Mohammad Darzi, S. Gorgin, K. Majidzadeh-A, R. Esmaeili
{"title":"Identification of Prognostic Genes in Her2-enriched Breast Cancer by Gene Co-Expression Net-work Analysis","authors":"Mohammad Darzi, S. Gorgin, K. Majidzadeh-A, R. Esmaeili","doi":"10.30699/ijbd.14.1.49","DOIUrl":"https://doi.org/10.30699/ijbd.14.1.49","url":null,"abstract":"Introduction: HER2-enriched subtype of breast cancer has a worse prognosis than luminal subtypes. Recently, the discovery of targeted therapies in other groups of breast cancer has increased patient survival. The aim of this study was to identify genes that affect the overall survival of this group of patients based on a systems biology approach. Methods: Gene expression data and clinical information on 58 patients with HER2-enriched cancer were downloaded from The Cancer Genome Atlas (TCGA). Co-expression modules were identified using the weighted gene co-expression network analysis (WGCNA). The Cox regression was used to determine the modules that had a significant relationship with the overall survival (OS) endpoint. Single-gene survival analysis was performed within the selected module. Finally, functional annotation to explore the significance of genes was performed using the Database for Annotation, Visualization, and Integrated Discovery (DAVID). Results: Of the six identified co-expression modules, two had significantly poor prognoses. Single-gene survival analysis showed that 39% of genes in the selected modules were identified as significant. The genes were mainly related to the biological pathways such as Ubiquitin-mediated proteolysis and RNA degradation. CHAMP1, PPP1R26, PRRC2B, KANSL3, and ANAPC2 were identified as the 5 most important genes associated with reduced OS, in order of significance. Conclusion: The systems biology approach can provide appropriate results relate to patient survival analysis. In this study, some genes were identified to be used as prognostic biomarkers in experimental studies related to the OS in the HER2-enriched subgroup. These genes can be considered potential candidates for therapeutic targets in this group of patients.","PeriodicalId":405995,"journal":{"name":"Iranian Quarterly Journal of Breast Diseases","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128199030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Women’s Lived Experiences of Femininity after Mastectomy and Treatment: A Qualitative Study","authors":"Azadeh Ghazafari, M. Nikoogoftar","doi":"10.30699/ijbd.14.1.36","DOIUrl":"https://doi.org/10.30699/ijbd.14.1.36","url":null,"abstract":"Introduction: Breast cancer is the most prevalent cancer among women, and mastectomy, the surgical treatment for this cancer, affects different aspects of patients’ life. This study aimed to describe women’s lived experiences of femininity after mastectomy and treatment. Methods: This qualitative study was conducted on 17 breast cancer survivors in Tehran in 2018-2019. The participants, who were selected through snowball sampling, had undergone mastectomy at least 6 months before and were younger than 50 years. Data were collected using in-depth semi-structured interviews and analyzed with the contractual content analysis method. Results: The analysis of patients’ experiences led to the identification of 7 main themes (and 18 subtheme): social life (social isolation, quitting the job or getting a part-time job, and dropping out of school), body image (being asymmetric, being unattractive, and requiring reconstructive surgery), others’ opinions (complaining about how others look at them and concerns of being pitied), marital relationships (fear of abandonment, fear of spouse’s pity, shame of being nude, and compromised sexual intimacy), reproductive health (premature menopause and possible infertility), perceived support (attending support group meetings and keeping in touch with cured ones), taking responsibilities of household works (inability to do housewife affairs and inability to do the housework). Conclusion: Mastectomy and treatment for breast cancer greatly affect many areas of individual and social life and marital relationships of patients, necessitating the need to develop and establish free support resources by NGOs and highlighting the government’s role in reducing the psychological and family damage caused by the disease.","PeriodicalId":405995,"journal":{"name":"Iranian Quarterly Journal of Breast Diseases","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130372523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mehrnoosh Esmailiyan, M. Kargarfard, F. Esfarjani, G. Vaseghi
