Identifying the reasons for delayed presentation of Pakistani breast cancer patients at a tertiary care hospital.

BACKGROUND: Delay in seeking health care by breast cancer patients is associated with advanced stage of disease at presentation and poor survival rates. This study aimed to identify the reasons for delayed presentation and their association with various sociodemographic variables. METHODS: A total of 200 female patients with abnormal clinical findings, ie, lump or palpable mass, were consecutively invited for this study. Diagnostic delay was defined as a consultation with a health care provider more than 3 months from the appearance of the first symptoms. Sociodemographic variables, presenting symptoms, knowledge about diseases and its symptoms, time between seeking medical attention after appearance of symptoms and causes of delayed presentation were investigated. Chi-squared and logistic regression tests for significance and associations were used. RESULTS: Among 125 women with breast cancer fulfilling the inclusion criteria, aged 24-75 years, 88.8% (n=111) presented late (≥3 months) and 59% presented with advanced stage of disease (stage III/IV). The majority (65.6%) were older than 40 years of age, 99.2% were married, 60.8% had <8 years of education, 67.2% had poor social status, and 64.8% had a negative family history of any cancer type. Almost all patients (96%) complained about the presence of a painless lump in their breast. Ignorance of disease or the presence of painless lumps in the breast and low financial resources for therapy (81.1%) were the main variables associated with delayed presentation. Educational factors (P<0.001, OR 4.682) and social status (P<0.001, OR 1.8) were also associated with delayed presentation. CONCLUSION: Our study highlighted the variables associated with delayed presentation in Pakistani breast cancer patients. A significant number of patients presented late owing to misconceptions and poor knowledge about the disease and its symptoms, while illiteracy and poor social status were the major contributing factors for delayed presentation, resulting in an advanced presentation of disease and ultimately a decreased survival rate.

Oxidative stress-induced DNA damage and homocysteine accumulation may beinvolved in ovarian cancer progression in both young and old patients.

BACKGROUND/AIM: Biochemical, environmental, and genetic factors such as oxidative stress-induced DNA damage and homocysteine (Hcy) accumulation in the blood are involved in the development and progression of ovarian cancer. This study measured some biomarkers closely linked to the progression of ovarian cancer and also found their correlates. MATERIALS AND METHODS: Thirty patients were diagnosed with ovarian cancer using pelvic examination, transvaginal ultrasound, and cancer antibody (CA-125) measurement. Total oxidative stress (TOS), DNA damage, Hcy, malondialdehyde (MDA), total antioxidant status (TAS), and other biochemical parameters were determined. RESULTS: TOS and DNA damage were positively and significantly correlated between themselves and were involved in causation of tumors as reflected by significantly (P < 0.001) higher CA-125, erythrocyte sedimentation rate (ESR), creatinine, and C-reactive protein (CRP) in both young and old patients. Both were significantly correlated with Hcy, LDL-cholesterol, alanine aminotransferase, aspartate aminotransferase, CRP, MDA, and CA-125. However, they were negatively correlated with TAS. Thus, excessive inflammation and oxidative stress caused an increase in DNA damage and enhanced Hcy content, leading to development of ovarian cancer. CONCLUSION: This study suggests the use of antioxidants as drugs to reduce oxidative stress, DNA damage, and other causes of cancer development.

Contribution of BRCA1 germline mutation in patients with sporadic breast cancer.

Hereditary artifacts in BRCA1 gene have a significant contributory role in familial cases of breast cancer. However, its germline mutational penetrance in sporadic breast cancer cases with respect to Pakistani population has not yet been very well defined. This study was designed to assess the contributory role of germline mutations of this gene in sporadic cases of breast cancer. 150 cases of unilateral breast cancer patients, with no prior family history of breast cancer and no other disorders or diseases in general with age range 35-75 yrs, were included in this study.Mutational analysis for hot spots on Exon 2, 3 and 13 of BRCA1 was done by using Single Strand Conformational Polymorphism (SSCP). Sequence analysis revealed five variants (missense) and one novel splice site mutation at exon 13. No germline mutation was observed on the remaining exons with respect sporadic breast cancer cases in Pakistani population. A vast majority of breast cancer cases are sporadic; the present study may be helpful for designing a better genetic screening tool for germline BRCA mutations in sporadic breast cancer patients of Pakistani population. Further studies involving a screening of entire coding region of BRCA1 is required to explore the merits of genetic diagnosis and counseling in breast cancer patients.

Cervical cancer: outcome of treatment and causes of failure.

OBJECTIVE: To summarize the data and look into the various treatments offered to cervical cancer patients at Institute of Nuclear Medicine and Oncology (INMOL) to highlight the most likely causes of treatment failure. METHODS: In this retrospective study, case files of all patients presenting with invasive carcinoma of uterine cervix during 1993-2002 were studied in respect to personal profile, disease related risk factors, pathological characteristics, treatment administered and outcome in the form of tumour response and survival. RESULTS: Early age at marriage, multiple marriages of self or spouse, multiparty, prolonged use of contraceptives and smoking were some of the risk factors for cervical cancer in this group of patients. Out of 618 patients presenting with invasive cervical cancer, 65% presented in advanced stages II and III. Apart from advanced stage at presentation, anaemia, poor nutrition, and ignorance about self-hygiene and lack of follow-up were main causes of treatment failure. Outcome of treatment was improved when chemotherapy was added to radiation. CONCLUSION: Advanced stage at diagnosis and lack of follow-up were main causes of treatment failure. Implementation of screening programs on national level for early detection is therefore recommended.