bluuebunny/crossref_metadata_2025 huggingface dataset:
Implementation of National Health Reform on China Genitourinary Multidisciplinary Team Consultation Platform
Authors: Qin X. , Ye D. ,   Urologic Chinese Oncology Group
Published: September 2018

Background and context:: Comprehensive management of multidisciplinary team (MDT) is the most effective mode in genitourinary(GU) cancers. Due to the uneven level in the management of GU cancers in China, top GU MDT services do not meet the medical needs of people. The blooming of “Internet+” mode promotes remote medical services, and is supported by health administrations. Aim: The country wide accessibility of high level medical services, and national health reform, especially in the field of GU cancers, will be addressed by the project. Strategy/Tactics: We developed an Internet platform of MDT management for GU cancers across China: “China GU MDT Consultation Platform (CUMP)”. Led by senior clinical staffs, and based on advanced internet and mobile technologies, CUMP is to meet the needs of clinical practices. With compatibility, universality and practicality, CUMP has the following advantages: unified data management, flexible models, stable and reliable remote video conference system, efficient cooperation, and convenient participation. Program/Policy process: Recruit top GU MDT and experts in China, and make consensus and guidelines of the implementations of MDT in GU cancers; Help other local institutions develop GU MDT and provide services, which are authenticated by the platform; Build a system that a single patient can receive top level GU MDT service locally and remotely, provided by the platform. Outcomes: Since April 2017, CUMP has successfully carried out remote MDT consultations involved 16 medical centers with GU MDT services or individual GU experts across China. As a start, 18 difficult cases were discussed and managed. More than 600 Chinese GU experts from medical institutions at all levels, have registered on CUMP, ready for submitting or accepting MDT service; another 34 top Chinese GU MDT units are on the waiting list to be technically authorized on CUMP. One Chinese consensus on the implementation of GU MDT was released last December. What was learned: The project was relevant to current obstacles in China's health reform by greatly enhancing the accessibility of GU MDT service. The majority of GU cancer patients can receive domestic top-level MDT service in a local institution; this project also helped to provide a great convenience to the development of local MDT service, so as to improve medical qualities, especially in GU cancers in different regions of China. The project made the technology and medical service transcend the boundary of administrative division and institution.
Quality of Life in Gynaecological Cancers and Tools for Its Improvement: An Indian Perspective
Authors: Ray A. Mishra
Published: September 2018

Background: Gynecologic cancer and treatment related morbidities adversely affect the quality of life (QOL) and overall outcome. QOL assessment and focus on QOL improvement still lag behind in the priority list of cancer management in Indian women. Aim: To assess the quality of life in India gynecologic cancer patients and possible tools for its improvement. Methods: This review is based on PubMed literature search of all the studies related to QOL in gynecologic cancer patients in India. The studies were categorized into those assessing QOL and improving QOL. Results: Unlike the abundant literature on QOL of patients with breast and oral cancers, the studies on QOL of women with gynecologic cancers are scarce. Nonetheless, twenty-five articles could be retrieved that directed efforts to identify parameters and tools assessing QOL as well as to modify treatment strategies for better QOL. The principal of nerve sparing technique and easily reproducible steps of laparoscopy and robotic hysterectomy has been recently used in Indian patients. It helped in improving QOL of operable cervical cancer patients. Ayurveda holds an important place in Indian medicine and has effective remedies for many diseases. Studies on the use of Ayurvedic drugs during chemotherapy and radiotherapy have shown reduction in treatment related toxicities. Conclusion: Improvement in 'quality of life' should be considered as important as increment in overall survival while managing women with gynecologic cancers. Better QOL would boost the patient's and family's compliance to treatment and improve disease specific outcome. Simpler QOL assessment tools and refined multimodal therapy techniques suitable for Indian population need to be integrated in national cancer treatment guidelines.
Pattern and Predictors of Unmet Supportive Care Needs in Cancer Patients
Authors: Okediji P. , Salako O. , Fatiregun O.
Published: September 2018

Background: The incidence of cancers is increasing, and this is associated with an increase in the burden of the disease. Patients with cancer have to deal with reduced physical functioning, emotional instability, difficulty in concentrating, and an overall diminished feeling of well-being. This creates deficits that have not been well catered for by traditional cancer care, leading to an overall dissatisfaction with care, and a reduced quality of life. Aim: This review aims at assessing the pattern of unmet needs in cancer patients and to provide information as to the factors that influence the perception of unmet needs. Methods: Studies directly focused on unmet needs in cancer patients were retrieved from MEDLINE, PubMed, PsychINFO, Embase, and Google Scholar; from the earliest records until 2016. Unmet needs in cancer patients have been measured with a wide variety of tools, with the Supportive Care Needs Survey (SCNS) being the most commonly used as a result of its strong psychometric properties, ease of use, responsiveness, and its coverage of all the domains of unmet needs. Results: The most common unmet needs were in the domains of health system and information, psychological, and physical and daily living. These needs were influenced by sociodemographic factors such as age, sex, marital status, income level; and clinical factors such as location of cancer, stage of disease, and tumor size. Conclusion: It is clear that cancer patients experience a wide range of unmet supportive needs, for which efforts need to be desperately made to improve the supportive care services for these patients and their quality of life. While it may not be possible to meet all the needs of every cancer patient, routine and regular monitoring of unmet needs using the appropriate tools is crucial so that cancer care and other health professionals can develop, implement, and streamline specific aspects of cancer care to strategically meet the specific needs of their patients.
Chronic Inflammation Toward Cancer Incidence: An Epidemiological Systematic Review
Authors: Michels N. , van Aart C. , Morisse J. , Huybrechts I.
Published: September 2018

