سرطان پستان

Breast cancer is one of the most common types of cancer among women worldwide. Genetic alterations and disruptions in the regulation of key signaling pathways, including the instability of the P53 protein, contribute to the progression of breast cancer. The MDM2 protein, a negative regulator of P53, is frequently expressed in breast cancer and leads to the degradation and functional inactivation of P53. In recent years, extensive efforts have been made to design effective antagonists to inhibit MDM2 function. These small-molecule compounds are designed to restore P53 activity and hold significant potential for targeted breast cancer therapy. In the present study, the interaction of the MDM2 protein with selected antagonists, including Nutlin-3, MI-63, and Idasanutlin, was investigated using the molecular docking method. The aim of this research was to evaluate the binding affinity of these antagonists to the MDM2 protein and assess their effectiveness in inhibiting MDM2 and stabilizing P53. The results indicated that the molecule MI-63 exhibited a stronger binding affinity to MDM2 compared to Idasanutlin and Nutlin-3. Therefore, it can be hoped that this antagonist may inhibit the MDM2 protein, prevent the degradation of P53, and ultimately stabilize its function.

 Graphene quantum dots (GQDs) conjugated with folic acid have a very high potential to identify cancer cells with high expression of folate receptor and cause tumor death by binding to an anti-cancer agent. The aim of this research is to design and evaluate a new nano-drug delivery system for breast cancer treatment.

GQDs nanoparticles were synthesized by pyrolysis of L-glutamic acid and its surface was coated with PEG and amine agent to create a longer half-life and more fluorescence intensity, and it was conjugated with folic acid for better binding to MCF-7 cancer cell line with folic acid receptor by thermal method. The structure of the nanocarrier was investigated using FTIR spectroscopy, fluorimetry, and TEM imaging methods. Penetration of nanoparticles into cells and their fluorescence emission were investigated by confocal microscopy.

The synthesized GQDs had a uniform, relatively spherical structure and a size below 10 nm. With the addition of amine and PEG agents to GQDs nanoparticles, significant fluorescence intensities of up to 1000 a.u. were observed. According to the FTIR results, folic acid was successfully conjugated on the GQDs nanocarrier after using thermal reaction. The entry and fluorescence emission of nanoparticles into MCF-7 cells was confirmed using confocal microscopy.

According to the results, replacing the thermal method in the synthesis of targeted GQDs nanoparticles, instead of using chemical reagents, can provide a cost-effective and easier method. Pegylated and folated GQDs were suitable nanocarriers for targeted drug delivery to the MCF-7 breast cancer cell line.

With the rising incidence of breast cancer, the need for an effective diagnostic method, particularly in multifocal and multicenter breast cancers, becomes increasingly urgent. The present study aimed to evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) in detecting multifocal and multicentric breast cancers.

This study was conducted cross-sectionally. The study population included patients with breast cancer who underwent MRI before surgery. The sample required for the study was collected through the census method. The Mc Nemar test was used to compare the results of the two methods of pathology and MRI. In addition, the Receiver Operating Characteristic (ROC) curve was used to determine the accuracy of MRI in diagnosing multifocal and multicentric breast cancers. All analyses were conducted using SPSS software (version 22).

In general, 94 patients were included in the study. The average age of the patients was 45.03 ± 11.37 years. Of the 21 cases reported based on the MRI results of the multifocal cancer, 9 (42.9%) had pathology consistent with the MRI results (P=0.238). The sensitivity, specificity, accuracy, and area under the curve (AUC) for the MRI diagnostic method were calculated as 60%, 86.1%, 80.8%, and 73% (CI 95%: 57.4 – 88.6), respectively.

Based on the research findings, this high specificity level contributes to the overall accuracy of MRI as a diagnostic tool, supporting its use in the diagnosis of multifocal and multicentric breast cancers.

Different methods of cancer treatment can lead to the destruction of fertility. Preserving fertility before starting treatment provides an opportunity for future fertility. This study aimed to explain how to provide fertility preservation services and the barriers to receiving them for breast cancer patients in Iran.

