bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Multisectoral Collaboration in Indonesia for Successful Health Promotion
Authors: Giselvania A. , Jayalie V.F. , Gondhowiardjo S.
Published: September 2018

Background: Cancer had caused 14,067,900 people suffered in 2012. In Indonesia, with 357,000 cases, added by mortality and morbidity, cancer has added the country double burden of disease. Thus, preventive measure should be done to tackle the problem. One of the best ways is health promotion through the massive campaign and multisectoral collaboration using the momentum of annual World Cancer Day (WCD). Annual WCD has been held by National Cancer Control Committee (NCCC)-Ministry of Health (MoH), however, 2017 is the kick-off event which engages multisector to promote cancer awareness and knowledge. Aim: This campaign aims to increase awareness and knowledge about cancer (including the healthy lifestyle, detection program and treatment) among Indonesian. Strategy: The national action was planned based on the strategic objective of NCCC. The campaign was coordinated by NCCC-MoH of Indonesia and implemented throughout the country. The local situation, condition and creativity were encouraged to ensure the successful campaign. Program process: Initial coordination was made by NCCC. The proposal was disseminated to the centers across Indonesia. Then, centers would carry out the event and report to the NCCC. Meanwhile, a massive campaign in Jakarta was held by NCCC. Outcomes: There were 25 out of 34 provinces, consisted of 18 nongovernmental organizations (NGOs), 20 professional societies, 37 hospitals and 25 provincial public health service involved in the WCD campaign. This WCD was held under decree of Minister of Health. Several programs in the WCD were press briefing, seminars, talk show, fun campaign in public areas (i.e., celebrity performance, yoga), promotion via local television/newspaper and social media; early detection such as Papanicolaou test, mobile mammography, breast ultrasound, clinical breast examination and visual inspection of acetic acid. The impact of WCD 2017 was tremendous compared with previous year, with multisectoral involvement, overloaded participants and broke the World of Record Museum-Indonesia (MURI) with the most dancer involved dance for the cancer survivor. In addition, the impact can be seen in 2018, when no decree of the minister and national movement provided. In 2018, NCCC only organized a training of trainer with the hope of having an extension of the hand to deliver knowledge and awareness. Nevertheless, each part of Indonesia was commemorating their own WCD without any coordination. These evidence showed that NCCC had been successful to increase awareness and knowledge about cancer. What was learned: Many people were involved in the preparation, starting from doctors, local government, NGOs, hospitals, MoH, companies, survivors and celebrities. Moreover, social media campaign and celebrities played a great role in making this event succeed. Therefore, multisector collaboration is an essential part of raising awareness and knowledge about cancer.
Knowledge, Attitudes and Behavior Regarding Healthy Lifestyle and Cancer Prevention Among Romanian University Students
Authors: Lotrean L.M.
Published: September 2018

Background: Healthy lifestyle promotion represents an important component of cancer prevention. The habits formed during youth have short term and long term influences on health promotion and disease prevention, while it is very probable that they will continue also during adulthood. Aim: The aim of this study is the assessment of knowledge, attitudes and behavior related to healthy lifestyle and cancer prevention among Romanian university students. Methods: A cross sectional study was performed in 2017 among 400 university students from the 4 main universities from Cluj-Napoca, a big university city situated in northwest Romania. It used anonymous questionnaires which investigated several issues related to smoking, nutritional habits, physical activity and weight management of students. Results: More than 80% of the students were aware about the relationship between the risk for cancer and smoking as well as physical activity related activity. Two thirds of the students knew the effect on cancer risk of overweight and consumption of fruits and vegetables, while one third were aware of the effects of red meat consumption. One out of five students were overweight or obese, while 37% were smokers (smoked in the last month). The majority did not meet the recommendations of eating 400 g of fruits and vegetables daily, while almost one third declared eating more than 500 g of red meat weekly. Conclusion: Future studies should focus on development, implementation and evaluation of educational programs for healthy lifestyle promotion and cancer prevention among Romanian university students.
Participation in Mammography Screening Accomplishes an Enduring and Significant Reduction in Breast Cancer Mortality in the Era of Modern Therapy: An Observational Study Spanning 52 Years
Authors: Smith R. ,   the Swedish Two-County Screening Evaluation Research Group
Published: September 2018