Background: It is well accepted that environment- and lifestyle-related factors (e.g., tobacco, diet, obesity and environmental pollutants) play a critical role in the development of nearly all cancers. Inflammation seems to be a major process that all of these risks factors have in common. Insight in the role of inflammation toward cancer development might have implications in prevention, early diagnosis and treatment of cancer (e.g., by selectively suppressing certain proinflammatory mediators). Aim: The aim of this review is to provide epidemiologic data on the correlation between chronic inflammation as measured by inflammatory blood parameters and the incidence of cancer. Methods: PubMed and Embase databases were searched until 2017 for English-written articles and screened by two independent authors. In vitro studies, animal studies or studies with chronically-ill subjects were excluded. Quality was assessed with the Newcastle-Ottawa scale. Results: The selected 22 observational studies included 14 nested case-control, 2 nested case-cohort and 6 prospective cohort studies. The articles originated from either Europe or the US. More than 70 different inflammatory markers were considered but C-reactive protein (CRP) was the most frequent one (followed by TNF-alpha and IL-6) and six studies combined markers of chronic inflammation into a score. Articles reported on the incidence of overall cancer (n=3) and eight site-specific cancers: non-Hodgkin lymphoma (NHL, n=1), breast (n=4), colorectal (n=6), endometrium (n=3), lung (n=3), pancreatic (n=2), prostate (n=3) and ovarian cancer (n=3). Evidence showed that elevated levels of circulating inflammatory markers are linked to an increased risk of overall, colon, endometrium, lung and ovarian cancer. The most robust and strong associations were found for colon cancer with five studies reporting significant results. Herein, CRP had the most consistent relation with odds/relative ratios ranging from 1.30 to 2.29. A definitive statement cannot be made for NHL, breast and prostate cancer due to a shortage of qualitative studies (short follow-up time, small case sample sizes) and/or inconclusive results. For pancreatic cancer, no significant results at all were found (even though these studies received the highest possible methodological quality score). Conclusion: Overall, chronic inflammation seems to play a pivotal role in cancer development. However, further research is necessary to resolve the inconclusive results and to clarify the mechanisms behind this association. Study quality improvements can be done by increasing the frequency of cytokine measures (instead of only one baseline measurement) and prolonging the follow-up.
The Development of a Wholly Online Master's Program for Oncology Clinicians
Authors: Dushyanthen S. , Barrett M. , Kok D. , McArthur G.
Published: September 2018

Background: The Master of Cancer Sciences brings together the academic strength of the University of Melbourne (UoM) and world leading content experts from the Victorian Comprehensive Cancer Centre (VCCC), to develop an innovative, interactive, evidence-based flagship educational program in cancer sciences. This program will enhance the capabilities of health professionals, in the rapidly evolving field of cancer research and clinical care. It will be wholly online and nested with qualification points at Specialist Certificate, Graduate Certificate and Masters Level to provide flexible progression and study options for practitioners in the cancer care workforce. Specific modular content from each subject will also be repurposed and repackaged as a series of derivative educational activities such as massive open online courses (MOOCs), workshops and webinars; broadening the reach of the masters programming to all. Aim: The aim of this program is to be the first cancer-specific, multidisciplinary, flexible, and wholly online master's program of its kind offered within Australia, and one of two available worldwide. Graduates will possess an unprecedented breadth of integrated cancer knowledge and skills. This initiative will unify the VCCC alliance partners as they contribute to directly supporting a world-class cancer workforce and provide best practice care to patients. Discussion: This presentation will explore the educational development process involved in developing the ten online subjects, through the engagement of content writing teams to collaborative development and repurposing modules into a series of derivative educational activities. Ultimately the graduate programs and their derivative educational activities will contribute to lifelong learning, ongoing professional development and high quality healthcare for better patient outcomes.
Core Biopsy and FNA: A Comparison of Diagnostic Yield in Lymph Nodes of Different Ultrasound Determined Malignant Potential
Authors: May B. , Rossiter A. , Heyworth P.
Published: September 2018

