Dissertations / Theses on the topic 'Breast Cancer South Australia'
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1
Cheok, Frida. "Participation in mammographic screenings in South Australia /." Title page, contents and abstract only, 1998. http://web4.library.adelaide.edu.au/theses/09PH/09phc51843.pdf.
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Agenbag, Gloudi. "Molecular genetic analysis of familial breast cancer in South Africa." Thesis, Link to the online version, 2005. http://hdl.handle.net/10019/953.
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Macharper, Anthony G. "Survival from cancer and socio-economic status in South Australia /." Title page, table of contents and abstract only, 1992. http://web4.library.adelaide.edu.au/theses/09MPM/09mpmm149.pdf.
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Daries, Valdiela. "The profile of breast cancer among patients attending a Breast Clinic in Cape Town, South Africa." Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/6033.
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Breast cancer is the leading cancer among women in South Africa (SA). Studies conducted in developing countries have shown that the majority of women present with advanced stage breast cancer at diagnosis. There is a gap in terms of recent data on the profile of breast cancer patients in SA. The purpose of the study was to obtain recent data with regards to the sociodemographic, clinical and risk factor profile of breast cancer in patients who presented at a Breast Clinic linked to a tertiary public hospital in the Western Cape in order to underpin the development of strategies for earlier detection and diagnosis of breast cancer. A cross-sectional descriptive medical record review was conducted. The studypopulation included all newly diagnosed patients with histological or cytological confirmedbreast cancer who presented at the Breast Clinic during the period 01 January 2009 to 31December 2010. All patients with a previous diagnosis of breast cancer were excluded. Data onthe socio-demographic, clinical and risk factor profile of breast cancer patients were collectedusing a standardised data capture sheet. Data was entered using Epidata version 3.1 and analysedusing Stata Statistical package version 12.After calculation of initial descriptive analysis for the whole sample, male subjects wereexcluded and further analysis was restricted to 585 female subjects. Stage at presentation wascategorised as “early stage” (stage 0, I, IIA, IIB) and “late stage” (stage IIIA, IIIB, IIIC, IV). Crude associations of potential predictors with stage at presentation were tested using Wilcoxon rank-sum tests for medians and Chi-square tests and Fischer Exact tests for proportions. Logistic regression was used to create a model with stage at presentation as dependent variable. Age and racial group were introduced in the model as possible confounders. Based on literature findings other variables present in the dataset were considered as potential predictors of stage at presentation (namely place of residence, employment status, medical aid status, family history of breast cancer, menopausal status, parity, having ever smoked or used alcohol, clinical signs of breast cancer as well as duration of symptoms) and introduced in the model if their bivariate association with the outcome (adjusted for age and race) was statistically significant. A significance level of p <; 0.15 was used. The only variable showing a significant association according to this criterion was the ordinal variable duration of symptoms. The final logistic regression model, therefore, included stage at presentation as the dependent variable and age, racial group and symptom duration as predictors.
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Moore, Simon Reading. "Oral cancer in South Australia : a twenty year study 1977-1996." Title page, table of contents and precis only, 1999. http://web4.library.adelaide.edu.au/theses/09DM/09dmm824.pdf.
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Kramer, Nicole. "Prevalence of shoulder morbidity after treatment for breast cancer in South Africa." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/27973.
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Introduction: Breast cancer is the most frequently diagnosed cancer and leading cause of cancer death among women and represents a considerable public health burden in South Africa and other low-middle income countries. Breast cancer management comprises single or combination treatment including surgery, radiotherapy and chemotherapy. Short and long-term complications of these treatments include shoulder morbidities such as pain, decreased range of motion, tightness, weakness, pain, numbness and lymphoedema, and may be present for up to 6 years post-surgery. An understanding of baseline demographic and clinical risk factors can guide rehabilitation and management strategies for high risk patients. Materials and Methods: This study was a cross-sectional analysis of the prevalence of shoulder pain and dysfunction in women attending their post-treatment annual follow up visit for unilateral breast carcinoma. The aim of this study was to quantify the burden of shoulder pain and disability in a tertiary academic hospital in Cape Town, South Africa, and identify potential risk factors for the development of shoulder morbidity. The primary objective of this study was to determine the prevalence of shoulder morbidity and the secondary objective was to evaluate associations between shoulder morbidity and risk factors such as treatment protocol or baseline demographics. Results: The majority of patients were of mixed ancestry, had their left side affected, received ALND and had undergone Modified Radical Mastectomy. The mean age was 60 years with a mean follow-up since surgery of 6 years. Three-quarters of patients reported a presence of pain or disability; 9% experienced severe pain and disability. Multivariable ordinal logistic regression analysis identified race, side, axillary surgery, chemotherapy and age as significant predictors of pain, and chemotherapy a significant predictor of disability. Discussion: The substantial burden of shoulder morbidity in this population represents a significant public health burden. The use of identified clinical and demographic characteristics may guide in the development of survivorship programmes incorporating surveillance and management of these high risk patients.
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Sagoo, Parminder. "Experiences of South Asian women with breast cancer : coping via 'strength through connection'." Thesis, University of East London, 2010. http://roar.uel.ac.uk/1882/.
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The aim of this qualitative study was to gain a better understanding of how British South Asian women cope with breast cancer. The NICE (2004) Guidance suggests that appropriate psychological support should be available for all patients through all stages of their treatment from diagnosis to end-of-life. A literature review indicated a paucity of UK based studies on which to base practice. In order to understand the coping experience of this group, ten female South Asian patients being treated for breast cancer were recruited for in-depth semi-structured interviews, which were recorded and transcribed. Data were analysed using constructivist grounded theory to produce a model conceptualising the resources or processes that this group used in order to cope with breast cancer. Analysis elucidated 'Strength through Connection' as the core category, and four main categories: a) Being in mind, b) Wearing a positive cap, c) Preserving relational identity, and d) Realigning values. Facets of the extant coping literature support these findings but much of this research is not from an ethno-cultural perspective. The pattern of coping found in this study can be viewed holistically within a cultural framework and interpreted as predominantly collectivist coping, thereby highlighting the significance of connectedness. Clinicians are encouraged to be better informed regarding cultural differences and preferences in coping, and recommendations are made for counselling psychology practice. The need for further research to meet the NICE (2004) Guidance is highlighted.
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Scullard, Nicole. "Subjective lived experiences of women with early stage breast cancer in Cape Town." University of the Western Cape, 2015. http://hdl.handle.net/11394/5081.
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Magister Artium - MABreast cancer is a common cause of death among women worldwide. It has long been recognized as a major public health burden in high-income countries, however, the majority of cases are said to occur in low and middle-income countries, such as in South Africa. A breast cancer diagnosis and treatment heralds a series of frightening events and can be a traumatic experience. The manner in which women perceive and cope with their illness is predictive of emotional and physical health outcomes. It is thus imperative to explore the experiences of South African women, whose voices may have been silenced in the past. The purpose of my study was to explore the subjective lived experiences of women with early stage breast cancer undergoing treatment. The objectives of the study were to; explore the emotional experiences of women with early stage breast cancer undergoing treatment and secondly to explore how women perceive their bodies through their experience of early stage breast cancer while undergoing treatment. Phenomenology was used as the theoretical position conceptualising the study as well as the research design. This research study adopted a qualitative approach utilising in-depth face to face semi-structures interviews for collecting data. The participants were selected through purposive sampling and comprised six women aged between 30 and 40 who are undergoing treatment for early stage breast cancer. The data was analysed using interpretative phenomenological analysis. Emotions experienced were characterised by the shock of the diagnosis due to factors such as lack of family history and age. Participants reported positive changes and viewpoints which they gained through their breast cancer journey. Emotions were heightened during treatment due to the physical change experienced and the effects this had on family members and the general public. Furthermore, results indicated that participants, even though they discovered a new found love for life and for their wellbeing, neglected their emotional needs in order to protect family members. An additional reason for this neglect centered on the lack of understanding other individuals may have regarding the experiences of participants. Recommendations involves the encouragement of accessing counselling services and that interventions tailored to the needs of each patient especially according to age. All ethical considerations as stipulated by the University of the Western Cape were adhered to.
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Winchester, Carolyn Margaret. "Anti-p53 and c-erbB2 as prognostic markers in South African breast cancer patients." Thesis, Cape Technikon, 2000. http://hdl.handle.net/20.500.11838/1518.
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Thesis (DTech(Biomedical Technology))--Cape Technikon, Cape Town, 2000The diagnosis of breast cancer is not possible using currently available serological detection of cancer markers as these lack adequate sensitivity or specificity. This study investigates the prevalence and significance of anti-p53 antibody and c-erbB-2 protein in the post-surgical sera of South African breast cancer patients and correlates these features with the clinicopathological characteristics of breast cancer. Further, this study investigates the possibilityofimproving prognostic sensitivityby combining the two subject markers to monitor each patient. Further, this study will provide the opportunity to investigate lNhether only certain types of breast cancer can elicit an immunological response and at what stage and grade of tumour antibodies are present in the postoperative serum. The study also establishes a foundation for determining in South Africa lNhether there is a genetic influence in the response to p53 mutation and INhther this response is higher in the indigenous African women compared to other South African women. The purpose of the study is to determine if the resulting findings can be used to enhance our ability to diagnose breast cancer and to identify node-negative breast cancer patients at high risk for early disease recurrence and or death, for 1Nh0m adjuvant therapy is unequivocally justified. The study accrued 92 South African breast cancer patients who were essentially women of colour 62 [67%] indigenous African women and 20 [22%] Caucasian of Indian descent, 6 [6%J of mixed [ColouredJ background and only 4 [4%J Caucasian of White descent. A predominantly indigenous African populationwas chosen becausethey are the group most likely to benefitfrom an easily repeatable, affordable serological cancer marker.
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Ng'ang'a, Mukuhi. "Delay in provision of breast cancer care in patients seen at a district hospital diagnostic breast unit in South Africa." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/28069.
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Background: There is evidence to show that delays in breast cancer management are detrimental to patient outcome. The aim of this study was to determine time trends and causes of delay in a newly established diagnostic breast clinic based at a district hospital in South Africa. Method: All patients who presented to Mitchells Plain District Hospital Breast Clinic from January to December 2015 and had a diagnosis of breast cancer were included in this study. The intervals between the time she first noted her symptoms to initial contact with a health professional and delivery of definitive therapy was documented. Patient delay referred to the interval from when the patient first noted her symptoms to her initial contact with a health care provider. Provider delay referred to the interval between the first hospital visit and onset of therapy. Result: A total of 33 patients were enrolled in this study. The median overall total delay (time lapse between the moment the patient first noticed her symptoms to time definitive anti-cancer treatment was started) was 157days, (range 29 to 839 days). Median patient delay (time lapse between the moment the patient first noticed her symptoms and the visit to a health professional) was 56 days, (range 7 to 730 days). Median overall provider delay (time lapse between the patients' first encounter with a clinician to time definitive anti-cancer treatment was started) was 84 days, (range 22 to 338 days). Median Referral delay was 11 days (range 4 to 39 days). Median Diagnostic delay was 15 days (range 9 to 135 days) and median treatment delay was 45 days (range 5 to 246 days). Conclusion: The median overall total delay for patients diagnosed with breast cancer at Mitchells Plain District Hospital does not compares well with institutions in developed nations but it is similar to studies done in developing nations. The largest contributor to this delay was patient delay. The main contributors to provider delay was related to diagnosis (almost exclusively related to tissue diagnosis) and treatment (mainly patients who received surgery as their first definitive therapy).
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Kamanga, Thembekile Nokukhanya. "A microsociological analysis of social support to women diagnosed with early stage breast cancer." Thesis, University of the Western Cape, 2016. http://hdl.handle.net/11394/5536.