Background: A significant decrease in breast cancer mortality has been demonstrated in populations invited to mammography screening. There have been questions regarding the value of mammography in the era of modern therapies, and the relative contribution of mammography screening and modern therapy on mortality reduction. Aim: We have sought to clarify the extent to which early detection through mammography screening contributes to the reduction of breast cancer death in the era of modern adjuvant therapies. We address this question by studying five decades of continuous data from a stable population spanning the pre- and postscreening and adjuvant therapy periods. Methods: We analyzed changes in breast cancer mortality in a stable population in Dalarna County, Sweden, among women aged 40-69 years during the 52 years from 1964 through 2015. Mortality data were obtained from the National Cause of Death Register in Sweden, and incidence data from the Swedish National Cancer Registry. Crude and incidence-based mortality rates were compared among four successive 13-year periods: the prescreening period from 1964 through 1976, the Swedish Two-County randomized screening trial period from 1977 through 1989, and two service screening periods from 1990-2002 and from 2003-2015. Furthermore, we measured the effect of early detection upon breast cancer mortality in women exposed to mammography screening by comparison with breast cancer death in women not exposed to mammography screening, within these three screening periods. Data were analyzed by Poisson regression, with corrections for lead time and self-selection bias. Results: There were 5844 incident cases and 1425 breast cancer deaths during the 52 years of observation. The relative breast cancer mortality rates associated with exposure to screening, adjusted for self-selection bias, were 0.46 (95% CI 0.30-0.69) in the trial period (1977-1989), 0.44 (95% CI 0.30-0.65) in the 1990-2002 period, and 0.37 (95% CI 0.24-0.56) in the 2003-2015 period. The significant reductions in incidence-based breast cancer mortality associated with exposure to screening were independent of contemporaneous changes in therapy. Conclusion: The combination of early detection of breast cancer through mammography screening and the resultant earlier treatment has significantly reduced breast cancer mortality in Dalarna County in the women exposed to screening, compared with the women not participating in screening, by a factor of 2.2 in the screening trial period, increasing to a factor of 2.7 in the most recent service screening period. These mortality benefits can be attributed to the far greater effectiveness of modern therapeutic methods upon cancers detected at screening compared with the poorer effectiveness of the same therapeutic methods in women not participating in screening.
Cancer Awareness Campaign and Screening
Authors: Omenukor K.
Published: September 2018

Background and context: Colorectal cancer is the 3rd leading cause of cancer-related mortalities, which can be prevented by early screening. However, inadequate knowledge regarding the importance of early screening contributes to low cancer screening rates in the population. Aims: A collaborative initiative between David Omenukor Foundation and Fight Colorectal Cancer Organization strives to cancer awareness and screening in the population. Strategy: The David Omenukor Foundation organized a 5-km WALK-A-THON in Mesquite, Texas, on March 10, 2018, as part of the activities to observe the March Colorectal Cancer Awareness Month. During the event, participants received free screening for colorectal, breast, and prostate cancers. Free cholesterol, diabetes, and blood pressure testing were also done because of the impact of these comorbidities on health outcomes. Education experts on cancer were available to teach aspects of healthy diets and exercise. Two cancer patients and a survivor also shared their experiences. Program/Policy process: The program seeks to increase cancer awareness among populations and promote the culture of early and regular screening. Outcomes: Free colorectal and breast cancer screenings were provided to 270 people. About 60 people received free prostate-specific antigen (PSA) test, whereas 135 people received fecal occult blood testing. Similarly, 75 women received mammogram testing. The total number of patients who received colorectal cancer screening increased from 50 on 11th March 2017 to 135 on March 11th, 2018. Impact: The foundation created awareness of all forms of cancer and emphasized the value of early screening as the most effective to avoid the cancer scourge. The participants benefitted from nutritional advice as one strategy for reducing the risk of colorectal cancer. The event indicated that the campaign on early screening for detection was beginning to catch up. Regular interactive events and screenings increase knowledge of cancer and reduce disparities in cancer screening in the community.
Attitudes and Perceptions of Health Care Providers About the Implementation of Population Based Cancer Screening Program in India. A study From Assam
Authors: Kedar A. , Hariprasad R. , Kanan R. , Mehrotra R.
Published: September 2018

Background: India is facing noncommunicable diseases epidemic with cancer as one of the main reasons of mortality. To bring this epidemic under control and as a measure of secondary prevention, government of India has rolled out operational framework for population cancer screening. As cancer screening is a new concept for Indian health care providers, this study focuses on the attitudes and perceptions of HCP from a district in Assam. Aim: To know the attitudes and perceptions of healthcare providers in Assam about the implementation of population based cancer screening program in India. Methods: This study was a part of ongoing Indian Council of Medical Research project at Cachar district, Assam. The study was conducted at Silchar, Assam and the study participants were attendees of the master trainers' workshop which was conducted for the pilot cancer screening program rolled out in Cachar district, Assam. Self-administered questionnaires were used to collect data from the health care providers on the last day of the training. Data were gathered from 58 participants. The participants were medical officers, auxillary nurse midwives (ANM), accredited social health activists (ASHA), staff nurses, nongovernmental organization (NGO) representatives and other health care providers from public health facilities. Results: Majority of the study participants agreed with the concept of screening. Half of the study participants stated that they could conduct screening comfortably along with their other responsibilities. Lack of human resources and an overburdened human resource were the main challenges foreseen in the implementation of the program. 91% of the participants wanted GOI to implement the cancer screening program. Majority of the health personnel were in favor of primary health center (PHC) as the first preferable site of population cancer screening followed by subcenter being second on preference for screening. One-third of study participants opined that screening should be done by specialist doctors. Almost one fifth of participants stated that ASHA should do the screening and almost same number of participants thought that medical officer at PHC should do the screening. Conclusion: This is the first pilot study on the population based cancer screening guidelines released by the government of India. The organized screening program is yet to be rolled out in the country. Though many challenges were foreseen by the healthcare providers in carrying out the population based cancer screening, majority were optimistic for the implementation of this screening program.
Colorectal Screening Programs in Gulf Countries: The Role of Primary Care
Authors: Fadhil I. , Alhomoud S.
Published: September 2018