{"title":"Comparing the Effects of 4 and 12 Weeks of Aerobic Training on Tumor Volume in Female Mice with Breast Cancer","authors":"Mehrnoosh Esmailiyan, M. Kargarfard, F. Esfarjani, G. Vaseghi","doi":"10.30699/IJBD.13.4.57","DOIUrl":"https://doi.org/10.30699/IJBD.13.4.57","url":null,"abstract":"Introduction: Tumor size is a contributing factor in cancer prognosis. On the other hand, regular exercise may play an important role in inhibiting tumor growth in breast cancer. Because of the key role of tumor volume in tumor metastasis, the aim of the present study was to compare the effects of a 4-week and a 12-week aerobic training on tumor volume in female mice with breast cancer. Methods: Forty female BALB/c mice (4-5 weeks old weighing 18 ± 2g) were randomly divided into the following 5 groups of 8 after cancer induction: primary prevention group, secondary prevention group, treatment, exercise, and cancer control. Aerobic exercise was performed for 4 weeks at different stages (prevention, during treatment, and after cancer) at an intensity equal to 40% to 50% of the maximal oxygen consumption. The exercise group performed aerobic exercise for 40 minutes at 18 m/min at a zero-degree incline 5 times a week for 12 weeks. At the end of the training intervention period, all mice were sacrificed and tumor volume was measured using a digital caliper. Data were analyzed using the ANOVA test on SPSS v.22. Results: After 4 weeks of exercise intervention, a significant decrease in tumor volume was observed in the primary prevention and control groups (P = 0.001), and after 12 weeks of aerobic training, a decrease in tumor volume was observed in the exercise and control groups (P = 0.007). However, there was no significant difference in the other groups. Conclusion: Moderate-intensity aerobic exercise can be used as an effective treatment method to reduce the volume of breast tumors. However, more research is needed to reach definitive results.","PeriodicalId":405995,"journal":{"name":"Iranian Quarterly Journal of Breast Diseases","volume":"13 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"113975378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A Critique of \"Effect of 10 Weeks of High-Intensity Interval Training on Protein Levels of NF-kB and Expression of Atrogin-1 and MuRF-1 in Cardiomyocytes of Female Mice with Breast Cancer\"","authors":"M. Sepandi","doi":"10.30699/IJBD.13.4.77","DOIUrl":"https://doi.org/10.30699/IJBD.13.4.77","url":null,"abstract":"In Volume 13, Issue 3 of Iranian Quarterly Journal of Breast Diseases, an article entitled \"Effect of 10 Weeks of High-Intensity Interval Training on Protein Levels of NF-kB and Expression of Atrogin-1 and MuRF-1 in Cardiomyocytes of Female Mice with Breast Cancer\" has been published on pages 62-71. This article contains useful and practical information, but it seems necessary to pay attention to a few points: In the statistical analysis section, the authors of the article state that: \"First, the normality of the data was used by Kolmogorov-Smirnov test. An independent t-test was then used to examine the differences between the training and control groups. The Pearson Correlation Coefficient was used to determine the relationship between heart weight and protein levels of Atrogin-1 and MuRF-1, NF-kB. SPPS software version 24 was used at a significance level of P≤0.05 for all statistical analyzes\" .The first point is that the presumption of normality of data distribution is the basis of many statistical tests. Descriptive or inferential methods can be used to examine the normality of the distribution of a quantitative variable. Descriptive methods include examining the mean, mode and median as well as drawing statistical graphs. There are also several tests to check the normality of data in statistical texts, but the most important are Kolmogorov-Smirnov, Lilliefors corrected Kolmogorov-Smirnov test and ShapiroWilk test (1). The KolomokrovSmirnov test (written misspelt in the text of the article) is a test for quantitative data that compares the variable distribution in the sample with the distribution assumed for the population (2). One of the limitations of statistical tests is the statistical power and sensitivity of the test result to the sample size (3). The Shapiro-Wilk test has higher statistical power than the previous two cases, and some authors have introduced this test as the best option to check the normality of the data when the sample size is small (4). Third, the independent t-test is a parametric test to compare the means of two samples (5). Therefore, it is better to show the average of the desired trait in the diagrams of 1 to 4 vertical axes. The fourth point is that under Figures 1 and 2, the phrase \"significant decrease compared to the control group\" is