Association of DNA repair gene variants with colorectal cancer: risk, toxicity, and survival.

BACKGROUND: Single nucleotide polymorphisms (SNPs) in DNA repair genes have a potential clinical value in predicting treatment outcomes. In the current study, we examined the association of SNPs in the genes XRCC1-rs25487, ERCC1-rs11615, ERCC2-rs238406, and ERCC2-rs13181 with colorectal cancer (CRC) risk, relapse-free survival (RFS), overall survival (OS), and toxicity during chemotherapy. METHODS: SNPs were analysed in 590 CRC cases and 300 controls using TaqMan technology. The association of SNPs with CRC risk and toxicity during chemotherapy was analysed using Chi2 test. The Kaplan-Meier method and log-rank test was used to measure the effects of the SNPs on RFS and OS. RESULTS: The CC genotype of ERCC2-rs238406 and the ERCC2-rs13181 C allele were associated with a significantly increased risk of CRC. The ERCC1-rs11615 genotype T/T was associated with stomatitis in adjuvant chemotherapy (p = 0.03). Also, more patients with the ERCC2-rs13181 C allele needed dose reduction compared to patients with the A/A genotype (p = 0.02). In first line chemotherapy, more patients with the ERCC1-rs11615 C allele suffered from nausea compared to those with the T/T genotype (p = 0.04) and eye reactions and thrombocytopenia were more common in patients with the ERCC2-rs13181 C allele compared to the A/A genotype (p = 0.006 and p = 0.004, respectively). ERCC2- rs238406 C/C was also associated with a higher frequency of thrombocytopenia (p = 0.03). A shorter 5-year OS was detected in stage I & II CRC patients with the ERCC2- rs238406 C allele (p = 0.02). However, there was no significant association between the SNPs and 5-year RFS. CONCLUSIONS: Both SNPs in ERCC2 were associated with risk of CRC as well as toxicity during first line treatment. In addition, ERCC2- rs238406 was linked to OS in early stage CRC. The ERCC1-rs11615 variant was associated with toxicity during adjuvant chemotherapy. The results add support to previous findings that SNPs in ERCC1 and ERCC2 have a prognostic and predictive value in clinical management of CRC.

Advanced colonic neoplasia in the first degree relatives of colon cancer patients: A colonoscopy-based study.

We aimed to determine the risk of advanced neoplasms among a cohort of asymptomatic first degree relatives (FDRs) of patients with sporadic colorectal cancer (CRC) compared with matched controls. Data for patients with a diagnosis of CRC made between September 2013 and August 2014 were obtained from a population-based cancer registry system in Tehran. Screening colonoscopies were done for 342 FDRs and the findings were compared to those from 342 age- and gender-matched healthy controls without a family history of CRC. We reported the association as conditional Odds Ratio (OR) using Mantel Hazel and Logistic regression. The prevalence of advanced neoplasia was 13.2% among FDRs and 3.8% in controls (matched OR [mOR], 4.0, 95% confidence interval [CI], 2.1 - 7.6; p < 0.001). In FDRs aged 40-49 years, the prevalence of advanced neoplasia was significantly higher than in their matched controls (mOR, 6.8, 95% CI, 1.5-31.4; p = 0.01). Family history of CRC in at least one FDR was the strongest predictor of advanced neoplasia (adjusted OR, 4.0, 95% CI: 2.1-7.6; p < 0.001). The age of the index case at diagnosis did not predict the presence of advanced colonic neoplasms in their FDRs. Our study indicates a high risk of advanced neoplasia in FDRs of CRC cases, where only eight colonoscopies are needed to detect one advanced neoplasia. Our data suggest that all FDRs, regardless of the age of CRC diagnosis in their index case, should be considered for a targeted early screening.

Adenoma detection rates in an opportunistic screening colonoscopy program in Iran, a country with rising colorectal cancer incidence.