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Magister Artium - MAThis study explored the social support provided by family of women diagnosed with early stage breast cancer. The aim was to present an account of social support that is solicited by and given to women diagnosed with early stage breast cancer. There is a dearth amount of literature on support from families of women with breast cancer in South Africa. Thus, this study can potentially contribute to filling the gap of knowledge in this area in the country. Qualitative method was used and in-depth interviews were utilized to study the women's experience of family social support. The theoretical framework underpinning the study is the relational communicational perspective.
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Patel, Geeta. "The psychosocial impact of breast cancer diagnosis and treatment in Black and South Asian women." Thesis, University of the West of England, Bristol, 2013. http://eprints.uwe.ac.uk/20099/.
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Breast cancer is the most common form of cancer in women of all ethnic groups. The diagnosis and treatment of the disease can be challenging and distressing for any individual. Research in this area has documented a range of physical, psychological and social consequences. However, very little work within the existing literature captures the experiences of Black and Minority Ethnic (BME) women, especially in the UK. The limited available research, based on American studies, show that while similarities in White and BME women’s breast cancer experiences exist, there are also aspects that are unique and specific to BME women, which are influenced by socio-cultural norms, behaviours and beliefs. Therefore, the aim of this research was to explore the psychosocial impact of breast cancer diagnosis and treatment in British Black and South Asian women. To research this area, a qualitatively driven mixed method approach was adopted. Four studies were undertaken, 3 qualitative and 1 quantitative. The first study was exploratory in nature, in which semi-structured one-to-one interviews were carried out with 11 Black and 11 South Asian women. The findings of this study informed the subsequent studies, the second of which consisted of focus group interviews with 10 Black and 10 South Asian women to explore the ways in which breast cancer experiences are managed. The third study involved interviews with 5 South Asian Indian, Gujarati-speaking women (with limited English proficiency). The findings from these studies show that psychosocial and cultural factors (such as support, appearance concerns, healthcare experiences, cultural beliefs about cancer, understanding of cancer and language barriers) play an important role in shaping BME women’s experiences of breast cancer. These findings informed the development of the final questionnaire study. This study investigated the psychosocial impact of breast cancer and aimed to compare breast cancer experiences between White, Black and South Asian women. A total of 173 women participated (80 White, 40 Black and 53 South Asian). The results from this study show that psychological distress, social support and receiving chemotherapy treatment are associated with quality of life. Furthermore, similarities and differences in Black, South Asian and White women’s breast cancer experiences (in relation to psychological distress, quality of life, control beliefs (pertaining to cancer), body image concerns and sources of support) are evident. The findings from this research highlight important implications for policy makers, healthcare professionals and researchers to enhance awareness and understanding, and to ensure the provision of culturally competent care and support to future breast cancer patients.
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Sunkara, Ranga Rao. "Comparative study of breast cancer in the United States, India, and South Africa: 1996- present." DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 2001. http://digitalcommons.auctr.edu/dissertations/1693.
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This study identifies forces that prevent or contribute to women's participation in breast cancer screening and other breast cancer prevention activities. The study was based on the premise that women from the lower socioeconomic groups in India, South Africa, and the United States had a higher rate of breast cancer because they are diagnosed at the more advanced stages of the disease and do not engage in breast screening opportunities. Moreover, there is limited access to services and transportation, and there is little faith in the professional health care provider and the treatment received from the health care provider.
Surveys and interviews were used to assess the women's level of involvement in breast cancer related prevention programs. Similar methods were used to assess the level of involvement by health care professionals in providing breast cancer prevention activities.
The researcher found that the issues related to breast cancer are comparable in South Africa, India, and the United States. Further, it was found that, for the women in all three countries, there was a lack of access to health care; thus, women were not receiving the medical treatment they needed; the women were diagnosed at the more advanced stages of the disease; there was a lack of available transportation to the sites where they could participate in health prevention programs; there was a lack of information about breast cancer made available to women of color; and the level of participation in health care programs is related to the socioeconomic conditions and to the cultural aspects of some women's lives and the long waiting periods for medical services.
The conclusion drawn from the findings suggests that a culture-sensitive model is needed for women of color, and health care professionals need to be more sensitive to the needs of women regardless of socioeconomic level. The three countries should consider holding global workshops on breast cancer, and health clinics and other medical facilities should send reminder cards to female patients or have health care workers do home visits to remind patients of the need for mammogram.
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Mentoor, J. L. D. (Juliet Lewie Dionee). "Identification of rare gene variants in South African breast cancer families through next generation sequencing." Thesis, University of Pretoria, 2017. http://hdl.handle.net/2263/63043.
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Breast cancer (BC) has become the leading cancer amongst women in South Africa. The
overall life time risk for developing this disease is one in 12 (National Cancer registry, 2000-
2011). A strong family history (≥3 affected) is an important factor for inherited predisposition to
BC that accounts for approximately 10% of cases worldwide. Mutations in several high- and
moderate risk breast cancer genes have been associated with familial BC and includes
BRCA1, BRCA2, TP53, PALB2, and CHEK2. Individuals that carry germline mutations in
BRCA1 and BRCA2 possess an 80% lifetime risk for BC. Mutations in BRCA1 and BRCA2 are
responsible for 29% and 25% of familial BC worldwide. In South Africa BRCA1 mutations
account for 19% and BRCA2 for 47% of familial breast cancer. Mutations associated with a
moderate risk for BC account for ~1% of cases. This data suggests that ~30% of South African
BC families are not characterised by pathogenic mutations in known breast/ovarian (BC/OVC)
genes. The purpose of the present study was to identify gene variants that may predispose to breast
cancer. Next generation sequencing was performed to investigate the germline DNA of highrisk
BC/OVC families that have previously tested negative for premature truncating mutations
in BRCA1/2, PALB2 and RAD51C. Paired-end whole exome sequencing was performed with
nine index cases, selected from six families with a strong background for BC/OVC. This
resulted in the discovery of an average of 26 000 coding variants in index cases. Gene
prioritisation strategies were incorporated to filter all exome variants and identify high-priority
genes for further analysis. After sequence verification, three high-priority genes were selected
for further analysis. The three genes coded for; a novel putative tumour suppressor (TCHP) that is pro-apoptotic;
the XPF-endonuclease homolog, EME2; and a POLQ like helicase enzyme (HELQ). Prioritised
genes were screened in a total of 61 high-risk families and cohorts of patients with BC or OVC
without a family history for their disease. Two potentially damaging variants (stop-gain & inframe
amino acid deletion) were identified in TCHP, four (frameshift, nonsense & two in-frame
deletions) in EME2 and one frameshift mutation in HELQ in high-risk families and cases that
were without a family history for BC/OVC.
The analyses performed in the last section of this project was aimed at identifying other
potential genes of interest by making use of a list of 516 well recognised and putative DNA repair genes. Through this approach, one additional truncating mutation in POLN
(p.Q837SfsX7) was highlighted as a potential gene of interest for future investigation.
Despite the key roles that the high-priority genes play in their respective processes, the
present study could not verify that the potential loss of function variants discovered make an
appreciable contribution towards BC/OVC susceptibility in our setting. Further investigation is
necessary to validate their involvement in breast/ovarian cancer predisposition.Thesis (PhD)--University of Pretoria, 2017.
Genetics
PhD
Unrestricted
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Taylor, Anne 1950. "Knowledge and reported behaviour of South Australian adults regarding sun protection." Adelaide : University of Adelaide, Dept. of Community Medicine, 1996. http://web4.library.adelaide.edu.au/theses/09MPM/09mpmt238.pdf.
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Woods, Laura Marion. "International differences in breast cancer survival and 'cure' by social deprivation : a comparative study of England and Australia." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.440545.
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Hanson, Victoria Funmilayo. "An empowerment programme for women on breast self-examination towards the prevention of breast cancer in Iddo Local Government, Oyo State, South-west Nigeria." University of the Western Cape, 2015. http://hdl.handle.net/11394/4682.
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Philosophiae Doctor - PhDCancer is a major public health concern in both developed and developing countries; it accounts for 13% of all deaths globally, of which 70% occur in middle- and low-income countries. In Nigeria, over 10 000 cancer deaths and 250 000 new cases of cancer are recorded yearly. Breast cancer is the second most common cancer worldwide, after lung cancer. It is the most common type of cancer diagnosed in women and the most common cause of death worldwide. Late detection and diagnosis of breast cancer leads to high mortality rate. In Nigeria certain cultural taboos are associated with breast cancer, which lead to poor information dissemination to women in rural communities. Breast self-examination (BSE) provides an inexpensive method for early detection of breast tumours. Knowledge and awareness about Breast Self-Examination are critical to promote consistent practices when the people concerned are empowered with the needed information to acquire the knowledge and skills which will inform practice of any health issue. In Nigeria it was reported that the number of women at risk of breast cancer increased progressively from 24.5 million in 1990 to about 40 million in 2010. This number is projected to rise to over 50 million by 2020, should the trend continue unabated. The current study explored the understandings of breast cancer and prevention, with particular emphasis on BSE practice among rural women, and developed an empowerment programme to promote uptake of this practice in a rural community in a south-western state of Nigeria. The study was framed in the Health Belief Model and Kieffer’s empowerment process. Participatory action research was used as study design and approach; and utilized both qualitative and qualitative methods. The sample for quantitative phase comprised 345 women aged 20 to 60 years, selected from 5 communities using a cross-sectional procedure. Data gathering instrument was a questionnaire. Summative statistics were calculated using the SPSS program. The sample for qualitative phase comprised of 95 women who were selected from the respondents to the quantitative phase. The data was collected through focus group discussion. The qualitative data was subjected to thematic analysis. Three themes that emerged for qualitative analysis which are: knowledge/awareness of BSE, practice and appeal for intervention, and misconception and fear. The survey results showed that a large proportion of the respondents (75.1% and 76.5%) had low levels of knowledge about BSE and did not practice BSE. Also, about 77% of the respondents expressed one form of barrier or another to BSE practice. However, despite these inadequacies, 87% of the respondents were ready and willing to improve their health if empowered with the right information and motivation. The empowerment program informed by the quantitative and qualitative phases and the stages of change with the full participation of the women. The program consisted of hands-on physical demonstrations, BSE pamphlets, and mnemonic songs were identified media of disseminating knowledge and practice of BSE. These media became the platforms for the empowerment programme developed for the women. A day was also set aside, just as is done for immunisation, for BSE practice and other women’s health issues to promote the prevention of breast cancer in the community. The “Physical demonstration” intervention resulted in an increase in the correct BSE practice from 23.5% at the beginning of the study, to 85.3% post the intervention. The “other intervention” resulted in 80% to 94.7% of participating women being able to practice correct physical step-by-step performance of BSE. The participatory approach contribute to a high levels of participation by women in Iddo local Government which led to the increase in the correct Breast Self–Examination as stated above.
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Tailor, Bharti. "The experiences of South Asian women with breast cancer and the complexities of whole person care." Thesis, University of Southampton, 2008. https://eprints.soton.ac.uk/71891/.
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This study investigates the experiences of South Asian women being treated for breast cancer within a British system of health and social care that recognises racialised inequalities in care and is striving to provide culturally sensitive care to an increasingly diverse population. The research was conducted in a National Health Service (NHS) Trust in an outer London suburb. It is a qualitative exploratory study based on eighteen in- depth interviews and participant observation of interactions between women with breast cancer and health care professionals. The interviews were conducted in three languages: English, Gujarati and Hindi. In examining whole person care from the perspectives of both health care professionals and South Asian women, this thesis demonstrates how ethnicity as both a category of social difference and a process of social identification can present significant challenges for holistic care at different stages of the patient pathway. The concept of othering is used to make sense of the complicated relationships between health care professionals and South Asian women and to examine the extent to which care is responsive to differences of ethnicity, culture and faith. The findings from participant observation and qualitative interview data suggest that health professionals can often reduce the complex experiences of South Asian women to cultural difference. Such thinking can serve to compromise therapeutic relationships in which mutual power sharing and decision making is inhibited. However, cultural stereotyping is not a uniform process and can be transformed in situ so that some women are able to access personalised and holistic care. Whilst recognising that the needs of South Asian are complex evidence from this study suggests that othering can be a central process through which health care professionals contribute to the marginalisation of South Asian women within health care services.
