Radiation exposure of the surgeons in sentinel lymph node biopsy

Sentinel node biopsy [SLNB] is the standard of care for breast cancer treatment and it is getting wide acceptance in Iran. The radiation safety of the procedure has been investigated under controlled conditions, but the standard dose of radiotracer and techniques are not always observed in the community setting. The aim of this study was to assess the magnitude of the absorbed doses of radiation to the hands of operating surgeons. Twenty consecutive SLNB procedures were studied. Radiation dose to the hands of the surgeons was measured by placing lithium fluoride thermoluminescent dosimeters [TLDs] in the surgeons' glove. The radiation dose to the abdomen and thyroid area was measured by placing TLDs at these areas. The injected dose of radiotracer, the time interval to the surgery and the duration of the surgery were recorded. The injected dose of radiotracer ranged from 0.1 to 5 mCi. The highest absorbed dose was recorded by TLD, placed on the non-dominant hand third finger [189.1 microSv]. Mean recorded doses were higher for non-dominant hand second finger [53.49 +/- 24.60 microSv]. The measured absorbed doses for the abdominal and thyroid area were lower than those for the fingers. This study has confirmed the procedure safety, even with high dose of radiotracer. Nevertheless, it is advisable to use the lowest dose of the radiotracer to avoid the waste of resources

Recurrence and survival effect in breast conserving surgery: what are the predictive and/or prognostic factors?

Breast conserving surgery [BCS] is a widely accepted form of operation in patients with early breast cancer. Recurrence remains one of the greatest concerns in breast conserving surgery. It can provoke serious anxiety in the patient and, when treated by mastectomy, negate the objective of conservation. In this study we investigated the prognostic value of demographic, clinical and pathological factors and biological markers in breast cancer patients treated with BCS. This study was performed on 258 patients who underwent BCS from 2002 to 2010. All of the surgeries were performed by a single surgical team. Recurrence and its risk factors were evaluated. The mean age of the patients at the time of diagnosis was 50. The overall 10 year survival was 81%, 5 year survival was 88% and recurrence rate after surgery was 9%. Lymphovascular Invasion [LVI] was observed in 41 [16%] patients and in 11 [48%] patients with recurrence. Our study confirmed that tumors with estrogen receptor negative and LVI had more recurrence rate but other demographic, clinical and pathological factors and biological markers [progesterone receptor, P53, HER-2] did not have any significant effect on recurrence. We recommend considering LVI and estrogen receptor assay as a prognostic factor in the patients treated with BCS

Euthanasia in cancer patients, Islamic point of view

Euthanasia is an important subject that concerns law and medicine as well as morality and religion in the 21[St] century. Euthanasia has become a challengeable problem in scientific arena. In some countries, legal and medical practitioners are allowed to kill those cancer patients who suffer from excessive pain while incur enormous amount of expenses for their treatments. We used 3 main sources to find Islamic views on euthanasia: First, the Islamic primary source, the Holy Quran, which is the most important and reliable source for finding Islamic perspectives. Second, traditions [hadith] which include Prophet Mohammad's and his relatives's [Imams] advices. Third, religious opinions and decrees [Fatwas] from great Muslim scholars who are called Mofti Al-Aazam in Sunni tradition and Ayatollah Al-Ozma in Shiite tradition. Based on the reasons proposed in the references, it can be concluded that euthanasia is forbidden in Islamic theology; and no types of euthanasia are allowed or accepted in Islam; and any action whether voluntary or involuntary that results in euthanasia of cancer patients is considered suicide and is strongly forbidden in Islam. Euthanasia is purely illegal in Judaism, Christianity, and Islam. In this study, we introduced a religious law based on Islamic point of view and Emamyeh section in Islam. To investigate the sensitive issue of euthanasia in Islam, the Holy Quran as the fundamental reference of Islamic law and Sonnah as the reference of Hadith [Traditions] were studied

Integrating spirituality into a group psychotherapy program for women surviving from breast cancer

