Tehran University Medical Journal

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The evaluate the diagnostic value of image guided Fine Needle Aspiration (FNA) in breast lesions, the cytologic results of 401 patients were studied. All patients had either unpalpable masses or lesions who were hardly possible to localize by palpation and FNA was performed by single radiologist under ultrasound guide in all cases. The cytologic results were divided into four categories (inconclusive, benign, suspicious and malignant. Pathologic results were also divided into two categories (benign, malignant) and additional statistical analysis was conducted to find te cut-off point between benign and malignant cytologic results. Following cytologic results were obtained: 7.98 percent inconclusive, 67.83 percent benign, 10.97 percent suspicious, 13.22 percent malignant. Of the patients undergone breast operation after image guided FNA, the surgical pathology of 128 cases were found. In this study the sensitivity, specificity and accuracy of image guided FNA were calculated as 94.34 percent, 82.67 percent and 87.5 percent respectively. Person's coefficient analysis revealed significant correlations between FNA diagnosis and surgical pathology (P<0.001, r=0.66). Thus, image guided FNA of breast lesions can be a reliable substitute for the excisional biopsy breast operation in many patients.

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Background: Depending on the lung volume in radiotherapy fields, breast cancer radiotherapy has documented side effects on pulmonary function, which can be determined by pulmonary function tests. Central lung distance (CLD), the distance from the chest wall to the edge of the field at the central axis, is an indicator of lung volume within the radiotherapy fields. In this study, we aim to detect the relationship between CLD and pulmonary function tests.

Methods: In this study we included 50 patients with breast cancer receiving postoperative adjuvant radiotherapy at Imam Hossein Hospital, Tehran, Iran. The patients received radiotherapy with a total dose of 4800-5000 cGy. For all patients, the central lung distances were measured using simulation of tangential fields, in addition to determination of pulmonary function, including force vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) determined before radiotherapy, one month and three months after radiotherapy.

Results: There is no significant statistical difference between the FEV1 and FVC values before radiotherapy and those measured one month after radiotherapy however there was a significant statistical decrease in the FEV1 and FVC before radiotherapy and those measured three months after radiotherapy (P<0.001 and P<0.006, respectively). There is a positive statistical correlation between the change in the FEV1 three months after therapy and the CLD (r=0.71, p<0.01) and that of the FVC three months after therapy and the CLD (r=0.59, p<0.01). Linear regression for the prediction of FEV1 and FVC three months after radiotherapy was designed according to the CLD, FEV1 and FVC values before radiotherapy.

Conclusions: Three months after breast radiotherapy, the FEV1 and FVC values decrease, and the CLD is a proper predictor of these changes.

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Background: Nonlethal genetic damage is the basis for carcinogenesis. As various gene aberrations accumulate, malignant tumors are formed, regardless of whether the genetic damage is subtle or large enough to be distinguished in a karyotype. The study of chromosomal changes in tumor cells is important in the identification of oncogenes and tumor suppressor genes by molecular cloning of genes in the vicinity of chromosomal aberrations. Furthermore, some specific aberrations can be of great diagnostic and prognostic value. Comparative genomic hybridization (CGH) is used to screen the entire genome for the detection and/or location chromosomal copy number changes.

Methods: In this study, frozen sections of 20 primary breast tumors diagnosed as invasive ductal carcinoma from the Cancer Institute of Imam Khomeini Hospital, Tehran, Iran, were studied by CGH to detect chromosomal aberrations. We compared histopathological and immunohistochemical findings.

Results: Hybridization in four of the cases was not optimal for CGH analysis and they were excluded from the study. DNA copy number changes were detected in 12 (75%) of the remaining 16 cases. Twenty-one instances of chromosomal aberrations were detected in total, including: +1q, +17q, +8q, +20q, -13q, -11q, -22q, -1p, -16q, -8p. The most frequent were +1q, +17q, +8q, -13q, similar to other studies. In three cases, we detected -13q, which is associated with axillary lymph node metastasis and was reported in one previous study. The mean numbers of chromosomal aberrations per tumor in metastatic and nonmetastatic tumors was 1.5 and 1, respectively. No other association between detected chromosomal aberrations and histopathological and immunohistochemical findings were seen.

