Breast Cancer In Pakistan Research Articles

Early post-operative outcome of pre-pectoral implant-based immediate total breast reconstruction with Polyglactin 910 (Vicryl™) mesh – low cost solution for a low-middle income country

BackgroundThe incidence of breast cancer in Pakistan has been rising with approximately one third of these patients requiring mastectomy. Among breast reconstruction treatment options, the use of Acellular Dermal Matrix (ADM) for pre-pectoral breast implant surgery has proven effective with improved cosmetic outcome. However, due to high cost it cannot be regularly implemented in a developing country like Pakistan. An alternative to ADM, Polyglactin 910 (Vicryl™, Ethicon) mesh has been introduced in pre-pectoral breast reconstructive surgery which has shown to be almost 10 times lower in cost. We set out to determine the frequency of early postoperative complications when using Polyglactin 910 mesh for pre-pectoral implant-based breast reconstruction surgery.MethodsA single centre, retrospective, chart review was conducted, and a total 28 women were included in the study. Thirty-two pre-pectoral implant-based mastectomies with Polyglactin 910 mesh were performed. Early post-operative outcomes (within 12 months of procedure) including duration of antibiotic use, post-operative infection, implant displacement, flap necrosis, seroma formation, wound dehiscence, hematoma formation, capsular contracture and reconstruction failure, were recorded.ResultsOnly 4 (12.5%) women experienced early post-operative morbidity. One patient developed a wound dehiscence, which eventually led to reconstruction failure and removal of the implant. Another patient had seroma formation and flap necrosis. None of the patients developed postoperative implant displacement, hematoma formation or capsular contracture in the early post-operative period.ConclusionThis study reveals that early post-operative outcomes with Polyglactin 910 mesh in breast reconstructive surgery are few, thus making it a cost effective, reliable, and safe treatment option, especially in developing countries like Pakistan.

Diagnostic Accuracy of Cell block Using HistoGel Tube Method in Breast Cancer in Pakistan

Background: Breast malignancy is the major cause of cancer-related deaths among women globally. Therefore, early diagnosis is the primary requisition for an effective treatment plan. Objective: To determine the diagnostic accuracy (sensitivity, specificity, positive predictive value, and negative predictive value) of fine needle aspirate cell blocks made by the HistoGel-tube method in patients with breast cancer. Methods: This cross-sectional study was carried out at the Department of Pathology, King Edward Medical University /Mayo Hospital, Lahore. The study duration was six months. 62 patients with breast lumps, of all ages, both genders, having easily accessible breast lesions and C III, C IV, C V smears on rapid onsite evaluation were included while patients who had received neo-adjuvant chemo- or radiotherapy and those reported as C I ,C II smears on ROSE were excluded. FNA was performed and HistoGel cell blocks were made in addition to the conventional smears. Data was entered in SPSS version 26. Results: The mean age of patients included in the study was 47 ± 13 years. 61(98.4%) patients were female while only 1(1.6%) patient was male. Sensitivity, Specificity, Positive predictive value, Negative predictive value and diagnostic accuracy came out to be 96%, 69%, 92%, 81%, and 90% respectively. Conclusion: HistoGel cell blocks have overall good diagnostic accuracy for the evaluation and diagnosis of breast malignancy.

Current Situation of Breast Cancer in Pakistan and the Dire Need of Early Diagnosis

Globocan statistics underscore Pakistan’s noticeable position in terms of the breast cancer burden, highlighting a concerning and escalating trajectory in its daily progression. Breast cancer stands as the most predominant and fatal malignancy in Pakistan, reporting 25,928 cases in the year 2020, accounting for 14% of all cancer diagnosis. The country is reported to have the maximum incidence and mortality rates in Asia, a dire result of the lack of national cancer registry. Late diagnosis, often determined by sociocultural factors, considerably contributes to the high mortality rate. Several risk factors, such as reproductive factors, age, dietary habits, further complicate the situation. Moreover, economic obstacles deter many from receiving the required treatment. The current review features the dire need for inclusive policies and improved affordability to battle breast cancer’s escalating influence in Pakistan.

