Enhancing Women's Quality of Life: Exploring the Impact of Mastectomy with and without Breast Reconstruction among Breast Cancer Survivors in Iraq.

BACKGROUND AND AIMS: Mastectomy, a common intervention for breast cancer, has substantial implications for a woman's quality of life (QoL). However, the literature on QoL outcomes following mastectomy-with or without breast reconstruction (BR) is scant. This study aims to assess and compare the QoL among Iraqi women post-mastectomy, examining the impacts of undergoing BR. METHODS: We conducted a comprehensive cross-sectional study across multiple centers in Iraq from April to September 2021. Our cohort consisted of 404 women who had a mastectomy for breast cancer treatment, 154 of whom also chose to have BR. Utilizing the European Organisation for Research and Treatment of Cancer's (EORTC) tools specifically, select domains from EORTC QLQ-BR23, QLQ-C30, and QLQ-BRECON23-we evaluated various facets of their QoL. RESULTS: The mean QoL score was 54 out of 100, with patients who did not undergo BR reporting slightly higher scores (55) compared to those who did (52). Notably, social and sexual functioning scores were statistically superior in the non-BR group. Satisfaction with surgery, sexual function, and breast aesthetics were the lowest rated aspects among BR patients, indicating a considerable gap between expectations and outcomes. Marital status and the type of mastectomy notably influenced body image and sexual function. A significant portion of patients (100 out of 250) opted out of BR due to recurrence concerns, while 26.2% (106 out of 154) pursued BR to restore their pre-mastectomy physique. CONCLUSION: Contrary to the anticipated benefits of BR, our findings suggest that women who underwent the procedure reported a lower QoL compared to those who did not. The outcomes highlight the discrepancy between expected and actual benefits of BR, suggesting a pressing need for comprehensive rehabilitation programs. These programs should aim to enhance the QoL for post-mastectomy patients and provide in-depth counseling to align expectations with the potential realities of BR.

Assessment of miRNA-10b Expression Levels as a Potential Precursor to Metastasis in Localized and Locally Advanced/Metastatic Breast Cancer among Iraqi Patients.

Breast cancer (BC) stands as the most prevalent form of carcinoma among women, ranking as the second leading cause of cancer-related mortality in the female population. The objective of this study is to assess the expression of miR-10b and determine its diagnostic and prognostic significance in breast cancer patients across various disease stages. The investigation was carried out in Baghdad at the Oncology Teaching Hospital within Baghdad Medical City and the Oncology Unit at Al-Yarmouk Teaching Hospital. A total of 150 samples were included and divided into two groups: the blood group consisting of 90 samples (including control subjects, localized BC patients, and those with metastatic and locally advanced BC) and the tissue group comprising 60 samples (representing both benign and malignant BC cases). The study spanned from March 2022 to January 2023, with patients' ages ranging from 24 to 75 years. The primary focus of this investigation was to identify the gene expression of miRNA-10b in all sample types. This was achieved by measuring gene expression levels and normalizing them to the level of a housekeeping gene (U6), and quantification was carried out considering the ΔCt value and the fold change method (2-ΔΔCt). The results revealed an upregulated fold expression of miRNA-10b, particularly in locally advanced and metastatic BC, where the expression was significantly higher compared to the other groups, with a fold expression of 1.770 ± 0.1070. In localized breast cancer, the fold expression was 1.624 ± 0.064, and in malignant tissue, it measured 1.546 ± 0.06754, all relative to apparently healthy control subjects. In summary, our research provides compelling evidence supporting the classification of miRNA-10b as an oncogenic factor in BC. The central involvement of miRNA-10b in the tumorigenic processes of BC highlights its reference for developing novel targeted therapeutic interventions and detection biomarkers for BC treatment. Notably, elevated expression of miRNA-10b was observed in BC tissues, correlating with an unfavorable distant metastasis-free survival outcome.

