Showing papers in "Asian Pacific Journal of Cancer Prevention in 2011"

Overview of the National Cancer screening programme and the cancer screening status in Korea.

Abstract: Organised cancer screening in Korea began in 1999 Operating system has been stabilised, target population have expanded and participation rate has been increased throughout its ten years Here we present an overview of the organised cancer screening system in Korea and introduce the National Cancer Screening Programme including results from 2002 to 2008 Furthermore, we present the results of the Korea National Cancer Screening Survey, a survey that is representative of the population, from 2004 to 2009 Finally, we discuss our achievements and the future challenges

Epidemiologic Risk Factors for Esophageal Cancer Development

Abstract: In retrospective studies of esophageal cancer (EC), cigarettes and hookah smoking, nass use (a chewing tobacco product), opium consumption, hot tea drinking, poor oral health, low intake of fresh fruit and vegetables, and low socioeconomic status have been associated with a higher risk of esophageal squamous cell carcinoma. Barrett's esophagus is clearly recognized as a risk factor for EC, and dysplasia remains the only factor useful for identifying patients at increased risk, for the development of esophageal adenocarcinoma in clinical practice. Here, we review the epidemiologic studies that have investigated the epidemiologic patterns and causes of EC.

Association between diabetes mellitus and breast cancer risk: a meta-analysis of the literature.

Abstract: Aim/hypothesis: Diabetes and breast cancer are both serious life-threatening diseases across the world. Some studies shows that diabetes is associated with many kinds of tumor, but links with breast cancer remain controversial. The aim of this study was to assess the association the available evidence. Subjects and methods: A meta-analysis was conducted including 16 studies published between 2000 and 2010 and summary relative risks(RRs) with 95% CIs were calculated using random-effects model. Results: The combined evidence supports that diabetes was associated with a statistically significant 23% increased risk of breast cancer, especially in postmenopausal women (RR=1.25 95%CI 1.20-1.29). The correlation between diabetes and breast cancer was the most obvious in Europe (RR=1.88,95%CI:1.56-2.25), followed by America (RR=1.16, 95%CI:1.12-1.20). In Asia the result was not significant (RR=1.01, 95%CI=0.84-1.21). Diabetes also increased mortality from breast cancer overall (RR=1.44, 95%CI:1.31-1.58). Conclusions/interpretation: This meta-analysis indicated that diabetes can be considered as a risk factor for breast cancer. In addition, menstruation status as well as geographical distribution can affect the relationship.

Role of human papilloma virus in oral tongue squamous cell carcinoma.

Abstract: Background: Human papilloma virus (HPV) is an important risk factor for head and neck cancer, specifically oropharyngeal cancer, but its association with oral tongue squamous cell carcinoma (SCC) is uncertain. The objectives were to determine the HPV16 prevalence in oral tongue SCCs, its integration status and to correlate the expression of oncogenic proteins with targets. Methods: In this case-control study with oral tongue SCC cases (n=60) and normal oral mucosa (n=46), HPV positivity was determined by polymerase chain reaction (PCR) using consensus and HPV 16 type specific primers and p16 immunohistochemistry (IHC). The viral integration status was determined with primers specific to the E2 gene and in situ hybridization (ISH). Immunohistochemical analysis of HPV oncogenic proteins (E6, E7) and their target proteins (p53, pRb, cyclinD1, p16, Notch-1, EGFR) proteins was carried out in HPV positive cases. The data was analyzed with SPSS software (v 11.0). Survival analysis was carried out by the Kaplan-Meier method. Results: HPV16 was detected in 48% (n=29) of the cases and none of the controls by PCR assay (p<0.001) while p16 IHC, as a surrogate HPV marker, detected 33% (n=18) of the cases; 18% (n=10) were detected by both the methods. Integration was observed in 83% (n=24) by E2-PCR and 67% (n=18) by ISH. The E6-p53 pathway was active in 33% of the cases; E7-pRb in 52% and both in 11%. HPV positivity was associated with well-differentiated cancers (p=0.041) and low recurrence rate (p=0.014). Conclusion: Our study confirms a positive correlation of HPV infection with oral tongue cancer.

Immunohistochemical Profile of Breast Cancer Patients at a Tertiary Care Hospital in South India

Abstract: Aims: 1) To evaluate the estrogen receptor(ER), progesterone receptor (PR) and Her-2 /neu expression in invasive breast carcinomas by immunohistochemistry and 2) to compare the pattern of expression with clinicopathological parameters like patient’s age, tumor size, mitotic index, histological type and grade and lymph node metastasis. Methods: This is a retrospective study of 321 female invasive breast carcinomas diagnosed in the Department of Histopathology, Apollo Speciality Hospital, Chennai from January 2009 to June 2010. Results: The age of the patients ranged from 24 to 99 years, with a mean of 53.8, and the majority of the tumors were T2 (83.8% in range of 2-5 cms), predominantly histological grade 2 (57.3%), followed by grade 3 (33.3%). ER, PR and Her-2/neu expression was seen in 59, 51 and 27% of cases respectively. Triple-negative breast cancers constituted 25 % of our cases. We also found characteristic associations between hormonal receptor and Her-2/ neu expression and various clinico-pathological parameters. Conclusions: The hormonal receptor expression appears to be lower in the Indian population compared to the West. A significant proportion of tumors in our study with Her2/neu overexpression also showed ER and PR positivity. Triple-negative breast tumors were most commonly grade 3, in women aged more than 50 years.

