The prevalence of ADSL (rs3788579) and CYP1A2 (rs17861162) polymorphisms in female breast cancer patients in North-West Iran

INTRODUCTION

Breast cancer is a prevalent and significant contributor to cancer-related mortality among women worldwide. Its increasing incidence, especially in regions like North-West Iran, necessitates a deeper understanding of genetic factors contributing to its development. Genetic alterations, particularly single nucleotide polymorphisms (SNPs), are implicated in breast cancer susceptibility, making investigation in this context crucial. This study explores the role of CYP1A2-rs17861162 and ADSL-rs3788579 SNPs in breast cancer risk among Iranian women.

METHODS

This study involved 200 female breast cancer patients and 200 healthy controls in North-West Iran. DNA was extracted from blood samples, and PCR-RFLP was used for genotyping the CYP1A2 and ADSL genes.

RESULTS

The CYP1A2-rs17861162 SNP exhibited a shift from the C allele to the G allele in breast cancer patients, resulting in a 21.7% decrease in CC genotype frequency and a 21.6% and 77.8% increase in CG and GG genotypes, respectively, compared to controls. In ADSL-rs3788579 SNP, breast cancer patients had a significantly higher prevalence of the T allele, with a 28.5% increase compared to controls. In healthy participants, CC was most common, while in the breast cancer group, TT was most common.

CONCLUSION

This study highlights significant genetic alterations in CYP1A2-rs17861162 and ADSL-rs3788579 SNPs among breast cancer patients in North-West Iran, suggesting their potential as diagnostic and prognostic biomarkers. Further research is warranted to elucidate the precise mechanisms underlying their contributions to breast cancer susceptibility in this population.

Evaluation of the Potential Diagnostic Role of the Lnc-MIAT, miR-29a-3p, and FOXO3a ceRNA Networks as Noninvasive Circulatory Bioindicator in Ductal Carcinoma Breast Cancer

Background

Over the last few decades, tremendous progress has been achieved in the early detection and treatment of breast cancer (BC). However, the prognosis remains unsatisfactory, and the underlying processes of carcinogenesis are still unclear. The purpose of this research was to find out the relationship between myocardial infarction-associated transcript (MIAT), FOXO3a, and miRNA29a-3p and evaluated the expression levels in patients compare with control and their potential as a noninvasive bioindicator in whole blood in BC.

Methods

Whole blood and BC tissue are taken from patients before radiotherapy and chemotherapy. Total RNA was extracted from BC tissue and whole blood to synthesize complementary DNA (cDNA). The expression of MIAT, FOXO3a, and miRNA29a-3p was analyzed by the quantitative reverse transcription-polymerase chain reaction (RT-qPCR) method and the sensitivity and specificity of them were determined by the receiver operating characteristic (ROC) curve. Bioinformatics analysis was used to understand the connections between MIAT, FOXO3a, and miRNA29a-3p in human BC to develop a ceRNA (competitive endogenous RNA) network.

Results

We identified that in ductal carcinoma BC tissue and whole blood, MIAT and FOXO3a were more highly expressed, whereas miRNA29a-3p was lower compared with those in nontumor samples. There was a positive correlation between the expression levels of MIAT, FOXO3a, and miRNA29a-3p in BC tissues and whole blood. Our results also proposed miRNA29a-3p as a common target between MIAT and FOXO3a, and we showed them as a ceRNA network.

Conclusions

This is the first study that indicates MIAT, FOXO3a, and miRNA29a-3p as a ceRNA network, and their expression was analyzed in both BC tissue and whole blood. As a preliminary assessment, our findings indicate that combined levels of MIAT, FOXO3a, and miR29a-3p may be considered as potential diagnostic bioindicator for BC.

Applications of different machine learning approaches in prediction of breast cancer diagnosis delay

Background

The increasing rate of breast cancer (BC) incidence and mortality in Iran has turned this disease into a challenge. A delay in diagnosis leads to more advanced stages of BC and a lower chance of survival, which makes this cancer even more fatal.

Objectives

The present study was aimed at identifying the predicting factors for delayed BC diagnosis in women in Iran.

Methods

In this study, four machine learning methods, including extreme gradient boosting (XGBoost), random forest (RF), neural networks (NNs), and logistic regression (LR), were applied to analyze the data of 630 women with confirmed BC. Also, different statistical methods, including chi-square, p-value, sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC), were utilized in different steps of the survey.

Results

Thirty percent of patients had a delayed BC diagnosis. Of all the patients with delayed diagnoses, 88.5% were married, 72.1% had an urban residency, and 84.8% had health insurance. The top three important factors in the RF model were urban residency (12.04), breast disease history (11.58), and other comorbidities (10.72). In the XGBoost, urban residency (17.54), having other comorbidities (17.14), and age at first childbirth (>30) (13.13) were the top factors; in the LR model, having other comorbidities (49.41), older age at first childbirth (82.57), and being nulliparous (44.19) were the top factors. Finally, in the NN, it was found that being married (50.05), having a marriage age above 30 (18.03), and having other breast disease history (15.83) were the main predicting factors for a delayed BC diagnosis.

Conclusion

Machine learning techniques suggest that women with an urban residency who got married or had their first child at an age older than 30 and those without children are at a higher risk of diagnosis delay. It is necessary to educate them about BC risk factors, symptoms, and self-breast examination to shorten the delay in diagnosis.

A recombinant affitoxin derived from a HER3 affibody and diphteria-toxin has potent and selective antitumor activity

High expression of receptor tyrosine-protein kinase erbB-3 (HER3) has been found in several malignancies such as breast cancer. In this study, we designed, produced and evaluated a new affitoxin consisting of a truncated form of diphtheria toxin and a HER3-binding affibody domains. The new affitoxin was expressed in Escherichia coli and purified by affinity chromatography. We evaluated the suitability of affitoxin to kill HER3 positive breast cancer cells with MTT and apoptosis assays. The protein synthesis inhibition was also evaluated. The IC50 value in HER3 negative cells is about 10 times more than HER3 positive cells in new design of affitoxin. The specificity of affitoxin for binding to HER3 positive cells was also investigated with binding assay with flow cytometry. The results show that, the new affitoxin is an anti-cancer molecule with specific binding to HER3 positive cells and may open a new window for the treatment of HER3-positive cancers.

2q35-rs13387042 variant and the risk of breast cancer: a case-control study

BACKGROUND

Breast Cancer is the most frequent neoplasm diagnosed among women worldwide. Genetic background and lifestyle/environment play a significant role in the disease etiology. According to Genome-wide association studies, some single-nucleotide polymorphisms such as 2q35-rs13387042-(G/A) have been introduced to be associated with breast cancer risk and features. In this study, we aimed to evaluate the association between this variant and the risk of breast cancer in a cohort of Iranian women.

METHODS

Demographics and clinical information were collected by interview and using patients' medical records, respectively. DNA was extracted from 506 blood samples, including 184 patients and 322 controls, and genotyping was performed using allele specific-PCR. SPSS v16 was used for statistical analysis.

RESULT

Statistically significant association was observed between AA genotype and disease risk in all patients [p_adj = 0.048; OR_adj = 2.13, 95% CI (1.01-4.50)] and also ER-positive breast cancers [p_adj = 0.015; OR_adj = 2.12, 95% CI (1.16-3.88)]. There was no association between rs13387042 and histopathological characteristics of the disease. Furthermore, overall survival was not statistically associated with genotype and allelic models even after adjustment for stage and receptor status (p > 0.05).