given, while the above diagrams show lower values in the control group, and this is a contradiction. But the last point is that in Figures 1 to 4, the meaning of Error Bars is unknown. The use of error bars is usually very common in articles extracted from experimental studies, but it should be noted that the error bar in a chart may indicate standard deviation, standard error of the mean or confidence interval, and these three types of error bar are statistically different (6). Therefore, it is so important to make clear what error bars represent via figure legends. Since one of the goals of the Iranian Quarterly Journal of Breast Diseases is to improve the quality of reports ","PeriodicalId":405995,"journal":{"name":"Iranian Quarterly Journal of Breast Diseases","volume":"134 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134647716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
منیره خیرخواه, S. Haghighat, Z. Omidi, Integrative Oncology
{"title":"Comparing the Effect of In-Person and Virtual Lymphedema Self-management Education on Quality of Life of Women with Breast Cancer: A Randomized Clinical Trial","authors":"منیره خیرخواه, S. Haghighat, Z. Omidi, Integrative Oncology","doi":"10.30699/IJBD.13.4.8","DOIUrl":"https://doi.org/10.30699/IJBD.13.4.8","url":null,"abstract":"Introduction: Breast cancer-related lymphedema is a chronic swelling accompanied by physical discomfort and prolonged treatment negatively affecting patients’ quality of life (QoL). Self-management is a vital phase in managing the results of treatment. So, the study aims to compare the effect of in-person and virtual self-management education on women’s quality of life. Methods: This was a randomized clinical trial conducted on 70 women with breast cancer-related lymphedema in the last one year, attending to Seyed_Khandan rehabilitation center in Tehran. Sampling was done by random allocation method in blocks of 2 with 35 subjects in each group. All subjects received routine lymphedema treatment. The in-person and virtual groups received the education at the clinic and the Telegram messenger, respectively. QoL was assessed using the Persian version of EORTC QLQ-C30 and QLQ-BR23 questionnaires on before, immediately, and three months after the intervention. Results: The mean age of the individuals was 51.42±9.71. Most subjects were married, had a diploma or higher, and the mean duration of lymphedema was 6.88 months. At the end of the study compared to the beginning of the study, physical, role, emotional and social functions decreased significantly in the virtual group compared with the in-person group. In this way, the status of the mentioned variables in the in-person group was better than the virtual one (P=0.006, P=0.026, P=0.014, P=0.023, respectively). Three months after the intervention, median scores on global health (P=0.21), physical functioning (P=0.004), role functioning (P=0.009), emotional functioning (P<0.001), social functioning (P=0.048) were still significantly greater for the in-person group. Also, the in-person group had a greater reduction in the median scores of systemic therapy side effects (P=0.002) and arm symptoms (P=0.45) compare with the virtual group. Conclusion: Self-management education led to improved quality of life, and in the comparison between the two methods, in-person method was more effective than virtual method. However, further studies are needed to investigate the efficacy and cost-effectiveness of both methods in educating patients with lymphedema.","PeriodicalId":405995,"journal":{"name":"Iranian Quarterly Journal of Breast Diseases","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114531454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Aghaei, H. Sajjadi, M. D. Zahedani, Seyed Hesamaddin Banihashemi, Elham Booshehri
{"title":"Comparing Sensitivity and Specificity of Liquid-Based and Conventional Cytology Smears in Fine Needle Aspirates for Diagnosis of Breast Mass","authors":"M. Aghaei, H. Sajjadi, M. D. Zahedani, Seyed Hesamaddin Banihashemi, Elham Booshehri","doi":"10.30699/IJBD.13.4.33","DOIUrl":"https://doi.org/10.30699/IJBD.13.4.33","url":null,"abstract":"","PeriodicalId":405995,"journal":{"name":"Iranian Quarterly Journal of Breast Diseases","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132105063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Y. S. Koohshoori, M. Marandi, M. Kargarfard, G. Vaseghi, جمال مشتاقیان
