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Abstract Pregnancy‐associated breast cancer (PABC) is a poor prognosis in women, and the mortality rate is higher in this subgroup of patients than in non‐PABC. This study aims to assess clinicopathological and ultrasound features of patients with PABC. Of 75 patients with breast cancer, 31 cases were in lactating, or pregnancy phase and 44 patients had no recent history of pregnancy/lactation at the time of cancer detection. The available pathological characteristics and ultrasound findings of the PABC and non‐PABC groups were compared. The analysis of ultrasound findings demonstrated that the percentages of antiparallel orientation (p = 0.04) and heterogeneous internal echo pattern (p = 0.002) were higher in the PABC group. The final Breast Imaging Reporting and Data System (BI‐RADS) assessment in the two groups was significantly different (p = 0.008). In this study, most PABCs were BI‐RADS 4c or 5; compared with age‐matched non‐PABC cases. There were significant differences in ER (p = 0.03), receptor groups (p = 0.007), and tumor grade (p = 0.02) in PABC compared to non‐PABC group. To conclude, radiologists should be careful about ultrasound findings of PABC and recommend core needle biopsy in suspected cases.

Abstract Background Breast cancer (BC), as the top neoplasm in prevalence and mortality in females, imposes a heavy burden on health systems. Evaluation of quality of care and management of patients with BC and its responsible risk factors was the aim of this study. Methods We retrieved epidemiologic data of BC from the Global Burden of Disease (GBD) 1990–2019 database. Epidemiology and burden of BC and its risk factors were explored besides the Quality of Care Index (QCI) introduced before, to assess the provided care for patients with BC in various scales. Provided care for BC risk factors was investigated by their impact on years of life lost and years lived with disability by a novel risk factor quality index (rQCI). We used the socio‐demographic index (SDI) to compare results in different socio‐economic levels. Results In 2019, 1,977,212 (95% UI: 1,807,615–2,145,215) new cases of BC in females and 25,143 (22,231–27,786) in males was diagnosed and this major cancer caused 688,562 (635,323–739,571) deaths in females and 12,098 (10,693–13,322) deaths in males, globally. The all‐age number of deaths and disability‐adjusted life years attributed to BC risk factors in females had an increasing pattern, with a more prominent pattern in metabolic risks. The global estimated age‐standardized QCI for BC in females in 2019 was 78.7. The estimated QCI was highest in high SDI regions (95.7). The top countries with the highest calculated QCI in 2019 were Iceland (100), Japan (99.8), and Finland (98.8), and the bottom countries were Mozambique (16.0), Somalia (8.2), and Central African Republic (5.3). The global estimated age‐standardized rQCI for females was 82.2 in 2019. Conclusion In spite of the partially restrained burden of BC in recent years, the attributable burden to risk factors has increased remarkably. Countries with higher SDI provided better care regarding both the condition and its responsible risk factors.

Abstract Background Cancer diagnostic probe (CDP) had been developed to detect involved breast cavity side margins in real‐time (Miripour et al. Bioeng Transl Med. e10236.). Here, we presented the results of the in vivo human model CDP studies on non‐neoadjuvant cases. Methods This study is a prospective, blind comparison to a gold standard, and the medical group recruited patients. CDP and frozen data were achieved before the permanent pathology experiment. The main outcome of the study is surgical margin status. From November 2018 to April 2020, 202 patients were registered, and 188 were assigned for the study. Breast‐conserving surgery at any age or gender, re‐surgery due to re‐currency, or involved margins are acceptable. Patients must be non‐neoadjuvant. The reliability of CDP scoring had been evaluated by the pathology of the scored IMs. Then, three models of the study were designed to compare CDP with the frozen sections. Receiver operating characteristic (ROC) curves and AUC were measured based on the permanent postoperative pathology gold standard. Results A matched clinical diagnostic categorization between the pathological results of the tested IMs and response peaks of CDP on 113 cases, was reported (sensitivity = 97%, specificity = 89.3%, accuracy = 92%, positive predictive value (PPV) = 84.2%, and negative predictive value (NPV) = 98%). Study A showed the independent ability of CDP for IM scoring (sensitivity = 80%, specificity = 90%, accuracy = 90%, PPV = 22.2%, and NPV = 99.2%). Study B showed the complementary role of CDP to cover the missed lesions of frozen sections (sensitivity = 93.8%, specificity = 91%, accuracy = 91%, PPV = 55.6%, and NPV = 99.2%). Study C showed the ability of CDP in helping the pathologist to reduce his/her frozen miss judgment (specificity = 92%, accuracy = 93%, PPV = 42.1%, and NPV = 100%). Results were reported based on the post‐surgical permanent pathology gold standard. Conclusion CDP scoring ability in intra‐operative margin detection was verified on non‐neoadjuvant breast cancer patients. Non‐invasive real‐time diagnosis of IMs with pathological values may make CDP a distinct tool with handheld equipment to increase the prognosis of breast cancer patients.

Background The prognostic factors of survival can be accurately identified using data from different health centers, but the structure of multi-center data is heterogeneous due to the treatment of patients in different centers or similar reasons. In survival analysis, the shared frailty model is a common way to analyze multi-center data that assumes all covariates have homogenous effects. We used a censored quantile regression model for clustered survival data to study the impact of prognostic factors on survival time. Methods This multi-center historical cohort study included 1785 participants with breast cancer from four different medical centers. A censored quantile regression model with a gamma distribution for the frailty term was used, and p -value less than 0.05 considered significant. Results The 10 th and 50 th percentiles (95% confidence interval) of survival time were 26.22 (23–28.77) and 235.07 (130–236.55) months, respectively. The effect of metastasis on the 10 th and 50 th percentiles of survival time was 20.67 and 69.73 months, respectively (all p -value

Abstract The Cox proportional hazards model is a widely used statistical method for the censored data that model the hazard rate rather than survival time. To overcome complexity of interpreting hazard ratio, quantile regression was introduced for censored data with more straightforward interpretation. Different methods for analyzing censored data using quantile regression model, have been introduced. The quantile regression approach models the quantile function of failure time and investigates the covariate effects in different quantiles. In this model, the covariate effects can be changed for patients with different risk and is a flexible model for controlling the heterogeneity of covariate effects. We illustrated and compared five methods in quantile regression for right censored data included Portnoy, Wang and Wang, Bottai and Zhang, Yang and De Backer methods. The comparison was made through the use of these methods in modeling the survival time of breast cancer. According to the results of quantile regression models, tumor grade and stage of the disease were identified as significant factors affecting 20th percentile of survival time. In Bottai and Zhang method, 20th percentile of survival time for a case with higher unit of stage decreased about 14 months and 20th percentile of survival time for a case with higher grade decreased about 13 months. The quantile regression models acted the same to determine prognostic factors of breast cancer survival in most of the time. The estimated coefficients of five methods were close to each other for quantiles lower than 0.1 and they were different from quantiles upper than 0.1.

