Role Playing for Improving Women’s Knowledge of Breast Cancer Screening and Performance of Breast Self-Examination

Background: To enhance knowledge and performance of screening as a strategy to control breast cancer, use of effective teaching methods is necessary. The objective of this study was to determine the effect of role-playing on knowledge of breast cancer screening and performance of breast self-examination (BSE). Methods: A quasi experimental design was used. Women enrolled in community cultural centers (n=314) were randomly divided into two educational groups: role playing (intervention) and lecture (control). Data were collected using a structured questionnaire before and after intervention. Reliability of the questionnaire was determined as 0.80 by Cronbach’s alpha. The women were followed up regarding performance of BSE one month later. Results: Of the 314 women, 113 (36%) and 132 (42%) had low and medium levels of knowledge, respectively. More than a third (38.2%) reported that TV and radio were the most important information sources for breast cancer and screening. There were significant differences between mean scores of knowledge before and after the intervention in both groups, but change was greater with role playing (31.3±1.9 as compared to 23.5±1.3) (P=0.001). After a month of educational intervention, 75.7% and 69.8% of those in role playing and control groups had undergone BSE. Conclusion: It appears that application of a role playing method by providers improves women’s knowledge and behavior with respect to breast cancer screening.     

Clonal Analysis of Peripheral Papilloma and Cancerous Cells of the Breast

OBJECTIVE Because almost al malignancies represent monoclonal proliferations,we have studied the clonal status of peripheral papil omas (peri-PM),ductal carcinomas in situ(DCIS),and normal breast tissues to explore a reliable way to distinguish benign and malignant(or pre-malignant) cases previously diagnosed morphologically. METHODS Twenty-six cases of peri-PM,25 cases of peri-PM with atypical ductal hyperplasia(ADH),27 cases of DCIS,16 cases of developed canceration and 20 specimens of normal tissue were examined in the study.The clonal status of these tissues was studied using an assay based on inactivation mosaicism of the lenth-polymorphic X-chromosomes at the androgen receptor(AR)locus. RESULTS Loss of polymorphism at the AR locus was found in all DCIS cases and 10 cases(10/25,40.0%)of peri-PM with ADH,indicating the monoclonality of the tumors.Twenty-four out of 26(92.3%)cases with peri-PM and 19 specimens of normal tissue were shown to be polyclonal.In 16 cases of developed canceration,identical X chromosome inactivation(monoclonal alterations)was observed from both the peri-PM with ADH part,and the DCIS part in each case. CONCLUSION These results contribute to the understanding of the genetic changes of peri-PM,and confirm the peri-PM withADH as a precancerous lesion of the breast.Clonal analysis might be a useful modality to screen high-risk cases from precancerous lesions or to distinguish between benign hyperplasia and early carcinoma.     

Analysis of the Relationship between Expressions of TF and MMP-9 and Prognosis of Breast Cancer Patients

OBJECTIVE To investigate expression of the tissue factor (TF)and matrix metalloproteinase-9(MMP-9)in breast cancers, and to assess their expression in relation to possible prognostic significance. METHODS The expression of TF and MMP-9 in 71 breast cancer specimens were determined by EnVision immunohistochemistry, and the positive expressions related to the patient clinical outcome. RESULTS Positive rates of TF and MMP-9 staining were respectively 43.7%and 42.3%.K-M monofactorial analysis showed that the 5-year survival rate of the patients with a positive expression of TF and MMP-9 was lower than those with negative expression(P<0.05).However,the COX multifactorial analysis indicated that TNM staging and lymph node metastasis were the prognostic factors for breast cancer patients,and that TF and MMP-9 could not be used as the independent prognostic factors(P >0.05). CONCLUSION The positive rates of TF and MMP-9 were considerably high in breast cancers,which could provide useful information for patient prognosis.     