BACKGROUND: Data on the quality of colonoscopies in populations with rising colorectal cancer (CRC) incidence is scarce. We aimed to calculate the adenoma detection rates (ADR), and assess the quality of colonoscopies in an opportunistic screening colonoscopy program in Iran. METHODS: All the colonoscopy and pathology reports of asymptomatic adults over age 50 who underwent screening colonoscopy between June 2007 and March 2013 were reviewed. The colonoscopy quality indicators including ADR were calculated, and patient factors associated with the adenoma detection were determined. RESULTS: A total of 713 asymptomatic adults aged 50 years and older who underwent their first-time screening colonoscopy were included in this study. ADR and advanced-ADR were 33.00% (95% CI: 29.52-36.54) and 13.18% (95% CI: 10.79-15.90), respectively. We observed a significantly higher rate of cecal intubation in patients with fair or better bowel preparation compared to those with poor prep, 90.00% vs. 70.45%, respectively (P < 0.001). Bowel preparation (adjusted OR: 2.49, 95% CI: 1.75-3.55), older age (≥60) (adjusted OR: 1.70, 95% CI: 1.22-2.36), and male gender (adjusted OR: 1.39, 95% CI: 1.01-1.92) were associated with the adenoma detection. CONCLUSIONS: Our ADR in both genders meets and exceeds the recommended colonoscopy quality benchmarks. The polyp and adenoma detection rates in the current study are comparable to those reported from Western countries where the incidence of CRC is traditionally high. These data are in line with the epidemiologic transition of CRC in Iran.

Effectiveness of a theory-based intervention to increase colorectal cancer screening among Iranian health club members: a randomized trial.

Colorectal cancer is the third most commonly diagnosed cancer and the fourth leading cause of death in the world. There are few published studies that have used theory-based interventions designed to increase colorectal cancer screening in community lay health organizations. The present study was guided by the theoretical concepts of the preventive health model. Twelve health clubs of a municipal district in Tehran were randomized to two study groups with equal ratio. The control group received usual services throughout the study while the intervention group also received a theory-based educational program on colorectal cancer screening plus a reminder call. Screening behavior, the main outcome, was assessed 4 months after randomization. A total of 360 members aged 50 and older from 12 health clubs completed a baseline survey. Participants in the intervention group reported increased knowledge of colorectal cancer and screening tests at 4 months follow-up (p's < .001). Moreover, exposure to the theory-based intervention significantly improved self-efficacy, perceived susceptibility, efficacy of screening, social support, and intention to be screened for colorectal cancer, from baseline to 4 months follow-up (p's < .001). The screening rate for colorectal cancer was significantly higher in the intervention group compared to the control group (odds ratio = 15.93, 95% CI = 5.57, 45.53). Our theory-based intervention was found to have a significant effect on colorectal cancer screening use as measured by self-report. The findings could have implications for colorectal cancer screening program development and implementation in primary health care settings and through other community organizations.

Colorectal Cancer Screening Pilot Project in Tehran-Iran, a Feasibility Study.

BACKGROUND: Colorectal cancer (CRC) is the third most common cancer in Iran, where there is no organised CRC-screening programme. This study aimed to evaluate feasibility of CRC screening using a qualitative fecal immunochemical test (FIT) among Iranian average-risk adults. METHODS: In this feasibility study, 7039 individuals aged 50-75 years were invited by community health workers (CHWs) in southern Tehran and its suburban districts between April 2018 and November 2019. The CHWs performed a qualitative FIT with cut-off level 50 ng Hb/mL buffer and referred those with positive-FIT for colonoscopy to the endoscopy center of Shariati hospital in Tehran. Outcomes included acceptance rate, FIT positivity rate, colonoscopy compliance, detection rates and positive predictive values (PPVs) with 95% confidence interval for CRC and advanced adenomas (AAs). RESULTS: Acceptance rate at initial invitation was 71.7%. From 4974 average-risk adults (1600 males and 3374 females) who were offered FIT, 96.8% (n=4813) provided valid samples, of whom 471 (9.8%) tested positive. Among FIT-positive participants, 150 (31.8%) underwent colonoscopy; CRC was detected in 2.0% (n=3) and adenomas in 27.3% (n=41). Detection rate of CRC and AAs per 1000-FIT-screened participants was 0.6 (0.1-1.8) [males: 0.7 (0.01-3.6), females: 0.6 (0.07-2.0)] and 4.2 (2.5-6.4) [males: 5.9 (2.6-11.0), females: 3.4 (1.7-6.0)], respectively. PPVs were 2.0% (0.4-5.7) for CRC and 13.3% (8.3-19.8) for AAs. There was no association between gender and the studied outcomes. CONCLUSION: Our results partially support the feasibility of scaling up organized CRC-screening through the existing healthcare system in Iran; it remains to be discussed carefully to ensure the capacity of healthcare system for adequate colonoscopy services.

