Germline pathogenic variants among high hereditary risk patients with breast and ovarian cancer and unaffected subjects in Lebanese Arab women

BACKGROUND The prevalence of germline pathogenic variants in high hereditary risk breast and/or ovarian cancer patients and unaffected subjects referred for testing is an unmet need in low and middle-income countries.AIM To determine the prevalence of germline pathogenic variants in high hereditary risk patients with breast and/or ovarian cancer and unaffected individuals.METHODS We retrospectively reviewed records of patients and unaffected subjects referred for germline pathogenic variant testing due to high hereditary risk between 2010-2020.Data was collected and analyzed on Excel sheet.RESULTS In total,358 individuals were included,including 257 patients and 101 unaffected individuals with relatives with breast or ovarian cancer.The prevalence of breast cancer susceptibility gene(BRCA)1/2 pathogenic variants was 8.63%(19/220)in patients with breast cancer,and 15.1%(5/33)in those with ovarian cancer.Among the 25 of 220 patients with breast cancer tested by next-generation sequencing,3 patients had pathogenic variants other than BRCA1/2.The highest risk was observed in those aged 40 years with breast cancer and a positive family history,where the BRCA1/2 prevalence was 20.1%(9/43).Among the unaffected subjects,31.1%(14/45)had the same BRCA1/2 pathogenic variants in their corresponding relatives.Among the subjects referred because of a positive family history of cancer without known hereditary factors,5.35%(3/56)had pathogenic variants of BRCA1 and BRCA2.The c.131G>T nucleotide change was noted in one patient and two unrelated unaffected subjects with a BRCA1 pathogenic variant.CONCLUSION This study showed a 8.63%prevalence of pathogenic variants in patients with breast cancer and a 15.1%prevalence in patients with ovarian cancer.Among the relatives of patients with BRCA1/2 pathogenic variants,31%tested positive for the same variant,while 5.3%of subjects who tested positive due to a family history of breast cancer had a BRCA pathogenic variant.

Navigating breast cancer brain metastasis:Risk factors,prognostic indicators,and treatment perspectives

In this editorial,we comment on the article by Chen et al.We specifically focus on the risk factors,prognostic factors,and management of brain metastasis(BM)in breast cancer(BC).BC is the second most common cancer to have BM after lung cancer.Independent risk factors for BM in BC are:HER-2 positive BC,triplenegative BC,and germline BRCA mutation.Other factors associated with BM are lung metastasis,age less than 40 years,and African and American ancestry.Even though risk factors associated with BM in BC are elucidated,there is a lack of data on predictive models for BM in BC.Few studies have been made to formulate predictive models or nomograms to address this issue,where age,grade of tumor,HER-2 receptor status,and number of metastatic sites(1 vs>1)were predictive of BM in metastatic BC.However,none have been used in clinical practice.National Comprehensive Cancer Network recommends screening of BM in advanced BC only when the patient is symptomatic or suspicious of central nervous system symptoms;routine screening for BM in BC is not recommended in the guidelines.BM decreases the quality of life and will have a significant psychological impact.Further studies are required for designing validated nomograms or predictive models for BM in BC;these models can be used in the future to develop treatment approaches to prevent BM,which improves the quality of life and overall survival.

Cancer risk in relatives of BRCA1/2 pathogenic variant carriers in a large series of unselected patients with breast cancer

Objective:The spectrum and risk of cancer in relatives of BRCA1/2 pathogenic variant carriers in the Chinese population have not been established.Methods:A family history of cancer in 9903 unselected breast cancer patients was retrospectively analyzed.BRCA1/2 status was determined for all patients and relative risks(RRs)were calculated to evaluate cancer risk in relatives of the patients.Results:The incidences of breast cancer in female relatives of BRCA1 carriers,BRCA2 carriers,and non-carriers were 33.0%,32.2%,and 7.7%,respectively.The corresponding incidences of ovarian cancer were 11.5%,2.4%,and 0.5%,respectively.The incidences of pancreatic cancer in male relatives of BRCA1 carriers,BRCA2 carriers,and non-carriers were 1.4%,2.7%,and 0.6%,respectively.The corresponding incidences of prostate cancer were 1.0%,2.1%,and 0.4%,respectively.The risks of breast and ovarian cancers in female relatives of BRCA1 and BRCA2 carriers were significantly higher than female relatives of non-carriers(BRCA1:RR=4.29,P<0.001 and RR=21.95,P<0.001;BRCA2:RR=4.19,P<0.001 and RR=4.65,P<0.001,respectively).Additionally,higher risks of pancreatic and prostate cancers were noted in male relatives of BRCA2 carriers than non-carriers(RR=4.34,P=0.001 and RR=4.86,P=0.001,respectively).Conclusions:Female relatives of BRCA1 and BRCA2 carriers are at increased risk for breast and ovarian cancers,and male relatives of BRCA2 carriers are at increased risk for pancreatic and prostate cancers.

