فصلنامه بیماری های پستان ایران
سال شانزدهم شماره 3 (پیاپی 62، پاییز 1402)

Obesity is a chronic disease induced by imbalance of energy ‎homeostasis‏ ‏which ‎has been associated with risk of menopausal estrogen-‎dependent breast cancer. The present study ‎aimed to examine the effect of 12-‎week concurrent (aerobic-resistance) training on the inflammation marker [Estradiol, Tumor Necrosis Factor-α (TNF-α), Interleukin-6(IL-6)] and ‎physical performance (VO2max, balance, flexibility and strength) in ‎obese postmenopausal women.‎

Our research was an unblinded randomized controlled clinical trial. Thirty sedentary and obese postmenopausal women were recruited [age 45–55years, overweight or obese (BMI >25 kg/m2), and inactive (<150 min/week of physical activity) and had an elevated Gail 5-year risk score of breast cancer (>1.66%)] and randomly divided into concurrent training (CT, n=12) and control group (CG, n=13).The ‎participant’s ‎took part in a 12-week supervised intervention training 5 days/week, (each session ‎of which ‎involved 60 minutes of strength training and 30 minutes of aerobic training). Blood ‎samples ‎were taken from the volunteers to measure estradiol and TNF-α and IL-6. Physical ‎function (strength, VO2max, flexibility and balance) ‎were evaluated pre, mid and post-‎intervention. Quantitative expression was evaluated using 2-∆∆ct method and REST software. ‎ANOVA tests ‎with Bonferroni correction were used to compare the groups at a significance level ‎of α<0.05.‎

In response to training, total fat mass (FM) , ‏lean body mass(LBM) and ‏waist circulation(WC)‏ ‏in the concurrent training group improved significantly compared with the control group (P < 0.05). The CT group experienced a reduction in FM (-7.73%; ‎P ‎‎<0.05) and an increase in LBM (2.5%; P <0.05).A significant decrease in the expression of IL-6 (P=0.004) and TNF-α (P=0.0013) was observed in the experimental group compared to the control group. There was no significant difference in estradiol levels in the experimental group compared to the control (P>0.05). VO2max (P=0.001), balance (P=0.001), strength [hand grip (32.7%), leg strength (31.4%)] and flexibility (P=0.002), in the experimental group increased significantly compared to the control group.

The concurrent training and exercise-induced fat mass loss appears to slow the ‎increase of pro ‎inflammatory cytokines in postmenopausal women that is an established risk ‎factor of breast cancer. ‎Thus, this study provides additional evidences to the intricate interaction ‎among estradiol, ‎inflammatory cytokines, adipose tissue and muscle mass in postmenopausal ‎women.‎

Mastectomy can have a negative impact on a women's self-esteem and sexual health. Breast reconstruction (BR) improves the psychological disorders and quality of life. So, with a low rate of BR in Yemen, we aim to assess the barriers that impede general surgeons from referring post-mastectomy patients for breast reconstruction.

This is a survey study to investigate the general surgeons’ knowledge, attitude, and practice toward BR in Yemen from January to March 2023. The survey was composed of 43 questions and categorized into four primary domains; demographic data, knowledge, attitude, and practice.

The majority of the respondents had good knowledge (80.3%) and attitude (75.4%), yet only 29% of them always discussed BR options with their breast cancer patients. Furthermore, only 16.9% always referred their fit patients to a plastic surgeon. Many surgeons (over 75%) believed that late-stage diagnosis, patient’s priority to treat cancer, lack of multidisciplinary teamwork, poor communication between general and plastic surgeons and financial limitation act as barriers for referral to BR.

The significant perceived barriers to BR in Yemen are lack of multidisciplinary team, late presentation of many breast cancer patients and financial constraints. So, we need to develop guidelines and a simplified referral protocol to facilitate access to breast reconstructive services provided by plastic surgeons.

Being diagnosed with cancer is a traumatic crisis and affects various aspects of a person's life. Therefore, the purpose of this research was to compare schema therapy and mindfulness-based stress reduction on post-traumatic growth and psychological capital in women with breast cancer.

The current research is quasi-experimental study with a pre-test-post-test control group design based on a three-month follow-up. The study population consisted of women with breast cancer referred to the Oncology Clinic of Imam Khomeini Hospital (RA) in Tehran between 2019 and 2023. Of whom, 45 were selected by the convenience sampling method and randomly were divided into two experimental groups and one control group (each group contained 15 people). To collect information, measuring tools such as Tedeschi and Calhoun’s post-traumatic growth Inventory (1996) and Luthans’s Psychological Capital Questionnaire (2007) were used. Data analysis was also done using variance analysis with repeated measures.

The results showed that post-traumatic growth and psychological capital in two methods of schema therapy and mindfulness-based stress reduction had significant differences compared to the control group. Moreover, the comparison of the two methods showed that the effect of mindfulness-based stress reduction treatment on post-traumatic growth and psychological capital was significantly different from schema therapy (p<0.05). The results of the Bonferroni post-hoc test also showed that the effectiveness of two mindfulness-based stress reduction and schema therapy was stable over time (p<0.05).

According to the findings, both methods of mindfulness-based stress reduction and schema therapy affected increasing post-traumatic growth and psychological capital in women with breast cancer. In addition, the comparison between the two methods showed that mindfulness-based stress reduction is more effective than schema therapy.

 Women recovering from breast cancer frequently worry about relapse, leading to severe impairment in their quality of life and economic burdens of treatment. Therefore, the current study attempted to predict health anxiety in patients recovering from breast cancer based on the intolerance of uncertainty and the mediating roles of cognitive flexibility and cyberchondria.