Clinical and Ultrasonographic Changes of the Breast after Use of Soy Isoflavones

Background: Phytoestrogens may be an alternative therapy in control of menopausal symptoms but theirdefinite effects on breast tissue must be determined. Our study aimed to define the clinical and ultrasonographicchanges of the breast after use of soy isoflavones in menopausal women. Materials and Methods: Menopausalwomen with hot flashes were randomly grouped as cases and controls and cases received soy isoflavones for12 weeks. Breast examination (BE) and ultrasonography (US) were done at 0, 6 and 12 weeks. Tenderness andnodularity on BE were graded 1-4 by breast surgeons. Results: There were 30 women in the case and 26 in thecontrol group. The mean age was 51.3 years and the mean age of menopause was 49.2 years. There was no changein the BE and US at 6 weeks in controls. In the case group, 10% had grade 1 tenderness and 13.3% grade 2tenderness and grade 1 nodularity in BE accompanied with diffuse small cysts in US. At 12 weeks, there was nochange in BE and US in the 2 groups. Conclusions: There was no statistically significant difference in the BE ofthe 2 groups at 6 and 12 weeks (p value=0.36 and 0.41 for nodularity and tenderness respectively) and in the USresults. Although the literature contains many facts concerning PEs and the breast, further prospective studiesare needed to identify structural breast changes produced by PEs in order to identify the appropriate dosageand indications of use.     

Can Breast Self-examination and Clinical Breast Examination Along With Increasing Breast Awareness Facilitate Earlier Detection of Breast Cancer in Populations With Advanced Stages at Diagnosis?

Breast cancer is the most common form of cancer among women worldwide. Early detection is central to improving disease outcomes. Three main screening methods – mammography, breast self-examination (BSE), and clinical breast examination (CBE) – have been developed and tested in Western nations. There is ongoing debate regarding the efficacy of BSE and CBE in terms of mortality reduction, and a number of international organizations no longer recommend them as screening methods. In technically less developed countries, however, where women are usually diagnosed with breast cancer at advanced stages and younger ages, the benefits of BSE and CBE might outweigh the harm and facilitate early detection of breast cancer. This paper reviews the history of BSE and CBE and discusses their value as early detection methods. It can contribute to informed decision-making by health policy-makers and clinicians who are involved in breast cancer screening in the developing world to improve women’s well-being.     

Study of Benign and Malignant Intraductal Lesions of the Breast by Fiberoptic Ductoscopy

OBJECTIVE To observe and subtype the appearance of intraductal papilloma (lesions) and of infiltrating ductal carcinoma or early infiltrating ductal carcinoma using a fiberoptic ductoscope (FDS) examination, and to discuss the differentiation and diagnosis of benign and malignant tumors by FDS.METHODS The characteristics of FDS images and diagnostic data for 229patients with intraductal papilloma (lesions) and 50 patients with ductal carcinoma, who were confirmed by surgical pathology from October 1998 to December 2003, were analyzed retrospectively.RESULTS The appearance of the lesions observed by FDS were grouped into 4 types: a monothelia (type Ⅰ), polythelia (type Ⅱ), superficies (type Ⅲ)and a mixture (type Ⅳ). Intraductal papillomas (lesions) were more commonly seen in type Ⅰ and Ⅱ, and intraductal carcinomas or early infiltrating ductal carcinomas were more commonly seen in type Ⅲ and Ⅳ;there was a statistically significant difference in the distribution of the ductoscopic types, except in type Ⅱ, between the two types of lesions, P＜0.001. The focal detection rate by FDS for intraductal papilloma and papillomatosis was 99.6% (228/229) and for breast cancer was 96.0% (48/50). The diagnostic accuracy was 97.8% (224/229) and 82.0% (41/50),respectively.CONCLUSION FDS can be a guide for the treament of benign and malignant intraductal tumors, with early discovery and accurate diagnosis.     

Could Anthropometric and Lipid Parameters Reflect Susceptibility to Breast Cancer? Comparison of Newly Diagnosed Breast Cancer and Apparently Healthy Women