Abstract Endocrine disrupting chemicals (EDCs) are organic compounds that have estrogenic activity and can interfere with the endocrine system. Bisphenol-A (BPA) is one of these compounds which possess a potential risk for breast cancer. The aim of this research was to evaluate BPA concentration in both the urine and breast adipose tissue samples of breast cancer mastectomy and mammoplasty patients and study correlations of BPA levels in breast adipose tissue with urine samples in the both groups. Urine and breast adipose tissue samples from 41 breast cancer mastectomy and 11 mammoplasty patients were taken. BPA concentrations were detected using an ELISA assay. Urinary BPA concentrations were significantly higher in cancerous patients (2.12 ± 1.48 ng/ml; P

Objective:This study aimed to provide further evidence on the accuracy of tumor size estimates and influencing factors.Materials and Methods:In this cross-sectional study, patients with a biopsy-proven diagnosis of breast cancer referred to our hospital to obtain a preoperative magnetic resonance imaging (MRI) between 2015 and 2016 were included. Data from 76 breast cancer patients with 84 lesions were collected. All participants underwent ultrasonography and MRI, and their mammograms (MGMs) were reevaluated for tumor size estimation. Measurements by the three imaging modalities were compared with the pathologically determined tumor size to assess their accuracy. Influencing factors such as surgical management, molecular and histopathological subtypes, and Breast Imaging Reporting and Data System enhancement types in MRI were also assessed.Results:The rates of concordance with the gold standard were 64.3%, 76.2%, and 82.1% for MGM, ultrasound (US), and MRI measurements, respectively. Therefore, the highest concordance rate was observed in MRI-based estimates. Among the discordant cases, US and MGM underestimation were more prevalent (70%); nevertheless, MRI showed significant overestimation (80%). Tumor size estimates in patients whose MRIs presented with either non-mass enhancement [p=0.030; odds ratio (OR)=17.2; 95% confidence interval (CI): 1.3–225.9] or mass lesion with non-mass enhancement (p=0.001; OR=51.0; 95% CI: 5.0–518.4) were more likely to be discordant with pathological measurements compared with those in cases with only mass lesion on their MRIs.Conclusion:MRI was more accurate than either US or MGM in estimating breast tumor size but had the highest overestimation rate. Therefore, caution should be practiced in interpreting data obtained from subjects whose MRIs present with non-mass enhancement or mass lesion with non-mass enhancement.

Abstract Background A higher risk for breast and ovarian cancer has been reported in BRCA carriers and prophylactic surgeries are proposed to reduce this risk. This retrospective cohort study has evaluated the indication of BRCA1/2 genetic tests in Iranian women and the rate of women's acceptance of prophylactic surgeries recommended by the surgeon. Methods Medical records of 147 high‐risk women according to NCCN clinical practice guidelines who referred for BRCA mutations testing were assessed. Individual information, indications for BRCA1/2 genetic testing and their results, physician recommendations, and type of accepted surgery were registered. To evaluate the current status of women an active visit follow‐up every six months was conducted. Results The mean age of women was 43.40 ± 10.94 and the median follow‐up time was 1.92 years. Genetic test results showed 49(33.3%) women were positive for either BRCA1/2 mutations. Although the occurrence of breast cancer younger than 40 was the most common indication for genetic tests (26.5%), positive breast cancer history in first‐degree relatives and two relatives younger than 50 was the most common indications with positive results. The rate of acceptance of prophylactic mastectomy and bilateral salpingo‐oophorectomy was (14.3% and 34.7%) in BRCA mutation carriers. Conclusion If the onset of breast cancer at a young age (less than 40) will be the only indication for a BRCA analysis, the rate of a positive result (12.8%) is very low. Further studies are warranted to evaluate the age limit for genetic testing in our country. Prophylactic mastectomy acceptance is very low in BRCA1/2 carriers in our centers.

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Abstract Background CD44 encoded by a single gene is a cell surface transmembrane glycoprotein. Exon 2 is one of the important exons to bind CD44 protein to hyaluronan. Experimental evidences show that hyaluronan–CD44 interaction intensifies the proliferation, migration, and invasion of breast cancer cells. Therefore, the current study aimed at investigating the association between specific polymorphisms in exon 2 and its flanking region of CD44 with predisposition to breast cancer. Methods In the current study, 175 Iranian female patients with breast cancer and 175 age-matched healthy controls were recruited in biobank, Breast Cancer Research Center, Tehran, Iran. Single nucleotide polymorphisms of CD44 exon 2 and its flanking were analyzed via polymerase chain reaction and gene sequencing techniques. Association between the observed variation with breast cancer risk and clinico-pathological characteristics were studied. Subsequently, bioinformatics analysis was conducted to predict potential exonic splicing enhancer (ESE) motifs changed as the result of a mutation. Results A unique polymorphism of the gene encoding CD44 was identified at position 14 nucleotide upstream of exon 2 (A37692→G) by the sequencing method. The A > G polymorphism exhibited a significant association with higher-grades of breast cancer, although no significant relation was found between this polymorphism and breast cancer risk. Finally, computational analysis revealed that the intronic mutation generated a new consensus-binding motif for the splicing factor, SC35, within intron 1. Conclusions The current study results indicated that A > G polymorphism was associated with breast cancer development; in addition, in silico analysis with ESE finder prediction software showed that the change created a new SC35 binding site.

Background: In March 2020, the World Health Organization declared the novel COVID-19 infection a pandemic. Among high-risk patients infected by the virus, breast cancer patients are vulnerable to present more severe infections. Iran is among the countries with a high incidence of COVID-19 , and most of the routine activities of medical centers are affected by the epidemic disease. Thus, there is a need to make some modifications to international protocols for dealing with breast cancer in the affected countries. Methods: The headings of breast cancer management protocols have been discussed among the university-affiliated professors in different disciplines involved in breast cancer management. The discussions were done through a “WhatsApp” group considering the tiles and the latest news about COVID-19. Under each title, we provide the consensus of all members in the related disciplines. Recommendations and Conclusion: In each specialty, all members agreed to choose minimal intervention. The modifications aim to reduce the workload of the medical centers as well as to provide the least interface of the patients with the medical centers. The members know that some recommendations may interfere with the routine best-practice recommendations and decrease the quality measures in the patient's outcome. Therefore, these recommendations are valid just in epidemic COVID-19 situation in the country.

