Assessment of Breast Cancer Prevention Practices among Women Attending Primary Health Care in Abha City, Aseer Region, Saudi Arabia

Cancer is a leading cause of death worldwide, with breast cancer being the most common (2.26 million new cases and 685,000 deaths). In Saudi Arabia, breast cancer ranked the first among females in 2014, accounting for 15.9% of all cancers reported among Saudi nationals and 28.7% of all cancers reported among females of all ages. Early detection of breast cancer could decrease the risks, have a better prognosis, and have better outcomes/more successful treatments. Prevalence of breast cancer reached more than 25% of all diagnosed cancer in the kingdom among women. Aim: This study aims to assess the knowledge and performance of women attending primary care centers about breast self-examination and mammogram screening for prevention and early detection of breast cancer in Abha city primary healthcare centers, Kingdom of Saudi Arabia. Research Method: cross sectional design was conducted by using questionnaire, which was distributed to primary care center nurses. The collected data was statistically analyzed using the Statistical Package for Social Sciences, version 25. Results: The study found that participants had poor awareness and knowledge about breast self-examination, risk factors for breast cancer, and trends and practices in early diagnosis of breast cancer. Conclusion and Recommendations: It recommends increasing awareness campaigns and providing educational programs to improve knowledge and practices.

The Effect of Hypofractionated Radiotherapy on Tumor Control and Survival in Patients with High-Risk Breast Cancer

BACKGROUND Adjuvant radiotherapy is given following surgery in breast cancer patients. Hypofractonated radiotherapy can significantly reduce the waiting time for radiotherapy, working load on machines, patient visits to radiotherapy departments and medical costs. Material and Methods 244 patients with high-risk breast cancer (stage IIB, stage III and stage IA with any of the following criteria: lymphovascular invasion, hormonal receptor negative, young age) who underwent Breast conservative surgery (BCS) or Modified radical mastectomy (MRM) were enrolled in this study. All patients received adjuvant radiotherapy with different hypofractionation schedules either 3900 cGY/13 fractions or 4240 cGY/16 fractions or 4005 cGY/15 fractions using linear accelerator with 6 MV photon beam. Lateral/Medial tangential and Ipsilateral supraclavicular fields were employed and the ipsilateral axilla was also irradiated if required to the same dose with posteroanterior field. Patients were followed every 3 mons for the first 2 years and every 6 mons thereafter. Outcomes were analyzed in terms of tumor control and survival. Results 244 patients with high-risk breast cancer requiring postoperative radiotherapy to the intact breast or chest wall were treated. The mean age was 48 years (range 28 - 69 years). The 5-year locoregional free survival of all patients was 93.8% the local relapse reported in 15 patients (6.2%) 7 patients at site of operated scar & 8 patients at the regional lymph nodes. The median follow up period was 75 months ranged from 49 to 102 months. Distant metastasis free survival was 92.2%, the distant metastasis reported in 19 patients which represent (7.8%) of all patients, median survival is 75 months ranged from 49 to 102 months and overall survival was 88.6%. Conclusion It is concluded that hypofractionated radiotherapy is a simple and effective protocol in patients with high-risk breast cancer regarding tumor control and survival.

THE EXPRESSION AND CLINICAL VALUE OF APOPTOSIS CONTROL GENE Bcl-2 AND Bax IN BREAST CANCER

Objective: To study the expression and clinical value of apoptosis control gene bcl-2 and bax in breast cancer. Methods: Protein bax and bcl-2 in 41 breast cancers obtained from operations in our hospital in 1996 were detected using ABC immunohistochemical stain assay and compared with 10 cases with normal breast tissues. Results: The positive rate of bax in normal breast tissue was 90% and in breast cancer was 59%, with a significant statistical difference between them (P<0.05), but there was no statistical difference in bcl-2 protein expression. Among the 41 breast cancer, the group with lymph node metastasis (21 cases) had obviously low bax expression (43%) and high bcl-2 expression (76%), showing significant difference to the group without lymph node metastasis (P<0.05). Conclusion: The antiapoptosis function of bcl-2 was stronger than bax in breast cancer. Protein bax and bcl-2 assay may be useful in understanding the biological behaviors of breast cancer.