Breast cancer screening among females in Iran and recommendations for improved practice: a review.

Abstract: Breast cancer is the second most common cancer amongst women, in Iran comprising 21.4% of female cancers. There are several screening modalities for breast cancer including breast self-examination, clinical breast examination and mammography. This research reviews the literature surrounding the implementation of these screening approaches in the Islamic Republic of Iran. After initial results produced approximately 208 articles, a total of 96 articles were included because they specifically addressed epidemiological characteristics of breast cancer, culture, religion, health seeking behavior, screening programs and the health system in Iran. Literature showed that breast self-examination and clinical breast examination were most common as there is no population-based mammography screening program in Iran. Additionally, most women appear to obtain information through the mass media. Results also indicate that Islamic beliefs and preventative medicine are very much aligned and can be used to promote breast cancer screening in Iran. These results highlight that there is a need for aggressive preventative measures focusing on breast self examination and gradually moving towards national mammography programs in Iran ideally disseminated through the media with government support.

Breast cancer prevention and control programs in Malaysia.

Abstract: Breast cancer is the most common cancer in Malaysian females. The National Cancer Registry in 2003 and 2006 reported that the age standardized incidence of breast cancer was 46.2 and 39.3 per 100,000 populations, respectively. With the cumulative risk at 5.0; a woman in Malaysia had a 1 in 20 chance of developing breast cancer in her lifetime. The incidence of cancer in general, and for breast cancer specifically was highest in the Chinese, followed by Indians and Malays. Most of the patients with breast cancers presented at late stages (stage I: 15.45%, stage II: 46.9%, stage III: 22.2% and stage IV: 15.5%). The Healthy Lifestyles Campaign which started in the early nineties had created awareness on breast cancer and after a decade the effort was enhanced with the Breast Health Awareness program to promote breast self examination (BSE) to all women, to perform annual clinical breast examination (CBE) on women above 40 and mammogram on women above 50. The National Health Morbidity Survey in 2006 showed that the prevalence rate of 70.35% by any of three methods of breast screening; 57.1% by BSE, 51.8% by CBE and 7.6% by mammogram. The current screening policy for breast cancer focuses on CBE whereby all women at the age of 20 years and above must undergo breast examination by trained health care providers every 3 years for age between 20-39 years, and annually for age 40 and above. Several breast cancer preventive programs had been developed by various ministries in Malaysia; among which are the RM50 subsidy for mammogram by the Ministry of Women, Family and Community Development and the SIPPS program (a call-recall system for women to do PAP smear and CBE) by the Ministry of Health. Measures to increase uptake of breast cancer screening and factors as to why women with breast cancer present late should be studied to assist in more development of policy on the prevention of breast cancer in Malaysia.

Practice and barriers toward breast self-examination among young Malaysian women.

Abstract: Introduction:The etiology of breast cancer is still unknown and adequate primary prevention strategies or interventions are still not possible. Therefore, early detection remains the first priority and regular practice of breast self-examination (BSE) influences treatment, quality of life, survival, and prognosis of breast cancer patients. Objectives: The objective of this study was to determine the practices and barriers towards breast self-examination among young Malaysian women. Methodology:Cross-sectional study was conducted among 251 female students at the Management and Science University, Shah Alam, Selangor, Malaysia. Questionnaires were distributed at gathering places such as the university cafeteria, the university plaza, the Islamic center, and at the library. In addition, questionnaires were distributed in the lecture halls. The proposal of this study was approved by the Ethics and Research Committee of Management and Science University. Data was analysis using SPSS version 13, t-test was used to analyze the associated factors toward the practice of BSE. Results:A total number of 251 students participated in this study. The majority of them were older than 20 years old,of Malay racial origin, single and from urban areas (66.5%; 63.7%; 96%; 70.9% respectively). Regarding their lifestyle practices, the majority of participants do exercise, are non-smokers and do not drink alcohol (71.3%; 98.4%; 94.4% respectively). More than half of the study participants mentioned that they have practiced BSE (55.4%). Regarding the sources of information about BSE, the majority mentioned that radio and TV were their main sources of information (38.2%). Age, exercise and family history of cancer significantly influenced the practice of BSE (p = 0.045; p=0.002; p=0.017 respectively). Regarding the barriers to BSE, the majority who never practiced BSE mentioned that lack of knowledge, not having any symptoms, and being afraid of being diagnosed with breast cancer were the main barriers to practicing BSE (20.3%; 14.3%; 4.4% respectively). Conclusion:More than half ofthe participants practiced BSE. Age, exercise and family history of cancer significantly influenced the practice of the BSE. Lack of knowledge, not having any symptoms and being afraid of being diagnosed with breast cancer were the main barriers to practicing BSE. There is an urgent need to develop a continuous awareness campaign among university students on the importance of performing BSE.

Review of the cervical cancer disease burden in mainland China.

