Incidence pattern and spatial analysis of breast cancer in Iranian women: Geographical Information System applications

Background: Breast cancer is the leading cancer in Iranian women, but no studies have yet been conducted on the distribution and pattern of its incidence.

Aim: To perform a spatial analysis and determine the incidence pattern of breast cancer in the Islamic Republic of Iran.

Methods: This was a cross-sectional, pathology-based study of all new female patients with breast cancer registered in the Islamic Republic of Iran in 2011 [n=10 233]. Initially, crude incidence rates were calculated for each province and the whole country per 100 000 person–years. Then, a direct standardization method and World Health Organization standard population were used to adjust for age effects on a geographical scale. Stata and Arc GIS software were used to calculate incidence rates and conduct spatial analysis.

Results: The mean [standard deviation] age of the patients was 50.9 [12.6] years. The national age-standardized incidence rate for breast cancer in women was 29.88 per 100 000 person–years, with a range of 5–72 in different provinces. The clustering incidence pattern was observed in Mazandaran, Tehran, Alborz, Isfahan and Markazi Provinces [P < 0.01]. There was a significant cluster of high incidence of breast cancer in Iranian women.

Conclusion: These findings may help to establish etiological hypotheses of cancer causation and identify spatial anomalies in cancer incidence or registration in the Islamic Republic of Iran. Our findings may also aid further research on the possible explanations for these clusters and associations

Cost-effectiveness of three rounds of mammography breast cancer screening in Iranian women

Background: Breast cancer is the most common cancer in Iranian women as is worldwide. Mammography screening has been introduced as a beneficial method for reducing mortality and morbidity of this disease

Objectives: We developed an analytical model to assess the cost effectiveness of an organized mammography screening program in Iran for early detection of the breast cancer

Patients and Methods: This study is an economic evaluation of mammography screening program among Iranian woman aged 40 - 70 years. A decision tree and Markov model were applied to estimate total quality adjusted life years [QALY] and lifetime costs

Results: The results revealed that the incremental cost effectiveness ratio [ICER] of mammography screening in Iranian women in the first round was Int. 37,350 dollars per QALY gained. The model showed that the ICER in the second and third rounds of screening program were Int.141,641 dollars and Int. 389,148 dollars respectively

Conclusions: Study results identified that mammography screening program was cost-effective in 53% of the cases, but incremental cost per QALY in the second and third rounds of screening are much higher than the accepted payment threshold of Iranian health system. Thus, evaluation of other screening strategies would be useful to identify more cost-effective program. Future studies with new national data can improve the accuracy of our finding and provide better information for health policy makers for decision making

Estimating the esophagus cancer incidence rate in Ardabil, Iran: a capture-recapture method

Background: Accurate cancer registry and awareness of cancer incidence rate is essential in order to define strategies for cancer prevention and control programs. Capture-recapture methods have been recommended for reducing bias and increase the accuracy of cancer incidence estimation

Objectives: This study aimed to estimate the esophagus cancer incidence by capture-recapture method based on Ardabil population-based cancer registry data

Patients and Methods: Total new cases of esophagus cancer reported by three sources of pathology reports, medical records, and death certificates to Ardabil province cancer registry center in 2006 and 2008 were enrolled in the study. All duplicated cases between three sources were identified and removed using Excel software. Some characteristics such as name, surname, father's name, date of birth and ICD codes related to their cancer type were used for data linkage and finding the common cases among three sources. The incidence rate per 100,000 was estimated based on capture-recapture method using the log-linear models. We used BIC, G2 and AIC statistics to select the best-fit model

Results: After removing duplicates, total 471 new cases of esophagus cancer were reported from three sources. The model with linkage between pathology reports, medical record sources and independence with the death certificates source was the best fitted model. The reported incidence rate for the years 2006 and 2008 was 18.77 and 18.51 per 100,000, respectively. In log-linear analysis, the estimated incidence rate for the years 2006 and 2008 was 49.71 and 53.87 per 100,000 populations, respectively

