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Background: Despite increasing global attention to the national human papillomavirus (HPV) immunization program, this program is controversial in Iran. Evidence indicate that HPV vaccination is not cost-effective in Iran. Using cost-effectiveness analysis for decision-making about public health interventions such as vaccination is debated, because its potential benefits may not fit this framework. Our objective was to evaluate economic effects of HPV vaccination by cost-benefit analysis (CBA). In this case, we used bivalent and quadrivalent in Iran in 2020. Methods: We performed a CBA from a societal perspective. We used two approaches of the vaccine's economic benefit: willingness to pay by discrete choice experiment; and cost of illness. Costs only included the vaccine cost. Results: The cost of two doses of bivalent and quadrivalent vaccines were US $ 29 and US $ 151, respectively (US $1 =IRR 42,000). The benefits of bivalent and quadrivalent vaccines were US $ -432, and US $ 380 per person using willingness to pay approach and they were US $ 7,375 and US $ 6,590 thorough cost-of-illness approach. The cost-benefit ratio (CBR) of bivalent and quadrivalent vaccines was -15.114 and 2.512 by willingness to pay approach, and it was 258.12 and 43.51, by cost of illness approach. Conclusions: This study confirms the benefit of both the national bivalent and quadrivalent vaccination program and provide reliable evidence for policy-makers when programming HPV vaccination.

Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) continues to be a worldwide healthcare problem. While our knowledge of the interaction of cancer and its management with COVID-19 mortality is gradually evolving, there are still many unanswered questions regarding the impact of COVID-19 on cancer and its prognosis. Several factors activated during COVID-19 have been implicated in tumorigenesis and the development of metastasis. Inflammation, hypoxia, reduced levels of angiotensin converting enzyme 2, elevated levels of Interleukin 6 and some other cytokines that are hallmarks of COVID-19 are capable of inducing tumor relapse and metastasis. On the other hand, there are reports that COVID-19 has been associated with cancer cure. Understanding the interaction between COVID-19 and tumor cells is essential for evaluating the potential long-term risks of COVID-19 in cancer patients, and for scheduling necessary preventive and therapeutic interventions. In this review, we briefly overview the potential impacts that COVID-19 might have on tumorigenesis and cancer relapse, as well as the role that COVID-19 might play in cancer remission and cure.

Cancer is one of the important health problems in Iran, which is considered as the third cause of death. Endocrine cancers are rare but mostly curable. Thyroid cancer, the most common endocrine tumors, includes about one percent of malignant cancer. In this study, we examined the 15-year national trend of endocrine cancer incidence in Iranian men and women. The data in each province were evaluated based on age, gender, and cancer type according to International Classification of Disease Codes version 10 (ICD-10) from 2005 to 2020 in Iran. All data were obtained from the reports of the Statistics Center of Iran (SCI), 6 phases of the step-by-step approach to monitoring the risk factors of chronic diseases over 18 years old (STEPs), and 3 periods of the CASPIAN study (survey of non-communicable diseases in childhood and adolescence). Statistical analyzes and graph generation were done using R statistical software. Poisson regression with mixed effects was used for data modeling and incidence rate estimation. The incidence of thyroid gland malignancy is higher in women than in men. On the other hand, the incidence of adrenal gland cancer is slightly higher in men than in women. The same pattern is observed for other endocrine neoplasms and related structures. The incidence rate of these types of cancers has generally increased from 2005 to 2020 in Iran. This increase is more in women than in men. In addition, in the middle of the country, there is a strong region in terms of the occurrence of these types of cancers. The incidence rate in these provinces is relatively higher for both sexes and all studied periods. We conducted a study to observe the changing trends for various types of endocrine cancers over 15 years in men and women. Considering the increasing trend of thyroid cancers in Iran, therefore, creating essential policies for the management of these types of cancers for prevention, rapid diagnosis, and, timely treatment is particularly important.

Background Cancer is a major health problem and cause of mortality worldwide. Despite the prevalence of other cancers in males and females, genital cancers are especially important because of their psychological effects on individuals. Currently, cervical cancer, corpus uteri neoplasm, and ovarian cancer are the most common gynecological cancers in Iran. Prostate cancer has increased in Iranian men in the last decade. Therefore, this study aimed to investigate the 15-year national trend in the incidence of genital cancers in the Iranian population. Methods In this study, we used Iranian cancer registration data collected by the Ministry of Health and Medical Education, demographic information from the reports of the Statistics Center of Iran, STEPs (STEPwise approach to non-communicable diseases risk factor surveillance), and Caspian (childhood and adolescence surveillance and prevention of adult non-communicable disease). A list of potential auxiliary variables and secondary variables at all levels of the province-age-sex were evaluated during the years. We used mixed-effects Poisson regression to model the data and calculate the incidence of each cancer. Results Our results show an enhancement in the outbreak of all types of male cancers, but the most important are prostate (11.46 in 2005 to 25.67 in 2020 per 100,000 males) and testicular cancers (2.39 in 2005 to 5.05 per 100,000 males). As for female cancers, there has been an increase in ovarian and corpus uteri neoplasm incidence with 6.69 and 4.14 incidences per 100,000 females in 2020, making them the most occurring female genital neoplasms. While the occurrence of cervical cancer has decreased over the years (4.65 in 2005 to 3.24 in 2020). In general, the incidence of genital cancers in men and women has amplified in the last 15 years. Conclusions Our study examined the trend of change for each malignant genital neoplasm for 15 years in Iranian men and women in each province. Considering the growing trend of the elderly population in Iran, patient awareness and early screening are essential in reducing mortality and costs imposed on patients and the health care system.