Abstract: Human papillomavirus (HPV) infection is a common sexually transmitted infection (STI) worldwide. HPV may cause several reproductive tract diseases and cervical cancer is the most serious health problem due to persistent high risk HPV infection. Although cervical cancer showed a declining trend over the past three decades in China, it remains a major health problem in Chinese women especially women living in rural China. The disease burden is believed to be underestimated given the relatively high HPV prevalence shown in recent studies. To date, prophylactic vaccination as a primary prevention of cervical cancer are available in many countries and regions of the world; yet, they are not yet accessible in mainland China. Before introduction of HPV vaccines, screening remains the predominant method of prevention. Selected population based screening sites are available in every province of China, yet, an organized screening program operating nationwide still does not exist. A better understanding of the disease burden is likely to help develop a comprehensive intervention policy for future management of cervical cancer in China. It is important to review the disease burden of cervical cancer and the current status of cervical cancer screening in mainland China.

Childhood cancer incidence and survival 2003-2005, Thailand: study from the Thai Pediatric Oncology Group.

Abstract: Background: Previous population-based incidences of childhood cancer in Thailand were achieved by extrapolating from data limited to a small number of cancer registries, not from the whole country. In addition, survival of childhood cancer patients is often described in specialized hospitals and/or institutions, but not in the general population. Methods: All children aged 0–15 years who were newly diagnosed as having cancer were registered from 18 treatment centers during 2003-5 and classified into 12 diagnostic groups according to the International Classification of Childhood Cancer. Incidences were calculated by a standard method and survival was investigated using the ThaiPOG (Thai Pediatric Oncology Group) population-based registration data. Overall survival was calculated by the Kaplan Meier method. Results: In the study period (2003-5) 2,792 newly diagnosed cases of childhood cancer were registered, with mean and median ages of 6.5 (SD=0.13) and 5.0 (0-14) years, respectively. The age-peak was between 1 and 4 years and the age-standardized rate (ASR) was 74.9 per million. Leukemia was the most common cancer (N=1421, ASR 38.1) followed by lymphoma (N=266, ASR 6.4) and neoplasms of the central nervous system (CNS, N=246, ASR 6.3). The follow-up duration totaled 101,250 months. The death rate was 1.11 per 100 person-months (95%CI: 1.02 -1.20). The 5-year overall survival was 54.9% (95%CI: 53.0%-56.9%) for all cancers. The respective, 5-year overall survival for (1) acute lymphoblastic leukemia (ALL), (2) acute non-lymphoblastic leukemia (ANLL), (3) lymphoma, (4) retinoblastoma, (5) renal tumors, (6) liver tumors, (7) germ cell tumors, (8) CNS tumors, (9) neuroblastoma, (10) soft tissue tumors and (11) bone tumors were (1) 64.5%, (2) 35.1%, (3) 59.5%, (4) 73.1%, (5) 70.4%, (6) 44.5%, (7) 70.6%, (8) 41.7%, (9) 33.6%, (10) 50.1%, and (11) 33.7%. Conclusions: The incidence of childhood cancer is lower than in western countries. Respective overall survival for ALL, lymphoma, renal tumors, liver tumors, retinoblastoma, soft tissue tumors is lower than those reported in developed countries while for CNS tumors, neuroblastoma and germ cell tumors the figures are comparable.

Taxanes: promising anti-cancer drugs.

Abstract: Taxanes are amongst the most promising antitumor agents available at hand today, of increasing importance in Asia given that cancer is now one of the major public health problems which needs to be dealt urgently for the benefit of affected patients. Several ongoing experimental and clinical trials have supported the fact that even with their side effects and poor solubilities, taxanes are still the first lines of treatment chosen for breast, ovary, lung and other metastatic cancers. Prolonging the life of cancer patients is the main aim of all researchers, scientists, pharmaceutical companies and clinicians; therefore this review emphasizes the mechanisms of action of taxanes and how they can play an important role in palliative treatment if not applied for curative purposes, hence being considered a boon for cancer management.

Hookah Smoking and Lung Cancer in the Kashmir Valley of the Indian Subcontinent

Abstract: Background: The literature about the causal relationship between lung cancer and tobacco smoking mostly concerns cigarettes. Hookah smoking is popular in the Kashmir valley of the Indian subcontinent, and is generally believed to be innocuous because of the passage of the smoke through water before inhalation. Objective: To determine the relationship of hookah smoking to lung cancer in Kashmir. Materials and Methods: In a casecontrol design, 251 cases of lung cancer and 500 age-matched controls were studied. A predefined questionnaire was administered through a personal interview regarding various smoking and dietary patterns and the results compared through statistical analyses. Results: There were 194 (178 current) ever-smokers amongst the cases and 223 (134 current) amongst controls. Smokers had a 4.2 times risk of lung cancer compared to non smokers (OR 4.23, 95% CI 3.0-5.96, p<0.0001). There were 120 hookah smokers amongst the cases and 100 amongst the controls and hookah smokers were nearly six times at risk for lung cancer as compared to nonsmokers (OR 5.83, (95% CI 3.95-8.60, p< 0.0001). Cigarette smokers were commoner amongst cases (46 vs 64 in controls; OR 3.49, 95% CI 2.18-5.60, p=0.000). The severity of smoking was associated with a higher risk of lung cancer (Chi-square 72.09, p 0.000).The practice of changing water of the hookah after each session proved non-existent. Conclusion: Hookah smoking is associated with a significantly higher risk for lung cancer in Kashmiri population, with about 6 fold elevated risk as compared to non-smoking controls.

Comparative anticancer potential of clove (Syzygium aromaticum)--an Indian spice--against cancer cell lines of various anatomical origin.