{"title":"The Effect of Aerobic Training on Tumor Growth and Expression of Bcl-2 Gene and Protein in Female Mice with Breast Cancer","authors":"Y. S. Koohshoori, M. Marandi, M. Kargarfard, G. Vaseghi, جمال مشتاقیان","doi":"10.30699/IJBD.13.4.67","DOIUrl":"https://doi.org/10.30699/IJBD.13.4.67","url":null,"abstract":"Introduction: The aim of this study was to investigate the effect of aerobic exercise with detraining in different phases of prevention on Bcl-2 gene expression and protein. Methods: For this purpose, 32 female BALB-c mice (18-20 g) were purchased and randomly assigned to four groups of primordial prevention (A), primary prevention (B), secondary prevention (C), and control (D). Group A performed aerobic exercise for 4 weeks, followed by injection of 4T1 cells and 8 weeks of detraining after the injection. Group B performed aerobic exercise for 4 weeks immediately after the injection of 4T1 cells and then detrained for 4 weeks. Group C received a 4T1 cell injection and maintained a sedentary life for 4 weeks, followed by 4 weeks of aerobic exercise. The subjects were killed 48 hours after the last training session and detraining courses and tumor tissues were removed. Real-time polymerase chain reaction was used to measure gene expression and western blotting was used to measure protein content.The one-way ANOVA test was used to analyze the data. Results: The mean gene expression due to aerobic exercise was significantly (P<0.001) lower in groups A (0.481), B (0.323), and C (0.035) compared with group D (1.711). Also, aerobic exercise caused a significant decrease in Bcl-2 (P=0.005) protein expression in groups A (0.692), B (0.821), and C (0.670) compared with group D (1.000). It should be noted that tumor growth in experimental groups was not significantly different from the control group (P=0.092). Conclusion: Exercise may be able to reduce anti-apoptotic agents in tumor cells, leading to apoptosis of tumor cells and reduced tumor growth.","PeriodicalId":405995,"journal":{"name":"Iranian Quarterly Journal of Breast Diseases","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128073710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Masoumeh Hedayati, K. Hajializadeh, M. Hedayati, E. Fathi, Cellular
{"title":"An Investigation of the Effectiveness of Emotionally-Focused Couple’s Group Therapy (EFCT) on Relational Aggression of Couples with Breast Cancer in Wives: A Semi-Experimental Study","authors":"Masoumeh Hedayati, K. Hajializadeh, M. Hedayati, E. Fathi, Cellular","doi":"10.30699/IJBD.13.4.40","DOIUrl":"https://doi.org/10.30699/IJBD.13.4.40","url":null,"abstract":"Introduction: Because of the nature of cancer and related hormonal changes, as well as the conditions resulting from stress tolerance, relational problems and aggression are major problems facing couples with breast cancer in wives. The aim of this study was to investigate the effect of emotionally focused couples therapy (EFCT) on relational aggression in couples with breast cancer in wives. Methods: This study was conducted with a pretest-posttest design and a control group. Twenty-two couples meeting the inclusion criteria were selected by convenience sampling from among people with breast cancer living in Tehran and randomly assigned to the experimental and control group. The experimental group received a 6-session (120 minutes per session) intervention of an adapted version of emotionally focused group therapy for couples (HMT). This intervention was meant to improve the psychological and relational indicators related to the quality of life of couples where the female partner was diagnosed with, or had a recurrence of, breast cancer and was in active treatment process or had gone through the treatments. The control group did not receive any intervention. Both groups answered the Buss-Perry Aggression Questionnaire (29-item instrument to measure physical aggression, verbal aggression, anger, and hostility) before and after the intervention. Analysis of covariance was used to evaluate the effect of treatment. Results: The experimental group demonstrated a decline in the mean of all factors after receiving the training program, as compared to the control group. The decrease was 11.01 points for physical aggression, 5.78 for verbal aggression, 8.37 for anger, and 10.95 for hostility. In contrast, the control group had a decrease of 0.41 points in anger and 0.17 points in hostility factors. The control group also displayed an increase of 0.06 points in the mean scores on both physical and verbal aggression components. Analysis of covariance revealed that EFCT had a significant decreasing effect on all the components of aggression in the experimental group as compared to the control group (P < 0.01). Conclusion: Through the education of correct mutual emotional understanding for couples and creating an atmosphere of trust and communication between them, EFCT intervention provides a ground for increasing marital satisfaction and reducing aggression in couples coping with breast cancer in wives. Accordingly, the intervention can be used to improve the quality of marital relations.","PeriodicalId":405995,"journal":{"name":"Iranian Quarterly Journal of Breast Diseases","volume":"166 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133118436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. S. Pashaki, S. Afshar, Kamal Mohamadian, M. Gholami, A. Moradi, Zahra Keshtpour Amlashi
