• Asian Pacific Journal of Cancer Prevention
• /
• 제16권15호
• /
• pp.6359-6364
• /
• 2015

Background: Preclinical studies have shown that the combination of an aromatase inhibitor (AI) and capecitabine in estrogen receptor (ER)- positive cell lines enhance antitumor efficacy. This retrospective analysis of a group of patients with metastatic breast cancer (MBC) evaluated the efficacy and safety of combined AI with capecitabine. Materials and Methods: Patients with hormone receptor-positive metastatic breast cancer treated between 1st January 2005 and 31st December 2010 with a combination of capecitabine and AI were evaluated and outcomes were compared with those of women treated with capecitabine in conventional dose or AI as a monotherapy. Results: Of 72 patients evaluated, 31 received the combination treatment, 22 AI and 19 capecitabine. The combination was used in 20 patients as first-line and 11 as second-line treatment. Mean age was 46.2 years with a range of 28-72 years. At the time of progression, 97% had a performance status of <2 and 55% had visceral disease. No significant difference was observed between the three groups according to clinical and pathological features. Mean follow up was 38 months with a range of 16-66 months. The median PFS of first-line treatment was significantly better for the combination (PFS 21 months vs 8.0 months for capecitabine and 15.0 months for AI). For second-line treatment, the PFS was longer in the combination compared with capecitabine and Al groups (18 months vs. 5.0 months vs. 11.0 months, respectively). Median 2 year and 5 year survival did not show any significant differences among combination and monotherapy groups. The most common adverse events for the combination group were grade 1 and 2 hand-for syndrome (69%), grade 1 fatigue (64%) and grade 1 diarrhoea (29%). Three grade 3 hand-foot syndrome events were reported. Conclusions: Combination treatment with capecitabine and AI used as a first line or second line treatment was safe with much lowered toxicity. Prospective randomized clinical trials should evaluate the use of combination therapy in advanced breast cancer to confirm these findings.

• Asian Pacific Journal of Cancer Prevention
• /
• 제16권17호
• /
• pp.7467-7472
• /
• 2015

Background: Breast cancer is known to be one of the most prevalent cancers among women in both developing and developed countries. The incidence of breast cancer in Pakistan has increased dramatically within the last few years and is the second country after Israel in Asia to have highest proportional cases of breast cancer. However, there are limited data for breast cancer available in the literature from Pakistan. Objectives: The study was conducted to bring to light the common clinical presentation of breast cancer and to evaluate the frequency of established risk factors in breast carcinoma patients and furthermore to compare the findings between premenopausal and postmenopausal women in Pakistan. Materials and Methods: A 6 months (from July 2012 to Dec 2012) cross sectional survey was conducted in Surgical and Oncology Units of Civil Hospital, Karachi. Data were collected though a well developed questionnaire from 105 female patients diagnosed with carcinoma of breast and analyzed using SPSS version 17. Institutional ethical approval was obtained prior to data collection. Results: Out of 105 patients, 43 were premenopausal and 62 were postmenopausal, 99 being married. Mean age at diagnosis was $47.8{\pm}12.4years$. A painless lump was the most frequent symptom, notived by 77.1%(n=81). Some 55.2% (n=58) patients had a lump in the right breast and 44.8%(n=47) in the left breast. In the majority of cases, the lump was present in upper outer quadrant 41.9% (n=44). Mean period of delay from appearance of symptoms to consulting a doctor was $5.13{\pm}4.8months$, from the shortest 1 month to the longest 36 months. Long delay (> 3 months) was the most frequent figure 41.9%. Considering overall risk factors most frequent were first pregnancy after 20 years of age (41%), physical breast trauma (28.6%), lack of breast feeding(21.9%), and early menarche <11 years (19%), followed by null parity (16.2%), consumption of high fat diet (15.2%), family history of breast cancer or any other cancer in first degree relatives (9.5% and 13.3%, respectively). Some of the less common factors were late menopause >54 years (8.6%), use of oral contraceptive pills (10.5%), use of hormone replacement therapy (4.7%),smoking (4.7%) and radiation (0.96%). Significant differences (p<0.005) were observed between pre and post menopausal women regarding history of physical breast trauma, practice of breast feeding and parity. Conclusions: A painless lump was the most frequent clinical presentation noted. Overall age at first child > 20 years, physical breast trauma, lack of breast feeding, early menarche <11 were the most frequent risk factors. Physical breast trauma, lower parity, a trend for less breast feeding had more significant associations with pre-menopausal than post-menopausal onset. Increase opportunity of disease prevention can be obtained through better understanding of clinical presentation and risk factors important in the etiology of breast cancer.