Objectives: To determine and compare the serum lipid profiles and anthropometric parameters of newly diagnosedBC patients and healthy women. Methods: Serum total cholesterol (TC), high density lipoprotein cholesterol (HDL-C),low density lipoprotein cholesterol (LDL-C), very low density lipoprotein cholesterol (VLDL-C), triglyceride (TG)and TC: HDL-C were measured in consent obtained newly diagnosed BC patients (n=155) and age matched apparentlyhealthy females (n=75). Weight (W), height (H), waist circumference (WC), hip circumference (HC) and mid upper armcircumference (MUC) of each women were recorded. Cut off values for each parameter was found by receiver operativecharacteristic (ROC) curves and risk associated with was calculated using SPSS version 16. Results: Majority (67%)of BC women were postmenopausal. The mean TC, HDL-C, LDL-C, VLDL-C, TC: HDL-C, TG concentrations ofBC patients who were not on cholesterol lowering drugs (n= 126) were 234 mg/dL (±51), 43 mg/dL (±10), 164 mg/dL(±44), 27 mg/dL (±14), 5.7(±1.7) and 135 mg/dL (±69) respectively. TC, LDL-C and TC: HDL-C of BC patients weresignificantly elevated when compared with healthy females. Significant difference in serum lipid profile parameters wasnot observed (p> 0.05) according to the menopausal status of BC and healthy women. One third (30.3%) of BC patientswere overweight and 45% were obese. Majority had elevated WC (72%), W: H ratios (89%) and MUC (89%). BMI,W: H and MUC of BC women were significantly higher (p<0.05) when compared with healthy females. Conclusions:The lipid parameters TC, LDL-C and TC: HDL-C above 203 mg/dL, 139 mg/dL and 3.9 respectively were risk factors.Among anthropometric measures, BMI>25 kg/m2 showed the highest risk while elevated W:H and MUC were alsosignificant risk factors among the study group.     

Significance of β-tubulin Expression in Breast Premalignant Lesions and Carcinomas

OBJECTIVE To explore the expression of β-tubulin in premalignant lesions and carcinomas of the breast,and to observe the relationship of its expression with breast cancer pathological features. METHODS The expression of β-tubulin was detected immunohistochemically in 50 specimens of premalignant lesions of the breast(ADH and Peri-PM with ADH),50 specimens of breast in situ ductal carcinomas(DCIS),and 50 specimens of invasive ductal carcinomas(IDC).Thirty specimens of normal breast tissues served as a control group. RESULTS Immunohistochemical analysis showed that:the differences among the 4 groups(normal breast tissues,breast premalignant lesions,DCIS and IDC,P<0.05)were significant, and there were also statistically significant differences between any 2 groups(P<0.05)except for the β-tubulin positive expression comparing DCIS versus IDC(P>0.05).In addition,β-tubulin was expressed at a higher level in Peri-PM with ADH compared to ADH(P<0.05).Following the degree of breast epithelial hyperplasia involved,and its development into carcinoma,the β-tubulin positive expression displayed an elevating tendency. We also found a significant positive relationship of β-tubulin expression with lymph node metastasis(P<0.05),but no significant correlation with histological grading and nuclear grade. CONCLUSION Centrosome defects may be an early event in the development of breast cancer and they can also promote tumor progression.Studies of aberrations of centrosomal proteins provide a new way to explore the mechanism of breast tumorigenesis.     

Analysis of the Clinicopathologic Features and Prognosis in Triple-Negative Breast Cancer

OBJECTIVE To investigate the clinical and pathological features,as well as prognosis in triple-negative breast cancer patients.METHODS A total of 509 cases of operable breast cancer from January,2002 to June,2002 treated in the Cancer Hospital of Tianjin Medical University were analyzed.The Her-2,ER and PR status was determined using immunohistochemistry.Of the total cases,one group was identifi ed as triple negative breast cancer,ie defi ned as ER,PR and Her-2 negative.The other group was non-triple-negative breast cancer.Clinicopathologic features of the groups were compared and 5-year disease-free survival(DFS) analyzed by the Kaplan-Meier method.RESULTS Of the total cases,21.4%(109/509) of cases were found to be triple-negative while 78.6%(400/509) were non-triple-negative.The triple negative group had higher incidence rates than the non-triple-negative group of the medullary type and Grade Ⅲ tumors(P < 0.05).There was no other difference in the clinicopathologic features between the 2 groups.From follow-up to June,2007,21.1%(23/109) of the triple-negative group and 12.7%(51/400) of the non-triple negative group had a local recurrence or distant metastasis,resulting in a signifi cant difference(P < 0.05).In the triple-negative group and non-triple-negative group,5-year DFS were 78.9% and 87.3% respectively.There was a statistically signifi cant difference between the 2 groups(P = 0.031).CONCLUSION Compared with non-triple-negative breast cancer,triple-negative breast cancer patients have an increased likehood of a local recurrence or distant metastasis and a poorer prognosis.     