Background: This study aimed to translate and validate the Fear of Cancer Recurrence Inventory (FCRI) questionnaire into Persian and to investigate its psychometric properties. Methods: The FCRI was translated to Persian using a linguistic methodology according to WHO guidelines. A total of 450 breast cancer survivors who had the following inclusion criteria were included: time elapse of more than six months after the treatment prior to the study; absence ofobjective markers of recurrence, fluency in the Persian language, and signing the informed consent. Internal consistency was estimated with Cronbach's ? coefficient and test-retest reliability with Interclass correlation. Concurrent validity was estimated through Pearson’s correlation between the FCRI and Hospital Anxiety and Depression Scale (HADS). Principal component analysis (PCA) and confirmatory factor analysis (CFA) were employed to evaluate dimensionality. Results: The Persian version was acceptable for patients. The content validity index (CVI) was 0.80. The instrument had good test-retest reliability (ICC= 0.96) and internal consistency (Cronbach’s ?=0.86). PCA and CFA indicated that the factor structure of the Persian version was similar to the original questionnaire and had acceptable goodness of fit. Correlations between the FCRI and HADS was remarkable (r= 0.252 – 0.639), indicating acceptable concurrent validity. Conclusions: The Persian version of FCRI could be considered a good cross-cultural equivalent for the original English version. The questionnaire was a reliable and valid instrument in terms of internal consistency, test-retest reliability, and dimensionality.

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Background: Using data from different health centers can provide more accurate knowledge of the survival prognostic factors and their effect on the patient’s survival. In this multicenter study, we aimed to investigate the role of prognostic factors on breast cancer survival with large data set. Methods: This historical cohort study was carried out using data from 1785 participants with breast cancer. Data were gathered from medical records of patients referring to 4 breast cancer research centers in Tehran, Iran, between 1997 and 2013. Age at diagnosis (year), size of the tumor, involve lymph nodes, tumor grade, type of surgery, auxiliary treatment of chemotherapy, radiotherapy, recurrence, and metastasis were the prognosis factors considered in this study. A shared frailty model with a gamma distribution for frailty term was used. Results: The median follow-up period was 29.71 months with the interquartile range of 19 to 61 months. During the follow-up period, 337 (18.9%) patients died from breast cancer and 1448 (81.1%) survived. The 1-, 3-, 5-, and 10-year survival rates were 96%, 84%, 76%, and 58%, respectively. In the Cox model by centers, in Center A, the type of surgery, number of nodes involved, and the grade 3 tumor; in center B, age, radiotherapy, metastasis, and between 1 and 3 involved nodes; in center C, age, radiotherapy, recurrence, metastasis, tumor size, and grade 3 tumor; and in center D, chemotherapy, metastasis, and lymph nodes involved were significant. Shared frailty model showed that type of surgery, number of lymph nodes involved, metastasis, radiotherapy, and the tumor grade are the prognostic factors survival in breast cancer. The frailty variance was significant, and it affirmed there was significant variability between centers. Conclusions: This study showed it is necessary to consider the frailty term in modeling multicenter survival studies and confirmed the importance of early diagnosis of cancer before the involvement of lymph nodes and the onset of metastasis and timely treatment could lead to longer life and increased quality of life for patients.

Background: Telling bad news to the patients after a diagnosis of breast cancer is one of the most important duties of a physician. The aim of this study was to explore breast cancer patient's preferences regarding how to receive bad news. Methods: A group of 15 women with breast cancer were purposively recruited to this qualitative study. Semi-structured in-depth interviews were conducted to identify the patients' preferences through content analysis. Results: The age of participants ranged between 28 and 58 years. Nine patients had undergone mastectomy and the remaining 6 had received conservative surgery. The minimum time between the diagnosis and receiving the news of cancer was 1 month, the maximum 15. Altogether, 250 codes were extracted after content analysis and categorized into 7 categories and 43 subcategories. The main categories were the method of disclosure of bad news, medical information, communication skills, emotional support, family involvement, the setting, psycho-spiritual care, and the word “cancer.” Conclusion: Knowing about patients' preferences regarding the methods of breast cancer diagnosis disclosure can help physicians to effectively deliver bad news. Therefore, it is necessary that the clinicians be informed about the themes that the patients consider important while delivering bad news to patients.

Background: Although various Oncoplastic Breast Surgery (OBS) techniques have been introduced for various sizes of the breast and locations of tumors , surgeons are still faced with serious challenges for the tumors which have developed in special anatomic parts of the breast. A good instance of these challenges is with the tumors located far from the Nipple Areola Complex (NAC) especially in the upper inner quadrant. We aimed to assess the application of the newly introduced OBS technique (Cross Technique) for tumors in these locations. Methods: The data of 95 patients who were suffering from breast cancer and operated with the Cross method were assessed in this prospective survey. Data was gathered regarding demographic variables, the size, location, and pathologic characteristics of tumors as well as the patients' BMI, breast circumference, and cup size. The patients were recruited to the study according to the inclusion and exclusion criteria and the study protocol which was approved by the research deputy surgery department in Tehran University of Medical Sciences. The data was then presented in a descriptive method. Results: Nighty-five patients underwent oncoplastic breast surgery using the Cross method in a span of time from November 2015 to May 2018. The patients had a mean age of 48.2 (ranging from 25 to 70 years) as well as ta wide range of breast circumferences and cup sizes (70 to 95 for the breast circumferences and A to E for the cup size). Clear surgical margins were obtained in 93 cases according to the permanent pathology reports. Complications were seen in 5 patients (2 slight hematoma and three ischemic skin flaps) all of which were managed conservatively. The most common histologic types of tumors were insitu and invasive ductal carcinoma (DCIS-IDC). The mean tumor size was 22.7 mm with a standard deviation of 9.2mm and most of the tumors were positive for estrogen receptor (ER)/progesterone receptor (PR). In the surgery of axilla, an average of six lymph nodes were excised while 22 patients were found out to have axillary lymph node involvement. Conclusion: Not only is the Cross method is not only a reliable choice for tumors located in the upper inner quadrant (UIQ), but it can also be applied safely for the tumors in upper outer quadrant (UOQ) and upper central part of the breast, although the best application for the technique is the tumors located far from the nipple areola complex.

Summary:. Breast surgery was revolutionized with the use of oncoplastic reshaping techniques minimizing breast deformities and esthetic complications. However, the application of the current oncoplastic techniques becomes challenging in some situations such as small-size breasts and when the tumors are located in special locations of the breast, for example, upper inner quadrant. In this article, an optimized oncoplastic technique named the “Cross” technique is introduced to overcome the abovementioned problems in the surgery of breast tumors located in the upper inner quadrant far from the center of the breast. Nineteen oncoplastic surgeries were performed by the same breast surgeon. The mean diameter and weight of the excised specimens were 20 mm and 74 g. The mean age of the patients was 51 years. Clear surgical margins were obtained in all patients. There was no marked deformity in the breast after surgery. The optimized technique produced promising results in our hands when applied to a selected group of patients. Moreover, the technique was found to reduce the need for revision surgery in ptotic breasts, as the alteration in the shape of the breast undergoing surgery is not significant enough to introduce asymmetry to the breasts.

