to Breast Cancer Screening in Saudi Arabia: A Systematic Review and Meta-Analysis

Breast cancer is a significant public health concern globally, and early detection through screening programs can improve treatment outcomes and reduce mortality rates. However, the uptake of breast cancer screening among women in Saudi Arabia is hindered by various barriers. This systematic review and meta-analysis aimed to elucidate the barriers to breast cancer screening among women in Saudi Arabia, providing insights into the multifaceted challenges hindering screening uptake and informing tailored interventions and policy recommendations. A comprehensive literature search was conducted across electronic databases and grey literature sources to identify relevant studies on barriers to breast cancer screening in Saudi Arabia. Studies conducted between 2017 and 2023, employing diverse settings and methodologies, were included in the analysis. Data on the prevalence of barriers, family history of breast cancer, and self-reported breast examination practices were extracted and synthesized. A total of 14 studies met the inclusion criteria, encompassing diverse populations and methodologies. The included studies predominantly employed cross-sectional survey designs and targeted various populations across different regions of Saudi Arabia. The barriers to breast cancer screening were investigated, revealing concerns such as fear of discovering cancer, embarrassment due to breast-related tests, fear of pain related to clinical examination, and lack of awareness. Additionally, a substantial proportion of participants reported a family history of breast cancer, indicating a significant risk factor for the disease. Self-reported breast examination practices varied among participants, with disparities in screening behaviors observed. Our review identified fear of diagnosis, embarrassment, and lack of awareness as key barriers to breast cancer screening in Saudi Arabia. Targeted interventions, including education and improved access, are essential to address these challenges and enhance early detection efforts, reducing the burden of breast cancer.

Palbociclib-Induced Vitiligo-Like Lesions: A Report of a Challenging Case

Cyclin-dependent kinase (CDK) 4 and 6 inhibitors, such as palbociclib, have emerged as essential in managing hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) advanced or metastatic breast cancer. While effective, these inhibitors can cause rare dermatologic side effects, including vitiligo-like depigmentation. We report a rare case of a 52-year-old female with HR+, HER2- metastatic breast cancer who developed vitiligo-like depigmentation following palbociclib treatment. The patient presented with asymptomatic depigmented lesions on the lower limbs and abdomen, appearing seven months after starting palbociclib. Examination and investigations confirmed the diagnosis after excluding other potential causes. Despite treatment with topical steroids and calcineurin inhibitors, there was no significant improvement, highlighting the need for more research into effective management strategies for drug-induced vitiligo. This case emphasizes the importance of recognizing rare dermatologic side effects of CDK4/6 inhibitors like palbociclib. Ongoing vigilance, reporting, and research are necessary to improve understanding and management of these side effects, ultimately enhancing patient care in oncology.

Using Inspiratory Muscle Training to Improve Respiratory Strength, Functional Capacity, Fatigue, and Stress in Breast Cancer Patients Undergoing Surgery

Purpose

The main aim of the trial was to assess the effectiveness of inspiratory muscle training on respiratory muscle strength, functional capacity, fatigue, and stress in post-surgical breast cancer survivors.

Methods

Forty-seven females who had undergone unilateral post-mastectomy were randomly assigned to an intervention group (IG; n = 24) and a control group (CG; n = 23). Both groups received aerobic exercise training. In addition, the intervention group received inspiratory muscle training 3 days a week for 8 weeks. Maximum inspiratory and expiratory pressure (Pimax) (Pemex), 6-minute walk test, Handgrip strength by hand-held dynamometer, Fatigue Assessment Scale (FAS), and Perceived Stress Scale pss 10 values were measured before the training and then at the eighth week for both groups.

Results

No differences were detected between the groups in terms of sample and clinical characteristics 8 weeks post-intervention. In favor of the intervention group, a significant difference with medium to high effect size was found in terms of Pimax, Pemax, FAS, PS, and 6MWT (p < 0.05). However, there was no difference in terms of handgrip strength (p-value: 0.072), with a medium effect size (0.070). Regarding within-group comparisons, IG exhibited substantial differences in all outcome measures (p < 0.05) compared to CG, with the exception of PImax and 6MWT.

