Association between 5’-UTR and 3’-UTR Polymorphisms of the TYMS Gene and Breast Cancer in Kurdish Women of Iraq

Breast cancer is a common cancer found among women worldwide. Many polymorphisms can play a role in the development of this disease. The study was conducted to evaluate whether 2R/3R and 6bp insertion/deletion polymorphisms of the TYMS gene are associated with breast cancer risk in the Kurdish Iraqi population. Materials and Methods: DNA was extracted from EDTA-treated peripheral blood samples and included 100 patients affected by breast cancer and 100 controls. Genotyping was performed by PCR-electrophoresis. Results: Our results showed a significant association between 6bp deletion homozygote genotype in breast cancer patients compared to healthy individuals (P = 0.042). No significant differences were observed for other allelic and genotypic frequencies. Conclusion: This study, performed for the first time on the Kurdish population, highlighted the need for further studies of the TYMS gene polymorphisms.     

吸烟和环境烟草烟雾暴露与女性肺癌的关系的病例──对照研究

在上海市区进行了女性肺癌病例—对照研究中共调查新病例649例，对照675例。资料分析表明各种组织学类型肺癌都与吸烟有联系．其中鳞癌和小细胞癌与吸烟关系非常密切．OR分别为5.6和9．9，吸烟使腺癌危险性略有增加，OR=1.195％可信阳=0.7～1.7,吸烟对肺癌总的相对危险度为2.4（95％可信限=1.8～3.3）。各类肺癌的危险性均随每日吸烟量的增加、吸烟年限的延长和开始吸烟年龄的提前而增加。鳞癌和小细胞癌危险性上升速度最快，腺癌危险性增加缓慢，且趋势不显著。本研究还发现工作环境中的环境烟草烟雾暴露使女性非吸烟者肺癌危险性增加到1.5倍，95％可信限=1．1～2.0。未发现儿童期父母吸烟和成年期丈夫吸烟增加女性非吸烟者肺癌危险性。     

Trastuzumab‐Related Cardiotoxicity in Early Breast Cancer: A Cohort Study

Background.

Concerns have been raised about the cardiac safety profile of trastuzumab for the adjuvant treatment of early stage breast cancer in clinical practice. We assessed trastuzumab-related cardiotoxicity and its predictors in a large cohort of Italian women.

Methods.

Through a record linkage between four regional health care databases, we identified the rate of severe cardiac adverse events among women treated with trastuzumab for early breast cancer in Lombardy. The cumulative risk of cardiotoxicity was estimated using the Kaplan-Meier method, and independent predictors were assessed using the Cox model.

Results.

Of 2,046 trastuzumab users, 53 (2.6%) experienced at least one hospitalization for a cardiac event, and there were two cardiac deaths. The cumulative risk of cardiotoxicity increased up to 2 years after starting treatment, reaching a plateau at 2.8%. The risk was low (0.2%) among young women, whereas the incidence was approximately 10% in women aged ≥70 years, irrespective of cardiovascular risk factors. Age and history of cardiac disease were strong predictors of cardiotoxicity, with a hazard ratio of 11.3 (95% confidence interval [CI]: 3.5–36.6) for women aged ≥70 years as compared with those <50 years of age. Hazard ratio was 4.4 (95% CI: 2.1–9.5) for women with a history of cardiac disease compared with those without a history of cardiac disease.

Conclusions.

Cardiotoxicity of trastuzumab varies considerably across subgroups of patients. The long-term safety profile was less favorable than in the largest clinical trial. Strategies to reduce cardiotoxicity in high-risk women should be investigated.     

