Kuwait Cancer Research Articles

Pathobiological features of breast tumours in the State of Kuwait: a comprehensive analysis

BackgroundBreast cancer accounts for 30.3% of all cancer types in Kuwaiti women. Death occurs in approximately 43% of these patients. Our goal was to conduct a comprehensive analysis of the pathobiological characteristics of the tumours in an attempt to determine any particular trend that could be present.MethodsOne hundred and sixty-six cases were included in this study. All the pathology reports and paraffin blocks pertaining to these cases were collected. Four micrometer sections were taken from each block, and immunostaining against Her-2, ER, and PgR was performed. Both the proportion and intensity of immunostaining were scored according to the Allred's method, and typing of the tumour was done according the WHO criteria regarding tumour classification. Grading of invasive carcinomas was done according to the modified Bloom-Richardson-Elston's method, and tumour stage was determined according to the criteria set by the American Joint Committee on Cancer.ResultsThe mean age of the patients below 55 years was 40, as compared to 68 for those above 55 (p < 0.0001). More than half of the cases were in the right breast, and were surgically treated by total mastectomy with axillary clearance. The majority of the tumours had irregular (stellate) margins, was invasive, and had a surrounding breast tissue of adenosis or fibrocystic type. Their mitotic index was 10–20 or >20 with a marked to moderate nuclear pleomorphism. They were mostly grade II or III, sized 2–5 or > 5 cm, had absent or scanty tumour lymphocytes, and were stage II or III. The in situ tumours were mainly ductal carcinoma (DCIS) of which comedo and cribriform were the major histological subtypes. The major histological subtypes of the invasive tumours were ductal-not otherwise specified, lobular, and tubular/cribriform. In this study, we also found a significant (p < 0.05) association between over expression of Her-2, lack of expression of ER and some of the characteristics mentioned above.ConclusionBreast cancer in Kuwait seems to be more aggressive than what is currently seen in Europe, North America, Australia, and parts of Asia. Further investigations regarding the features observed in this study need to be performed.

Pattern of breast diseases in Kuwait Cancer Control Center, Kuwait

10754 Background: The aim of this case series study is to evaluate the outline and pattern of female breast cancers in Kuwait. Methods: Our study consisted of data from 300 cases of female breast cancer seen in our outpatient department. Data on profile of their disease at presentation and known risk factors was retrieved. The analysis indented to examine the pattern of the disease and risk factor profile of the patients. Results: Out of 300 patients, 52% were Kuwaiti citizens, 24% were Arabs from other countries, 23% were of Asian origin and 1% was of other nationality. Their median age ± SD (Standard Deviation) was 50 ± 9.7 years. Most patients were younger than 55 years (77.4%) and were predominantly premenopausals (63%). Only 18% had stage I disease at presentation, whilst 54 %, 24 %, and 4% had stage II, III and IV disease, respectively. Among patients with known axillary nodal status (298 patients) 44.3% were node-negative whilst 39.6% and 16.8% had N1 and N2 disease, respectively. History of benign breast disease was positive in 9% and only 1% had breast biopsy done before the biopsy which diagnosed cancer. In 20.7% there was family history of breast cancer. Among them 11.7% had first degree relative with breast cancer, 3.3%, 7.3% and 1% patients had either mother, sister or both with history of breast cancer. Whilst 12% patients had second degree relatives with breast cancer, 3% patients out of them had both first and second degree relatives with breast cancer. History of alcohol ingestion was rare, only 0.7% patients were taking alcohol. 9.7% patients were nulliparous, while 10.7% patients had their first child after the age of 30 years. Breast feeding was common, 80 % patients breast fed their children and 43.3 % did that for more than 6 months. Age at menarche was 12 years or less in 34 % patients and age at menopause was more than 55 years in only 6.3% patients. Oral contraceptives were used by 38.7% patients, 12%, 9.3% and 17.3% patients used them for 2 or less, 2 to 5 or more than 5 years, respectively. Only 3% patients took hormone replacement therapy, 7 of them took that fore more than 2 years. Only 6 % patients gave history of smoking and only half of them were currently smoking. Conclusions: This data analysis suggested that pattern of breast cancer in Kuwait is similar to other countries in this region. No significant financial relationships to disclose.

Thyroid cancer in Kuwait: Review of 117 cases

One hundred and seventeen patients with thyroid cancer were seen at the Radiotherapy and Isotope Centre, Al-Sabah Hospital, Kuwait, between 1963 and 1974. Thyroid cancer constituted 4.7 per cent of all cancer cases among females and 2.4 per cent among males. Of these carcinomas, 58 per cent were papillary, 25 per cent follicular, 11 per cent anaplastic and 1.7 per cent medullary. Four cases (3.4 per cent) were of malignant lymphoma. The 10-year survival was 74, 96 and 21 per cent for papillary, follicular and anaplastic tumours respectively. The present series confirms the prognostic value of age, sex and histology and shows that node metastasis does not prejudice survival. The study does not show any correlation between the type of operation and survival.