Predictive Factors of Advanced Colonic Adenomas and Cancer Using Data Mining.

BACKGROUND Colorectal cancer is the third common cancer in Iran. In this study we aimed to identify factors associated with the prevalence of advanced colonic neoplasms among a high-risk population. METHODS Participants were 474 first degree relatives of patients with colon cancer who underwent a screening colonoscopy at Digestive Disease Research Institute, Shariati Hospital affiliated to Tehran University of Medical Sciences. Features examined in this study were age, sex, body mass index, Aspirin use, smoking, and relationship type with patients with cancer in family. Also, patient's age at the time of cancer diagnosis, number and sex of the patients with colon cancer in the family were assessed. Data analysis was performed by data mining methods using K-Medoid clustering and decision tree C4.5. RESULTS Results showed that female sex of the patients with colon cancer and their young age (< 60 years old) at the time of cancer diagnosis were important predictive factors for the prevalence of colorectal advanced neoplasms among their family members. CONCLUSION Data mining methods were found to be applicable in recognizing predictive factors of colorectal advanced neoplasms in each cluster and tree.

Motivational interviewing and screening colonoscopy in high-risk individuals. A randomized controlled trial.

OBJECTIVE: To measure the impact of motivational interviewing (MI) on cancer knowledge and screening practice among first degree relatives (FDRs) of patients with colon cancer. METHODS: This randomized controlled trial targeted patients with colon cancer first to recruit their possible FDRs. Digit randomization of the eligible index patients into intervention or control groups resulted in allocating their belonging FDRs to the same study arm. FDRs (n = 120) in intervention arm received MI counseling on phone by a trained oncology nurse and FDRs (n = 120) in control group received standard generic information by a physician on phone. Primary outcome was the rate of documented colonoscopy in FDRs within six months after the baseline. RESULTS: A total of 227 FDRs were followed up, 115 in the intervention and 112 in the control group. At follow-up, the uptake of screening colonoscopy in the intervention group was 83.5% versus 48.2% in controls (crude odds ratio, 5.4; 95% confidence interval, 2.9-10.0, P < .001). CONCLUSION: This was the first randomized controlled trial in Iran that confirmed the efficaciousness of a phone-based MI counseling in improving colonoscopy uptake among family members of patients with colon cancer. PRACTICE IMPLICATIONS: Phone-based motivational counseling that involves trained nurses or health providers seems to be feasible approach in Iran health system and enhances screening for colon cancer.

Annual Trends of Gastrointestinal Cancers Mortality in Iran During 1990-2015; NASBOD Study.

