Do Clinical Features and Survival of Single Hormone Receptor Positive Breast Cancers Differ from Double Hormone Receptor Positive Breast Cancers?

The significance of the single hormone receptor positive phenotype of breast cancer is still poorly understood.The use of hormone therapy has been found to be less effective for this type, which has a survival outcome midwaybetween double positive and double negative phenotypes. The aim of this study was to investigate differencesin patient and tumor characteristics and survival between double-receptor positive (ER+PR+), double receptornegative (ER-PR-) and single receptor positive (ER+PR- and ER-PR+) breast cancer in an Asian setting. Atotal of 1,992 patients with newly diagnosed stage I to IV breast cancer between 2003 and 2008, and whereinformation on ER and PR were available, were included in this study. The majority of patients had ER+PR+tumors (n=903: 45.3%), followed by 741 (37.2%) ER-PR-, 247 (12.4%) ER+PR-, and 101 (5.1%) ER-PR+ tumors.Using multivariate analysis, ER+PR- tumors were 2.4 times more likely to be grade 3 compared to ER+PR+tumors. ER+PR- and ER-PR+ tumors were 82% and 86% respectively less likely to be grade 3 compared withER-PR- tumors. ER-PR+ tumours were associated with younger age. There were no survival differences betweenpatients with ER+PR+ and ER-PR+ tumors. However, ER+PR- tumors have poorer survival compared withER+PR+ tumours. ER-PR- tumours had the worst survival. Adjuvant hormonal therapy with tamoxifen wasfound to have identical survival advantage in patients with ER+PR+ and ER-PR+ tumors whereas impact wasslightly lower in patients with ER+PR- tumors. In conclusion, we found ER+PR- tumors to be more aggressiveand have poorer survival when compared to ER+PR+ tumors, while patients with ER-PR+ tumours were younger,but had a similar survival to their counterparts with ER+PR+ tumours.     

Survival Analysis of 2003-2005 Data from the Population-based Cancer Registry in Macao

Aim: Macao Cancer Registry was established in 2003. It is population-based and has been collecting cancerreports from all possible settings where pathological and management services are available. To get a betteridea over the prognosis and survival of all and major cancer sites, a survival analysis was here performed toestimate the relative survival rates of cancers diagnosed and registered during 2003 to 2005 with a follow-up ofvital status till 31 Dec, 2008. Methods: 3,244 cancer cases diagnosed and registered during 2003-2005 in MacaoCancer Registry were considered for analysis. Cases of in-situ carcinoma, extreme age and poor data quality weredeliberately excluded, leaving 2,623 newly diagnosed cancers eligible. Vital status of registered cases through 31December 2008 was confirmed by matching with death certificates and review from the Hospital InformationSystem (HIS) of the only public hospital. Observed survival rates were calculated using a Life Table method,and relative survival rates were examined using an algorithm written in SAS by Paul Dickman with minoradaptations. Apart from general relative survival rates, specific rates by sex and age strata were also estimated.Results: 3-year and 5-year relative survival rates of all cancers were 61% and 56% respectively for both sexes;(54% and 47%, respectively, for males and 68% and 64%for females). The 3-year relative survival rates formajor cancer sites ranged from 21% to 90%, with lung cancer showing the lowest and female breast cancer thehighest. 5-year relative survival rates for major cancer sites ranged from 18% to 85%, with liver cancer showingthe lowest and again female breast cancer the highest. Female cancer patients had higher relative survival thanmales across the 5-year follow up period, with a sex difference of nearly 15%. Conclusion: Comparison of survivalrates from this first trial in Macao, deriving survival statistics from population-based cancer registration, withother Asian countries/cities, like Taiwan, Singapore and Japan, showed Macao and Taiwan to have the closestestimates for 3-year relative survival. Random variation was found to exist in the stratification of sex and age incertain cancer sites due to scarce case numbers in the subgroups. It is important to note that the 3-year survivalrates are relatively more consistent and reliable than 4-year or 5-year ones. Promotion of reporting cancerstage by physicians as well as improvement in data quality of cancer registration are essential to allow furtherinformative statistics derived from the cancer registry with reference to cancer prevention.     

