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The prediction of lymphedema via the combination of the selected data mining algorithms
Anaram Yaghoobi Notash , Peiman Bayat, Shahpar Haghighat, Ali Yaghoobi Notash ,
Volume 79, Issue 11 (2-2022)
Abstract
Background: Breast cancer is the second leading cause of cancer death in women, after lung cancer. Due to the importance of predicting this disease, the use of data mining methods in medical research is more significant than before. Data mining algorithms can be a great help in preventing the development of lymphedema in patients. The aim Of this study was to create a diagnosis system that can predict the probability of lymphedema in breast cancer patients.
Methods: In the present study, the factors of lymphedema in 1117 patients with breast cancer have been collected. The likelihood of developing lymphedema is predicted using ensemble learning via 5 heterogeneous classification algorithms, feature selection and the genetic algorithm (The Two-layer Ensemble Feature Selection method). After collecting the data of patients with breast cancer from 2009 to 2018, and data preprocessing using the optimized ensemble learning algorithm and feature selection, we will examine the likelihood of developing lymphedema for the new patient. Finally, the factors affecting the disease have been extracted. Excluding the time of collecting statistical data, the period of the study was from September 2019 to February 2021. This study is performed at Seyed Khandan Rehabilitation Center, Tehran, Iran.
Results: The results of algorithms showed that the accuracy of the ensemble learning method with selected classification algorithms (SVM with RBF kernel) is 87% and the accuracy of the ensemble learning with feature selection method is 90%. According to the final evaluation of the proposed method, the most effective risk factors for lymphedema have been extracted.
Conclusion: Unfortunately, treatment and diagnosis are not without complications, and one of the most important of these complications in breast cancer is lymphedema in the upper extremities, which can affect the quality of life in patients. It is essential to have a method that can accurately suggest to a specialist whether a new patient will develop lymphedema in the future or how likely it is to develop it, using patient’s own clinical and demographic characteristics.
 

Secondary cancers during the radiotherapy of prostate cancer: a review article
Seyed Hamid Zoljalali Moghaddam, Reza Laripour, Ebrahim Hazrati, Hamed Bagheri, Nazila Eyvazzadeh, Hamid Reza Baghani, Emad Parvaneh Aval ,
Volume 79, Issue 12 (3-2022)
Abstract
Prostate cancer is the most common and second leading cause of death among men in the world. Nowadays, radiotherapy has been known as one of the most affecting methods for prostate cancer treatment. Nevertheless, radiotherapy is accompanied by the concern of developing secondary cancers by the scattered radiation to the neighbor  organs at risk. Several studies have shown that secondary cancers after the radiotherapy of prostate cancer treatment, occur in tissues such as the bladder and rectum which have been exposed to direct or indirect radiations. Therefore, this review study aimed to evaluate the influencing factors for developing secondary cancers after the radiotherapy of prostate cancer. To access the previously validated published studies, Persian and English keywords such as prostate cancer, secondary cancers, radiotherapy and organs at risk have been searched in ISID, Google Scholar, Science Direct, PubMed, and World Health Organization, between 1997 and 2021. Totally 246 pieces of literature have been selected which finally, by ignoring the similar and overlapping studies, only 40 studies were reviewed. In the present study, the most affecting factors for developing secondary malignancies including the anatomical status changes, dose variations, smoking and the impact of the various treatment techniques, have been studied. The results of the reviewed studies showed a reduction of secondary cancer risks with performing the modern modalities such as proton therapy to treat prostate cancer. Moreover, organ movements and anatomical status changes which vary from one patient to others, have been reported to make a significant difference in the relative risk of secondary cancers. It has been shown that smoking may increase the risk of secondary cancers after the radiotherapy of prostate cancer, so radiotherapy and smoking may cause genetic mutations. Despite the advantages of radiotherapy for prostate cancer treatment, developing secondary cancers after the radiotherapy should not be ignored. Assessments of the affecting factors for secondary cancers after the radiotherapy of prostate cancer require social and comprehensive studies which can result in an accurate modality with fewer side effects.

