Factors Affecting Breast Cancer Research Articles

Doğurganlık çağındaki kadınların meme kanserini önleme davranışlarını etkileyen faktörler

Amaç: Araştırmada doğurganlık çağındaki kadınların meme kanseri önleme davranışlarını etkileyen faktörlerin belirlenmesi amaçlanmıştır. Yöntem: Kesitsel ve ilişkisel tipte olan araştırma, Türkiye’de Tokat iline bağlı bir kasabada bulunan Aile Sağlığı Merkezi (ASM)’ne kayıtlı 181 katılımcı ile yürütülmüştür. Veriler, Sosyodemografik Veri Formu ve Meme Kanseri Önleme Davranışlarını Etkileyen Faktörleri Belirleme Ölçeği (MEKÖD) ile toplanmıştır. Bulgular: Kadınların MEKÖD ölçeği toplam puan ortalaması 115.59±15.43 olup, %55.8’inin Kendi Kendine Meme Muayenesi (KKMM) yaptığı, %96.1’inin düzenli Klinik Meme Muayenesi (KMM) kontrolüne gitmediği, %66.9’unun mamografi çektirmediği belirlenmiştir. KKMM bilgisi olanların, KKMM yapanların ve muayene zamanını bilenlerin, birinci derece akrabalarında meme kanseri olanların meme kanserini önleme davranışları daha yüksektir (p

Breast cancer insights from Northern Israel: a comprehensive analysis of survival rates among Jewish and Arab women.

This study investigates breast cancer survival rates between 2000 and 2022 in northern Israel, focusing on ethnicity, socioeconomic status, age at diagnosis, and the Charlson Comorbidity Index. Analyzing data from Clalit Health Services, we studied 8,431 breast cancer patients (6,395 Jewish, 2,036 Arab). We compared five- and ten-year survival rates across different demographics. Ethnicity showed a minor impact on survival (OR 1.12, 95% CI: 0.93 - 1.35). Socioeconomic status had a significant effect, with a higher level of improving survival (OR 2.50, 95% CI: 2.04 - 3.08). Age was crucial; women 18-39 had better survival than 60-100, but no significant difference was found between the 18-39 and 40-59 age groups [OR (CI 0.90 - 1.53, p = 0.231)]. For the Charlson Comorbidity Index, women with scores of 3-10 showed lower survival compared to scores of 0 and 1-2. There was a notable improvement in five-year survival rates among patients aged 18-59 diagnosed from 2009-2018 (90.7%) compared to 2000-2008 (86.9%) (p = 0.0046), but not in patients aged 60-100. The study highlights that socioeconomic status, age, and comorbidity scores are significant in determining survival rates for breast cancer. The improvement in survival rates for younger patients diagnosed more recently reflects advancements in treatment and care. This research provides valuable insights into the factors affecting breast cancer survival rates, underscoring the role of socioeconomic status, age, and comorbidities while also highlighting the progress in breast cancer treatment over recent years.

Factors Affecting Breast Cancer Screening Behavior Among Women in Saudi Arabia: A Retrospective Cross-Sectional Study.