This qualitative study was conducted using the conventional qualitative content analysis method. Participants included service providers and breast cancer survivors who were purposively selected. Sampling continued until data saturation. Data were collected through the use of unstructured, in-depth interviews with participants. Data analysis was performed using the Granheim and Landman method (2004).

Data analysis led to the emerging theme entitled insufficient coverage of fertility preservation services in breast cancer patients. It means that despite access to different fertility preservation methods by the latest technology in the world, there are obstacles, such as lack of equal access to services, high costs, lack of insurance coverage, urgency in starting treatment, priority to save the patient's life, and lack of information to some patients, prevents some eligible people from receiving fertility preservation services.

Considering the importance of having children in improving the quality of life of breast cancer survivors, it seems necessary to remove the barriers to fertility preservation in breast cancer survivors.

Sexual problems in breast cancer patients with a history of mastectomy are an issue that impairs their quality of life and is associated with an increase in medical and health costs. The present study aimed to predict sexual function based on the dimensions of mindfulness (trait, relational, and sexual) and the mediating role of body image in women with breast cancer who have undergone mastectomy.

This correlational descriptive research was conducted in 2023-2024. The sample included 181 married patients with mastectomy surgery who were selected using convenience method. Sexual Mindfulness Measure (SMM), Five Facet Mindfulness Questionnaire (FFMQ), Relationship Mindfulness Measure (RMM), and Marital Sexual Function Scale (MSFS) were used to investigate the research objectives. Sampling was conducted both online and in person. The SPSS (version 25) and R software were used for data analysis. The data were analyzed in the descriptive section using mean, frequency, standard deviation, and Pearson correlation coefficient, and in the inferential statistics section using structural equation modeling.

The results showed that the proposed model has a good fit. Moreover, the two dimensions of sexual and relational mindfulness directly predicted marital sexual functioning (P<0.01). Additionally, the two dimensions of relational and sexual mindfulness with the mediating role of body image could significantly predict sexual function in married women with a history of mastectomy (P<0.01).

To enhance the sexual function of patients, therapists are recommended to focus on components such as sexual mindfulness, relational mindfulness, and body image.

The present case-control study was conducted between September 2016 and August 2019 at Ayatollah Khansari Hospital in Arak (Iran) and aimed to comprehensively identify risk factors associated with breast cancer among local women. 

The research included 400 confirmed breast cancer cases and 400 age-matched healthy controls randomly selected from female hospital visitors. Sample size calculation was justified based on prior epidemiological studies assuming a breast cancer prevalence of approximately 50%, with calculations set at a 95% confidence interval and 80% statistical power. Data collection was performed using an interviewer-administered standardized questionnaire covering domains, such as socio-demographic characteristics, reproductive history, medical conditions, lifestyle behaviors, and family history. Data analysis utilized binary and multivariate logistic regression conducted through the SPSS (version 16) software, allowing for rigorous identification of independent risk factors. 

The results identified significant breast cancer risk factors, notably including family history of breast cancer (OR=12.02, 95% CI: 4.20–32.56, P<0.001), low education level (OR=6.38, 95% CI: 4.71–11.47, P<0.001), older age at first pregnancy (OR=3.21, 95% CI: 1.83–4.61, P<0.001), and early menarche (OR=2.43, 95% CI: 1.81–4.33, P<0.001). Urban lifestyle was found not to be significantly associated with breast cancer risk in multivariate analysis (OR=1.13, 95% CI: 0.98–1.40, P=0.068). 

These findings underscore the necessity for targeted genetic screening and tailored educational programs, particularly addressing women with lower educational status and family history of breast cancer, to improve early detection and prevention.

The EORTC QLQ-BR45 and QLQ-BR42 questionnaires have been developed to measure the quality of life in breast cancer patients, with 22 and 19 additional items, respectively, compared to the QLQ-BR23 questionnaire. The current project had the objective of evaluating the construct validity of the Persian translation of the QLQ-BR45 and QLQ-BR42 questionnaires.