Tobacco Smoking and Risk of Second Primary Lung Cancer

IntroductionLung cancer survivors are at high risk of developing a second primary lung cancer (SPLC). However, SPLC risk factors have not been established and the impact of tobacco smoking remains controversial. We examined the risk factors for SPLC across multiple epidemiologic cohorts and evaluated the impact of smoking cessation on reducing SPLC risk.MethodsWe analyzed data from 7059 participants in the Multiethnic Cohort (MEC) diagnosed with an initial primary lung cancer (IPLC) between 1993 and 2017. Cause-specific proportional hazards models estimated SPLC risk. We conducted validation studies using the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (N = 3423 IPLC cases) and European Prospective Investigation into Cancer and Nutrition (N = 4731 IPLC cases) cohorts and pooled the SPLC risk estimates using random effects meta-analysis.ResultsOverall, 163 MEC cases (2.3%) developed SPLC. Smoking pack-years (hazard ratio [HR] = 1.18 per 10 pack-years, p < 0.001) and smoking intensity (HR = 1.30 per 10 cigarettes per day, p < 0.001) were significantly associated with increased SPLC risk. Individuals who met the 2013 U.S. Preventive Services Task Force’s screening criteria at IPLC diagnosis also had an increased SPLC risk (HR = 1.92; p < 0.001). Validation studies with the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial and European Prospective Investigation into Cancer and Nutrition revealed consistent results. Meta-analysis yielded pooled HRs of 1.16 per 10 pack-years (p_meta < 0.001), 1.25 per 10 cigarettes per day (p_meta < 0.001), and 1.99 (p_meta < 0.001) for meeting the U.S. Preventive Services Task Force’s criteria. In MEC, smoking cessation after IPLC diagnosis was associated with an 83% reduction in SPLC risk (HR = 0.17; p < 0.001).ConclusionsTobacco smoking is a risk factor for SPLC. Smoking cessation may reduce the risk of SPLC. Additional strategies for SPLC surveillance and screening are warranted.     

Association between Smokeless Tobacco Use and Waterpipe Smoking and the Risk of Lung Cancer: A Systematic Review and Meta-Analysis of Current Epidemiological Evidence

Background: Smokeless tobacco and waterpipes are used by hundreds of millions of people worldwide and consumption rates exceed that of cigarette smoking in much of South East Asia and parts of the Middle East. However, the cancer risks of these methods of tobacco consumption are less well-characterized than those of cigarette smoking. The objective of this study was to systematically review the epidemiological evidence on the association between smokeless tobacco use and waterpipe smoking and lung cancer risk. Methods: The MEDLINE, EMBASE, Web of Science and OpenSIGLE databases were searched to identify eligible case-control and cohort studies (published before 1st December 2020 in any language) that adjusted for cigarette smoking or included non-cigarette smokers only. Summary odds ratio/relative risk estimates and confidence intervals were extracted, and pooled risk ratios (RRs) for lung cancer were calculated using random effects meta-analysis. Results: The literature search identified 2,465 publications: of these, 26 studies including 6,903 lung cancer patients were included in the synthesis (20 studies of smokeless tobacco use, five of waterpipe smoking, one of both). Our results suggest that smokeless tobacco use is associated with an increased risk of lung cancer among non-cigarette smokers, and that betel quid tobacco may be particularly hazardous. The random effects meta-analysis showed that exclusive use of any type of smokeless tobacco (pooled RR = 1.53, 95%CI 1.09 – 2.14), betel quid chewing (pooled RR = 1.77, 95%CI 1.06 – 2.95), and waterpipe smoking (pooled RR = 3.25, 95%CI 2.01 – 5.25) were significantly associated with an increased risk of lung cancer. Conclusions: This meta-analysis of case-control/cohort studies supports the hypothesis that use of smokeless tobacco and waterpipe smoking is associated with increased risk of developing lung cancer. Considering the widespread and increasing use of smokeless tobacco in developing countries, and increasing prevalence of waterpipe smoking in almost all societies, these findings inform formulation of public health policy, legislation and tobacco control measures at national and international level to increase awareness and decrease the prevalence of smokeless tobacco use and waterpipe smoking.     

Cost analysis of the National Breast and Cervical Cancer Early Detection Program: selected states, 2003 to 2004

BACKGROUND.

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) was established by the U.S. Congress in 1990. In recent years, there has been an emphasis on ascertaining the NBCCEDP's costs of delivering screening and diagnostic services to medically underserved, low‐income women. The objective of this report was to address 3 economic questions: What is the cost per woman served in the program, what is the cost per woman served by program component, and what is the cost per cancer detected through the program?

METHODS.

The authors developed a questionnaire to systematically collect activity‐based costs on screening for breast and cervical cancer from 9 participating programs. The questionnaire was developed based on well established methods of collecting cost data for program evaluation. Data were collected from July 2003 through June 2004.

RESULTS.

With in‐kind contributions, the cost of screening services to women in 9 programs was estimated at $555 per woman served. Without in‐kind contributions, this cost was $519. Among the program components, screening and coalitions/partnerships accounted for the highest and lowest cost per woman served, respectively. The median cost of screening a woman for breast cancer was $94, and the cost per breast cancer detected was $10,566. For cervical cancer, these costs were $56 and $13,340, respectively.

CONCLUSIONS.