Background Early detection of breast cancer is crucial for effective treatment and minimizing mortality, requiring effective screening methods like self-examination, clinical examination, and mammography. However, not all women in Saudi Arabia comply with these examinations, and studies examining its practice and barriers of low uptake are scant. The aim of this study is to investigate factors influencing breast cancer screening behavior among women in Saudi Arabia. Methods This cross-sectional study involving 806 women from October to November 2022 used an online questionnaire for the data collection process, including questions about demographic characteristics, awareness assessment, breast cancer screening behavior, symptoms, risk factors, and screening programs. Factors affecting the screening behavior were analyzed using the logistic regression model with adjusted odds ratio (AOR) and 95% confidence interval (CI). Results Among the 806 women who participated in the study, 479 (59.4%) were under 40 years old, and half of them were urban residents (n = 394, 48.9%). Only 134 subjects (16.6%) had a history of breast screening. Social media (n = 519, 64.5%) was the predominant source of screening information. The primary obstacles to breast cancer screening were the absence of tumor symptoms (n = 333, 41.3%), insufficient knowledge about early detection (n = 249, 31%), lack of time (n = 245, 30%), fear of discovering a tumor (n = 187, 23%), and lack of awareness about screening centers (n = 155, 19%).In regression analysis, predictive factors for breast cancer screening behavior were as follows: age over 40 years old (AOR: 2.56; 95% CI: 1.70-3.87), residents of big cities (AOR: 3.57; 95% CI: 1.02-12.56), positive family history of breast cancer (AOR: 2.53; 95% CI: 1.50-4.28), proximity to the screening center (AOR: 2.56; 95% CI: 1.22-5.39), and using contraceptive pills for more than five years (AOR: 1.78; 95% CI: 1.04-3.04), and were statistically significant (all p-values < 0.05). Conclusions In this study, the most perceived barriers to BSE were the absence of tumor symptoms, followed by insufficient knowledge about early detection, lack of time, fear of discovering a tumor, and lack of awareness about screening centers. Additionally, the predictive factors for breast cancer screening behavior were as follows: age over 40 years old, residents of big cities, positive family history of breast cancer, proximity to the screening center, and using contraceptive pills for more than five years. Given the identified factors affecting breast self-examination behavior in this study, public education initiatives are crucial for raising awareness, facilitating self-examination, and ultimately improving health outcomes and reducing breast cancer treatment costs in society.

Factors Affecting Breast Screening Behavior of First-Degree Relatives of Breast Cancer Patients in China: A Cross-sectional Study.

Breast cancer is the most common cancer in women, and first-degree relatives (FDRs) of breast cancer patients have a significantly higher risk of developing breast cancer. However, the factors affecting breast cancer screening behavior of FDRs in China remain unclear. The aim of this study was to determine the social cognitive theory factors influencing screening behaviors of FDRs. A cross-sectional survey was conducted, and 430 FDRs were recruited. Data were collected using demographic information and self-reported questionnaire based on the social cognitive theory. The structural equation modeling method was used to analyze the influence of social cognitive factors on breast cancer screening behavior. The model showed a good fit (goodness of fit = 0.462). Goal setting and self-regulation (β = 0.631, P < .001) and positive outcome expectation (β = 0.098, P = .042) were positively related to breast cancer screening behavior. Negative outcome expectation was negatively related to breast cancer screening behavior (β = -0.102, P = .024). In addition, positive outcome expectation, negative outcome expectation, and goal setting and self-regulation are mediators of self-efficacy (β = 0.475, P < .001) to breast cancer screening behavior. Goal setting and self-regulation are important influences on breast cancer screening behavior. The social cognitive theory is both applicable to and effective in explaining and predicting breast cancer screening behavior. Health professionals can develop appropriate intervention strategies based on the social cognitive theory among FDRs. It is necessary to focus on the people who influence women, such as spouses, mothers, or daughters.

Association between Family History of Breast Cancer and Breast Density in Saudi Premenopausal Women Participating in Mammography Screening.

Mammographic density and family history of breast cancer (FHBC) are well-established independent factors affecting breast cancer risk; however, the association between these two risk factors in premenopausal-screened women remains unclear. The aim of this study is to investigate the relationship between mammographic density and FHBC among Saudi premenopausal-screened women. A total of 446 eligible participants were included in the study. Mammographic density was assessed qualitatively using the Breast Imaging Reporting and Data System (BIRADS 4th edition). Logistic regression models were built to investigate the relationship between mammographic density and FHBC. Women with a family history of breast cancer demonstrated an 87% greater chance of having dense tissue than women without a family history of breast cancer (95% CI: 1.14-3.08; p = 0.01). Having a positive family history for breast cancer in mothers was significantly associated with dense tissue (adjusted odds ratio (OR): 5.6; 95% CI: 1.3-24.1; p = 0.02). Dense breast tissue in Saudi premenopausal women undergoing screening may be linked to FHBC. If this conclusion is replicated in larger studies, then breast cancer risk prediction models must carefully consider these breast cancer risk factors.