New Approaches to the Prognosis and Diagnosis of Breast Cancer Using Fuzzy Expert Systems

Breast cancer remains a significant global health challenge, necessitating effective early detection and prognosis to enhance patient outcomes. Current diagnostic methods, including mammography and MRI, suffer from limitations such as uncertainty and imprecise data, leading to late-stage diagnoses. To address this, various expert systems have been developed, but many rely on type-1 fuzzy logic and lack mobile-based applications for data collection and feedback to healthcare practitioners. This research investigates the development of an Enhanced Mobile-based Fuzzy Expert system (EMFES) for breast cancer pre-growth prognosis. The study explores the use of type-2 fuzzy logic to enhance accuracy and model uncertainty effectively. Additionally, it evaluates the advantages of employing the python programming language over java for implementation and considers specific risk factors for data collection. The research aims to dynamically generate fuzzy rules, adapting to evolving breast cancer research and patient data. Key research questions focus on the comparative effectiveness of type-2 fuzzy logic, the handling of uncertainty and imprecise data, the integration of mobile-based features, the choice of programming language, and the creation of dynamic fuzzy rules. Furthermore, the study examines the differences between the Mamdani Inference System and the Sugeno Fuzzy Inference method and explores challenges and opportunities in deploying the EMFES on mobile devices. The research identifies a critical gap in existing breast cancer diagnostic systems, emphasizing the need for a comprehensive, mobile-enabled, and adaptable solution by developing an EMFES that leverages Type-2 fuzzy logic, the Sugeno Inference Algorithm, Python Programming, and dynamic fuzzy rule generation. This study seeks to enhance early breast cancer detection and ultimately reduce breast cancer-related mortality.

Identification of the risk of breast cancer in patients suffering from endometriosis:A meta-analysis

Background:Breast cancer and endometriosis are two significant diseases that threaten the health of female worldwide.The relationship between them is still in a state of controversy.In present study,we identified the risk of breast cancer in patients with endometriosis through a meta-analysis.Methods:A systematic search of the PubMed,Embase and Cochrane Library,with the terms for endometriosis,breast and cancer,tumor,neoplasm,or carcinoma combined.Studies on related risk estimates of endometriosis and breast cancer were included in the meta-analysis.Furthermore,a series of analytical methods such as sensitivity analysis,the Cochran Q test,Begg’s and Egger’s test were used to analyze the information of collected studies.Results:Finally,a total of 8 studies were included.After statistical analysis based on STATA software,the combined odds ratio of the results was 1.13(95%CI:1.09–1.17).And the results of subgroup analysis showed that the odds ratio values of different outcome indexes were 1.06(95%CI:1.02–1.09,P<0.05),the effective effect estimates were presented in SIR(P=0.006,I^(2)=80.3%).Conclusion:In present study,we identified that patients with endometriosis have an increased risk of breast cancer.It is worth considering that our research was a summary analysis of epidemiological data.More in-depth studies are needed to determine the pathophysiology of this relationship.

Identifying barriers to early diagnosis of breast cancer and perception of women in Malwa region of Punjab,India