Conclusion

In post-operative breast cancer survivors, respiratory muscle training combined with aerobic training increases respiratory muscle strength and functional ability while lowering stress and tiredness.

Understanding Breast Cancer Awareness, Perceptions, and Screening Practices Among the Population of Jazan, Saudi Arabia: A Cross-Sectional Study

BACKGROUND

 Breast cancer represents a significant global health challenge, with Saudi Arabia experiencing high incidence rates, particularly among females. Early detection through screening methods such as mammography and breast self-examination offers promise in reducing mortality rates. However, participation in screening remains suboptimal, posing a barrier to effective cancer control. In regions like Jazan, situated in southwestern Saudi Arabia, comprehensive studies on breast cancer awareness and screening practices are lacking.

METHODS

This cross-sectional study conducted in Jazan, Saudi Arabia, aimed to comprehensively assess breast cancer awareness, perceptions, and screening practices among the local population. An online survey platform was utilized to reach individuals aged 18 years or older residing in Jazan. Recruitment efforts utilized social media platforms, community networks, and local organizations to ensure diverse representation across socioeconomic backgrounds, education levels, and geographical locations. A meticulously designed questionnaire captured demographic information, breast cancer awareness, knowledge, health-seeking behaviors, screening practices, and barriers to mammogram screening. Participants provided electronic informed consent before self-administering the questionnaire.

RESULTS

 The study conducted in Jazan, Saudi Arabia, encompassed 533 participants, predominantly young to middle-aged individuals. Most participants were Saudi nationals (97.6%), employed in the government sector (55.7%), and resided in urban areas (61.0%). Awareness of breast cancer was high, with 98.1% having heard of the disease. However, perceptions of age of onset and prevalence varied. While participants showed varied awareness of breast cancer warning signs and risk factors, family history was a commonly agreed-upon risk factor (54.4%). Health-seeking behavior for breast cancer symptoms varied, with nipple changes prompting the most immediate medical attention (36.4%). Although most participants were aware of self-breast examination (84.6%) and mammograms (56.7%), utilization rates were suboptimal, with barriers including fear (79.7%) and embarrassment (71.5%) hindering mammogram screening uptake.

CONCLUSION

 This study provides insights into breast cancer awareness and screening practices among participants in Saudi Arabia. While awareness of breast self-examination and mammography is high, disparities in screening service access persist due to barriers like fear and embarrassment. Addressing these barriers through culturally sensitive interventions and collaborative efforts is crucial for enhancing screening uptake and promoting health equity.

The epidemiological and clinicopathological features of breast cancer in Riyadh, Saudi Arabia

OBJECTIVES

To investigate the epidemiological and clinicopathological features of breast cancer (BC) in Saudi Arabia to improve decisions regarding resource allocation, disease control, and management.

METHODS

We retrieved the records of all patients who presented with histologically proven BC at King Fahad Medical City between 2019 and 2020. The data were analyzed quantitatively, and the results were expressed as percentages and frequencies.

RESULTS

This study comprised 419 patients. The mean age was 50.13 (± 10.96) years. The majority of the patients were obese (56.6%), and approximately a quarter had a history of oral contraceptive pill use, breast biopsy, or an affected family member. Most cases were from the central region (80.1%), followed by the southern provinces (12.7%). Breast lumps were the most common complaint (89%), whereas hypertension and diabetes mellitus were the most common comorbidities. Invasive ductal carcinoma was the most common pathologic type (89.7%). Most patients presented with TNM stages II and III (55.2%), and 27.7% had metastasis. The main therapeutic modalities included radical mastectomy (63.8%), neoadjuvant chemotherapy (60.4%), and adjuvant radiotherapy (82.9%).

CONCLUSION

In Saudi Arabia, a trend of BC incidence migration towards older patients may be ensuing. However, prediction of an advanced and aggressive presentation requires the enhancement of screening programs and standardized protocols for disease management.