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Habib, Sanzida Zohra. "South Asian immigrant women’s access to and experiences with breast and cervical cancer screening services in Canada." Thesis, University of British Columbia, 2012. http://hdl.handle.net/2429/42855.
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A qualitative feminist study, informed by social constructionist epistemology, antiracist theories and intersectionality perspectives, was conducted in order to understand South Asian immigrant women’s access to and experiences with breast and cervical cancer screening services in Canada. Particular attention was paid to the wider context of their lives and their experiences of migration, resettlement, integration and general access to the Canadian healthcare system. The study also explored how the broader systems, structures and policies in Canadian society shape South Asian immigrant women’s participation in and access to cancer screening services. Thirty one South Asian immigrant women were interviewed in individual, couple and group settings in greater Vancouver. Research findings indicated that women’s age, length of stay since immigration, educational and generational status, not/having a family history or symptoms impact their use or lack of use of cancer screening services; but these factors also intersect in complex ways with various systemic and structural issues including not having a recommendation from physicians, women’s financial instability, access to income, employment, settlement services and community resources, levels of socioeconomic integration and familiarity with the Canadian healthcare system, and gender roles and responsibilities. Women’s narratives also showed that the immigration factor amplify the intersecting forms of inequities and the social determinants of health such as gender, class, poverty, racialization and discrimination, and affect women’s physical and mental health and access to healthcare services, cancer screening being one of them. An intersectional analysis revealed that the gendered and racialized immigration and integration policies, multicultural discourses and neoliberal ideologies and practices intersect to situate South Asian immigrant women into racialized and disadvantaged situations as the ‘other’ wherein access to preventive cancer screening services becomes especially challenging. South Asian women’s access to cancer screening and other healthcare services needs to be understood beyond the attempts to know their cultural health beliefs and practices, and beyond the neoliberal ideas of ‘self-care,’ ‘individual responsibility,’ ‘patient empowerment,’ and ‘culturally sensitive care.’ Also, equitable access to health care cannot be ensured without resisting these women’s racialized position as the ‘other’ and addressing the social, political, historical, material and structural inequities in Canadian society.
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Hassan, Mohammed Hashim Abdalraheem. "Characterization of ATP-binding cassette drug transporters and their role in breast cancer treatment using in silico approach." University of the Western Cape, 2019. http://hdl.handle.net/11394/7255.
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>Magister Scientiae - MScBreast cancer is the most common cancer in women worldwide, and is the second most common cancer in the world, responsible for more than 500 000 deaths annually. Estimates are that 1 in 8 women will develop breast cancer in their lifetime. In South Africa, breast cancer in women affects about 16.6 % of the population and could see a 78 % increase in cases by 2030. Comprehensive therapy on breast cancer including surgical operation, chemotherapy, radiotherapy, endocrinotherapy, etc. could help, but still has serious side effects. The Chemotherapy resistance against anticancer drugs is an emerging concern. Biomarkers have been identified as a viable option for early detection and progression of disease. Examples of biological indicators for disease could be the ATP-binding cassette (ABC) drug transporters that utilizes the energy derived from ATP hydrolysis to efflux many chemically diverse compounds across the plasma membrane, thereby playing a critical and important physiological role in protecting cells from xenobiotics. These transporters are also implicated in the development of multidrug resistance (MDR) in cancer cells that have been treated with chemotherapeutics. High expression of these membrane proteins as a family of ABC drug transporters are one of the main reasons for drug resistance by increasing the efflux rate of the anti-cancer drug from cancer cells. ABC drug transporters are considered to be one of the largest protein families in living organisms. There are 48 genes in the human genome that encode ABC transporters, which are divided into seven subfamilies (ABCA-ABCG). Studies revealed that ABC transporter genes has been shown to be associated with tumour development, progression and response to therapy, suggesting their possible use as diagnostic, prognostic and predictive biomarkers. The aim of this study was to investigate and identify novel ABC transporter genes that could be implicated in breast cancer and MDR and potentially would be a therapeutic target for successful chemotherapy treatment and disease progression and survival in breast cancer patients. An in silico approach was used to identify 10 ABC transporter genes (ABCB2, ABCB9, ABCB10, ABCC1, ABCC4, ABCC5, ABCC10, ABCC11, ABCC12, ABCD1) implicated in breast cancer by conferring drug resistance through over-expression in cancer cells. The in silico study investigated the tissue expression specificity, protein interaction/s, pathways, and comparative toxicogenomics of the identified ABC transporter genes using several computational software such as Tissue-specific Gene Expression and Regulation (TiGER), the Human Protein Atlas (HPA), Search Tool for the Retrieval of Interacting Genes/Proteins (STRING), and The Comparative Toxicogenomics Database (CTD). The 48 ABC transporter genes were shortlisted through very selective criteria that narrowed the genes down to 10. Differential expression analysis of the genes using TiGER and HPA compared expression in normal versus cancerous tissue of the candidate genes. The result showed that ABCC11 was preferentially expressed in breast tissue with an enrichment value higher than 10.0. The results also showed ABCC10 overexpressed in breast cancer tissue, making these two genes top candidates for further analysis. Result from STRING database showed a strong functional interaction network between the prioritized genes through protein homology, co-expression and text mining as evidence for the observed interactions. Furthermore, the prioritized list of genes was submitted to the CTD for intersectional analysis to obtain the toxicity relationship between the genes and the Tamoxifen as the first line chemotherapeutic treatment for breast cancer. Venn diagrams obtained from CTD showed intersectional relation between ABCB2, ABCC1, ABCC4, ABCC11, and ABCD1 genes and Tamoxifen. Furthermore, an in silico validation of the prognostic/predictive values of the 10 prioritized genes (list 2) was carried out using an online biomarker validation tool and database for cancer gene expression data using survival analysis (SurvExpress) and gene expression based survival analysis web application for multiple cancer (PROGGENE). Results obtained from the PROGGENE survival and predictive analysis showed good prognostic values for the genes ABCB2, ABCC1, ABCC4, ABCC10 and ABCC12 with their significance measured by the probability value (Pv) (0.053, 0.001118, 0.01286, 0.00604, 0.00157 respectively). From this study ABCC1, ABCC4, ABCC5, ABCC10, and ABCC11 genes could serve as putative therapeutic target biomarkers for breast cancer treatment following further in depth analysis. However, the variance in the effectiveness of individual genes suggests that the set of genes would perform better than individual gene in the management of breast cancer. The modulating roles of ABCC4, ABCC5 ABCC10, and ABCC11 in drug induced apoptosis, suggest they could probably play an important role in personalized medicine and could serve as biomarkers to monitor the prognosis and/or therapeutic outcome of chemotherapy drugs in breast cancer patients. The use of modern genomics, proteomics, bioinformatics, and systems biology approaches has resulted in a substantial increase in our ability to identify molecular mechanisms that are involved in MDR in cancer and to find drugs that may block or reverse the development of drug resistance. By using an in silico approach in this study, a list of five ABC transporter genes were identified, of which two (ABCC10 and ABCC11) could potentially serve as prognostic and predictive biomarkers for the management of breast cancer treatment.
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Elliott, Diana. "The impact of genetic counselling for familial breast cancer on women's psychological distress, risk perception and understanding of BRCA testing." University of Western Australia. School of Population Health, 2008. http://theses.library.uwa.edu.au/adt-WU2008.0190.
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[Truncated abstract] Background: A review of the literature indicated there was a need for more long-term randomised controlled studies on the effects of BRCA counselling/testing on high risk women, including improved strategies for risk communication. Reviews have also shown women are confused about the significance of inconclusive or non informative results with a need for more research in this area. Aims: The general aim of this study was to evaluate the impact of breast cancer genetic counselling on psychological distress levels, perception of risk, genetic knowledge and understanding of BRCA testing/test results in a cohort of 207 women from high risk breast cancer families who were referred for genetic counselling in Perth during the period 1997 to 2001. Short- and long-term impact of BRCA genetic counselling/testing was determined in women with and without cancer in a randomised controlled trial as part of which women were randomised to either receive immediate versus delayed genetic counselling. This included family communication patterns before BRCA testing, anticipated outcomes of testing on oneself and family including intentions for result disclosure. Comprehension of index and predictive BRCA testing with possible results was assessed both in the short- and the long-term and understanding of individual or family BRCA test results was evaluated at long-term. The effect of genetic counselling on breast cancer risk perception in unaffected women was evaluated. This study considered a theoretical framework of educational learning theories to provide a basis for risk communication with possible relevance for future research. ... Only 25% of the original study population (52/207) reported BRCA results and women's understanding of results is concerning. Key findings were: 1. The majority of affected women received an inconclusive result. 2. Out of twelve unaffected women who reported results, seven were inconclusive which are not congruent with predictive testing. This implies that these women did not understand their test result. 3. A minority of untested relatives did not know whether a family mutation had or had not been found in their tested family member or what their actual test result was. This implies either a lack of disclosure or that woman did not understand the rationale for and significance of testing for a family mutation. 4. Three relatives did not understand a positive result was a mutation. Conclusion: The implication of this research for breast cancer counselling and testing services is that women who wait for counselling are no worse off in terms of short- or long-term general psychological distress than women who receive the intervention early. There is a suggestion that unaffected women without the disease found counselling more advantageous than affected women. The meaning of BRCA results as reported by women is concerning particularly women's understanding of negative and inconclusive results and further research is needed in this area. Too much information presented at counselling may affect women's comprehension of risk, BRCA testing and future test results and further research is required to evaluate the effects of information overload.
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Loncke, Bernadette Serena. "Perceptions and Behaviors of Caribbean and South American Women of Color Living in the United States Towards Breast Cancer." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2295.
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Breast cancer is a global public health issue, and even though the incidence and mortality rates for this disease have declined, a substantial gap in mortality rates between U.S. women of color and European American women remains. Strategies have been initiated to decrease this gap, but they have not addressed the special needs of women of color residing in the United States, who tend to be diagnosed only after they have developed late-stage breast cancer. The purpose of this phenomenological study was to understand the perceptions and behaviors of 20 first-generation Caribbean and South American-born women of color living in Atlanta, Georgia, related to breast cancer awareness, screening, treatment, and follow-up care. Qualitative data analysis was used to identify themes that included, but were not limited to, the role of genes in breast cancer, lifestyle influences and risk of breast cancer, environmental factors, positive perceptions of foods and their impact on breast health, the role of culture on health care decisions, fear of harm from radiation exposure, familial relationships, understanding why they sought screening and/or treatment, and familial health histories and increased risk of breast cancer. The participants' cues to take action were influenced by knowledge, health insurance coverage, confidence, educational attainment, age, income, family support, and self-motivation. Culture, race, or ethnicity had little to no effect on whether the women received breast cancer screening or mammography. The findings could facilitate social change by educating Caribbean and South American women of color in the United States about breast cancer and the need for screening, to reduce the incidence of breast cancer and the mortality rates among the target population and improving their quality of life.
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Martyn, Rebecca. "Illness representations, coping and locus of control in breast cancer : a comparative study amongst South Asian Indian women and white indigenous women." Thesis, University of Leicester, 2002. http://hdl.handle.net/2381/31339.
