Asian Pacific Journal of Cancer Prevention

Basirat, Maryam;Rabiei, Maryam;Bashardoust, Nazanin 1

https://doi.org/10.7314/APJCP.2016.17.S3.1 PDF KSCI

The aim of this research was to describe the incidence and histopathological subtypes of head and neck lymphoma in Guilan province, Iran. In this retrospective study, all cases of head and neck cancers registered in Iranian Cancer Registry Program in Guilan province of Iran from 2004 to 2009 were obtained and included in the analysis. Out of 1,510 cases, 169 (11.2%) were reported as lymphomas (87 cases of non-Hodgkin, 67 cases of Hodgkin, and 13 cases of unknown type). The mean ages of males and females diagnosed with Hodgkin's lymphoma were 30.4 and 28.7 years, respectively. For non-Hodgkin's lymphoma the respective figures were 50.5 and 49.3 years old. Among various histological subtypes of non-Hodgkin's lymphoma, the diffuse large B-cell type (74.2%) was the most frequent while immunoblastic lymphoma (1.1%) was the least frequent. Nodular sclerosis (58.2%) and mixed cellularity (18.0%) types were most frequent among Hodgkin's lymphomas.

Abdollahi, Mahbubeh;Hajizadeh, Ebrahim;Baghestani, Ahmad Reza;Haghighat, Shahpar 5

https://doi.org/10.7314/APJCP.2016.17.S3.5 PDF KSCI

Breast cancer, the second cause of cancer-related death after lung cancer and the most common cancer in women after skin cancer, is curable if detected in early stages of clinical presentation. Knowledge as to any age cut-off points which might have significance for prognostic groups is important in screening and treatment planning. Therefore, determining a change-point could improve resource allocation. This study aimed to determine if a change point for survival might exist in the age of breast cancer diagnosis. This study included 568 cases of breast cancer that were registered in Breast Cancer Research Center, Tehran, Iran, during the period 1986-2006 and were followed up to 2012. In the presence of curable cases of breast cancer, a change point in the age of breast cancer diagnosis was estimated using a mixture survival cure model. The data were analyzed using SPSS (versions 20) and R (version 2.15.0) software. The results revealed that a change point in the age of breast cancer diagnosis was at 50 years age. Based on our estimation, 35% of the patients diagnosed with breast cancer at age less than or equal to 50 years of age were cured while the figure was 57% for those diagnosed after 50 years of age. Those in the older age group had better survival compared to their younger counterparts during 12 years of follow up. Our results suggest that it is better to estimate change points in age for cancers which are curable in early stages using survival cure models, and that the cure rate would increase with timely screening for breast cancer.

Moradpour, Farhad;Gholami, Ali;Salehi, Mohammad;Mansori, Kamiar;Maracy, Mohammad Reza;Javanmardi, Setareh;Rajabi, Abdolhalim;Moradi, Yousef;Khodadost, Mahmod 11

https://doi.org/10.7314/APJCP.2016.17.S3.11 PDF KSCI

Gastrointestinal cancers remain the most prevalent cancers in many developing countries such as Iran. The aim of this study was to estimate incidence, prevalence and mortality, as well as time trends for gastrointestinal cancers in Isfahan province of Iran for the period 2001 to 2010 and to project these estimates to the year 2020. Estimates were driven by applying the MIAMOD method (a backward calculation approach using mortality and relative survival rates). Mortality data were obtained from the Ministry of Health and the relative survival rate for all gastrointestinal cancers combined was derived from the Eurocare 3 study. Results indicated that there were clear upward trends in age adjusted incidence (males 22.9 to 74.2 and females 14.9 to 44.2), prevalence (males 52.6 to 177.7 and females 38.3 to 111.03), and mortality (males 14.6 to 47.2 and females 9.6 to 28.2) rates per 100,000 for the period of 2001 to 2010 and this upward state would persist for the projected period. For the entire period, the male to female ratio increased slightly for all parameters (incidence rate increased from 1.5 to 1.7, prevalence from 1.4 to 1.6, and mortality from 1.5 to 1.7). In males, totals of 2,179 incident cases, 5,097 prevalent cases and 1,398 mortality cases were predicated to occur during the study period. For females the predicted figures were 1,379, 3,190 and 891, respectively. It was concluded that the upward trend of incidence alongside increase in survival rates would induce a high burden on the health care infrastructure in the province of Isfahan in the future.

Dashdebi, Kamel Ghobadi;Noroozi, Azita;Tahmasebi, Rahim 17

https://doi.org/10.7314/APJCP.2016.17.S3.17 PDF KSCI

Colorectal cancer is a major cause of mortality worldwide. Fecal occult blood testing has proven a very effective screening tool for early detection and mortality reduction. The aim of this study was to determine predictors factors related to fecal occult blood testing using the Health Belief Model method among residents of Bushehr, Iran. A cross sectional study was performed on a sample of 600 men and women more than 50 years of age. The sample was selected by a convenience method from patients referred to public and private laboratories throughout the city. Each subject filled out a questionnaire which was designed and developed based on Health Belief Model constructs. Statistical analysis was conducted using ANOVA, T-test, chi-square test, and logistic regression. Fecal occult blood tests were performed on 179 (29.8%) out of 600 subjects, of which 95 patients (58.1%) did a periodic examination test and 84 patients (46.9%) had a doctor's advice for testing. According to the logistic regression model, the perceived barriers (P=0.0, Exp(B)= 0.3), perceived benefits (P<0.01, Exp(B)= 1.9) and self-efficacy (P<0.01, Exp(B)= 1.6) were predictive factors related to occult blood testing among subjects. The results showed that reducing people's perception of barriers to testing, increasing perceived benefits of screening, and reinforcing self efficacy can have major effect in increasing the rate of fecal occult blood screening for colorectal cancer prevention.

Farzaneh, Farah;Noghabaei, Giti;Barouti, Esmat;Pouresmaili, Farkhondeh;Jamshidi, Javad;Fazeli, Atena;Taghavi, Shaghayegh;Emamalizadeh, Babak;Darvish, Hossein 23

https://doi.org/10.7314/APJCP.2016.17.S3.23 PDF KSCI

Breast cancer (BC) is the most common cancer and the second cause of mortality in women all around the world. It is caused by several factors including genetic determinants, so that both genetic susceptibility factors and environmental factors are involved in the etiology. Significance of genes functioning in steroid hormone synthesis and metabolism are well established in breast cancer susceptibility. In this study, 134 women with BC and 135 normal controls were analyzed for their genotypes for the polymorphisms, rs743572, rs10046 and rs4646903, resided in CYP17, CYP19 and CYP1A1 genes, respectively. Significant differences in distributions of allele and genotype frequencies were found for the rs10046 polymorphism in CYP19 (p-value=0.01, OR (CI 95%) =1.59 (1.1-2.3), p-value=0.04, OR (CI 95%) =1.7 (1.1-2.5) respectively). For rs743,572 and rs 4646903 polymorphisms, no significant associations were observed. A significant association was observed between the rs10046 polymorphism of the CYP19gene and breast cancer in Iranian patients. Due to inconsistent previous results, more studies in different populations with larger sample sizes are indicated.

Pakzad, Reza;Khani, Yousef;Pakzad, Iraj;Momenimovahed, Zohre;Mohammadian-Hashejani, Abdollah;Salehiniya, Hamid;Towhidi, Farhad;Makhsosi, Behnam Reza 27

https://doi.org/10.7314/APJCP.2016.17.S3.27 PDF KSCI

Stomach cancer, the fourth most common cancer and the second leading cause of cancer-related death through the world, is very common in parts of Iran. Geographic variation in the incidence of stomach cancer is due to many different factors. The aim of this study was to assess the geographical and spatial distribution of stomach cancer in Iran using data from the cancer registry program in Iran for the year 2009. The reported incidences of stomach cancer for different provinces were standardized to the world population structure. ArcGIS software was used to analyse the data. Hot spots and high risk areas were determined using spatial analysis (Getis-Ord Gi). Hot and cold spots were determined as more than or less than 2 standard deviations from the national average, respectively. A significance level of 0.10 was used for statistical judgment. In 2009, a total of 6,886 cases of stomach cancers were reported of which 4,891 were in men and 1,995 in women (standardized incidence rates of 19.2 and 10.0, respectively, per 100,000 population). The results showed that stomach cancer was concentrated mainly in northwest of the country in both men and women. In women, northwest provinces such as Ardebil, East Azerbaijan, West Azerbaijan, Gilan, and Qazvin were identified as hot spots (p<0.1). In men, all northwest provinces, Ardabil, East Azerbaijan, Gilan, Qazvin, Zanjan and Kurdistan, the incidences were higher than the national average and these were identified as hot spots (P<0.01). As stomach cancer is clustered in the northwest of the country, further epidemiological studies are needed to identify factors contributing to this concentration.

Pakzad, Reza;Ghoncheh, Mahshid;Pournamdar, Zahra;Pakzad, Iraj;Momenimovahed, Zohre;Salehiniya, Hamid;Towhidi, Farhad;Makhsosi, Behnam Reza 33

https://doi.org/10.7314/APJCP.2016.17.S3.33 PDF KSCI

Skin cancer is one of the most common cancers worldwide, including in Iran. Variations in its incidence rate among geographical areas are due to various contributing factors. Since there has been a lack of studies on this topic in our country, the present spatial analysis of skin cancer incidence in Iran in 2009 was conducted using data from the cancer registry system for the country. The reported incidences of the disease were standardized on the basis of the World Health Organization population and the direct method. Then the data were inserted into the GIS software, and finally, using the analysis of hot spots (Getis-Ord Gi), high-risk areas were drawn. Provinces that were 1.9 SD higher or lower than the national average were considered hot spots or cold spots, with significance at the level of 0.05. In 2009, a total of 9,964 cases of skin cancer occurred, 3,696 in women and 6,268 in men (standardized incidence rates of 15.8 and 22.6, respectively). The results of the study showed that in men and women, the disease demonstrated high incidence in the central provinces and desert regions. In women, Yazd Province and in men, Qom Province had significant hot spots (p <0.05). While Isfahan, Markazi, Tehran and Kurdistan provinces were expected to be hot spots, the differences from the national average were not significant at the 0.05 level. As well, the provinces of Sistan Va Baluchistan, Kerman, and Hormozgan were identified as cold or low-risk disease regions (p <0.05). The central provinces of the country due to hot weather conditions, more solar radiation, and closer vicinity to the central desert of Iran demonstrated higher incidence rates for skin cancer, so further epidemiological studies into the etiology and early detection are essential in these areas.