CONCLUSION

There is a statistically significant association between 2q35-rs13387042 and breast cancer risk. rs13387042-AA genotype might be a risk-conferring factor for breast cancer development in the Iranian population. However, further consideration is suggested to confirm its role in risk assessment and probable association with other genetic markers.

miR-888 and E-Cadherin Levels in Ductal Carcinoma Breast Cancer as Possible Cancer-Related Markers

Background: Cancer occurs due to genetic or epigenetic factors. Breast cancer (BC) is the most common cancer among females and is considered one of the leading causes of cancer death worldwide. Epigenetic biomarkers have proven to be important in cancer management. Methods: E-cadherin gene expression and its associated regulatory microRNA, miR-888, were studied in 60 ductal carcinoma BC patients compared with normal controls using real-time Reverse Transcription Polymerase Chain Reaction. In addition, the association of the gene and microRNA expression with hormone receptors and other clinicopathologic characteristics were assessed. The correlation between plasma and tumor miR-888 expression was studied to evaluate its potential as a marker of noninvasiveness. Results: The results showed a significant increase in expression of miR-888, and a decrease in E-cadherin expression in tumor tissues compared with normal controls. The miR-888 and E-cadherin mRNA levels showed an inverse correlation. The overexpression of miR-888 in both tumor and plasma and downregulation of E-cadherin were particularly prominent when there was nodal involvement and distant metastasis status as we well as being significantly associated with higher disease stages and triple-negative tumor hormone receptor status. The Kaplan-Meier survival curves indicated that overall survival was significantly poor in BC patients with higher miR-888 and lower E-cadherin expression. Conclusions: Our study indicated that elevated eXpression of miR-888 may be a negative prognostic factor in breast cancer.

Tendency to Breast Cancer Screening Among Rural Women in Southern Iran: A Structural Equation Modeling (SEM) Analysis of Theory of Planned Behavior

Background:

Early detection of breast cancer is a crucial factor in surviving the disease. This study aimed to investigate the mammography screening based on the theory of planned behavior (TPB) among rural women in Fasa and Shiraz cities, Iran.

Methods:

This study is a cross-sectional study performed on 800 female clients referring to rural health centers in Fasa and Shiraz cities in southern Iran in early 2021. The authors decided to send and distribute the electronic questionnaire form through the WhatsApp application in collaboration with the health staff of rural health centers for the people covered by these centers. Data gathering tools were a questionnaire on demographic characteristics, a questionnaire based on constructs of TPB, and behavior of mammography screening. Using the structural equation model (SEM), the TPB constructs and demographic variables were entered into the model. Data analysis was executed employing SPSS software version 26 and Amos version 24 (IBM Co., Ann Arbor, MI, USA). Analyzing the data was carried out using the 1-way analysis of variance (ANOVA), logistic regression, and structural equation analysis. During data analysis, various model indicators such as the goodness of fit, including comparative fit index (CFI), goodness-of-fit index (GFI), root mean square error of approximation (RMSEA), and chi-square index/df were evaluated. The significance level in all tests was considered 0.05.

Results:

The knowledge, attitude, and perceived behavioral control were the predictors of intention and behavior of mammography screening among the women. Among demographic variables, age, literacy, being menopausal, cancer in family, city, and ethnicity contribute more to the variance variation in TPB constructs. In this study, 7.2% of Persians, 8% of Qashqai Turks, and 4.5% of Arabs are contemplating going to mammography screening. In total, 6.8% (54 people) of all individuals intended to go mammography screening, and 5.4% (43 people) had a history of mammography screening. Goodness-of-fit indices (χ² = 18.45, df = 10, n = 800, χ²/df = 1.845, RMSEA = 0.032, GFI = 0.90, non-normed fit index (NNFI) = 0.91) of conceptual model of this study indicate the suitability of the model.

Conclusions:

The results of the study indicated that the constructs of the TPB can predict mammography screening behaviors in rural women. It has also demonstrated that mammographic behavior can be improved in rural women using education based on the TPB model, emphasizing critical psychological factors of creating or changing behavior.

Association of Estrogen Receptor, Progesterone Receptor, and Human Epidermal Growth Factor Receptor 2 Expression with Breast Cancer Metastasis in Iran

BACKGROUND

Metastasis is an important factor in the survival estimate of patients with breast cancer. The present study aimed to examine the frequency of epidermal growth factor receptor 2 (HER2), estrogen receptor (ER), and progesterone receptor (PR) expression in relation to the metastatic site, pattern, and tumor size in patients with metastatic breast cancer (MBC).

METHODS

In this retrospective study, the medical records of patients diagnosed with MBC at Motahari Clinic (Shiraz, Iran) during 2017-2019 were examined. Metastasis was confirmed using computed tomography, and a total of 276 patients were included in the study. Based on the expression of receptors, the patients were categorized into luminal A, luminal B, HER2, and TNBC groups. The frequency and percentage of receptors in relation to the metastatic site, size, and pattern were compared using the Chi square test. P<0.05 was considered statistically significant.

RESULTS

The frequency of receptor positivity in the 276 selected medical records were of the subtype HER2-enriched (n=48), luminal A (n=43), luminal B (n=146), and TNBC (n=39). The most common metastatic sites were the bones (47.1%), lungs (34.4%), liver (27.9%), brain (20.3%), and other organs (12.7%). The first site of metastasis occurred in the bones (36.6%), lungs (17.4%), liver (15.6%), brain (10.5%), and other organs (7.6%). The frequency of receptor expression was different in relation to the first metastatic site (P=0.024). There was a statistically significant difference between the frequency of receptor expression in patients with bone (P=0.036), brain (P=0.031), and lung (P=0.020) metastases. The frequency of receptor expression was also significantly different in relation to the size of liver metastasis (P=0.009). Luminal A and B subtypes showed higher rates of bone metastasis as the first metastatic site.

CONCLUSION

The difference in the frequency of receptor expression in relation to the metastatic site and tumor size can be used as predictive and prognostic factors in patients with breast cancer.

Population Based Survival Analysis of Females Diagnosed with Breast Cancer and Its Related Factors in Kerman Province from 2001 to 2015, Using Parametric Log-Logistic Models

Background: Breast cancer is the most common cancer among women worldwide and 14.2% of deaths in Iranian women were due to breast cancer. Objectives: The present study aimed at investigating the survival of females with breast cancer diagnosed over 14 years and its related factors in Kerman Province. Methods: This is a longitudinal study. Information about 2851 females diagnosed with breast cancer was inquired from the Cancer Registry of Kerman University of Medical Sciences from March 2001 to March 2015. Data analysis was performed by Stata 14 and SPSS 22. Results: Totally, 8511 women diagnosed with breast cancer were enrolled in this study. The median survival time among patients with grade 3 at diagnosis was 0.51 of patients with grade 1 (P = 0.016). The median survival time among patients with stage 4 at diagnosis was 0.11 of patients with stages 0 and 1 (P < 0.001). The median survival time among post-menopause patients at diagnosis was 0.65 of pre-menopause patients (P = 0.014). The median survival time among patients with secondary metastasis was 0.22 of patients without it (P < 0.001) and the median survival time among patients with hormonotherapy was 1.52 of patients without this treatment (P = 0.013). Conclusions: Early diagnosis can improve the survival of patients with breast cancer. Periodic checkups especially in menopause ages are recommended. Hormone therapy has been successful in increasing patients’ survival.

The effect of mobile health educational intervention on body image and fatigue in breast cancer survivors: a randomized controlled trial

BACKGROUND

Cancer-related fatigue, physical changes, and pain are among the most troublesome symptoms caused by breast cancer treatment and influence the patients' quality of life. The aim of the present study was to examine the effect of mobile health educational intervention on body image and fatigue in breast cancer survivors.

METHODS

The present clinical trial study conducted on 38 women with breast cancer referred to Golestan and Shahid Baghaei 2 hospitals, Ahvaz, south west Iran in 2018-2019. Patients were randomly assigned into two intervention group, and control groups on 1:1 basis. Data collection tool included three parts: cancer fatigue scale, body image concern inventory, and demographic information. Text messages sent to intervention group via WhatsApp messenger for 7 weeks on a daily schedule. The control group did not receive any messages. Data were analyzed using SPSS Version 23.0.

