Malaysian Breast Cancer Patients Research Articles

Multiple SNPs Downregulate Gene Expression of Matrix Metallopeptidase 2 in MCF7 Breast Cancer Cells

Introduction: On a global scale, breast cancer contributes the highest cancer-related deaths in women due to metastasis which renders the treatments ineffective and non-targeted. The members of Matrix Metallopeptidases, particularly Matrix Metallopeptidase 2 (MMP2), are among the key players in breast cancer metastasis. In most cases, MMP2 was markedly upregulated and linked to poor prognosis. In a previous study, in silico analyses revealed that several coding single nucleotide polymorphisms (SNPs) of MMP2 were shown to reduce gene expression and mRNA stability of MMP2 in Malaysian breast cancer patients. Therefore, to validate the in silico predictions, the objective of this study was to determine the effects of multiple coding SNPs of MMP2 on the gene expression and mRNA stability of MMP2 in breast cancer cells. Methods: In the current study, breast adenocarcinoma MCF7 cells were transfected with MMP2 wild type and variant containing the coding SNPs. After confirmation of transfection by DNA sequencing, the gene expression level of MMP2 was evaluated by quantitative reverse transcription polymerase chain reaction (RT-qPCR) whereas mRNA stability of MMP2 was determined following treatment with actinomycin D. Results: MMP2 wild type and variant were successfully transfected in MCF7 cells based on sequencing and PCR analysis. It was found that the presence of coding SNPs lowered the gene expression level of MMP2, but not the stability of MMP2 mRNA. Conclusion: This study supports the in silico effects of MMP2 coding SNPs on its gene expression in an in vitro model.

22P Impact of an online Asian genetic risk calculator on risk perception: Cancer-related distress and uptake of genetic counselling among Malaysian breast cancer patients (The ARiCa Study)

22P Impact of an online Asian genetic risk calculator on risk perception: Cancer-related distress and uptake of genetic counselling among Malaysian breast cancer patients (The ARiCa Study)

Barriers to help-seeking for Malaysian women with symptoms of breast cancer: a mixed-methods, two-step cluster analysis

BackgroundImproving help-seeking behaviour is a key component of down-staging breast cancer and improving survival, but the specific challenges faced by low-income women in an Asian setting remain poorly characterized. Here, we determined the extent of help-seeking delay among Malaysian breast cancer patients who presented at late stages and explored sub-groups of women who may face specific barriers.MethodsTime to help-seeking was assessed in 303 women diagnosed with advanced breast cancer between January 2015 and March 2020 at a suburban tertiary hospital in Malaysia. Two-step cluster analysis was conducted to identify subgroups of women who share similar characteristics and barriers. Barriers to help-seeking were identified from nurse interviews and were analyzed using behavioural frameworks.ResultsThe average time to help-seeking was 65 days (IQR = 250 days), and up to 44.5% of women delayed by at least 3 months. Three equal-sized clusters emerged with good separation by time to help-seeking (p < 0.001). The most reported barrier across clusters was poor knowledge about breast health or breast cancer symptoms (36.3%), regardless of help-seeking behaviour (p = 0.931). Unexpectedly, women with no delay (9 days average) and great delay (259 days average) were more similar to each other than to women with mild delays (58 days average), but, women who experienced great delay reported poor motivation due to fear and embarrassment (p = 0.066) and a lack of social support (p = 0.374) to seek help.ConclusionsDown-staging of breast cancer in Malaysia will require a multi-pronged approach aimed at modifying culturally specific social and emotional barriers, eliminating misinformation, and instilling motivation to seek help for breast health for the women most vulnerable to help-seeking delays.

Impact and Association of Anaemia Severity and Its Treatment With Quality of Life of Breast Cancer Patients in Malaysia

