Epidemiology of cancer in Saudi Arabia thru 2010-2019: a systematic review with constrained meta-analysis

Explainable Artificial Intelligence in Quantifying Breast Cancer Factors: Saudi Arabia Context

Breast cancer represents a significant health concern, particularly in Saudi Arabia, where it ranks as the most prevalent cancer type among women. This study focuses on leveraging eXplainable Artificial Intelligence (XAI) techniques to predict benign and malignant breast cancer cases using various clinical and pathological features specific to Saudi Arabian patients. Six distinct models were trained and evaluated based on common performance metrics such as accuracy, precision, recall, F1 score, and AUC-ROC score. To enhance interpretability, Local Interpretable Model-Agnostic Explanations (LIME) and SHapley Additive exPlanations (SHAP) were applied. The analysis identified the Random Forest model as the top performer, achieving an accuracy of 0.72, along with robust precision, recall, F1 score, and AUC-ROC score values. Conversely, the Support Vector Machine model exhibited the poorest performance metrics, indicating its limited predictive capability. Notably, the XAI approaches unveiled variations in the feature importance rankings across models, underscoring the need for further investigation. These findings offer valuable insights into breast cancer diagnosis and machine learning interpretation, aiding healthcare providers in understanding and potentially integrating such technologies into clinical practices.

Breast Cancer Screening Awareness and Associated Factors Among Saudi Females: A Cross-Sectional Study in Jeddah, Saudi Arabia (2024)

BACKGROUND

Breast cancer (BC) represents a major health concern for women globally, including those in Saudi Arabia. Awareness and early detection through screening practices are vital measures in improving BC outcomes.

OBJECTIVE

This study aims to assess the awareness and associated factors of BC screening among Saudi females in Jeddah, Saudi Arabia.

METHODS

A cross-sectional study was conducted in 2024 among Saudi females aged 18 and above, residing in Jeddah. Data was collected using a structured questionnaire that included sections on demographic characteristics, Breast Cancer Awareness Measure (Breast CAM), knowledge, and factors influencing participation in screening programs. The collected data was analyzed using IBM SPSS Statistics.

RESULTS

The study, consisting of 454 participants, found that half of them rarely or never checked their breasts and many were not confident about noticing any changes in their breasts. There was a strong awareness of the Ministry of Health's (MOH) BC screening program, but most were uncertain about the age at which screenings should start and end. Only a small percentage reported receiving an invitation for breast screening and an even smaller percentage have participated in the screening. Significant associations were found between higher awareness of BC signs, a monthly family income of over 20,000, and being medically free (p-value <0.05).

CONCLUSION

The study found a significant gap in BC awareness and screening practices among females in Jeddah, Saudi Arabia. This underlines the importance of targeted health education and awareness programs, as well as accessible and affordable screening services, to improve early detection and outcomes for BC.

Breast Cancer Knowledge and Associated Behaviors in Northern Borders, Saudi Arabia: A Cross-Sectional Study

Background Breast cancer remains a significant public health issue globally and is notably pervasive within the female population, representing a leading cause of concern. It poses a challenge across different age groups and is influenced by diverse risk factors that include genetic predispositions and various elements of lifestyle. Saudi Arabia, mirroring the global situation, has also seen its share of this disease's impact, prompting a closer look at the factors contributing to its prevalence. Educating the public and advocating for lifestyle changes are crucial steps in cancer prevention. With early-stage diagnosis and screening, many lives can potentially be saved. Our research is focused on understanding the level of awareness and preventative practices among women in the Northern Border region of Saudi Arabia. It seeks to explore the influence of familial history on knowledge and perceptions surrounding breast cancer, which could guide future educational and screening programs. Methods This cross-sectional study engaged 643 female participants, aged 18 and above, from the Northern Border region of Saudi Arabia upon their informed consent. Data were compiled via a structured questionnaire encompassing sociodemographic information, breast cancer knowledge, and preventive practices. Results The data disclosed that a significant majority (86%) recognized breast lumps as indicative of breast cancer, with 69.1% cognizant of hereditary risks. Awareness about lactation as a preventative strategy was noted in 76.7% of the participants, followed by 70.6% acknowledging the merits of a healthy diet. The study unveiled no substantial awareness disparity between individuals with or without a family history of the disease. Alarmingly, 80.4% had never sought a breast examination, and a parallel 83.7% had not undergone mammography. Conclusion The study sheds light on the heterogeneity in breast cancer awareness among women in Saudi Arabia's Northern Border region. Although the recognition of lumps and the preventative role of lactation is relatively high, there remains a deficit in comprehending additional symptoms, signs, and risk factors. The conspicuously low rates of breast cancer examinations and mammography underscore an urgent need for enhanced educational initiatives and a strategic push toward bolstering participation in regular cancer screenings.

Imaging Patterns in Breast Cancer for Women Under 40 Years: A Descriptive Cohort Study

BACKGROUND AND AIM

Breast cancer is the most frequently occurring malignant disease in women and remains the leading cause of cancer-related deaths among females worldwide. The aim of this study is to evaluate the imaging findings of breast cancer in women under the age of 40 and analyze their pathological patterns.

METHOD

A retrospective study was conducted from 2013 to 2019, involving 120 patients below 40 years of age with pathologically confirmed primary epithelial breast cancers. The data were collected from the electronic records of a tertiary hospital in Riyadh, Saudi Arabia. Mammograms were performed for 115 patients, ultrasounds were conducted for all patients, and MRI scans were carried out for 47 patients.

RESULTS

All radiological findings and clinical characteristics of the 120 cases were retrieved from our digital-based system. The majority of breast cancer patients (83.4%) were between 30 and 40 years old, and the most common clinical presentation was a mass (45.8%). Out of the 73 patients who underwent genetic tests, 32.9% tested positive for gene mutations. No statistically significant correlation was found between specific age groups and breast composition (P = 0.216), specific mammogram abnormalities such as masses (P = 0.262), or microcalcifications (P = 0.421). Ultrasonography was performed for all patients, with abnormalities detected in only one patient who was diagnosed with Paget's disease of the nipple. Masses, with or without parenchymal changes, were the predominant feature in 88.3% of cases.

CONCLUSION

The imaging findings in breast cancer cases typically involve masses with suspicious features, irregular shape, and spiculated margins on mammograms, and irregular shape with microlobulated or angular margins on ultrasound. MRI features commonly include masses with irregular shape and heterogeneous enhancement. The luminal B subtype was identified as the most prevalent pathological feature, characterized by a high proliferative index (Ki-67%).

Breast Cancer in Young Women: Is It Different? A Single-Center Retrospective Cohort Study

Introduction

Breast cancer (BC) is one of the commonest cancers among women worldwide. Differences regarding tumor biology, presentation, genetics, and molecular subtypes may contribute to the relatively poorer prognosis among younger women. Limited information exists regarding pathologic characteristics and long-term outcomes among this group.

Methods

This retrospective cohort study included 695 BC patients diagnosed over a 10-year period and investigated the clinicopathological characteristics and long-term disease outcomes among patients diagnosed at age less than or equal to 40 years compared with older ones. Cox regression analysis was performed, and Kaplan-Meier curves were generated to assess overall survival (OS).

Results

Compared with the younger patients (⩽40 years) estrogen receptor (ER) and progesterone receptor (PR) expression was mainly positive in older patients (>40 years) (76.2% vs 61.3% and 64.2% vs 49.6%, respectively). The most common molecular subtype in both age groups was luminal B (44.1% in older and 40.3% in younger). A clinical complete remission after neoadjuvant therapy was observed more frequently in older patients (76.7%; N = 442) in comparison with the younger patients (66.4%; N = 79) (P = .018). Recurrence and disease progression were significantly more likely to occur among younger patients accounting for 12.6% and 29.4% of the cases, compared with 6.3% and 18.2% in older patients (P = .016 and P = .006, respectively). The overall mortality was 132 (19%) of 695, with 88% cancer-related deaths. Estrogen receptor and PR expression (P ⩽ .001 and P = .003, respectively), molecular subtype (P = .002), tumor grade (P = .002), and N stage (P = .038) were the variables that were found to be significantly influenced by age. The OS was not statistically different among 2 age groups, but younger patients with luminal A molecular subtype showed significantly poor outcome (P = .019).

Conclusion

Overall survival in women diagnosed with BC at age less than or equal to 40 years is not significantly worse than older patients. However, among patients with luminal A subtype, younger women had relatively poor survival. Further research is needed to understand this age-based disparity in outcomes.

Prevalence of Depression and Anxiety Symptoms Among Patients With Cancer in Najran, Saudi Arabia

BACKGROUND

Depression and anxiety are associated with poor health consequences in patients with cancer, and these mental health issues may affect cancer treatment. They are frequently triggered by stress, and cancer is among the most stressful conditions experienced by a person. Depression and anxiety are related to several sociodemographic variables in patients with cancer. However, only a few studies have examined the prevalence of depression and anxiety symptoms in patients with cancer in Saudi Arabia.

OBJECTIVES

To detect the prevalence of depression and anxiety symptoms among patients with cancer at the Najran Oncology Center in Najran, Saudi Arabia, and determine the risk factors associated with these symptoms.

METHODS

A cross-sectional study was conducted from April 1, 2023, to September 30, 2023, on a convenience sample of patients diagnosed with cancer who were receiving chemotherapy at Najran Oncology Center, King Khalid Hospital, Najran, Saudi Arabia, and who agreed to participate in the study. The Hospital Anxiety and Depression Scale was used. Data on the demographic characteristics of the patients were collected using a self-administered questionnaire. Moreover, medical data were collected from the medical records of the patients.

RESULTS

In total, 92 patients with various cancer diagnoses were recruited in this study. Among them, 51 and 41 were women and men, respectively. Moreover, 81 were married and 11 were either single, widow, or divorced. The mean age of the participants was 51.24 ± 15.15 years. The prevalence rates of depression and anxiety were 42.4% and 23.9%, respectively. There were significant associations between depression and marital status in patients with cancer-associated pain and those with a current history of chemotherapy. Furthermore, the association between anxiety and cancer-associated pain was significant. However, marital status was not associated with anxiety. Age, sex, family history of mental disorders, cancer duration, current cancer stage, and surgical interventions were not associated with the prevalence of depression and anxiety.