SERM Therapy for patients of breast cancer and otherwise.

Madam, In Pakistan, the most frequently diagnosed cancer among females is breast cancer, where every year at least 90,000 women suffer from the disease [1]. This incidence is 2.5 times higher than that of Pakistan’s neighbouring countries and the highest in Asia[1]. The current treatments for breast cancer in the country are all invasive forms of therapy and include radiation therapy, chemotherapy, lymph node removal, and mastectomy. This letter aims to draw attention to a newer form of treatment for breast cancer known as selective estrogen receptor modulators (SERMs). Selective estrogen receptor modulators (SERMs) are synthetic molecules that provide a non-invasive therapy for breast cancer patients. Recent studies have proposed that the specificity of SERM’s mechanism of action and antiviral properties yield fruitful outcomes in treating covid-positive breast cancer patients [2], giving SERMs a significant advantage over former treatments such as radiation therapy or chemotherapy which reduce the body’s ability to fight infections. SERMs block the effects of estrogen on breast tissue, preventing cancer cells from dividing. They also act as an adjuvant in breast cancer therapy [3], suppressing secondary tumor formation. A recent study published in the Journal of Clinical Oncology showed significant benefits from two years of tamoxifen therapy in estrogen receptor- positive premenopausal patients of breast cancer [4]. On various other tissues, they act as estrogen, allowing for their use alongside other treatments for postmenopausal women to prevent bone loss and osteoporosis [3]. Despite SERM ‘s wide range of benefits in patients with breast cancer, it is not a fully recognized form of treatment for this population in Pakistan. Such hormonal therapy is only offered by a handful of high-end private-sector hospitals. This is attributed to a lack of research in this area due to various socio-economic factors. A limited choice of treatment for women with breast cancer in Pakistan results from fear of stigmatization and feminine sensitivity [5]. Attention should be brought to alternative therapies for breast cancer treatment to improve prognosis and help patients make the best possible shared decision-making choices.

Novel Noninvasive Serum Biomarkers for Prompt Diagnosis of Breast Carcinoma.

Immune cell infiltration is associated with improved prognosis in the microenvironment of breast cancer. The incidence of breast cancer in Pakistan is 2.5 times higher than that in neighboring countries of Asia, accounting for 34.6% of female cancers. The objectives of this study were to compare and determine apoptotic mediators and biomarkers for breast carcinoma, such as serum granzyme B, cytochrome C, and vitamin D by ELIZA and calcium spectrophotometrically. Study groups were differentiated into malignant breast disease G-I, benign proliferative breast disease G-II, and healthy control group G-III. The immune-related prognostic markers and therapeutic targets were determined through the interaction of proteins by molecular docking and AutoDock Vina software. The level of granzyme B and cyt C was higher in Group-I, -II, and -III. Likewise, the mean vitamin D level was greater in Group-I than those in other groups. Through SwissDock, the proteins granzyme B and cyt C with vitamin D, single amino acid residue MET34 (H-bond 2.75 Å), and ILE81(H-bond 2.092 Å) were revealed to actively participate in interactions. This study reveals granzyme B and cyt C as biomarkers for malignant breast disease and benign proliferative breast disease, while hypovitaminosis D and hypocalcemia are complications or comorbidities of breast cancer.

Breast Cancer in Pakistan: Screening and Detection

Breast Cancer in Pakistan: Screening and Detection

Breast Cancer Awareness and Associated Factors among Women in Pakistan: A Cross-Sectional Descriptive Study.

