Background and Aim: Globally, breast cancer is the most common cancer among women. The stage of the disease at diagnosis is a core determinant of its health outcome. In low to middle-income countries like Nigeria, advanced stage of disease presentation for medical care represents a significant problem. While mortality rates from breast cancer are declining in developed countries like Canada, they are increasing in developing countries like Nigeria. It is well documented that presentation for medical care at the early stages of the disease improves outcome. Knowledge of the factors that impact seeking medical care after breast cancer symptom discovery in women and knowledge of the factors that impact participation in breast health activities by women is important in reducing breast cancer-related mortality. Methods and Design: This integrative review critically examined the determinants of health outcomes of women living with breast cancer in Canada and Nigeria from 1990-2014. Specifically, it examined the factors that impact seeking medical care after breast cancer symptom discovery in women. It also explored the factors that impact participation in breast health activities by women in the two countries from 1990 to 2014. A total of 303 articles were identified and retrieved by searching the following databases: CINAHL, MEDLINE, and EMBASE. Grey literature from relevant organizations websites were identified using Google Scholar. Among the 303 articles identified, 55 met the inclusion criteria. Results and Conclusion: Findings from the articles that met the inclusion criteria showed that Canadians have a high level of breast health awareness. The findings also suggest that women in Nigeria have rather poor knowledge of breast health awareness and breast cancer. In Nigeria, presentation with an advanced stage of the disease made survival very low. This also compromises the quality of life of the patients. The major factors responsible for the late presentations were a lack of breast cancer awareness and education. Other social factors that mitigate against early presentations for medical care include misconceptions about breast cancer treatment and outcomes. In line with the findings of this study, it is recommended that wide spread culturally sensitive, linguistically appropriate, health education programs to teach breast health awareness should be developed and disseminated. Such health awareness programs should be targeted at women through various channels such as the media, the television, and radio. Also, within the hospital, the developed education programs should be integrated into the existing women health education programs. Non-government and other charitable organizations can also make significant contributions to breast health awareness through sponsoring health talks and workshops targeted at relevant segments of the population. Key search words: Breast cancer, breast neoplasm, diagnosis, prevention and control, health knowledge, patient attitude and practice, breast self-examination, awareness, patient education as topic, mass screening, early detection of cancer, Nigeria, Canada.

A descriptive study was conducted with the purpose of refining the Sexual Adjustment Questionnaire (SAQ) and further establishing reliability and validity. Twelve women receiving treatment for breast cancer and 22 women who were at least three months post-treatment for breast cancer voluntarily participated in the research study. Each was administered the Sexual Adjustment Questionnaire. Findings of the study revealed that the SAQ in its entirety was internally consistent. Repatterning of sexual behavior subsequent to having breast cancer did not occur in either group of women. Both the women receiving cancer treatment and those post-treatment experienced a noticeable change in their sexual behavior since having cancer.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / abstract / toc / Social Work and Social Administration / Doctoral / Doctor of Philosophy

EGF receptors are key regulators of cell survival and growth in normal and transformed tissues. Ligand binding results in formation of homo/hetero dimers of these receptors, followed by activation of the kinase activity and subsequent tyrosine phosphorylation of many downstream molecules. The activation of these receptors is not only mediated by the binding of their cognate ligands, but by transactivaton by other molecules as well. Recent studies have identified an oncogenic glycoprotein MUC1 as a binding partner for EGFR and that MUC1 expression can potentiate EGFR-dependent signal transduction. After receptor activation, EGFR is typically downregulated via an endocytic pathway that results in receptor degradation or recycling. We report here that MUC1 expression inhibits the degradation of ligand-activated erbB1. In addition, MUC1 expression results in prolonged activation of Akt, but not ERK1,2 MAPKinase. The MUC1-mediated protection against degradation occurs with a decrease in EGF-stimulated ubiquitination of erbB1, and an increase in erbB1 recycling. We then utilized the WAP-TGFα transgenic mouse model of breast cancer and determined that a loss of Muc1 expression dramatically alters mammary tumor progression. While 100% of WAP-TGFα/Muc1^(+/+) mice form mammary gland tumors, only 37% of WAP-TGFα/Muc1^(-/-) form tumors. Furthermore, expression of cyclin D1 expression is significantly suppressed in tumors derived from WAPTGFα/Muc1^(-/-) animals, and loss of Muc1 expression resulted in a significant inhibition in the formation of hyperplastic lesions in the mammary gland. We also observed metastatic pulmonary adenocarcinoma (1/29) and perivascular lymphoma of unknown origin (28/29) in the WAP-TGFα transgenic mice but not in the WAP TGFα/Muc1^(-/-) animals. To determine the effects of Muc1 expression on metastasis in a model lacking perivascular lymphoma, we crossed MMTV-Wnt-1 and MMTV-MUC1 transgenic mice and evaluated interactions between Muc1 and EGFR. Although the MMTV-Wnt-1 mice are non-metastatic, a majority (6/10) of the bitransgenic MMTVWnt- 1/MMTV-MUC1 formed pulmonary metastases. Furthermore, overexpression of MUC1 increases the breast cancer cell invasion in vitro. The MUC1 induced increase in invasion is found to be EGF and EGFR-kinase dependent. Collectively, these data indicate that MUC1 expression contributes to many of the hallmarks of cancer and in addition, is an important modulator of EGFR-associated mammary tumor progression.