An Enhanced LightGBM-Based Breast Cancer Detection Technique Using Mammography Images

Breast cancer (BC) is the leading cause of mortality among women across the world. Earlier screening of BC can significantly reduce the mortality rate and assist the diagnostic process to increase the survival rate. Researchers employ deep learning (DL) techniques to detect BC using mammogram images. However, these techniques are resource-intensive, leading to implementation complexities in real-life environments. The performance of convolutional neural network (CNN) models depends on the quality of mammogram images. Thus, this study aimed to build a model to detect BC using a DL technique. Image preprocessing techniques were used to enhance image quality. The authors developed a CNN model using the EfficientNet B7 model's weights to extract the image features. Multi-class classification of BC images was performed using the LightGBM model. The Optuna algorithm was used to fine-tune LightGBM for image classification. In addition, a quantization-aware training (QAT) strategy was followed to implement the proposed model in a resource-constrained environment. The authors generalized the proposed model using the CBIS-DDSM and CMMD datasets. Additionally, they combined these two datasets to ensure the model's generalizability to diverse images. The experimental findings revealed that the suggested BC detection model produced a promising result. The proposed BC detection model obtained an accuracy of 99.4%, 99.9%, and 97.0%, and Kappa (K) values of 96.9%, 96.9%, and 94.1% in the CBIS-DDSM, CMMD, and combined datasets. The recommended model streamlined the BC detection process in order to achieve an exceptional outcome. It can be deployed in a real-life environment to support physicians in making effective decisions. Graph convolutional networks can be used to improve the performance of the proposed model.

Exploring Integrative Approaches: Insights Into Complementary Medicine Practices Among Breast Cancer Survivors in Saudi Arabia

OBJECTIVES

Complementary and integrative medicine (CAM) is a prevalent approach often used with conventional medical practices The study aims to understand the factors influencing breast cancer (BC) survivors' decisions regarding CAM therapy and the drivers behind their use.

SETTING

This research was conducted at an academic hospital in Saudi Arabia. The study used cross-sectional research with a questionnaire. Participants were enrolled in the study through BC survivors' groups on WhatsApp. Individuals who were actively following up at the clinic were also interviewed. Informed consent was obtained.

RESULTS

The study surveyed 211 BC survivors, aged 34-49 (50.2%), who had undergone surgery (93.4%), hormonal therapy (66.4%), and chemotherapy (87.7%). Less than half (44.5%) had chronic conditions such as diabetes and hypertension. CAM users were 43.6%. The most used CAM modalities were Zamzam water, honey, and water read-upon Quran. A significant motivator for CAM use was to boost the immune system. More than half of patients used less than 100 SAR per month on CAM modalities. Exactly 80.4% of CAM users perceived benefits from CAM use. Predictors of CAM use included higher family monthly income, radiation therapy, and being diagnosed from 1 to 5 years. BC survivors without medical conditions after diagnosis were less likely to use CAM.

CONCLUSION

The study highlights the prevalence, predictive factors, motivations, and perceived benefits of CAM use among BC survivors in Saudi Arabia, emphasizing the need for understanding and integration into cancer care plans and the need for further research on CAM safety and efficacy.

Knowledge of Non-Invasive Biomarkers of Breast Cancer, Risk Factors, and BSE Practices Among Nursing Undergraduates in Farasan Island, KSA

Background of the Study

Mammograms are sometimes met with issues of overdiagnosis and underdiagnosis; therefore, they are less reliable in identifying cancer in women with dense breasts. As a result, it is critical to be aware of other sensitive screening techniques for the early diagnosis of breast cancer.

Aim

The ultimate objective of this study was to assess the knowledge of nursing undergraduates regarding non-invasive biomarkers, such as volatile organic compounds in breath, nipple aspirate fluid, sweat, urine, and tears, for the early detection of breast cancer to help improve patient care, determine the risk factors, and encourage practice of breast self-examination.

Methods

Cross-sectional research was done in the Department of Nursing at Farasan campus using a self-structured questionnaire as the study tool. A total of 260 students willingly participated. The study tool had evaluation questions focused on the non-invasive biomarkers of breast cancer, risk factors, and breast self-examination practices to collect data. The data were subjected to descriptive and inferential statistics. The statistical significance was calculated at P < .05. Data analyses were done using Microsoft Excel (2013).