Background: Breast cancer is considered a chronic disease owing to the increases in survival rate. Thus, better body image and patient satisfaction with the surgery have become more important factors to be considered when choosing the surgical approach. The aim of this study was to compare body image and patient satisfaction following three different approaches. Methods: We evaluated 183 consecutive patients who had undergone three different surgeries including breast-conserving surgery (BCS), mastectomy, or mastectomy followed by reconstruction (M-R). Body image was evaluated using the BICI questionnaire, and patient satisfaction was rated using a multiple-choice question and a scale ranging from 1 to 10. Results: A significantly better body image was observed in the M-R and BCS groups compared with mastectomy (P = 0.02). In body image subscale analysis, social functioning scores were higher in the M-R and BCS groups than in the mastectomy group (P = 0.01), but no differences were obtained between surgery groups in appearance dissatisfaction subscale. Patients were more satisfied with BCS than the other two surgeries (P = 0.008). Conclusion: Based on the results of this study, it could be proposed that both oncoplastic BCS and implant reconstruction could provide patients with acceptable body image, while BCS could bring about better satisfaction with the surgery. Reconstruction may be an alternative for the patients to improve body image and satisfaction when BCS is not applicable.

Background: Warfarin induced breast necrosis is a rare complication of oral anticoagulant therapy. Although it can be related to protein C, S, and antithrombin III deficiency; the pathogenesis of necrosis is still unknown. Case presentation: We report a case of a 38-year-old woman with extensive left breast necrosis after receiving warfarin for treatment of deep vein thrombosis. Simple mastectomy was performed and the wound was closed secondarily with an abdominal advancement flap. Rivaroxaban was prescribed after discontinuation of warfarin. Conclusion: Although breast necrosis following warfarin usage is uncommon, it should be considered in women presenting with breast symptoms after initiation of warfarin. Early diagnosis and appropriate management are essential to prevent extensive loss of breast tissue.

Background: Women with atypical hyperplasia are about 4 times more likely to develop breast cancer compared with the general population. Atypical hyperplasia has been recommended to be used as a criterion for the inclusion of women in chemoprevention programs. Chemoprevention offers promise as a strategy for reducing the incidence of breast cancer in high-risk population. Methods: A literature search was conducted in PubMed and Scopus databases using the search terms “breast atypia,” “chemoprevention,” and “risk-reducing therapy” for papers published from 1966 to Aug 2017. The search was limited to English-language papers and human studies. It yielded 114 search items. Article selection for possible inclusion was performed using the title and abstract. Finally, 12 studies were identified as eligible for inclusion in the review. Results: The rates of atypical ductal hyperplasia (ADH) ranged from a low of 2 per 10000 mammograms in 1995 to a high of 6 per 10000 mammograms in 2011. Lobular neoplasia was an incidental finding in 0.5%–3.5% of core biopsies. True incidence of lobular neoplasia is unknown. Women with atypical breast lesions have a 5%–11% risk of developing breast cancer within 5 years and a 17%–26% risk of developing breast cancer within 10 years. The reported risk of breast cancer with atypical hyperplasia (ADH and ALH are often grouped together) is approximately 19% within 15 years. It is believed that the initiation of chemoprevention would be appropriate if the 10-year breast cancer risk is 4% to 8%. Breast cancer risk reduction by chemoprevention is reported to be 32% to 55% in breast atypia. Conclusion: According to our findings, patients with a diagnosis of ADH, ALH, or severe ADH should be considered for chemoprevention if they are at least 35 years of age and have no contraindications to treatment. Only 4%–20% of high-risk women decide to take chemoprevention, on average.

Background: Despite being a frequent plastic surgery complaint, the causes and predisposing factors for breast ptosis have not been studied profoundly. Studying ptosis causative factors will improve prevention, patient select and education, surgical outcome, and patient education. The present study aims to demonstrate the potential predisposing factors for breast ptosis. Methods: In a 6-month study was conducted at the research department of Kaviani Breast Diseases Institute, Tehran, Iran, all female patients referring to the breast clinic were assessed. Patients with a background of severe comorbidities, history of breast surgery, and breast cancer were excluded. Data on demographic characteristics, current and past medical history, physical examination, and ptosis presence grade were collected. Results: A total number of 141 patients, with the mean age of 35.8 years, were included. About 72% of the patients had varying grades of breast ptosis. Patients with ptosis tended to be of older age, weight, BMI, and brassiere size, were more likely to be menopausal, and had begun wearing brassiere at younger ages. The ordinal model revealed an association between ptosis and age, age at wearing brassiere, current breast size, and smaller cup size in patients. Conclusion: We suggest age and breast size as the predisposing factors for breast ptosis. In our study, there was no relation between breast ptosis and history of lactation or the number of pregnancies. The effects of hormonal and menstrual status, as well as drinking and smoking habits, need to be investigated further.

Background: Physicians’ beliefs about disclosure manner and their ethical attitude for telling the truth is an important issue in patient-physician interaction. The aim of this study was to examine clinicians’ practice and perception of disclosure models for giving bad news to breast cancer patients. Methods: Participants (n = 207, age 21–61 years, mean work experience = 4.03 ± 6 years) working in different medical centers in Tehran, Iran, were recruited by purposive sampling method. They completed clinicians’ attitude and practice of Breaking Bad News (BBN) scales. Psychometric properties (reliability and validity) of these scales were approved. Results: Clinicians’ practice differed significantly by their perception of disclosure model for giving bad news. Furthermore, difference in clinicians’ practice and perception of disclosure model for BBN was observed for age, gender, medical work experience in oncology setting, and receiving special training. Finally, clinicians’ perception of disclosure model for BBN (Adj. R2 = 0.32), age (Adj. R2 = 0.17), gender (Adj. R2 = 0.11), and receiving special training for giving bad news (Adj. R2 = 0.09) positively predicted their practice of BBN. Conclusion: Findings of the study point to the importance of the clinicians’ perception of disclosure model for giving bad news and transcultural variables as factors affecting their practice. Therefore, it seems necessary to incorporate special BBN trainings and protocols culturally adapted to the Iranian society in educational curricula of medical specialties in breast cancer setting.