Despite increasing global attention to the national human papillomavirus (HPV) immunization program, this program is controversial in Iran. Evidence indicates that HPV vaccination is not cost-effective in Iran. Using cost-effectiveness analysis for decision-making about public health interventions such as vaccination is controversial because its potential benefits may not fit this framework. This study aimed to evaluate the economic effects of the HPV vaccination by cost-benefit analysis (CBA) using bivalent and quadrivalent in Iran in 2020. We performed a CBA from a societal perspective. We used two approaches of the vaccine's economic benefits: willingness to pay by discrete choice experiment and cost of illness. Costs only included the vaccine cost. The cost of two doses of bivalent and quadrivalent vaccines were US $29 and the US $151, respectively (US $1 = IRR 42,000). The benefits of bivalent and quadrivalent vaccines were US $ - 432, US $380 per person using the willingness to pay approach, and they were US $7375 and US $6590 thorough cost-of-illness approach. The cost-benefit ratio (CBR) of bivalent and quadrivalent vaccines was - 15.11 and 2.51 by the willingness to pay approach, and 258.12 and 43.51 by the cost of illness approach. This study confirms the benefits of the national bivalent and quadrivalent vaccination programs and provides reliable evidence for policy-makers programming HPV vaccination.

Summary Background & aims Malnutrition is prevalent in upper gastrointestinal cancer patients. The purpose of this study was a comprehensive assessment of nutritional status in newly diagnosed patients with esophageal cancer. Methods Newly diagnosed esophageal cancer patients were referred to a chemo-radiation referral center in Mashhad, Iran, between February 2017 to February 2019. Anthropometric indices, a Patient-Generated Subjective Global Assessment (PG-SGA) tool, body composition, dietary intake, nutritional-related complications, and laboratory tests were assessed. Results One hundred and eighty-nine patients with a mean age of 67.1 ± 12 and a male to female ratio of 98 to 91 were included. Ninety-seven (51.3%) of patients had experienced significant weight loss and 56 (29.6%) were underweight at diagnosis. According to PG-SGA, 179 (94.7%) needed nutritional interventions. Reduced muscle mass and low handgrip strength were observed in 70 (39.4%) and 26 (14.4%) of patients, respectively. Inadequate intakes of energy (less than 24 kcal/kg/day) and protein (less than 1.2 g/kg/day) were found in 146 (77.8%) and 171 (91%) patients, respectively. The mean total daily energy and protein intakes of subjects were 943.8 ± 540 kcal/day, and 30.6 ± 21 g/day, respectively. The most common nutritional-related complications were as follows: dysphagia (84.8%), anorexia (31.6%), constipation (62.1%), esophageal pain (48.4%), and dyspepsia (41.1%). Conclusion Our study demonstrated a high prevalence of malnutrition in newly diagnosed esophageal cancer patients. This fact demonstrates the importance of early screening of nutritional status via PG-SGA tool, clinical evaluation, dietary intake evaluations, and laboratory tests, based on which effective nutritional interventions and Symptoms management may be introduced in these patients.

OBJECTIVE: The purpose of this randomized controlled trial study was to assess the effects of medical nutrition therapy (MNT) compared with general nutritional advice (NA) on nutritional status in esophageal cancer (EC) patients during Chemoradiation (CRT). METHOD: The sample includes one hundred newly diagnosed patients with EC. The MNT group received individualized nutritional therapy. The NA group received general nutritional advice at the beginning of the participation. Patient-Generated- Subjective Global Assessment (PG-SGA), anthropometric indices, body composition, dietary intake, laboratory tests, and nutrition-related complications were assessed. RESULTS: Forty-nine cases were in the MNT group. The MNT group had significantly more favorable energy (26.4±14.1 vs. 18.2±11.2 kcal/kgw.day) and protein (1±0.6 vs. 0.7±0.4 g/kgw.day) intake than the NA group at the final evaluation. The PG-SGA score diminished but not significantly in both groups (11±6 vs. 12±6). As compared to the NA group, patients in the MNT group experienced more frequently no weight loss (21% vs. 11%) or mild weight loss (40% vs 35%) during the treatment. Meanwhile, moderate weight loss was more frequently observed in the NA group (26% vs. 44%). In the MNT group, those with severe weight loss had not proper adherence to the nutritional protocol. Mid-upper arm circumference, body composition, laboratory tests, physical performance, and nutrition-related complications were not significantly different between the two groups. CONCLUSION: As compared to general NA, MNT improved energy and macronutrients intake in patients with EC undergoing CRT which resulted in less severe weight loss and potentially better nutritional status.

Background: Malnutrition is prevalent in esophageal cancer patients which affects cancer prognosis. The purpose of this study was a comprehensive assessment of nutritional status during Chemoradiation (CRT). Methods: Newly diagnosed adults with esophageal cancer were recruited for this study. Patient-Generated- Subjective Global Assessment (PG-SGA), anthropometric indices, body composition, dietary intake, laboratory tests, and nutritional-related complications were assessed before, after, and 4 to 6 weeks after CRT. Results: Seventy-one cases were enrolled. The mean age was 66.8±12 years. Patients’ mean weight loss was 2.42±2.4 kilograms during treatment. A significant reduction observed in mean MUAC (26.68±4.9 vs. 25.42±5.1 cm), fat mass percentage (24.11±11.8 vs. 22.8±12.5), fat free mass index (16.87±2.4 vs. 16.47±2.6 kg/m2) and hand grip strength (43.2±19 vs. 36.1±20 kg) during CRT (all p-values

On March 11th 2020, the coronavirus outbreak was declared a pandemic by the WHO. One of the groups that is considered high risk in this pandemic are cancer patients as they are treated with a variety of immune system suppressor treatment modalities and this puts them in a great risk for infectious disease (including COVID-19). Therefore, cancer patients require higher level measures for preventing and treating infectious diseases. furthermore, cancer patients may bear additional risk due to the restriction of access to the routine diagnostic and therapeutic services during such epidemic. Since most of the attention of health systems is towards patients affected with COVID-19, the need for structured and unified approaches to COVID-19 prevention and care specific to cancer patients and cancer centers is felt more than ever. This article provides the recommendations and possible actions that should be considered by patients, their caregivers and families, physician, nurses, managers and staff of medical centers involved in cancer diagnosis and treatment. We pursued two major goals in our recommendations: first, limiting the exposure of cancer patients to medical environments and second, modifying the treatment modalities in a manner that reduces the probability of myelosuppression such as delaying elective diagnostic and therapeutic services, shortening the treatment course, or prolonging the interval between treatment courses.