• KSBB Journal
• /
• 제19권1호
• /
• pp.83-87
• /
• 2004

폐경 전후 여성에서의 갱년기 증상 등은 흔하게 발생되는 문제이며 이에 대한 해결책으로서 오랜 기간 동안 여성 호르몬 대체요법이 사용되어져 왔다. 그러나 최근 여성호르몬 대체 요법에 따른 유방암 및 심혈관 질환 위험 증가로, 자연 여성호르몬 대체요법의 사용 효과에 대한 관심이 높아지고 있다. 이 연구는 자연 생약 추출물이 갱년기 증상에 미치는 영향을 관찰하여 복합 자연 요법의 유용성을 밝히고자 하였다. 연구 시점에서 실험군과 대조군간의 기초적인 신체 특성과 혈중 호르몬 수치, 골대사지표, 그리고 혈중 지질은 차이가 없었다. 성장호르몬 수치로서 IGF-1 혈중농도가 실험군에서 증가하였으나, 통계적 유의성은 없었다. 연구시점에 갱년기증상을 가지고 있었던 대상자중 실험군에서는 57.1%, 대조군에서는 16.7%에서 증상이 개선되었으며 (OR=6.67, 95% C.I.0.49-91.33), 연구 개시점에는 특별한 증상을 느끼지는 않았으나 연구 종료 시점에서 이전에 비해 개선된 효과를 보였다고 대답한 대상자는 실험군에서 58.3%, 대조군에서는 21.7%로서 실험군에서 개선된 비율이 통계학적으로 유의하게 높았다(OR=5.04, 95% C.I. 1.40-18.14). 치료 후 3개월에 시행한 실험군과 대조군 사이의 체질량지수, 혈압, 혈중, E2, FSH, Osteocalcin, Total cholesterol, LDL, HDL, TG 등은 연구개시점과 연구종료 시점 사이에서의 평균변화는 통계학적으로 의미 있는 차이를 보이지 않았으나, 골생성 지표인 혈중 ALKP는 시험제 투여 3개월 이후 실험군에서 통계학적으로 유의한 감소를 보여 1년 후 골밀도의 상승효과가 기대되었다(p＜0.01). 혈중 중성지방 (TG)은 시험제 투여 1개월 후 대조군에서는 투여전 대비 26.9$\pm$62 (mg%) 증가하였고, 3개월 후 12.852 (mg%) 증가하였으나, 실험군에서는 1개월후 -8.040 (mg%) 감소하였고, 3개월 후 -4.436 (mg%) 감소하여 통계적으로 유의하게 감소하였다(p＜0.01, Student t-test). 시험제 3개월 치료 후 실험군의 체중, 수축기 혈압, 이완기 혈압은 대조군에 비하여 감소하는 비율이 높았으나 통계학적인 유의성은 보이지 않았다(p＞0.05). 연구시점에 고혈압 상태였으나 시험 제 투여 3개월 후 정상혈압으로 판정 된 사람의 비율은 실험 군에서 대조군에 비해 더 많았으나 통계학적인 의미는 없었다(p＞0.05).

• Asian Pacific Journal of Cancer Prevention
• /
• 제16권14호
• /
• pp.6055-6059
• /
• 2015