Conclusions: Based on the obtained results, it can be concluded that none of the sources of pathology reports, death certificates and medical records individually or collectively were fully covered the incidence cases of esophagus cancer and need to apply some changes in data abstracting and case finding

Relationships between family levels of socioeconomic status and distribution of breast cancer risk factors

Not only the expand development of knowledge for reducing risk factors, but also the improvement in early diagnosis and treatment of cancer, and socioeconomic inequalities could affect cancer incidence, diagnosis stage, and mortality. The aim of this study was investigation the relationships between family levels of socioeconomic status and distribution of breast cancer risk factors. This descriptive cross-sectional study has conducted on 526 patients who were suffering from breast cancer, and have registered in Cancer Research Center of Shahid Beheshti University of Medical Sciences from March 2008 to December 2013. A reliable and valid questionnaire about family levels of socioeconomic status has filled by interviewing the patients via phone. For analyzing the data, Multinomial logistic regression, Kendal tau-b correlation coefficient and Contingency Coefficient tests have executed by SPSS[19]. The mean age of the patients was 48.30 [SD=11.41]. According to the results of this study, there was a significant relationship between family socioeconomic status and patient's age at diagnosis of breast cancer [p value<0.001]. Also, the relationships between socioeconomic status and number of pregnancies, and duration of breast feeding were significant [p value> 0.001]. In the multiple logistic regressions, the relationship between excellent socioeconomic status and number of abortions was significant [p value> 0.007]. Furthermore, the relationships between moderate and good socioeconomic statuses and smoking were significant [p value=0.05 and p value=0.02, respectively]. The results have indicated that among those patients having better socioeconomic status, age at cancer diagnosis, number of pregnancies and duration of breast feeding was lower, and then number of abortions was more than the others. According to the results of this study, it was really important to focus on family socioeconomic status as a critical and effective variable on breast cancer risk factors among the Iranian women

Regression dilution bias in blood pressure and body mass index in a longitudinal population-based cohort study

Use of single measurement of risk factors can distort their estimated effects, due to random error in measurements. The aim of this study was to examine the extent of underestimation in the estimated effect of common variables in physical exam i.e. systolic and diastolic blood pressure [SBP, DBP] and body mass index [BMI] on cardiovascular diseases in Tehran Lipid and Glucose Study [TLGS]. A subsample [1167 men and 1786 women] of the original cohort, who had replicate measures of the variables in triennial interval, was used to calculate the regression dilution ratios [RDRs] in men and women. RDRs were determined by parametric and nonparametric methods. Hazard ratios [HR] of risk factors, per one standard deviation change, were corrected for regression dilution bias. The estimated RDRs by parametric method in men and women were 45% and 35% for SBP and 54% and 64% for DBP, respectively. There were 26% and 25% underestimation in HR of SBP and 23% and 33% in HR of DBP in men and women. The corresponding underestimation for BMI was about 8%. RDRs of men and women and in age groups by both methods were fairly similar. They were relatively constant during the 10-year follow-up for SBP and BMI. Using baseline measurements of blood pressure underestimate its real association with CVD events and the estimated HRs. The underestimations are independent of age and sex, and it can be fairly constant in short to moderate time intervals

correlation between the family levels of socioeconomic status and stage at diagnosis of breast cancer

Stage is one of the most important prognostic factors for the cancer diagnosis, including the breast cancer. Studies have found that the rate of breast cancer late-stage diagnosis, among the women with lower socioeconomic status, is more than the others. The aim of this study was investigation the relationship between family levels of socioeconomic status and stage at diagnosis of breast cancer. This cross-sectional, descriptive study has conducted on 526 patients who have suffered from breast cancer, and have registered in Cancer Research Center of Shahid Beheshti university of Medical science, from March 2008 till December 2013. A reliable and valid questionnaire about family status of socioeconomic status, have filled by interviewing the patients via phone. For analyzing the data, Multinomial logistic regression, Kendal tau-b correlation coefficient and Contingency Coefficient tests have executed by SPSS19. The results have indicated that the mean age of the patients was 48.30 [SD=11.41]. There was a significant relationship between stage at diagnosis of breast cancer and family levels of socioeconomic status at the time of diagnosis [p=0.024]. Also, the relationship between stage at diagnosis and living place [in or out of Tehran] was significant [p=0.044]. In the Multiple logistic regressions, these associations were significant. There wasn't any significant relationship between stage of diagnosis of breast cancer and age, marital status and family history. Regarding the results of this study, deep paying attention to the family socioeconomic status as an important variable in stage at diagnosis of breast cancer, among Iranian women, was too important, and then providing the prevention plans related to this topic has seemed necessary