Breast cancer is a highly prevalent cancer in females worldwide, with new cases around one million every year. In Pakistan, cancer of breast is the most common carcinoma in diagnosis, with one in nine females. Due to high burden of breast cancer in Pakistan, presented work purposes to investigate knowledge and awareness of breast carcinoma, its symptoms, and risk factors among Pakistani women, which play an important part in the early diagnosis of breast cancer. A sample of 1000 females were approached generally from universities, hospitals, public places, local markets, rural areas and other cities for on-site data collection through face-to-face interviews and online data collection through telephonic interviews in Pakistan using the Breast Cancer Awareness Measure (BCAM). By using SPSS V. 25.0, the information provided by the individuals first changed in awareness scores and was then analyzed. The study displayed, that mainstream participants lacked knowledge of breast carcinoma (63.2%) and the importance of its screening tools (64.7% and 83.2% lacked knowledge of mammography and BRCA tests respectively) for early detection. Almost 45% of respondents never noticed a change in their breasts. Most participants were unaware about breast cancer development is age-related and lifetime risk. Slightly more than 50% of the participants of the study were not knowledgeable regarding modifiable risk factors of breast carcinoma. A commonly known symptom was Breast lump by 53% of the respondents. Association was determined between demographic variables and breast cancer knowledge scores. Only 37.4% of respondents were found to be knowledgeable regarding breast cancer. BCAM is a productive instrument to assess awareness of breast carcinoma in females. The study indicated awareness of breast cancer is suboptimal in the population of Pakistan. Efforts should be made by public awareness campaigns and broadcasting of information about breast cancer and health education to increase awareness of risk factors.

Assessment of Vitamin D Deficiency and its Possible Risk with Breast Cancer in Pakistan

Aim: To assess the vitamin D deficiency as a possible risk factor in breast cancer. Study design: Cross-sectional study Place and duration of study: Surgical Unit-II, Ward 5, Liaquat University of Medical & Health Sciences Jamshoro from 1stJanuary 2022 to 31st December 2022. Methodology: One hundred and twenty-seven patients with the complaints of lump/mass in the breast or nipple discharge ≥6-week duration and diagnosed as breast cancer regardless of stage/grade presented were enrolled. Results: 59.8% while the illiterate, primary, middle, secondary and higher were 36.2%, 14.2%, 17.3%, 20.5% and 11.8%. The statistical significance was observed for vitamin D deficiency in accordance with residence (p=0.03), duration of disease (p=0.05), educational status (p=0.05), hypertension (p=0.01), smoking (p=0.00), obesity (p=0.02), diabetes mellitus (p=0.04), raised CRP (p=0.00), hypocalcemia (p=0.00), ER/PR positive (p=0.01) and family history of breast cancer (p=0.04). Conclusion: Vitamin D deficiency is more prevalent in patients with breast cancer with rural population predominance. Keywords: Breast cancer, breast carcinoma, and vitamin D deficiency.

BREAST CANCER: EARLY DETECTION INITIATIVE IN PAKISTAN

BREAST CANCER: EARLY DETECTION INITIATIVE IN PAKISTAN

Classification Modelling: A Case Study of Breast Cancer Patients of Islamabad

Purpose: The rate of breast cancer in Pakistan is the highest among all other Asian countries and all other types of cancer. The foremost treatment for breast cancer patients of stage 2 and stage 3 is surgery. The main types of surgery in this era are Mastectomy and Breast Conservative surgery. The decision about the type of surgery depends on the demographic and clinical factors. Approach: In this study, the seven characteristics have been considered. A purposive sample of 365 breast cancer patients were collected from the two main hospitals in Islamabad. The foremost objective of this study was to classify each breast cancer patient regarding surgery type based on significant explanatory characteristics. The binary logistics regression and discriminant analysis techniques were used and the significance of each parameter was tested. Findings: The main effects i.e., age, tumor size, Estrogen Receptor, and Progesterone Receptor were found to be significant with some diverse probabilities and all two-factor interactions were found to be non-significant. The sensitivity of logistic regression and discriminant analysis is almost the same i.e., 93.1% and 92.8% respectively whereas the specificity of these two techniques is also almost the same i.e., 70.8% and 71.9% respectively. The overall actual correct classify rate and Apparent error rate of both these techniques are found to be 87.7% and 12.3% respectively. Implications: In brief, it was deducted that the Tumor size stage is the most imperative characteristic among other significant characteristics in discriminating between two types of surgery