Role of Anti Angiogenic Therapy in Prevention of Recurrence in Hormonal Positive Breast Cancer: A Secondary Prevention Strategy and Method of Therapy

Existing literature supports the role of signaling protein vascular endothelial growth factor (VEGF) in tumor growth and metastasis and furthers its involvement in recurrence. In both experimental and clinical studies, VEGF has been shown to be a significant factor involved for aberrant blood vessel growth, and in fact is the target of several classes of antineoplastic drugs [1] [2] [3] [4]. That said, the current standard of care for estrogen receptor positive breast cancer (although improved over the last decade), has not provided a “meaningful preventive shift” since the discovery of angiogenesis and its role in induction of recurrence. In this article, we discuss an anti angiogenic therapy implementing natural compounds to inhibit the production of VEGF. We applied our preclinical data to justify the predicted effect on VEGF. We used liquid biopsy to monitor patients response to therapy as a surrogate for recurrence. We hypothesize that by inhibition of angiogenesis through this protocol, we are able to positively impact tumor recurrence. It is our experience that patients in our sample even with high recurrence scores (based on Oncotype Dx testing) had a major reduction in recurrence when estrogen blockers were combined with this protocol. We also propose longitudinal studies to compare outcomes with combinational therapies with estrogen blockers in highly expected to recur disease.

Application effect of quality control circle in postoperative functional exercise compliance of breast neoplasms patients:a meta-analysis

Background:Good adherence to post-operative exercise is crucial for long-term exercise intervention programs aimed at improving compliance,motivation for functional exercise,and quality of life among breast cancer patients.This study aims to evaluate the application effect of quality control circles on postoperative functional exercise compliance in breast neoplasm patients.Methods:A comprehensive search was conducted in CNKI,Wanfang,VIP,CBM,PubMed,Cochrane Library,Web of Science and CINAHL databases from their establishment to May 06,2023.Manual search and backtracking of relevant literature were also conducted.The search terms included a combination of subject terms and free words.Meta-analysis was performed using RevMan 5.4 software on eligible literature.Results:Initially,517 papers were retrieved,and after removing duplicates 238 papers using NoteExpress software,279 titles and abstracts were reviewed.Subsequently,225 non-compliant papers were excluded,leaving 54 full texts to be read.After excluding 38 non-compliant papers,16 eligible papers were included for Meta-analysis.These papers comprised a total of 1,342 patients(679 in the test group and 663 in the control group).The heterogeneity test using a fixed effects model showed P=0.22 and I2=21%.The Meta-analysis results demonstrated that the implementation of quality control circles alongside usual care significantly improved compliance with postoperative functional exercise in breast cancer patients(odds ratio=6.68,95%confidence interval(4.97,8.98),P<0.00001).Conclusion:Quality control circles activities can effectively enhance compliance with post-operative functional exercise among breast cancer patients,aiding in the recovery of affected limb function,improvement of self-care ability,and early reintegration into society and normal life,thereby enhancing quality of life.It is important to continually accumulate experience in applying relevant quality control circles activities in clinical work and promptly enhance the level of care accordingly,as the functional exercise of breast cancer patients after surgery involves a long-term and gradual improvement process.

Comparison of the effects of two typesof multileaf collimators on tumor control probabilityin radiotherapy for breast cancer after conservativesurgery based on the EUD model

Objective To compute and compare the tumor control probability(TCP) of volumetric modulated arc therapy(VMAT) for breast cancer after conservative surgery based on two types of multileaf collimator(MLC) through a retrospective planning study.Methods For a group of 9 patients diagnosed with left breast cancer,VMAT plan based on Agility MLC and beam modulator(BM) MLC were designed.The prescription dose was 50 Gy covering at least 95% of the planning target volume,2 Gy per fraction.TCPs were calculated according to dose-volume histogram(DVH) analysis.Results The TCP of the BM VMAT plan was slightly higher than that of the Agility VMAT plan(94.61% vs 94.23%) but was inferior with respect to delivery efficiency;the delivery time was reduced for Agility VMAT plan by 35% compared to BM VMAT plan.Conclusion For breast cancer radiation therapy after conservative surgery,BM VMAT plans provide slightly higher TCP while the delivery of Agility VMAT plans is significantly faster than the BM VMAT plans.