Anaemia is a crucial issue among cancer patients and need to be treated properly. High incidence of anaemia in patients with cancer have been associated with several physiological manifestations, leading to decreased quality of life (QOL). The current study aimed to assess the severity of anaemia, evaluate the current treatment guideline of anaemia, and to determine the association between the level of anaemia and its treatment on quality of life of breast cancer patients in Malaysia. This prospective study conducted among breast cancer patients in multicancer centers in Malaysia including three follow ups after receiving their chemotherapy. Clinical data were collected from their medical records and at each follow up, they asked to fill up a functional assessment chronic therapy (FACT-An) questionnaire. Descriptive and inferential statistical analysis were done using SPSS. The mean age of participants was 52 ± 11 years old, and out of 120 participants, 32% received anti-anaemic treatments including 87% of them were prescribed with iron supplementation and only 13% received combination of blood transfusion and iron therapy. Surprisingly, none of the participants received erythropoietin stimulating agents (ESAs). Statistical tests also indicated a significant association between anti-anaemic treatments with haemoglobin level and QOL scores. However, this association was insufficient to significantly improve QOL or palliate anaemia severity among participants. This study showed a great evidence that, the current practice of anaemia treatment (iron therapy) among breast cancer patients in Malaysia’s healthcare setting, was not sufficient to palliate anaemia severity or to improve patients’ QOL. There is still a lot of gaps to improve in the management of anaemia among breast cancer patients to show a significant improvement in haemoglobin level. Therefore, respective organisations and oncologists are required to raise awareness about the optimal treatment of anaemia among breast cancer patients, as a result, improve their general wellbeing

Online Health Information Seeking Behaviours among Malaysian Breast Cancer Patients, Survivors and Caretakers: A Content Analysis

Exploring online health information seeking behaviour (HISB) among Malaysian breast cancer patients, survivors and caretakers is crucial in understanding the ways these people used, communicated and disseminated online health information related to breast cancer. HISB has been explored and approached from different viewpoints which include extensive studies on online platform. Nonetheless, such expositions are considered inadequate as studies on cancer related online HISB are still scarce especially among Malaysians. The methodology used in this study is qualitative content analysis. Adapting the Health Information National Trends Survey (HINTS) 2021, the data was collected from 113 respondents via Survey Monkey platform. The users’ online health information searching behaviour with regards to cancer information were also investigated. Using content analysis to analyse the data, we identified three overarching themes in relation to online cancer-related information seeking behaviours among them. Three major themes identified are (i) internet as the primary source of cancer-related information, (ii) experience of seeking cancer-related information online and (iii) issue with seeking and sharing online cancer-related information. The findings of this study are of significance for the healthcare practitioners, public health experts and health communication researchers. Future studies should consider exploring how online health information seeking behaviour among these groups can contribute to engaging them to choose credible online cancer-related information and how these behaviours can help Malaysian health practitioners to offer, disseminate and fulfil the health information needs of these groups.

Diagnostic Interval: Experiences among Women with Breast Cancer in Malaysia

BACKGROUND: The diagnostic pathway is critical for early breast cancer detection and prognosis improvement. Countries such as the United Kingdom, particularly England, have implemented faster diagnosis standards to ensure that patients receive a definitive diagnosis of cancer or are ruled out within 28 days of referral. However, there is a severe shortage of data on the experiences of breast cancer patients in Malaysia during the diagnostic interval. AIM: This study aimed to explore what happened to the women during the diagnostic phase prior to confirmation of breast cancer. METHODOLOGY: Purposive sampling was applied, and 14 participants were recruited from two government hospitals. The participants took part in in-depth, face-to-face, one-time, and audio-recorded interviews. All the interviews were subsequently transcribed verbatim and analyzed using narrative analysis. RESULTS: The diagnostic interval for the women in this study was 1–3 months from first medical contact till diagnosis. Four themes were identified during the analysis for the diagnostic interval: 1) Women who are suspected of having breast cancer; 2) Women who experience false reassurance; 3) Woman who experience delayed referral; and 4) Women who experience inconclusive investigation results. CONCLUSIONS: This study indicates that early warning signs of breast cancer may prompt doctors to take immediate action. However, unexpected delays may occur as a result of staffing and system issues in the healthcare system. Healthcare professionals should aggressively refer patients with typical symptoms and actively follow-up with patients who present with atypical symptoms in the community. Continuing education for healthcare professionals is necessary to improve diagnostic and referral procedures.