RESULTS

The mean age of participants was 46.34 ± 9.96. The mean score of cancer fatigue scale after the intervention in the intervention group was decreased significantly (p = 0.005), but no statistically significant difference was observed in the control group. There was a significant difference in the mean score of body image concern inventory in the intervention group (p = 0.002) after the intervention compared with the control group.

CONCLUSION

Mobile health educational intervention improved cancer-related fatigue and body image among women breast cancer survivors. The integration of education for the management of fatigue and body image disturbance as part of routine care among breast cancer survivors is recommended.

A Study on Breast Reconstruction in a Developing Country: A Comprehensive Evaluation of the Techniques and Oncologic Outcomes

BACKGROUND

Breast cancer, with an incidence of 33.2 per 100,000 in Iranian population, is considered as the most common cancer in Iranian women. Nowadays, with the increasing survival rates, breast reconstruction has been integrated into surgical techniques of breast cancer treatment. The aim of this study was to evaluate the current status of breast reconstruction in Iranian population.

PATIENTS AND METHODS

This retrospective study was conducted in Imam Hospital between January 2008 and June 2018. All the patients underwent breast reconstruction surgery. The trend of reconstruction and complication rates were 2 major outcomes. Logistic regression model was used to predict complications. Student t test was used to compare means.

RESULTS

Fifty-five patients underwent 60 autologous breast reconstruction surgeries and 152 patients underwent 193 prosthesis-based reconstruction surgeries. Most of cases were invasive ductal carcinoma ± ductal carcinoma in situ (126 cases, 68%). Among 253 surgeries in 207 patients, 98 cases (38.7%) were 2-stage implant, 91 (36.0%) were 1-stage implant, 3 (1.2%) were acellular dermal matrix + prosthesis, 31 (12.2%) were pedicled transverse rectus abdominis myocutaneous flap, 25 (9.8%) were latissimus dorsi flap ± prosthesis, and 4 (15.8%) were latissimus dorsi flap. Among prosthesis-based reconstructions, chemotherapy could predict the occurrence of complications (odds ratio, 2.87; 95% CI, 1.07-7.68), whereas none of these factors could predict the occurrence of complications in autologous reconstructions. The most prevalent complication was seroma formation (48.5% of all complications). Overall complication rates (including major and minor) were higher among autologous reconstructions compared with prosthesis-based reconstructions (45.8% and 21.1%, respectively, P < 0.001).

CONCLUSIONS

The trend of breast reconstruction is changing in Islamic Republic of Iran as a developing country. Implant-based reconstruction has surpassed autologous reconstructions in recent years. In terms of complications, we observed higher rates among autologous reconstructions.

Immunotherapy for Breast Cancer Treatment

Breast cancer, as a heterogeneous disease, includes a wide range of pathological and clinical behaviors. Current treatment protocols, including radiotherapy, chemotherapy, and hormone replacement therapy, are mainly associated with poor response and high rate of recurrence. Therefore, more efforts are needed to develop alternative therapies for this type of cancer. Immunotherapy, as a novel strategy in cancer treatment, has a potential in treating breast cancer patients. Although breast cancer has long been considered problematic to treat with immunotherapy, as it is immunologically "cold," numerous newer preclinical and clinical reports now recommend that immunotherapy has the capability to treat breast cancer patients. In this review, we highlight the different immunotherapy strategies in breast cancer treatment.

PD-L1 expression in tumor lesions and soluble PD-L1 serum levels in patients with breast cancer: TNBC versus TPBC

BACKGROUND

Block of programmed cell death protein 1 (PD-1) interaction with its ligand, PD-L1, enhances anti-tumor activity.

OBJECTIVES

We aimed to assess the association between PD-L1 expression in tumor cells and CD8+ tumor infiltrating T cells (TILs) as well as soluble (s)PD-L1 serum levels in patients with triple negative breast cancer (TNBC) compared to triple positive (TPBC).

METHODS

A total of 113 tumor sections and 133 serum samples were available from 144 patients with breast cancer (72 TNBC and 72 TPBC). Dual immunohistochemistry staining was applied to determine differential PD-L1 expression in tumor cells and CD8+ TILs. Soluble PD-L1 serum levels were also evaluated in patients compared to 40 healthy women by ELISA method.

RESULTS

Despite TPBC patients which were mostly grades 1/2, TNBC patients were grade 3 (72% versus 66.7%, P < 0.001). Most of the TNBC patients were stages I/II, whereas most of the TPBC patients were stages III/IV (57.3% versus 68.3%,P = 0.005). There was no difference in tumor size and metastasis between TNBC and TPBC patients, although the number of involved lymph nodes was significantly more in TPBC patients (P = 0.0012). PD-L1 expression was detected in 11.5% of samples mostly in TNBC subtype and was associated with advanced grades (P = 0.039). There was no relationship between PD-L1 expression and tumor stage. PD-L1 expression in CD8+ TILs was nonsignificantly higher than tumor cells. Serum levels of sPD-L1 showed no difference between patients and healthy women. We found no correlation between PD-L1 expression in tumor lesions and serum levels of sPD-L1 in patients.

CONCLUSION

PD-L1 expression was more detected in our patients with TNBC. It seems that, these patients who are resistant to standard chemotherapy regimens may get benefit from PD-L1 inhibition therapy and because of its low serum levels, sPD-L1 cannot interfere with this therapy.

Geographical and socioeconomic inequalities in female breast cancer incidence and mortality in Iran: A Bayesian spatial analysis of registry data

BACKGROUND

In Iran, trends in breast cancer incidence and mortality have generally been monitored at national level. The purpose of this study is to examine province-level disparities in age-standardised breast cancer incidence versus mortality from 2000 to 2010 and their association with socioeconomic status.

METHODS

In this study, data from Iran's national cancer and death registry systems, and covariates from census and household expenditure surveys were used. We estimated the age-standardised incidence and mortality rates in women aged more than 30 years for all 31 provinces in the consecutive time intervals 2000-2003, 2004-2007 and 2008-2010 using a Bayesian spatial model.

RESULTS

Mean age-standardised breast cancer incidence across provinces increased over time from 15.0 per 100,000 people (95% credible interval 12.0,18.3) in 2000-2003 to 39.6 (34.5,45.1) in 2008-2010. The mean breast cancer mortality rate declined from 10.9 (8.3,13.8) to 9.9 (7.5,12.5) deaths per 100,000 people in the same period. When grouped by wealth index quintiles, provinces in the highest quintile had higher levels of incidence and mortality. In the wealthiest quintile, reductions in mortality over time were larger than those observed among provinces in the poorest quintile. Relative breast cancer mortality decreased by 16.7% in the highest quintile compared to 10.8% in the lowest quintile.

CONCLUSIONS

Breast cancer incidence has increased over time, with lower incidence in the poorest provinces likely driven by underdiagnoses or late-stage diagnosis. Although the reported mortality rate is still higher in wealthier provinces, the larger decline over time in these provinces indicates a possible future reversal, with the most deprived provinces having higher mortality rates. Ongoing analysis of incidence and mortality at sub-national level is crucial in addressing inequalities in healthcare systems and public health both in Iran and elsewhere.

Accuracy of self-perceived risk perception of breast cancer development in Iranian women

BACKGROUND

The accuracy of subjective risk perception is a matter of concern in breast cancer development. The objective of this study was to evaluate the accuracy of self-perceived risk assessment of breast cancer development and compared to actual risk in Iranian women.

METHODS

The demographic, clinical, and reproductive characteristics of 800 women aged 35-85 years were collected with an in-person interview. The self-perceived risk and the actual risk were assessed using the visual analog scale (VAS) and he Gail model respectively. Gail's cutoff of 1.66% risk was used to categorize the estimated 5-year actual risk as low/average risk (< 1.66%) and high risk (≥ 1.66). In low/average risk, if the self-perceived risk > actual risk, then individuals were considered as overestimating. Similarly, in high-risk women, if the perceived risk < actual risk, then, the subjects were labeled as under-estimate; otherwise, it was labeled as accurate. The Kappa statistics were used to determine the agreement between self-perceived risk and actual risk. ROC analysis was applied to determine the accuracy of self-perceived risk in the prediction of actual risk.