Costs per woman served, screened, and cancers detected are needed for programs to accurately determine the resources required to reach and screen eligible women. With limited program resources, these cost estimates can provide useful information to assist programs in planning and implementing cost‐effective activities that could maximize the allocation of program resources. Cancer 2008. Published 2007 by the American Cancer Society     

Screening for Lung Cancer in Individuals Who Never Smoked: An International Association for the Study of Lung Cancer Early Detection and Screening Committee Report

Screening with low-dose computed tomography of high-risk individuals with a smoking history reduces lung cancer mortality. Current screening guidelines and eligibility criteria can miss more than 50% of lung cancers, and in some geographic areas, such as East Asia, a large proportion of the missed lung cancers are in never-smokers. Although randomized trials revealed the benefits of screening for people who smoke, these trials generally excluded never-smokers. Thus, the feasibility and effectiveness of lung cancer screening of individuals who never smoked are uncertain. Several known and suspected risk factors for lung cancers in never-smokers such as exposure to secondhand smoke, occupational carcinogens, radon, air pollution, and pulmonary diseases, such as chronic obstructive pulmonary disease and interstitial lung diseases, and intrinsic factors, such as age, are well noted. In this regard, knowledge of risk factors may make possible quantification and prediction of lung cancer risk in never smokers. It is worth considering if and how never smokers could be included in population-based screening programs. As the implementation of these programs is challenging in many countries owing to multiple factors and the epidemiologic differences by global regions, these issues will need to be evaluated in each country taking into account various factors, including accuracy of risk assessment and cost-effectiveness of screening in never smokers. This report aims to outline current knowledge on risk factors for lung cancer in never smokers to propose research strategies for this topic and initiate a broader discussion on lung cancer screening of never smokers. Similar considerations can be made in current and ex-smokers, which do not fulfill the current screening inclusion criteria, but otherwise are at increased risk. Although screening of never smokers may in the future be effectively conducted, current evidence to support widespread implementation of this practice is lacking.     

Sexual Quality of Life of Breast Cancer Survivors: A Cross-Sectional Study

Aim: Sexual quality of life (SQL), one of the essential issues of sexual and reproductive health, negatively affects the overall quality of life. This study aimed to investigate the SQL of breast cancer survivors. Methods: In this cross-sectional study, 410 breast cancer survivors were recruited in a two-stage sampling process. The quota sampling method was employed in the first stage, and convenience sampling was used in the second stage between December 2020 and September 2021. The data were collected using the sexual Quality of Life–Female, Female Sexual Function Index, Revised Religious Attitude. Results: The mean age of the participants and the time since the disease diagnosis were 42.64 ± 6.02 years and 13.9 ± 4.80 months, respectively. The mean score of SQL was 66.65 ± 10.23 (95% Confidence Interval: 66.63-67.62). Multiple linear regression analysis showed that the SQL of breast cancer survivors was significantly correlated with their occupation (β=0.12, P<0.008), education (β=-0.23, P<0.001), their spouse’s education (β=0.16, P<0.001), belief in the sex initiation by the spouse (β=0.23, P<0.001), fear of being hurt by sexual intercourse (β=0.21 P < 0.001), receiving training about sexual relations (β = 0.1, P < 0.049), lumpectomy (β = 0.11, P < 0.001), sexual function (β = 0.13 β = 0.001), and religious attitude (β = 0.27, P < 0.001). These factors explain 60% of the variance of the SQL score. Conclusion: Considering the various factors contributing to the SQL of breast cancer survivors can inform interventions targeted at improving the health status of these women.     

Association between Healthy Eating Index-2015 and Breast Cancer Risk: A Case-Control Study

Objective: Diet quality is known to influence cancer risk. The Healthy Eating Index (HEI) is one of the most frequently used measures of diet quality. However, the association between HEI-2015 and breast cancer risk is not known. The present study was undertaken to evaluate the association between HEI-2015 and breast cancer risk. Methods: A case-control study comprising 134 breast cancer patients and 265 cancer-free controls were conducted. Dietary intakes were assessed using a validated food frequency questionnaire (FFQ), from which the HEI-2015 score was calculated. Logistic regression was used to derive the odds ratios (ORs) for measuring the association between HEI-2015 scores and breast cancer risk. Results: Subjects in the top quartile of HEI-2015 had a 46% lower chance of breast cancer compared with subjects in the bottom quartile (OR 0.54; 95% CI 0.30, 0.98). After adjustment for potential confounders such as age, age at menarche, oral contraceptive drug use, menopausal status, marital status, body mass index, smoking and education level, the association between HEI-2015 score and a lower risk of breast cancer was enhanced (OR 0.32; 95% CI 0.16, 0.65). Conclusion: We successfully demonstrated that a higher HEI-2015 score was associated with a reduced breast cancer risk.     