Human papilloma virus (HPV) vaccine, prevention of cervical cancer: a review article
Sahar Seddiq, Fatemeh Khalili , Asghar Abdoli, Fatemeh Azarkish, Kamal Abdolmohammadi ,
Volume 80, Issue 3 (6-2022)
Abstract
According to the official statistics of the World Health Organization (WHO), cervical cancer is one of the most common cancers among women after breast, colorectal, and lung cancers. The US Centers for Disease Control and Prevention (CDC) says all women have the chance to get the disease, and women over the age of 30 are more likely to get it. However, this cancer is a types of cancer that can be prevented through vaccination. This study aimed to investigate the role of vaccines in the prevention of cervical cancer. In this review study, articles published between 2016-2022 from PubMed, SID, Cochrane Library, Science Direct, and Google Scholar databases were examined. Keywords Papilloma vaccine and cervical cancer in Persian sources and HPV vaccine and Cervical Cancer in English sources were used. The subject search was also performed using MeSH medical subject headings and through the Pubmed database. Vaccination against human papillomavirus is the most cost-effective public health measure against cervical cancer. In many developed and developing countries, serious programs are underway for HPV vaccination and screening for cervical cancer. In most countries, HPV vaccination has been added to their mandatory immunization programs, effectively reducing the incidence of cervical infections and cancers. In countries where vaccination is not complete, health education and screening programs such as PAP smears every 2 years for all women and every year for those with high cancer risk or abnormal smears, have been consolidated. HPV vaccination is highly effective and has been added to immunization programs in many countries. Nowadays, three types of vaccines have been presented, of which the 9-valent Gardasil vaccine is more effective than the other two types, but in terms of cost-effectiveness, the 4-valent Gardasil vaccine is more suggested. Due to the high prevalence of cervical cancer in Iran, it is suggested that the HPV vaccine be used, screening tests be optimized and performed on a regular basis, and ways to prevent cervical cancer be taught.

A review on the role of mp-MRI for detection, localization and staging of prostate cancer
Ghazaleh Jamshidi , Farshid Babapour Mofrad , Mahyar Ghafoori, Hamidreza Saligheh Rad ,
Volume 80, Issue 6 (9-2022)
Abstract
Background: Prostate cancer (PCa) has been one of the most prevalent cancers in men in recent years. Multi-parametric magnetic resonance imaging (mp-MRI) has been increasingly applied in the diagnosis, localization and staging of prostate cancer. This approach uses a combination of morphology information obtained from T2-weighted image along with at least two functional imaging modalities, such as diffusion-weighted (DWI), dynamic-contrast-enhancement (DCE), and magnetic-resonance-spectroscopy (MRS). This review gives a comprehensive overview of the theories and methodologies of the mp-MRI for diagnosing prostate cancer. The search was fulfilled using a list of search engines.
Methods: In this study, with a systematic review of studies conducted during February 2015 to October 2021, the role and potential of integrating the results of morphological and functional imaging in a multi-parameter approach were evaluated and the optimal combination was introduced. This article collected studies that have employed mp-MRI in prostate cancer including: peer-reviews, research articles, academic reports and conferences. This review has been studied from September 2016 to January 2022.
Results: According to the reported results, the optimum combination of T2-w, DWI and DCE in the mp-MRI approach provides the highest sensitivity and specificity in the diagnosis, localization and staging of prostate cancer. Applying the field strength of 3T versus 1.5T improves detection accuracy including improving sensitivity and specificity as well, and also the application of endorectal coils does not provide much advantage compared to pelvic phased-array coil in term of prostate cancer detection accuracy. 
Conclusion: MP-MRI as a precision instrument plays a valuable role in the diagnosis of prostate cancer. The most suitable combination of the pulse sequences to achieve the goals of this approach is T2-w, DWI and DCE. This review is comprehensive overview covered previous articles of mp-MRI in prostate cancer for all the researchers in this field and expresses the positive and negative points of each modality. Moreover, this article reports the sensitivity and the Specificity of the recent researches.

Skin metastases in breast cancer: a review article
Behnaz Varaminian, Marzieh Ghalamkari , Tayeb Ramim, Masoumeh Roohaninasab ,
Volume 80, Issue 8 (11-2022)
Abstract
Skin metastases from breast cancer usually occur in more advanced stages of the disease, but can sometimes be the first clinical manifestation of breast cancer or the first evidence of a previous tumor recurrence. These demonstrations significantly reduce survival. Skin metastases from breast cancer have different manifestations. The most common manifestations are nodules. These nodules are soft, round or oval, mobile, firm, and elastic in texture and can be single or multiple, often flesh-colored, but can also be brown, bluish black, and pink to reddish brown. In the absence of a previous history of cancer, it can be difficult to diagnose the early location of metastatic cancers. However, metastases usually show histopathological similarities to the primary tumor. Soft tissue breast metastases usually have a better prognosis than breast or bone cancer metastases. Also, skin metastases from breast cancer do not necessarily have a poor prognosis as skin metastases from other malignancies. The relative risk of death from skin metastases to other malignancies is more than four times higher than skin metastases from breast cancer. Differential diagnosis includes cutaneous lymphoma, intracranial leukocyte infiltration, and cutaneous metastasis. Metastatic skin lesions are often mistaken for benign lesions. Recognizing them quickly is important to prevent long-term anti-inflammatory treatment that delays proper diagnosis. Therefore, to rule out metastasis, abnormal or nodular lesions should be considered for biopsy in patients with a history of systemic malignancy or suspected malignancy. Cutaneous metastases are usually a sign of widespread disease and may not be treatable in most cases. Treatment options include systemic and/or topical treatments. Extensive skin metastases require systemic treatment. For thicker skin metastases, radiation therapy, surgical or electrochemical resection is indicated as monotherapy or in combination. Oxygen in combination with topical 5% methotrexate (OFAMTX, 5% methotrexate in a carrier solution) is a recently described method that facilitates drug penetration into the epidermis. In the absence of visceral or lymph node metastases, OFAMTX is useful as a local skin treatment. This treatment is an effective and tolerable method for superficial skin metastases. Using local treatment in combination with systemic agents increases the overall effectiveness of treatment on skin metastases.

