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The hospital factor on breast feeding failure

Rajakumar MK

Family Practitioner, 1977;2:67-68.

Preliminary findings of a survey on the influences of institutional facilities on mothers in the post-partum period in hospital that affect breast-feeding were reported. It was observed that although advice on breast-feeding is now given, there is a conflict between advice and practice so that the advice has been ritualistic. There is a lack of follow-up on advice, and the mother is not helped and encouraged to breast-feed and to overcome her initial disappointment and difficulties. It was also pointed out that the artificial milk-food industry exercises a negative influence through maternity ward staff by provision of milk samples to maternity units and by visits of their sales staff to the mothers. It was emphasised that the hospital factor could be an important cause of failure of the mother to breast-feed.

Matched MeSH terms: Breast; Breast Feeding
Breast feeding in Kelantan

Balakrishnan S, Hussein HB

J Trop Pediatr Environ Child Health, 1977 Apr;23(2):80-2.
PMID: 585738
Matched MeSH terms: Breast Feeding*
Fulltext Relationship between patient factors and specific learning needs of women on breast cancer

Raja Lexshimi R, Siti Mariam B, Rohaizak M, Subahan M, Nabishah M

Malaysian Journal of Public Health Medicine, 2017;17(1):14-23.

The type of specific learning needs of women with breast cancer using the Information Needs Questionnaire (INQ) had been identified prior to developing a breast cancer education package. It is also important to determine the types of patient factors such as demographic and clinical factors that influence women’s specific learning needs on breast cancer. This study thus reports the findings on what type of patient factors influence women’s specific learning needs related to the types of INQ. A total of 140 women with breast cancer who sought treatment at Universiti Kebangsaan Malaysia Medical Centre participated in this cross sectional study. Age showed a significant relationship with specific learning needs on sexual attractiveness (p=0.001) and self-care (p=0.048). Duration of illness was related to information on spread of breast cancer (p=0.040) and self-care (p=0.047). Education level showed a significant relationship with cure (p=0.001), sexual attractiveness (p=0.007) and spread of breast cancer (p=0.003). Occupation showed a significant relationship with specific learning needs on sexual attractiveness (p=0.005), chemotherapy (p=0.043), radiotherapy (p=0.039) and hormonal therapy (p=0.043). On treatment received, a significant relationship was noted with sexual attractiveness (p=0.009), radiotherapy (p=0.029), hormonal therapy (p=0.038) and targeted therapy (p=0.047). Ethnicity and Marital status showed no significant relationship with all the specific learning needs. Findings of this study concluded that certain patient factors had significant relationship with certain specific learning needs. All the patient factors studied and their influence on the specific learning needs were taken into consideration prior to developing the breast cancer education package.

Matched MeSH terms: Breast Neoplasms*
Fulltext Atypical presentation of giant fibroadenoma of the breast

Burud IAS, Azmi N

Pan Afr Med J, 2021 07 05;39:168.
PMID: 34539964 DOI: 10.11604/pamj.2021.39.168.26975
Matched MeSH terms: Breast/surgery
Fulltext Metaplastic breast carcinoma with upper limb gangrene

Rajan R, Abdullah N, Abdullah NMA, Mohd Kassim AY

Breast Cancer (Dove Med Press), 2017;9:297-299.
PMID: 28496362 DOI: 10.2147/BCTT.S126909

Metaplastic breast carcinomas (MBCs) are rapidly growing tumors with histological heterogeneity, and triple negative receptor status. The aim of this case report is to highlight a case of advanced MBC with axillary artery infiltration leading to gangrene of the ipsilateral upper limb, in a young woman.

