Saturday, January 25, 2020

The risk factors for breast cancer

The risk factors for breast cancer INTRODUCTION Breast cancer is the most common type of cancer among women in Malaysia with an overall age-standardized incidence (ASR) of 46.2 per 100,000 population [1]. The incidence of breast cancer differs among Malaysia states; it is the most common cancer among women in Penang, followed by Sabah [2]. However, there is no previous study on risk factors associated done in Penang before. Determining the risk factors of breast cancer helps to identify women who may benefit most from screening or other preventive measures, also offers hopeful promise of modifying those factors, thus preventing breast cancer occurrence. Many risk factors of breast cancer have been found and many of them have been recognized as established factors. Advancing age is one of the most important factors [3]. Reproductive factors like timing of menarche and menopause, parity play a major role in breast cancer incidence [4, 5] . Also, lifestyle factors like alcohol consumption [6-9], high fat diet [10-14] and smoking [15-17] have been identified by many studies as risk factors for breast cancer. This study aimed to determine the relationship between the socio-demographic factors, family history, reproductive factors, the life-style factors and external factors with the occurrence of the breast cancer among the study population. MATERIAL AND METHODS Study design A matched case-control study was conducted in Penang General Hospital, Penang Island, Malaysia between 20th November 2009 and 22th January 2010 using a standardized questionnaire that designed into two languages: English and Malay. Both cases and controls were matched by age group and ethnicity. Sample size was calculated according to that reported by CARIF-UM (Release New Malaysian Breast Cancer Genetic Study) which stated that 14% of breast cancer patients in Malaysia who have family history of breast cancer [18] and the relative risk for strong family history ranging from 2.5 to 4.5 [19] , the minimum sample size was 149 patients per group. Ethical Approval Our study was approved by Clinical Research Centre and Medical Research Ethic Committee of Ministry of Health Malaysia. Considering the ethical issues, written consent was signed by each case and verbal agreement for interview participation was obtained from all control subjects. All the personal information collected was considered confidential. Data Collection The cases were recruited from a convenience sample of prevalent breast cancer women who attended the oncology clinic, day-care chemotherapy center, oncology ward, and the surgical ward during the period of conducting this research. Women with confirmed diagnosis of breast cancer histologically regardless of the stage and met the following criteria; above 20 years old, non-pregnancy, without any gynecological problems (e.g., artificial menopause by hysterectomy), hormonal and psychological problems, were called for interview. Only one patient refused to participate. Our controls were non-breast cancer women who attended the outpatient clinics and outpatient pharmacy during the same period. Women who are non-pregnant, matched by age group and ethnicity to the cases recruited, without any malignancies, gynological, hormonal and endocrine, and psychological problems are eligible to be our controls. Statistical Analysis All data entry and analyses were conducted using SPSS version 15 Microsoft program. Descriptive statistics including mean and standard deviations (SD) for continuous variables, frequencies and percentages for categorical variables were used to describe the study population. Crude ORs with 95% CI were calculated using simple logistic regression models that examined the association between breast cancer status and risk factors. Significant independent variables with P values RESULTS In all, 300 women within two groups were interviewed; 150 women with breast cancer and 150 control women without breast cancer. The means  ± SD age of cases and controls were 52.81  ± 11.13 years (range 23-83 years) and 52.40  ± 11.52 years (range 22-78 years), respectively. Statistically, there is no significant difference between cases and controls in term of age (P value= 0.75) and race frequency (P value= 1.00). Among each cases and controls group, 34.7 % were Malay, 50.7 % were Chinese, 14.0 % were Indian and 0.7 % were other races. Socio-demographic Risk Factors The results of socio-demographic risk factors obtained from univariate logistic regression analysis summarized in Table 1 showed that lower educational level and occupation were significantly related to breast cancer risk (P Family History Family history of first degree relative with other types of cancer (nasopharyngeal, ovarian, Lung, bladder, stomach, or