Knowledge,Attitude and Practice of Breast Self-examination Among Women in a Suburban Area in Terengganu,Malaysia

Introduction: Breast cancer is the most frequently diagnosed cancer in Malaysian women, irrespective ofage group and ethnicity. The observed low survival rates are related to late stage at presentation despite theavailability of breast self examination (BSE) as a reliable screening method for early detection. Materials andMethods: This cross-sectional study was designed to determine the knowledge, attitude and practice towardsBSE amongst women aged 15 years old and above. Systemic random sampling was applied and informationgathered through guided interview by using a structured questionnaire. Results: A total of 86 respondents wererecruited, with a mean age of 40.5 years (SD: 15.51), more than 80% having a secondary or tertiary level ofeducation. The total score was 16.9 (total mean percent: 60.4%) for knowledge, 37.1 (77.3%) for attitude and9.56 (34.1%) for practice. The proportions of respondents with good score for knowledge, attitude and practicewere 38.4%, 73.3% and 7.0%, respectively. Not knowing the correct method of BSE, lack of knowledge on cancersigns and lack of motivational support from parents, spouse or friends appeared to be related with the poorpractices. Conclusion: Enhancement of breast cancer awareness and focusing on recognized barriers by healthcare professionals with the involvement of spouses, family and community would have a substantial beneficialimpact on BSE practice.     

Endometrial Cancer in Thai Women: Clinico-pathological Presentation and Survival

Objective: To assess the characteristic features, treatment, survival, and prognostic factors of Thai endometrialcancer (EMC) patients. Methods: Clinico-pathological data of EMC patients who were treated in the institutionfrom 1992 to 2008 were collected. Survival rates and prognostic factors were studied. Results: The mean age ofthe 261 patients was 55.4 ± 9.92 years. The most common complaint was abnormal uterine bleeding (87.3%).More than half (75.4%) had other medical illnesses or other cancers (10.7%). The majority (78%) had earlystage disease. Post-operative adjuvant therapy was given in 41.4%; the most common was radiation therapy(37.2%). From a median follow-up of 57.5 months (range 0.03-212.3 months), progressive disease was encounteredin 16 patients. Eighteen experienced recurrence (three local, 13 distant metastases and two local and distant).Overall, 30 patients died of cancer, while 18 died of other medical illnesses. The 5-year progression-free, cancerspecific, and overall survivals (95% confidence intervals) were 86.5% (82.1-90.8%), 88.0% (83.9-92.2%), and83.6% (78.7-88.4%), respectively. Significant prognostic factors for survival were: histology, grade, depthof myometrial invasion, cervical involvement, lymphovascular invasion, lymph node status, and Her-2/ neuexpression. Conclusion: Most endometrial cancer patients in Thailand present at early stages and experiencegood survival outcomes.     

Women’s Knowledge,Attitudes, and Practices about Breast Cancer in a Rural District of Central India

Background: Breast cancer accounted for almost 25% of all cancers in women globally in 2012. Althoughbreast cancer is the most prevalent cancer in India, there is no organised national breast cancer screeningprogramme. Local studies on the burden of breast cancer are essential to develop effective context-specificstrategies for an early detection breast cancer programme, considering the cultural and ethnic heterogeneityin India. This study examined the knowledge, attitudes, and practices about breast cancer in rural women inCentral India. Materials and Methods: This community-based cross sectional study was conducted in Wardhadistrict, located in Maharashtra state in Central India in 2013. The sample included 1000 women (609 rural,391 urban) aged 13-50 years, selected as representative from each of the eight development blocks in the district,using stratified cluster sampling. Trained social workers interviewed women and collected demographic andsocio-economic data. The instrument also assessed respondents’ knowledge about breast cancer and its symptoms,risks, methods of screening, diagnosis and treatment, as well as their attitudes towards breast cancer and selfreportedpractices of breast cancer screening. Chi-square and t-test were applied to assess differences in the levelsof knowledge, attitude, and practice (the outcome variables) between urban and rural respondents. Multivariablelinear regression was conducted to analyse the relationship between socio-demographic factors and the outcomevariables. Results: While about two-thirds of rural and urban women were aware of breast cancer, less than7% in rural and urban areas had heard about breast self-examination. Knowledge about breast cancer, itssymptoms, risk factors, diagnostic modalities, and treatment was similarly poor in both rural and urban women.Urban women demonstrated more positive attitudes towards breast cancer screening practices than their ruralcounterparts. Better knowledge of breast cancer symptoms, risk factors, diagnosis, and treatment correlatedsignificantly with older age, higher levels of education, and being office workers or in business. Conclusions:Women in rural Central India have poor knowledge about breast cancer, its symptoms and risk factors. Breastself-examination is hardly practiced, though the willingness to learn is high. Positive attitudes towards screeningprovide an opportunity to promote breast self-examination.     