Factors Contributing For Breast Cancer In Pakistan

Breast cancer is the most common malignancy among women around the Globe. Asian countries have highest ratio of breast cancer. About 60 % cases from Asian countries due to lack of health care facilities and awareness about breast cancer in general population. Classification based on age, stage of disease, location of development and family history. Breast cell tumor due to gene mutation prognosis the disease into malignancies. Symptoms may appear in early stage or late stages of disease.Material and method:The literature review was conducted through different sources such as Google scholars, PubMed, MEDLINE and data base. The key words was used breast cancer incidence in Pakistan, prevalence of breast cancer, causes of breast cancer in Pakistan. Only those studies was selected published during the period of 2010 to 2020 and published in English.Results:From this literature review, following factors has been identified, effecting on breast cancer development. Lack of knowledge about breast cancer development. Lack of health care facilities in rural areas, family history and economic problems.Conclusion:Pakistani women are unaware of breast cancer knowledge. Low health care budget, early identification of disease, family history of breast cancer are major contributing factors of breast cancer.

Perception of breast cancer risk factors: Dysregulation of TGF-β/miRNA axis in Pakistani females.

Breast cancer poses a serious health risk for women throughout the world. Among the Asian population, Pakistani women have the highest risk of developing breast cancer. One out of nine women is diagnosed with breast cancer in Pakistan. The etiology and the risk factor leading to breast cancer are largely unknown. In the current study the risk factors that are most pertinent to the Pakistani population, the etiology, molecular mechanisms of tumor progression, and therapeutic targets of breast cancer are studied. A correlative, cross-sectional, descriptive, and questionnaire-based study was designed to predict the risk factors in breast cancer patients. Invasive Ductal Carcinoma (90%) and grade-II tumor (73.2%) formation are more common in our patient's data set. Clinical parameters such as mean age of 47.5 years (SD ± 11.17), disturbed menstrual cycle (> 2), cousin marriages (repeated), and lactation period (< 0.5 Y) along with stress, dietary and environmental factors have an essential role in the development of breast cancer. In addition to this in silico analysis was performed to screen the miRNA regulating the TGF-beta pathway using TargetScanHuman, and correlation was depicted through Mindjet Manager. The information thus obtained was observed in breast cancer clinical samples both in peripheral blood mononuclear cells, and biopsy through quantitative real-time PCR. There was a significant dysregulation (**P>0.001) of the TGF-β1 signaling pathway and the miRNAs (miR-29a, miR-140, and miR-148a) in patients' biopsy in grade and stage specifically, correlated with expression in blood samples. miRNAs (miR-29a and miR-140, miR-148a) can be an effective diagnostic and prognostic marker as they regulate SMAD4 and SMAD2 expression respectively in breast cancer blood and biopsy samples. Therefore, proactive therapeutic strategies can be devised considering negatively regulated cascade genes and amalgamated miRNAs to control breast cancer better.

Patient Delay in Breast Cancer Diagnosis in Two Hospitals in Karachi, Pakistan: Preventive and Life-Saving Measures Needed

PURPOSEPatients with breast cancer in Pakistan commonly present with advanced disease. The objectives of this study were to evaluate the frequency and length of delays in seeking medical consultation and to assess the factors associated with them.METHODSFour hundred ninety-nine patients with newly diagnosed breast cancer were enrolled and interviewed over the period from February 2015 to August 2017. Information on sociodemographic factors, delay to medical consultation, stage of breast cancer at presentation, and tumor characteristics of the breast cancer were collected through face-to-face interviews and medical file review.RESULTSThe mean (standard deviation) age of patients with breast cancer was 48.0 (12.3) years. The mean (standard deviation) patient delay was 15.7 (25.9) months, with 55.2% of women detecting a breast lump but not seeking a medical consultation because of a lack of awareness about the significance of the lump. A total of 9.4% of the women decided to seek treatment initially using complementary and alternative medicine and traditional treatment; 9.4% of the women presented to a health care provider with a breast lump but no action was taken, and they were wrongly reassured about the lump without mammography or biopsy. For 26% of the women, the delay in presentation was caused by anxiety, fears and misconceptions regarding diagnosis and treatment, and other social factors including possible adverse effects on their relationship with their husband. Multivariable analysis showed a strong association of lower socioeconomic status (odds ratio [OR], 8.11 [95% CI, 2.46 to 26.69]) and late stage of breast cancer (OR, 4.83 [95% CI, 1.74 to 13.39]) with a patient delay of ≥ 3 months.CONCLUSIONPatient delay is a serious problem in Pakistan. There is an urgent need for intensive and comprehensive breast cancer education that addresses the myths and misconceptions related to breast cancer.