Abstract: Spices, active ingredients of Indian cooking, may play important roles in prevention and treatment of various cancers. The objective of the present study is to compare the in vitro anticancer activities of three different extracts of Clove (Syzygium aromaticum L), a commonly used spice and food flavouring agent, against different kinds of cancer cell lines of various anatomical derivations. Water, ethanol and oil extracts were screened for anti proliferative activity against HeLa (cervical cancer), MCF-7 (ER + ve) and MDA-MB-231 (ER - ve) breast cancer, DU-145 prostate cancer and TE-13 esophageal cancer cell lines, along with normal human peripheral blood lymphocytes. Inhibition of cell proliferation was assessed using MTT assay as a vital stain. In the examined five cancer cell lines, the extracts showed different patterns of cell growth inhibition activity, with the oil extract having maximal cytotoxic activity. Morphological analysis and DAPI staining showed cytotoxicity to be a result of cell disruption with subsequent membrane rupture. Maximum cell death and apoptotic cell demise occurred in TE-13 cells within 24 hours by clove oil at 300 μl/ml with 80% cell death whereas DU-145 cells showed minimal cell death. At the same time, no significant cytotoxicity was found in human PBMC's at the same dose.

Culture, attitude and knowledge about breast cancer and preventive measures: a qualitative study of South Asian breast cancer patients in the UK.

Abstract: Background: Little is known about the influence of culture and beliefs about breast cancer, and its implications on preventive health behaviour among South Asian people in the UK. Methods: Using a qualitative approach, 24 South Asian breast cancer patients and their significant others were interviewed. Results: Most patients were unfamiliar with the subject of cancer; they expressed lack of knowledge of cancer as a disease and its symptoms. They identified a painless lump in the breast as sign of abnormality, but not cancer. They also did not know any non-lump breast symptoms. Over half participated in breast screening after encouragement from daughters or relatives. Most did not practise breast self-examination. Perceptions of cancer and health behaviour were influenced by cultural beliefs. Common themes were cancer is a taboo subject and cancer is a stigma. Patients also expressed misunderstandings about the cause of cancer. Cancer in the family had ramifications on children’s marriage prospects and may cause marital breakdown. Terminology used also caused communication problems with healthcare professionals and within the family: the use of ‘chest’ to substitute ‘breast’ changed the meaning of the message conveyed. Conclusions: Cultural beliefs and practices accentuate difficulties in understanding breast cancer, breast screening and breast self-examination, and can prevent South Asian women from adopting preventive health practices.

Piper betel Linn (betel vine), the maligned Southeast Asian medicinal plant possesses cancer preventive effects: time to reconsider the wronged opinion.

Abstract: Since antiquity, Piper betel Linn (betel vine; family Piperaceae) has been an important medicinal agent in the various traditional and folk systems of medicine in Southeast Asia countries. The leaves are the most valued plant part and in the past were routinely used as a chewing agent to prevent halitosis. The leaves are also supposed to harden the gum, conserve the teeth and to prevent indigestion, bronchitis, constipation, congestion, coughs and asthma. Innumerable scientific studies have validated the ethnomedicinal claims. Betel leaves are an integral component of the betel quid that consists of areca nut (Areca catechu Linn.), tobacco (Nicotiana tabacum L) and slaked lime; a highly abused agent with carcinogenic properties. Regular chewing of betel quid is associated mainly with oral cancer and detail studies with individual constituents of the quid have shown that both tobacco and areca nut are carcinogenic, while slaked lime is shown to promote the process of carcinogenesis. However unlike other constituents of the betel quid, the betel leaves devoid carcinogenic effects and on the contrary possesses cancer preventive effects including against the carcinogens present in tobacco. This review for the first time provides information on cancer preventive effects and also addresses the various mechanisms which might be involved.

Circulating miRNAs: promising biomarkers of human cancer.

Abstract: Background With the development of technologies to look at the expression levels of hundreds of miRNAs at a time and the clear role of miRNAs in cancers, groups began looking at miRNAs profiles of different cancers, especially the circulating miRNAs. We intended to make sure whether circulating miRNAs could be a promising biomarker of human cancers. Method We comprehensively searched the Cochrane Library, Medline and EMbase from 1966 to Nov 2009 for the following terms: ("miRNA" or "microRNA") and ("tumor" or "carcinoma") and ("plasma*" or "serum" or "circulating"). Detailed information was extracted from studies that met the inclusion criteria: blood-based miRNAs in human cancers and studies published in the English literature. Results The current review show that different researches use different measurement methods which might impact the results; Cancers treatment might have an affect on circulating miRNAs; some miRNAs are multi-faceted RNA; small sample size might produce selection bias. Furthermore, because of the lack of randomized controlled trials and the heterogeneous nature of the available data, no attempt was made to perform quantitativemeta-analyses. Conclusions In this review, based on those researches, circulating miRNAs are promising and difficulties for their future application for diagnosing human cancers.

MiR-138 suppresses expression of hypoxia-inducible factor 1α (HIF-1α) in clear cell renal cell carcinoma 786-O cells.