Early warning prevention and control strategies to reduce perioperative venous thromboembolism in patients with gastrointestinal cancer

BACKGROUND Venous thromboembolism(VTE)is a major cause of unexpected and perioperative in-hospital deaths.It is characterized by high morbidity,high mortality,high misdiagnosis rate,and high missed diagnosis rates.VTE is a common postoperative complication in cancer patients.VTE is preventable,and early identification of risk factors leading to VTE and appropriate early preventive actions can reduce its occurrence and mortality.Presently,there is no uniform standard for the prevention and control of VTE in clinical practice,and hospitals in China lack mature and effective protocols for the assessment,prevention,and treatment of VTE.AIM To explore whether an early warning program could influence the occurrence of deep vein thrombosis(DVT)postoperatively.METHODS This is a comparative retrospective cohort study,which enrolled patients who underwent laparotomic or laparoscopic gastrointestinal tumor resection for gastrointestinal cancer between January 2016 and December 2019.Patients were divided into a control group and an early warning group depending on whether or not the early warning program was implemented.A venous thromboembolism prevention and control team was established.The outcomes included the occurrence of DVT,the correct rate of VTE assessment,the coagulation indicators,and the mastery of VTE knowledge by the nurses.RESULTS A total of 264 patients were included in this study,with 128 patients in the control group and 136 patients in the early warning group.The occurrence rate of DVT in the early warning group was 6.6%(9/136),compared with 14.1%(18/128)in the control group(P<0.05).The correct rates of VTE risk assessment by the nurses and standard implementation rate of VTE preventive measures were 86.8%vs 65.6%and 80.2%vs 57.8%in early warning and control groups,respectively(all P<0.001).The independent factors associated with postoperative DVT occurrence were age(OR=1.083,95%CI:1.070-3.265,P=0.032),Hyperlipidemia(OR=1.127,95%CI:1.139-2.564,P=0.042),preoperative high VTE risk(OR=2.131,95%CI:1.085-5.178,P=0.001),time of operation(OR=2.268,95%CI:2.005-5.546,P=0.026)and not adoption of early warning prevention(OR=3.747,95%CI:1.523-6.956,P=0.017).CONCLUSION The early warning strategy was independently associated with the decreasing occurrence of VTE,and it might be suitable for protection from VTE in patients undergoing gastrointestinal cancer surgery.

Efficacy and prognosis of mastoscopic axillary lymph node dissection for breast cancer:a systematic evaluation and meta-analysis

Objective:To systematically evaluate the efficacy and prognosis of breast lumpectomy axillary lymphatic dissection for the treatment of breast cancer.Methods:We use computer to search PubMed,The Cochrane Library,EMBASE,Web of Science,China Knowledge Network,Wanfang database,VIP database and CBM for randomized controlled trials(RCTs)of breast lumpectomy in axillary lymphatic dissection for breast cancer.The search time frame was from the database establishment to July 2021.Meta-analysis was performed using Revman 5.4.1 software after 2 investigators independently screened the literature,extracted information,and evaluated the risk of bias of the included studies.Results:A total of 20 RCTs including 2672 patients were included.Mastoscopic axillary lymph node dissection(MALND)was used in the trial group and conventional axillary lymph node dissection(CALND)was used in the control group.The results showed that the trial group was more effective in controlling bleeding volume[MD=-54.72,95%CI(-79.73,-29.71),P<0.00001],postoperative drainage[MD=-98.99,95%CI(-128.83,-69.15),P<0.00001],length of hospital stay[MD=-2.75,95%CI(-4.67,-0.83),P=0.005],and incidence rate of adverse reaction[RR=0.30,95%CI(0.19,0.45),P<0.00001]were superior to the control group,and the differences were statistically significant.Conclusions:Current evidence suggests that MALND can achieve better outcomes compared with CALND.It is more advantageous in controlling the bleeding volume,postoperative drainage,length of hospital stays,and incidence rate of adverse events.