Breast Cancer in Pakistan: Alarming Situation of Breast Cancer in Near Future

The article's abstract is no available.

Detection of novel infiltrating ductal carcinoma-associated BReast CAncer gene 2 mutations which alter the deoxyribonucleic acid-binding ability of BReast CAncer gene 2 protein.

BReast CAncer gene 2 (BRCA2), a tumor suppressor gene located on chromosome 13q, encodes a 384-kDa protein which activates homologous recombination pathway to repair ssDNA damage. Keeping in view the high prevalence of breast cancer in Pakistan and significant association of BRCA2 with breast cancer, this project was initiated to investigate the mutational status of BRCA2 in Pakistani breast cancer patients. For this purpose, blood samples of 45 individuals, including 24 female patients (infiltrating ductal carcinoma of breast), who visited Institute of Nuclear Medicine, Oncology and Radiotherapy Hospital and Ayub Medical Complex, Abbottabad, Khyber Pakhtunkhwa, and 21 normal female residents of the area were collected and processed to extract deoxyribonucleic acid (DNA). Different regions of BRCA2 exon 11 were amplified through polymerase chain reaction (PCR), and PCR-amplified products of one (NF45) normal sample and four cancerous (205BC, 215BC, 218BC, 222BC) samples were subjected to DNA sequence analysis. Analysis of retrieved sequences revealed one novel nonsense mutation in sample 205BC. The observed mutation (delA21587) shifted the normal frame of amino acid (N905I, T906L, K907R, E908N, L909F, H910M, E911K, T912Q, and D913T) in encoded mutant protein and converted L914 into premature termination codon. In case of sample 222BC, another novel substitution mutation (A>G24962) was observed, which altered codon of I (isoleucine) into the codon for M (methionine) at position 2040 in resultant mutant protein. The results reflect the unique mutational profile of BRCA2 in Pakistani infiltrating ductal carcinoma patients and suggest an extension of study on a large scale.

Frequency locally advanced and metastatic breast cancer at the time of presentation in a private hospital in Peshawar.

Breast cancer is the most common cancer among women and Pakistan has the highest rate of breast cancers in Asia. Breast cancer patients present very late with their symptoms in Pakistan as compared to the developed world. As a result, our survival outcomes are very poor. To estimate the frequency of breast cancer patients presenting with locally advanced and metastatic disease at presentation at our dedicated one-stop breast care unit (BCU) at Rehman Medical Institute Peshawar. Study Design: Observational study. Setting: Rehman Medical Institute Peshawar. Period: 1st January 2018 to 31st December 2018. Material and Methods: Data was prospectively collected of all breast cancer patients presenting to BCU and recorded both electronically and in hard copy, and analysed. Results: A total of 83 patients were identified. 30% of the patients had metastatic disease at presentation while 34% had locally advanced disease. Only 36% had early breast cancer. Conclusion: This study supported the previously reported trend of very late presentation of patients with breast cancer in Pakistan.

Spectrum and prevalence of BRCA1/2 germline mutations in Pakistani breast cancer patients: results from a large comprehensive study

