The effectiveness of group problem-solving therapy on women's sexual function and satisfaction after mastectomy surgery.

BACKGROUND: Breast cancer is the second cause of death and the most common cancer in women worldwide, threatening different aspects of individual and mental health, quality of life, sexual function, and sexual satisfaction. This study aimed to determine the effectiveness of group counseling based on a problem-solving solution on women's sexual function and satisfaction after mastectomy surgery. METHODS: The present research was an open pilot study, with a pretest, a post-test, and a follow-up period. Of women referred to the Tehran Breast Cancer Institute, 32 were selected using convenience sampling. The group received eight 90-min sessions of problem-solving solution counseling. This approach is based on cognitive-behavioral therapy and can improve an individual's ability to cope with stressful life experiences. The data collection tool was FSFI and sexual satisfaction questionnaires, which were filled before the intervention (baseline), immediately after the intervention, and one month later (follow up). Data analysis was performed using SPSS 21 statistical software application at the certainty level of 95% (P < 0.05). RESULTS: The mean FSFI score increased from 18.37 ± 8.35 before the intervention to 20.88 ± 7.67 immediately after the intervention and 22.95 ± 5.79 one month later (P < 0.0001). Also, the mean sexual satisfaction score was 65.27 ± 5.98, 68.08 ± 5.61, and 70.46 ± 5.35 before the intervention, immediately after the intervention, and one month later, respectively (P < 0.05). The results also showed that although the two components of sexual function and satisfaction were statistically significant after sexual counseling, this improvement was not clinically progressive. The mean sexual function and satisfaction score was still low after sexual counseling. CONCLUSIONS: It was observed that sexual function and satisfaction were improving among the patients after the intervention. Thus, sexual health counseling sessions are recommended for breast cancer patients.

Mutation Spectra of BRCA Genes in Iranian Women with Early Onset Breast Cancer - 15 Years Experience.

Breast cancer is the most common cancer in Iran. In the recent years an upward trend has been observed in the Iranian population. Early detection by molecular approaches may reduce breast cancer morbidity and mortality. We provided consultation to 3,782 women diagnosed with early onset breast cancer during the past 15 years (1999-2014). To establish a data set for BRCA gene alterations of the Iranian families at risk, two hundred and fifty four women who met our criteria were analyzed. A total number of 46 alterations including 18 variants with unknown clinical significance (39.1%), 18 missense mutations (39.1%), 7 Indels (15.2%) and 3 large rearrangement sequences (6%) were identified. Further scanning of affected families revealed that 49% of healthy relatives harbor identical causative mutations. This is the first report of comprehensive BRCA analysis in Iranian women with early onset breast cancer. Our findings provide valuable molecular data to support physicians as well as patients for the best decision making on disease management.

The validity of MRI in evaluation of tumor response to neoadjuvant chemotherapy in locally advanced breast cancer.

BACKGROUND: Physical Examination (PE) and breast MRI are two of the currentmethods which have usually used in diagnosis of primary breast cancer. Their accuracy in detection of: either complete response or presence of residual tumor, however, has not yet been established in patients who have been received Neoadjuvant Chemotherapy (NAC).The purpose of this study was to evaluate the diagnostic accuracy of breast MRI in assessment of residual neoplastic tissue after NAC in patients with Locally Advanced Breast Cancer (LABC). METHODS: Twenty patients with LABC have undergone contrast-enhanced MRI before and after the NAC. Considering histology as the gold standard, the tumor sizes in MRI and PE have compared with the histology results. We have calculated for all below: the accuracy, sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) for each of MRI and physical examination, as well as Pearson's correlation coefficients between the results of MRI and PE, and their histology results. RESULTS: We have found an accuracy of 85% for MRI with a sensitivity of 100%, a specificity of 50%, a PPV of 83.3%, and an NPV of 100%. In addition, theaccuracy for PE was 70% with a sensitivity of 71.4%, a specificity of 66.6%, a PPV of 83.3%, and an NPV of 50%. In this study, the calculated Pearson's correlation coefficient for MRI and histology was 0.817 (p<0.0001) versus 0.26 (p=0.26) for correlation between PE and histology. CONCLUSION: MRI has higher sensitivity but less specificity than PE for detection of residual tumor after NAC in locally advanced breast carcinoma. Also, the tumor size that has measured by MRI had highly correlation with the histology.

Breast cancer molecular subtypes and associations with clinicopathological characteristics in Iranian women, 2002- 2011.