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This study investigated illness representations for breast cancer amongst a lay population of South Asian and White indigenous women. A comparative correlational design was used to examine illness representations, coping styles and health locus of control in relation to breast cancer. In addition subjects provided information on the levels of breast cancer awareness, levels of early detection behaviour and knowledge of risk factors and treatment. Relationships between the different components of illness representations and their associations with coping, locus of control and level of breast-self examination were explored. The sample comprised 17 South Asian women and 18 White indigenous women. No significant differences were found between groups on level of breast awareness or early detection behaviours. Illness representations for both groups were found to be high on identity, and moderately high on consequence, time-line, cure/control and on risk/treatment. Significant associations were identified for higher scores on cure/control and risk/treatment scales with lower scores on denial, acceptance and venting of emotion coping for the South Asian group. There was a significant correlation between cure/control and level of breast self-examination for the White group. Moderately high scores on cure/control and risk/treatment are encouraging and are tentatively linked to less passive coping styles and higher levels of breast self-examination. Overall, there was a high level of similarity on the measure, and in early detection behaviours for the groups. These similarities may reflect the particular nature of this group of South Asian women. Implications of these findings are that health interventions should focus on raising knowledge for risk factors and treatment, and increasing beliefs in cure and control. Further investigation of illness representations for breast cancer amongst South Asian groups is needed. Age, socio-economic status and degree of acculturation are factors that may be particularly relevant in relation to early detection behaviour and coping styles.
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Araujo, Monica Rodrigues. "Perspectives and Experiences of Individuals Undergoing Predictive Testing for Hereditary Breast and Ovarian Cancer (HBOC) Syndrome in the Western Cape, South Africa." Master's thesis, Faculty of Health Sciences, 2018. http://hdl.handle.net/11427/30057.
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Breast cancer is the most common malignancy affecting females globally. Hereditary breast and ovarian cancer (HBOC) syndrome is caused by pathogenic variants in BRCA1 and BRCA2 and is seen in approximately 50% of families with a strong history of breast and ovarian cancers. Predictive testing (PT) is offered to unaffected individuals with a positive family history of HBOC, with an already identified BRCA1 or BRCA2 mutation in an affected family member. There is an overwhelming amount of research that has focused on the after-effects of diagnostic genetic testing for HBOC but there has been little investigation into how individuals experience the actual PT process. The present study therefore aimed to investigate individuals’ decisions for undergoing and their experiences of PT for HBOC in a local context, by focusing on at-risk South African individuals residing in the Western Cape Province. Sixteen participants were recruited retrospectively from the breast cancer and/or clinical genetics clinics at Groote Schuur Hospital, Tygerberg Hospital and private genetic counselling practices in Cape Town. Semi structured interviews were conducted, and the interview transcripts were analysed using the framework approach for qualitative data analysis. Using this approach, five themes were identified relating to the perspectives and experiences of individuals undergoing PT for HBOC, in selected settings in the Western Cape. While some participants felt that their decision to pursue PT was influenced by their family history of cancer and the associated cancer-related distress, others felt that their decision was made out of a sense of duty to their families or in solidarity with those that were affected or received a positive test result. Overall, the participants felt that the pre-test counselling was beneficial in allowing for an improved understanding of HBOC, however not all participants felt that the pre-test counselling prepared them for receiving their results. Receiving a negative test result was often accompanied by feelings of guilt and did not exempt participants from the fear of developing cancer. Some of the concerns raised by participants that received a positive test result were centred around prophylactic intervention and its effect on body image. Overall, participants felt empowered by their mutation status and felt that they were better able to manage their risk. The need for additional support, both practical and emotional support, was particularly evident amongst mutation-carriers. The findings of this study provide valuable insight into the perspectives and experiences of this population, which could potentially impact the services that are provided to individuals undergoing PT for HBOC in similar settings.
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Chilwesa, Paul Mambwe. "Comparison of 18F-Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (18F-FDG PET/CT) and conventional imaging (CI) for locally advanced breast cancer staging: a prospective study from a tertiary hospital cancer centre in Western Cape." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/31433.
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Background: Breast cancer is the second most common cancer in adults and the most frequent cancer diagnosed in women. In South Africa, breast cancer accounts for 38.5% of cancers diagnosed in women. Since the presence, extent and location of distant metastases is one important prognostic factor in locally advanced breast cancer (LABC), accurate staging at diagnosis is crucial to ensure patients receive the appropriate treatment. Increasing evidence shows that the use of 18F-FDG PET/CT for disease staging of LABC may improve diagnostic sensitivity.
Aim: To prospectively assess the difference in diagnostic accuracy between whole-body PET/PET-CT and conventional imagine (CI) for staging LABC.
Methods: A total of 42 participants with clinical stage III and a select few stage II breast cancer underwent both 18F-FDG PET/CT and CI.
Results: 18F-FDG PET/CT found significantly more (p=0.0077) distant metastatic sites than CI (36% vs. 21%). 18F-FDG PET/CT upstaged 9 (21.4%) of patients from clinical stage IIIa to stage IIIc, and changed management of 54% of patients. Thirty-eight percent (38%) of the patients had their clinical stage unchanged. One of 5 suspected metastatic sites 18F FDG PET/CT was positive for malignancy on biopsy.
Conclusion: The 18F-FDG PET/CT is useful for staging locally advanced non-inflammatory infiltrating ductal carcinoma of the breast. Use of 18F-FDG PET/CT was superior to conventional imaging in assessing metastatic mediastinal lymphadenopathy, but with a poor specificity. The use of 18F-FDG PET/CT in LABC is useful, with the biopsy of isolated suspicious lesions for metastasis increasing its accuracy.
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Grant, Kathleen Ann. "Analysis of the clinical utility of gene expression profiling in relation to conventional prognostic markers in South African patients with breast carcinoma." Thesis, Stellenbosch : Stellenbosch University, 2014. http://hdl.handle.net/10019.1/95824.
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Thesis (PhD)--Stellenbosch University, 2014.ENGLISH ABSTRACT: Breast cancer is a heterogeneous disease characterised by marked inter-individual variability in presentation, prognosis and clinical outcome. The recognition that morphological assessment has limited utility in stratifying patients into prognostic subgroups led to clinico-pathological classification of tumour biology, based on receptor expression using immunohistochemical (IHC) techniques. This standard is currently complemented by the development of gene expression profiling methodology that led to the identification of intrinsic molecular subtypes, reflecting tumour genetics as the true driver of biological activity in breast cancer. The study was based on the hypothesis that molecular classification of breast carcinomas integrated with established clinico-pathological risk factors will improve current diagnostic and risk management algorithms used in clinical decision-making. A pathology-supported genetic testing strategy was used to evaluate microarray-based gene profiling against diagnostic pathology techniques as the current standard. Clinico-pathological factors including age, number of positive axillary nodes, tumour size, grade, proliferation index and hormone receptor status was documented for 141 breast cancer patients (143 tumours) referred for microarray-based gene expression profiling between 2007 and 2014. Subsets of patients were selected from the database based on the inclusion criteria defined for three phases in which the study was performed, in order to determine 1) the percentage of patients stratified as having a low as opposed to high risk of distant recurrence using the 70-gene MammaPrint profile within the inclusion criteria, 2) correlation of HER2 status as determined by IHC and fluorescence in situ hybridisation (FISH) with microarray-based mRNA readout (TargetPrint), and 3) the relationship between hormone receptor determination as reported by standard IHC and molecular subtyping using the 80-gene BluePrint profile. Similar distribution patterns for MammaPrint low- and high-risk profiles were obtained irrespective of whether fresh tumour biopsies or formalin-fixed paraffin embedded (FFPE) tissue was used. During the first phase of the study, 60% of the 106 tumour specimens analysed with MammaPrint were classified as low-risk and 40% as high-risk using a newly-developed MammaPrint pre-screen algorithm (MPA) aimed at cost-saving. In the second phase of the study, performed in 102 breast tumours, discordant or equivocal HER2 results were found in four cases. Reflex testing confirmed the TargetPrint results in discordant cases, achieving 100% concordance regardless of whether fresh tumour or FFPE tissue was used for microarray analysis. For the third phase of the study 74 HER2-negative tumour samples were selected for comparative analysis. Statistically significant positive correlations were found between protein expression (IHC score) and mRNA (TargetPrint) levels for estrogen receptor (ER) (R=0.53, p<0.0001) as well as progesterone receptor (PR) (R=0.62, p<0.0001), while combined ER/PR tumour status was reported concordantly in 82.4% of these tumours. BluePrint was essential for interpretation of these results used in treatment decision-making. The MPA developed in South Africa in 2009 was validated in this study as an appropriate strategy to prevent chemotherapy overtreatment in patients with early-stage breast cancer. The use of microarray-based analysis proved to be a reliable ancillary method of assessing HER2 status in breast cancer patients. Risk reclassification based on the TargetPrint results helped to avoid unnecessary high treatment costs in false-positive cases, in addition to providing potentially life-saving treatment to those for whom it was indicated. While neither IHC nor TargetPrint estimation of intrinsic subtype correlated independently with the molecular subtype as indicated by BluePrint profiling, the ability to distinguish between basal-like and luminal tumours was enhanced when the combined protein and mRNA values was considered. Genomic profiling provided information over and above that obtained from routine clinico-pathological assessments. This finding supports the relevance of a pathology-supported genetic testing approach to breast cancer management, whereby advanced genomic testing is combined with existing clinico-pathological risk stratification methods for improved patient management.
AFRIKAANSE OPSOMMING: Borskanker is „n heterogene siekte wat gekenmerk word deur merkbare inter-individuele variasie in kliniese beeld, prognose en uitkoms. Die beperkings van morfologiese klassifikasie vir identifikasie van prognostiese subgroepe het gelei tot klinies-patologiese tumor karakterisering op grond van reseptor uitdrukking deur gebruik van immunohistochemiese (IHC) toetse. Hierdie standaard word tans gekomplementeer deur ontwikkeling van geenuitdrukking tegnologie wat gelei het tot die identifikasie van intrinsieke molekulêre subtipes, wat die tumor genetika reflekteer as die ware drywer van biologiese aktiwiteit in borskanker. Die huidige studie is gebaseer op die hipotese dat integrasie van die molekulêre klassifikasie van borskanker met konvensionele risiko klassifikasie skemas huidige diagnostiese en behandelings algoritmes kan verbeter vir kliniese besluitneming. „n Patologie-gesteunde strategie is gebruik om mikroplaat-gebaseerde geen profilering te evalueer teen standaard patologie diagnotiese tegnieke. Kliniese-patologiese faktore insluitend ouderdom, aantal positiewe aksillêre limfnodes, tumor grootte, gradering, proliferasie indeks en hormoon reseptor status is gedokumenteer in 141 borskanker pasiente (143 tumore) wat verwys is vir mikroplaat-gebaseerde geenuitdrukking profilering tussen 2007 en 2014. Pasiënt subgroepe is geselekteer uit die databasis volgens die insluitingskriteria soos gedefiniëer in die drie fases waarvolgens hierdie studie uitgevoer is, om vas te stel 1) watter proporsie pasiënte geklassifiseer word as lae- of hoë-risiko vir latere herhaling van die borskanker deur gebruik van die 70-geen MammaPrint profile binne die insluitingskriteria, 2) hoe korreleer HER2 status soos vasgestel deur IHC en fluoreserende in situ hybridisasie (FISH) toetsing met mikroplaat-gebaseerde RNA lesings (TargetPrint), en 3) wat die verwantskap is tussen hormoon reseptor status soos deur standaard IHC gerapporteer en molekulëre klassifikasie volgens die 80-geen BluePrint profiel. Soortgelyke verdelingspatrone vir MammaPrint lae- teenoor hoe-risiko profiele is waargeneem ongeag of vars tumor biopsies of formalien-gefikseerde paraffin bevattende weefsel gebruik is. Tydens die eerste fase van die studie is 60% van die 106 tumore as lae-risiko en 40% as hoë-risiko geklassifiseer met toepassing van die nuwe MammaPrint Presifting Algoritme (MPA) wat ontwikkel is met die doel op kostebesparing. In die tweede fase van die studie waar 102 tumore ingesluit is, het die resultate van vier gevalle verskil van mekaar of was onbepaald ten opsigte van HER2 status. Refleks herevaluering het die TargetPrint resultate bevestig in alle nie-ooreenstemmende gevalle, en 100% ooreenstemming is bereik ongeag of vars tumor biopsies of formalien-gefikseerde paraffin bevattende weefsel gebruik is vir mikroplaat analise. In die derde fase van die studie is 74 HER2-negative tumore selekteer vir vergelykende analise. Statisties beduidende positiewe korrelasies is waargeneem tussen proteïen uitdrukking (IHC) en mRNA (TargetPrint) vlakke vir die estrogeen reseptor (ER) (R=0.53, p<0.0001) sowel as progesteroon reseptor (PR) (R=0.62, p<0.0001), terwyl gekombineerde ER/PR reseptor status ooreenstemming getoon het in 82.4% tumore. BluePrint was noodsaaklik vir die korrekte interpretasie van die resultate wat gebruik is in kliniese besluitneming vir behandeling van pasiënte. The MPA wat in Suid Africa ontwikkel is in 2009, is gedurende hierdie studie bevestig as n toepaslike strategie om onnodige handeling met chemoterapie te voorkom in pasiënte met vroeë stadium borskanker. Die gebruik van mikroplaat-gebaseerde analise is aangetoon as „n betroubare aanvullende metode om HER2 status te evalueer. Risiko herklassifikasie gebaseer op TargetPrint resultate het onnodige hoë behandelingskoste in vals-positiewe gevalle vermy, sowel as om die verskaffing van potensieël lewensreddende behandeling vir die toepaslike pasiënte te verseker. Genomiese profilering het inligting addisioneel tot dit wat met roetine klinies-patologies metodes verkry kan word verskaf. Hierdie bevinding ondersteun die relevansie van „n patologie-gesteunde genetiese toets benadering tot hantering van borskanker, waardeur genomiese toetsing gekombineer word met bestaande klinies-patologiese risiko stratifisering metodes om pasiënt behandeling te verbeter.