Comparison of Direct and Indirect Methods of Teaching Breast Self-Examination – Influence on Knowledge and Attitudes of Iranian Nursing and Midwifery Personnel

Background: Breast cancer is the most common cancer in women. Monthly breast self-examination (BSE) has beenpresented as one of the best screening methods available. The aim of this study was to compare effects of both direct and indirect methods of teaching of BSE on knowledge and attitudes of nursing and midwifery personnel. Materials andMethods: The present study was performed on 89 nursing and midwifery personnel in Valiasr hospital of Borujen city.Participants were randomly divided into a direct and an indirect training group. Researcher-designed BSE knowledgeand attitude and demographic information questionnaires were used for data collection. Results: Before the educationintervention, the mean levels of knowledge and attitude were 9.82±2.79 and 56.5±6.21 in the direct training group and9.59±2.71 and 54.5±4.51 in the indirect training group; after the intervention, they reached 19.2±0.96 and 62.9±4.21, and 11.0±2.58 and 59.0±3.44, respectively. The difference in the mean levels of knowledge and attitude were significantly higher in the direct training group post intervention (P<0.05). Conclusion: It appears that educational planners and hospital personnel education officials should seek to teach aspects of crucial health behavior to female personnel using cooperative and direct training methods.     

Clear Cell Carcinoma of the Breast: A Rare Breast Cancer Subtype – Case Report and Literature Review

BackgroundGlycogen-rich clear cell breast carcinoma is a rare histological breast cancer subtype. Its prognosis may vary depending on specific clinical and pathological characteristics such as low grade, strong positivity of estrogen receptor (ER) expression and early diagnosis.ConclusionsGlycogen-rich clear cell carcinoma of the breast is a rare tumor. Early diagnosis, absence of lymph node metastases and ER/PR positivity are associated with a better prognosis, as in other common breast cancer subtypes.Key Words: Breast cancer, Glycogen-rich clear cell carcinoma     

Relationship of Optimism–Pessimism and Health-Related Quality of Life in Breast Cancer Survivors

ABSTRACT

Few studies have investigated the influence of optimism–pessimism in breast cancer survivors. This study used a retrospective design with 268 adult women who completed the Minnesota Multiphasic Personality Inventory (MMPI) as part of their medical care approximately 10 years prior to their breast cancer diagnosis and Medical Outcome Study Short-Form General Health Survey (SF-36 or SF-12), on average, 8 years after diagnosis. MMPI pessimism scores were divided into quartiles, and t tests were used to determine differences between those highest and lowest in pessimism on health-related quality-of-life (QOL) measures, demographics, and disease status. The mean age at diagnosis of breast cancer was 63 years, and 74% had early-stage breast cancer. Patients age 65 years and older were significantly lower on physical health–related QOL scales. There were no significant differences in health-related QOL scores by stage of disease. Patients with a pessimistic explanatory style were significantly lower on all of the health-related QOL scores, compared to those with a nonpessimistic style. Breast cancer survivors who exhibit a pessimistic explanatory style report lower health-related QOL for years after receiving a cancer diagnosis, compared to nonpessimistic women.     

The Detection and Analysis of Estrogen and Progesterone Receptors in Breast Cancer （Report of 1,393 Patients）

Objective  To explore the distribution of estrogen receptors (ER) and progesterone receptors (PR) in patients with breast cancer and to compare the results with clinical parameters. Methods  Breast cancer specimens of 1393 cases were stained for the ER and PR by a SP Two -Step method, and analyzed with respect to age, menstrual status, histopathology and metastasis of axillary lymph nodes. Results  The correlation coefficients between ER and PR were positive-(P< 0.0001). The negative expression of ER in patients 39 years or less was the highest with a statistical significance (P<0.0001 ). There was no relationship between the patient’s age and positive expression of ER, PR and negative expression of PR (P>0.05). There were significantly higher positive rates of ER and lower positive rates of PR in post-menopausaf patients than in pre -menopausal cases(P<0.0001). There was no relationship between the status of ER, PR and the corresponding histopathology (P>0.05). The patients with no metastasis in the axillary lymph nodes had higher simultaneous positive rates of ER and PR (P<0.0001), and those with axillary lymph node metastasis had significantly higher rates of negative expression of ER and PR(P<0.0001). Conclusion  The positive and negative distributions of ER and PR have some regular patterns which may be used as a reference to choose combined therapy and to predict the prognosis for breast cancer patients.     