Relationship between demographic and pathological characteristics on the 5-year survival rate of gastric cancer patients in Tehran province
Fatemeh Ghafari, Shahram Agah, Shiva Irani , Marjan Mokhtare, Ali Mohammad Alizadeh ,
Volume 80, Issue 8 (11-2022)
Abstract
Background: Gastric cancer (GC) is one of the most common malignancies and is considered as one of the leading causes of cancer deaths worldwide. Despite considerable progress in the disease's control and treatment, the patients' survival rate is relatively low. Different factors can affect the survival rate of GC patients. The current study aims to evaluate the association of demographic and pathological characteristics with the survival rate of GC patients.
Methods: This descriptive-analytical study was conducted on Fifty-six patients with gastric cancer from October 2015 to October 2016, who were referred to the gastroenterology clinic of Imam Khomeini and Rasoul Akram Hospitals in Tehran province and followed up for five consecutive years. The survival rate of the patients was measured using Kaplan-Meier method. Moreover, the Log-rank test and the COX regression model were used to determine the association of the survival rate with the demographic and pathological characteristics, including gender, age, tumor location, tumor type, tumor differentiation, metastasis, tumor staging, and Helicobacter pylori status. Data analysis was performed via SPSS version 22, and a P<0.05 was considered statistically significant. 
Results: A total of 56 patients were studied; 73% were men, and 27% were women. Our results showed that gastric cancer is more common in males and older people. Patients' one-year, three-year, and five-year survival rates were 67%, 35%, and 26%, respectively. Also, the survival rate of participants over 60 and in advanced stages of GC was lower than others. The Log-rank test showed that age, tumor type, tumor differentiation, metastasis, and tumor staging could affect the survival rate. However, in the COX regression model, age, metastasis, and tumor staging influenced the survival rate of patients.
Conclusion: The results indicated that the survival rate of gastric cancer patients was relatively low, and the early diagnosis of GC could be a substantial factor in increasing the patients' survival rate. Therefore, an appropriate screening program is necessary to increase the survival rate of GC patients.

Real-time tracking of hypoxia glycolysis in conization samples for cervical intraepithelial neoplasia detection
Zohreh Sadat Miripour, Mahsa Faramarzpour, Parisa Aghaee, Elham Shirali , Soheila Sarmadi, Parisa Hoseinpour , Mohammad Abdolahad ,
Volume 80, Issue 10 (1-2023)
Abstract
Background: Although cervical cancer in adult women with early diagnostic tests has better treatment ability and disease management, precise and fast diagnosis of any signs of cervical intraepithelial neoplasia (CIN) I-III and high-risk dysplasia is vital. If any precancerous/abnormal suspicious cells are not detected in the routine diagnostic process (pathology), they cannot be treated before the lesion turns into cervical cancer, consequently help increasing the patient’s survival rate.
Methods: In this clinical study, the efficiency and diagnostic accuracy of the electrochemical measuring device of glycolysis metabolism in cancer cells (HEA: Hypoxia electrochemical assay) on in-vitro human fresh cervical samples were studied. The samples were prepared from 40 candidates of conization through a history of abnormal cell presentation in their pap smear results. The study was conducted at the Gynecology Department, Yas Hospital, Tehran University of Medical Sciences, and assistant hospitals from August 2018 to June 2021. Patients provided consent according to an ethically approved protocol. A CIN-based scoring of HEA responses was proposed by considering the pathology reports of HEA-tested regions.
Results: The diagnostic calibration of the sensor was achieved by comparing the ROS/H2O2 electrochemical current related to cell glycolysis with the presence of cancer cells in the samples' histology. The current diagnostic threshold obtained by the sensor to differentiate cancerous areas from others showed an accuracy of 95% (P<0.0001). The accuracy and sensitivity of the sensor were 95% and 100%, respectively. Therefore, a matched clinical diagnostic classification between the pathological results of tested tissues and the sensor's electrochemical ROS/H2O2 response was proposed based on CIN categorization.
Conclusion: Further pathological evaluation of the tested samples showed that electrochemical detection of glycolysis metabolism in cervical conization specimens could detect 10% of CIN lesions missed by conventional pathology of assayed patients, which was confirmed in the pathology re-examination. Therefore, as a complementary method, it can help better diagnose CIN lesions in the conization.