Factors Influencing Iranian Women's Participation in Breast Cancer Screening Programs: A Systematic Review

Background: Breast cancer screening programs are one of the most important methods for the early detection of breast cancer in women. Several studies have been conducted to identify factors affecting breast cancer screening behaviors among Iranian women. This study is conducted to systematically review the factors influencing women’s participation in breast cancer screening programs in Iran.&#x0D; Methods: Papers were collected by using the keywords breast, mammary, screening, early detection, diagnosis*, examination, testing, and Iran from various English-language databases, including PubMed, Scopus, Web of Science, and databases in Persian language including SID and Magiran. The search was limited to the title and abstract of papers published between January 1, 2000, and May 1, 2021. A narrative synthesis was performed to summarize findings of the obtained papers.&#x0D; Results: In this study, 1345 papers were initially found and, after screening the title, abstract, and full-text, 39 papers were selected. Most of them were cross-sectional (n= 28). Results indicated that socioeconomic factors, individual characteristics, recommendation of health workers, knowledge, Islamic beliefs, support by family, and activities of the Iranian government are frequently mentioned as contributing factors and can be applied to increase participation of Iranian women in breast cancer screening.&#x0D; Conclusion: The results demonstrate that lack of knowledge and a positive attitude towards breast cancer screening is a major problem regarding Iranian women's non-participation in the screening programs. Therefore, the need for regular implementation of the national screening program in the country, providing appropriate educational methods to increase women's awareness, removing barriers and improving women's access to health care providers should be the priorities of the Iranian health system to prevent breast cancer.

Abstract P4-07-08: IMPACT ON OVERALL SURVIVAL ACCORDING TO BREAST CANCER IMMUNOPHENOTYPES: REAL-WORLD DATA IN METASTATIC BREAST CANCER IN ECUADOR

Abstract Background: Breast cancer immunohistochemistry subtype classification by hormone receptor has become the standard practice for therapeutic decision making. The subtype is one of the crucial factors affecting breast cancer prognostic. Despite the progress in understanding of complex mechanisms in progression of breast cancer, the treatment is a global challenge health around the world, the 5-year survival rate is 26%. Currently in develop countries, in the metastatic stage, a gain in survival in the HR+/HER2+ subtype has been evidenced, likely attributable to major advances in HER2-targeted treatment (1). However, although in developed countries there is access to targeted therapy, in the Ecuadorian health system, difficulties complicate patients access to health care and treatment. Methods: We conducted a retrospective study about survival data in breast cancer metastatic according immunohistochemistry subtype. We analyzed all primary invasive breast cancer cases in the period from 2016 to 2020 in an oncology institute of Ecuador, the final study sample consisted for 83 patients. The overall survival was calculated by the Kaplan-Meier method and compared by the long-rank test. Multivariable adjusted hazard ratios (HR) were estimated by Cox regression models. Results: There were 31 patients (37.1%) with a HR(+)/HER2(-) breast cancer subtype, 15 patients HR(+)/HER2(+), 5 patients HER2 (+),18 patients HR(-)/HER2(-) and 14 patients without breast cancer subtype identified. Most patients were treated with different chemotherapy protocols; additional, in the group of women with HR(+)/HER2(+) subtype and HER2 (+) subtype only 15.87% were treated with HER2-targeted treatment, the vast majority in the last year. The best survival pattern was observed among women with HR(+)/HER2(-) breast cancer subtype with 35 months (IC 95% = 14,9 – 55), followed by HR(+)/HER2(+) with 27 months (IC 95% = 13,21 – 40,79), HER2 with 24 months (IC 95% = 4.4 – 32), and 14 months (IC 95% = 0 – 29.7) for HR(-)/HER2(-), however the difference wasn’t significant (p = 0.08). Hazard ratio of HR(+)/HER2(-) breast cancer subtype for breast cancer specific mortality risk was 1.61 (IC 95% = 0.64 – 4.19 p = 0.29). Conclusions: Hormone receptor subtype wasn’t s a significant independent prognostic factor in female metastatic breast cancer patients in a single center of Ecuador. However, there is a trend that subtype HR(+)/HER2(-) breast cancer subtype, has a better survival than the rest of the subtypes. These results differ from those of the rest of the world, probably access to target medicine and difficulties in access to health care system are the cause. Thus, better strategies for early access to adequate chemotherapy protocols should be developed Citation Format: Evelyn Valencia-Espinoza, Emiliano Pulla-Cadmilema, Lissette P. Velez Avila, Lissette Yagual Bohorquez, Maria del Mar Sanchez Salazar, Patricia Tamayo Aguilar, Jimmy Martin-Delgado, Glenda Ramos Martinez, Katherine Garcia Matamoros, Roberto Escala Cornejo, Felipe Campoverde Merchan, Ruth Engracia Vivanco, Mayra Santacruz Maridueña, Isabel Delgado Guerrero, Veronica Torres Floril, Diego Garcia Gamboa, Elina A. Rodriguez-Melendez. IMPACT ON OVERALL SURVIVAL ACCORDING TO BREAST CANCER IMMUNOPHENOTYPES: REAL-WORLD DATA IN METASTATIC BREAST CANCER IN ECUADOR [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-08.