RESULTS

The perceived risk was significantly higher than actual risk (p = 0.001, 0.01 for 5-year and lifetime risk respectively). Both in low and high-risk groups about half of the women over-estimate and underestimate the risk by subjective risk perception. For a 5-year risk assessment, there was no agreement between perceived risk and actual risk (Kappa = 0.00, p = 0.98) but a very low agreement between them in lifetime risk assessment (Kappa = 0.09, p = 0.005). The performance of accuracy of risk perception versus actual risk was very low (AUC = 0.53, 95% CI 0.44-0.61 and AUC = 0.58, 95% CI 0.54-0.62 for the 5-year risk and lifetime risk respectively).

CONCLUSION

The clinical performance of risk perception based on VAS is very poor. Thus, the efforts of the public health education program should focus on the correct perception of breast cancer risk among Iranian women.

Which Domains of Social Support Better Predict Quality of Life of Women with Breast Cancer? A Cross-Sectional Study

Objectives:

The study aimed at investigating the specific role of social support types (SSTs) on quality of life (QoL) and its domains of women with breast cancer in Iran.

Methods:

In this cross-sectional study, a number of 223 women with breast cancer visiting three cancer centers of Tehran, Iran, participated from October 2014 to May 2015. Medical Outcome Study-Social Support Scale and Functional Assessment of Cancer Therapy-Breast Cancer were used for data gathering. Backward multiple regression was utilized, adjusted by age, education, and family size.

Results:

The study indicated positive correlations between all SSTs and QoL domains, whereas only positive social interaction (PSI) showed a significant association with physical well-being. PSI showed the only predictive performance in terms of all QoL outcomes, beyond the covariates.

Conclusions:

The study revealed the PSI as the most influential support type to enhance all domains of QoL of women with breast cancer.

Detection of human papillomavirus genotypes, herpes simplex, varicella zoster and cytomegalovirus in breast cancer patients

BACKGROUND

The role of viruses as a cause of breast cancer (BC) has been significantly investigated in recent years. Human papillomavirus (HPV) has been detected in invasive breast carcinomas, while most studies have only focused on the detection of viral DNA, we aimed to examine the prevalence and genotypes of HPV among Iranian BC patients. We also examined the presence of herpes simplex-1 (HSV-1), herpes simplex-2 (HSV-2), varicella zoster virus (VZV), and cytomegalovirus (CMV) in these samples.

METHODS

We collected and analyzed 70 Formalin-Fixed Paraffin-Embedded (FFPE) blocks including 59 BC samples, and 11 benign breast lesions as control from Iranian patients using nested PCR. Real-time PCR utilized as a confirming test to nested PCR findings. Genotyping of HPV positive samples was performed, the samples were also subjected to a multiplex PCR to detect HSV-1, HSV-2, VZV, and CMV in BC.

RESULTS

Papillomavirus DNA was present in 7 of 59 BC samples (11.8%); while none was detected in control samples. The most prevalent type was HPV18, followed by HPV 6. All HPV positive patients had high tumor grades (II/ III) with a histologic diagnosis of ductal carcinoma. The patient age range was 33 to 73 years with a median of 51 years. Most of HPV positive patients had low levels of education. HPV16 was not detected. Also, 5 of 59 BC specimens (8.47%), were positive for HSV-1. But none of the samples were positive for HSV-2, VZV, and CMV.

CONCLUSIONS

Our results suggest a carcinogenesis role for High-risk HPV (HPV18) in breast tumors. Our findings of HSV-1 and low-risk HPV (HPV6) in BCs may propose a cancer-causing role for them. Further large-scale studies are warranted to assess the significance of our findings.

Association of ApaI and TaqI polymorphisms in VDR Gene with Breast Cancer

Background:

Vitamin D inhibits cell proliferation via the vitamin D receptor (VDR), which may affect breast cancer risk. This study aimed to investigate the association of ApaI and TaqI polymorphisms of the VDR gene with breast cancer risk which followed by stratified analysis.

Materials and methods:

A case-control study was conducted on 150 breast cancer patients and 150 healthy controls. VDR ApaI and TaqI genotyping were performed by PCR-RFLP. Some demographic and pathologic features of patients were extracted from their archived files and then were analyzed by genotypes distributions.

Results:

For ApaI polymorphism, our data showed a significant difference between the patient and healthy groups for mutant allele carriers compared with those with AA genotype. Besides, statistical analysis showed that there was a significant association between the C allele and the increased risk of breast cancer. For TaqI polymorphism, statistical analysis revealed that there was a significant association between CC genotype and increased risk of breast cancer. Also, there was a significant association between the C allele and the increased risk of breast cancer. In a preliminary study, stratified analysis based on the size of tumor and lymph node metastasis revealed no significant association between two ApaI and TaqI variations and these parameters.

Conclusions:

Based on our results, the VDRApaI and TaqI variations could be considered as genetic risk factors for breast cancer. However, further studies with a larger sample size are required to obtain more accurate outcomes, especially in stratified analysis.

Effects of the Continuous Care Model on the Health-Promoting Lifestyle in Breast Cancer Survivors: A Randomized Clinical Trial

Breast cancer is the most frequently diagnosed cancer and the chief cause of cancer-related death among women worldwide, with the incidence increasing exponentially particularly in low- to middle-income countries. The increase in the incidence of breast cancer is partly accounted for by increases in life expectancy due to improvements in public health, but also related to an increase in risk factors for cancer including smoking, excess body weight, decreased physical activity, and changes in reproductive activity. Health-promoting lifestyle is therefore one of the major topics of importance in studying chronic illnesses and cancer. Health promotion interventions, including the use of care models, have a vast contribution to make in terms of timely diagnosis and improved survival. One such care model, which has been designed to increase self-care, adherence, and performance in chronic patients, is the continuous care model (CCM). This study was conducted with the purpose of determining the influence of the CCM on the health-promoting lifestyle of patients with breast cancer during 2017-2018. In this randomized clinical trial, 60 patients with breast cancer were chosen by convenience sampling followed by random allocation into treatment and control groups. Six sessions of group discussion were held for the treatment group according to the CCM and items in the health-promoting lifestyle questionnaire. Data collection tools included a general health questionnaire, a demographic questionnaire, a family support questionnaire, and the Health Promoting Lifestyle Profile (HPLP), which respondents completed before and after the intervention. P values ≤ .05 were considered significant. When comparing the mean score of health-promoting lifestyle in both the control and treatment groups, before and after the intervention, significant increases in every dimension were observed. The average overall health promotion lifestyle was revealed to be significantly elevated from 123.48 to 147.12. However, in the control group the mean scores had slightly increased or were the same in all the dimensions. In addition, the average overall health promotion lifestyle had increased from 119.89 to 121.32. The observed difference in mean scores was not statistically significant. The CCM increased the score of health-promoting lifestyle of patients with breast cancer. Therefore, this caring model can be considered an alternative to improve healthy lifestyles of patients with cancer.

Association of Obesity-Related Genetic Variants (FTO and MC4R) with Breast Cancer Risk: A Population-Based Case-Control Study in Iran

Background:

Heterogeneous breast cancer is the most common cause of cancer-related mortality. Obesity defined by BMI is a known major risk factor for breast cancer.

Objectives:

The purpose of this study was to explore the role of obesity related-polymorphisms rs9939609 Fat Mass and Obesity-associated (FTO) and rs17782313 MC4R in breast cancer development.

Materials and Methods:

Matched peripheral blood serum was obtained from 64 breast cancer patients and 83 normal controls. Height and weight were measured to calculate BMI. All were genotyped for the SNPs rs9939609 and rs17782313 using a Tetra-primer ARMS-PCR method. For statistical analysis, the chi-square test and SPSS software were used.

