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Azim HA, Elghazawy H, Ghazy RM, Abdelaziz AH, Abdelsalam M, Elzorkany A, Kassem L. Clinicopathologic Features of Breast Cancer in Egypt-Contemporary Profile and Future Needs: A Systematic Review and Meta-Analysis. JCO Glob Oncol 2023; 9:e2200387. [PMID: 36888929 PMCID: PMC10497263 DOI: 10.1200/go.22.00387] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/06/2023] [Accepted: 01/24/2023] [Indexed: 03/10/2023] Open
Abstract
PURPOSE Breast cancer (BC) is the most common cancer among Egyptian females. No current national cancer database is available in Egypt to provide reliable data on the specific clinicopathologic features of BC in this population. Herein, we investigated the clinical profile of BC among Egyptian women. METHODS A systematic review of studies on BC published from inception until December 2021 was performed. We explored pooled estimated proportions of different stages of BC at presentation in Egypt and other clinicopathologic features including age, menopausal status, tumor (T) and lymph node (N) stages, and biological subtypes. Data analysis was performed using meta package (R). RESULTS Twenty-six studies were eligible for our systematic review and meta-analysis, including 31,172 BC cases. In 12 studies, including 15,067 patients with BC, the estimated mean age was 50.46 years (95% CI, 48.7 to 52.1; I2, 99%), with a pooled proportion of premenopausal/perimenopausal women of 57% (95% CI, 50 to 63; I2, 98%). Among 9,738 patients with BC, pooled proportions of stage I, II, III, and IV were 6% (95% CI, 4 to 8; I2, 90%), 37% (95% CI, 31 to 43; I2, 93%), 45% (95% CI, 42 to 49; I2, 78%), and 11% (95% CI, 9 to 15; I2, 87%), respectively. The pooled proportions of patients with T3 and T4 tumors were 21% (95% CI, 14 to 31; I2, 99%) and 8% (95% CI, 5 to 12; I2, 96%), respectively, while those with positive lymph nodes were 70% (95% CI, 59 to 79; I2, 99%). CONCLUSION Dominance of advanced stage and young age at diagnosis represented the two main features of BC among Egyptian women. Our data may serve to guide the policymakers in Egypt as well as other countries with lower resources to prioritize the diagnostic and therapeutic needs in this context.
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Affiliation(s)
- Hamdy A. Azim
- Clinical Oncology Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt
- Cairo Oncology Center, Cairo, Egypt
| | - Hagar Elghazawy
- Cairo Oncology Center, Cairo, Egypt
- Clinical Oncology Department, Ain Shams University, Cairo, Egypt
| | - Ramy M. Ghazy
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | | | | | - Amira Elzorkany
- Training and Biostatistics Administration, Ministry of Health and Population, Alexandria, Egypt
| | - Loay Kassem
- Clinical Oncology Department, Kasr Alainy School of Medicine, Cairo University, Giza, Egypt
- Cairo Oncology Center, Cairo, Egypt
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Cheng JS, Chen TC, Chen TDI, Ku HP, Huang SW, Wu TS, Chien RN, Chang ML. Association between breast cancer and hepatitis C: A joint study of hospitalized patients and nationwide cohorts. Transl Res 2022; 245:117-129. [PMID: 35259528 DOI: 10.1016/j.trsl.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 02/19/2022] [Accepted: 02/28/2022] [Indexed: 11/17/2022]
Abstract
Whether hepatitis C virus (HCV) infection is associated with breast cancer risk remains elusive, and we aimed to elucidate it. A nationwide population-based cohort study of the Taiwan National Health Insurance Research Database (TNHIRD) was conducted. Additionally, breast cancer risk factors, and HCV core expression were surveyed in breast cancer patients of a tertiary care center. Three TNHIRD cohorts (1:4:4, propensity score-matched, 2003-2012), including HCV-treated (3646 HCV-infected females with interferon-based therapy ≥6 months), HCV-untreated (n = 14,584) and HCV-uninfected (n = 14,584) cohorts, were enrolled. The HCV-untreated cohort had the highest 9-year breast cancer cumulative incidence (2.017%; 95% confidence interval [CI]: 1.382%-2.846%), while the HCV-treated (1.073%; 0.414%-2.356%), and HCV-uninfected (1.453%; 0.785%-2.486%) cohorts showed no difference. Untreated HCV infection (hazard ratio [HR]: 1.701; 95% CI: 1.205%-2.400), urban residency (1.658, 1.183-2.323), and baseline cardiovascular events (1.920; 1.005-3.668) were associated with incident breast cancers. The interaction analysis showed that particularly among patients <49 years, HCV infection was associated with breast cancer development (2.193; 1.097-4.384). Of 12,170 hospitalized breast cancer patients, 4.90% were HCV Ab-positive. HCV Ab-positive patients were older (60.92+/-10.82 vs 53.91+/-11.38 years, P < 0.0001) and had a higher body mass index (25.39+/-5.1 vs 24.5+/-4.3 kg/m2, P = 0.007), rates of diabetes (30.60 vs 19.98%, P < 0.0001), hypertension (46.9 vs 30.39%, P < 0.0001), dyslipidemia (25.52 vs 20.28%, P = 0.031), and hyperuricemia (11.38 vs 5.52%, P < 0.0001) than their counterparts. No HCV core-positive cells were demonstrated in breast cancer tissues. Conclusions: Untreated HCV infection, urbanization, and cardiovascular events were potential risk factors for breast cancer. The HCV-associated risk was most prominent among patients <49 years, might not be associated with in situ HCV core-related oncogenesis but with metabolic alterations, and was reversed by anti-HCV therapy.
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Affiliation(s)
- Jur-Shan Cheng
- Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Tse-Ching Chen
- Department of Pathology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tai-DI Chen
- Department of Pathology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsin-Ping Ku
- Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Wei Huang
- Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ting-Shu Wu
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, Chang Gung University, Linkou, Taiwan
| | - Rong-Nan Chien
- Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Ling Chang
- Division of Hepatology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Alsughayer AM, Dabbagh TZ, Abdel-Razeq RH, Al-Jussani GN, Alhassoon S, Sughayer MA. Changing Trends in Estrogen Receptors/Progesterone Receptors/Human Epidermal Growth Factor Receptor 2 Prevalence Rates Among Jordanian Patients With Breast Cancer Over the Years. JCO Glob Oncol 2022; 8:e2100359. [PMID: 35436143 PMCID: PMC9302262 DOI: 10.1200/go.21.00359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Estrogen receptors (ERs), progesterone receptors (PRs), and human epidermal growth factor receptor 2 (HER2) are the mainstay of breast cancer management, and their prevalence rates vary among different populations possibly related to ethnic/genetic and/or socioeconomic status. In a previous study conducted at the King Hussein Cancer Center (published 2006), Jordan ER/PR/HER2 rates for patients diagnosed in 2003-2004 were 50.8%/57.5%/17.5%, respectively. The aim of this study is to revisit the prevalence rates to see if they have changed over the years with changing socioeconomic status. MATERIALS AND METHODS We retrieved clinicopathologic data of all patients (1,185) diagnosed with breast cancer during 2018. The data included age, histologic type, grade, and ER/PR/HER2 status as determined by immunohistochemistry and/or fluorescence in situ hybridization for HER2. RESULTS The mean age of patients was 52 (median = 51, range = 25-92) years, and the majority (73.2%) had invasive carcinoma of no special type. ER/PR/HER2 were 77.0%/72.4%./23.8%, respectively. Triple-negative breast cancers were 10.1%. In comparison with previous results of 2006, the changes are statistically significant. Similar changes were seen in other Middle Eastern populations. The current rates are close to those of Western populations. CONCLUSION Rates of ER/PR/HER2 expression have significantly changed and are close to those of Western populations for ER/PR. We propose that such changes are secondary to the adoption of a westernized lifestyle and socioeconomic changes.
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Khaled HM, Soliman AS. Medical Oncology Education in Egypt Over the Past 50 Years: the Experience of the National Cancer Institute of Cairo University. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:87-94. [PMID: 34109530 PMCID: PMC8189725 DOI: 10.1007/s13187-021-02038-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/24/2021] [Indexed: 06/12/2023]
Abstract
This manuscript outlines the progress of education in the field of medical oncology in Egypt over the past 50 years. The manuscript illustrates the origin of the Egyptian medical oncology program since the creation of the only specialized cancer center in the country, the National Cancer Institute of Cairo University (NCI-Cairo) in 1969, from Cairo University Medical School. The manuscript also outlines the NCI-Cairo's educational program for developing a cadre of academic medical oncologists for NCI-Cairo, other Egyptian medical institutions, and countries in the Middle East and Africa. We also emphasize the capacity building that resulted over the past 50 years from academic and professional standpoints, the changing curriculum in medical oncology, and the differences between the medical oncology and clinical oncology education programs in the country. Medical oncology research resulted from international collaborations and highlighted needs for cancer prevention and control. Finally, we propose possible future directions for medical oncology education and research in the country and a roadmap for low- and middle-income countries (LMICs) that are developing their medical oncology programs.
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Affiliation(s)
- Hussein M Khaled
- Medical Oncology Department, National Cancer Institute, Cairo University, Fom El Khalig Square, Cairo, 11796, Egypt.
| | - Amr S Soliman
- City University of New York Medical School, New York, NY, USA
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Rocha PRS, Oliveira VD, Vasques CI, Dos Reis PED, Amato AA. Exposure to endocrine disruptors and risk of breast cancer: A systematic review. Crit Rev Oncol Hematol 2021; 161:103330. [PMID: 33862246 DOI: 10.1016/j.critrevonc.2021.103330] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 03/16/2021] [Accepted: 03/26/2021] [Indexed: 02/06/2023] Open
Abstract
AIM The aim of this study was to investigate the association between human exposure to endocrine disruptors (EDs) and the risk of breast cancer. METHODS This was a systematic review conducted by searching Cochrane Library, LILACS, Livivo, PubMed, and Science Direct. Observational studies addressing the association between exposure to EDs and breast cancer risk in adults were included. Risk of bias was assessed using the National Toxicology Program's Office of Health Assessment Translation tool. RESULTS a total of 37 studies were included. Most studies reported that exposure to organochlorine pesticides, phthalates, heavy metals, and polycyclic aromatic hydrocarbons was associated with increased breast cancer risk. CONCLUSION qualitative analysis of observational studies indicates that human exposure to EDs is associated with increased breast cancer risk. Additional studies are needed to determine whether this association is causal.