Objective:The aim of present study is to identify the breast cancer screening barriers among the women with breast cancer of Malwa region of Punjab,India.The study was conducted at three government hospitals representing almost all districts of Malwa region.Methods:The quantitative research design was followed using empirical research methods.Study was carried out by one-to-one interview by the field investigator and research assistant.Total of 363 breast cancer patient has been interviewed through the scheduled questionnaire and results has been recorded for further analysis.In this study,five barriers are described namely as personal barriers,socio-cultural barriers,economic barriers,health­system barriers,and treatment barriers which contains various questions regarding barriers to breast cancer screening.Univariate analysis methods have been used for the analysis to access the socio-demographic profile of women.Data has been obtained with the help of 5-point liker scale.Binary logistic model was chosen.Results:Majority of participants were in the age groups 50-<60 years(3&6%,140/363)and>60 years(31.1%,112/363).Majority of these women(47.4%,171/363)were illiterate and most of them were housewives.The major barriers to breast cancer screening faced by most of the women were having no knowledge about screening services(90.9%,329/363),the importance of early diagnosis(90.9%,329/363),different screening methods(95.5%,347/363)and place of availing screening services(91.2%,330/363)misguided belief in God and fate(81.5%,295/363)and preferring duties than taking care of health(70.2%,254/363).Education qualification(odds ratio[OR]0.74,β'=-0.309,t=-5.357,P=0.000)and socioeconomic class(OR 1.43,β’=0.354,t=3.399,P=0.001)were found to be significant determinant of the barriers among women.Conclusion:The survey was conducted in the women between the age 40-60 years and as an outcome,the unawareness about screening services,fatalistic attitude,fear of being diagnosed with the cancer,low per capita income was found out significant factors that restricted the women for early check-up for the breast cancer.

Breast cancer-related lymphedema: Symptoms, diagnosis, risk reduction, and management

The global burden of breast cancer continues to increase largely because of the aging and growth of the world population. More than 1.38 million women worldwide were estimated to be diagnosed with breast cancer in 2008, accounting for 23% of all diagnosed cancers in women. Given that the 5-year survival rate for breast cancer is now 90%, experiencing breast cancer is ultimately about quality of life. Women treated for breast cancer are facing a life-time risk of developing lymphedema, a chronic condition that occurs in up to 40% of this population and negatively affects breast cancer survivors' quality of life. This review offers an insightful understanding of the condition by providing clinically relevant and evidence based knowledge regarding lymphedema symptoms, diagnosis, risk reduction, and management with the intent to inform health care professionals so that they might be better equipped to care for patients.

Risk factors and natural history of breast cancer in younger Chinese women

AIM: To investigate the age differences in the risk factors, clinicopathological characteristics and patterns of treatment of female breast cancer patients. METHODS: Seven thousand one hundred and fiftytwo women with primary breast cancer from the Hong Kong Breast Cancer Registry were recruited after receiving patients' consent, they were asked to complete standardized questionnaires which captured their sociodemographic characteristics and risk factors associated with breast cancer development. Among them, clinicopathological data and patterns of treatment were further collected from medical records of 5523 patients with invasive breast cancers. Patients were divided into two groups according to the age at diagnosis: younger(< 40 years old) vs older patients(≥ 40 years old) for subsequent analyses.RESULTS: Analysis on the sociodemographic characteristics and exposure to risk factors were performed on 7152 women with primary breast cancer and the results revealed that younger patients were more likely to have unhealthy lifestyles; these include a lack of exercise(85.4% vs 73.2%, P < 0.001), having high stress in life(46.1% vs 35.5%, P < 0.001), having dairy/meat-rich diets(20.2% vs 12.9%, P < 0.001),having alcohol drinking habit(7.7% vs 5.2%, P = 0.002). Younger patients were also more likely to have hormone-related risk factors including nulliparity(43.3% vs 17.8%, P < 0.001) and an early age at menarche(20.7% vs 13.2%, P < 0.001). Analyses on clinicopathological characteristics and patterns of treatment were performed on 5523 women diagnosed with invasive breast cancer. The invasive tumours in younger patients showed more aggressive pathological features such as having a higher percentage of grade 3 histology(45.7% vs 36.5%, P < 0.001), having a higher proportion of tumours with lymphovascular invasion(39.6% vs 33.2%, P = 0.003), and having multifocal disease(15.7% vs 10.3%, P < 0.001); they received different patterns of treatment than their older counterparts.CONCLUSION: Younger patients in Hong Kong are more likely to encounter risk factors associated with breast cancer development and have more aggressive tumours than their older counterparts.

