Breast Cancer Research Center Research Articles

Refractory and Recurrent Idiopathic Granulomatous Mastitis Treatment: Adaptive, Randomized Clinical Trial.

Idiopathic granulomatous mastitis (IGM) is mostly described as an autoimmune disease with higher prevalence among Middle Eastern childbearing-age women. This study aimed to evaluate the best treatment of choice in patients with resistant or recurrent IGM. Patients with established recurrent or resistant IGM who were referred to the Breast Cancer Research Center from 2017 to 2020 were randomly assigned to either one of the following treatment groups: A (best supportive care), B (corticosteroids: prednisolone), and C (methotrexate and low-dose corticosteroids). This adaptive clinical trial evaluated radiological and clinical responses, as well as the potential side effects, on a regular basis in each group, with patients followed up for a minimum of 2 years. A total of 318 participants, with a mean age of 33.52 ± 6.77 years, were divided into groups A (10 patients), B (78 patients), and C (230 patients). In group A, no therapeutic response was observed; group B exhibited a mixed response, with 14.1% experiencing complete or partial responses, 7.7% maintaining stability, and 78.2% experiencing disease progression. Accordingly, groups A and B were terminated due to inadequate response. In group C, 94.3% achieved complete response, 3% showed partial remission, and 2.7% had no response to therapy. Among the entire patient cohort, 11.6% tested positive for antinuclear antibodies, 3.5% for angiotensin-converting enzyme, and 12.3% for erythema nodosum. Notably, hypothyroidism was a prevalent condition among the patients, affecting 7.2% of the cohort. The incidence of common side effects was consistent across all groups. The most effective treatment option for patients with recurrent or resistant IGM is a combination therapy involving steroids and disease-modifying antirheumatic drugs such as methotrexate.

The oncological safety and long-term cosmetic effect of free dermal fat graft with epidermis removal for breast defect repair in breast conserving surgery

BackgroundFree dermal fat grafts (FDFG) are used for immediate breast defect repair in breast-conserving surgery (BCS), and have achieved satisfactory immediate postoperative cosmetic effects (Sawai et al., 2004) [1]. However, the oncologic safety and long-term cosmetic outcomes of these surgical procedures remain unknown. Therefore, t，in this study, we aim to investigate the oncological safety and long-term cosmetic outcomes of FDFG in patients with breast cancer. MethodsThis matched retrospective case-control study included patients with non-special types of breast cancer who underwent FDFG for breast defect repair after BCS or BCS alone at two breast cancer research centers in Guangxi Province, China, from January 2016 to December 2019. The patients were divided into either the FDFG or BCS group. Control cases were screened using propensity score matching, and survival analysis and cosmetic evaluations were performed. ResultsA total of 442 patients with breast cancer were included in the study. After 1:4 propensity score matching, 53 and 212 patients were included in the FDFG and BCS groups, respectively. The median follow-up time was 49.9 (9.0–76.0) months. The rate of local recurrence in the FDFG group (9.4 %) was significantly higher than that in the BCS group (1.9 %; p < 0.05). The total cosmetic evaluation score was significantly higher in the BCS group 18 months after surgery than in the FDFG group (p < 0.05). ConclusionsIn this retrospective study, FDFG was significantly associated with an increased risk of local recurrence. Further prospective studies are required to confirm these results. No significant difference in long-term cosmetic effects were observed for FDFG than for BCS alone for immediate breast defect repair.

Critical Assessment of Three Decades of Breast Cancer Research in Yemen: Systematic Review