BACKGROUND: Gastrointestinal (GI) neoplasms are among the most common cancers in Iran. This study aimed to measure annual trends in mortality rates from GI cancers in Iran between 1990 and 2015. METHODS: This study was part of an ongoing study termed the 'National and Subnational Burden of Diseases' study in Iran. Data used in this study was obtained from the Iranian Death Registration System (1995 to 2010) and from 2 major cemeteries in Tehran (1995 to 2010) and Isfahan (2007 to 2010). All-cause mortality rates were estimated using the spatio-temporal model and the Gaussian process regression model. Age-standardized mortality rates (ASMR) per 100 000 person-years was calculated using data from Iran and the standard world population for comparison. RESULTS: Among GI cancers, gastric cancer represented the leading cause of mortality followed by cancers of the esophagus, liver, and colorectal cancers with the ASMR of 20.5, 5.8, 4.4, and 4.0 per 100 000 persons-years, respectively, between 1990 and 2015. While a decreasing trend occurred in mortality of esophageal, gastric, and colorectal cancers, particularly in the recent decade, we recorded an upward pattern and steady rise in mortality rates from liver, pancreatic, and gallbladder cancers during the study period. The ASMR of all studied causes were enhanced by advancing age and were found to be more prominent in adults aged 50 or older. Among all age-groups, higher death rates were detected in males versus females for all studied cancers except for gallbladder and biliary tract cancers. CONCLUSION: Gastric cancer mortality is still high and death rates from several other GI cancers are increasing in the nation. Interventions for cancer prevention, early detection, and access to high quality cancer treatment services are needed to reduce GI cancer burden and death rates in Iran and in the region.

Cost-effectiveness of Screening Colonoscopy in Iranian High Risk Population.

BACKGROUND: Colorectal cancer (CRC) is the fourth most common cancer among men and the second among women in Iran. First-Degree Relatives (FDRs) of patients with CRC are known to be at higher risk of CRC. The aim of this study was to identify the most cost-effective strategy for CRC screening in Iranian high risk individuals. METHODS: A Markov model was developed to assess the cost-effectiveness of six colonoscopy screening strategies for individuals at increased risk of CRC because of positive history of the disease in at least one first-degree relative in their family. Our strategies included five-yearly or ten-yearly colonoscopy starting from the age of 40 or 50 and colonoscopy once at 50 or 55 years. Data were extracted from the published literature, Globocan 2012 database, and national cancer registry reports. The Markov model contained 11 mutually exclusive health states. Time horizon of model was life time and cycle duration was 1 year. Outcomes included life year gains, Quality Adjusted Life Years (QALYs) and costs. The TreeAge Pro software was used for data modeling. RESULTS: All six screening strategies increased the life expectancy and QALY and were costlier than no screening. The incremental cost per QALY gained for CRC screening varied from $489 for one colonoscopy screening per lifetime at 55 years to $3,135 for colonoscopy screening every five years starting at the age of 40, compared with no screening. When strategies were compared with the next best strategy, dominated strategies were removed from analysis, one colonoscopy screening per lifetime at 55 years old; or every ten years starting at the age 40; or every five years starting at age 40 remained with incremental cost effective ratios of $489, $2,505, and $26,080 per QALY gained, respectively. CONCLUSIONS: CRC colonoscopy screening in high-risk individuals is cost-effective in Iran. Colonoscopy screening every 10 years starting at the age of 40 was the most cost-effective strategy.

Cancer Screening Awareness and Practice in a Middle Income Country; A Systematic Review from Iran

Objective: Ageing population and noticeable changes in lifestyle in developing countries like Iran caused an increase in cancer incidence. This requires organized cancer prevention and screening programs in population level, but most importantly community should be aware of these programs and willing to use them. This study explored existing evidence on public awareness and practice, as well as, adherence to cancer screening in Iranian population. Methods: Major English databases including Web of Science, PubMed, Scopus, and domestic Persian databases i.e., SID, Magiran, and Barakat search engines were searched. All publications with focus on Iranian public awareness about cancer prevention, screening, and early detection programs which were published until August 2015, were explored in this systematic review. For this purpose, we used sensitive Persian phrases/key terms and English keywords which were extracted from medical subject headings (MeSH). Taking PRISMA guidelines into considerations eligible documents, were evaluated and abstracted by two separate reviewers. Results: We found 72 articles relevant to this topic. Screening tests were known to, or being utilized by only a limited number of Iranians. Most Iranian women relied on physical examination particularly self-examination, instead of taking mammogram, as the most standard test to find breast tumors. Less than half of the average-risk adult populations were familiar with colorectal cancer risk factors and its screening tests, and only very limited number of studies reported taking at least one time colonoscopy or FOBT, at most 5.0% and 15.0%, respectively. Around half of women were familiar with cervical cancer and Pap-smear test with less than 45% having completed at least one lifetime test. The lack of health insurance coverage was a barrier to participate in screening tests. Furthermore some people would not select to be screened only because they do not know how or where they can receive these services. Conclusion: Low awareness and suboptimal use of screening tests in Iran calls for effective programs to enhance intention and compliance to screening, improving the patient-physician communication, identifying barriers for screening and providing tailored public awareness and screening programs.