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Affiliation(s)
- Priscilla Roberta Silva Rocha
- Faculty of Ceilândia, University of Brasília, Campus Universitário s/n, Metropolitan Center, Brasília, DF, 72220-275, Brazil.
| | | | - Christiane Inocêncio Vasques
- Nursing Department, School of Health Sciences, University of Brasília, Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil
| | - Paula Elaine Diniz Dos Reis
- Nursing Department, School of Health Sciences, University of Brasília, Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil
| | - Angélica Amorim Amato
- Department of Pharmaceutical Sciences, School of Health Sciences, University of Brasília, Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, DF, 70910-900, Brazil
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6
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Epidemiology of De Novo Metastatic Breast Cancer. Clin Breast Cancer 2021; 21:302-308. [PMID: 33750642 DOI: 10.1016/j.clbc.2021.01.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/27/2020] [Accepted: 01/24/2021] [Indexed: 11/22/2022]
Abstract
Most cases of metastatic breast cancer (MBC) arise as a recurrence of a previously treated early breast cancer. Distinct from recurrent MBC is de novo MBC (dnMBC), which describes patients who present with distant sites of disease at initial diagnosis and is reviewed here. dnMBC represents approximately 3% to 6% of new breast cancer diagnoses in high-income countries. This incidence has not declined despite decades of widespread use of population-based mammography screening. Overrepresentation of both biologically aggressive tumors and patients negatively impacted by social determinants of health are characteristics of dnMBC. Survival has generally been superior for patients with dnMBC compared with those with recurrent MBC, although it is similar to that for patients with recurrent MBC with long disease-free intervals. Subgroups of patients with dnMBC who experience prolonged survival include those with human epidermal growth factor receptor-2-positive disease or hormone receptor-positive bone-only disease. Opportunities to decrease dnMBC presentation may include novel screening modalities suited for biologically aggressive breast tumors and improved access to health care. Recognizing that there will remain some women diagnosed with dnMBC, refining our ability to identify those likely to be long-term survivors could allow for appropriate escalation or de-escalation of care. Finally, evaluation of tumor genomics in robust sample sizes has the potential to advance our knowledge of the biology of dnMBC as an entity distinct from recurrent MBC.
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Leso V, Ercolano ML, Cioffi DL, Iavicoli I. Occupational Chemical Exposure and Breast Cancer Risk According to Hormone Receptor Status: A Systematic Review. Cancers (Basel) 2019; 11:cancers11121882. [PMID: 31783577 PMCID: PMC6966433 DOI: 10.3390/cancers11121882] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 11/22/2019] [Accepted: 11/25/2019] [Indexed: 12/12/2022] Open
Abstract
Breast cancers include a heterogeneous group of diseases with clinical behaviors that may vary according to the hormonal receptor status. However, limited knowledge is available on the role of breast cancer environmental and occupational risk factors in the onset of specific molecular disease phenotypes. Therefore, the aim of this review was to provide an overview on the possible correlation between occupational chemical exposures and breast cancers with a specific receptor pattern. Pubmed, Scopus, and ISI Web of Science databases were systematically reviewed to identify all the studies addressing chemical exposure in workplaces and risk of breast cancer classified according to the presence of estrogen and/or progesterone receptors. Some positive associations were reported between solvent, polycyclic aromatic hydrocarbon, organophosphoric insecticide, and synthetic fiber exposure and estrogen receptor-positive cases, while other investigations demonstrated a relationship with receptor-negative tumors or failed to detect any significant effect. Overall, further investigation should overcome limitations due to the self-reported information on work histories, the chemical classification in general categories, and the lack of environmental or biological monitoring exposure data. This may support the development of suitable and individually "tailored" occupational risk assessment and management strategies to protect the health of exposed workers, particularly those with hypersusceptibility conditions.
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Affiliation(s)
- Veruscka Leso
- Correspondence: ; Tel.: +39-081-746-4763; Fax: +39-081-746-2133
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Zhang Q, Gong Y, Guo XJ, Zhang P, Ding CF. Multifunctional Gold Nanoparticle-Based Fluorescence Resonance Energy-Transfer Probe for Target Drug Delivery and Cell Fluorescence Imaging. ACS APPLIED MATERIALS & INTERFACES 2018; 10:34840-34848. [PMID: 30264982 DOI: 10.1021/acsami.8b12897] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Drug delivery system has a profound significance for imaging capabilities and monitoring apoptosis process precisely in cancer therapeutic field. Herein, we designed cysteamine (CS)-stabilized gold nanoparticles, CS-gold nanoparticles (AuNPs)-doxorubicin (DOX), for fluorescence-enhanced cell imaging and target drug delivery. For cancer therapy, DOX was incorporated to CS-AuNPs by disulfide linkages which could be cleaved by glutathione (GSH) in cancer cells specifically. In addition, red-emissive DOX was quenched effectively by particular quenching effect of fluorescence resonance energy transfer from DOX to AuNPs, rendering monitoring target drug release by visual luminescence. The released DOX-SH acted as an indicator for cancer cells with red fluorescence and was further used for stimuli-responsive drug therapy. After an overall investigation of detection for GSH, proapoptosis for cancer cells, and inhibition for tumor tissues in vivo, the CS-AuNPs-DOX nanoprobe shows an obviously enhanced performance. This proposal provides an intelligent strategy for cell imaging and drug delivery, which serves as a promising candidate for anticancer therapeutic applications.
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Affiliation(s)
- Qian Zhang
- Key Laboratory of Sensor Analysis of Tumor Marker, Ministry of Education; Shandong Key Laboratory of Biochemical Analysis; Key Laboratory of Analytical Chemistry for Life Science in Universities of Shandong; College of Chemistry and Molecular Engineering , Qingdao University of Science and Technology , Qingdao 266042 , P. R. China
| | - Yan Gong
- Key Laboratory of Sensor Analysis of Tumor Marker, Ministry of Education; Shandong Key Laboratory of Biochemical Analysis; Key Laboratory of Analytical Chemistry for Life Science in Universities of Shandong; College of Chemistry and Molecular Engineering , Qingdao University of Science and Technology , Qingdao 266042 , P. R. China
| | - Xin-Jie Guo
- Key Laboratory of Sensor Analysis of Tumor Marker, Ministry of Education; Shandong Key Laboratory of Biochemical Analysis; Key Laboratory of Analytical Chemistry for Life Science in Universities of Shandong; College of Chemistry and Molecular Engineering , Qingdao University of Science and Technology , Qingdao 266042 , P. R. China
| | - Peng Zhang
- Key Laboratory of Sensor Analysis of Tumor Marker, Ministry of Education; Shandong Key Laboratory of Biochemical Analysis; Key Laboratory of Analytical Chemistry for Life Science in Universities of Shandong; College of Chemistry and Molecular Engineering , Qingdao University of Science and Technology , Qingdao 266042 , P. R. China
| | - Cai-Feng Ding
- Key Laboratory of Sensor Analysis of Tumor Marker, Ministry of Education; Shandong Key Laboratory of Biochemical Analysis; Key Laboratory of Analytical Chemistry for Life Science in Universities of Shandong; College of Chemistry and Molecular Engineering , Qingdao University of Science and Technology , Qingdao 266042 , P. R. China
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Ding C, Xu Y, Zhao Y, Zhong H, Luo X. Fabrication of BSA@AuNC-Based Nanostructures for Cell Fluoresce Imaging and Target Drug Delivery. ACS APPLIED MATERIALS & INTERFACES 2018; 10:8947-8954. [PMID: 29457719 DOI: 10.1021/acsami.7b18493] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Drug delivery which can offer efficient and localized drug transportation together with imaging capabilities is highly demanded in the development of cancer theranostic approaches. Herein, we report the construction of bovine serum albumin (BSA) gold nanoclusters (BSA@AuNCs) for cell fluoresce imaging and target drug delivery. BSA@AuNCs were modified with cyclic arginine-glycine-aspartate with the product RGD-BSA@AuNCs to enhance cell internalization of the nanoclusters. Furthermore, doxorubicin hydrochloride or doxorubicin (DOX), a widely used chemotherapy drug, was also used to modify RGD-BSA@AuNCs. The final design of the DOX/RGD-BSA@AuNC system was constructed through the disulfide bond. The physical microstructure and biological characterization of the BSA@AuNCs were realized through high-resolution transmission electron microscopy and confocal laser fluorescence microscopy. As the disulfide bonds were cleaved by glutathione in cancer cells, DOX-SH molecules were released from the nanosystem to inhibit the growth of cancer cells. The as-prepared DOX/RGD-BSA@AuNC system can be used not only to deliver drug but also to achieve the antitumor effect by in vivo imaging, demonstrating its promising applications in cancer treatment.