Enayatrad, Mostafa;Mirzaei, Maryam;Salehiniya, Hamid;Karimirad, Mohammad Reza;Vaziri, Siavash;Mansouri, Fiezollah;Moudi, Asieh 39

https://doi.org/10.7314/APJCP.2016.17.S3.39 PDF KSCI

Cancer is a major public health problem in Iran. The aim of this study was to evaluate trends in incidence of ten common cancers in Iran, based on the national cancer registry reports from 2004 to 2009. This epidemiological study was carried out based on existing age-standardized estimate cancer data from the national report on cancer registry/Ministry of Health in Iran. The obtained data were analyzed by test for linear trend and $P{\geq}0.05$ was taken as the significant level. Totals of 41,169 and 32,898 cases of cancer were registered in men and females, respectively, during these years. Overall age-standard incidence rates (ASRs) per 100,000 population according to primary site weres 125.6 and 113.4 in males and females, respectively. Between 2004 and 2009, the ten most common cancers (excluding skin cancer) were stomach (16.2), bladder (12.6), prostate (11), colon-rectum (10.14), hematopoeitic system (7.1), lung (6.1), esophagus (6.4), brain (3.2), lymph node (3.8) and larynx (3.4) in males; and in females were breast (27.4), colon-rectum (9.3), stomach (7.6), esophagus (6.4), hematopoeitic system (4.9), thyroid (3.9), ovary (3.6), corpus uteri (2.9), bladder (3.2) and lung (2.6). Moreover, results showed that skin cancer was estimated as the most common cancer in both sexes. The lowest and the highest incidence in females and males were reported respectively in 2004 and 2009. Over this period, the incidence of cancer in both sexes has been significantly increasing (p<0.01). Like other less developed and epidemiologically transitioning countries, the trend of age-standardized incidence rate of cancer in Iran is rising. Due to the increasing trends, the future burden of cancer in the Iran is going to be acute with the expected increases in aging populations. Determining and controlling potential risk factors of cancer should hopefully lead to decrease in its burden.

Ghoncheh, Mahshid;Pournamdar, Zahra;Salehiniya, Hamid 43

https://doi.org/10.7314/APJCP.2016.17.S3.43 PDF KSCI

Breast cancer is the most common malignancy in women around the world. Information on the incidence and mortality of breast cancer is essential for planning health measures. This study aimed to investigate the incidence and mortality of breast cancer in the world using age-specific incidence and mortality rates for the year 2012 acquired from the global cancer project (GLOBOCAN 2012) as well as data about incidence and mortality of the cancer based on national reports. It was estimated that 1,671,149 new cases of breast cancer were identified and 521,907 cases of deaths due to breast cancer occurred in the world in 2012. According to GLOBOCAN, it is the most common cancer in women, accounting for 25.1% of all cancers. Breast cancer incidence in developed countries is higher, while relative mortality is greatest in less developed countries. Education of women is suggested in all countries for early detection and treatment. Plans for the control and prevention of this cancer must be a high priority for health policy makers; also, it is necessary to increase awareness of risk factors and early detection in less developed countries.

Ghoncheh, Mahshid;Mahdavifar, Neda;Darvishi, Efat;Salehiniya, Hamid 47

https://doi.org/10.7314/APJCP.2016.17.S3.47 PDF KSCI

Breast cancer is the most common malignancy in women in Asia and its incidence is rapidly increasing. Information on the incidence and mortality of breast cancer is essential for planning health and more studies. This study aimed to investigate the age-specific incidence and mortality of breast cancer in Asia in 2012. A total of 639,824 cases of breast cancer were recorded in Asian countries, those with the five highest standardized incidence rates being Israel, Lebanon, Armenia, Singapore, and Kazakhstan. The highest number of deaths was observed in India, China, Indonesia, Pakistan, and Japan, respectively. Tith increasing income and improving living standards in developing countries, the incidence of breast cancer increases. This may be due to longer life, higher exposure to risk factors, eating more fatty foods and obesity, and lower pregnancy rates. The variation in incidence rates of breast cancer is very pronounced in Asia (from 80.5 in Israel to 4.6 in Bhuta). A similar situation exists for mortality rates (from 1.8 in Bhutan to 25.2 in Pakistan).

Pakzad, Reza;Moudi, Asieh;Pournamdar, Zahra;Pakzad, Iraj;Mohammadian-Hafshejani, Abdollah;Momenimovahed, Zohre;Salehiniya, Hamid;Towhidi, Farhad;Makhsosi, Behnam Reza 53

https://doi.org/10.7314/APJCP.2016.17.S3.53 PDF KSCI

Colorectal cancer is one of the most common cancers. Due to demographic changes, it is predicted that the incidence of this cancer will increase. Variations of its incidence rate among geographical areas are due to various contributing factors. Since there have been a lack of studies on this topic in our country, the present assessment of spatial patterns of colorectal cancer incidence in Iran was performed. In this ecological study, the new cases of colon cancer were extracted from Cancer Registry Center report of the Health Deputy of Iran in 2009. The reported incidences of the disease were standardized on the basis of the World Health Organization population and the direct method. Then the data were inserted into the GIS software, and finally, using the analysis of hot spots (Getis-Ord Gi) high-risk areas were drawn. Provinces that are higher or lower than the national average (1.9 SD) were considered hot spots or cold spots, significant at the level of 0.05. A total of 6,210 cases of colorectal cancer were registered in Iran in 2009, of which 3,727 were in men and 2,783 in women (age-standardized rates of 11.3 and 10.9 per 100,000 population, respectively). The results showed that in central and northern Iran including Isfahan, Qom, Tehran, Qazvin and Mazandaran significant hot spots in men were present (p <0.05). In women also we have high incidence in northern and central states: Mazandaran province (p<0.01) and the province of Tehran (p<0.05) had higher incidences than the national average and were apparent as significant hot spots. Analysis of the spatial distribution of colorectal cancer showed significant differences between different areas pointing to the necessity for further epidemiological studies into the etiology and early detection.

Mahdavifar, Neda;Pakzad, Reza;Ghoncheh, Mahshid;Pakzad, Iraj;Moudi, Asieh;Salehiniya, Hamid 59

https://doi.org/10.7314/APJCP.2016.17.S3.59 PDF KSCI

Breast cancer (BC) is the most common cancer in females (27% of the total) and the main cause of death (16%) due to cancer in women in developed and developing countries. Variations in its incidence rate among geographical areas are due to various contributing factors. Since there have been a lack of studies on this topic in our country, the present spatial analysis of breast cancer incidence in Iran in 2009 was conducted using data from the national cancer registry system. The reported incidences of the disease were standardized according to the World Health Organization population and the direct method. Then data was inserted into the GIS software and finally, using the Hot Spot Analysis (Geties-Ord Gi), high-risk areas were drawn. Provinces with incidences 1.96 SD higher or lower than the national average were considered as hot spots or cold spots, at the significance level of 0.05%. In 2009, a total of 7,582 cases of BC occurred in Iran. The annual incidence was 33.2 per hundred thousand people. Our study showed that the highest incidence of BC in women occurred in the central provinces of the country, Tehran, Isfahan, Yazd, Markazi and Fars. The results of hot spots analysis showed that the distribution of high-risk BC was focused in central parts of Iran, especially Isfahan province (p <0.01). The other provinces were not significantly different from the national average. The higher incidence in central provinces may be due to greater exposure to carcinogens in urban areas, a Western lifestyle and high prevalence of other risk factors. Further epidemiological studies about the etiology and early detection of BC are essential.

Khan, Mohammad Haroon;Hussain, Shahid;Bano, Raisa;Jamshed-ul-Hassan, Hafiz;Aadil ur Rehman, Muhammad 65

https://doi.org/10.7314/APJCP.2016.17.S3.65 PDF KSCI

Lung cancer is one of the most common malignancies in the world. Its incidence and mortality rates are on the rise in Pakistan. However, epidemiological studies to identify common lung cancer determinants in the Pakistani population have been limited. In this study, data of 440 cases and 323 controls were collected from different hospitals in Peshawar and Islamabad, along with information about socio-demographic factors including age, sex and smoking. Univariate and multi-factorial analyses of socio-demographic factors in association with each other were also performed. Overall survival analysis highlighted that, out of 440 patients in the lung cancer dataset, 204 people were uncensored with a median survival time of 13 months (95% CI=12-18). There were 41 femaleand 399 male patients. Differences were observed between length of survival in the males and females (${\chi}12$ = 6.1; p-value = 0.01). Gender was observed to be significantly related to survival (p-value< 0.01), with better survival in females (hazard ratio=2). Cox regression was extended to adjust for the covariate age (z = 2.5; p-value = 0.02). Survival analysis was also performed on the basis of smoking groups (current smokers, former smokers and never smoked individuals) and smoking duration (smoking duration >10 years, <10 years and never smoked). Smoking duration was significantly associated with survival (p-value < 0.01), with better survival in never smokers in comparison to both smoking for greater or less than 10 years. Strong associations were observed for smoking group with duration greater than 10 years, OR=6.1(3.9-9.5) on univariate and multifactorial analysis OR=11.3(CI=6.8-19.3).

Hussain, Shahid;Bano, Raisa;Khan, Muhammad Tahir;Khan, Mohammad Haroon 71

https://doi.org/10.7314/APJCP.2016.17.S3.71 PDF KSCI

Pancreatic cancer is a leading cause of fatality worldwide. Several population studies have been conducted on genetic diagnosis of pancreatic cancer but the results from epidemiologic studies are very limited. CYP17A gene has a role in disease formation but its influence on pancreatic cancer is unclear. A polymorphism in the 5'UTR promoter region of CYP17A1-34T/C (A1/A2) has been associated with multiple cancers. The aim of the current study was to assess associations of this polymorphism and socio-demographic risk factors with pancreatic cancer. A total of 255 and 320 controls were enrolled in the study, and were genetically analyzed through PCR-RFLP. Statistical analysis was conducted with observed genotype frequencies and odds ratios (ORs) and 95% CIs were estimated using unconditional logistic regression. The impact of socio-demographic factors was accessed through Kaplen-Meir analysis. According to our results, the A2/A2 genotype was significantly associated with pancreatic cancer (OR=2.1, 95%CI = 1.3-3.5). Gender female (OR=2.6, 95%CI=1.8-3.7), age group 80s/80+ years (OR=2.2, 95% CI=1.2-4), smoking both former (OR=4.6, 95% CIs=2.5-8.8) and current (OR=3.6, 95% CI=2-6.7), and family history (OR=7.1; 95%CI = 4.6-11.4) were also found associated with increased risk. Current study suggests that along with established risk factors for pancreatic cancer CYP17A1-34T/C may play a role. However, on the basis of small sample size the argument cannot be fully endorsed and larger scale studies are recommended.