Background: Adenoid cystic carcinoma (AdCC) of the breast is a rare type of invasive breast cancer, accounting for less than 1% of all breast cancer cases. It is usually a low-grade tumor that rarely metastasizes to the axillary lymph nodes and distant organs. AdCC of the breast is mostly negative for estrogen receptor, progesterone receptor, and HER2-neu. However, despite being triple-negative, it has favorable outcome, and patients with AdCC of the breast generally have a good to excellent long-term survival. Case presentation: Here we report a case of a 51-year-old female presenting with left breast mastalgia who was finally diagnosed with AdCC of the left breast. The patient underwent breast?conserving surgery and axillary staging followed by adjuvant chemoradiation. Conclusion: Because of the rarity of AdCC of the breast, it has been difficult to conduct prospective trials to determine the best treatment option. Different types of therapy, including BCS and mastectomy with or without axillary staging with or without adjuvant chemoradiation have been reported, all with overall good to excellent long-term results. Prospective controlled trials will help in determining the best treatment.

Background: Breast cancer is the most prevalent site-specific cancer and one of the most frequent causes of cancer death in women worldwide. Neoadjuvant chemotherapy, along with surgical treatment—breast conserving surgery (BCS) or mastectomy—is an important part of treatment for locally advanced breast cancer. As BCS is preferred to mastectomy in terms of cosmetic, quality-of-life, and functional outcomes, it would be the preferred treatment for locally advanced breast cancer (LABC), if its oncological safety is confirmed. Methods: In this study, we retrospectively compared the oncologic outcomes of post-neoadjuvant chemotherapy BCS with mastectomy in 202 patients with LABC. Results: There were no significant differences between BCS and mastectomy regarding overall survival, local recurrence, contralateral breast cancer, and distant metastasis. Conclusions: Our study showed that post-neoadjuvant chemotherapy BCS is an oncologically safe surgical treatment in LABC and that BCS can be considered as an acceptable treatment in selected patients with LABC.

Background: The AJCC pN-staging system is the current risk stratification strategy for axillary nodal staging in most cancer centers. Recently, another staging system named "Lymph Node Ratio" or LNR has been developed and also postulated to have prognostic value. Precise prognostication of breast cancer by these two systems has multiple methodological dilemmas which are overlooked in the literature and still remain matters of debate. Methods: These two issues are categorized into seven queries, including: the number of nodes considered adequate for proper axillary staging; attitude toward Z-0011 trial; impacts of neo-adjuvant therapies; the origin and evolution of stratification cutoffs; the position where patients without axillary involvement should be placed; role of diverse endpoints in survival definition, outcome analyses and prognosis prediction; and ultimately the current opinion regarding the superiority between the two systems. This review sought to explore these topics through analysis of 58 recently published articles found by MEDLINE search. Results: The analysis revealed that precise prognostication by pN-staging system requires at least 10 excised-nodes, but LNR system minimally depends on the quantity of excised-nodes. Adhering to Z-0011 trial findings obstructs the provision of sufficient nodes for pN-staging. Neo-adjuvant chemotherapy alters the axillary nodal climate and therefore disrupts proper axillary staging. Cutoffs of LNR system have a more clear history of formation than the pN-staging's. Breast cancer-specific survival is the type of survival better portraying cancer-related events. Conclusions: LNR system seems at least as accurate as pN-staging in prognostication of breast cancer patients.

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Background: Evidence on physicians' attitude toward conflict of interest is scant on a global scale and almost non-existent in a regional/national scale. This investigation is a pioneer to evaluate this issue in the Middle East and Iran. Methods: We invited physicians of different (sub)specialties/educational levels who were engaged in breast cancer management to take an online 13-question survey regarding their attitude toward different statements on conflict of interest. The responses were then collected and analyzed. Results: The questionnaire was returned by 91 out of 157 recipients (response rate = 57.9%). Based on the answers, advertisement by pharmaceutical sales representatives in academia was considered inappropriate (63.8%) and influential on clinical practice (80.2%). It was the belief of 59.4% of participants that local practice norms defined whether or not to accept travel grants. According to these norms, they might have accepted paid travels (53.9%), but not financial offers (72.2%). It was acceptable to deliver (74.8%) or attend (68.9%) a speech when a financial/scientific relationship with industrial companies existed and 93.4% believed that the disclosure and transparency rules should be respected in such situations. Physician-industry financial contracts were generally unfavorable (60.5%), especially when it came to prescribing a drug among other equally effective choices (71.1%). The majority of respondents (92.3%) stated that they would choose the best approach for the patients regardless of possible prejudgments on conflict of interest. Conclusion: The observed variation in physicians' standpoints highlights the necessity for more comprehensive training and implementation of rigorous protocols regarding conflict of interest.

Background: Self-efficacy is a psychological source for helping patients adjust with breast cancer. The aim of the present review was to synthesize the studies on self-efficacy of women with breast cancer, to determine important factors affecting the perception of self-efficacy in breast cancer as well as to describe the role of self-efficacy in the breast cancer. Methods: "Self-Efficacy (SE), Cancer-Related Self-Efficacy, Symptom-Management Self-Efficacy, Women, Breast Cancer, and Breast Neoplasms" , as keywords, were searched in PubMed, CINAHL, OVID, and Web of Science from 2000 to 2016. We included only original articles published in English language, measuring self-efficacy in women with breast cancer. Results: Twenty-four articles were chosen based on the inclusion criteria. The results of this review revealed that demographic variables, breast cancer diagnosis and type of treatment, bio-psycho-socio-spiritual status, and physician-patient relationship affect cancer specific SE. SE impacts on physical and mental health, pain management, quality of life, body image, clinician-patient communication, and health information seeking behavior. Conclusions: This review showed that breast cancer self-efficacy is a critical component for enhancement of goal-directed behaviors in patients and it should be supported by health care providers and family members. Findings of this review has some limitations, since great amount of findings were based on cross sectional data. Further research is needed to examine the impacts of breast cancer self-efficacy on health-related variables.

Despite many advances in the treatment of breast cancer, it is still the second most common cause of death in women in the United States. It has been shown that inflammation plays a major role in the treatment of these cancers and inflammatory factors enhance tumor growth, invasion, metastasis, and vascularization. In this study, we would like to analyze peripheral blood neutrophil-lymphocyte ratio (NLR) in breast cancer patients and its correlation with disease staging. This cross-sectional analytic study was conducted in Imam Hospital, affiliated with Tehran University of Medical Sciences; a total of 195 female patients with breast cancer met the inclusion criteria. All of the patients had a complete blood count with leukocyte differential performed before chemotherapy. Medical records including pathology reports were also available. Data for all patients were collected prior to any surgical intervention. Exclusion criteria included clinical evidence of active infection, presence of hematological disorders, acute as well as chronic inflammatory or autoimmune diseases, or prior steroid therapy. Higher platelet count was significantly associated with the higher stage. The stage was not associated with the hemoglobin level. There was no association between the tumor size and age of patients with NLR. There was a significant relationship between NLR and IDC. There was a significant relationship between IDC and NLRs of less than 8.1 and greater than 3.3. There was a significant relationship between NLR and vascular invasion. There was no association between NLR and estrogen receptor and HER2. There was no significant relationship between the PLR and the cancer stage. In this study, NLR showed a significant relation with the disease staging. As the NLR increases the stage increases as well. Therefore, this ratio may be helpful in the preoperative evaluation of patients with breast cancer.