Extrinsic Risk Factors for Women Breast Cancer in Gaza Strip, Palestine: Associations and Interactions in a Case-Control Study

Background: Worldwide, breast cancer (BC) is the most frequently diagnosed neoplastic disease in women around menopause that is the leading cause of DALYs, because it causes a significant reduction of these women’s ability to function normally in everyday life. Methods: The present hospital-based case-control study was carried out between January and August 2018 using a structured questionnaire on 105 breast cancer women and 210 controls who are clinically free from breast cancer. Data about the study cases were collected in the oncology day-care clinics of the two main hospitals in Gaza strip “Al-Shifa and European Gaza hospitals”. Univariate logistic regression and multivariate logistic regression analyses were employed to identify the significant factors associated with BC. Results: Multivariate logistic regression analyses with adjustment for all confounders revealed that woman with BMI more than or equal 30 kg/m2 are under risk of getting BC 2.9 times greater than those having BMI less than 29 kg/m2 (AOR = 2.895;95% CI: 1.305 - 6.423). Analysis of risk according to reaching menopause showed that the estimated AOR was greater among those reached menopause (3.137, 95% CI 1.824 - 5.395) than among those that did not reach menopause. The risk of developing BC in the case of a history of incidence of BC in the family was more than two times higher (AOR = 2.632, 95% CI 1.528 - 4.535) than in case of the history of a free family of BC. Conclusion: In this context, the above-mentioned risk factors must be taken into consideration in BC management processes in the Gaza strip.

Physical activity engagement after breast cancer: Advancing the health of survivors

Background: Physical inactivity is identified as the fourth leading risk factor for global mortality and associated with increased breast cancer diagnosis and risks of recurrence. Objectives: To investigate the level of physical activity engagement after breast cancer in survivors and healthy controls. Design: A descriptive casecontrol study on survivors and matched (ethnic, gender, age) healthy controls was surveyed using a pre-post questionnaire and a 1-minute cancer control media. The socio- and medical demographic data, physical activity status information were obtained from self report questionnaires. Results: Breast cancer survivors (n = 51) were found to participate in low-moderate level of physical activity while healthy controls (n = 45) participated in moderate-vigorous level of physical activity. Healthy adults reported more barriers and excuses but all participants (90% survivors and control) were unaware of the strong inverse relationship between level of physical activity and risks of cancer recurrence. The post test on video showed an increased awareness and intention to re-engagement in physical activity for cancer control (M = 7.1 ± 1.53, p < 0.01). Conclusion: The finding suggests that simple public health message within the Model of cancer survivorship care must be disseminated. The “teachable moments” after a cancer diagnosis should be optimised to promote rehabilitation for physically active lifestyle.

A Cross Sectional Study of the Knowledge and Practice of Self-Breast Examination among Market Women at the Makola Shopping Mall, Accra, Ghana

Background: Breast cancer is one of the most common cancers in women worldwide. With an estimated incidence of 1,676,633 with 521,817 deaths in the year 2012, the figure is expected to hit the 82.5 millionth mark by 2015. Breast cancer screening is reported to be extremely low in most low-middle income countries like Ghana. This study was to determine the knowledge and practices of self-breast examination among market women at Makola Shopping Mall in Accra, Ghana. Methods: The study was conducted at the Makola Shopping Mall in Accra among women above the age of 20 years who owned a store and sell at the mall. Data were collected using mixed method involving in-depth interviews and questionnaire survey. Random samples of 170 participants were selected from a population of 400 for the quantitative survey. A total of eight in-depth interviews were conducted to generate qualitative data to complement the survey data. Results: Majority (60%) of the respondents were between the ages of 20 - 40 years. There’s a high literacy rate among the participants. Though awareness of self-breast examination was very high (93%), only 27% practiced self-breast examination in line with the recommended one week period after menses due to lack of knowledge of the basic skills to do self-breast examination. Conclusion: In view of the lack of knowledge resulting in non-performance of self-breast examination, continuous education on breast cancer screening should be given to the women to enable them acquire the skills of performing self-breast examination to promote early detection of the disease.