The role of rectal sparing devices in post-prostatectomy radiotherapy: a review article
Arezoo Mehrabian, Hamed Ghaffari, Soheila Refahi , Mohammad Haghparast , Abolhasan Rezaeyan,
Volume 80, Issue 12 (3-2023)
Abstract

                                                                
Adjuvant or salvage radiotherapy can control biochemical relapse after radical prostatectomy and reduce the risk of distant metastases. Dose-escalated radiotherapy after radical prostatectomy can lead to improved biochemical relapse-free survival. Over the last decades, despite the technological advancements in prostate radiotherapy, radiation-induced rectal toxicity is still the main limiting factor for dose escalation owing to the anatomical proximity of the prostate gland to the rectum. To this end, several rectal sparing devices, including Endorectal balloons (ERBs), prostate-rectum spacers (e.g. SpaceOAR hydrogel), and rectal retractor have been explored to increase the distance between the prostate and the rectum to reduce rectal radiation doses and toxicities. Over the last decade, several studies applied these devices during post-prostatectomy radiotherapy setting. Therefore, the purpose of this review is to evaluate the impact of rectal sparing devices on dose-volume parameters of anorectal, radiation-induced rectal toxicity, and prostate bed motion during post-prostatectomy radiotherapy. The results showed that although using ERBs can lead to stability in the target volume position, it cannot reduce rectal radiation doses, in particular dose to the anterior rectal wall. The application of ERBs can reduce the received dose of the anal wall and increase the geometric reproducibility of the clinical target volume (CTV) position. However, the role of ERBs in reducing the received dose of the rectal wall is still controversial, which can be associated with the displacement of the anterior rectal wall towards the prostate bed (high radiation dose area). The use of SpaceOAR hydrogel can significantly increase the distance between the rectum and the prostate bed and ultimately reduce the dose received by the rectal wall. Also, the use of rectal retractor remarkably reduces rectal radiation doses. The dosimetric and clinical results of the use of SpaceOAR hydrogel and rectal retractor are very promising, and these devices can be used for patients after the necessary evaluations by radiation oncologist in post-prostatectomy radiotherapy. However, further studies will be required to elucidate the efficacy of SpaceOAR hydrogel and rectal retractor in reducing radiotherapy-induced rectal toxicity following post-prostatectomy radiotherapy.

Keywords: prostatectomy, prostate cancer, radiotherapy, rectum.


Secondary cancers evaluation inside organs at risk during the prostate cancer radiotherapy: a brief report
Reza Shamsabadi, Seyed Hamid Zoljalali Moghadam, Hamidreza Baghani , Seyed Ali Zoljalali Moghadam ,
Volume 81, Issue 3 (6-2023)
Abstract
Background: In prostate cancer radiotherapy, due to the proximity of the prostate to the rectum, it can be affected by high radiation doses. It has been reported that about 70% of secondary cancers after prostate cancer radiotherapy occur in the bladder and rectum, which are exposed to direct radiation. Since prostate cancer radiotherapy may be accompanied by side effects, the aim of this study is to investigate the risk of secondary cancers after the radiotherapy of prostate cancer inside the outfield organs.
Methods: The dose volume histogram data relevant to 39 patients with prostate cancer (who were treated with 3-dimensional conformal radiotherapy technique in 2022 in Tehran) were extracted, and the uniform absorbed dose inside the sensitive tissues was calculated according to the gEUD concept. Then, the risks of secondary malignancies following prostate cancer radiotherapy were calculated using the model introduced by the BEIR report. Accordingly, the lifetime attributable risk values (LAR) were estimated based on the desired organs and patient age at exposure time through the calculation of Excess relative risk (ERR) and Excess absolute risk (EAR) values.
Results: From the obtained results, the gEUD values for the rectum ranged from 51.04 Gy to 74.69 Gy and for the bladder from 27.22 Gy to 75.51 Gy. The maximum calculated risk values for the rectum and bladder were calculated to be 49.85% and 74.91%, respectively. Besides, a significant level of secondary cancer risk within the rectum and bladder was obtained for most of the studied patients. Furthermore, small values of secondary cancer risks were estimated for patients who were irradiated at older ages, and higher ones were obtained for patients who were irradiated at younger ages.
Conclusion: The results showed that there is a higher probability of developing secondary malignancies in the bladder than the rectum. The information obtained in this research can improve the performance of the treatment process, so that information about secondary cancers following radiation therapy for prostate cancer will ultimately help doctors design more effective and optimal treatment designs.