Background: Idiopathic granulomatous mastitis (IGM) is a rare benign breast disease, which can mimic breast cancer. As the managements of IGM and breast cancer are entirely different and the initial clinical manifestations are similar in several cases, it is very important to differentiate them. Case presentation: We reported a 48-year-old female patient with IGM and breast cancer. She was referred to the outpatient clinic with bilateral large masses and clinical impression of bilateral breast cancer with inflammatory features in the right side. Through pathology, the diagnoses of invasive ductal carcinoma (IDC) for the left breast lesion and IGM for the right breast lesion were confirmed, respectively. Incisional biopsy was performed for the right breast lesion to rule out breast cancer and to make sure of the diagnosis of IGM. Conclusion: To the best of our knowledge, breast cancer and IGM were reported only in two studies. Although IGM is not the underlying cause of breast malignancy, the diagnosis of breast cancer should always be kept in mind. Any other lesions in these patients should be assessed well to rule out breast cancer.

Background: The role of diagnostic pathology has become more prominent. This study aimed to compare the accuracy of frozen section compared with permanent section in the morning and afternoon working hours. Methods: In this cross-sectional study, 99 patients with stage 1 and 2 breast cancer who underwent sentinel and non-sentinel lymph node biopsy between 2013 and 2015 were included. The results of frozen section and permanent pathology of the lymph nodes were compared with one another. The time of pathologic evaluation including morning (before 2pm) and afternoon (after 2 pm) was also considered in the comparative analysis. Results: The mean age of the patients was 48.58±8.96 years. The accuracy of frozen section biopsy of the sentinel lymph node was 79.80%, 81.0%, and 78.0% in general, before 2 pm, and after 2 pm, respectively. The accuracy of frozen section biopsy of the non-sentinel lymph node was 62.32%, 65.1%, and 57.7% in general, before 2 pm, and after 2 pm, respectively. Conclusions: There was no difference in the accuracy of the frozen section biopsy before and after 2 pm for the sentinel or non-sentinel lymph node biopsy.

Background: In an attempt to reduce the risk of developing lymphedema following breast cancer surgery, some researchers suggested that by identifying and preserving the lymphatic plexus which drains ipsilateral arm we can minimize the risk of lymphedema. The procedure is known as axillary reverse mapping (ARM). In the current study, we investigated the oncological safety of this technique. Methods: A total of 60 patients who were undergoing axillary lymph node dissection were involved. The indications for axillary dissection were whether clinically node-positive axilla or positive sentinel lymph node biopsy. ARM was performed by injecting 2 ml of methylene blue subcutaneously in the upper and medial part of ipsilateral patients’ arm along the intermuscular groove. Results: ARM nodes were identified by means of methylene blue injection in 51(85%) patients (identification rate = 85%). For the subgroup of clinically positive axillary lymph nodes, identification rate was 93.1%, and the corresponding figure was 77.4% for positive SLNB group (P = 0.148). Pathological evaluation of harvested ARM nodes demonstrated metastatic involvement in 8(27.5%) and 1(3.2%) patients in clinically positive and SLNB positive groups respectively (P = 0.026). Conclusions: Based on the findings of this study it seems that ARM could be considered as a safe procedure in patients who are a candidate for ALND when SLNB is positive. In contrast, in patients with clinically positive axillary nodes, there is a considerable risk of tumoral metastasis in ARM nodes.

Background: Breaking bad news to cancer patients is one of the important responsibilities in the oncology setting. The purpose of this study is develop and validate a new theoretically based tool for measurement of attitude and practice of physicians toward breaking bad news. Methods: The psychometric properties of the scale were established by following the guidelines of Clark and Watson. In the first phase, a literature review was performed to create items; then items were assessed for content validity through individual interview (n = 12) and construct validity was assessed by using factor analysis. Reliability was evaluated by Cronbach’s alpha. Research data was gathered from physicians working in breast cancer setting. Results: A total of 12 expert reviews concluded that a large amount of items of attitude and practice questionnaires were important and essential (Content Validity Ratio > 0.73). The exploratory and confirmatory factor analyses for a sample of physicians (n = 200) indicated a 12-item of attitude scale with three factors: full disclosure, non-disclosure and individual disclosure. Cronbach’s Alpha for the factors returned 0.746, 0.834 and 0.795, respectively. The exploratory and confirmatory factor analyses for a sample of physicians (n = 200) indicated a 20-item of practice scale with six factors: preparation, setting of the interaction, communicate well, use of the “cancer” word, patient’s right to know and close the interview, and summarized. Cronbach’s Alpha for the factors returned 0.765, 0.63, 0.65, 0.793, 0.759 and 0.7, respectively. Conclusions: A resultant 12 items of attitude and 20 items of practice questionnaire were developed to assess how physicians are giving bad news to breast cancer patients. The reliability of the new tools needs to be evaluated for further studies. This new questionnaire will provide researchers and clinicians with a thorough and suitable instrument to measure belief and practice regarding disclosing the truth to breast cancer patients.

Objective: The aims of this study are scoring the educational wards of Imam Hospital complex, comparison of different wards according to educational, research and treatment scores and finally improvement of hospital's curriculum.Methods: For assessing the educational performance a questionnaire was filled by the wards' directors. Another questionnaire was filled by faculty members in order to evaluating the research situation of the ward. Customers' satisfaction was assessed through questionnaires which were filled by residents, interns, students and patients. Data were analyzed using SPSS-13.Results: In educational sector, pediatric ward has the first rank, infection ward the second rank. In the research sector infection ward the first and the pediatric ward have the second rank. Training customers have the most satisfaction of general ward and Patient had more satisfaction of surgery ward (3 and 4 surgery ward).With 47% score to training sector, 28% to research sector and 25%to satisfaction, the infection ward has the first rank, pediatric ward second rank and orthopedic ward the third rank of Imam Khomeini complex.Conclusion: In Imam Khomeini complex survey of wards ranking, the infection ward has the first rank pediatric ward second rank and orthopedic ward the third rank in overall survey.