Matched MeSH terms: Breast Neoplasms; Carcinoma, Ductal, Breast
Fulltext A Participatory, Needs-Based Approach to Breastfeeding Training for Confinement Centres

Foong SC, Foong WC, Tan ML, Ho JJ, Omer-Salim A

Int J Environ Res Public Health, 2022 Sep 01;19(17).
PMID: 36078639 DOI: 10.3390/ijerph191710914

With a focus on traditional practices rather than evidence-based practices, breastfeeding support is sub-optimal in confinement centres (CCs). We used a participatory, needs-based approach to develop a training module for CC staff adopting Kern's six-step approach as our conceptual framework. Of 46 identified CCs, 25 accepted our invitation to a dialogue aimed at establishing relationships and understanding their needs. An interactive training workshop was developed from the dialogue's findings. The workshop, attended by 32 CCs (101 participants), was conducted four times over a four-month period. Questions raised by the participants reflected deficits in understanding breastfeeding concepts and erroneous cultural beliefs. Correct answers rose from 20% pre-test to 51% post-test. Post-workshop feedback showed that participants appreciated the safe environment to ask questions, raise concerns and correct misconceptions. An interview conducted 14 months later showed that while some CCs improved breastfeeding support, others made no change due to conflict between breastfeeding and traditional postnatal practices, which was aggravated by a lack of support due to the COVID-19 pandemic. A participatory approach established a trustful learning environment, helping CCs appreciate the value of learning and adopting new concepts. However, cultural perceptions take time to change, hence continuous training and support are vital for sustained changes.

Matched MeSH terms: Breast Feeding*
Fulltext Presentation of Breast Cancer and Impact of Patient Navigation on Timeliness of Diagnosis and Treatment and on Adherence to Treatment Recommendations in a Multicenter Network in Malaysia

Jaganathan M, Ang BH, Ali A, Sharif SZ, Mohamad M, Mohd Khairy A, et al.

JCO Glob Oncol, 2024 Mar;10:e2300297.
PMID: 38484197 DOI: 10.1200/GO.23.00297

PURPOSE: Breast cancer deaths disproportionately affect women living in low- and middle-income countries (LMICs). Patient navigation has emerged as a cost-effective and impactful approach to enable women with symptoms or suspicious mammogram findings to access timely diagnosis and patients with breast cancer to access timely and appropriate multimodality treatment. However, few studies have systematically evaluated the impact of patient navigation on timeliness of diagnosis and treatment in LMICs.
METHODS: We established a nurse- and community-navigator-led navigation program in breast clinics of four public hospitals located in Peninsular and East Malaysia and evaluated the impact of navigation on timeliness of diagnosis and treatment.
RESULTS: Patients with breast cancer treated at public hospitals reported facing barriers to accessing care, including having a poor recognition of breast cancer symptoms and low awareness of screening methods, and facing financial and logistics challenges. Compared with patients diagnosed in the previous year, patients receiving navigation experienced timely ultrasound (84.0% v 65.0%; P < .001), biopsy (84.0% v 78.0%; P = .012), communication of news (63.0% v 40.0%; P < .001), surgery (46% v 36%; P = .008), and neoadjuvant therapy (59% v 42%, P = .030). Treatment adherence improved significantly (98.0% v 87.0%, P < .001), and this was consistent across the network of four breast clinics.
CONCLUSION: Patient navigation improves access to timely diagnosis and treatment for women presenting at secondary and tertiary hospitals in Malaysia.

Matched MeSH terms: Breast/pathology
Chatbots for breast cancer education: a systematic review and meta-analysis

Lin SJ, Sun CY, Chen DN, Kang YN, Hoang KD, Chen KH, et al.

Support Care Cancer, 2024 Dec 27;33(1):55.
PMID: 39730943 DOI: 10.1007/s00520-024-09096-9