BackgroundPathogenic germline mutations in BRCA1 and BRCA2 (BRCA1/2) account for the majority of hereditary breast and/or ovarian cancers worldwide. To refine the spectrum of BRCA1/2 mutations and to accurately estimate the prevalence of mutation in the Pakistani population, we studied 539 breast cancer patients selected for family history and age of diagnosis.MethodsComprehensive screening for BRCA1/2 germline mutations was performed using state-of-the-art technologies.ResultsA total of 133 deleterious mutations were identified in 539 families (24.7%), comprising 110 in BRCA1 and 23 in BRCA2. The prevalence of BRCA1/2 small-range mutations and large genomic rearrangements was 55.4% (36/65) for families with breast and ovarian cancer, 27.4% (67/244) for families with two or more cases of breast cancer, 18.5% (5/27) for families with male breast cancer, and 12.3% (25/203) for families with a single case of early-onset breast cancer. Nine mutations were specific to the Pakistani population. Eighteen mutations in BRCA1 and three in BRCA2 were recurrent and accounted for 68.2% (75/110) and 34.8% (8/23) of all identified mutations in BRCA1 and BRCA2, respectively. Most of these mutations were exclusive to a specific ethnic group and may result from founder effects.ConclusionsOur findings show that BRCA1/2 mutations account for one in four cases of hereditary breast/ovarian cancer, one in five cases of male breast cancer, and one in eight cases of early-onset breast cancer in Pakistan. Our study suggests genetic testing of an extended panel of 21 recurrent BRCA1/2 mutations for appropriately selected patients and their families in Pakistan.

Current situation of breast cancer in Pakistan with the available interventions

Current situation of breast cancer in Pakistan with the available interventions

Death anxiety, perceived social support, and demographic correlates of patients with breast cancer in Pakistan

Among several forms of miseries experienced by cancer patients, one of the significant experiential problems is the inevitable fear of death. The present study aimed at exploring the relationship between death anxiety, perceived social support, and different demographic variables. A sample of 80 breast cancer patients was recruited from different departments of oncology in Pakistan. Research findings revealed that death anxiety was negatively associated with social support. Moreover, it was found that education and marital status were associated with death anxiety among patients with breast cancer. Results suggest that social support assist in reducing death anxiety and enhance their recovery course.

Association analysis and allelic distribution of deletion in CC chemokine receptor 5 gene (CCR5Δ32) among breast cancer patients of Pakistan.

Chemokine CC receptor type 5 (CCR5) is a cell surface receptor that has high affinity for chemotropic cytokines called chemokines. The CCR5 gene contains a 32 base pairs (bp) deletion (CCR5Δ32). This deletion may result in a malformed and nonfunctional receptor, reported to be responsible for the development and dissemination of different cancers. CCR5Δ32 exists in two allelic forms i.e. deletion (D) and wild type (WT). This study aims to detect the role of CCR5Δ32 in breast cancer development. Blood samples were collected from breast cancer patients (330) and controls of same gender (306). Along with this histopathologically diagnosed malignant tissue samples were also excised from breast lesions of 100 patients. Genetic variations within the blood and tissue samples were examined by PCR then observed through gel electrophoresis and confirmed by direct DNA sequencing. Obtained DNA sequences were aligned and analyzed by MEGA6 software. Genotypic and association analyses were done by SPSS software version 17.0. Deletion of 32bp in CCR5 gene has been analyzed. Genotypic variations of CCR5Δ32 are; homozygous wild type (WT/WT), heterozygous deletion (WT/D) and homozygous deletion (D/D). Statistical analyses of CCR5Δ32 data revealed that WT/D was significantly higher in blood samples of breast cancer patients (7.27% (24/330)) as compare to controls (1.30% (4/306)). In tumor tissue samples WT/WT being the most frequent genotype (99.00% (99/100)) with 1.00 (1/100) of D/D which suggested that it may be acquired. Hence, association analysis showed that CCR5Δ32 is positively associated with breast cancer in Pakistan (p < 0.001). The risk ratio of CCR5Δ32 was 5.6610 (95% confidence interval: 2.0377 to 15.7267) and odds ratio was calculated to be 6.0335 (95% confidence interval: 2.1288 to 17.0999) which signifies that deletion also increases the risk of breast cancer development. Moreover, association analyses also revealed that clinicopathological features do not have any impact on the CCR5Δ32 genotype of breast cancer. This suggests that deletion of 32bp in CCR5 gene may be associated with breast cancer. CCR5 signals the activation and migration of immune cells at the site of tumor formation. Because of deletion; deformed CCR5 receptor might be unable to express and function properly which may subdue the immunity against cancer hence, leading to its progression.