The Decision-Making Journey of Malaysian Women with Early Breast Cancer: A Qualitative Study

Background: The survival outcomes for women presenting with early breast cancer are influenced by treatmentdecisions. In Malaysia, survival outcome is generally poor due to late presentation. Of those who present early,many refuse treatment for complementary therapy. Objective: This study aimed to explore the decision makingexperiences of women with early breast cancer. Materials and Methods: A qualitative study using individualin-depth interviews was conducted to capture the decision making process of women with early breast cancerin Malaysia. We used purposive sampling to recruit women yet to undergo surgical treatment. A total of eightparticipants consented and were interviewed using a semi-structured interview guide. These women were recruitedfrom a period of one week after they were informed of their diagnoses. A topic guide, based on the Ottawa decisionsupport framework (ODSF), was used to facilitate the interviews, which were audio recorded, transcribedand analysed using a thematic approach. Results: We identified four phases in the decision-making process ofwomen with early breast cancer: discovery (pre-diagnosis); confirmatory (‘receiving bad news’); deliberation;and decision (making a decision). These phases ranged from when women first discovered abnormalities in theirbreasts to them making final surgical treatment decisions. Information was vital in guiding these women. Supportfrom family members, friends, healthcare professionals as well as survivors also has an influencing role. However,the final say on treatment decision was from themselves. Conclusions: The treatment decision for women withearly breast cancer in Malaysia is a result of information they gather on their decision making journey. Thisjourney starts with diagnosis. The women’s spouses, friends, family members and healthcare professionals playdifferent roles as information providers and supporters at different stages of treatment decisions. However, thefinal treatment decision is influenced mainly by women’s own experiences, knowledge and understanding.     

Variation in Rates of Post-Mastectomy Radiotherapy Among Women with Early Invasive Breast Cancer in England and Wales: A Population-Based Cohort Study

AimsThis study examined whether patterns of post-mastectomy radiotherapy (PMRT) among women with early invasive breast cancer (EIBC) varied within England and Wales and explored the role of different patient factors in explaining any variation.Materials and methodsThe study used national cancer data on women aged ≥50 years diagnosed with EIBC (stage I–IIIa) in England and Wales between January 2014 and December 2018 who had a mastectomy within 12 months of diagnosis. A multilevel mixed-effects logistic regression model was used to calculate risk-adjusted rates of PMRT for geographical regions and National Health Service acute care organisations. The study examined the variation in these rates within subgroups of women with different risks of recurrence (low: T1-2N0; intermediate: T3N0/T1-2N1; high: T1-2N2/T3N1-2) and investigated whether the variation was linked to patient case-mix within regions and organisations.ResultsAmong 26 228 women, use of PMRT increased with greater recurrence risk (low: 15.0%; intermediate: 59.4%; high: 85.1%). In all risk groups, use of PMRT was more common among women who had received chemotherapy and decreased among women aged ≥80 years. There was weak or no evidence of an association between use of PMRT and comorbidity or frailty, for each risk group. In women with an intermediate risk, unadjusted rates of PMRT varied substantially between geographical regions (range 40.3–77.3%), but varied less for the high-risk (range 77.1–91.6%) and low-risk groups (range 4.1–32.9%). Adjusting for patient case-mix reduced the variation in regional and organisational PMRT rates to a small degree.ConclusionsRates of PMRT are consistently high across England and Wales among women with high-risk EIBC, but variation exists across regions and organisations for women with intermediate-risk EIBC. Effort is required to reduce unwarranted variation in practice for intermediate-risk EIBC.     

Cervical Cancer Detection between Conventional and Liquid Based Cervical Cytology: a 6-Year Experience in Northern Bangkok Thailand