Objective: The aim of this review is to critically assess three decades (1989 to 2019) of breast cancerresearch in Yemen and to identify the gaps in, and need for, breast cancer research in Yemen.Methodology: A search was performed in Web of Science, EMBASE, PubMed, Google Scholar and Ovidto identify articles on breast cancer research in Yemen that were published in the last three decades. Thearticles were selected and reviewed by experts in this field, based on clinical relevance and future researchimplications.Results: This review comprised 19,031 participants, extracted from 27 articles that were included andanalyzed. Breast cancer patients in Yemen were commonly diagnosed at an early age of 50 years or younger.Overall, awareness of breast cancer among Yemeni women was very poor. Some studies reported that a lowrate of only 11%-17.4% of Yemeni women practiced breast screen examination. Only 1.6% of the Yemeniwomen had been screened by a mammogram test. The highest performed surgery was a modified radicalmastectomy (N=211). The highest cases of breast cancer were reported in Hadramout (N=956) and the mostcommon histological subtype was invasive ductal carcinoma (N=2695).Conclusions: Yemen is characterised by three decades of scattered, fragmented and poor quality breastcancer research. Therefore, there is a need to establish a breast cancer research center in Yemen to researchall aspects of breast cancer in Yemen, and to build bridges for collaborations in breast cancer researchglobally.

Investigation of Prognostic Factors of Survival in Breast Cancer Using a Frailty Model: A Multicenter Study.

Background:Using data from different health centers can provide more accurate knowledge of the survival prognostic factors and their effect on the patient’s survival. In this multicenter study, we aimed to investigate the role of prognostic factors on breast cancer survival with large data set.Methods:This historical cohort study was carried out using data from 1785 participants with breast cancer. Data were gathered from medical records of patients referring to 4 breast cancer research centers in Tehran, Iran, between 1997 and 2013. Age at diagnosis (year), size of the tumor, involve lymph nodes, tumor grade, type of surgery, auxiliary treatment of chemotherapy, radiotherapy, recurrence, and metastasis were the prognosis factors considered in this study. A shared frailty model with a gamma distribution for frailty term was used.Results:The median follow-up period was 29.71 months with the interquartile range of 19 to 61 months. During the follow-up period, 337 (18.9%) patients died from breast cancer and 1448 (81.1%) survived. The 1-, 3-, 5-, and 10-year survival rates were 96%, 84%, 76%, and 58%, respectively. In the Cox model by centers, in Center A, the type of surgery, number of nodes involved, and the grade 3 tumor; in center B, age, radiotherapy, metastasis, and between 1 and 3 involved nodes; in center C, age, radiotherapy, recurrence, metastasis, tumor size, and grade 3 tumor; and in center D, chemotherapy, metastasis, and lymph nodes involved were significant. Shared frailty model showed that type of surgery, number of lymph nodes involved, metastasis, radiotherapy, and the tumor grade are the prognostic factors survival in breast cancer. The frailty variance was significant, and it affirmed there was significant variability between centers.Conclusions:This study showed it is necessary to consider the frailty term in modeling multicenter survival studies and confirmed the importance of early diagnosis of cancer before the involvement of lymph nodes and the onset of metastasis and timely treatment could lead to longer life and increased quality of life for patients.

Narrative Therapy and Hope in Breast Cancer Patients

Background: Narrative therapy is one of the most important ways of improving the quality of life and mental health by increasing women's hope in breast cancer. These patients often think that they have many problems, especially with hopelessness, body image, sexuality, and helplessness. It is effective for improving mental and physical health as an effective way of changing behavior. Aim: The purpose of this study was to evaluate the effectiveness of narrative therapy on increasing level of hope in breast cancer patients that was present at the Breast Cancer Research Center of Iran in 2017. Methods: We conducted a clinical pretest and posttest study, with two experimental groups. All of the participants had already received their primary treatments. They response, Hert Hope Index (HHI). Twenty-six patients had individual therapy, 24 patients in 5 groups were treated with group therapy. We had 8 sessions weekly which lasted 100-120 minutes. Narrative therapy was done for two groups. Both groups were reassessed to monitor the changes in hope (posttest) and reported. Results: According to the demographic characteristics of the participants, the mean age in the individual and group therapy was 47 (± 9) and 51 (± 8) respectively. Data analysis showed that according to their marital status ( P = 0.56), occupation ( P = 0.71), education ( P = 0.96), was not statistically significant difference. The hope scores in the individual therapy before and after the treatment were 32 (± 6) and 21.04 (± 5), respectively. And group therapy 29 (± 6) and 27 (± 4) respectively. These results showed that increasing of hope during the study in group therapy ( P &lt; 0.0001), the difference between the two groups (α = 95%, P &lt; 0.001). On the other hand, these results showed, there wasn't significant difference between the hope levels before and after intervention in the individual group ( P &lt; 0.025). Conclusion: This study showed that, the effects of narrative treatment with group therapy on the increasing hope level in breast cancer patients. It suggests that narration can be a psychological recovery of cancer survivors in group therapy and promotion their quality of life.