Objective: Cancer related fatigue is a distressing condition and correlated with decrease in quality of life of patients with malignant conditions. In continuation of our previous research, we assessed long term anti-fatigue effects of melatonin in patients with the breast cancer. Material and methods: In this clinical trial, 92 breast cancer patients were randomly assigned to receive either melatonin (18 mg/day) or placebo from 1 week before the adjuvant treatments until 2 years after their completion. The levels of fatigue were assessed before and after intervention using Brief Fatigue Inventory (BFI) and were compared at a significance level of P ≤ .05. Results: The BFI scores were similar between the 2 groups at the baseline (placebo group: 5.56 ± 1.59 and melatonin group: 5.72 ± 1.68, P = .67). After the intervention, not only the mean fatigue score was significantly lower in melatonin group (2.93 ± 1.04 vs 1.99 ± 1.02, P Conclusion: Long-term usage of melatonin even after completion of adjuvant therapies in women with breast cancer decreased the levels of fatigue associated with the malignant condition and its treatments. The trial registry name and URL, and registration number: Iranian Registry of Clinical Trials, https://en.irct.ir/trial/62267 , IRCT20180426039421N3

Highlights • The relative importance for serious side effects was the highest among all attributes. • Mothers express more WTP for the quadrivalent vaccine compared to bivalent due to its protection against genital warts. • Quadrivalent vaccination could be the most suitable candidate for implementation in the national immunization schedule., This study aimed to identify mothers’ preferences and willingness-to-pay (WTP) for human papillomavirus (HPV) vaccines (in this case, bivalent and quadrivalent) in Iran. We used a discrete choice experiment (DCE) method to present mothers with choices between two hypothetical profiles of vaccines, described by combinations of five attributes, each with two or three levels. We analyzed the DCE results using conditional logistic regression and measured WTP estimates for each attribute. Our response rate was 53.96%, while the completion rate for questioner was 93.57%. We identified protection against cervical cancer, protection against genital warts, protection duration, serious side effects, and cost to influence mothers’ preferences for HPV vaccination. The relative importance for serious side effects was the highest among all attributes. Mothers’ WTP for bivalent and quadrivalent HPV vaccines was in US $ −432 (US $1 = IRR 42,000) and US $ 380, respectively. Quadrivalent vaccination could be the most suitable candidate for implementing the national immunization schedule. The reason is that mothers express more WTP for the quadrivalent vaccine than bivalent due to its protection against genital warts.

Background We aimed to report, for the first time, the results of the Iranian National Population-based Cancer Registry (INPCR) for the year 2014. Methods Total population of Iran in 2014 was 76,639,000. The INPCR covered 30 out of 31 provinces (98% of total population). It registered only cases diagnosed with malignant new primary tumors. The main sources for data collection included pathology center, hospitals as well as death registries. Quality assessment and analysis of data were performed by CanReg-5 software. Age standardized incidence rates (ASR) (per 100,000) were reported at national and subnational levels. Results Overall, 112,131 new cancer cases were registered in INPCR in 2014, of which 60,469 (53.9%) were male. The diagnosis of cancer was made by microscopic confirmation in 76,568 cases (68.28%). The ASRs of all cancers were 177.44 and 141.18 in male and female, respectively. Cancers of the stomach (ASR = 21.24), prostate (18.41) and colorectum (16.57) were the most common cancers in men and the top three cancers in women were malignancies of breast (34.53), colorectum (11.86) and stomach (9.44). The ASR of cervix uteri cancer in women was 1.78. Our findings suggested high incidence of cancers of the esophagus, stomach and lung in North/ North West of Iran. Conclusion Our results showed that Iran is a medium-risk area for incidence of cancers. We found differences in the most common cancers in Iran comparing to those reported for the World. Our results also suggested geographical diversities in incidence rates of cancers in different subdivisions of Iran.

Background: Prostate cancer is the second most common malignancy among Iranian men after stomach cancer. To understand the nature of the disease and plan and develop a population-based cancer registry, it is essential to recognize the clinical and pathological characteristics of the tumors, as well as treatment results. Objectives: The present study aimed to evaluate the clinical and pathological characteristics of prostate cancer and evaluate the routine practice, including treatment outline and results of treatment in six referral centers in Iran. Methods: This prospective observational pilot study recruited patients with prostate cancer between April 2015 and October 2015 at six referral centers in Iran. The participating physicians included consecutive patients according to inclusion criteria. Demographic, clinicopathologic, and treatment data were collected by the physicians using an electronic case report form (eCRF). The patients were followed for 18 months, and during this period, four visits were scheduled for each patient to collect the data. Results: A total number of 102 patients from six centers in five different cities of Iran were included in the study. Sixty-seven (65.7%) patients were diagnosed by needle biopsy as the first diagnostic method, 23 (22.5%) by radical prostatectomy, and 12 (11.8%) by open prostatectomy. Total at-risk times of patients for overall survival (OS) and progression-free survival (PFS) were 1480.9 and 1437 months, respectively. Median (IQR) values of OS and PFS were 18.2 (9.2 - 20.5) and 18.2 (6.8 - 20.4) months, respectively. Forty (39.2%) patients underwent surgery, 58 (56.8%) underwent radiotherapy, and 13 (12.7%) received chemotherapy. Twenty-nine (28.4%) patients experienced adverse events over the follow-up period. Eight deaths were reported that were unrelated to treatment adverse effects. Conclusions: This pilot registry could serve as a valuable tool for the development of a comprehensive nationwide registry for patients with prostate cancer in Iran.