Conclusion: Since intermediately to widely invasive carcinomas are more likely to have chromosomal aberrations, CGH can be a valuable prognostic tool. Furthermore, CGH can be used to detect targeting molecules within novel amplifications which holds the potential for a new therapeutic approach for intractable cancer.

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Background: Radiation to some parts of the heart is unavoidable in the therapeutic course of primary tumors in many kinds of cancer, including breast cancer. The aim of this study was to assess the frequency of acute and subacute cardiac complications following radiotherapy in patients with left breast cancer.
Methods: In this study, we enrolled 53 patients with left breast cancer who underwent mastectomy or lumpectomy between September 2005 and September 2006 in Imam Khomeini Hospital Complex, and subsequently underwent chemotherapy with anthracyclines (<450mg/m²) and Endoxan plus taxane/fFluorouracil followed by radiotherapy. In all patients, electrocardiography and echocardiography were performed before initiation of radiotherapy, immediately after radiotherapy and again three and six months later to check for radiotherapy-induced cardiac complications such as pericardial effusion, valvular lesions, left ventricular dysfunction, conduction system disturbances and other variables.
Results: Thirty-nine patients completed the follow-up period. Among these, 10 (25.6%) patients experienced cardiac complications following radiotherapy. Among these, mild pericardial effusion in seven (53.85%) patients, mild mitral regurgitation in three cases (23.08%) and Right Bundle Branch Block (RBBB) in two cases (15.38%) were the most common complications. We found no correlation between cardiac complication and tumor dose, dose fraction and type of chemotherapy protocol. We noted no cases of new or more serious complications, such as cardiomyopathies or coronary artery disease, nor any changes in ejection fraction by the end of the follow-up period.

Conclusion: In patients with left breast cancer, acute and subacute cardiac complications following radiotherapy are not serious and have no clinical significance. Further studies are needed for more assessments in this area.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Seroma formation, or the subcutaneous collection of fluid, is a common problem after surgery for the breast cancer. It may lead to wound-related complications and also can delay adjuvant therapy. The aim of this study was to investigate the effect of various clinical and therapeutic variables on seroma formation.
Methods: A prospective cross sectional study of patients who underwent surgical therapy for breast cancer was carried out. Modified radical mastectomy was performed on 67 patients (65%) and 28 patients (27.2%) underwent breast conservative surgery. Simple extended mastectomy was done for the remaining 8 patients (7.8%). Seroma formation was studied in relation to age, type of surgery, tumor size, nodal involvement, preoperative chemotherapy, surgical instrument (electrocautery or scalpel), use of pressure garment, and duration of drainage. All of the patients followed for 4 weeks after surgery.
Results:  A total of 103 patients with breast cancer were studied. The mean age of the patients was 48.3 years (25-82). Seroma occurred in 27 (26.2%) patients. There was statistically significant relation between age and seroma formation after breast cancer surgery (p=0.005), while other factors studied was found to be significantly ineffective. In addition, there was not any relation between seroma formation and drain duration. However, two factors including type of the operation and level of lymphatic dissection was considerable with confidence interval up to 90%, but it was not statistically significant with confidence interval >95% (p=0.068 and 0.063 respectively).
Conclusion: These findings suggest that the age is a predicting factor for seroma formation in breast cancer patients, while other factors do not significantly affect that.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Detection rate of Ductal Carcinoma Insitu of the breast (DCIS) have increased rapidly over the past decade, which is generally attributed to the widespread use of screening mammography. The aim of this study was to evaluate the prevalence of ductal carcinoma in situ in patients who had been referred to Tehran university medical centers.
Methods: In a retrospective study, medical records of the patients with diagnosis of breast cancer in 3 teaching hospitals of Tehran University of Medical Sciences (Cancer Institute, Sina and Shariati Hospitals between 1994-2003) were reviewed and records with ductal carcinoma in situ were selected and analyzed.
Results: Between 2244 medical records of breast cancer 23 patients had DCIS (1.02%). Mean age was 47.3 years just one patient had been detected by screening mammography and others had clinical symptoms. 48% of patients had mass with mean size of 3.3cm. All had undergone open biopsy (four incisional, 19 excisional). Treatment included 65.2% modified radical mastectomy, 30.4% lumpectomy with axillary dissections and 3.8% lumpectomy alone. Nine patients had radiotherapy after surgery and ten took tamoxifen as hormonal therapy. Two patients (8.6%) in lumpectomy group had recurrence in follow ups. Median follow up time was 84 months.
Conclusion: This study shows that the Prevalence of early stages of breast cancer especially ductal carcinoma in situ is extremely low. (DCIS was 1.02 in comparison with 15-30% in western countries). These findings indicate the need for increasing public information about breast cancer in Iran and improving screening programs of breast cancer.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Breast conservative therapy is associated with similar outcomes in comparison with mastectomy. The aim of this study is assessment of local recurrence rate and related risk factors in patients who have been treated with radiotherapy after conservative surgery for breast cancer.