Background: Breast cancer arising in young patients (? 40 years) is being considered as a distinct clinical entity with more aggressive tumor features and poorer survival. Our aim was to assess the impact of age on survival among a large group of Iranian women diagnosed with breast cancer. Methods: In a cross-sectional study, demographic and clinicopathological characteristics of patients with breast cancer who were treated in two referral centers in Tehran, Iran during the past 13 years were reviewed and extracted from an electronic database. Patients were divided into two groups based on the age at the time of diagnosis (?40 and >40 years). The association of age with different clinicopathological features and its impact on disease-free survival were assessed. Results: Study population comprised of 353(26.1%) patients who were 40 years old or younger and 1000(73.9%) who were older. Compared to older patients, younger participants had more commonly tumor size larger than 5 cm (P = 0.034), higher chance of lymph node metastasis (P = 0.036), and overexpression of HER-2 (P = 0.004). No significant differences were observed between the two groups regarding ER, PR, and LNR (lymph node ratio). Age was the only factor affecting patients' disease-free survival and younger patients had higher chance of local or distant metastases compared to older subjects (HR: 1.49, 95%CI: 1.02-2.17, P = 0.038). Conclusions: Based on the results of current study, it can be suggested that younger patients who are diagnosed with breast cancer tend to have larger tumor size, higher chance of lymph node metastasis and overexpression of HER-2 compared to patients older than 40 years. Age was the only significant factor that was associated with shorter disease-free survival.

Background: Modified radical mastectomy (MRM), as a surgical treatment in breast cancer patients, may lead to important complications with significant morbidities including seroma formation. In this study, we used topical phenytoin to evaluate its impact on breast and axillary wound drainage and seroma formation after MRM. Methods: In a double-blinded randomized clinical trial, patients with breast cancer who were candidates for modified radical mastectomy (MRM) were enrolled. The patients were randomly assigned to two groups using a simple randomization method. Group A received topical phenytoin 1% solution for the irrigation of the mastectomy wound during the MRM procedure while group B (control group) underwent wound irrigation with normal saline solution. In addition to demographic data, postoperative variables including daily drainage of breast and axillary drains, drain removal days, and possible complications including seroma formation and their management were recorded. Results: Except for daily drainage recorded on the fifth postoperative day, the drainage of both axillary and breast drains were significantly different between group A and B in the following days. Compared to group B, axillary drains could be removed significantly earlier in group A. In regard to the breast drains, they were removed earlier in group A with no statistically difference compared to group B, the difference was not statistically significant. Seroma was detected in 7(8.3%) patients, 3 patients in group A and 4 patients in group B, with no significant differences between the two groups. All the patients underwent repeated aspirations. Conclusions: Our findings showed that topical irrigation of the surgery site with phenytoin was effective in reducing axillary surgical wound drainage.

Background: Quality of life (QOL) is becoming an important indicator of treatment efficacy in patients with breast cancer. Most previous studies have compared patients' QOL following breast conserving surgery (BCS) and mastectomy with or without reconstruction. Our aim was to assess the impact of BCS versus oncoplastic breast surgery (OBS). Methods: Selection of patients for BCS or OBS was performed according to standard criteria e.g the breast and tumor size. The QOL was assessed by employing EORTC QLQ-C3 and QLQ-BR23 questionnaires concurrently and one year after the surgery. The QOL scores one year after the surgery were compared between two groups using analysis of covariance, after adjusting for the baseline values. Results: A total of 120 patients with a mean age of 46.16±1.4 years were enrolled in the study. BCS and OBS were the main surgical treatment techniques in 57(47.5%) and 63(52.5%) patients, respectively. At the time of the last follow-up visit, there were no differences between the two groups regarding functional scales such as physical (P = 0.761), role (P = 0.356), emotional (P = 0.107), cognitive (P = 0.051), and social functioning (P = 0.659). No differences were observed between the two groups regarding nine symptom scales. Based on the results of breast cancer specific module of the questionnaire, no differences were observed in functional scales and symptoms with the exception of arm symptoms which were less common in OBS group (P = 0.023) Conclusions: Based on the results of the current study, it could be suggested that there are no significant differences in the in scores of QOL components between patients who received BCS or OBS.

Background: The purpose of this study was to assess Iranian surgeons' perceptions toward mastectomy and breast conserving therapy (BCT) and determine the contributing factors. Methods: In this cross-sectional study, a structured questionnaire was devised and hosted on survey.tums.ac.ir and a link to the questionnaire was emailed to surgeons registered in Iranian Medical Council, branch of Tehran. The results of the current study were compared to a similar study which was performed in 2004 on a comparable sample of surgeons in Tehran, Iran. Results: A total 166 surgeons filled out the study questionnaire. Only 24 surgeons declared that they have not performed BCT before. Variables that showed a significant association with performing BCT were attending a breast surgery or surgical oncology fellowship (P = 0.010) and breast surgery workshop (P = 0.042). No associations were observed between performance of BCT and age category (P = 0.951), gender (P = 0.416), duration of practice (P = 0.821), number of breast cancer patients per year (P = 0.083), and setting of practice categorized as teaching – nonteaching hospitals (P = 0.417). Comparing the results of the current study with the study performed in 2004 revealed a significant increase in the frequency of surgeons who performed BCT (85.5% vs 19.3%, respectively) (P < 0.001). Participants of the current study were more likely to mention "lack of experience" as the reason for not performing BCT compared to the previous study (P = 0.004). Conclusions: Our results delineated that there was a significant increase in the percentage of surgeons performing BCT compared to the previous study. Factors significantly associated with performing BCT were participating in a surgical oncology or breast surgery fellowship or short courses in breast surgery.

Oncoplastic breast surgery (OBS) has gained widespread acceptance during the last two decades as an integral component of breast cancer surgery. OBS combines oncological principles of breast cancer surgery with plastic surgery techniques to provide the best cosmetic results without compromising oncological outcome of breast cancer treatment and it has opened up the possibility to perform breast conservation in large tumors. The purpose of this review is assessment of the oncological outcome of OBS in the treatment of breast cancer. We performed an extensive search of PubMed for articles published on oncological results and safety of OBS. There are few randomized clinical trials (RCTs) comparing the results of OBS with standard breast conservation techniques; however, based on the results of several prospective studies, it can be concluded that in terms of oncological outcome, OBS is at least as safe as standard techniques for breast conservation.

Background: Sentinel lymph node biopsy (SLNB) has replaced axillary lymph node dissection (ALND) in early breast cancer patients as the first line surgical approach to axillary nodes. Further dissection is performed only when SLN is involved by tumor cells. However, in a significant proportion of patients, non-sentinel nodes are still not involved and axillary dissection has no additional therapeutic benefits. Selective axillary clearance has been considered to prevent unnecessary dissection. The purpose of this study was to define predictors of non-sentinel lymph node involvement in patients with positive SLNB. Methods: Patients with early stage breast cancer and positive SLNB who underwent ALNDin a referral hospital in Tehran, Iran between2010 and 2012 were recruited into the study. Relations between different clinico-pathological characteristics and involvement of non-sentinel nodes were investigated. Results: From 139 patients who had positive SLNB and underwent ALND, only in 71 cases (51%) positive non-sentinel lymph nodes (NSLNs) were detected. In univariate analysis, there was no association between tumor size, lymphovascular invasion, ER, PR and HER-2 expression and NSLN metastasis. In contrast, presence of more than one SLN (P = 0.016) and a sentinel node ratio (SNR) more than 0.5 showed a significant association (P< 0.001). Only the latter remained as the significant predictor of NSLN involvement in mutltivariate analysis (P < 0.001, OR = 3.706). Conclusions: Based on our results, patients with a SNR more than 0.5 were more commonly diagnosed with NSLN metastasis. Thus, it is recommended that surgeons think twice before skipping ALND in this subgroup of patients.