Investigating the status of health literacy and its predictive factors in women with breast cancer referring to university teaching hospitals and Javadalameh Clinic in Kerman, 2021

Introduction:Health literacy is among the most critical factors affecting breast cancer survival. This study was designed and implemented with the aim of determining the level of health literacy and its predictors in women with breast cancer referring to university teaching hospitals and Javadolaeme Clinic in Kerman in 2021.&#x0D; Methods: This cross-sectional study was conducted on women with breast cancer referred to university teaching hospitals and Javadolaeme Clinic in Kerman city in 2021. To collect data, a self-administered questionnaire including the demographic profile of the patients, and the valid and reliable Persian version of the health literacy of Iranian women with breast cancer (HELBA: Health Literacy of Breast Cancer for Adults) was used. The questionnaire was entered into SPSS version 20 software and analyzed.&#x0D; Results: In this study, nearly 15.3% of participants had low health literacy. According to the univariate logistic regression model, the health literacy level of the study participants had a significant relationship with all the demographic variables included in the study except the age of the spouse (P&lt;0.05). In the multivariate logistic regression model, only the spouse's education level had a significant relationship with the health literacy of the participants in the study. The chance of having health literacy was 4.33 times and 5.87 times (more likely in participants with spouses with a diploma level of education and participants with spouses with a university education than in participants with spouses with education below a diploma.&#x0D; Conclusion: The results of this study showed that the level of health literacy in many women with breast cancer is sufficient, however, educational planning should be done to improve the level of literacy in this group, especially emphasizing the health literacy of the spouses.

CO111 Evaluating Mediator Factors Affecting Breast Cancer Screening in American Women: An Application of the Andersen's Behavioral Model to 2011 to 2015 MEPS Panel Data

The obtaining and avoidance of breast cancer screening (BCS) has a large effect on women’s health. Despite national campaigns to improve BCS, participation remain suboptimal among women in the United States. Therefore, The aims of this study were to evaluate the prevalence of BCS in women from the United States, and to identify predictors of BCS guided by Andersen’s Behavioral Model (ABM).

Impact of intestinal dysbiosis on breast cancer metastasis and progression.