Background: A rising trend in colorectal cancer incidence has been observed in Gulf countries. In Saudi Arabia, colorectal cancer has been the most common cancer in men and 3rd most common in female since 2002. Moreover, in a recent study in Saudi Arabia, the 5-year survival for colorectal cancer patients was 45% and 28% of patents were diagnosed with distant metastases. Aim: Present the existing colorectal screening programs in Gulf countries, highlight the role of primary care professionals, national guidelines, challenges and barriers to implementation, as well as priority actions to improve implementation. Methods: Data reported based on in-depth review of published literatures on relevant database (PubMed, Science Direct) and gray literatures, including WHO/IARC country mission reports. To support the data, an interview with national managers and key informants, was undertaken. Results: Four case studies on colorectal cancer screening in Saudi Arabia, UAE, Qatar, and Kuwait. Conclusion: Introduction of colorectal cancer screening is feasible in Gulf countries, in a phased manner. The national guidelines for colorectal cancer screening assist in integration of screening into primary care as well as early diagnosis in symptomatic persons. Pilot program in Qatar, KSA of colorectal cancer screening with FIT, targeting healthy persons aged 45-75 years, 4.5% were found to be positive. To improve uptake of the screening, Gulf countries need to invest in training of primary care professional in examination, referral mechanisms and setting up multidisciplinary diagnosis and treatment facilities. Raising awareness of colorectal cancer among the public.
Assessing the Quality of Life Among Caregivers of Patients With Haematological Cancer
Authors: Mishra V.S. , Chandrakala S. , Saranath D.
Published: September 2018

Background: Studies have demonstrated poor quality of life (QOL) among cancer caregivers, but few studies have evaluated QOL and related psychosocial functioning among caregivers for people with hematologic cancer patients. The disease and its associated treatment can have overwhelming consequences for patients and their informal caregivers mostly close family members. Aim: The aim of the study was to analyze the impact of cancer diagnosis and its treatment in caregivers´ quality of life (QoL) and to observe the association with perceived social support. To compare the chronic myeloid leukemia patients to other leukemia patients caregiver to find differences and understand which aspects of QoL are more impacted. Methods: The current study is on-going study; sample is composed of caregivers of patients with chronic myeloid leukemia patients and acute myeloid leukemia, acute lymphoblastic leukemia and other patient's caregiver from the Department of Hematology, KEM Hospital, Mumbai India. We are using Caregiver Quality of Life Index-Cancer (CQOLC) for measuring quality of life among caregivers of cancer patients and Multidimensional Scale of Perceived Social Support (MSPSS) for social support. Results: With the small study sample of caregivers of patients mean age 34.78 ± 6.87 with the age range of 27-45 years, 25% of whom were men. Mean QOL score is 78.34 ± 15.53. In regression analysis caregivers education has shown significant t = 5.611, < 0.05. While marital status shown significant value with social support 3.931, 3.872, < 0.01. While CML caregivers had lower scores for the quality of life and less perceived social support. Conclusion: Caregivers of patients with cancer showed increased burden scores and financial issues and less perceived social support. This could be explained by their unique care situation. These caregivers need more attention and additional counseling session for coping with the situation.
Time, Distance and Economics Influencing Cancer Care: Experience From a Regional Cancer Center in India
Authors: Ballari N. , Miriyala R. , Jindia T. , Gedela S. , Annam L. , Ghoshal S.
Published: September 2018