Transfer learning with different modified convolutional neural network models for classifying digital mammograms utilizing Local Dataset.

BACKGROUND: Breast cancer is the leading cause of cancer-related mortality among women worldwide. The incidence and mortality increased globally since starting registration in 1990. Artificial intelligence is being widely experimented in aiding in breast cancer detection, radiologically or cytologically. It has a beneficial role in classification when used alone or combined with radiologist evaluation. The objectives of this study are to evaluate the performance and accuracy of different machine learning algorithms in diagnostic mammograms using a local four-field digital mammogram dataset. METHODOLOGY: The dataset of the mammograms was fullfield digital mammography collected from the oncology teaching hospital in Baghdad. All the mammograms of the patients were studied and labeled by an experienced radiologist. Dataset was composed of two views CranioCaudal (CC) and Mediolateral-oblique (MLO) of one or two breasts. The dataset included 383 cases that were classified based on their BIRADS grade. Image processing included filtering, contrast enhancement using contrast limited adaptive histogram equalization (CLAHE), then removal of labels and pectoral muscle for improving performance. Data augmentation was also applied including horizontal and vertical flipping and rotation within 90 degrees. The data set was divided into a training set and a testing set with a ratio 9:1. Transfer learning of many models trained on the Imagenet dataset was used with fine-tuning. The performance of various models was evaluated using metrics including Loss, Accuracy, and Area under the curve (AUC). Python v3.2 was used for analysis with the Keras library. Ethical approval was obtained by the ethical committee from the College of Medicine University of Baghdad Results: NASNetLarge model achieved the highest accuracy and area under curve 0.8475 and 0.8956 respectively. The least performance was achieved using DenseNet169 and InceptionResNetV2. With accuracy 0.72. The longest time spent for analyzing one hundred image was seven seconds. DISCUSSION AND CONCLUSION: This study presents a newly emerging strategy in diagnostic and screening mammography by using AI with the help of transferred learning and fine-tuning. Using these models can achieve acceptable performance in a very fast way which may reduce the workload burden among diagnostic and screening units.

Knowledge, Attitude, and Practice of Oncologists toward Chemotherapy Resistance: A Questionnaire Development and Pilot Testing.

BACKGROUND: Chemotherapy resistance is caused by a multiplicity of reasons; some of which can be avoided and others that are beyond the scope of current treatment methods. Since chemotherapy is administered under the supervision of health personnel, the role of oncologists cannot be undermined, and yet none is known about their knowledge and perspective. This research is the first-ever study aiming to develop a valid and reliable tool to determine oncologists' knowledge, attitude, and practice (KAP) toward chemotherapy resistance. METHODS: Based on information gathered from literature searches, in-depth interviews with oncologists, and discussions with experts, an English-language questionnaire was developed. The questionnaire was tested for validity and reliability. A final version of the questionnaire (63 items) was piloted among 64 practicing oncologists and oncology trainees via convenient sampling. Data analysis was done using SPSS. RESULTS: Correlation coefficients for each of the questionnaire's domains were more than 0.7 (P<0.001), which suggests that the questionnaire had strong test-retest reliability. The overall internal consistency (Cronbach's alpha) for knowledge (0.728), attitude (0.722), and practice (0.716) were greater than 0.7 indicating good internal consistency. Participants demonstrated a low level of knowledge and a positive attitude toward chemotherapy resistance. A statistically significant difference was noted between the knowledge score and education level, years of experience in the medical and oncology field, and experiencing resistance cases. CONCLUSION: The developed questionnaire was found to be valid and reliable and can be used as an assessment tool for assessing oncologists' knowledge, attitude, and practice toward chemotherapy resistance in future studies. This study also reported that the oncologists have low knowledge on chemotherapy resistance and a predominantly positive attitude towards fighting chemotherapy resistance. Thus, it is essential for current practices in chemotherapy to be optimized to reduce the risk of chemotherapy resistance.