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Gerber, Jaclyn. "Cytochrome P450 polymorphisms : relevance in two South African disease populations." Thesis, Stellenbosch : Stellenbosch University, 2003. http://hdl.handle.net/10019.1/53345.
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Thesis (MSc)--Stellenbosch University, 2003.ENGLISH ABSTRACT: With knowledge of the human genome increasing constantly we are continually faced with new and potentially groundbreaking methods for managing, treating and/or identifying diseases and predisposition to diseases and conditions at a genetic level. The human cytochrome P450 (CYP) super-family of genes code for enzymes that can participate in metabolism of drugs and foreign chemicals and in steroid synthesis and metabolism. Mutations in these genes may contribute to clinically relevant diseases. In this study, the effects of mutations within four CYP genes were evaluated in two South African disease groups - variegate porphyria and breast cancer. Variegate porphyria (VP) has an unusually high incidence in South Africa due to the R59W founder mutation in the protoporphyrinogen oxidase (PPOX) gene that causes a disruption in the haem biosynthetic pathway. VP presents with variable clinical symptoms and has a relatively low penetrance. It is expected that environmental factors and modifier genes play a role in the clinical expression of VP. CYP genes are implicated as candidate modifier genes for the expression of VP due to the function they have in metabolising many drugs contraindicated in porphyria patients, and the necessity of haem binding to the apoprotein to produce a functional CYP enzyme. This is the first study to investigate CYPs as possible modifier genes for VP clinical expression. Six CYP polymorphisms (CYPIAlml, CYPIAlm2, CYPIA2 - 734 C>A, CYPIBI 8372 A>C, CYP2D6*3, CYP2D6*4), associated with four CYP loci, were genotyped in a VP population and a suitable control population. The results observed are suggestive of CYPIAlml and CYPIBI playing a role as modifiers for the clinical expression of VP as they were significantly associated (P
AFRIKAANSE OPSOMMING: Met die konstante toename van kennis oor die mensgenoom kom ons voortdurend te staan voor nuwe metodes vir die beheer, behandeling en/of identifikasie van siektes en vatbaarheid vir siektes op 'n genetiese vlak. Die mens sitochroom P450 geensuperfamilie kodeer vir ensieme betrokke in die metabolisme van medisyne en ander chemiese stowwe en steroïed-sintese en -metabolisme. Mutasies in hierdie gene kan 'n bydrae lewer tot kliniese relevante siektes. In hierdie studie is die effek van mutasies in vier sitochroom gene bestudeer in twee Suid-Afrikaanse siekte groepe, variegate porfirie en borskanker. Variegate porfirie (VP) het 'n besonderse hoë frekwensie in Suid-Afrika as gevolg van die R59W stigter-mutasie in die protoporfirinogeen oksidase (PPOX) geen. Hierdie mutasie lei tot 'n versteuring in die heem biosintese padweg. VP presenteer met variërende kliniese simptome en het 'n betreklike lae penetrasie. Daar word vermoed dat omgewingsfaktore en kandidaat modifiserende gene 'n rol speel in die kliniese beeld van VP. Sitochroom P450 gene is geïdentifiseer as kandidaat modifiserende gene as gevolg van hulle rol in die metabolisme van verbode medikasie vir porfirie pasiënte, asook die binding van heem aan die apoproteïen wat noodsaaklik is vir die produksie van funksionele sitochroom P450 ensiem. Hierdie is die eerste studie wat sitochroom P450 gene as moontlike modifiserende gene vir die kliniese uitdrukking van VP ondersoek. Ses sitochroom P450 polimorfismes (CYPIAlml, CYPIAlm2, CYPIA2 -734 C>A, CYPIBI 8372 A>C, CYP2D6*3, CYP2D6*4) is ondersoek in beide 'n VP populasie en 'n geskikte kontrole populasie. Die resultate suggereer 'n rol vir CYPIAlml en CYPIBI in die modifisering van die kliniese uitdrukking van VP aangesien hulle betekenisvolle assosiasie (P
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Mylvaganam, Arunthathi. "Lung cancer risk amongst uranium miners : the Radium Hill study /." Title page, contents and abstract only, 1993. http://web4.library.adelaide.edu.au/theses/09PH/09phm997.pdf.
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Sanderson, Christine. "Feeding the baby : new mothers' experiences of breastfeeding." Title page, table of contents and abstract only, 1998. http://web4.library.adelaide.edu.au/theses/09MPM/09mpms216.pdf.
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Funded by the Primary Health Care Initiatives Program. Bibliography: p. 161-170. This thesis examines the public health of breastfeeding from a feminist perspective, based on a qualitative longitudinal study. From reviewing the history of infant feeding, a number of discourses of breastfeeding are identified and their continuing influence on contemporary thinking is discussed.
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Gibson, Brendan John Joseph, and brendan gibson@health gov au. "From Transfer to Transformation: Rethinking the Relationship between Research and Policy." The Australian National University. National Centre for Epidemiology and Population Health, 2004. http://thesis.anu.edu.au./public/adt-ANU20040528.165124.
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The most common and enduring explanation for the way research is used (or abused or not used) in policy is the two communities theory. According to this theory, the problematic relationship between research and policy is caused by the different cultures inhabited by policy makers and researchers. The most common and enduring types of strategies that are put forward to increase research use in policy involve bridging or linking these two communities. This study challenges this way of thinking about the relationship between research and policy. Four case studies of national public health policy in Australiabreast cancer screening, prostate cancer screening, needle and syringe programs in the community, and needle and syringe programs in prisonsare used to present the context, events, processes, research, and actors involved in policy making. Three theories are deployed to explore the relationship between research and policy in each of the cases individually and across the cases as a whole. These theories bring different determinants and dynamics of the relationship to light and each is at least partially successful in increasing our understanding of the relationship between research and policy. The Advocacy Coalition Framework (ACF) understands the relationship in terms of a power struggle between competing coalitions that use research as a political resource in the policy process. The Policy Making Organisation Framework (PMOF) understands the relationship in terms of institutional and political factors that determine the way data is selected or rejected from the policy process. The Governmentality Framework (GF) understands the relationship in terms of the Foucauldian construct of power/knowledge that is created through discourse, regimes of truth and regimes of practices found in public health policy and research. This study has found that in three of the four case studies, public health policy was strongly influenced by research, the exception being NSP in prisons. In all cases, however, it is not possible to construct a robust and coherent account of the policy process or the policy outcome without considering the multifaceted role of research. When these theories are explored at a more fundamental level they support the argument that when research influences policy it is transformed into knowledge-for-policy by being invested with meaning and power. This process of transformation occurs through social and political action that mobilises ideal structures (such as harm minimisation and the World Health Organisations principles for evaluating screening programs) and material structures (such as medical journals and government advisory bodies) to resolve meta-policy problems (such as how to define complex public health problems in a way that makes them amenable to empirical research and practical action). This study provides good evidence that the notion of research transfer between two communities is a flawed way of understanding the researchpolicy relationship. Rethinking the relationship between research and policy involves building an enhanced theoretical repertoire for understanding this complex social interaction. This step is essential to the success of future efforts to make public health policy that is effective, just and emancipatory. This study makes a contribution to this task.
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Van, der Walt Jacobus Gert. "Radiation field shaping through low temperature thermal-spray in radiotheraphy." Thesis, Bloemfontein : Central University of Technology, Free State, 2009. http://hdl.handle.net/11462/116.
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Thesis (D. Tech.) -- Central University of Technology, Free State, 2009Superficial cancerous lesions are commonly treated through low energy X-ray or electron radiation in radiotherapy. The treatment units that produce the radiation are equipped with square, rectangular and round applicators of different sizes. These applicators attach to the treatment units and define the radiation field size applied during treatment. An applicator is chosen to fit the shape of the cancerous lesion on the patient as closely as possible. Since cancerous lesions are irregular in shape, there will always be an area of healthy tissue between the edge of the lesion and the edge of the standard field shape. This healthy tissue will be irradiated along with the lesion during treatment which is undesirable since the cancer wound heals through reparative growth of the surrounding healthy tissue after treatment. Traditional techniques that were developed to shield this healthy tissue and thus shape the radiation field to the shape of the lesion present various shortcomings. This study introduces a new thermal-spray process for producing radiation field shaping shields which overcomes most of the shortcomings encountered with the traditional field shaping techniques. Since none of the commercially available thermal-spray equipment could be used to produce field shaping shields, new thermal-spray equipment was designed and fabricated tailor made to the application. Different techniques to determine the contours of the treatment area on the patient were investigated. These included a patient contact technique using a plaster bandage impression and a non-contact technique using 3D laser scanning. From the plaster bandage impression a plaster model can be produced onto which a high density low melt material such as Wood’ s alloy can be thermally sprayed to produce a field shaping mask. A model can also be produced from the 3D laser scanning data through laser sintering (LS) in nylon polyamide powder or through computer numerical controlled (CNC) milling in a block of low density polyurethane. The thermal-spray technique was evaluated by comparing the field shaping ability of radiation shields produced through the technique to the field shaping ability of shields produced through the traditional techniques. Radiographic film was used for this purpose and the results are presented in the form of isodensity charts. The required thicknesses of thermal-sprayed field shaping masks to shield radiation of various energies were also determined. The thicknesses were determined through radiation transmission measurements of known thicknesses of sprayed sheets of Wood’ s alloy. X-ray imaging showed that there were no defects present within thermal-sprayed layers of Wood’ s alloy that may negatively affect the shielding ability of masks produced through the technique.
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Seo, Mi Won. "Quand la reconstruction mammaire devient une affaire publique : agir et se mobiliser en tant que patientes atteintes d’un cancer du sein en Corée du Sud (2011-2015)." Thesis, Paris, EHESS, 2020. http://www.theses.fr/2020EHES0063.