Background: There is a geographical, socioeconomical and logistic diversity among the cancer patients who reach a regional cancer center. In a developing economy like that of India's, only a minority of patients have medical insurance. So in our setup a cancer patient is met with time, distance and financial challenges. These intangible factors theoretically are expected to influence the ultimate outcome of cancer treatment. Aim: To evaluate the prevailing demographic and economic variables of cancer patients visiting our RCC and to look for any correlation among each other. Methods: The demographic details of cancer patients registered at our RCC between August 2017- September 2017 were retrieved retrospectively. Distance traveled to get to the RCC and get a diagnosis of cancer, time taken for diagnosis and initiation of treatment, and the source of finances for treatment were collected. A correlation among these factors was attempted to be identified. Statistical correlation was identified using Student t-test. Results: Among 591 patients who were analyzed, the median age of patient was 55 years old. The median time taken for the patient to reach the RCC from permanent residence after the beginning of cancer related complaints was 3.19 months. The median distance traveled for the same was 131 km. The source of income was private employment for 223 patients and government employment for 164 patients and self-employment for 200 patients. Only 164 patients had some kind of structured health scheme to manage their health care expenses. Among these, 96 patients had private insurance/reimbursement and 64 patients had government reimbursement. 384 (64%) of patients presented with advanced and locally advanced stage disease while 114 (19%) patients presented to us with early stage disease. However a correlation between delay in presentation to the RCC, distance traveled to reach the RCC, source of income and advanced stage of disease couldn't not be established. Conclusion: Majority of patients visiting our RCC is from far off places and most of these patients pay for the cancer treatment themselves without any support from government or private insurances. All these factors may be responsible for late or advanced stage presentation of cancer patients.
Geographic Variation in Compliance With FOBT Colorectal Cancer Screening Programs: The Role of Attitudes Toward Health and Help Seeking
Authors: Goodwin B. , March S. , Ireland M. , Crawford-Williams F. , Manski D. , Ford M. , Dunn J.
Published: September 2018

Background: Utilization of health services is thought to vary between urban and nonurban residents. In Australia, colorectal cancer (CRC) patients in peri-urban and rural areas tend to be diagnosed at a more advanced stage than their urban counterparts and have poorer 5 year survival rates. Aim: In this study, we investigate the effect that attitudes toward health and health related help-seeking have on compliance with population CRC screening programs and whether this varied among varied locations. We also examined the rate of recipients complying with overall program guidelines as opposed to the commonly reported participation rates in mail-out screening programs. Methods: A cross-section of recipients (n=371) who reported receiving a mail-out fecal occult blood test (FOBT) as part of the National Bowel Cancer Screening Program (NBCSP) in Australia were surveyed in 2017 regarding compliance. Attitudinal constructs including fatalism, stoicism and consideration of future consequences known to impact health-related help seeking were also measured. Logistic regression models were tested to assess the attitudinal predictors of program compliance in urban, peri-urban and rural groups. Results: Program participation (% returning kits) was relatively even across geographical locations, however, compliance with overall screening guidelines (returning kit or engaging in suitable alternative) was significantly lower in peri-urban, compared with urban, areas. Higher levels of stoicism and lower levels of consideration for future consequences were associated with lower NBCSP compliance in rural and peri-urban, but not urban areas. Fatalism was not associated with NBCSP compliance. Conclusion: Attempts to increase compliance with mail-out CRC screening program guidelines need to consider the use of appropriately tailored interventions that reflect the different ways in which socio-cultural and psychological factors impact cancer screening practices in geographically diverse communities. Interventions to enhance compliance in nonurban areas should promote the consideration of one's future, and discourage stoic attitudes to health.
Assessment of Palliative Care Needs in Hospital Settings in Rwanda
Authors: Mukasahaha D. , Uwinkindi F. , Grant L. , Downing J. , Turyahikayo J. , Leng M. , Muhimpundu M.A.
Published: September 2018

Background: Rwanda is among the first African countries with a palliative care (PC) policy and implementation plan. A partnership with the Ministry of Health (MoH) through the Rwanda Biomedical Centre (RBC) and the University of Edinburgh has supported an integrated approach including expanding the evidence base. Aim: To assessing the need for (PC) to inform policy, service delivery and training. Methods: A point prevalence PC needs assessment was conducted in nine public hospitals (referral, provincial and district). A records census identified those with life-limiting illness (LLI) who were then invited to participate by interview. The assessment tool included the APCA African POS, POS S, WHO performance status and demographic information. Results: 608 case notes were reviewed, 152 eligible and 124 completed assessment. 25% of all patients admitted had LLI, of which 99.2% had evidence of unmet need determined by at least one score on the APCA POS ≥ 3. Diagnoses 29% cancer, 29% cardiovascular disease, 16.9% end-stage organ failure and 13.7% HIV. Symptoms with greatest impact; nausea and vomiting (34.7%) and pain (32.3%). 63.7% with WHO performance status 4 or 5. 8.1% seen by existing PC services. Conclusion: Although the MoH and RBC are making bold steps toward developing PC in Rwanda, there remains a significant amount of unmet PC needs. Meeting this need requires recognition of the scope of PC needs beyond cancer, feedback to the hospitals and health care workers, thinking strategically how to further strengthen the health system and further capacity building and training.
1K4Cancer Breaks the Silence: A Crowd-Funding Campaign by Sebeccly Cancer Care
Authors: Udoh A. , Salako O. , Okafor V.
Published: September 2018