Recurrence and survival in early breast cancer subtypes
Ali Taghizadeh, Leila Pourali, Mona Joudi, Bahareh Makvandi , Elahe Hasanzadeh, Saeideh Ahmadi Simab , Golshid Nouri Hosseini , Mehrdad Gazanchian,
Volume 81, Issue 3 (6-2023)
Abstract
Background: Breast cancer is the most common type of cancer in many countries, accounting for over 18% of all cancers in females. There are more than one million new cases of breast cancer each year. Most women diagnosed with breast cancer are over the age of 50, but younger women can also get breast cancer. About one in seven women are diagnosed with breast cancer during their lifetime. There's a good chance of recovery if it's detected at an early stage. In Iran, breast cancer is the most common cancer among women, making up 21.4% of all female cancers. The mortality rate of this cancer is 4.33 for every 100,000 people. The purpose of this research is to see how often different kinds of early breast cancer come back and how long people live after being diagnosed.
Methods: This retrospective study evaluated the medical records of 500 breast cancer patients at two hospitals in Mashhad, Iran during April 2006 to March 2016. We used SPSS software, version 16 (SPSS Inc., Chicago, IL, USA) to analyze data. A P value less than 0.05 means that the results are considered statistically significant.
Results: We included 230 women with breast cancer. The average overall survival was 130.7 months, with 83.2% of people surviving for five years and 78.8% surviving for 10 years. The stage of the disease is strongly linked to the recurrence (P=0.000). Additionally, the specific type of disease is also strongly related to disease recurrence (P=0.01) or metastasis (P=0.01). Patients who have the triple-negative subtype had the highest chance of the cancer spreading and recurrence compared to patients with other subtypes.
Conclusion: The different types of breast cancer are strongly linked to the disease recurrence or metastasis. Patients with triple-negative subtypes had the most cases of cancer spreading to other parts of the body and coming back again, compared to other subtypes. Our findings also showed that patients with the triple-negative disease had the worst overall and disease-free survivals.

Risk assessment of carcinogenic and non-carcinogenic effets of exposure to heavy metals in hookah smoke using the monte carlo simulation technique
Taibe Ruenifard, Ali Oghazyan, Mohammad Hossien Saghi , Mahdi Ghorbanian , Ayoob Rastegar, Shahram Nazari ,
Volume 81, Issue 4 (7-2023)
Abstract
Background: This study aimed to evaluate the carcinogenic and non-carcinogenic health risks of heavy metals in seven types of tobacco widely consumed in the east of the country through inhalation exposure.
Methods: This descriptive-analytical study was conducted from April 2022 to October 2022 in the city of Bojnord, Iran on sook of seven popular tobacco brands. Metal concentrations in sook of tobacco were determined using inductively coupled plasma-optical emission spectroscopy. In order to analyze the data and ensure the accuracy of the results, the amount of metals in the samples was repeated three times, and their average was analyzed. Monte Carlo software was used to assess possible risks.
Results: The results of this study showed heavy metal concentrations in sook tobaccos were, respectively, Fe>Zn>Mn>Ba>Pb>Ni>Cu>Mo>Cr>As>Cd. The concentration of heavy metals such as arsenic, cadmium and molybdenum in Alrah brand tobacco was higher than other types of tobacco. So that the amounts of heavy metals including arsenic, cadmium and molybdenum for this brand were 14.2±0.05, 10.4±0.06 and 11.6±0.04 micrograms per gram, respectively. The hazard index (HI) values for different types of tobacco, including Al-Rah, Amordadsub, Al-Fakher, Al-Rubi, Mazaya, traditional flavorless, and Nakhle, were 2.64, 2.41, 2.05, 1.7, 1.49, 1.46, and 1.44, respectively. The lifetime cancer risk (ILCR) for Amordadsub, Al-Rah, Nakhla, Mazaya, Al-Rubi, Al-Fakher, and traditional flavorless tobaccos was 2.8×10-3, 2.43×10-3, 1.72×10-3, 1.58×10-3, 1.43×10-3, 9.58×10-4, and 8.08×10-4, respectively. Lead in Alrah tobacco sook had the highest non-carcinogenic risk value with a value of 1.59.
Conclusion: According to the obtained results, Alrah tobacco sook has a higher cancer and non-cancer risk than regular tobacco and can cause non-carcinogenic and carcinogenic risks for consumers. Thus, it is necessary to regularly monitor the quality of prevalent tobacco to reduce delete human health risks.