colon cancers) increased the risk significantly (P Reproductive Risk Factors According to the reproductive factors (Table 3), women with late ages at menopauses (= 55 years old) (OR=2.8, 95%CI: 1.18 6.67), or history of menstrual irregularity (OR= 3.2, 95%CI: 1.00 10.08) or who had never breastfed (OR= 1.74, 95%CI=: 1.09 2.76) were more likely to have breast cancer. The protective effect of breastfeeding found to be a duration dependent; women who had breastfed for only few months had a higher risk by 1.51 ( 95%CI: 0.83 2.77) compared to breastfed women for a total of more than 1 year, and the risk increased in non-breastfed women to 2.08 (95%CI= 1.22 3.57). Nevertheless, no statistically significant association were observed between breast cancer and the age at menarche, number of children (parity), age at first full term pregnancy, number of abortions and menopausal status. Life Style and External Risk Factors Breast cancer risk ratios were higher for women who had a history of benign breast disease (OR=2.8, 95%CI: 1.13 6.88) and who had never practiced low fat diet (white meat, white fish, skinless chicken and avoid deep fried food) (OR=1.81, 95%CI: 1.14 2.86). However, other lifestyle factors like; smoking, alcohol consumption, body mass index (BMI = 25 kg/m2) and external hormone use, like OCP and HRT were not significant statistically to be risks for breast cancer. Multivariate Results Among all factors included in the multivariable model (Table 5), occupation, breastfeeding and practicing low-fat diet play important protective roles against breast cancer; unemployed women (adjusted OR= 2.7, 95%CI: 1.59 4.61), never breastfed women (adjusted OR= 1.94, 95%CI: 1.15 3.27) and never practiced low-fat diet (adjusted OR = 1.97, 95%CI: 1.18 3.27) were found to be associated with breast cancer risk as statistically significant independent factors. Other factors contributing to breast cancer risk were: family history of distant relatives with breast cancer (adjusted OR= 3.70, 95%CI: 1.48 -9.20) and first degree relatives with other cancers (adjusted OR= 5.27, 95%CI: 1.38 20.1). Also, women with histories of benign breast disease (adjusted OR= 3.14, 95%CI: 1.17 8.40) and menstrual cycle irregularity (adjusted OR= 4.94, 95% CI: 1.42 17.26) were more likely to have breast cancer. OCP use was significantly related to breast cancer risks; however, this was not related to the duration. While using OCP for 5 years increased the risk by only 3 times (95% CI: 1.02 9.00). DISCUSSION In a pooled analysis of 150 breast cancer cases and 150 non-breast cancer controls, associations between breast cancer and various demographic, reproductive, and lifestyle factors were examined. Both cases and controls were chosen intentionally from the same hospital during the same study period. The risk of breast cancer has been reported to be associated with socio-demographic status [24-26]. Age is a very important risk factor; it was found that breast cancer incidence generally increases with age. The mean age at diagnosis for all breast cancer patients is 50.7  ± 11.0 years. The peak age reaches between 40 and 49 and thereafter the number of breast cancer patients decreases quite dramatically with only 4.0% above 70 years old (Figure 1). Also, only 2.0% of cases were diagnosed below the age of 30 which is consistent with Singletary findings [3]. According to the other socio-demographic factors studied, higher level of education has a protective effect (P Occupation status also plays an important role as a protection factor against breast cancer in both univariate and multivariate analysis (P Family history is an important factor in our population; an adjusted OR of 3.7 (95%CI = 1.48 9.2) was found for women with a distant relative with breast cancer, which is within the OR range reported by previous literature [19, 37] and higher than that reported by others [3, 38]. However, having first degree-relatives with breast cancer is not significantly related to the breast cancer risk (P > 0.05). This may be explained partially because of the high frequency of controls (7 of 150 controls vs. 16 of 150 cases) that had first-degree relatives with breast cancer. Such a high number of family histories in controls may result in an underestimation of increased risk due to the family history. Furthermore, history of first degree relatives with other cancer (gastric, pancreatic, colon, lung carcinoma.etc) is significantly more frequent in patients than in controls with the adjusted odd ratio of 5.27 (95% CI= 1.38 20.1). Recently, it has been discovered that clustering of first degree cases of breast, pancreas and stomach carcinomas in a family has been associated with mutations in the breast cancer susceptibility gene BRCA2 [39]. Breastfeeding is