Honarmand, Marieh;Farhad-Mollashahi, Leila;Nakhaee, Alireza;Nehi, Masoume 77

https://doi.org/10.7314/APJCP.2016.17.S3.77 PDF KSCI

Oral squamous cell carcinoma (OSCC) is one of the ten most common causes of cancer death worldwide. Assessment of molecular changes can help detect and control lesions. The aim of this study was evaluation of salivary levels of ErbB2 and CEA in OSCC patients. In this case-control study, 27 OSCC patients and 26 healthy controls participated. After obtaining consent and filling out a questionnaire, unstimulated saliva samples were collected from people in the morning for measurement of the two markers using ELISA. Data were analyzed using Mann Whitney U test in SPSS 19 software with P<0.05 considered significant. Subjects were in the age range of 40 to 65 years. \Salivary level CEA was elevated in OSCC samples ($42.6{\pm}21.1ng/ml$) as compared to those of controls ($22.6{\pm}22.1ng/ml$) (p< 0.01), but no significant variation was noted for ErbB2 ($5.2{\pm}1.8ng/ml$ and $4.93{\pm}2.14ng/ml$, p=0.28). The role of ErbB2 as a tumor marker in patients with OSCC must still be regarded as controversial and needs further studies to clarify any significance for early detection or screening. In contrast the salivary level of CEA may find application for early detection of patients.

Honarvar, Behnam;Sayar, Negin;Tahmasebi, Sedigheh;Zakeri, Zeinab;Talei, Asra;Rostami, Sara;Khademi, Sahar;Sarvestani, Amene Sabzi;Sekhavati, Eghbal 81

https://doi.org/10.7314/APJCP.2016.17.S3.81 PDF KSCI

Globally, the burden of breast cancer (BC) continues to increase. BC related lymphedema (BCRL) is currently non curable and as a life time risk it affects at least 25% of BC patients. Knowing more about BCRL and appropriate control of its modifiable risk factors can improve quality of life (QOL) of the affected patients. In this case control study to detect factors, 400 women with BCRL (as the case group) and 283 patients with BC without lymphedema (as the control group) that were referred to Shiraz University of Medical Sciences affiliated BC clinic center were assessed. The data were analyzed in SPSS. The mean age of the case group was $52.3{\pm}11.0years$ and of the control group was $50.1{\pm}10.9years$. In patients with BCRL, 203(50.7%) had left (Lt) side BC and in non- lymphedema group 151 (53.3%) had Lt side BC. Out of all BCRL patients, 204 (51%) had lymphedema in all parts of their affected upper extremities, 100 (25%) had swelling in the arm and forearm and 23 (5.7%) had edema in both the upper extremity and trunk. Edema, heaviness, concern about changing body image, pain and paresthesia were the most common signs/symptoms among patients with BCRL. In BCRL patients, the difference of circumference between the affected upper limb and non-affected limb was $4.4{\pm}2.5cm$ and the difference in volume displacement was $528.7{\pm}374.4milliliters$. Multiple variable analysis showed that moderate to severe activity (OR; odds ratio =14, 95% CI :2.6-73.3), invasiveness of BC (OR =13.7, 95% CI :7.3-25.6), modified radical mastectomy (OR=4.3, 95% CI :2.3-7.9), BMI =>25 (OR=4.2, 95% CI :2-8.7), radiotherapy (OR=3.9, 95% CI :1.8-8.2), past history of limb damage (OR=1.7, 95% CI :0.9-3.1) and the number of excised lymph nodes (OR=1.06, 95% CI :1.02-1.09) were the significant predictors of lymphedema in women with BC. Modifiable risk factors of BCRL such as non-guided moderate to severe physical activity, high BMI and trauma to the limb should be controlled as early as possible in BC patients to prevent development of BCRL and improve QOL of these patients.

Ameri, Ahmad;Mortazavi, Nafiseh;Ahmadi, Helaleh Khoshbakht;Novin, Kambiz 87

https://doi.org/10.7314/APJCP.2016.17.S3.87 PDF KSCI

To investigate whether excision repair cross complementing-group1 (ERCC1) expression status could serve as a bio-predictor of response to platinum-based induction chemotherapy for head and neck cancers (HNCs) patients with a diagnosis of epithelial HNC were studied retrospectively. Paraffin embedded tumor samples of the patients were analyzed by reverse transcription-polymerase chain reaction (RT-PCR) to determine ERCC1 expression status and its correlation with response to platinum-based induction chemotherapy was investigated. Of 44 included patients, 33 were male (75%) and 11 were female (25%) with a mean age of 53 years. Some 36% of patients whose tumor samples had high ERCC1 expression showed no response to induction chemotherapy. The value for patients with low ERCC1 expression was 9% and the difference was statistically significant (p=0.03). The ERCC1 expression state did not significantly vary between patient groups according to sex, age, primary tumor site, and tumor and node stage. Our study indicates that ERCC1 expression status detected by RT-PCR might serve as a bio-predictor of response to platinum-based induction chemotherapy for epithelial HNCs.

Mohammadi, Gohar;Akbari, Mohammad Esmaeil;Mehrabi, Yadolah;Motlagh, Ali Ghanbari;Pour, Elham Partovi;Roshandel, Gholamreza;Khosravi, Ardasheir 93

https://doi.org/10.7314/APJCP.2016.17.S3.93 PDF KSCI

Completeness is an important indicator of data quality in cancer registry programs. This study aimed to estimate the completeness of registered cases in a population based cancer registry program implemented in five provinces of Iran. Capture-recapture methods were used to estimate the number of cases that may have been missed and to estimate rates of completeness for different categories of age, year, and sex. The data used for this study were obtained from three sources: 1) National Pathology Database; 2) National Hospital Discharge Database; and 3) National Death Registry Database. The three sources were linked and duplicates were identified based on first name, last name, father's names, and date of birth, ICD code, and case's residency address using Microsoft Excel. Removing duplicates, the three sources reported a total of 35,643 cases from March 2008 to March 2011. Running many different multivariate models of capture-recapture and controlling for source dependencies revealed an overall under-reporting of 49% in all five registries combined. The estimated completeness differed based on age, sex, and year. The overall completeness was higher for males than females (71.2% for males and 59.9% for females). Younger age had lower rates of completeness compared to older age (38.1% for <40 years, 55.4% for 40-60 years, and 76.7 for >60 years). The results of this study indicated a moderate to severe (depending on the age, sex and year) degree of completeness in the population based cancer registration of Iran.

Mirzaei, Mohsen;Mirzadeh, Mahboobahsadat;Mirzaei, Mojtaba 101

https://doi.org/10.7314/APJCP.2016.17.S3.101 PDF KSCI

The number of deaths is often measured to monitor the population health status and priority of health problems. However, number of years of life lost (YLL) is a more appropriate indicator in some cases. We have calculated the YLL of adult cancers and its trend over the past few years in Yazd to provide planners with baseline data. Data obtained from death registration system were used to calculate the YLL, based on each individual's age at death, and the standardized expected YLL method was applied with a discount rate of 0.03, an age weight of 0.04, and a correction factor of 0.165. All data were analyzed and prepared in Epi6 and Excel 2007. A total of 3,850 death records were analyzed. Some 550 patients in Yazd province aged ${\geq}20$ die annually due to cancer (male: female ratio 1.3). The average ages at death in lung, CNS, breast cancer and leukemia cases were 68.5, 59, 58.7 and 61, respectively. The age group of 40-59 with 21 % had the highest cancer mortality percentage. Premature cancer deaths have caused 40,753 YLL (5,823 YLL annually). Females lose on average more life years to cancer than do men (11.6 vs 9.8 years). Lung cancer (12.1%), CNS tumors (11.7%) and leukemia (11.4 %) were the leading causes terms of YLL due to all cancers in both sexes. From 2004 to 2010, cancer-caused YLL as a fraction of all YLL increased from 12.8 to 15.2 %. This study can help in the assessment of health care needs and prioritization. Cancer is the major cause of deaths and the trend is increasing. The use of YLLs is a better index for measurement of premature mortality for ranking of diseases than is death counts. Longer periods of observation will make these trends more robust and will help to evaluate and develop, better public health interventions.

Bagheri-Nesami, Masoumeh;Goudarzian, Amir Hossein;Babaei, Ghasem Jan;Badiee, Milad;Mousavi, Mostafa;Sharifi, Mohammad Sadegh 107

https://doi.org/10.7314/APJCP.2016.17.S3.107 PDF KSCI

This study aimed to determine sleep disorders and associated risk factors in leukemia patients undergoing chemotherapy in Imam Khomeini Hospital of Sari, Iran. This cross-sectional study was conducted in 2015 with 100 patients selected. Inclusion criteria included complete mental and psychological health and being over 18 years old, and exclusion criteria included suffering other cancers, other chronic diseases, concurrent radiotherapy, and chemotherapy. The Pittsburgh Sleep Quality standard questionnaire was used to collect data. The questionnaire consisted of mental sleep quality, sleep latency, sleep duration, sleep quality, sleep disturbances, use of sleeping drugs, and impaired daily functioning. Data were analyzed by software SPSS 18 and by using descriptive and inferential tests (Pearson, Spearman, T-test and chi-square). Totals of 47 men (47%) and 53 women (53%) with a mean age of $44.1{\pm}1.7$, participated in the study. The mean overall score of sleep quality was $9.3{\pm}3.9$, which represents the average sleep quality in most participants. T-test shows that males have better sleep quality than females (t=2.1; 95%CI:0.004-0.25; P<0.01). Also the sleep quality increased with age (r=0.22, P=0.03). Results show that the amount of sleep quality was only moderate in most patients, so it is necessary to take coping strategies to improve their quality of sleep.

Momenyan, Somayeh;Sadeghifar, Majid;Sarvi, Fatemeh;Khodadost, Mahmoud;Mosavi-Jarrahi, Alireza;Ghaffari, Mohammad Ebrahim;Sekhavati, Eghbal 113

https://doi.org/10.7314/APJCP.2016.17.S3.113 PDF KSCI

Quantile regression is an efficient method for predicting and estimating the relationship between explanatory variables and percentile points of the response distribution, particularly for extreme percentiles of the distribution. To study the relationship between urbanization and cancer morbidity, we here applied quantile regression. This cross-sectional study was conducted for 9 cancers in 345 cities in 2007 in Iran. Data were obtained from the Ministry of Health and Medical Education and the relationship between urbanization and cancer morbidity was investigated using quantile regression and least square regression. Fitting models were compared using AIC criteria. R (3.0.1) software and the Quantreg package were used for statistical analysis. With the quantile regression model all percentiles for breast, colorectal, prostate, lung and pancreas cancers demonstrated increasing incidence rate with urbanization. The maximum increase for breast cancer was in the 90th percentile (${\beta}$=0.13, p-value<0.001), for colorectal cancer was in the 75th percentile (${\beta}$=0.048, p-value<0.001), for prostate cancer the 95th percentile (${\beta}$=0.55, p-value<0.001), for lung cancer was in 95th percentile (${\beta}$=0.52, p-value=0.006), for pancreas cancer was in 10th percentile (${\beta}$=0.011, p-value<0.001). For gastric, esophageal and skin cancers, with increasing urbanization, the incidence rate was decreased. The maximum decrease for gastric cancer was in the 90th percentile(${\beta}$=0.003, p-value<0.001), for esophageal cancer the 95th (${\beta}$=0.04, p-value=0.4) and for skin cancer also the 95th (${\beta}$=0.145, p-value=0.071). The AIC showed that for upper percentiles, the fitting of quantile regression was better than least square regression. According to the results of this study, the significant impact of urbanization on cancer morbidity requirs more effort and planning by policymakers and administrators in order to reduce risk factors such as pollution in urban areas and ensure proper nutrition recommendations are made.