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Affiliation(s)
- Caifeng Ding
- Key Laboratory of Sensor Analysis of Tumor Marker, Ministry of Education, College of Chemistry and Molecular Engineering , Qingdao University of Science and Technology , Qingdao 266042 , PR China
| | - Yujuan Xu
- Key Laboratory of Sensor Analysis of Tumor Marker, Ministry of Education, College of Chemistry and Molecular Engineering , Qingdao University of Science and Technology , Qingdao 266042 , PR China
| | - Yanan Zhao
- Key Laboratory of Sensor Analysis of Tumor Marker, Ministry of Education, College of Chemistry and Molecular Engineering , Qingdao University of Science and Technology , Qingdao 266042 , PR China
| | - Hua Zhong
- Key Laboratory of Sensor Analysis of Tumor Marker, Ministry of Education, College of Chemistry and Molecular Engineering , Qingdao University of Science and Technology , Qingdao 266042 , PR China
| | - Xiliang Luo
- Key Laboratory of Sensor Analysis of Tumor Marker, Ministry of Education, College of Chemistry and Molecular Engineering , Qingdao University of Science and Technology , Qingdao 266042 , PR China
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Jowell A, Zhou B, Barry M. The impact of megacities on health: preparing for a resilient future. Lancet Planet Health 2017; 1:e176-e178. [PMID: 29851637 DOI: 10.1016/s2542-5196(17)30080-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 07/06/2017] [Indexed: 06/08/2023]
Affiliation(s)
- Ashley Jowell
- Center for Innovation in Global Health, Stanford University, Stanford, CA 94305, USA
| | - Bright Zhou
- Center for Innovation in Global Health, Stanford University, Stanford, CA 94305, USA
| | - Michele Barry
- Center for Innovation in Global Health, Stanford University, Stanford, CA 94305, USA.
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Keshet-Sitton A, Or-Chen K, Yitzhak S, Tzabary I, Haim A. Light and the City: Breast Cancer Risk Factors Differ Between Urban and Rural Women in Israel. Integr Cancer Ther 2016; 16:176-187. [PMID: 27440788 PMCID: PMC5739126 DOI: 10.1177/1534735416660194] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Women are exposed to indoor and outdoor artificial light at night (ALAN) in urban and rural environments. Excessive exposure to hazardous ALAN containing short wavelength light may suppress pineal melatonin production and lead to an increased breast cancer (BC) risk. Our objective was to address the differences in BC risks related to light exposure in urban and rural communities. We examined indoor and outdoor light habits of BC patients and controls that had lived in urban and rural areas in a 5-year period, 10 to 15 years before the time of the study. Individual data, night time sleeping habits and individual exposure to ALAN habits were collected using a questionnaire. A total of 252 women (110 BC patients and 142 controls) participated in this study. The sample was divided to subgroups according to dwelling area and disease status. Age matching was completed between all subgroups. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated for urban and rural women separately, using binary logistic regression. OR results of urban population (92 BC patients and 72 control) revealed that BC risk increases with daily use of cellphone (OR = 2.13, 95% CI = 1.01-4.49, P < .05) and residence near strong ALAN sources (OR = 1.51, 95% CI = 0.99-2.30, P < .06). Nevertheless, BC risk decreases if a woman was born in Israel (OR = 0.44, 95% CI = 0.21-0.93, P < .03), longer sleep duration (OR = 0.75, 95% CI = 0.53-1.05, P < .1), and reading with bed light illumination before retiring to sleep (OR = 0.77, 95% CI = 0.61-0.96, P < .02). Furthermore, in the rural population (18 BC patients and 66 control) BC risk increases with the number of years past since the last menstruation (OR = 1.12, 95% CI = 1.03-1.22, P < .01). However, BC risk decreases with longer sleep duration (OR = 0.53, 95% CI = 0.24-1.14, P < .1), reading with room light illumination before retiring to sleep (OR = 0.55, 95% CI = 0.29-1.06, P < .07), and sleeping with closed shutters during the night (OR = 0.66, 95% CI = 0.41-1.04, P < .08). These data support the idea that indoor and outdoor nighttime light exposures differ between urban and rural women. Therefore, we suggest that women can influence BC risk and incidence by applying protective personal lighting habits. Further studies with larger sample sizes are needed to strengthen the results.
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Affiliation(s)
| | | | | | - Ilana Tzabary
- 3 Soroka University Medical Center, Beer-Sheva, Israel
| | - Abraham Haim
- 1 University of Haifa, Mount Carmel, Haifa, Israel
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12
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Saber Raza M, Broom M. Survival analysis modeling with hidden censoring. JOURNAL OF STATISTICAL THEORY AND PRACTICE 2016. [DOI: 10.1080/15598608.2016.1152205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Smith BL, Ramadan M, Corley B, Hablas A, Seifeldein IA, Soliman AS. Measuring the effect of improvement in methodological techniques on data collection in the Gharbiah population-based cancer registry in Egypt: Implications for other Low- and Middle-Income Countries. Cancer Epidemiol 2015; 39:1010-4. [PMID: 26590335 DOI: 10.1016/j.canep.2015.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 09/24/2015] [Accepted: 11/01/2015] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to describe and quantify procedures and methods that maximized the efficiency of the Gharbiah Cancer Registry (GPCR), the only population-based cancer registry in Egypt. The procedures and measures included a locally-developed software program to translate names from Arabic to English, a new national ID number for demographic and occupational information, and linkage of cancer cases to new electronic mortality records of the Ministry of Health. Data was compiled from the 34,058 cases from the registry for the years 1999-2007. Cases and registry variables about demographic and clinical information were reviewed by year to assess trends associated with each new method or procedure during the study period. The introduction of the name translation software in conjunction with other demographic variables increased the identification of detected duplicates from 23.4% to 78.1%. Use of the national ID increased the proportion of cases with occupation information from 27% to 89%. Records with complete mortality information increased from 18% to 43%. Proportion of cases that came from death certificate only, decreased from 9.8% to 4.7%. Overall, the study revealed that introducing and utilizing local and culture-specific methodological changes, software, and electronic non-cancer databases had a significant impact on data quality and completeness. This study may have translational implications for improving the quality of cancer registries in LMICs considering the emerging advances in electronic databases and utilization of health software and computerization of data.
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Affiliation(s)
- Brittney L Smith
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198-4395, U.S.A
| | | | - Brittany Corley
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198-4395, U.S.A
| | | | | | - Amr S Soliman
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198-4395, U.S.A.
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Breast cancer by age at diagnosis in the Gharbiah, Egypt, population-based registry compared to the United States Surveillance, Epidemiology, and End Results Program, 2004-2008. BIOMED RESEARCH INTERNATIONAL 2015; 2015:381574. [PMID: 26495294 PMCID: PMC4606134 DOI: 10.1155/2015/381574] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 07/30/2015] [Indexed: 12/04/2022]
Abstract
Objective. Although breast cancers (BCs) in young women often display more aggressive features, younger women are generally not screened for early detection. It is important to understand the characteristics of young onset breast cancer to increase awareness in this population. This analysis includes all ages, with emphasis placed on younger onset BC in Egypt as compared to the United States. Methods. BC cases in the Gharbiah cancer registry (GCR), Egypt, were compared to those in the Surveillance, Epidemiology, and End Results (SEER) database. This analysis included 3,819 cases from the GCR and 273,019 from SEER diagnosed 2004–2008. Results. GCR cases were diagnosed at later stages, with <5% diagnosed at Stage I and 12% diagnosed at Stage IV. 48% of all SEER cases were diagnosed at Stage I, dropping to 30% among those ≤40. Significant differences in age, tumor grade, hormone receptor status, histology, and stage exist between GCR and SEER BCs. After adjustment, GCR cases were nearly 45 times more likely to be diagnosed at stage III and 16 times more likely to be diagnosed at stage IV than SEER cases. Conclusions. Future research should examine ways to increase literacy about early detection and prompt therapy in young cases.
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Abstract
Breast cancer is the most common cancer in women worldwide. The majority of breast cancers show overexpression of estrogen receptors (ERs) and progesterone receptors (PRs). The development of drugs to target these hormone receptors, such as tamoxifen, has brought about significant improvement in survival for women with hormone receptor-positive breast cancers. Since information about ER and PR is vital for patient management, quality assurance is important to ensure accurate testing. In recent guidelines, the recommended definition of ER and PR positivity is 1% or more of cells that stain positive. Semiquantitative assessment of ER and PR is important for prognosis and, hence, management. Even with the development of genomic tests, hormone receptor status remains the most significant predictive and prognostic biomarker.
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Affiliation(s)
- Cheng-Har Yip
- Department of Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia
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Albini A, Rosano C, Angelini G, Amaro A, Esposito AI, Maramotti S, Noonan DM, Pfeffer U. Exogenous hormonal regulation in breast cancer cells by phytoestrogens and endocrine disruptors. Curr Med Chem 2014; 21:458-500. [PMID: 24304271 PMCID: PMC4153070 DOI: 10.2174/09298673113206660291] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 08/19/2013] [Accepted: 10/04/2013] [Indexed: 01/25/2023]
Abstract
Observations on the role of ovarian hormones in breast cancer growth, as well as interest in contraception, stimulated research into the biology of estrogens. The identification of the classical receptors ERα and ERβ and the transmembrane receptor GPER and the resolution of the structure of the ligand bound to its receptor established the principal molecular mechanisms of estrogen action. The presence of estrogen-like compounds in many plants used in traditional medicine or ingested as food ingredients, phytoestrogens, as well as the estrogenic activities of many industrial pollutants and pesticides, xenoestrogens, have prompted investigations into their role in human health. Phyto- and xenoestrogens bind to the estrogen receptors with a lower affinity than the endogenous estrogens and can compete or substitute the hormone. Xenoestrogens, which accumulate in the body throughout life, are believed to increase breast cancer risk, especially in cases of prenatal and prepuberal exposure whereas the role of phytoestrogens is still a matter of debate. At present, the application of phytoestrogens appears to be limited to the treatment of post-menopausal symptoms in women where the production of endogenous estrogens has ceased. In this review we discuss chemistry, structure and classification, estrogen signaling and the consequences of the interactions of estrogens, phytoestrogens and xenoestrogens with their receptors, the complex interactions of endogenous and exogenous ligands, the evaluation of the health risks related to xenoestrogens, and the perspectives toward the synthesis of potent third generation selective estrogen receptor modulators (SERMs).