In spite of a significant relation between spirituality and hope, happiness and life satisfaction, the effectiveness of spiritual interventions in the mentioned mental strengths has been less dealt with. The present study is conducted in order to determine the effectiveness of spiritual group intervention on the increase of hope, life satisfaction and happiness in women surviving from breast cancer. Sixty women surviving from Breast Cancer were voluntarily assigned in to case and control groups, and were assessed before and after Islamic perspective spiritual intervention by spiritual experience, hope, happiness and life satisfaction questionnaires. Statistical analysis of data was performed using descriptive and inferential statistics through covariance. The spiritual intervention resulted in significant increase of hope, happiness and life satisfaction [P < 0.05]. Spiritual intervention appears to be a potentially beneficial intervention for increasing mental strengths among those suffering from breast cancer. Therefore, it seems necessary to consider it as an important element incomprehensive treatment, plans, and in palliative and supportive care

novel scheme for optimal control of a nonlinear delay differential equations model to determine effective and optimal administrating chemotherapy agents in breast cancer

Determining the optimal and effective scheme for administrating the chemotherapy agents in breast cancer is the main goal of this scientific research. The most important issue here is the amount of drug or radiation administrated in chemotherapy and radiotherapy for increasing patient's survival. This is because in these cases, the therapy not only kills the tumor cells, but also kills some of the healthy tissues and causes serious damages. In this paper we investigate optimal drug scheduling effect for breast cancer model which consist of nonlinear ordinary differential time-delay equations. In this paper, a mathematical model of breast cancer tumors is discussed and then optimal control theory is applied to find out the optimal drug adjustment as an input control of system. Finally we use Sensitivity Approach [SA] to solve the optimal control problem. The goal of this paper is to determine optimal and effective scheme for administering the chemotherapy agent, so that the tumor is eradicated, while the immune systems remains above a suitable level. Simulation results confirm the effectiveness of our proposed procedure. In this paper a new scheme is proposed to design a therapy protocol for chemotherapy in Breast Cancer. In contrast to traditional pulse drug delivery, a continuous process is offered and optimized, according to the optimal control theory for time-delay systems

Margin status influence on the outcome of patients treated with breast conserving surgery

Breast conserving surgery [BCS] followed by local radiotherapy is the standard treatment for early stage of breast cancer. Margin status may have an important impact on local recurrence and overall survival of patients treated with BCS, but this has not been defined adequately. In this study, we investigated the relationship between microscopic margins and outcome of BCS. Three hundred eighty four patients treated with BCS between 1999 and 2010 were included in our study. All surgeries were performed by a single surgical team. Margins were defined as close if surgical margins were less than 2 mm, as free if surgical margins were more than 2 mm and as positive if malignant cells were present in one of the tissue edges. Demographic, clinical, and pathological factors as well as biological markers, recurrence, and survival rates were compared between the close and the free margins groups. The mean age of patients at the time of diagnosis was 54.2 years. There were 34 [9%] recurrence cases and overall survival was 128.7 months and ten years survival rate was 81%. There was no significant difference between the close and the free margins groups in terms of demographic parameters, tumor characteristics, biological factors [estrogen and progesterone receptor status] and lymphovascular invasion. Also recurrence rate did not differ significantly between these two groups. Our study indicates that there is no significant difference between the patients with close and the free margins in terms of treatment results. There is no clear consensus in the surgeons' community over the definition of acceptable margin width in BCS, so additional studies are required to find the right answer

Psychosocial care for breast cancer: physicians' perspective

Many literatures have documented that psychosocial care can improve health outcomes and reduce morbidity in women with breast cancer. The aim of this study was to evaluate the opinion of the breast cancer professional team members on integration of psychosocial care in regular management of breast cancer. A cross sectional sample of 313 physicians involving in diagnosis, treatment and supportive care for breast cancer patients were interviewed using a questionnaire. The majority of participants [52.7%] declared that psychosocial care is necessary for all patients with breast complaints. All except one of the respondents irrespective to their age and job believed that providing the patients with psychosocial supportive care definitively have some positive points for the patients with breast cancer. Of all respondents, 29.6% thought it should be offered as soon as suspicion is raised toward breast cancer, 54.7% preferred to provide such care after the diagnosis of malignancy is confirmed, 11.3% thought it should be prescribed before surgery and 4.4% believed that care should be provided before adjuvant therapy. The necessity of providing psychosocial care for breast cancer patients was mentioned by the majority of respondents; however there are some major differences among the team members of breast cancer care in regard to psychosocial supportive care. The results of this study highlight the insufficient collaboration among medical team members and the necessity of multidisciplinary approach to all aspects of the important disease through programmed sessions and provide the patients with an integrated comprehensive care