Objectives: To determine the prevalence of abnormal Papanicolaou (Pap) smear, cervical intraepithelial neoplasia(CIN) 2 or higher and cancer between conventional Pap smear (CPP) and liquid based Pap smear (LBP). Methods: Thisretrospective study was conducted at Bhumibol Adulyadej Hospital, Bangkok, Thailand between January 2011 andDecember 2016. Data was collected from medical records of participants who attended for cervical cancer screening test.Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for detectingCIN 2 or higher were evaluated by using the most severity of histopathology reports. Results: A total of 28,564 caseswere recruited. Prevalence of abnormal Pap smear from CPP and LBP were 4.8 % (1,092/22,552) and 5.7 % (345/6,012),respectively. Percentage of unsatisfactory smears in CPP (52.3%) was higher than LBP (40.5%). From CPP and LBP,cervical cancer percentages were 0.2 and 0.1, respectively. Sensitivity, specificity, PPV, NPV and accuracy of CPP andLBP for detection cancer were 42.5 vs 26.1%, 99.9 vs 100.0%, 69.8vs 75.0%, 99.7 vs 100.0 % and 99.7 vs 99.7%,respectively. Conclusion: Prevalence of abnormal cervical cytology and cancer from CPP and LBP were 4.8/0.2and 5.7/0.1 percent, respectively. Unsatisfactory smear of LBP was less than CPP. Sensitivity, specificity, PPV, NPVand accuracy of CPP and LBP for detection CIN 2 or higher and cancer were comparable.     

Cognition of Breast Cancer Among Gestational Age Turkish Women: A Cross-Sectional Study

The aim of the study is to describe the cognition of breast cancer with respect to knowledge, beliefs, attitudesand behavior in a group of gestational age Turkish women. A questionnaire survey was therefore performed on201 randomly selected women registered to the health database in Aydin. In age, marital status, and occupationwere found to significantly impact on breast self-examination (BSE) performance, which should still be consideredas an important tool for early diagnosis, although it does not substitute clinical examination and education. Asdelayed diagnosis is the leading problem in the management of disease, well-structured education should besupported to increase awareness of breast cancer. Given to the remarkable role of nurses in the community onwomen’s health, a more focused approach on education of young female populations by nurses in Turkey shouldbe considered.     

A Legal and Epidemiological Consideration of the Causal Relationship between Tobacco and Lung Cancer

This study reviewed issues including causality among tobacco companies’ illegal acts, smoking, and lung cancer occurrence. In tobacco lawsuits so far, the burden of proof regarding negligence and a causal relationship has fallen on plaintiffs, who are the injured party. However, since the legislation of the Product Liability Act, the possibility of mitigating plaintiffs’ burden of proof has opened up. Nevertheless, this alone cannot prevent the immense socioeconomic cost incurred due to smoking. It is legislatively necessary to enact a tobacco management law so that the no-fault liability of tobacco companies, which are the defendants, for compensation can be acknowledged. However, it is necessary to take supplementary measures through the social security system such as establishing the upper limits for liquidated damages in lawsuits and creating a relief fund for the victims of smoking. In addition, it is fundamentally necessary for courts to accept the methods for inferring causality that are based on the natural sciences and epidemiology in situations such as tobacco lawsuits, where a causal relationship cannot be proven easily. In particular, jurists, too, must consider the application of population-based evidence presented by epidemiologists to lawsuits in a forward-looking manner for redressing damages to individuals with diseases; thus, bridging the gap between normative adjudication and scientific judgment to draw a conclusion about a causal relationship.     

Association between Smoking and p53 Mutation in Lung Cancer: A Meta-analysis

AimsTo carry out a meta-analysis on the relationship between smoking and p53 gene mutation in lung cancer patients.Materials and methodsPubMed, Web of Science, ProQest and Medline were searched by using the key words: ‘lung cancer or lung neoplasm or lung carcinoma’, ‘p53 mutation’ and ‘smoking’. According to the selection criteria, 15 articles were identified and methodologically analysed by stata 12.0 software package. Crude odds ratios with 95% confidence intervals calculated using the fixed-effects model were used to assess the strength of association between smoking and p53 mutation in lung cancer.ResultsIn total, 15 articles with 1770 lung cancer patients were identified; 69.6% of the patients were smokers, 30.4% were non-smokers. Overall, smokers with lung cancer had a 2.70-fold (95% confidence interval 2.04–3.59) higher risk for mutation than the non-smokers with lung cancer. In subgroup analyses, the increased risk of p53 mutation in smokers than in non-smokers was found in the non-small cell lung cancer (NSCLC) group (odds ratio = 2.38, 95% confidence interval = 1.71–3.32) and in the NSCLC and SCLC group (odds ratio = 3.82, 95% confidence interval = 2.19–6.69).ConclusionsThis meta-analysis strongly suggests that p53 mutation is associated with smoking-induced lung cancer. Smokers with lung cancer had a higher risk for p53 mutation than non-smokers.     