Policymakers require estimates of the future number of cancer patients in order to allocate finite resources to cancer prevention, treatment and palliative care. We examine recent cancer incidence trends in Iran and present predicted incidence rates and new cases for the entire country for the year 2025. We developed a method for approximating population-based incidence from the pathology-based data series available nationally for the years 2008 to 2013, and augmented this with data from the Iranian National Population-based Cancer Registry (INPCR) for the years 2014 to 2016. We fitted time-linear age-period models to the recent incidence trends to quantify the future cancer incidence burden to the year 2025, delineating the contribution of changes due to risk and those due to demographic change. The number of new cancer cases is predicted to increase in Iran from 112 000 recorded cases in 2016 to an estimated 160 000 in 2025, a 42.6 increase, of which 13.9 and 28.7 were attributed to changes in risk and population structure, respectively. In terms of specific cancers, the greatest increases in cases are predicted for thyroid (113.8), prostate (66.7), female breast (63.0) and colorectal cancer (54.1). Breast, colorectal and stomach cancers were the most common cancers in Iran in 2016 and are predicted to remain the leading cancers nationally in 2025. The increasing trends in incidence of most common cancers in Iran reinforce the need for the tailored design and implementation of effective national cancer control programs across the country. © 2021 Union for International Cancer Control.

Background: Despite the genetic test’s benefits in early detection of disease, many people do not have the test performed. This study aimed to systematically review the associated factors with a preference for the gene tests regarding breast cancer. Methods: It was a systematic review study. Data were collected from Scopus, PubMed, Web of Science (WOS), ProQuest, and Embase databases. All full-text English language studies up to 2020 that addressed the preference for the gene screening tests for early detection of breast cancer were included. Data extracted and assessed for quality by two independent reviewers. Disagreements were resolved by a consensus meeting with a third reviewer. The vote counting was determined for identifying the associated factors with the preference.Results: From 1269 initially retrieved citations, 25 studies were included. According to vote counting analysis, age was identified as strongly negative factor while being married, income, family history of breast cancer, personal history or presence of breast cancer, BRCA-related knowledge were identified as strongly positive factors with preference of genetic tests for breast cancer. About 96% of articles were in high quality.Conclusion: There was low evidence in associated factors with a preference on gene tests, especially for psychological factors. So, further research is needed to help policymakers to develop early detection strategies and increase people's participation that leads to the success of the strategies and avoiding the high cost of treatment as well.Systematic review registration: PROSPERO 2020 (ID: CRD42020190811).

Background Nearly 56% of at-risk carriers are not identified and missed as a result of the current family-history (FH) screening for genetic testing. The present study aims to review the economic evaluation studies on BRCA genetic testing strategies for screening and early detection of breast cancer. Methods This systematic literature review is conducted within the Cochrane Library, PubMed, Scopus, Web of Science, ProQuest, and EMBASE databases. In this paper, the relevant published economic evaluation studies are identified by following the standard Cochrane Collaboration methods and adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement reporting some recommendations for articles up to March 2020. Thereafter, the inclusion and exclusion criteria are applied to screen the articles. Disagreements are resolved through a consensus meeting. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist is used in the evaluation of quality. Finally, a narrative synthesis is performed. To compare the different levels of incremental cost-effectiveness ratio (ICER), the net present value is calculated based on a discount rate of 3% in 2019. Results Among 788 initially retrieved citations, 12 studies were included. More than 60% of the studies were originated from high-income countries and were published after 2016. It is noteworthy that most of the studies evaluated the payer perspective. Moreover, the robustness of the results were analyzed through one-way and probabilistic sensitivity analyses in nearly 66% of these studies. Nearly, 25% of the studies are focused and defined population-based and family history BRCA tests as comparators; afterwards, the cost-effectiveness of the former was confirmed. The highest and lowest absolute values for the ICERs were $65,661 and $9 per quality adjusted life years, respectively. All studies met over 70% of the CHEERs criteria checklist, which was considered as 93% of high quality on average as well. Conclusions The genetic BRCA tests for the general population as well as unselected breast cancer patients were cost-effective in high and upper-middle income countries and those with prevalence of gene mutation while population-based genetic tests for low-middle income countries are depended on the price of the tests.

Background and Objectives: As the most common neoplasm among females and the second most common cancer globally, breast cancer imposes enormous costs on health systems. This study aims to estimate levels of breast cancer in Iran and provinces, and examine correlates of incidence of breast cancer, focusing on place of residence, using the most recent nationally available data. Material and Methods: This study is based on a total of 8333 breast cancer cases (259 males and 8074 females) registered by Iran Cancer Registration System during a Persian year (March 21th 2009 through March 20th 2010). Complementary demographic data about the study population was obtained from the 2011 National Census, conducted by Iranian Statistical Center. The Age-Standardized Rate (ASR) of breast cancer was estimated for the overall population, the capital city of provinces, large metropolitan areas, and four categories of provinces located in the north, south, east, west, and center of Iran. Results: Only 3.1% of total 8333 breast cancer patients were men. The mean (SD) age of female and male participants were, respectively, 50.5(12.7) and 56.5 (15.4). The rate of breast cancer for the country was estimated at 33.1 cancers per 100,000 population, and the estimated rates for men and women was are respectively 24.6 and 0.82 per 100,000 population. The incidence of breast cancer in Iran varies from 15 cancers per 100,000 population in urban areas to 34.6 cancers in large metropolitan areas. Also, the estimated rate of breast cancers ranged from 18.1, 19.1 and 19.7 cancers in the west, north, and east of the country, respectively, to 29.3 and 29.7 cancers per 100,000 population in southern and central provinces of Iran. With rising the level of urbanization of provinces, the estimated rate of breast cancer increased (r=0.71, P

One of the health issues related to patients suffering from cancer is paying attention to mental health of the patients and their families. This research was carried out to determine the effect of teaching marital life skills for mastectomy women in the increase of marital satisfaction of this group of patients as well as its direct effect on their spouses’ satisfaction. This was a quasi-experimental research designed as pretest/posttest with random assignment and control group. 22 women suffering from breast cancer, undergoing mastectomy, treated by radiotherapy and having marital satisfaction lower than the moderate level based on the short form (40-question) of the ENRICH (evaluation and nurturing relationship issues, communication and happiness) questionnaire were selected via purposive sampling and divided into experimental and control groups using random assignment. The pretest was carried out on experimental and control groups and the husbands. The intervention was performed during 12 didactic sessions, two a week, for women of the experimental group in the absence of their husbands. Results indicated that the mean score of marital satisfaction in mastectomy women and their husbands in the experimental group was higher than that of the control group, and the difference was statistically significant. In conclusion, the combined intervention method used in this research was effective in increasing marital satisfaction of mastectomy women, and had also a positive effect on their husbands’ marital satisfaction.

