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Elhatw A, Chung HL, Kamal RM, De Jesus C, Jean S, Vishwanath V, Ferreira Dalla Pria HR, Patel MM, Guirguis MS, Moseley TW. Advanced Breast Imaging Modalities — DBT, CEM, MBI, PEM, MRI, AI. Curr Breast Cancer Rep 2023. [DOI: 10.1007/s12609-023-00483-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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Kamal RM, Mostafa S, Salem D, ElHatw AM, Mokhtar SM, Wessam R, Fakhry S. Body mass index, breast density, and the risk of breast cancer development in relation to the menopausal status; results from a population-based screening program in a native African-Arab country. Acta Radiol Open 2022; 11:20584601221111704. [PMID: 35795247 PMCID: PMC9252007 DOI: 10.1177/20584601221111704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/17/2022] [Indexed: 12/04/2022] Open
Abstract
Background Risk factors are traits or behaviors that have an influence on the development of breast cancer (BC). Awareness of the prevalent risk factors can guide in developing prevention interventions. Purpose To evaluate the correlation between the breast density, body mass index, and the risk of breast cancer development in relation to the menopausal status in a native African-Arab population. Material and methods The study included 30,443 screened females who were classified into cancer and non-cancer groups and each group was further sub-classified into pre- and postmenopausal groups. The breast density (BD) was reported and subjectively classified according to the 2013 ACR BI-RADS breast density classification. The weight and height were measured, and the body mass index (BMI) was calculated and classified according to the WHO BMI classification. Results A statistically significant difference was calculated between the mean BMI in the cancer and non-cancer groups (p: .027) as well as between the pre- and postmenopausal groups (p < .001). A positive statistically insignificant correlation was calculated between the breast density and the risk of breast cancer in the premenopausal group (OR: 1.062, p: .919) and a negative highly significant correlation was calculated in the postmenopausal group (OR: 0.234, p < .001). Conclusion BMI and BD are inversely associated with each other. The current studied population presented unique ethnic characteristics, where a decreased BD and an increased BMI were found to be independent risk factors for developing breast cancer.
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Affiliation(s)
- Rasha M Kamal
- Department of Radiology, Cairo University – Baheya Breast Cancer Foundation, Giza, Egypt
| | - Salma Mostafa
- Department of Radiology, Cairo University, Giza, Egypt
| | - Dorria Salem
- Department of Radiology, Cairo University, Giza, Egypt
| | - Ahmed M ElHatw
- Resident of Radiology, National Cancer Institute, Cairo, Egypt
| | | | - Rasha Wessam
- Department of Radiology, Cairo University – Baheya Breast Cancer Foundation, Giza, Egypt
| | - Sherihan Fakhry
- Department of Radiology, Cairo University – Baheya Breast Cancer Foundation, Giza, Egypt
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Elghazaly H, Aref AT, Anderson BO, Arun B, Yip CH, Abdelaziz H, Ghosn M, Al-Foheidi M, Cardenosa G, Leung JWT, Gado N, Balch CM, Sabry M, Ezz Elarab L, Giuliano AE, El-Zawahry HM, Abdel Karim K, Nasr A, Maki H, Chung H, Saadeddin A, Abdelwahab MM, Al Tahan FM, Chalabi N, Frolova M, Kamal RM, Shehata MA, Bahie Eldin N, Elghazawy H. The first BGICC consensus and recommendations for breast cancer awareness, early detection and risk reduction in low- and middle-income countries and the MENA region. Int J Cancer 2021; 149:505-513. [PMID: 33559295 DOI: 10.1002/ijc.33506] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/14/2021] [Accepted: 01/22/2021] [Indexed: 01/31/2023]
Abstract
In low-middle income countries (LMICs) and the Middle East and North Africa (MENA) region, there is an unmet need to establish and improve breast cancer (BC) awareness, early diagnosis and risk reduction programs. During the 12th Breast, Gynecological & Immuno-oncology International Cancer Conference - Egypt 2020, 26 experts from 7 countries worldwide voted to establish the first consensus for BC awareness, early detection and risk reduction in LMICs/MENA region. The panel advised that there is an extreme necessity for a well-developed BC data registries and prospective clinical studies that address alternative modalities/modified BC screening programs in areas of limited resources. The most important recommendations of the panel were: (a) BC awareness campaigns should be promoted to public and all adult age groups; (b) early detection programs should combine geographically distributed mammographic facilities with clinical breast examination (CBE); (c) breast awareness should be encouraged; and (d) intensive surveillance and chemoprevention strategies should be fostered for high-risk women. The panel defined some areas for future clinical research, which included the role of CBE and breast self-examination as an alternative to radiological screening in areas of limited resources, the interval and methodology of BC surveillance in women with increased risk of BC and the use of low dose tamoxifen in BC risk reduction. In LMICs/MENA region, BC awareness and early detection campaigns should take into consideration the specific disease criteria and the socioeconomic status of the target population. The statements with no consensus reached should serve as potential catalyst for future clinical research.
