published_or_final_version / Community Medicine / Master / Master of Public Health

No description available.

MBBCh Department of Surgery University of the Witwatersrand 08 March 2017 / Background: Breast cancer recurrence is a major clinical event and represents a principal cause of breast cancer related death. A discordance rate between receptor status of primary and matched recurrence tumours has been reported in the literature but the extent of this in our population is unknown. Repeating Immuno-histochemistry (IHC) and fluorescent in-situ hybridization (FISH) studies have financial and workforce implications in a resource-constrained environment. However, the results of these receptor studies have prognostic implications. Therefore it is important to determine the extent of change in receptors in the recurrence. Aim: To compare the hormone receptor profile between breast cancer primary and matched loco-regional recurrence and to ascertain the extent of receptor discordance. Methods: All patients who presented to the respective breast care facilities for breast cancer recurrences between 2006 and 2014 were identified using the mammography department records. The specimens for each patient were scrutinized. Oestrogen receptor (ER) and progesterone receptor (PgR) status as well as the Human Epidermal growth factor type 2 receptor (HER2) receptor statuses were noted for each patient and a comparison was made between primary and matching recurrence, with loss and gain being noted. Results: In the analysis, significant discordance was found for matching hormone receptor status. Discordance in oestrogen receptor status occurred in 14.3% of cases: change occurred both from ER-positive to -negative and vice versa. For progesterone receptor status this occurred in 25.7% of cases. A discordance of 14.8% was noted for HER2 receptor status. These results are not dissimilar to what has been previously reported in the literature. Of note, adverse receptor discordance: positive to negative was noted in a total of 19 receptors (ER 4; PgR 11; HER2 4) Conclusion: These results confirm the phenomenon of receptor discordance between breast cancer primary and recurrence. The results support the necessity of confirming receptor status on all loco-regional recurrent disease. This reinforces the importance of obtaining a confirmatory biopsy in patients where recurrence is suspected and therefore allowing the appropriate targeted therapy to be selected. / MT2017

One in 8 women will be diagnosed with breast cancer in the United States and estrogen receptor (ER) status largely influences the type and subsequent success of treatment employed. Although ER-positive breast cancer can be treated with endocrine therapy, the more invasive ER-negative breast cancer is non-responsive to this therapy and cytotoxic agents are often utilized which are associated with many adverse side effects. Consequently, there is a genuine need to develop more effective, less toxic treatments for invasive breast cancer. Indole-3-carbinol is a phytochemical found in cruciferous vegetables and one of its major metabolites, 3,3’-diindolylmethane (DIM), exhibits a broad range of anticancer and antitumorigenic activities. ER-negative MDA-MB-231 and MDA-MB-453 breast cancer cell growth was inhibited after treatment with a novel series of methylenesubstituted DIMs (C-DIMs), namely 1,1-bis(3’-indolyl)-1-(p-substitutedphenyl) methanes containing trifluoromethyl (DIM-C-pPhCF3), t-butyl (DIM-C-pPhtBu) and phenyl (DIM-C-pPhC6H5) groups. In addition, DIM-C-pPhC6H5 (40 mg/kg/d) inhibited tumor growth in nude mice bearing MDA-MB-231 cells as xenografts. Treatment of breast cancer cells with C-DIMs lead to downregulation of cyclin D1 and induction of non-steroidal anti-inflammatory drug-activated gene 1. Detection of necrosis, caspasedependent or caspase-independent apoptosis were not observed in breast cancer cells treated with C-DIMs, however autophagic cell death was induced by C-DIMs. DIM and ring-substituted DIMs have exhibited antitumorigenic activity in tumor murine mammary models. An investigation into the mechanism of cell death induced by DIM and 5,5’-dibromoDIM (5,5’-diBrDIM) in both ER-positive (MCF-7) and ERnegative (MDA-MB-231) breast cancer cells revealed modulation of several key signaling pathways involved in growth control. Both DIM and 5,5’-diBrDIM downregulated cyclin D1, although only 5,5’-diBrDIM induced a depolarization of the mitochondrial membrane. In addition, apoptosis was observed in MCF-7 cells treated with 5,5’-diBrDIM but not MDA-MB-231 cells. In summary, C-DIMs may represent new mechanism-based agents for treatment of breast cancer through induction of autophagic cell death. The ring-substituted DIMs correspond to a novel class of uncharged mitochondrial poisons that are also highly effective in inhibiting breast cancer cell growth. Results of this research provide evidence for the potential role of two new series of DIM analogs for the treatment of highly aggressive breast cancer.

