• Asian Pacific Journal of Cancer Prevention
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• v.17 no.7
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• pp.3035-3041
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• 2016

Breast cancer (BC) is the most common malignancy of women worldwide. In the past it was considered as disease of older middle aged women, but the incidence of BC in young females is growing in recent years concordant with studies in Pakistan. In this paper, we reviewed the mutant functions of tumor suppressor genes (BRCA1, BRCA2, p53, ATM and PTEN), epigenetic transformation and involvement of estrogen receptors in development of breast cancer. We further reviewed the current situation of BC in Pakistan that depicts a higher incidence in young females. According to SKMCH and RC data, age group 45-49 years is more prone to BC with high rate of incidence 45.42%. A few studies explored the high expression of ER, PR and HER-2/neu in Pakistani females. Moreover, presence of BRCA1 (c.1961dupA) mutation in Pakistani shows concordance with data in different areas of world. But we are unable to find an authentic study that can explore epigenetic based transformation of breast tumors in Pakistan. This area of research needs more attention to explore the complete picture of BC in Pakistan.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.3
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• pp.1337-1340
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• 2016

Background: There is a noticeable change in the approach with which women nowadays seek help for diseases like breast cancer, primarily due to awareness campaigns, but what happens after surgical procedures is of great significance too. This study focused on the several psychological connotations attached to mastectomy and how the patients cope. Objective: To understand the pattern of anxiety and level of depression among Pakistani patients undergoing mastectomy. Materials and Methods: The sample size consisted of 88 patients who had undergone mastectomy at the different surgical units of the Civil Hospital, Karachi, from January 2012-December 2014; The questionnaire was administered before they were discharged i.e. within 3 days of surgical procedures. The patients were asked if they were willing to participate in this study, those who agreed signed the consent form and then we preceded by asking questions with a standardized tool. A self made questionnaire was constructed keeping in mind the nature and specification of the disease, which consisted of 20 questions related to anxiety and depression, focusing on a mixture of psychological and physiological symptoms. Results: There were a total of 88 patients out of which 36 (41%) were aged 51 to 60 years, 24 (27.2%) of the patients were in the age category of 41 to 50 years, 17 aged 61 and above (19.3%) and only 11 (12.5%) 30-40 years of age, the youngest of all the age categories. The pattern of depression and anxiety was found to be similar among all age categories, severe depression and anxiety predominating over moderate level of such symptoms, with only relatively few patients sufering mild or no depression symptoms. Conclusions: It was concluded that going through mastectomy leads to moderate to severe levels of depression and anxiety, primarily because the females feel incomplete and insecure after losing a part of themselves.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.sup3
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• pp.65-70
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• 2016

Lung cancer is one of the most common malignancies in the world. Its incidence and mortality rates are on the rise in Pakistan. However, epidemiological studies to identify common lung cancer determinants in the Pakistani population have been limited. In this study, data of 440 cases and 323 controls were collected from different hospitals in Peshawar and Islamabad, along with information about socio-demographic factors including age, sex and smoking. Univariate and multi-factorial analyses of socio-demographic factors in association with each other were also performed. Overall survival analysis highlighted that, out of 440 patients in the lung cancer dataset, 204 people were uncensored with a median survival time of 13 months (95% CI=12-18). There were 41 femaleand 399 male patients. Differences were observed between length of survival in the males and females (${\chi}12$ = 6.1; p-value = 0.01). Gender was observed to be significantly related to survival (p-value< 0.01), with better survival in females (hazard ratio=2). Cox regression was extended to adjust for the covariate age (z = 2.5; p-value = 0.02). Survival analysis was also performed on the basis of smoking groups (current smokers, former smokers and never smoked individuals) and smoking duration (smoking duration >10 years, <10 years and never smoked). Smoking duration was significantly associated with survival (p-value < 0.01), with better survival in never smokers in comparison to both smoking for greater or less than 10 years. Strong associations were observed for smoking group with duration greater than 10 years, OR=6.1(3.9-9.5) on univariate and multifactorial analysis OR=11.3(CI=6.8-19.3).