Background: The tissue diagnosis of lymphoma and metastases is commonly obtained from affected lymph nodes. The lymph nodes chosen for biopsy are often the consequence of their appearance on ultrasound, which determines their risk of malignancy. Two frequently used percutaneous sampling techniques are core biopsy and fine needle aspiration (FNA). While core biopsy obtains a larger tissue sample and provides a degree of architectural information, FNA is considered less invasive and has the advantage of immediate confirmation of adequacy by the attending cytologist. Anecdotally, core biopsy is more commonly used when a lymph node is suspected of harboring neoplasia, however a feature of malignancy is hypercellularity, which theoretically should increase the diagnostic yield of FNA. Aim: The aim of this project was to compare the diagnostic capability of FNA and core biopsy in lymph nodes of different malignant potential, as defined by ultrasound, and determine if the radiologic appearance can guide clinicians in their choice of sampling technique. The project also reviewed the role of clinical experience in both the choice of sampling technique and diagnostic yield. Methods: Retrospective study of percutaneous lymph node biopsies performed at a large tertiary hospital between July 2016 and March 2018. The associated ultrasounds were reviewed and the lymph nodes were classified as high or low risk of malignancy by their sonographic appearance. The end point for analysis was the capacity for FNA or core biopsy to provide a definitive diagnosis. The diagnostic yield was then separately assessed for lymph nodes of high and low malignant potential. The effect of clinical experience on diagnostic yield was also examined, by comparing the outcomes of radiology consultants and radiology trainees. Results: 296 lymph node biopsies were reviewed and statistical analysis was performed using logistic regression analysis. Core biopsy, in comparison with FNA, was used twice as often in lymph nodes of high malignant potential, supporting the aforementioned anecdotal evidence. Core biopsy demonstrated superior diagnostic yield in comparison with FNA, providing a diagnostic sample 45% ( P = 0.313) more often in low-risk lymph nodes and 209% ( P = < 0.05) more often in high-risk lymph nodes. Consultant radiologists used FNA 81% more often than core biopsy in lymph nodes of high malignant potential, while radiology trainees used core biopsy 104% more often than FNA in the same group. In high-risk lymph nodes, trainees were 117% ( P = 0.105) more likely to obtain a diagnostic sample than consultants. Conclusion: Core biopsy is superior to FNA in the tissue sampling of lymph nodes regardless of ultrasound determined risk of malignancy. Biopsies obtained by radiology trainees provided a diagnosis twice as often as those obtained by radiology consultants. This appeared to be the consequence of consultant preference for FNA over core biopsy.
Use of Social Media in Breast Cancer Awareness: GCC Countries’ Experience
Authors: Mansour D. , Nashwan A. , Abu Rasheed H. , Hararah M. , Nassar H. , Abu Abbas R. , Alnuaimi M. , Mrayat B.
Published: September 2018

Background: Breast cancer is the highest incident cancer among women in the world today as well as in the Gulf Cooperation Council (GCC) countries. Improving the public awareness is significant in decreasing the overall morbidity and mortality of breast cancer. Social media brings a new dimension to healthcare as it offers a medium to communicate to be used by the public, patients, and health professionals to communicate health-related issues with the possibility of potentially improving health outcomes. According the Arab Social Media Report 2017 , the GCC countries largely dominate the top five spots in terms of penetration rates of key social media platforms among their populations, including Facebook, Twitter, LinkedIn, and Instagram. Social media platforms are now frequently used on a large adoption rate by the public to address health-related issues especially in GCC countries. Compared with the rest of the Arab region, the Gulf countries largely have more balanced age breakdowns of young users who are under 30 and those who are over 30 years old, indicating the maturity of usage across age groups in society. Aim: This paper aims to provide an overview of the available evidence concerning the use of social media platforms in breast cancer awareness campaigns in GCC. Methods: A literature search was conducted using PubMed and Google Scholar databases for articles published between 2010 and March 2018. Several keywords have been used. Search was limited to articles in English and Arabic describing the use of social media platforms in breast cancer awareness campaigns in any of the GCC countries. Results: More than 500 studies have been identified in the initial search. Fifteen articles have been deemed eligible. The majority are discussing the importance of using media (mass and social) as the main source of breast cancer information, however, a multilevel intervention should be considered as many interventions should be used to create culturally appropriate breast cancer awareness campaigns in the GCC countries. Conclusion: Apparently, media have been used to raise breast cancer awareness to promote breast cancer screening programs including self-exam and mammogram, benefits of early detection, and modifiable risk factors. However, social media should not be viewed as a solution to the complexities of behavior change and improved health outcomes; instead, use of social media in health promotion should be valued for its potential to engage with audiences for enhanced communication and improved capacity to promote programs, products, and services. The use of various social media platforms is variable across age, educational, and socioeconomic groups; therefore, breast cancer awareness campaigns utilizing social media should be tailored according to the target group, however public communication in the GCC still considered as a significant challenge due to the cultural diversity and language barriers.
Strengthening African Population-Based Cancer Registration Through Regional Mentorship: UICC Fellowship Experience at Zimbabwe National Cancer Registry
Authors: Motsuku L. , Chokunonga E. , Sengayi M. , Singh E. , Khoali L. , Borok M.
Published: September 2018