Methods: This is a cohort study which data of all breast cancer patients who have visited in follow up clinic in radiation oncology department of cancer institute of Imam Khomeini Hospital complex in Tehran, Iran, during years 2007-2009 were collected. All of the patients were investigated for local recurrence and the possible risk factors.

Results: Two hundred and seventy seven patients have entered the study and all have followed for at least one year since data entry. Median follow-up time from the start of radiotherapy were 35 months (12-148 mo). We had seven cases (2.5%) with local recurrences (2.5%) which most of them occurred in first year after treatment. Because of low rate of recurrence none of the variables such as margin and nodal status has significant correlation with local recurrence which this should be due to small number of patient and short time of follow up.

Conclusions: At median follow up of 35 months from the beginning of radiation therapy, local recurrence rate was 2.5% which is similar to the literature. We recommend to follow a larger group of patients for longer times to estimate recurrence risk after breast conservative therapy.

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Background: Fever in neutropenic patients is a medical emergency which may happen in patients undergoing chemotherapy. The definition of neutropenia varies from institution to institution but is usually defined as an absolute neutrophil count (ANC) < 500 cells/l or < 1,000 cells/l with a predicted nadir of < 500 cells/l. Bacterial and fungal infections are the most important in neutropenic patients. Viral infections with agents such as herpes simplex virus and cytomegalovirus are common but less than other pathogens. Case presentation: We report a patient with fever & neutropenia following cytomegalovirus infection during chemotherapy course for breast cancer. Conclusion: Although fever and neutropenia after cytomegalovirus infection is not very common but prompt diagnosis and treatment of this disease reduces the mortality and morbidity associated with cytomegalovirus. For this reason, screen testing for CMV infection in high risk patients including patients with cancer and preemptive therapy in patients with viremia, for prevention of CMV disease could be considered as a strategy for prevention of CMV infection.