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Affiliation(s)
- Hesham Elghazaly
- Clinical Oncology Department, Ain shams University, Cairo, Egypt
| | - Adel T Aref
- School of Public health, University of Adelaide, Adelaide, Australia
| | - Benjamin O Anderson
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington, USA
| | - Banu Arun
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cheng-Har Yip
- Subang Jaya Medical Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Hany Abdelaziz
- Clinical Oncology Department, Ain shams University, Cairo, Egypt
| | - Marwan Ghosn
- Hematology and Oncology Department, Saint Joseph University, Beirut, Lebanon
| | - Meteb Al-Foheidi
- Princess Noorah Oncology Center/College of Medicine, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Gilda Cardenosa
- Wake Forest Baptist Medical Center, Winston Salem, North Carolina, USA
| | - Jessica W T Leung
- Breast Imaging Department, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nivine Gado
- Clinical Oncology Department, Ain shams University, Cairo, Egypt
| | - Charles M Balch
- Surgical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mohamed Sabry
- Clinical Oncology Department, Ain shams University, Cairo, Egypt
| | - Lobna Ezz Elarab
- Clinical Oncology Department, Ain shams University, Cairo, Egypt
| | - Armando E Giuliano
- Surgical Oncology Division, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Heba M El-Zawahry
- Medical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | | | - Azza Nasr
- Radiotherapy Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Hussein Maki
- Khartoum Oncology Specialized Center, Khartoum, Sudan
| | - Hannah Chung
- Breast Imaging Department, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ahmed Saadeddin
- King Abdullah Specialized Children's Hospital, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | | | | | - Nivine Chalabi
- Radiology Department, Ain Shams University, Cairo, Egypt
| | - Mona Frolova
- NN Blokhin National Medical Research Center of Oncology, Moscow, Russia
| | - Rasha M Kamal
- Radiology Department, Cairo University, Cairo, Egypt
| | - Mohamed A Shehata
- Clinical Oncology Department, Menoufia University, Shebin Elkom, Egypt
| | | | - Hagar Elghazawy
- Clinical Oncology Department, Ain shams University, Cairo, Egypt
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Kamal RM, Helal MH, Mansour SM, Haggag MA, Nada OM, Farahat IG, Alieldin NH. Can we apply the MRI BI-RADS lexicon morphology descriptors on contrast-enhanced spectral mammography? Br J Radiol 2016; 89:20160157. [PMID: 27327403 DOI: 10.1259/bjr.20160157] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: To assess the feasibility of using the MRI breast imaging reporting and data system (BI-RADS) lexicon morphology descriptors to characterize enhancing breast lesions identified on contrast-enhanced spectral mammography (CESM). METHODS: The study is a retrospective analysis of the morphology descriptors of 261 enhancing breast lesions identified on CESM in 239 patients. We presented the morphological categorization of the included lesions into focus, mass and non-mass. Further classifications included (1) the multiplicity for "focus" category, (2) the shape, margin and internal enhancement for "mass" category and (3) the distribution and internal enhancement for "non-mass" category. Each morphology descriptor was evaluated individually (irrespective of all other descriptors) by calculating its sensitivity, specificity, positive-predictive value (PPV) and negative-predictive value (NPV) and likelihood ratios (LRs). RESULTS: The study included 68/261 (26.1%) benign lesions and 193/261 (73.9%) malignant lesions. Intensely enhancing foci, whether single (7/12, 58.3%) or multiple (2/12, 16.7%), were malignant. Descriptors of "irregular"-shape (PPV: 92.4%) and "non-circumscribed" margin (odds ratio: 55.2, LR positive: 4.77; p-value: <0.001) were more compatible with malignancy. Internal mass enhancement patterns showed a very low specificity (58.0%) and NPV (40.0%). Non-mass enhancement (NME) was detected in 81/261 lesions. Asymmetrical NME in 81% (n = 52/81) lesions was malignant lesions and internal enhancement patterns indicative of malignancy were the heterogeneous and clumped ones. CONCLUSION: We can apply the MRI morphology descriptors to characterize lesions on CESM, but with few expectations. In many situations, irregular-shaped, non-circumscribed masses and NME with focal, ductal or segmental distribution and heterogeneous or clumped enhancement are the most suggestive descriptors of malignant pathologies. ADVANCES IN KNOWLEDGE: (1) The MRI BI-RADS lexicon morphology descriptors can be applied in the characterization of enhancing lesions on CESM with a few exceptions. (2) Multiple bilateral intensely enhancing foci should not be included under the normal background parenchymal enhancement unless they are proved to be benign by biopsy. (3) Mass lesion features that indicated malignancy were irregular-shaped, spiculated and irregular margins and heterogeneous internal enhancement patterns. The rim enhancement pattern should not be considered as a descriptor of malignant lesions unless CESM is coupled with an ultrasound examination.
