Implementing p53 Expression in Colorectal Cancers in Ugandan Patients | Chapter 6 | Medical Research and Its Applications Vol. 10

 

Aim: The aim of the study was to determine the association of p53 expression with grade, stage, LVI status, histopathological subtype and topography of CRC.

 

Introduction: The topography of colon tumours is also different with right-sided colon tumours more commonly observed in developed high-income countries whilst many Sub-Saharan African countries report a high proportion of left-sided colon tumours, especially rectal tumours. In Uganda, the Kampala Cancer Registry has reported a steady increase in colorectal cancer (CRC) in the past 20 years, however, is still lower compared to developed high-income countries. Colon tumour topography varies as well; in industrialized high-income countries, right-sided colon tumours are more frequently detected than in developing low-income ones. In colorectal cancer (CRC), the p53 gene is often altered. This leads to the production of an aberrant protein, which can be detected early by immunohistochemistry. A poor prognosis and reduced survival have been associated with the detection of p53 in malignant cells.

 

Methods: During the period 2008 to 2021, immunohistochemistry was carried out on 51 patients’ paraffin-embedded tissue blocks of CRC. TP53 expression was detected using the indirect immunoperoxidase method which uses monoclonal antibody p53, DAKO Agilent USA, Clone DO-7. The grade and histopathological subtypes of CRC were evaluated using the haematoxylin and eosin stain. The demographic data and topography of the tumours were obtained from the clinical patients’ files and the Kampala Cancer Registry.

 

Results: Out of 51 patient tissue blocks that were studied, 27(52.9%) expressed p53 in the nucleus of malignant CRC cells. There were 20(74.1%) left-sided colon tumours and 7(25.9%) right-sided colon tumours that expressed p53 and this reached statistical significance (p=0.0004). The presence of p53 expression was also significantly associated with the presence of lymphovascular invasion (p=0.0561) and the classical adenocarcinoma histological subtype (p=0.0000). There was a negative correlation between CRC grade and p53 expression (r=-0.1189; p=0.4059) and between CRC stage and p53 expression (r=-0.1702; p=0.2324). The present study did not evaluate the role of radiotherapy in the response to rectal tumours that have positive p53 expression, however, future studies may evaluate this role in Ugandan patients. Similar to other parts of the world in Ugandan patients, p53 expression is more commonly present in left-sided colon tumours.

 

Conclusions: The intensity of p53 expression is not influenced by stage and grade of CRC. Similar to other parts of the world, p53 expression is more commonly present in left-sided tumours. Therefore these findings support the theory, that right-sided colon tumours have a different pathogenesis than left-sided colon tumours, and hence have a different prognosis. Further studies should be carried out to determine the types of genetic mutations or epigenetic factors responsible for the difference in prognosis between left-sided and right-sided CRC in Ugandan patients.

 

 

Author(s) Details

Richard Wismayer

Department of Surgery, Masaka Regional Referral Hospital, Masaka, Uganda, Department of Surgery, Faculty of Health Sciences, Equator University for Science and Technology, Masaka, Uganda, Department of Surgery, Faculty of Health Sciences, Habib Medical School, IUIU University, Kampala, Uganda and Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.

Julius Kiwanuka

Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.

Henry Wabinga

Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.

Michael Odida

Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda and Department of Pathology, Faculty of Medicine, Gulu University, Gulu, Uganda.

 

Please see the link:- https://doi.org/10.9734/bpi/mria/v10/1176

 

Correlation of the Expression of Vascular Endothelial Growth Factor with Clinical Staging and Outcome in Patients Affected with Colorectal Carcinoma: A Study from Uganda | Chapter 8 | Medicine and Medical Research: New Perspectives Vol. 2

Introduction: Invasion and metastasis are the most life-threatening aspects of the colorectal neoplastic process. Many studies have shown that invasion, metastasis, and solid tumour growth are dependent on new blood vessel formation from established vasculature. According to data from the Kampala Cancer Registry in Uganda, the number of instances of colorectal cancer (CRC) has increased in this area, and patients are presenting at an advanced stage and younger ages.  A relationship between tumour growth, distant metastasis, and a poor prognosis with an increased expression of VEGF has been reported in studies.

