Breast Cancer Care in Developing Countries Agarwal, Gaurav; Ramakant, Pooja; Sánchez Forgach, Ernesto R. ...
World journal of surgery,
October 2009, Letnik:
33, Številka:
10
Journal Article
Recenzirano
Background
Breast cancer is the commonest cancer of women the world over, and its incidence is rising, especially in developing countries, where the disease poses a major health care challenge. This ...growing incidence in developing countries reflects the advanced stage at diagnosis, low levels of public awareness of the risk for the disease, and poor medical infrastructure and expertise, with the resultant poor treatment outcomes.
Methods
This article provides a collective edited summary of the presentations at the symposium titled “Breast Cancer Care in Developing Countries,” held as part of the Breast Surgery International program at the International Surgical week 2007, Montreal, Canada, August 2007. The aim of the presentations was to bring out the diverse clinical pathological and outcomes-related facts of breast cancer care available to women in several countries. As the incidence of breast cancer continues to rise steadily in the developing world, the lack of awareness of this disease and the absence of breast cancer screening programs make it almost certain that the majority of breast cancers are diagnosed at an advanced stage. In addition, the quality of care available for breast cancer patients varies widely according to where the patient is treated.
Results
Though there are some centers of excellence providing multimodality protocol-based treatment on a par with the best anywhere in the world, most breast cancer patients receive inadequate and inappropriate treatment because of a lack of high-quality infrastructure—and sometimes skills—and, above all, because of limited financial resources.
Conclusions
In countries where these limitations are present, there is a need to emphasize public health education, promoting early diagnosis. In addition, resources must be directed toward the creation of more public facilities for cancer treatment. As these goals are met, it is likely that there will be a much-needed improvement in breast cancer care in developing countries.
Because of complex pathophysiology and severe consequences, traumatic brain injuries (TBI) are an important medical problem. Pathophysiology of TBI includes local and systemic stress response, in ...which interleukin-8 (IL-8) is considered as a key mediator of neuroinflammation. However, prognostic relevance of IL-8 measurement in adult patients with severe TBI is not certain. Therefore, IL-8 was determined in blood samples from central venous and jugular bulb catheter and in cerebrospinal fluid of twenty patients with isolated TBI at admission to Intensive Care Unit. None of the patients had history of stroke, dementia, autoimmune diseases, acute infection or medication with anti-inflammatory drugs. Ten patients died due to traumatic brain injury, while the other ten recovered well. While there was no significant difference of IL-8 levels in cerebrospinal fluid between survivors and nonsurvivors, central venous plasma level of IL-8 was significantly lower in survivors (71.00 ± 14.17 pg/ml), than in nonsurvivors (111.26 ± 16.9 pg/ml). Receiver Operating Characteristic (ROC) analysis revealed significant prognostic value for IL-8 in the blood as well as for the age of patients, Glasgow Coma Scale (GCS) and Acute Physiologic and Chronic Health Evaluation (APACHE II). These findings suggest that the central venous plasma values of IL-8 at admission might be an early predictive marker in patients with severe TBI, comparative to standard clinical prognostic markers such as APACHE II and GCS.
In early 2020, the spread of coronavirus disease-2019 (COVID-19) led the World Health Organization to declare this disease a pandemic. Initial epidemiological data showed that patients with cancer ...were at high risk of developing severe forms of COVID-19. National scientific societies published recommendations modifying the patients' breast cancer (BC) management to preserve, in theory, quality oncologic care, avoiding the increased risk of contamination. The Senology International Society (SIS) decided to take an inventory of the actions taken worldwide. This study investigates COVID-19-related changes concerning BC management and analyzes the will to maintain them after the pandemic, evaluating their oncological safety consequences.
SIS network members participated in an online survey using a questionnaire (Microsoft
Forms) from June 15
to July 31
, 2020.
Forty-five responses from 24 countries showed that screening programs had been suspended (68%); magnetic resonance imagines were postponed (73%); telemedicine was preferred when possible (71%). Surgeries were postponed: reconstructive (77%), for benign diseases (84%), and in patients with significant comorbidities (66%). Chemotherapy and radiotherapy protocols had been adapted in 28% of patients in both. Exception for telemedicine (34%), these changes in practice should not be continued.