CONCLUSIONS

Our findings underline the importance of identifying depression and anxiety in patients with cancer. Marital status, presence of pain, and current chemotherapy history were significantly associated with depression and pain with anxiety.

RECOMMENDATIONS

Further studies with a higher number of patients with cancer should be conducted in Saudi Arabia and other Arab countries. Screening for depression and anxiety symptoms should be a part of the comprehensive evaluation of patients with cancer. Appropriate treatment interventions must be provided to patients with cancer who present with mental disorders.

Understanding the Quality of Life Among Patients With Cancer in Saudi Arabia: Insights From a Cross-Sectional Study

INTRODUCTION

Cancer patients' quality of life (QoL) significantly influences treatment response and mortality rates. Understanding QoL domains among patients with cancer and what affects it can help create interventions that improve QoL and ease patients' experience. This study measures the OoL among patients with cancer and influencing factors.

METHODS

A prospective cross-sectional questionnaire-based study included cancer patients aged >18 currently receiving treatment. The questionnaire collected social and economic data, followed by the validated Arabic version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30). Means and standard deviations for described numeric variables and frequencies and percentages described categorical variables. Analysis of variance, F-tests, and P-values were reported.

RESULTS

Among 182 cancer patients, 60% were female. Younger patients exhibited higher QoL in physical and role functioning (P = .016 and .03) and experienced more significant financial impact (P = .0144). Females reported more adverse effects from cancer symptoms, including fatigue, nausea, vomiting, and pain (36.7% vs 25.5%, P = .005; 20.6% vs 11.5%, P = .0186; 34.7% vs 25.1%, P = .0281). Single patients had superior QoL in physical functioning compared to others (P = .0127). Patients traveling long distances were more likely to face adverse financial consequences (P = .007). Asthmatic patients exhibited lower QoL in physical, role, and cognitive functioning (72.3 vs 37.8, P = .0147; 76.4 vs 22.2, P = .0024; 84.7 vs 44.4, P = .0038) and reported increased dyspnea and appetite loss (16 vs 55.6 and 26.1 vs 66.7, both P < .05).

CONCLUSION

Factors influencing QoL in Saudi cancer patients include age, marital status, gender, hospital distance, and chronic conditions. Thus emphasizing the necessity for personalized care strategies to enhance outcomes and alleviate the overall burden of cancer care.

Frequency of Healthy Control Genotype of VDR Gene Polymorphisms in the Saudi Population of the Ha'il Region: A Comparative Study with Worldwide Population

Genetic polymorphisms in the vitamin D receptor (VDR) may influence the biological effects of vitamin D and increase a person's susceptibility to cancer. Previous studies have shown that different ethnic groups exhibit varying frequencies of the VDR gene variants TaqI, ApaI, FokI, and BsmI. However, the allelic distribution of these VDR polymorphisms in the Saudi population of Ha'il region is not sufficiently explored. In this study, efforts were made to ascertain the frequency of VDR polymorphisms in the Saudi population of Ha'il region, and then comparison was made for VDR polymorphism rates with other populations of the world. Allele and genotype frequencies of VDR TaqI, ApaI, BsmI and FokI gene was determined. The frequency distribution for the variant allele of VDR TaqI, ApaI, BsmI and FokI was found to be 70, 33, 50 and 25%, respectively. A significant frequency distribution was found for VDR-TaqI, ApaI and FokI variants in comparison with other populations of the world. Whereas, almost all of the studies dealing with VDR-FokI failed to show substantial difference while comparing with the data reported from the population of Ha'il region of Saudi Arabia. A significant pattern in the frequency of VDR gene variations have been found in the Saudi population of Ha'il region, which may be attributed to ethnic variance. The understanding of the worldwide distribution of VDR markers could help with high-risk screening of those who are exposed to environmental hazards and people of Ha'il region, who are predispose to cancer.

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.

Prevalence of Preexisting Cardiovascular Diseases in Prostate Cancer Patients and Cardiac Risks of Hormonal Therapy

Background

Cardiovascular diseases (CVDs) are a prominent cause of mortality in prostate cancer patients. However, it has been reported that patients with preexisting CVDs are at greater risk. Literature on the magnitude of this problem in Saudi Arabia is lacking.

Objectives

To measure the prevalence of prostate cancer patients with preexisting CVDs in our population and to elucidate the possible risk factors of new cardiovascular events (CVEs) in patients who received androgen deprivation therapy (ADT).

Materials and Methods

This retrospective study included all patients newly diagnosed with prostate cancer at a tertiary hospital in the Eastern Province of Saudi Arabia from October 2008 to January 2019. The prevalence of preexisting cardiovascular diseases in these patients were determined. In addition, the incidence of new CVEs after initiating ADT was determined along with the risk factors for the same.

Results

The prevalence of preexisting CVD in our cohort was 16%. About 6% of the patients who received ADT had CVEs after a median follow-up of 39 months (IQR: 11-49 months). In the univariate analysis, hyperlipidemia (P = 0.002), stroke (P = 0.001), peripheral vascular disease (P = <0.001), cardiac patients with stents (P = <0.001), and cardiac patients without stent (P = <0.001) were significant risk factors of new CVEs after initiating ADT. However, in the multivariate regression analysis, only history of stroke and CVD (with or without stent) were found to be significant risk factors of new CVEs after initiating ADT (P = 0.01).

Conclusion

About one-fifth of the prostate cancer patients had preexisting CVDs. This study also found that luteinizing hormone-releasing hormone agonist could be a risk factor for new CVEs.

Knowledge and barriers to screening for colorectal cancer among individuals aged 40 years or older visiting primary healthcare clinics in Al-Khobar, Eastern Province

BACKGROUND

Colorectal cancer (CRC) ranks third as the most common cancer in the world and the 4th most common cause of deaths from cancer. In Saudi Arabia, CRC is the most common cancer in males and the third most common in females. Early screening reduces the risk of CRC and death. However, there is a lack of awareness of CRC screening in Saudi Arabia. The objective of this study was to determine the knowledge, practices, and barriers to CRC screening using the Health Belief Model (HBM).

MATERIALS AND METHODS

This study enrolled Saudis aged 40 years or older visiting PHCCs in Al-Khobar. Data were collected using a self-administered questionnaire or a direct interview of the selected participants. Information sought included sociodemographics, past CRC screening, CRC knowledge, and HBM items. Data analysis was done using SPSS; the Chi-squared test and ANOVA were used to determine statistical significance.

RESULTS

A total of 206 of the individuals approached completed the questionnaire. The average age was 51.1 years, and 51% were males. Only 10% reported that a physician had provided information on CRC prevention or discussed/recommended screening for CRC, and 10% had undergone screening for CRC. Seventy-five percent of respondents had heard of CRC, and 74% said that CRC was preventable. Regarding the HBM, no significant difference in the mean scores for perceived susceptibility, perceived severity, self-efficacy, and benefits of CRC screening was found by age groups. The mean score for perceived severity was higher for females than males. About 60% of participants were extremely likely to have a screening test for CRC done on the day if recommended by the doctor.

CONCLUSION

The knowledge and awareness of CRC screening of the targeted sample is inadequate. Individuals with higher perceived susceptibility, severity of CRC, and perceived benefit of the screening tests were more willing to undergo the test. The highest perceived barrier was having no symptoms, and the lowest was "getting a stool test is too much of a hassle." These findings underline the importance of having a national screening program and campaigns to deal with the concerns of people and raise awareness of CRC.

Metastatic papillary thyroid carcinoma in pleural effusion: a case report and review of the literature

INTRODUCTION

Papillary thyroid carcinoma accounts for the most common type of thyroid cancer of well-differentiated type. Papillary thyroid carcinoma is featured by biologically low-grade and less aggressive tumors with a survival rate of 10 years in most of the diagnosed cases. Papillary thyroid carcinoma can be presented with the involvement of cervical lymph nodes in about 50% of the patients, yet distant spread is very uncommon.

CASE PRESENTATION

Herein, we discuss a Saudi male patient in his early 50s with a history of papillary thyroid carcinoma who presented to the emergency department complaining of shortness of breath and a radiological finding of hydrothorax. Cytologic examination together with immune-histochemical staining and molecular studies of pleural effusion aspiration concluded the definitive diagnosis of metastatic papillary thyroid carcinoma in the pleural space.

CONCLUSIONS

Papillary thyroid carcinoma seldom causes metastatic niches in the pleural space; this is a rare clinical presentation, nevertheless, a differential diagnosis of thyroid metastasis needs to be excluded. A definitive diagnosis of metastatic papillary thyroid carcinoma can be made using clinical presentation, cytologic examination, immunohistochemical investigation, and molecular testing. The most common mutation found in papillary thyroid carcinoma cases is the V600E mutation found in the BRAF gene, yet these patients have a relatively low probability of cancer recurrence. Patients with papillary thyroid carcinoma who have the BRAF mutation frequently experience metastases and relapses of the disease after the cancer has progressed aggressively. To help with therapy planning and the introduction of BRAF inhibitors, genetic testing for BRAF mutation may therefore prove to be a useful tool, especially in cases of aggressive subtypes of TC.

Public Awareness of Obesity as a Risk Factor for Cancer in Central Saudi Arabia: Feasibility of ChatGPT as an Educational Intervention

BACKGROUND

While the link between obesity and chronic diseases such as diabetes and cardiovascular disorders is well-documented, there is a growing body of evidence connecting obesity with an increased risk of cancer. However, public awareness of this connection remains limited.

STUDY PURPOSE

To analyze public awareness of overweight/obesity as a risk factor for cancer and analyze public perceptions on the feasibility of ChatGPT, an artificial intelligence-based conversational agent, as an educational intervention tool.

METHODS

A mixed-methods approach including deductive quantitative cross-sectional approach to draw precise conclusions based on empirical evidence on public awareness of the link between obesity and cancer; and inductive qualitative approach to interpret public perceptions on using ChatGPT for creating awareness of obesity, cancer and its risk factors was used in this study. Participants included adult residents in Saudi Arabia. A total of 486 individuals and 21 individuals were included in the survey and semi-structured interviews respectively.

