High Rates Of Breast Cancer Research Articles

Cancer in Heterozygote Carriers of Fanconi Anemia Genes

▪Background: Fanconi anemia (FA) is an inherited bone marrow failure syndrome, characterized by a defect in DNA repair, increased frequency of birth defects, and high risks of malignancies. Relatives of patients with FA are concerned about the risk of cancer in themselves or other family members. Carrier grandparents with mutations in genes for FA were reported in 2007 to have no increase in overall cancer incidence, except for a higher rate of breast cancer among FANCC carrier grandmothers (Berwick et al, Cancer Research 67:9591, 2007); this study included 944 relatives among 312 families. Tischkowitz et al also did not find increased risks of cancer in 575 relatives among 36 families, except for prostate cancer (Tischkowitz et al, BMC Cancer 8:257, 2008). The relative risk of breast cancer associated with germline mutations in genes in the BRCA/FA DNA repair pathway in the general population not due to BRCA1 or BRCA2 is 5 to 10 fold (Couch et al, JAMA Oncology 3:1190, 2017), suggesting that heterozygotes for FA might be at increased risk. The FA cohort at the National Cancer Institute (NCI) is sufficiently large to again address the question of cancer in FA heterozygotes.Hypothesis: Patients heterozygous for a mutated gene in the BRCA/FA DNA repair pathway have an increased risk of cancer. Identification of FA genes with increased cancer risk in heterozygotes, and specific cancer types in relatives of patients with FA, would guide screening recommendations for these categories of family members, and studies to determine whether FA heterozygotes with cancer should be managed with modifications of drug or radiation doses.Methods: We evaluated cancer risks in relatives of probands in the NCI FA cohort. We collected self-report or proxy report data on the presence or absence of cancer, cancer type, age at cancer diagnosis for individuals with a history of cancer, and age at death from other causes or current age. We studied obligate heterozygotes (parents and offspring of probands with FA), relatives with a 50% probability of heterozygosity (grandparents), and relatives with a 2/3 probability of being carriers (siblings without FA). We determined the ratio of observed/expected cases (O/E) using data from SEER cancer registries, with adjustment for age, sex, and birth cohort. Confirmatory genotyping is being done by targeted panel next-generation sequencing for participants with DNA available.Results and Discussion: Our study includes 94 families. Twenty-one cancers were reported in 188 parents, with 24 expected (O/E 0.86, 95% CI [confidence interval] 0.53-1.31). Three hundred and twenty-seven grandparents had 89 cases with cancer, expected 125 (O/E 0.71, CI 0.57-0.88). There were 122 siblings, with 1 cancer case and 4 expected (O/E 0.26, CI 0.01-1.46). Among 12 offspring there was 1 case of leukemia (O/E 1:0.12, CI 0.2-44.64). Specific cancers had increased O/E in parents (2 cases of salivary gland cancer, O/E 27.3, CI 3.31-98.66), grandparents (5 with liver cancer O/E 4.7, CI 1.53-10.96; 9 with leukemia O/E 2.42, CI 1.11-4.59), and a single case of acute myeloid leukemia in an offspring (O/E of 402.44, CI 10.19-2242.85). Four cases of prostate cancer in parents (O/E of 1.47, CI 0.4-3.76) and 8 in grandparents (O/E 0.47, CI 0.2-0.93) failed to support the suggestion by Tischkowitz et al that prostate cancer was significantly increased in male relatives (5 cases, O/E 3.1, CI 1.1-8.8). Missing data include birth dates, death dates, or cancer dates for 44 grandparents and 2 siblings.Our results suggest that heterozygotes for mutations in FA genes do not appear to have an increased risk of cancer compared with the general population, in agreement with data from other cohorts. Further analyses will be done after completion of genotyping the relatives, with the caveat that DNA may not be available from some of the grandparents. The NCI FA study is limited by the numbers of participants, and the missing data, particularly in the grandparent generation. In addition, data are reported by the individuals or their proxies, and medical record validation may not be possible; the types and ages of cancers cannot be confirmed. Although the types of cancer and risks in FA heterozygotes are similar to those in the general population, the potential concern that management of patients who are carriers of a defect in DNA repair may need to be modified requires future investigation. DisclosuresNo relevant conflicts of interest to declare.

Generation and Biological Characteristics of a Mouse Model of Breast Cancer that Copresents with Diabetes Mellitus.

Both diabetes and breast cancer are common diseases worldwide, and diabetes is also linked to higher rates of breast cancer. Epidemiological data also indicate that diabetes may be one of the risk factors for breast cancer. However, the effect of diabetes on breast cancer progression in vivo is rarely reported. We established an ideal animal model of breast cancer using transgenic MMTV-PyMT mice, which spontaneously developed breast cancer. In this model, the animals copresented with diabetes mellitus, which allowed us to study the effect of high glucose on breast cancer. Compared with MMTV-PyMT mice without diabetes, MMTV-PyMT mice with diabetes developed heavier tumors and exhibited greater tumor volumes. Furthermore, high glucose promoted the invasiveness and metastasis of breast cancer in MMTV-PyMT mice. This breast cancer model in which mice copresented with diabetes provides a useful tool to study the effect of diabetes on breast cancer. Anat Rec, 302:269-277, 2019. © 2018 Wiley Periodicals, Inc.