Cox models survival analysis based on breast cancer treatments

The aim of this study is to evaluate the association between different treatments and survival time of breast cancer patients using either standard Cox model or stratified Cox model. The study was conducted on 15830 women diagnosed with breast cancer in British Columbia, Canada. They were divided into eight groups according to patients' ages and stage of disease Either Cox's PH model or stratified Cox model was fitted to each group according to the PH assumption and tested using Schoenfeld residuals. The data show that in the group of patients under age 50 years old and over age 50 with stage ? cancer, the highest hazard was related to radiotherapy [HR= 3.15, CI: 1.85-5.35] and chemotherapy [HR= 3, CI: 2.29- 3.93] respectively. For both groups of patients with stage ?? cancer, the highest risk was related to radiotherapy [HR=3.02, CI: 2.26-4.03] [HR=2.16, CI: 1.85-2.52]. For both groups of patients with stage III cancer, the highest risk was for surgery [HR=0.49, CI: 0.33-0.73], [HR=0.45, CI: 0.36-0.57]. For patients of age 50 years or less with stage IV cancer, none of the treatments were statistically significant. In group of patients over age 50 years old with stage ?V cancer, the highest hazard was related to surgery [HR=0.64, CI: 0.53-0.78]. The results of this study show that for patients with stage I and II breast cancer, radiotherapy and chemotherapy had the highest hazard; for patients with stage III and IV breast cancer, the highest hazard was associated with treatment surgery

Frequency of human papillumavirus among women with high-grade squamous intraepithelial lesions and invasive cervical cancer attending Shahid Beheshti University of Medical Sciences Clinics, Tehran, Iran

The previous studies reported some information about prevalence release of high-risk HPV types in HSIL or cervical cancer globally and in Iran, however, this information is not enough for final judgment about vaccination against HPV or any screening program. The aim of the present study was to assess the HPV type distribution in HSIL and ICC specimens of women attending Shahid Beheshti University of Medical Sciences teaching hospitals, Tehran, Iran for treatment during 10 years. This retrospective- descriptive study evaluated the HPV type distribution of pathologic specimens of Iranian women with invasive cervical cancer [ICC] and high-grade squamous cell intraepithelial lesions [HSIL]. Formalinfixed tumor biopsies that were retrieved from women presenting with histological confirmation for ICC and 17 pathologic confirmation for HSIL specimens. The most frequently identified HPV type 16 among both groups, women with invasive cervical cancer [42.18%] and women with High Grade Squamous Intraepithelial Lesion [29.41%], followed by HPV18, HPV31 and 26. HPV16 and / or 18 accounted for 82.2% of all infected samples. The dominance of HPV16 over other high-risk types might be even higher than in a region with low HPV exposure. However, there was no strong evidence for any judgment that show to the policy makers; which one is cost-effectiveness and feasibility for cervical cancer prevention in Iran, vaccination, screening or both? More population based study and national meta-analysis needed for better understanding of HPV prevalence and HPV DNA patterns in Iran

Associations of demographic and socioeconomic factors with complete treatment and follow up of colon cancer