RESULTS

About 65% of the participants are not completely aware of cancer and its risk factors. Significant differences in awareness were observed concerning age groups (p < .0001), socio-economic status (p = .041), and regional distribution (p = .0351). A total of 10 themes were analyzed from the interview data, which included four positive factors (accessibility, personalization, cost-effectiveness, anonymity and privacy, multi-language support) and five negative factors (information inaccuracy, lack of emotional intelligence, dependency and overreliance, data privacy and security, and inability to provide physical support or diagnosis).

CONCLUSION

This study has underscored the potential of leveraging ChatGPT as a valuable public awareness tool for cancer in Saudi Arabia.

Oral Squamous Cell Carcinoma Mimicking Lichenoid Reaction After Implant Placement: A Case Report

The early detection of oral squamous cell carcinoma (OSCC) poses significant challenges, especially if it mimics a benign condition. This report presents a case of a 79-year-old nonsmoker Saudi male patient with an alveolar lesion that initially resembled an implant-induced reaction but upon biopsy revealed dysplastic squamous epithelium indicative of squamous cell carcinoma (SCC). This case highlights that lesion mimicry, the absence of pain, and low cancer awareness can cause diagnostic delays. Treatment options for OSCC include surgery, chemotherapy, and radiotherapy, with surgery being the primary treatment modality. This case emphasizes the need for heightened vigilance among healthcare providers, regular follow-ups, and enhanced cancer awareness to promote early detection and intervention. Recognizing the diverse clinical presentations of OSCC remains essential for effective management and improved patient outcomes, despite the complexities of its etiology and diagnostic challenges.

Patient Satisfaction and Quality of Life After Mastectomy at King Abdulaziz Medical City, Jeddah

Background Overall well-being after surgical intervention is one of the most important aspects of assessing quality of life (QOL), yet it is not well explored in the literature. In this paper, it was necessary to involve the patient's perspective of the nature of their QOL. The burden of being diagnosed with breast cancer is an adaptation to a new lifestyle, having to deal with disease stigma, interpersonal relations problems, and being limited to specific clothing. This can be very challenging for patients. This study aims to identify which patient group, based on their treatment regimen, exhibits higher levels of satisfaction and dissatisfaction compared to other groups. Methods A retrospective, cross-sectional study analyzing the QOL among female breast cancer patients who underwent mastectomy, with or without breast reconstruction, in King Abdulaziz Medical City, Jeddah, between 2009 and 2022. Patients' demographics and phone numbers were obtained from each patient's medical record file in our hospital. Phone call-based interviews were conducted to contact patients to assess their QOL, satisfaction, and regrets after surgery. We excluded patients who do not speak Arabic, are illiterate, have memory disorders, patients who underwent lumpectomy or palliative mastectomy, patients with metastatic stage 4 cancer at the time of diagnosis, patients who are males, and patients who passed away. Results A total of 2,309 patients were screened during the period aforementioned; a total of 346 patients met our inclusion criteria. All of whom are female participants with a current mean age of 52.3 ± 11.5 years. There were 301 (86.99%) participants reported being satisfied, while only 45 (13.01%) participants reported being unsatisfied with surgery outcomes. Although the majority of participants were satisfied after mastectomy, many of them still struggled with psychological, social, and/or emotional challenges. These challenges can have a significant impact on a patient's overall well-being and QOL and must be addressed to provide patients with the highest quality of care possible. Conclusion The study findings highlight the significant impact of mastectomy on patients' lives. It is important to consider individual patient experiences and circumstances when evaluating treatment outcomes and patient satisfaction. We observed that patient satisfaction may vary depending on several factors, including patients' baseline satisfaction. Those factors may be psychological, such as body image issues, low self-esteem, the feeling of losing a body part, and fear of recurrence or metastasis. Other factors may be postoperative-related complications, including lymphedema, redundant skin, chronic pain, and operation scar. Additionally, factors may be socially related, such as loss of confidence, social withdrawal, embarrassment, inability to buy prostheses, being limited to specific clothes, and occupational impact.

Prognostic value of glucose transporter proteins-1 (GLUT1) in breast carcinoma

Several studies have reported increased glucose transporters (GLUT) expression in different cancer types, including breast cancer. The primary purpose of this study is to examine GLUT1 immunoexpression in breast cancer patients in Saudi Arabia and to determine its significance. The study examined the association between GLUT1 immunophenotype and the clinicopathological characteristics in breast cancer. GLUT1 expression was analyzed in retrospectively collected tissue samples (n = 578) from breast cancer patients using immunohistochemistry. A total of 311 (54%) of the cases expressed GLUT1 cytoplasmic immunohistochemical staining. In univariate analysis, we found a significant association between GLUT1 expression and high-grade tumors (p < 0.0001). Positive estrogen and progesterone receptor results predicted lower GLUT1 immunoexpression (p < 0.0001 for both). Vascular invasion showed a significant association with GLUT1 immunoexpression (p = 0.045). Our findings support that GLUT1 immunohistochemistry can be used as a marker to determine the grade and hormonal receptor status in breast cancer.

Visualizing breast cancer research trends in KSA: A bibliometric analysis

Objectives

Bibliometric analysis has emerged as a valuable method for identifying emerging areas in a given research field. Breast carcinoma has maintained a stable rank as the most common cancer affecting women worldwide. This study performed bibliometric profiling to shed light on breast cancer research conducted in KSA over the past two decades and to present the research output in the field of microRNAs (miRNA) in breast cancer in KSA.

Methods

The Web of Science (WoS) and PubMed databases were selected for data retrieval, because of their high coverage, inclusion of high impact journals and easy access to high quality publications. Data retrieval was performed on January 31, 2022. Data were analyzed with Incites from WoS, PubMed and VOSviewer software version 16.1.8.

Results

The most dynamic institutions, authors and active funding bodies were identified, and output on research in the field of miRNA was assessed. Bibliometric parameters including the number of publications and citation index were analyzed. A total of 3831 publications in the field were identified. A steep increase was observed in breast cancer research. The maximum number of publications was observed in 2021. King Saud University and King Faisal Specialist Hospital & Research Centre funded most of the projects and contributed the most publications. Visible progress was seen in research exploring the diagnostic and prognostic roles of mRNAs and their therapeutic potential in breast cancer.

Conclusion

Breast cancer research has attracted substantial attention, as reflected by a notable increase in scientific publications over the past two decades in KSA. The bibliometric parameters revealed crucial information regarding research contributions from various institutions and authors. In the field of miRNAs, notable research investment was observed, but a significant lacuna exists. This study provides a reference that may aid oncologists, researchers and policymakers in planning future research.

The American Thyroid Association risk stratification and long-term outcomes of differentiated thyroid cancer: a 20-year follow-up of patients in Saudi Arabia

Background

Studies have reported differing factors associated with poor outcomes in patients with differentiated thyroid cancer (DTC). We aimed to describe our 20 years of experience in the management of thyroid cancer (TC) and identify predictors of treatment outcomes.

Methods

We conducted a retrospective review of medical records of patients with TC seen in the Thyroid Center at King Saud University Medical City (KSUMC) in Riyadh, Saudi Arabia, between the years 2000 and 2020. Demographic and clinical data including pathological characteristics were collected. The American Thyroid Association (ATA) risk stratification was determined for all patients at the postoperative period as well as the response to therapy at the final follow-up visit.

Results

A total of 674 patients (mean age: 47.21 years) with TC, 571 (84.7%) of which were women, were included. There were 404 (60.0%) patients with ATA low risk, 127 (18.8%) with intermediate risk, and 143 (21.2%) with high-risk histology. Overall, 461 patients (68.4%) had an excellent response to treatment, 65 (9.6%) had an indeterminate response, 83 (12.3%) had a biochemical incomplete response, and 65 (9.6%) had a structural incomplete response. Patients who had an excellent response were mostly ATA low risk (n = 318 of 431, 68.1%), whereas 40 of 65 patients (61.5%) of those with ATA high-risk histology had a structural incomplete response to treatment. There were significantly more women who had an excellent response compared with men. Obesity, lymphovascular invasion, and size of the tumor were significant predictors of worse outcomes to therapy.

Conclusion

Tumor size, lymphovascular invasion, and obesity are strong predictors of a worse response to therapy among patients with TC. Patients with obesity should be carefully followed up regardless of their risk stratification in light of the recent compelling evidence associating obesity with thyroid cancer and its higher risk of a worse disease outcome. ATA risk stratification is well correlated with patient long-term outcomes.

Psychometric Properties and Factorial Analysis of the Arabic McGill-QoL Questionnaire in Breast Cancer

Purpose

This study aimed to assess the psychometric properties of the Arabic McGill Quality of Life Questionnaire-Revised (MQOL-R) in breast cancer survivors.

Patients and Methods

One-hundred-forty breast cancer survivors were recruited and completed the questionnaire. The construct validity was assessed using confirmatory factor analysis (CFA). MQOL-R scores were correlated with Global Health Status/QoL and functional subscales of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) for convergent validity. Reliability was estimated using Cronbach's alpha and intraclass correlation coefficients (ICC).

Results

CFA reproduced a four-factor model (ie, physical, psychological, existential, and social) with good fit indices (comparative fitting index = 0.980; root mean square error of approximation = 0.091), with all items significantly loading on their respective subscales. The total MQOL-R scores were correlated with the global health status/QoL and functional subscales of the EORTC QLQ-C30 (r = -0.172, P < 0.01). Known-group validity was proven by different MQOL-R scores according to functional status (50.62 ± 6.35 vs 45.98 ± 7.19, P < 0.01). Reliability was supported by good internal consistency and high test-retest correlation coefficients for the Arabic MQOL-R and its subscales (ICC range, 0.83-0.95).

Conclusion

The Arabic MQOL-R demonstrated adequate construct validity, factor structure, excellent test-retest reliability, and good internal consistency. This tool is valuable for assessing the quality of life in research and physical therapy rehabilitation settings among Arabic-speaking breast cancer survivors.

