Breast cancer incidence trends in Golestan, Iran: An age-period-cohort analysis by ethnic region, 2004-2018

BACKGROUND

We aimed to examine the effects of age, diagnosis year (calendar period) and birth year (cohort) on the incidence trends of breast cancer among Golestan women, Northeast Iran, 2004-2018.

METHODS

Incidence data were obtained by residential status (urban/rural) and ethnic region (Turkmens/non-Turkmens). We calculated age-standardized incidence rates (ASRs) per 100,000 person-years. The estimated annual percentage change (EAPC) were calculated, and age-period-cohort (APC) models fitted to assess non-linear effects of period and cohort as incidence rate ratios (IRRs).

RESULTS

The total number of female breast cancer cases in Golestan, 2004-2018, were 3853, with an overall ASR of 31.3. We found higher rates in urban population (40.5) and non-Turkmens region (38.5) compared to rural area (20.8) and Turkmens region (20.2), respectively. There were increasing trends in incidence rates overall (EAPC= 4.4; 95%CI: 2.2, 6.7), with greater changes in rural areas (EAPC=5.1), particularly among non-Turkmens (EAPC=5.8). The results of the APC analysis indicate the presence of significant non-linear cohort effects with increasing IRRs across successive birth cohorts (IRR=0.1 and IRR= 2.6 for the oldest and the youngest birth cohorts vs. the reference birth cohort, respectively).

CONCLUSION

We found increasing trends in breast cancer incidence among Golestan women over the study period, with disparities in patterns and trends by residence area and ethnic region. The observed cohort effects suggest an increasing prevalence of key risk factors for breast cancer in this Iranian population. Further investigations are warranted to clarify the relationships between determinants such as reproductive factors and ethnicity in the region.

Colorectal cancer incidence trends in Golestan, Iran: An age-period-cohort analysis 2004-2018

BACKGROUND

We investigated the effects of factors including age, birth year (cohort) and diagnosis year (period) on colorectal cancer (CRC) incidence trends in Golestan, Northeast of Iran, 2004-2018.

METHODS

We obtained data on incidence cases of CRC from the Golestan Population-based Cancer Registry by sex and area of residence (urban/rural). Age-standardized incidence rates (ASRs) were calculated using the World standard population and presented per 100,000 person-years. We calculated the estimated annual percentage change (EAPC) with 95 % confidence intervals (95 % CI) fitted age-period-cohort (APC) models to assess non-linear period and cohort effects as incidence rate ratios (IRRs).

RESULTS

Overall, 2839 new cases of CRC (ASR = 13.7) were registered in the GPCR over 2004-2018. Our findings suggested significantly increasing trends in CRC incidence rates from 2004 to 2018 (EAPC = 3.7; 95%CI: 0.4, 7.1), with the greatest changes occurring in rural women (EAPC= 4.7; 95%CI: 0.4, 9.2). We observed a strong cohort effect with a consistent increase in the IRR across successive birth cohorts, starting with the oldest birth cohort (1924) (IRR= 0.1 versus the reference birth cohort of 1955) through to the most recent cohort born in 1983 (IRR= 1.9). The largest cohort effects were found among rural females (IRR = 0.0, and IRR = 2.5 for the oldest and the youngest birth cohorts vs. the reference birth cohort, respectively).

CONCLUSION

The increasing trends in CRC rates in Golestan are largely driven by generational changes in exposure to underlying risk factors. Further investigations are warranted to deliver effective prevention strategies for the control of CRC in Golestan.

Esophageal and gastric cancer incidence trends in Golestan, Iran: An age-period-cohort analysis 2004 to 2018

Golestan province in the northeast of Iran is part of the Asian esophageal cancer belt and is known as a high-risk area for esophageal (EC) and gastric cancers (GC). Data on incident cases of EC and GC during 2004 to 2018 were obtained from the Golestan Population-based Cancer Registry (GPCR). The age-standardized incidence rates (ASRs) were calculated and presented per 100 000 person-years. The estimated annual percentage change (EAPC) with 95% confidence interval (95% CI) were calculated. We also fitted age-period-cohort (APC) models to assess nonlinear period and cohort effects as incidence rate ratios (IRRs). Overall, 3004 new cases of EC (ASR = 15.7) and 3553 cases of GC (ASR = 18.3) were registered in the GPCR. We found significant decreasing trends in incidence rates of EC (EAPC = -5.0; 95% CI: -7.8 to -2.2) and less marked nonsignificant trends for GC (EAPC = -1.4; 95% CI: -4.0 to 1.4) during 2004 to 2018. There was a strong cohort effect for EC with a consistent decrease in the IRR across successive birth cohorts, starting with the oldest birth cohort (1924; IRR = 1.9 vs the reference birth cohort of 1947) through to the most recent cohort born in 1988 (IRR = 0.1). The marked declines in EC incidence rates in Golestan relate to generational changes in its underlying risk factors. Despite favorable trends, this population remains at high risk of both EC and GC. Further studies are warranted to measure the impact of the major risk factors on incidence with a view to designing effective preventative programs.