Background: South Africa (SA) recently established an urban population-based cancer registry in Ekurhuleni metropolitan district in Gauteng Province. The Ekurhuleni Population-Based Cancer Registry (EPBCR) aims to inform cancer policy and comprehensive cancer control programs. The registry covers 3.5 million residents including public/private, rural/urban patients and a mix of the multiethnic SA population. The first complete year's data will be published in April 2018. It is crucial that high-quality data collected by newly established registries are comparable regionally and globally. The Union for International Cancer Control (UICC) fellowship provides a practical opportunity for South African National Cancer Registry staff to learn from the Zimbabwe National Cancer Registry (ZNCR), a well-established population-based registry in the region. Aim: To enhance the SA EPBCR through observation and application of methods for population-based cancer registration used at the ZNCR. Methods: A desktop review of published and unpublished articles/reports of the ZNCR was conducted. Semi-structured informal interviews were conducted with registry staff to understand data processes from case finding to reporting. Representative data sources were visited to understand case-finding processes. Results: The ZNCR was established in 1985 through a collaborative research agreement between the Ministry of Health (MoH) and International Agency for Research on Cancer (IARC). Its activities are overseen by a 17-member constituted multidisciplinary advisory committee. The registry staff comprise one registrar, one executive assistant (EA) and four health information assistants (HIA). The process of ensuring quality data are guided by the African Cancer Registry Network and the International Association of Cancer Registries standards for population-based cancer registries. The ZNCR uses a combination of active and passive case-finding methods where HIAs have unrestricted access to patient information in private and public sectors such as hospitals, pathology laboratories, radiotherapy centers and death registries. HIAs conduct patient interviews for accurate demographics and to complete missing information. Cases are coded according to International Classification of Diseases for Oncology-V3 and Canreg software is used for data entry, quality control and analysis. The hard copies are stored in locked cabinets in offices with restricted access. The data are then used for reporting and research. Conclusion: The support of government, commitment of advisory committee volunteers, highly trained and experienced staff are key elements behind the success of ZNCR. Strict adherence to international practices for population-based cancer registration has enabled ZNCR to produce high-quality data for research and cancer programs. The processes used by ZNCR will be customised and implemented at EPBCR.
Cervical Cancer Awareness Campaign in Qatar: A Population-Based Campaign
Authors: Alemrayat B. , Abu-Abbas R. , Al-Naemi M. , AlTwaisi O. , Saibi W. , Zaheer R. ,   R. Khattab, Adnan M.
Published: September 2018

Background: In 2012, it has been estimated that almost 527,600 new patients were diagnosed with cervical cancer causing over 265,000 deaths worldwide. Locally, the disease is affecting a substantial number of women in Qatar, placing it fifth in terms of the most common cancers among females in the country. Unfortunately, most cases are diagnosed at advanced stages, making the treatment more challenging. This is mainly due to the poor knowledge of the disease and the lack of awareness campaigns about cervical cancer. Aim: To raise the awareness about cervical cancer among women in Qatar to promote prevention and early detection. Methods: Qatar Cancer Society (QCS) launched a population-based campaign aimed at raising the public awareness about cervical cancer. In January 2018, health educators from QCS conducted 15 workshops in numerous public and private sectors across Qatar including companies, hotels, hospitals, and healthcare centers to educate the public about the signs and symptoms of the disease, its risk factors, as well as methods of prevention and early detection. In addition, the campaign was advertised in 10 local newspapers, 4 TV programs, 3 radio programs, social media, and 2 Web sites to deliver the educational material to a larger audience as possible. A hotline number was also reserved to answer women's questions and concerns about the disease. To promote the prevention and early detection of cervical cancer, women were encouraged to do Pap tests for free in Al-Ahli and Al-Emadi hospitals. Moreover, QCS organized a closing ceremony at the end of the campaign for all women who did the Pap test and a raffle draw was done to appreciate their participation. Results: A total of 635 women attended the various awareness workshops that were delivered over a month period. Interestingly, 100 women aged 21-65 years visited Al-Ahli and Al-Emadi hospitals to have Pap tests for cervical cancer screening. All of these women reported that they have never done the test before and they became aware of it from QCS campaign. Of note, participants indicated that it was the first time for them to learn about human papilloma virus (HPV) vaccine which prevents 70% of all cervical cancer cases. In addition, about 150 calls were received inquiring about different aspects of the disease. The closing ceremony came to reinforce the awareness messages delivered by QCS where an educational video about cervical cancer was presented, followed by a speech by a cervical cancer survivor who talked about her battle with the disease and her treatment journey. Conclusion: Despite the widespread of cervical cancer among women in Qatar, little was known about its signs and symptoms, prevention, and early detection methods. This population-based awareness campaign was very effective in raising the awareness about cervical cancer, which will help in detecting the disease at earlier stages, and will ultimately result in higher survival rates.
Epidemiology of Colorectal Cancer in Jordan, From 2003 to 2012
Authors: Alzaghal M.
Published: September 2018

