Medicine and Health Sciences Commons^™

Morphological And Metabolic Criteria Of Covid-19 Vaccine Associated Axillary Nodes On 18-Fluorodeouxyglucose Pet/Ct Imaging In Breast Cancer Patients, Nosheen Fatima, Unaiza Zaman, Areeba Zaman, Sidra Zaman, Rabia Tehseen, Maseeh Uz Zaman

Department of Radiology

Background: In the current era vaccine-associated lymphadenopathy (VAL) is not an uncommon presentation on 18F-FDG PET/CT examinations in patients inoculated with Coronavirus disease 2019 (COVID-19) vaccination. In this study, we are presenting data of VAL on 18F-FDG PET/CT regarding its prevalence, temporal response to vaccination and imaging characteristics of VAL.
Methods: Seventy-eight (78) consecutive vaccinated breast cancer (BC) patients who had 18FDG PET/CT were retrospectively analyzed. All patients had COVID-19 vaccine shots in contralateral arms and none in breast cancer site axilla (BSA). In 35 patients 18FDG avid nodes were found in vaccine site axilla (VSA). In 25 patients 18FDG …

A Single Centre Experience Of Local Perforator Flaps In Oncoplastic Breast Surgery: A Cross-Sectional Study, Sana Zeeshan, Lubna Vohra, Uzma Shamsi, Nida Zahid, Danish Ali, Nargis Asad, Cristina Garusi

Section of General Surgery

Background & objectives: Various oncoplastic techniques have emerged over the years to preserve breast cosmesis and symmetry without compromising the principles of tumor excision. One of the newer techniques for breast volume replacement to achieve symmetry and cosmesis is the use of fasciocutaneous pedicled chest wall perforator flaps or local perforator flaps (LPF). The objectives of this study were to document the details of the surgical procedure as well as patient-reported satisfaction and well-being following the procedure using a validated BREAST-Q tool among Pakistani women.
Materials & methods: This cross-sectional study was conducted from March 2019 to February 2021 enrolling …

Neither Tumor-Infiltrating Lymphocytes Nor Cytotoxic T Cells Predict Enhanced Benefit From Chemotherapy In The Dbcg77b Phase Iii Clinical Trial, Elahe Shenasa, Elisabeth Specht Stovgaard, Maj-Britt Jensen, Karama Asleh, Nazia Riaz, Dongxia Gao, Samuel Leung, Bent Ejlertsen, Anne-Vibeke Laenkholm, Torsten O. Nielsen

Section of General Surgery

Recent studies have shown that immune infiltrates in the tumor microenvironment play a role in response to therapy, with some suggesting that patients with immunogenic tumors may receive increased benefit from chemotherapies. We evaluated this hypothesis in early breast cancer by testing the interaction between immune biomarkers and chemotherapy using materials from DBCG77B, a phase III clinical trial where high-risk premenopausal women were randomized to receive chemotherapy or no chemotherapy. Tissue microarrays were evaluated for tumor-infiltrating lymphocytes (TILs) assessed morphologically on hematoxylin and eosin-stained slides, and by immunohistochemistry for CD8, FOXP3, LAG-3, PD-1 and PD-L1. Following REMARK reporting guidelines, data …

Male Breast Cancer: The Three Decades' Experience Of A Tertiary Care Hospital In A Lower-Middle Income Country, Sana Zeeshan, Muhammad Tayyab, Fatima Shaukat, Muhammad Usman Tariq, Nargis Khan, Lubna Vohra

Section of General Surgery

Introduction Male breast cancer is uncommon and managed on the guidelines of female breast cancer due to tumor rarity. We sought to identify the incidence, clinicopathological features, and survival of all male breast cancer patients managed in our hospital. Methods A retrospective cross-sectional study was conducted at Aga Khan University Hospital (AKUH), Karachi, Pakistan, from January 1986 to December 2018. Demographic data, treatment records, and follow-up data of all male breast cancer patients who were treated at AKUH was reviewed. Results Thirty-eight out of 42 patients who presented over a period of 32 years were included. The mean age was …

Current Perspectives Of Oncoplastic Breast Surgery In Pakistan, Lubna Mushtaque Vohra, Dua Jabeen, Danish Ali, Syeda Sakina Abidi, Sana Zeeshan, Abida Khalil Sattar

Section of General Surgery

Oncoplastic breast surgery is based on the concept of tumour-specific immediate reconstruction. It combines both local and distant techniques to maintain breast texture, symmetry and cosmesis without compromising oncological outcome. The current narrative review was planned to highlight the current state and future of oncoplastic breast surgery in low- and middle-income countries where its utilisation in surgical practice remains insubstantial because majority of the surgeons who are treating breast cancer are either general surgeons or breast surgeons who do not have expertise in oncoplastic breast surgery or reconstructive surgery. Moreover, scarcity of financial resources, ignorance about oncoplastic breast surgery techniques, …