After confirming the Persian translation of the EORT QLQ-BR45 questionnaire, 480 samples were enrolled in the study for its psychometric evaluation. Confirmatory factor analysis was used to assess the performance of the item and scale of the QLQ-BR45 and QLQ-BR42 questionnaires' total scores and their subscales. Due to the lack of statistical acceptance of the calculated indices, the construct validity of the 23 and 22 questions of QLQ-BR45 was assessed separately to suggest a more appropriate scoring system for these questionnaires.

In the confirmatory factor analysis of the EORTC QLQ-BR45 tool, the indices RMSEA, NFI, NNFI, and CFI were 0.099, 0.516, 0.638, and 0.676, respectively. The QLQ-BR42 factor analysis showed that the indices were 0.111, 0.742, 0.6, and 0.646, respectively. The factor analysis results for the QLQ-BR23 tool showed NFI, NNFI, CFI, and RMSEA values of 0.830, 0.886, 0.909, and 0.061, respectively. In 22 additional items of the QLQ-BR45, these indexes were 0.853, 0.917, 0.913, and 0.07, respectively, all of which indicate acceptable model fit.

As per the current study, the 45 items in the EORTC QLQ-BR45 tool are not a good fit in the combined factor model. Instead of integrating the two sections mentioned, it is suggested that the new 22-item tool be used as an instrument to assess the quality of life in breast cancer patients.

Spiritual well-being, finding meaning of life during illness, and social support are critical factors that significantly impact the quality of life of women with breast cancer. The present study aimed to predict the spiritual well-being of women with breast cancer based on their meaning of life and the level of social support they receive in West and East Azerbaijan, Iran.

In this study, the required data was collected through questionnaires from 215 women diagnosed with breast cancer. The collected data was analyzed using SPSS software (version 16), Pearson's correlation coefficient, multiple regression analysis, and analysis of variance (ANOVA).

The obtained findings indicated that 34% of the variations in spiritual well-being was attributed to the meaning of life (R²=0.34), while 27% was attributed to social support (R²=0.27). A statistically significant relationship was observed between education level and social support (P=0.006) and the meaning of life (P=0.01). However, no statistically significant relationship was found between other demographic variables and spiritual well-being, meaning of life, and social support (P>0.05).

Based on the results of the present study, adequate social support and assistance in finding meaning of life during illness helps to enhance the spiritual well-being of women with breast cancer. These insights can be utilized to improve the quality of health and psychological care provided to these patients.

Mindfulness-based interventions are considered to be one of the cognitive-behavioral treatments, the inclusion of which in diseases such as breast cancer can probably lead to a reduction in pain intensity and an increase in the quality of life in sufferers. Consequently, this research focuses on evaluating the influence of online mindfulness-based cognitive therapy on pain severity and quality of life in women undergoing treatment for breast cancer.

This research is a randomized controlled clinical trial conducted on 54 women diagnosed with breast cancer who visited Seyed Al Shohada Hospital in Isfahan, Iran, in 2023. Participants were selected based on specific inclusion criteria and randomly assigned to either an experimental group (27 participants) or a control group (27 participants) using block randomization. The test group received virtual educational programs in eight sessions of 90 minutes (once a week) in lectures and a question-and-answer manner. The first and last meeting was conducted online on the platform of the Skyroom system and other meetings were conducted offline through the formation of a group on the Eitaa social network in the form of video submission. It is noteworthy that the control group did not receive training. Pain intensity and quality of life were measured in both groups before and after the educational intervention. Data analysis was performed using the SPSS (version 20) software, employing chi-square tests, independent t-tests, and paired t-tests. Data analysis was performed at a significance level of less than 5%.

Both groups were comparable in terms of all demographic characteristics. After the intervention, there was a statistically significant decrease in the average pain severity score within the experimental group compared to their baseline measurements and relative to the control group (P<0.001); the effect size for pain intensity was equal to 1.41. Additionally, there was a statistically significant improvement in the quality of life scores for the experimental group post-intervention compared to both their pre-intervention scores and those of the control group (P<0.001); the effect size for the quality of life variable was equal to 1.95.