Perceived Family Support of Women with Breast Cancer and Affecting Factors in Turkey

Background: The purpose of this study was to examine the percieved family support of the women with breastcancer and the affecting factors. Methods: The subjects were breast cancer cases undergoing treatment (n=240).The sample for this study was formed by women who accepted participation, were in the facility between thedates and hours when the study was applied, and who were selected with a nonprobability sampling technique(n=120). Results: Two thirds of the women with breast cancer were in the 40-59 age group. The lowest scorewomen with breast cancer for perceived family support scale was 0.00, and the highest was 40.0, with a mean of30.1 ±8.85. Conclusion: In this study, it was determined that perceived family support of Turkish women withbreast cancer was reasonable.     

Increased Risk of Breast Cancer in Multiparous and Lactating Women Attending A Breast Care Clinic in Pakistan: A Paradigm Shift?

Aims and Objectives: A changing paradigm shift with multiparity (MP) and breast feeding (BF) has beenreported in recent years in breast cancer (BC). Our aim was to observe associations of parity, BF and other riskfactors with BC among a local population attending a breast care clinic. Materials and methods: A total of 1,039women (mean age 39 ± 15 years) attended for screening or presented with palpable breast lumps at KIRAN,Pakistan. The majority were in middle and low socioeconomic strata. As per American Cancer Society (ACS)guidelines 2003, mammography and ultrasound were performed, along with fine needle aspiration cytology(FNAC) in 195 women with Breast Imaging Reporting and Data Set (BIRADS) IV/V, high risk patients withBIRADS III on mammography and with suspicious ultrasound findings. Results: The study population wasstratified into two groups; one with BC on FNAC in 181 women (17% p<0.001) and other including 858 healthywomen after screening for cancer. The BC group had relative predominance of MP (86% p<0.001), BF (85%p<0.001), family history FH (8% p=0.106) and post-menopause PM (49% p<0.001) as compared to the healthypopulation. Estimated relative risk (RR) of BC in women with MP, BF, F/H and PM was 3.12 (95% CI=2.05-4.73; p <0.001), 2.47 (95%CI=1.69-3.61; p<0.001), 1.45 (95%CI=0.93-2.41; p=1.06) and 2.33 (95%CI=1.70-3.02;p<0.001) respectively. Higher incidence of BC was observed between 30-40 years 23% (p<0.001) and between40-50 years 38% (p<0.001). Conclusion: MP, BF and PM have significant associations with BC in the studiedPakistani women and this possible paradigm shift now needs to be evaluated for confounding factors.     

How Do Adolescents Assess and Rank the Risk of Areca Nut Use? Findings from a Study in Mumbai,India

Objective: Areca nut use, along with tobacco, is a contributor to India’s high rates of oral cancer. Areca nut use is culturally accepted, often initiated early in adolescence, and said to lead to later tobacco use. Unlike tobacco prevention, there are scarce prevention or harm-reduction programmes or campaigns specifically targeted at areca nut. Methods: A participative ranking method was used to understand adolescents’ assessment of risks of areca nut. Five focus group discussions were conducted with 31 adolescents, 19 fe-male and 12 male, non-users and users of chewing tobacco, water-pipe (hookah) and areca nut. Participants categorized and ranked the risk of 16 activities, including the use of areca nut and various tobacco-products, and discussed reasons for these risk-rankings. Results: Despite differences between groups on the assessment of risks associated with the 16 different activities, all the groups, user and non-user, rated cigarette smoking as having the highest risk, chewing fennel and using mouth fresheners as no risk, and areca nut as low risk. The other activities were ranked differently by each group. Adolescents’ perceptions of smoking or online games as risky was influenced by greater exposure to messaging on harmful consequences of the activity through multiple channels such as mass media, interpersonal networks including parents, and classroom health-education sessions. Inadequate knowledge about the harmful consequences of areca nut use, greater social and cultural acceptability, and the sweet taste of commercially packaged areca nut influenced low-risk perceptions. Conclusion: Perceptions of risk from an activity often determines preventive behaviors. Presently, adolescents do not perceive areca use as risky. In comparison to smoking they con-sider it less harmful. More research is required to better understand areca nut use and its cul-tural determinants. However, targeted health communication messages and prevention poli-cies and programmes have to be initiated to reduce areca nut use and associated burden of oral cancer.     