Analysing The Trends In Breast Surgery Practice During Covid-19 Pandemic: A Comparative Study With The Pre-Covid Era, Lubna M. Vohra, Dua Jabeen, Nargis Khan, Azmeena Nizar, Anum Jamil, Tariq Siddiqui

Section of General Surgery

Background: The emergence of coronavirus disease 2019 (COVID-19) pandemic has crippled the healthcare systems all over the world. Cancer treatment is indispensable and disruption in its provision can lead to unanticipated consequences. No local data exists that has quantified the impact of COVID-19 pandemic on breast cancer surgery in a lower middle-income country (LMIC), therefore, the present retrospective comparative cohort study is directed to determine the trends in breast surgery operative volumes and its outcomes at our institution in Pakistan.
Materials and methods: Data was collected retrospectively from Pre-COVID-19 and COVID-19 era to determine impact of the current pandemic on …

Fear, Faith And Finances: Health Literacy Experiences Of English And Swahili Speaking Women Newly Diagnosed With Breast And Cervical Cancer, Diana Kassaman, Tayreez Mushani, Peterson Kiraithe, Sharon Brownie, Margaret Barton-Burk

School of Nursing & Midwifery, East Africa

Breast and cervical cancer are among the leading causes of cancer-related deaths globally. In Kenya, delayed presentation and diagnosis contribute to breast and cervical cancer mortality. The Kenyan government acknowledges the cancer burden with estimated 39,000 new cases diagnosed and 27,000 deaths per annum. Mortality can be reduced if cancer is diagnosed early and with appropriate treatment. Health Literacy (HL) about cancer screening, diagnosis and treatment is important in reducing mortality, but there is little understanding about HL levels, experiences of patients diagnosed with breast and cervical cancer and the contexts in which they make decisions. In this study, health …

Factors Associated With Mammographic Breast Density Among Women In Karachi Pakistan, Uzma Shamsi, Shaista Afzal Saeed, Azra Shamsi, Syed Iqbal Azam, David Callen

Community Health Sciences

Background: There are no studies done to evaluate the distribution of mammographic breast density and factors associated with it among Pakistani women.
Methods: Participants included 477 women, who had received either diagnostic or screening mammography at two hospitals in Karachi Pakistan. Mammographic breast density was assessed using the Breast Imaging Reporting and Data System. In person interviews were conducted using a detailed questionnaire, to assess risk factors of interest, and venous blood was collected to measure serum vitamin D level at the end of the interview. To determine the association of potential factors with mammographic breast density, multivariable polytomous logistic …

Proteomics-Derived Basal Biomarker Dna-Pkcs Is Associated With Intrinsic Subtype And Long-Term Clinical Outcomes In Breast Cancer, Karama Asleh, Nazia Riaz, Angela S. Cheng, Dongxia Gao, Samuel C Y. Leung, Meenakshi Anurag, Torsten O. Nielsen

Centre for Regenerative Medicine & Stem Cell Research

Precise biomarkers are needed to guide better diagnostics and therapeutics for basal-like breast cancer, for which DNA-dependent protein kinase catalytic subunit (DNA-PKcs) has been recently reported by the Clinical Proteomic Tumor Analysis Consortium as the most specific biomarker. We evaluated DNA-PKcs expression in clinically-annotated breast cancer tissue microarrays and correlated results with immune biomarkers (training set: n = 300; validation set: n = 2401). Following a pre-specified study design per REMARK criteria, we found that high expression of DNA-PKcs was significantly associated with stromal and CD8 + tumor infiltrating lymphocytes. Within the basal-like subtype, tumors with low DNA-PKcs and high …

Fears And Barriers: Problems In Breast Cancer Diagnosis And Treatment In Pakistan, Sidra Saeed, Muhammad Asim, Malik Muhammad Sohail

Community Health Sciences

Background: Women in Pakistan lack appropriate awareness about diagnosis and treatment for breast cancer due to a range of multifaceted barriers. There is a dearth of literature examining the socio-cultural factors that inhibit women from breast cancer screening, diagnosis and treatment in Punjab, Pakistan. Addressing this gap, this qualitative study sought to identify and explore the barriers that hinder women from seeking timely screening and treatment.
Methods: In this process 45 women (age = 18-50 years) with breast cancer were purposively sampled and interviewed from the Punjab Institute of Nuclear Medicine (PINUM) hospital, Faisalabad, Pakistan.
Results: An inductive approach was …