Correlation between Expression of P38 MAPK-Signaling and uPA in Breast Cancer

OBJECTIVE To study the expression of phosphorylated p38 mitogen-activated protein kinase(p-p38)and uPA and the correlation of their expression with breast cancer clinicopathological characteristics,and to investigate the role of the p38MAPK-signaling pathway in regulating uPA expression in breast cancer cells. METHODS Immunohistochemistry(S-P) was used to test the expression of p-p38 and uPA in 60 specimens of breast cancer tissues.Western blots were adopted to detect expression of the p-p38 and uPA proteins in MDA-MB-231 and MCF-7 breast cancer cells,and uPA expression a er treatment with SB203580,a specific inhibitor of p38 MAPK. RESULTS The positive rate of the p-p38 protein and uPA protein expression in the breast cancer tissues was 56.7% and 60.0%,respectively.The expression of p-p38 was positively related to the expression of uPA(r=0.316,P<0.05).The expression of p-p38 and uPA was related to lymph node metastas is and the TNM stage(P<0.05),but it was not related to the patient’s age or tumor size(P>0.05).The expression of p-p38 and uPA in MDA-MB-231 cells was higher than that in MCF-7 cells.SB203580 inhibited the p38 MAPK pathway and reduced uPA protein expression. CONCLUSION The p38 MAPK-signaling pathway promotes breast cancer malignant progression by up-regulating uPA expression,and it may be an important process in breast cancer invasion and metastasis.     

Expression of Cox-2 and Bcl-2 in Paget’s Disease of the Breast

Background: Paget’s disease (PD) is a rare form of intraepithelial adenocarcinoma that involves breast andextramammarian tissues. It is often associated with ductal carcinoma in situ and/or invasive ductal cancer.Molecular pathways that play a role in development of Paget’s disease are stil unclear. Expression patterns ofCox-2 and bcl-2 were therefore assessed. Materials and Methods: Patients with a histopathological diagnosis ofPaget’s disease were included in this study. Patient files were analysed retrospectively. Results: Invasive cancerwas diagnosed in 35 (76.1%) of the patients, 7 (15.2%) had ductal carcinoma in situ and 4 (8.7%) patients had noassociated neoplasm. Twenty four (52.2%) patients showed COX-2 expression in Paget cells whereas no expressionwas seen in 22 (47.8%) patients. No relation was found between COX-2 expression and the lesion underlyingPaget’s disease (p=0.518). Bcl-2 expression in Paget cells was found positive in 12 (26.1%) and negative in 27(58,7%) cases. There was no relation between Bcl-2 expression and the lesion accompanying Paget’s disease(p=0.412). No relation was observed between COX-2 expression and Bcl-2 expression (p=0.389). Conclusions:In breast cancer, COX-2 expression is associated with poor prognostic factors. As COX-2 expression increasesthe tendency to metastasize also increases. In our study we found a significantly high COX-2 expression inPaget’s disease of the breast. We suggest that COX-2 expression and inflammatory processes may play a rolein pathogenesis of the Paget’s disease of the breast.     

In Vivo Selection of Phage Sequences and Characterization of Peptide-specific Binding to Breast Cancer Cells

OBJECTIVE To screen specific polypeptide target binding to breast cancer xenogra s in vivo from a phage-displayed peptide library in order to provide peptide sequences for breast cancer tumor-targeting diagnosis and therapy. METHODS A mouse model for carrying breast cancer xenografts was established using Tientsin Albinao II mice(TA II).A 12-peptide library was biopanned through 4 rounds. Phages were recovered and titrated from tumor xenografts and control tissue(liver).The distribution of phages was detected by immunohistochemical staining. RESULTS Phage homing to breast cancer was enriched through 4 rounds of biopanning,being 14-fold of that recovered from liver tissue.A peptide sequence,ASANPFPTKALL was characterized by randomly picked-up clones which appeared most frequently. Immunohistochemical staining revealed phage localization in cancer xenografts 40 min after injection of the enriched phages. When a specific phage was tested individually,the phage reclaimed from breast cancer xenografts was 14 times as those from control tissues. CONCLUSION Tumor-specific homing peptides may provide an effective tool for breast cancer target therapy.The in vivo phage display selection technique employed in this study was feasible and applicable to screening peptides that home to breast cells.     