Results

A significant knowledge gap existed among the study participants about the non-invasive biomarkers of breast cancer. A lesser percentage of students (25%) stated that they do breast self-examination on a monthly basis. The most common reasons for not doing the breast self-examination were "not knowing how to do the breast self-examination" (77.3%), fear of a positive diagnosis (53.9%), thinking that they are not at risk as all were in their teens and hence not required (44.7%), and lack of time (48.7%). Age and frequency of breast self-examination were significantly associated (P < .05) as those few students (22.7%) who were doing breast self-examination practices every 2-4 months belonged to a higher study year. Furthermore, knowledge regarding incidence rates and health care expenditure by the government on breast cancer was also significantly low (P < .05).

Conclusions

Outcomes would help prioritize actions to help future nurses better understand breast cancer, allowing them to extend patient care in the best way possible.

Trends, Capacity Growth, and Current State of Community Pharmacies in Saudi Arabia: Findings and Implications of a 16-Year Retrospective Study

Purpose

Community pharmacies provide access to medicines and pharmaceutical services. Consequently, adequate availability and sufficient workforce capacity must be ensured for effective healthcare delivery. This study assessed the community pharmacy sector in Saudi Arabia, including density, workforce capacity, and evolution from 2007 to 2022.

Methods

This retrospective study measured community pharmacy infrastructure and workforce capacity using international indicators and standardized measures, including community pharmacy and community pharmacist density per 10,000 people and ratio of community pharmacists per pharmacy. Several data sources and platforms were used to collect the data including the Ministry of Health, Saudi General Authority for Statistics, and Ministry of Human Resources and Social Development.

Results

The number of community pharmacies increased by 89.30%, from 5466 in 2007 to 10,347 in 2022, and density increased from 2.25 to 3.22. However, density varied by region, from 3.97 to 1.95. The number of community pharmacists increased by 98.02%, from 10,932 in 2007 to 21,648 in 2022, and community pharmacist density increased from 4.51 to 6.73. However, the ratio of community pharmacists per pharmacy remained unchanged (2.0 in 2007 and 2.1 in 2022). Female pharmacists were first issued licenses to practice in community pharmacies in 2016, and the proportion of female pharmacists to total increased from 0.29% (n=42) in 2016 to 10.95% (n=2370) in 2022. The nationalization policy for community pharmacies was implemented in 2020, and the proportion of Saudi pharmacists increased from 3.08% (n=581) in 2019 to 19.90% (n=4306) in 2022, while proportion of expatriate pharmacists decreased from 96.92% (n=18,292) to 80.10% (n=17,342).

Conclusion

The findings showed that the community pharmacy sector in Saudi Arabia recently experienced substantial growth comparable to high-income countries. However, further improvements are required in some regions to increase community pharmacy density. Moreover, the ratio of pharmacists per pharmacy should be improved to meet the healthcare system needs.

Exploring the geospatial epidemiology of breast cancer in Iran: identifying significant risk factors and spatial patterns for evidence-based prevention strategies

BACKGROUND

Breast Cancer (BC) is a formidable global health challenge, and Iran is no exception, with BC accounting for a significant proportion of women's malignancies. To gain deeper insights into the epidemiological characteristics of BC in Iran, this study employs advanced geospatial techniques and feature selection methods to identify significant risk factors and spatial patterns associated with BC incidence.

METHODS

Using rigorous statistical methods, geospatial data from Iran, including cancer-related, sociodemographic, healthcare infrastructure, environmental, and air quality data at the provincial level, were meticulously analyzed. Age-standardized incidence rates (ASR) are calculated, and different regression models are used to identify significant variables associated with BC incidence. Spatial analysis techniques, including global and local Moran's index, geographically weighted regression, and Emerging hotspot analysis, were utilized to examine geospatial patterns, identify clustering and hotspots, and assess spatiotemporal distribution of BC incidence.

RESULTS

The findings reveal that BC predominantly affects women (98.03%), with higher incidence rates among those aged 50 to 79. Isfahan (ASR = 26.1) and Yazd (ASR = 25.7) exhibit the highest rates. Significant predictors of BC incidence, such as marriage, tertiary education attainment rate, physician-to-population ratio, and PM2.5 air pollution, are identified through regression models.