 This descriptive correlational study included 196 patients with breast cancer referred to Hazrat Rasool Akram, Bazarganan, and Tarbiat Modares Hospitals for post-treatment follow-up and Rahe_Aramesh and Sepid clinics in Tehran for psychotherapy. In this research study, the convenience sampling method was employed. Questionnaires (Freeston et al. (1994), Salkovskis health anxiety (1989), McElroy and Shevline cyberchondria (2014), and Dennis and Vander wal's (2010) cognitive flexibility) were used as tools to collect data for this survey. Respondents completed questionnaires in person or online. SPSS-25 and R software were used for data analysis. Data were analyzed using the Pearson correlation coefficient and structural equation modeling method.

 The results of this research indicate that the proposed model is a good fit. There was a positive and significant correlation between intolerance of uncertainty and health anxiety with the mediating role of cyberchondria in individuals recovered from breast cancer (P<0.01). In addition, cyberchondria serves as a positive and significant mediator in the relationship between intolerance of uncertainty and health anxiety (P <0.01).

 To improve anxiety, psychological interventions in breast cancer patients should target factors such as intolerance of ambiguity, cognitive flexibility, and cyberchondria.

 In analyzing time-to-event data, it is frequent that a proportion of individuals will never experience the event of interest. Using the cured models instead of standard ones for survival analysis will result in accurate estimates for predicting survival time. This study aimed to estimate the effect of potential risk factors on long-term and short-term survival of breast cancer patients.

 The study included 770 women diagnosed with early-stage breast cancer and treated with either breast conserving therapy or modified radical mastectomy with post-surgical radiation between 2005 and 2015. All study participants were followed up until September 2022. The review of the medical records of these patients was carried out at Shahid Sadoughi Hospital and the Ramazan Zadeh Radiotherapy Center in Yazd. Kaplan-Meier method was used to estimate disease-free survival and distant metastatic-free survival rates. Distant metastasis and prognostic factors were modeled by Cox proportional hazards and Semiparametric Mixture Cure models. Data analysis was done by Rstudio software.

 In this study, 218(28.3%) patients died, and metastasis occurred in 198(25.7%) patients until the end of the follow-up period. Based on the univariable and multivariable Semiparametric Mixture Cure model, the stage of disease was significant, and the risk of short-term distant metastatic-free survival for patients with stage IIIa was 2.7 times higher than patients with stage I and II of disease through multivariable Semiparametric Mixture Cure model.

 The Semiparametric Mixture Cure model could estimate the long-term and short-term distant metastatic-free survival based on prognostic factors.

 Clinical and laboratory studies show that taking aspirin and ibuprofen during chemotherapy or before breast cancer reduces the number of cancer cells and prevents their transmission. This study aimed to investigate the mechanical properties of cells after cell treatment with these two drugs.

 This study examined the effects of aspirin and ibuprofen, in combination and independently, at two concentrations of 5 µL and 10 µL on the mechanical properties of MCF-7 cancer cells. Next, it compared them with the mechanical properties of healthy MCF-10 cells. The mechanical properties of the cells were measured using an atomic force microscopy (AFM) device. Finally, the Young’s modulus and the deformation of all cell groups were calculated and examined.

 Our results showed that the deformation chart of cancer cells approached that of healthy cells using aspirin and ibuprofen. In addition, the numerical value of Young’s modulus in MCF-7 when using 10 µL of aspirin compared to other treatment groups had the highest value close to Young’s modulus of healthy cells.

 Using the separate or combined use of aspirin and ibuprofen, the mechanical properties of cancer cells were closer to those of healthy cells. The viable metastatic cell count probably decreased due to increased stiffness in cancer cell lines using aspirin and ibuprofen.

New studies show that inhibiting the growth of tumorsby reducing the expression of angiogenesis factors in various ways, including sports activity, can be a valuable method in controlling the progress of cancer. Galectin-1 and galectin-3 play a vital role in inducing and maintaining tumor angiogenesis. The present research aimed to compare the effect of two selected exercise programs on the expression of galectin-1 and galectin-3 genes in the tumor tissue of female balb-c mice with breast cancer.

Twenty-four female balb-c mice were infected with breast tumor by injection of MC4L2 estrogen receptor dependent cancer cells. Then, they were divided into three groups of eight: tumor (T), tumor +aerobic exercise (T+AE), and tumor + high intensity interval training (T+HIIT). The T+AE group performed an aerobic exercise protocol for six weeks, five days a week, and each session lasted 60 minutes. The T+HIIT group performed high intensity interval training protocol three days a week for six weeks, and each session lasted 60 minutes. Finally, mice were anesthetized by injecting ketamine and xylazine, the tumor tissue was removed and frozen in liquid nitrogen. The expression of galectin-1 and galectin-3 was measured by Real Time-PCR method, and the results were expressed as fold change at a significant level (P<0.05) with GENEX software.

The results showed that the aerobic exercise protocol had no significant effect on the expression of galectin-1 in the T+AE group, compared to the T group, while it decreased the expression of galectin-3 by 1.70 times (P=0.00). In the T+HIIT group, compared to the T group, the expression of galectin- 1 decreased 3.04 times (P=0.00), and the expression of galectin-3 decreased 6.57 times (P=0.00). In the T+HIIT group, compared to the T+ group, AE, the expression of galectin-1, decreased 2.58 times (P=0.00), and the expression of galectin-3 decreased 3.86 times (P=0.00).

Aerobic exercise by reducing the expression of galectin-3 and high intensity interval training by reducing the expression of galectin-1 and galectin-3 are effective in preventing the progression of breast cancer.