Epidemiological pattern of non-fatal injuries in Iran

To present the incidence rate and distribution of non-fatal injuries in Iran. A one- year study was carried out in all 28 provinces of Iran in 2002-3. Overall, 53,6624 individuals [1,11626 households] from all provinces of the country were randomly selected for the study. In each province about 2000 households in urban and 2000 families in rural areas were included in the study. The guardians or heads of the households were interviewed by using a questionnaire that included information about any accidental injuries taken medical cares within the year prior to the date of data collection and some other demographic information. It is estimated that more than 9.2 million injuries with about 8286 deaths and 74379 hospitalizations occurred in Iran each year. The incidence rate of all types of non-fatal injuries was [444.3 per 100,000]. The top three causes of non-fatal injuries were transport accidents [237 per 100,000], falls [106.2 per 100,000] and struck by thrown, projected of falling object [69.8 per 100,000]. The non-fatal injuries were more common among males than females [8039.6 vs. 2021.7 per 100,000] and nearly equivalent among residence of urban areas compared to those from rural areas [5024.1 vs. 5075.5 per 100,000]. In Iran injuries are one of the main leading causes of diseases and hospital admissions in both rural and urban areas, and this figure for transport accidents is quite high in the world

Colorectal cancer prevalence according to survival data in Iran 2007

Colorectal cancer is a common [5000 new cases per year in Iran] and lethal disease. Regarding the high incidence [7 cases per 100000] and survival rate of colorectal cancer and the priority of prevalence index in cancer management, in this study, 1, 2-3 and 4-5 year point prevalence were determined according to survival data. In this study, survival and incidence data were used for the determination of cancer prevalence. Incidence data were extracted from cancer registry in Iran and survival data were determined during a descriptive study through the follow up of 2342 colorectal cancer patients. 1, 2-3 and 4-5 year point prevalence were estimated from incidence rates in different years and the proportion of patients surviving 0.5, 1.5, 2.5, 3.5 and 4.5 year[s] from diagnosis. Proportion of cases surviving 0.5, 1.5, 2.5, 3.5 and 4.5 year[s] from diagnosis were 79.2%, 65.08%, 57.36%, 51.76% and 48.87%, respectively. Estimates of 1, 2-3 and 4-5 year prevalence were 4156, 5715 and 4283, respectively. The cumulative 5 year prevalence was 13954 cases. These estimates of 1, 2-3 and 4-5 year prevalence are applicable to the evaluation of initial treatment, clinical follow-up and point of cure, respectively. Therefore, 1, 2-3 and 4-5 year point prevalence estimates are necessary in health service planning for cancer management

OCT-4, an embryonic stem cell marker expressed in breast, brain and thyroid carcinomas compared to testicular carcinoma

Cancer stem cells are a small subpopulation of cells within a tumor which are responsible for maintaining the tumor mass. A number of factors such as OCT-4 that govern the fate of adult stem cells also play a role in malignant cell transformation. OCT-4 is a key regulator of self-renewal in embryonic stem cells; its expression is potentially correlated with tumorigenesis and can affect some aspects of tumor behavior such as tumor recurrence or resistance to therapies. We have investigated the potential expression of OCT-4 on a panel of tumors including breast, brain, thyroid and testicular carcinomas, using immunohistochemistry. The level of expression of OCT-4 was then compared to different tumor types and degree of differentiation. OCT-4 was expressed at the highest levels on nuclear site of seminoma compared with other tumors. The expression of OCT-4 was detectable in both nucleus and the cytoplasm of almost all breast tumors, but it was detectable at much lower level in normal breast tissues. OCT-4 expression was noted on poorly differentiated papillary carcinoma of thyroid compared to normal follicles of thyroid gland adjacent to the tumor. Breast carcinomas and papillary carcinomas of thyroid express elevated levels of embryonic stem cell gene OCT-4, suggesting that these tumors may contain cells indicative of embryonic-like stem cells. Identification of cancer stem cells in different malignant tumors may be useful for prognostic evaluation and administration of a new treatment which target this sub-population of tumor cells

