Knowledge, attitudes and practices among urban women of Riyadh, Saudi Arabia, regarding breast cancer

Objectives: To determine the knowledge, attitudes and practices [KAP] of urban women in Riyadh regarding Breast Cancer [BC] and its available screening and treatment modalities. Design: Cross-sectional descriptive study. Setting: BC Awareness day campaigns conducted in Riyadh city from October 2010 to October 2013

Subjects: Six hundred females aged more than 18 years who responded to a well-structured questionnaire comprising of 37 questions. Main Outcome Measures: The level of knowledge and awareness regarding the risk factors and prevention of BC, misconceptions, symptomatology including KAP, regarding self breast examination [SBE], mammography and treatment for BC

Results: Out of the 600 participants with a mean age of 31.9 years [ +/- 10.49], 342 [57.0%] were married, and 215 [35.8%] were employed. The education level was considerably high; with 363 [60.5%] graduates. Late child bearing age [48.2%], positive family history [75%], increase in age [83.5%], and fatty diet [60.5%] were reported important risk factor for BC. A breast lump [70.8%], underarm lump [60.2%], breast pain [53.7%], change in nipple shape [58.7%] and nipple discharge [51.8%] were reported as the important symptoms for BC. About 348 [58.0%] had heard about SBE and 290 [48.3%] knew how to perform SBE. Nearly 433 [72.2%] believed that early detection for BC is possible with mammography and sound waves. Only 42 [7.0%] knew the treatment for BC. Majority of women 565 [94.2%] wanted more media awareness campaigns regarding the issue

Conclusion: There is an immediate need for an aggressive campaign to increase awareness regarding BC in Saudi Arabia

Diffuse sclerosing variant papillary thyroid carcinoma: clinicopathological and treatment outcome analysis of 44 cases

Objectives: Aim was to evaluate clinicopathological and treatment outcomes of diffuse sclerosing variant papillary thyroid carcinoma [DSV-PTC]. Design: Retrospective study. Setting: Two major tertiary care hospitals of Riyadh, Saudi Arabia

Material: Medical records of 1192 patients with confirmed papillary thyroid cancers [PTC], who were treated or followed up during the period of July 2000 and December 2012 were reviewed. Main outcome measure: To evaluate the clinicopathologic features and treatment outcomes of patients with DSV- PTC and perform comparative analysis of DSV-PTC with classic-variant PTC [CV-PTC]

Results: A total of 44 cases [3.7%] of DSV-PTC were identified. DSV-PTC patients were younger than their CV-PTC [p = 0.001]. The mean tumor size was larger in DSV-PTC as compared to CV-PTC [p < 0.0001]. Advanced pathologic tumor [pT] stage and positive lymph nodes were more often present in DSV-PTC than in CV-PTC [p < 0.0001 and p < 0.0001 respectively]. Median follow-up was 8.05 years [range: 1.62-11.4]. Ten-year disease-specific survival [DSS] rates were lower in DSV-PTC [74.4%] than in CV-PTC [89.4%]; p = 0.001

Conclusion: DSV-PTC is more aggressive variant as compared to CV-PTC, and is associated with inferior DSS rates. An aggressive surgical approach followed by radioiodine therapy is warranted for these patients

safe radiotherapy in patients with implanted cardiac pacemaker

Radiotherapy to cancer patients having implanted cardiac pacemakers [ICPs] is challenging decision. The literature reported serious life threatening complications secondary to ICP malfunction. As the number of patients with ICPs requiring radiation therapy is on rise, it is recommended that cardiologist, physicist and radiation oncologist be aware of the potential risks to ICPs and their prevention. Most of radiotherapy centers do not have internal policy and procedures [IPPs] to handle cancer patients with ICP receiving radiation. This article reported three radiotherapy courses in two cancer patients with ICP treated at our center. The Pub med and cochrane database were searched for the potential hazards and effects of radiotherapy on patients having ICPs. The reviewed literature showed that modern multi-programmable pacemakers are very sensitive to radiation therapy in comparison old generation pacemakers. The radiation therapy candestroy ICP or at least can affect its function. There is no safe radiation threshold for ionizing radiation, however it is not contraindicated. Megavoltage radiation can be safely delivered to patients with cardiac pacemakers provided direct irradiation of pacemakers is avoided, adequate monitoring is required during and after irradiation and the dose to the pacemaker generator should be kept below 2 Gy. Close follow-up with cardiologists and a pacemaker clinic is essential. Radiotherapy departments should have their own protocols in place for cancer patients with ICPs

Does intravenous contrast agent affect dose calculations of three dimensional treatment planning system?

The use of computed tomography [CT] with intravenous contrast leads to high accuracy in delineating target volumes and organs at risk [OAR] during treatment planning for conformal radiotherapy. The dose calculation algorithm using CT scan depends on the tissue density which is presented by Hounsfield units [HUs]. Due to the high atomic number of injected contrast media, high HU values are obtained during CT scanning thereby the treatment planning system considers it high density tissue. This misinterpretation results in high absorption of photon beams and thus affects the dose calculation. The objective of this study was to determine if the use of intravenous contrast results in sign[flcant difference in dose calculations compared to the standard calculation based on non enhanced CT scans. Two sets of planning CTs were taken for the patients after proper immobilization. The images were initially taken without intravenous contrast and then with contrast in the same position and coordinates. Twenty patients included in the study [12 head and neck cancer patients and 8 pelvic cancer patients]. The volume was drawn on the CT with contrast after fusing the images with the CT without contrast. The 3D dose calculations were done on the CT with and without contrast by using the same planning parameters. The ECLIPSE treatment planning system was used with pencil beam algorithm for dose calculation. The effect of intravenous contrast was tested by calculating the percent change of dose in planning target volume [PTV] and normal structures between the contrast and no contrast CT based calculations. The percentage dose difference between CT non-contrast based calculation and CT contrast based c‡ilculation ranges from 0 to 4% with mean difference 0.9 +/- 0.7% with non significant p value 0.5. The mean difference for pelvic tumors was 1.2% while for head and neck tumors 0.8%. Also, the organs at risk did not show any signifi cant difference between contrast and non contrast with mean difference 1.5 +/- 2 1.1+2.2%, 1.3 +/- 0.4%, and 0.95 +/- 0.8% in the spinal cord, brain stem, small bowel and rectum respectively. The ylvic tumors showed non significant difference between enhanced CT and non enhanced CT based calculatioiiwith p value 0.06, and the same for head and neck tumors with p value 0.09. The three dimensional [3D] treatment planning calculations in head and neck and pelvic tumors based on CT scans with intravenous contrast do not result in statistical significant difference in dose calculations compared to the standard non contrast CT