Current preventive treatment for recurrence after curative hepatectomy for liver metastases of colorectal carcinoma: A literature review of randomized control trials

To review the preventive approaches for recurrence after curative resection of hepatic metastases from coloreclal carcinoma, we have summarized all available publications reporting randomized control trials (RCTs) covered in PubMed. The treatment approaches presented above include adjuvant intrahepatic arterial infusion chemotherapy,systemic chemotherapy, neoadjuvant chemotherapy, and immunotherapy. Although no standard treatment has been established, several approaches present promising results, which are both effective and tolerable in posthepatectomy patients. Intrahepatic arterial infusion chemotherapy should be regarded as effective and tolerable and it increases overall survival (OS) and diseasefree survival (DFS) of patients, while 5-fluorouracil-based systemic chemotherapy has not shown any significant survival benefit. Fortunately chemotherapy combined with hepatic arterial infusion and intravenous infusion has shown OS and DFS benefit in many researches. Few neoadjuvant RCT studies have been conduced to evaluate its effect on prolonging survivals although many retrospective studies and case reports are published in which unresectable colorectal liver metastases are downstaged and made resectable with neoadjuvant chemotherapy.Liver resection supplemented with immunotherapy is associated with optimal results; however, it is also questioned by others. In conclusion, several adjuvant approaches have been studied for their efficacy on recurrence after hepatectomy for liver metastases from colorectal cancer (CRC), but multi-centric RCT is still needed for further evaluation on their efficacy and systemic or local toxicities. In addition, new adjuvant treatment should be investigated to provide more effective and tolerable methods for the patients with resectable hepatic metastases from CRC.

Lay perceptions of breast cancer in Western Kenya

AIM: To explore lay perceptions of causes, severity, presenting symptoms and treatment of breast cancer. METHODS: In October-November 2012, we recruited men and women(18 years and older) from households and health facilities in three different parts of Western Kenya, chosen for variations in their documented burdens of breast cancer. A standardized and validated tool,the breast cancer awareness measure(BCAM), was administered in face-to-face interviews. Survey domains covered included socio-demographics, opinions about causes, symptoms, severity, and treatment of breast cancer. Descriptive analyses were done on quantitative data while open-ended answers were coded, and emerging themes were integrated into larger categories in a qualitative analysis. The open-ended questions had been added to the standard BCAM for the purposes of learning as much as the investigators could about underlying lay beliefs and perceptions. RESULTS: Most respondents were female, middle-aged(mean age 36.9 years), married, and poorly educated. Misconceptions and lack of knowledge about causes of breast cancer were reported. The following(in order of higher to lower prevalence) were cited as potential causes of the condition: Genetic factors or heredity(n = 193, 12.3%); types of food consumed(n = 187, 11.9%); witchcraft and curses(n = 108, 6.9%); some family planning methods(n = 56, 3.6%); and use of alcohol and tobacco(n = 46, 2.9%). When asked what they thought of breast cancer's severity, the most popular response was "it is a killer disease"(n = 266, 19.7%) a lethal condition about which little or nothing can be done. While opinions about presenting symptoms and signs of breast cancer were able to be elicited, such as an increase in breast size and painful breasts, earlystage symptoms and signs were not widely recognized. Some respondents(14%) were ignorant of available treatment altogether while others felt breast cancer treatment is both dangerous and expensive. A minority reported alternative medicine as providing relief to patients. CONCLUSION: The impoverished knowledge in these surveys suggests that lay education as well as better screening and treatment should be part of breast cancer control in Kenya.

A Totally Absorbable Multilayer PLGA Implant Device Containing Doxorubicin Inhibited Tumor Growth and Metastasis without Systemic Toxicity in Murine Breast Cancer and an Ideal Pharmacological Paradigm for Regional Chemotherapy