Bayesian Multivariate Joint Modeling for Multiple Events Time Data and Survival

Individuals may experience multiple recurrent events and a dependent terminal event during their life period of a disease. Follow-up may be interrupted for some reasons. Also, death can stop the follow-up. Therefore, it is considered as a terminal event. In this article, we propose a Bayesian multivariate joint frailty model that jointly analyzes two types of recurrent events with a dependent terminal event. The Markov chain Monte Carlo methods are used to estimate the posterior distributions of model parameters. The performance of this approach is examined based on simulation study using exponential distribution. We apply the proposed method to a real dataset on breast cancer, which motivated this research. The main purpose was to model the dependency between multiple recurrent events (locoregional and metastatic) and the terminal event (death) after a breast cancer. Funding: This work was supported by tarbiat modares university, faculty of medical science. The collection of cancer data used in this study was supported by Shahid Beheshti Breast Cancer Research Center in Iran. Declaration of Interest: The authors declare that they have no competing interests.

Factors Impacting Pathologic Complete Response after Neoadjuvant Chemotherapy in Breast Cancer: A Single-Center Study

Background: Neoadjuvant chemotherapy is the standard treatment for patients with locally advanced breast cancer which was recently introduced for operable breast cancer especially to achieve negative margins in breast conservation. Several studies have shown that Pathologic complete response (pCR) after neoadjuvant chemotherapy increases survival rate. The aim of this study therefore, was to evaluate the rate of pathologic complete response and its effective factors in breast cancer research center (BCRC). Methods: During a cross-sectional study, 179 patients with stage I to III breast cancer, who received neoadjuvant chemotherapy in breast cancer research center from 1997 to 2014, were included. Cases with pathologic complete response were defined as no tumor residue in the breast tissue and axillary region. This group of patients was compared with patients who had residual tumor at pathology. Data were analyzed by descriptive and inferential statistics using SPSS 19. Results: The mean age of patients was 45.4 years. Thirty-four patients (19%) were identified in the pathological complete response group (pCR). There was no significant difference between the pCR and non-pCR groups with respect to Age, Menopausal status, Family history of breast cancer, Tumor size, Histological type, Hormone receptors, Her-2neu and Phenotypic subtypes. However, ki67 index was significantly different between the two groups of patients, indicating that in patients with Ki67 of more than 40, pCR was the most observed (P = 0.01). Conclusions: This study showed that among the demographic, clinical, pathological and therapeutic factors, Ki67 can be a predicting factor for pathologic complete response after neoadjuvant chemotherapy.

Prognostic Cut Point for Breast Cancer Age of Diagnosis

Background: In oncology studies, categorizing a quantitative prognostic variable or determining cut point is aimed at categorizing individuals into homogenous groups. Such categorizations are useful for treatment recommendations and clinical trial design. Objectives: This article aims at determining the cut point for breast cancer diagnosis age by factors affecting the patients’ survival, using cure model. Methods: In this longitudinal study, a total 559 patients with breast cancer referring to breast cancer research center, Tehran, Iran, from 1986 to 2006 entered the study. Patients were followed until 2013. The last status of patients was recorded, using telephone conversation. Then, the cut point of breast cancer diagnosis age was determined, using change point cure model with survival-related covariates and R v.2.15.0 software. Results: In the present study, the mean age of diagnosis was reported 46.31 ± 11.17. Median time of follow-up was 68.36 months with the range of 0.89 to 324. The results showed that age cut point was 49.45 (± 0.64). In young group, one unit increase in tumor size led to 57% reduction in the chance of cure. In old group, the chance of recovery declined by 51%. In old group, the chance of cure among those with lymph node declined by %61 compared to those without lymph node. In the young group, this variable was not significant. Level of education, type of surgery, and estrogen receptor had no significant relationship with cure in none of the age groups at 5% error level. Conclusions: The results showed that the effect of age in breast cancer prognosis is adjusted at 50-year cut point, leading to two relatively homogeneous groups. This cut point is effective in assessing predictive and prognostic factors in breast cancer. The difference between effect of tumor size and effect of lymph node involvement in different age groups can be helpful in determining more appropriate therapeutic strategies.