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Affiliation(s)
| | | | | | | | | | | | | | - U Pfeffer
- Universita degli Studi dell'Insubria, Facolta di Medicina e Chirurgia, Dipartimento di Biotecnologie e Scienze della Vita, Viale Dunant, n.3 Varese, Italy, 21100.
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Eng A, McCormack V, dos-Santos-Silva I. Receptor-defined subtypes of breast cancer in indigenous populations in Africa: a systematic review and meta-analysis. PLoS Med 2014; 11:e1001720. [PMID: 25202974 PMCID: PMC4159229 DOI: 10.1371/journal.pmed.1001720] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 07/29/2014] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Breast cancer is the most common female cancer in Africa. Receptor-defined subtypes are a major determinant of treatment options and disease outcomes but there is considerable uncertainty regarding the frequency of poor prognosis estrogen receptor (ER) negative subtypes in Africa. We systematically reviewed publications reporting on the frequency of breast cancer receptor-defined subtypes in indigenous populations in Africa. METHODS AND FINDINGS Medline, Embase, and Global Health were searched for studies published between 1st January 1980 and 15th April 2014. Reported proportions of ER positive (ER+), progesterone receptor positive (PR+), and human epidermal growth factor receptor-2 positive (HER2+) disease were extracted and 95% CI calculated. Random effects meta-analyses were used to pool estimates. Fifty-four studies from North Africa (n=12,284 women with breast cancer) and 26 from sub-Saharan Africa (n=4,737) were eligible. There was marked between-study heterogeneity in the ER+ estimates in both regions (I2>90%), with the majority reporting proportions between 0.40 and 0.80 in North Africa and between 0.20 and 0.70 in sub-Saharan Africa. Similarly, large between-study heterogeneity was observed for PR+ and HER2+ estimates (I2>80%, in all instances). Meta-regression analyses showed that the proportion of ER+ disease was 10% (4%-17%) lower for studies based on archived tumor blocks rather than prospectively collected specimens, and 9% (2%-17%) lower for those with ≥ 40% versus those with <40% grade 3 tumors. For prospectively collected samples, the pooled proportions for ER+ and triple negative tumors were 0.59 (0.56-0.62) and 0.21 (0.17-0.25), respectively, regardless of region. Limitations of the study include the lack of standardized procedures across the various studies; the low methodological quality of many studies in terms of the representativeness of their case series and the quality of the procedures for collection, fixation, and receptor testing; and the possibility that women with breast cancer may have contributed to more than one study. CONCLUSIONS The published data from the more appropriate prospectively measured specimens are consistent with the majority of breast cancers in Africa being ER+. As no single subtype dominates in the continent availability of receptor testing should be a priority, especially for young women with early stage disease where appropriate receptor-specific treatment modalities offer the greatest potential for reducing years of life lost. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Amanda Eng
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - Valerie McCormack
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
| | - Isabel dos-Santos-Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Dey S. Preventing breast cancer in LMICs via screening and/or early detection: The real and the surreal. World J Clin Oncol 2014; 5:509-519. [PMID: 25114864 PMCID: PMC4127620 DOI: 10.5306/wjco.v5.i3.509] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 03/27/2014] [Accepted: 06/11/2014] [Indexed: 02/06/2023] Open
Abstract
To review the present status of breast cancer (BC) screening/early detection in low- and middle-income countries (LMICs) and identify the way forward, an open focused search for articles was undertaken in PubMed, Google Scholar and Google, and using a snowball technique, further articles were obtained from the reference list of initial search results. In addition, a query was put up on ResearchGate to obtain more references and find out the general opinion of experts on the topic. Experts were also personally contacted for their opinion. Breast cancer (BC) is the most common cancer in women in the world. The rise in incidence is highest in LMICs where the incidence has often been much lower than high-income countries. In spite of more women dying of cancer than pregnancy or childbirth related causes in LMICs, most of the focus and resources are devoted to maternal health. Also, the majority of women in LMICs present at late stages to a hospital to initiate treatment. A number of trials have been conducted in various LMICs regarding the use of clinical breast examination and mammography in various combinations to understand the best ways of implementing a population level screening/early detection of BC; nevertheless, more research in this area is badly needed for different LMIC specific contexts. Notably, very few LMICs have national level programs for BC prevention via screening/early detection and even stage reduction is not on the public health agenda. This is in addition to other barriers such as lack of awareness among women regarding BC and the presence of stigma, inappropriate attitudes and lack of following proper screening behavior, such as conducting breast self-examinations. The above is mixed with the apathy and lack of awareness of policy makers regarding the fact that BC prevention is much more cost-effective and humane than BC treatment. Implementation of population level programs for screening/early detection of BC, along with use of ways to improve awareness of women regarding BC, can prove critical in stemming the increasing burden of BC in LMICs. Use of newer modalities such as ultrasonography which is more suited to LMIC populations and use of mHealth for awareness creation and increasing screening compliance are much needed extra additions to the overall agenda of LMICs in preventing BC.
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Corbex M, Bouzbid S, Boffetta P. Features of breast cancer in developing countries, examples from North-Africa. Eur J Cancer 2014; 50:1808-1818. [PMID: 24767469 DOI: 10.1016/j.ejca.2014.03.016] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 03/10/2014] [Accepted: 03/14/2014] [Indexed: 01/04/2023]
Abstract
Epidemiological features of breast cancer appear to be different in developing countries compared to Western countries, with notably large proportions of young patients, male patients and aggressive forms of the disease. Using North-Africa (Morocco, Algeria, Tunisia, Libya and Egypt) as an example, we document the magnitude and explore possible explanations for such patterns. Articles and reports published since the seventies were reviewed. Results show that breast cancer incidence in females is 2-4 times lower in North-Africa than in Western countries while incidence in males is similar. Consequently, the relative proportion of male breast cancer is high (≈2% of all breast cancers). Similarly, the incidence of aggressive forms of the disease, like inflammatory or triple negative breast cancer (in females), is not higher in North Africa than in Western countries, but their relative proportion in case series (up to 10% for inflammatory and 15-25% for triple negative) is significantly higher because of low incidence of other forms of the disease. In North Africa, the incidence among women aged 15-49 is lower than in Western countries, but the very low incidence among women aged more than 50, combined to the young age pyramid of North-Africa, makes the relative proportions of young patients substantially higher (50-60% versus 20% in France). Such epidemiological features result mainly from peculiar risk factor profiles, which are typical for many developing countries and include notably rapid changes in reproductive behaviours. These features have important implications for breast cancer control and treatment.
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Affiliation(s)
- Marilys Corbex
- Institute of Tropical Medicine, Nationalestraat, 155, 2000 Antwerpen, Belgium.
| | - Sabiha Bouzbid
- Badji Mokhtar University, Faculty of Medicine, Annaba, Algeria
| | - Paolo Boffetta
- Institute for Translational Epidemiology and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States; International Prevention Research Institute, Lyon, France
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Hasiniatsy NRE, Vololonantenaina CR, Rabarikoto HF, Razafimanjato N, Ranoharison HD, Rakotoson JL, Samison LH, Rafaramino F. First results of hormone receptors' status in Malagasy women with invasive breast cancer. Pan Afr Med J 2014; 17:153. [PMID: 25120866 PMCID: PMC4119455 DOI: 10.11604/pamj.2014.17.153.3045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 02/14/2014] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Breast cancer is the most common malignancy tumor amongst Malagasy women registered at the pathology unit of the "Institut Pasteur de Madagascar". In Madagascar, there is no laboratory practicing hormone receptors' status on these tumors. Until now no study about hormone receptors' status of Malagasy women with invasive breast cancer was performed. So it will be the first study talking about this topic. The aim of this study was to determine hormone receptors' status in Malagasy women with invasive breast cancer. METHODS This retrospective and descriptive study was based on patients' medical files from 2009 to 2011. It included all invasive breast cancer diagnosed in Malagasy women at the pathology laboratory located at the "Institut Pasteur de Madagascar", in Antananarivo. Along this period this laboratory has sent paraffin blocks of invasive breast carcinoma in two pathological laboratories in France. RESULTS We collected 77 cases of invasive breast cancer along this period. The mean age was 48.8 +/- 10.7, ranging from 26 years to 70 years. There were 46.8 % (n = 36) women with progesterone receptor positive (PR+), 53.2 % (n = 41) with progesterone receptor negative (PR-). For the estrogen receptor, 61.0 % (n = 47) were positive and 36.4 % (n = 28) were negative. ER+/PR+ represented 44.2 % (n = 34); ER-/PR- 33.8 % (n = 26); ER +/ PR- 16.8 % (n = 13); ER-/PR+ and ER-/PR- represented respectively 2.6 % (n = 2). CONCLUSION Patients in our study had more important rate of ER-, PR- and a less important rate of ER+/PR+, PR+. These results suggest that more study related to Hormone Receptor profile should be conducted in Malagasy women with breast cancer.
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Affiliation(s)
| | | | | | | | | | | | | | - Florine Rafaramino
- Service Oncologie-Hématologie-Radiothérapie HUJRA, Antananarivo, Madagascar
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Leung J, McKenzie S, Martin J, Dobson A, McLaughlin D. Longitudinal Patterns of Breast Cancer Screening: Mammography, Clinical, and Breast Self-Examinations in a Rural and Urban Setting. Womens Health Issues 2014; 24:e139-46. [DOI: 10.1016/j.whi.2013.11.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 11/12/2013] [Accepted: 11/12/2013] [Indexed: 11/27/2022]
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Nguyen-Pham S, Leung J, McLaughlin D. Disparities in breast cancer stage at diagnosis in urban and rural adult women: a systematic review and meta-analysis. Ann Epidemiol 2013; 24:228-35. [PMID: 24462273 DOI: 10.1016/j.annepidem.2013.12.002] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 11/11/2013] [Accepted: 12/23/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE Survival from breast cancer is dependent on stage at diagnosis and some evidence suggests that rural women are more likely than urban women to be diagnosed with advanced stage disease. This systematic review and meta-analysis compared the stage of breast cancer at diagnosis between women residing in urban and rural areas. METHODS PubMed (1951-2012), EMBASE (1966-2012), CINAHL (1982-2012), RURAL (1966-2012), and Sociological abstracts (1952-2012) were systematically searched in November 2012 for relevant peer reviewed studies. Studies on adult women were included if they reported quantitative comparisons of rural and urban differences in staging of breast cancer at diagnosis. RESULTS Twenty-four studies were included in the systematic review and 21 studies had sufficient information for inclusion in the meta-analysis (N = 879,660). Evidence indicated that patients residing in rural areas were more likely to be diagnosed with more advanced breast cancer. Using a random effects model, the results of the meta-analysis showed that rural breast cancer patients had 1.19 higher odds (95% confidence interval, 1.12-1.27) of late stage breast cancer compared with urban breast cancer patients. CONCLUSIONS Rural women were more likely than urban women to be diagnosed at a later stage. Preventive measures may need to target the rural population.