Background: Cancer is the first cause of death followed by ischemic heart disease (IHD) and stroke, worldwide, with increasing 19.5% years of life lost (YLL) due to cancer from 2007 to 2017. The cancer burden is steadily increased with decreasing 4.4% death rate from 2007 - 2017. The incidence rate of cancer is twice to 3 times higher in developed countries with low mortality due to care regarding developing countries. Objectives: Here, we report the 10 years’ incidence and mortality of malignancies in Iran with different patterns compared to the other parts of the world. Methods: Data of national cancer registry system from 2005 to 2014 were analyzed in order to find out the trend of age standardized incidence rate (ASIR)/age standardized mortality rate (ASMR)/ mortality to incidence ratio (MIR) in both sexes in Iranian population. Results: Growing trend in ASIR for both sexes in all of the cancers were seen. ASMR decreased from 2005 to 2014 in both sexes with higher rate in males. MIR decreased by half in 2014 compared to 2005 regarding the increase of cancer in Iran. Conclusions: In Iran, the incidence of cancer is increasing due to aging people and death is decreasing due to the good care of patient. So, it is a good sample of developing country, which is comparable with the developed ones.

Background: Breast cancer is the most common cancer in women worldwide with a rising incidence rate in most countries. Considering the increase in life expectancy and change in lifestyle of Iranian women, this study investigated the age-adjusted trend of breast cancer incidence during 2000-2009 and predicted its incidence to 2020. Materials and Methods: The 1997 and 2006 census results were used for the projection of female population by age through the cohort-component method over the studied years. Data from the Iranian cancer registration system were used to calculate the annual incidence rate of breast cancer. The age-adjusted incidence rate was then calculated using the WHO standard population distribution. The five-year-age-specific incidence rates were also obtained for each year and future incidence was determined using the trend analysis method. Annual percentage change (APC) was calculated through the joinpoint regression method. Results: The bias adjusted incidence rate of breast cancer increased from 16.7 per 100,000 women in 2000 to 33.6 per 100,000 women in 2009. The incidence of breast cancer had a growing trend in almost all age groups above 30 years over the studied years. In this period, the age groups of 45-65 years had the highest incidence. Investigation into the joinpoint curve showed that the curve had a steep slope with an APC of 23.4% before the first joinpoint, but became milder after this. From 2005 to 2009, the APC was calculated as 2.7%, through which the incidence of breast cancer in 2020 was predicted as 63.0 per 100,000 women. Conclusions: The age-adjusted incidence rate of breast cancer continues to increas in Iranian women. It is predicted that this trend will continue until 2020. Therefore, it seems necessary to prioritize the prevention, control and care for breast cancer in Iran.

Background: Gastrointestinal tract cancers are among the most common cancers in Iran and comprise approximately 38% of all the reported cases of cancer. This study aimed to describe the epidemiology and to investigate spatial clustering of common cancers of the gastrointestinal tract across the counties of Iran using full Bayesian smoothing and Moran I Index statistics. Materials and Methods: The data of the national registry cancer were used in this study. Besides, indirect standardized rates were calculated for 371 counties of Iranand smoothed using Winbug 1.4 software with a full Bayesian method. Global Moran I and local Moran I were also used to investigate clustering. Results: According to the results, 75,644 new cases of cancer were nationally registered in Iran among which 18,019 cases (23.8%) were esophagus, gastric, colorectal, and liver cancers. The results of Global Moran’s I test were 0.60 (P=0.001), 0.47 (P=0.001), 0.29 (P=0.001), and 0.40 (P=0.001) for esophagus, gastric, colorectal, and liver cancers, respectively. This shows clustering of the four studied cancers in Iran at the national level. Conclusions: High level clustering of the cases was seen in northern, northwestern, western, and northeastern areas for esophagus, gastric, and colorectal cancers. Considering liver cancer, high clustering was observed in some counties in central, northeastern, and southern areas.

Introduction: The first hospital palliative care unit (HPCU) in Iran (FARS-HPCU) has been established in 2008 in the Cancer Institute, which is the largest referral cancer center in the country. We attempted to assess the performance of the HPCU based on a comprehensive conceptual framework. The main aim of this study was to develop a conceptual framework for assessment of the HPCU performances through designing a value chain in line with the goals and the main processes (core and support). Materials and Methods: We collected data from a variety of sources, including international guidelines, international best practices, and expert opinions in the country and compared them with national policies and priorities. We also took into consideration the trend of the HPCU development in the Cancer Institute of Iran. Through benchmarking the gap area with the performance standards, some recommendations for better outcome are proposed. Results: The framework for performance assessment consisted of 154 process indicators (PIs), based on which the main stakeholders of the HPCU (including staff, patients, and families) offered their scoring. The outcome revealed the state of the processes as well as the gaps. Conclusion: Despite a significant improvement in many processes and indicators, more development in the comprehensive and integrative aspects of FARS-HPCU performance is required. Consideration of all supportive and palliative requirements of the patients through interdisciplinary and collaborative approaches is recommended.

OBJECTIVES The aim of this study was to explore the spatial pattern of female breast cancer (BC) incidence at the neighborhood level in Tehran, Iran. METHODS The present study included all registered incident cases of female BC from March 2008 to March 2011. The raw standardized incidence ratio (SIR) of BC for each neighborhood was estimated by comparing observed cases relative to expected cases. The estimated raw SIRs were smoothed by a Besag, York, and Mollie spatial model and the spatial empirical Bayesian method. The purely spatial scan statistic was used to identify spatial clusters. RESULTS There were 4,175 incident BC cases in the study area from 2008 to 2011, of which 3,080 were successfully geocoded to the neighborhood level. Higher than expected rates of BC were found in neighborhoods located in northern and central Tehran, whereas lower rates appeared in southern areas. The most likely cluster of higher than expected BC incidence involved neighborhoods in districts 3 and 6, with an observed-to-expected ratio of 3.92 (p

Background: Breast cancer is the most common cancer among women in Iran. The aim of this study was to explore the spatial autocorrelation and the estimation incidence rates variance among Iranian provinces. Methods: In this cross-sectional exploratory study, age-standardized incidence rates from 2004 to 2010 were analyzed in order to detect hot and cold spots map and estimate the rates using ordinary kriging Results: Mapping of clusters showed that hot and cold spots located in the East and North East regions of Iran. Maps of estimated values for 2004 were between 0.06 - 101.15 and for 2010 between 20.85 - 329.68, which indicate increase in incidence rates, especially in some areas. Conclusions: There are relatively large differences between the geographic distribution of the breast cancer clusters in the East and North East regions of the country in comparison to other areas. Policy makers are advised to consider such provincial diversity for better understanding of factors affecting the incidence of breast cancer.