Revalence and associated factors of fatigue among breast cancer patients in Malaysia—A prospective study

Self-Medication Practices among Health Sciences Students: The Case of Mekelle UniversityGirma Belachew Gutema, Diriba Alemayehu Gadisa, Zerihun Abebe Kidanemariam, Derbew Fikadu Berhe, Abera Hadgu Berhe, Mussie Ghezu Hadera, Gebremedhin Solomon Hailu, Naod Gebresamuel Abrha, Raghavendra

A Review on Communication Issues Related to The Process and Treatment for Breast Cancer Patients in Malaysia

A Review on Communication Issues Related to The Process and Treatment for Breast Cancer Patients in Malaysia

"I Lost My Gift to Him": The Consequences of Female Sexual Dysfunction on Breast Cancer Survivors in Malaysia.

Sexuality is currently neglected in the medical care of cancer patients although female sexual dysfunction (FSD) and sexual problems are highly prevalent among breast cancer patients in Malaysia. This paper explores the consequences of breast cancer and its treatment on the sexuality and sexual health of women with breast cancer using a qualitative design and a phenomenological methodology. Fourteen married women with breast cancer who fulfill the criteria for FSD from Kelantan, Malaysia participated in two interviews: in-depth interview and followed by photo-elicitation interview after two weeks duration. The interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. We identified overlapping themes that can be explained by sexual script theory. Breast cancer treatments disturb the sex response cycle, leading to changes in sexuality, from intimacy in marriage to women preferring physical affection to intercourse. The women struggled with a perceived imperfection about symbol of femininity after noticing changes in their husbands' sexual performance and after experiencing their own sentiments of inadequacy as a wife. Fear and guilt surfaced as part of the journey, accompanied by frustration on the part of the spouse, or him becoming more attentive. This study highlights the problem of breast cancer and its treatment as regards the sexual well-being of patients and their spouses. Hence, recognizing and addressing sexual health will improve the overall experience for survivors.

Time Taken for Symptom Recognition, First Consultation, Diagnosis and First Definitive Treatment and Its Associated Factors among Women with Breast Cancer.

Background:Breast cancer patients in Malaysia often present late, delaying diagnosis and treatment. Decisions on health-seeking behaviour are influenced by a complex interplay of several factors. Early detection and subsequent successful treatment are the main goal in order to reduce breast cancer mortality. The aims of this study were to identify the time taken by women with breast cancer for consultation, diagnosis and first definitive treatment and the factors associated with the initiation of definitive treatment. Methods:In this cohort study, we interviewed 328 women with histologically confirmed breast cancer at five medical centres in Malaysia. Times were measured from recognition of symptoms to first consultation to diagnosis and to the first definitive treatment. The event was initiation of definitive treatment. Data was analysed using multivariable Cox proportional hazards regression. Results:The mean age was 47.9 (standard deviation 9.4) years and 79.9% were ethnic Malays. The median follow-up time was 6.9 months. The median times for first doctor consultation, diagnosis and initiation of treatment were 2 months, 5.5 months and 2.4 weeks, respectively. The percentage of consultation delay more than a month was 66.8%, diagnosis delay more than three months was 73.2% and treatment delay more than one month was 11.6%. Factors associated with not initiating the definitive treatment were pregnancy (adjusted hazard ratio (AHR) 1.75; 95% Confidence Interval (CI): 1.07, 2.88), taking complementary alternative medicine (AHR 1.45; 95% CI: 1.15, 1.83), initial refusal of mastectomy (AHR 3.49; 95% CI: 2.38, 5.13) and undergoing lumpectomy prior to definitive treatment (AHR 1.62; 95% CI: 1.16, 2.28). Conclusions:Delays in diagnosis and consultation were more serious than treatment delays. Most respondents would accept treatment immediately after diagnosis. Respondents themselves were responsible for a large proportion of the delays. This study was successful in understanding the process of breast cancer patients’ experience, from symptoms recognition to consultation, diagnosis and treatment.

Tualang Honey Supplementation Improves Inflammatory and Bone Markers among Postmenopausal Breast Cancer Patients: A Randomised Controlled Trial

Honey is traditionally used among breast cancer patients in Malaysia with the belief that it can improve the overall health. Therefore, this study aims to determine the effects of Tualang honey supplementation on levels of inflammatory markers, bone markers and oestradiol among postmenopausal breast cancer patients. Seventy-two patients on anastrozole were recruited and randomly divided into two groups (n = 36/group, with or without 20 g/day of Tualang honey for 12 weeks). Levels of interleukin-1 beta (IL-1β), tumour necrosis factor alpha (TNF-α) and carboxy-terminal crosslinked telopeptide of type 1 collagen (CTX) at post-intervention with anastrozole, increased significantly compared to their corresponding levels at pre-intervention. Meanwhile, at post-intervention with anastrozole+honey, procollagen type 1 amino-terminal propeptide level increased significantly, CTX level decreased significantly, with no change in inflammatory markers compared to their pre-intervention levels. In conclusion, Tualang honey supplementation prevented the increased inflammation, reduced bone resorption and increased bone formation without changes in oestradiol level.