Amount raised: The 1K4Cancer campaign raised a total of $18,099. Background and context: Poverty, chronicity of spending, paying out-of-pocket for health care needs, and the prohibitive cost of cancer drugs are some of the reasons cancer patients don't start or complete treatment. Over 90% of Nigerian cancer patients pay for healthcare expenses out-of-pocket; putting a heavy strain on their finances and those of their caregivers. Sebeccly is a cancer charity that enables cancer care access to indigent cancer patients through several fundraising modalities, one of which is the 1K4Cancer. The campaign is a cancer drug fund and crowd fundraiser that appeals for a minimum donation worth $2.50. Launched in October 2012 (for 3 months), and relaunched in March 2018, 1K4Cancer provides treatment aid to breast cancer patients. Aim: To raise funds and provide access to cancer care to indigent breast cancer patients. Strategy/Tactics: The 1K4Cancer campaign reaches out to individuals/organizations by leveraging on social media, relationship management with donors and several 1K4Cancer ambassadors to engage networks to raise funds to support cancer treatment and screening services. This strategy has an online and offline component, with the offline driving the online component. Program process: The 1K4Cancer runs under 7 broad categories: Community events: Focus on advocacy and education on cancer prevention and early detection. Health talks and the 1K4Cancer appeal are delivered during community outreaches. Online community engagements: partnerships with online blogs and influencers to promote the campaign were secured. The social media community was engaged in heartwarming messages and call-to-action statements to support indigent cancer patients. Media partnership: partnerships with online and traditional media houses were secured. The 1K4Cancer message was published on several eminent blogs. Relationship management with donors: past and prospective donors were engaged to promote the campaign. 1K4Cancer remains transparent and accountable through an online monthly newsletter. Donation collection: donations were made through online bank transfer and Sebeccly's online donation platforms. Volunteers: recruitment of 1K4Cancer volunteers who helped to promote and create more awareness about the campaign offline. Partnerships with hospitals: the beneficiaries of the campaign receive cancer care at Lagos University Teaching Hospital, and Lagos State University Teaching Hospital. Costs and returns: $2715 has been spent on online adverts, branding materials, creatives, publications, administrative charges, and logistics. Total returns so far: $15,384. What was learned: Leveraging on goodwill, accountability, the Internet, and a compelling story are necessary ingredients to a crowd-funding campaign. The 1K4Cancer is an innovative crowd-funding campaign that relieves the financial burden of cancer patients and help achieve access to quality cancer care.
Household, Moderate Physical Activity and the Risk of Breast Cancer Among Nigerian Women: An Epidemiological Study
Authors: Azubuike S. , McNally R. , Hayes L.
Published: September 2018

Background: Breast cancer incidence in Nigeria has risen by >120% since 2000. The mortality rate (25.9/100,000/yr) ranks highest in Africa. Inverse associations between household physical activities (PA) as well as moderate PA, and breast cancer risk have been suggested in literature. However, the roles of these activities in breast cancer risk have not been widely studied in Africa. As the socioeconomic status of many Nigerian women improves, their household and daily routines are expected to change. These have implications for their level of physical activity. Aim: The aim of this study was to investigate if there is an association between household, as well as moderate PA and breast cancer risk among Nigerian women. Methods: The study was a multisite hospital based case-control design involving 379 histologically confirmed breast cancer cases and 403 controls. The participants aged ≥ 20 years were interviewed in-person between October 2016 and May 2017 using a pretested questionnaire. Cases were selected from oncology wards and controls from ophthalmology wards. Self-reported household and moderate PA were summarized as both hours per week and metabolic equivalents (MET) hours per week (met-hr/wk). Data were analyzed using multivariable logistic regression, adjusting for known confounders. SPSS version 23 was used for all analyses. Results: The odd of having breast cancer (based on MET-hr/wk) was 40% less among women in the upper tertile of household PA than those in the lowest tertile (95% CI, 0.39-0.94). This was stronger among younger (OR: 0.50, 95% CI, 0.26-0.94), premenopausal (OR: 0.46; 95% CI, 0.24-0.89) and lean women (OR: 39, 95% CI, 0.16-0.87). Moderate PA was also associated with reduced breast cancer risk ( P = 0.04). Conclusion: The study suggested that household and moderate physical activities were protective of breast cancer among Nigerian women. Household chores and other routine moderate activities could provide opportunities for breast cancer prevention in Nigeria. Future studies could consider the use of community controls to authenticate the findings.
Sedentarity and Colorectal Cancer in Morocco
Authors: Hatime Z. , El Kinany K. , Deoula M. Mint Sidi , Nejjari C. , El Abkari M. , Errihani H. , Ismaili Z. , Samlani Z. , Alaoui R. , El Rhazi K.
Published: September 2018