Women and Tobacco Use: Discrepancy in the Knowledge,Belief and Behavior towards Tobacco Consumption among Urban and Rural Women in Chhattisgarh,Central India

Background: Tobacco consumption has become pandemic, and is estimated to have killed 100 million peoplein the 20th century worldwide. Some 700,000 out of 5.4 million deaths due to tobacco use were from India. Theera of global modernization has led to an increase in the involvement of women in tobacco consumption in thelow income and middle-income countries. Tobacco consumption by females is known to have grave consequences.Objectives: To assess: (1) the tobacco use among urban and rural women; (2) the discrepancy in the knowledge,belief and behavior towards tobacco consumption among urban and rural women in Durg-Bhilai Metropolitan,Chhattisgarh, Central India. Materials and Methods: The study population consisted of 2,000 18-25 year oldyoung women from Durg-Bhilai Metropolitan, Chhattisgarh, Central India, from both urban and rural areas.Data were collected using a pretested, anonymous, extensive face to face interview by a female investigator toassess the tobacco use among women and the discrepancy in the knowledge, belief and behavior towards tobaccoconsumption among urban and rural individuals. Results: The prevalence of tobacco use was found to be 47.2%.Tobacco consumption among rural women was 54.4% and in urban women was 40%. The majority of the womenfrom urban areas (62.8%) were smokers whilst rural women (77.4%) showed preponderance toward smokelesstobacco use. Urban women had a better knowledge and attitude towards harms from tobacco and its use thanthe rural women. Women in rural areas had higher odds (1.335) of developing tobacco habit than the urbanwomen. Conclusions: Increased tobacco use by women poses very severe hazards to their health, maternal andchild health, and their family health and economic well-being. Due to the remarkably complex Indian pictureof female tobacco use, an immediate and compulsory implementation of tobacco control policies laid down byt he WHO FCTC is the need of the hour.     

Does Life Expectancy Affect Treatment of Women Aged 80 and Older with Early Stage Breast Cancers?

BACKGROUND: Data are needed on how life expectancy affects treatment decisions among women ≥80 years with early stage breast cancer. METHODS: We used the linked Surveillance Epidemiology and End Results-Medicare claims dataset from 1992-2005 to identify women aged ≥80 newly diagnosed with lymph node negative, estrogen receptor positive tumors, ≤5 centimeters. To estimate life expectancy, we matched these women to women of similar age, region, and insurance, not diagnosed with breast cancer. We examined 5-year mortality of matched controls by illness burden (measured with the Charlson Comorbidity Index [CCI]) using Kaplan-Meier statistics. We examined treatments received by estimated life expectancy within CCI levels. We further examined factors associated with receipt of radiotherapy after breast conserving surgery (BCS). RESULTS: Of 9,932 women, 39.6% underwent mastectomy, 30.4% received BCS plus radiotherapy, and 30.0% received BCS alone. Estimated 5-year mortality was 72% for women with CCIs of 3+, yet 38.0% of these women underwent mastectomy and 22.9% received radiotherapy after BCS. Conversely, estimated 5-year mortality was 36% for women with CCIs of 0 and 26.6% received BCS alone. Age 80-84, urban residence, higher grade, recent diagnosis, mammography use, and low comorbidity, were factors associated with receiving radiotherapy after BCS. Among women with CCIs of 3+ treated with BCS, 36.9% underwent radiotherapy. CONCLUSIONS: Many women aged ≥80 with limited life expectancies receive radiotherapy after BCS for treatment of early stage breast cancers while many in excellent health do not. More consideration needs to be given to patient life expectancy when considering breast cancer treatments. KEY WORDS: Breast cancer, older women, treatment, life expectancy, radiation.     