Use of Adjuvant Endocrine Therapy Among Post-Menopausal Breast Cancer Patients in Malaysia.

ContextGlobally, breast cancer is the most common cancer affecting women, and adjuvant endocrine therapy (AET) is part of its treatment modality, which improves patients’ outcome. However, there are concerns on side effects related to its use, which may affect treatment adherence.PurposeThis study was conducted to explore attitude and practice on using AET among breast cancer patients in Malaysia.Patients and MethodsPostmenopausal breast cancer patients on at least 3 months of AET attending the outpatient oncology clinic at a tertiary care hospital were interviewed. Patients underwent in-depth interviews exploring their attitude and practices while on AET using a semi-structured interview guide. The interviews were transcribed verbatim and analyzed using thematic analysis.ResultsThere were four main themes for attitude toward the use of AET: 1) benefits of using AET, 2) concerns on taking AET, 3) beliefs on alternative treatment, and 4) beliefs toward the doctor. For practice, six themes were obtained: 1) correct use of AET, 2) appointment adherence, 3) information-seeking behavior, 4) counseling services obtained, 5) experienced side effects of AET, and 6) usage of complementary and alternative medicines.ConclusionSeveral themes concerning attitude and practice of breast cancer patients receiving AET were identified, which may be addressed during treatment consultations in clinical practice.

Development and evaluation of a sustainable video health education program for newly diagnosed breast cancer patients in Malaysia.

Wider breast cancer (BC) treatment options, short consultation time with physicians, lack of knowledge, and poor coping skills at the time of diagnosis may affect patients' decisions causing treatment delays and non-adherence. To address this gap, a breast care nurse video orientation program was started. Our aim was to evaluate the video on patients' knowledge, satisfaction, and treatment adherence. The video was developed using the BC delay explanatory model. A self-administered pre- and post-survey on 241 newly diagnosed BC patients in University Malaya Medical Center was performed. The Wilcoxon matched paired signed rank test was used to evaluate patients' pre and post perceived knowledge using a Likert scale 0 to 4 (0 = "no knowledge," 4 = "a great degree of knowledge"). Treatment adherence among participants were measured after 1-year follow-up. Eighty percent of the patients reported that the video met or exceeded their expectations. In total 80.5% reported that the video was very effective and effective in improving their perspective on BC treatments. There was improvement in perceived knowledge for treatment options (mean scores; M = 0.93 versus M = 2.97) (p < 0.001) and also for perceived knowledge on types of operation, information on chemotherapy, radiotherapy, hormone therapy, healthy diet, physical activity after treatments, and care of the arm after operation(p < 0.001). In total 89.4%, 79.3%, and 85.9% adhered to surgical, chemotherapy, and radiotherapy recommended treatment, respectively. The video improved patients' perceived knowledge and satisfaction. The program improved access not only to new BC patients but also the public and found sustainable using the YouTube platform.

Mitochondrial DNA mutations in Malaysian female breast cancer patients.