Cancer Stigma Among 800 Saudi Citizens: A Cross-Sectional Study and Literature Review

INTRODUCTION

Cancer-related stigmatization is a noteworthy phenomenon, yet it has not received sufficient attention in public health studies. Despite recent advancements in treatment and improvements in survival, the burden of stigma remains a challenging concern for individuals diagnosed with cancer.

AIM

This study aims to assess the presence of cancer stigma in the Saudi Arabian population by using the Cancer Stigma Scale (CASS).

METHODS

A cross-sectional study was conducted among the general population of Saudi Arabia. Data collection was facilitated through a self-administered online questionnaire, incorporating socio-demographic variables such as age, gender, and regional residence and employing the CASS instrument to gauge the prevalent attitudes and stigmas related to cancer.

RESULTS

Out of the 874 participants, a majority of 87.1% were female, with 60.2% aged between 20 and 39 years. Notably, 59% reported having a close friend or family member diagnosed with cancer. The average CASS score stood at 1.59 (SD 0.39) on a 5-point scale, with an overwhelming 97.1% registering scores under 2.5, suggesting a generally low stigma perception. In dissecting the CASS components, 'severity' recorded the highest mean score (mean: 2.23), followed by 'awkwardness' (mean: 1.86) and 'financial discrimination' (mean: 1.71). 'avoidance' registered the lowest mean score at 1.11. Notably, a trend of increasing stigma was observed with advancing age, and male respondents indicated a marginally higher propensity towards stigmatizing attitudes.

CONCLUSION

In Saudi Arabia, cancer-related stigma is generally low. However, 'severity' is the most prominent stigma aspect, with 'avoidance' being the least. Older individuals and males exhibit slightly higher stigmatizing attitudes. These insights highlight the need for targeted public health efforts to address remaining stigmatization, especially based on age and gender.

Unlocking the Anticancer Potential of Frankincense Essential Oils (FEOs) Through Nanotechnology: A Review

Cancer is a group of heterogeneous diseases that occur when cells in the body proliferate and divide uncontrollably. As the current treatment modalities have pros and cons, the discovery of new chemotherapeutic agents with the least side effects is one of the most investigated research areas. In this context, plant-based natural products are a rich source of drugs and have served humanity for ages. Frankincense essential oils (FEOs) are among the most promising plant-based oils in Gulf countries. In addition to their high cultural value, FEOs are also famous for their engaging biological activities, including anti-cancerous. However, the practical application of FEOs is often hindered/by their low water solubility, limited bioavailability, high volatility, and sensitivity toward heat, humidity, light, or oxygen. Thus, a significant demand for technological advancement would improve their ability to target particular cells and tissues. Nanotechnology emerged as an exciting approach in this context. Through suitable nano-formulation (functionalization or encapsulation into a nanostructure), issues arising due to solubility, targeting capability, and delivery can be controlled.

Expression pattern, prognostic value and potential microRNA silencing of FZD8 in breast cancer

Breast cancer (BC) is one of the most widespread types of cancer affecting females, and therefore, early diagnosis is critical. BC is a complex heterogeneous disease affected by several key pathways. Among these, WNT proteins and their frizzled receptors (FZD) have been demonstrated to be crucial in regulating a number of cellular and molecular events in BC tumorigenesis. The role of the WNT receptor, FZD8, in BC has received minimal attention; for that reason, the present study examined the prognostic value of its protein expression pattern in a BC cohort. FZD8 cytoplasmic expression pattern analysis revealed that ~38% of the primary samples presented with a high expression profile, whereas ~63% of the samples had a low expression profile. Overall, ~46% of the malignant tissues in the lymph node-positive samples exhibited an increased FZD8 cytoplasmic expression, whereas 54% exhibited low expression levels. An increased expression of FZD8 was associated with several clinicopathological characteristics of the patients, including a low survival rate, tumor vascular invasion, tumor size and grade, and molecular subtypes. Affymetrix microarray triple-negative BC datasets were analyzed and compared with healthy breast tissues in order to predict the potential interfering microRNAs (miRNAs) in the WNT/FZD8 signaling pathway. A total of 29 miRNAs with the potential to interact with the WNT/FZD8 signaling pathway were identified, eight of which exhibited a significant prediction score. The target genes for each predicted miRNA were identified. On the whole, the findings of the present study suggest that FZD8 is a potential prognostic marker for BC, shedding some light onto the silencing mechanisms involved in the complex BC signaling.

Preoperative Thyroid-Stimulating Hormone Levels and Risk of Thyroid Cancer in Post-thyroidectomy Patients for Thyroid Nodules: A Study From a Tertiary Hospital in Western Saudi Arabia

Background Although serum thyroid-stimulating hormone (TSH) is one of the basic investigations to assess thyroid nodules, its role in thyroid oncogenesis remains unclear. Previous literature has conflicting findings regarding TSH levels and the prediction of malignancy. This study aims to investigate the association between TSH levels and the risk of malignancy and advanced staging in patients who underwent thyroidectomy for nodular thyroid disease. Additionally, it aims to assess if higher TSH correlates with malignancy in Bethesda staging III, IV, and V. Methodology This retrospective cohort study was conducted among participants who underwent near-total/total thyroidectomy or hemithyroidectomy at King Abdulaziz Medical City between 2016 and 2021. Results A total of 378 cases were included, and 50.3% of the cases had malignant nodules in the surgical histopathology findings. The median TSH levels were higher in malignant nodules compared to benign ones (1.64 mIU/L versus 1.49 mIU/L; p < 0.001). Additionally, higher TSH levels were not associated with advanced staging or malignancy in patients with Bethesda stage III-V. Conclusions Higher TSH levels are associated with an increased risk of malignancy in patients with nodular thyroid disease. Using TSH levels as an adjunctive tool for identifying high-risk patients with thyroid nodules would aid in management planning.

Knowledge and Awareness of Leukemia Among the Population of Eastern Province, Saudi Arabia

INTRODUCTION

Cancer is characterized by the rapid proliferation of abnormal cells that exceed their normal boundaries, infiltrating other body parts and leading to metastasis, a distinctive feature setting it apart from other diseases. Metastasis is the primary cause of cancer-related deaths, with nearly 10 million global fatalities, making it the leading cause of mortality. Leukemia, a type of cancer originating in the bone marrow or blood cells, presents significant complications and is associated with various risk factors, including a positive family history, smoking, and obesity. This study aims to evaluate the general knowledge of leukemia and its associated risks among the inhabitants of the Eastern Province, Saudi Arabia.

METHODS

A cross-sectional survey was conducted targeting all residents of the Eastern Province, Saudi Arabia, who were Saudi nationals, spanning both genders and aged 15 to 59 years. The questionnaire was distributed electronically through social networking applications, and responses were collected via Google Forms (Google, Mountain View, CA).

RESULTS

The study findings indicated that the most frequently identified risk factors for leukemia included blood disorders, genetic disorders, and extensive exposure to radiation and chemicals. The most prevalent leukemia symptoms were bruising and bleeding, followed by vomiting, nausea, and headache. The most commonly reported side effects of leukemia treatment were dizziness, followed by anorexia and exhaustion.

CONCLUSION

The study revealed a lack of awareness about leukemia and its associated risks among participants. This underscores the need for continued educational initiatives and awareness campaigns to improve leukemia knowledge and early detection rates, potentially leading to better outcomes for affected individuals. Future research should aim to overcome study limitations and provide a broader perspective on leukemia awareness throughout Saudi Arabia.

Characterization and verification of MMP family members as potential biomarkers in kidney clear cell renal carcinoma

Renal cell carcinoma can arise from lesions in the renal epithelium. This particular type of cancer is prevalent in the realm of renal cancers and is associated with an unfavorable prognosis. Among these cases, over 70% are classified as kidney renal clear cell carcinoma (KIRC). Since the underlying causes of KIRC haven't been fully understood, there is an urgent need for deeper investigation into its pathogenesis. Various tools, software, and molecular analysis was used, including Search Tool for the Retrieval of Interacting Genes/Proteins (STRING), Cytoscape, University of ALabama at Birmingham CANcer data analysis Portal (UALCAN), muTarget, Gene Expression Profiling Interactive Analysis (GEPIA), OncoDB, Human Protein Atlas (HPA), cBioPortal, Kaplan-Meier (KM) plotter, Gene Set Enrichment Analysis (GSEA), Tumor IMmune Estimation Resource (TIMER), Encyclopedia of RNA Interactomes (ENCORI), DrugBank, Encyclopedia of RNA Interactomes (RT-qPCR), targeted bisulfide sequencing (bisulfide-seq), and receiver operating curve (ROC) to matrix metallopeptidase (MMP) gene family constituents, with the precise objective of identifying a small set of hub genes. These hub genes hold the potential to be harnessed as molecular biomarkers for KIRC. By performing STRING and CytoHubba analyses of the 24 MMP gene family members, MMP2 (matrix metallopeptidase 2), MMP9 (matrix metallopeptidase 9), MMP14 (matrix metallopeptidase 14), and MMP16 (matrix metallopeptidase 16) were recognized as hub genes having highest degree scores. After conducting an in-depth expression analysis of MMP2, MMP9, MMP14, and MMP16 using various The Cancer Genome Atlas (TCGA) databases and RT-qPCR techniques, these displayed a significant increase in expression at both the mRNA and protein levels within KIRC samples when compared to control samples. The impact of the over expression of MMP2, MMP9, MMP14, and MMP16 also left a distinct mark on the worst overall survival (OS) rates of KIRC patients. Furthermore, a targeted bisulfide-seq investigation unveiled a correlation between promoter hypomethylation patterns and the up-regulation of these key genes in KIRC patients. Additionally, hub genes were involved in various diverse oncogenic pathways. In conclusion, four MMP gene family members, including MMP2, MMP9, MMP14, and MMP16 may serve as therapeutic target and molecular biomarker in KIRC.