Background: Colorectal cancer is an important public health problem. There are nearly one million new cases of colorectal cancer diagnosed world-wide each year and half a million deaths. Regionally it is the fourth most common cause of morbidity and mortality. Recent reports show that, in Jordan, it ranked the second among all new cancers in both males and females. Aim: To explore and identify the epidemiology of colorectal cancer in Jordan over the 10 years period 2003-2012 to provide update information regarding the likely future. Methods: This project was a descriptive study, cases were identified from Jordan cancer registry (JCR), all Jordanian cases diagnosed and registered in 2003-2012 were included, data on age, sex, primary site, morphology, grade and stage were collected and filtered, frequency by graphs and tables was demonstrated, SPSS software version 17 was used for analysis, and official approval to do the study was taken from the registry. Results: Total number of colorectal cancers in Jordan registered in JCR from 2003 to 2012 was 3299 cases among both genders, 1833 in males which accounted for (55.6%) and 1466 cases (44.4%) in females. In 2012, there were 567 (11.3%) of all newly diagnosed cases among Jordanians compared with 357 (10.3%) in 2003. Male to female ratio was (0.9:1) compared with (1.4:1) in 2003. The median age at diagnosis was 61 years for both genders in 2012, in 2003 it was (51). The overall age-standardized incidence rate (ASR) increased from 11/100,000 in 2003 to 16.3/100.000 in 2012. Conclusion: This study will provide health professionals researchers and policy makers with detailed information about colorectal cancer epidemiology through 2003-2012 and it demonstrate the magnitude of the problem, which will assist in planning and evaluation and to identify priorities, and this will provide a solid database for establishing screening programs for early detection.
Colorectal Cancer Epidemiology in Tanzania: Patterns in Relation to Dietary and Lifestyle Factors
Authors: Katalambula L. , Petrucka P. , Buza J. , Ngoma T.
Published: September 2018

Background: Chronic noncommunicable diseases are increasingly captured as contributing to morbidity and mortality in low and middle income countries. Aim: This study aimed to investigate the epidemiology of colorectal cancer and the potential modifiable local risk factors in Tanzania. Methods: A cross sectional retrospective chart audit study was conducted to establish the pattern and distribution of colorectal cancer, The Food Frequency Questionnaire and the Step® survey tool were used to collect data. Descriptive statistics, χ2 tests, and regression analysis were used and augmented by data visualization to display risk variable differences. Results: Tanzania's colorectal cancer incidence has increased six times in the last decade in which major towns and cities of Dar es Salaam (20.2 per 100,000), Pwani (7.2 per 100,000), Kilimanjaro (4.4 per 100,000), Arusha (4.2 per 100,000), and Morogoro (3.6 per 100,000) had the highest percentage. This study reported that, almost 45% of the participants were hypertensive. Two major dietary patterns, namely “healthy” and “western”, existed among the study sample. Obesity was found in 25% of participants, whereas overweight was present in 28%; of note, the prevalence was higher in females (26.9%) than in males (23.6%) respectively. The prevalence of alcohol consumption was 21.5%, with a significantly lower rate of smoking (12.2%) noted within the study subjects. Both alcohol consumption and tobacco smoking were more common in men than women (22.7 vs. 20.6% and 24.5 vs. 3.2%, respectively). The prevalence of vigorous, moderate, and low physical activity for both sexes was 18.6%, 54.1% and 42.3%, respectively. Conclusion: Evidence from this study demonstrate that, like other NCDs CRC is increasing in Tanzania. Colon cancer is increasing at higher rate than rectal cancer seeming to align with change in lifestyle. Major towns and cities had the highest share of CRC patients. Diet, obesity, tobacco smoking, alcohol consumption, and sedentary behavior have potential role to play in the rising trend of CRC and other NCDs. We recommend a large longitudinal study with robust methodology which can establish cause and effect relationships between specific lifestyle behaviors and the incidence of colorectal cancer.
Epidemiology of Childhood Cancer in Indonesia: Study of 14 Population Based Cancer Registries
Authors: Agustina J. , Sinulingga D.T. , Suzanna E. , Tehuteru E. , Ramadhan R. , Kadir A.
Published: September 2018