 

Aim: The aim of this study was to analyse the correlation of VEGF with the clinicopathological characteristics of Ugandan patients with colorectal cancer.

 

Methods: Immunohistochemistry was carried out on fifty-two patients’ paraffin-embedded tissue blocks of CRC between 2008–2021. VEGF expression was detected using the indirect immunoperoxidase method which used monoclonal antibody VEGF, DAKO Agilent USA, Clone VG1, and reference M7273. The haematoxylin and eosin stains were used to evaluate the grade, lymphovascular invasion status, and histopathological subtypes of CRC. The demographic data, staging, and topography of the tumours were obtained from the clinical patients’ files and the Kampala Cancer Registry. The biopsy specimens were obtained during colonoscopy and the resected colorectal specimens at operation. Using a standard pretested Data Extraction Form, data for all tissue samples was extracted from the clinical patients’ files in the respective hospitals and the Kampala Cancer Registry.

 

Results: Out of fifty-two CRC participants, there were 7(43.7%) participants with stage IV disease compared to 2(12.5%) with stage I disease and this reached statistical significance (p=0.0479). There were 11(68.8%) participants with grade II disease compared to 2(12.5%) with grade I disease from those that stained positively for VEGF (p=0.0012). Classical adenocarcinoma constituted 13(81.3%) participants compared to 3(18.8%) mucinous adenocarcinomas and signet ring colorectal carcinoma from those that stained positively for VEGF (p=0.0000). CRC grading was negatively correlated with VEGF-1 expression (r=-0.0565) (p=0.7091). The mechanism responsible for increasing the results of chemotherapy with anti-VEGF therapy is not entirely understood. However, tumour apoptosis may be increased with the inhibition of angiogenesis.

 

Conclusions: There was a tendency to increase the expression of VEGF with increasing stages of CRC. A poor prognosis and increased VEGF-1 expression were substantially correlated with the existence of metastases. More effective medical interventions for colorectal cancer in Uganda are required, utilizing chemotherapy and anti-VEGF drug combinations.

 

Author(s) Details

 

Richard Wismayer
Department of Surgery, Masaka Regional Referral Hospital, Masaka, Uganda, Department of Surgery, Faculty of Health Sciences, Equator University for Science and Technology, Masaka, Uganda, Department of Surgery, Faculty of Health Sciences, Habib Medical School, IUIU University, Kampala, Uganda, Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda and Department of Surgery, Mulago National Referral Hospital, Kampala, Uganda.

 

Julius Kiwanuka
Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.

 

Josephat Jombwe
Department of Surgery, Mulago National Referral Hospital, Kampala, Uganda.

 

Emmanuel Elobu
Department of Surgery, Mulago National Referral Hospital, Kampala, Uganda.

 

Henry Wabinga
Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.

 

Michael Odida
Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda and Department of Pathology, Faculty of Medicine, Gulu University, Gulu, Uganda.

 

Please see the book here:- https://doi.org/10.9734/bpi/mmrnp/v2/1622

Assessment of CDX2 Expression as a Prognostic Marker in Colorectal Adenocarcinoma Patients from Uganda | Chapter 5 | Medicine and Medical Research: New Perspectives Vol. 2

 

Aim: The objective of this study was to determine the association between CDX2 and clinicopathological features of colorectal adenocarcinoma in Ugandan patients.

Introduction: Colorectal cancer (CRC) is one of the major cancer types worldwide. Although the burden of CRC is highest in developed countries, the Kampala Cancer Registry in Uganda, reports a steady rise in the incidence of early-onset CRC. Molecular markers such as CDX2 represent a bowel-specific tumour suppressor which inhibits the dissemination and progression of colorectal cancer. Recent advances in the field of cancer biology have introduced novel biomarkers such as CDX2 that hold promise in guiding personalized therapeutic decisions and have revolutionised prognostication. In developed high-income countries, the reduced expression of CDX2 identifies a sub-group of patients linked to a poor outcome.