an important protective factor among our population; women who had never breastfed their baby have a 1.74 (95%CI: 1.09 2.76) higher risk of getting breast cancer and the adjusted odd ratio is 1.94 (ever versus never, 95%CI = 1.15 3.27) in the multivariate analysis. Our finding is in agreement with these studies [40-48], however, others failed to find any association [31, 36, 49-52]. Moreover, the duration of breastfeeding has also an important effect; found that the longer the lactation period, the least the risk of breast cancer. This inverse relationship between the duration of breastfeeding and the risk of breast cancer have been suggested by other studies [46, 53-60], however, other revealed that this is mainly confined to women diagnosed before the age of 40 with a weak trend for older patients [61]. History of irregular menstrual cycle (Polymenorrhea, Oligomenorrhea, or Amenorrhea) had an increased risk; the OR range (3.17- 4.94) and this supports the Turkish study [62] which found that menstrual irregularity increased the risk by 1.61 (95% CI 1.05-2.49). Others [55, 63, 64] did not find any significant relation between menstrual irregularity and breast cancer risk. However, it has been reported that menstrual irregularity decreased the risk [65] This study detected a significant association between oral contraceptive use and breast cancer, consistent with other local studies [27, 36, 66] and other international studies [46, 67]. Whereas we could not find any relationship between the duration of OCP used and the risk of breast cancer, so our study does not support the growing body of evidence that long-term use of oral contraceptives, especially during certain parts of reproductive life, is associated with a modest increase in breast cancer risk [46, 68]. However, most studies found no or weak association of OCP use with the risk of breast cancer [34, 69-71]. The association between OCP use and breast cancer is also related to the duration, dosage, type of OCP and the age of first use [72]. Previous history of benign breast disease is highly significant in the present study (P Practicing low-fat diet (take only white meat, white fish, and skinless chicken and avoid deep fried food) exhibited an inverse association with the risk of breast cancer, which is significant in both univariate and multivariate analysis (crude OR 1.81, 95%CI= 1.14 2.86) and (adjusted OR: 1.96, 95%CI=1.18 3.27) respectively for women who had never practicing low fat diet. Red and fried meat consumption and fatty foods were suggested as important risk factors for breast cancer [11, 73]. For each additional 100 g (3.5 oz) daily of meat consumption the risk of breast cancer increased risk by 56% in a French case-control study [13]. Another cohort study [74] reported a significant relative risk (RR) of 1.7 for women who reported eating the skin on poultry. Null high consumptions of fatty forms, namely fried fish and chicken with skin were associated with an increase of breast cancer risk [75]. Other case-control studies reported a protective effect of poultry and fish against the devel opment of breast cancer [76]. Also, there was no evidence for a positive association between total dietary fat intake and risk of breast cancer and no reduction in the risk even among women whose energy intake from fat was less than 20 percent of the total energy intake [77]. Some case-control studies and cohort studies have shown weak and inconsistent associations between high intake of dietary fat and poultry with the occurrence of breast cancer [14, 78]. Other well-established factors that have been studied; smoking cigarettes, alcohol intake, regular use of HRT, pre and post-menopausal body mass index (BMI), marital status and the level of monthly income , age at menarche, age at first full-term pregnancy, number of abortions, menopausal status and parity were found not to be significant in this study (P > 0.05). Strength and Limitation To our own knowledge, the present study is the first case-control study of breast cancer to investigate the risk factor in Penang Island, Malaysia. Both cases and control were matched by age group and ethnicity which add some strength to our study. This research studied almost all the socio-demographic, reproductive, lifestyle and external risk factors, so the confounding effects of all of these factors had been taken into consideration when getting our result by multivariate analysis. Furthermore, the questionnaire was designed into two languages (English and Malay), hence most of the three main ethnic groups in Penang (Chinese, Malay, and Indian) are fluent in either or both of them. As other case-control studies, our work has some limitations. The question regarding menstrual history (age at menarche, age at menopause) of the respondent