Global DNA Methylation in Precancerous and Cancerous Lesions of the Uterine Cervix

Introduction: Persistent human papillomavirus (HPV) infection is the primary causal agent in the developmentof the uterine cervix carcinoma. Nevertheless, only a minority of high-risk HPV-associated lesions progressto cervical cancer, suggesting involvement of other molecular alterations. Among putative changes, aberrantmethylation might be a crucial event. Design: Paraffin-embedded samples of benign lesions, cervical intraepithelialneoplasia (CIN) and invasive squamous cell carcinomas (SCC) were analyzed for DNA 5-methylcytosine contentby immunohistochemistry with anti-5-methylcytosine antibodies and by high-performance liquid capillaryelectrophoresis (HPCE). Results: No significant difference of DNA 5-methylcytosine content was observed betweennormal tissues, benign lesions, low-grade lesions and high-grade lesions (p=0.6). In contrast, DNAs extractedfrom invasive SCC were hypomethylated when compared with normal and preneoplastic lesions (p=0.0004). Anassociation between global DNA hypomethylation and the SCC stage was confirmed by HPCE. Conclusions: Thetransition from CIN lesions to invasive carcinoma seems to be closely linked to global DNA hypomethylation,which could be a useful marker of invasive uterine cervical lesions.     

Long-term Survival Outcomes of Primary Breast Cancer in Women With or Without Preoperative Magnetic Resonance Imaging: A Matched Cohort Study

Aims

To investigate whether preoperative magnetic resonance imaging (MRI) in patients with primary breast cancer is predictive of disease-free (DFS) and overall survival and to determine the prognostic factors indicating survival.

The Effect of Education on the Early Diagnosis of Breast and Cervix Cancer on the Women’s Attitudes and Behaviors Regarding Participating in Screening Programs

The objective of this paper was to define the effect of education on the early diagnosis of breast and cervix cancer on the women?s attitudes and behaviors regarding participating in Cancer Early Diagnosis, Screening and Training Centers-CEDSTC screening programs. This semi-experimental study was completed with 342 women. The data were collected with forms “Champion’s Health Belief Model Scale Breast Cancer-HBMSBC” and “Health Belief Model Scale for Cervical Cancer and the Pap Smear Test-HBMSCCPST.” When the women’s health beliefs before and after 6 months of the education about the early diagnosis of breast and cervical cancers are considered, it is seen that the HBMSBC subscales health motivation, breast self-examination (BSE), and evasion to mammography (MMG) decreased and BSE self-efficacy and MMG benefit attitudes increased and HBMSCCPST subscales pap smear benefit attitudes increased and evasion to pap smear attitude decreased (p < 0.05). Six months after the education, 28.4% of the women had undergone MMG, 69.9% had performed BSE, and 33.6% had undergone a pap smear test. Education regarding early diagnosis of breast and cervix cancer was found to have positive effects on the health behaviors of the women related to BSE, MMG, and pap smear tests. The women require professional education program for increasing their attitudes and behaviors for CEDSTC screening programs. We suggest regularly providing education to increase participation in early screening programs.     

Prognostic Significance of Mesenchymal–Epithelial Transition in Triple-Negative Breast Cancers

Introduction

The prognostic value of the mesenchymal–epithelial transition (MET) in triple-negative breast cancers (TNBCs) remains controversial. A meta-analysis of the impact of MET in TNBCs was performed by searching published data.

Treatment Outcomes and Prognostic Factors in Male Patients With Stage IV Breast Cancer: A Population-based Study

Purpose

Male breast cancer (MBC) represents < 1% of breast cancer patients, and limited data exists regarding metastatic MBC. To better characterize this patient subset, we performed a population-based study examining prognostic factors among patients with stage IV MBC.

Are Women in Kuwait Aware of Breast Cancer and Its Diagnostic Procedures?

The aim of this study was to examine the knowledge and awareness of women in Kuwait with regard to risk factors, symptoms and diagnostic procedures of breast cancer. A total of 521 questionnaires were distributed among women in Kuwait. Results showed that 72% of respondents linked breast cancer factors to family history, while 69.7% scored abnormal breast enlargement as the most detectable symptom of the disease. Some 84% of participants had heard about self-examination, but knowledge about mammograms was limited to 48.6%and only 22.2% were familiar with diagnostic procedures. Some 22.9% of respondents identified the age over 40 years as the reasonable age to start mammogram screening. Risk factor awareness was independent on age groups (p>0.05), but both high education and family history increased the likelihood of postivie answers; the majority knew about a few factors such as aging, pregnancy after age 30, breast feeding for short time, menopause after age of 50, early puberty, and poor personal hygiene. In conclusion, 43.1% of participants had an overall good knowledge of breast cancer with regards to symptoms, risk factors and breast examination. Very highly significant associations (p<0.005) were evident for all groups except for respondents distributed by nationality(p=0.444). Early campaigns for screening the breast should be recommended to eliminate the confusion of wrong perceptions about malignant mammary disease.