CONCLUSION

The study's results provide valuable information for the development of evidence-based prevention strategies to reduce the burden of BC in Iran. The findings underscore the importance of early detection, health education campaigns, and targeted interventions in high-risk clusters and adjacent regions. The geospatial insights generated by this study have implications for policy-makers, researchers, and public health practitioners, facilitating the formulation of effective BC prevention strategies tailored to the unique epidemiological patterns in Iran.

Comprehensive Retrospective Analysis of Colorectal Cancer Incidence Patterns in Saudi Arabia

Colorectal cancer (CRC) is the commonest cancer in Saudi males and the third most common in Saudi females. Although CRC represents a major public health challenge, the resources to evaluate its burden are inadequate. This study aims to elucidate the magnitude of CRC incidence trends in the Saudi population by age, gender, and administrative region. Data for multiple incidence measures were analyzed from the Saudi Cancer Registry (SCR) retrospectively from 2001 to 2018. Temporal trends were further analyzed by age group, gender, administrative region, and globally using joinpoint regression analysis. The number of CRC cases climbed by 335.6% and the disease increased by 56.4% to comprise 12.2% of all cancers cases. The age-standardized incidence rate (ASR) increased by 152% overall, and the median age at diagnosis peaked at 60 and 58 years for males and females, respectively. Riyadh and the Eastern Region had the highest ASR for both genders, peaking at 21.8 and 19.2 for males and 17.4 and 16.5 for females per 100 K population. Our prediction model identified growing trends with annual percentage changes (APCs) of 4.59% in males (CI: 3.1-6.1) and 3.91% among females (CI: 2.4-5.5). Males above 75 years had the highest APC (7.9%, CI: 5.3-10.7), whereas the highest APC among females was found in the age group 70-74 (5.4%, CI: 2.8-8). Globally, APC was the highest for both genders compared to selected countries. CRC incidence is increasing alarmingly in Saudi Arabia and is projected to continue. There is a need for better screening strategies, preventative measures, and awareness-building.

Updates on Triple-Negative Breast Cancer in Type 2 Diabetes Mellitus Patients: From Risk Factors to Diagnosis, Biomarkers and Therapy

Triple-negative breast cancer (TNBC) is usually the most malignant and aggressive mammary epithelial tumor characterized by the lack of expression for estrogen receptors and progesterone receptors, and the absence of epidermal growth factor receptor (HER)2 amplification. Corresponding to 15-20% of all breast cancers and well-known by its poor clinical outcome, this negative receptor expression deprives TNBC from targeted therapy and makes its management therapeutically challenging. Type 2 diabetes mellitus (T2DM) is the most common ageing metabolic disorder due to insulin deficiency or resistance resulting in hyperglycemia, hyperinsulinemia, and hyperlipidemia. Due to metabolic and hormonal imbalances, there are many interplays between both chronic disorders leading to increased risk of breast cancer, especially TNBC, diagnosed in T2DM patients. The purpose of this review is to provide up-to-date information related to epidemiology and clinicopathological features, risk factors, diagnosis, biomarkers, and current therapy/clinical trials for TNBC patients with T2DM compared to non-diabetic counterparts. Thus, in-depth investigation of the diabetic complications on TNBC onset, development, and progression and the discovery of biomarkers would improve TNBC management through early diagnosis, tailoring therapy for a better outcome of T2DM patients diagnosed with TNBC.

Insights on the Role of Polyphenols in Combating Cancer Drug Resistance

Chemotherapy resistance is still a serious problem in the treatment of most cancers. Many cellular and molecular mechanisms contribute to both inherent and acquired drug resistance. They include the use of unaffected growth-signaling pathways, changes in the tumor microenvironment, and the active transport of medicines out of the cell. The antioxidant capacity of polyphenols and their potential to inhibit the activation of procarcinogens, cancer cell proliferation, metastasis, and angiogenesis, as well as to promote the inhibition or downregulation of active drug efflux transporters, have been linked to a reduced risk of cancer in epidemiological studies. Polyphenols also have the ability to alter immunological responses and inflammatory cascades, as well as trigger apoptosis in cancer cells. The discovery of the relationship between abnormal growth signaling and metabolic dysfunction in cancer cells highlights the importance of further investigating the effects of dietary polyphenols, including their ability to boost the efficacy of chemotherapy and avoid multidrug resistance (MDR). Here, it is summarized what is known regarding the effectiveness of natural polyphenolic compounds in counteracting the resistance that might develop to cancer drugs as a result of a variety of different mechanisms.