Unique CD44 intronic SNP is associated with tumor grade in breast cancer: a case control study and in silico analysis

BackgroundCD44 encoded by a single gene is a cell surface transmembrane glycoprotein. Exon 2 is one of the important exons to bind CD44 protein to hyaluronan. Experimental evidences show that hyaluronan–CD44 interaction intensifies the proliferation, migration, and invasion of breast cancer cells. Therefore, the current study aimed at investigating the association between specific polymorphisms in exon 2 and its flanking region of CD44 with predisposition to breast cancer.MethodsIn the current study, 175 Iranian female patients with breast cancer and 175 age-matched healthy controls were recruited in biobank, Breast Cancer Research Center, Tehran, Iran. Single nucleotide polymorphisms of CD44 exon 2 and its flanking were analyzed via polymerase chain reaction and gene sequencing techniques. Association between the observed variation with breast cancer risk and clinico-pathological characteristics were studied. Subsequently, bioinformatics analysis was conducted to predict potential exonic splicing enhancer (ESE) motifs changed as the result of a mutation.ResultsA unique polymorphism of the gene encoding CD44 was identified at position 14 nucleotide upstream of exon 2 (A37692→G) by the sequencing method. The A > G polymorphism exhibited a significant association with higher-grades of breast cancer, although no significant relation was found between this polymorphism and breast cancer risk. Finally, computational analysis revealed that the intronic mutation generated a new consensus-binding motif for the splicing factor, SC35, within intron 1.ConclusionsThe current study results indicated that A > G polymorphism was associated with breast cancer development; in addition, in silico analysis with ESE finder prediction software showed that the change created a new SC35 binding site.

Frequency of Fat Necrosis in Mammography and Sonography and Correlation with Pathology for Differentiation of Breast Cancer in Breast Cancer Research Center

Frequency of Fat Necrosis in Mammography and Sonography and Correlation with Pathology for Differentiation of Breast Cancer in Breast Cancer Research Center

Investigating the Factors Affecting the Mammographic Density of Breast Tissue in Patients Referred to the Breast Cancer Research Center, Iran

Investigating the Factors Affecting the Mammographic Density of Breast Tissue in Patients Referred to the Breast Cancer Research Center, Iran

Challenges With Identifying Indication for Examination in Breast Imaging as a Key Clinical Attribute in Practice, Research, and Policy

PurposeTo assess indication for examination for four breast imaging modalities and describe the complexity and heterogeneity of data sources and ascertainment methods. MethodsIndication was evaluated among the Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) breast cancer research centers (PRCs). Indication data were reported overall and separately for four breast imaging modalities: digital mammography (DM), digital breast tomosynthesis (DBT), ultrasound (US), and magnetic resonance imaging (MRI). ResultsThe breast PRCs contributed 236,262 women with 607,735 breast imaging records from 31 radiology facilities. We found a high degree of heterogeneity for indication within and across six data sources. Structured codes within a data source were used most often to identify indication for mammography (59% DM, 85% DBT) and text analytics for US (45%) and MRI (44%). Indication could not be identified for 17% of US and 26% of MRI compared with 2% of mammography examinations (1% DM, 3% DBT). ConclusionsMultiple and diverse data sources, heterogeneity of ascertainment methods, and nonstandardization of codes within and across data systems for determining indication were found. Consideration of data sources and standardized methodology for determining indication is needed to assure accurate measurement of cancer screening rates and performance in clinical practice and research.

Determination of a Change Point in the Age at Diagnosis of Breast Cancer Using a Survival Model.