Background: Medication policy development in Thailand is continually promoting rational drug use. Letrozole, an endocrine therapy drug, is usually prescribed for post-menopausal status early and advanced stage breast cancer. After Ministry of Public Health announced Letrozole as compulsory licensed drug in 2009, more breast cancer patients can access to this drug at low cost especially those within universal coverage schemes. To ensure that Letrozole is rationally prescribed, the drug utilization study was conducted. Objectives: The aim of this study was to describe the appropriate use of Letrozole in breast cancer and the relationship between appropriate use and health benefit schemes. Materials and Methods: A retrospective study to evaluate use of Letrozole in breast cancer patients was performed for six months between January - June 2010 in seven regional cancer hospitals, Thailand. All prescriptions of Letrozole were identified from pharmacy dispensing databases and prescription papers. A medical record review was also performed to evaluate appropriate use referring to the drug use evaluation criteria. The approved criterion of this study was referred from the guideline of Thai National Formulary version 2010. Results: There were 681 prescriptions of Letrozole for 254 breast cancer patients with an average age of $58.6{\pm}10.0years$. The patients in universal coverage scheme (UCS), civil servant medication benefit scheme (CSMBS) and social security scheme (SSS) were 77.7%, 18.5% and 8.7% respectively. 10.6% were prescribed Letrozole for the first time. Letrozole were prescribed by oncologists (82.8%). The average number of tablets per prescription was $58{\pm}10$. Calcium supplements were prescribed concomitant with Letrozole for 19.4%. To assess drug use evaluation criteria, 45 prescriptions were excluded because of uncompleted clinical data, 636 prescriptions were evaluated. The study showed 86 prescriptions (13.5%) with inappropriate use including 6 (0.9%) not prescribed for estrogen receptor (ER) and/or progesterone receptor (PR) positive, 31 (4.9%) not prescribed for post-menopausal and 49 (7.7%) not prescribed for an appropriate duration. Appropriate use percentages in different health benefit schemes were similar, 85.7% of CSMBS, 86.4% of SSS and 86.7% of UCS. The relationship between health benefit scheme and appropriate use of Letrozole was not significantly different, ${\chi}^2$ (2, N = 636) = 0.081, p > 0.05. Conclusions: The study showed inappropriate use in breast cancer patients because of non-compliance with duration, menopausal status and hormone receptor requirements. To prescribe appropriate indication did not referred to the appropriate practice along the treatment. Drug use evaluation proved very useful for detecting the sign of inappropriate use and allows immediate feedback to the stakeholder for developing medication policy in the future. Importantly, there was no significantly difference in appropriate use of Letrozole across health benefit schemes.

• Asian Pacific Journal of Cancer Prevention
• /
• 제15권7호
• /
• pp.3233-3238
• /
• 2014

Background: The aim of this study was to analyze the demographic and clinical characteristics of male breast cancer patients in Serbia, and furthermore to determine overall survival and predictive factors for prognosis. Materials and Methods: In the period of 1996-2006 histopathological diagnosis of breast cancer was made in 84 males at the Institute for Oncology and Radiology of Serbia. For statistical analyses the Kaplan-Meier method, long-rank test and Cox proportional hazards regression model were used. Results: The mean age at diagnosis with breast cancer was $64.3{\pm}10.5$ years with a range from 35-84 years. Nearly 80% of the tumors showed ductal histology. About 44% had early tumor stages (I and II) whereas 46.4% and 9.5% of the male exhibitied stages III and IV, respectively. Only 7.1% of male patients were grade one. One-fifth of all patients had tumors measuring ${\leq}2cm$, and 14.3% larger than 5 cm. Lymph node metastasis was recorded in 40.4% patients and 47% relapse. Estrogen and progesterone receptor expression was positive in 66.7% and 58.3%, respectively. Among 14.3% of individuals tumor was HER2 positive. About two-thirds of all male patients had radical mastectomy (66.7%). Adjuvant hormonal (tamoxifene), systematic chemotherapy (CMF or FAC) and adjuvant radiotherapy were given to 59.5%, 35.7% and 29.8% patients respectively. Overall survival rates at five and ten years for male breast cancer were 55.0% and 43.9%, respectively. According to the multivariate Cox regression predictive model, a lower initial disease stage, a lower tumor grade, application of adjuvant hormone therapy and no relapse occurrence were significant independent predictors for good overall survival. Conclusions: Results of the treatment would be better if disease is discovered earlier and therefore health education and screening are an imperative in solving this problem.

• Asian Pacific Journal of Cancer Prevention
• /
• 제15권24호
• /
• pp.10905-10909
• /
• 2015