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Background: Based on the reports, high frequency of special alleles of HLA class II genes might be associated with susceptibility to or protective from a particular cancer. These alleles might vary depending on the geographical region. Here we investigate the association between alleles of HLA class II genes and breast cancer in Iranian women.
Methods: 100 patients with pathologically proved breast cancer who referred to Cancer Institute, Tehran University of Medical Sciences in Tehran, Iran, were divided to two groups based on ages (40 years old and less/ or more than 40 years old) and were randomly selected and compared with a group of 80 healthy blood donor subjects. HLA class II alleles were determined by amplification of DNA with polymerase chain reaction (PCR) method followed by HLA-typing using sequence-specific primer (SSP) for each allele.
Results: The most frequent alleles in the DR and DQ regions in group 1 (40 years old and less) in comparison with control group were HLA-DQA1*0301 (p=0.002) and HLA-DQB1*0302 (p>0.05). In contrast HLA-DQA1*0505 (p=0.004) had significantly lower frequency in this group compared with control group. Patients of group two (more than 40 years old) had a higher frequencies of HLA-DQA1*0301 (p=0.001) and HLA-DRB1*1303 (p=0.02) and a lower frequency of HLA-DQA1*0101 (p=0.002) compared to healthy control.
Conclusion: These findings provide information of a positive and negative association between certain alleles of HLA class II and breast cancer in our population and also might support that the pattern of inheritance in the early and late onset of breast cancer differ substantially.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Aldehyde dehydrogenase 1 (ALDH1) is a marker of normal and malignant human mammary stem cells that has been reported to be associated with poor prognosis. Studies on the detection of ALDH1+ cells can help the treatment of patients with breast cancer. The aim of this study was to determine the activity of ALDH1 in breast cancer and its relationship with the pathological features of the tumors.
Methods:  ALDH1 activity was studied by immunohistochemistry in 121 paraffin-embedded histological samples of breast cancer patients from Department of Pathology of Milad Hospital, Tehran, Iran during 2006-2007. The relationship of ALDH1 with the pathological features of the tumors (size, grade, lymph node metastasis and vascular invasion) was also investigated.
Results:  Eighty-five percent of breast cancer samples expressed ALDH1 in their cytoplasm with a wide range of intensity (weak, moderate and strong), while 18 samples (14.9%) were completely negative. The majority of cases (97.1%) showed ALDH1 positivity in the stroma of tumors which varied from weak (2.9%) to strong (73.5%). ALDH1 H-score (ALDH1% × intensity) of tumor cells varied from 0 to 240 (mean= 80). ALDH1 H-score was ≤80 in 62 (51.2%) and >80 in 59 (48.8%) samples. There was no statistically significant relationship between ALDH1 H-score and age (P=0.358), tumor size (P=0.375), tumor grade (P=0.207), lymph node metastasis (P=0.125) or vascular invasion (P=0.190).
Conclusion: ALDH1 activity was demonstrated in 85.1% of breast cancer samples although its level of expression was not correlated with the pathologic features of breast tumors.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Breast cancer is the most common form of hereditary cancer worldwide and is an important cause of morbidity and mortality. Approximately 5-10% of breast and ovarian cancers are due to the highly penetrating germline mutations in cancer predisposing genes. Two genes, BRCA1 and BRCA2, account for at least half of these cases. The demand for BRCA1 and BRCA2 mutation screening is rapidly increasing as their identification will affect the medical management of people at increased risk for the disease. Therefore, the aim of this study was to investigate BRCA1/2 mutations in 100 high risk Iranian families.
Methods:  One hundred families who met the minimal risk factors for breast/ovarian cancer were screened among the families referred to Kawsar Human Genetics Research Center for the diseases in 2009-2011. The entire coding sequences and each intron/exon boundaries of BRCA1/2 genes were screened for by direct sequencing and MLPA in both patients and the controls.
Results:  In the present study, we could detect the following novel mutations: p.Gly1140Ser, p.Ile26Val, p.Leu1418X, p.Glu23Gln, p.Leu3X, p.Asn1403His, p.Asn1403Asp, p.Lys581X, p.Pro938Arg, p.Thr77Arg, p.Leu6Val, p.Arg7Cys, p.Leu15Ile, p.Ser177Thr, IVS7+83(-TT), IVS8 -70(-CATT), IVS2+9(G>C), IVS1-20(G>A), IVS1-8(A>G), p.Met1Ile, IVS2+24(A>G), IVS5-8 (A>G), IVS2(35-39)TTcctatGAT, IVS13+9 G>C in BRCA1 and p.Glu1391Gly, p. Val1852Ile, IVS6-70(T>G), 1994-1995 (InsA) in BRCA2.
Conclusion: Ten mutations seemed to be pathogenic and the disease-causing mutations were seen in 16% of the families. In addition, from the total number of substitutions and reassortments (42), 80% related to BRCA1 and 20% to mutations in BRCA2 genes.

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Background: Regarding the immunomodulatory effects of lactobacillus bacteria, this study aimed to evaluate the effect of oral administration of Lactobacillus reuteri, as probiotic bacteria, on natural killer cell cytotoxicity and tumor-specific lymphocyte proliferation in Balb/c mice with breast adenocarcinoma.

Methods: A total of 30 female mice, aged 6- 8 weeks and with a weight of approximately 17- 19 g, were randomly divided into two groups of 15 mice. The case group received Lactobacillus reuteri at a dose of 2.7× 108 bacteria in half a milliliter of sterile phosphate buffer saline (PBS) and the control group only received PBS. The probiotic group received the regimen for two weeks prior to tumor transplantation, as they did for 30 days after transplantation with three-day intervals and durations of seven days. For the evaluation of natural killer cell cytotoxicity and also tumor-specific lymphocyte proliferation response, LDH and BrdU assays were performed respectively according to the manufacturers' instructions.

Results: The study showed that the mice in the case group which were receiving Lactobacillus reuteri had statistically significant differences in the replication of tumor -specific lymphocytes, natural killer cell cytotoxicity and delayed hypersensitivity responses Compared to the mice in the control group.