Association between 15 known or potential breast cancer susceptibility genes and breast cancer risks in Chinese women

Objective:There are many hereditary breast cancer patients in China,and multigene panel testing has been a new paradigm of genetic testing for these patients and their relatives.However,the magnitude of breast cancer risks related to multiple breast cancer susceptibility genes are largely unknown in Chinese women.Methods:We screened pathogenic variants in 15 established or potential breast cancer susceptibility genes from 8,067 consecutive Chinese female breast cancer patients and 13,129 Chinese cancer-free female controls.These breast cancer patients were unselected for age at diagnosis or family history.Results:We found that pathogenic variants in TP53[odds ratio(OR):16.9,95%confidence interval(CI):5.2–55.2];BRCA2(OR:10.4,95%CI:7.6–14.2);BRCA1(OR:9.7,95%CI:6.3–14.8);and PALB2(OR:5.2,95%CI:3.0–8.8)were associated with a high risk of breast cancer.ATM,BARD1,CHEK2,and RAD51D were associated with a moderate risk of breast cancer with ORs ranging from 2-fold to 4-fold.In contrast,pathogenic variants of NBN,RAD50,BRIP1,and RAD51C were not associated with increased risk of breast cancer in Chinese women.The pathogenic variants of PTEN,CDH1,and STK11 were very rare,so they had a limited contribution to Chinese breast cancer.Patients with pathogenic variants of TP53,BRCA1,BRCA2,and PALB2 more often had earlyonset breast cancer,bilateral breast cancer,and a family history of breast cancer and/or any cancer.Conclusions:This study provided breast cancer risk assessment data for multiple genes in Chinese women,which is useful for genetic testing and clinical management of Chinese hereditary breast cancer.

Development and evaluation of the screening performance of a low-cost high-risk screening strategy for breast cancer

Objective:To develop and evaluate the screening performance of a low-cost high-risk screening strategy for breast cancer in low resource areas.Methods:Based on the Multi-modality Independent Screening Trial,6 questionnaire-based risk factors of breast cancer(age at menarche,age at menopause,age at first live birth,oral contraceptive,obesity,family history of breast cancer)were used to determine the women with high risk of breast cancer.The screening performance of clinical breast examination(CBE),breast ultrasonography(BUS),and mammography(MAM)were calculated and compared to determine the optimal screening method for these high risk women.Results:A total of 94 breast cancers were detected among 31,720 asymptomatic Chinese women aged 45–65 years.Due to significantly higher detection rates(DRs)and suitable coverage of the population,high risk women were defined as those with any of 6 risk factors.Among high risk women,the DR for BUS[3.09/1,000(33/10,694)]was similar to that for MAM[3.18/1,000(34/10,696)],while it was significantly higher than that for the CBE[1.73/1,000(19/10,959),P=0.002].Compared with MAM,BUS showed significantly higher specificity[98.64%(10,501/10,646)vs.98.06%(10,443/10,650),P=0.001],but no significant differences in sensitivity[68.75%(33/48)vs.73.91%(34/46)],positive prediction values[18.54%(33/178)vs.14.11%(34/241)],and negative prediction values[99.86%(10,501/10,516)vs.99.89%(10,443/10,455)].Further analyses showed no significant difference in the percentages of early stage breast cancer[53.57%(15/28)vs.50.00%(15/30)],lymph node involvement[22.73%(5/22)vs.28.00%(7/25)],and tumor size≥2 cm[37.04%(10/27)vs.29.03%(9/31)]between BUS and MAM.Subgroup analyses stratified by breast densities or age at enrollment showed similar results.Conclusions:The low-cost high-risk screening strategy based on 6 questionnaire-based risk factors was an easy-to-use method to identify women with high risk of breast cancer.Moreover,BUS and MAM had comparable screening performances among high risk women.

Clinical and pathological features and risk factors for primary breast cancer patients