The implementation of online mindfulness-based cognitive therapy significantly reduces pain severity while enhancing the quality of life for women with breast cancer; therefore, it is advisable to incorporate this method alongside other medical treatments through suitable programs.

Breast cancer is the most prevalent cancer among women. Pain and anger are two of the most common and debilitating consequences of this condition, significantly affecting the quality of life of patients. Therefore, the present study aimed to compare the effectiveness of Emotional Awareness and Expression Therapy (EAET) with Acceptance and Commitment Therapy (ACT) in alleviating the severity of pain and anger in women with breast cancer.

This research employed an interventional design with a pre-test-post-test structure, including a control group and a two-month follow-up. The statistical population consisted of women with breast cancer who were referred to Mehr Soheila Charity Center in Alborz. A total of 75 eligible participants were selected through convenience sampling and randomly assigned to three groups: two experimental groups (n=25 in each group) and one control group (n=25). The experimental groups received their respective therapies: EAET and ACT. Both therapies were administered separately in the form of group sessions over 8 sessions, each lasting 90 minutes, between the winter of 2023 and the spring of 2024. The control group received no intervention. Data were collected using Siegel's Multidimensional Anger Scale (MAI) and the Visual Analog Scale (VAS) for pain. The resulting data were analyzed in SPSS software (version 24) using repeated measures analysis of variance

In the experimental group receiving ACT, the mean and (standard deviation) of anger levels in the post-test was 88.47 (10.93) compared to the pre-test 113.28 (12.33), illustrating a significant decrease (P<0.05). This reduction was also sustained in the follow-up phase at 90.04 (10.15). In addition, in this group, the mean pain intensity in the post-test was 3.90±0.94 compared to the pre-test (5.28±1.00), highlighting a significant decrease (P<0.05). The results of (3.761±0.94) continued to the follow-up phase as well. In the experimental group receiving EAET, the mean anger levels in the post-test was 80.428±7.76 compared to the pre-test (117.95±12.24), displaying a significant decrease (P<0.05). This reduction was also sustained in the follow-up phase at 82.90±8.46. Furthermore, the pain intensity in the post-test was 2.61±0.49 compared to the pre-test (5.714±1.05), showing a significant decrease (P<0.05), and the score of pain (2.571±0.50) was sustained to the follow-up phase. The EAET has been more effective than ACT.

As evidenced by the obtained results, the use of EAET and ACT can be an effective method in the reduction of pain and anger of breast cancer patients. Therefore, it is recommended that these methods be used in treatment centers as group therapy.

Improving the quality of life of women with breast cancer requires psychological interventions. The purpose of this research was to compare the effectiveness of acceptance and commitment therapy and cognitive-existential therapy on psychological flexibility in women with breast cancer in Ahvaz.

The current research employed a pre-test-post-test design that included a control group and a three-month follow-up phase. The statistical population consisted of all women diagnosed with breast cancer in Ahvaz city in 2024. From this population, a sample of 45 participants was selected using a convenience sampling method. These participants were subsequently assigned to three groups, each comprising 15 individuals: two experimental groups and one control group. Their age was between 18 to 45 years old, and all of them were under medication treatment. For the first experimental group, psychotherapy protocol based on acceptance and commitment (Izadi & Abedi, 2015) and the second experimental group, Kissan cognitive-existential therapy (Bahmani, 2010), but the control group was not subjected to any psychological intervention. The research tool included the psychological flexibility questionnaire of Dennis and Vanderwaal (2010). Analysis of variance with repeated measures was used to analyze the data.

The results showed that both treatments, treatment based on acceptance and commitment and cognitive-existential therapy are significantly effective on the psychological flexibility of women with breast cancer (p<0.01). Also, no significant difference was seen between the effectiveness of acceptance and commitment therapy and cognitive-existential therapy on psychological flexibility.

The findings of this study indicated that both acceptance and commitment therapy (ACT) and cognitive-existential therapy (CET) effectively enhance psychological flexibility in women with breast cancer.