Purpose: The aim of this study was to evaluate the diagnostic value of FNA-Tg for detecting lymph node metastases in patients with a history of differentiated thyroid cancer (DTC). Materials and Methods: A total of 58 patients with DTC diagnosis and evidence of single or multiple suspicious cervical lymph nodes were assessed. All underwent total or near-total thyroidectomy with (35 cases) or without (23 cases) radioiodine (RAI) ablation, followed by thyroid stimulating hormone (TSH) suppression therapy. A total of 68 lymph nodes were examined by ultrasound-guided fine needle aspiration (US-FNA) for both cytological examination and FNA-Tg measurement. Serum Tg and anti-thyroglobulin antibody (TgAb) levels were also measured. Diagnostic performance including sensitivity, specificity, accuracy, positive (PPV) and negative predictive value (NPV) of FNAC and FNA-Tg were calculated and compared. The Spearman's rank correlation coefficient was used to estimate the relationship between FNA-Tg and serum TgAb. Results: The FNA-Tg levels were significantly higher with DTC metastatic lymph nodes (median 927.7 ng/mL, interquartile range 602.9 ng/mL) than non-metastatic lymph nodes (median 0.1 ng/mL, interquartile range 0.4 ng/mL) (p<0.01). Considering 1.0 ng/mL as a threshold value for FNA-Tg, the sensitivity, specificity, accuracy, PPV and NPV of FNA-Tg were 95.7%, 95.5%, 95.6%, 97.8% and 91.3%, respectively. The sensitivity and accuracy of the combination of FNAC and FNA-Tg were significantly higher than that of FNAC alone (p<0.05). The diagnostic performance of FNA-Tg was not significantly different between cases with or without RAI ablation, and the serum TgAb levels did not interfere with FNA-Tg measurements. Conclusions: Measurement of FNA-Tg is useful. The combination of FNAC and FNA-Tg is more sensitive and accurate for detecting lymph node metastases in patients with a history of DTC than FNAC alone. Serum TgAbs appear to be irrelevant for measurement of FNA-Tg.

• 대한한의학회지
• /
• 제28권4호
• /
• pp.74-85
• /
• 2007

Objective : In this study we wanted to confirm if proper stimulation and de-Qi of traditional Korean medical acupuncture could increase hot flash relief efficacy. Design : A randomized controlled, single blind study. We used two modalities of acupuncture, one with optimal stimulation [Study group; Korean medical acupuncture (TKMA)] and one with minimal stimulation [Control group; Minimal acupuncture (MA)]. Same acupoints [PC6(內關), HT8(少府), HT7(神門), LI4(合谷), ST36(足三里), SP6(三陰交), Ren4(關元)] were used in both groups. Fifty-two patients were treated twice a week for 8 weeks, and follow up was done after 4 weeks from the last treatment. Patients were checked hot flash VAS (visual analog scale), frequency and duration every time they visited. Results : Hot flash relief efficacy by 100mm hot flash VAS was obvious in both groups. Hot flash VAS scores of study group were smaller than the scores of control group at the early stage (3rd, $4^{th}$ and $8^{th}$ visit), but there wasn't a remarkable difference between study and control group at the end of the trial. Besides, diminution of hot flash VAS was faster and more even in the study group than control group by visualization using 'Box plot'. We compared frequency and duration of hot flash, 100mm sweating, palpitation, sleep disturbance VAS, and Kupperman Index, MENQOL, Patient's global assessment score. Both groups showed definite decrease from the baseline, but the difference was not statistically significant. There wasn't any adverse event. Hot flash relief efficacy was kept in most patients after 4 weeks' follow-up. Conclusion : Acupoint combination by Traditional Korean medical theory is effective on hot flashes and hot flash relief efficacy was faster and more even in optimal stimulation than minimal stimulation.

• 생명과학회지
• /
• 제19권12호
• /
• pp.1841-1846
• /
• 2009

갱년기의 여성에는 여러 폐경 증후들이 나타나는데, 특히 에스트로겐의 감소로 인한 골 손실의 증가 등으로 골다공증질환의 발병율이 높아지게 된다. 이러한 갱년기 증후군을 치료하기 위해 호르몬 대체 요법으로 치료를 하고 있으나 유방암과 자궁암 등의 부작용에 대한 논쟁의 여지가 있어 갱년기 증후군을 치료하는데 양면성을 가진다. 그러므로 본 연구에서는 쉽게 섭취 할 수 있으며, 부작용이 없는 해조류인 감태 추출물을 이용하여 in vivo 실험을 통해 갱년기 장애 시 나타날 수 있는 골 손실에 미치는 영향을 검토하였다. 난소 절제술을 시행한 군들에서 전체적으로 체중이 증가하였으나, 난소절제 후 감태 추출물을 투여에 의한 체중 감소는 나타나지 않아 감태 추출물이 체중 감소에는 크게 영향을 미치지 않은 것으로 나타났다. 난소절제 시(OVX-CON) 에스트로겐 결핍으로 bone turnover가 증가되어 비 난소절제(SHAM)군에 비해 혈장 중의 ALP의 활성이 증가되었으나, 난소 절제 후 감태 추출물을 투여한 군에서 그 활성이 유의적으로 감소하는 경향이 나타났다. 이것은 난소 절제 후 에스트로겐의 분비가 감소되는데 반해 감태 추출물 투여가 에스트로겐 대체 작용을 함으로써 난소절제로 인한 골 손실 정도를 완화시켜 준 것으로 추측되어진다. 골 용해 지표인 혈액 중의 CTx는 난소절제군이 비 절제군에 비해 높은 수준을 보여 난소 절제군에 있어 골 용해가 증가되었음을 나타내었다. 반면 감태 추출물의 투여로 인해 CTx 함량이 감소하였으며, EC-200군의 경우 SHAM과 비슷한 수준으로 나타났다. 이는 난소절제로 인해 bone turnover가 증가된 상태에서 감태 추출물의 투여로 bone turnover가 감소하여 골 흡수 저해 효과를 타나낸 것으로 추정된다. 또한 결합조직 중의 collagen 함량은 난소절제로 인하여 감소하였으나, 감태 추출물의 투여에 의해 점진적으로 회복되는 경향을 나타내었다. 이상의 결과로부터 estrogen 부족으로 인한 골 손실의 예방에 감태가 유익한 효과를 가지며, 이를 활용한 기능성식품 개발도 가능할 것으로 기대되어 진다.