Purpose: The purpose of this thesis was to perform a scoping review of the current literature and available clinical practice guidelines to generate an understanding of the primary health care needs of women following treatment for breast cancer. Methods: Based on an extensive scoping review of the literature, research findings regarding the complications of breast cancer treatments and corresponding primary care interventions were synthesized. Additionally, validation of the findings of the scoping review was performed through semi-structured interviews with two primary care physicians and three post-treatment breast cancer patients. Results: Eleven broad categories related to the primary health care needs of women after undergoing treatments for breast cancer were identified. These included concerns related to: surgical complications, lymphedema, gynecologic and menopausal symptoms, psychosocial issues, additional primary cancers, cardiovascular implications, osteoporosis, lifestyle changes, fatigue, cognitive dysfunction, and pregnancy. Additionally, it was determined that the majority of existing clinical practice guidelines for breast cancer were outdated, and related to cancer detection and treatment as opposed to survivorship care. Summary: Findings from the scoping review and interviews demonstrate the vast range of primary care needs of women after undergoing treatment for breast cancer. Additionally, these results highlight the critical need for the development of a comprehensive set of current clinical practice guidelines which target primary care physicians and are specifically focused on the survivorship needs of women following breast cancer treatment. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2011-07-22 16:09:35.682

Digital Image-based Elasto-Tomography (DIET) is an emerging technology for non-invasive breast cancer screening. This technology relies on obtaining high resolution images of a breasts surface under high frequency actuation; typically 50-100Hz. Off-the-shelf digital cameras are unable to capture images directly at these speeds and current digital camera set-ups that are potentially capable of high speed image capture are either low in resolution, expensive, or occupy a volume too large to have them placed about the breast in a dense array. A method is presented for obtaining the required high speed image capture at a resolution of 1280x1024 (1.3 mega-pixels) and actuation frequency of 100Hz. The apparatus uses two Kodak CMOS KAC-9648 imaging sensors in combination with frame grabbers and the dSpace control system, to produce an automated image capture system. The final working system produced images that enabled effective 3D motion tracking of the surface of a silicon phantom actuated at 100Hz. The surface of the phantom was strobed at pre-selected phases from 0 to 360 degrees, and an image was captured for each phase. The times at which image capture occurred were calculated for a phase lag increment of 10 degrees resulting in an image effectively every 0.00028s for the actuator cycle of 0.01s. The comparison of the actual trigger times and pre-selected ideal trigger times gave a mean absolute error of 1.4%, thus demonstrating the accuracy of the final system.