Conclusion: Daily consumption of probiotics seems to regulate the immune system and consequently it can be helpful in people with cancer. Moreover, consumption of probiotics in healthy individuals can also boost the efficiency of the immune system against a variety of abnormalities.

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Background: The high number of breast cancer patients who receive radiation therapy after surgery has caused many to think about a shorter period of radiotherapy, which can significantly reduce the radiotherapy machine time, labor hours, and fewer patient visits. This study was designed to evaluate the acute skin effects and cosmetic outcomes of short course radiotherapy in early-stage breast cancer in comparison with the conventional treatment method.
Methods: Fifty-two patients with operable breast cancer (pT1-3pN0M0) who underwent breast conservation surgery in Tehran Cancer Institute during January 2011 to January 2012, were randomly assigned to undergo radiotherapy by either receiving conventional treatment (dose: 50 Gy in 25 fractions) with subsequent electron boost or a short-course hypofractionated radiotherapy (dose: 42.5 Gy in 16 fractions) and a subsequent electron boost.
Results: There were no skin changes during the first or the second week of treatment in the two groups. Cutaneous complications began after the third week as grade 1 skin toxicity after termination of the short-course radiotherapy but there were no difference in complication rate after four weeks of treatment. Six months and one year after treatment, there were no differences in terms of skin complications or cosmetic outcomes between the two groups.
Conclusion: Although the use of a whole-breast irradiation with a hypofractionated schedule was associated with desirable outcomes, in term of skin toxicity and cosmetics, but longer follow-up periods with larger sample sizes are needed to confirm these results.

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Background: Several reports indicate that the probiotics can increase body resistance against malignant tumors. The aim of this study is to evaluate the effect of Lactobaci-llus reuteri Persian type culture collection (PTCC) 1655 in preventing tumor growth, improving weight and survival rate in mice with breast cancer.
Methods: Twenty mice, the BALB/c at six weeks age, weighing approximately 17 gram were divided into two groups. Oral administration of 500 micro liters of Lactobacillus reuteri suspension performed for the first group 14 days before tumor transplantation. The second group (control) received the same volume of phosphate buffer saline (PBS). Then the mice had tumor transplantation surgery. Lactobacillus reuteri was prescribed in the first group in seven-day period and three-day interruption pattern. At the same time the second group (control) received PBS. This process was continued until 45 day. The tumor growth, histology and body weight were evaluated in both group and the mortality of mice was recorded.
Results: In the mice transplanted tumors that had received probiotics, tumor growth decreased in comparison with control group. In this group the body weight increased (P>0/05). In addition, the survival of these mice had significantly increased compared to control group (P=0.002). The evaluation of tumor tissue also showed increased immune system function in mice receiving the probiotic (P>0/05).
Conclusion: Lactobacillus reuteri can improve immune system function and have an important role to help treatment of cancer.

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Background: Breast cancer is the most common cancer in women. Non-coding RNAs especially miRNAs have important regulatory roles in cancer. MiRNAs are 21-24 nucleotides which have different levels of expression between tumors and normal tissues. In this study, we have analyzed expression level of miR-520d in three different groups of breast cancer.
Methods: Fifty nine samples were divided into different groups according to their immunohistochemistry (IHC) classification: estrogen receptor (ER) positive and/or progesterone receptor (PR) positive group (as group I) human epidermal growth factor receptor 2 (HER2) positive group (as group II) and Triple negative group (as group III). After small RNA extraction from tissues, cDNAs were synthesized and Real time RT-PCR carried out using DNA binding dye. Expression levels were analyzed by LinRegPCR and REST software.
Results: MiR-520d under- expressed in all of three different groups. The expression ratio in groups I ,II, and III were 0.193, 0.167, 0.21, respectively, but only the result from group II was significant (P=0.017). According to the different clinicopathological status of breast cancer, miR-520d underexpressed significantly not only in patients with metastatic lymph node (P=0.019) but also in patients which have cancer at stage III (P=0.036). 
Conclusion: In this study, we found that miR-520d possibly acts as a tumor suppressor. It may be useful for diagnosis of tumor from normal tissue. In addition, miR-520d significantly underexpressed in HER-2 positive group of breast cancers. Therefore, it may be useful as an additional diagnostic test in this group of breast tumors along with other biomarkers.