A systematic review on the effect of brachytherapy in the treatment of prostate cancer
Mostafa Kazemi , Mohammad Hossain Dadkhah Tehrani , Ali Asghar Khaleghi, Masoud Mohammadi ,
Volume 81, Issue 9 (12-2023)
Abstract
Background: Prostate cancer is one of the most common cancers in the world, which is associated with a high prevalence, especially in the elderly male population. Treatment options for non-metastatic prostate cancer usually include active surveillance, radiotherapy and surgery, so the aim of the present study is a systematic review of brachytherapy in the treatment of prostate cancer.
Methods: The study conducted is a systematic review article in which a review of the treatment of prostate cancer with brachytherapy has been done. The information used is taken from articles published in Persian and English in Google scholar, SID and PubMed databases from 2000 to 2022. The selected keywords in this article included Brachy therapy, Prostate cancer, Radio therapy, Prostate neoplasms, High dose rate, Low dose rate and External beam radio therapy. Selection of studies was done according to PRISMA guidelines.
Results: Brachytherapy can be classified into 2 types of permanent implantation and temporary implantation based on the length of the treatment period. In permanent brachytherapy implants for prostate cancer, iodine (125I) or palladium (103Pd) are used as radioactive sources for low dose rate cases and for high dose rate brachytherapy. Iridium (192Ir) is used. Brachytherapy is usually used in two ways, either as a monotherapy in which LDR and HDR are used to treat some low-risk patients, or as a booster treatment after other treatments such as EBRT, which here may be part of the treatment process before, after, or during treatment. In contrast to brachytherapy alone, brachytherapy plus EBRT is an appropriate approach in patients with intermediate-risk and high-risk disease. In high-risk patients, the combined use of EBRT and HDR-BT can lead to better results than EBRT alone. Brachytherapy treatment is not suitable for every disease.
Conclusion: One of the main advantages of this treatment method is the ability to administer a high dose of radiation while minimizing radiation exposure to adjacent healthy organs. Since optimal dose distribution occurs in the treatment, quality treatment can be ensured. The results obtained from both forms of brachytherapy are generally suitable and comparable to other treatment methods with fewer side effects.

Cost-effectiveness analysis of colonoscopy compared to sigmoidoscopy for colorectal cancer screening in high-risk individuals in Iran
Ahmad Tahmasebi-Ghorrabi , Zahra Heydarifard, Behrouz Nemati, Majid Davari, Alireza Delavari, Hamideh Salimzadeh , Ali Akbari Sari ,
Volume 81, Issue 9 (12-2023)
Abstract
Background: Screening is a cost-effective method for prevention, early detection of the disease and reducing the burden of the third deadliest cancer in the world, i.e. colorectal cancer. This study aimed to analyze the cost-effectiveness of colonoscopy screening compared to sigmoidoscopy for colorectal cancer in high-risk individuals in Iran.
Methods: This economic evaluation study was conducted using the cost-effectiveness method between July 2016 and February 2017. Evaluation of the effectiveness of screening methods was done using a systematic review. Cost evaluation was also done using the costs obtained from the tariff approved by the Iranian Ministry of Health in 2015 for colonoscopy and sigmoidoscopy. Finally, the combined model of decision tree and Markov was used to evaluate the cost effectiveness. Incremental Cost Effectiveness Ratio (ICER) formula was used for cost effectiveness analysis considering the final outcome of 5-year survival of high-risk individuals. Excel and TreeAge software were used for data analysis.
Results: The effectiveness of sigmoidoscopy and colonoscopy in increasing 5-year survival is 11 and 15.7%, respectively, and colonoscopy screening is 4.7% more than sigmoidoscopy. The cost of colonoscopy and sigmoidoscopy screening was calculated as 1000 and 19920 billion Rials, respectively. Based on cost-effectiveness analysis, the cost of treating patients in the case of screening with colonoscopy and sigmoidoscopy is lower than without screening. The ICER ratio of colonoscopy and sigmoidoscopy compared to no screening was -4/441/389/160 and -4/757/954/940 Rials respectively, and colonoscopy compared to sigmoidoscopy was -3/699/785/880 Rials, respectively. Finally, the use of colonoscopy leads to spending 3/699/785/880 Rials less in exchange for obtaining 4722 additional survivals with the prevention of colorectal cancer compared to sigmoidoscopy.
Conclusion: Screening by colonoscopy and sigmoidoscopy methods are effective in reducing the incidence and death of colorectal cancer compared to no screening. Screening by colonoscopy is a dominant option for the high-risk population in Iran. Colonoscopy screening is more cost effective compared to sigmoidoscopy. However, decisions about colorectal cancer screening and screening methods depend on local resources and personal preferences.