• Journal of Preventive Medicine and Public Health
• /
• 제38권1호
• /
• pp.82-92
• /
• 2005

Objective : To evaluate the relationships among sociodemographic characteristics, health behaviors, levels of pros and cons and stages of change in Pap testing for uterine cervical cancer. Methods : A questionnaire survey was performed on 560 randomly sampled people who were assigned to participate in a Pap testing program by the National Cancer Screening Project in 2003' between 25 September and 10 October in Gyeonggi, Korea. Data about the behaviors and intentions of Pap testing, sociodemographic characteristics, health behaviors, and levels of acknowledged benefit (pros) and barrier (cons) for Pap testing was collected. The stages of change were grouped according to behaviors and intentions of Pap testing as passive, active, and relapse. Results : Logistic analysis between the passive and active groups showed that city dwellers, 'high' and 'middle' groups in terms of the individual s health belief, those who had undergone a health examination within the past 2 years, and those who had undergone hormone replacement therapy had a higher odds ratios to be in the active group. As the 'benefit' scores increased and the 'Unnecessity' scores decreased, the probabilities to be in the active group increased. According to the logistic analysis results between the active and relapse groups, those who were 60 years or older, members of the National Heath Insurance, and those who had not undergone a health examination within the past 2 years had a higher odds ratio to be in the relapse group. The 'Benefit' scores were not significant in this relationship. The probabilities of being in the relapse group increased as the Unnecessity and 'Shamefulness' scores increased. Conclusions : In conclusion, health planners should inform women in the passive group of the benefits and necessity of Pap testing. It would be better to reduce the barriers to the active group of undergoing Pap smear. This study might be a useful guide for future planning of Pap testing program.

• 지역사회간호학회지
• /
• 제17권4호
• /
• pp.512-520
• /
• 2006

Purpose: To investigate the risk factors of arthritis, this study was carried out with 1,829 Korean women aged between 40-64 who responded to a health behavior survey. Methods: Data were extracted from the results of the 2001 National Survey on Health and Nutrition conducted by the Ministry of Health and Welfare. Results: 1 Financial difficulty and continuous anxiety about health were directly associated with arthritis. The odd ratios of these two factors of arthritis were 1.43 and 1.82 respectively. 2. With regard to the presence or absence of arthritis according to demographic characteristic, the incidence of arthritis was higher in the age between 50-64, in the group whose education level was middle school or lower, and in those who experienced the death of spouse, divorce or separation. Nevertheless, it was not significantly different according to financial status and employment status. 3. Concerning the presence or absence of arthritis according to psychological characteristic, the incidence of arthritis was found to be higher in those who were not healthy by subjective health assessment, in those who were always anxious about their health, in those who were always depressed and sad, and in those who felt heavy stress. 4. With regard to the presence or absence of arthritis according to the health behavior, the incidence of arthritis was higher in postmenopausal cases and cases who were having hormone therapy, and the incidence of arthritis was higher in those who did not drink alcohol, those with BMI higher than 25, and those who slept shorter than 7 hours a day. Conclusion: Based on the above results, it is required to provide a means applicable to communities by developing preventive education that can prevent the incidence of arthritis in middle-aged women as well as intervention programs.