Breast Cancer in Europe: Epidemiology, Risk Factors, Policies and Strategies. A Literature Review

INTRODUCTION: Breast cancer is the most commonly diagnosed cancer in European women, accounting for 28.8% of the total number of cancer diagnosis in Europe. Over the past few decades, several factors have led to remarkable improvements in overall breast cancer outcomes in Europe, such as early detection, screening, and progresses in treatment. However, breast cancer remains the most common cancer in females in Europe, yet more there is an increase in the incidence and mortality rates in some European countries. This research summarizes the current status of breast cancer in Europe, including epidemiology, risk factors, policies, and strategies. The results can help to better identify this health problem, which could help in developing better breast cancer control or prevention strategies and policies.
 
 METHODS: A literature review was conducted using five electronic databases (PubMed, Google Scholar, ProQuest, Eurostat, BioMed) and the European Commission reports for studies that reported on epidemiology and risk factors of breast cancer, or policies and strategies that target it in Europe. In addition, the Social Ecological Model (SEM) was used in categorizing the breast cancer risk factors into different levels.
 
 RESULTS: Europe and North America have the highest rate of breast cancer globally. Incidence and prevalence of breast cancer vary across Europe, and so does its mortality rates. Breast cancer was found to be associated with a number of risk factors, including but not limited to aging, use of hormone therapy, older age at the first birth, and smoking which are common in Europe. Cancer in general, and breast cancer have attracted specific attention, and the European Union has focused many of the resources and expertise on the topic.
 
 CONCLUSION & RECOMMENDATIONS: Breast cancer remains a major public health issue in Europe, despite the efforts and actions being taken. Therefore, current efforts against breast cancer in Europe need to be revisited and improved.

Factors influencing delayed presentation of breast cancer at a tertiary care hospital in Pakistan

Breast cancer is the leading cause of death despite the continuous development of newer and more effective modalities of treatment for breast cancer. In Asia, Pakistan has the highest rate of breast cancer. Breast cancer treatment shows better prognosis when it is diagnosed at an early stage, but mortality increases significantly with delayed diagnosis and advanced stage of disease. Delay in diagnosis and nonavailability of treatment are the major factors responsible for advanced stage and low survival. The objective of our study was to identify the factors responsible for delayed presentation of patients with breast carcinoma. A cross-sectional study using a questionnaire method was conducted at the Foundation University Medical College from January 2015 to December 2016. A total of 89 patients gave consent and were interviewed using a prestructured questionnaire during the study. Age ranged from 25 to 64years. Majority of patients were in stage T3N1M0 (31.5%). Second most common stage was T4N0M0 (14.6%). Thirteen patients (12.4%) were in stage T3N0M0, and 10 patients (11.2%) were in T3N2M0. Delay ranged from 3months to more than 1year; 43.8% presented with delay of 3 to 6months. The reasons for delay were lack of knowledge about breast cancer (41%), lack of availability of health care services (32.6%), purdah and religious reasons (6.7%), and fear of being diagnosed with cancer (10.1%). The main reasons for delay identified in our study were lack of knowledge and availability of appropriate health care facilities. In order to improve outcome of breast cancer, more focus is needed on spreading awareness and improving health care services in rural areas.

Clinicopathological Characteristics and Outcomes of the Ongoing “Joven & Fuerte” Cohort of Young Women With Breast Cancer in Mexico

Background: Despite high rates of breast cancer (BC) in young women from low and middle income countries, their needs and concerns are not systematically studied or addressed. Understanding the characteristics of young women with BC in limited-resource settings and the issues they face is of great relevance to the medical community, to tailor clinical interventions and supportive care for this unique and understudied patient population. The Mexican cohort Joven & Fuerte has the goal of comprehensively characterizing and assessing the needs of YWBC in Mexico using patient- and physician-based surveys. Aim: The Mexican cohort Joven & Fuerte has the goal of comprehensively characterizing and assessing the needs of YWBC in Mexico using patient- and physician-based surveys. Methods: A prospective cohort of newly diagnosed YWBC was established at the three Joven & Fuerte sites. Eligible women answer electronic surveys on relevant topics, such as sociodemographic characteristics, fertility, genetics, and psychosocial needs, among others, while clinicians complete prespecified surveys registering clinicopathologic features and outcomes. Patients are evaluated at diagnosis, after 6 months, and annually for 5 years. Substudies assessing changes in cognition, sexual function and satisfaction, quality of life, and depression/anxiety are being carried out, and biologic samples are obtained and stored frozen for future research. Here, we report the baseline clinicopathological characteristics of patients included up to March 2018, as well as data on recurrence and mortality. Results: To date, 276 young women with BC with median age at diagnosis of 36 years (2140 y) have been accrued. 22% were single and 23%, childless. 42% had higher education and 31% were used. 80% presented with a self-detected mass. Clinical stage at diagnosis was distributed as follows: stage 0: 3%, I: 11%, IIA: 26%, IIB: 18%, III: 36%, and stage IV: 8%. The most frequent subtype was hormone-receptor (HR) pos/HER2 neg (52%), followed by triple neg (23%), HER2 pos/HR pos (17%) and HER2 pos/HR neg (8%). Histologic grade distribution among the patients was as follows: low grade (16%), intermediate grade (18%), and high grade (66%). Up to June 2017, 15 patients out of 120 (12.5%) have developed distant recurrences, and 12 patients (10%) have died as a consequence of breast cancer. With a median follow-up of 19 months, breast cancer free survival and overall survival was 87.7% and 89.9%, respectively. Conclusion: To our knowledge, this represents the first prospective cohort of young women with BC in Latin America. We are expanding this project to other centers in the region. Our findings will help develop culturally tailored interventions aimed at improving the medical and psychosocial outcomes of this vulnerable patient population.