Breast cancer has a high mortality rate among malignant tumors, with metastases identified as the main cause of the high mortality. Dysbiosis of the gut microbiota has become a key factor in the development, treatment, and prognosis of breast cancer. The many microorganisms that make up the gut flora have a symbiotic relationship with their host and, through the regulation of host immune responses and metabolic pathways, are involved in important physiologic activities in the human body, posing a significant risk to health. In this review, we build on the interactions between breast tissue (including tumor tissue, tissue adjacent to the tumor, and samples from healthy women) and the microbiota, then explore factors associated with metastatic breast cancer and dysbiosis of the gut flora from multiple perspectives, including enterotoxigenic Bacteroides fragilis, antibiotic use, changes in gut microbial metabolites, changes in the balance of the probiotic environment and diet. These factors highlight the existence of a complex relationship between host-breast cancer progression-gut flora. Suggesting that gut flora dysbiosis may be a host-intrinsic factor affecting breast cancer metastasis and progression not only informs our understanding of the role of microbiota dysbiosis in breast cancer development and metastasis, but also the importance of balancing gut flora dysbiosis and clinical practice.

Prediction of the breast cancer mortality rate and its effective factors using genetic algorithm and logistic regression

Introduction: Logistic regression is one of the most common models used to predict and classify binary and multiple state responses in medicine. Genetic algorithms search techniques inspired by biology have recently been used successfully as a predictive model. The aim of present study was to use the genetic algorithm and logistic regression models in diagnosing and predicting factors affecting breast cancer mortality.&#x0D; Methods: Data of 2836 people with breast cancer during the years 2014-2018 were examined. Information was registered in the cancer registration system of Kerman University of Medical Sciences. Death status was considered as the dependent variable, while age, morphology, tumor differentiation (grad), residence status, and place of residence were considered as independent variables. Sensitivity, specificity, accuracy, and area under the receiver operating characteristic (ROC) curve were used to compare the models.&#x0D; Results: The logistic regression model determined factors affecting the breast cancer mortality rate, (with sensitivity (0.60), specificity (0.80), area under the ROC curve (0.70), and accuracy (0.77)), and also genetic algorithm model (with sensitivity (0.21), specificity (0.96), area under the ROC curve (0.58) and accuracy (0.87)) did so.&#x0D; Conclusion: The sensitivity and area under the ROC curve of the logistic regression model were higher than those of the genetic algorithm, but the specificity and accuracy of the genetic algorithm were higher than those of the logistic regression. According to the purpose of the study, two models can be used simultaneously.

Exploring influencing factors in breast cancer survivors’ experience in Lebanon

BackgroundThe research objective was to investigate social and cultural factors affecting breast cancer survivors’ experiences in Lebanese.MethodsA snowball sampling of 20 breast cancer survivors participated in the study. Semi-structured open-ended interviews were used to collect data.ResultsThe results showed that family support and religious beliefs were the primary supporting sources for breast cancer survivors. On the other hand, their body image and children were the major concerns. Thus, family and religious beliefs were needed to overcome breast cancer’s daily burden.ConclusionWomen with breast cancer perceived their cancer experience through their social roles, reflecting a concern for image and role preservation.

Early Dietary Exposures Epigenetically Program Mammary Cancer Susceptibility through Igf1-Mediated Expansion of the Mammary Stem Cell Compartment

Diet is a critical environmental factor affecting breast cancer risk, and recent evidence shows that dietary exposures during early development can affect lifetime mammary cancer susceptibility. To elucidate the underlying mechanisms, we used our established crossover feeding mouse model, where exposure to a high-fat and high-sugar (HFHS) diet during defined developmental windows determines mammary tumor incidence and latency in carcinogen-treated mice. Mammary tumor incidence is significantly increased in mice receiving a HFHS post-weaning diet (high-tumor mice, HT) compared to those receiving a HFHS diet during gestation (low-tumor mice, LT). The current study revealed that the mammary stem cell (MaSC) population was significantly increased in mammary glands from HT compared to LT mice. Igf1 expression was increased in mammary stromal cells from HT mice, where it promoted MaSC self-renewal. The increased Igf1 expression was induced by DNA hypomethylation of the Igf1 Pr1 promoter, mediated by a decrease in Dnmt3b levels. Mammary tissues from HT mice also had reduced levels of Igfbp5, leading to increased bioavailability of tissue Igf1. This study provides novel insights into how early dietary exposures program mammary cancer risk, demonstrating that effective dietary intervention can reduce mammary cancer incidence.