Metaplastic Breast Carcinoma: Clinicopathological Parameters And Prognostic Profile, Saroona Haroon, Shamail Zia, Umme Aiman Shirazi, Omer Ahmed, Ishaq Azeem Asghar, Asad Diwan, Anoshia Afzal, Muhammad Irfan, Syed Jawwad Ali, Atif A. Hashmi

Department of Pathology and Laboratory Medicine

Introduction: Metaplastic breast carcinoma (MBC) is defined as breast cancer with a heterologous non-glandular component. MBC is considered a special type of breast cancer with a prognosis that is worse than invasive ductal carcinoma (IDC) of the breast. MBC is the most common breast cancer with a triple-negative profile. Therefore, in this study, we evaluated the clinicopathological parameters, recurrence and survival of MBC in our population.
Methods: We conducted a retrospective observational study in the Department of Histopathology at Prince Faisal Oncology Centre, Buraidah, Saudi Arabia, over a period of five years. All cases diagnosed as MBC were included in …

Risk Factors Of Breast Cancer Among Patients In A Tertiary Care Hospitals In Afghanistan: A Case Control Study, Zekrullah Baset, Jamshid Abdul Ghafar, Yasmin Parpio, Ahmed Maseh Haidary

School of Nursing & Midwifery

Background: Breast cancer is the second most common causes of women's death, worldwide. Data on risk factors associated with female breast cancer in the Afghan population is very limited. The aim of our study was to identifying risk factor associated with female breast cancer in Afghanistan.
Methods: A retrospective case-control study was conducted with inclusion of 201 cases and 201 controls. Patient information was collected by interviewing the patient through a structured questionnaire. Histopathological information was collected from the hospital integrated laboratory management system. The data was analyzed by using logistic regression with univariate and multivariable analyses to determine the …

A Multidisciplinary Approach To Triage Patients With Breast Disease During The Covid-19 Pandemic: Experience From A Tertiary Care Center In The Developing World, Abida K. Sattar, Hania Shahzad, Adnan Abdul Jabbar, Azmina Tajdin Valimohammad, Sadaf Khan, Yasmin Vellani, Romana Idrees, Nasir Ali, Imrana Masroor, Humera Saeed, Gulzar S. Lakhani, Nadia Ayoub, Atif Waqar, Muhammad Zia-Ul Islam, Salman Kirmani, Asad Latif, Ather Enam

Section of General Surgery

Background: The COVID-19 pandemic has created a need to prioritize care because of limitation of resources. Owing to the heterogeneity and high prevalence of breast cancers, the need to prioritize care in this vulnerable population is essential. While various medical societies have published recommendations to manage breast disease during the COVID-19 pandemic, most are focused on the Western world and do not necessarily address the challenges of a resource-limited setting.
Aim: In this article, we describe our institutional approach for prioritizing care for patients presenting with breast disease.
Methods and results: The breast disease management guidelines were developed and approved …

Telementoring For Breast Surgeons Practicing In Remote Areas, Fatima Mubarik, Hania Shahzad, Syeda Sakina Abidi, Sana Zeeshan, Lubna Mushtaque Vohra, Sadaf Khan, Abida Khalil Sattar

Medical College Documents

Telementorship allows an expert surgeon to mentor another surgeon through an advanced procedure from a remote location via 2-way audio-visual communication. The current article was planned to review the existing literature and evaluate the utility of telementorship regarding educating rural surgeons in Pakistan about multidisciplinary breast cancer care. Publications from 2016 to 2020 were searched on PubMed and GoogleScholar and 10 most recent publications were selected. Review of literature revealed that even though telementorship in this context might be comparable to onsite mentorship, multiple concerns need to be addressed before its implementation. These include lack of concrete evidence regarding its …

Patient Delay In Breast Cancer Diagnosis In Two Hospitals In Karachi, Pakistan: Preventive And Life-Saving Measures Needed, Uzma Shamsi, Shaista Khan, Syed Iqbal Azam, Shaheryar Usman, Amir Maqbool, Tiffany Gill, Romaina Iqbal, David Callen

Department of Surgery

Purpose: Patients with breast cancer in Pakistan commonly present with advanced disease. The objectives of this study were to evaluate the frequency and length of delays in seeking medical consultation and to assess the factors associated with them.
Methods: Four hundred ninety-nine patients with newly diagnosed breast cancer were enrolled and interviewed over the period from February 2015 to August 2017. Information on sociodemographic factors, delay to medical consultation, stage of breast cancer at presentation, and tumor characteristics of the breast cancer were collected through face-to-face interviews and medical file review.
Results: The mean (standard deviation) age of patients with …

Psychosocial Implications In Breast Cancer, Daniyal Aamir, Yamna Waseem, Mustafa Saleem Patel

Medical College Documents

No abstract provided.