Full textAbstract:
En 2012, en Corée du Sud, une association de patientes atteintes d’un cancer du sein organise une grève du silence devant la Cour Constitutionnelle pour dénoncer les inégalités d’accès à la reconstruction mammaire. Cette action collective inédite des patientes revendiquant un meilleur accès à la chirurgie questionne le lien entre l’émancipation et l’action collective. Cette étude examine dans quelle mesure l’action collective et le discours des patientes mobilisées pour revendiquer l'accès à la reconstruction mammaire sont émancipateurs et explore d’autres voies possibles d’émancipation. Cette recherche repose sur une enquête ethnographique réalisée à Seoul pendant 7 mois entre 2013 et 2014 et une intervention sociologique d’une durée de trois mois menée en 2015. L’observation du quotidien des malades s’est déroulée au sein de l’association nationale de patientes et dans un hôpital public. Une soixantaine d'entretiens ont été réalisés avec les femmes et les professionnels qui travaillent auprès de patients atteints d’un cancer (du sein). La thèse rend compte de la manière dont le cancer du sein s’introduit dans l’économie et la politique nationale welfariste tout en étant traversé par les normes sociales. L’analyse révèle les messages véhiculés par les femmes au nom de leur libération. Nous montrons que leurs messages nourrissent les tensions entre les patientes de profils sociodémographiques différents au lieu de les atténuer, tout en favorisant le conformisme aux normes sociales et à la culture biomédicale du cancer. Cette thèse révèle également comment l’expérience du corps des patientes ayant vécu le parcours de soins est à la base de leur capacité d’action face au corps médicalIn 2012, in South Korea, an association of breast cancer patients organized a silence vigil before the Constitutional Court to criticize unequal access to breast reconstruction surgery. This unprecedented collective action by patients demanding better access to health care questions the link between emancipation and collective action. This study examines to what extent the collective action and the discourse of patients mobilized to demand better access to breast reconstruction are emancipatory and explores other possible ways of emancipation.An ethnographic survey was carried out in Seoul for 7 months between 2013 and 2014 and a sociological intervention was put in place for three months in 2015. The observation of patients' daily lives took place in the national patients’ association and in a public hospital. About 60 interviews were conducted with women and professionals who work with (breast) cancer patients.The thesis accounts for the way in which breast cancer is introduced into the national welfarist politics and economy and while being crossed by social norms. The analysis reveals the messages conveyed by women in the name of their liberation. It also shows their messages foster tensions between patients of different socio-demographic profiles rather than attenuating them, while promoting conformity with social norms and the biomedical culture of cancer. The thesis reveals how the experience of the body of patients in the process of care pathway is the basis of their ability to act vis-à-vis the medical profession
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Cheok, Frida. "Participation in mammographic screenings in South Australia / Frida Cheok." Thesis, 1998. http://hdl.handle.net/2440/19292.
Full textAbstract:
Includes bibliographical references (18 leaves).2 v. : ill., maps ; 30 cm.
Examines the factors that predict attendence to mammography screening by comparing various groups of attenders and non-attenders.
Thesis (Ph.D.) -- University of Adelaide, Dept. of Public Health, 1999
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Prodehl, Leanne. "Triple negative breast cancer in South Africa." Thesis, 2016. http://hdl.handle.net/10539/22459.
Full textAbstract:
MBChB FCS (SA) Cert GIT
Department of Surgery
University of the WitwatersrandThere were 275 patients with triple negative breast cancer identified out of 1898 patients (14.4%). The prevalence at Milpark Breast Care Unit was 13.9% and 16.1% at Helen Joseph Hospital. 135 patients were further analysed. Stage at presentation was IIa and IIb in approximately half (47.23%) of the patients. Patients presented with large tumours - 57.78% greater than two centimeters, and lymph node positive disease (55.55%). The majority (72.73%) of patients had high-grade, poorly differentiated tumours. This is consistent with studies showing that triple negative breast cancers present with more advanced tumours. There was a non-significant trend for younger patients to present with more advanced tumours with more aggressive histology. The triple negative breast cancer is challenging to manage due to its lack of response to steroid blockade and lack of biological therapy. This was reflected in the number of patients treated with multimodality therapy. 94.81% of patients had chemotherapy, 59.26% as neoadjuvant and 40.74% as adjuvant treatment. There were 93 (68.89%) patients treated with radiation therapy. There was a recurrence in 22.96% of patients, with preponderance to lymph node and visceral metastases. Recurrences occurred early, the median was 23.1 months and all had occurred within eight years. Younger patients had more recurrences (32.35%) and all occurred within six years. Stage at presentation and lymph node involvement were significantly associated with recurrence. Complete pathological response to neoadjuvant chemotherapy is associated with improved outcomes. The recurrence rate was 1.25% if there was a complete pathological response in both the breast and lymph nodes. The mortality rate was 19.26% and was greater in younger patients, 23.53% for women 40 years old and younger and 31.82% for women 35 years old and younger. Mortality was significantly associated with stage at presentation and lack of surgery but not lymph node positivity. Conclusion The prevalence of triple negative breast cancer in two South African breast care units was similar to some studies but less than studies in West and East Africa. Patients in these units, similar to other units, presented at a more advanced stage and had poorer outcomes than luminal breast cancers. Younger patients showed a trend to more advanced presentation and poorer outcomes than older patients within the triple negative subtype. This suggests than the outcomes of young patients cannot be explained by preponderance to aggressive subtypes alone.
MT2017
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Langa, Bridget Cebisile. "Genomic instability in South African breast cancer patients." 2013. http://hdl.handle.net/11394/3600.
Full textAbstract:
Magister Scientiae (Medical Bioscience) - MSc(MBS)Breast cancer (BC) is one of the most common malignancies in women. Death results from treatment failure and metastatic disease. Thousands of lives might be saved if it was possible to detect and eliminate occult metastatic cells before they become clinically evident. Therefore, there is a critical need to identify new markers to improve treatment options for these patients. Genomic instability is the earliest indication of breast cancer and the use of genomic methodologies is a progress towards early detection and treatment, through the identification of biomarkers that can be translated into novel therapy targets. The interferon regulatory factor-1(IRF-1) gene, localized on chromosome 5q31.1, is believed to act as a tumor suppressor gene in breast cancer. The IRF-1 was found to be inactivated by single nucleotide polymorphism (SNP) in breast cancer suggesting that the loss of its function might be critical to the development of the disease. The phosphatidylinositol 3-kinase (PIK3) signaling pathway mediates key cellular functions and alterations of genes in this pathway, including PIK3CA, serine-threonine protein kinases (AKT1and AKT2), phosphatase and tensin homolog (PTEN), fibroblast growth factor receptor 2 (FGFR2) and ERBB2, whose expression have been demonstrated to be altered in breast cancer patients. In addition, these genes are linked to treatment resistance. vi In this study, we have investigated allelic loss of IRF-1 gene in primary tumors obtained from patients undergoing mastectomy at Groote Schuur hospital (Cape Town, South Africa). These samples were then further analyzed for the DNA copy number changes of specific genes involved in the PIK3/AKT signaling pathway. Statistical analysis has been performed in order to correlate genomic findings with clinical-histopathological and follow up information from the patients and to establish whether these genes can predict prognosis. Our data analysis has indicated that 46 cases (45.5%) out of 101 cases were informative for the IRF-1 dinucleotide marker used for LOH analysis (Figure 3.1). LOH was detected in 23 of these informative cases (23/46; 50%). No statistical significance was found between LOH at the IRF-1 locus and age (≤50 years or >50 years) (P value = 1.0000) and earlier stage (Stages I and II) (P value= 0.4982) based on Fisher’s exact test. Patients presented a high level of DNA copy number changes in genes involved in the PIK3/AKT pathway. The most frequent changes were observed in the PIK3CA and PTEN genes. PIK3CA presented high copy number in 36.8% of the cases. PTEN was observed with low copy number in 47.5% of the cases. This dissertation shows the effectiveness of genomic methodologies as means for the detection of early breast cancer progression in South African women. The PIK 3/AKT genes can validate the usefulness of breast cancer therapies.
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Moodley, Louise Claire. "Existential reflections of South African women with breast cancer." Thesis, 2012. http://hdl.handle.net/10539/11327.
Full textAbstract:
The period following a breast cancer diagnosis has been described as a time of reflection and
inward search for existential meaning. The purpose of this study was to explore how South
African women dealt with suffering, the possibility of death and found meaning in their diagnosis
and ensuing treatment and its termination. This sample comprised of eight South Africa women
between the ages of 30 to 57 years, diagnosed with breast cancer, and who had terminated active
oncology treatment. The design of the study was qualitative. Semi-structured interviews were
utilised to examine the existential issues facing the respondents. The data was analysed using
Patton’s principles of Thematic Content Analysis (1987) which reduced the narratives into three
key themes namely: existential reflections, existential meaning and role of culture. Physical and
emotional suffering was experienced as an outcome of participants’ treatment and ensuing
circumstance. This suffering was understood as the price that one must pay in order to survive
cancer and thus most participants assigned positive connotations to treatment in order to ascribe
meaning. As treatment affected every aspect of participants’ lives, there was a need to greatly
revise and re-evaluate ones’ values and purpose in life. In addition, participants expressed deep
regret and guilt over the manner in which they had lived their lives before their diagnosis. This
seemed to initiate a bargaining process which resulted in more intrinsically fulfilled women.
Participants seemed to engage in many strategies in order to defeat their cancer and continue on
with their lives; these strategies were mainly controlled by hope and positivity. This was greatly
associated with the meaning participants made from their experience. Two predominant elements
were utilised to make meaning: religion and spirituality, and purpose in life. There seemed to be
an interconnectedness between helping others and helping oneself that was derived from
spirituality and religion and ones’ perceived purpose in life. All aspects of meaning making and
adjustment seemed to heavily influence by one’s cultural affiliations and beliefs. From this study,
it is evident that South African women engage in meaning-making activities and successfully
negotiate these in order to achieve meaning and adjustment to having breast cancer. This research
suggests that once a comprehensive understanding is developed of the range of existential
concerns that South African women experience, we will be better able to provide resources that
are more adequately suited to assist with their experienced difficulties and this may result in
improved levels of adjustment and quality of life
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Wang, Shuei-Ming, and 王雪閔. "Genetic polymorphisms associated with breast cancer in south Taiwan." Thesis, 2005. http://ndltd.ncl.edu.tw/handle/62141944979641846335.
Full textAbstract:
碩士國立成功大學
醫學檢驗生物技術學系
93
Breast cancer is the leading cause of cancer mortality among women in Taiwan. More than 45% of inherited breast cancers are caused by mutations in breast cancer susceptibility gene 1/2 (BRCA1/2). In this study, we collected 189 female patients of breast cancer and 421 controls. The single nucleotide polymorphisms in the BRCA2 as well as RAD51 DNA repair genes are examined for their association with familial/sporadic breast cancers by restriction fragment length polymorphism (RFLP) method. In addition, genes involved in the estrogen metabolism play potential role in modulating individual susceptibility to breast cancer and appeared as good candidates for risk factors in the etiology of sporadic breast cancer. To investigate the genetic polymorphisms associated with sporadic breast cancer, the SNPs in xenobiotic metabolism enzyme (XME) genes, which are important for estrogen metabolism, are examined in this study, too. In our study, we found that a large amount of sporadic breast cancer patients have family members that suffer from other types of cancers. To identify the genetic polymorphisms associated with familial predisposition to cancers, the patients with familial histories of various cancers are examined for their genotypes in various XME genes. Results in this study indicate that no significant risk for breast cancer is attributed by BRCA2 N372H and RAD51 g135c in south Taiwan. The BRCA1 185delAG and 5382insC as well as BRCA2 6174delT, the BRCA1/2 hotspot mutations in Ashkenazi Jewishs, were not identified in our subjects. Also, the 10 bp-deletion of BRCA1 intron 7, identified by Li SL et al, was not observed in our study. Mutations in XME genes, especially the GST enzymes, affect the detoxification activities in cells. Levels of variations in XME genes are strongly correlated with breast cancers as well as other types of cancers. Genetic variation in XME genes is a useful marker for familial cancer predisposition.
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Coyne, Jennifer Tressa. "Mammography screening : the role of the fear appeals and message framing, and the application of the health belief model and the extended parallel process model." Thesis, 2011. http://hdl.handle.net/1885/149749.