Mapping Women's World

Feminist geography and geographic information system(GIS) have been the most dynamic research areas over the last decade. Unfortunately, high breast cancer mortality rates have been reported in the northern part of the United states, with recent attention focused on the northern part of the United States. In this article, the authors investigate whether such a high rate of breast cancer is evenly spread in northern parts. The purpose of this article is to provide a more detailed analysis of the breast cancer distribution in the United States by comparing the spatial distribution of breast cancer cases against physical environmental factors using Geographic Information System (GIS). Further, it gives background information to the GIS and its applications in health-related research.

Effect of Diet on Evolutionary Obstetrics

Diet and health are both related directly to the reproductive functions of a female in that nutrient intake effects exactly what hormones are produced and at what amounts. According literature women of Western societies produce more progesterone and estradiol from their ovaries leading to high rates of breast cancer in the West

Breast Cancer Epidemiology, Screening, Treatment and Awareness in Pakistan

Breast cancer is the most common type of cancer and the most common cause of cancer-related mortality among women worldwide. Pakistan alone has the highest rate of Breast Cancer than any other Asian country as approximately 40% female patients are with Breast cancer appears at Atomic energy Cancer hospitals (AECHs) during the year 2015-2016. According to a research conducted approximately 1 out of every 10 women are likely to suffer from this disease at any point in their lives and about 80% of invasive breast cancer occurred in women above 45 years, In this study epidemiology, screening, treatment facilities and awareness of breast cancer by Atomic energy Cancer hospitals among Pakistani will be highlighted. The data is collected by 18 AECHs running all over country by Pakistan Atomic Energy Commission (PAEC) through Nuclear Medicine and Oncology Division, Directorate of Medical Sciences, Islamabad.

570P - Breast cancer risk and reproductive status in Naypyitaw region, Myanmar

Background: Breast cancer is a major public health problem and is the most commonly diagnosed cancer in Myanmar women who have lived around Naypyitaw Region. High rate of breast cancer in developed countries are associated with increase prevalence of known risk factors like nulliparity or low parity where as higher parity might account of relative lower incidence of breast cancer. Although menopause itself is not associated with an increased risk of developing cancer, two main factors (increasing age and obesity) are linked with a higher risk of cancer after menopause. Since Myanmar is developing country, we want to know that these risks are also observed in our patients. We aimed to evaluate the differences and similarities in the risk factors of female breast cancer according to menopausal status and parity with previous establish data. Methods: Data from 230 breast cancer women who have registered at Naypyitaw General Hospital, Oncology ward from January 1st to the end of 2016 were reviewed and analyzed. Results: Out of 230 patients, 91 patients (39.56%) were premenopausal (age range (25-48) years) and 139 patients (60.43%) had reached menopause (age range (40-82) years). Among nulliparous or single patients, 26 patients (36.61%) were premenopausal and 45 patients (63.38%) were postmenopausal. For the parous women, 67 patients (42.13%) were premenopausal and 92 patients (57.86%) were postmenopausal. According to the parity, single or nulliparous were found in 71 patients (30.86%), primiparous in 20 patients (8.69%), parity (2-4) in 109 patients (47.39%) and parity ≥5 in 30 patients (13.04%).Table: 570P Parity risk with breast cancerParityPatients (%)Nulliparous or Single71 (30.86%)Primiparous20 (8.69%)Multiparous139 (60.43%) Open table in a new tab Conclusions: In this study, most of our patients are postmenopausal and this finding supports the previous established data. But the majority of our breast cancer patients are multiparous and this finding is deviated from the established fact that multiparous is a protective factors against breast cancer. But we don’t yet have a conclusive issue to this, as our findings are based only on Naypyitaw region only. Further studies are required to confirm this finding. Legal entity responsible for the study: Naypyitaw General Hospital Funding: None Disclosure: All authors have declared no conflicts of interest.

"Joven & Fuerte": Program for Young Women with Breast Cancer in Mexico -Initial Results.