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Affiliation(s)
| | - Janni Leung
- School of Population Health, The University of Queensland, Brisbane, Australia
| | - Deirdre McLaughlin
- School of Population Health, The University of Queensland, Brisbane, Australia.
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El-Shinawi M, Youssef A, Alsara M, Aly MK, Mostafa M, Yehia A, Hurlbert M, El-Tawab RA, Mohamed MM. Assessing the level of breast cancer awareness among recently diagnosed patients in Ain Shams University Hospital. Breast 2013; 22:1210-1214. [PMID: 24054904 DOI: 10.1016/j.breast.2013.08.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 06/09/2013] [Accepted: 08/30/2013] [Indexed: 11/28/2022] Open
Abstract
UNLABELLED Breast cancer is the leading female malignancy among Egyptian women. The majority of Egyptian breast cancer patients present at late stages of the disease with a large tumor size compared to Western countries. Low breast cancer awareness, social and cultural factors were suggested to play crucial role in late presentation of breast cancer among Egyptians. The aim of our present study is to establish a questionnaire-based survey that can assess levels of breast cancer awareness among Egyptians. Patients enrolled were interviewed and answered 60 questions related to knowledge, symptoms, risk factors, prevention and management options of breast cancer. We evaluated our interactions with breast cancer patients and defined the level of awareness gained from education and culture of Egyptian women. Our results described that Egyptian breast cancer patients lack knowledge about their illness and condition. The lowest levels of awareness were related to age, education and culture. We concluded that breast cancer public awareness and women education programs covering factors identified in our study is warranted among Egyptian population. Overview OBJECTIVE To assess breast cancer awareness among recently diagnosed breast cancer Egyptian patients. SUBJECTS AND METHODS Among 289 interviewed breast cancer patients we enrolled 45 patients who fulfilled the study inclusion criteria. Participants were asked to answer a validated 60-item questionnaire that inquires about socio-demographic characteristics, knowledge of breast cancer symptoms, risk factors, symptoms, prevention, general management and willingness to participate in awareness campaigns. The average of interview time was about 45 min, depending on patient's age and education level. RESULTS The mean age of included patients was 48.2 ± 10.19 years. Geographical distribution revealed that 66.7% patients were from Cairo and the rest were from other governorates, including Aswan, Sharqia, Mansora, Qena, Kalyobia, Elminya and Sohag. Among interviewed patients 85% were non-working housewives, 42.2% of them were illiterate. Questions about knowledge of breast cancer revealed that 53.33% of patients knew an acquaintance with breast cancer; however, they spent a median time of 3 months to seek medical advice after recognizing the first symptom with a delay range between a month and 72 months. We found that 73% of the participants presented to a physician with the same first recognized symptom and 75.6% didn't think of cancer then as a possible diagnosis. Total breast cancer knowledge scores had an average of 13.3 (out of 35 knowledge points), with 93% of the patients recognizing "painless breast mass" as a breast cancer symptom and 44% only recognized the concept of breast self examination. Interestingly, 61.4% identified breastfeeding as a risk factor for breast cancer, 60% did not recognize mammography as an early detection method, and 57.7% agreed that clinical breast examination (CBE) is important for early detection. Regarding management, 75% said breast cancer was potentially curable and 60% said medical care could be helpful regardless the age of presentation. CONCLUSION Egyptian breast cancer patients knew little about their condition. Less awareness was related to age and education level. Low knowledge of risk factors, early detection and management of breast cancer should be addressed by designing patient education programs, where less educated patients are supported by health care professionals to participate in the management of breast cancer. Moreover, we found that 67% and 97% of enrolled breast cancer patients were willing as well to participate in spreading awareness among their community and among their own families, respectively.
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Affiliation(s)
- Mohamed El-Shinawi
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Abbassia, 11566 Cairo, Egypt.
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Trends in Breast Cancer Incidence Rates by Age and Stage at Diagnosis in Gharbiah, Egypt, over 10 Years (1999-2008). J Cancer Epidemiol 2013; 2013:916394. [PMID: 24282410 PMCID: PMC3824336 DOI: 10.1155/2013/916394] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 09/09/2013] [Accepted: 09/10/2013] [Indexed: 02/07/2023] Open
Abstract
Background. This study was undertaken to evaluate trends in breast cancer incidence in Egypt from 1999 to 2008 and to make projections for breast cancer occurrence for the years 2009–2015. Patients and Methods. We utilized joinpoint regression and average annual percent change (AAPC) measures with 95% confidence intervals (CI) to describe the trends in breast cancer incidence rates from the Gharbiah Cancer Registry by age and stage at diagnosis and to estimate expected breast cancer caseloads for 2009–2015. Results. From 1999 to 2008, the AAPC in breast cancer incidence rates in Gharbiah significantly increased among women 50 years and older and among localized tumors (AAPC %, 95% CI, 3.1% to 8.0%). Our results predict a significant increase in breast cancer caseloads from 2009 to 2015 among women aged 30–39 (AAPC %, 95% CI, 0.9% to 1.1%) and among women aged 40–49 years (AAPC %, 95% CI, 1.0% to 2.6%). Conclusion. These results have important implications for allocating limited resources, managing treatment needs, and exploring the consequences of prior interventions and/or changing risk factors in Egypt and other developing countries at the same stages of demographic and health transitions.
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Moore MA. Overview of Cancer Registration Research in the Asian Pacific from 2008-2013. Asian Pac J Cancer Prev 2013; 14:4461-84. [DOI: 10.7314/apjcp.2013.14.8.4461] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Tyrosine kinase inhibitors (TKIs) in human and pet tumours with special reference to breast cancer: a comparative review. Crit Rev Oncol Hematol 2013; 88:293-308. [PMID: 23768779 DOI: 10.1016/j.critrevonc.2013.05.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 04/27/2013] [Accepted: 05/17/2013] [Indexed: 12/13/2022] Open
Abstract
Tyrosine kinase receptors (TKRs) play a key role in tumour cell proliferation and survival since they are involved in endothelial cell activation leading to tumour neoangiogenesis. In particular, vascular endothelial growth factor receptors (VEGFRs), platelet-derived growth factor receptor (PDGFR), stem cell factor receptor (c-KitR), and colony-stimulating factor 1 (CSF-1) are overexpressed or constitutively activated in human and pet malignancies. A variety of small molecule inhibitors targeting specific tyrosine kinases (known as tyrosine kinase inhibitors or TKIs) have recently been approved, or are under investigation, for the treatment of human cancer. TKI application in animal cancer is however relatively recent. This review aims to illustrate the major aspects of tyrosine kinase dysfunctions, with special regard to human and animal cancer of the mammary gland, providing an update on the background of the anti-angiogenic and anti-neoplastic properties of TKIs in human and veterinary cancer.
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Hussein O, Mosbah M, Farouk O, Farag K, El-Saed A, Arafa M, Abdallah A. Hormone receptors and age distribution in breast cancer patients at a university hospital in northern egypt. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2013; 7:51-7. [PMID: 23825439 PMCID: PMC3694824 DOI: 10.4137/bcbcr.s12214] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Breast cancer is the most common cancer among Egyptian women. The disease is often advanced at diagnosis. Since molecular profiling is not feasible in routine practice, we sought to examine the association of age distribution with hormone receptor profile, disease stage and outcome among Egyptian women. PATIENTS AND METHODS We conducted a retrospective review of breast cancer patients treated at Mansoura University Cancer Center in the Nile Delta from 2006 through 2011. Age groups were examined in relation to hormone receptors status and tumor clinicopathological criteria. Additionally, the effect of receptor status on disease relapse and disease-free survival was examined with logistic regression and Kaplan-Meier analysis. RESULTS A total of 263 patients were included in the current analysis. About 66.9% (n = 176) of patients were hormone receptor positive, 14.1% (n = 37) were Her2/neu positive, and 19.0% (n = 50) were triple negative. Median age of the patients was 52 years and was equal across all receptor status types. Triple negative status correlated with increased risk of disease relapse (odds ratio = 1.8, P = 0.03) and with shortened disease-free survival (hazards ratio = 2.6, P < 0.01). CONCLUSION The age distribution and receptor status pattern in the Nile Delta region does not explain the aggressive behavior of the disease. The age of the patients at diagnosis is older than patients in earlier studies from Egypt emphasizing the importance of implementing mammographic screening programs.