Breast cancer, the second cause of cancer-related death after lung cancer and the most common cancer in women after skin cancer, is curable if detected in early stages of clinical presentation. Knowledge as to any age cut-off points which might have significance for prognostic groups is important in screening and treatment planning. Therefore, determining a change-point could improve resource allocation. This study aimed to determine if a change point for survival might exist in the age of breast cancer diagnosis. This study included 568 cases of breast cancer that were registered in Breast Cancer Research Center, Tehran, Iran, during the period 1986-2006 and were followed up to 2012. In the presence of curable cases of breast cancer, a change point in the age of breast cancer diagnosis was estimated using a mixture survival cure model. The data were analyzed using SPSS (versions 20) and R (version 2.15.0) software. The results revealed that a change point in the age of breast cancer diagnosis was at 50 years age. Based on our estimation, 35% of the patients diagnosed with breast cancer at age less than or equal to 50 years of age were cured while the figure was 57% for those diagnosed after 50 years of age. Those in the older age group had better survival compared to their younger counterparts during 12 years of follow up. Our results suggest that it is better to estimate change points in age for cancers which are curable in early stages using survival cure models, and that the cure rate would increase with timely screening for breast cancer.

Application of Canonical Correlation Analysis for Detecting Risk Factors Leading to Recurrence of Breast Cancer.

Background:Advances in treatment options of breast cancer and development of cancer research centers have necessitated the collection of many variables about breast cancer patients. Detection of important variables as predictors and outcomes among them, without applying an appropriate statistical method is a very challenging task. Because of recurrent nature of breast cancer occurring in different time intervals, there are usually more than one variable in the outcome set. For the prevention of this problem that causes multicollinearity, a statistical method named canonical correlation analysis (CCA) is a good solution.Objectives:The purpose of this study was to analyze the data related to breast cancer recurrence of Iranian females using the CCA method to determine important risk factors.Patients and Methods:In this cross-sectional study, data of 584 female patients (mean age of 45.9 years) referred to Breast Cancer Research Center (Tehran, Iran) were analyzed anonymously. SPSS and NORM softwares (2.03) were used for data transformation, running and interpretation of CCA and replacing missing values, respectively. Data were obtained from Breast Cancer Research Center, Tehran, Iran.Results:Analysis showed seven important predictors resulting in breast cancer recurrence in different time periods. Family history and loco-regional recurrence more than 5 years after diagnosis were the most important variables among predictors and outcomes sets, respectively.Conclusions:Canonical correlation analysis can be used as a useful tool for management and preparing of medical data for discovering of knowledge hidden in them.

Comparison of SF-6D and EQ-5D Scores in Patients With Breast Cancer.

BackgroundUtility values are a key component of a cost-utility analysis. The EQ-5D and SF-6D are two commonly used measures for deriving utilities. Of particular importance is assessing the performance of these instruments in terms of validity.ObjectivesThis study aimed to compare the performance of the EQ-5D and the SF-6D in different states of breast cancer.Patients and MethodsThis was a cross-sectional study of 163 patients with breast cancer who attended the breast cancer subspecialty clinic affiliated with the breast cancer research center (BCRC) at ACECR, in Tehran, Iran, and were consecutively recruited. Patients completed several questionnaires, including the EQ-5D, SF-36, and general questions regarding their demographic characteristics. Utility values for different states of breast cancer were obtained using predetermined algorithms for the EQ-5D and SF-6D. The distribution of the utility values and the differences between the different states for both instruments were statistically assessed. Furthermore, the agreement between the two instruments was evaluated using intra-class correlation coefficients and Bland-Altman plots.ResultsThe mean and median EQ-5D utility scores for the total sample were 0.685 and 0.761, respectively. The mean SF-6D utility score for the total sample was 0.653, and the median utility score was 0.640. The mean utility values of the EQ-5D for “state P,” “state R,” “state S,” and “state M” were estimated as 0.674, 0.718, 0.730, and 0.552, respectively. The SF-6D provided mean utility values of 0.638, 0.677, 0.681, and 0.587 for those states. Both instruments assigned statistically significant (P < 0.01) scores for different states. The intra-class correlation for the two measures was 0.677 (95% confidence interval (CI): 0.558 - 0.764). The Bland-Altman plot indicated a better agreement on the higher values and that at higher values, the EQ-5D yields a higher score than the SF-6D; this relationship was reversed at lower values.ConclusionsAlthough the two instruments were able to discriminate between various states, the values derived from these instruments were quite different. This distinction could have influenced the conclusions of an economic evaluation. Further research is required to determine which instrument should be used in economic evaluations.