BACKGROUND: Effective education and awareness regarding breast cancer are critical. Traditional educational methods often fail to meet the diverse information needs of patients. Patients should be provided with tailored, accessible information to improve their retention and understanding of disease-related information.
PURPOSE: This systematic review and meta-analysis evaluated the effectiveness of chatbots for providing breast cancer education. By examining patient satisfaction with and the usability and efficacy of chatbot interventions, this study seeks to support the integration of chatbot technology into cancer education.
METHODS: This review, which was conducted in accordance with PRISMA guidelines, included studies from MEDLINE, Embase, and the Cochrane Library up to May 2024. The main inclusion criterion was chatbot interventions for breast cancer education. Meta-analysis was performed using Review Manager and Open Meta-Analyst software.
RESULTS: Of the 208 articles initially identified, 6 studies met the inclusion criteria, involving a total of 1342 women with early-stage or at-risk hereditary breast cancer. The meta-analysis revealed that most participants (85 to 99%) reported high satisfaction with chatbot interventions for breast cancer education, with no significant differences in satisfaction compared to genetic counselors or physicians. The chatbot interventions also showed positive effects on knowledge acquisition (mean proportion = 90.8%) and alleviated patients' symptoms significantly more than routine care.
CONCLUSION: This study demonstrated that chatbots can effectively provide personalized and interactive educational support, enhancing patients' understanding and retention of disease-related information. The integration of chatbot technology into educational programs can empower patients, ultimately promoting breast cancer awareness and prevention.

Matched MeSH terms: Breast Neoplasms*
Fulltext Breast cancer 100 years on--what we have learnt!

Forrest AP

Med J Malaysia, 1996 Mar;51(1):163-73; quiz 174.
PMID: 10968004
Matched MeSH terms: Breast Neoplasms/diagnosis*; Breast Neoplasms/epidemiology; Breast Neoplasms/prevention & control; Breast Neoplasms/therapy*
Differentiation of elemental composition of normal and malignant breast tissue by instrumental neutron activation analysis

Ng KH, Bradley DA, Looi LM, Mahmood CS, Wood AK

Appl Radiat Isot, 1993 Mar;44(3):511-6.
PMID: 8472024

Multi-elemental quantitative analyses of 15 paired samples of normal and malignant human breast tissue by instrumental neutron activation analysis are reported. The elements, Al, Br, Ca, Cl, Co, Cs, Fe, K, Na, Rb, Zn were detected. Significantly elevated concentration levels were found for Al, Br, Ca, Cl, Cs, K, Na, Zn in malignant compared to normal tissue. Although the role of elemental composition in breast cancer is unclear, this finding may be of importance as another parameter for differentiating normal from malignant tissue.

Matched MeSH terms: Breast/chemistry*; Breast Neoplasms/pathology; Breast Neoplasms/chemistry*
Cytogenetic analysis of invasive breast cancer: a study of 27 Asian patients

Tan PH, Lui WO, Ong P, Lau LC, Tao M, Chong Y

Cancer Genet. Cytogenet., 2000 Aug;121(1):61-6.
PMID: 10958943

Tumor cytogenetic analysis from 27 patients with breast cancer diagnosed at the Singapore General Hospital revealed complex karyotypic aberrations in 12 cases. The study group comprised 25 women and 2 men, ranging in age from 33 to 78 years (median 52 years). Ethnic distribution consisted of 22 Chinese, 3 Malaysian, and 2 Indian patients. Pathologic assessment disclosed 24 invasive ductal, 2 invasive mucinous, and 1 mixed invasive mucinous and ductal carcinomas. Histologic grading showed 3 grade 1, 10 grade 2, and 12 grade 3 tumors; 2 cancers were not graded, because they had been subjected to prior chemotherapy. Tumor sizes ranged from 1.5 to 10 cm (median 3 cm). Eleven cases were axillary node negative, whereas the remaining 16 node-positive cancers affected as many as 3 nodes in 8 cases and 4 or more nodes in another 8. Twenty cases demonstrated estrogen-receptor positivity, and 8 cases progesterone-receptor positivity. The spectrum of cytogenetic abnormalities involved chromosomes 1, 3, 6, 7, 8, 11, 16, and 17 and ranged from gains and deletions of both long and short arms, trisomy, monosomy, and other rearrangements. There was a trend toward the presence of karyotypic abnormalities in tumors of higher grade.