Despite the high rates of breast cancer among young Mexican women, their special needs and concerns have not been systematically addressed. To fulfill these unsatisfied demands, we have developed "Joven & Fuerte: Program for Young Women with Breast Cancer in Mexico," the first program dedicated to the care of young breast cancer patients in Latin America, which is taking place at the National Cancer Institute of Mexico and the two medical facilities of the Instituto Tecnológico y de Estudios Superiores de Monterrey. The program was created to optimize the complex clinical and psychosocial care of these patients, enhance education regarding their special needs, and promote targeted research, as well as to replicate this program model in other healthcare centers across Mexico and Latin America. From November 2013 to February 2017, the implementation of the "Joven & Fuerte" program has delivered specialized care to 265patients, through the systematic identification of their particular needs and the provision of fertility, genetic, and psychological supportive services. Patients and families have engaged in pedagogic activities and workshops and have created a motivated and empowered community. The program developed and adapted the first educational resources in Spanish dedicated for young Mexican patients, as well as material for healthcare providers. As for research, a prospective cohort of young breast cancer patients was established to characterize clinicopathological features and psychosocial effects at baseline and during follow-up, as a guide for the development of specific cultural interventions addressing this vulnerable group. Eventually, it is intended that the program's organization and structure can reach national and international interactions and serve as a platform for other countries.

Supportive care needs among Mexican young women with breast cancer.

e21552 Background: Despite high rates of breast cancer (BC) in young Mexican women, information about their particular needs and concerns is largely unknown. Understanding the patients individual needs in a population with unique socio-cultural features is essential to guide supportive care and improve their quality of life. We aim to describe the unmet needs of Mexican young women with breast cancer (YWBC). Methods: A cross-sectional study including women with stage I-III BC aged 40 years or younger at diagnosis was conducted at the National Cancer Institute in Mexico City. YWBC were invited to complete the Supportive Care Needs Survey, Short Form-34 (SCNS-SF34), a comprehensive tool that measures the perceived unmet needs of cancer patients. The survey was previously adapted and validated in our population for its use. Results: 81 consecutive patients with median age at diagnosis of 35.09 (SD 3.9) years were included. 45.7% were married and 29.2% completed secondary school. 92.6% had stage II-III BC. 70.4% were undergoing active treatment and 29.6% were either on hormonal therapy or surveillance. From a total standardized score of 100, the health systems and information domain had the highest mean score (39.3), followed by the psychological domain (36.3). The sexuality domain had the lowest mean score (27). The highest ranked items of unmet needs (by mean crude score) were: to be informed about cancer is under control or diminishing (2.9), to be informed about things you can do to help yourself get well (2.8), lack of energy and fatigue (2.7), and fear about the cancer spreading (2.7). Perceived needs among patients undergoing active treatment were greater compared to those in follow-up (z = -2.390 p = 0.017), predominantly in the sexuality domain (z = -2.084 p = 0.037). Conclusions: Mexican YWBC have specific needs that are currently not systematically addressed. The predominant unmet need regarding health systems and information should be a priority. Further research to understand the needs and concerns of this unique and understudied patient population will aid tailor clinical interventions and supportive care.

Abstract P4-20-04: Young women with breast cancer in Mexico: A report of the pilot phase of the “Mujer Joven y Fuerte” prospective cohort

Abstract Background: Despite high rates of breast cancer in young women from low-and-middle-income countries (LMICs), their needs and concerns are not systematically studied or addressed. Understanding the characteristics of young women with breast cancer (YWBC) and the issues they face is of great relevance to the medical community, in order to tailor clinical interventions and supportive care for this unique and understudied patient population. The Mexican cohort “Mujer Joven y Fuerte” (Young and Strong Woman) has the goal of comprehensively characterizing and assessing the needs of YWBC in Mexico using patient- and physician-based surveys. Methods: A prospective cohort of newly diagnosed YWBC was established in November 2014 at two Mexican cancer centers in Mexico City and Monterrey. Eligible women answer web-based surveys on relevant topics including physical activity, genetics, psychosocial needs, and fertility. Clinicians complete pre-specified surveys using the US NIH BOLD Task Force common data elements registering clinical/pathologic characteristics and outcomes. Patients are evaluated at diagnosis, after 6 months, and annually for 5 years. Sub-studies assessing changes in cognition, sexual function and satisfaction, quality of life and depression/anxiety are being conducted, and biologic samples are stored for future research. Results: 96 YWBC with median age at diagnosis of 34 (21-41 y) were accrued to our pilot phase. 26% were single and 25% childless. 43% had higher education and 28% were employed. 90% presented with a self-detected mass. Clinical stage at diagnosis was distributed as follows: stage 0: 2%; I: 15%; IIA: 13%; IIB: 17%; III: 47%, and stage IV: 6%. The most frequent molecular subtype was HR+/HER2- (47%), followed by HER2+ (26%) and triple negative (21%). First follow-up results will be available shortly. Conclusions: To our knowledge, this represents the first prospective cohort of YWBC in Latin America. We are expanding this project to other centers in the region. Our findings will help develop culturally tailored interventions aimed at improving the psychosocial and medical outcomes of this vulnerable patient population. Citation Format: Villareal-Garza CM, Platas A, Castro-Sánchez A, Miaja M, Bargalló-Rocha E, Martinez-Cannon BA, Vega Y, Fonseca A, Ramos-Elias P, Márquez-Perez CJ, Bukowski A, Goss P, St. Louis J, Chapman J-A, Partridge A, Meneses A, Mohar A. Young women with breast cancer in Mexico: A report of the pilot phase of the “Mujer Joven y Fuerte” prospective cohort [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-20-04.