Determine the most important factors affecting breast cancer in Iraq

Today cancer is one of the diseases leading to death in the world in general and in the Middle East in particular, according to the reports of the World Health Organization. In spite of this, early detection through the availability of the necessary data on the disease in patients and the variety of variables studied helps in the large percentage of treatment, and that Increasing awareness among members of the Iraqi community, especially women, about breast cancer, proves its ability to recover from this disease through early and periodic examination and self-examination, and it was found that the number of injuries in terms of ages was for the second category (70-40), and this indicates that menstruation or what is known as the stage of hope is the stage that females must do early and periodic examination of this disease, and that the diagnosis of the disease was a clinical test or tissue culture, and therefore it was recommended to spread awareness for early and self-examination to detect the disease early and this greatly helps for treatment, with changing the data registration form for this type of disease to include more important variables, especially the genetic factor variable.

Clinicopathological Factors Affecting Breast Cancer Survival in Jamaican Women: A Retrospective Review.

Breast cancer is the leading cause of cancer affecting women worldwide. The survival rate is primarily affected by the stage of the disease and several other demographic and clinicopathological factors. This study is a retrospective cohort study of female patients of the University Hospital of the West Indies diagnosed with breast cancer between 2011 and 2016. The age, tumor size, SBR/Nottingham grade, tumor histologic subtype, tumor molecular subtype, and survival status of the cohort on November 1, 2019, were determined. The data were summarized. Survival across each variable was compared using univariate log-rank tests, Cox proportional hazard models, and crude and adjusted models. A second wave analysis was performed excluding patients whose survival status was presumed. A total of 503 patients were analyzed. The overall survival rate at 1, 3, and 5years were 96.4%, 84.9%, and 79.0%, respectively, for the entire cohort. The molecular subtype was the most significant clinicopathological factor affecting overall survival. A younger age < 40years, higher histologic grade, estrogen receptor-negative breast cancers, invasive ductal type breast cancers, and T1 lesions were associated with poorer survival outcomes at 5years. The findings were reproduced after a second wave analysis excluding patients who were presumed alive was applied. Breast cancer overall survival in Jamaica is consistent with that of other developing countries in the literature. This study is an important contribution to the growing body of literature available and aids to the overall understanding of the behavior of breast cancer locally.

Molecular Profile and Clinico-pathological Characteristics of Breast Cancer in Central India: First Investigative Report.

Stage at presentation and molecular profile are the two most important factors affecting breast cancer prognosis. This is the first study on molecular breast cancer subtypes from Central India. We prospectively reviewed 260 consecutive breast cancer patients diagnosed at the Department of Surgery, Government NSCB Medical College, Jabalpur (MP), between January 2017 and December 2020. Clinico-pathological and molecular profiles and their associations with the characteristics of the tumor were analyzed. The median age at diagnosis was 44.7years (range 21-93). Eleven percent (n = 11) were in clinical stage I, 12.7% (n = 12) were in stage II, 56% (n = 146) in stage III, and 20% (n = 52) were in stage IV. Metastatic lymph node positivity rate was 85% at the time of diagnosis. Luminal subtype was present in 50% (n = 131), Her 2 neu-enriched type in 21.5% (n = 55), and triple-negative subtype in 28.5% (n = 74). A stronger association was observed for each increasing clinical stage for Her 2 neu-enriched and triple-negative breast cancer (TNBC) but not luminal-type tumors. For grade of tumors, patients with luminal subtype had a higher percentage of lower grades (p = .001); however, Her 2-enriched and TNBC had higher proportion of grade III tumors (for Her 2-enriched p = .04, TNBC p = .001). In Central India, like other regions of India, breast cancer occurs at an earlier age and is diagnosed at a more advanced stage. In this region, pre-menopausal breast cancer is more common than post-menopausal and TNBC tumors have similar incidence in pre-menopausal and postmenopausal women.