<p>Chemotherapy remains the only available treatment for triple-negative (TN) breast cancer. Although some TN breast cancers respond initially to neoadjuvant chemotherapy, the majority of patients die within three years of treatment due to recurrent tumor growth. Developing ex vivo models for TN breast cancer recurrence and defining responsible molecules will be crucial to developing effective combination therapies for TN breast cancer patients. We have developed an in vitro model of TN breast cancer dormancy/recurrence. Short-term exposure of tumor cells to chemotherapy at clinically relevant doses enriches for a dormant tumor cell population. Several days after removing chemotherapy, dormant tumor cells regain proliferative ability and establish colonies, resembling tumor recurrence. Tumor cells from "recurrent" colonies exhibit increased chemotherapy resistance, resembling therapy resistance of recurrent tumors in patients. Furthermore, we identify a novel signaling axis [nuclear bFGF/DNA-dependent protein kinase (DNA-PK)] supported by chemotherapy-enriched dormant TN breast cancer cells. This signaling axis drives accelerated DNA repair in chemo-residual TN breast cancer cells. Targeting this axis with either with a bFGF shRNA or DNA-PK small molecule inhibitor blocks recurrent colony formation. Using the Oncomine gene expression database, we found that bFGF expression in tumor samples from TN breast cancer patients predicts five year tumor recurrence following neoadjuvant chemotherapy treatment. Finally, we demonstrate that recurrent tumor cells exhibit increased invasiveness, reflecting the aggressive behavior of recurrent tumors in patients. Collectively, these studies identify a novel signaling axis in TN breast cancer that likely contributes to tumor recurrence and provide molecular targets for developing future therapeutics against TN breast cancer.</p> / Dissertation

Why does breast cancer receive so much more federal funding and fundraising efforts than other types of cancers, particularly lung cancer – the leading cause of cancer related deaths? This question is critical to public relations practitioners, in order to replicate or build on the success of breast cancer campaigns. This study was conducted in two parts. First, an Internet survey was distributed as a pilot study to examine public perceptions of cancer related issues. Next, depth interviews were conducted with 25 experts in the cancer field from across the nation. A comparison of pilot study results with actual statistics shows that breast cancer advocates are making a significant difference in people’s perceptions. Breast cancer advocacy campaigns are so pervasive, people don’t understand the significant numbers of other cancers that are diagnosed each year, as opposed to breast cancer. Interviews revealed that breast cancer awareness and funding have benefited from a perfect storm. According to interview participants, breast cancer advocacy may be attributed to: the feminist movement, the HIV/AIDS campaign, celebrity endorsers, and a passionate advocate named Nancy Brinker, who had just lost her sister, Susan G. Komen, to breast cancer. Screening and surgical technology also advanced at the right time, allowing breast cancer research funding and awareness to benefit from the perfect storm. It’s clear that Komen and other breast cancer advocates have made a huge impact on public perceptions of the disease and its research funding. Will other advocates be able to replicate it with the same degree of success, or will it take another perfect storm? / Department of Journalism

This thesis focuses on the modelling and prediction of factors affecting attendance to screening invitations of the NHS Breast Screening Programme. The analysis is based on data collected by the Warwickshire, Solihull and Coventry Breast Screening Unit from 1989 up to 2001 with respect to invitation to screening for the prevention of breast cancer in non-symptomatic women. Using a novel approach to the analysis of the data, from the perspective of the screening episode of each woman, rather than the usual analysis from the perspective of the screening round of the units, a statistical analysis is carried out on the whole registered population for the first time. Amendments to the current formulae for coverage calculations, the introduction of a new parameter (invitation rate) and the proposal for a reduction of the invitation period (period of time between two consecutive invitations) follows from the analysis. A preliminary analysis of predictive methodologies, including traditional statistical methods and artificial intelligent methods, gives the foundation to the formulation of two new algorithms; the first, for the prediction of attendance of women to screening invitations, and the second for the prediction of occurrence of screening variation (change of appointment dates) of women to invitations. Both algorithms are based on neural network generated models able to learn from the previous screening behaviour history of the woman, a technique not previously explored for the prediction of attendance. The accuracy of the new proposed algorithm for the prediction of attendance to invitation is tested on a blind study using data not previously seen by the predictive system, and for which results were unknown at the time when the predictions were made. From the obtained results, it is concluded to recommend the implementation by the NHS Breast Screening Unit of the two algorithms proposed for the prediction of the women’s attendance and screening variation to their invitation for screening. With these predictions, women likely not to attend, or change appointment date, can be identified and appropriately targeted with the aim of increasing their attendance in the short term, and in the long term, reducing breast cancer mortality.