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  • ISSN: 2373-9436
    Volume 3, Issue 3
    Review Article
    Heidel RE*
    Abstract: The Patient Protection and Affordable Care Act (PPACA) put into federal law numerous opportunities for cancer research and cancer epidemiology. The legislation created the Patient-Centered Outcomes Research Institute (PCORI) and established the types of research needed to compare treatments in patient populations and generate relevant outcome data. Comparative Effectiveness Research (CER) uses randomized trials and observational cohort designs to establish the magnitude of comparable treatment effects in real-world populations. The field of cancer research and epidemiology is uniquely positioned to lead the evolution of clinical evidence as it relates to CER and the goals and objectives of the PPACA and PCORI. The amount of data and outcomes in tumor registries and secondary databases gives researchers ample opportunities to conduct research on cancer treatments, epidemiology, diagnosis, and survival.
    Research Article
    Santiago Sherwell-Cabello, Antonio Maffuz-Aziz, Silvia N. López-Hernández, Carlos A. Domínguez-Reyes, Sonia Labastida-Almendaro and Sergio Rodríguez-Cuevas
    Background: Breast cancer is the main cause of death by cancer in Mexican women of age 25 or older. This disease has steadily increased amongst young women. They usually present an aggressive and advanced breast cancer.
    Methods: Data on women diagnosed with breast cancer between 2005 and 2011 was collected by retrospectively reviewing in FUCAM. The five-year disease-free survival (DFS) and overall survival (OS) were compared between patients younger than and older than 40. Clinical, pathological and immunohistochemical characteristics were assessed, and the variables with statistical significance were analyzed in a multivariate analysis.
    Results: From 2291 patients treated, a total of 276 patients (12.0%) of ages 23-40 were diagnosed with breast cancer in this institution. Over half of these patients were diagnosed with an advanced clinical stage (III or IV) and the triple-negative subtype was the most frequently found. Both young age and absence of estrogen receptors were highly correlated with poorer outcome. A mean follow-up of 38.25 months showed significantly lower rates of both disease-free survival and overall survival in women under 40 years old. Conclusion: This study shows that 12% of Mexican women with breast cancer are 40 years old or younger, significantly higher compared with other countries. Young women present an unfavorable outcome. Regardless the adverse clinical and histopathologic characteristics, young age is the most important independent factor contributing to poor prognosis.
    Benita Kiat Tee Tan*, Gek HsiangLim, PuayHoonTan, Yoon Sim Yap and Kee Seng Chia
    Purpose: Remarkable differences in breast cancer incidence in the three main ethnic groups in Singapore have been described, we report the survival differences.
    Methods: Using the Singapore national breast cancer registry, and a local hospital registry, relative survival ratios (RSR) were used to describe prognosis. Poisson regression modelling was used to calculate relative risks for different follow-up periods, age groups, time of diagnosis, disease stages and tumour characteristics.
    Results: 20517 women patients diagnosed between 1968 and 2006 were included, (Chinese: 85%, Malay: 10%, Indian: 5%). Overall 5-year RSR was highest in the Chinese (79%), followed by the Indians (72%) and the Malays (59%). Survival improved over the years for all, but the differential trend persisted in the stage-by-stage comparison. Malays were younger and had more advanced disease. Malay ethnicity, adjusted for follow-up, age and stage, has an increased risk of death. In the institutional registry, ER/PR status was similar in the 3 ethnic groups. Chinese had less high grade tumours, and were less likely to have lymphovascular and these features remained significant after adjustments for follow-up, stage, ethnicity and tumour subtype. Malay ethnicity remained a significant risk of death after including tumour characteristics (RR 1.7, CI 1.1- 2.7).
    Conclusions: Ethnic differences in breast cancer survival in Singapore exist: Chinese have the best survival, followed by the Indians and the Malays. Stage of the cancer, tumour factors such as grade and lymphovascular invasion and perhaps the subtype are responsible for part of this difference. Ethnicity remained an independent risk of death.
    Phuong U Le, Jie Li, Christiane Cantin, Catherine Collins, Andre Nantel, Tammy-Lynn Tremblay, John F Kelly, Edwin Wang, Maureen D O'Connor-McCourt, and Anne EG Lenferink*
    Targeting of the tumor vasculature has evolved into an integral part of existing standard anti-cancer therapies. However, recent pre-clinical and clinical studies have shown that the efficacy of these treatments is often temporary and frequently followed by renewed tumor growth. In an attempt to overcome this problem we transcriptionally profiled laser capture micro dissected micro vessels from both tumor and matching adjacent normal breast tissue obtained from patients diagnosed with infiltrating ductal carcinoma (IDC). Vascular enrichment of the LCM samples was confirmed by Q-PCR of CD31 and transcription profiles were generated and analyzed using the Genespring software and the WebGestalt Toolkit. Hierarchical two-dimensional clustering of the transcriptome data identified 219 significantly up-regulated transcripts in at least 4/8 patient samples (cut-off >1.3-fold, p<0.05). Several of these genes (i.e. AGRN, FLNA and ILR4) were selected and their over expression was confirmed at the protein level in tumor versus normal tissue. However, the overall heterogeneity we observed in the vascular gene expression patterns pose a significant problem for individual genes/proteins to be used as a robust breast cancer vascular specific marker or validated therapeutic target. We therefore mined our data set further by applying an in-house developed bioinformatics network method incorporating clinical information of the patient. This approach generated a 15-gene ‘Vascular-Derived Prognostic Predictor' which, using six publicly available datasets, robustly identified those patients with an increased risk of recurrence.
    Case Report
    Galen Foulke*, Jihua Cheng and Cristina Truica
    Abstract: Ecthyma gangrenosum is the cutaneous manifestation of bacteremia traditionally associated with Pseudomonas Aeruginosa bacteremia. It classically presents as gunmetal grey bullae with a pink macular margin. To our knowledge, no case reports exist detailing the occurrence of ecthyma gangrenosum in a healthy young woman undergoing treatment for breast cancer. We present such a case to raise awareness of this entity in patients receiving chemotherapy.
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