Feasibility of Colon Cancer Screening by Fecal Immunochemical Test in Iran.

BACKGROUND: Colorectal cancer (CRC) is the third most common cancer in Iran, where there is no mass screening for the disease yet. We aimed to measure the feasibility of a pilot CRC screening program based on fecal immunochemical test (FIT) in Iranian population and the implications for scaling-up at the national level. METHODS: A single quantitative FIT was offered by health navigators to individuals aged between 45 and 75 years in primary health centers in rural and urban areas in Tehran. Participants who had a positive FIT were referred for colonoscopy. RESULTS: A total of 1044 asymptomatic average-risk individuals were enrolled. The mean age (SD) was 54.1 ± 7.0 years and nearly 63.0% (n = 657) were female. Only a small fraction of the participants had a prior screening practice (2.2%) and were aware of colon cancer (13.7%). In sum, 1002 returned the FIT kit, of whom the stool sample was unsatisfactory for testing in six participants (0.6%). The FIT uptake was 96.0%, positivity rate was 9.1% and the detection rates were 11.9% for adenomas and 7.1% for advanced adenomas. No cancer was detected. The positive predictive value (PPV) of the FIT was about 17% for any colonic neoplasms. CONCLUSION: This is the first study that reports minimal quality metrics within a CRC screening process. FIT modality as a test of choice for colon cancer screening in average-risk people is a safe and highly acceptable method of screening in Iranian people. The results of the current study may not be limited to Iranians, and could have implications to other developing countries with similar trends of CRC epidemic.

Prevalence of Active and Passive Smoking among Adult Population: Findings of a Population-Based Survey in Kerman (KERCADRS), Iran.

BACKGROUND: Smoking is one of the major modifiable risk factors for non-communicable diseases. Our aim was to report the pattern of active and passive smoking using the data collected through a population-base household survey in Kerman, Iran [(KERCADRS) Kerman Coronary Artery Disease Risk Factors Study]. METHODS: Using a cluster random sampling design, we recruited 5900 adult persons (15-75 years old) into our survey. After consenting, every participant was interviewed by a trained interviewer. The section for smoking included questions about daily (smoking at least one cigarette per day), non-daily, past and passive cigarette smoking as well as the duration of the exposure. We used Kerman population distribution (as the target population) to adjust our estimates using direct standardization method. FINDINGS: Overall, 8.3% of study participants (15.5% in men vs. 0.8% in women, P = 0.010) reported themselves as daily smokers and an additional 1.7% (2.9% in men vs. 0.4% in women, P = 0.010) as non-daily smokers. The passive smoking was common in total (27.5%), while women experienced more exposure than men (30.1% vs. 25.0%, P = 0.010). In daily smokers, 3.2% smoked more than 20 cigarettes per day. Among passive smokers, 62.6% were exposed to cigarette smoke more than 6 days per week. CONCLUSION: Smoking is pretty common among adult populations, particularly in men. A majority of tobacco-free young adult women are exposed to passive smoking. Age and gender oriented interventions are required to change this risk pattern in Kerman community to prevent from further smoking related morbidities and mortalities.

Cancer risk awareness and screening uptake in individuals at higher risk for colon cancer: a cross-sectional study.