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Affiliation(s)
- Osama Hussein
- Department of Surgical Oncology, Mansoura University Faculty of Medicine, Egypt
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Soliman AS, Schairer C. Considerations in setting up and conducting epidemiologic studies of cancer in middle- and low-income countries: the experience of a case-control study of inflammatory breast cancer in North Africa in the past 10 years. Cancer Med 2012; 1:338-49. [PMID: 23342283 PMCID: PMC3544462 DOI: 10.1002/cam4.36] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 08/02/2012] [Accepted: 08/22/2012] [Indexed: 12/28/2022] Open
Abstract
This article illustrates some issues we faced during our experience in conducting an epidemiologic case-control study of inflammatory breast cancer in North Africa. We expect that some of the questions we had to ask in order to address these issues might be helpful to others in setting up epidemiologic studies in developing regions. We describe our experience from different angles including the use of multiple sites to achieve adequate sample size, standardizing diagnosis of disease, identifying cancer cases at the time of diagnosis, control selection procedures, logistics of study implementation, questionnaire development and interviewing, biologic specimens, and procedures for protection of human subjects. We have developed a brief checklist to summarize important issues for conducting future epidemiologic studies in these or similar low- or middle-income countries.
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Affiliation(s)
- Amr S Soliman
- Department of Epidemiology, University of Michigan School of Public Health Ann Arbor, Michigan, 48109-2029, USA.
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Herzog CM, Dey S, Hablas A, Khaled HM, Seifeldin IA, Ramadan M, El-Hamzawy H, Wilson ML, Soliman AS. Geographic distribution of hematopoietic cancers in the Nile delta of Egypt. Ann Oncol 2012; 23:2748-2755. [PMID: 22553197 PMCID: PMC3457749 DOI: 10.1093/annonc/mds079] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 02/09/2012] [Accepted: 02/13/2012] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Previous evidence indicated that incidence rates of non-Hodgkin's lymphoma (NHL) are high in Egypt although little is known about risk factors. MATERIALS AND METHODS Using data from the population-based cancer registry of Gharbiah governorate in Egypt, we assessed the 1999-2005 incidence of hematopoietic cancers (HCs) based on the ICD-O3 by age- and sex-specific urban-rural distribution. RESULTS NHL showed the highest incidence among all HCs (11.7 per 100 000). Urban incidence of HCs was higher than rural incidence. Incidence rates of Hodgkin's lymphoma (HL) and NHL were high especially among urban males up to the 64-year age category. Rural incidence of HL and NHL was high below age 20. Among the districts of the governorate, we observed NHL incidence pattern similar to that observed for hepatocellular carcinoma because of the possible link to hepatitis C virus for both cancers. Comparison to the published HCs data from Algeria, Cyprus, and Jordan showed the highest NHL rate in Egypt than the other countries in the region. CONCLUSIONS Future studies should define the role of environmental exposures in hematopoietic carcinogenesis in this population. In-depth studies should also investigate the role of access to health care in the urban-rural variation of HC distribution in this population.
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Affiliation(s)
- C M Herzog
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, USA
| | - S Dey
- Indian Institute of Public Health, Delhi, Public Health Foundation of India, New Delhi, India
| | - A Hablas
- Gharbiah Cancer Registry and Tanta Cancer Center, Tanta, Egypt
| | - H M Khaled
- National Cancer Institute, Cairo University, Cairo, Egypt
| | - I A Seifeldin
- Gharbiah Cancer Registry and Tanta Cancer Center, Tanta, Egypt
| | - M Ramadan
- Gharbiah Cancer Registry and Tanta Cancer Center, Tanta, Egypt
| | - H El-Hamzawy
- Gharbiah Cancer Registry and Tanta Cancer Center, Tanta, Egypt
| | - M L Wilson
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, USA
| | - A S Soliman
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, USA.
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Taheri NS, Nosrat SB, Aarabi M, Tabiei MN, Kashani E, Rajaei S, Besharat S, Semnani S, Roshandel G. Epidemiological Pattern of Breast Cancer in Iranian Women: Is there an Ethnic Disparity? Asian Pac J Cancer Prev 2012; 13:4517-4520. [DOI: 10.7314/apjcp.2012.13.9.4517] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Veruttipong D, Soliman AS, Gilbert SF, Blachley TS, Hablas A, Ramadan M, Rozek LS, Seifeldin IA. Age distribution, polyps and rectal cancer in the Egyptian population-based cancer registry. World J Gastroenterol 2012; 18:3997-4003. [PMID: 22912550 PMCID: PMC3419996 DOI: 10.3748/wjg.v18.i30.3997] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 03/23/2012] [Accepted: 04/12/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To describe the clinical and epidemiologic profiles of the disease and to compare the findings with those generated from the previous hospital-based studies.
METHODS: The Gharbiah cancer registry is the only population-based cancer registry in Egypt since 1998. We analyzed the data of all colorectal cancer patients included in the registry for the period of 1999-2007. All medical records of the 1364 patients diagnosed in Gharbiah during the study period were retrieved and the following information abstracted: age, residence, diagnosis date, grade, stage, topology, clinical characteristics, and histology variables. Egyptian census data for 1996 and 2006 were used to provide the general population’s statistics on age, sex, residence and other related demographic factors. In addition to age- and sex-specific incidence rate analyses, we analyze the data to explore the incidence distribution by rural-urban differences among the 8 districts of the province. We also compared the incidence rates of Gharbiah to the rates of the Surveillance Epidemiology and End Results (SEER) data of the United States.
RESULTS: Over the 9 year-period, 1364 colorectal cancer cases were included. The disease incidence under age 40 years was relatively high (1.3/105) while the incidence in the age groups 40 and over was very low (12.0/105, 19.4/105 and 21.2/105 in the age groups 40-59 years, 60-69 years and > 70 years, respectively). The vast majority of tumors (97.2%) had no polyps and 37.2% of the patients presented with primary lesions in the rectum. Colorectal cancer was more common in patients from urban (55%) than rural (45%) areas. Regional differences in colon and rectal cancer incidence in the 8 districts of the study province may reflect different etiologic patterns in this population. The registry data of Egypt shows a slightly higher incidence of colorectal cancer than the United States in subjects under age 40 years. The results also shows significantly lower incidence of colorectal cancer in subjects over age 40 years compared to the same age group in the United States SEER.
CONCLUSION: Low rate of polyps, low incidence in older subjects, and high rate of rectal cancer in Egypt. Future studies should explore clinical and molecular disease patterns.
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Runnak MA, Hazha MA, Hemin HA, Wasan AA, Rekawt RM, Michael HD. A population-based study of Kurdish breast cancer in northern Iraq: hormone receptor and HER2 status. A comparison with Arabic women and United States SEER data. BMC WOMENS HEALTH 2012; 12:16. [PMID: 22727195 PMCID: PMC3403969 DOI: 10.1186/1472-6874-12-16] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 06/22/2012] [Indexed: 11/10/2022]
Abstract
Background Hormone receptor (HR) and HER2 expression predict the therapeutic response and prognosis of breast cancer. In the Middle-East, breast cancer is diagnosed at a young age, and Arabic women are reported to have a low frequency of HR positive tumors. This study investigates HR and HER2 expression among Kurdish and Arabic women. Methods During 2008–2010, the Sulaimaniyah Directorate of Health records identified 514 Sulaimaniyah Kurdish women, 227 Kurdish women of other Governates, and 83 Arabic women with a first diagnosis of breast cancer. The breast cancers of 432 women had immunohistochemistry (IHC) performed for estrogen and progesterone receptors (ER and PR) and HER2. Age specific and age standardized incidence rates were calculated for Sulaimaniyah Kurds. Results were compared with Egypt and with United States (US) SEER data. Results The median patient age was 46 years and 60.4% were < 50 years old. Tumors of 65.2% of women were ER+/HER2- with the rate increasing to 78.3% in patients ≥ 60 years old in proportions similar to US whites. The total annual age standardized incidence for breast cancer among Sulaimaniyah Kurds was 40.5/100,000 women, a rate similar to Egypt but much lower than the US. By HR/HER2 subtype, the highest age specific incidence rates were 16.4 and 45.4/100,000 for ER+/PR+/HER2- tumors in women < 50 or ≥ 50 years old, respectively (US whites: 37.7 and 226.1/100,000). Tumors of 20.4% of Sulaimaniyah women were HER2+ with annual incidence rates for ER-/PR-/HER2+ tumors of women <50 or ≥ 50 years old being 4.0 and 6.3/100,000 (US whites: 3.2 and 14.4/100,000). No significant differences in ER or HER2 status were found between Kurdish and Arabic patients. Conclusions Compared to the US, low age standardized and age specific breast cancer incidence rates were found in Kurdish women; nevertheless, the proportional expression of HR and HER2 for both Kurds and Arabs was comparable to that of US white women. The great majority of the breast cancer was ER+/HER2- and should respond to anti-estrogen therapy.
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Affiliation(s)
- Majid A Runnak
- Department of Pathology, Shorsh General Hospital, Sulaimaniyah, Iraq
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Uddin N, Fateem E, Hablas A, Seifeldin IA, Brown E, Merajver SD, Soliman AS. Public and professional educational needs for downstaging breast cancer in Egypt. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2012; 27:149-55. [PMID: 22057985 PMCID: PMC4276029 DOI: 10.1007/s13187-011-0282-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We conducted focus groups with women from urban and rural areas in the Nile Delta region to investigate their attitudes regarding breast cancer diagnosis, treatment, and screening. Six 60-min focus groups, each group comprised of 6-10 women with ages between 20-69 years, were conducted. Discussions included breast health, breast cancer diagnosis, treatment, early detection and screening, and communication for breast health. Almost all urban and rural women reported that women do not see physicians until they are seriously ill or have advanced cancer. They reported that oncologists or gynecologists were important to be seen first if a woman suspected breast cancer and primary care physician are not the primary line of cancer diagnosis. Other deterring factors besides distrust in primary care physicians included attitude that breast cancer equals death and lack of knowledge of early detection and screening techniques. Women felt that public education campaigns must be implemented to improve early detection and screening methods for breast cancer. The majority of beliefs regarding breast cancer and screening were common among urban and rural women. Culture-specific and tailored professional and public education programs in developing countries are essential for achieving downstaging cancer.