Objectives: Mastectomy as a treatment for breast cancer can disturb marital satisfaction of many couples. In this way, existential anxieties stemming from this potentially deleterious event, and inefficient responses to them, could be mediating. The purpose of this study is to investigate the effectiveness of a rehabilitation method based on existential approach and Olson's marital enrichment model on marital satisfaction of women who had undergone mastectomy and their husbands . Methods: In this study, a single subject research design is used. The study population comprised couples who had referred to Radiotherapy department of Imam Hussein hospital in Tehran, that among them three couples whose average age was 20 to 50 years old, wife's had undergone mastectomy, tumor has not spread to other parts of the body, and had no prior history of psychiatric disorders before cancer, were selected through purposeful sampling and Intervention in 12 sessions of 90 minutes once a week, has been designed to suit their specific needs. The level of couple's marital satisfaction was evaluated using Dyadic Adjustment Scale. Results: Comparing couple's scores on the diagram during 9 time measurement (3 times baseline, 4 times during intervention, and 2 times follow up assessment) and calculating recovery percentage, represent increasing in score of marital adjustment scale. Discussion: So it seems that, this kind of an eclectic couple therapy, by considering couples existential anxiety, has been promoted their marital satisfaction. Explanations are given in discussion part .

Objective: This study was conducted to improve the body image and self-esteem among breast cancer patients after mastectomy. Materials & Methods: Our study comprised of 23 breast cancer patients in Imam Hossein Hospital, aged between 30-60 years, all of whom had undergone mastectomy and then radiotherapy. The study participants were selected through purposeful sampling and then randomly assigned to the case (10) and control (13) groups. The intervention program (cognitive behavioral group intervention) consisted of 12 sessions of intervention (2 sessions per week) each taking 90 minutes, in a 6 week process. Both group members completed the “body image and relationships scale” and the “Pope self- esteem questionnaire” before and after training. Analysis of covariance to eliminate the pretest effect on posttest results and ANOVA to determine the differences between the groups were used through SPSS 18 in this study. Results: This intervention was significantly effective on improving the mean score of body image and self- esteem in the breast cancer/mastectomy patients of the case group compared to that of the control group (P

Background: It is important to be able to predict cancer incidence and mortality rates for planning and managing the risk factors. Objectives: The present study investigated the changes in the incidence and mortality rates of five most common cancers in Iran. Methods: The cancer incidence and mortality data were obtained from the national cancer and mortality registries. Five most common cancers in both men and women were selected. Changes in the incidence and mortality rates of the selected cancers in both sexes were estimated by age group, annual percent change (APC), and average APC (AAPC) and then graphically displayed. Results: The most common cancers (except skin cancer) were breast, colorectal, stomach, esophageal, and thyroid cancers in women and stomach, prostate, bladder, colorectal, and esophageal cancers in men, respectively. The AAPCs of all cancer incidence rates had increased by 11.9% in men and 11.6% in women from 2002 to 2010. Also, the mortality rates had enhanced by 0.4% and 0.1% per year in men and women from 2006 to 2011, respectively. The greatest APC was reported in prostate cancer. The rate had increased by 41.9% from 2002 to 2004, by 13.4% from 2004 to 2008, and slowly augmented by 3.9% from 2008 to 2010. In women, the greatest APC was observed in colorectal cancer; the rate had enhanced by 13.4% per year from 2002 to 2010. The greatest increase for age-standardized mortality and incidence in 2011 was attributed to gastric cancer (12.5% and 17.1% per 100,000 men, respectively). In women, the highest age-standardized mortality rate was related to gastric cancer at 6.9% per 100,000 women. The incidence and mortality patterns of colorectal and esophageal cancers in men and women were similar, although they were slightly higher in men than women. Conclusions: Overall, cancer incidence rates had increased in both sexes. Many factors were responsible, such as changes in lifestyle, environmental factors, increased life expectancy, improvements in the registration systems, and declining mortality rates due to early detection and treatment. The results of this study provided useful information for the prediction of changes in the incidence and mortality of cancer and subsequent design of cancer control programs in Iran.

Introduction: Cancer Registry is one of the important components of health information systems in developing countries. Continuous monitoring of data quality can have a crucial role in controlling cancers. This study aimed to assess the quality of cancer registry data in terms of completeness of coverage and validity. Methods: Data were collected from three main sources, including Pathology registry, Hospital and national death registries in five provinces in Iran during March 2008-March 2011. We used two source capture-recapture method for estimate of cancer registry coverage and measures of validity were percentage of death certificate only (DCO%), histological verified cases (MV%); cancer incidence in childhood based on sex and age group, percentage of cancer in the elderly (80 years or above) and mortality-to-incidence ratio (M:I).We compared them to international standards. Results: The overall completeness was estimated at 54.2% and 32.4% under reporting for stomach cancer in a period of three years (2008 - 2010). MV% and percentage of unknown primary site of the tumor were 68.7%, and 5% respectively. The mortality-to-incidence ratio for men and women was 37.6% and 28.2%, and percentage of cancer in the elderly was 10.9% in 2010 year. The age-specific rate in girls and boys in age groups of 5 - 9 and 10 - 14 years was lower than minimum of the recommended international standards. Conclusions: The results of this study showed data quality of cancer registry is relatively low in terms of the completeness and validity. Cancer registries should pay great attention to the quality of their data. In addition to technical measures in data processing, continuous evaluation of their quality in order to achieve the set goals is essential.