Methodology: During the period 2008 to 2021, immunohistochemistry was carried out on 55 patients’ paraffin-embedded tissue blocks of CRC. CDX2 expression was detected using the indirect immunoperoxidase method which uses monoclonal antibody CDX2, DAKO Agilent USA, and Clone DAK-CDX2. The grade, LVI status and histopathological subtypes of CRC were evaluated using the haematoxylin and eosin stain. The demographic data, topography and stage of the tumours were obtained from the clinical patients’ files and the Kampala Cancer Registry.

Results: Out of 55 CRC participants that were studied, the mean age (SD) was 52.4 (15.8) years and the loss of CDX2 expression was 18.9% overall. Lack of CDX2 expression was significantly associated with lymphovascular invasion (LVI) (p=0.005). There were 55.6% that presented with poorly-differentiated adenocarcinoma compared to 22.2% presenting with well-differentiated adenocarcinoma in those that exhibited a lack of CDX2 expression, however, this was not statistically significant (p=0.126). In those exhibiting a lack of CDX2 expression, there were 40% of participants presented with stage IV disease compared to 20% of CRC participants with stage I disease (p=0.329). There was a negative correlation between the CRC grade and CDX2 expression (r=-0.0235) which did not reach statistical significance (p=0.8729). The findings in the present study in Ugandan patients, in keeping with previous studies in the West found that loss of CDX2 expression was associated with poor prognostic markers such as lymphovascular invasion. These findings from colorectal cancer patients in Uganda are testimony to the role of loss of CDX2 as a poor prognostic factor in colorectal adenocarcinoma.

Conclusions: Loss of CDX2 expression is associated with poor prognostic markers such as the presence of lymphovascular invasion in Ugandan patients. Loss of CDX2 expression is more frequently seen in advanced-stage colorectal cancer (CRC) because it is linked to a biologically aggressive tumor. More research in Uganda is required to determine how chemotherapy affects CDX2-negative tumors and how this relates to survival.

Author(s) Details

 

Richard Wismayer
Department of Surgery, Masaka Regional Referral Hospital, Masaka, Uganda, Department of Surgery, Faculty of Health Sciences, Equator University for Science and Technology, Masaka, Uganda, Department of Surgery, Faculty of Health Sciences, Habib Medical School, IUIU University, Kampala, Uganda and Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.

 

Julius Kiwanuka
Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.

 

Henry Wabinga
Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.

 

Michael Odida
Department of Pathology, Faculty of Medicine, Gulu University, Gulu, Uganda.

 

Please see the book here:- https://doi.org/10.9734/bpi/mmrnp/v2/1619

 

GNAS Mutation Patterns in Colorectal Cancer: Insights from a Ugandan Cohort | Chapter 7 | Medical Science: Recent Advances and Applications Vol. 3

Introduction: In Uganda, the incidence of colorectal cancer (CRC) is rising, though still relatively low compared to developed countries, with a 5-year survival rate of 5.6%. Western literature shows that GNAS mutations are linked with failed treatment outcomes and a poor prognosis in CRC. The GNAS gene mutations are detected in many tumour types, as with KRAS (Kirsten rat sarcoma viral oncogene homolog) mutations. The global prevalence of the GNAS mutation in colorectal tumours varies.

Study Objective: The objective of this study was to determine the prevalence of pathological GNAS gene mutations and compare them to the clinicopathological features of CRC in Ugandan patients.