Background: Seroma formation is a common complication after breast cancer surgery. Several techniques such as tube drainage, fibrin sealant and suturing methods have been employed to prevent or reduce seroma formation. Capitonnage, a suturing method widely used following hydatid cyst removal, has been used after breast surgery in limited studies. Our aim was to compare the effectiveness of tube drainage, fibrin sealant and capitonnage to prevent early complications. Methods: Eligible patients with breast cancer who were candidate for breast conserving surgery were enrolled and randomized into three different groups (tube drainage, capitonnage, capitonnage plus fibrin sealant). Patients were visited on 5th,12th and 19th days after surgery and were assessed for any probable complications. Results: A total of 90 patients were enrolled. One patient developed seroma in tube drainage and capitonnage group, while no participant from capitonnage plus fibrin sealant group experienced the mentioned complication. Three patients developed skin necrosis, all of them were treated with capitonnage plus fibrin sealant protocol. Conclusions: Based on our observations, it seems that capitonnage alone or in combination with fibrin sealant do not lead to significant differences in frequency of complications after breast cancer surgery such as hematoma, seroma and surgical site infection.

Background: Sentinel lymph node biopsy has shown to be a good alternative procedure for axillary lymph node dissection and to lead to lower frequency of morbidity, though this technique has its own side effects. It needs especial equipment and may not be available in some medical centers, especially in developing countries. This study aimed to identify a subgroup of patients with higher probability of metastasis to sentinel lymph node that can be excluded from indications of this procedure. Methods: In this cross-sectional study, the clinical data of 195 patients with breast cancer who underwent sentinel lymph node biopsy in Tehran, Iran, between 2009 and 2011 were reviewed. Whenever tumor features showed significant association with sentinel node metastasis in univariate analyses, logistic regression was used to identify independent predictors. Results: Univariate analyses revealed that tumor size and lymphovascular invasion have significant association with sentinel lymph node metastasis (P = 0.009 and P < 0.001, respectively). Moreover, age had an significant association with positive sentinel lymph node biopsy (SLNB) (P = 0.004). Other factors, including tumor grade, estrogen receptor, progesterone receptor, and human epidermal growth factor receptor-2, were not associated with positive sentinel lymph node biopsy in univariate analysis. All factors that showed significant association in univariate analysis remained statistically significant predictors of positive SLB in multivariate analysis. Conclusions: It seems that young breast cancer patients, those who have tumors larger than 5 cm and those with lymphovascular invasion, are at an increased risk of sentinel lymph node metastasis.

Background: The purpose of this study was to examine religious, cultural, and social beliefs of healthy women about breast cancer in rural settings in Iran. Methods: In the present study, 16 in-depth interviews with health care leaders, social and religious experts and 11 focus group discussions were conducted with 79 women in the rural areas near the capital city of Tehran, Iran. Grounded theory model was used to analyze the data. Results: Some women believed that religious customs and rituals, such as praying, taking a vow, or going on a pilgrimage to a holy place, might have healing effects if performed in addition to seeking medical care medical care. Many believed that God intervenes in the entire course of any illness, from occurrence to cure. Although few had fatalistic views toward cancer, the majority believed that patients could try to change their destiny. With respect to the relationship between moral behavior and disease, 4 types of opinions were identified; good people suffer, evil people get punished, evil people do not suffer, and everything has a scientific explanation. Participants believed that self-perception, their husbands, deficiencies in the health care system, and financial concerns influence breast cancer outcome. Conclusions: Our study showed that many participants were not aware of any available support in the healthcare system. They generally believed in the healing effect of prayers, only when it is sought in parallel with medical care.

Welcome to Archives of Breast Cancer (ABC), a new journal with sole focus on breast diseases and especially breast cancer. Breast cancer is a devastating disease that impacts many women and threatens their health and wellbeing. A large number of health professionals from a wide spectrum of clinical disciplines, such as surgery, medical oncology, public health, pathology, radiation oncology, diagnostic radiology, and nuclear medicine, are involved in dealing with such a challenging and common disease. The concept of applying a multidisciplinary approach to clinical and non-clinical aspects of breast cancer has been found to be of vital importance to the understanding of this prevalent type of cancer. Such collaboration can also improve the quantity and quality of the research in this field. To this end, journals which choose to publish multidisciplinary articles as their primary focus can serve as the academic forum to share ideas from a variety of expertise. Archives of Breast Cancer can certainly add to the depth and quality of the research in the field. Articles on a single topic would be readily available to the readers from multiple disciplines and all in one journal. This would eventually lead to fruitful interaction among specialists seeking to investigate this disease, yet,from different perspectives. The benefits of this interaction in the process of devising appropriate strategies and approaches in dealing with the problem are crystal clear. The world of medical sciences has witnessed an abundant increase in the quality and quantity of breast-cancer-related research. In the past 20 years, the number of published articles indexed in PubMed from 1994 to 2014 is more than 5 times than the number published before 1993 (about 170,000 compared to 30,000). Meanwhile, the number of PubMed indexed medical journals dedicated to breast cancer research has also risen from 5 in 1993 to 17 in 2014. This increasing trend highlights an essential need for development of a journal that will specifically publish breast-cancer-related articles and papers. It will pave the way for those who are interested in the subject and who seek to find the results of the most recent research in this field. Thus, this journal, as its main goal, provides an opportunity for better communication and interaction among medical practitioners, basic science researchers, and health care professionals interested in breast diseases. To achieve this goal, ABC benefits from one of the most qualified editorial boards selected from related specialties with various academic affiliations. The vision of ABC is to become a source of reliable and wellresearched articles focusing on breast cancer. Second, it intends to be an outstanding media, introducing to the world of medicine, cutting edge technologies, recent clinical approaches, diagnostic and practical methods, and even surgical details crucial in dealing with breast cancer. We hope that we can make a considerable contribution to the prevention, early detection, management, and rehabilitation of patients suffering from breast cancer. All the members of ABC editorial staff believe that collaboration and interaction amongthe related scientists, physicians and surgeons, social experts, and policy makers from the four corners of the world would be the ultimate means to achieve the goals of the journal.