Abstract: Objectives: Hypoxia-inducible factor-1alpha (HIF-1a) is widely considered to be one of the key regulators in cancer cells. Here, we investigated a microRNA regulating expression of HIF-1a and explored its functions in clear cell renal cell carcinoma (ccRCC) cells. Methods and materials:Western blot and reporter assays were used to assess HIF-1a as a direct target of miR-138. The effects of miR-138 or si-HIF-1a on ccRCC 786-O cells were also estimated by apoptosis analysis and cell migration assay. Results: The data showed HIF-1a to be one target of miR-138. Futhermore, inhibition of the expression of HIF-1a with specific siRNA or miR-138 could increase apoptosis and reduce the migration of 786-O cells. Conclusions: miR-138 could inhibit the expression of HIF-1a and regulate the apoptosis and migration of ccRCC cells.

The present scenario of cervical cancer control and HPV epidemiology in India: an outline.

Abstract: Objective: To give a clear picture with epidemiological evidence about the present scenario of cervical cancer control and HPV in India. Design: Review of published studies, concentrating on recent systematic reviews, meta-analyses and large prospective studies. Conclusions and recommendations: Cervical cancer is unique among cancers in that it can largely be prevented through screening and removal of precursor lesions. It is the second most common cancer among women worldwide and is the most common malignancy in developing countries, particularly in India. Nowadays, cervical screening for women is necessary because there are no signs and symptoms of cervical precancers. The establishment of a prevention program is urgently required considering both screening and vaccination. But most women in India do not have access to effective screening programmes. It has been estimated that in India, even with a major effort to expand cytology services, it will not be possible to screen even one-fourth of the population once in a lifetime in the near future. New HPV vaccines will also help prevent HPV infection and the precancerous changes that lead to cervical cancer. The focus on detection and prevention of cervical cancer must be emphasized in a highly populated country like India to prevent its extensive spread.

Effects of education based on the health belief model on screening behavior in high risk women for breast cancer, Tehran, Iran.

Abstract: Background Breast cancer is the most common malignancy in women. Early diagnosis allows efficient treatment and increases survival, but the efficacy of breast self examination (BSE) is not sufficiently well established. The American Cancer Society aims to give women the opportunity to recognize the utility, limitations and adverse effects of breast cancer screening through education models based on psychological theories. With the Health Belief Model, people's health perceptions and attitudes influence their practices, for example with screening. Objective The purpose of this randomized controlled clinical trial was to determine the effect of education based on this model on breast cancer screening in high risk Iranian women. Materials and methods Participants were women with a family history of breast cancer (mother, sister, and daughter). After explanation of the study objectives to participants, they were recruited on obtaining oral consent and each filled out the study questionnaire based on the Health Belief Model. Allocation was into two groups by computerized randomization, control and intervention, receiving education on breast cancer screening. Perceived susceptibility to and seriousness of breast cancer, perceived usefulness of and barriers to BSE, clinical breast examination, and mammography, and self-efficacy in the ability to perform these, were assessed, with comparison of scores for BSE practice before and after education and doing mammography and clinical examination by a physician in intervention and control group. Results The mean age was 37.8 ± 11.7 (range 19-60). The mean rank in the intervention group significantly differed before and after the education, but except for " perceived threat" and "perceived usefulness of breast self examination", we did not find any significant differences from the control group. After educational sessions, breast self examination and clinical examination practice rates were elevated. Conclusion Health education based on well known psychological theories for breast cancer screening should be extended to the entire populations in developing countries. In addition, we should pay attention to barriers to women undergoing mammography, such as costs, shame and accessibility, and increase the target population awareness and positive attitudes towards benefits of early breast cancer screening.

A case-control study of risk factors for lung cancer in Mumbai, India.

Abstract: In the year 2010, it is estimated that nearly 1.35 million new cases and 1.18 million deaths with lung cancer occurred. In India, among males, lung cancer rates vary across the country which has encouraged us to conduct a case-control study to study the risk factors. The present unmatched hospital-based case-control study conducted at Tata Memorial Hospital included subjects registered between the years 1997-99. There were 408 lung 'cancer cases' and 1383 'normal controls'. Data on age, tobacco habits, occupational history, dietary factors, tea, coffee were collected by the social investigators. Univariate and regression analysis were applied for obtaining the odds ratio for risk factors. In the study, cigarette smoking (OR=5.2) and bidi smoking (OR=8.3), as well as alcohol consumption (OR=1.8), demonstrated dose-response relationships with lung cancer risk. Among the dietary items, only red-meat consumption showed 2.2-fold significant excess risk. Consumption of milk showed a 60% reduction in risk; while coffee showed a 2-fold excess risk for lung cancer. In addition, exposure to use of pesticides showed a 2.5-fold significant excess risk for lung cancer.

Comparison of breast cancer in Indonesia and Malaysia--a clinico-pathological study between Dharmais Cancer Centre Jakarta and University Malaya Medical Centre, Kuala Lumpur.