Results:

In subgroup analyses defined by BMI, FTO rs9939609 genotypes (TT/AA/AT) were significantly associated with the risk of breast cancer only in non-obese subjects (p < 0.005). TT genotypes of MC4R rs17782313 in non-obese and genotypes TT/CC in the overweight group were also statistically associated with breast cancer (p &lt; 0.005). No significant associations between any variants and breast cancer risk were seen in obese subjects.

Conclusion:

Based on the absence of an association between obesity-related SNPs and breast cancer in obese subjects, it is proposed that weight gain in Iranian women will help prevent breast cancer risk. The result help for preparing and designing a safe and versatile recombinant drug in future.

Risk Assessment for Breast Cancer Development and Its Clinical Impact on Screening Performance in Iranian Women

Introduction

The aim of this study is to estimate the objective and subjective risk and to examine their associations with three forms of breast cancer screening.

Methods

This cross-sectional study was conducted with a sample of 800 women aged 35–85 years from the community setting and outpatient clinic in Babol, the north of Iran. The demographic, socio-economic characteristics and the risk factor profiles were collected through in-person interview. The health belief model (HBM) and visual analog scales were used to assess the women’s perceived risk of breast cancer. The practice of women regarding breast self-examination (BSE), breast clinical examination (BCE), and mammography were measured. We used the Gail model in estimating 5-year and lifetime risk. The logistic regression model was applied to determine the relationship of calculated and perceived risk on screening behaviors.

Results

The mean of estimated 5-year and lifetime risk were 0.89 ±0.89 and 8.87 ±3.84 percent respectively while the perceived personal risk on visual scale perception was much greater than the calculated risk. The high 5-year calculated risk was a predictor of mammography practice but not BSE and BCE; however, after adjusting the subscales of HBM and socio-demographic characteristics, its effect remained significant (adjusted OR=1.97(95% CI: 1.02–3.08)). The perceived risk from HBM in particular self-efficacy (p=0.001) remained positively significant on all forms of screening practice.

Conclusion

While the perceived risk from HBM scale was meaningful in screening performance, the calculated risk from the Gail model had a clinical impact on mammography behaviors independent of HBM scales.

Association of CYP1A1 M2 (A2455G) Polymorphism with Susceptibility to Breast Cancer in Mazandaran Province, Northern Iran: A Case-control Study

Background:

Breast cancer is one of the most frequent women malignancies in the world. The cytochrome P450 1A1 (CYP1A1) is a key enzyme in xenobiotics metabolism. Moreover, CYP1A1 plays a critical role in the etiology of breast cancer by involving in 2-hydroxylation of estrogen. Therefore, single-nucleotide polymorphisms (SNPs) of its coding gene have been verified to be important in cancer susceptibility. The aim of the study was to evaluate the association of CYP1A1 M2 (A2455G) includes rs1048943 of this SNP polymorphism with the risk of breast cancer in Mazandaran province.

Methods:

Ninety-six breast cancer patients with known clinicopathological characters and 110 healthy women as control were genotyped for CYP1A1 M2 polymorphisms by the restriction fragment length polymorphism technique.

Results:

The analysis of CYP1A1 gene (polymorphism M2) showed that the frequency of homozygous wild genotypes (AA), heterozygous (AG), and mutant genotype (GG) in the patient group, respectively, 78%, 22%, and 0%, and also the frequency of genotypes AA, AG, and GG in healthy included 82%, 16%, and 2%, respectively. Statistical analysis by Logistic regression model at P < 0.05 showed no significant correlation between polymorphisms in CYP1A1M2 and breast cancer risk (odds ratio = 0.84, confidence interval = 0.33–2.17).

Conclusions:

The results indicated that the M2 allelic genotypes were significantly associated neither with breast cancer risk nor with clinicopathological characteristics in Mazandaran province.

Nutrition knowledge, attitudes, and practice towards breast cancer prevention among the female population of Iran University of medical science students

Diet plays a measurable role in breast cancer (BC) prevention. The aims of this study were to assess nutrition-related BC prevention Knowledge, attitudes and practice (KAP) of female university students and to examine the relationship between demographic characteristics of students and their KAP. We conducted a cross-sectional study among 500 female students from Iran University of Medical Science (IUMS). A pretested self-administered questionnaires were used to assess the participants' nutrition-related BC prevention KAP. A total of 500 students completed the survey. Students' knowledge with the mean score of 16.97, significantly varied by age (P= 0.03), the field of study (P= 0.001) and family history of BC (P= 0.01). The mean score of attitudes and practice toward nutrition-related BC prevention factors were 24.86 and 39.39, respectively. A significant relationship was observed between nutrition knowledge and attitude (r = 0.27, P < 0.001). Also, Nutrition-related attitudes were positively correlated with the BC prevention dietary practices (r = 0.23, P < 0.001). Nutrition KAP about BC prevention factors was found to be influenced by individual factors such as age, field of study, familial history of BC, job and residency status. Together, our findings confirm that increasing nutrition knowledge is not sufficient for dietary behavior change, but is necessary.

Measurement of peripheral dose to the pelvic region and the associated risk for cancer development after breast intraoperative electron radiation therapy

This study aimed to measure the received dose to the pelvic region of patients during breast intraoperative electron radiation therapy (IOERT). Furthermore, we compared the findings with those of external beam radiation therapy. Finally, secondary ovarian and uterus cancer risks following breast IOERT were estimated. In the current study, the received dose to the pelvic surface of 18 female patients during breast IOERT boosts were measured by thermoluminescent dosimeter (TLD-100) chips. All patients were treated with 12 Gy given in a single fraction. To estimate the dose to the ovary and uterus of the patients, conversion coefficients for depth from the surface dose were obtained in a Rando phantom. Given the received dose to the pelvic region of the patients, secondary ovarian and uterus cancer risks following breast IOERT were estimated. The received doses to the ovary and uterus surface of the patients were 0.260 ± 0.155 mGy to 31.460 ± 6.020 mGy and 0.485 ± 0.122 mGy to 22.387 ± 15.476 mGy, respectively. Corresponding intra-pelvic (ovary and uterus) regional doses were 0.012 ± 0.007 mGy to 1.479 ± 0.283 mGy and 0.027 ± 0.001 mGy to 1.164 ± 0.805 mGy, respectively. Findings demonstrated that the ratio of the received dose by the pelvic surface to the regional dose during breast IOERT was much less than external beam radiation therapy. The mean of the secondary cancer risks for the ovary in 8 and 10 MeV electron beam energies were 135.722 ± 117.331 × 10^-6 and 69.958 ± 28.072 × 10^-6, and for the uterus were 17.342 ± 10.583 × 10^-6 and 2.971 ± 3.604 × 10^-6, respectively. According to our findings, the use of breast IOERT in pregnant patients can be considered as a safe radiotherapeutic technique, because the received dose to the fetus was lower than 50 mGy. Furthermore, IOERT can efficiently reduce the unnecessary dose to the pelvic region and lowers the risk of secondary ovarian and uterus cancer following breast irradiation.

Barriers to Breast Self-examination among Iranian Women

Background

Breast cancer is a very common cancer in women which is diagnosable using inexpensive, accessible, and easy screening programs in the early stages of the disease. Culture, beliefs, and opinions of women affect adoption of screening techniques. Nursing professionals are supposed to be aware of such influencing factors. Therefore, this study was conducted to investigate barriers to breast self-examination (BSE) among women in Isfahan province.

Materials and Methods

During a cross-sectional descriptive and correlational study in 2017, 1509 women in rural and urban areas of Isfahan province were selected using multistage sampling method. Data were collected by visiting homes, using a questionnaire, and conducting interviews and were analyzed using descriptive and analytical statistics.

Results

The results showed that barriers consisted of lack of awareness about breast examination (p = 0.006), lack of awareness about BSE techniques (p < 0.001), and lack of training by personnel of healthcare centers (p = 0.016), which were significantly associated with residency areas (i.e., urban and rural areas). Moreover, women's educational level was significantly associated with 5 of 10 barriers and their occupation was significantly associated with 2 of 10 barriers to BSE.