Abstract P2-07-10: Breast health behaviors of women under 40 accessing the Avon breast health outreach program

Abstract Background Breast cancer is the most common cancer among women, and tends to be more aggressive when diagnosed in women <40 years. However, limited research exists on breast health behaviors of women <40. This study analyzes trends in breast health behaviors and diagnostic data among women <40 served by the Avon Breast Health Outreach Program (BHOP) which links medically underserved women to breast health education and screening services. Methods Confidential client intake records of female clients (n= 192,296) of Avon BHOP grantees continuously-funded from 2011-2015 were analyzed, along with breast cancer diagnosis data from a select number of clients (n=82) from January-March 2016. Results Approximately 7% of Avon BHOP clients from 2011-2015 were <40 years (n=12,872). Women <40 had a significantly lower odds of having been taught breast self-exam (BSE), knowing about mammograms before their visit, having had a clinical breast exam (CBE) in the past 2 years, and having had a mammogram in the past 2 years compared to women ≥40. Over 80% of women <40 reported being taught BSE and knowing about mammograms before their visit, compared to 94% among women ≥40. The percent who reported a CBE in the past 2 years increased by approximately 5% among both <40 and ≥40 women, to a high of 64.6% and 78.2%, respectively, in 2015. Reporting a mammogram in the past 2 years also increased by approximately 5% in both groups, to a high of 25.9% and 70.3%, respectively, in 2015. Women <40 had a significantly higher odds of having breast-related symptoms (OR=7.64) and a relative diagnosed with breast cancer (OR=1.23) compared to women ≥40. For women <40, the adjusted odds of having had a mammogram in the past 2 years were 1.34 times higher (p<0.001) among those who had a relative diagnosed with breast cancer compared to those who did not, while the odds were 1.09 (p<0.001) among women ≥40. From January-March 2016, 10 breast cancer cases in women <40 were reported by 7 Avon BHOP grantees; 38 cases were reported in women ≥40. Of the 10 diagnosed cases, the majority were Hispanic (70%) and 30% were Stage IV compared to 6% among women ≥40, however the difference was not statistically significant (p=0.096). Discussion In 2015 the American Cancer Society estimated that 4.2% of breast cancer cases were diagnosed in women <40. While the Avon BHOP diagnosis data is limited, the results nonetheless demonstrate a higher rate of breast cancer in this age group. Additionally, the association between being <40 and having a later stage diagnosis compared to those ≥40 appears to be a meaningful trend, and, while not significant in our preliminary data, we anticipate the finding to persist. While Avon BHOP clients <40 had a significantly lower odds of knowing about screening behaviors compared to ≥40, a large percentage had knowledge of breast health, and increasingly reported higher rates of screening behaviors. There was also a greater positive association between having a relative with breast cancer and having had a mammogram in the past 2 years in women <40 compared to ≥40. These findings suggest that Avon BHOP clients <40 increasingly understand their breast cancer risk and seek screening services accordingly. It is important to provide clear screening guidelines for this population. Citation Format: Gates-Ferris K, Bauer KM, Senter L. Breast health behaviors of women under 40 accessing the Avon breast health outreach program [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-07-10.

Reflections on Cultivating Community-based Participatory Research Partnerships with the Afghan Immigrant Community.