Full textAbstract:
Breast cancer is a prominent and severe disease affecting Australian women and a decrease in breast cancer mortality rates has been attributed to mammography screening. Phase one of this study tests the application of the Health Belief Model (HBM) with mammography screening behaviour, and further tests the value of an extended HBM involving three additional variables. Phase two of this study tests the Framing Postulate of Prospect Theory and attempts to explain results by using the Extended Parallel Process Model (EPPM) and the HBM. Participants included 269 women aged 50 to 69 years and included women who do, and women who do not, obtain regular mammograms. Participation involved completing an initial survey before reading one of three framed messages randomly assigned, and completing a subsequent survey. Survey items were based on the HBM and the EPPM. Results showed that the basic 4-factor HBM was significantly associated with screening behaviour - despite only one core HBM factor, perceived barriers, having an association on its own. The extended 7-factor HBM was found to be significantly more associated with screening behaviour than the 4-factor HBM. Results of the present study provide support for the use of fear appeals but indicate the HBM does not adequately account for the perceived benefits of the appeals. Results further showed the EPPM accounted for pre-existing screening behaviour, but not for the effects of the fear appeal. Results suggest further clarification is required as to the effects and explanations of fear appeals and message framing in applied settings related to mammography screening.
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McIntyre, Elisabeth. "Creating a breastfeeding friendly environment : a new public health perspective / Elisabeth McIntyre." 1999. http://hdl.handle.net/2440/19631.
Full textAbstract:
Bibliography: leaves 250-267.xx, 267, [90] leaves : ill., map ; 30 cm.
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Aims to develop a model to improve breastfeeding in a low socio-economic area through the development of health promotion strategies to create a supportive environment for breastfeeding.
Thesis (Ph.D.)--University of Adelaide, Dept. of Public Health, 2000?
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McIntyre, Elisabeth. "Creating a breastfeeding friendly environment : a new public health perspective / Elisabeth McIntyre." Thesis, 1999. http://hdl.handle.net/2440/19631.
Full textAbstract:
Bibliography: leaves 250-267.xx, 267, [90] leaves : ill., map ; 30 cm.
Aims to develop a model to improve breastfeeding in a low socio-economic area through the development of health promotion strategies to create a supportive environment for breastfeeding.
Thesis (Ph.D.) -- University of Adelaide, Dept. of Public Health, 2000?
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Bhana-Nathoo, Deepa. "Imaging features of triple negative breast cancer in a tertiary hospital in South Africa." Thesis, 2019. https://hdl.handle.net/10539/28176.
Full textAbstract:
A research report submitted to the Faculty of Health Sciences, University of the
Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of
Master of Medicine in Diagnostic Radiology
Johannesburg, 2019INTRODUCTION Breast cancer is one of the leading causes of cancer deaths worldwide. Triple negative breast Cancer (TNBC) is an aggressive subtype, commonly described as presenting at a younger age, in women of African descent and in low socioeconomic groups. Commonly it demonstrates benign imaging features making diagnosis a challenge. Early detection and treatment is imperative. AIM To determine the common imaging features of TNBC in South Africa. METHOD A retrospective study was conducted at a tertiary institution in South Africa. the study population included all biopsy proven TNBC patients presenting between 01/01/2012 – 30/06/2016. All the initial mammograms were re-read by three independent radiologists using a data collection sheet. Illegible or incomplete reports were excluded from the study. RESULTS In our population, TNBC commonly presented in African women with an average age of 54.2 and range 25-95 years, with 47% being pre-menopausal. Typical mammographic features were an oval (27%) or irregular (27%) shaped mass with well circumscribed margins (33%). Our lesions were much larger than those reported in the literature (1). Global asymmetry and architectural distortion were commonly associated features. On ultrasound, the lesions were mostly irregularly shaped (56%) with spiculated borders (29%) and hypoechoic (80%) with axillary adenopathy (81%). CONCLUSION The majority of our patient population presented with a clinically palpable mass, that was larger and had more aggressive features than usually described in the literature. This can be attributed to delayed presentation, due to numerous factors. In order to improving the detection rate and reduce mortality, education and screening programs play a major role.
E.K. 2019
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Herd, Olivia Jayne. "Analysis of radiosensitivity in South African cervical and breast cancer patients." Thesis, 2015. http://hdl.handle.net/10539/18487.
Full textAbstract:
Introduction: Ionising radiation can cause DNA double strand breaks (DSB), that result in chromosomal aberrations if un- or mis-repaired. Individuals with compromised DNA damage repair mechanisms display increased chromosomal radiosensitivity. The G0-micronucleus assay (MN assay) and the γ-H2AX assay are two assays used in radiobiology to study DNA DSB and repair.
Breast cancer is the leading cancer amongst South African women, with a lifetime risk of 1 in 34. Since most cancer patients in South Africa present with late-stage disease, chemotherapy and radiotherapy are commonly-used treatments. Several international studies have shown breast cancer patients to be more chromosomally radiosensitive than healthy controls. These studies have not been confirmed on a cancer population living in South Africa.
Cervical cancer is the second most common cancer in South Africa; however, it is the leading cancer amongst black women with a lifetime risk of 1/35 compared to 1/82 in white women. Studies show a genetic link to cervical cancer susceptibility and DNA damage repair genes. International studies on radiation-induced DNA damage in lymphocytes of cervical cancer patients remain inconclusive and have never been performed on a South African population. Cervical cancer is caused by infection with the Human Papilloma Virus (HPV). Human Immunodeficiency Virus (HIV), HPV and cervical cancer are epidemiologically linked. Due to the high rate of HIV in South Africa, a significant proportion of cervical cancer patients receiving radiotherapy treatment will be HIV-positive. Studies show an effect of HIV on chromosomal radiosensitivity, however this has not been confirmed on a cancer population. The MN assay on the biopsies and exfoliated cervical cells of cervical cancer
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Kaloianova, Maria Simeonova. "Imaging features of male breast cancer in a South African population." Thesis, 2017. https://hdl.handle.net/10539/24861.
Full textAbstract:
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in Diagnostic Radiology
Johannesburg, 2017.INTRODUCTION: Male breast cancer is a very rare entity, representing less than 1% of all cancers affecting men (1, 2). Only 0.7% of all breast carcinomas are attributed to male breast cancer (3). As a result, there is little published data worldwide and especially from South Africa about the imaging features of breast malignancy in men. This study looked at the mammographic and ultrasound features of male breast cancer in the South African context. AIM: To describe the imaging features of male breast cancer in a South African population. METHOD: The histological reports of all patients who met the inclusion criteria were extracted from the National Health Laboratory Services (NHLS) patient records database and printed. The demographic data was used to trace the relevant diagnostic imaging studies that were performed for each patient. Only the mammography and ultrasound reports were reviewed, images were not re-reviewed. RESULTS: Seventy-six patients between the ages of 31 to 89 with confirmed primary breast malignancy were found in the NHLS database for the predetermined eleven-year period. Only 20 of the 76 had imaging reports available for assessment. Thirty-five percent of malignant lesions demonstrated microcalcifications, while 20% were spiculate, 20% irregular and 25% macrolobulated. On ultrasound, only 35% of lesions were hypoechoic with 20% demonstrating posterior acoustic shadowing. Invasive ductal carcinoma represented 91% of all primary male malignant breast lesions in our study population, with 8% of lesions attributed to invasive papillary carcinoma and only 1% ductal carcinoma in-situ. CONCLUSIONS: Male breast cancer in South Africa is similar to male breast cancer elsewhere, not only on imaging but also on histology and immunohistochemistry.
LG2018
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Muller, Xanthene. "Chromosomal radiosensitivity in South African breast cancer patients before and after radiotherapy." Thesis, 2013. http://hdl.handle.net/10539/12556.
Full textAbstract:
Introduction: Radiosensitivity (RS) of South African women with breast cancer was investigated as it has been studied in European women, but to date this has not been studied in South African women. The micronucleus assay was used to determine the amount of DNA damage on lymphocytes of breast cancer patients.
Materials and Methods: The first component to this study involved the collection of blood samples from breast cancer patients and healthy individuals. For the second component, blood samples from breast cancer patients were collected before and after the completion of radiotherapy (RT). A centromeric micronucleus assay using the Fluorescent in situ Hybridisation (FISH) pancentromeric probe was used to investigate the origin of the micronuclei (MN) and to distinguish between radiation-induced [centromere negative (CM-)] and spontaneous [centromere positive (CM+)] MN.
Results: Micronucleus frequencies were slightly higher in breast cancer patients than those observed in lymphocytes of healthy donors. This was noted for the different radiation doses and indicated a trend towards an enhanced chromosomal radiosensitivity in this cancer population. Results were compared before and after radiotherapy. The micronucleus scores for the 0 Gy (sham irradiated samples) were significantly higher (p < 0.05) post radiotherapy. This is an expected result as ionising radiation causes more damage. However, blood samples from post-therapy patients, were shown to have fewer MN after subsequent in vitro 2 Gy and 4 Gy irradiation respectively. When assessing the centromeric micronucleus assay results, a significantly (p < 0.05) higher number of CM- MN was observed than CM+ MN after RT, thereby indicating that ionising radiation causes more breaks in the chromosomes (clastogenic damage).
Discussion and Conclusion: This study demonstrates that a group of South African breast cancer patients have slightly higher micronucleus frequencies compared to a population of healthy women, indicating a trend towards a higher sensitivity to radiation.
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Reeves, Michelle Diana. "Characterisation of BRCA1 genomic rearrangements in South African breast and/or ovarian cancer families." Diss., 2007. http://hdl.handle.net/2263/29071.
Full textAbstract:
Germ-line mutations within the breast cancer susceptibility genes, BRCA1 and BRCA2 are responsible for inherited susceptibility to breast and ovarian cancer. A wide spectrum of pathogenic mutations has been identified within both genes, but alterations within these genes occur far less frequently than originally believed. A large number of breast cancer families that showed linkage to BRCA1 were not found to carry a pathogenic BRCA1 mutation following the use of “classical” PCR based assays. In 1997, a large genomic rearrangement was reported within BRCA1, using Southern blotting. Numerous groups then employed semi-/quantitative methods to determine the presence and/or frequency of such alterations. This search extended the mutation spectrum of this gene, and to date at least 69 unique rearrangements have been reported. The contribution of these alterations to the burden of breast/ovarian cancer differs greatly between populations ranging from 0% to 36% of all BRCA1 mutations in the Finnish and Dutch populations respectively. Mutation screening has previously indicated that small mutations within the two BRCA genes are responsible for 59% of breast/ovarian cancer susceptibility in South Africa. To determine whether large rearrangements contribute to breast cancer susceptibility in South Africa, 74 BRCA1/2 small mutation negative patients from 58 breast / ovarian cancer families were screened for large intragenic BRCA1 rearrangements using Multiplex Ligation-dependent Probe Amplification (MLPA). In this first study of large genomic rearrangements within BRCA1 in South Africa, three genomic aberrations were detected. A deletion of exon 22 (IVS21-36del510) was identified in a Dutch immigrant. This deletion represents one of the Dutch founder mutations. Both exons 23 and 24 were found deleted in a South African family of Greek ancestry. The breakpoints of this deletion were not characterized. Simultaneous deletions of these two exons (where the breakpoints could not be characterized) have been reported in the Italian and Spanish populations. One of the genomic aberrations detected by MLPA in the present study erroneously appeared as a deletion of exon 18. Sequence analysis of this variant identified it as a single base pair substitution (c.5215G_A). This variant (R1699Q) has been reported previously, but its pathological significance is unconfirmed. In total, two large genomic rearrangements were detected in two families, of which only one is a South African, of Greek ancestry. This indicates that such mutations play a small role (1.75%; 1/57) in familial breast / ovarian cancer in South Africa (Dutch immigrant excluded). No rearrangements were identified in the Afrikaner population, indicating that such mutations do not contribute to the burden of familial breast/ovarian cancer in this population (0/40). The remaining South African breast/ovarian cancer risk may to some extent be explained by large rearrangements within BRCA2, or by mutations in other low penetrance breast cancer susceptibility gene(s). BRCA2 will now be screened by MLPA, followed by mutation screening of genes such as p53 and CHEK2 in high-risk families.Dissertation (MSc)--University of Pretoria, 2011.