Conclusions

Among the several factors that may affect BSE, a part of them in Isfahan women act as obstacle that they are moderated by some demographic factors such as residency areas, education level, and occupation. Therefore, nursing plans and interventions aimed at developing BSE should be tailored to suit the unique demographic characteristics of women.

Evaluation of miRNA-9 and miRNA-34a as potential biomarkers for diagnosis of breast cancer in Iranian women

PURPOSE

MicroRNAs are involved in diverse biological processes and their dysregulation is a common event in various diseases including breast cancer. Breast cancer is a major threat to women's health. This study was designed to examine the expression levels of miR-9 and miR-34a in breast tumor tissue samples and plasma of breast cancer patients, compare their expression pattern between tissue samples and plasma samples of patients and analyze their relationship with tumor clinical features. Also, the potential of these miRNAs as diagnostic biomarkers for breast cancer was investigated.

MATERIALS AND METHODS

The expression levels of miR-9, miR-34a and CDH1 were measured by real-time reverse transcription polymerase chain reaction and ΔΔct method. Data were analyzed using t-test and one-way ANOVA. The sensitivity and specificity of miRNAs were determined by receiver operating characteristic (ROC) curve.

RESULTS AND DISCUSSION

The expression levels of miR-9 and miR-34a were significantly down-regulated in tumor tissues compared to healthy tissues (fold change = 0.26, p = 0.0051 for miR-9 and fold change = 0.55, p = 0.021 for miR-34a). While no significant difference was observed in the expression levels of miR-9 (p = 0.205) and miR-34a (p = 0.132) in plasma samples of patients compared to normal plasma. CDH1 expression in tumor tissue was not significantly different from normal tissue (p = 0.33). We found that expression level of miR-9 in patients with tumor size larger than 5 cm (p = 0.026) and expression level of miR-34a in patients with higher stage (lll & lV, p = 0.03) were significantly down-regulated. Also miR-34a expression level was positively correlated with patient's age (p = 0.03).

CONCLUSION

According to the ROC curves, the area under the curve (AUC) of miR-9 in tissue was 0.71 (p = 0.009) with sensitivity 83.33% and specificity 70.37%. The AUC for miR-34a in tissue was 0.72 (p = 0.007) with sensitivity 72% and specificity 76%. Thus miR-9 and miR-34a have the capability for distinguishing tumor tissues from healthy tissues and the study of their expression levels in tissue may be used as a biomarker for the diagnosis of breast cancer patients from healthy women.

Dietary patterns and breast cancer risk among Iranian women: A case-control study

AIM

Breast cancer is the most common cancer among women worldwide. Most previous studies focused on individual nutrients or foods rather than overall dietary patterns. We aimed to assess the association between major dietary patterns and breast cancer risk.

METHOD

In a hospital-based case-control study, 134 women diagnosed as breast cancer and 267 controls were recruited from referral hospitals in Tehran, Iran. Dietary intakes were evaluated by using a validated 168-item food frequency questionnaire. Dietary pattern were identified by factor analysis. Odds ratios (OR) were estimated using logistic regression.

RESULTS

Two dietary patterns were extracted: healthy and unhealthy. The "Healthy" dietary pattern was loaded for high consumptions of fruits, vegetables, seeds, legume, fish and sea foods, whole grains, liquid oils, olive oils and olive and lack of salt intake. "Unhealthy" dietary pattern was characterized by high factor loadings for sweets, soft drinks, mayonnaise, solid oils, processed meat, fried and boiled potato and salt intake. In multivariate logistic regression analyses, the healthy dietary pattern was not associated with breast cancer risk (OR: 0.83; 95%CI: 0.36, 1.89; P-trend = 0.50), while women in the highest quartile of the unhealthy dietary pattern had a significantly increased breast cancer risk (OR: 2.21; 95%CI: 1.04, 4.690; P-trend = 0.009). When stratified by menopausal status, unhealthy dietary pattern showed inverse association with breast cancer risk only among post-menopausal women (OR: 3.56; 95%CI: 1.16, 10.95; P-trend = 0.008).

CONCLUSIONS

Our findings showed that an unhealthy dietary pattern might be associated with higher risk of breast among Iranian women.

Impact of Delayed Adjuvant Radiotherapy in the Survival of Women with Breast Cancer

Objective Our objective was to determine whether a delay in adjuvant radiotherapy is related to a decrease in relapse-free survival and disease-specific survival of women with operable breast cancer. Methods Data on 1000 patients diagnosed with breast cancer were recorded. The cohort was divided into five groups according to the timing of radiotherapy: ≤30 days, 31 to 60 days, 61 to 90 days, 91 to 120 days, and >120 days. The relapse-free survival and disease-specific survival were also calculated in relation to the number of patients. Results This study found no statistical difference for delays in adjuvant radiotherapy in patients with early breast cancer, but we noted a statistical decrease in disease-specific survival in patients with locally advanced breast cancer receiving radiotherapy after a delay of at least 60 days. Conclusion Waiting times for radiotherapy should be as short as reasonably achievable, given the specific risk factors in the individual patient.

An infodemiology study on breast cancer in Iran

Purpose

According to the studies conducted in Iran, the breast cancer is the most frequent type of cancer among women. This study aimed to explore the state of health information supply and demand on breast cancer among Iranian medical researchers and Iranian Web users from 2011 to 2015.

Design/methodology/approach

A mixed method research is conducted in this study. In qualitative part, a focus group interview is applied to the users to identify their selected keywords searched for breast cancer in Google. The collected data are analyzed using Open Code software. In quantitative part, data are synthesized using the R software in two parts. First, users’ internet information-seeking behavior (ISB) is analyzed using the Google Trends outputs from 2011 to 2015. Second, the scientific publication behavior of Iranian breast cancer specialists are surveyed using PubMed during the period of the study.

Findings

The results show that the search volume index of preferred keywords on breast cancer has increased from 4,119 in 2011 to 4,772 in 2015. Also, the findings reveal that Iranian scholars had 873 scientific papers on breast cancer in PubMed from 2011 to 2015. There was a significant and positive relationship between Iranian ISB in the Google Trends and SPB of Iranian scholars on breast cancer in PubMed.

Research limitations/implications

This study investigates only the state of health information supply and demand in PubMed and Google Trends and not additional databases often used for medical studies and treatment.

Originality/value

This study provides a road map for health policymakers in Iran to direct the breast cancer studies.

Self-Confidence and Quality of Life in Women Undergoing Treatment for Breast Cancer

Introduction: Quality of life is an important topic in the study of chronic diseases, especially cancer which can have a major effect on patient self-confidence. This study was conducted to determine quality of life and its relationship with self-confidence in women undergoing treatment for breast cancer. Methods: This cross-sectional, descriptive, analytical study was conducted in 2016 on 166 women with breast cancer undergoing treatment at Ghazi, Al-Zahra, International and/or Shams hospitals in Tabriz. The subjects were selected through convenience sampling. A personal-demographic questionnaire, the Cancer Quality of Life Questionnaire (QLQ-C30), and the Rosenberg Self-Esteem Scale (RSES) were completed for each patient. The data obtained were analyzed using independent t-tests, one-way ANOVA, multivariate linear regression and Pearson’s correlation coefficients. Findings: The mean total score of quality of life was 59.1±17.4, ranging from 0 to 100. The highest mean score was obtained in the cognitive subscale (74.9±23.8) and the lowest in the emotional subscale (51.4±21.1). The mean score for self-confidence was 0.3 with a standard deviation of 0.1, ranging from -1 to +1. There was a significant positive relationship between self-confidence and quality of life, except in three symptom subscales for diarrhea, constipation and loss of appetite (P<0.05). Self-confidence, disease duration, lifestyle, marital satisfaction and caregiver status were among the predictors of quality of life. Discussion: Given the significant relationship between quality of life and self-confidence, health care providers may need to pay special attention to women undergoing treatment for breast cancer and perform timely measures to maintain their belief in themselves.