Hedayati, Mehdi;Nozhat, Zahra;Hannani, Masoomeh 119

https://doi.org/10.7314/APJCP.2016.17.S3.119 PDF KSCI

Thyroid cancer, the most common endocrine neoplasia, consists of four main types of carcinomas: papillary, follicular, and anaplastic, all with thyroid follicular origin, and medullary thyroid cancer (MTC) related to para-follicular cells. Cronic diseases such as diverse cancers may be associated with cachexia, especially at advanced stage. Cancer-induced cachexia is associated with diminished quality of life, functional performance, reduced response to antitumor therapy, and increased morbidity and mortality. Myostatin (Mst) is one of the outstanding molecules in the skeletal muscle loss process in cancer and it may be released by both skeletal muscle and cachexia-inducing tumors. Recently changes in serum levels of Mst have been identified as an important factor of cancer-induced cachexia. The goal of this study was to assessserum Mst levels in MTC patients. In this descriptive and case-control study, 90 participants were selected, comprising 45 MTC patients (20 males, $29{\pm}13.9years$, 25 females, $29{\pm}14.5years$) and 45 control individuals (25 males, $23.1{\pm}11.6years$, 20 females, $31.5{\pm}14.4years$). Serum Mst was determined using an ELISA kit and body mass index (BMI) was calculated by weight and height measurements. The Kolmogorov Simonov test showed a normal distribution for log transformed Mst serum levels in both case and control groups. Geometric means were 5.9 and 8.2 ng/ml respectively, and a significant difference was found according to the independent t-test results (P<0.01). There was also a significant difference mean of Mst between females in control and MTC groups, but not for the males. Pearson correlation test showed no correlation between age and BMI with Mst serum levels. The findings of this study support the hypothesis that Mst serum levels may have a potential ability for early diagnosis of cachexia in MTC patients, especially in females.

Emami, Seyed Ahmad;Asili, Javad;HosseinNia, Shima;Yazdian-Robati, Rezvan;Sahranavard, Mehrdad;Tayarani-Najaran, Zahra 125

https://doi.org/10.7314/APJCP.2016.17.S3.125 PDF KSCI

Nepeta cataria L. has been used in traditional medicine of some countries. Here the cytotoxic and apoptogenic activity of methanol extracts, n-hexane, dichloromethane, ethyl acetate, n-butanol, and acqueous extracts and the essential oil obtained from the aerial parts of the plant were evaluated with PC3, DU-145 and MCF-7 cell lines. Cell viability, histograms of PI stained fragmented DNA in apoptotic cells and Western blot analysis of proteins involved in the cascade of apoptosis were compared in all samples. Thirty components were identified as volatile, representing 99.7% of essential oil composition after GC-MS analysis of the oil obtained from aerial parts of the N. cataria by hydro-distillation. The major oil components of the essential oil were nepetalactone stereoisomers. Comparing IC50 values showed estrogen receptor positive PC3 cells were more sensitive to the cytotoxic effects of N. cataria in comparison with low hormone-receptor presenting DU-145 cells. Among multiple extracts and essential oils of the plant, only the ethyl acetate extract could significantly decrease cell viability in PC3 cells, in a concentration dependent manner. Ethyl acetate extract of N. cataria treated cells showed a sub-G1 peak in PC3 cells in a concentration dependent manner that indicates the involvement of an apoptotic process in ethyl acetate extract-induced cell death. Western blotting analysis showed that in PC3 cells treated with ethyl acetate (48 h) caspase 3 and PARP were cleaved to active forms. Overall, the results suggest that further analytical elucidation of N. cataria in respect to finding new cytotoxic chemicals with anti-tumor activity is warranted.

Mirmalek, Seyed Abbas;Jangholi, Ehsan;Jafari, Mohammad;Yadollah-Damavandi, Soheila;Javidi, Mohammad Amin;Parsa, Yekta;Parsa, Tina;Salimi-Tabatabaee, Seyed Alireza;Kolagar, Hossein Ghasemzadeh;Jalil, Saeed Khazaei;Alizadeh-Navaei, Reza 131

https://doi.org/10.7314/APJCP.2016.17.S3.131 PDF KSCI

Breast cancer is the most common malignancy and also the second leading cause of cancer death among women and also in women that have a high mortality. Previous studies showed that magnesium (Mg) has cytotoxic effects on malignant cell lines. However, the anti-cancer effects of Mg on MCF-7 breast cancer cells are uncertain. This study was aimed at the comparison of the cytotoxic effect of Mg salt (MgCl2) and cisplatin on MCF-7 cells and fibroblasts (as normal cells). After treatment with various concentrations of MgCl2, and cisplatin as a positive control for 24 and 48 hours (h), cytotoxicity activity was measured by MTT assay. In addition, apoptosis was determined by annexin V/propidium iide assay. Both cisplatin and the MgCl2 exhibited dose-dependent cytotoxic effects in the MCF-7 cell line, although the LD50 of the Mg was significantly higher when compared to cispaltin ($40{\mu}g/ml$ vs. $20{\mu}g/ml$). Regarding annexin V/propidium results, treatment of MCF-7 cells with LD50 concentrations of cisplatin and Mg showed 59% and 44% apoptosis at 24h, respectively. Finally, the results indicated that Mg has cytotoxic effects on MCF-7 cells, but less than cisplatin as a conventional chemotherapeutic agent. However, regarding the side effects of chemotherapy drugs, it seems that Mg can be considered as a supplement for the treatment of breast cancer.

Khoshravesh, Sahar;Taymoori, Parvaneh;Roshani, Daem 135

https://doi.org/10.7314/APJCP.2016.17.S3.135 PDF KSCI

Since the mean age of breast cancer in women living in developing countries, compared with those in developed countries, is lower by about 10 years, repetition of mammography can play an important role in reducing morbidity and mortality. Hence, this study aimed to investigate the relationship between family history of breast cancer and risk perception and its impact on repetition of mammography. In this cross-sectional study, 1,507 women aged 50 years and older, referred to the mammography center of Regions 1 and 6 in Tehran, Iran, were enrolled. Data were collected using a self-report questionnaire and analyzed using SPSS and LISREL. According to our findings, knowledge about the time interval of mammography was found to have the highest correlation with repetition of mammography (r=0.4). Among the demographic variables, marital status (${\beta}$= -0.1) and family history of breast cancer (${\beta}$=0.1) had the most direct and significant impact on repetition of mammography (P <0.05). Among the other variables studied, knowledge (${\beta}$=-0.5) had the highest direct and significant impact on repetition of mammography (P <0.05). Family history of breast cancer was one of the predictors of repetition of mammography, but the results did not prove any relationship with risk perception. Further studies are needed to assess the effect of risk perception and knowledge about time interval on the initiation and continuation of mammography.

Ahmadipour, Habibeh;Sheikhizade, Sahar 143

https://doi.org/10.7314/APJCP.2016.17.S3.143 PDF KSCI

Breast and cervical cancers are among leading causes of morbidity and mortality in women worldwide. Regular screening is very important for early detection of these cancers, but studies indicate low rates of screening participation. In this survey we studied the rate of screening participation among women 18-64 years old referred to urban health centers in Kerman, Iran in 2015. A cross-sectional study was carried out on 240 women who were selected using a multistage sampling method. Data collected using a questionnaire covered demographics and questions about common cancer screening status in women. Analysis was by SPSS 19. The mean age of participants was $31.7{\pm}7$. Most (97.1%) were married, housewives (83.3%), had high school diploma (43.8%) and a monthly income more than ten million Rls. The frequency of the Pap test performance was higher in women who were employed and with a university degree (p<0.05). The frequency of mammography performance in women over 40 years was also higher in women with university degree (p<0.05). There was no statistically significant difference in the frequency of pelvic examination, and self and clinical breast examinations based on education, household income and employment (p>0.05). Our study found that the rate of screening participation among women is low. Investigation of the barriers, increasing the awareness of women about the importance and advantages of screening and also more incentives for health personnel especially family physicians to pay more attention to preventive programs could be effective.

Yassaee, Vahid Reza;Ravesh, Zeinab;Soltani, Ziba;Hashemi-Gorji, Feyzollah;Poorhosseini, Seyed Mohammad;Anbiaee, Robab;Joulaee, Azadeh 149

https://doi.org/10.7314/APJCP.2016.17.S3.149 PDF KSCI

Breast cancer is the most common cancer in Iran. In the recent years an upward trend has been observed in the Iranian population. Early detection by molecular approaches may reduce breast cancer morbidity and mortality. We provided consultation to 3,782 women diagnosed with early onset breast cancer during the past 15 years (1999-2014). To establish a data set for BRCA gene alterations of the Iranian families at risk, two hundred and fifty four women who met our criteria were analyzed. A total number of 46 alterations including 18 variants with unknown clinical significance (39.1%), 18 missense mutations (39.1%), 7 Indels (15.2%) and 3 large rearrangement sequences (6%) were identified. Further scanning of affected families revealed that 49% of healthy relatives harbor identical causative mutations. This is the first report of comprehensive BRCA analysis in Iranian women with early onset breast cancer. Our findings provide valuable molecular data to support physicians as well as patients for the best decision making on disease management.