Molecular pathology of colorectal cancer: The Saudi situation in perspective

Colorectal cancer (CRC) is one of the most common cancers worldwide, and one of the most common causes of cancer deaths. In recent times, significant advancements have been made in elucidating the molecular alterations of the disease, and the results have been an improved understanding of CRC biology, as well as the discovery of biomarkers of diagnostic, prognostic, and therapeutic significance. In this review, an evaluation is carried out of the molecular pathology research of CRC emanating from Saudi Arabia. The verdict is that the data on the molecular alterations in CRC from Saudi patients is at best modest. This dearth of molecular pathology data is aptly reflected in the paucity of molecular markers recommended for testing by the Saudi National Cancer Centre guidelines for CRC management. Large scale multi-institutional and multiregional translational studies are required to generate molecular data that would inform diagnostic, prognostic, and risk-stratification guidelines for Saudi CRC patients.

Analyzing Cardiovascular Characteristics of Patients Initially Diagnosed with Breast Cancer in Saudi Arabia

Introduction Cancer is a condition where abnormal cells proliferate uncontrollably, leading to metastasis, which can be related to death. Breast cancer is the most prevalent type among women worldwide. Early detection with screening mammography has contributed to the decline in breast cancer incidence and mortality. Breast cancer patients are more likely to develop cardiovascular disease, with elderly patients dying from complications. Understanding the patients' cardiovascular status prior to treatment is essential. The study's objective was to evaluate the cardiovascular characteristics of women with breast cancer at diagnosis within the designated time frame of one year. Methodology This was a retrospective study that focused on patients in Taif City, Saudi Arabia, who were initially diagnosed with primary breast cancer over a span of one year. The inclusion criteria encompassed eligible patients, while those not meeting the criteria were excluded. Data extraction from patients' records was conducted, and the analysis was executed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States). Results This study analyzed the cardiovascular attributes of breast cancer patients, focusing on 136 female cases. The study found significant patterns concerning cardiovascular risk factors in breast cancer patients, categorized by menopausal status. Premenopausal female cases had a mean age of 43.09 ± 8.31 years, while postmenopausal patients had an average age of 58.07 ± 11.70 years. Postmenopausal patients had a higher prevalence of overweight/obesity, irregular menstrual cycles, type II diabetes, hypertension, and hyperlipidemia compared to their premenopausal counterparts. No significant differences were found between the two groups regarding low-density lipoprotein (LDL) cholesterol levels, axillary lymph node metastasis, or distant metastasis. This study emphasized the importance of regular check-ups for menopausal women to detect potential health complications early. Conclusion In summary, breast cancer is a global health concern, and understanding its impact on the cardiovascular system is crucial for comprehensive patient care. A study in Saudi Arabia found associations between cardiovascular risk factors and menopausal status in breast cancer patients. Postmenopausal patients had more prevalent risk factors, emphasizing the need for proactive assessment and management. Age-appropriate screenings and interventions are essential. Integrated healthcare approaches should consider the interplay between breast cancer and cardiovascular health, with medical professionals vigilant in evaluating and addressing risk factors to mitigate complications and optimize long-term outcomes.

Therapeutic benefits of prophetic medicine remedies in treating hematological diseases (A review article)

Hematological disorders are common medical ailments constituting an important cause of morbidity and mortality worldwide, which may be managed efficiently using different prophetic medicine remedies as adjuvants to current therapeutics. Prophetic medicine includes the body of knowledge about medicine that has been derived from the deeds, customs (sunnah), ahadith (sayings), actions, and agreements of Prophet Muhammad, peace be upon him. This review article aims at exploring the magnitude of therapeutic benefits of prophetic medicine remedies as adjuvant treatments to many different types of hematological disorders. Herein, we reviewed many published research studies throughout the literature to delineate the potential therapeutic benefits of prophetic remedies on hematological disorders. Several types of hematological disorders may benefit from prophetic medicine remedies that are rich in natural antioxidants that combat oxidative stress-induced harm e.g. nigella sativa, oral honey, camel milk and urine, Ajwa date fruits, olive oil, Zamzam water and figs. Many prophetic medicine remedies were reported to decrease the hematological cytotoxicity effects induced by different chemicals and are beneficial in treating anemias e.g. iron deficiency anemia, sickle cell anemia, thalassemia, coagulopathies and hematological malignancies as leukemia and myeloma. These remedies treat or alleviate the different hematological disorders using different mechanisms e.g. modulating the immune function, treating deficiencies of different substances, protecting against toxins-induced cytotoxicity, decreasing platelets aggregation, suppressing clotting factors activation, exerting antineoplastic effects (enhancing cancer cells cytotoxicity) and inhibiting angiogenesis. Prophetic medicine remedies exert clinically significant therapeutic benefits for treating COVID-19 pandemic, anemia, thrombosis, thalassemia and blood cancers without inducing toxicity or side effects.

Knowledge of Cancer Genetics and the Importance of Genetic Testing: A Public Health Study

Background Cancer represents a global concern as the second-leading cause of mortality worldwide. It is defined as a genetic disease that develops as a result of several genetic abnormalities and changes to specific genes. Thus, early preventive measures and clinical interventions can be implemented with impressive results using genetic testing and screening for hereditary susceptibility. Objectives The present study assessed the knowledge of cancer genetics and of the importance of genetic testing among the general population in Saudi Arabia's Makkah Province. Methods  A descriptive cross-sectional study was conducted among the general population in Makkah Province. The data were collected through an online questionnaire from November 2022 through December 2022. Results The study recruited 1,329 participants, the largest group of whom were 21-30 years old (n=524, 39.4%). About 60.1% of the respondents were female. The findings reveal that 52.52% of the respondents had poor knowledge, while only 4.82% exhibited good knowledge. Conclusion Approximately half the total participants possessed an inadequate understanding of cancer genetics and the importance of genetic testing. This indicates the need for awareness campaigns and programs to improve the general population's understanding of the genetic predisposition to cancer.

A Cross-Sectional Evaluation of Knowledge About Breast Cancer and Perceived Barriers to the Uptake of Mammogram Screening Among Northern Saudi Women: A Population-Based Study

Background

Mammogram screening (MS) is the gold-standard method for early detection of breast cancer (BC), and its use has been proven to minimize BC-related deaths and reduce treatment costs. However, recent epidemiological surveys have reported that rates of mammogram uptake by the Saudi female population are low. Here, we assessed the knowledge of BC and perceived barriers to MS uptake among pre-eligible northern Saudi women.

Participants and Methods

We administered a standard and validated Arabic questionnaire to 400 women aged 40-69 years. SPSS version 21.0 (IBM Corporation, Armonk, NY, USA) was used for data analysis. We applied logistic regression analysis to find the factors associated with participants' knowledge of BC and MS. Spearman correlation test was applied to find the correlation between knowledge and barrier scores.

Results

The study participants reported that smoking habits (61.3%) and unhealthy food habits (57.8%) were the most common risk factors for BC. Of the studied participants, 56.3% had low or medium degrees of knowledge about BC risk factors and MS. The degree of knowledge was significantly associated with education level (adjusted odds ratio [aOR], 2.35; 95% confidence interval [CI]. = 1.61-3.13; P = 0.008) and a family history of BC (aOR, 3.66; 95% CI, 1.94-5.49; P < 0.001). Fear of a BC diagnosis (50.8%) and concerns regarding test procedures were the most common barriers to MS uptake. We also found a negative correlation between participants' knowledge and perceived barriers to MS (rho = -0.389, P < 0.001).

Conclusion

We recommend that concerned authorities offer women multiple health education sessions covering BC risk factors and the necessity for pre-eligible women to undergo MS spaced at regular intervals at different facilities. Furthermore, a multicentric mixed-methods survey is warranted to find the qualitative aspects of barriers to MS.

Clinical and Therapeutic Profile of Non-Hodgkin's Lymphoma: A Retrospective Study From a Najran Oncology Center

Background Non-Hodgkin lymphomas (NHL) represent a group of lymphoproliferative disorders, with a limited understanding of their clinical spectrum, primary extranodal variety, histopathology, and immunohistochemistry, particularly in developing countries. The objective of this study was to evaluate the clinicopathological characteristics and survival rates of NHL patients treated at King Khaled Hospital in Najran City, Saudi Arabia. Method In this retrospective chart review of NHL cases that received chemotherapy at the Oncology Center of King Khaled Hospital in Najran City, Saudi Arabia, between 2014 and 2021, we evaluated the clinicopathological features, survival rate, and associated factors. Using standardized data collection sheets, we extracted information on patients' age, gender, tumor type, stage, baseline laboratory evaluations, disease status, cancer treatment, and survival from electronic medical records. Univariate analysis was employed to identify factors associated with mortality and relapse. Results We included 43 NHL patients with a mean age of 59.23 ± 20.17 years, with a higher frequency among females (65.1%). B symptoms were present in 32 (74.4%) cases. The common primary site was peripheral lymph nodes (79.1%). Diffuse large B-cell lymphoma was the most common morphologic type (67.4%), and 46.5% of the patients had advanced-stage disease (stages III-IV). All patients received the first line of treatment, with the most common chemotherapy used being the RCHOP regimen (67.4%). Additionally, radiotherapy was performed in seven (16.3%) cases. Relapse occurred in eight (18.6%) cases with a median period of 47.5 months (Min: 20 - Max: 77 months). The mean overall survival time was 43.25 ± 2.98 months (range 12-168 months), and the one, three, and five-year survival rates were 91%, 58%, and 38%, respectively and the mortality rate was 32.6%. Univariate analysis showed that Burkitt lymphoma had (odds ratio (OR): 11.87; 95% confidence interval (CI): 1.58-89.09, p=0.016) and elevated lactate dehydrogenase (LDH) ((OR: 1.26; 95% CI: 0.35-4.54), p=0.014) were associated with mortality. Moreover, advanced age and the total number of first chemotherapy cycles were associated with relapse (p< 0.05). Conclusion The study highlights the variability of NHL cases, with a significant proportion presenting with advanced-stage disease and in middle age. The results suggest poor survival rates for patients with Burkitt lymphoma subtypes and elevated LDH levels.