Value Of Elastography In Differentiating Benign From Malignant Breast Lesions Keeping Histopathology As Gold Standard, Faryal Farooq, Syed Mubarak, Shaista Shaukat, Noman Khan, Kahkashan Jafar, Tariq Mahmood, Muhammad Arif Saeed

Department of Radiology

Background: Breast cancer is the most common cancer in females, both in developed and developing countries. Pakistan has the highest breast cancer incidence rate in Asia. Guidelines recommend screening for detecting breast cancer with mammography and ultrasonography (US). Shear-wave elastography (SWE) is a newer technique that can aid additional characterization of breast lesions.
Objective: The aim of this study was to determine the diagnostic accuracy of breast ultrasound elastography in differentiating benign from malignant breast lesions using histology diagnosis as the gold standard.
Materials and methods: The study was conducted at the Abbasi Shaheed Hospital and Jinnah Post Graduate Medical …

Experiences Of The Breast Cancer Patients Undergoing Radiotherapy At A Public Hospital Peshawar Pakistan, Gulzar Habibullah, Raisa Raisa, Shanaz Hussein Cassum, Rehana Elahi

School of Nursing & Midwifery

Objective: This study aimed to explore the experiences of female breast cancer patients undergoing radiotherapy (RT) in a public hospital in Peshawar, Pakistan.
Methods: This study employed a descriptive exploratory method. A purposive sample of 14 breast cancer women undergoing RT was selected for this study. Data were collected over the period of 5 months, using a semi-structured interview guide and conducting in-depth face-to-face interviews. These interviews were audio taped and transcribed by a bilingual transcriber. The translated version of the interview was coded, and the analysis was done manually.
Results: Four main categories emerged from data analysis, which were: …

Adjuvant Hormonal Therapy In Postmenopausal Women With Breast Cancer: Physician's Choices, Asi Jamal, Shiyam Kumar, Sajjad Raza, Maria Mehboob, Osama Ishtiaq

Internal Medicine, East Africa

The choice of adjuvant hormonal therapy in postmenopausal women with hormone receptor positive breast cancer has remained a matter of controversy and debate. The variety of agents is available, with each claiming to be superior. This clinical survey was undertaken to get an impression of the physician's first choice of therapy in an attempt to find out what questions still need to be answered in the making of "standard of care." A web-based clinical survey was sent to the cancer physicians around the world, and 182 physicians responded to the survey. Most were medical oncologists in a tertiary care hospital. …

Knowledge, Attitude And Preventive Practices For Breast Cancer Among Health Care Professionals At Aga Khan Hospital Karachi, Shiyam Kumar, Ayesha Mallick Imam, Nauman Fazal Manzoor, Nehal Masood

Department of Radiation Oncology

OBJECTIVE: To assess the knowledge and practice of risk factors, symptoms and screening for breast cancer among health care professionals.

METHODS: A cross sectional study was carried out at The Aga Khan University Hospital from January 2008 to March 2008. A total of 336 health care workers including consultants (48), fellows (17), residents (76), medical officers (14), interns (37), nurses (94) and fourth and final year medical students (50) were requested to fill a questionnaire designed to assess the knowledge about the risk factors, signs and symptoms, screening tools, breast self examination (BSE) and treatment.

RESULTS: More than two third …

Breast Cancer In Pakistan - Awareness And Early Detection, Saba Sohail, Shams Nadeem Alam

Department of Radiology

No abstract provided.

Clinical, Pathological And Molecular Factors Predicting Axillary Node Involvement In Primary Breast Cancer In Pakistani Women, T. Siddiqui, A. Salam, S. Khan, N. Kayani, Shahid Pervez

Department of Pathology and Laboratory Medicine

Background:

Axillary lymph node involvement in primary breast cancer is one of its most important prognostic features. Thus any factors that may predict axillary lymph node involvement in this setting could be potentially helpful in treatment planning and other interventions.

Objective:

The objective of this study was to evaluate clinical, pathological and immuno-histochemical markers in univariate and multivariate analysis, which may be helpful predictors of axillary lymph node involvement in breast cancer.

Method:

A retrospective analysis of 555 cases. Of these 58% had axillary nodal positivity and 42% were negative.

Conclusion:

Factors of no significance included patient’s age, height, weight, …