Investigating the association between K589E polymorphism of EXO1 gene with the susceptibility lung malignancy as a prognostic marker in the Iranian population
Jamshid Ansari, Milad Pezeshki, Azam Ahmadi, Ali Chehrei,
Volume 81, Issue 9 (12-2023)
Abstract
Background: Lung cancer has the highest incidence and mortality rate of all cancers worldwide. In Iran, it is one of the commonly diagnosed malignancies, and its frequency is increasing rapidly. Genetic variants in DNA repair genes are linked to differences in efficiency of repairing DNA damage, which can influence lung cancer susceptibility. EXO1 is a key gene involved in the mismatch repair pathway. The K589E polymorphism in EXO1 may alter the DNA repair activity of the encoded protein and impact lung cancer risk. The aim of this study was to investigate associations between the K589E polymorphism in EXO1 and lung cancer risk in the Iranian population, and evaluate its potential as a prognostic biomarker.
Methods: This case-control study was conducted to investigate EXO1 K589E variant with susceptibility to lung malignancy in the Iranian population. One hundred patients with lung cancer as a patient group and 100 healthy individuals from Khansari Hospital located in Markazi province were studied, from January 2020 to May 2022. DNA extraction from blood samples of participants was done using a kit.  Genotype determination of both patient and control groups was done using PCR-RFLP technique. Finally, statistical results were analyzed using SPSS software and the logistic regression method.
Results: Genotype and allele frequency  analysis showed the AA genotype (P=0.004, OR=5.391, 95% CI: 1.690-17.200) and A allele (P=0.010, OR=2.851, 95% CI: 1.291-6.300) were correlated with susceptibility to lung cancer. On the other hand, people carrying the G variant allele had a lower risk of lung cancer.
Conclusion:  In summary, this study found the AA genotype and A allele of K589E in EXO1 are correlated with risk of lung cancer in Iranians, while the G allele has protective effects. The K589E polymorphism may serve as a prognostic biomarker for lung cancer susceptibility, but more studies with high population size are required.

Microbiota and probiotics, a new approach in the prevention and treatment of breast cancer: a review article
Saeedeh Keyvani-Ghamsari , Kiana Nouri, Ali Khaleseh Nejad , Shokoufeh Hassani,
Volume 81, Issue 11 (1-2024)
Abstract
Today, despite vast advances in cancer diagnosis and treatment, breast cancer is still the leading cause of cancer-related deaths in women. Various factors such as race, age, family history, mutation in the BRCA1/2 gene, diet, inactivity, alcohol consumption, and estrogen levels have been identified as risk factors for breast cancer. In recent years, microbiota has also been recognized as a new risk factor in breast cancer. In fact, the change in the microbial balance that occurs due to many environmental and internal factors of the body can be effective in the spread of cancer by affecting the intracellular pathways and signals. Studies have shown that intestinal dysbiosis affects the spread of breast cancer by affecting the metabolism and production of estrogen, or mechanisms unrelated to estrogen, such as the production of microbial metabolites that affect the immune system and lead to chronic inflammation. In addition, it has been proven that the breast tissue also has its microbiota, the types of which are different in healthy people, patients, even in different stages of breast cancer, and its subgroups. In such a way that a large amount of Proteobacteria, Firmicutes, Lactobacillus, and Actinobacteria are observed in healthy breasts, while their ratio changes in cancerous tissues. Considering the relationship between microbiota and breast cancer, maintaining a healthy microbiota is a new and significant approach to reducing the risk of developing, spreading, and managing this cancer. In this regard, compounds such as probiotics that can affect the balance of intestinal microbiota are considered as an effective approach to prevent and treat breast cancer. Probiotics can stimulate the growth of beneficial bacteria and inhibit the growth of harmful bacteria by causing physicochemical changes and affecting the metabolism of the intestinal microbiota. Furthermore, the consumption of probiotics can prevent the proliferation of cancer cells and reduce the tumor size by balancing the immune system, reducing inflammation, and inducing apoptosis in the cancer cells. This study describes the importance of microbiota in breast cancer, the difference between microbiota in a healthy person and a sick person, and the role of probiotics in the treatment of breast cancer.

Existential distress in palliative care of cancer patients at the end of life: a systematic review
Hossein Eskandari, Faramarz Sohrabi , Adeleh Rezagholizadeh Shirvan , Mohammad Asgari , Neda Shahvaroughi Farahani ,
Volume 81, Issue 12 (2-2024)
Abstract
Background: The experience of existential distress, along with other forms of distress, is one of the common experiences in end-of-life patients. Therefore, the purpose of this research is to review related studies and conceptualize existential distress in palliative care of cancer patients.
Methods: This study was a systematic review, which was conducted from May 1 to July 31, 1402 at Allameh Tabatabai University and search strategy was written and performed in MEDLINE, Web of Science/PubMed and Scopus databases from the beginning of 2003 to the end of 2022. The inclusion criteria included all quantitative, qualitative, mixed and review studies that focused on the experience of adult patients. Lack of access to the full text of the article and studies in non-English language, clinical trial (randomized and non-randomized), letter to the editor, case report and protocol were excluded from the list of studies. After removing duplicate articles, two research authors reviewed the studies independently according to the inclusion and exclusion criteria, and the differences between them were resolved by discussion.
Results: After searching, screening and selecting articles based on inclusion and exclusion criteria, finally 22 articles were included in the study, of which three were review articles, eight were quantitative and 11 were qualitative. Terminally cancer patients experience existential distress, and the data are significant for estimating the prevalence of these symptoms, especially in the severe category. In addition to examining the prevalence of this symptom, patients have described their experience of existential distress in several categories: Feelings of loneliness and isolation (or loss of support system), relationship concerns (concerns about family, changes in relationships, and conflictual relationships), loss of control/autonomy (physical control, cognitive and emotional control), burden on others, loss of sense of continuity (loss of roles, pleasurable activities and sense of self), uncompleted life tasks, hopelessness/helplessness, dissolving of the future, uncertainty and frightening ambiguity, feeling guilt/ regret about the past, lack of meaning, inevitable thoughts of death.
Conclusion: It seems that the themes raised beyond cultural differences show the universal human suffering, whose accurate conceptualization can help to develop effective therapeutic interventions to reduce existential distress.