Completeness is an important indicator of data quality in cancer registry programs. This study aimed to estimate the completeness of registered cases in a population based cancer registry program implemented in five provinces of Iran. Capture-recapture methods were used to esti-mate the number of cases that may have been missed and to estimate rates of completeness for different categories of age, year, and sex. The data used for this study were obtained from three sources: 1) National Pathology Database; 2) National Hospital Discharge Database; and 3) National Death Registry Database. The three sources were linked and duplicates were identified based on first name, last name, father's names, and date of birth, ICD code, and case's residency address using Microsoft Excel. Removing duplicates, the three sources reported a total of 35,643 cases from March 2008 to March 2011. Running many different multivariate models of capture-recapture and controlling for source dependencies revealed an overall under-reporting of 49% in all five registries combined. The estimated completeness differed based on age, sex, and year. The overall completeness was higher for males than females (71.2% for males and 59.9% for females). Younger age had lower rates of completeness compared to older age (38.1% for40 years, 55.4% for 40-60 years, and 76.7 for60 years). The results of this study indicated a moderate to severe (depending on the age, sex and year) degree of completeness in the population based cancer registration of Iran.

Background: There are important differences regarding cancer disclosure in various geographical populations (Europeans, Western Asia, Eastern Asia), depending on multiple sociocultural factors, and therefore, there is no standard protocol on this issue, especially in Iran. Objectives: To evaluate the amount of information that Iranian patients have and their preference for the disclosure of the cancer diagnosis. Patients and Methods: In this cross sectional descriptive research, patients admitted in the oncology departments of 3 referral medical centers, Imam Hussein, Shohada-e-Tajrish and Modarres, in Tehran, from March 2007 to April 2008, were questioned about their awareness and knowledge regarding their diagnosis. Two different structured questionnaires were designed for the people who know and who didn't know their diagnosis. For the former, the survey concerned their psychological reactions to their situations, whether they would prefer to know about their diagnosis and by whom they are preferred to be informed .For the latter, the questionnaire included their preference whether to know the diagnosis and their current emotional state. Descriptive statistics and chi square test was applied to analyze gathering Data, using SPSS version 14. Results: 60.3 of the patients knew their diagnosis. Among the subjects who did not know their diagnosis, 88 preferred to be more informed about their diagnosis and 68 had some psychological reaction to their situations. Among the subjects who knew their diagnosis, 92.1 preferred to know their diagnosis, 73.6 preferred to be informed directly by their physicians. Following the diagnostic disclosure, 81.5 reported that they had felt nervous, anxious and worried. Conclusions: The majority of Iranian patients with malignancy want to know the truth and they prefer to be informed directly by their doctors. © 2015, Mazandaran University of Medical Sciences.

Background Considering the hygiene facilities and sharing the data of diseases, considerable attempts to promote the public awareness have been made by various media; however, most of the provided information is based on numerical and verbal statistics, and may not provide suitable understanding for people in regard with the situation of diseases. Objectives The main aim of this study is to design an interactive WebGIS system in which people could simply produce and observe their favorite maps of different cancers and environmental parameters. They can use this tools to produce their personalized maps and explore various aspects of the cancer. Materials and methods A system has been developed by using WebGIS for convenience of ordinary users without any knowledge about geospatial information system (GIS) to observe the situation of the diseases and environmental conditions in terms of static and user-produced interactive maps. It has also provided the possibility of spatial comparison of the arbitrary parameters in the framework of bar and pie diagrams. This system has been designed and launched on cancer database of Iran where information of meteorological stations has been embedded as environmental parameters. Results The innovative idea in this study has received less attention in previous works including possibility of producing web-based Choropleth map so that users could easily select the parameters and algorithms for classification and interactive coloring in the system to produce their personalized maps. Conclusions Development of WebGIS tools and increased cooperation of people in terms of inserting the spatial labels on the map to report a disease or using their views about reasons of occurring a specific cancer in a specific region may cause turning the process of mono-direction flow of information to users to a bi-directional flow of information. As a result, cancer specialists could use the knowledge of local people and residents of different regions of the country to better analyze the situation of various kinds of cancers.

Iran was engaged in the Program of Action for Cancer Therapy (PACT) in 2012, and delegates from the International Atomic Energy Agency (IAEA), and the World Health Organization (WHO) evaluated the National Cancer Control Program (NCCP) status (the imPACT mission), based on which they provided recommendations for improvements of NCCP in the I.R. of Iran. We reported the results of this situational analysis and discussed the recommendations and their implication in the promotion of NCCP in the I.R. of Iran. International delegates visited the I.R. of Iran and evaluated different aspects and capacities of NCCP in Iran. In addition, a Farsi version of the WHO/IAEA self-assessment tool was completed by local experts and stakeholders, including experts from different departments of the Ministry of Health and Medical Education (MOHME) and representatives from the National Cancer Research Network (NCRN). Following these evaluations, the PACT office provided recommendations for improving the NCCP in Iran. Almost all the recommendations were endorsed by MOHME.The PACT program provided 31 recommendations for improvement of NCCP in Iran in six categories, including planning, cancer registration and information, prevention, early detection, diagnosis and treatment, and palliative care. The most important recommendation was to establish a strong, multi-sectoral NCCP committee and develop an updated national cancer control program.The imPACT mission report provided a comprehensive view about the NCCP status in Iran. An appropriate response to these recommendations and filing the observed gaps will improve the NCCP status in the I.R. of Iran.