We hypothesize that a cylinder implant made of multilayer Poly-lactic-co-glycolic-acid (PLGA) membrane can be a method for controlled and extended drug release. We fashioned a multilayer cylindrical implant termed STID100 that released doxorubicin for 3 weeks in an orthotopic 4T1 breast cancer model in Balb/C mice. This implant starts as a thin doxorubicin-embedded PLGA membrane, and is then rolled into a cylinder containing an air gap between the membrane layers. Its controlled sustained release delivered 2× the amount of the intravenous (IV) equivalent of doxorubicin, inhibited the primary tumor, and prevented lung metastasis. Importantly it did not cause weight loss, splenomegaly, or cardiac toxicity vs systemically administrated doxorubicin. This favorable safety profile is further substantiated by the finding of no detectable plasma doxorubicin in multiple time points during the 3-week period, and low tumor doxorubicin concentration. The implant system delivered to the specification of an ideal pharmacological paradigm might offer a better coverage of the local tumor, significantly preventing metastatic spread with less drug toxicity to many vital organs, compared to the traditional pharmacology of IV route. The profile of STID made it an attractive therapeutic alternative in metastatic tumor prevention, pain management and many other diverse clinical scenarios.

Hypofractionated Radiation Therapy for the Treatment of Breast Cancer: Experience of National Institute of Oncology, Rabat, Morocco

Hypofractionated radiation therapy has proven effective on locoregional control and tolerance in the adjuvant treatment of breast cancer. The aim of this study is to compare the results of hypofractionated radiation therapy versus conventional radiation therapy in terms of local control and tolerance. It was a retrospective study of patients observations collected from January 2007 to December 2008 in Department of Radiation Therapy in Institut National d’Oncologie de Rabat. The treatment results were evaluated by the rate of locoregional recurrence, distant recurrence and research of late toxicities. Radiotherapy was delivered using the same technique in both groups, by gamma photons of cobalt 60 with an energy of 1.25 MeV. They were 2 groups: the first group treated with standard dose rate and the second group treated by hypofractionated radiation therapy. The mean age of the patients was 42.8 ± 6.9 years old in the standard group and 43.22 ± 7.2 years old in the hypofractionation group. We noted a predominance of infiltrating ductal carcinoma. The majority of patients were pT2, pN0 and pN1. The majority of patients had radical surgery and chemotherapy with anthracyclines in both groups. We noted a statistically significant difference in the irradiation of chest wall between the standard (89.2%) and hypofractionated group (70.3%), with p = 0.043. The median duration of radiation therapy was statistically different in both groups: 39 days in the standard and 23 days in the hypofractionated group (p 0.001). The local recurrences were statistically identical to 12 and 24 months (p = 0.999). Concerning toxicities, the frequency of adverse event was similar in both groups. Hypofractionated radiation therapy with a total dose of 42 Gy at 2.8 Gy per fraction in 5 fractions weekly is comparable to standard radiotherapy in terms of local control and tolerance and is therefore a very good alternative to standard treatment.

Expectations and Perspectives of Users with the Screening Program for Cervical Cancer

Objective: Evaluate user satisfaction before and after taking the Pap. Methodology: Observational and prospective study. It was carried out in two health centers in San Luis Potosicity, Mexico in 93 users which attended for a Pap test from February to June 2015. The satisfaction was assessed using multidimensional scaling SERVQUAL whit 5 dimensions to evaluate the quality of services in an organization: reliability, responsibility, security, empathy and touchable and materials goods (tangible elements). This scaling was obtained internal consistency by Cronbach’s alpha coefficient with a value of 0.74. For data analysis, nonparametric test Wilcoxon for related samples was used. Results: In all cases, perspective was less than expectancy where the means of the scores before attention (expectation) and after care (perspective) there was a statistically significant difference (p = 0.000). Before receiving care users had an expectation of 192.96 points, after care perspective score dropped to 184.49 points indicating that the care provided was not what they expected. The difference in scores was 8.47 points (p = 0.004). Conclusions: Users of the screening program for cervical cancer were unsatisfied because the attention was not what they expected. In most of the indicators studied, a high percentage of dissatisfaction was obtained.