根治性宫颈切除治疗早期宫颈癌临床价值的循证评价

目的系统评价根治性宫颈切除术治疗早期宫颈癌的安全性及保留生育功能的可行性。方法 我们系统检索PubMed、Embase、Cochrane Library以及中文全文数据库,对2000年1月至2009年12月国内外公开发表的所有有关根治性宫颈切除术治疗早期宫颈癌的文献进行回顾,对符合纳入标准的临床对照试验,采用Stata 9.2软件进行Meta分析,对无对照的临床研究则采用描述性分析,主要评价指标为生存率。结果 共纳入4篇根治性宫颈切除术和根治性全子宫切除术治疗早期宫颈癌生存率比较的临床对照试验和17篇无对照的临床研究,结果显示,根治性宫颈切除术和根治性全子宫切除术治疗早期宫颈癌的生存率差异无统计学意义,根治性宫颈切除术术后总妊娠率为47%。结论 宫颈根治切除术不会降低早期宫颈癌患者术后生存时间,不增加术后复发率,且能维持正常的妊娠及生育功能,提高患者生存质量,因而是安全可行的,但需要更多高质量的临床随机对照试验进一步验证。     

Effect of Obesity on Neoadjuvant Systemic Therapy Outcomes in Patients with Early Breast Cancer: A Retrospective Institutional Study

Background: Obesity and overweight are usually considered as poor prognostic factors in early breast cancer. Body mass index (BMI) is a significant predictive factor for lower pathologic complete response (pCR) rates after neo-adjuvant systemic therapy (NST). The relationship between obesity and breast cancer prognosis varies according to patient and tumor characteristics such as menopausal status and tumor subtype, respectively. Patients and Methods: Between March 2010 and October 2013, 80 patients with early breast cancer who had received standard NST from KFSH Saudi Arabia were included in this study. For statistical analysis, the study participants were categorized into two groups based on their BMI, as normal (BMI < 25 kg/m2) and obese groups (BMI ≥ 25 kg/m2). pCR was defined as non-invasive cancer in the breast/axillary tissue. Results: The median age of our patients was 48 (range, 38-68) years. Invasive ductal carcinoma (IDC) subtype was identified in 93.8% of the cases. Additionally, 26 (32.5%) and 33 (41.25%) patients were diagnosed with stage II and stage IIIA breast cancer, respectively. Lymphovascular invasion was detected in 32.5%, whereas intermediate and high-grade malignancy were found in 61.25% and 32.5% of the patients, respectively. Forty-four patients (55%) were obese. pCR was achieved in 56 patients (70%), and the comparison between patients with and without pCR revealed that those in the former group had significantly lower tumor grades. Significantly, lower relapse and mortality rates were distinguished in patients who achieved pCR than in those who did not. Additionally, comparison between normal and obese patients revealed that a high number of patients in both groups were post-menopausal (p = 0.001). However, survival analysis indicated the absence of significant differences in disease-free survival between the two groups based on BMI (p = 0.19). Conversely, patients with normal BMI had significantly better overall survival than obese patients (p = 0.029), with a higher mortality rate noted in the obese group (16.7% vs 2.3%, p = 0.037). Conclusions: In the present study, 58.3% of patients that failed to achieve pCR had BMI above the normal level; they moreover had higher relapse rates and lower survival compared with normal BMI patients. This finding needs to be verified through further prospective studies to determine if BMI is a risk factor for breast cancer.     

Beliefs about Breast Cancer among Women in the Western Amazon: A Population-Based Study

Objective: Evaluate the beliefs about the risk factors for breast cancer in a population of women from the westernAmazon and determine the factors associated with the higher belief scores presented by this population. Methods:A population-based cross-sectional study included 478 women aged >40 years residing in Rio Branco, Acre, Brazil.An American Cancer Society questionnaire was applied to assess the knowledge, attitudes, and beliefs about breastcancer. Results: The main beliefs about the risk factors for breast cancer were breast trauma (95%), use of underwirebra (58.5%), and a high number of sexual partners (55.5%). Women from younger age groups presented higher beliefscores (Bcoefficient: –0.04, 95% CI: –0.07; –0.01) than those of women from older age groups. A strong association wasnoted between high knowledge scores of risk factors and signs/symptoms of the disease and high belief scores in thestudy group (Bcoefficient:0.33;95%CI:0.28;0.38). Conclusion: The results indicate the existence of important beliefsrelated to the risk factors for breast cancer. Women from younger age groups, women who have seen a gynecologist inthe past 2 years, and women who had more knowledge about the risk factors and signs and symptoms of breast cancerhad higher belief scores.