Methodology: The participants attending the Surgical Departments of Masaka Regional Referral Hospital, Mulago National Referral Hospital, Uganda Martyrs’ Hospital, Lusaka, and Mengo Hospital were prospectively recruited. This was a cross-sectional study in which formalin-fixed paraffin-embedded (FFPE) CRC blocks were obtained from 2008 to 2021. The histopathological diagnosis of colorectal adenocarcinoma, grade and LVI status was obtained by two consultant pathologists from the H&E slides. Data was abstracted from the medical case files for AJCC stage, topography and demographics. DNA was extracted from CRC FFPE tissue blocks, and using the Qiagen custom design panel, library preparation was completed. There were 56 genes which were represented in the custom panel. The GNAS gene was sequenced using the above library preparation and NGS sequencing. Categorical data were summarised using proportions and frequencies corresponding to the GNAS mutation status. Categorical and continuous variables were analysed using Fischer’s exact tests and chi-square tests. A p-value of ≤0.05 was considered statistically significant.

Results: There were 127 CRC participants with a mean (SD) age of 54.9(16.0) years. The male: female ratio was 1.2. Late-stage (III+IV) CRC constituted 85.8% of CRC participants. The majority were moderately differentiated CRC (75.6%) and had positive lymphovascular invasion (89.8%). The majority of tumours were in the rectum (44.8%), and 74% were left-sided colon tumours. There were 36(28.3%) colorectal tumours that were GNAS mutation positive. Out of the MSI tumours, there were 18(50%) GNAS-positive tumours and 34(37.4%) GNAS-negative tumours (p=0.192). There were 4(11.1%) GNAS-positive tumours compared to 16(17.6%) GNAS-negative tumours with stage IV disease (p=0.301). Out of the tumours that were GNAS mutation positive, 40(31.5%) were KRAS mutation negative and 4(3.1%) were KRAS mutation positive (p=0.447).

Conclusions: In Uganda, the prevalence of GNAS mutations is similar to the prevalence from Japan, however, different to the prevalence reported in other countries. There was no relation between GNAS mutation and demographics, topography, grade, LVI status, stage, MSI status and K-ras mutation status in Ugandan CRC patients. This is the first study in Uganda and in East Africa which has reported on the prevalence of GNAS gene mutations in CRC patients, so further studies are required in this context.

 

Author (s) Details

 Richard Wismayer
Department of Surgery, Masaka Regional Referral Hospital, Masaka, Uganda, Department of Surgery, Faculty of Health Sciences, Equator University of Science and Technology, Masaka, Uganda, Department of Surgery, Faculty of Health Sciences, Habib Medical School, IUIU University, Kampala, Uganda, Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda, Institute of Genetics and Cancer, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.

 

Rosie Matthews
Institute of Genetics and Cancer, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.

 

Celina Whalley
Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.

 

Julius Kiwanuka
Department of Epidemiology and Biostatistics, College of Health Sciences, Makerere University, Kampala, Uganda.

 

Fredrick Elishama Kakembo
Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda and African Centre of Excellence in Bioinformatics and Data Intensive Sciences, Infectious Diseases Institute, Makerere University, Kampala, Uganda.

 

 

Steve Thorn
Institute of Genetics and Cancer, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK and Department of Oncology, University of Oxford, Oxford, UK.

 

Henry Wabinga
Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.

 

Michael Odida
Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda and Department of Pathology, Faculty of Medicine, Gulu University, Gulu, Uganda.

 

Ian Tomlinson
Institute of Genetics and Cancer, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK and Department of Oncology, University of Oxford, Oxford, UK.

 

Please see the book here:- https://doi.org/10.9734/bpi/msraa/v3/5345

Features of Breast Cancer in Women under 50 Years of Age in HIV Positive and Negative Patients in Limpopo Province, South Africa | Chapter 6 | Medical Science: Recent Advances and Applications Vol. 2

Background: Breast cancer and HIV are major global burden of disease among women. There are 39.9 million people globally living with HIV in 2023 and 53% of which were women and girls. Breast cancer is the most diagnosed cancer in women and incidence with 2.3 million comprising 11.6% of all cancer cases in 2022. Breast cancer is commonly occurring in elderly women in Europe and America. However, in Africa, it happens often among younger women.

Objective: Primary objective of the study is to better understand the features of breast cancer (stage, hormonal status, grading and molecular subtype) in women under 50 years and to identify any differences between HIV-positive and negative groups of breast cancer patients.