Background: Childhood cancer was about 3%-5% cases of all cases. Dharmais National Cancer Hospital was pointed out by Ministry of Health as National Quality Control of Cancer Burden Data in 2016. To provide national cancer burden data, Ministry of Health established 14 population based cancer registries in 2016, located in 14 provinces in Indonesia. The coverage area was 26 districts/municipalities in each selected provinces with total coverage number of population was 14% of Indonesia. Aim: This study was to describe quality data of 14 population based cancer registries in Indonesia and to describe the epidemiology of childhood cancer during 2008-2012. Methods: We used 14 population based cancer registries data that collected in Office of National Quality Control of Cancer Burden Data, Dharmais National Cancer Center, within age 0-19 years old during 2008-2012. We analyzed quality data of 14 population based cancer registries data based on WHO-IARC rules for cancer registry data. Results: There were 4156 cases. The average of percentage microscopic verification was 59%, 7 out of 7 provinces had lower percentage of microscopic verification. The highest was South Sulawesi (98%) followed by Central Java (92.9%), and East Borneo (79.4%). Most of them had over 25% of DCO. DKI Jakarta had the highest incidence age-standardized rate (7.1) followed by Bali (4.9) and North Sulawesi (4.8). The most frequent childhood cancer cases were in male (57%), between 10-14 years old. Both in male and female had similar rank of the most frequent cases, other malignant epithelial (22.4%: 17.2%), leukemia (19.3%: 14.3%), and other and unspecified malignant tumor (9.4%: 8.4%). Conclusion: The coverage and quality data of childhood cancer in 14 population based cancer registries data were low. Each population based cancer registries should improve the process of cancer registration.
Organochlorine Pesticides Exposure as a Risk Factor for Breast Cancer in Young Women: A Case Control Study
Authors: Swain S.K. , Kaur N. , Banerjee B.D. , Thamineni K. , Sharma T.
Published: September 2018

Background: Young women (< 40 years) constitutes about 10%–25% of total breast cancer cases in south-Asian women and an increase in incidence rates have been noted in the recent past. It is higher compared with their western counterparts, where rates of 5%–10% are reported. Younger women usually present with more aggressive tumor and poorer prognosis, suggesting that breast cancer in young women represents a distinct entity. Exposure to environmental estrogens such as organochlorine compounds in pesticides and industrial chemical has been proposed to be a risk factor for breast cancer. There is rampant use of pesticides in farming in south-Asian countries. However the associations between organochlorine compounds and breast cancer risk, reported in different studies has been inconsistent. Hence this study was planned with the objectives to assess the serum levels of organochlorine compound and the presence of other risk factors in north Indian population of young women diagnosed with breast cancer. Aim: To assess the serum level of organochlorine compounds and the other risk factors in north-Indian population of young women diagnosed with breast cancer. Methods: This case control study was conducted at UCMS & GTB Hospital, Delhi, India in 42 patients of breast cancer ≤ 40 years age and 42 age-matched-controls. The study subjects were evaluated for various known risk factors such as family history of breast or ovarian cancer, age of menarche, number of pregnancies and abortions, duration of breast feeding, oral contraceptive intake, obesity, benign breast disease & biopsy, etc. Study subjects were also evaluated for exposure to environmental pollutants by performing of assays of twelve different organochloride pesticides in their blood samples. Genetic analysis also done to look for polymorphisms of genes: BRCA1 at Q365R, BRCA2 at 6174delT and p53 at 216 location. Results: Significant association was seen between serum level of β- HCH, heptachlor, dieldrin, p,p'-DDE and risk of breast cancer in young women in our patient population. Significant association was also found between early age of menarche, obesity, BRCA 2 and p53 gene polymorphism as risk factors for breast cancer. Conclusion: Exposure to organochlorine pesticides could be an important modifiable risk factor, responsible for an increase in the rates of breast cancer in younger women. Polymorphism of p53 at 216 location & BRCA2 at 6174delT could be independent susceptibility marker in younger women with breast cancer. Larger studies are required to validate these results.
Breast Self-Examination: Attitudes and Knowledge Among Polish Nurses
Authors: Panczyk M. , Woynarowska-Sołdan M. , Koczkodaj P. , Iwanow L. , Bączek G. , Gotlib J.
Published: September 2018

Background: Breast cancer (BC) is 1 of the most challenging types of malignant cancer, both in Poland and in the world. Accordingly to the latest epidemiologic data, in Poland in 2015 BC was the most frequent cancer among women and was second leading cause of cancer deaths. World Health Organization highlights that BSE has significant role in empowering women to take responsibility for their own health and is recommended as an educational tool in raising women's awareness about BC risk. Appropriate knowledge level about BSE is especially crucial among nurses - in many cases nurses are the first and only source of knowledge about BSE and BC for women. Aim: To investigate level of knowledge about BSE among Polish nurses. Methods: To assess BSE correctness performed by nurses, authors used the scale based on 4 items. Each item referred to 1 following principle of appropriate BSE: regularity (once a month); BSE performed 2-3 days after menstruation among women in premenopausal age and within the set day among postmenopausal women; using both visual and palpation technique; examination in standing and lying position. For each principle respondent received 1 point. Total maximum number of points was 4. Among the variables characterizing the examined group of nurses potential qualitative and quantitative factors were identified, the impact of which on the correctness of BSE performance has been assessed. To evaluate the impact of specific factors on the probability of correct BSE performance the logistic regression method has been used. Results: In our study all nurses declared that they had performed BSE at least once in their life. However, less than half (41.1%) did this for the first time at the age of 20 or earlier. 56.7% of nurses regularly examined their breasts once a month. Among menstruating women (N = 1058) at the recommended time (2-3 days after the end of menstruation), BSE was performed by 67.3% of nurses, the others during different periods of the menstrual cycle. Among postmenopausal women (N = 184) 30.4% have been performing BSE on a specific day of the month. Almost all subjects (about 98%) used both - viewing and palpation method. 58.9% did it in 2 positions - standing and lying. The average number of points on the BSE correctness scale, including 4 items, was 2.8 points. BSE was fully correctly performed by 27.5% of women (4 p.) and almost fully correctly by 33.9% of nurses (3 p.). Less than 1% of nurses carried out BSE contrary to the 4 recommendations assessed during the study. Conclusion: Despite medical education only about 1/3 of nurses has performed BSE in a completely correct way. It shows the need of constant education in this matter which has significant meaning for same nurses but also for women educated by them. Moreover, in the face of alarming epidemiologic data on BC and unsatisfactory quality of performed BSE, devoting more attention in the nurses´ education process for BC issues should be considered.
Cervical Cancer Incidence and Trends in Uasin Gishu County, Kenya (2010 to 2014)
Authors: Kosgei A. , Chesumbai G. , Buziba N. , Atundo L.
Published: September 2018