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Affiliation(s)
- Rasha M Kamal
- 1 Women's Imaging Unit, Department of Radiology, Kasr ElAiny Hospital, Cairo University, Egypt
| | - Maha H Helal
- 2 Women's Imaging Unit, Department of Radiology, National Cancer Institute, Cairo University, Egypt
| | - Sahar M Mansour
- 1 Women's Imaging Unit, Department of Radiology, Kasr ElAiny Hospital, Cairo University, Egypt
| | - Marwa A Haggag
- 2 Women's Imaging Unit, Department of Radiology, National Cancer Institute, Cairo University, Egypt
| | - Omniya M Nada
- 2 Women's Imaging Unit, Department of Radiology, National Cancer Institute, Cairo University, Egypt
| | - Iman G Farahat
- 3 Department of Pathology, National Cancer Institute, Cairo University, Egypt
| | - Nelly H Alieldin
- 4 Department of Biostatistics and Cancer Epidemiology, National Cancer Institute, Cairo University, Egypt
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El-Bassyouni HT, Afifi HH, Eid MM, Kamal RM, El-Gebali HH, El-Saeed G, Thomas MM, Abdel-Maksoud SA. Oxidative Stress -a Phenotypic Hallmark of Fanconi Anemia and Down Syndrome: The Effect of Antioxidants. Ann Med Health Sci Res 2015; 5:205-12. [PMID: 26097763 PMCID: PMC4455011 DOI: 10.4103/2141-9248.157511] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: Oxidative stress plays a major role in the pathogenesis of leukemia-prone diseases such as Fanconi anemia (FA) and Down syndrome (DS) Aim: To explore the oxidative stress state in children with DS and FA by estimating the levels of antioxidants (e.g., malondialdehyde [MDA], total antioxidant capacity, and superoxide dismutase [SOD] activity) and DNA damage, and to evaluate of the effect of antioxidant treatment on these patients. Subjects and methods The study included 32 children clinically diagnosed with (15 patients) and FA (17 patients) in addition to 17 controls matched for age and sex. MDA, total antioxidant capacity, SOD activity, and DNA damage were measured. Antioxidants including Vitamin A, E, and C were given to the patients according to the recommended daily allowance for 6 months. Clinical follow-up and re-evaluation were conducted for all patients. Laboratory tests including complete blood count, karyotyping, DNA damage, and oxidative stress were re-evaluated. Statistical analysis was performed using statistical computer program Statistical Package for the Social Sciences version 14.0. Results: Children with FA and DS had elevated levels of oxidative stress and more DNA damage than controls. Oxidative stress parameters and DNA damage improved in FA and DS patients after antioxidant administration. Conclusion: Early administration of antioxidants to FA and DS patients is recommended for slowing of the disease course with symptoms amelioration and improvement of general health.
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Affiliation(s)
- H T El-Bassyouni
- Department of Clinical Genetics, National Research Centre, Cairo, Egypt
| | - H H Afifi
- Department of Clinical Genetics, National Research Centre, Cairo, Egypt
| | - M M Eid
- Department of Human Cytogenetics, National Research Centre, Cairo, Egypt
| | - R M Kamal
- Institute of Postgraduate Childhood Studies, Ain Shams University, Cairo, Egypt
| | - H H El-Gebali
- Institute of Postgraduate Childhood Studies, Ain Shams University, Cairo, Egypt
| | - Gsm El-Saeed
- Department of Medical Biochemistry, National Research Centre, Cairo, Egypt
| | - M M Thomas
- Department of Clinical Genetics, National Research Centre, Cairo, Egypt
| | - S A Abdel-Maksoud
- Department of Clinical Pathology, National Research Centre, Cairo, Egypt
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Afifi HH, El-Ruby MO, El-Bassyouni HT, Ismail SI, Aglan MS, El-Harouni AA, Mazen IM, Zaki MS, Bassiouni RI, Hosny LA, El-Kamah GY, El-Kotoury AI, Ashour AM, Abdel-Salam GM, El-Gammal MA, Hamed K, Kamal RM, El-Nekhely I, Temtamy SA. The most encountered groups of genetic disorders in Giza Governorate, Egypt. BRATISL MED J 2010; 111:62-69. [PMID: 20429316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This study presents the prevalence, relative frequency, and analysis of genetic diseases/malformations in 73260 individuals. Cases included were ascertained from: Pediatric outpatient clinics of two governmental hospitals and two primary health care centers (PHCCs) in Giza Governorate; Neonatal intensive care unit (NICU) in the selected hospitals and Outpatients Human Genetics Clinics (NRC). 62819 persons visited the outpatients clinics of selected hospitals and PHCCs in Giza governorate. Out of these persons 731 cases (1.16%) proved to have known genetic disorders or malformations. 7755 neonates were delivered in the selected hospitals. Out of these neonates 666 newborns entered NICU and 3% (20 neonates) of them had genetic or congenital disorders. Also, 2686 patients were ascertained from the Human Genetics Clinics, NRC. The overall parental consanguinity rate among the 3417 diagnosed cases was 55%, ranging from 29.5-75%. The study showed a high prevalence of genetic/malformation disorders among Egyptians, with frequencies comparable to other Arab populations (Tab. 4, Ref. 25). Full Text (Free, PDF) www.bmj.sk.