are likely to be affected by recall bias. There was a chance of error in recall especially for age at menarche that had been many decades earlier and this may have affected the results. We tried to minimize this bias through assisting the memory of subjects. Some of the Chinese cases were excluded due to the language barrier (they cannot speak Malay or English), that may cause some selection bias. Finally, generalizability of our findings may be precluded by our population features; they have high mean ages, low educational level and belong to a mid socioeconomic class, also by the difference in the ethnicity distribution among different Malaysia states. CONCLUSION In summarily, family history with breast cancer or other cancer, history of benign breast disease, menstrual irregularity, and oral contraceptive used were found to be significantly associated with increased breast cancer risk, whereas breastfeeding, occupation and practicing low fat diet have protective effects against breast cancer. Late age at menopause and education level are significant risk factor only in the univaraite analysis. REFERENCES Lim, G. and Y. Halimah, Second report of the national cancer registry cancer incidence in Malaysia 2003. National Cancer Registry, Ministry of Health, Malaysia, 2004. Rosemawati, A. and A. Sallehudin, Cancer registration in Malaysia. 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Friday, January 17, 2020

Ida’s Impairment

1) (1) The U. S. GAAP section 360-10-35-21 states â€Å"A long-lived asset (asset group) shall be tested for recoverability whenever events or changes in circumstances indicate that its carrying amount may not be recoverable†. An example of an event like this is a significant decrease in the market price of a long-lived asset. As stated in the case, one of Ida’s competitors sold its extremely comparable commercial building for an amount significantly less than its asking price.Since these assets are very similar in comparison, this significantly less price for the competitor’s building is an example of a decrease in the market price of Ida’s commercial building. Therefore under the U. S. GAAP, Ida needs to test the U. S. commercial building for recoverability. (2) Under IAS 36. 12, there are certain external factors that lead you to want to test for recovery such as a decline in market value. The sale of the building across the street is an example of one of those external factors.IAS 36. 6 explains impairment and how to record impairment. Under IFRSs IAS 36. 66, the recoverable amount of cash-generating units (CGUs) should be determined for the individual asset. Therefore, a recoverability test must be done. 2) As of U. S. GAAP 360-10-35-17, when reporting to its U. S. based lender as of December 31, 2010, Ida should record $600 for impairment on the U. S. commercial building. Under GAAP, one must compare the fair value to the carrying amount.Since the fair market value is $3,900 and the carrying amount is $4,500, impairment is calculated as the difference $600. *All dollars in thousands (U. S. GAAP 360-10-35-17) 3) Under IAS 36. 6, when reporting to its parent as of December 31, 2010, Ida should record $500 for impairment on the U. S. commercial building. The recoverable amount for the commercial building is $4,000. The carrying amount is $4,500. Since the carrying amount is greater than the recoverable, the impairment is the diffe rence. *All dollars in thousands (IAS 36. 6)

Thursday, January 9, 2020

The Troubled Succession of Charles V of Spain

By the time he was 20, in 1520, Charles V ruled the largest collection of European land since Charlemagne over 700 years earlier. Charles was Duke of Burgundy, King of the Spanish Empire and the Habsburg territories, which included Austria and Hungary, as well as Holy Roman Emperor; he continued to acquire more land throughout his life. Problematically for Charles, but interestingly for historians, he acquired these lands piecemeal - there was no one single inheritance - and many of the territories were independent countries with their own systems of government and little common interest. This empire, or monarchia, may have brought Charles power, but it also caused him great problems. The Succession to Spain Charles inherited the Spanish Empire in 1516; this included peninsular Spain, Naples, several islands in the Mediterranean and large tracts of America. Although Charles had a clear right to inherit, the manner in which he did so caused upset: in 1516 Charles became regent of the Spanish Empire on his mentally ill mother’s behalf. Just a few months later, with his mother still alive, Charles declared himself king. Charles Causes Problems The manner of Charles’ rise to the throne caused upset, with some Spaniards wishing for his mother to remain in