Background: Globally, cervical cancer is the fourth most common cancer in women, and the seventh overall, with an estimated 528,000 new cases (GLOBOCAN 2012). Cervical cancer is currently the most common cancer among women of Uasin Gishu County. Eldoret Cancer Registry (ECR) is a population based registry that collects cases diagnosed in Uasin Gishu County whose population is 894,179; 50% male and 50% female (2009 National Census). Aim: The aim of this study is to determine the incidence and trends of cervical cancer in Uasin Gishu for a 5 year period based on ECR data. Methods: Cancer registrars undertook case finding and abstraction in health facilities in Uasin Gishu. Confirmed malignant tumors were abstracted on to the Case Registration Form. Coding was done using ICD-O-3. CanReg5 was used for data entry, quality checks and data management. Data analyzed was for all women between the ages of 15-80 years. Results: A total of 2539 cancer cases were registered for the period 2010-2014 comprising of 1144 male and 1395 female. Cancer of the cervix was the most common cancer in female with 265 cases; 19.3% of all female cancers. ASR was 24.8 per 100,000. The most affected age group was 30-54 years. Stage I cases were 9%, stage II had 10%, stage III had 21%, stage IV 5% and unknown stage was 54%. There was high incidence observed in 2011 as compare with other years. 242 cases were histologic diagnosis, 10 cytology, 10 clinical investigation, death certificate only were 3 cases. Conclusion: Cervical cancer incidence was very high among women of Uasin Gishu County. Notably, most of the cases have unknown stage which may be associated with the fact that most patients are diagnosed within the county and may go for treatment elsewhere, or some go for traditional treatment in the villages after diagnosis and others may not come back for treatment after diagnosis due to cultural beliefs.
Effectiveness of Hypnosis Techniques to Quit Smoking
Authors: Bilachi J. ,   Hidalgo, Peres Isidro
Published: September 2018

Background: The main reason for carrying out this study was to realize that tobacco addicted are more than their beliefs, family, social life, religion, profession, and paradigms. Aim: The objective of this project was to help patients quit smoking through hypnosis techniques and, consequently, to help them face quitting methods more comfortably and safely and also avoid relapse. Methods: This project started with a biographical questionnaire, identification of smoker phases and some suggestion hypnotics are also evaluated through classic tests (vigils suggestions) and the Tellegen Absorption Scale. After collecting the data, we proceeded to an intervention plan that in synthesis had the following phases: sessions 3 and 4 aimed at obtaining a hypnotic trance with sufficient stability and depth, we value the state achieved as a medium-deep trance and spontaneous hypnotic phenomena. The next sessions, 5 and 6, we apply as ego strengthening and suggestions to demystify previously recorded thoughts, feelings and, consequently, behavior. Sessions 7 we explain the concept and importance of self-hypnosis. Results: The quantitative results will be presented here to show the effectiveness of the project developed. The most important information is the number of people who interrupted tobacco dependence: 16 (80%) out of 20 quit smoking, of which 10 (50%) were men and 10 (50%) were women. Four patients (20%) did not complete the treatment, 2 men and 2 women. Conclusion: It was possible to verify that quitting smoking through hypnosis is effective, because the smokers can transform their cognitive system and, thereby, they can change, naturally, their biopsychological paradigms in all contexts of their lives.
Incidence and Risk Factors of Arm Lymphedema Following Breast Cancer Treatment
Authors: Sekyere M. Owusu
Published: September 2018