OBJECTIVES The main purpose of this study was to evaluate changes in the time trends of stomach, colorectal, and esophageal cancer during the past decade in Iran. METHODS Cancer incidence data for the years 2001 to 2010 were obtained from the cancer registration of the Ministry of Health. All incidence rates were directly age-standardized to the world standard population. In order to identified significant changes in time trends, we performed a joinpoint analysis. The annual percent change (APC) for each segment of the trends was then calculated. RESULTS The incidence of stomach cancer increased from 4.18 and 2.41 per 100,000 population in men and women, respectively, in 2001 to 17.06 (APC, 16.7%) and 8.85 (APC, 16.2%) per 100,000 population in 2010 for men and women, respectively. The corresponding values for colorectal cancer were 2.12 and 2.00 per 100,000 population for men and women, respectively, in 2001 and 11.28 (APC, 20.0%) and 10.33 (APC, 20.0%) per 100,000 in 2010. For esophageal cancer, the corresponding increase was from 3.25 and 2.10 per 100,000 population in 2001 to 5.57 (APC, 12.0%) and 5.62 (APC, 11.2%) per 100,000 population among men and women, respectively. The incidence increased most rapidly for stomach cancer in men and women aged 80 years and older (APC, 23.7% for men; APC, 18.6% for women), for colorectal cancer in men aged 60 to 69 years (APC, 24.2%) and in women aged 50 to 59 years (APC, 25.1%), and for esophageal cancer in men and women aged 80 years and older (APC, 17.5% for men; APC,15.3% for women) over the period of the study. CONCLUSIONS The incidence of gastrointestinal cancer significantly increased during the past decade. Therefore, monitoring the trends of cancer incidence can assist efforts for cancer prevention and control.

BACKGROUND: Breast cancer is the most common cancer among women worldwide. Based on the latest Iranian national cancer department report, the total number of women registered with breast cancer was 6976 cases during 2007. Five year survival is one of the indicators used for evaluation of the quality for care to different types of malignancies including breast cancer. OBJECTIVES: The aim of this study was to estimate survival rate of breast cancer in 6147 Iranian patients at a national level in different geographic regions. MATERIALS AND METHODS: 6147 cases of breast cancer, which had telephone number and were diagnosed between 2001-2006, were called to obtain information about their life status. Survival estimates were calculated using the Kaplan-Meier method, and the survival probability was calculated for the overall cohort and in different categories of gender, age and pathologic type of tumor. Hazard ratios (HR) according to demographic and risk variables were calculated by Cox's proportional hazard model. RESULTS: The overall 5-year survival rate was 71.0%. The mean survival time was different between men and women, which was statistically significant. The number of men involved with breast cancer was 172 (2.8%) of all cases. The 5-year survival rate for patients in age group 41-50 years was significantly higher than other age groups (P = 0.001). The likelihood of death was higher in patients with 61 years old or more years rather than those below forty years old (HR = 1.31; 95% CI: 1.12-1.55). CONCLUSIONS: THE FINDINGS OF THIS STUDY MIGHT HELP IRANIAN HEALTH MANAGERS: 1) to be more conscious about geographical and regional determinants which will affect overall survival rate. 2) To carry preventive activities such as public education particularly in Iranian men. 3) To think about screening and early detection of breast cancer.

Introduction Gastro-Intestinal (GI) cancers are the most common cancer types and leading cause of cancer death in Iran. Genetic abnormalities in TS and ERCC1 have seen in GI cancers frequently and associated to chemotherapy response. The aim of this study was evaluation of TS and ERCC1 abnormalities in Iranian patients with GI cancers and relationship between them and clinical and pathological characteristics. Methods Seventy patients with different type of GI cancers including esophageal, gastric and colorectal cancers were selected. cDNA was derived from paraffin-embedded tumor (FFPE) specimens to determine TS and ERCC1 mRNA expression relative to the beta –actin as a reference gene using fluorescence –based, real-time reverse transcriptase polymerase chain reaction (RT-PCR). Clinical and pathologic factors including age, sex, tumor site, grade, LVI, PNI, T and N staging also were recorded. Results Totally 70 patients with mean age 58.54 (25 to 82) were evaluated that 18 (25.7%) of them were female and 52 (74.3%) were male, also 27 (38.6%) had upper GI (esophago-gastric) and 43 (61.4%) had lower GI (Colorectal) cancer. Most of the patients had advanced T (80%) and LN+ (60%) disease. Frequency of ERCC1+ was 43% that was not significant difference according to upper or lower GI site (44% vs. 42%, p=0.832). Frequency of TS+ was 27% that although had difference according to upper or lower GI site (38% vs. 21%) but it was not significant (p=0.140). Considering TS and ERCC1 together, 33 (47%) were TS and ERCC1 negative, 25 (36%) TS or ERCC1 positive and 12(17%) TS and ERCC1 positive. There was no significant difference based on site between three category (p=0.379). In comparison of TS and ERCC1 with different clinical (age: upper or lower than 59 and sex: male or female) and pathologic (T stage: T1T2 versus T3T4 and N stage: positive or negative) were not found significant differences. Conclusion ERCC abnormalities are more frequent in GI cancer than TS. TS abnormalities in contrast to ERCC1 are detected more in upper GI cancers than lower GI. There is not any correlation between TS and ERCC1 abnormalities and different clinical and pathologic factors.

Objective: Majority of colorectal cancers (CRC) happen via two distinct mechanisms of genomic instability: chromosomal and microsatellite instability. The proportion to which colorectal cancers belong to these pathways is well addressed in literature. However, there is much paucity and controversy regarding this proportion in early onset CRC; therefore, in the present study, major proteins involved in chromosomal and microsatellite instability pathways were determined in 104 early-onset CRC specimens. Materials and Methods: Outcome measures comprised expression of 4 mismatch repair (MMR) proteins (MLH1, MSH2, MSH6, PMS2), and two representative proteins of chromosomal instability pathway (P53 and β-catenin), which were determined by immunohistochemistry. Results: Twenty-nine cases (27.9%) had loss of expression of MMR proteins, of which 17 belonged to MutSα pathway and 12 to MutLα. Four tumors had solitary loss of PMS2. Tumors with abnormal MMR status were more likely to be right sided, and occurred mainly in familial setting ( P P Conclusions: Taken together, our study demonstrated that loss of expression of MMR proteins happens more frequently in early-onset CRC, and on the contrary, the role of CIN pathway is less highlighted at the same time. Moreover, because of its ability to track the losses of expression of PMS2, IHC is recommended for determining the eligibility of mutation analysis of MMR genes, especially in younger ages.