Matched MeSH terms: Breast Neoplasms/genetics*; Breast Neoplasms/pathology*; Carcinoma, Ductal, Breast/genetics; Carcinoma, Ductal, Breast/pathology; Breast Neoplasms, Male/genetics*; Breast Neoplasms, Male/pathology*
Microcalcification clustering parameters in breast disease: a morphometric analysis of radiographs of excision specimens

Ng KH, Looi LM, Bradley DA

Br J Radiol, 1996 Apr;69(820):326-34.
PMID: 8665132

X-ray microradiography of surgically excised breast specimens offers the possibility of morphological characterization of calcifications. When combined with digital imaging techniques there exists added potential for obtaining valuable basic quantitative morphometric information regarding differences between microcalcifications in tissues exhibiting evidence of fibrocystic change, benign and malignant tumours. A total of 157 excised breast specimens from 84 patients were microradiographed using a Softex Super Soft X-ray unit and Kodak AA high resolution industrial film. A Quantimet 570C image analysis system was used to digitize and analyse the microradiographs. Of the 157 microradiographs, 51 (from 30 patients) revealed microcalcification clusters. The existence of significant differences between the three identified categories of tissue were indicated by clustering parameters. These included the number of particles per cluster, area of clusters, maximum distance to nearest neighbour, and geometric mean distance to nearest neighbour. The distribution pattern index (DPI), another of the clustering parameters used in this study, has been observed to be a particularly powerful discriminator. The value for fibrocystic change was found to be significantly smaller (0.514) than that for benign tumour (0.796) whilst that for benign tumour was observed to be significantly larger than that for malignant tumour (0.604) at a p-value of less than 0.05 (Kruskal-Wallis one-way analysis of variance).

Matched MeSH terms: Breast Diseases/etiology; Breast Diseases/radiography*; Breast Neoplasms/complications; Breast Neoplasms/radiography*; Fibrocystic Breast Disease/complications; Fibrocystic Breast Disease/radiography*
Postmastectomy radiotherapy in patients with breast cancer

Bhoo-Pathy N, Pignol JP, Verkooijen HM

Lancet, 2014 Nov 22;384(9957):1846.
PMID: 25457914 DOI: 10.1016/S0140-6736(14)62239-X
Matched MeSH terms: Breast Neoplasms/mortality*; Breast Neoplasms/radiotherapy*
Fulltext The comparative accuracy of ultrasound and mammography in the detection of breast cancer

Tan KP, Mohamad Azlan Z, Rumaisa MP, Siti Aisyah Murni MR, Radhika S, Nurismah MI, et al.

Med J Malaysia, 2014 Apr;69(2):79-85.
PMID: 25241817 MyJurnal

AIM: This study was performed to determine the accuracy of ultrasound (USG) as compared to mammography (MMG) in detecting breast cancer.

METHODS: This was a review of patients who had breast imaging and biopsy during an 18-month period. Details of patients who underwent breast biopsy were obtained from the department biopsy record books and imaging request forms. Details of breast imaging findings and histology of lesions biopsied were obtained from the hospital Integrated Radiology Information System (IRIS). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of USG and MMG were calculated with histology as the gold standard.

RESULTS: A total of 326 breast lesions were biopsied. Histology results revealed the presence of 74 breast cancers and 252 benign lesions. USG had a sensitivity of 82%, specificity of 84%, PPV = 60%, NPV = 94% and an accuracy of 84%. MMG had a sensitivity of 49%, specificity of 89%, PPV = 53%, NPV = 88% and an accuracy of 81%. A total of 161 lesions which were imaged with both modalities were analyzed to determine the significance in the differences in sensitivity and specificity between USG and MMG. Sensitivity of USG (75%) was significantly higher than sensitivity of MMG (44%) (X(2)1=6.905, p=0.014). Specificity of MMG (91%) was significantly higher than specificity of USG (79%) (X(2)1=27.114, p<0.001). Compared with MMG, the sensitivity of USG was 50% (95% CI 10%-90%) higher in women aged less than 50 years (X(2)1=0.000, p=1.000) and 27% (95% CI 19%-36%) higher in women aged 50 years and above (X(2)1=5.866, p=0.015). Compared with MMG, the sensitivity of USG was 40% (95% CI 10%-70%) higher in women with dense breasts (X(2)1=0.234, p=0.628) and 27% (95% CI 9%-46%) higher in women with non-dense breasts (X(2)1=4.585, p=0.032).