OBJECTIVE: We aimed to measure cancer knowledge and feasibility of a screening colonoscopy among a cohort of individuals at higher risk of colon cancer. METHODS: This study was conducted as part of an ongoing screening cohort, in which first degree relatives (FDRs) of patients with colon cancer are invited to participate in a free of charge screening colonoscopy. We enrolled 1017 FDRs in the study between 2013 and 2014 measuring their data on demographics, cancer knowledge and colonoscopy uptake. A p value of <0.05 was considered statistically significant. RESULTS: The relative's mean age was 48.7 years. Only about 28% of FDRs were aware of their increased risk for cancer, near 35.0% had ever heard about colonoscopy with 22% aware of the correct age to start screening. Comparing cancer knowledge of FDRs at high risk versus those at moderate risk, we recorded non-significant differences (p>0.05). Almost two-thirds of FDRs expressed willingness to undergo a colonoscopy and 49.2% completed the procedure, of which 12.8% had advanced neoplasm. CONCLUSIONS: Our data indicated that remarkable numbers of FDRs were not still informed of their cancer risk or never received a physician recommendation for screening. The desirable uptake at first invitation, which would be higher over successive invitations, supports the feasibility of a family-based recruitment approach for early screening. This has promising implications to introduce targeted screening colonoscopy into the healthcare system in Iran and other developing nations.

Physicians' Knowledge and Attitude Towards Fecal Microbiota Transplant in Iran.

BACKGROUND Fecal microbiota transplant (FMT) is employed to replace the 'unhealthy' microbiota of the patient with the 'healthy' microbiota of a pre-screened healthy donor. Given the growing importance of gut microbiota dysbiosis in the pathogenesis of intestinal or extraintestinal diseases; it is conceivable that FMT becomes integrated in the routine clinical practice. Our objective was to assess the knowledge and attitude of the Iranian physicians towards FMT. METHODS We surveyed the participants of Iranian gastroenterology and hepatology 2014 conference. RESULTS Overall, 146 (68.5%) were familiar with FMT; of whom 132 (94.28%) were willing to accept FMT if scientifically and ethically approved and 115 (88.46%) were willing to refer their patients for FMT if indicated. In total, 42 (30.7%) had identified stool preparation as the most unappealing aspect of FMT, while 17 (11.6%) reported the therapeutic use of fecal material as the most unappealing and 39 (28.5%) indicated that both are equally unappealing. The doctors who had an overall positive opinion toward FMT reported less negative feelings towards FMT. CONCLUSION Iranian physicians are willing to accept FMT as a therapeutic option if it is scientifically justified and ethically approved. Nevertheless, physicians prefer to skip the stool preparation phase; as they are more in favour of synthetic microbiota as opposed to fecal microbiota.

Mean Polyp per Patient Is an Accurate and Readily Obtainable Surrogate for Adenoma Detection Rate: Results from an Opportunistic Screening Colonoscopy Program.

BACKGROUND The incidence of colorectal cancer is rising in several developing countries. In the absence of integrated endoscopy and pathology databases, adenoma detection rate (ADR), as a validated quality indicator of screening colonoscopy, is generally difficult to obtain in practice. We aimed to measure the correlation of polyp-related indicators with ADR in order to identify the most accurate surrogate(s) of ADR in routine practice. METHODS We retrospectively reviewed the endoscopic and histopathological findings of patients who underwent colonoscopy at a tertiary gastrointestinal clinic. The overall ADR and advanced-ADR were calculated using patient-level data. The Pearson's correlation coefficient (r) was applied to measure the strength of the correlation between the quality metrics obtained by endoscopists. RESULTS A total of 713 asymptomatic adults aged 50 and older who underwent their first-time screening colonoscopy were included in this study. The ADR and advanced-ADR were 33.00% (95% CI: 29.52-36.54) and 13.18% (95% CI: 10.79-15.90), respectively. We observed good correlations between polyp detection rate (PDR) and ADR (r=0.93), and mean number of polyp per patient (MPP) and ADR (r=0.88) throughout the colon. There was a positive, yet insignificant correlation between advanced ADRs and non-advanced ADRs (r=0.42, p=0.35). CONCLUSION MPP is strongly correlated with ADR, and can be considered as a reliable and readily obtainable proxy for ADR in opportunistic screening colonoscopy programs.