power; others supported Charles’ infant brother as heir. On the other hand, there were many who flocked to the court of the new king. Charles caused more problems in the manner in which he initially governed the kingdom: some feared he was inexperienced, and some Spaniards feared Charles would focus on his other lands, such as those he stood to inherit from Holy Roman Emperor Maximilian. These fears were exacerbated by the time it took Charles to put aside his other business and travel to Spain for the very first time: eighteen months. Charles caused other, much more tangible, problems when he arrived in 1517. He promised a gathering of towns called the Cortes that he wouldn’t appoint foreigners to important positions; he then issued letters naturalizing certain foreigners and appointed them to important positions. Furthermore, having been granted a large subsidy to the crown by the Cortes of Castile in 1517, Charles broke with tradition and asked for another large payment while the first was being paid. He’d so far spent little time in Castile and the money was to finance his claim to the Holy Roman throne, a foreign adventure feared by Castilians. This, and his weakness when it came to resolving internal conflicts between the towns and nobles, caused great upset. The Revolt of the Comuneros 1520-1 During the years 1520 - 21, Spain experienced a major rebellion within its Castilian kingdom, an uprising that has been described as the largest urban revolt in early modern Europe. (Bonney, The European Dynastic States, Longman, 1991, p. 414) Although certainly true, this statement obscures a later, but still significant, rural component. There is still debate on how close the revolt came to succeeding, but this rebellion of Castilian towns - who formed their own local councils, or communes - included a true mix of contemporary mismanagement, historical rivalry, and political self-interest. Charles wasn’t completely to blame, as pressure had grown over the last half-century when towns felt themselves increasingly losing power versus the nobility and the crown. The Rise of the Holy League Riots against Charles had begun before he had even left Spain in 1520, and as the riots spread, towns began rejecting his government and forming their own: councils called comuneros. In June 1520, as nobles remained quiet, hoping to profit from the chaos, the comuneros met and formed themselves together in the Santa Junta (Holy League). Charles’ regent sent an army to deal with the rebellion, but this lost the propaganda war when it started a fire that gutted Medina del Campo. More towns then joined the Santa Junta. As the rebellion spread in the north of Spain, the Santa Junta initially tried to get Charles V’s mother, the old queen, on their  side for support. When this failed, the Santa Junta sent a list of demands to Charles, a list intended to keep him king and moderate his actions and make him more Spanish. The demands included Charles returning to Spain and giving the Cortes a much greater role in government. Rural Rebellion and Failure As the rebellion grew larger, cracks appeared in the alliance of towns as each had their own agenda. The pressure of supplying troops also began to tell. The rebellion spread into the countryside, where people directed their violence against the nobility as well as the king. This was a mistake, as the nobles who had been content to let the revolt carry on now reacted against the new threat. It was the nobles who exploited Charles to negotiate a  settlement and a noble led army which crushed the comuneros  in battle. The revolt was effectively over after the Santa Junta was defeated in battle at Villalar in April 1521, although pockets remained until early 1522. The reaction of Charles wasn’t harsh given the standards of the day, and the towns kept many of their privileges.  However, the Cortes was never to gain any further power and became a glorified bank for the king. The Germania Charles faced another rebellion which occurred at the same time as the Comunero Revolt, in a smaller and less financially important region of Spain. This was the Germania, born out of a militia created to fight Barbary pirates, a council which wanted to create a Venice like city-state, and class anger as much as a dislike of Charles. The rebellion was crushed by the nobility without much crown help. 1522: Charles Returns Charles returned to Spain in 1522 to find royal power restored. Over the next few  years, he worked to change the relationship between himself and the Spaniards, learning Castilian, marrying an Iberian woman and calling Spain the heart of his empire. The towns were bowed and could be reminded of what they had done if ever they opposed Charles, and the nobles had fought their way to a closer relationship with him.