Methods: A retrospective descriptive quantitative study was designed to analyse the profile of women under 50 years old with breast cancers who attended Mankweng Breast Oncology Clinic from July 2020 to December 2021. Mankweng Breast Cancer Clinic register was used to get patients’ initial data, and the patients’ relevant records were assessed to collect detailed information. The statistical software package SPSS v29 was used for data analysis.

Results: A total of 109 breast cancer patients were evaluated. The mean age was 40.6 years among HIV-negative patients and 39 years among HIV-positive patients. Regarding HIV status, 28 patients (25.7%) were HIV-positive, while 81 patients (74.3%) were HIV-negative.

In the HIV-positive group, the distribution of molecular subtypes was as follows: Luminal A in 5 patients (24%), Luminal B in 8 patients (38%), HER2+ overexpression in 3 patients (14%), and Triple Negative in 5 patients (24%). Regarding disease stage, 6 patients (21%) were diagnosed at an early stage, while 22 patients (79%) presented with late-stage disease. Among the HIV-negative group, the molecular subtypes were distributed as follows: Luminal A in 16 patients (22%), Luminal B in 41 patients (58%), HER2+ overexpression in 7 patients (10%), and Triple Negative in 7 patients (10%). Regarding disease stage, 16 patients (20%) were diagnosed at an early stage, while 65 patients (80%) presented with late-stage breast cancer. Regarding the histological type of breast cancer in this study, all patients both HIV-positive and HIV-negative patients had Invasive ductal carcinoma (no special type).

Conclusion: Mean age of breast cancer in HIV-positive women is slightly younger than HIV-negative. Triple negative molecular subtype was proportionately more in the HIV-positive group in comparison to HIV-negative patients. Majority of breast cancer patients presented in an advanced stage in both HIV-positive and negative groups. Initiative of Routine breast cancer screening should take place on this population of women under 40-year age.

 

Author (s) Details

Mirza Mohamod Zahir Uddin Bhuiyan
Department of General Surgery, Mankweng Academic Hospital, Faculty of Health Sciences, University of Limpopo, Limpopo, South Africa.

Please see the book here:- https://doi.org/10.9734/bpi/msraa/v2/5096

Comparison of 404 Patients with Right- and Left-sided Colon Cancer in Uganda: Differences in Clinicopathological Profile | Chapter 9 | Research Developments in Medicine and Medical Science Vol. 5

 Introduction: In Western nations right-sided colon cancers (RSCC) present at an earlier age and advanced stage. Researchers believe that skilled is a difference 'tween left-sided colon tumor (LSCC) and RSCC. In Uganda however, it is obscure whether differences lie in the pathological sketch between RSCC and LSCC. The aim of this study search out determine distinctnesses in clinicopathological characteristics between RSCC and LSCC in Ugandan sufferers.Methodology: A cross-sectional study was attended in which colorectal adenocarcinoma formalin-fixed paraffin-entrenched tissue (FFPE) blocks were got from 2008 to 2021. Colorectal specimens were acquired from prospectively recruited patients. In the backward-looking study arm, FFPE blocks and data were acquired from the archives of pathology workshop repositories. Parameters intentional included age, sex, position of the tumour, grade, stage, lymphovascular (LVI) status and histopathological subtype 'tween LSCC and RSCC.Results: Patients with RSCC were not older than those accompanying LSCC (mean age, 56.3 years vs 53.5 age; p=0.170). There was no difference in the stage betwixt RSCC and LSCC. Poorly differentiated tumours were more usually found in RSCC than in LSCC (18.7% vs 10.1%; p=0.038). Moderately and poorly differentiated colonic tumours were more low with RSCC (89.3%) than accompanying LSCC (75.1%) (p=0.007). Younger patients had more poorly differentiated tumours than earlier patients (19.6% against 8.6%; p=0.002). LVI was more common accompanying RSCC than with LSCC (96.8% vs 85.3%; p=0.014). Mucinous adenocarcinoma (MAC) was more common accompanying RSCC (15.8%) compared to LSCC (8.5%) (p=0.056) even though statistical significance was inexact.Conclusions: Clinicopathological features of RSCCs likely to be different from those of LSCCs. RSCCs likely to be guide MAC, a higher grade and LVI status distinguished to LSCC. LSCC and RSCC present predominantly accompanying an advanced stage; therefore, governmental screening programmes for the early discovery of CRC are necessary to reduce death in our Ugandan population.