BACKGROUND Breast cancer is the most common malignancy in women all around the world.According to the latest statistics in 2018,there were more than 2.08 million new breast cancer cases all around the world and more than 620000 deaths;the proportion of breast cancer deaths in women with cancer is 15%.By studying age,clinicopathological characteristics and molecular classification,age at menarche,age at birth,number of births,number of miscarriages,lactation time,surgical history of benign breast lesions,history of gynecological diseases,and other factors,we retrospectively summarized and compared the disease history of patients with primary breast cancer and patients with benign thyroid tumors admitted to our hospital in the past 10 years to explore the clinicopathological characteristics and risk factors for primary breast cancer.AIM To investigate the clinical and pathological features and risk factors for primary breast cancer treated at our center in order to provide a reference for the prevention and treatment of breast cancer in the Zhuhai-Macao region.METHODS Through a retrospective case-control study,149 patients with primary breast cancer diagnosed and treated at Zhuhai Hospital of Guangdong Provincial Hospital of Traditional Chinese Medicine from January 2013 to March 2020 were included as a case group,and 165 patients with benign breast tumors diagnosed and treated from January 2019 to March 2020 were included as a control group.The data collected included age,age at menarche,age at first birth,number of births,number of miscarriages,lactation time,history of surgery for benign breast lesions,history of familial malignant tumors,history of gynecological diseases,history of thyroid diseases,and the tumor characteristics of the patients in the case group including pathological diagnosis,pathological type,tumor size,lymph node metastasis,distant metastasis,stage,and molecular classification,among others.In the case group,the chi-square test was used to analyze the clinical and pathological features of patients in three age groups(<40,40-59,and≥60 years).A multifactor logistic regression analysis was used to analyze correlations between the two groups.RESULTS Among 149 patients with primary breast cancer,the average age was 48.20±12.06 years,and the proportion of patients at 40-59 years old was the highest,accounting for 61.8%of cases.The molecular type was mainly luminal B type,accounting for 69.2%of cases,and at the time of diagnosis,the tumor stage was mainly stage I/II,accounting for 62.4%of cases.There were no statistically significant differences in the distributions of tumor location,pathological type,tumor size,lymph node metastasis,stage,or molecular classification among the three age groups(<40,40-59,and≥60 years)(P≥0.05).The differences in the distribution of distant metastasis among the three age groups(<40,40-59,and≥60 years)were statistically significant(P<0.01).The differences in lactation time,history of familial malignant tumors,history of gynecological diseases,and history of thyroid diseases between the two groups were not statistically significant(P≥0.05).The differences in age at disease diagnosis,age at menarche,and history of surgery for benign breast lesions were statistically significant(P<0.01).The difference in age at first birth was also statistically significant(P<0.05).CONCLUSION The highest incidence of breast cancer in the Zhuhai-Macao region is present among women aged 40-59 years.There is a larger proportion of stage I/II patients,and the luminal B type is the most common molecular subtype.Distant metastasis occurs mainly in the≥60-year-old group at the first diagnosis;increased age,late age at menarche,and late age at first birth may be risk factors for primary breast cancer,and a history of surgery for benign breast lesions may be a protective factor for primary breast cancer.

A scoring system for predicting the risk of breast cancer-related lymphedema

Objective:We aimed to establish a scoring system to predict the risk of breast cancer-related lymphedema.Methods:From April 2017 to December 2018,533 patients who previously underwent surgery for breast cancer were enrolled in this cross-sectional study.Univariate analysis was performed to explore and define the risk factors.A scoring system was then established on the basis of odds ratio values in the regression analysis.Results:The additive scoring system values ranged from 6 to 22.The receiver operating characteristic(ROC)curve of this scoring system showed a sensitivity and specificity of 83.3%and 57.3%,respectively,to predict the risk of lymphedema at a cut-off of 15.5 points;the area under the curve was 0.736(95%confidence interval:0.662-0.811),with x2=5.134(P=0274)for the Hosmer-Lemeshow test.Conclusions:The predictive efficiency and accuracy of the scoring system were acceptable,and the system could be used to predict and screen groups at high risk for breast cancer-related lymphedema.

Tumor-Immune Interaction System with the Effect of Time Delay and Hyperglycemia on the Breast Cancer Cells

Breast cancer in women is a complicated and multifaceted disease. Studies have demonstrated that hyperglycemia is one of the most significant risk factors for breast cancer. Hyperglycemia is when the sugar level in human blood is too high, which means excess glucose. Glucose excess can encourage the growth, invasion, and migration of breast cancer cells at the cellular level. Though, the effects of glucose on the dynamics of breast cancer cells have been examined mathematically by a system of ordinary differential equations. However, the non-instantaneous biological occurrences leading to the secretion of immuno-suppressive cytokines by tumors to evade immune surveillance and the immune cells’ derivation of cytokines to attack the tumor cells are not yet discussed. Therefore, investigating the biological process involved in the dynamics of tumors, immune and normal cells with excessive glucose concentration is inviolable to determining the best procedure for controlling tumors’ uncontrollable growth. Time delay, denoted by τ, is used to describe the time tumor cells take to secrete immunosuppressive cytokines to evade immune surveillance and the time immune cells take to recognize and attack the tumor cells. We have studied the local stability analysis of the biological steady states in both delayed and non-delayed system. The Routh-Hurwitz stability criterion is used to analyze the dynamical equilibrium of the cells’ population. Hopf bifurcation was analyzed by using time delay s as a bifurcation parameter. The analytical results suggest an unstable scenario for a tumor-free equilibrium point as normal cells are bound to grow to their carrying capacity. The result predicts a stable system for coexisting equilibrium when the interaction is instantaneous (τ = 0). However, when τ > 0, the coexisting equilibrium point switches from stable to unstable. The numerical results not only validate all the analytical results but also show the case of possible situations when glucose concentration is varied, indicating that both tumor growth and immune system efficiency are highly affected by the level of glucose in the blood. This concluded that the delay in the secretion of cytokines by immune cells and derivation cytokines by the tumors helps to identify the possible chaotic situation under different glucose concentration and the extent to which such delay can have on restoration of the normal cells when glucose concentration is low.