Background: breast cancer patients were found to experience multiple concurrent symptoms. These concurrent symptoms (termed symptom cluster) could have synergistic effects on patient functional status and quality of life. Understanding symptom cluster provided us new insight in symptom assessment and symptom management. Previous studies on symptom cluster among breast cancer patients focused on Caucasian. The current study attempt to identify symptom cluster and the factors associated with it among Chinese breast cancer patients. Methods: this study was a secondary analysis on a sample of 348 breast cancer patients. Data on symptom distress (assessed by Memorial symptom Assessment scale Short Form) was retrieved. Symptom clusters were identified through factor analysis using principal components method and Varimax rotation. Demographics and medical characteristics were proposed to be associated with symptom cluster. Uni-variate analysis and linear regression performed on these variables. Results: four symptom clusters (namely gastrointestinal cluster, general malaise cluster, self image cluster, and cutaneous cluster) were identified. Recurrence of breast cancer and chemotherapy were associated with either gastrointestinal cluster or general malaise cluster. Age, cancer status and occupation were associated with self image cluster while no variable was associated with cutaneous cluster. Conclusion: The current study provided empirical evidence that Chinese breast cancer patients experienced similar symptom clusters as Caucasian. Future study could be done to verify these four symptom clusters and identify underlying mechanism. Recommendations: health care providers could pay more attention to those suffer from breast cancer recurrence or currently receiving chemotherapy. These patients tend to experience gastrointestinal cluster and general malaise cluster. Clinical setting and evaluation tools could be adjusted to fit these high risk groups. / published_or_final_version / Public Health / Master / Master of Public Health

No description available.

Thesis (M.Nurs.)--University of Hong Kong, 2008. / Includes bibliographical references (p. 140-149)

Thesis (Ph.D.)--State University of New York at Buffalo, 2007. / Title from PDF title page (viewed on July 22, 2009). Department of Counseling, School, and Educational Psychology, State University of New York at Buffalo. Advisors: James Donnelly, Michael Zevon. Includes bibliographical references (leaves 88-104).

The purpose of this study was to explore the socioeconomic needs and concerns of a group of new breast cancer patients and their families with consideration of changes in roles and relationships and patient's feelings about self. The study was conducted in co-operation with the A. Maxwell Evans Clinic, a cancer treatment centre under the direction of the Cancer Control Agency of British Columbia. The scope of this study was restricted to new breast cancer patients referred to the New Patients Clinic in May, 1978 and their primary care-givers. In this study, the primary care-givers were family members most responsible for the patient's rehabilitation. The sample consisted of 16 patients and 14 primary care-givers. Two of the patients' primary care-givers were not available at the time of the interview. The sample included patients with breast cancer in Stages 1, 2, 3 and 4. One interview schedule was designed for the patient and a shorter form for the primary care-giver. An open-ended question about the patients and primary care-givers' greatest concerns were included to identify needs not covered by scheduled topics and to give respondents an opportunity to expand and priorize concerns. Socioeconomic change was defined in terms of changes in place of residence, work activities outside the home, family roles and responsibilities, relationships with family and friends, and feelings about self. The findings indicated that the area of greatest change was in family roles and relationships. Most primary care-givers were interested in talking to the interviewer about some anxieties concerning their new role as primary care-giver. Some primary care-givers also were interested in more information about how to create a rehabilitative environment for the patient. All patients were generally positive toward the Clinic. Several patients expressed a number of suggestions for improving support services and offered ideas about . the attitudes of significant others which affect the patient's sense of well-being and ability to recover. The researcher makes some recommendations for enhancing and developing supportive services for the consideration of the medical team and the specialized social services department in a cancer clinic. The recommendations include approaches to help families recognize and develop new roles to help the patient recover. / Arts, Faculty of / Social Work, School of / Graduate

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