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Background: Breast cancer is one of the most important causes of death in women. One of the various gene expression involved in breast cancer is human epidermal growth factor receptor 2 (HER2/neu) gene expression increases. Factors of dietary affect on regulation of hormone secretion and the rate of breast cancer. One of these factors is amount and type of fats in diet. Gamma-linolenic acid (GLA) and Docosah-exaenoic acid (DHA) are members of poly unsaturated fatty acids. In this study, effects of dietary GLA and DHA alone or together with paclitaxel on treatment of mice mammary carcinoma has been evaluated.
Methods: Thirty female balb/c mice were divided in six groups randomly. Carcinoma-tous mass induced by tumor implantation method. Spontaneous breast adenocarcinoma of mice were used as tumor stock. The tumors of these mice were removed aseptically, dissected into 0.5 cm3 pieces. These pieces were transplanted subcutaneously into their right flank. GLA and DHA added to the mice diet two week prior to tumor implanta-tion. At the end of intervention, tumors were removed and HER2 gene expression was measured. The weight of animal and tumor volume measured weekly.
Results: It was not significant change in the weight of animals that consumed DHA and DHA with taxol. Tumor volume in those groups that received corn oil with taxol (P<0.01), DHA (P<0.05) and DHA with taxol (P<0.001) showed significant decrease in comparison with control group. HER2 gene expression in DHA with taxol decreased significantly in comparison with control group (P<0.05).
Conclusion: Consumption of DHA oil with taxol causes decrease the volume of carcin-oma mass. The future studies with large number of sample is needed to support this finding.

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Background: Metformin has been suggested as anti-cancer in retrospective studies. We design a prospective controlled study about metformin efficacy in the window time between biopsy and definite surgery with changes of Ki-67 as the primary endpoint.

Methods: The primary cohort had composed of 50 pathologically diagnosed invasive breast cancers, accrued in Medical Oncology Department of Iran Cancer Institute from February to November 2014. Patients neither had indication of neoadjuvant chemotherapy, nor involved with diabetes mellitus. They followed during the time period of biopsy and definitive surgery with taking tests on pathology specimens for ER, PgR, HER-2/neu and Ki-67 index. We checked fasting insulin and glucose level as well as quality of life and adverse effects in both times in the intervention group. Metformin (1500 mg/day) was prescribed to intervention group from pathology report to the night before surgery.

Results: From 45 patients, 25 had been received metformin for median time of 2.8 weeks. Controlled group included 20 patients who followed in the window time. There were no statistically significant differences between two groups regarding baseline clinical and tumor characteristics such as age, stage, grade, ER, PgR, HER2 status, time and type of surgery. However, immunohistochemistry study showed decrease of median Ki-67 from 35.14 to 29.6% in the intervention group and increase from 24.5 to 30.6 in the control group. Both of these results were statistically significant. Patients tolerated metformin very well, but mild gastrointestinal symptoms were seen in 30% of cases. There was a correlation between metabolic factor of HOMA score (fasting insulin level fasting blood sugar/405) and changes in Ki-67.

Conclusion: In the present study metformin prescription in the short period of time between Biopsy and definite surgery had shown inhibition of breast cancer cell growth. We found relationship between metformin anti-proliferative effect and glucose and insulin metabolism. To find direct apoptotic stimulation of metformin and long-term results of this drug further studies in the adjuvant settings with cooperation of pharmacokinetic groups are recommended.

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Background: Breast cancer is one of the most prevalent cancers among women and features increasing trends of incidence rates. Worldwide, yearly about 1.67 million of new cases and 522,000 of deaths from breast cancer are registered. The aim of this study was to determine the risk factors of breast cancer in women and to identify high risk groups.

Methods: In a case-control study, 170 women with breast cancer who were registered in cancer registration system from 2011 to 2015 at Dezful City, Iran, were compared with 170 healthy women with confirmation of mammography. After age matching of groups, the needed information about risk factors and demographic information including information, educational level, marital status, family history of breast cancer, age at menarche, parity, oral contraceptive use, age at first pregnancy, menopausal status, and age at menopause, breastfeeding, stress, abortion, alcohol use and smoking, hormone therapy and physical activity was collected by a questionnaire. The analysis of collected data was performed by using odds ratio and logistic regression model and SPSS software, version 16 (SPSS, Inc., Chicago, IL, USA). The statistical significance was set at a two-sided p-value of %5.