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.3
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• pp.1535-1537
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• 2016

Background: Primary myelodysplastic syndrome (MDS) is an acquired clonal disorder of myeloid progenitor cells, characterized by peripheral cytopenias in the presence of hypercellular marrow with dysplastic features. Our aim was to study the demographical and clinicopathological features of adult Pakistani patients with MDS at disease presentation. Materials and Methods: This single centre study was conducted at Liaquat National Hospital and Medical College, extending from January 2010 to December 2014. Data were retrieved from the patient archives. Results: Overall 45 patients were diagnosed at our institution with de novo MDS during the study period. There were 28 males and 17 females. Age ranged between 18 and 95 years with a mean age of $57.6{\pm}17.4years$ and median of 64 years. The male to female ratio was 1.7:1. The main presenting complaints were generalized fatigue (60%), fever (33.3%), dyspnea (15.5%), bleeding (13.3%) and weight loss (11.1%). Examination was unremarkable in 42.2% of patients. Physical examination revealed pallor in 37.7%, followed by petechial and purpuric rashes in 20%. The commonest laboratory finding was anemia (hemoglobin < 10 g/dl in 41 (91.1%) patients. Out of these, 27 (60%) patients had normocytic anemia, followed by macrocytic (22.2%) and microcytic (8.8%). Conclusions: Primary MDS in Pakistani patients demonstrates a male preponderance. The proportion of anemic patients was high in our series with predominance of normocytic anemia. However, other clinico-hematological features appear comparable to published data.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.1
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• pp.357-360
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• 2016

Background: Acute myeloid leukemia (AML) is an acquired clonal frequent malignant disorder of myeloid progenitor cells. Our aim was to study demographical and clinicopathological features of adult Pakistani AML patients at presentation. Materials and Methods: In this single centre study extending from January 2010 to December 2014, data were retrieved from the patient records with a predetermined performa and analyzed with SPSS version 22. Results: Overall 125 patients were diagnosed at our institution with de novo AML during the study period. There were 76 males and 49 females (ratio 1.5:1), with an age range between 15 and 85 years and a mean age of $38.8{\pm}20.1years$. The major complaints were fever (72.8%), generalized weakness (60%), bleeding (37.6%) and dyspnea (12%). Physical examination revealed pallor in 56.8%, splenomegaly and hepatomegaly in 16% and 12.8%, respectively, and lymphodenopathy in 10.4%. The mean hemoglobin was $8.19{\pm}2.12g/dl$ with a mean MCV of $86.0{\pm}9.83fl$, a mean total leukocyte count of $43.1{\pm}68.5{\times}10^9/l$, an ANC of $3.09{\pm}6.66{\times}10^9/l$ and a mean platelet count of $62.3{\pm}78.6{\times}10^9/l$. Conclusions: AML in Pakistani patients is seen in a relatively very young population with male preponderance, compared with the west. However, clinico-pathological features appear comparable to published data.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.4
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• pp.2031-2033
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• 2016

Background: Symptomatic multiple myeloma (MM) is an acquired B-cell malignant proliferation of antibody secreting plasma cells, characterized by end organ damage due to monoclonal immunoglobulin secretion. The aim of this study wa to determine the stage stratification according to an international scoring system in adult Pakistani MM patients at presentation. Materials and Methods: This single centre retrospective study extendedfrom January 2012 to December 2015. Data were retrieved from the departmental maintained records. Results: A total of 39 patients were diagnosed at our center with MM during the period of the study, 25 males and 14 females. Age ranged between 36 and 81 with a mean of $54.5{\pm}14.8$ and a median of 57 years. Common presenting complaints included fatigue (80.9%), backache (79.3%) and bone pain (66.2%). Overall, 9 patients were in ISS stage I (23%), 12 were in stage II (30.7%) and 18 were in stage III (46.1%). Out of the total, 29 (74.3%) had kappa immunoglobulin andthe remaining 10 (25.6%) had lambda type myelomas. IgG myeloma was commonest, seen in 26 (66.6%) followed by IgA in 11 (28.2%) with non secretory myeloma in one (2.5%) and light chain disease also in one patient (2.5%). Conclusions: MM in Pakistani patients is seen in a relatively young population with male predominance. Primarily patients are symptomatic and risk stratification revealed a predominance of advanced stage III disease in our setting.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.4
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• pp.1833-1835
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• 2016