Psycho-social Determinants of Colorectal Cancer Screening in Iran.

BACKGROUND: Colorectal cancer (CRC) is the third most prevalent cancer among Iranians, and threatens them at younger ages. This study was guided by the theoretical concepts of the preventive health model (PHM) to assess the attitudes and beliefs of Iranians towards CRC screening. METHODS: This cross-sectional study was conducted with participation of 200 individuals aged 50 years or older in a Teaching Hospital in Tehran, Iran. Background characteristics (e.g., age, gender, marital status) were assessed and a validated instrument drawn from the PHM was applied to measure cognitive and psychosocial variables (i.e., self-efficacy, intention to screening, perceived susceptibility, cancer worries, response efficacy, and social support). Data were collected via face-to-face interviews and analyzed using the SPSS version 13.00 for Windows. RESULTS: The age of the participants ranged from 50 years to 83 years (mean 60.13). Most respondents were married (62.5%), unemployed (42%), and had secondary or higher education (44.5%). Overall, 11% of respondents reported prior screening. Individuals obtained relatively poor scores on self-efficacy, intention to screening, perceived susceptibility, cancer worries, response efficacy, and social support. CONCLUSIONS: In this study, individuals mostly reported poor attitude in regard to CRC screening. The results of the present study could guide policy makers in designing tailored interventions to increase the participation of individuals in screening programs.

Quality evaluation of national cancer registry system in Iran: study protocol.

BACKGROUND: Cancer registry can be a very important component of health information system in developing countries. Routine collection of data and ongoing monitoring of their quality can have a crucial role in priority setting and evidence-based policy making for controlling cancers and trends follow-up in low and middle-income countries. Evaluation of cancer registered data consists of four important components including: comparability, completeness, validity, and timeliness. Similar frameworks are utilized in different countries all over the world. METHODS AND MATERIALS: We will use the national annual cancer registry reports in Iran alone or perhaps along with other Iranian published reports about childhood cancer incidence to determine the stability and trend of incidence rates over time and compare above mentioned reports with childhood cancer incidence data reported by other countries through a systematic review as well as in some cases meta-analysis in order to assess data quality. Data will also be collected from other sources such as death certificates to estimate mortality rates and other different methods will also be additionally applied, by use of which death certificates would be utilized to assess the quality of data, too. CONCLUSION: As the first step for proper measuring incidence rate of all types of cancers all over the country, we will assess and evaluate reported national cancer registry data in Iran in order to estimate the national burden of cancers in 1990 - 2013.

Perception of breast cancer screening among Iranian women without experience of mammography: a qualitative study.

BACKGROUND: In Iran, there are high rates of breast cancer. It is among the five most common cancers, the first among cancers diagnosed, and is the leading cause of cancer deaths among Iranian women. OBJECTIVES: The purpose of this qualitative study was to explore perception of breast cancer screening among Iranian women who have never had a mammograph. MATERIALS AND METHODS: The current study was part of a qualitative research conducted by means of content analysis method and purposive sampling of 16 women over the age of 30 years who had not undergone mammography using individual semi-structured interviews. Interviews were recorded and transcribed verbatim. The data were under continuous consideration and comparative analysis in order to achieve data saturation. RESULTS: After codification of data, three concept categories were achieved including: i) low awareness, ii) worries, and iii) lack of motivation. CONCLUSIONS: Although there is a tendency among Iranian women to participate in breast cancer screening, there is a powerful cultural belief that breasts are sexual organs that should not be discussed publicly. Due to the incidence of breast cancer in Iranian women, it is critical that breast awareness education be performed by health care experts to explore the concepts of breast cancer and breast cancer screening.