Reflections on Cultivating Community–based Participatory Research Partnerships with the Afghan Immigrant Community Mehra Shirazi Background Using a community–based participatory research (CBPR) approach, we describe the process of a first–time campus–community partnership between UC Berkeley School of Public Health and the Afghan Coalition in California. Objectives: We reflect on lessons learned in cultivating a unique community health partnership to provide a preliminary understanding of how Afghan immigrant women view their breast health, and to determine and assess their barriers to breast cancer screening. This story will emphasize the importance and challenges of (1) negotiating equitable collaborative relationships, (2) recruitment and retention of participants by community members and ways to overcome cultural and language barriers, (3) training of community members, and (4) data dissemination. Conclusion Conducting meaningful community partnerships should be driven by a social justice agenda where community has control over the production of knowledge and engaged in all phases of research. There is also a need for transparency and mutual agreement around roles and responsibilities where researchers take on facilitative roles and do not attempt to control the research process. These are the reflections of the first community/campus partnership between the Afghan Coalition of Alameda County, CA and the UC Berkeley School of Public Health in an effort to provide a preliminary understanding of how Afghan women view their breast health. This was done through in–depth semi–structured interviews conducted with non–English speaking first–generation immigrant Afghan women above the age of 40. This narrative aims to describe the experience of engaging in community–academic partnerships that brought forth essential information pertaining to the breast health [End Page 21] screening practices of Afghan women which then led to a five–year breast health education intervention program funded by the National Institute of Health. My mother, my sister, my aunt, my daughter . . . In telling their stories, the women were speaking about their struggles, their pain and resilience. They painted an accurate picture of breast cancer in their communities, which remained a subject considered taboo in Afghan culture. It was clear this was more than a “make sure everyone gets a pamphlet” intervention. No intervention was going to work unless it was a part of the community itself; not for them or about them or even from them. In a refugee community struggling against the label of terrorist as the United States entered its second decade of war in Afghanistan, information and access to preventative healthcare, including breast cancer screening, was minimal. And the stories kept coming. My niece, my daughter–in–law . . . Working with the Afghan community of Alameda County, CA, the largest Afghan refugee population in the United States, two–thirds of whom are female, meant we were approaching a long–established community with its own politics, social and cultural norms, and community leaders. It can be easy, and expedient, to paint broad circles in the name of increased access, but it was clear that previous research on immigrant Muslim women and breast cancer hadn’t addressed the scope of what we were facing. The women here were less literate, unaware of screening recommendations, and hampered by their immigrant status, cultural valuation of female modesty, and a necessary wariness of any dealings with officialdom in the age of the “War on Terror” wherein the community was consistently approached for informants. My mother–in–law, my cousin, my wife . . . Establishing any partnership is part act of faith and part extended learning curve, but the development of a true partnership across culture, language, religion, and deep societal mistrust required more than good intentions. The high rates of breast cancer anecdotally reported in the population, as well as the lack of access to care still faced by an established community (mean residence in the US was 16 years) pointed to the need for a culturally based intervention program to establish and address attitudes toward breast cancer screening among a population with limited English language usage, high rates of illiteracy in any language, cultural concerns around female modesty, and limited access to healthcare providers. Two groups, from the UC Berkeley School of Public Health and the community via the non–profit Afghan Coalition came together for a...

The Prognostic Impact of Molecular Subtypes and Very Young Age on Breast Conserving Surgery in Early Stage Breast Cancer.

BackgroundPremenopausal breast cancer with a triple-negative phenotype (TNBC) has been associated with inferior locoregional recurrence free survival (LRFS) and overall survival (OS) after breast conserving surgery (BCS). The aim of this study is to analyze the association between age, subtype, and surgical treatment on survival in young women (≤40 years) with early breast cancer in a population with a high rate of breast cancer in young women.MethodsThree hundred thirty-two patients ≤40 years old with stage I-II invasive breast cancer who underwent surgery at a single institution between 1998 and 2012 were identified retrospectively. Uni- and multivariate analysis evaluated predictors of LRFS, OS, and disease free survival (DFS).ResultsMost patients (64.2%) underwent BCS. Mean age and follow-up time were 35 (25 ± 3.61) years, and 72 months (range, 24–252), respectively. In multivariate analysis, multicentricity/multifocality and young age (<35 years) independently predicted for poorer DFS and OS. Those aged 35–40 years had higher LRFS and DFS than those <35 in the mastectomy group (p=0.007 and p=0.039, respectively). Patients with TNBC had lower OS compared with patients with luminal A subtype (p=0.042), and those who underwent BCS had higher OS than patients after mastectomy (p=0.015).ConclusionYoung age (< 35 years) is an independent predictor of poorer OS and DFS as compared with ages 35–40, even in countries with a lower average age of breast cancer presentation. In addition, TNBC in the young predicts for poorer OS. BCS can be performed in young patients with TNBC, despite their poorer overall survival.