Poorhosseini, Seyed Mohammad;Hashemi, Mohammad;Olyaei, Nasrin Alipour;Izadi, Amir;Moslemi, Elham;Ravesh, Zeinab;Hashemi-Gorji, Feyzollah;Kheiri, Hamid Reza;Yassaee, Vahid Reza 155

https://doi.org/10.7314/APJCP.2016.17.S3.155 PDF KSCI

Breast cancer (BC) is the second most common cancer in the world and by far the most frequent cancer among women, with an estimated 1.67 million new cancer cases diagnosed in 2012 (25% of all cancers). Polygene expression analysis is used to predict the prognosis and determine the most appropriate treatment regimen. The objective of this study was to examine the gene expression profiles of SIRT3, HRAS, LSP1, SCUBE2 and AP2A2 in Iranian women with BC.A total of 136 patients including healthy controls were categorized into three groups based on the relapse of the disease. Expression of desired genes in formalin-fixed, paraffin embedded tissues collected from all groups of participants was analyzed via the RT PCR method. RNA extraction and cDNA synthesis were performed then real-time quantitative PCR was carried out. Gene expression analysis revealed that the expression of SIRT3 was equal among patient and control groups. LSP1 was down regulated in all patient groups relative to controls but reduced expression in the metastatic group relative to the non-metastatic one was not significant. HRAS was significantly overexpressed in total and metastatic tumor samples versus normal but not in non-metastatic cases. SCUBE2 expression showed significant over-expression in both overall tumor samples and the non-metastatic group as compared to normal tissues. Gene expression level of AP2A2 in all groups was not detectable. Our data are compatible with a tumor suppressor role of LSP1 related to potential prognostic factor for tumor recurrence and outcome. This study for the first time assayed the prognostic value and changes in the expression of SIRT3, LSP1, HRAS, SCUBE2 and AP2A2 genes in women with breast cancer in the Iranian population and findings confirmed potential biomarker and prognostic capability of these genes. Such expression profiling data can critically improve prognosis and treatment decisions in cancer patients.

Moshki, Mahdi;Taymoori, Parvaneh;Khodamoradi, Sahmireh;Roshani, Daem 161

https://doi.org/10.7314/APJCP.2016.17.S3.161 PDF KSCI

Iranian women are at high risk of low compliance with repeat mammography due to a lack of awareness about breast cancer, negative previous experiences, cultural beliefs, and no regular visits to a physician. Thus research is needed to explore factors associated with repeated mammography participation. Applying the concept of perceived risk as the guiding model, this study aimed to test the fit and strength of the relationship between perceived risk and physician recommendation in explaining repeat mammography. A total of 601 women, aged 50 years and older referred to mammography centers in region 6, were recruited via a convenience sampling method. Using path analysis, family history of breast cancer and other types of cancer were modeled as antecedent perceived risk, and physician recommendation and knowledge were modeled as an antecedent of the number of mammography visits. The model explained 49% of the variance in repeat mammography. The two factors of physician recommendation and breast self-examination had significant direct effects (P < 0.05) on repeat mammography. Perceived risk, knowledge, and family history of breast cancer had significant indirect effects on repeat mammography through physician recommendation. The results of this study provide a background for further research and interventions not only on Iranian women but also on similar cultural groups and immigrants who have been neglected to date in the mammography literature.

Attari, Seyedeh Maryam;Ozgoli, Giti;Solhi, Mahnaz;Majd, Hamid Alavi 167

https://doi.org/10.7314/APJCP.2016.17.S3.167 PDF KSCI

One of the major causes of morbidity and mortality in breast cancer patients is delay in seeking help. Leventhal's self-regulation model provides an appropriate framework to assess delay in seeking help. The aim of this study was to investigate the relationship between "illness perception" and "help seeking delay" in breast cancer patients based on Leventhal's self-regulation model. In this correlational descriptive study with convenience sampling conducted in 2013, participants were 120 women with breast cancer who were diagnosed in the last year and referred to chemotherapy and radiotherapy centers in Rasht, Iran. Data collection scales included demographic data, Revised Illness Perception Questionnaire (IPQ-R)and a researcher made questionnaire to measure the delay in seeking help. Pre-hospital delay (help seeking delay) was evaluated in 3 phases (assessment, disease, behavior). The data were analyzed using SPSS-19. The mean (SD) age calculated for the patients was $47.3{\pm}10.2$. Some 43% of the patients had a high school or higher education level and 82% were married. The "pre-hospital delay" was reported ${\geq}3months$. Logistic regression analysis showed that none of the illness perception components were correlated with appraisal and behavioral delay phases. In the illness delay phase, "time line" (p-value =0.04) and "risk factors"(p-value=0.03) had significant effects on reducing and "psychological attributions" had significant effects on increasing the delay (p-value =0.01). "Illness coherence" was correlated with decreased pre-hospital patient delay (p-value<0.01). Women's perceptions of breast cancer influences delay in seeking help. In addition to verifying the validity of Leventhal's self-regulation model in explaining delay in seeking help, the results signify the importance of the "illness delay phase" (decision to seek help) and educational interventions-counseling for women in the community.

Ghalib, Noori Nasr;Nasrullayeva, GM;Qaziyev, AY;Al-Ali Jawad, KH 175

https://doi.org/10.7314/APJCP.2016.17.S3.175 PDF KSCI

Breast cancer is the most common cancer among the population as a whole and among females, yet it is highly curable if diagnosed at an early stage. Different methods are used to diagnose breast cancer. One of these methods features immunological tests using flow cytometry to determine T-lymphocyte (CD4/CD8) ratios in peripheral blood. One hundred patients with breast cancer (50 from Basra, Iraq, and 50 from Baku, Azerbaijan) confirmed to have breast cancer by histopathology were studied. Blood samples were collected from all patients before initiation of treatment and were used for analysis. The mean age of women from Basra was $51.2{\pm}10.7years$ and that of women from Baku was slightly higher at $54.8{\pm}12.2$. The mean CD4/CD8 ratio in Basra was 1.4 and in Baku was 1.8 with P value < 0.05. The percentage of Basra patients who have CD4/CD8 value less than 1 was 50%, while the percentage for Baku patients was 24 % (p < 0.05). While the CD4/CD8 T-lymphocyte ratio might be useful for early diagnosis in patients with breast cancer parallel with other confirmed tests factors involved in explaining variation between countries such as that observed here need to be taken into account.

Shargh, Shohreh Alizadeh;Movafagh, Abolfazl;Zarghami, Nosratolah;Sayad, Arezou;Mansouri, Neda;Taheri, Mohammad;Pour, Atefeh Heidary;Iranpour, Mostafa;Ghaedi, Hamid;Montazeri, Vahid;Massoudi, Nilofar;Hashemi, Mehrdad;Mortazavi-Tabatabaei, SA 179

https://doi.org/10.7314/APJCP.2016.17.S3.179 PDF KSCI

Breast cancer is the most prevalent type of cancer among women around the world, and mortality is primarily caused by micro-metastatic disease. The complex mechanisms of breast cancer invasion and metastasis are intrinsically related to the malignant cell type so that early detection of micro-metastases can help prolongation of survival for patient. The aim of the present research work was evaluation of the expression status of mammoglobin protein as a candidate molecular marker in the negative sentinel lymph node (SLN). Fifty tumor specimens, and 50 normal adjacent breast tissue samples from the same patients were selected on the basis of having more than 10% tumor content for RNA extraction from SLNs. Tumor samples and normal adjacent breast tissue were archived in the form of frozen fresh tissue in liquid nitrogen. Real-time PCR was performed on a Bioner life express gradient thermal cycler system. Mammoglobin gene overexpression in breast cancer metastasis was investigated. Single marker results were mammaglobin 66.7% and CK19 50.0%, with 58.3% for the two in combination. Due to improved outcome with at least 3 genes (83.3%), it seems, triple marker evaluation will be most likely useful for detecting micro-metastases instead of studying separate genes.

Hoseini, L;Kashani, F Lotfi;Akbari, S;Akbari, ME;Mehr, S Sarafraz 185

https://doi.org/10.7314/APJCP.2016.17.S3.185 PDF KSCI

Breast cancer is the first or second malignancy among women worldwide. Illness perception (IP) and quality of life (QoL) are major issues considering breast cancer management. An attempt was here made to inspect the predictive variables influencing IP and their impact on QoL in cancer patients. The key predictors adapted from previous studies including life satisfaction, perceived social support, self-esteem, hope, optimism, and spiritual well being were taken into account. Our sample included 200 female volunteers suffering from breast cancer applying exclusion criteria. The data were collected using various questionnaires and statistically analyzed by means of path analysis and structural equation modeling. The results revealed that of the six predictors, spiritual well being and social support had direct effects on QoL and IP. The only path with significant indirect correlation with IP was social support. Spiritual well being had the second significant direct effect on IP. Self-esteem occupied the third rank in direct effects on both QoL and IP. In conclusion, here in Iran and most likely in other strongly religious communities, spiritual intervention is an effective strategy to raise QoL. Also social support helps women suffering from breast cancer to experience better conception and coping strategies.

Habib, Omran S;Hameed, Lamis A;Ajeel, Narjis A;Al-Hawaz, Mazin H;Al-Faddagh, Zaki A;Nasr, Ghalib N;Al-Sodani, Ali H;Khalaf, Asaad A;Hasson, Hasson M;Abdul-Samad, Aida A 191

https://doi.org/10.7314/APJCP.2016.17.S3.191 PDF KSCI

Breast cancer is the most frequent cancer in females. Its incidence is higher in developed countries than in developing ones partly due to variation in risk exposure and partly due to better detection methods. Scattered evidence in Basrah, Iraq, suggests that breast cancer has been increasing at a significant pace in recent years. This study aimed to measure the current level of risk of breast cancer among females in Basrah and to describe the time trend over almost a decade of years. Data on breast cancer cases from all sources of cancer registration in Basrah governorate were compiled for the years 2005-2012. The data for each year were first checked separately for duplicate reporting of cases among various sources. Then the eight files were pooled together and checked again for any duplicate cases among years of registration. The final set of data contained 2,284 cases of breast cancer (2,213 female cases and 71 male cases). All patients were inhabitants of Basrah governorate at the time of diagnosis. Figures on the Basrah population were obtained from various sources including the Ministry of Health, Ministry of Planning and Developmental Collaboration and local household surveys. It was possible to have total population estimates for each year and by age and sex. The data were imported into SPSS (version 17) software. Age specific and year specific incidence rates were calculated. The age standardized incidence rate was also calculated using world population as the standard population to be 34.9 per 100,000 females. Age-wise, no case was reported among children aged less than 15 years and the incidence increased with advancing age reaching a peak of 123.8/100,000 females at the age range of 50-54 years. The time trend of the crude incidence rate showed only modest increased risk with passage of years and no age shift could be documented in this study. Breast cancer in females in Basrah is a significant health problem. The current incidence rate (crude, 23.7/100,000, age-standardized, 34.9/100,000) is high and justifies intensive efforts to improve early detection of cases, provide better treatment amenities and introduce long term preventive measures. Using the age standardized incidence rate as reported in this paper, it is possible to put the risk in Basrah within a regional and international context.

