فصلنامه بیماری های پستان ایران
سال شانزدهم شماره 2 (پیاپی 61، تابستان 1402)

Fear of cancer recurrence (FCR) is defined as fear or worry about the possibility of cancer returning or progressing. High FCR may adversely affect quality of life and increase healthcare expenses. This study examined the relationship between personality traits and fear of cancer recurrence with the mediation of cognitive emotion regulation in breast cancer survivors.

In this descriptive correlational study, 300 women with breast cancer referred to Cancer Institute in Tehran for their regular follow-ups after treatment in 2022 and satisfied the inclusion criteria were recruited based on convenience sampling. They completed the questionnaires online for FCR, five big personality traits and cognitive emotion regulation. Data were analyzed using Pearson's correlation coefficient and Path analysis.

Results revealed that both adaptive and maladaptive strategies of cognitive emotion regulation positively and significantly mediated the relationship between neuroticism and FCR at (P<0.01) and (P<0.05), respectively. Moreover, the relationship between agreeableness and conscientiousness with FCR was negatively and significantly mediated by adaptive and maladaptive strategies (P<0.01).  Adaptive strategies negatively and significantly mediated the relationship between extraversion and FCR (P<0.01), and maladaptive strategies negatively and significantly mediated the relationship between openness and FCR (P<0.05) in breast cancer survivors.

Breast cancer survivors with neurotic personality traits employ maladaptive strategies instead of adaptive strategies of cognitive emotion regulation and exhibit more FCR. In contrast, patients with agreeableness, conscientiousness, extroversion, and openness personality traits employ adaptive strategies or avoid maladaptive strategies and exhibit less FCR.

Women with breast cancer often face many psychological problems after mastectomy, especially difficulties in regulating body image attitudes and emotions, which necessitate therapeutic attention. Consequently, this study was conducted to investigate the effectiveness of mindfulness-integrated cognitive behavioural therapy on emotion regulation difficulties and body image in mastectomy patients.

This study was a randomized clinical trial.  The population included all patients undergoing mastectomy in Tehran in 2022.  Convenience sampling was adopted in selecting 24 patients from three hospitals (Modares, Moheb Yas, and Hazrat Rasool Akram), psychotherapy clinics, and social media. The participants (n=24) were divided into two groups of equal size-one experimental and one control group. The two groups were assessed at three different times: pre-test, post-test, and two-month follow-up. The questionnaires used in this study were the Body Image Scale (BIS, Hopwood et al. 2001) and the Difficulties in Emotion Regulation Scale (DERS, Gratz & Roemer 2003). Statistical analysis was carried out using SPSS-25 software. Frequency, mean, and standard deviation were reported for descriptive statistics, and repeated measures analysis of variance was used for inferential statistics.

Findings showed that MiCBT significantly improves body image and emotion regulation difficulties in mastectomy patients. Significant effect sizes were reported for emotion regulation difficulties (η²=0.59, p≥0.01) and body image (η²=0.55, p≥0.01).

In combination with medications, MiCBT can be used to improve emotional problems and body image in mastectomy patients.

Volumetric measurement through water displacement and circumferential measurement is commonly employed for lymphedema diagnosis. This study aimed to investigate the association between diagnostic thresholds of circumferential and volumetric arm measurements in patients with breast cancer.

This was a cross-sectional study on patients with breast cancer related lymphedema presenting to a lymphedema clinic in Tehran between 2009 and 2019. Demographic characteristics, circumferential measurements (at seven time points along the upper limb), and volumetric measurements (using the water displacement method) were extracted from patient documents. Inter-limb circumference differences of >2 cm and ≥2 cm, >5 cm and ≥5 cm for the sum of all circumference measures, inter-limb volume differences of >10% and ≥10%, >200 and ≥200 ml were assessed. We examined the association between different indices by Cohen’s kappa coefficient and evaluated the accuracy of circumference measurements compared to volumetric measurements.

Totally 4647 cases were assessed for circumference and volumetric measurements. Substantial agreement was found between circumference index >2 and >5 cm (Kappa=0.720), and circumference index >2 and volumetric index >10% (Kappa =0.628). The >2cm index had a higher association with >200 ml (R2= 0.296). Considering the volume difference of >200 ml as a standard index, the ≥2 cm index had the highest sensitivity (90.74%) and accuracy (83.19%) compared to other indices.

Considering the index >200 ml as the standard volumetric threshold, the highest sensitivity and accuracy were related to the index ≥2 cm. About 30% of edema volume changes could be predicted by circumferential measurement. It seems that evaluating the effect of other variables influencing edema estimation should be assessed in future studies.

Breast cancer is the most frequent malignancy in women worldwide. The purpose of this study was to investigate some established risk factors for breast cancer in women aged 22 to 63 in Urmia.