{"title":"Effects of Melatonin on IL-6 Serum Level Changes and Fatigue Caused by Adjuvant Chemoradiotherapy in Breast Cancer Women: A Randomized Controlled Trial","authors":"A. S. Pashaki, S. Afshar, Kamal Mohamadian, M. Gholami, A. Moradi, Zahra Keshtpour Amlashi","doi":"10.30699/IJBD.13.4.23","DOIUrl":"https://doi.org/10.30699/IJBD.13.4.23","url":null,"abstract":"Introduction: Cancer-related fatigue is one of the most common and debilitating complications of breast cancer. Cancer patients have been found to have lower levels of melatonin, and fatigue has been shown to be correlated with both melatonin and interleukin (IL-6) in cancer patients. This study aimed to evaluate the fatigue and serum level of IL-6 in response to melatonin treatment in breast cancer patients. Methods: In this double-blinded clinical trial, 74 women with breast cancer were evaluated for the effect of melatonin on fatigue induced by adjuvant chemotherapy and radiotherapy. The intervention group (n = 38) started receiving 6 mg of oral melatonin from 6 to 7 days before the start of adjuvant therapy until the disease progression, while the control group (n = 36) received a placebo during this time. The fatigue scores and serum IL-6 levels of both groups were measured at baseline and after the intervention, and the changes were compared. Results: The mean age of participants in the control group was 46.05 ± 10.55 y, and that of the intervention group was 50.47 ± 10.79 y (P = 0.223). The mean postintervention fatigue scores for the placebo and melatonin groups were 52.61 ± 4.57 and 25.16 ± 15.86, respectively (P < 0.001). There was no difference in the mean IL-6 level between the groups (P = 0.721). Conclusion: Administering melatonin in women with breast cancer undergoing adjuvant chemotherapy and radiotherapy leads to a significant reduction in fatigue but does not affect serum IL- 6 levels.","PeriodicalId":405995,"journal":{"name":"Iranian Quarterly Journal of Breast Diseases","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126539529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rasoul Najafi, Meysam Olfatifar, Mahdi Razi, Fatemeh Amiri
{"title":"Analyzing the Survival of Patients with Breast Cancer with a Multistate Model","authors":"Rasoul Najafi, Meysam Olfatifar, Mahdi Razi, Fatemeh Amiri","doi":"10.30699/ijbd.13.2.19","DOIUrl":"https://doi.org/10.30699/ijbd.13.2.19","url":null,"abstract":"Introduction: Breast cancer is the second most common cancer and one of the most common causes of death in women. Metastasis is also a challenge for breast cancer patients, affecting their survival. This study aimed to determine the survival rate and measure the factors affecting the progression of the disease from the time of diagnosis by considering metastasis as an intermediate condition using the disease-mortality model. Methods: This retrospective study included 493 women with breast cancer referred to Imam Khomeini Clinic, Hamadan, between 2001 and 2017. First, the required information was extracted from patients’ files according to a checklist, and then the effect of background and clinical variables on the natural course of the disease was examined using a multistate model. Results: The risk of metastasis for people whose tumor size was 2-5 cm and >5 cm was higher than that for people whose tumor size was <2 cm (HR, 1.28; [95% CI, 1.10-1.79]; and HR, 2.48; [95% CI, 1.25-3.91], respectively). People with estrogen-, progesterone-, and epidermal growth factor–positive tumors were at higher risk for metastasis (HR, 2.58; [95% CI, 1.96-3.40]; HR, 1.69; [95% CI, 1.7-2.26]; and HR, 1.73; [95% CI, 1.29-2.31], respectively). Conclusion : Public education on the importance of periodic examinations and early detection of breast cancer, as well as recognizing the symptoms of the disease, can help a person detect the disease early. Therefore, the patient can see a doctor before the tumor gets bigger and the disease progresses, which will help in timely treatment of the disease.","PeriodicalId":405995,"journal":{"name":"Iranian Quarterly Journal of Breast Diseases","volume":"71 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125184862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}