Cancer development has been ascribed with diverse genetic variations which are identified in both mitochondrial and nuclear genomes. Mitochondrial DNA (mtDNA) alterations have been detected in several tumours which include lung, colorectal, renal, pancreatic and breast cancer. Several studies have explored the breast tumour-specific mtDNA alteration mainly in Western population. This study aims to identify mtDNA alterations of 20 breast cancer patients in Malaysia by next generation sequencing analysis. Twenty matched tumours with corresponding normal breast tissues were obtained from female breast cancer patients who underwent mastectomy. Total DNA was extracted from all samples and the entire mtDNA (16.6kb) was amplified using long range PCR amplification. The amplified PCR products were sequenced using mtDNA next-generation sequencing (NGS) on an Illumina Miseq platform. Sequencing involves the entire mtDNA (16.6kb) from all pairs of samples with high-coverage (~ 9,544 reads per base). MtDNA variants were called and annotated using mtDNA-Server, a web server. A total of 18 of 20 patients had at least one somatic mtDNA mutation in their tumour samples. Overall, 65 somatic mutations were identified, with 30 novel mutations. The majority (59%) of the somatic mutations were in the coding region, whereas only 11% of the mutations occurred in the D-loop. Notably, somatic mutations in protein-coding regions were non-synonymous (49%) in which 15.4% of them are potentially deleterious. A total of 753 germline mutations were identified and four of which were novel mutations. Compared to somatic alterations, less than 1% of germline missense mutations are harmful. The findings of this study may enhance the current knowledge of mtDNA alterations in breast cancer. To date, the catalogue of mutations identified in this study is the first evidence of mtDNA alterations in Malaysian female breast cancer patients.

A Retrospective, Observational Study to Determine the Patient and Tumor Characteristics of HER2-Positive Breast Cancer Patients Treated at Five Main Public Cancer Centers in Malaysia

Introduction Human epidermal growth factor receptor 2 (HER2) overexpressing breast cancer is a high-risk subtype with poor prognosis. The incidence of HER2 expressing tumors is high in Malaysia; however, there is limited information on the characteristics of these tumors. Therefore, we sought to collect the patient and tumor characteristics of HER2+ breast cancer cases at five centers in Malaysia. Patients and Methods A retrospective review was conducted of the data from charts of patients diagnosed with HER2+ breast cancer between January 2014 and December 2015 at Hospital Kuala Lumpur, Institute Kanser Negara, Hospital Pulau Pinang, Hospital Besar Sarawak, and Hospital Likas in Malaysia. Results Of the 1,519 screened patient’ charts, 396 were included for the analysis. The average age of HER2+ breast cancer cases at diagnosis was 51.07 years. A high percentage of cases presented at an advanced stage (38.89 and 12.12% with stage 3 and 4, respectively). About 58.84% of patients were categorized as “high-risk,” with one or more lymph node involvement. Close to half (47.98%) of cases presented with T2 stage tumors, and infiltrating ductal carcinomas were reported in 85.35% of tumors. The most common immunohistochemical subtype was estrogen receptor (ER)+/progesterone receptor (PR)+/HER2+ (47.47%), followed by ER–/PR–/HER2+ (37.12%). Conclusion HER2 overexpressing tumors represent an aggressive subtype in Malaysia with large tumor size, high tumor grade, and lymph node involvement. Early diagnosis and management of these tumors may help improve the survival rates. Future studies should help elucidate the treatment patterns and outcomes in HER2+ breast cancer patients in Malaysia.

Impact of CYP3A4 and CYP3A5 single nucleotide polymorphisms on anastrozole-associated adverse events among Malaysian breast cancer patients

The catalytic activity of the cytochrome P450A (CYP3A4) enzyme is reportedly affected by the presence of single nucleotide polymorphisms (SNPs), leading to inter-individual variability in drug efficacy and adverse reactions. CYP3A4 polymorphisms can serve as potential biomarkers for predicting the efficacy of many drugs, including those used in breast cancer treatment. This study was conducted on 94 hormone receptor-positive postmenopausal breast cancer patients who received 1 mg of anastrozole per day. Anastrozole-associated adverse events (AAAEs), such as musculoskeletal adverse events (MSAEs), hot flashes, mood disturbance and vaginal dryness/dyspareunia, were assessed according to the Common Terminology Criteria for Adverse Events (CTCAE). The polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was performed to determine the allelic frequency of CYP3A4*4, CYP3A4*18A, CYP3A4*18B, CYP3A4*22 and CYP3A5*3. The frequencies of CYP3A4*18A T&gt;C (rs28371759), CYP3A4*18B G&gt;A (rs2242480) and CYP3A5*3 were 0.03, 0.48 and 0.64, respectively. However, no CYP3A4*4 A&gt;G (rs55951658) or CYP3A4*22 C&gt;T (rs35599367) alleles were detected. No significant association was observed between the alleles and the development of AAAEs. We have demonstrated for the first time that CYP3A4*18B G&gt;A is highly prevalent among Malaysian breast cancer patients. The clinical relevance of CYP3A4*18B is currently under investigation by our group.