Characteristics of colorectal polyps and cancer; a retrospective review of colonoscopy data in iran.

BACKGROUND Early diagnosis and endoscopic resection of adenomatous polyps is the main approach for screening and prevention of colorectal cancer (CRC). We aimed to assess polyp detection rate (PDR) and to characterize demographic, clinical, and pathological features of colorectal polyps in an Iranian population. METHODS We retrospectively analyzed the data from 5427 colonoscopies performed during 2007-2012 at Masoud Clinic, the main endoscopy center associated with Sasan Alborz Biomedical Research Center, in Tehran, Iran. RESULTS Our sample included 2928 (54%) women and 2499 (46%) men, with the mean age of 48.3 years (SD=16.1). The most common reasons for colonoscopy included screening in 25.0%, and gastrointestinal bleeding in 15.2%. Cecal intubation was successful in 86% of patients. The quality of bowel preparation was fair to excellent in 78.1% (n=4235) of colonoscopies. Overall PDR was 42.0% (95% CI: 40.6-43.3). The PDR in men (51.1%, 95% CI: 49.1-53.1) was significantly higher than women (34.2%, 95% CI: 32.4-35.9, p<0.001). Polyps were more frequently observed in patients after the 6(th) decade of life (F=3.2; p=0.004). CRC was detected in 2.9% (73/2499) of men and 1.9% (57/2928) of women (p=0.02). The mean age for patients with cancer was significantly higher than that for individuals with polyps, 60.9 (SD=13.4) year vs. 56.9 (SD=13.7) year, respectively (p=0.001). Almost 82.8% of the lesions were precancerous with tubular type predominance (62.3%) followed by tubulo-villous (10.3%), villous (6.6%), and serrated (3.6%). Hyperplastic/inflammatory polyps comprised 17.2% of lesions. CONCLUSION Distal colon was more prone to develop polyps and cancer than proximal colon in our series. These findings provide a great infrastructure for next preventive programs and have implications for colorectal cancer screening at population-level.

The trend of national and sub-national burden of gastrointestinal and liver diseases in Iran 1990 to 2013; study protocol.

BACKGROUND: It is expected that gastrointestinal (GI) and liver diseases inflict considerable burden on health systems in Iran; therefore, highlighting the significance of GI disorders across the other most burdensome diseases requires comprehensive assessment and regular updates of the statistics of such diseases in Iran. OBJECTIVE: To assess in-depth sub-national estimates and trends for the incidence and prevalence of selected GI and liver diseases by age, gender and province over the period 1990 - 2013 in Iran. METHODS: This is a national and sub-national burden of disease study on 21 GI diseases using all available data sources, including cancer registry, death registration system data, hospital data, and all available published data. Analyses will be performed separately by gender, age groups, year, and province. We will conduct 21 separated systematic reviews of the literature for 21 diseases categories through searching online international electronic databases (i.e. the Medline database of the National Library of Medicine, Web of Science, and Scopus), Iranian search engines (i.e., IranMedex, Scientific Information Database (SID), and IRANDOC), and gray literature. We will search the medical literature published between January 1985 and December 2013. We generated two models, Spatio-temporal and Multilevel Autoregressive models, to estimate mean and uncertainty interval for the parameters of interest by gender, age, year, and province. The models will be informed by data of gender, age, year, and province. Markov Chain Monte Carlo (MCMC) methods will be used to perform Bayesian inference in both modeling framework. All programs will be written in R statistical packages (version 3.0.1). RESULTS: We will calculate and present 1990 to 2013 trends in terms of prevalence, years of life lost due to premature mortality (YLLs), years lived with disability (YLDs), and disability-adjusted life years DALYs for the 21 selected GI diseases by gender, and province. We will also quantify the uncertainty interval for the estimates of interest. CONCLUSION: Results of the present study will have implications for policy making; as they allow for understanding geographic distributions of the selected GI diseases, and identifying health disparities across provinces.