Hussain, Riyadh Abdul-Ameer;Habib, Omran S 197

https://doi.org/10.7314/APJCP.2016.17.S3.197 PDF KSCI

On an international scale, the burden of cancer in absolute numbers continues to increase, mainly due to aging of population in many countries, the overall growth of the world population, changing lifestyle with increasing cancer-causing behavior, like cigarette smoking, changing dietary habits and sedentary life. Cancer is the second-leading cause of death and disability in the world, after only heart disease. Recently, increasing incidence and mortality of cancer have also become evident in the developing world. In Iraq and particularly in Basrah in the southern part of the country, the burden has definitely increased and deserves extensive research. The present paper is part of an extensive household survey carried out in Basrah in 2013. Among the objectives was to validate official cancer registration in the governorate. The cross-sectional survey had a retrospective component to inquire about the incidence of cancer and cancer-related deaths during the three years preceding the date of inquiry (2010-2012). A convenient sample of 6,999 households with 40,688 inhabitants using multistage cluster sampling was surveyed involving all urban and rural areas of Basrah. The official cancer registration activities in Basrah seemed to have attained a high level of registration coverage (70-80%) but the gap, represented by missed cases, is still high enough to criticize the system. Most of the missing cases were either not notified by treating facilities or they were diagnosed and treated outside Basrah. Using a set of parameters, the pattern of cancer was consistent based on data of the household survey and data of the cancer registry but a gap still existed in the coverage of incident cancer and mortality by cancer registration. Integrated serious steps are required to contain the risk of cancer and its burden on the patient through improving the registration process, improving early detection, diagnostic and management capabilities and encouraging scientific research to explore the hidden risk factors and possible causes of low registration coverage. Periodic household surveys seemed feasible and essential to support routine registration.

Rezaeian, Shahab;Khazaei, Salman;Khazaei, Somayeh;Mansori, Kamyar;Moghaddam, Ali Sanjari;Ayubi, Erfan 201

https://doi.org/10.7314/APJCP.2016.17.S3.201 PDF KSCI

This study aimed to quantify associations of the human development inequality (HDI) index with incidence, mortality, and mortality to incidence ratios for eight common cancers among different countries. In this ecological study, data about incidence and mortality rates of cancers was obtained from the Global Cancer Project for 169 countries. HDI indices for the same countries was obtained from the United Nations Development Program (UNDP) database. The concentration index was defined as the covariance between cumulative percentage of cancer indicators (incidence, mortality and mortality to incidence ratio) and the cumulative percentage of economic indicators (country economic rank). Results indicated that incidences of cancers of liver, cervix and esophagus were mainly concentrated in countries with a low HDI index while cancers of lung, breast, colorectum, prostate and stomach were concentrated mainly in countries with a high HDI index. The same pattern was observed for mortality from cancer except for prostate cancer that was more concentrated in countries with a low HDI index. Higher MIRs for all cancers were more concentrated in countries with a low HDI index. It was concluded that patterns of cancer occurrence correlate with care disparities at the country level.

Yari, Saeed;Asadi, Ayda Fallah;Varmazyar, Sakineh 205

https://doi.org/10.7314/APJCP.2016.17.S3.205 PDF KSCI

Excessive exposure to chemicals in the workplace can cause poisoning and various diseases. Thus, for the protection of labor, it is necessary to examine the exposure of people to chemicals and risks from these materials. The purpose of this study is to evaluate semi-quantitative health risks of exposure to harmful chemical agents in the context of carcinogenesis in a latex glove manufacturing industry. In this cross-sectional study, semi-quantitative risk assessment methods provided by the Department of Occupational Health of Singapore were used and index of LD50, carcinogenesis (ACGIH and IARC) and corrosion capacity were applied to calculate the hazard rate and the biggest index was placed as the basis of risk. To calculate the exposure rate, two exposure index methods and the actual level of exposure were employed. After identifying risks, group H (high) and E (very high) classified as high-risk were considered. Of the total of 271 only 39 (15%) were at a high risk level and 3% were very high (E). These risks only was relevant to 7 materials with only sulfuric acid placed in group E and 6 other materials in group H, including nitric acid (48.3%), chromic acid (6.9%), hydrochloric acid (10.3%), ammonia (3.4%), potassium hydroxide (20.7%) and chlorine (10.3%). Overall, the average hazard rate level was estimated to be 4 and average exposure rate to be 3.5. Health risks identified in this study showed that the manufacturing industry for latex gloves has a high level of risk because of carcinogens, acids and strong alkalisand dangerous drugs. Also according to the average level of risk impact, it is better that the safety design strategy for latex gloves production industry be placed on the agenda.

Habib, Omran S;Hussain, Riyadh Abdul-Ameer 213

https://doi.org/10.7314/APJCP.2016.17.S3.213 PDF KSCI

Cancer is a major health problem in the Arab region including Iraq. An adequate database is essential for effective cancer control strategies. Such a database may be provided through cancer registration but supportive household surveys may be useful. This article reports selected results on the feasibility of household surveys to support and validate cancer registration in Basrah governorate - southern Iraq. A large scale multi-stage cluster sample household survey was carried out in Basrah during 2013. It covered 6,999 households and involved gathering data on demographic characteristics and both incident cancer cases and cancer-related deaths among members of these households during a three-year recall period (2010-2012). The data obtained yielded an average annual incidence rate of 91 per 100,000 population (age-standardized incidence rate of 148.8 /100,000) and cancer specific mortality rate of 68 per 100,000 population (age-standardized mortality rate of 126.3/100,000). The results showed an overall pattern of cancer similar to that reported according to cancer registration but the household survey results were consistently higher than those of the cancer registration by a margin of approximately 20- 30% with respect to incident cancer and about 70 % with respect to cancer-specific mortality. Household surveys on cancer, while costly and time consuming, are a very useful additional source of information on cancer at the population level. They can be performed for specific purposes with effective resource mobilization.

Chamani, Fatemeh;Sadeghizadeh, Majid;Masoumi, Mahbobeh;Babashah, Sadegh 219

https://doi.org/10.7314/APJCP.2016.17.S3.219 PDF KSCI

Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver making up more than 80 percent of cases. It is known to be the sixth most prevalent cancer and the third most frequent cause of cancer related death worldwide. Epigenetic regulation constitutes an important mechanism by which dietary components can selectively activate or inactivate target gene expression. The miR-34 family members including mir-34a, mir-34b and mir-34c are tumor suppressor micro RNAs, which are expressed in the majority of normal tissues. Several studies have indicated silencing of miR-34 expression via DNA methylation in multiple types of cancers. Bioactive nutrients like curcumin (Cur) have excellent anticarcinogenic activity and minimal toxic manifestations in biological systems. This compound has recently been determined to induce epigenetic changes. However, Cur is lipophilic and has a poor systemic bioavailability and poor absorption. Its bioavailability is increased through employing dendrosome nanoparticles. The aim of the current study was to investigate the effect of dendrosomal nanocurcumin (DNC) on expression of mir-34 family members in two HCC cell lines, HepG2 and Huh7. We performed the MTT assay to evaluate DNC and dendrosome effects on cell viability. The ability of DNC to alter expression of the mir-34 family and DNA methyltransferases (DNMT1, DNMT3A and 3B) was evaluated using semi-quantitative and quantitative PCR. We observed the entrance of DNC into HepG2 and Huh7 cells. Gene expression assays indicated that DNC treatment upregulated mir34a, mir34b and mir34c expression (P<0.05) as well as downregulated DNMT1, DNMT3A and DNMT3B expression (P<0.05) in both HepG2 and Huh7 cell lines. DNC also reduced viability of Huh7 and HepG2 cells through restoration of miR-34s expression. We showed that DNC could awaken the epigenetically silenced miR-34 family by downregulation of DNMTs. Our findings suggest that DNC has potential in epigenetic therapy of HCC.

Khodadost, Mahmoud;Mosavi-Jarrahi, Alireza;Hashemian, Seyed Sepehr;Sarvi, Fatemeh;Maajani, Khadije;Moradpour, Farhad;Khatibi, Seyed Reza;Amini, Hossein 225

https://doi.org/10.7314/APJCP.2016.17.S3.225 PDF KSCI

Cancer registration is an important component of a comprehensive cancer control program, providing timely data and information for research and administrative use. Capture-recapture methods have been used as tools to investigate completeness of cancer registry data. This study aimed to estimate the completeness of lung cancer cases registered in Ardabil Population Based Cancer Registry (APBCR) with a three-source capture-recapture method. Data for all new cases of lung cancer reported by three sources (pathology reports, death certificates, and medical records) to APBCR for 2006 and 2008 were obtained. Duplicate cases shared among the three sources were identified based on similarity of first name, last name and father's names. A log-linear model was used to estimate number of missed cases and to control for dependency among sources. A total of 218 new cases of lung cancer was reported by three sources after removing duplicates. The estimated completeness calculated by log-linear method was 26.4 for 2006 and 27.1 for 2008. The completeness differed according to gender. In men, the completeness was 26.0% for 2006 and 28.1 for 2008. In women, the completeness was 36.5% for 2006 and 46.9 for 2008. In conclusion, none of the three sources can be considered as a reliable source for accurate cancer incidence estimation.

Marandi, Aref Kashefi;Shojaiefard, Abolfazl;Soroush, Ahmadreza;Abdegah, Ali Ghorbani;Jafari, Mehdi;Khodadost, Mahmoud;Mahmoudzade, Hossein 231

https://doi.org/10.7314/APJCP.2016.17.S3.231 PDF KSCI

Gastroesophageal cancer is one of the most common types of cancer worldwide. Despite significant developments in management, 5-year survival in the developing world is less than 20 percent. Due to restricted research about the impact of preoperative chemotherapy (POC) on tumor resection, pathological response and postoperative complications in Iran, we designed and implemented the present retrospective cross- sectional study on 156 patients with gastroesophageal cancer (GEc) between 2013 and 2015 at Shariati Hospital of Tehran. Two groups were included, the first group had previously received preoperative chemotherapy and the second group had only undergone surgery. All patients were followed for at least one year after the operation in terms of tumor recurrence, relapse free survival and one-year survival. The two groups were eventually compared regarding tumor resection, pathological response, postoperative complications, recurrence rate and survival. The mean age was $66.5{\pm}7.3years$ and 78 percent were male. The tumor resectability, pathological response and postoperative complications in the group which received POC were 93.5%, 21.8% and 12.8%, respectively, and in the surgery alone group figures for tumor resection and postoperative complications were 76% and 29.5%, respectively. Also based on our study the 5-year survival in the POC group was better (79.5% vs. 66.5%). Using standard neoadjuvant regimens (preoperative chemotherapy/chemoradiotherapy) beforesurgery could increase tumor resectability, pathological response, and improve the general status of the patients. Therefore using POC may be recommended over surgery alone.