Isolation and characterization of the primary epithelial breast cancer cells and the adjacent normal epithelial cells from Iranian women's breast cancer tumors

As an experimental model, most studies rely on established human cancer cell lines; however, some genetical or phenotypical differences exist between these cells and their original tumor. Therefore, primary cells isolated directly from tissue are believed to be more biologically relevant tools for studying human and animal biology. Here, we aimed to isolate primary epithelial cancer and normal cells from breast tumors of Iranian women, for the first time. Thus, we isolated the epithelial and fibroblast cells from biopsy samples of patients with breast cancer based on differential centrifugation followed by culture in selective media. Normal epithelial cells obtained from the tissue biopsy away from the core of the tumor, based on the pathological diagnosis. Flow cytometry analysis indicated the positive immunoreactivity of the isolated epithelial cells against CD24 and Epithelial Specific Antigen (ESA/EpCAM), while they displayed a concomitant low expression of CD44 and CD49f. In contrat to fibroblasts, the qPCR data indicated the expression of luminal intracellular cytokeratin (Ck18) in both normal and cancer epithelial cells, but there was no expression of myoepithelial/basal markers, CK5 and vimentin. The epithelial cancer cells were reactive to cytokeratin 19 (CK19) antibody, whereas the normal epithelial cells were not. The expression of calmodulin-like protein (CLP) was also lower in the cancer epithelial cells than in the normal ones. In conclusion, primary epithelial normal and cancer cells, in addition to the fibroblasts were isolated and characterized from breast tumor of Iranian patients; and CLP expression is suggested as a susceptibility marker for breast cancer screening.

Alternative Splicing in Breast Cancer and the Potential Development of Therapeutic Tools

Alternative splicing is a key molecular mechanism now considered as a hallmark of cancer that has been associated with the expression of distinct isoforms during the onset and progression of the disease. The leading cause of cancer-related deaths in women worldwide is breast cancer, and even when the role of alternative splicing in this type of cancer has been established, the function of this mechanism in breast cancer biology is not completely decoded. In order to gain a comprehensive view of the role of alternative splicing in breast cancer biology and development, we summarize here recent findings regarding alternative splicing events that have been well documented for breast cancer evolution, considering its prognostic and therapeutic value. Moreover, we analyze how the response to endocrine and chemical therapies could be affected due to alternative splicing and differential expression of variant isoforms. With all this knowledge, it becomes clear that targeting alternative splicing represents an innovative approach for breast cancer therapeutics and the information derived from current studies could guide clinical decisions with a direct impact in the clinical advances for breast cancer patients nowadays.

Demographic Characteristics, Survival and Prognostic Factors of Early Breast Cancer Patients with Type 2 Diabetes Mellitus: A Hospital-Based Cohort Study

Objective: With increasing prevalence of type 2 diabetes mellitus and breast cancer in Iran, we aimed to search hospital registries of breast cancer patients to investigate type 2 diabetes mellitus association with survival outcomes of early breast cancer after adjustment of confounding factors. Methods: In a retrospective cohort study conducted from July 2003 to Feb 2014 and followed up until death or December 2016, female patients with early breast cancer who have been treated for the first time at the Cancer Institute of Iran, were divided to diabetic and non-diabetic groups. Primary and secondary outcomes were relapse free survival (RFS) and overall survival (OS). SPSS version 23 was used for analysis of data. Other variables included age, tumor stage, hormone receptor status, tumor subtype, and patient’s body mass index (BMI). Result: From a total of 1021 patients, 218 (21.4%) had type 2 diabetes mellitus. Diabetic patients had a higher mean age (53.31 vs 47.00), higher mean BMI (31.13 vs 29.15), lower HER2 expression (20.8% vs 32.1%) and higher frequency of luminal A subtype (61.1% vs 51.0). Overall, after adjustment of other variables, diabetes status did not affect RFS or OS independently. However, in luminal A subgroup, patients with diabetes mellitus had significantly lower survival outcomes of OS (135.277 vs 154.701) and RFS (114.107 vs 133.612) as well as OS higher hazard ratio of 1.830 and RFS hazard ratio of 1.663 compared to non-diabetic patients. BMI, hormone receptor status and tumor stage significantly affected the survival of the patients. Conclusion: In the present study, in addition to known breast cancer risk factors, BMI and type 2 diabetes mellitus had an independent impact on survival of the patients, highlighting the importance of health issues such as obesity and diabetes suboptimal performance in the treatment outcomes of early breast cancer patients in Iran.

Induction of Apoptosis in Human Breast Cancer MCF-7 Cells by a Semi-Synthetic Derivative of Artemisinin: A Caspase-Related Mechanism

Background: Artesunate has recently been used in some pharmacological preparation to induce tumor cell apoptosis. The drug is a semi-synthetic derivative of artemisinin, traditionally used for its antimalarial. However, up to now, its anticancer mechanism against different types of tumors is not known. Objectives: The most important purposes of the present research was firstly investigating induction of apoptosis on human breast cancer MCF-7 cells by the drug and, in the second place, introducing its possible mechanism of action. Materials and Methods: The MTT assay was used to investigate the inhibitory effect of artesunate on growth of breast cancer MCF-7 cells. For this aim, different concentrations of artesunate were used to treat the cells and flow cytometry assay was done followed by annexin V-FITC/PI staining. The activities of caspase-3, -8 and -9 were then determined by relative assay kits. Results: Based on the results from MTT assay, it was found that artesunate could significantly inhibit the growth of MCF-7 cells in a dose- and time-dependent manner. On the other hand, the flow cytometry findings showed that the anti-proliferative activity of artesunate on MCF-7 cells is due to apoptosis. Besides, caspase colorimetric assays revealed a significant rise in cellular levels of the initiators (caspase-8 and -9) and effector (caspase-3) in the cells treated by artesunate. Conclusions: According to our results, it could be concluded that artesunate could inhibit the growth of MCF-7 breast cancer cells through induction of apoptosis by intrinsic and extrinsic caspase-dependent pathways. Therefore, we claim that artesunate could be introduced as a suitable candidate for the treatment of the breast cancer.

Relationship of Social Determinants of Health with the Three-year Survival Rate of Breast Cancer

Background: Social determinants of health are among the key factors affecting the pathogenesis of diseases. Considering the increasingly high prevalence of breast cancer and the association of social determinants of health with its occurrence, related morbidity and mortality and survival rate, this study sought to assess the relationship of three-year survival rate of breast cancer with social determinants of health. Materials and Methods: This cohort study was conducted on males and females presenting to the Cancer Research Center of Shohada-E-Tajrish Hospital from 2006 to 2010 with definite diagnosis of breast cancer. Data were collected via phone interviews. Kaplan-Meier and Cox regression was fitted using SPSS (version 18) and PH assumption was tested by STATA (version 11) software. Results: The study was performed on 797 breast cancer patients, aged 25-93 years with mean age of 54.66 (SD=11.86) years. After 3 years from diagnosing cancer 700 (87.8%) patients were alive and 97 (12.2%) patients were dead. Using log rank test, there was relationship between 3-year survivals with age, education, childhood residence, sibling, treatment type, and district were significant (p<0.05). Using Cox PH regression, 3-year survival was related to age, level of education, municipal district of residence and childhood condition (p<0.05). Conclusion: Social determinants of health such as childhood condition, city region residency, level of education and age affect the three-year survival rate of breast cancer. Future studies must focus on the effect of childhood social class on the survival rates of cancers, which have been paid less attention to.

Breast cancer research in Iran: a scientometric analysis of publications output from 1991 to 2015 in Scopus

Introduction

As a common type of malignancy, breast cancer is one of the major causes of death in women globally. The purpose of the current study was to analyze Iran research performance on Breast Cancer in the context of national and international studies, shown in the publications indexed in Scopus database during 1991–2015.