Toxicity of Nab-Paclitaxel Compared to Paclitaxel in a Tertiary Hospital in Jeddah, Saudi Arabia: A Retrospective Cohort Study

Background Nanoparticle albumin-bound paclitaxel has been developed to avoid the toxicities associated with Cremophor-solved paclitaxel. Although many studies confirm this hypothesis, there is recent evidence showing no difference between paclitaxel and nab-paclitaxel in their efficacy and safety profile. This study further assesses the toxicity of both paclitaxel and nab-paclitaxel in adult patients with breast and pancreatic cancer in a tertiary hospital in Jeddah, Saudi Arabia. These toxicities include neutropenia, anaemia, and effects on kidney and liver functions. Methods The study is a retrospective cohort study done at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from January 2018 to December 2021, conducted on patients diagnosed with breast or pancreatic cancer treated with paclitaxel or nab-paclitaxel. Results There is a statistically significant difference between the two groups in developing anaemia, renal, and liver toxicity (P<0.05). On the other hand, there are no statistically significant differences in developing neutropenia between the two groups (P=0.084). Conclusions Nab-paclitaxel might not be better than paclitaxel in reducing the risk of neutropenia, anaemia, and liver toxicity, as predicted. Nevertheless, both medications require that the patient's renal functions be monitored during the treatment. Further studies conducted in multiple oncology centres with a larger sample are needed to evaluate the toxicity of paclitaxel and nab-paclitaxel in adult patients with breast and pancreatic cancer.

Antitumor Activity of Ligustilide Against Ehrlich Solid Carcinoma in Rats via Inhibition of Proliferation and Activation of Autophagy

Background Cancer is the second-leading cause of death worldwide. According to a 2018 WHO report, 9.6 million deaths occurred globally due to cancer. Ehrlich carcinoma is characterized by rapid proliferation and a short survival time. Ligustilide is a phthalide derivative and is one of the main compounds in Danggui essential oil and Rhizoma Chuanxiong. It has many protective effects, such as anticancer, anti-inflammatory, antioxidant, and neuroprotective effects. Aims We conducted this study to investigate the antitumor activity of ligustilide against Ehrlich solid carcinoma (ESC) in rats by affecting beclin 1, mammalian target of rapamycin (mTOR), B-cell lymphoma 2 (BCL2), and 5' AMP-activated protein kinase (AMPK). Materials and methods Twenty rats were intramuscularly implanted in the thigh of the left hind limb with a 200-µL tumor cell suspension in PBS containing 2 × 10⁶ cells. After eight days of inoculation, 10 rats out of the 20 were treated with oral 20 mg/kg ligustilide daily. At the end of the experiment, samples of muscles with ESC were separated. Sections prepared from the muscle samples with ESC were immunohistochemically stained with anti-Ki67 antibodies. Another part of the muscle samples with ESC was used to assess gene expression and protein levels of beclin 1, mTOR, BCL2, and AMPK. Results  Treatment of carcinoma rats with ligustilide elevated the mean survival time and reduced tumor volume and weight. Moreover, examination of tumor tissue stained with hematoxylin/eosin showed an infiltrative, highly cell-dense mass supported by a small to moderate amount of fibrovascular stroma and intersected with multifocal myofibril necrosis. Treatment with ligustilide ameliorated all these effects in the carcinoma group without affecting the control group. Finally, treatment with ligustilide significantly decreased the expression of beclin 1, mTOR, and AMPK associated with elevated expression of BCL2. Conclusions  Our study aimed to explore the potential chemotherapeutic activity of ligustilide against ESC. We found that ligustilide effectively reduced tumor size and weight, indicating its antineoplastic activity against ESC. We further investigated that ligustilide inhibits cell proliferation by suppressing Ki67 and mTOR and activates autophagy through beclin 1 activation. Moreover, ligustilide inhibits apoptosis by upregulating BCL2. Finally, ligustilide reduced the expression of AMPK, preventing its ability to promote tumor cell growth.

Knowledge and Awareness About Gastric Cancer Among the General Population in Al-Baha City, Saudi Arabia

Background Gastric cancer is a significant health concern worldwide, and its incidence varies across different populations. This study aimed to assess the level of knowledge and awareness of gastric cancer among the general population in Al-Baha City, Saudi Arabia.  Methodology This is a cross-sectional study that was conducted among the residents of Al-Baha city older than 18 years. The study was conducted based on a questionnaire that has been developed by a previous study. Data were initially recorded in an Excel sheet before being exported to the SPSS program, version 25 for data analysis. Results The survey included 426 respondents from Al-Baha city, Saudi Arabia, with 56.8% being females and the majority being in the age groups (21-30 years). Alcohol consumption (mean=4.5, SD= 0.77), smoking cigarettes or Shisha (mean= 4.38, SD=0.852), family history of gastric cancer (mean= 4, SD=1.008), a past medical history of gastric cancer (mean= 3.99, SD=0.911), stomach ulcer (mean=3.76, SD=0.898), and consumption of smoked food (mean= 3.69, SD=0.956) are the most widely recognized risk factors. The most highly recognized symptoms are gastrointestinal bleeding (mean= 4.03, SD=0.875), abdominal lump (mean= 3.94, SD=0.926), weight loss (mean= 3.93, SD=0.963), recurrent nausea and vomiting (mean=3.76, SD=0.956), and abdominal pain (mean= 3.57, SD=0.995). The study also identified several subgroups of the population that may benefit from targeted educational programs, including individuals in the age group of 41-50 years and those in non-medical occupations. Conclusion The study found that participants had a moderate level of knowledge about the risk factors and symptoms of gastric cancer, with significant variability among different subgroups of the population. Further research is needed to investigate the prevalence and risk factors of gastric cancer in Saudi Arabia and other similar populations, to develop effective prevention and management strategies for this disease.

Knowledge and Perception of Physicians of Different Specialties in Saudi Arabia Toward Helicobacter pylori

Background

Helicobacter pylori (H. pylori) is a key pathogen causing several gastrointestinal diseases. Fortunately, H. pylori infection is treatable, which can lower its comorbidities. However, data assessing physicians' awareness of H. pylori is lacking in Saudi Arabia.

Objective

To assess the knowledge and awareness of physicians of different specialties who practice in Saudi Arabia about H. pylori infection.

Methods

This is a cross-sectional study conducted between May and September 2022 on physicians across all regions in Saudi Arabia using a validated online questionnaire covering their knowledge and awareness of H. pylori infection. An independent t-test, one-way ANOVA, and Games-Howell as a post hoc test were used to analyze the data. A General Linear Model was also employed to determine significant predictors among the variables reliant on H. pylori awareness.

Results

The results showed that the mean awareness score of 474 physicians was 76.99± 6.9, indicating that participants had sufficient knowledge about H. pylori infection. In general, the internal medicine specialists (28.3%) had better awareness of H. pylori infection than the other specialties. Moreover, the university hospital sector performed the best, scoring 80.68±13.3, and the southern region had the highest-ranked physicians with a score of 81.56 ±13.7 in terms of H. pylori awareness. Furthermore, the general linear model revealed a statistical significance (p<0.05) for the following demographic aspects concerning H. pylori awareness: the physicians' age group of 30-39 years, duration of experience of 11-15 years, the hospital sectors of Nation Guards (NGH) and Security Forces (SFH), and the southern and central regions of practice in Saudi Arabia.

Conclusion

Physicians in Saudi Arabia have relatively sufficient awareness of H. pylori; however, they are highly influenced by age, years of experience, the hospital sector involved, and the region where the physicians practice.

Awareness of the Link Between the Consumption of Ultra-Processed Food and Colorectal Cancer Risk in Saudi Arabia

Introduction Cancer is a group of diseases with uncontrollable growth of abnormal cells. Colorectal cancer (CRC) is one of the most common cancers. Increased intake of animal-source foods, sedentary lifestyle, decreased physical activity, and increased prevalence of excess body weight are independently associated with CRC risk. Additional risk factors include heavy alcohol consumption, cigarette smoking, and consumption of red or processed meat. Ultra-processed food (UPF) is made utilizing multiple components and a number of procedures. Soft drinks and salty or sugary snacks typically contain a lot of added sugar, fats, and processed carbohydrates, which negatively affect the balance of the gut bacteria, nutrients, and bioactive substances that are necessary for the prevention of CRC. The aim of this study is to assess the awareness of the general population in Saudi Arabia toward the relationship between UPF and CRC. Methods A cross-sectional questionnaire-based study was conducted in Saudi Arabia between June and December, 2022. Result The study involved 802 participants, of which 84% consumed UPF and 71% were aware of the link between UPF and CRC. Only 18.3% were familiar with the particular type of UPF and only 29.4% knew how to prepare them. The prevalence of participants who were aware of the link between UPF and CRC was significantly more among the older age groups, people living in the Eastern Region, and those who knew how to manufacture UPF, while the prevalence of awareness was significantly less among those who regularly consumed UPF. Conclusion The study showed that a significant portion of subjects regularly ate UPF, and only a few were aware of its link to CRC. This highlights the need for greater awareness of the fundamentals of UPF and its impact on health. Governmental organizations should develop a strategy to raise public awareness of excessive UPF use.

Determinants of quality of life of cancer patients at a tertiary care medical city in Riyadh, Saudi Arabia

BACKGROUND

Incidences of cancer are increasing at an unprecedented rate in Saudi Arabia, making it a major public health concern. Cancer patients are faced with physical, psychological, social, and economic challenges, all of which can impact quality of life (QoL).

OBJECTIVES

This study aims to explore the sociodemographic, psychological, clinical, cultural, and personal factors that could affect the overall QoL of cancer patients.

METHODS

A total of 276 cancer patients who attended the King Saud University Medical City's oncology outpatient clinics between January 2018 to December 2019 were included. QoL was assessed with the Arabic version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30. Psychosocial factors were assessed with several validated scales.

RESULTS

QoL was poorer among patients who were female (p = 0.001), have visited a psychiatrist (p = 0.028); were taking psychiatric medications (p = 0.022); and had experienced anxiety (p < 0.001), depression (p < 0.001), and distress (p < 0.001). The most used method to self-treat was Islamic Ruqya (spiritual healing; 48.6%), and the most often perceived cause for developing cancer was evil eye or magic (28.6%). Good QoL outcomes were associated with biological treatment (p = 0.034) and satisfaction with health care (p = 0.001). A regression analysis showed that female sex, depression, and dissatisfaction with health care were independently associated with poor QoL.