Abstract: Introduction: The age standardised incidence rate (ASR) of breast cancer in Malaysia which is a high middle- income country is similar to Indonesia, a low middle-income country. (Globocan 2008) It is however unknown whether the presentation of breast cancer differs between these two countries. Objective: We compared the stage, age at presentation, and pathological characteristics of breast cancer between two tertiary hospitals in Indonesia and Malaysia; Dharmais Cancer Centre (DCC), which is the national cancer referral centre in Indonesia, and University Malaya Medical Centre (UMMC), which is an academic hospital with established breast oncology services in Kuala Lumpur. One thousand, one hundred and fourteen consecutive women (477 in UMMC: 637 in DCC) who were newly diagnosed with breast cancer between January and December, 2010 were included. Patient's age, TNM stage at presentation, and pathological characteristics were compared. Estrogen receptor (ER) and progesterone receptor (PR) were considered positive if 10% or greater of invasive cell nuclei were stained while HER2 was considered positive with an immunohistochemostry staining intensity of 3+. Logistic regression analyses were performed to identify differences. Results: Median age at diagnosis was 52 years in UMMC and 47 years in DCC, whereby patients in DCC were more likely to be very young at diagnosis (aged < 35 years) compared to their counterparts in UMMC (Odds ratio (OR): 2.09; 95%CI: 1.32-3.31). Approximately one third of patients in UMMC presented with TNM stage III or IV, compared to 63% in DCC. Patients in DCC were three times more likely to present with metastatic breast cancer compared to patients in UMMC (OR: 3.01; 95% CI: 2.02-4.48). The percentage of low grade tumours in DCC was higher than in UMMC (28% vs 11% respectively), and the difference persisted even after multivariate adjustment. Although the frequency of ER and PR positivity appeared to be higher in UMMC (65% and 55% respectively) compared to DCC (48% and 40% respectively), these differences were not statistically significant following adjustment for age, stage, HER2 status and grade. The frequency of HER2 positivity was 45% in DCC compared to 26% in UMMC, and remained significantly higher even after multivariate adjustment (multivarite OR:1.76; 95%CI:1.25-2.47, in DCC compared to UMMC). The proportion of triple negative breast cancer was however similar in the two centres (19% in UMMC vs 21% in DCC). Conclusion: Indonesian women with breast cancer seem to present at a younger age and at later stages compared to Malaysian women. Their tumors were more likely to be of low grade and HER2 positive, even after adjustment for other factors, while hormone receptor positivity proved similar in the two groups. The higher HER2 positivity rate in Indonesian patients warrants further study.

Awareness of cervix cancer risk factors in educated youth: a cross-sectional, questionnaire based survey in India, Nepal, and Sri Lanka

Abstract: Objective: The main aim of this study was to evaluate the awareness of cervix cancer risk factors among Educated Youth with respect to socio demographic factors. Materials and methods: A cross-sectional questionnaire survey was carried out among 1268 female undergraduate students in Delhi , Mangalore (India), Pokhara (Nepal) and Kandy (Srilanka) between 25 April 2010 and 20 August 2010 using structured questionnaire containing details of awareness of cervix cancer risk factors and socio demographic details. Descriptive statistics and testing of hypothesis were used for the analysis. Data analyzed using EPI INFO and SPSS 16 software. Results: In the 1,268 subjects, the mean age of Indian (528, 41.6%), Nepalese (480, 37.9%) and Srilankan (260, 20.5%) were 18.3 ± SD 0.7, 18.6 ± SD 0.8 and 18.0 ± SD 1.5 years, respectively. Distribution of students according to religion varied across the countries. Majority of the students were Hindus in India (61.4%) and Nepal (89.6%) while in Srilanka the majority (53.8%) were Buddhist. Relationships could be established between nationality and risk factors viz. awareness regarding cervix cancer (p= 0.024), sexual activity at an early age (before 16) can cause cervix cancer (p=0.0001), multiple sex partners can cause cervix cancer (p=0.001), condom/other birth control measures cant prevent HPV infection (p=0.0001), smoking as a risk factor(p=0.0001), hereditary risk factor (p=0.015), and first degree relative (p=0.0001). Conclusion: These results indicate that there is an urgent need for a reinvigorated and tailored approach to cervix cancer prevention among the educated youth in India, Nepal and Srilanka. Prevention efforts should be focused on improving social awareness, enforcing education strategies to reduce risk factors and improving the strength and quality of counselling.

Prevalence and distribution of high risk human papillomavirus (HPV) Types 16 and 18 in Carcinoma of cervix saliva of patients with oral squamous cell carcinoma and in the general population in Karnataka India.

Abstract: Background: In view of conducting HPV vaccination in India it is most important to understand the prevalence of HPV genotypes in this population, not only in squamous cell carcinoma of cervix and oral cavity but also in the general population. In this study we explored the prevalence and distribution of high-risk HPV types 16 and 18 in carcinoma of cervix, saliva of patients with oral squamous cell carcinoma and in general population in Karnataka. Methods: Cervical cancer specimens after punch biopsy (n=60) were obtained from women attending Karnataka Institute of Medical Sciences and Karnataka Cancer Therapy and Research Institute, Hubli (KCTRI). Saliva rinse of (n=34) OSCC patients from KCTRI and (n=396) normal individuals from different regions of North Karnataka, were collected and PCR based high-risk HPV genotyping was carried out. Results: Using consensus PCR primers it was observed that 96.7% patients were infected with HPV irrespective of specific type in cervical cancer. Among them, HPV 16 was observed in 89.7%, HPV 18 in 86.2% and both HPV 16 and 18 in 79.3% patients. In OSCC, 70.6% were positive for HPV, among which HPV 16 prevalence was observed in 45.8%, HPV 18 in 54.2%, and HPV 16 and 18 multiple infection in 4.18%. In general population, HPV prevalence was observed in 84.4%. Among them, HPV 16 was observed in 2.75% and HPV 18 in 22.0% patients. In general population, multiple infection with HPV 16 and 18 was not observed but 75.3% were found to be infected by HPV genotypes other than HPV 16 & 18. Conclusions: Our study reveals that multiple infection of HPV 16 and 18 is quite high in cervical cancer and in case of OSCC, it was in conformity with the other studies. In general population HPV 18 prevalence was observed to be high. With this, we can conclude that both HPV 16 and 18 vaccinations will reduce the burden of cervical cancer and OSCC in Karnataka.