Colorectal cancer prevalence according to survival data in Iran in 2007

Colorectal cancer is a common and lethal disease with 5000 new cases reported each year in Iran. This study was done to estimate the 1, 2-3 and 4-5 year point prevalence of colorectal cancer in Iran. In this descriptive study we studied the follow-up of 2342 patients with colorectal cancer documented in the cancer registry in Iran during a time period of 4 years from March 2001 to March 2005. One-year, 2-3 year and 4-5 year point prevalence were estimated from incidence rates in different years and proportion of patients surviving 0.5, 1.5, 2.5, 3.5 and 4.5 years after diagnosis. Proportion of cases surviving 0.5, 1.5, 2.5, 3.5 and 4.5 years from diagnosis were 79.2%, 65.08%, 57.36%, 51.76% and 48.87% respectively. Estimation of prevalence at 1, 2-3 and 4-5 years were 4156, 5715 and 4283 cases, respectively. Cumulative 5 year prevalence was 13954 cases. Estimates of prevalence at 1, 2-3 and 4-5 years are necessary for the evaluation of initial treatment, clinical follow-up and point of cure, and also for identification of patients who need further social support or health care. Therefore 1, 2-3 and 4-5 year point prevalence estimation are necessary in health service planning for cancer management. Colorectal cancer is a common and lethal disease with 5000 new cases reported each year in Iran. This study was done to estimate the 1, 2-3 and 4-5 year point prevalence of colorectal cancer in Iran. In this descriptive study we studied the follow-up of 2342 patients with colorectal cancer documented in the cancer registry in Iran during a time period of 4 years from March 2001 to March 2005. One-year, 2-3 year and 4-5 year point prevalence were estimated from incidence rates in different years and proportion of patients surviving 0.5, 1.5, 2.5, 3.5 and 4.5 years after diagnosis. Proportion of cases surviving 0.5, 1.5, 2.5, 3.5 and 4.5 years from diagnosis were 79.2%, 65.08%, 57.36%, 51.76% and 48.87% respectively. Estimation of prevalence at 1, 2-3 and 4-5 years were 4156, 5715 and 4283 cases, respectively. Cumulative 5 year prevalence was 13954 cases. Estimates of prevalence at 1, 2-3 and 4-5 years are necessary for the evaluation of initial treatment, clinical follow-up and point of cure, and also for identification of patients who need further social support or health care. Therefore 1, 2-3 and 4-5 year point prevalence estimation are necessary in health service planning for cancer management

Five and ten years survival in breast cancer patients mastectomies vs. breast conserving surgeries personal experience

Breast carcinoma is the first malignancy among Iranian ladies and the second cause of death due to cancers after gastric carcinoma. According to the World Health Organization the annual incidence rate of breast cancer will rise 1.8 to 2 percent. It is one of the most important health problems. Five year survival is one of the indicators used for evaluation of the quality of care to different types of malignancies. In this study we decided to compare the result of mastectomy and breast conserving surgery in the survival of patients with breast carcinoma. This is a retrospective study using data from breast carcinoma cases in a private clinic under supervision of the author during years 1994 until 2007. These cases base on the clinical status underwent surgery as mastectomy or breast conserving with other necessary treatment. The number of patients with acceptable follow up was 464 cases that 441 were included to define survival. The data were analyzed by SPSS and survival estimated by Kaplan Mayer method. Survival curve was estimated for 441 cases of them, six cases were men and the age of patients was 22 to 104 years old with average of 53.24 years and standard deviation of 12.41. The most cases were among 45-55 years old. Five and ten years survival for all cases was 81% and 77% respectively. These data for mastectomies patients was 78 and 70 percent and for breast preserving cases was 86 and 78 percent which was not significant in log rank test with p-value equally 0.13. There was no significant difference between mastectomies patients versus breast preserving cases in all clinical stages although the crude data shows better situation in breast preserving surgery [BPS]. Breast cancer is one of the most important health problems, nowadays breast preserving surgery is choice treatment for stage I and II throughout the world. In this study overall 5 years survival was 81% comparable with developed countries with different health delivery system and quality of care and it is much better than other reports from Iran, regional and comparable countries. Because of many reasons such as physical, social and psychological effect of BPS, we recommend it as the best choice for managing breast cancer patients in stage I and II and even III in clinically approved cases in Iran similar to other countries

Ten year breast cancer screening and follow up in 52200 women in Shahre-Kord, Iran [1997-2006]