Adjuvant endocrine therapy side-effects among postmenopausal breast cancer patients in Malaysia

Objective: This study was conducted to determine the prevalence and severity of menopausal symptoms and their associated risk factors among postmenopausal breast cancer patients receiving adjuvant endocrine therapy.Methods: Postmenopausal breast cancer patients on endocrine therapy were recruited at three hospitals in Malaysia. Presence and severity of menopausal symptoms were determined using the Menopause Rating Scale. Sociodemographic and clinical data were collected from medical records.Results: A total of 192 patients participated in this study. Commonly reported symptoms were musculoskeletal pain (59.9%), physical and mental exhaustion (59.4%), and hot flushes (41.1%). Multivariate analyses indicated that increasing number of years after menopause until the start of endocrine therapy was significantly associated with less likelihood of reporting menopausal symptoms and musculoskeletal pain. Patients with primary or secondary education levels reported significantly less menopausal urogenital symptoms compared to patients with a tertiary education level. Patients using aromatase inhibitors were twice as likely to experience musculoskeletal pain compared to patients using tamoxifen (odds ratio, 2.18; 95% confidence interval, 1.06–4.50; p < 0.05).Conclusion: Menopausal symptoms and musculoskeletal pain are common problems encountered by postmenopausal breast cancer patients receiving adjuvant endocrine therapy and should be closely monitored for successful treatment.

Linguistic and Psychometric Validity of the Malay BREAST-Q in Women Undergoing Breast Cancer Surgery in Malaysia

Background: BREAST-Q is a PROMs used to measure and assess patient satisfaction and quality of life before and after breast cancer surgery. BREAST-Q composed of 5 different modules and each module comprised of multiple scales. Each module has preoperative and postoperative versions to assess the impact of surgery. Four subscales with common items from the 5 modules: “satisfaction with the breast”, psychosocial, sexual and physical well-being were subjected to testing. Two other subscales, “satisfaction with overall outcomes” and “satisfaction with the care” were only validated linguistically. Currently, the BREAST-Q has already been translated into 25 languages. Linguistic and psychometric validation of BREAST-Q has not been performed in Malaysia. Aim: To translate the BREAST-Q into Malay language and perform psychometric validation. Methods: Translation of the English BREAST-Q to Malay language was done based on linguistic validation protocol provided by MAPI Research Trust. Content and face validation were performed to determine contextual accuracy, acceptability and understanding of the items. The finalised Malay BREAST-Q then underwent psychometric testing. Breast cancer patients (n=186) who were planned for breast cancer surgery were conveniently sampled at the breast clinic of UMMC between June 2015 to June 2016. Consented participants completed the questionnaire in the same visit following their diagnosis. Retest was done 2-3 weeks after the first questionnaire administration in 62 patients who were admitted for their surgery. Data were analyzed using SPSS and AMOS software. Results: Content experts (4 breast surgeons) agreed the items in BREAST-Q comprehensively measured the concept of interest and I-CVI for each item was 1.0. Participants agreed the questionnaire was comprehensive and easy to understand. The average time taken to complete the questionnaire was 15.3 minutes. Test–retest analysis showed good reproducibility with intraclass correlation coefficient (ICC) value of 0.71-0.98. Internal consistencies were good for all items in each subscale with Cronbach's alpha values of 0.83-0.95. The highest interitem correlation for each item with at least one other item in the construct ranged from 0.47 to 0.90. The lowest corrected item-total correlation (CITC) values ranged from 0.47 to 0.72. In exploratory factor analysis, the KMO values were excellent in all 4 subscales (0.76, 0.92, 0.91, and 0.86). Single factor was extracted in 3 subscales that explained more than 50% of the variance and 3 factors (breast pain, general pain, and discomfort) were extracted in “physical well-being” subscale that cumulatively explained more than 50% of the variance. Conclusion: The Malay BREAST-Q demonstrated good reliability, content and face validity, and excellent psychometric properties. Hence, we propose the use of the Malay BREAST-Q to measure patient reported outcomes among breast cancer patients in Malaysia undergoing breast cancer surgery.