Expression of Cyclin E and Its Relationship with the Prognosis of Patients with Breast Cancer

Objective： To investigate the expression of cyclin E in breast cancer tissues and its relationship with prognosis of the patients with breast cancer. Methods： The expression of cyclin E, HER-2/neu, nm23-H1 and actin was detected in 80 breast cancer tissues and 18 benign breast tumor tissues by immunohistochemical methods. The relationship between cyclin E and the remaining genes or the clinical data of the patients with breast cancer was analyzed. Results： The over expression rate of cyclin E in malignant tissues was obviously higher than that in benign tumor tissues （P〈0.01）. The over expression of cyclin E in later stage of disease was higher than that in early stage of disease （P〈0.05）. The expression of cyclin E in ER positive tissues was lower than that in ER negative tissues （P〈0.05）. The expression of cyclin E in PR positive tissues and PR negative tissues had no significant difference （P〉0.05）. The expression of cyclin E in HER-2/neu positive tissues was higher than that in HER-2/neu negative tissues （P〈0.05）. And the expression of cyclin E in ER, PR and HER-2/neu all positive tissues was much higher （P〈0.01）. There was no significant difference in the expression of cyclin E between nm23-H1 positive tissues and nm23-H1 negative tissues （P〉0.05）. The expression of cyclin E in actin positive and continuous distribution tissues was lower than that in actin negative or discontinuous distribution tissues （P〈0.05）. Conclusion： The expression of cyclin E has a strong correlation to the prognosis of the patients with breast cancer.     

Diagnosis and Treatment Experience of 14 Cases of Breast Cancer Associated with Pregnancy or Lactation

Objective： To explore the diagnosis and treatment experience of breast cancer associated with pregnancy or lactation. Methods： From January 1990 to December 2005, 14 cases with breast cancer associated with pregnancy or lactation were analyzed retrospectively （TNM stage Ⅱ, 2 cases; stage Ⅲ, 11 cases; stage Ⅳ, 1 case）. Diagnosis was established by fine needle aspiration biopsy primarily or routine pathological method if necessary. Abortion was used for discontinuation of pregnancy in 1 case with early pregnancy and 1 case with meddle pregnancy. 2 patients with late pregnancy received cesarean section, 10patients of breast cancer associated with lactation received multidisciplinary and-tumor treatment after discontinuation of lactation. Results： Diagnosis was confirmed by fine noodle aspiration biopsy in 9 cases and by secondary routine pathological method in the other 5 cases, 12 cases were followed up, 1 case of stage Ⅳ died of metastasis 5 months after diagnosis. 3-, 5-year survival rates in 10 cases of stage Ⅲ were 66% and 30% respectively. One case remained alive without recurrence for 8 years up to now. Conclusion： A thorough breast examination is necessary at the first antenatal visit physicians should aggressively pursue work-up in women with a palpable breast tass. In the patients during the second and third trimness, the various modalities available for treatment inholding abortion and their risks and beneath modalities available for treatment including abortion and their risks and benefits must be discussed openly with patients and their families.     

Over-expression of EGFR in Breast Cancer

Objective： To explore the relationship of overexpression of epidermal growth factor receptor （EGFR） in occurrence, development and treatment of breast cancer. Methods： Samples of 46 breast adenoma tissues and 86 breast cancer tissues were regularly dehydrate-fixed, embedded in paraffin, sliced in to 5μm thick, stained with SABC immunohistochemistry and coloured with DAB. Results： The positive staining of EGFR was shown as brown- yellow and distributed in cytoplasm. The positive rates in the tissues of breast adenosis and breast cancer were 17.04% （6/46） and 56.98% （49/86） respectively. The positive rates of EGFR in the tissue of invasive ductal carcinoma was 64.49% （41/59）, which was significantly higher than that in in situ carcinoma （P〈0.05）. The positive rate of lymph metastasis group was higher than that in non-lymph metastasis group （P〈0.05）. Conclusion： The overexpression of EGFR was related with occurrence, lymph metastasis and pathologic types of breast cancer. The examination of EGFR in the breast cancer can serve as a guidance for target chemotherapy.