Genetics
unrestricted
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Choene, Mpho Susan. "Evaluating the effect of South African Herbal extracts on breast cancer cells." Thesis, 2013. http://hdl.handle.net/10539/12362.
Full textAbstract:
In this research we aimed to investigate the anti-proliferative properties of three South African plants: Kedrostis foetidissima, Euphorbia mauritanica and Elytropappus rhinocerotis against breast cancer cells. This was done on the basis of their documented ethno-medicinal use against cancer and other ailments. The plant extracts were screened for cytotoxicity and pro-apoptotic activity against two breast cancer cell lines MCF-7 and YMB-1. With an IC50 ~ 100 μg/ml, K. foetidissima was the only extract that exhibited significant cytotoxicity on both cell lines, whilst E. mauritanica was cytotoxic to MCF-7 cells only. The cytotoxicity assay was followed by the Annexin-V detection assay to evaluate the occurrence of apoptosis. The results observed suggested that K. foetidissima was inducing significant apoptosis on both YMB-1 and MCF-7 cells, whilst E. mauritanica was inducing significant apoptosis on MCF-7 cells.
Since both K. foetidissima and E. mauritanica crude extracts induced apoptosis to MCF-7 cells, they were selected for gene expression studies on MCF-7 using real-time PCR. This was done with the aim of investigating if these extracts were having an effect on the tumour suppressors p53 and RBBP6, which were shown in previous studies to be deregulated in up to 50% of cancers. From the real-time PCR data we observed no changes in the expression levels of these genes following treatment with the herbal extracts. This may suggest that these plants have an effect on other components of the apoptotic pathway other than the tumour suppressors p53 and RBBP6.
The antiproliferative activity observed whilst treating these particular cell lines with K. foetidissima and E. mauritanica suggests that these South African herbal plants present themselves as potential future cancer therapeutic agents; however, further studies on these herbal plants need to be performed to validate these results.
KEYWORDS: Apoptosis
Breast cancer
Euphorbia mauritanica
Kedrostis foetidissima
p53
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Van, der Wiel Renee. "Unravelling stereotype, unanticipated sociality : breast cancer treatment at a public healthcare facility in post-apartheid Johannesburg." Thesis, 2013. http://hdl.handle.net/10539/13184.
Full textAbstract:
This dissertation presents an ethnographic account of a socially diverse, public breast cancer clinic in Johannesburg. The findings of this qualitative research radically challenge the unproblematised and overdetermined use of the categories of race and gender in existing literature concerning this disease. The growing breast cancer epidemic in South Africa affects all demographic categories of women including young women. Yet, previous research frames this as a racialised and gendered crisis. Black women have been depicted as ignorant “problem patients” who resist biomedical treatment, and all women are described as having a particular relationship to their breasted bodies and a deep fear of mastectomy. Departing from these stereotypes, this ethnography reveals unanticipated data showing, firstly, that race, class, age and level of education did not determine women’s relationship to breast cancer and biomedicine. Secondly, socially diverse women commonly experienced breast cancer as a life-threatening disease that evoked confrontation with existential concerns regarding suffering, death, family, and faith. Due to these commonalities, an intimate and powerful sociality existed amongst women at this clinic. Thirdly, within this sociality, women accepted mastectomy as a necessity in creating a healthy body. Breastlessness was normalised and women generally were reluctant of breast reconstruction, thus destabilising the conceptual relationship between breasts and gender. This dissertation’s deconstruction of the use of hegemonic social categories is a significant intervention in a context where these categories are often viewed as absolute determinants of social and health phenomena, and therefore prompts more nuanced approaches to understanding experiences of illness in post-apartheid South Africa.
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Hadad, Amir Hossein. "CFM : comprehensive fuzzy logic-based modelling algorithm in breast cancer prognosis." Phd thesis, 2010. http://hdl.handle.net/1885/150243.
Full textAbstract:
A novel supervised machine learning algorithm that improves the 1993 Sugeno-Yasukawa (SY) modelling algorithm to produce fuzzy models is presented in this thesis. There have been over 1500 citations of their study, however, there are only a handful of studies done on improving the performance of the SY technique. A modified version of SY modelling algorithm (CFM: Comprehensive Fuzzy Modelling) which produces statistically significant improvements of the original work of SY with regards to classification accuracy is introduced in this thesis. There are several reasons behind the shortcomings of the original work. Firstly, although the modelling technique was novel at the time it was presented, some of the component algorithms used in the technique were basic and now need improvements. Secondly, the algorithm developed for the fine tuning of the initially generated fuzzy models operates in a serial manner. In other words, it fine tunes different parameters of the model one at a time. This is not an effective method compared to parallel fine tuning performed by other algorithms such as a genetic algorithm. Lastly, the SY technique creates a group of intermediate models before creating the final model. In the SY technique, unlike the presented technique, there is no fine tuning of the intermediate models that are the building blocks of the final fuzzy model of the system. By overcoming these problems, the CFM technique achieves better performance. Simulations were performed for benchmark machine learning datasets to evaluate the modelling algorithm. The classification accuracy of the CFM algorithm for these datasets were among the highest compared to the existing studies and improved the SY algorithm results.
As an application area, we have focused on patients' survival classification diagnosed to be affected by breast cancer. For women, breast cancer is the most common cancer and has the highest mortality rate based on a recent survey performed by the Australian Institute of Health and Welfare. Therefore the analysis of prognosis factors and survival classification of breast cancer are of great importance. Two case studies on a breast cancer treatment dataset provided by the Canberra Hospital were performed by employing the CFM algorithm developed in this thesis. This contains over 10 years of follow-up data for 814 breast cancer patients. For these two case studies, the presented fuzzy logic based technique and supervised machine learning techniques were employed for classifying patients into survival categories. In both case studies, the CFM algorithm achieved the highest classification accuracy for survival classification compared to the other machine learning algorithm.
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De, Vos Cheryl Lisa. "Breast cancer in the Ashkenazi Jewish population of South Africa: some psychosocial issues." Thesis, 2014.
Find full textAbstract:
Specific mutations in the breast cancer susceptibility genes 1 and 2 (BRCA1 and BRCA2) have been found to be the cause of breast cancer (BRCA) in about 20% of cases in the Jewish population. Affected women often experience a variety of emotional and social issues, which need to be addressed. The aim o f this study was to investigate some
o f the psychosocial issues associated with BRCA, the knowledge o f and feelings about it,
its treatment and screening strategies, and attitudes to genetic testing in Ashkenazi Jewish women. The subjects were women aged > 18 years with BRCA (30 subjects, Group A),or who had an affected first-degree relative (FDRs) (9 subjects, Group B), or without a family history of BRCA (30 controls, Group C). They were ascertained from the Genetic Counselling files held at the South African Institute for Medical Research (SAIMR), the Medical Oncology Centre o f Rosebank, Johannesburg, the Reach for Recovery organisation, the patient network, or, in the case o f the controls, from the records of the Union of Jewish Women (UJW). A schedule o f questions was specifically constructed (and checked in a pilot study) for use in this study and the Beck Depression Inventory (BDI) was selected to measure depression. A face-to-face interview was conducted with each subject and the schedule and BDI were completed. The average age of the subjects was 57 years, 36 years and 52 years in groups A, B and C respectively. The average age o f Group A subjects at diagnosis was 48.7 years and all had had surgery. The subjects' knowledge of the genetics of BRCA scored between moderate and good. Many Group B subjects overestimated the lifetime risk of developing BRCA. Almos. half (46.7%) the Group A women reported shock as the dominating emotion after diagnosis and they were very concerned that their children would develop the condition (43.3%) or that the cancer would metastasise (26.7%). Only 13 (26.5%) of the medical practitioners involved in the care of the Group A subjects in this study discussed emotional issues with their patients.The group B subjects, after the diagnosis was made in a relative, reported fear of developing BRCA (5), fear o f dying o f the disease (5), and feeling out of control (4).Most subjects (87%) felt that women with BRCA and their relatives would benefit from professional counselling. Less than 25% of subjects in all groups undertook regular breast self-examination (BSE), but one-third of group A subjects discovered a lump themselves.Medical practitioners recommended mammograms in older women to all Group B subjects and most (76%) o f the Group C subjects. However, regular CBE and BSE were only recommended rarely. Half the Group A and Group B subjects stated that they would request genetic testing if it were available locally, mostly to determine whether their children were at risk, or, in the case of FDR's, whether they should improve their vigilance. In order for holistic treatment to be given to affected women and their relatives’ psychosocial and genetic counseling issues should be addressed. Also, the findings suggest that women require further education on the importance o f using available screening strategies for the condition and on the possibility o f genetic testing for BRCA susceptibility in high-risk families. However, such testing needs to be carefully supported and monitored to prevent or ameliorate any adverse psychological or social responses.The study has given an insight into the knowledge of BRCA genetics, the emotional burden, and attitudes to screening and testing possibilities, associated with BRCA in the local Ashkenazi Jewish population.
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Chen, Wenlong. "The molecular aetiology of inherited breast cancer in the South African black population." Thesis, 2016. http://hdl.handle.net/10539/19755.
Full textAbstract:
2015
Dissertation submitted to the Faculty of Health Science, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Master of Science in Medicine.Hereditary breast cancer (HBC), caused by mutations in tumour suppressor genes, has been well studied in Caucasian and Ashkenazi Jewish populations. Little is known about the genetic aetiology or the clinical epidemiology of HBC in African and South African black populations. Founder mutations within specific genes have been described for numerous populations worldwide. In South African black women, breast cancer often presents with early age of onset, rapid progression of disease and adverse histological phenotypes. It is possible that mutations within already described HBC-associated genes account for this phenotype in the South African black population. Genetic mutations within the BRCA1 and BRCA2 genes contribute to the development of breast cancer in high-risk cancer patients internationally. The proportion of breast cancers caused by mutations in the BRCA1 and BRCA2 genes in the local black population is currently not well understood. This study screened 33 South African black women presenting with early onset, high-risk breast cancer, for genetic mutations in the BRCA1 and BRCA2 genes. These individuals were selected on predefined high-risk criteria, including early age of disease onset, family history and cancer histology. Mutation screening was done using bi-directional Sanger sequencing of the exons of both genes, and MLPA analysis. A total of 59 distinct single nucleotide variants were found in the BRCA1 and BRCA2 genes. Three of these variants are pathogenic or likely pathogenic (BRCA1: c.431dupA; BRCA2: c.582G>A & c.7712A>G). Five novel variants with unknown clinical significance were also found (BRCA1: c.3751T>G, c.306A>C, c.5332+78C>T, c.212+66A>G; BRCA2: c.681+10T>G). There is little evidence to suggest that these novel variants are likely to have a functional impact and to be pathogenic. The remaining 51 variants were previously reported. No large gene/exon deletions or duplication mutations were found on MLPA analysis. The allele frequency data of the 51 previously reported variants were compared to the allele frequencies of two separate control groups: an ethnically matched control group (established and investigated in-house by a previous Masters student in the Division) and the 1000 genomes project data. This comparison was done to screen for tag SNPs for future genetic association studies in black South Africans and to evaluate potential background genetic differences within the BRCA genes of different African populations. One allele within the BRCA1 gene occurred at a frequency which was statistically significant as compared to the normal South African black population and one allele within the BRCA2 gene was statistically significant. The two control groups were also compared against each other. The allele frequencies were significantly different between the two control groups, suggesting that other African population groups (1000 genomes project data) do not serve well as control groups for sub-Saharan African populations. Genetic mutations within the BRCA1 and BRCA2 genes account for approximately 10% (3/33) of the breast cancer cases within this high-risk cohort. Thus, the proportion of BRCA mutations contributing to the development of inherited breast cancer in sub-Saharan blacks appears to be in keeping with data reported for other ethnic groups. No evidence of any founder mutation/s was evident, although the sample size tested here was too small to exclude their existence.