Taghavi, Afsoon;Hashemi-Bahremani, Mohammad;Hosseini, Leili;Bazmi, Shabnam 239

https://doi.org/10.7314/APJCP.2016.17.S3.239 PDF KSCI

This article investigates ethical challenges cancer patients face in the end stages of life including doctors' responsibilities, patients' rights, unexpected desires of patients and their relatives, futile treatments, and communication with patients in end stages of life. These patients are taken care of through palliative rather than curative measures. In many cases, patients in the last days of life ask their physician to terminate their illness via euthanasia which has many ethical considerations. Proponents of such mercy killing (euthanasia) believe that if the patient desires, the physician must end the life, while opponents of this issue, consider it as an act of murder incompatible with the spirit of medical sciences. The related arguments presented in this paper and other ethical issues these patients face and possible solutions for dealing with them have been proposed. It should be mentioned that this paper is more human rational and empirical and the views of the legislator are not included, though in many cases human intellectual and empirical comments are compatible with those of the legislator.

Fallah, Raheleh;Akbari, Mohammad Esmaeil;Azargashb, Eznollah;Khayamzadeh, E 245

https://doi.org/10.7314/APJCP.2016.17.S3.245 PDF KSCI

Due to increasing incidence of breast cancer, recognition of risk factors has become increasingly important. Over the past few decades, among risk factors of this disease, stressful life events have attracted particular attention, but their relationship with breast cancer incidence and survival remains a mystery. This study aimed to examine the relationship between severe stressful life events and incidence and survival of women with breast cancer. In this case-control study, using a structured telephone interview with 355 women with breast cancer and also with 516 women with benign breast diseases who were matched in demographic characteristics, necessary information about the experience of major stressful events in the years before the diagnosis were collected. Data were analyzed using statistical methods of ${\chi}^2$, t, and Kaplan-Meier with a significance level of <0.05. Generally, in the case and control groups, there were no significant association between experience of stressful life events and incidence of breast cancer. Regarding associations between each of the events and incidence of breast cancer only "severe interpersonal problems with spouse" was significant. In the breast cancer group, even after controlling confounding variables, there was no significant association between major stressful events and disease-free survival, or overall 5-and 10-year survival. In this study, only "severe interpersonal problems with spouse" was confirmed as a risk factor. This result can be useful in developing preventive policies. More research regarding the interactive effects of psycho-social factors in the incidence and survival of breast cancer with stressful life events is recommended.

Khazaei, Salman;Rezaeian, Shahab;Khazaei, Somayeh;Mansori, Kamyar;Moghaddam, Ali Sanjari;Ayubi, Erfan 253

https://doi.org/10.7314/APJCP.2016.17.S3.253 PDF KSCI

Geographic disparity for colorectal cancer (CRC) incidence and mortality according to the human development index (HDI) might be expected. This study aimed at quantifying the effect measure of association HDI and its components on the CRC incidence and mortality. In this ecological study, CRC incidence and mortality was obtained from GLOBOCAN, the global cancer project for 172 countries. Data were extracted about HDI 2013 for 169 countries from the World Bank report. Linear regression was constructed to measure effects of HDI and its components on CRC incidence and mortality. A positive trend between increasing HDI of countries and age-standardized rates per 100,000 of CRC incidence and mortality was observed. Among HDI components education was the strongest effect measure of association on CRC incidence and mortality, regression coefficients (95% confidence intervals) being 2.8 (2.4, 3.2) and 0.9 (0.8, 1), respectively. HDI and its components were positively related with CRC incidence and mortality and can be considered as targets for prevention and treatment intervention or tracking geographic disparities.

Amirijavid, Shaghayegh;Entezari, Maliheh;Movafagh, Abolfazl;Hashemi, Mehrdad;Mosavi-Jarahi, Alireza;Dehghani, Hossein 257

https://doi.org/10.7314/APJCP.2016.17.S3.257 PDF KSCI

Cancer causes cells to avoid death while being the second cause of death in the world itself. Damaged cells in the absence of apoptosis will increasingly amplify their inefficient genome. Of the two main apoptosis inducing pathways in cells, the first has p53 protein as the main initiating factor in the cascade. According to research results this protein s mutated in 50% of cancers and sointerest has cooncentrated on the second pathway that features death receptors. Among these receptors TRAIL1/DR5 is especially expressed in cancer cells. So targeting such receptors can initiate the apoptotic cascade in cells. Interestingly by substitution of activating ligands with antibodies as agonists, we could efficiently turn on the apoptosis pathway. First of all, three small peptides from the DR5 protein extracellular domain were synthesized and injected with two different kind of adjuvants (Fround and liposomal encapsulation) separately into mice at 15 day intervals. As a result, liposomal peptides induced the immune system more efficient than Frounds adjuvant and at the end point the antibodies which were obtained from liposomal peptide injection induced much more effective death. Liposomal formol could be used as an adjuvant in immunization utilizing small peptides. They carry, protect and deliver peptides very efficiently. In addition, small peptides of a certain size from the extracellular domain of DR5 proteins not only can induce immune system but also produce antibodies playing a remarkable anti-cancer roles against breast cancer cells (MCF-7).

Majdfar, Zahra;Khodadost, Mahmoud;Majlesi, Freshteh;Rahimi, Abbas;Shams, Mohsen;Mohammadi, Gohar 263

https://doi.org/10.7314/APJCP.2016.17.S3.263 PDF KSCI

Cervical cancer is the fourth common cancer among women worldwide. Pap smear screening has resulted in deceasing incidence of cervical cancer in developed countries but low uptake of Pap smear screening among women in developing countries is still a public health challenge. The aim of this cross-sectional study was to assess the relationship between self-efficacy and timely uptake of Pap smear among Iranian women. A total of 580 married women referred to primary health care centers covered administratively by Shahid Beheshti University of Medical Sciences in Tehran were administered a questionnaire by trained staff. Data were analyzed with SPSS (version 16) software, using univariate and multivariate logistic regression. The mean age for participants was $33.1{\pm}8.8years$. There was a significant association between self-efficacy and Pap smear screening (P<0.01). There was also a positive correlation between duration of marriage and husband's education with Pap smear uptake (P<0.01). In univariate analysis, there was a significant association between Pap smear uptake and level of selfefficacy (OR = 15.3 for intermediate and OR=7.4 for good level), duration of marriage (OR = 5.7 for 5-14 years and OR=10.4 for more than 15), age (OR =2.7 for 27-34 years and OR=7.4 for more than 35 years) and husband education level (OR=2.3 for more than 12 years of education). In multivariate analysis, significant associations persisted between Pap smear uptake and self-efficacy (OR = 23.8; 95% CI: 8.7, 65.5), duration of marriage (OR = 5.9; 95% CI: 2.8, 12.2), age (OR = 3.9; 95% CI: 1.2, 12.9) and husband's education (OR = 2.5; 95% CI: 2.0, 10.3). Efforts are needed to increase women's knowledge about cervical cancer and improve their self-efficacy and perceptions of the Pap smear screening in order to reduce cervical cancer incidence and mortality rates.

Roshani, Zahra;Kamrani, Ahmad Ali Akbari;Shati, Mohsen;Sahaf, Robab 269

https://doi.org/10.7314/APJCP.2016.17.S3.269 PDF KSCI

Presently, the world population of the elderly is growing. By improving health hygiene and welfare indicators, mortality and birth rates decrease and life expectancy increases, making the present century the century of elderly. Aging is one of the main risk factors for development of cancer, which itself is the second cause of death in old people. This study was conducted to assess the prevalence of cancer in the elderly covered by the Islamic Republic of Iran Broadcasting (IRIB) insurance program and to obtain suitable programs for cancer screening and early detection, increase patient survival, improve elderly care and to reclaim the cost of treatment in comparison to the national and international statistics. This is a cross-sectional study conducted on all elderly patients diagnosed with malignancy based on their pathology reports. In this study, of the total 75,500 patients covered by IRIB insurance, 17.2% belonged to the elderly group, males accounting for 53.3%. The most common cancers in old men were prostatic cancer (61.3%), colon cancer (10.3%) cancer of the hematologic system, bladder cancer (9.6%), lung cancer (9.1%), thyroid cancer (3.9%) and brain tumors (1.3%). In the elderly women, the most common cancers were breast cancer (80.1%), colon cancer (5.1%), thyroid cancers (4.4%), bladder and hematologic system malignancies (3.6), lung cancer (2.9%) and brain tumors (0.7%). In addition, the prevalence of cancer was almost the same as national and international statistics. With the exception of non-melanoma skin cancer no difference was shown in prevalence of cancer between IRIB elderly patients and the other groups of cancer patients in Iran.

Mansouri, Neda;Movafagh, Abolfazl;Soleimani, Shahrzad;Taheri, Mohammad;Hashemi, Mehrdad;Pour, Atefeh Heidary;Shargh, Shohreh Alizadeh;Mosavi-Jarahi, Alireza;Sasaninejad, Zahra;Zham, Hanieh;Hajian, Parastoo;Moradi, Hossein Allah;Mirzaei, Hamid Reza;Fardmanesh, Hedieh;Ohadi, Mina 275

https://doi.org/10.7314/APJCP.2016.17.S3.275 PDF KSCI

The membrane epithelial mucin MUC1 is expressed at the luminal surface of most simple epithelial cells, but expression is greatly increased in most breast cancers. The aims of present study were to investigate expression of the MUC1 gene and interactive affects in metastases. Whole cell RNA isolation from 50 sentinel lymph nodes (SNLs) of breast cancer patients was performed using reverse transcription and real-time PCR. All patients were diagnosed with breast cancer and without metastasis, confirmed by IHC staining. The evaluation of tumor and normal samples for expression of MUC1 gene, the results were 49.1% non-expressive and 45.3% expression (Student t, p = 0.03). Also in comparison of normal breast tissue and breast cancer SLN for MUC1 gene, MUC1 negative SLNs were 75.0% (18 samples) and MUC1 positive samples were 25.0% (6 samples). Over-expression of MUC1 gene may offer a target for therapy related to progression and metastasis in women with breast cancer.