The Prevalence of Metabolic Syndrome Among Newly Diagnosed Malaysian Breast Cancer Patients

Background: The incidence of breast cancer has increased in South East Asian (SEA) women. Malaysia has the highest obesity rates in SEA. Malaysian Breast Cancer Survivorship Cohort (MyBCC) study is a hospital-based prospective cohort study that aims to study the association between lifestyle factors and overall survival and quality of life of Malaysian breast cancer patients. Metabolic syndrome (MS) is associated with increasing levels of inflammatory cytokines and leptin that can stimulate cell proliferation through various mechanisms, hence indicating both an increased risk of developing breast cancer and a poorer prognosis. However, there is very scarce information available on the presence of MS among the newly diagnosed breast cancer patients. This is an early report of the presence of MS in the MyBCC study. Aim: We aim to evaluate the presence of MS among newly diagnosed breast cancer patients and to determine the association of MS and sociodemographic factors. Methods: 370 newly diagnosed breast cancer patients were interviewed at baseline. The anthropometric data (waist circumference, hip circumference, body weight, body height and body fat percentage) and also blood for lipid profile and glucose profile were collected. The MS status of the patients was defined using a modified International Diabetes Federation worldwide definition; presence of central obesity (waist circumference ≥ 80 cm) and any of two or more of the following criteria: (i) raised triglyceride with ≥ 1.7 mmol/L, (ii) reduced HDL-cholesterol that &lt; 1.3 mmol/L, (iii) diagnosed with hypertension and (iv) diagnosed with diabetes. Results: Among the 370 breast cancer patients, most were aged 51 years and above (258, 69.7%), were Chinese (180, 48.6%), had secondary school education level (168, 45.4%), had less than RM3500 household income (193, 52.2%) and were postmenopausal (250, 67.6%). Most of the patients were obese or overweight (268, 72.4%) and around half of the patients (190, 51.4%) had high body fat percentage. 140 patients had MS (37.8%). MS was significantly higher among patients aged 61 years and above (59, 42.1%) and 51 to 60 years (50, 35.7%) compared with 20 to 50 years of age group (31, 22.1%) ( P &lt; 0.05). The patients with MS were significantly higher among Chinese ethnicity (57, 40.7%), unemployed (95, 70.4%), and postmenopausal (108, 77.1%) ( P &lt; 0.05). Conclusion: The prevalence of MS is high in newly diagnosed Malaysian breast cancer patients. With longer follow-up, further analysis will be done to look at association with outcomes.

Association of Allelic Interaction of Single Nucleotide Polymorphisms of Influx and Efflux Transporters Genes With Nonhematologic Adverse Events of Docetaxel in Breast Cancer Patients

PurposeNonhematologic adverse events (AEs) of docetaxel constitute an extra burden in the treatment of cancer patients and necessitate either a dose reduction or an outright switch of docetaxel for other regimens. These AEs are frequently associated with genetic polymorphisms of genes encoding for proteins involved docetaxel disposition. Therefore, we investigated that association in Malaysian breast cancer patients. Materials and MethodsA total of 110 Malaysian breast cancer patients were enrolled in the present study, and their blood samples were investigated for different single nucleotide polymorphisms using polymerase chain reaction restriction fragment length polymorphism. AEs were evaluated using the Common Terminology Criteria for Adverse Events, version 4.0. ResultsFatigue, nausea, oral mucositis, and vomiting were the most common nonhematologic AEs. Rash was associated with heterozygous and mutant genotypes of ABCB1 3435C>T (P < .05). Moreover, patients carrying the GG genotype of ABCB1 2677G>A/T reported more fatigue than those carrying the heterozygous genotype GA (P < .05). The presence of ABCB1 3435-T, ABCC2 3972-C, ABCC2 1249-G, and ABCB1 2677-G alleles was significantly associated with nausea and oral mucositis. The coexistence of ABCB1 3435-C, ABCC2 3972-C, ABCC2 1249-G, and ABCB1 2677-A was significantly associated with vomiting (P < .05). ConclusionThe prevalence of nonhematologic AEs in breast cancer patients treated with docetaxel has been relatively high. The variant allele of ABCB1 3435C>T polymorphism could be a potential predictive biomarker of docetaxel-induced rash, and homozygous wild-type ABCB1 2677G>A/T might predict for a greater risk of fatigue. In addition, the concurrent presence of specific alleles could be predictive of vomiting, nausea, and oral mucositis.