Oral Health-Related Quality of Life in Breast Cancer Patients in the Northern Region of Saudi Arabia

BACKGROUND

Breast cancer is one of the most prevalent diseases, and ignoring dental health care before and after treatment can have severe long-term consequences. Additionally, this may have a negative impact on the patient's general quality of life.

AIM

The aim of the present study was to assess oral health-related quality of life (OHRQoL) among breast cancer patients and identify possible factors associated with the outcome.

METHODOLOGY

In this observational cross-sectional study, 200 women who had received breast cancer therapy and were being followed up at a hospital made up the sample. The study was conducted between January 2021 and July 2022. Information on sociodemographic characteristics, general health, and breast cancer was recorded. The decayed, missing, and filled teeth index was used in clinical examinations to identify caries experience. OHRQoL was evaluated using the Oral Health Impact Profile (OHIP-14) questionnaire. After adjusting for confounding variables, a logistic regression analysis was used to determine the related factors.

RESULTS

The mean OHIP-14 score was 11.48 (SD 1.35). There was a 63.0% prevalence of negative impacts. Age and the time frame from cancer diagnosis were found to be significantly linked with the outcome by binary logistic regression analysis.

CONCLUSIONS

Breast cancer survivors who were ≤55 years old and the time elapsed since diagnosis was less than 36 months had a poor OHRQoL. To lessen the negative impacts of cancer treatment and enhance quality of life, patients with breast cancer need special oral care and should be monitored before, during, and after cancer treatment.

Descriptive Study and Surgical Management Among Infiltrating Lobular Carcinoma Patients Admitted to King Abdulaziz Medical City From 2000 to 2017: A Retrospective Cross-Sectional Study

INTRODUCTION

Invasive lobular carcinoma (ILC) is the second most common histologic type of breast carcinoma. The etiology of ILC is unknown; however, many contributing risk factors have been suggested. Treatment of ILC can be divided into local and systemic. Our objectives were to assess the clinical presentations, risk factors, radiological findings, pathological types, and surgical options for patients with ILC treated at the national guard hospital. Identify the factors associated with metastasis and recurrence.

METHODS

Retrospective cross-sectional descriptive study at a tertiary care center in Riyadh. All adult patients aged 16 years and above, from different nationalities, and both genders, were diagnosed with ILC from 2000 to 2017 and followed up at KAMC. The sampling technique was a non-probability consecutive technique. Among 1066 patients identified, 91 patients were diagnosed with ILC over seventeen years study period.

RESULTS

The median age at the primary diagnosis was 50. On the clinical examination, 63 (71%) cases were found to have palpable masses which was the most suspicious finding. On radiology, the most encountered finding was speculated masses which were seen in 76 (84%). Regarding the pathology, unilateral breast cancer was seen in 82 while bilateral breast cancer was found only in eight. For the biopsy, a core needle biopsy was the most commonly used in 83 (91%) patients. The most documented surgery for ILC patients was a modified radical mastectomy. Metastasis in different organs was identified with the musculoskeletal system being the commonest site. Different significant variables were compared between patients with or without metastasis. Skin changes, post-operative invasion, estrogen, progesterone, and HER2 receptors were significantly associated with metastasis. Patients with metastasis were less likely to have conservative surgery. Regarding the Recurrence and five years survival, out of 62 cases, 10 had recurrence within five years, which was more prevalent in patients who had fine needle aspiration, excisional biopsy, and nulliparous patients.

CONCLUSION

To our knowledge, this is the first study to exclusively describe ILC in Saudi Arabia. The results of this current study are highly important, as these results provide baseline data of ILC in the capital city of Saudi Arabia.