PINK RIBBON AND PINKTOBER

The month of October comes with a familiar sight of ‘pink ribbon’ display and events organized in this context, globally. While this is an integral part of the international calendar in the developed world, developing countries like Pakistan attach little importance to promotion of this concept brand. One of the reasons for this apathy is a lack understanding amongst the social circles and general population about what the pink ribbon advocates. This editorial is meant to highlight the true spirit and importance of this symbol.&#x0D; A ‘pink ribbon’ is an international symbol of breast cancer awareness with the month of October referred to as ‘pinktober’ chosen as the breast cancer awareness month in many countries over the world. Breast cancer is the most common cancer amongst the female gender with more than one million women worldwide diagnosed with the disease every year. The WHO in its global health estimate reported 508000 deaths in women worldwide from this disease in the year 20111.More than 58% of deaths from breast cancer are known to occur in less developed countries2, which sets aside the misconception that the disease is a problem of the more affluent class. Early detection of breast cancer with its favorable impact on morbidity and mortality associated with the disease is now established as the cornerstone of management3.&#x0D; Against the backdrop of the magnitude and impact of this condition there is a dire need for creating awareness about the symptoms and treatment of the disease as well as promoting research and facilities leading to early detection, multimodality treatment and support for those suffering from the disease. Pink ribbon as a concept brand allows a platform to achieve these goals by raising money and encouraging scientific progress. The first known use of Pink Ribbon dates back to 1991 when it was handed out by the Susan G Koman foundation to participants of a New York city race for breast cancer survivors and adopted as an official symbol in 19924. Buying, wearing, displaying or sponsoring pink ribbon is a sign of support for women health. Thousands of pink ribbon products are advertised and sold each year with part of the earnings spent in promoting breast cancer awareness and funding research.&#x0D; The month of October as the national breast cancer awareness month (NBCAM) was started in 1985 by the American Cancer Society and pharmaceutical company Astra Zeneca. The organization behind NBCAM is keen on promoting mammography as a screening tool for early detection of breast cancer. Running, walking and riding besides observing pink dress day and pink hijab day form the essence of events organized globally as fundraisers under this banner.&#x0D; The campaign for helping breast cancer patients is not limited to diagnosis and treatment only. Addressing the burden of physical, social and psychological stigma associated with the disease is as important as the initial steps in management. The term She-ro, derived from hero is sometimes used to refer to those suffering from the disease. After treatment, the she-ro regains her femininity by using breast reconstruction, prosthetic devices, wigs, cosmetics, and clothing to present an aesthetically appealingappearance5.Breast cancer culture, or pink ribbon culture, refers to steps taken in public to effectively address different aspects of the disease. It supports the efforts of the doctors, promotes diagnostic modalities such as mammograms and various treatment options on offer for breast cancer patients.&#x0D; Pakistan has the highest rate of breast cancer in Asia. One out of every nine women is at the risk of breast cancer making the Pakistani women most susceptible to the disease after the non Arab Israeli women6. Studies have shown that a significant number of young women make the afore-mentioned list. Therefore, Pink Ribbon has reading-prc-Iterature been running Youth Awareness Program in collaboration with Higher Education Commission (HEC) since 2012. This program not only educates the young women about the importance of self-examination and screening modalities like ultrasound scan and mammograms but also through their interaction with members of their family and society makes them conscious of the disease and advocating regular check-ups. Benefit is also derived from established women groups and Lady Health workers who are in contact with the population in far-flung areas of the country, in spreading awareness to the grass root level. In collaboration with Pakistan Atomic Energy Commission hospitals, Pink ribbon has launched a free nationwide Breast Cancer screening program and is working on building a dedicated Breast Cancer Hospital in Lahore, Pakistan.&#x0D; Realizing the disease burden and the health, social and financial implications of breast cancer it is imperative that Pink Ribbon as a source of Breast Cancer awareness is propagated in the society and an all out moral and material support be extended to the organizations working under this banner.

Germline mutations of the DNA repair pathways in uterine serous carcinoma

ObjectiveTreatment options are limited for patients with uterine serous carcinoma (USC). Knowledge of USC's somatic mutation landscape is rapidly increasing, but its role in hereditary cancers remains unclear. We aim to evaluate the frequency and characteristics of germline mutations in genes commonly implicated in carcinogenesis, including those within homologous recombination (HR) and mismatch repair (MMR) pathways in patients with pure USC. MethodsBy using targeted capture exome sequencing, 43 genes were analyzed in a cohort of 7 consecutive patients with paired tumor and non-tumor USC samples in our institutional tumor repository. Mutations predicted to have damaging effects on protein function are validated by Sanger Sequencing. ResultsWe found 21 germline mutations in 11 genes in our USC cohort. Five patients harbored 7 germline mutations (33.3%) within genes involved in the HR pathway, RAD51D being the most common. Four patients had 9 (42.8%) germline mutations in hereditary colon cancer genes, most commonly MLH. All patients (42.7%) who are platinum-sensitive had HR germline mutations (RAD50, NBN, ATM). Patients with HER2 overexpression (2/7, 28.6%) had germline HR mutations and were platinum-sensitive. Three patients in our cohort reported a personal history of breast cancer, one with HR germline mutation, and 2 in patients with germline mutations in HCC genes. In addition, 5 out of 7 patients had germline mutations in genes associated with growth factor signaling pathway. ConclusionsA significant proportion of our cohort harbor germline mutations in DNA repair genes. This may be associated with the high rate of breast cancer in our patients and their family, and suggests a targeted cohort for genetic counseling. If validated in a larger cohort, our findings may allow clinicians to expand therapeutic options to include targeted therapies and inclusion of USC patient in preventative and genetic counseling.

Clinical trial design of Boron Neutron Capture Therapy on breast cancer using D-D coaxial compact neutron generator as neutron source and Monte Carlo N-Particle simulation method