Methods

Data were retrieved from the Scopus citation database in this scientometric study. The following string was employed; “breast cancer OR breast malignancy OR breast tumor OR mammary ductal carcinoma” keywords in the main title, abstract and keywords and Iran in the affiliation field were the main related keywords. The terms used were searched in Scopus using the tab specified for searching documents. Time span analyzed was 1991 to 2015 inclusive. Using the analyzing software of Scopus, we analyzed the results.

Results

Iran’s increasing publication production during 1991–2015 in breast cancer research which indexed in Scopus, consists of 2,399 papers with an average of 95.96 papers per year, and achieved an h-index of 48. Iranian cancer research articles have received 15,574 citations during 1991–2015, and average citations per paper were 6.49. Iran ranked 27th among the top 30 nations with a worldwide stake of 0.67 %, the 20 top publishing journals published 744 (31%) Iranian research articles on breast cancer, among them, there were 15 Iranian journals.

Conclusion

The number of Iranian research papers on breast cancer and also the number of citations to them, is increasing. Although the quantity and quality of papers are increasing, regarding the prevalence of breast cancer in Iran and also the ineffectiveness of screening programs in the early detection of the cases, more effort should be made, and Iranian policy makers should consider more investment on breast cancer research.

Breast and cervical cancer-screening uptake among females in Ardabil, northwest Iran: a community-based study

PURPOSE

Breast and cervical cancers are the most commonly diagnosed type of cancer and cause of cancer-related deaths in Iranian females. In contrast to previous studies, this study was carried out with a large sample size for assessment of breast self-examination (BSE)-, clinical breast examination (CBE)-, mammography-, and Pap smear-uptake rates and determination of associations among these screening behaviors with sociodemographic and cognitive variables in Azeri females.

MATERIALS AND METHODS

This was a cross-sectional, community-based study that was carried out among 1,134 females 20-60 years old during March-June 2016. Data-collection variables included sociodemographic questions, screening behaviors for breast and cervical cancer, self-efficacy, beliefs, and barriers to breast and cervical cancer screening. Collected data were analyzed by SPSS version 13 using χ2, Mann-Whitney U, and logistic regression tests.

RESULTS

Among the 1,134 participants, 53.9%, 9.8%, and 28.1% had done BSE, CBE, and Pap smear tests, respectively, and among the 625 females aged >40 years, 187 (29.9%) had done the mammography test. Moreover, 416 (36.7%), 103 (16.5%), and 64 (5.6%) females had done BSE, mammography, and CBE regularly, respectively. Beliefs, barriers, income, health insurance, number of children, and age were all important factors for BSE and regular BSE and mammography. Females who had high belief scores were more likely to undertake mammography (odds ratio [OR]: 1.2, 95% confidence interval [CI]: 1.03-1.5), regular mammography (OR: 4.2, 95% CI: 1.9-9.3), regular CBE (OR: 1.25, 95% CI: 1.2-1.3), and Pap smears (OR: 1.2, 95% CI: 1.1-1.4). Also, females who had high self-efficacy scores were more likely to perform regular BSE (OR: 1.8, 95% CI: 1.4-2.5) and mammography (OR: 2.5, 95% CI: 1.4-4.6) than females with lower self-efficacy scores.

CONCLUSION

The frequency of breast and cervical cancer screening was low in our study. The findings of this study indicated that beliefs, self-efficacy, and barriers were important predictive factors of cancer-screening behavior among the females studied.

Survival Rates for Breast Cancer in Iranian Patients: a Meta- Analysis

BACKGROUND

Breast cancer is the most common cancer among Iranian women. Since development of the disease in Iranian women occurs relatively early, the survival rate matters considerably. In different countries, survival of breast cancer patients varies considerably. Therefore, the one-year, three-year, five-year, and ten- year survival rates for breast cancer in Iran were assessed using a meta-analysis.

MATERIALS AND METHODS

This systematic review and meta-analysis was based on valid Iranian sources including SID, MAGIRAN and IRANMEDEX, along with reliable English databases, namely, PUBMED and SCOPUS. In domestic databases, a search was conducted based on key words of breast cancer and survival rate, and in international databases, with "breast cancer" and the equivalent of "neoplasm" of Mesh Word, "survival rate" and "Iran. " Then all reviewed papers and theses which met the inclusion criteria were selected for investigation. To conduct the analysis STATA 11.2 software and random-effects models were used.

RESULTS

In 24 studies, 22,745 participants were included. The one-year, three-year, five-year and ten-year survival rates were 0.956, 0.808, 0.695 and 0.559, respectively. The minimum and maximum survival rates for 5-years were 0.48 and 0.87. The average age of the onset of the disease was 48.3.

CONCLUSIONS

As in Iran, since the onset of the disease is at low age, in spite of the relatively high survival rate as compared to other cancers, prevention and screening programs at early age for early stage diagnosis seems necessary.

Survival Analysis of Patients with Breast Cancer using Weibull Parametric Model

BACKGROUND

The Cox model is known as one of the most frequently-used methods for analyzing survival data. However, in some situations parametric methods may provide better estimates. In this study, a Weibull parametric model was employed to assess possible prognostic factors that may affect the survival of patients with breast cancer.

MATERIALS AND METHODS

We studied 438 patients with breast cancer who visited and were treated at the Cancer Research Center in Shahid Beheshti University of Medical Sciences during 1992 to 2012; the patients were followed up until October 2014. Patients or family members were contacted via telephone calls to confirm whether they were still alive. Clinical, pathological, and biological variables as potential prognostic factors were entered in univariate and multivariate analyses. The log-rank test and the Weibull parametric model with a forward approach, respectively, were used for univariate and multivariate analyses. All analyses were performed using STATA version 11. A P-value lower than 0.05 was defined as significant.

RESULTS

On univariate analysis, age at diagnosis, level of education, type of surgery, lymph node status, tumor size, stage, histologic grade, estrogen receptor, progesterone receptor, and lymphovascular invasion had a statistically significant effect on survival time. On multivariate analysis, lymph node status, stage, histologic grade, and lymphovascular invasion were statistically significant. The one-year overall survival rate was 98%.

CONCLUSIONS

Based on these data and using Weibull parametric model with a forward approach, we found out that patients with lymphovascular invasion were at 2.13 times greater risk of death due to breast cancer.

14-bp Insertion/Deletion Polymorphism of the HLA-G gene in Breast Cancer among Women from North Western Iran

BACKGROUND

The human leukocyte antigen-G (HLA-G) gene is highly expressed in cancer pathologies and is one strategy used by tumor cells to escape immune surveillance. A 14-bp insertion/deletion (InDel) polymorphism of the HLA-G gene has been suggested to be associated with HLA-G mRNA stability and the expression of HLA-G. The aim of present study was to assess any genetic association between this polymorphism and breast cancer among Iranian-Azeri women.

MATERIALS AND METHODS

In this study 227 women affected with breast cancer, in addition to 255 age-sex and ethnically matched healthy individuals as the control group, participated. Genotyping was performed using polymerase chain reaction and electrophoresis assays. The data were compiled according to the genotype and allele frequencies, compared using the Chi-square test. Statistical significance was set at P<0.05.

RESULTS

In this case-control study, no significant difference was found between the case and control groups at allelic and genotype levels, although there is a slightly higher allele frequency of HLA-G 14bp deletion in breast cancer affected group. However,when the stage I subgroup was compared with stage II plus stage III subgroup of affected breast cancer, a significant difference was seen with the 14 bp deletion allele frequency. The stage II-III subgroup patients had higher frequency of deletion allele (57.4% vs 45.8%) than stage I cases (χ2=4.16, p-value=0.041).

CONCLUSIONS

Our data support a possible action of HLA-G 14bp InDel polymorphism as a potential genetic risk factor for progression of breast cancer. This finding highlights the necessity of future studies of this gene to establish the exact role of HLA-G in progression steps of breast cancer.