Anti-proliferative effects of organic extracts from root bark of Juglans Regia L. (RBJR) on MDA-MB-231 human breast cancer cells: role of Bcl-2/Bax, caspases and Tp53.

Abstract: With increasing use of plant-based cancer chemotherapeutic agents, exploring the antiproliferative effects of phytochemicals has gained increasing momentum for anticancer drug design. The present study was undertaken to investigate the effect of root bark of Juglans regia (RBJR) organic extracts on cell proliferation, and to determine the molecular mechanism of RBJR-induced cell death by determining the expression of Bcl-2, Bax, caspases, Tp53, Mdm-2 and TNF-alpha in MDA-MB-231 human breast cancer cells. The results demonstrate that WNRB suppressed proliferation and induced apoptosis in a dose and time dependent manner by modulating expression of key genes. This involved characteristic changes in cytoplasmic and nuclear morphology, DNA fragmentation (TUNEL assay), levels of mRNA and expression of corresponding proteins. Real Time PCR and western blot analysis revealed that the expression of of Bax, caspases, tp53, and TNF-alpha was markedly increased in MBA-MB-231 cells treated with the RBJR extract. In contrast Bcl2 and mdm-2 expression was down regulated after exposure. In summary, our data suggest the presence of bioactive compound(s) in WNRB capable of killing breast carcinoma cells through induction of apoptosis, and therefore a candidate source of anticancer drugs.

MDR1 gene C3435T polymorphism is associated with clinical outcomes in gastric cancer patients treated with postoperative adjuvant chemotherapy.

Abstract: Objective: To evaluate the impact of the multi-drug resistance 1(MDR1) C3435T polymorphism on clinical outcomes in gastric cancer patients treated with postoperative adjuvant chemotherapy. Methods: From January 2005 to December 2008, 102 patients with surgically resected gastric cancers were enrolled into this study in the Affiliated Jiangsu Cancer Hospital of Nanjing Medical University. The polymorphism was tested using real time polymerase chain reaction (RT-PCR) cycling probes and the relationship with clinical outcomes after postoperative adjuvant chemotherapy was analyzed by SPSS 17.0. Results: The CT/TT genotype of C3435T was significantly associated with a shorter progression-free survival (PFS) and overall survival (OS) compared with the CC genotype [PFS: adjusted hazard ratio(HR)= 2.01, 95% confidence intervals(CI): 1.17-3.45, P = 0.012; OS: adjusted HR = 2.37, 95% CI: 1.31-4.28, P=0.004]. TNM stage was also associated with PFS (adjusted HR = 2.33, 95% CI: 1.34-4.05, P = 0.003) and OS (adjusted HR = 2.62, 95% CI: 1.44-4.76, P = 0.002) in gastric cancer patients treated with postoperative adjuvant chemotherapy. Conclusion: Our results suggest that the MDR1 gene C3435T polymorphism is associated with clinical outcomes in gastric cancer patients treated with postoperative adjuvant chemotherapy. This now needs to be confirmed by a randomized prospectively controlled study.

Influence of MDR1 gene codon 3435 polymorphisms on outcome of platinum-based chemotherapy for advanced non small cell lung cancer.

Abstract: Objective: To evaluate the influence of multi-drug resistance 1 (MDR1) gene codon 3435 polymorphisms on response to platinum-based chemotherapeutic regimens for advanced non small cell lung cancer (NSCLC). Methods: Responses and overall survival were evaluated in a series of patients presenting between March 1, 2005 and December 31, 2010. MDR1 gene C3435T polymorphisms were genotyped using peripheral blood with real time polymerase chain reaction (RT-PCR) and relationships between the MDR1 C3435T genetic polymorphismand response rate of chemotherapy were analyzed by SPSS 13.0. Results: Overall response to chemotherapy in the eligible 103 patients was 21.4%. Patients with C/C genotype in MDR1 codon 3435 had a significantly higher response rate (24.5%) than those for C/T(19.0%) and T/T(12.5%) (P<0.05). The overall median survival time (MST) of patients was 19 months, values with C/C, C/T and T/T genotype were 21, 15.5 and 17 months, respectively (P=0.487). Conclusion: Our research suggested that patents with the C/C genotype in MDR1 codon 3435 could be more sensitive to platinum-based chemotherapy than patients with C/T and T/T; however, no significant difference was found between overall survival and MDR1 codon 3435 genetic polymorphisms.

Clinical observation of Endostar® combined with chemotherapy in advanced colorectal cancer patients.