BRCA1 Gene Expression in Breast Cancer in Kuwait: Correlation with Prognostic Parameters

Objectives: This study assessed the BRCA1 gene expression in breast cancer in Kuwait, and compared it with other known prognostic factors for the disease. Materials and Methods: Forty-eight random samples of archival paraffin-embedded breast cancer tissues were studied for BRCA1 gene expression. Immunohistochemical method utilizing antibodies against different epitopes on the BRCA1 protein was used to study BRCA1 protein expression. In addition, for 29 patients, reverse transcription-polymerase chain reaction was used to detect BRCA1 mRNA expression. BRCA1 expression was correlated with age, histological type and grade of breast cancer, estrogen and progesterone receptor status, and C-erbB-2 expression. Results: No demonstrable BRCA1 mRNA and protein expression was found in 79 and 83% of the breast cancer tissues, respectively. A positive relationship was demonstrated between lack of BRCA1 (mRNA and protein) expression and high histological grade, negative estrogen and progesterone receptor status, and overexpression of C-erbB-2 in the breast cancer tissues. Conclusions: The study demonstrated lack of BRCA1 gene expression (mRNA and protein) in the majority of breast cancers in Kuwait and confirmed the inverse relationship between BRCA1 expression and parameters that determine poor prognosis in breast cancer.

Prevalence of Endometrial Proliferation in Pipelle Biopsies in Tamoxifen-Treated Postmenopausal Women with Breast Cancer in Kuwait

Objective: To determine the prevalence of pathologic changes in the endometrium of tamoxifen-treated asymptomatic postmenopausal patients with breast cancer. Subjects and Methods: Fifty postmenopausal asymptomatic breast cancer patients with positive estrogen receptor status were treated with 20 mg of tamoxifen daily for a period of 5–60 months. The control group consisted of 30 asymptomatic postmenopausal breast cancer patients who were negative for estrogen receptor and therefore did not receive tamoxifen. Endometrial biopsies were performed using Pipelle endometrial suction curette at least 5 months after the study began. The endometrium was classified as atrophic (negative finding) and proliferative or hyperplastic (positive findings). The study and control groups were compared for demographic characteristics, risk factors for endometrial cancer, histological findings and the duration of tamoxifen treatment. Results: A significantly greater prevalence of endometrial abnormalities existed among the tamoxifen-treated than control patients (76 vs. 33%, p < 0.001). The abnormal endometrial changes were further demarcated in both groups into proliferative (54 vs. 26.7%, p = 0.02) and hyperplastic (22 vs. 6.6%, p = NS). In the study group, 63.6% of hyperplastic endometrium was simple hyperplasia and 36.4% was complex/no atypia hyperplasia, while in the control group all the cases were simple hyperplasia. No endometrial cancer was detected in either group. In addition, there was a positive association between the duration of tamoxifen exposure (<1 year vs. ≧1 year) and the endometrial abnormalities (46.6 vs. 88.6%, p = 0.003; proliferative 57.1 vs. 74.1%, p = 0.015; hyperplastic 42.8 vs. 25.8%, p = NS). Conclusion: The adjuvant use of tamoxifen is associated with significant time-dependent abnormal endometrial changes among patients with cancer of the breast.

Prognostic significance of CEA and CA 19-9 in colorectal cancer in Kuwait.

Preoperative CEA and CA 19-9 levels have been used in the past as prognostic indicators in colorectal cancer, but Dukes' stage is still considered to be the most important prognostic factor. Recent survival estimates may have been influenced by the fact that in the last decade adjuvant chemotherapy and postoperative irradiation have been included in the routine management of advanced-stage disease. In a heterogeneous Kuwaiti population higher reference levels (95th percentile) of CEA and CA 19-9 have been found than those usually employed. In the present study 62 patients with Dukes' stage B + C could be analyzed for two-year disease-free survival (DFS). Relapse was observed in 19 patients, 28 patients were disease free and 15 patients with censored observations were included. No significant difference in DFS was observed in Dukes' B (69%) versus Dukes' C (48%) patients (p = 0.09). On the other hand, Dukes' stage B + C patients with elevated preoperative levels of CEA or CA 19-9 had a significantly poorer DFS than patients with normal levels. For CEA levels below or above the cutoff the DFS was 74% versus 23% (p = 0.003); for CA 19-9 levels below or above the cutoff the DFS was 71% versus 33% (p = 0.004). In 54 patients with Dukes' stage B + C for whom preoperative levels of both CEA and CA 19-9 were available multivariate analysis revealed a decreasing risk of relapse in the following order: CEA and/or CA 19-9 elevated (chi-square 7.09; p = 0.008), CA 19-9 elevated (chi-square 6.27; p = 0.01), CEA elevated (chi-square 5.47; p = 0.02), and Dukes' C (chi-square 2.08; p = 0.15 n.s.). Hence, novel treatment protocols may have improved the disease-free survival, but the use of adjuvant chemotherapy and/or radiotherapy is of questionable benefit in patients who have elevated levels of CEA and/or CA 19-9 prior to treatment.

Value of Clinical Examination, Scintigraphy and Fine-Needle Aspiration Cytology in the Diagnosis of Solitary Thyroid Nodules

The diagnosis of malignancy in solitary thyroid nodules (STN) is difficult. This paper reviews 91 cases of STN that underwent surgery after fine-needle aspiration cytology (FNAC) at the Kuwait Cancer