The effect of laughter therapy on promoting the health of women with breast cancer: a systematic review
Shohre Behrouz, Alireza Ebrahimi , Ehsanmoosa Farkhani,
Volume 82, Issue 2 (4-2024)
Abstract
Background: Breast cancer is one of the most important cancers in women. Considering the importance of design for improving physical and mental health, quality of life of vulnerable women, the present study aims to design of humor and laughter programs in women with breast cancer and its effects in promoting their health.
Methods: In this systematic review, in order to access relevant articles used from Persian and English databases SID, Magiran, Cochrane Library, MEDLINE/PubMed, Scopus and Science direct, and the key words "Humor therapy", "Laughter therapy", "Breast Cancer", "Wit and Humor as Topic" and "Breast Neoplasms" using logical operators (AND, OR, NOT) were used. All articles were evaluated between January 2008 and January 2023. To assess the quality of the articles, the "Jadad" scale was used.
Results: Among the 975 articles in the initial search, 525 articles are due to the repetition of the title and 442 articles due to other reasons such as not assigning humor therapy in breast cancer, not implementing the joke and laughter intervention program, the language of the article not being related to English or Farsi, and not Conducting clinical trials were excluded, and finally eight articles that scored higher than 3 were included in the systematic review. The results of the studies showed that laughter therapy had an effective role in improving the quality of life, improving various aspects of mental health, reducing negative emotions such as anxiety, stress, depression, pain intensity, fatigue and strengthening positive emotions such as self-esteem, mood. while There has been a non-significant decrease in the dermatitis caused by radiotherapy and the activity of immune cells and the serum level of cortisol.
Conclusion: Considering the positive effect of laughter therapy in reducing the negative emotions of patients, it is recommended that nursing managers and psychologists use this easy, fun, uncomplicated and accessible intervention to improve the physical, mental and emotional health of women with breast cancer.

Investigating the role of ultrasound in diagnosing malignant axillary lymph nodes in patients with breast cancer in patients referred to Golestan Hospital in Ahvaz
Fatemeh Khaksarmadani, Azim Motamedfar, Mohammad Momen Gharibvand,
Volume 82, Issue 3 (5-2024)
Abstract
Background: Breast cancer ranks as one of the most prevalent cancers among women worldwide and remains a major cause of mortality. The axillary lymph node (ALN) status, especially in the absence of distant metastasis, is a significant prognostic indicator in breast cancer management. Non-invasive methods, such as ultrasound, have gained prominence in the diagnostic landscape, particularly for evaluating dense breast tissue where traditional imaging may have limitations. This study was conducted to assess the diagnostic accuracy of ultrasound in detecting malignant ALNs among breast cancer patients.
Methods: This descriptive-analytical study was conducted on 150 women diagnosed with breast cancer who visited Golestan Hospital in Ahvaz, Iran, between 2021 and 2022. Patients were initially examined clinically, and subsequently, ALN evaluations were performed using a GE S6 logic ultrasound machine. Key radiologic parameters including lymph node size, morphology, cortical thickness, and vascular distribution were assessed. Stata software was used for data analysis, and pathology results were considered the gold standard to determine ultrasound’s sensitivity and specificity in detecting malignancy.
Results: We found 77.7% of the 150 patients had metastatic ALNs, indicating a high rate of lymphatic spread in this population. Ultrasound showed a sensitivity of 86.09% and a specificity of 51.52% in detecting malignant nodes. Radiological signs of cancer, like abnormal morphology and increased cortical thickness, were strongly linked to positive pathological findings. This shows that ultrasound is a useful tool for diagnosis.
Conclusion: The results indicate that ultrasound, as a non-invasive and accessible modality, can serve as a valuable diagnostic tool for identifying malignant ALNs in breast cancer patients. Integrating ultrasound with physical examination could enhance diagnostic precision, potentially reducing the need for invasive procedures such as biopsies. However, more research is necessary to establish the role of ultrasound in clinical protocols and investigate its potential to guide customized treatment strategies. Such advancements could optimize patient outcomes, enhance resource allocation, and ultimately contribute to more effective breast cancer management.

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