Yazdi, Hamid Reza;Movafagh, Abolfazl;Fallah, Fateme;Shargh, Shohreh Alizadeh;Mansouri, Neda;Pour, Atefeh Heidary;Hashemi, Mehrdad 279

https://doi.org/10.7314/APJCP.2016.17.S3.279 PDF KSCI

It has been established that different kinds of bacteria agents are involved in various cancers. Although the mechanism of tumorigenesis is not clearly understood, there is evidence for the presence of bacteria within tumors, with at least a progression effect for some bacteria that prepare suitable microenvironments for tumor cell growth. The aim of current study was to evaluate bacterial dysbiosis in sentinel lymph nodes of breast cancer patients. One hundred and twenty three fresh-frozen sentinel lymph nodes and a corresponding number of normal adjacent breast tissue specimens and five normal mastectomy samples were investigated employing RT-PCR. In addition using genus-specific primers were applied. There was a significant differences as presence of Methylobacterium radiotolerance DNA recorded between patients and normal control group (p= 0.0). Based on our research work, further studies into the role of microbes in breast cancer would be of great interest.

Kalaghchi, Bita;Abdi, Robab;Amouzegar-Hashemi, Farnaz;Esmati, Ebrahim;Alikhasi, Afsaneh 287

https://doi.org/10.7314/APJCP.2016.17.S3.287 PDF KSCI

Cervical cancer is one of the most common gynecological cancers in Iranian women. This study was initiated to assess whether the combination of paclitaxel and cisplatin with radiation might feasible for these patients. The aim was to assess tumor response and toxicity of weekly cisplatin and paclitaxel along with radiotherapy in the treatment of cervical cancer. Women with primary untreated squamous cell carcinoma of the cervix with FIGO stages IB2 to IIIB were treated with weekly injections of cisplatin 30 mg/m2 and paclitaxel 35 mg/m2 for 5-6 weeks along with radiotherapy. A total of 25 patients were enrolled in this study who completed the intended treatment. Disease was assessed prior to treatment by pelvic examination and contrast enhanced MRI of the abdomen and pelvis. Response was assessed 1 month after completion of treatment by physical examination and 3 months after also by MRI.Toxicity was assessed and was graded using RTOG grading. There was a complete response rate of 84% after 3 months. The major toxicity was grade 1 and 2 anemia (92%). The mean duration of treatment was 58 days. In conclusion, combination chemotherapy with cisplatin and paclitaxel along with radiotherapy in patients with locally advanced squamous cell carcinoma of cervixwas well tolerated, in contrast to other studies, but it seems that there was no increase in tumor response and progression free survival with this treatment regimen.

Amirijavid, Shaghayegh;Entezari, Maliheh;Movafagh, Abolfazl;Hashemi, Mehrdad;Mosavi-Jarahi, Alireza;Dehghani, Hossein 293

https://doi.org/10.7314/APJCP.2016.17.S3.293 PDF KSCI

TRAIL, tumor necrosis factor (TNF)-related apoptosis-inducing ligand belongs to one of important cytokine superfamilIES, tumor necrosis factor ($TNF{\alpha}$). TRAIL-2 receptor agonists activate several cell signaling pathways in cells in different manners and could lead to apoptosis or necrosis. Agonistic egg yolk antibodies like IgY which have been developed in a selective manner could activate TRAIL death receptors such as TRAIL-2 (DR5) and thus apoptosis signaling. We here investigated induction of apoptosis in human breast cancer cells (MCF7 cell line) by an IgY produced against an 21 aminoacid epitope of the human TRAIL-2 receptor. As the first step a small peptide of 21 aminoacids choosen from the extracellular domain of DR5 protein was produced with a peptide synthesizer. After control assays and confirmation of the correct amino acid sequence, it was injected to hens immunized to achieve high affinity IgYs. At the next step, the produced IgYs were extracted and examined for specificity against DR5 protein by ELISA assay. Subsequently, the anticancer effect of such IgYs was determined by MTT assay in the MCF7 human breast cancer cell line. The produced peptides successfully immunized hens and the produced antibodies which accumulated in egg yolk specifically recognized the DR5 protein. IgYs exerted significant toxicity and killed MCF7 cells as shown by MTT assay.

Yaghoobi, Hajar;Bandehpour, Mojgan;Kazemi, Bahram 299

https://doi.org/10.7314/APJCP.2016.17.S3.299 PDF KSCI

Cytolethal distending toxin (CDT) is a secreted tripartite genotoxin produced by many pathogenic gram-negative bacteria. It is composed of three subunits, CdtA, CdtB and CdtC, and CdtB-associated deoxyribonuclease (DNase) activity is essential for the CDT toxicity. In the present study, to design a novel potentially antitumor drug against lung cancer, the possible mechanisms of cdtB anticancer properties were explored in the A549 human lung adenocarcinoma cell line. A recombinant plasmid pcDNA3.1/cdtB was constructed expressing CdtB of human periodontal bacterium Aggregatibacter actinomycetemcomitans and investigated for toxic properties in A549 cells and possible mechanisms. It was observed that plasmid pcDNA3.1/cdtB caused loss of cell viability, morphologic changes and induction of apoptosis. Furthermore, measurement of caspase activity indicated involvement of an intrinsic pathway of cell apoptosis. Consequently, the recombinant plasmid pcDNA3.1/cdtB may have potential as a new class of therapeutic agent for gene therapy of lung cancer.

Golmohammadi, Rahim;Rakhshani, Mohammad Hassan;Moslem, Ali Reza;Pejhan, Akbar 305

https://doi.org/10.7314/APJCP.2016.17.S3.305 PDF KSCI

PTEN protein is an important tumour suppressor factor detectable by immunohistochemistry. The goal of the present study was to investigate the prognostic role of PTEN gene expression focusing on length of survival in breast cancer patients. This descriptive-analytical study was conducted on 100 breast cancer cases referred to Sabzevar hospitals in the north east of Iran between 2010 and 2011, followed up to 2015. The PTEN gene expression of tumour tissue samples was determined using specific monoclonal antibodies. The data were analyzed using Chi-square test and Fisher's exact test. Patient length of survival was analyzed after 4 years of follow-up using the Cox regression model. The PTEN gene was expressed in 70 of 100 samples, while being found at a high level in all noncancerous samples. There was an inverse significant relationship between expression of PTEN and tumour stage and grade (p<0.001). In addition, expression of PTEN in invasive ductal tumours was less than in non-invasive tumours. There was also an inverse significant relationship between the likelihood of death and PTEN gene expression (p<0.01). These findings indicate that lack of PTEN gene expression can be sign for a worse prognosis and poor survival in breast cancer.

Mohseny, Maryam;Amanpour, Farzaneh;Mosavi-Jarrahi, Alireza;Jafari, Hossein;Moradi-Joo, Mohammad;Monfared, Esmat Davoudi 311

https://doi.org/10.7314/APJCP.2016.17.S3.311 PDF KSCI

Breast cancer is one of the most common causes of cancer mortality in Iran. Social determinants of health are among the key factors affecting the pathogenesis of diseases. This cross-sectional study aimed to determine the social determinants of breast cancer survival time with parametric and semi-parametric regression models. It was conducted on male and female patients diagnosed with breast cancer presenting to the Cancer Research Center of Shohada-E-Tajrish Hospital from 2006 to 2010. The Cox proportional hazard model and parametric models including the Weibull, log normal and log-logistic models were applied to determine the social determinants of survival time of breast cancer patients. The Akaike information criterion (AIC) was used to assess the best fit. Statistical analysis was performed with STATA (version 11) software. This study was performed on 797 breast cancer patients, aged 25-93 years with a mean age of 54.7 (${\pm}11.9$) years. In both semi-parametric and parametric models, the three-year survival was related to level of education and municipal district of residence (P<0.05). The AIC suggested that log normal distribution was the best fit for the three-year survival time of breast cancer patients. Social determinants of health such as level of education and municipal district of residence affect the survival of breast cancer cases. Future studies must focus on the effect of childhood social class on the survival times of cancers, which have hitherto only been paid limited attention.

Mansouri, Neda;Movafagh, Abolfazl;Sayad, Arezou;Pour, Atefeh Heidary;Taheri, Mohammad;Soleimani, Shahrzad;Mirzaei, Hamid Reza;Shargh, Shohreh Alizadeh;Azargashb, Eznollah;Bazmi, Haleh;Moradi, Hossein Allah;Zandnia, Fatemeh;Hashemi, Mehrdad;Massoudi, Nilofar;Mortazavi-Tabatabaei, SA 317

https://doi.org/10.7314/APJCP.2016.17.S3.317 PDF KSCI

Detection of micrometastasis in sentinel lymph nodes (SLNs) is a very useful tool for appropriate assessment of the clinical stage of disease in breast cancer patients. Early identification of clinically relevant disease could lead to early treatment or staging approaches for breast cancer patient. Micrometastases in SLNs of women with invasive breast cancer are of great significance in this context. In this study we examined SLN biopsies considered to have small numbers of cancerous cells by real time RT-PCR. All of the samples underwent immunohistochemical staining for cytokeratin for confirmation of the presence or absence of micrometastases. BUB1b expression assay of selected patients with and without metastasis showed overexpression in the former, but not in normal breast and lymph node tissue. Our results may be taken into account in the discussion about the merits of routine use of molecular assessment in pathogenetic studies of SLNs.

Moghaddam, Ali Sanjari;Nazarzadeh, Milad;Moghaddam, Hossein Sanjari;Bidel, Zeinab;Karamatinia, Aliasghar;Darvish, Hossein;Jarrahi, Alireza Mosavi 323

https://doi.org/10.7314/APJCP.2016.17.S3.323 PDF KSCI

Breast cancer risk assessment has developed during years and evaluation of genetic factor affecting risk of breast cancer is an important component of this risk assessment. The aim of this meta-analysis was to investigate the role of XRCC1 polymorphisms (Arg194Trp, Arg280His and Arg399Gln) in risk of breast cancer among different population and categories of menopausal status.PubMed, Medline, Web of Science, and PubMed Central were systematically searched to identify studies evaluating association between breast cancer and XRCC1 gene polymorphisms (Arg194Trp, Arg280His and Arg399Gln). Two authors independently extracted required information. Odds Ratios were pooled for four genetic inheritance models using both fixed and the DerSimonian and Laird random-effect models. Egger's test and contour-enhanced funnel plot was used to evaluate publication bias and small study effect. Additional subgroup analysis was performed for menopausal status, ethnicity, and source of controls. After evaluation and applying inclusion criteria on extracted studies, fifty three studies were included in this meta-analysis. For polymorphisms of Arg194Trp and Arg280His, no significant association was observed in all genetic models. Arg194Trp had a protective effect in post-menopausal status only in homozygote model (OR=0.57 [0.37-0.88]). Arg399Gln showed significant association with breast cancer in homozygote (OR=1.21 [1.10-1.34]), dominant (OR=1.09 [1.03-1.15]) and recessive (OR=1.21 [1.09- 1.35]) genetic models. Arg399Gln was associated with higher risk in post-menopausal status for homozygote and heterozygote models. Our findings suggest that XRCC1 gene polymorphisms modify breast cancer risk in different populations and different categories of menopausal status.

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