Breast cancer is a heterogeneous disease that is affected by ethnicity of patients. According to hormone receptor status and gene expression profiling, breast cancers are classified into four molecular subtypes, each showing distinct clinical behavior. Lack of sufficient data on molecular subtypes of breast cancer in Iran, prompted us to investigate the prevalence and the clinicopathological features of each subtype among Iranian women. A total of 428 women diagnosed with breast cancer from 2002 to 2011 were included and categorized into four molecular subtypes using immunohistochemistry. Prevalence of each subtype and its association with patients' demographics and tumor characteristics, such as size, grade, lymph-node involvement and vascular invasion, were investigated using Chi-square, analysis of variance and multivariate logistic regression. Luminal A was the most common molecular subtype (63.8%) followed by Luminal B (8.4%), basal-like (15.9%) and HER-2 (11.9%). Basal-like and HER-2 subtypes were mostly of higher grades while luminal A tumors were more of grade 1 (P<0.001). Vascular invasion was more prevalent in HER-2 subtype, and HER-2 positive tumors were significantly associated with vascular invasion (P=0.013). Using muti-variate analysis, tumor size greater than 5 cm and vascular invasion were significant predictors of 3 or more nodal metastases. Breast cancer was most commonly diagnosed in women around 50 years of age and the majority of patients had lymph node metastasis at the time of diagnosis. This points to the necessity for devising an efficient screening program for breast cancer in Iran. Further, prospective surveys are suggested to evaluate prognosis of different subtypes in Iranian patients.

Breast cancer knowledge, attitudes and screening behaviors in two groups of Iranian women: physicians and non-health care personnel.

Breast cancer is one of the most frequent malignancies worldwide which is characterized by early onset and diagnosis at advanced stages in Iranian women. Increasing women's awareness and implementing breast cancer screening programs detect cancer earlier and reduce mortality. Physicians play a pivotal role in this regard. Further, there is limited literature about knowledge, attitude, and screening behaviors in Iranian women. Using a questionnaire, we assessed and compared breast cancer knowledge, attitude, and screening behaviors in 102 female physicians and 94 female non-health care personnel, who were mostly from the hospital's cleaning and housekeeping sections. Of the physicians and of non-health care personnel, respectively, 93.1 and 24.7 % felt confident about their knowledge and 37.6 and 26.1 % performed monthly breast self-examination. Of physicians aged 40 and over, 31.25 and 18.75 % had clinical breast examination and mammogram, respectively, within 12 months prior to date of data collection. In non-health care personnel aged 40 and over, the results were 27.59 % for clinical breast examination and 17.24 % for mammogram at the same period of time. Despite the higher knowledge and socioeconomic class of physicians, there were no significant difference in screening behaviors between physicians and non-health care personnel (P > 0.05).

Nursing faculties' knowledge and attitude on evidence-based practice.

BACKGROUND: Evidence-based practice (EBP) is one of the main professional competencies for health care professionals and a priority for medicine and nursing curriculum as well. EBP leads to improve effective and efficient care and patient outcomes. Nurse educators have responsibility to teach the future nurses, and an opportunity to promote patient outcomes. Therefore, the aim of this study was to describe nurse educators' knowledge and attitude on EBP. MATERIALS AND METHODS: This was a descriptive study conducted in nursing faculties of two major universities of medical sciences affiliated to Ministry of Health and Medical Sciences in Tehran, Iran. Data were gathered using a three-section questionnaire. Content and face validity was further enhanced by submitting it to nursing research and education experts. Statistical analysis was carried out using SPSS 11 software. RESULTS: According the results, nursing faculties' knowledge of EBP was mainly moderate (47.1%). Significant statistical relationship was found between the level of knowledge with education and teaching experience in different nursing programs. Nurses generally held positive attitudes toward EBP (88.6%) and there was no statistical significant relationship with demographic variables. CONCLUSION: Nursing educators are in a position to influence nursing research in clinical practice in the future. Therefore, it is critical to achieve implementation of EBP and be a change agent for a paradigm shift toward EBP.

Epstein-Barr virus and breast cancer: lack of evidence for an association in Iranian women.

Controversies regarding the role of Epstein-Barr virus (EBV) in breast cancer and lack of published literature in this regard in Iran, prompted us to assess EBV presence in 100 breast carcinoma and 42 control biopsies obtained from Iranian women. Breast carcinoma cases were comprised of 81 invasive ductal carcinoma NOS, 9 invasive lobular carcinoma, 1 apocrine carcinoma, 2 cribriform carcinoma, 2 papillary carcinoma and 5 mucinous carcinoma. Control biopsies consisted of 13 fibroadenoma, 9 benign epithelial proliferation (adenosis and sclerosing adenosis), 9 usual ductal hyperplasia, 4 atypical ductal hyperplasia, 4 non-proliferative fibrocystic changes and 3 normal breast tissue. To identify EBV-infected cells we applied immunohistochemical analysis, using monoclonal antibody against Epstein-Barr virus-encoded nuclear antigen 2 (EBNA-2) and latent membrane protein 1 (LMP-1). Further, polymerase chain reaction (PCR) was used to amplify EBV DNA, with primers that cover the EBV encoded RNA (EBER) and BamHIW regions. EBNA-2 and LMP-1 immunohistochemistry were negative in all breast cancer and control specimens. Using PCR, none of the 100 breast cancer samples or the 42 control specimens showed detectable EBV DNA. These results indicate that EBV may not play a significant role in the etiology of breast cancer in Iranian women.