The SIS survey showed significant changes in BC's diagnosis and treatment during the first wave of the COVID-19 pandemic, but most of these changes should not be maintained. Indeed, women have fewer severe forms of COVID-19 and are less likely to die than men. The risk of dying from COVID-19 is more related to the presence of comorbidities and age than to BC. Stopping screening and delaying treatment leads to more advanced stages of BC. Only women aged over 65 with BC under treatment and comorbidities require adaptation of their cancer management.
Oncoplastic surgery is the seamless joining of the extirpative and reconstructive aspects of breast surgery that is performed by a single surgeon. A symposium was held at ISW 2007 in Montreal with a ...prearranged aim to publish an article on the current and historical record of the developing specialty of oncoplastic breast surgery. The presenters and authors are well-known breast surgeons from Australia, Croatia, India, Sweden, and South Africa.
Breast cancer is a leading cause of mortality and morbidity in women, mostly due to high metastatic capacity of mammary carcinoma cells. It has been revealed recently that metastases of breast cancer ...comprise a fraction of specific stem-like cells, denoted as cancer stem cells (CSCs). Breast CSCs, expressing specific surface markers CD44(+)CD24(-/low)ESA(+) usually disseminate in the bone marrow, being able to spread further and cause late metastases. The fundamental factor influencing the growth of CSCs is the microenvironment, especially the interaction of CSCs with extracellular matrix (ECM). The structure and function of ECM proteins, such as the dominating ECM protein collagen, is influenced not only by cancer cells but also by various cancer treatments. Since surgery, radio and chemotherapy are associated with oxidative stress we analyzed the growth of breast cancer CD44(+)CD24(-/low)ESA(+) cell line SUM159 cultured on collagen matrix in vitro, using either native collagen or the one modified by hydroxyl radical. While native collagen supported the growth of CSCs, oxidatively modified one was not supportive. The SUM159 cell cultures were further exposed to a supraphysiological (35 microM) dose of the major bioactive lipid peroxidation product 4-hydroxynonenal (HNE), a well known as 'second messenger of free radicals', which has a strong affinity to bind to proteins and acts as a cytotoxic or as growth regulating signaling molecule. Native collagen, but not oxidised, abolished cytotoxicity of HNE, while oxidized collagen did not reduce cytotoxicity of HNE at all. These preliminary findings indicate that beside direct cytotoxic effects of anticancer therapies consequential oxidative stress and lipid peroxidation modify the microenvironment of CSCs influencing oxidative homeostasis that could additionally act against cancer.
Antropometrija je dio antropologije koji upotrebljava metode mjerenja radi kvantitativnog određivanja morfoloških osobina i funkcionalnih sposobnosti čovječjeg tijela. Važnost antropometrije danas je ...posebice prepoznatljiva u industrijskom dizajniranju i ergonometriji. Uporaba u arhitekturi važna je za svrhe prikupljanja statističkih podataka o distribuciji tjelesnih dimenzija unutar određene populacije, a koristi se za stalno poboljšanje novih proizvoda.
U članku autori opisuju razvoj i vrste antropometrije, povijesni prikaz proučavanja dimenzija ljudskog tijela i šake, metode koje su u uporabi za funkcionalno mjerenje šake i radiografske metode za mjerenje šake, a čiji rezultati mogu poslužiti kao dopuna učinjenim antropometrijskim mjerenjima.
Breast cancer is the most common malignancy in women. Early diagnosis and more effective treatment of invasive breast cancer resulted in significant mortality reduction, improvement of survival and ...the quality of life of the patients. The management od non-invasive breast cancer, on the contrary, is still controversial and the problem of overdiagnosis and overtreatment of patients come to evidence. In the following text a multidisciplinary team of experts brings the first consensus guidelines aimed to standardize and optimize the criteria and management in diagnosis, treatment and monitoring of non-invasive breast cancer patients in the Republic of Croatia.
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