Results: The results of this study showed that, women with the family history [OR: 6.78 (95% CI: 2.15-21.41)] and women with the stress history [OR: 4.86 (95% CI: 2.46-9.59)] had higher risk of breast canser, while women with the history of having physical activity at least once a week [OR: 0.29 (95% CI: 0.13-0.65)] and women with the history breast feeding for 3 to 4 years [OR: 0.36 (95% CI: 0.16-0.81)] had lower risk of breast cancer.

Conclusion: It is recommended that the mentioned risk factors and protective factors be considered in first and second level (screening) of preventive programs.

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Breast cancer is the most common cancer in women and one of the leading of death among them. The high and increasing incidence of the disease and its difficult treatment specifically in advanced stages, imposes hard situations for different countries’ health systems. Body temperature is a natural criteria for the diagnosis of diseases. In recent decades extensive research has been conducted to increase the use of thermal cameras and obtain a close relationship between heat and temperature of the skin's physiology. Thermal imaging (thermography) applies infrared method which is fast, non-invasive, non-contact and flexibile to monitor the temperature of the human body. This paper investigates highly diversified studies implemented before and after the year 2000. And it emphasizes mostly on the newely published articles including: performance and evaluation of thermal imaging, the various aspects of imaging as well as The available technology in this field and its disadvantages in the diagnosis of breast cancer. Thermal imaging has been adopted by researchers in the fields of medicine and biomedical engineering for the diagnosis of breast cancer. With the advent of modern infrared cameras, data acquisition and processing techniques, it is now possible to have real time high resolution thermographic images, which is likely to surge further research in this field.  Thermography does not provide information on the structures of the breast morphology, but it provides performance information of temperature and breast tissue vessels. It is assumed that the functional changes occured before the start of the structural changes which is the result of disease or cancer. These days, thermal imaging method has not been established as an applicative method for screening or diagnosing purposes in academic centers. But there are different centers that adopt this method for the diognosis and examining purposes. Thermal imaging is an effective method which is highly facilitative for breast cancer screening (due to the low cost and without harms), also, its impact will increase by combining other methods such as a mammogram and sonography. However, it has not been widely recognizesd as an accepted method for determineing the types of tumors (benign and malignant) and diseases of breast tissue.

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Stable molecular changes during cell division without any change in the sequence of DNA molecules is known as epigenetic. Molecular mechanisms involved in this process, including histone modifications, methylation of DNA, protein complex and RNA antisense. Cancer genome changes happen through a combination of DNA hypermethylation, long-term epigenetic silencing with heterozygosis loss and genomic regions loss. Different combinations of N-terminal’s changes cooperate with histone variants with a specific role in gene regulation. It have led to load a setting histone that determine transcription potential of a particular gene or genomic regions. DNA methylation analysis in genome region using methylation-specific digital karyotyping of normal breast tissue detect gene expression patterns and DNA specific methylation can be found in breast carcinoma too more than 100 genes in breast tumors or cell lines of breast cancer are reported hypermethylated. Important of DNA methylation on cancer has been concentrated CpG islands hypermethylation. Most of the techniques are able to identify hypermethylated areas. Often, methylated genes play important role in cell cycle regulation, apoptosis, metastasis and tissue invasion, angiogenesis and hormonal signaling. Cyclin D2 (CCND2) gene is an important regulator of cell cycle and increased of expression inhibits the transition from G1 to S cell cycle. This gene is frequently methylated in breast cancer and has been proposed as the first event. Other cell cycle regulator is p16ink4A / CDKN2A that methylated in a large number of human cancers, including breast cancer. Another regulator of the proliferation of breast cancer that methylated is tumor suppressor RAR-β cancer that has been found in lobular and ductal carcinoma. Recent studies have showed the role of epigenetic silencing in the pathogenesis of breast cancer in which tumor suppressor genes have been changed by acetylation and DNA deacetylation. Histone deacetylase inhibitors have different roles in cancer cells and could show the ways of new treatment for breast cancer. In this review, various aspects of breast cancer epigenetics and its applications in diagnosis, prediction and treatment are described.