Background: The colorectal cancer (CRC) ranks third among the most nationally prevalent cancers. Several factors including lifestyle modifications are interacting for the emergency of this disease. Morocco has experienced an epidemiologic transition accompanied by the adoption of an unhealthy lifestyle and the physical activity and the sedentary behavior changes. Aim: This study aimed to identify the association between sedentary lifestyle and the onset risk of CRC in Morocco. Methods: This is a national multicenter study of cases/controls which were matched on the sex, age and the recruiting center. All data are collected through a retrospective questionnaire including socio-demographic characters and the lifestyle behaviors (physical activity and sedentary). A sedentary person is defined as being more than 4 hours in a sitting or lying position, at work, at home, during travel, excluding time spent on sleep. Conditional logistic regression was performed to assess the association between sedentary behavior and CRC risk taking into account confounders. Data entry and data analyses were performed by SPSS software 20. Results: In total, 1453 couples (case/control) have been included in this study. 50.2% had colon cancer and 49.8% had rectal cancer. The average age were respectively 56.45 ± 13.95 years and 55.50 ± 13.70 years. For the sex, there were 49.3% male and 50.7% female in each group (case/control). The majority of the cases and controls fall into the poor class. The majority of the cases (43.7%) are overweight with a BMI between 25 and 29.9, 38.7% have a normal weight with a BMI between 18.5 and 24.9. For controls, patients with normal weight (45.6%) and those with overweight (43%) represent the majority. With regard to sedentary behavior, we note that cases are more sedentary (as being >4 hours in a sitting or lying position, at work, at home, during travel, excluding time spent on sleep) than controls with a percentage of 40.5% cases vs 36.2% of controls and a significant difference between cases and controls with OR = 1.19 (1.03-1.39), P = 10−3. Conclusion: The results of this study indicate that sedentary lifestyle is an overall risk factor for CRC. The issue of sedentary life is a major public health issue. Efforts must be made to address this sedentary problem, which will become an even more important health problem in the age of technology, with the massive use of activities that further entrap sedentary life such as social networks.
Antismoking Social Norms Increase Cessation Behaviours Among Lower and Higher SES Smokers: An Australian Population-Based Study
Authors: Schoenaker D. , Brennan E. , Wakefield M. , Durkin S.
Published: September 2018

Background: Disapproval of smoking from close others, observation of others' quitting activity and denormalisation of smoking in the broader community can provide an environment that helps smokers to quit. However, it remains unclear which social norms have the greatest influence, and if there is a similar impact on quitting-related cognitions and behaviors among lower and higher socioeconomic status (SES) smokers. Aim: This study sought to examine the influence on quitting-related cognitions and behaviors of a variety of social norms: subjective (perceived disapproval of smoking among close family and friends); internalized injunctive (feeling embarrassed about being a smoker); and close descriptive norms (living in a household with someone who, successfully or unsuccessfully, tried to quit in the past 12 months). Methods: A telephone survey was conducted among 1454 Australian adult smokers between 2012 and 2014 who were followed-up ∼1 week after the baseline interview. Logistic regression analyses examined prospective associations of baseline social norms with quitting-related cognitions and behaviors at follow-up. Analyses were adjusted for baseline demographic characteristics, addiction level, tobacco control policies (cost increases, plain packaging implementation and mass media campaign exposure) and quitting-related outcomes measured at baseline. Differences in associations between lower and higher SES smokers (based on educational attainment and area-based disadvantage) were examined through interaction terms and stratified analyses. Results: Sixty-three percent of participants perceived disapproval from family and friends, 30% felt embarrassed to be a smoker, and 12% lived with a recent quitter. Baseline disapproval, embarrassment and household quitting activity were each associated with having quitting as a high priority and with setting a firm date to quit in the next month. Both disapproval and embarrassment also predicted engaging in behaviors to limit smoking, and only embarrassment was associated with increased likelihood to talk about quitting with family or friends and to make a quit attempt. No associations were found between social norms and being highly confident to quit and seeking help to quit. Associations were mostly comparable for lower and higher SES smokers, with no significant negative effects of social norms on quitting thoughts and behaviors overall or among subgroups. Conclusion: Within the strong tobacco control environment in Australia, smokers from lower and higher SES groups who perceive that their family and friends disapprove of their smoking, feel embarrassed to be a smoker and/or who live in a household with a recent quitter are more likely to prioritize quitting and intend to quit soon. These findings also indicate that the internalized injunctive social norm (i.e., feeling embarrassed) was the strongest predictor of smokers' quitting related behaviors, including making a quit attempt.
Association Between Nasopharyngeal Carcinoma and Cytomegalovirus in Sudan
Authors: Ahmed H.
Published: September 2018