AN EPIDEMIOLOGY AND MOLECULAR GENETIC STUDY ON BREAST CANCER SUSCEPTIBILITY

Objectives. To investigate the genetic susceptibility for breast cancer of Chinese, a hospital-based case-control study, pedigree survey and molecular genetic study were conducted. Methods. Logistic regression model and stratification methods were used in the risk factors analysis. Li-Mantel-Gart and Falconer methods were used to analyze the segregation ratio and heritability. Polymerase chain reaction(PCR) and polyacrylamide gel electrophoresis were used to detect AI, G-banding technique was used to detect the chromosome aberration of peripheral blood lymphocyte. Results. Family history of breast cancer is related to enhanced breast cancer risk significantly, OR is 3905(95%CI=1079～1413), and it widely interacts with other risk factors. Accumulative incidence of breast cancer in first degree relatives is 999%, which is larger than that in second, third degree and non-blood relatives. Segregation ratio is 0021, heritability among first degree relatives is 356±58%. Frequencies of LOH at BRCA1 and BRCA2 loci in sporadic breast cancer are 612% and 577% respectively. In the sibs, both of them show LOH at D13S173 locus, and high frequencies of chromosome aberrations were observed. Conclusions. Genetic susceptibility contributes to breast cancer occurrence of Chinese, and its racial variation may be one of the important reasons for the large difference of incidence between western and eastern countries.

Alcohol and tobacco misuse: Reducing aerodigestive cancer risk

Significant concerns over the health,social and economic burdens of the two most common,and frequently co-misused drugs of abuse,alcohol and tobacco,has encouraged focused but separate health promotion and disease prevention policies.However,this separation of focus means that while individuals who present with alcohol-related problems are increasingly supported to attain and maintain abstinence from alcohol they are not routinely assisted to refrain from smoking.This is tragically inopportune as alcohol and tobacco have an established"synergistic"effect on aerodigestive cancer risk.Moreover,even when patients successfully tackle their alcohol problems they remain at increased risk for developing these cancers,especially if they continue to smoke.A case series is presented together with a discussion on how service provision for co-misuse could be improved to obviate aerodigestive cancer risk.Given the prevalence of alcohol and tobacco use in the United Kingdom,these observations may have far reaching implications for the individual,health provider(s)and wider society.

青少年和年轻人结直肠癌特点及诊疗的研究进展

结直肠癌是较为常见的消化系统恶性肿瘤。近年来,随着人们生活方式、饮食结构的改变及环境污染的加剧,青少年和年轻人(AYAs)结直肠癌的发生率明显升高。AYAs是指15~39岁人群,与老年癌症患者相比,AYAs癌症患者具有更高的长期和晚期风险,预后更差,结直肠癌也成为导致AYAs死亡的重要原因。本研究以结直肠癌为切入点,分析AYAs结直肠癌的发病危险因素、临床特点,探讨AYAs结直肠癌的诊疗方法,以期为临床拟订防控措施提供依据。

基于光学表面监视系统的乳腺癌放射治疗定位质控

目的将光学表面监视系统(OSMS)用于乳腺癌的放射治疗(简称放疗)定位环节的质量控制,探索其可行性和有效性。方法选择海南省肿瘤医院2017年9月至2020年3月女性乳腺癌患者60例,年龄27~71岁,平均年龄46.1岁(标准差9.91岁);手术治疗方式,保乳术后放疗26例,乳腺全切术后放疗34例;肿瘤部位,左乳43例,右乳17例。根据是否行OSMS质控,分为试验组29例(定位过程中加入OSMS质控)和对照组31例(未加入OSMS质控)。试验组定位完成后,增加OSMS重复性监测环节,通过OSMS测量患者重复摆位的平移误差和旋转误差,并依据测量结果对固定装置进行调整;对照组不加入OSMS辅助,按照科室定位流程,常规定位。在后续的放射治疗过程中,采集摆位影像,记录两组患者的位置偏差数据。分析两组的摆位偏差。结果试验组摆位偏差总体偏小。在Z方式(腹背方向)及总偏差上差异有显著统计学意义[(0.056±0.286)cm vs(0.192±0.406)cm、(0.474±0.237)cm vs(0.661±0.299)cm。P<0.01]。试验组系统误差和随机误差均偏小,在X方向(左右方向)和Z方向上差异有统计学意义(P<0.05),且计算得到的计划靶区(PTV)外放边界也更小。试验组摆位误差在X、Y、Z方向上分布区间更加集中在小误差(≤0.3 cm)范围,差异有显著统计学意义(P<0.01)。结论基于OSMS的乳腺癌放疗定位安全有效,可以识别出重复性差的治疗体位和标记点,帮助提高放疗定位质量。