Brassiere wearing and breast cancer risk:A systematic review and meta-analysis

AIM： To evaluate existing evidence for the association between different type of brassiere exposures and the risk of breast cancer.METHODS： Ovid Medline, CINAHL, Cochrane Data Base of Systematic Reviews, Pubmed, Scopus, Proquest, Sciencedirect, Wiley Online Library, WanFang Data, Hong Kong Index to Chinese Periodicals, China Journal Net, Chinese Medical Current Contents, Chinese Biomedical Literature Database, China Academic Journals Full-Text database, Taiwan Electronic Periodical Services and HyRead; reference lists of published studies; origi-nal research studies published in English or Chinese examining the association between type and duration of brassiere-wearing and breast cancer risk. Data were abstracted by a frst reviewer and verifed by a second. Study quality was rated according to predefned criteria. “Fair” or “good” quality studies were included. Results were summarised by meta-analysis whenever adequate material was available.RESULTS： Twelve case-control studies were included in the review. Meta-analysis showed brassiere wearing during sleep was associated with a two times ofincreased odds. CONCLUSION： The present review demonstrates insuffcient evidence to establish a positive association between the duration and type of brassiere wearing and breast cancer. Further research is essential; specifcally, a large-scale epidemiological study of a better design is needed to examine the association between various forms of brassiere exposure in detail and breast cancer risk, with adequate control of confounding variables.

Risk Factors for Breast Cancer in the City of Douala: A Case Control Study

Background: The breast cancer is an abnormal proliferation of mammary gland cells. This condition as well as other cancers is globally increasing in the world. It is the most frequent malignancy of women in the world and is a public health problem. Generally in Africa and central Africa in particular, few studies have been realized in search of risk factors of breast cancer. It’s all in this optical we began the study to determine the risk factors of this disease in the city of Douala. Patients and Methods: We conducted a case-control study, gave retrospectives collect on five years and prospectives collect on seven months. The studied population was all women aged 18 years and above with breast cancer diagnostic on histological plan for cases;and women from 18 years or more with normal physical examination and mammography. We have done our research in three reference hospitals of the city of Douala and two laboratories of pathological anatomy. The data were collected at the search files and the patients where interviewed. The parameters studied were: socio-demographic profile, clinic and Para clinic parameters, and the histological type. Results: At the end of this study, breast cancer is predominantly on young women in the city of Douala with a middle age of 44.08 ± 2.6 years. The most significant risk factors were age, age of the first birth ≥ 30 years, age of the first sexual act ≤ 18 years, low economic level, tobacco, hormonal contraceptive, parity. Conclusion: Finally, the malignancy of the breast takes a primordial place within the feminine population of Douala with many risk factors likes causes.

Risk Factors for Breast Cancer: A Case-Control Study of 315 Women Followed in the Gynecology and Oncology Departments of Two University Teaching Hospitals in Yaounde, Cameroon

Introduction: Breast cancer is the most common cancer and the first cause of cancer-related deaths among women in Cameroon. The aim of the study was to investigate its risk factors for breast cancer at two University Teaching Hospitals in Yaoundé. Methodology: A case-control study was conducted for 5 months, from February 25th to July 25th 2015, at the Gynecology unit of the Yaoundé Gyneco-Obstetric and Pediatric Hospital (YGOPH) and the Medical Oncology unit of the Yaoundé General Hospital (YGH). One hundred and five patients with breast cancer (cases) were compared to 210 women who did not have breast cancer (controls). SPSS Version 18.0.0 software was used to analyze the data with a statistical significance considered at P-value 50 years (P three times per week (P = 0.002;OR = 2.14;CI = [1.33 - 3.45]), palm oil consumption > two times per week (P = 0.001;OR = 2.38;CI = [1.4 - 4.1]). After multivariate analysis, age > 50 years (aOR = 41.48;CI = [2.46 - 69.9]) and consumption of red meat > three times per week [aOR = 7.33;(1.49 - 36)] were the risk factors considered significant for breast cancer. Conclusion: Age > 50 years and red meat consumption are independent risk factors for breast cancer at the Yaoundé General Hospital and at the Yaoundé Gyneco-Obstetric and Pediatric Hospital.