A case-control study was conducted  to investigate risk factors for breast cancer among women in Urmia. Data were collecctd through interviews with175 breast cancer patients and 172 control women during 2016 to 2018.

The results of univariate logistic regression analysis havee shown Single women (OR 1.253, 95% CI 0.587-2.671) and women with a primary level of education wereat high risk for breast cancer (OR 2.87, 95% CI 1.383-5.986). multivariate logistic regression model indicated that high BMI (OR 1.1, 95% CI 1–1.21) and an increasing  number of pregnancies (OR 3.04, 95% CI 1.37–6.74) were significantly associated with breast cancer.

The study indicated that the average age of breast cancer onset in Urmia is lower than that in other regions of the country. Moreover, women with a history of hormone therapy and women with an increasing  number of pregnancies were at higher risk of developing breast cancer.

Doxorubicin is a pervasive drug in cancer treatment, but its consumption is restricted due to various side effects in the body tissues. Therefore, this research aimed to reduce the side effects of this drug through the impact of a period of aerobic training along with the consumption of curcumin nano micelles on the expression level of CAS3, CAS9, BCL2, and BAX genes in cardiac tissues of Balb C mice with breast cancer induced by 4T1 cell line.

24 female Balb/C mice were randomly assigned to four control groups:  treated with doxorubicin, treated with doxorubicin and aerobic exercise training, treated with doxorubicin and nanocurcumin and bimardoxorubicin supplement, aerobic exercise training, and supplement. The 4T1 cell line, arising mouse mammary tumor, was used in this study. Doxorubicin (2mg/kg) was injected subcutaneously six times on days 28, 21, 14, 7, 1, and 35.

Aerobic exercise training significantly decreased the expression level of CAS3, CAS9 and BAX genes, while it had no significant effect on the level of BCL2 (P≤ 0/05). Nanomicelle curcumin supplement caused a significant decrease in the expression of CAS3 and CAS9 genes, but it had no significant effect on the BAX gene expression. However, it caused a significant increase in BCL2 gene expression (P≤ 0/05).

It can be concluded that aerobic exercise training and consumption of Nano micelles containing curcumin as a therapeutic supplement alone or simultaneously reduced sensitivity to cardiac apoptosis and protected non-target tissues in the heart during doxorubicin therapy. Doxorubicin (DOX) inhibits the growth of tumor cells and improves the effectiveness of cancer treatment.

Identifying breast cancer risk factors is essential for assessing the current state of the cancer care system. The maini aim of the presentstudy was to compare the reproductive risk factors of breast cancer.

The current case-control research was executed in 2021 on women with and without a history of breast cancer, referring to the Basra Hospital for Women and Children and Basra Teaching hospital. The participants were divided into two groups: diagnosed (121 women) and healthy subjects (484 women). Demographic characteristics and reproductive risk factors were compared between the two groups.

The results revealed that hormone replacement therapy (HRT) after menopause [OR=2.64, (95% CI 1.68-5.72)], age of menopause >46 years [OR=2.13, (95% CI 1.88-5.17)], breastfeeding ≤11 months [OR=1.81 (95% CI 1.71-4.09)], having a history of abortion [OR=1.68 (95 CI 0.62-2.76)], contraceptive pill usage [OR=1.47 (95% CI 0.73-2.18)], age of menarche ≤13 years [OR=1.42 (95% CI 0.78-1.94)], and being overweight or obese [OR=1.36 (95% CI 0.56-1.72)] increase the risk of breast cancer. None of those variables showed a significant correlation in multivariate analysis.

Age of menopause >46 years, hormone replacement therapy after menopause, and breastfeeding ≤11 months were the most significant risk factors for breast cancer. It is suggested that the treatment staff pay special attention to persuading breastfeeding and early diagnosis protocols for controlling breast cancer.

New changes in the health care system have made cancer care in home settings rather than in-patient situation. The diagnosis of breast cancer in a woman affects all family members and accordingly changes the duties of family members. Family involvement in this patient’s care may consequence better outcomes. Family caregivers can be unpaid family members who help the patient with physical care and the disease process, and they should know their roles to do it better. This study aimed to review family caregivers’ roles in the life of women with breast cancer. 

Database search was done in google scholar, PubMed, science direct, Magiran, and SID. The keywords were Family Caregivers, Breast Cancer, and Role. Research articles published from 1990 till 2017 with the relevant topic were selected for this study. Overall 80 articles were searched and 42 were used. 

 After reviewing these articles family caregivers’ roles were organized in three dimensions. 1) medical-instrumental roles such as screening, diagnosis, treatment, Physical care of the patient, and pain relieve 2) psychosocial roles such as decision making, encouraging and giving hope, emotional and spiritual support, and Strengthen relationships and 3) Roles related to finance such as life cost, providing treatment and care cost and following insurance claims. 

 Family caregivers of patients with breast cancer can learn specific roles to care for their family members or friends to have fewer side effects during caregiving.