Background: All breast cancer patients are at risk for developing lymphedema (LE) as a complication of breast cancer surgery and radiation. The reported incidence ranges from 5%-60%. In Ghana, 50% of women with breast cancer who come to the hospital present with late-stage breast cancer. Komfo Anokye Teaching Hospital (KATH) has no available data to support LE incidence. Aim: To determine the incidence and risk factors of lymphedema after breast cancer treatment at the oncology unit of KATH, Kumasi, Ghana between 01 January 2005 to 31 December 2008. Methods: Breast cancer and lymphedema related variables were collected from the medical records of breast cancer patients. Data were analyzed using descriptive statistics and χ2 tests. Results: Among 313 patients treated for breast cancer between 2005 and 2008, 31 (9.9%) developed lymphedema after treatment. A χ2 test showed that axillary lymph node dissection was statistically a significant risk factor of lymphedema (χ2 test value = 7.055, P = 0.008). Radiation and late stage of breast cancer diagnosis may have contributed in development of lymphedema despite having P value > 0.05. Age, BMI and hypertension were also not associated with lymphedema. Conclusion: This study provides evidence that the incidence of lymphedema was 9.9% with axillary lymph node dissection as a statistically significant risk factor of lymphedema. Implication for practice: With majority of breast cancer patients presenting with late stage disease and also undergoing axillary lymph node dissection, lymphedema will continue to be a problem in Ghana. Knowing the incidence and risk factors of lymphedema not only helps in the early detection and effective management of lymphedema but also provides base-line data for further research on lymphedema in Ghana.
Advances in Screening and Early Detection
Authors: Kotschan N.
Published: September 2018

Background and context: Although breast, cervical and prostate cancer screening are provided to communities in support of the Early Detection Saves Lives campaign in South Africa, it is crucial to collaborate with other health partners for services such as HIV/AIDS, tuberculosis, social services and screening for noncommunicable diseases. This is due to the high prevalence of HIV/AIDS, tuberculosis and noncommunicable diseases in the country. HIV/AIDS-related cancers are rising with other diseases and this impacts on the patient's treatment, care and quality of life. Aim: The primary objective of the introduction of these health partners and other sectors (education, women in presidency, commission for gender equality, transport and home affairs) are to ensure that the patient receives holistic care and postscreening runs effectively where both patient and medical professional hold updated records. Strategy/Tactics: 1. We worked closely with respective Community-Based Primary Healthcare Centres (PHC) on corporate funded outreaches scheduled in five provinces of SA, using our mobile units for screening purposes. 2. Remote areas with reduced access to specialized healthcare services were specifically targeted. 3. Captured patient histories, identification, and treatment (pre- and postscreening) provided PinkDrive/MBTM with sufficient information to run streamlined screening processes. 4. Patients were first screened for HIV-AIDS, tuberculosis and thereafter screened for noncommunicable diseases, e.g., gender-related cancers and obesity. Outcomes: 1. In a collaborative structure, we have found that the patient is privy to understanding the level, importance and stage of cancer with other related illnesses. 2. Results are more controlled and the patient's health record is captured at the relevant health institutions. 3. Holistic healthcare services and medical treatments are monitored, measured and managed appropriately at the relevant healthcare institution. 4. A relatively high demand for Pap smear screening was noted at many PHCs as many were still utilizing outdated Pap smear kits. What was learned: Collaborative initiatives are good success stories incorporating best practices and also benefitting the patients and medical professional. We are living in a digital age and yet our equipment and machinery is not state of the art. The mobile truck, in many instances, has to travel to the most remote areas with poor road infrastructure. New technology will make a remarkable difference, especially if it is systemised to the relevant institution, upgraded, built-in with latest developments so that the mobile truck is able to travel on all road types. For South Africa, PinkDrive/MBTM have grown tremendously and are continuously building public private partnerships.
The Comparison of Melphalan Administration on Day −3 With Administration on Day −1 on Neutrophil and Platelet Engraftment in Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplantation
Authors: Unal A. , Kaynar L. , Keni N. , Eser B. , Cetin M. , Yıldızhan E. , Varol F. , Çiftçi S. , Eser B.
Published: September 2018

Background: High dose chemotherapy followed by ASCT is the most important step of MM treatment. Melphalan, an alkylating agent, is the most preferable drug for conditioning regimens and dosage and timing is important with regard to side effects or engraftment timing. Engraftment time is determinative on infections and hospitalization duration. Aim: To compare of the neutrophil and thrombocyte engraftment time in patients with multiple myeloma who received melphalan 200 mg/m2 single dose on day −3 and day −1 as conditioning regimen. Methods: We compared the neutrophil and thrombocyte engraftments retrospectively in patients with multiple myeloma who received melphalan 200 mg/m2 single dose on day −3 and day −1 as conditioning regimen. There were 29 patient receiving melphalan on day −1 and 42 patient on day −3. Results: Administration of melphalan on day −3 was better than on day. Neutrophil engraftment time and hospitalization duration was shorter in patients who received melphalan on day −3 than patients who received melphalan on day −1. In day −3 group, there was no failure neither in neutrophil nor in thrombocyte engraftment but 1 patient could just get thrombocyte engraftment on day 33. In day −1 group, 2 patients could not get engraftment. Conclusion: Administration of melphalan on day −3 is better than on day −1 in terms of neutrophil engraftment and hence in terms of hospitalization duration.