Is chronic hepatitis C virus infection a risk factor for breast cancer?

AIM:To evaluate the prevalence of breast tumors in adult females with chronic hepatitis C virus(HCV) infection.METHODS:Prospective,single-center study,based on female outpatients consulting in a liver unit,for 1 year.The study group included females with present and/or past history of chronic infection by HCV.Patients with spontaneous recovery were excluded.Chronic hepatitis had been proved by liver biopsy in the majority of cases and/or biological markers of inflammation and fibrosis.The control group included female patients with other well documented chronic liver diseases:chronic hepatitis B,alcoholic liver disease,autoimmune hepatitis,hemochromatosis,non alcoholic liver disease,chronic cholangitis.Participating patients were prospectively questioned during consultation about past breast history and follow-up by mammography.RESULTS:Breast carcinoma was recorded in 17/294 patients with HCV infection(5.8%,95% CI:3.1-8.4) vs 5/107 control patients(4.7%,95% CI:0.67-8.67).Benign tumors of the breast(mastosis,nodules,cysts) were recorded in 75/294 patients with HCV infection(25.5%,95% CI:20.5-30.5) vs 21/107(19.6%,95% CI:12.1-27.1) in the control group.No lesion was noted in 202 patients with HCV(68.7%,95% CI:63.4-74) vs 81 control patients(75.7%,95% CI:67.6-83.8).Despite a trend to an increased prevalence in the group with HCV infection,the difference was not significant compared to the control group(P=NS).In patients over 40 years,the results were,respectively,as follows:breast cancer associated with HCV:17/266 patients(6.3%,95% CI:3.4-9.3) vs 5/95 patients(5.2%,95% CI:0.7-9.7) in the control group;benign breast tumors:72/266 patients with HCV infection(27%,95% CI:21.7-32.4) vs 18/95 patients(18.9%,95% CI:11-26.8) in the control group;no breast lesion 177/266(66.5%,95% CI:60.9-72.2) in patients with HCV infection vs 72/95(75.7%,95% CI:67.1-84.4) in the control group.The differences were not significant(P=NS).CONCLUSION:These results suggest that chronic HCV infection is not a strong promoter of breast carcinoma in adult females of any age.

Competing risks of death in younger and older postmenopausal breast cancer patients

AIM: To show a new paradigm of simultaneously testing whether breast cancer therapies impact other causes of death. METHODS: MA.14 allocated 667 postmenopausal women to 5 years of tamoxifen 20 mg/daily ± 2 years of octreotide 90 mg, given by depot intramuscular injections monthly. Event-free survival was the primary endpoint of MA.14; at median 7.9 years, the tamoxifen+octreotide and tamoxifen arms had similar event-free survival(P = 0.62). Overall survival was a secondary endpoint, and the two trial arms also had similar overall survival(P = 0.86). We used the median 9.8 years follow-up to examine by intention-to-treat, the multivariate time-to-breast cancer-specific(Br Ca) and other cause(OC) mortality with log-normal survival analysis adjusted by treatment and stratification factors. We tested whether baseline factors including Insulin-like growth factor 1(IGF1), IGF binding protein-3, C-peptide, body mass index, and 25-OH vitamin D were associated with(1) all cause mortality, and if so; and(2) cause-specific mortality. We also fit step-wise forward cause-specific adjusted models.RESULTS: The analyses were performed on 329 patients allocated tamoxifen and 329 allocated tamoxifen+octreotide. The median age of MA.14 patients was 60.1 years: 447(82%) < 70 years and 120(18%) ≥ 70 years. There were 170 deaths: 106(62.3%) BrC a; 55(32.4%) OC, of which 24 were other malignancies, 31 other causes of death; 9(5.3%) patients with unknown cause of death were excluded from competing risk assessments. BrC a and OC deaths were not significantly different by treatment arm(P = 0.40): tamoxifen patients experienced 50 BrC a and 32 OC deaths, while tamoxifen + octreotide patients experienced 56 Br Ca and 23 OC deaths. Proportionately more deaths(P = 0.004) were from BrC a for patients< 70 years, where 70% of deaths were due to Br Ca, compared to 54% for those ≥ 70 years of age. The proportion of deaths from OC increased with increasing body mass index(BMI)(P = 0.02). Higher pathologic T and N were associated with more BrC a deaths(P < 0.0001 and 0.002, respectively). The cumulative hazard plot for Br Ca and OC mortality indicated the concurrent accrual of both types of death throughout followup, that is the existence of competing risks of mortality. MA.14 therapy did not impact mortality(P = 0.77). Three baseline patient and tumor characteristics were differentially associated with cause of death: older patients experienced more OC(P = 0.01) mortality; patients with T1 tumors and hormone receptor positive tumors had less BrC a mortality(respectively, P = 0.01, P = 0.06). Additionally, step-wise cause-specific models indicated that patients with node negative disease experienced less BrC a mortality(P = 0.002); there was weak evidence that, lower C-peptide(P = 0.08) was associated with less BrC a mortality, while higher BMI(P = 0.01) was associated with worse OC mortality.CONCLUSION: We demonstrate here a new paradigm of simultaneous testing of therapeutics directed at multiple diseases for which postmenopausal women are concurrently at risk. Octreotide LAR did not significantly impact breast cancer or other cause mortality, although different baseline factors influenced type of death.

