Mammography and Ultrasonography Reports Compared with Tissue Diagnosis - An Evidence Based Study in Iran, 2010

Akbari, Mohammad Esmaeil,Haghighatkhah, Hamidreza,Shafiee, Mohammad,Akbari, Atieh,Bahmanpoor, Mitra,Khayamzadeh, Maryam Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.5

Background: Breast cancer is the most prevalent cancer and the fifth cause of cancer death in Iranian women. Early detection and treatment are important for appropriate management of this disease. Mammography and ultrasonography are used for screening and evaluation of symptomatic cases and the main diagnostic test for breast cancer is pathological. In this study we evaluated mammography and ultrasonography as diagnostic tools. Methods: In this cross-sectional study 384 mammography and ultrasonography reports for 255 women were assessed, divided into benign and malignant groups. Suspected cases were referred for pathology evaluation. The radiologic and pathologic reports were compared and also comparison was performed based on age groups (more and less than 50 years old), history of breastfeeding and gravidity. Statistical analysis was performed by SPSS. Results: The mean ages of malignant and benign cases were $49{\pm}11.6$ and $43{\pm}11.2$ years, respectively. Sensitivity and specificity for mammography were 73% and 45%, respectively. Sensitivity and specificity for ultrasonography were 69% and 49%, respectively. There were statistical differences between specificity of mammography in patients based on factors such as history of gravidity, breastfeeding and sensitivity in patients equal or more than 50 years old and less. Conclusion: Factors affecting different results in mammography and ultrasonography reports were classified into three groups, consisting of skill, experience and training of medical staff, and setting of instruments. It is recommended that health managers in developing countries pay attention the quality of setting and man power more than current status. Policy-makers and managers must establish guidelines regarding breast imaging in Iran.

Expression of EMSY, a Novel BRCA2-link Protein, is Associated with Lymph Node Metastasis and Increased Tumor Size in Breast Carcinomas

Madjd, Zahra,Akbari, Mohammad Esmaeil,Zarnani, Amir Hassan,Khayamzadeh, Maryam,Kalantari, Elham,Mojtabavi, Nazanin Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.4

Background: The EMSY gene encodes a BRCA2-binding partner protein that represses the DNA repair function of BRCA2 in non-hereditary breast cancer. Although amplification of EMSY gene has been proposed to have prognostic value in breast cancer, no data have been available concerning EMSY tissue expression patterns and its associations with clinicopathological features. Materials and Methods: In the current study, we examined the expression and localization pattern of EMSY protein by immunohistochemistry and assessed its prognostic value in a well-characterized series of 116 unselected breast carcinomas with a mean follow up of 47 months using tissue microarray technique. Results: Immunohistochemical expression of EMSY protein was detected in 76% of primary breast tumors, localized in nuclear (18%), cytoplasmic (35%) or both cytoplasmic and nuclear sites (23%). Univariate analysis revealed a significant positive association between EMSY expression and lymph node metastasis (p value=0.045) and larger tumor size (p value=0.027), as well as a non-significant relation with increased risk of recurrence (p value=0.088), whereas no association with patients' survival (log rank test, p value=0.482), tumor grade or type was observed. Conclusions: Herein, we demonstrated for the first time the immunostaining pattern of EMSY protein in breast tumors. Our data imply that EMSY protein may have impact on clinicipathological parameters and could be considered as a potential target for breast cancer treatment.

Incidence and Survival in Breast Cancer Patients and Stressful Life Events

Fallah, Raheleh,Akbari, Mohammad Esmaeil,Azargashb, Eznollah,Khayamzadeh, E Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.no.sup3

Due to increasing incidence of breast cancer, recognition of risk factors has become increasingly important. Over the past few decades, among risk factors of this disease, stressful life events have attracted particular attention, but their relationship with breast cancer incidence and survival remains a mystery. This study aimed to examine the relationship between severe stressful life events and incidence and survival of women with breast cancer. In this case-control study, using a structured telephone interview with 355 women with breast cancer and also with 516 women with benign breast diseases who were matched in demographic characteristics, necessary information about the experience of major stressful events in the years before the diagnosis were collected. Data were analyzed using statistical methods of ${\chi}^2$, t, and Kaplan-Meier with a significance level of <0.05. Generally, in the case and control groups, there were no significant association between experience of stressful life events and incidence of breast cancer. Regarding associations between each of the events and incidence of breast cancer only "severe interpersonal problems with spouse" was significant. In the breast cancer group, even after controlling confounding variables, there was no significant association between major stressful events and disease-free survival, or overall 5-and 10-year survival. In this study, only "severe interpersonal problems with spouse" was confirmed as a risk factor. This result can be useful in developing preventive policies. More research regarding the interactive effects of psycho-social factors in the incidence and survival of breast cancer with stressful life events is recommended.