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Affiliation(s)
- Nazneen Uddin
- Department of Medicine, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Elham Fateem
- Gharbiah Cancer Society and Gharbiah Cancer Registry, Tanta 31512, Egypt
| | - Ahmed Hablas
- Gharbiah Cancer Society and Gharbiah Cancer Registry, Tanta 31512, Egypt
| | | | - Elissa Brown
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Sofia D. Merajver
- Department of Medicine, University of Michigan Medical School, Ann Arbor, MI 48109, USA. Department of Epidemiology, University of Michigan School of Public Health, 109 Observatory St., Ann Arbor, MI 48109, USA
| | - Amr S. Soliman
- Department of Epidemiology, University of Michigan School of Public Health, 109 Observatory St., Ann Arbor, MI 48109, USA
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Schlichting JA, Soliman AS, Schairer C, Banerjee M, Rozek LS, Schottenfeld D, Harford JB, Merajver SD. Association of inflammatory and noninflammatory breast cancer with socioeconomic characteristics in the Surveillance, Epidemiology, and End Results database, 2000-2007. Cancer Epidemiol Biomarkers Prev 2011; 21:155-65. [PMID: 22028401 DOI: 10.1158/1055-9965.epi-11-0833] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Inflammatory breast cancer (IBC) is a rare and highly aggressive form of primary breast cancer. Little is known about the risk factors for IBC, specifically the association with socioeconomic position (SEP). METHODS The association between breast cancer type (IBC vs. non-IBC) with county-level SEP in the Surveillance, Epidemiology, and End Results database for cases diagnosed from 2000 to 2007 was examined. County-level SEP characteristics included metropolitan versus non-metropolitan residence, percentage below the poverty level, percentage less than high-school graduate, and an index combining the poverty and high-school variables. IBC and non-IBC age-adjusted incidence rates were calculated, stratified on SEP and race/ethnicity. The odds of IBC versus non-IBC given a particular SEP characteristic, adjusting for age and race/ethnicity, was examined through fitting of hierarchical logistic regression models (HLM). RESULTS Incidence rates for IBC generally increased as SEP decreased, whereas the opposite was found for non-IBC. HLM results showed that low SEP is associated with higher odds of IBC: highest (≥ 20%) versus lowest (<10%) persons below the poverty level [OR (95% confidence interval, CI) = 1.25 (1.09-1.43)]; highest (>28.76%) versus lowest (≤ 15.99%) persons less than high-school graduate [OR (95% CI) = 1.25 (1.10-1.42)]; and low SEP as measured by poverty-high school index versus high SEP [OR (95% CI)= 1.26 (1.11-1.44)]. CONCLUSION Overall breast cancer has been found to be positively associated with SEP, whereas in this analysis, IBC was associated with decreasing SEP. IMPACT Studies focused on understanding the disparity in IBC incidence, as well as interventions to eliminate these differences are needed.
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Affiliation(s)
- Jennifer A Schlichting
- Department of Epidemiology, University of Michigan,109 Observatory St., Ann Arbor, MI 48109, USA.
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Salhia B, Tapia C, Ishak EA, Gaber S, Berghuis B, Hussain KH, DuQuette RA, Resau J, Carpten J. Molecular subtype analysis determines the association of advanced breast cancer in Egypt with favorable biology. BMC WOMENS HEALTH 2011; 11:44. [PMID: 21961708 PMCID: PMC3204283 DOI: 10.1186/1472-6874-11-44] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Accepted: 09/30/2011] [Indexed: 01/10/2023]
Abstract
BACKGROUND Prognostic markers and molecular breast cancer subtypes reflect underlying biological tumor behavior and are important for patient management. Compared to Western countries, women in North Africa are less likely to be prognosticated and treated based on well-characterized markers such as the estrogen receptor (ER), progesterone receptor (PR) and Her2. We conducted this study to determine the prevalence of breast cancer molecular subtypes in the North African country of Egypt as a measure of underlying biological characteristics driving tumor manifestations. METHODS To determine molecular subtypes we characterized over 200 tumor specimens obtained from Egypt by performing ER, PR, Her2, CK5/6, EGFR and Ki67 immunohistochemistry. RESULTS Our study demonstrated that the Luminal A subtype, associated with favorable prognosis, was found in nearly 45% of cases examined. However, the basal-like subtype, associated with poor prognosis, was found in 11% of cases. These findings are in sharp contrast to other parts of Africa in which the basal-like subtype is over-represented. CONCLUSIONS Egyptians appear to have favorable underlying biology, albeit having advanced disease at diagnosis. These data suggest that Egyptians would largely profit from early detection of their disease. Intervention at the public health level, including education on the benefits of early detection is necessary and would likely have tremendous impact on breast cancer outcome in Egypt.
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Affiliation(s)
- Bodour Salhia
- Integrated Cancer Genomics Division, Translational Genomics Research Institute, 445 N Fifth Street, Phoenix, AZ 85004, USA.
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Colacino JA, Soliman AS, Calafat AM, Nahar MS, Van Zomeren-Dohm A, Hablas A, Seifeldin IA, Rozek LS, Dolinoy DC. Exposure to phthalates among premenstrual girls from rural and urban Gharbiah, Egypt: a pilot exposure assessment study. Environ Health 2011; 10:40. [PMID: 21575223 PMCID: PMC3112381 DOI: 10.1186/1476-069x-10-40] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 05/16/2011] [Indexed: 05/02/2023]
Abstract
BACKGROUND Phthalates have been identified as endocrine active compounds associated with developmental and reproductive toxicity. The exposure to phthalates in premenstrual Egyptian females remains unknown. The objective of this study was to characterize phthalate exposure of a potentially vulnerable population of premenstrual girls from urban and rural Egypt. MATERIALS AND METHODS We collected one spot urine sample from 60 10-13 year old females, 30 from rural Egypt, and 30 from urban Egypt from July to October 2009. Samples were analyzed for 11 phthalate metabolites. Additionally, we collected anthropometrics as well as questionnaire data concerning food storage behaviors, cooking practices, and cosmetic use. Phthalate metabolite concentrations were compared between urban and rural Egyptians as well as to age and gender matched Americans. RESULTS Monoethyl phthalate (MEP), was detected at the highest concentration in urine of Egyptian girls (median: 43.2 ng/mL in rural, 98.8 ng/mL in urban). Concentrations of urinary metabolites of di-(2-ethylhexyl) phthalate and dibutyl phthalate were comparable between Egyptians and age matched US girls. Storage of food in plastic containers was a statistically significant predictor of urinary mono-isobutyl phthalate (MiBP) concentrations when comparing covariate adjusted means. CONCLUSIONS Urinary concentrations of phthalate metabolites were similar in Egyptian and US populations, suggesting that phthalate exposure also occurs in developing nations. Dietary intake is likely an important route of exposure to phthalates in both urban and rural populations.
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Affiliation(s)
- Justin A Colacino
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
- Center for Global Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Amr S Soliman
- Center for Global Health, University of Michigan, Ann Arbor, Michigan, USA
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Antonia M Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Muna S Nahar
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Adrienne Van Zomeren-Dohm
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Ahmed Hablas
- Tanta Cancer Center and the Gharbiah Cancer Society, Gharbiah, Egypt
| | | | - Laura S Rozek
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Dana C Dolinoy
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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Androgen receptor polyglutamine tract length in Egyptian male breast cancer patients. Breast Cancer Res Treat 2011; 129:575-81. [PMID: 21505847 DOI: 10.1007/s10549-011-1510-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 04/06/2011] [Indexed: 10/18/2022]
Abstract
Male breast cancer (MBC) is a rare disease in the U.S., accounting for less than 1% of all breast cancers. Rates of MBC in Africa are more variable than in the U.S., therefore, understanding the risk factors involved in a population like Egypt can clarify the nature of MBC. The polyglutamine tract (QT) is a variable region of the androgen receptor (AR), a nuclear receptor which is important in modulating androgen actions and generally inhibits growth in breast tissue. It is hypothesized that a long QT results in weaker AR activity over the lifetime, resulting in less AR mediated control over cellular division and higher risk of MBC. As a corollary, we expect to see a distribution skewed toward longer QTs in MBC patients compared to controls and overall relatively longer QT's in populations with higher rates of MBC. This study aimed to investigate for the first time the distribution of AR QT lengths among MBC patients in Egypt. Paraffin-embedded tumor tissues from 44 Egyptian MBC patients were analyzed for this polymorphism. Amplification followed by fragment length analysis revealed QT length. For the control series, blood from 43 Egyptian males without a family or personal history of breast or prostate cancers was collected and analyzed similarly. There was no significant difference between patients and controls with respect to mean QT length (P = 0.84; means were 19.5 ± 2.8 and 19.3 ± 4.2, for patients and controls, respectively). Though, short QT lengths were more prevalent among controls (14.0%), but almost absent in cases (2.3%). Although the mean lengths were not different in cases and controls, the near absence of short tracts in cases suggests a possible protective effect of very short QT lengths against MBC. In populations in which there is variable incidence of MBC by region, investigations of the distribution of AR QT lengths are warranted to further delineate its role as a risk factor in MBC.
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Dey S, Zhang Z, Hablas A, Seifeldein IA, Ramadan M, El-Hamzawy H, Soliman AS. Geographic patterns of cancer in the population-based registry of Egypt: Possible links to environmental exposures. Cancer Epidemiol 2010; 35:254-64. [PMID: 21036119 DOI: 10.1016/j.canep.2010.09.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2010] [Revised: 09/07/2010] [Accepted: 09/30/2010] [Indexed: 12/13/2022]
Abstract
BACKGROUND We investigated the variation in cancer incidence in Gharbiah, Egypt to explore geographic differences in relation to demographic and environmental exposures. METHODS Using data from the only population-based cancer registry of Gharbiah, we studied the 10 most common cancers in men and women over 4 years (1999-2002). Census data provided denominators and urban-rural definitions. Crude and adjusted incidence rates (IRs), incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were estimated using Poisson regression. RESULTS Incidence of all common cancers was higher among men than women and urban incidence was higher than rural incidence for all cancer sites. Among men and women urban-rural incidence difference was highest for prostate cancer (IRR=4.85, 95% CI=3.76, 6.26) and uterus (IRR=6.05, 95% CI=4.17, 8.78), respectively. Among men and women, El-Santa district had the highest urban-rural difference within districts for laryngeal cancer (IRR=29.45, 95% CI=10.63, 81.61) and uterine cancer (IRR=15.98, 95% CI=2.69, 95.10), respectively. El-Santa also showed the highest urban incidence among all eight districts for most cancer sites. CONCLUSIONS Geographic differences of cancers in Gharbiah need in-depth investigation with respect to specific environmental factors that explain the geographic cancer in this region.