CONCLUSION: Accuracy of USG was higher compared with MMG. USG was more sensitive than MMG regardless of age group. However, MMG was more specific in those aged 50 years and older. USG was more sensitive and MMG was more specific regardless of breast density. In this study, 20% of breast cancers detected were occult on MMG and seen only on USG.

Matched MeSH terms: Breast; Breast Neoplasms; Breast Density
Fulltext Is it necessary to excise all breast lesions? Experience from a university-based breast unit

Ng CH, Nur-Aishah T

Malays Fam Physician, 2009;4(2-3):66-70.
PMID: 25606166 MyJurnal

Breast cancer is becoming more important in Asia since it affect the younger age group. Question arises whether it is safe for breast lesions to be left in-situ if all the elements in triple assessment are benign. The aim of this study is to audit all the excision biopsies of breast lumps done in the University Malaya Medical Centre (UMMC), to review the association of age with the type of pathological finding and to evaluate the rate of carcinoma in these biopsies.

Matched MeSH terms: Breast Diseases; Breast Neoplasms*
Fulltext Epidemiology of breast cancer in Malaysia

Yip CH, Taib NA, Mohamed I

Asian Pac J Cancer Prev, 2006;7(3):369-74.
PMID: 17059323

Data from the National Cancer Registry of Malaysia for 2004 provide an age-standardised incidence rate (ASR) of 46.2 per 100,000 women. This means that approximately 1 in 20 women in the country develop breast cancer in their lifetime. However, the rate differs between the three main races, the Malays, Chinese and Indians. The age standardized incidence in Chinese is the highest, with 59.7 per 100,000, followed by the Indians at 55.8 per 100,000. The Malays have the lowest incidence of 33.9 per 100,000. This translates into 1 in 16 Chinese, 1 in 16 Indian and 1 in 28 Malay women developing breast cancer at some stage in their lives. The commonest age at presentation is between 40-49 years, with just over 50% of the cases under the age of 50 years, 16.8% below 40, and 2% under 30. Some 55.7% of all cases were found to be ER positive. The commonest presenting symptom was a lump in the breast in over 90% of cases, generally felt by the woman herself. The mean size of the lump was 4.2 cm, and on average, the women waited 3 months before seeking medical attention. Over the 12-year period from 1993 to 2004, about 60-70% of women presented with early stage (Stages 1-2) while 30-40% presented with late breast cancer (Stages 3-4). Especially Malays present at later stages and with larger tumours. Consequently their survival is worse than with Chinese and Indian women. The challenge in Malaysia is to be able to provide a comprehensive service in the diagnosis and treatment of breast cancer, and this requires training of a team of health professionals dedicated to breast health, such as breast surgeons, radiologists specializing in breast imaging, breast pathologists, plastic surgeons specializing in breast reconstruction, medical and radiation oncologists, psycho-oncologists, counselors, and breast nurses. Advocacy can play a role here in galvanizing the political will to meet this challenge.

Matched MeSH terms: Breast Neoplasms/diagnosis; Breast Neoplasms/epidemiology*
Options for Addressing the Dilemma of Managing Dense Breasts

Newman LA, Yip CH

JAMA Surg, 2020 04 01;155(4):279-280.
PMID: 32096827 DOI: 10.1001/jamasurg.2020.0280
Matched MeSH terms: Breast Neoplasms*; Breast Density
Fulltext A case report of juvenile giant fibroadenoma of the breast: How common?