Estimating Completeness of Cancer Registration in Iran with Capture-Recapture Methods

Mohammadi, Gohar,Akbari, Mohammad Esmaeil,Mehrabi, Yadolah,Motlagh, Ali Ghanbari,Pour, Elham Partovi,Roshandel, Gholamreza,Khosravi, Ardasheir Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.no.sup3

Completeness is an important indicator of data quality in cancer registry programs. This study aimed to estimate the completeness of registered cases in a population based cancer registry program implemented in five provinces of Iran. Capture-recapture methods were used to estimate the number of cases that may have been missed and to estimate rates of completeness for different categories of age, year, and sex. The data used for this study were obtained from three sources: 1) National Pathology Database; 2) National Hospital Discharge Database; and 3) National Death Registry Database. The three sources were linked and duplicates were identified based on first name, last name, father's names, and date of birth, ICD code, and case's residency address using Microsoft Excel. Removing duplicates, the three sources reported a total of 35,643 cases from March 2008 to March 2011. Running many different multivariate models of capture-recapture and controlling for source dependencies revealed an overall under-reporting of 49% in all five registries combined. The estimated completeness differed based on age, sex, and year. The overall completeness was higher for males than females (71.2% for males and 59.9% for females). Younger age had lower rates of completeness compared to older age (38.1% for <40 years, 55.4% for 40-60 years, and 76.7 for >60 years). The results of this study indicated a moderate to severe (depending on the age, sex and year) degree of completeness in the population based cancer registration of Iran.

Genomic Profiling of Chronic Myelogenous Leukemia: Basic and Clinical Approach

Aliasghar Keramatinia,Alireza Ahadi,Mohammad Esmaeil Akbari,Maryam Mohseny,Alireza Mosavi Jarahi,Narjes Mehrvar,Neda Mansouri,S.A. Mortazavi Tabatabaei,Abolfazl Movafagh 대한암예방학회 2017 Journal of cancer prevention Vol.22 No.2

Chronic myeloid leukemia (CML) is a hematological stem cell cancer driven by BCR-ABL1 fusion protein. We review the previous and recent evidence on the significance of CML in diagnostic and clinic management. The technical monitoring of BCR-ABL1 with quantitative real time-PCR has been used in assessing patient outcome. The cytogenetic mark of CML is Philadelphia chromosome, that is formed by reciprocal chromosomal translocations between human chromosome 9 and 22, t(9:22) (q34:q11). It makes a BCR-ABL1 fusion protein with an anomaly tyrosine kinase activity that promotes the characteristic proliferation of progenitor cells in CML and acute lymphoblastic lymphoma. The targeting of BCR-ABL1 fusion kinase is the first novel paradigm of molecularly targeted curing.

Fitting Cure Rate Model to Breast Cancer Data of Cancer Research Center

Baghestani, Ahmad Reza,Zayeri, Farid,Akbari, Mohammad Esmaeil,Shojaee, Leyla,Khadembashi, Naghmeh,Shahmirzalou, Parviz Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.17

Background: The Cox PH model is one of the most significant statistical models in studying survival of patients. But, in the case of patients with long-term survival, it may not be the most appropriate. In such cases, a cure rate model seems more suitable. The purpose of this study was to determine clinical factors associated with cure rate of patients with breast cancer. Materials and Methods: In order to find factors affecting cure rate (response), a non-mixed cure rate model with negative binomial distribution for latent variable was used. Variables selected were recurrence cancer, status for HER2, estrogen receptor (ER) and progesterone receptor (PR), size of tumor, grade of cancer, stage of cancer, type of surgery, age at the diagnosis time and number of removed positive lymph nodes. All analyses were performed using PROC MCMC processes in the SAS 9.2 program. Results: The mean (SD) age of patients was equal to 48.9 (11.1) months. For these patients, 1, 5 and 10-year survival rates were 95, 79 and 50 percent respectively. All of the mentioned variables were effective in cure fraction. Kaplan-Meier curve showed cure model's use competence. Conclusions: Unlike other variables, existence of ER and PR positivity will increase probability of cure in patients. In the present study, Weibull distribution was used for the purpose of analysing survival times. Model fitness with other distributions such as log-N and log-logistic and other distributions for latent variable is recommended.

