RISK PROFILE FOR BREAST CARCINOMA AND TUMOUR HISTOPATHOLOGY OF MEDICAL UNINSURED PATIENTS IN PAKISTAN

Authors

  • Uzma Raza
  • Aziza Khanam
  • Meh- Jabeen
  • Mohammad Furqan
  • Saleem -ul- Haque

Abstract

Background: Breast carcinoma is an unpredictable disease in the sense that some patients may die atearly disease stage due to wide-spread metastasis within six months to one year, while others maysurvive longer. This study was aimed to evaluate the risk factors for breast carcinoma occurrence andhistopathological features of breast carcinoma developed in the social and economical conditions ofPakistan. Methods: A total of 224 female breast cancer diagnosed patients with uncovered medicalinsurance visiting at the Oncology clinic of a teaching hospital at Karachi, Pakistan were selected for thestudy. Two hundred and twenty-four (224) healthy female subjects free of any cancer diagnosis wereselected as control from different areas of the city. Information on stress, occupation, life history, and lifestyle was obtained through personal interviews. Breast tumour pathology was evaluated for histologicalgrade, lymph node metastasis and hormone receptor status by using standard methods. Student’s t-test,Chi-square test and ANOVA were used for comparison. Results: Breast cancer patients in significantlyhigh percentage reported early marriages, abortion occurrence, stressful life style, family cancer historyand past disease suffering from diabetes and hypertension. Life style including aerosol chewing and fatrich food intake was significantly high among the patients (p<0.05). On histopathological analysis,patients at the age of 40 years and below were identified in significantly high percentage with tumourgrade III, 1–3 lymph node metastasis and hormone receptor negative type. Increasing age was associatedwith low tumour grade and less percentage of lymph node metastasis. Significantly high percentage ofpatients were presented with hormone receptor positive tumour (p<0.05). Conclusion: The contributingfactors for breast carcinoma occurrence were related to life history and life-style of the patients. Medicalinsurance uncovered patients at initial diagnosis were presented in significantly high percentage withadvanced disease including high tumour grade and lymph node metastasis due to less use of preventiveand screening service which delays the diagnosis, effecting both survival and treatment cost.Keywords: Pakistan, Risk Factors, Breast cancer, Women

References

Lostumbo L, Carbine N, Wallace J. and Ezzo J. Prophylactic

mastectomy for the prevention of breast cancer. Cochrane

Database Syst Rev 2004;18:CD 002748.

Bhurgri Y, Bhurgri A, Hassan S H, , Zaidi SH, Rahim A,

Sankaranarayanan R, et al. Cancer incidence in Karachi,

Pakistan: First results from Karachi cancer Registry. Int J

Cancer 2000;85:325–29.

Ravdin PM. Prognostic factors in breast cancer. In: Textbook

of breast cancer. A clinical guide to therapy. G. Bonadonna,

G.N. Hortobagyil and A.M. Gianni (eds) London: Martin

Duntz; 1997.p.35–63.

Rosen PP, Oberman HA. Atlas of tumor pathology. Tumours

of the mammary gland. Washington, DC: Armed Forces

Institute of Pathology; 1992.

Nichols HB, Trentham-Dietz A, Love RR, Hampton JM,

Hoang Anh PT, Allred DC, et al. Differences in breast cancer

risk factors by tumor marker subtypes among Premenopausal

Vietnamese and Chinese women. Cancer Epidemiol

Biomarkers 2005;14:41–7.

Gonzalez CA. The European prospective investigation into

cancer and nutrition (EPIC). Public Health Nutr 2006;9:124–

Kruk J, Aboul-Enein HY. Psychological stress and the risk of

breast cancer: a case control study. Cancer Detect Prev

;28:399–408.

Megdal SP, Kroenke CH, Laden F, Pukkala E,

Schernhammer ES. Night work and breast cancer risk: a

systematic review and meta analysis. Eur J Cancer

;41:2023–32.

Kendal WS. Statical Kinematics of axillary nodal metastases

in breast carcinoma. Clin Exp Metastasis 2005;22:177–83.

Kim KJ, Huh SJ, Yang JH, Park W, Nam SJ, Kim JH, et al.