Background: Oncogenic viruses has a great impact in the etiology of several human cancers. Human cytomegalovirus is found throughout all geographic locations and socioeconomic groups, and infects between 60% and 70% of adults in industrialized countries and almost 100% in emerging countries. The role of human cytomegalovirus in the etiology of several cancers was well established, but there is little data regarding its association with nasopharyngeal carcinoma, particularly in Sudan. Aim: Therefore, the aim of this study was to screen for the detection of human cytomegalovirus in tissue blocks obtained from Sudanese patients with nasopharyngeal carcinoma. Methods: Formalin fixed paraffin wax processed nasopharyngeal carcinoma tissue were obtained from 150 tissue blocks and retrospectively investigated for the presence of human cytomegalovirus using polymerase chain reaction. Results: Of the 150 nasopharyngeal carcinoma tissue specimens, human cytomegalovirus was identified in 53/150 (35.3%) of the samples. Out of the 53 samples infected with human cytomegalovirus, 33/97 (34%) were among males and 20/53 (37.7%) were among females. Of the 53 positive samples, 36/53 (68%) were found to harbor Epstein-Barr virus. Conclusion: The current study has shown a relatively considerable association between human cytomegalovirus and nasopharyngeal carcinoma. The great majority of samples sheltering human cytomegalovirus were also found to hide Epstein-Barr virus, which proposes the potentiality of Epstein-Barr virus over human cytomegalovirus.
P53 Silencing and Mammosphere Formation in Breast Cancer Cells Harbouring P53 Gain-of-Function Mutations Trigger Epithelial-Mesenchymal Transition
Authors: Yee Z.Y. , Lim C.L. , Chung F.L. Felicia , Leong C.O.
Published: September 2018

Background: Mutations in p53 gene are observed in ∼50% of all human cancers. In breast cancer alone, 12%-32% of luminal, 84% of basal-like and 75% of HER-2 expressing tumors have apparent p53 mutations. Tumor cells undergo epithelial-mesenchymal transition (EMT) to metastasise from primary sites to form secondary tumors at distant regions of the body. EMT is a complex biologic phenomenon which governs the transition of cancer cells with epithelial characteristics to mesenchymal traits, gaining new properties such as aggressiveness and invasiveness. Recent studies revealed that mutations in the p53 gene can give rise to alternate functional phenotypes leading to tumor initiation and progression. Aim: The aim of this study is to develop a robust human breast cancer cellular model to investigate p53 gain-of-function (GOF) mutations and EMT as well as evaluating the EMT phenotype associated with these mutations. Methods: Two breast cancer cell lines, namely MDA-MB-468 and HCC38 carrying the R273H and R273L missense mutations, respectively, were subjected to p53 knockdown using shRNA directed against p53 gene through lentiviral vector transduction. The transduced cells were then harvested for Western blotting to evaluate the protein expression of EMT markers which includes E-cadherin, SNAIL, ZEB1 and vimentin compared with the nontransduced control cells. Subsequently, both cell lines were subjected to mammosphere generation and redifferentiation to determine the basal expression of the EMT markers. Results: Silencing of p53 using siRNA in MDA-MB-468 and HCC38 downregulated E-cadherin expressions but upregulated vimentin levels. Furthermore, E-cadherin levels reduced significantly after conversion from adherent parental cells to mammospheres, but rebound upon redifferentiation. Conversely, vimentin was upregulated in mammospheres as compared with the parental and redifferentiated groups. Conclusion: p53 knockdown in breast cancer cells harboring R273H and R273L mutations favor vimentin expression but not E-cadherin, suggesting that p53-GOF mutants are involved in EMT and the development of metastatic tumors. The mammosphere model accurately recapitulates cell plasticity between epithelial and mesenchymal states, as evidenced by the expression of mesenchymal cell markers in the mammospheres, and epithelial cell markers in adherent and redifferentiated cells.
National Comprehensive Cancer Network: Global Utilization of Clinical Oncology Guidelines
Authors: Carlson R. , Donnelly C. , Winckworth-Prejsnar K. , Bacigalupo J. , McClure J.
Published: September 2018

Background: The global influence and demand for clinical oncology guidelines is increasing. National Comprehensive Cancer Network (NCCN), American Society of Clinical Oncology (ASCO), European Society of Medical Oncology (ESMO), and various other organizations develop clinical oncology guidelines, which are used across regions to provide evidence-based recommendations for the management of cancer.1 Aim: To identify and analyze utilization trends of clinical oncology guidelines outside the US. Methods: In 2017, NCCN distributed an electronic survey to 212,423 registered users of the NCCN Web site outside the US through a third party software. Participants were prompted to respond to the following statement “I consult the following guidelines regularly: (Select all that apply).” Options included several clinical oncology guidelines, as well as the option “I do not regularly consult clinical oncology guidelines.” The survey also included the following query: “In my opinion, the NCCN Guidelines are: (select one per row).” The survey then listed several descriptors and the respondents were asked to select strongly agree, agree, no opinion, disagree, or strongly disagree for each one. Results: NCCN received 1698 responses to the survey from oncology professionals outside of the US. Of this pool, 82% of respondents identified as physicians and 18% were other oncology professionals. Of respondents to the first query (n=1190), 89% selected the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines), 55% ESMO Clinical Practice Guidelines, 50% ASCO Guidelines, 20% National Institute for Health and Care Excellence (NICE) guidelines, 15% local, national, or other oncology guidelines, 11% Sociedad Española de Oncología Médica (SEOM), 8% Cancer Care Ontario Guidelines, 7% Multinational Association of Supportive Care in Cancer (MASCC), 6% Japanese Society of Medical Oncology Clinical Guidelines, and 6% do not regularly consult clinical oncology guidelines. In response to the second query (n=1392), more than 90% of respondents outside of the US “strongly agree” or “agree” that the NCCN Guidelines are useful in patient care decision-making, a reliable reference, up-to-date, objective and balanced, evidence-based, and helpful in clinical teaching. Conclusion: Based on data presented, NCCN Guidelines are consulted more frequently than any other clinical oncology guideline outside the US. Previous research indicates similar utilization trends. We believe, in part, healthcare professionals outside the US consult the NCCN Guidelines frequently due to the descriptors listed in the survey results. Additional research is needed to identify the synergies between the relevance of international clinical oncology guidelines and local utilization trends to better serve the needs of patients globally.
A Panel Containing PD-1, IL-2Rα, IL-10, and CA15-3 as a Biomarker to Discriminate Breast Cancer from Benign Breast Disease
Authors: Liu C. , Sun B. , Xu B. , Meng X. , Li L. , Song Q. , Wu S. , Yu J.
Published: September 2018