Effect of Metformin Therapy on Biological Properties and Prognosis of Breast Cancer Patients Complicated with Type-2 Diabetes.

Objectives:To evaluate the effect of Metformin therapy on patients of breast cancer with complications of Type-2 diabetes.Methods:Altogether 102 cases of breast cancer complicated with Type-2 diabetes admitted into Hebei General Hospital from January 2019 to December 2020 were included in the study. They were divided into two groups per whether Metformin was administered in the regimen, namely Metformin group and non-Metformin group. In the meanwhile, 106 cases of breast cancer without Type-2 diabetes admitted in the same period were selected to form a control group. Three groups were compared in terms of general data (incl. age, body mass, family history, menopause or not), clinical staging, tumor histological differentiation, molecular subtyping (Incl. Luminal A, Luminal B, ERBB2+, Basal-like) and prognosis.Results:Compared with the control group, Metformin group and non-Metformin group presented more patients with an older age and post-menopause state (P<0.05), but the latter two groups were not significantly different (P > 0.05). Patients in Metformin group and non-Metformin group had higher clinical staging and histological differentiation and more cases of Basal-like subtype than those in the control group (P < 0.05), without significant difference between those two groups (P > 0.05). More cases of local relapse, lymphatic and distant metastasis were seen in Metformin and non-Metformin groups, but the differences were not significant (P > 0.05). Both groups had lower 5-year survival rates than the control group (P < 0.05). Metformin group had a higher overall survival rate as well as a survival rate free of other lethal reasons than the non-Metformin group (P < 0.05) but was not significantly different from the control group in the survival rate free of other lethal reasons (P > 0.05).Conclusions:Type-2 diabetes remains one of the risk factors affecting breast cancer development, progress and prognosis, which could lower the 5-year overall survival rate among breast cancer patients. This is especially evident among menopaused women. Metformin therapy may improve the prognosis of patients of breast cancer complicated with Type-2 diabetes.

Prevalence of Breast Cancer and its Associated Factors for Recurrence in Hospital Tengku Ampuan Afzan from 2008 to 2012

INTRODUCTION: Breast cancer is the commonest malignancy in Malaysian women. Cancer recurrence commonly seen in the first 2 years can be detrimental. Thus, identifying its prognostic factors is important. MATERIALS AND METHODS: We have retrospectively analyzed 179 women with breast cancer based on 5 years single center database with minimum follow up of 2 years. The demographic and clinico[1]pathological characteristics were determined using descriptive statistics. Survival was calculated based on Kaplan-Meier method. Multivariate analysis by Cox proportional hazards was performed to evaluate the potential factors affecting breast cancer recurrence. RESULTS: Mean follow up was 42 months, with mean age 52 years and 60.9% presented in Stage II disease. Overall recurrence was 41.9% with local recurrence 2.1%, regional recurrence 12.3% and distant recurrence 27.4%. 50% of our patients developed recurrence at 25 months. On univariate analysis, time to first presentation was significantly correlated with recurrence. In multivariate analysis, the tumor size, lymph node positivity and lympho-vascular invasion were independently associated with recurrence. Discussion: To date, local studies on prognostic factors in breast cancer recurrence remained sparse. Based on this study, factors associated with breast cancer recurrence identified and coincides with the previous evidence. Furthermore, this would provide evidence to improve the survival for patients with breast cancer in local settings. CONCLUSION: Further studies also need to be done on the non-compliant patients with advanced disease at presentation to determine factors towards their perception of surgical care in breast oncology.

Provider Barriers and Facilitators of Breast Cancer Guideline-Concordant Therapy Delivery in Botswana: A Consolidated Framework for Implementation Research Analysis.