Treatment results and prognostic factors of early breast

cancer treated with a breast conserving operation and

radiotherapy. J Clin Oncol 2005;35:126–33.

Missmer SA, Eliassen AH, Barbieri R, Hankinson SE.

Endogenous estrogen, androgen and progesterone

concentrations and breast cancer risk among post menopausal

women. J Natl Cancer Inst 2004;96:1856–65.

Grann VR, Troxel AB, Zojwalla NJ, Jacobson JS, Hershman

D, Neugut AI. Hormone receptor status and survival in a

population-based cohort of patients with breast carcinoma.

Cancer 2005;103:2241–51.

Helpern MT, Bian J, Ward EM, Schrag NM, Chen AY.

Insurance status stage of cancer at diagnosis among women

with breast cancer. Cancer 2007;110:403–11.

Ramnik S. Histopathology. In: Medical Laboratory

Technology. New Delhi India: Jaypee Brothers Medical

Publishers (P) LTD; 2006.p. 1031–4.

Breast: In: John DB, Marilyn G. (eds) Theory and Practice of

histological techniques. China: Harcourt Publishers Limited;

p. 1824–25.

National Nutritional Survey 1985–87 Report, Islamabad:

National Institute of health, Government of Pakistan; 1988.

Michael JG. Cancer of the breast. In: Peter, JM, Ronald, AM

(eds). Oxford Textbook of surgery. Vol-1. New York: Oxford

University Press Inc; 1994.

Labreche FP, Goldberg MS. Exposure to organic solvents

and breast cancer in women: A hypothesis. Am J Ind Med

;32:1–14.

Shelia Hoar Zahm SH, Blair A. Occupational cancer among

women: Where have we been and where are we going? Am J

Ind Med 2003;44:565–75.

Bauer ME, Perks P and Lightman SL, Shanks N. et al.

Restraint stress is associated with changes in glucocorticoid

immunoregulation. Physiol Behav 2001;73:525–32.

Bowman RE, Ferguson D, Luine VN. Effects of chronic

restraint stress and estradiol on open field activity, spatial

J Ayub Med Coll Abbottabad 2011;23(1)

http://www.ayubmed.edu.pk/JAMC/23-1/Uzma.pdf

memory, and monoaminergic neurotransmitters in

ovariectomized rats. Neuroscience 2002;113:401–10.

Key T, Appleby P, Barnes I, Reeves G; Endogenous

Hormones and Breast Cancer Collaborative Group.

Endogenous sex hormones and breast cancer in

Postmenopausal women: reanalysis of nine prospective

studies. J Natl Cancer Inst 2002;94:606–16.

Schernhammer ES, Laden F, Speizer FE, Willett WC, Hunter

DJ, Kawachi I, et al. Rotating night shifts and risk of breast

cancer in women participating in the nurses’ health study. J

Natl Cancer Inst 2001;93:1563–8.

Parkins T. Does abortion increase breast cancer risk? Natl

Cancer Inst 1993;85:1987–8.

Tutera AM, Sellers TA, Potter JD, Drinkard CR, Wiesner G,

Folsom AR. Association between family history of cancer and

breast cancer defined by estrogen and progesterone receptor

status. Genet Epidemiol 1996;13:207–21.

Lee S, Colditz G and Berkman LF, Kawachi I. A prospective

study of job strain and coronary heart disease in U.S. women.

Int J Epidemiol 2002;31:1147–53.

Monteiro GI, Jorge M, Marques VP, Ortiz M, Ravasco P.

The effect of locoregional recurrence on survival and distant

metastasis after conservative treatment for invasive breast

carcinoma. Clin Oncol 2005;17:111–7.

Truong PT, Berthelet E, Lee J, Kader HA, Olivotto IA. The

prognostic significance of the percentage of

positive/dissected axillary lymph nodes in breast cancer

recurrence and survival in patients with one to three positive

axillary lymph nodes. Cancer 2005;103:2006–14.

Published

2011-06-01

Issue

Vol. 23 No. 1 (2011): JOURNAL OF AYUB MEDICAL COLLEGE, ABBOTTABAD

Section

ORIGINAL ARTICLE

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