This study was conducted to determine the outcomes of the project of 'Integration of Breast Cancer Screening and Early Detection' into Primary Health Care [PHC] System and to detect the incidence rate, mortality rate and the stage of reported breast cancers, during the timeframe of the project in Shahre-Kord. A prospective cohort study was conducted, reviewing medical records of all women aged over 30 in Shahre-Kord district who participated in the screening project between 1997 and 2006. Patients' demographic data, risk factors, diagnostic approach, treatments after definite diagnosis, and time of death of the deceased patients due to breast cancer were investigated from four sources: Provincial Health Centre, direct conversation via telephoning and interview, medical records of patients admitted to Seyed-Al Shohada Hospital, Isfahan [as the only referral oncology hospital in the region], and the provincial vital registry system as a part of national cancer registry Overall 52200 women were eligible to enter the study and in this population, 40 breast cancer cases were detected. Incidence rate of breast cancer in women older than 30 years, during the timeframe of study, is estimated as 77.6 per 100000. Clinical features of the patients were as follow: stage-IIA [20%], stage-IIB [40%], stage-IIIA [30%] and stage-IIIB [10%]. All 40 cases of cancer underwent pathology diagnosis, which showed infiltrative ductal carcinoma in 38%, invasive ductal carcinoma in 33%, ductal carcinoma in 25%, and infiltrative colloidal carcinoma in 4% of them. During the study, 31 cases [77.5%] survived and 9 cases [22.5%] died, all due to breast cancer The mean age of breast cancer in this study was significantly lower than Western countries. Mortality rate due to breast cancer in this study during ten year follow up was 1.73 in 100000 women population, which is less than the national figure of 3.16 in 100000

Epidemiology of deaths from injuries in the Islamic Republic of Iran

A 1-year study of fatal injuries was carried out in 10 provinces of the Islamic Republic of Iran based on a population of 16 740 637 in 2000-01. All reported deaths were compared and validated with other sources of death registration. Out of 66 846 deaths, 9733 [58/100 000] resulted from injuries. Overall, 14.9% of all deaths with 26.9% of years of lost life were from injuries. Most fatal injuries were unintentional [48.0/100 000]. Deaths from traffic injuries [30.0/100 000] are the highest in the world. Of 1693 intentional fatal injuries, 61% were due to suicide, at a mean age of 29 years

5 year survival of breast cancer in Shohada-e- Tajrish and Jorjani Hospitals

Breast cancer is the most common cancer and the second most common cancer of cancer death in Iranian women after gastric carcinoma; although it is the second most common cancer in the western women after lung cancer. Its survival depends on multiple factors, which are very important to identify in order to understand natural history of the disease in Iran. In the present study, 154 patients with T1-T2-T3-NO-N1-MO breast cancer participated between March 1996 and March 1998 after surgery followed by adjuvant chemotherapy and/or radiation therapy and/or tamoxifen and were followed up for at least 5 years. Different factors might be effective on survival evaluation. Data was analyzed by SPSS, using chi-square and Kaplan Mayer method for survival analysis. 5 year survival was 76.5%.It decreased by lymph node involvement [72.9% versus 88.9%, p=0.034] and increased in estrogen receptor positive tumors [84.3% versus 62.5,p=0.024]. Left breast cancer patients survived more than right ones [87.5% versus 76.5%, p=0.004]. Tumor size, type of pathology, age, type of surgery [breast conservative surgery or mastectomy] progestrone receptors, HER-2 proto- oncogene and type of chemotherapy had no effect on survival. There is high survival by adjuvant therapy in Iran when breast cancers is detected at an early stage without lymph node involvement and receive appropriate therapy. The other factors should be studied more by future researches

Surveying the role of tamoxifen on thyroid function tests in patients with breast cancer referring to Shohada-E-Tajrish Hospital

While tamoxifen has been shown to alter concentration of many hormones and their binding globulins, there have been conflicting results on its effects on the thyroid function tests. We attempted to clarify these effects by studying subject in an uncontrolled clinical trial.We evaluated 64 women with breast cancer who had participated in a nonrandomized pretest posttest study. They were given 20mg tamoxifen orally daily at least for 12 months. Measurement of thyroid stimulation hormone [TSH], free thyroxin index [FTI], thyroxin [T[4]] and three idothyronin [T[3]] were made for each subject before and after 6 and 12 months of treatment.Results revealed that T4 level has significantly increased 6 months, but not 12 months, following the therapy [p < 0.0001]. Meanwhile, T[3] and TSH levels remained unchanged during the follow up period [NS]. FTI results showed a significant increase in the mean value within the normal range after one year [p < 0.005]. Tamoxifen may induce increased level of FTI within the first year of treatment, however, this change is within the normal level. Moreover, T[4] increased during the first 6 months but return within the normal range after 12 months