Cancer is the second cause of death in the world, and colon cancer is the third cause of death and is one of the most common cancers which will cure with early diagnosis, treatment and sufficient follow up. Assessing factors which affect this cancer is important for prolonging patient survival. Socioeconomic factors are among effective factors of cancer morbidity and mortality. Because mortality rates for colon cancers vary by socioeconomic characteristics, this study has been performed to recognize the relationship between socioeconomic factors with treatment and follow up of colon cancer. This was a cross-sectional, descriptive study for patients with colon cancer registered in Cancer Research Center of Shahid Beheshti University of Medical Sciences from April 2005 to November 2006. Patients were selected randomly, and the study was conducted using questionnaires filled by interviewing the patients via phone [if a patient was dead, the questions were asked from their family members]. Data analysis was done using SPSS [version 19] software. The study was performed on 520 colon cancer patients with age range of 23-88 years. The mean age of the patients was 63 [S.D. = 11.8] and the median age was 64.Two hundred thirty seven [45.4%] patients were female and 283[54.4%] were male. Using Chi- square test, age< 60 [P=0.002] and female gender [P=0.034] had a significant correlation with complete treatment and there was a significant relationship between complete follow up and age< 60 [P=0.037], academic education [P=0.02] and having insurance [P=0.021]. Multiple logistic regression tests were used to evaluate concurrent effects of variables on treatment and follow up. Correlated variables to complete treatment include: age< 60 [P=0.001], and female gender [P = 0.023].The Odds Ratio [OR] of completing treatment for patients under 60 years of age versus patients above 60 years was 3.13 [95% C.I. 1.55 to 6.34], and the OR of completing treatment for women versus men was 1.91[95% C.I. 1.33 to 2.74]. Correlated variables to follow up were academic education [P = 0.018] and having insurance [P = 0.046]. The OR of cancer follow up in illiterate patients versus college-educated patients was 0.45[95% C.I. 0.24 to 0.82], and the OR of cancer follow up in patients without insurance versus patients with health was 0.46[95% C.I. 0.21 to 0.98]. Age is a correlated factor on completing colon cancer treatment. Women have more complete colon cancer treatment than men. Academic education and having insurance were the most important factors among socioeconomic factors observed in a five-year follow up after treatment. As the population of the old is increasing, executing effective interventions to improve treatment and follow up procedures for old patients is of prime importance. It seems that increasing the insurance contribution in follow up measures may lead to increase in the regular follow up and may affect patients' survival.

Breast cancer survival analysis: applying the generalized gamma distribution under different conditions of the proportional hazards and accelerated failure time assumptions

The goal of this study is to extend the applications of parametric survival models so that they include cases in which accelerated failure time [AFT] assumption is not satisfied, and examine parametric and semiparametric models under different proportional hazards [PH] and AFT assumptions. The data for 12,531 women diagnosed with breast cancer in British Columbia, Canada, during 1990-1999 were divided into eight groups according to patients' ages and stage of disease, and each group was assumed to have different AFT and PH assumptions. For parametru: models, we fitted the saturated generalized gamma [GG] distribution/ and compared this with the conventional AFT model. Using a likelihood ratio statistic, both models were compared to the simpler forms including the Weibull and lognormal. For semiparametric models, either Cox's PH model or stratified Cox model was fitted according to the PH assumption and tested using Schoenfeld residuals. The GG family was compared to the log-logistic model using Akaike information criterion [AIC] and Baysian information criterion [BIC]. When PH and AFT assumptions were satisfied, semiparametric and parametric models both provided valid descriptions of breast cancer patient survival. When PH assumption was not satisfied but AFT condition held, the parametric models performed better than the stratified Cox model. When neither the PH nor the AFT assumptions were met, the log normal distribution provided a reasonable fit. When both the PH and AFT assumptions are satisfied, the parametric and semiparametric models provide complementary information. When PH assumption is not satisfied, the parametric models should be considered, whether the AFT assumption is met or not