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Affiliation(s)
- H H Afifi
- Clinical Genetics Department, Human Genetics and Genome Research Division, National Research Centre, Cairo, Egypt.
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Kamal RM, Abdel Razek NM, Hassan MA, Shaalan MA. Missed breast carcinoma; why and how to avoid? J Egypt Natl Canc Inst 2007; 19:178-194. [PMID: 19190691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Introduction : Despite the advances in mammography techniques, it still has a number of limitations. It is estimated that about 10 to 25% of lesions are overlooked in mammograms out of which about two thirds are detected retrospectively by radiologists and oncologists. Causes of missed breast cancer on mammography can be secondary to many factors including those related to the patient (whether inherent or acquired), the nature of the malignant mass itself, poor mammographic techniques, provider factors or interpretive skills of radiologists and oncologists (including perception and interpretation errors). Aim of Work : The aim of this study is to investigate the aforementioned factors hindering early breast cancer detection and in turn lowering mammographic sensitivity and to outline the major guidelines to overcome these factors aiming to an optimum mammographic examination and interpretation by radiologists and oncologists. Subject and Methods : We conducted this multicenter study over a two-year interval. We included 152 histopathologicaly proven breast carcinomas that were initially missed on mammography. The cases were subjected to mammography, complementary US, MRI and digital mammography in some cases and all cases were histopathologically proven either by FNAB, CNB or open biopsy. Results : Revision of the pathological specimens of these 152 cases revealed 121 infiltrating ductal carcinomas, 2 lobular, 4 mucinous, 14 inflammatory carcinomas, 6 carcinomas in situ (3 of which were intracystic), 2 intraductal papillary carcinomas and 3 cases with Paget's disease of the nipple. In analyzing the causes responsible for misdiagnosis of these carcinomas we classified them into 4 causative factors; patient, tumor, technical or provider factors. Tumor factors were the most commonly encountered, accounting for 44.1%, while provider factors were the least commonly encountered in 14.5 %. Carcinomas were detected using several individual or combined complementary techniques. These techniques mainly included double reading, additional mammography views, ultrasound and MRI examinations. Forty four carcinomas were detected on double and re-reading by more experienced radiologists. Additional mammographic views were recommended in 35 (23%) cases. Complementary ultrasound examination was performed for all 152 cases (100%) and showed a higher sensitivity than mammography in carcinoma detection. It was diagnostic in 138 (90.8%) cases only. In the remaining 14 cases, further MRI and biopsy were performed. Conclusion : Why can breast carcinoma be missed? Four main factors are responsible for missing a carcinoma: (1) Patient factors (Inherently dense breasts or acquired dense breasts). (2) Tumor factors (subtle carcinoma, masked carcinoma, multifocal carcinoma and multicentric carcinoma). (3) Technical factors (bad exposure factors, malpositioned breasts and bad processing quality). (4) Provider factors (bad perception and misinterpretation). How to avoid missing a breast carcinoma? Review clinical data and use US and other adjunct techniques as MRI and biopsy to assess a palpable or mammographically detected mass. Be strict about positioning and technical factors. Try to optimize image quality. Be alert to subtle features of breast cancers. Always consider the well defined carcinoma. Compare current images with multiple prior studies to look for subtle increases in lesion size. Look for other lesions when one abnormality is seen. Judge a lesion by its most malignant features. Double reading and the use of computer aided diagnosis (CAD) and finally FFDM (Full Field Digital Mammography). Close cooperation between the oncologist, radiologist and pathologist is essential to avoid missing any case of breast carcinoma. Key Words : Missed breast carcinoma -Mammography - Ultrasonography -MRI.
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Affiliation(s)
- Rasha M Kamal
- The Departments of Radiodiagnosis, Cairo University and General Surgery, National Cancer Institute
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Affiliation(s)
- M M Saleh
- National Research Centre and Arab Drug Co., Cairo
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