Wednesday, January 1, 2020

Greek Culture And Culture Of The Odyssey - 1848 Words

Greek Life and Culture in The Odyssey Greek culture and life was very different during the time of The Odyssey compared today’s world. The Odyssey is believed to have been written around the Bronze Age, which was approximately 700 B.C.E. There are many aspects about Greek life and culture that can be observed throughout The Odyssey. Greek life and culture can consist of gender roles, religion, and social expectancies. There are some characteristics that can be seen to be common during this time frame. Some of the major values and characteristics that are portrayed in Homer’s epic poem are courage, strength, and cunningness. It is evident that in ancient Greek culture there were certain gender roles expectancies. Men were the providers†¦show more content†¦It is clear that men dominated in the Greek culture. â€Å"Women were expected to be faithful to their husbands, but the reverse was not the case as husbands could freely engage the services of prostitutes, live-in lovers, and courtesans† (Cartwright n.pag.). This issue can be perceived in The Odyssey. For example, Odysseus expected Penelope’s fidelity but his unfaithfulness to her is not an issue. Although he was gone for a long time and his real intention was to return to Penelope, his unfaithfulness cannot be ignored. During this time frame it was acceptable for the man to be unfaithful, but a woman could not do the same. Lynn Peppas states that for women in Greece, â€Å"It was her job to raise children, spin wool and flax, and weave it into bedding and clothes. She had to manage servants or slaves and care for them when the y were ill† (Daily Life in Greece,† n.pag). It is also made seen that women were expected not to intervene on anything regarding their life. The male had all the decisions in regards to the woman. Women had little say to anything. An instance where this is portrayed is when Telemachus states to Penelope, â€Å"You should go back upstairs and take care of your work, / Spinning and weaving, and have the maids to theirs. / Speaking is for men, for all men, but for me / Especially, since I am the master of this house† (376-379). In this statement Telemachus is being clear that a woman cannot make any decisions and only a male can. Religion isShow MoreRelatedExamples Of Archetypes In The Odyssey1291 Words   |  6 PagesArchetypes in The Odyssey All humans have ideals and patterns in common. Humans from a thousand years ago and humans in modern times have archetypes. Archetypes are characters, actions, or situations that are repeated in all human life. Archetypes are found in myths, legends, dreams, films, music, literature and several other forms of entertainment. In fact, The Odyssey, a prominent piece of writing, contains many archetypes. The Odyssey is a 3,000 year-old epic written by Homer in Ancient GreeceRead MoreExamples Of Archetypes In Homers Odyssey1292 Words   |  6 Pagesfact, The Odyssey, a prominent piece of writing, contains many archetypes. The Odyssey is a 3,000-year-old epic written by Homer in Ancient Greece. It describes the adventures of Odysseus. As well as being found in The Odyssey, archetypes are evident throughout Greek culture. These archetypes depict the ideals and beliefs of the Ancient Greeks. Through Homer’s use of archetypes in The Odyssey, the reader gains insights into Ancient Gre ek culture. Three major archetypes shown in The Odyssey includeRead MoreArchetypes In Ancient Greek Culture879 Words   |  4 PagesThe connections between humans and culture over time are in ancient literature. 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A great example of a piece of culture that has managed to endure the test of time is Homer’s The Odyssey, and epic poem telling of Odysseus, a warrior and a king, and his long and trying journey back to his home country(FaglesRead MoreArchetypes In Homers The Odyssey1383 Words   |  6 PagesAncient Greeks’ history consisted of monsters, creatures, gods, goddesses, fights, and battles. It shows that Ancient Greeks were very imaginative and creative. There were three main archetypes that were used in Homer’s epic ,The Odyssey, which show different aspects of Ancient Greek culture. Those three archetypes were: the hero/father figure archetype, the monster archetypes, and the search for love. The hero archetype explained the Ancient Greeks’ love for thrill and adventure; Odysseus went