Montelukast for treatment of refractory pruritus in patients on hemodialysis

One of the most common complaints in patients with end-stage renal disease [ESRD] is uremic pruritus. In the recent years, many drugs have been proposed for its treatment which have had paradoxical outcomes. We studied the antipruritus effect of montelukast sodium, a leukotriene receptor antagonist, in patients on hemodialysis. The study was conducted as randomized, single-blind, placebo-controlled crossover study in 5 hemodialysis centers. Sixteen patients with refractory pruritus were selected and were divided into 2 groups to receive firstly montelukast and then placebo, or vice versa. Patients were treated by montelukast tablets, 10 mg daily, for 20 days and the washout period was 14 days. Of 16 patients whom were included in the study, 1 died during the placebo period of myocardial infarction and another patient who received montelukast for 20 days faced hemoglobin decrease during the placebo period diagnosed as myelodysplastic syndrome. At the end of the treatment with montelukast, pruritus was reduced by 35% [95% CI, 9.5% to 62.5%], while it was reduced 7% [95% CI, 0.5% to 15.9%] with placebo [P = .002]. The patients' compliance was assessed satisfactory, except for 1 patient who exited the study due to anemia. Montelukast is more effective than placebo in the treatment of uremic pruritus not responding to the currently available antipruritus drugs, and it can be considered as a new and rather safe and effective treatment option in uremic patients

Thymectomy after plasmapheresis in myasthenia gravis: results of long term follow up

Myasthenia gravis is the most common disorder of neuromuscular junction and several treatment modalities have been described for its management. Thymectomy has been employed as a treatment modality for several years. Plasmapheresis has also been supposed as an adjunct to thymectomy in several articles. In this study, we describe long-term results of thymectomy after plasmapheresis in myasthenic patients operated on in Shohada-e-Tajrish medical center from March 1996 to March 2001. Information related to patients was obtained from medical records. All 46 patients underwent plasmapheresis before thymectomy and were transferred to ICU [intensive care unit] postoperatively. The surgical approach in all patients was median sternotomy and complete removal of thymus gland. Long term results of surgery were obtained via calling the patients. By this manner 31 of 46 patients were followed up. Forty-six patients including 36 women [78.3%] and 10 men [21.7%] with the mean age of 25.6 +/- 11.8 years were operated on in this period of time. The mean duration of symptoms was 15.7 months before the surgery. No postoperative mortality was seen. Five patients [10.9%] developed postoperative myasthenic crisis which was minimal in 4 of them. The mean duration of ICU stay was 18.9 hours. Thirtyone of 46 patients were followed up with a mean duration of 7. 7 years. Twelve patients [38.7%] had complete remission without using any drug. Twelve patients [38.7%] had significant improvement via decreasing the drug dosage necessary to control their symptoms. Two patients [6.4%] had no change in their disease status after the operation and in 1 patient [3.2%] with thymic pathology of invasive thymoma, the disease worsened. Four patients [12.9%] had disease recurrence after a period of complete remission. Result of operation was more satisfactory in patients younger than 30 years [p < 0.05%]. Thymic hyperplasia foresees more favorable outcome compared to other thymic pathologies. The mean duration of time necessary to reach final results was 19.6 months. As a result of this study, thymectomy seems to be a successful treatment modality in myasthenic patients and should be performed as soon as possible during the disease course. Besides, plasmapheresis has a significant role in decreasing the complications and improving the results of thymectomy in myasthenic patients and long term follow up is necessary for accurate evaluation of final results of operation

Clinicopathological features of primary central nervous system lymphoma

To investigate the anatomic location, immunologic, and clinicopathological features of patients with primary central nervous system lymphoma [PCNSL]. From May 1993 to December 2004, at Shohada Hospital, Tehran, Iran, the clinical data of 110 PCNSL patients, including the age, sex, duration of symptoms, radiological findings, site of tumors, immune status, and history of immunocompromised state [such as organ transplantation, radiotherapy, steroid therapy or AIDS] were assessed. The mean age of the patients with PCNSL was 47.02 +/- 15.8 years. There were 42 female and 68 male patients. One hundred and six cases [96.3%] were diagnosed as B-cell lymphoma. Most of the PCNSL in our study are unifocal. More than 70% of tumors were in a cerebral hemisphere and periventricular location, usually involving the corpus callosum or basal ganglia. No patients had been in immunocompromised states. Symptoms of increased intracranial pressure or changes in personality, vision, or motor function are most common. Seizures are seen in approximately 10% of patients. The number of PCNSL cases showed a gradual rise in incidence. The results of this single hospital 12-year survey of PCNSL are in agreement with data from other single institutions and regional surveys concerning clinical features. However, in contrast with the literature, most of our patients were immunocompetent. The age at diagnosis is also lower than in most reports