Mohd Firdaus CA, Norjazliney AJ, Abdul Rashid NF

Ci Ji Yi Xue Za Zhi, 2017 10 5;29(3):177-179.
PMID: 28974914 DOI: 10.4103/tcmj.tcmj_64_17

Breast lesions are rare prepubescents. The majority of breast lesions in this age group are benign. The most common of these rare lesions is juvenile fibroadenoma, which accounts for only 0.5% of all fibroadenomas. It is uncommon to have a palpable lesion in juveniles as very small lesions show obvious asymmetry. Fibroadenomas can grow to a large size, and surgical intervention is cosmetically challenging, especially in achieving symmetry in a developing breast. A 12-year-old girl presented with right breast swelling associated with tenderness. The mass had initially been small on self-discovery 1 year previously and grew with time. There was no overlying skin changes or any significant risk factors for breast malignancy. Triple assessment showed features of fibroadenoma, but we were unable to rule out a phyllodes tumor. She subsequently underwent excision biopsy of the right breast lesion for symptomatic control and histopathology examination (HPE) of the lesion. The HPE report confirmed the diagnosis of fibroadenoma. The patient recovered well postoperatively with no complications. Juvenile breast lesions are rare, and it is a challenge to provide an adolescent with the best treatment in terms of clinical and psychological care. A surgical approach requires meticulous planning to ensure a fine balance between adequate resection and the best cosmetic outcome for a developing breast.

Matched MeSH terms: Breast; Breast Diseases; Breast Neoplasms
Fulltext Structural Studies of Epithelial Mesenchymal Transition Breast Tissues

Mohd Sobri SN, Abdul Sani SF, Sabtu SN, Looi LM, Chiew SF, Pathmanathan D, et al.

Sci Rep, 2020 02 06;10(1):1997.
PMID: 32029810 DOI: 10.1038/s41598-020-58932-5

At the supramolecular level, the proliferation of invasive ductal carcinoma through breast tissue is beyond the range of standard histopathology identification. Using synchrotron small angle x-ray scattering (SAXS) techniques, determining nanometer scale structural changes in breast tissue has been demonstrated to allow discrimination between different tissue types. From a total of 22 patients undergoing symptomatic investigations, different category breast tissue samples were obtained in use of surgically removed tissue, including non-lesional, benign and malignant tumour. Structural components of the tissues were examined at momentum transfer values between q = 0.2 nm-1 and 1.5 nm-1. From the SAXS patterns, axial d-spacing and diffuse scattering intensity were observed to provide the greatest discrimination between the various tissue types, specifically in regard to the epithelial mesenchymal transition (EMT) structural component in malignant tissue. In non-lesional tissue the axial period of collagen is within the range 63.6-63.7 nm (formalin fixed paraffin embedded (FFPE) dewaxed) and 63.4 (formalin fixed), being 0.9 nm smaller than in EMT cancer-invaded regions. The overall intensity of scattering from cancerous regions is a degree of magnitude greater in cancer-invaded regions. Present work has found that the d-spacing of the EMT positive breast cancer tissue (FFPE (dewaxed)) is within the range 64.5-64.7 nm corresponding to the 9th and 10th order peaks. Of particular note in regard to formalin fixation of samples is that no alteration is observed to occur in the relative differences in collagen d-spacing between non-lesional and malignant tissues. This is a matter of great importance given that preserved-sample and also retrospective study of samples is greatly facilitated by formalin fixation. Present results indicate that as aids in tissue diagnosis SAXS is capable of distinguishing areas of invasion by disease as well as delivering further information at the supramolecular level.

Matched MeSH terms: Breast/pathology; Breast/surgery; Breast/ultrastructure*; Breast Neoplasms/pathology*; Breast Neoplasms/surgery; Breast Neoplasms/ultrastructure; Carcinoma, Ductal, Breast/pathology*; Carcinoma, Ductal, Breast/surgery; Carcinoma, Ductal, Breast/ultrastructure
Standardisation of clinical breast-density measurement

Ng KH, Yip CH, Taib NA

Lancet Oncol, 2012 Apr;13(4):334-6.
PMID: 22469115 DOI: 10.1016/S1470-2045(12)70093-1
Matched MeSH terms: Breast/pathology*; Breast Neoplasms/diagnosis*

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