Background: Multiple myeloma (MM) is an acquired clonal B-cell malignancy which primarily affects elderly individuals with an annual incidence of approximately 1% of all malignancies. Our aim is to study demographic and clinicopathological features of adult Pakistani MM patients at presentation. Materials and Methods: This single centre retrospective study extended from January 2010 to December 2014. Data were retrieved from the patients' maintained records on predetermined performa. Results: Overall, 61 patients were diagnosed at our institution with MM during the study period. There were 43 males and 18 females. Age ranged between 34 and 81 years with a mean of $56.1{\pm}12.8$ and a median of 57 years. The male to female ratio was ~2:1. Common presenting complaints included fatigue (81.9%), backache (80.3%) and bone pain (67.2%). Physical findings revealed pallor (44.2%) as a presenting clinical feature. The mean hemoglobin value was $8.9{\pm}1.7g/dl$ with a mean MCV of $85.3{\pm}11.0fl$. Severe anemia with hemoglobin <8.5 gm/dl was seen in 40.9%. The mean total leukocyte count was $8.9{\pm}8.2{\times}10^9/l$, the ANC was $5.0{\pm}3.1{\times}10^9/l$ and the mean platelet count was $188.4{\pm}150.6{\times}10^9/l$. Conclusions: MM in Pakistani patients is seen in a relatively young population with male preponderance. The majority of patients present with symptomatic anemia and backache to seek medical attention. However, clinico-pathological features appear comparable to the published literature.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.8
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• pp.4009-4011
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• 2016

Background: Classical Hodgkin's lymphoma (cHL) is a B-cell lymphoid neoplasm characterized by a distinctive biological behavior with potentially curable disease characteristics. It is an uncommon hematological malignancy which primarily affects younger individuals. The rationale of this study was to determine its clinico-hematological profile along with stage stratification in Pakistani patients. Materials and Methods: In this descriptive study, adult patients with Hodgkin's lymphoma were enrolled from January 2010 to December 2014. Results: Sixty two histopathologically confirmed cases of cHL were identified. There were 42 males and 20 females, with a male to female ratio of 2: 1. The mean age was $29.7{\pm}13.8$ years with the median age of 30 years. B symptoms were present in 72.5% of patients. Histopathologically, the mixed cellularity type constituted 62.9% of cases, followed by nodular sclerosis in 25.8%, lymphocyte predominant in 9.6% and lymphocyte depleted in 1.6%. Stages I and II were present in 43.5% of patients at disease presentation, with 56.4% in stages III and IV. Conclusions: Our analysis shows that clinico-pathological features of Hodgkin's lymphoma in Pakistan are comparable to published data. Mixed cellularity is the commonest histological variant and advanced stage at presentation are common findings in our patients.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.1
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• pp.369-372
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• 2016

Background: Acute myeloid leukemia is an acquired clonal heterogeneous stem cell disorder. Hence, various parameters are sought out to categorize this disease into subtypes, so that as a consequence specific treatment modalities can be offered. Conventionally, the practically used method for classification utilizes French American British (FAB) criteria based on morphology and cytochemistry. The aim of present study was to determine the current spectrum of AML sub types in patients in Karachi. Materials and Methods: This single centre cross sectional study was conducted at Liaquat National Hospital, Karachi, extending from January 2010 to December 2014. Data were retrieved from archives were analyzed with SPSS version 22. Results: A total of 125 patients were diagnosed at our institution with de novo AML during five years period, 76 males and 49 females. Median age was 34.5 years. AML-M1 was the predominant FAB subtype (23.2%) followed by M2 (18.4%), M3 and M4 (16% each), M0 (14.4%), M5 (7.2%), M6 (3.2%) and M7 (1.6%). Conclusions: AML in Pakistani patients is seen in a relatively young population. The most common FAB subtype observed in our study was acute myeloblastic leukemia, without maturation (M1).

• Imaging Science in Dentistry
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• v.43 no.4
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• pp.267-272
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• 2013

Purpose: Demirjian's dental maturity scores and curves have been widely used for human age determination. Several authors have reported considerable differences between the true and estimated age based on the Demirjian curves, which have been accounted for by ethnicity. The purpose of the current study was to assess the role of ethnicity-specific dental maturation curves in age estimation of Saudi children. Materials and Methods: A sample of 452 healthy Saudi children aged 4 to 14 years were aged based on the original French-Canadian Demirjian curves and several modified Demirjian curves specified for certain ethnic groups: Saudi, Kuwaiti, Polish, Dutch, Pakistani, and Belgian. One-way ANOVA and a post hoc Scheff$\acute{e}$'s test were used to assess the differences between chronological age and dental age estimated by the different curves (P<0.05). Results: The curves designed for Dutch, Polish, Saudi, and Belgian (5th percentile) populations had a significantly lower error in estimating age than the original French-Canadian and Belgian (50th percentile) curves. The optimal curve for males was the Saudi one, with a mean absolute difference between estimated age and chronological age of 8.6 months. For females, the optimal curve was the Polish one, with a mean absolute difference of 7.4 months. It was revealed that accurate age determination was not related to certain ethnicity-specific curves. Conclusion: We conclude that ethnicity might play a role in age determination, but not a principal one.