&lt;span&gt;A clinical trial simulation of Boron Neutron Capture Therapy (BNCT) for breast cancer was conducted at National Nuclear Energy Agency Yogyakarta, Indonesia. This was motivated by high rate of breast cancer in the world, especially in Indonesia. BNCT is a type of therapy by nuclear reaction &lt;/span&gt;&lt;sup&gt;10&lt;/sup&gt;&lt;span&gt;B(n,α)&lt;/span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;span&gt;Li that produces kinetic energy totaling 2.79 MeV. High Linear Energy Transfer (LET) radiation of α-particle and recoil &lt;/span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;span&gt;Li would locally deposit their energy in a range of 5-9 μm, which corresponds to the human cell diameter. Fast neutron coming out of Compact Neutron Generator (CNG) was moderated using Fe and MgF&lt;/span&gt;&lt;sub&gt;2&lt;/sub&gt;&lt;span&gt; material. A collimator, along with breast cancer and the corresponding organ at risk were designed compatible to Monte Carlo N-Particle X (MCNPX). The radiation were simulated by the MCNPX software and the physical quantities were counted by tally MCNPX codes. The highest neutron thermal flux was found at a depth of 1.4 cm on fat tissue. En face and upward intersection radiation techniques were adopted for the breast cancer radiation. The average dose rate of radiation used on breast cancer was 1.72×10&lt;/span&gt;&lt;sup&gt;-5 &lt;/sup&gt;&lt;span&gt;Gy/s for the en face method and 8.98×10&lt;/span&gt;&lt;sup&gt;-6 &lt;/sup&gt;&lt;span&gt;Gy/s for the upward intersection method. Dose 50±3 Gy was given into cancer cell, (4.18±0.06) ×10&lt;/span&gt;&lt;sup&gt;-2&lt;/sup&gt;&lt;span&gt; Gy into heart and (8.16±0.06) ×10&lt;/span&gt;&lt;sup&gt;-2&lt;/sup&gt;&lt;span&gt;Gy into lung for 806.34 hours irradiation.&lt;/span&gt;

Primary care characteristics and their association with health screening in a low-socioeconomic status public rental-flat population in Singapore- a mixed methods study.

BackgroundIn Singapore, subsidized primary care is provided by centralized polyclinics; since 2000, policies have allowed lower-income Singaporeans to utilize subsidies at private general-practitioner (GP) clinics. We sought to determine whether proximity to primary care, subsidised primary care, or having regular primary care associated with health screening participation in a low socioeconomic-status public rental-flat community in Singapore.MethodsFrom 2009–2014, residents in five public rental-flat enclaves (N = 936) and neighboring owner-occupied precincts (N = 1060) were assessed for participation in cardiovascular and cancer screening. We then evaluated whether proximity to primary care, subsidised primary care, or having regular primary care associated with improved adherence to health screening. We also investigated attitudes to health screening using qualitative methodology.ResultsIn the rental flat population, for cardiovascular screening, regular primary care was independently associated with regular diabetes screening (adjusted odds ratio, aOR = 1.59, CI = 1.12–2.26, p = 0.009) and hyperlipidemia screening (aOR = 1.82, CI = 1.10–3.04, p = 0.023). In the owner-occupied flats, regular primary care was independently associated with regular hypertension screening (aOR = 9.34 (1.82–47.85, p = 0.007), while subsidized primary care was associated with regular diabetes screening (aOR = 2.94, CI = 1.04–8.31, p = 0.042). For cancer screening, in the rental flat population, proximity to primary care was associated with less participation in regular colorectal cancer screening (aOR = 0.42, CI = 0.17–0.99, p = 0.049) and breast cancer screening (aOR = 0.29, CI = 0.10–0.84, p = 0.023). In the owner-occupied flat population, for gynecological cancer screening, usage of subsidized primary care and proximity to primary care was associated with higher rates of breast cancer and cervical cancer screening; however, being on regular primary care followup was associated with lower rates of mammography (aOR = 0.10, CI = 0.01–0.75, p = 0.025). On qualitative analysis, patients were discouraged from screening by distrust in the doctor-patient relationship; for cancer screening in particular, patients were discouraged by potential embarrassment.ConclusionsRegular primary care was independently associated with regular participation in cardiovascular screening in both low-SES and higher-SES communities. However, for cancer screening, in the low-SES community, proximity to primary care was associated with less participation in regular screening, while in the higher-SES community, regular primary care was associated with lower screening participation; possibly due to embarrassment regarding screening modalities.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0411-5) contains supplementary material, which is available to authorized users.

Breast cancer risk and genetic ancestry: a case-control study in Uruguay.

BackgroundUruguay exhibits one of the highest rates of breast cancer in Latin America, similar to those of developed nations, the reasons for which are not completely understood. In this study we investigated the effect that ancestral background has on breast cancer susceptibility among Uruguayan women.MethodsWe carried out a case–control study of 328 (164 cases, 164 controls) women enrolled in public hospitals and private clinics across the country. We estimated ancestral proportions using a panel of nuclear and mitochondrial ancestry informative markers (AIMs) and tested their association with breast cancer risk.ResultsNuclear individual ancestry in cases was (mean ± SD) 9.8 ± 7.6% African, 13.2 ± 10.2% Native American and 77.1 ± 13.1% European, and in controls 9.1 ± 7.5% African, 14.7 ± 11.2% Native American and 76.2 ± 14.2% European. There was no evidence of a difference in nuclear or mitochondrial ancestry between cases and controls. However, European mitochondrial haplogroup H was associated with breast cancer (OR = 2.0; 95% CI 1.1, 3.5).ConclusionsWe have not found evidence that overall genetic ancestry differs between breast cancer patients and controls in Uruguay but we detected an association of the disease with a European mitochondrial lineage, which warrants further investigation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12905-015-0171-8) contains supplementary material, which is available to authorized users.