The heart and lungs are among the organs at risk of receiving additional radiation during radiation therapy of breast cancer patients. In recent years, artificial intelligence and machine learning have brought about significant advancements in the field of medicine. This study aimed to predict the radiation dose received by the heart and lungs in breast cancer patients undergoing radiotherapy, taking into account the anatomical characteristics of these organs through the application of machine learning techniques.

This applied study was conducted by reviewing medical records in 2023 and extracting anatomical features present in chest computed tomography scans of 210 female patients with left breast cancer who had undergone lumpectomy surgery. Patient data were extracted from the Picture Archiving and Communication Syste, and multi-label classification algorithms were employed to predict the radiation dose received by the heart and lungs. The performance of the algorithms was further evaluated using metrics such as accuracy, precision, recall, F1-Score, and Hamming loss.

Based on the performance evaluation results of 7 multi-label classification algorithms and considering 16 anatomical variables influencing the amount of radiation received by the heart and lungs, the Random Forest (RF) algorithm achieved the best performance among other algorithms with an accuracy of 41.9%, precision of 73.3%, recall of 70.6%, F1 score of 73.1%, and Hamming loss of 27.4%.

The use of machine learning algorithms and considering anatomical features make it possible to identify suitable patients for 3D wedge pair radiotherapy. More advanced techniques, such as Intensity-Modulated Radiation Therapy or Deep Inspiration Breath Hold, can be recommended for other patients at risk of receiving high doses of radiation to the heart and lungs.

Breast cancer is one of the most common cancers diagnosed in women. Melatonin is a natural indole amine synthesized in the pineal gland. A large number of studies show that melatonin can be an attractive candidate for combination therapy due to its antioxidant and cytotoxic activities. It was hypothesized that melatonin in combination with capecitabine may show a synergistic effect on MCF-7 and SK-BR-3 breast cancer cell lines. To investigate the effect of the above medicines on the level of superoxide dismutase enzyme activity, It was performed alone and in combination, on cell lines. The results showed that in both cell lines, the combined use of two medicines led to a greater increase in the activity of the superoxide dismutase enzyme. The synergistic property of these two compounds is clearly evident in the results of the superoxide dismutase enzyme. The combined use of these two compounds leads to a reduction in the dose of capecitabine. Which will result in reducing the side effects of this medicine

Gemcitabine is one of the most famous chemotherapy drugs and its use is subject to limitations. In the present study, Gemcitabine with the aim of increasing its antitumor properties was injected into the PEGylated niosomal nano-carriers and the toxicity of non-drug niosomes was studied on the fibroblast cell line (HFF) and the toxicity of the drug-containing niosomes to the breast cancer cell line (MCF-7).

Niosomal vesicles were prepared using span 60(77.5%), cholesterol (17.5%) and polyethylene glycol (5%) by thin-film method and Gemcitabineis were loaded into the niosomes. Drug loading percentage was measured in nano-carriers. Their physicochemical properties were assayed, And the drug release rate was examined at 37 degrees Celsius, pH 7.4 and 42 degrees Celsius, pH 5.4. At the end, the toxicity of non-drug niosomes was studied on the fibroblast cell line (HFF) and the toxicity of the drug-containing niosomes on the MCF-7 breast cancer cell line ().

PEGylated niosomes containing Gemcitabineis showed a size of 126.6nm, 39.1 ± 3.28% drug encapsulation efficiency, -29.91±0.42 mV of zeta potential. The release of the drug from niosomes was slow and morphological examination of the nanoparticles showed that they have a smooth and spherical surface. Cellular studies showed that non-drug niosomes produce little toxicity to HFF cell line and its toxicity are not significant. Also, the toxicity of noisome Gemcitabine compared to non-noisome Gemcitabine on the MCF-7 cell was significantly higher (p-value<0.01).

The results of this study indicate that PEGylated niosomal nano-carriers containing Gemcitabineis having the proper physicochemical properties, can be an appropriate carrier for drug delivery to breast cancer cells.