IntroductionSystemic treatment for breast cancer in sub‐Saharan Africa (SSA) is cost effective. However, there are limited real‐world data on the translation of breast cancer treatment guidelines into clinical practice in SSA. The study aimed to identify provider factors associated with adherence to breast cancer guideline‐concordant care at Princess Marina Hospital (PMH) in Botswana.Materials and MethodsThe Consolidated Framework for Implementation Research was used to conduct one‐on‐one semistructured interviews with breast cancer providers at PMH. Purposive sampling was used, and sample size was determined by thematic saturation. Transcribed interviews were double‐coded and analyzed in NVivo using an integrated analysis approach.ResultsForty‐one providers across eight departments were interviewed. There were variations in breast cancer guidelines used. Facilitators included a strong tension for change and a government‐funded comprehensive cancer care plan. Common provider and health system barriers were lack of available resources, staff shortages and poor skills retention, lack of relative priority compared with HIV/AIDS, suboptimal interdepartmental communication, and lack of a clearly defined national cancer control policy. Community‐level barriers included accessibility and associated transportation costs. Participants recommended the formal implementation of future guidelines that involved key stakeholders in all phases of planning and implementation, strategic government buy‐in, expansion of multidisciplinary tumor boards, leveraging nongovernmental and academic partnerships, and setting up monitoring, evaluation, and feedback processes.DiscussionThe study identified complex, multilevel factors affecting breast cancer treatment delivery in Botswana. These results and recommendations will inform strategies to overcome specific barriers in order to promote standardized breast cancer care delivery and improve survival outcomes.Implications for PracticeTo address the increasing cancer burden in low‐ and middle‐income countries, resource‐stratified guidelines have been developed by multiple international organizations to promote high‐quality guideline‐concordant care. However, these guidelines still require adaptation in order to be successfully translated into clinical practice in the countries where they are intended to be used. This study highlights a systematic approach of evaluating important contextual factors associated with the successful adaptation and implementation of resource‐stratified guidelines in sub‐Saharan Africa. In Botswana, there is a critical need for local stakeholder input to inform country‐level and facility‐level resources, cancer care accessibility, and community‐level barriers and facilitators.

Impact of breast cancer risk factors on clinically relevant prognostic biomarkers for primary breast cancer

PurposeIn addition to impacting incidence, risk factors for breast cancer may also influence recurrence and survival from the disease. However, it is unclear how these factors affect combinatorial biomarkers for aiding treatment decision-making in breast cancer.MethodsPatients were 8179 women with histologically confirmed invasive breast cancer, diagnosed and treated in a large cancer hospital in Beijing, China. Individual clinicopathological (tumor size, grade, lymph nodes) and immunohistochemical (IHC: ER, PR, HER2, KI67) markers were used to define clinically relevant combinatorial prognostic biomarkers, including the Nottingham Prognostic Index (NPI: combining size, grade, nodes) and IHC4 score (combining ER, PR, HER2, KI67). Odds ratios (ORs) and 95% confidence intervals (CIs) for associations between breast cancer risk factors and quartiles (Q1–Q4) of NPI and IHC4 were assessed in multivariable polytomous logistic regression models.ResultsOverall, increasing parity (ORtrend(95% CI) = 1.20(1.05–1.37);Ptrend = 0.007), overweight (OR(95% CI)vs normal = 1.60(1.29–1.98)), and obesity (OR(95% CI) vs normal = 2.12(1.43–3.14)) were associated with higher likelihood of developing tumors with high (Q4) versus low (Q1) NPI score. Conversely, increasing age (ORtrend(95% CI) = 0.75(0.66–0.84);Ptrend < 0.001) and positive family history of breast cancer (FHBC) (OR(95% CI) = 0.66(0.45–0.95)) were inversely associated with NPI. Only body mass index (BMI) was associated with IHC4, with overweight (OR(95% CI) vs normal = 0.82(0.66–1.02)) and obese (OR(95% CI) vs normal = 0.52(0.36–0.76)) women less likely to develop high IHC4 tumors. Notably, elevated BMI was associated with higher NPI irrespective of hormone receptor-expression status.ConclusionsOur findings indicate that factors affecting breast cancer incidence, particularly age, parity, FHBC, and BMI, may impact clinically relevant prognostic biomarkers with implications for surveillance, prognostication, and counseling.