Author(s) Details:

Richard Wismayer,
Department of Surgery, Masaka Regional Referral Hospital, Masaka, Uganda, Department of Surgery, Faculty of Health Sciences, Habib Medical School, IUIU University, Kampala, Uganda and Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.

Julius Kiwanuka,
Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.

Henry Wabinga,
Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.

Michael Odida,
Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda and Department of Pathology, Faculty of Medicine, Gulu University, Gulu, Uganda.

Please see the link here: https://stm.bookpi.org/RDMMS-V5/article/view/9893

Breast Cancer Stage at the Time of Presentation: Clinicopathological Correlations | Chapter 7 | Highlights on Medicine and Medical Science Vol. 4

 Background: Breast cancer is the most commonly diagnosed malignancy and the second leading cause of death in women in Iraq, accounting for 23% of all cancer-related deaths. The disease's low survival rate is a direct result of the disease's advanced stages at diagnosis. The goal of this study is to document the composite stage of breast cancer in Iraqi patients at the time of diagnosis, as well as to correlate the observed findings with other clinical and pathological parameters at presentation.  Patients and Methods: This was a retrospective study that included the clinical and pathological characteristics of 448 Iraqi female breast cancer patients. The UICC TNM Classification System of Breast Cancer and the American Joint Committee on Cancer Staging were used to determine the composite stage of breast cancer. The parameters studied included the patient's age, disease stage, marital and educational status, history of lactation and hormonal intake (for a minimum of 6 months), family history of breast or other cancer, the affected breast side, and the effected breast side. The primary cancer's hormone (estrogen and progesterone) receptor (ER, PR) and Her2 content. Using the SPSS version 16.0 statistical program, a statistical analysis was performed to correlate the recorded composite stages at diagnosis with the corresponding clinical and pathological data. Four (0.9 percent) of the 448 patients had ductal carcinoma in situ (Stage 0). Stages I, II, and III were represented by 7.6 percent, 46.9 percent, and 39.3 percent, respectively, while Stage IV was represented by only 5.4 percent. There was no correlation found between the stage of breast cancer and the patients' age or history of lactation. The marital and educational statuses were found to have a significant relationship. status, history of hormonal use, contralateral breast involvement, and a family history of cancer The ER+PR+Her2+ (Triple Positive/Luminal B), ER-PR-Her2- (Triple Negative), ER+PR+Her2- (Luminal A), and ER-PRHer2+ (Her2) subtypes were found in 13.4%, 11.8 %, 48.2 %, and 9.8 % of the cases, respectively. The correlation between the composite stage and the corresponding breast cancer subtypes, as determined by immunohistochemical staining, was highly significant at p 0.01.

 Conclusions and Recommendations: Regression in Stage IV breast cancer at the time of presentation among Iraqi patients is one of the fruitful outcomes of launching the National Breast Cancer Early Detection Program. More professional efforts, supported by practical policy decisions, are recommended to reduce the stage of breast cancer by promoting evidence-based protocol guidelines and implementing comprehensive, well-designed diagnostic, screening, and cancer control strategies.


Author (S) Details

Prof. Dr. Nada A. S. Alwan
National Cancer Research Center, Baghdad University, Iraq.


Furat N. Tawfeeq
National Cancer Research Center, Baghdad University, Iraq.

Mina H. Maallah
Public Health, City University London, UK.

Safana A. Sattar
National Cancer Research Center, Baghdad University, Iraq.

View Book :- https://stm.bookpi.org/HMMS-V4/article/view/1690