CONCLUSIONS

This study demonstrates that several factors could influence cancer patients' QoL. For instance, female sex, depression, and dissatisfaction with health care were all predictors of poor QoL. Our findings support the need for more programs and interventions to improve the social services for cancer patients, along with the need to explore the social difficulties oncology patients face and address such obstacles through improving social services by expanding the scope of social workers' contribution. Larger multicenter longitudinal studies are warranted to examine the generalizability of the results.

Risk of Breast Cancer Progression after Treatment in the Western Region of Saudi Arabia

Background:

The risk of breast cancer progression is one of the most difficult factors to predict as it is studied in different populations, patient groups, or time frames, resulting in conflicting estimates of incidence rates reported in the literature. The purpose of this study is to identify predictive factors for breast cancer recurrences in a sample of the Middle Eastern population.

Methodology:

A cohort retrospective study included all eligible breast cancer patients at the National Guard Health Affairs (NGHA) Hospital in Jeddah, Western region, from 2015 to 2021. Our primary outcome was the progression status of the patients; we adjusted for demographic, clinical, and molecule characteristics of the population. From 2015 to 2021, there were 319 patients diagnosed with breast cancer. Multiple logistic regression analysis was used to estimate predictors of breast cancer progression.

Results:

One of five breast cancer patients had breast cancer progression (20.83%), while 66.15% of the progression patients were between the ages of 41–65. In multivariate analysis, age, progesterone receptor (PR), family history, and tumor size were significant predictors of breast cancer progression. The age group of 20–40 years was a protective predictor of breast cancer progression, patients in the young age group were less likely to be diagnosed with progression (OR = 0.35; CI = 0.15, 0.81). While negative PRs and tumor size greater than 2 cm were significant predictor factors of breast cancer progression (OR = 2.07; CI = 1.09, 3.91, OR = 2.02; CI = 1.9, 3.78).

Conclusion:

Although the effect of young age as a protective factor for the progression of breast cancer remains controversial, our study revealed that patients between 41 and 60 years of age had a higher rate of progression. Future larger prospective studies are needed to delineate the role of age and PR hormone receptors in determining the best treatment options for women with breast cancer in the Saudi population.

Cost-efficiency analysis of conversion to biosimilar filgrastim for supportive cancer care and resultant expanded access analysis to supportive care and early-stage HER2+ breast cancer treatment in Saudi Arabia: simulation study

AIMS

This study estimated, for Saudi Arabia, the cost-efficiency of converting patients from reference Neupogen and Neulastim to one of two filgrastim biosimilars (Nivestim, Zarzio); the budget-neutral expanded access to supportive care with biosimilar filgrastim and therapeutic care to ado-trastuzumab emtansine thus afforded; and the number-needed-to-convert (NNC) to provide supportive or therapeutic treatment to one patient.

MATERIALS AND METHODS

Replicating prior studies, we modeled the cost-efficiencies gained from converting varying proportions of a hypothetical panel of 4,000 patients undergoing six cycles of cancer treatment from Neupogen or Neulastim to one of the two biosimilar G-CSF formulations, using national cost inputs. Cost-savings in USD were used to estimate the additional doses of biosimilar G-CSF and expanded access to ado-trastuzumab emtansine on a budget-neutral basis, and NNC to purchase one additional dose of supportive or therapeutic treatment.

RESULTS

Savings from conversion from reference to a biosimilar filgrastim were $3,086,400 (Nivestim) and $3,460,800 (Zarzio). With reference pegfilgrastim, savings from conversion were $11,712,240 (Nivestim) and $12,086,640 (Zarzio). Biosimilar conversion from reference to biosimilar filgrastim enabled expanded access to ado-trastuzumab emtansine ranging from 61 patients (5 days, Nivestim) to 191 patients (14 days, Zarzio). For supportive care, biosimilar conversion enabled expanded access ranging from 8,244 patients (5 days, Nivestim) to 25,882 patients (14 days, Zarzio). For biosimilar conversion from daily filgrastim, the NNC for treatment with ado-trastuzumab emtansine decreased as days of injections increased [5 days: 395 (Nivestim), 352 (Zarzio); 14 days: 141(Nivestim), 126 (Zarzio)]. Alternately, for biosimilar conversion from single-injection pegfilgrastim to daily biosimilar filgrastim, the NNC for treatment with ado-trastuzumab emtansine rose as days of injections increased, being highest under the 14-day scenario (146, Nivestim; 130, Zarzio).

CONCLUSION

This simulation study demonstrated significant potential cost-savings from biosimilar conversion. These savings provide budget-neutral increased access to supportive and therapeutic cancer care.

Public Awareness of Colorectal Cancer Screening in the Al-Baha Region, Saudi Arabia, 2022

BACKGROUND

According to the WHO, cancer is ranked as the second leading cause of death, accounting for an estimated 9.6 million deaths in 2018. This study aimed to assess public awareness about colorectal cancer (CRC) screening and the barriers that prevent Saudi individuals from undergoing CRC screening.  Materials and methods: A cross-sectional study was conducted in the Prince Mishari Bin Saud General Baljurashi Hospital, and a supervised self-administered questionnaire was utilized. Sociodemographic data, knowledge about colorectal cancer, and attitude toward screening were included in the survey. Data were analyzed using IBM SPSS Version 23 (SPSS Inc., Chicago, IL, USA) and Pearson's chi-square test. A P<0.05 was considered statistically significant.

RESULTS

A total of 396 eligible participants completed the survey. About 209 (52%) were female, and 124 (31.3%) belonged to the age group of 18-29 years. Nearly (49.7%) knew that detecting colorectal cancer before symptoms appear is possible. About 64% of the participants cited colonoscopy as the screening method for CRC. More than half of the participants (58.1%) expressed their willingness to be screened for colorectal cancer, while only 2.8% reported that they had undergone screening before. Participants with higher educational status demonstrated better knowledge regarding CRC than others (p<0.05).

CONCLUSION

 The overall knowledge of CRC was found to be poor in Al-Baha residents, irrespective of age. Implementing new strategies to increase public awareness about colorectal cancer will aid in the early diagnosis of CRC. We recommend targeted education and screening programs to improve the level of screening awareness and aid in the early diagnosis of colorectal cancer.

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

Background and Objectives: Breast cancer is considered the most commonly diagnosed type of cancer among women globally and in Saudi Arabia. This study aimed to assess breast cancer incidence patterns and trends among the Saudi female population. Materials and Methods: Breast cancer incidence parameters were obtained from the Saudi Cancer Registry (SCR). The data were retrospectively analyzed for the period from 2001 to 2017 to investigate changes in incidence rates. Temporal trends were also analyzed through joinpoint regression analysis and were dissected by age groups and administrative regions. Results: During the specified period, breast cancer jumped by 55% to constitute 30.9% of all cancer cases among Saudi females. The median age at diagnosis increased to reach 51 years at the end of that period, with an overall increase of 6.3%. The overall Age-Standardized Incidence Rate (ASR) escalated by 151.7% from 11.8/100,000 to 29.7/100,000 population for that period. The Eastern region noticeably had the highest ASR and peaked at 52.2/100,000 population. The joinpoint analysis of the ASR showed increased trends, with an annual percent change (APC) of 5.13% (p < 0.05, [95% CI 4−6.3]). An age-specific analysis was also performed and showed that the age group 70−74 years had the highest trend (APC 10.2%, [95% CI 7.2−13.4], p < 0.05). Region-specific analysis revealed that the Jouf region had the highest trend among the regions (APC 8.8%, [95% CI 3.7−14.2], p < 0.05). Conclusions: Our analysis indicates increased breast cancer incidence in Saudi Arabia with an alarming pace. With the existing trend, it is expected that Saudi Arabia will continue to display an increase in breast cancer incidence. Long-term preventive measures and more effective screening strategies are warranted to alleviate the burden of the disease.

Evaluation of participation and performance indicators in a breast cancer screening program in Saudi Arabia

OBJECTIVES

To evaluate early performance indicators for breast cancer screening at the King Abdulaziz University Hospital in Saudi Arabia.

METHODS

This study retrospectively evaluated data from women who underwent their first breast cancer screening program in Jeddah, Saudi Arabia between 2012 and 2019. Data on screening results were used to estimate performance indicators and generate descriptive statistics.

RESULTS

Of the 16000 women invited from 2012 to 2019, a total of 1911 (11.9%) participated. The majority of women (68.8%) were between 40 and 55 years old. Based on the screening process results, 26.6%, 40.1%, 9.7%, 1.3%, 0.7%, and 5.2% of women had BI-RADS scores of R1, R2, R3, R4, R5, and R0 respectively. The remaining 16.3% did not have mammogram records. The recall rate, or the percentage of women who underwent further evaluation, was 19.9%; 18.9% underwent a biopsy procedure. In addition, 1.6% of women had cancer screen-detected, although only 0.7% were diagnosed with breast cancer.

CONCLUSION

In light of the low participation and high recall rates, it is essential that the screening program utilizes performance indicators to optimize resource utilization and ensure the quality of the service provided. Additionally, a national framework and standardized performance indicators could mitigate this problem for other cancer screening programs.

Level and predictors of breast cancer awareness among Saudi women: A nationwide study

BACKGROUND

Breast cancer occurs when abnormal breast cells grow rapidly and uncontrollably. Early detection and intervention have been established to significantly decrease mortality rates.

OBJECTIVE

There is a lack of focused research investigating the degree of breast cancer awareness among Saudi women. Thus, this study aimed to fill this gap by conducting a nationwide survey on a large pool of women.

DESIGN

A cross-sectional web-based nationwide study.

METHODS

This study targeted Saudi women from all regions of the country and was conducted from 20 August to 3 September 2021. The study used the Breast Cancer Awareness Measure questionnaire to measure breast cancer awareness. This study was approved by the King Abdullah International Medical Research Center institutional review board.