Provider Attitudes and Screening Practices Following Changes in Breast and Cervical Cancer Screening Guidelines.

Changes to national guidelines for breast and cervical cancer screening have created confusion and controversy for women and their primary care providers. To characterize women's primary health care provider attitudes towards screening and changes in practice in response to recent revisions in guidelines for breast and cervical cancer screening. In 2014, we distributed a confidential web and mail survey to 668 women's health care providers affiliated with the four clinical care networks participating in the three PROSPR (Population-based Research Optimizing Screening through Personalized Regimens) consortium breast cancer research centers (385 respondents; response rate 57.6 %). We assessed self-reported attitudes toward breast and cervical cancer screening, as well as practice changes in response to the most recent revisions of the U.S. Preventive Services Task Force (USPSTF) recommendations. The majority of providers believed that mammography screening was effective for reducing cancer mortality among women ages 40-74 years, and that Papanicolaou (Pap) testing was very effective for women ages 21-64 years. While the USPSTF breast and cervical cancer screening recommendations were widely perceived by the respondents as influential, 75.7 and 41.2 % of providers (for mammography and cervical cancer screening, respectively) reported screening practices in excess of those recommended by USPSTF. Provider-reported barriers to concordance with guideline recommendations included: patient concerns (74 and 36 % for breast and cervical, respectively), provider disagreement with the recommendations (50 and 14 %), health system measurement of a provider's screening practices that use conflicting measurement criteria (40 and 21 %), concern about malpractice risk (33 and 11 %), and lack of time to discuss the benefits and harms with their patients (17 and 8 %). Primary care providers do not consistently follow recent USPSTF breast and cervical cancer screening recommendations, despite noting that these guidelines are influential.

Comparing Coping Styles in Cancer Patients and Healthy Subjects

The purpose of this study was to compare copying styles between cancer patients and healthy people. The statistical population of this study consisted of all patients who had referred to Laleh Hospital as well as Breast Cancer Research Center. Among them, 80 patients were selected by convenience sampling. Healthy people were selected by random sampling method and the groups were matched in age and education level with each other. The Coping Strategies Questionnaire (CSQ) of Lazarus and Folkman was used and the collected data was introduced to SPSS and was analyzed by descriptive statistical methods as well as ANOVA analysis. The results of this study showed that cancer patients mostly use emotion-focused coping strategies compared with healthy people and they generally use the subscales of confrontive coping, escape-avoidance and seeking social support while they hardly use the subscales of self-controlling, accepting responsibility, planful problem solving and positive reappraisal.

Investigation of the age trends in patients with breast cancer and different sizes of tumors in Breast Cancer Research Center of Isfahan University of Medical Sciences in 2001-2010.

Background:Breast cancer is the most common cause of death in women in the age range of 35-55 years. Each year, one or two cases of breast cancer per 1000 women are diagnosed as new cases. Despite the serious prognosis and high rate of morbidity, mortality, and pathogenicity, in the case of early diagnoses, the prognosis will be better. The aim of this study was to investigate the age trends in breast cancer patients with different sizes of tumors in Breast Cancer Research Center of Isfahan University of Medical Sciences in 2001-2010.Materials and Methods:The information in radiotherapy and oncology of Isfahan University of Medical Sciences and Milad Hospital from 2001 to 2010 were coded and analyzed. Frequency of patients’ age groups, tumor sizes and the year of cancer diagnosis were calculated. Correlation test was used for data analysis in statistical analysis in social science (SPSS) software version 18.Findings:Among the 3722 patients with breast cancer, the highest relative frequency distribution, respectively was observed in the age of 40-49 years (34.4%), 50-59 years (26.6%), 30-39 years (17.7%), 60-69 years (13.2%), 20-29 years (2.5%), 70 years and older (5.2%) and less than 20 years. Relative frequency distribution of tumor sizes in a variety of 5 cm (T2) was with the frequency of 59.8%, and then 26% at 5 cm (T3), 10.5% at 2 cm (T1), 3.1% at T4 and 0.6 at In-situ, respectively.Conclusion:The investigation of age trends showed that diagnosis rate of breast cancer increased from 2001 to 2004. It reached its highest value in 2006 at the age range of 30-39 years. Then, the trend has been downward, and it has continued to decline until 2010, which could be the result of the equipping screening system and recording the malignant cases. 85.8% of the examined tumors in T2 and T3 group were visible and may be disturbing. Comparing the frequency distribution of the infected population showed that the highest incidence of breast cancer diagnosis were in the age range of 40-49 years. It seems that as long as the mass has not reached an obvious palpable state, it has not been diagnosed.