Idiopathic true aneurysm of the proximal radial artery with the appearance of an enlarging mass: A case report

INTRODUCTION AND IMPORTANCE

Aneurysm of the radial artery is one of the rare cases in the field of vascular surgery, and its diagnosis and management is one of the challenges in this era. Without proper diagnosis and treatment, it may affect the patient's lifestyle and reduce the quality of life because of pain and limitation in activity. Importantly, it may cause limb or life threatening complications including arterial thromboembolism and aneurysm rupture.

CASE PRESENTATION

A 50-year-old woman was presented with a true proximal right radial artery aneurysm with the manifestation of an enlarging mass since 2 years ago, which had gradually become painful. The radiologic investigations revealed the presence of an aneurysm in the proximal radial artery. The patient underwent surgery consisting of ligation of the radial artery proximal and distal to the aneurysm and excision of the aneurysm sac. Pathologic examination confirmed the diagnosis.

CLINICAL DISCUSSION

Any enlarging mass in the pathways of arterial branches can be arterial aneurysm, even if not pulsatile. Prompt physical examination and imaging modalities can help for diagnosis and decision making for either segmental arterial resection or vascular reconstruction.

CONCLUSION

Radial artery aneurysm, as a rare but potentially devastating arterial disease should be in differential diagnosis of any forearm mass and managed promptly.

Early prediction of renal parenchymal injury with serum procalcitonin

INTRODUCTION

Urinary tract infection (UTI) is one of the most common bacterial infections in children that can be associated with renal parenchymal injuries and late scars. Dimercaptosuccinic acid (DMSA) renal scan is known as golden standard for detecting acute pyelonephritis (APN) that has a lot of difficulties and limitations.

OBJECTIVES

we designed this study the accuracy of one inflammatory marker, serum procalcitonin (PCT) to identify as an early predictor of renal injuries.

PATIENTS AND METHODS

A prospective study was carried out in 95 patients who admitted in the hospital with the first febrile UTI. Serum PCT of all patients was measured; sensitivity, specificity, positive and negative predictive value (PPV and NPV) of this marker was analyzed compared to DMSA scan. P value <0.05 was taken as significant.

RESULTS

In total, 79 females and 16 males were investigated. There are 42 cases in group 1 with normal DMSA scan and 53 patients in group two with renal parenchymal injuries in their scans. Mann-Whitney test showed a meaningful relation between the two groups regarding PCT level (P<0.0001). Sensitivity, specificity, PPV and NPV of PCT reported in optimum cut off were 70%, 88.1%, 88.1% and 70%, respectively. The positive likelihood ratio (PLR) of PCT test was 5.8.

CONCLUSION

In the current survey, PCT was the eligible inflammatory marker to predict renal parenchymal injuries in children with proper sensitivity, specificity, PPV and NPV that play also a pivotal role in the children aged less than 24 months, although, more studies should be undertaken to confirm.

Human papilloma virus 16/18 genotypes in patients with squamous cell carcinoma of cervix in northeast Iran

Background:

A relation has been established between infection with high-risk types of human papilloma virus (HPV) and development of cervical cancer. To estimate the risk of HPV infection for cervical malignancies, we conducted a case-control study in northeast Iran.

Materials and Methods:

This study was carried out on 123 paraffin embedded blocks with exact diagnosis of squamous cell carcinoma (SCC). A total of 100 cervical tissue specimens with normal histopathology product of hysterectomy were also used as control. Both groups were tested for the presence of HPV DNA and HPV 16/18 subtypes using PCR assay.

Results:

Large non-keratinising subtype of cervical carcinoma was the most frequent one (62.6%), followed by keratinising and small cell subtypes (27% and 10%, respectively). Overall prevalence of HPV infection in SCC of cervix was 34.2% (42 out of 123 cases). HPV 16 was the most common type in this group (21 cases, 17.1%), followed by HPV 18 (16 cases, 13%) and other subtypes (5 cases, 4.1%). In this study, overall prevalence of HPV infection in control group was 12% (including 3% HPV 16; 5% HPV 18 and 4% other subtypes).

Conclusion:

Although association of HPV 16/18 and SCC of cervix was relatively higher than control group, compared with the previous study, the association between cervical SCC and HPV infection was significantly lower in our study; and possibly, the other risk factors play a major role in carcinogenesis of cervical carcinoma in this region.