Influence of Distinct Radiotherapy Techniques to Induce Second Cancer Risks in Left Breast Cancer

Influence of distinct radiotherapy techniques to induce second cancer risks in left breast cancer. Material and methods: Ten female patients with intact left breast cancer. Two treatment plans for each patient: 1) two tangential beams 3D-Conformal radiotherapy, 2) intensity-modulated radiotherapy (IMRT) plan. Estimation of second cancer risk from Organ equivalent dose models (OEDs) in three dose-response model for organs at risk in left breast cases. Results: The P-value for OED models in 3D-IMRT for left lung, both lung, heart, right lung, right breast, thyroid, liver and spinal cord in linear dose model was 0.016, 0.005, 0.019, 3.95E-06, 5.79E-07, 0.003, 1.78E-10 and 0.000206475 respectively, for linear exponential dose model 0.0577, 0.024, 0.031, 3.40E-06, 3.28E-07, 0.003, 2.01E-10 and 0.000120072 respectively and in plateau dose model 0.088, 0.042, 0.039, 3.18E-06, 2.53E-07, 0.003, 2.27E-10 and 9.00535E-05 respectively. Conclusion: organ equivalent dose models for organs at risk increasing in IMRT than tangential beams.

Cervix and breast cancers in Oujda city in Eastern Morocco: Determinants and risk factors

A retrospective study was conducted in 2008 on 681 in Eastern Morocco in order to estimate the incidence of cervical and breast cancer, and to determine the social determinants and risk factors associated with these two types of cancer. Another goal of the study was to give health decision makers evidence of the necessity for early diagnosis and treatment. A questionnaire was used before the clinical gynecological examination and sampling cell for the Pap smear. Any woman with a Pap smear suspect had to do a biopsy at the reference centre. Physicians, obstetricians and midwives in the consultation process did gynecological examination and breast palpation. Patients with a suspicious nodule underwent ultrasound and mammography by radiologists on site. Gynecological samples were carried out systematically to all ever-married women to detect cancer of the cervix. Software Excel and SPSS 17 were used for data processing. Patients with high social status were more susceptible to develop breast cancer whereas women with cervical cancer were poor, belonging to a class with a low marital status of widowed or divorced having been married at an early age. The majority of women were married (81%), poor (80%) and illiterate (66%). Breastfeeding women were less affected by breast cancer than women not breastfeeding. For cervical cancer, the difference was not statistically significant. Women using contraceptives were vulnerable to both breast and cervical cancer. For cervical cancer, over 15% of women with a family history were screened positive. No relationship was found between breast cancer and family history. Taking into account regional particularities, we stress the importance of social determinants and risk factors and show that our results are consistent with those published by other researchers. Breast and cervical cancers constitute a real challenge in Morocco. Their socioeconomic burden can be reduced by early detection and treatment. The delayed diagnosis complicates the task both in terms of survival and cost of treatment. Consequently, Moroccan health authorities are urged to adopt preventive and cost effective strategies.