Prognostic Factors for Survival in Patients with Breast Cancer Referred to Omitted Cancer Research Center in Iran

Baghestani, Ahmad Reza,Shahmirzalou, Parviz,Zayeri, Farid,Akbari, Mohammad Esmaeil,Hadizadeh, Mohammad Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.12

Background: Breast cancer is a malignant tumor that starts from cells of the breast and is seen mainly in women. It's the most common cancer in women worldwide and is a major threat to health. The purpose of this study was to fit a Cox proportional hazards model for prediction and determination of years of survival in Iranian patients. Materials and Methods: A total of 366 patients with breast cancer in the Cancer Research Center were included in the study. A Cox proportional hazard model was used with variables such as tumor grade, number of removed positive lymph nodes, human epidermal growth factor receptor 2 (HER2) expression and several other variables. Kaplan-Meier curves were plotted and multi-years of survival were evaluated. Results: The mean age of patients was 48.1 years. Consumption of fatty foods (p=0.033), recurrence (p<0.001), tumor grade (p=0.046) and age (p=0.017) were significant variables. The overall 1- year, 3-year and 5-year survival rates were found to be 93%, 75% and 52%. Conclusions: Use of covariates and the Cox proportional hazard model are effective in predicting the survival of individuals and this model distinguished 4 effective factors in the survival of patients.

Application of a Non-Mixture Cure Rate Model for Analyzing Survival of Patients with Breast Cancer

Baghestani, Ahmad Reza,Moghaddam, Sahar Saeedi,Majd, Hamid Alavi,Akbari, Mohammad Esmaeil,Nafissi, Nahid,Gohari, Kimiya Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.16

Background: As a result of significant progress made in treatment of many types of cancers during the last few decades, there have been an increased number of patients who do not experience mortality. We refer to these observations as cure or immune and models for survival data which include cure fraction are known as cure rate models or long-term survival models. Materials and Methods: In this study we used the data collected from 438 female patients with breast cancer registered in the Cancer Research Center in Shahid Beheshti University of Medical Sciences, Tehran, Iran. The patients had been diagnosed from 1992 to 2012 and were followed up until October 2014. We had to exclude some because of incomplete information. Phone calls were made to confirm whether the patients were still alive or not. Deaths due to breast cancer were regarded as failure. To identify clinical, pathological, and biological characteristics of patients that might have had an effect on survival of the patients we used a non-mixture cure rate model; in addition, a Weibull distribution was proposed for the survival time. Analyses were performed using STATA version 14. The significance level was set at $P{\leq}0.05$. Results: A total of 75 patients (17.1%) died due to breast cancer during the study, up to the last follow-up. Numbers of metastatic lymph nodes and histologic grade were significant factors. The cure fraction was estimated to be 58%. Conclusions: When a cure fraction is not available, the analysis will be changed to standard approaches of survival analysis; however when the data indicate that the cure fraction is available, we suggest analysis of survival data via cure models.

Survival Analysis of Patients with Breast Cancer using Weibull Parametric Model

Baghestani, Ahmad Reza,Moghaddam, Sahar Saeedi,Majd, Hamid Alavi,Akbari, Mohammad Esmaeil,Nafissi, Nahid,Gohari, Kimiya Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.18

Background: The Cox model is known as one of the most frequently-used methods for analyzing survival data. However, in some situations parametric methods may provide better estimates. In this study, a Weibull parametric model was employed to assess possible prognostic factors that may affect the survival of patients with breast cancer. Materials and Methods: We studied 438 patients with breast cancer who visited and were treated at the Cancer Research Center in Shahid Beheshti University of Medical Sciences during 1992 to 2012; the patients were followed up until October 2014. Patients or family members were contacted via telephone calls to confirm whether they were still alive. Clinical, pathological, and biological variables as potential prognostic factors were entered in univariate and multivariate analyses. The log-rank test and the Weibull parametric model with a forward approach, respectively, were used for univariate and multivariate analyses. All analyses were performed using STATA version 11. A P-value lower than 0.05 was defined as significant. Results: On univariate analysis, age at diagnosis, level of education, type of surgery, lymph node status, tumor size, stage, histologic grade, estrogen receptor, progesterone receptor, and lymphovascular invasion had a statistically significant effect on survival time. On multivariate analysis, lymph node status, stage, histologic grade, and lymphovascular invasion were statistically significant. The one-year overall survival rate was 98%. Conclusions: Based on these data and using Weibull parametric model with a forward approach, we found out that patients with lymphovascular invasion were at 2.13 times greater risk of death due to breast cancer.