Abstract P2-12-10: Psycho-spiritual therapy for improving the quality of life and spiritual well-being of women with breast cancer

Abstract Objective: Psychological distress and morbidity are common consequences of diagnosis and treatment of breast cancer and associated with poor quality of life (QOL). Among several approaches, spirituality has been shown to be significantly associated with improving the quality of life of these patients. The aim of this study was to assess the role of psycho-spiritual therapy intervention in improving the quality of life and spiritual well-being of patients with breast cancer. Methods: This was a randomized controlled trial study which was conducted in the Breast Cancer Research Center, St. S. Al-Shohada hospital, Isfahan, Iran. Sixty-eight patients with breast cancer were randomized to either psycho-spiritual therapy intervention group or control group who received routine management and educational programs. Before and after 6 weeks of psycho-spiritual therapy sessions, the quality of life was evaluated using Cancer quality-of-life questionnaire (QLQ-C30) and its supplementary breast cancer questionnaire (QLQ-BR23) and Spiritual well-being was measured using the Functional Assessment of Chronic Illness Therapy Spiritual Well-being scale (FACIT-Sp12). Multivariate, repeated-measures ANOVA, T-test and Paired T-test were used for analysis using Predictive Analytic Soft Ware (PASW, version 18) for windows. Results: In all sixty five patients actually completed the six-week intervention and were evaluated for the outcomes. The mean Global health status score/QOL reached from 44.37 (SD: 13.03) to 68.63 (SD: 10.86), (p &amp;lt; 0.001), (Cohen's d effect size: 2.16, 95% CI: 1.56–2.78). There was a statistically significant difference in all functional scales of QLQ-C30 (p &amp;lt; 0.05) as well as spiritual well-being after intervention. (p = 0.02) Conclusions: The results of this trial showed that the psycho-spiritual therapy program can improve the spiritual well-being and QOL of women with breast cancer. This program, with its ease of implementation and home practice, could be adopted in comprehensive care programs for women with breast cancer. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-12-10.

Standardized Breast Cancer Mortality Rate Compared to the General Female Population of Iran

Breast cancer is the most common cancer in women. Improvements of early diagnosis modalities have led to longer survival rates. This study aimed to determine the 5, 10 and 15 year mortality rates of breast cancer patients compared to the normal female population. The follow up data of a cohort of 615 breast cancer patients referred to Iranian Breast Cancer Research Center (BCRC) from 1986 to 1996 was considered as reference breast cancer dataset. The dataset was divided into 5 year age groups and the 5, 10 and 15 year probability of death for each group was estimated. The annual mortality rate of Iranian women was obtained from the Death Registry system. Standardized mortality ratios (SMRs) of breast cancer patients were calculated using the ratio of the mortality rate in breast cancer patients over the general female population. The mean age of breast cancer patients at diagnosis time was 45.9 (±10.5) years ranging from 24-74. A total of 73, 32 and 2 deaths were recorded at 5, 10 and 15 years, respectively, after diagnosis. The SMRs for breast cancer patients at 5, 10 and 15 year intervals after diagnosis were 6.74 (95% CI, 5.5- 8.2), 6.55 (95%CI, 5-8.1) and 1.26 (95%CI, 0.65-2.9), respectively. Results showed that the observed mortality rate of breast cancer patients after 15 years from diagnosis was very similar to expected rates in general female population. This finding would be useful for clinicians and health policy makers to adopt a beneficial strategy to improve breast cancer survival. Further follow-up time with larger sample size and a pooled analysis of survival rates of different centres may shed more light on mortality patterns of breast cancer.