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Affiliation(s)
- Subhojit Dey
- Indian Institute of Public Health, Public Health Foundation of India, New Delhi, India
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Attar E, Dey S, Hablas A, Seifeldin IA, Ramadan M, Rozek LS, Soliman AS. Head and neck cancer in a developing country: a population-based perspective across 8 years. Oral Oncol 2010; 46:591-6. [PMID: 20619719 DOI: 10.1016/j.oraloncology.2010.05.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 05/13/2010] [Accepted: 05/14/2010] [Indexed: 11/26/2022]
Abstract
Head and neck cancer (HNC) has been studied in different regions of the world but little is known about its incidence patterns in the Middle East and Egypt. In this study from Egypt's only population-based registry, we analyzed data from 1999 to 2006, to estimate incidence, incidence rate ratios (IRRs) and 95% confidence intervals (CIs) categorized by age, district and subsites. Overall urban incidence of HNC was twice or more that of rural incidence for both males (IRR=2.59; 95% CI=2.26, 2.97) and females (IRR=2.00; 95% CI=1.64, 2.43). Highest urban-rural difference for males was seen in 40-49years (IRR=2.79; 95% CI=1.92, 4.05) and for females in 30-39years (IRR=2.94; 95% CI=1.60, 5.40). Among subsites, highest incidence among males was for larynx (1.53/10(5)) and among females for gum and mouth (0.48/10(5)). Maximum urban-rural difference in males was for paranasal sinus (IRR=4.66; 95% CI=1.88, 11.54) and in females for lip (IRR=8.91; 95% CI=1.89, 41.98). The study underscores the patterns of HNC incidence in Egypt while indicating the need for future analytical studies investigating specific risk factors of HNC in this population.
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Affiliation(s)
- Esra Attar
- Department of Epidemiology, University of Michigan, School of Public Health, Ann Arbor, MI, USA
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Dey S, Soliman AS. Cancer in the Global Health Era: Opportunities for the Middle East and Asia. Asia Pac J Public Health 2010; 22:75S-82S. [DOI: 10.1177/1010539510372846] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The global burden of cancer is rising with almost 70% of cancer cases being in low- and middle-income countries (LMICs).The Middle East and Asia have two thirds of the world’s population and the largest regional concentration of LMICs. Because of massive demographic and epidemiologic transitions, cancer mortality is projected to increase substantially in these populations. Lung cancer among men and breast cancer among women are the most prominent cancer sites in both the Middle East and Asia. Enhanced tobacco control and managing obesity are the most important measures for effective control of most cancers. However, detailed research is required within each population to best identify risk factors and to develop evidence-based methods for cancer prevention. International collaborations are an essential step in facilitating this process, because it can improve cancer registries, create robust infrastructure, improve skills of personnel and lead to effective cancer control and prevention.
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Affiliation(s)
- Subhojit Dey
- University of Michigan School of Public Health, Ann
Arbor, MI, USA
| | - Amr S. Soliman
- University of Michigan School of Public Health, Ann
Arbor, MI, USA,
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Dey S, Hablas A, Seifeldin IA, Ismail K, Ramadan M, El-Hamzawy H, Wilson ML, Banerjee M, Boffetta P, Harford J, Merajver SD, Soliman AS. Urban-rural differences of gynaecological malignancies in Egypt (1999-2002). BJOG 2009; 117:348-55. [PMID: 20015310 DOI: 10.1111/j.1471-0528.2009.02447.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE In previous studies, we have shown a three to four times higher urban incidence of breast cancer and estrogen receptor-positive breast cancers in the Gharbiah Province of Egypt. We investigated the urban-rural incidence differences of gynaecologic malignancies (uterine, ovarian and cervical cancers) to explore if they show the same trend that we found for breast cancer. DESIGN Cancer registry-based incidence comparison. SETTING Gharbiah population-based cancer registry (GPCR), Tanta, Egypt. SAMPLE All patients with uterine, ovarian and cervical cancer in GPCR from 1999 to 2002. METHODS We calculated uterine, ovarian and cervical cancer incidence from 1999 to 2002. For each of the three cancers, we calculated the overall and age-specific rates for the province as a whole, and by urban-rural status, as well as for the eight districts of the province. RESULTS Incidence of all three cancer sites was higher in urban than in rural areas. Uterine cancer showed the highest urban-rural incidence rate ratio (IRR = 6.07, 95% CI = 4.17, 8.85). Uterine cancer also showed the highest urban incidence in the oldest age group (70+ age category, IRR = 14.39, 95% CI = 4.24, 48.87) and in developed districts (Tanta, IRR = 4.14, 95% CI = 0.41, 42.04). Incidence rates by groups of cancer sites showed an increasing gradient of urban incidence for cancers related to hormonal aetiology, mainly of the breast and uterus (IRR = 4.96, 95% CI = 2.86, 8.61). CONCLUSIONS The higher urban incidence of uterine cancer, coupled with our previous findings of higher incidence of breast cancer and estrogen receptor positive breast cancer in urban areas in this region, may be suggestive of possible higher exposure to environmental estrogenic compounds, such as xenoestrogens, in urban areas.
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Affiliation(s)
- S Dey
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
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Tight junctions: a barrier to the initiation and progression of breast cancer? J Biomed Biotechnol 2009; 2010:460607. [PMID: 19920867 PMCID: PMC2777242 DOI: 10.1155/2010/460607] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Accepted: 08/27/2009] [Indexed: 12/11/2022] Open
Abstract
Breast cancer is a complex and heterogeneous disease that arises from epithelial cells lining the breast ducts and lobules. Correct adhesion between adjacent epithelial cells is important in determining the normal structure and function of epithelial tissues, and there is accumulating evidence that dysregulated cell-cell adhesion is associated with many cancers. This review will focus on one cell-cell adhesion complex, the tight junction (TJ), and summarize recent evidence that TJs may participate in breast cancer development or progression. We will first outline the protein composition of TJs and discuss the functions of the TJ complex. Secondly we will examine how alterations in these functions might facilitate breast cancer initiation or progression; by focussing on the regulatory influence of TJs on cell polarity, cell fate and cell migration. Finally we will outline how pharmacological targeting of TJ proteins may be useful in limiting breast cancer progression. Overall we hope to illustrate that the relationship between TJ alterations and breast cancer is a complex one; but that this area offers promise in uncovering fundamental mechanisms linked to breast cancer progression.
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Fedewa SA, Soliman AS, Ismail K, Hablas A, Seifeldin IA, Ramadan M, Omar HG, Nriagu J, Wilson ML. Incidence analyses of bladder cancer in the Nile delta region of Egypt. Cancer Epidemiol 2009; 33:176-81. [PMID: 19762298 PMCID: PMC2763030 DOI: 10.1016/j.canep.2009.08.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Revised: 08/18/2009] [Accepted: 08/20/2009] [Indexed: 12/13/2022]
Abstract
Bladder cancer is the most common malignancy among Egyptian males and previously has been attributed to Schistosoma infection, a major risk factor for squamous cell carcinoma (SCC). Recently, transitional cell carcinoma (TCC) incidence has been increasing while SCC has declined. To investigate this shift, we analyzed the geographical patterns of all bladder cancers cases recorded in Egypt's Gharbiah Population-Based Cancer Registry from 1999 through 2002. Data on tumor grade, stage, and morphology, as well as smoking, community of residence, age and sex, were collected on 1209 bladder cancer cases. Age-adjusted incidence rates were calculated for males, females, and the total population for the eight administrative Districts and 316 communities in Gharbiah. Incidence Rate Ratios (IRR) and 95% confidence intervals (CI) were computed using Poisson Regression. The male age-adjusted incidence rate (IR) in Gharbiah Province was 13.65/100,000 person years (PY). The District of Kotour had the highest age-adjusted IR 28.96/100,000 among males. The District of Kotour also had the highest IRR among all Districts, IRR=2.15 95% CI (1.72, 2.70). Kotour's capital city had the highest bladder cancer incidence among the 316 communities (IR=73.11/100,000 PY). Future studies on sources and types of environmental pollution and exposures in relation to the spatial patterns of bladder cancer, particularly in Kotour District, may improve our understating of risk factors for bladder cancer in the region.
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Affiliation(s)
- Stacey A. Fedewa
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Amr S. Soliman
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Kadry Ismail
- Gharbiah Cancer Society and Gharbiah Cancer Registry, Tanta, 31512, Egypt
| | - Ahmed Hablas
- Gharbiah Cancer Society and Gharbiah Cancer Registry, Tanta, 31512, Egypt
| | | | - Mohamed Ramadan
- Gharbiah Cancer Society and Gharbiah Cancer Registry, Tanta, 31512, Egypt
| | - Hoda G. Omar
- Gharbiah Cancer Society and Gharbiah Cancer Registry, Tanta, 31512, Egypt
| | - Jerome Nriagu
- Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Mark L. Wilson
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
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Breast cancer hormone receptor status in Egypt: are we asking the questions that matter most? Breast Cancer Res Treat 2009; 120:161-3. [PMID: 19618263 DOI: 10.1007/s10549-009-0474-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Accepted: 07/08/2009] [Indexed: 10/20/2022]
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