RESULTS

Overall, poor breast cancer awareness scores were demonstrated by 71% of the participants. Unemployed women were more likely to have poor breast cancer awareness.

CONCLUSION

Our study reports an alarmingly high level of poor overall breast cancer awareness in Saudi women. Interventions should be implemented to combat this lack of awareness.

Patterns of Immunohistochemical Expression of P53, BCL2, PTEN, and HER2/neu Tumor Markers in Specific Breast Cancer Lesions

Objective

This study aimed to associate the expression of P53, BCL2, PTEN, and HER2/neu tumor markers in specific breast cancer lesions.

Methods

This study analyzed the immunohistochemical expression of P53, BCL2, PTEN, and HER2/neu tumor markers for 306 patients who presented with lesions. Tissue blocks and patients' identification data were retrieved from the department of pathology, AL Madinah Almonwarah hospital, Al Madinah, UAE.

Results

Of the 306 patients, 104 had benign lesions and 202 had malignancy (including 194 females and 6 males). Most females were presented with invasive ductal carcinoma (IDC), followed by infiltrating ductal carcinoma, and invasive lobular carcinoma (ILC), representing 70%, 23.2%, and 3.7%, respectively. Positive P53, BCL2, PTEN, and HER2 were identified in 20.8%, 11.9%, 91%, and 18.3%, respectively.

Conclusion

: The expression of P53, BCL2, PTEN, and HER2/neu tumor markers among Saudi patients with breast cancer is relatively similar in many parts of the world.

Cinchona officinalis Phytochemicals-Loaded Iron Oxide Nanoparticles Induce Cytotoxicity and Stimulate Apoptosis in MCF-7 Human Breast Cancer Cells

The present study aimed to synthesize iron oxide nanoparticles loaded with quinine and alkaloids-rich Cinchona officinalis (Peruvian bark) stem bark extract, and further evaluate their cytotoxic effect and apoptosis mechanisms in MCF-7 breast cancer cells. Nanoparticles were prepared by biological reduction of iron oxide with Cinchona officinalis extract, using the green synthesis method. The nanoparticles were characterized by XRD, FT-IR, and UV-vis spectroscopy and transmission electron microscopy (TEM). In vitro cytotoxicity analyses of Cinchona officinalis extract, ferrous oxide, and Cinchona officinalis extract-loaded iron oxide nanoparticles (CO-NPs) were carried out using the MTT test for 24 h and 48 h. We found that CO-NPs reduced the MCF-7 cell viability with IC₅₀ values of 16.2 and 9 µg/mL in 24 h and 48 h, respectively. In addition, CO-NPs were tested with normal hMSCs to determine their toxicity, and we did not find noticeable cytotoxicity. Confocal fluorescent microscopy revealed that CO-NPs efficiently increased the nuclear condensation and chromatin damage in propidium iodide staining; meanwhile, there was decreased mitochondrial membrane potential in CO-NPs-treated MCF-7 cells. In addition, AO-EB staining confirmed the late apoptotic and apoptotic morphology of cancer cells. Further gene expression analysis confirmed that the upregulation of tumor suppressors, Cdkn1A, Prb, and p53 was significantly increased, and inflammatory traits such as TNF-α and Nf-κb were increased in cancer cells treated with CO-NPs. Apoptotic stimulators such as Bax and caspase-3 expression were highly significantly increased, while mdm-2 and Bcl-2 were significantly decreased. Overall, the enhanced cytotoxic potential of the Cinchona officianlis stem bark extract loaded CO-NPs versus free Cinchona officianlis extract might be due to the functional stabilization of bioactive compounds, such as alkaloids, quinine, flavonoids, phenolics, etc., into the iron oxide, providing bioavailability and internalization of cinchona metabolites intracellularly.

Bacterial Infections among Patients with Chronic Diseases at a Tertiary Care Hospital in Saudi Arabia

Infections caused by multi-drug-resistant bacteria in patients with chronic diseases have been associated with high mortality and morbidity. While few reports have evaluated bacterial infections in multiple chronic disease patients, the focus of the current study was to investigate the prevalence of bacterial infections and the susceptibility profiles of causative strains among various groups of patients suffering from chronic diseases. Microbiological reports of patients suffering from cancer, diabetes mellitus, cardiovascular diseases, kidney diseases, and skin burns were retrospectively collected from a tertiary hospital in Saudi Arabia. Approximately 54.2% of recruited patients were males, and positive urine was the most prevalent specimen associated with kidney disease patients (25%). Escherichia coli isolates were predominant among cardiovascular, kidney, and cancer patients. Staphylococcus aureus was commonly detected in diabetics and those with burns. Although resistance patterns varied based on the type of specimens and underlying diseases, Escherichia coli showed limited resistance to colistin, carbapenems, and tigecycline, while S. aureus demonstrated susceptibility to ciprofloxacin, gentamicin, and rifampin. These observations are crucial for clinicians and policymakers to ensure effective treatment plans and improve outcomes in these patients with comorbidity.

Brain Tumors in Saudi Arabia: An Observational and Descriptive Epidemiological Analysis

Introduction: Brain tumors are one of the major causes of death and morbidity around the world. A prospective existential retrospective observational population-cohort study based on the comprehensive research work on brain tumors in the Saudi population was conducted, with statistics drawn from the Saudi Cancer Registry data collected and published by the Ministry of Health, Saudi Arabia, which is a national document prepared and maintained by the National Health Information Center, from 2006 to 2016. For the analysis of the brain tumor distribution and trends in Saudi Arabian inhabitants, the current study outlined the brain tumor incident rates in the age-standardized incidence rates (ASIRs) and crude incidence rates (CIRs) in the inhabitants of Saudi Arabia by distinct age cohorts, the year of diagnosis, and the core administrative regions of Saudi Arabia. Method: Statistical tools, such as GraphPad Prism and SPSS 2.0, were used for the analyses of the t-test, Kruskal–Wallis test, and descriptive statistics, including the sex ratio and other demographic features. Between 2006 and 2016, Saudi Arabia recorded 1854 and 1293 cases of brain tumors in males and females, respectively. Results: The highest percentage and mean number of brain tumor cases were recorded among males and females in the age group 0–4 years, and the lowest proportion of brain tumor cases were reported among males and females in the higher age group (55–69 years). The highest mean CIR and ASIR were found in the male and female populations of the Riyadh region, and the highest CIR and ASIR sex ratios were found in the Baha and Naj regions of Saudi Arabia, respectively. Males in the Jazan region had the lowest average CIRs and ASIRs. The Baha and Jazan regions of Saudi Arabia recorded the lowest mean CIR and ASIR among females. Conclusion: The Riyadh region had the most significant increases in ASIRs and CIRs for brain tumors in males and females from 2006 to 2016, whereas the Jazan region had the least significant changes in the ASIRs in males and females.

Female Healthcare Workers' Knowledge, Attitude towards Breast Cancer, and Perceived Barriers towards Mammogram Screening: A Multicenter Study in North Saudi Arabia

Breast cancer is the most commonly diagnosed cancer among women in the Kingdom of Saudi Arabia and other Middle East countries. This analytical cross-sectional study assessed knowledge, attitude towards breast cancer, and barriers to mammogram screening among 414 randomly selected female healthcare workers from multiple healthcare facilities in northern Saudi Arabia. Of the studied population, 48.6% had low knowledge, and 16.1% had a low attitude towards breast cancer risk factors and symptoms. The common barriers to mammogram screening were fear to discover cancer (57.2%) and apprehension regarding radiation exposure (57%). Logistic regression analysis found that lack of awareness regarding mammogram was significantly associated with age (p = 0.030) and healthcare workers category (ref: physicians: p = 0.016). In addition, we found a significant negative correlation between knowledge and barrier scores (Spearman’s rho: −0.315, p < 0.001). It is recommended to develop target-oriented educational programs for the healthcare workers, which would empower them to educate the community regarding the risk factors and the importance of mammogram screening. Furthermore, a prospective study is warranted in other regions of the Kingdom of Saudi Arabia to understand the region-specific training needs for the healthcare workers.

Adherence to Hormonal Therapy in Breast Cancer Patients in Saudi Arabia: A Single-Center Study

Breast cancer is one of the most common types of cancer in women. Approximately three-quarters of all breast cancer patients have estrogen and/or progesterone receptor positivity. As a result, the majority of patients receive hormonal treatment for between five and 10 years. Long-term use of hormonal therapy reduces the recurrence rate and the risk of death. In Saudi patients, adherence to hormonal therapy is not adequately assessed. The primary objective of this study is to determine the clinical outcomes associated with hormonal therapy adherence in breast cancer patients.

This is a retrospective cohort study of patients who received adjuvant hormonal therapy for hormone-receptor-positive breast cancer. Patients were included if they had received at least two prescription refills following their breast cancer diagnosis. The primary outcome measure was mortality and disease progression in relation to hormonal therapy adherence. Progression of disease is defined as local recurrence or radiographic evidence of metastatic disease. The secondary outcome measure was the study population's adherence to hormonal therapy. The proportion of days covered during hormonal therapy was used to assess adherence (PDC). PDC was calculated as the number of days in the prescription period divided by the total number of days in the prescription period. Patients are considered adherent if their PDC value is greater than 0.8. The mortality and disease progression curves were generated using the Kaplan-Meier method. The proportion of patients adhering to hormonal therapy was determined using descriptive analysis. The IRB granted approval. A total of 121 patients were included in the study from the 380 patients screened. Tamoxifen, letrozole, and anastrozole were administered to 58%, 27%, and 14% of patients, respectively. The median age was 53 years. Women who were postmenopausal constituted 52.3% of the study population. The majority of patients were in Stages II and I (56.2% and 16.53%, respectively). The majority of the tumors were Grade II (58.68 %). Adherence was not associated with disease progression (HR, 0.66; 95% CI, 0.25-1.72) or mortality (HR, 1.391; 95 percent CI, 0.33-5.82). Disease progression and mortality were not found to be significantly associated with hormonal therapy adherence in this study. A larger study is required to confirm the findings of our study.