Background: Programmed cell death protein 1 (PD-1), an immune checkpoint molecule, has recently been recognized as a predictive and prognostic biomarker in several malignant tumors, but its diagnostic value remains largely unknown. Aim: We aimed to investigate the differential diagnostic efficiency of PD-1 and other immune molecules, and propose a panel of immune molecules combined with cancer antigen 15-3 (CA15-3) to distinguish breast cancer (BC) from benign breast disease (BBD). Methods: Ninety-one eligible BC patients and 31 BBD patients were enrolled. Pretreatment peripheral blood was collected and tested for mRNA expression of PD-1, cytotoxic T lymphocyte antigen 4 (CTLA-4), forkhead box P3 (FOXP3), transforming growth factor beta (TGF-β), interleukin-10 (IL-10), IL-2 receptor alpha (IL-2Rα), and cluster of differentiation 28 (CD28) by quantitative real-time PCR. Results: The diagnostic areas under curve (AUCs) of PD-1, IL-2Rα, and IL-10 for BC-BBD discrimination were 0.764, 0.758, and 0.743, respectively. The diagnostic efficiencies of these 2 parameters in distinguishing early-stage or advanced BC from BBD were consistent with a role in BC-BBD discrimination. A panel of PD-1 + IL-10 + IL-2Rα + CA15-3 showed the highest AUC (0.862), with sensitivity of 0.933 and specificity of 0.724, for BC-BBD discrimination. In addition, for early-stage BC discrimination, this panel also had the highest AUC (0.811), with a sensitivity of 0.933 and specificity of 0.614, while for advanced BC discrimination, a panel of PD-1 + IL-10 + CA15-3 exhibited the highest AUC (0.896), with a sensitivity of 0.933 and specificity of 0.783. Conclusion: These data indicate that the panel containing PD-1, IL-2Rα, IL-10, and CA15-3 can effectively discriminate BC from BBD with a high efficiency. After further confirmation, it could be used to complement conventional imaging modalities, especially in discriminating early-stage BC from BBD.
Impact of Delay in Treatment on Survival of 6353 Oral Cancers: Results of a Nationwide Screening Program in Taiwan
Authors: Lee Y.-H.
Published: September 2018

Background: Previous studies have indicated the issue of delay treatment in patients diagnosed as oral cancer in population-based screening because oral cancer patients often lack the knowledge to understand rapid progress of oral cancer. Aim: To evaluate the impact of delay in treatment on the survival of oral cancer detected by screening. Methods: We enrolled residences aged 18 years or older with cigarette smoking and/or betel quid chewing who attended Nationwide Oral Cancer Screening program between 2004 and 2009. Cases with prior history of oral cancer were excluded. Demographic characteristics, oral habits, time of delay in treatment after screening and cancer stage were collected. The survival status of oral cancer was ascertained by following up this cohort until the end of 2012. Results: A total of 6353 oral cancers were detected by screening with a median of 19 (interquartile range 12 to 29) days for treatment. Oral cancer with earlier clinical stage had less delay in treatment ( P < 0.01) while gender, age, and diagnostic year had no difference in delay. In univariate analysis, older age (hazard ratio, HR = 1.01), clinical stage (HR = 1.96 for stage II, 3.13 for stage III, 6.42 for stage IV as compared with stage I), and delay in treatment after screening longer than 3 weeks (HR = 1.11) or 6 weeks (HR = 1.64) were highly associated with worse prognosis. In multivariate analysis, delay in treatment more than 6 weeks (HR = 1.34, 95% CI 1.21-1.48) led to poor survival of oral cancer. Conclusion: Subjects with cigarette smoking and/or betel quid chewing who attended oral cancer screening and were detected as oral cancer patients should be advised to undergo treatment no more than 6 weeks.