Abstract: OBJECTIVE Endostar® (Rh-endostatin injection) is a new recombinant human endostatin developed by Shandong Simcere-Medgenn Bio-Pharmaceutical Co., Ltd in China. This study was performed to evaluate the efficacy and safety of Endostar plus leucovorin calcium/ 5-fluorouracil/oxaliplatin (FOLFOX4) in treating patients with advanced colorectal cancer. METHODS Thirty-six patients with advanced colorectal cancer were retrospectively assigned to one of two treatment groups: FOLFOX4 (control) or FOLFOX4 plus Endostar (Endostar) according to patient accreditation. The observational end points were overall response rate, overall survival, progression-free survival and toxicity. RESULTS The response rate and progression-free survival of Endostar were significantly better than those of control group (P <0.05), but significance was not observed for median survival. In addition, gastrointestinal side effects and incidence of leucopenia were not lower than in the control group (P<0.05). CONCLUSIONS The addition of Endostar to FOLFOX4 resulted in a higher objective response rate and longer time to disease progression. Hypertension and cardiac ischemia were the principal safety concerns, but were manageable. Endostar deserves to be further investigated by randomized controlled clinical trails.

Recognising symptoms of breast cancer as a reason for delayed presentation in Asian women--the psycho-socio-cultural model for breast symptom appraisal: opportunities for intervention.

Abstract: Introduction: Advanced presentation of breast cancer and the problem of late diagnosis is well documented. Patient delay beyond three months has been shown to reduce survival. This paper aims to explore the experience of Malaysian women presenting with advanced breast cancer with regards to their interpretation of breast symptoms. Method: Purposive sampling of 19 breast cancer patients presenting with delayed treatment and/ or advanced cancer diagnosed within two years at the University Malaya Medical Centre, Kuala Lumpur were carried out. In-depth interviews were conducted using a self-devised interview guide. The interview guide covered the journey of the patient from discovering of symptoms to their present state. The audiotaped interviews were transcribed verbatim. NVivo 8 qualitative software was utilised for data management. Grounded theory with thematic analysis was utilised. Results: Nine women delayed seeking diagnosis although recognizing the symptom, five did not recognize symptom, three delayed treatment and two did not delay health attention. Themes that emerged with regards to triggering help seeking behavior were: a) poor symptom knowledge and recognition; b) importance of knowledge of the disease and its' outcomes; c) role of coping mechanisms and affect; and lastly d) role of significant others in appraising a breast symptom. Conclusion: Symptom recognition remains an important public health issue in Malaysia. Educating women, their significant others and primary health and primary care providers in detecting early staged breast cancer are needed. Supporting and sanctioning women with breast symptoms are important. The psycho-social-cultural model of symptom appraisal may serve as an important addition to the fight against cancer in countries that do not have the resources for population based screening mammogram programmes.

Current status of thyroid cancer screening in korea: Results from a nationwide interview survey

Abstract: Objective: Since 2000, thyroid cancer has been increasing most rapidly in Korea. Although the cause of the increase is not clear, thyroid cancer screening could be identified as one of its causes. The purpose of this study was to examine the screening rate of thyroid cancer and its related factors using nationwide data. Methods: The study population was derived from the 2009 Korea National Cancer Screening Survey (KNCSS), an annual cross-sectional survey that uses a nationally representative random sampling to investigate cancer screening rates. A total of 2,000 Korean adults participated. The screening method of thyroid cancer was restricted to thyroid ultrasonography. Logistic regression was used to identify factors associated with undergoing thyroid cancer screening. Results: Of all participants, 13.2% (8.4% men and 16.4% women) underwent thyroid ultrasonography. On multiple analyses, age, residence, belief in cancer screening, regular health check-ups, smoking, alcohol drinking, and exercise were associated with thyroid cancer screening. Subjects who underwent other cancer screening, such as gastric, colorectal, breast, or cervical, were more likely to have had a thyroid ultrasonogram that those who did not get screened. Conclusions: We presented the number and characteristics of examinees utilized ultrasonography as a thyroid screening tool in Korea. Although these results revealed that cancer screening might play a major role in the increase of thyroid cancer incidence, further research is needed to determine causes of the rapidly increasing incidence of thyroid cancer in Korea.

Risk factors of nasopharyngeal carcinoma in Turkey-an epidemiological survey of the Anatolian Society of Medical Oncology.

Abstract: Background: Nasopharyngeal carcinoma is a rare disease in most parts of the world with a multifactorial etiology involving an interaction of genetic, viral, environmental and dietary risk factors. This is the first epidemiologic study aimed to evaluate the risk factors of nasopharyngeal carcinoma in the Turkish population. Methods: We conducted a multicentric, retrospective, case-control study using a standardized questionnaire which captured age, sex, occupation, household type, blood group, dietary habits, smoking, alcohol consumption and oral hygiene. The study included 183 cases and 183 healthy controls matched by sex and age. Multiple logistic regression and univariate analysis were employed. Results: The peak age incidence was 40-50 years and the male to female ratio was 2:1. We observed significant associations between elevated nasopharyngeal carcinoma risk and low socioeconomic status, rural household type (OR:3.95, p 0.05); furthermore salty foods had a borderline p value (OR:2.14, p=0.053). Blood type A increased the risk (OR:2.03, p=0.002) while blood type 0 was a protective factor (OR:0.53, p=0.009). Rare habit of teeth brushing (OR:6.17, p<0.001) and ≥10 decayed teeth before diagnosis (OR:2.17, p<0.001) increased the risk. Conclusions: The nasopharyngeal carcinoma risk factors described in the literature are also applicable for the Turkish population. People with type A blood are at risk in Turkey. Salted foods have also a border risk out of the endemic regions. This is the only study showing that poor oral hygene is a serious risk factor for nasopharyngeal carcinoma.