Project description:Background: Interval breast cancers can occur through failure to detect an abnormality at the time of screening (missed interval cancer), or as a new event after a negative screen (true interval cancer). The development and progression of true interval tumors (TIBC) is known to be different than screen-detected tumors (SDBC). However, much work still needs to be done to understand the biological characteristics and clinical behaviour of these TIBC. Objectives: To characterize the gene expression profile in TIBC and SDBC aimed to identify biological markers that may be associated with the emergence of symptomatic breast cancer in the screening interval. Material and Methods: An unsupervised exploratory gene expression profile analysis was performed among 10 samples (discovery set, TIBC=5 and SDBC=5) using Affymetrix Human Gene 1.0 ST arrays and interpreted by Ingenuity Pathway Analysis. Differential expression of selected genes was confirmed in validation series of 91 patients (TIBC=12 and SDBC=79) by immunohistochemistry and 24 patients (TIBC=8 and SDBC=16) by RT-qPCR, expanding the analysis to other genes in same pathway (mTOR, 4E-BP1, eIF-4G and S6). Results: Exploratory gene expression analysis identified 1060 transcripts with a p value <0.05 and 132 transcripts with an adjusted p value <0.01 difference between TIBC and SDBC samples. Based on biological implications in breast cancer, four genes were selected for further validation: CP (ceruloplasmin) and RPS6KB2 (ribosomal protein S6 kinase, 70kDa, polypeptide 2) both up-regulated in TIBC vs SDBC and PTEN (phosphatase and tensin homolog) and TGFBR3 (transforming growth factor beta receptor III), down-regulated in TIBC vs SDBC. Their differential expression was confirmed by RT-qPCR and immunohistochemistry, suggesting mTOR pathway overexpression in TIBC at both mRNA and protein level. Further expanded analysis by immunohistochemistry for mTOR pathway activation, including expression of phosphorylated forms of mTOR, 4E-BP1, eIF-4G, RPS6KB2 and S6, confirmed the upregulation of this pathway in TIBC. Conclusions: TIBC and SDBC shows differential expression profile both at the gene and protein levels. The mTOR signaling is significantly upregulated in TIBC compared with SDBC, suggesting an enhanced aggressiveness of TIBC. Besides, CP may also represent novel immunohistochemical marker helpful in distinguishing between TIBC and SDBC. Further studies with larger sets of patients are guaranteed to verify these findings associated with TIBC.

Project description:Background: Interval breast cancers can occur through failure to detect an abnormality at the time of screening (missed interval cancer), or as a new event after a negative screen (true interval cancer). The development and progression of true interval tumors (TIBC) is known to be different than screen-detected tumors (SDBC). However, much work still needs to be done to understand the biological characteristics and clinical behaviour of these TIBC. Objectives: To characterize the gene expression profile in TIBC and SDBC aimed to identify biological markers that may be associated with the emergence of symptomatic breast cancer in the screening interval. Material and Methods: An unsupervised exploratory gene expression profile analysis was performed among 10 samples (discovery set, TIBC=5 and SDBC=5) using Affymetrix Human Gene 1.0 ST arrays and interpreted by Ingenuity Pathway Analysis. Differential expression of selected genes was confirmed in validation series of 91 patients (TIBC=12 and SDBC=79) by immunohistochemistry and 24 patients (TIBC=8 and SDBC=16) by RT-qPCR, expanding the analysis to other genes in same pathway (mTOR, 4E-BP1, eIF-4G and S6). Results: Exploratory gene expression analysis identified 1060 transcripts with a p value <0.05 and 132 transcripts with an adjusted p value <0.01 difference between TIBC and SDBC samples. Based on biological implications in breast cancer, four genes were selected for further validation: CP (ceruloplasmin) and RPS6KB2 (ribosomal protein S6 kinase, 70kDa, polypeptide 2) both up-regulated in TIBC vs SDBC and PTEN (phosphatase and tensin homolog) and TGFBR3 (transforming growth factor beta receptor III), down-regulated in TIBC vs SDBC. Their differential expression was confirmed by RT-qPCR and immunohistochemistry, suggesting mTOR pathway overexpression in TIBC at both mRNA and protein level. Further expanded analysis by immunohistochemistry for mTOR pathway activation, including expression of phosphorylated forms of mTOR, 4E-BP1, eIF-4G, RPS6KB2 and S6, confirmed the upregulation of this pathway in TIBC. Conclusions: TIBC and SDBC shows differential expression profile both at the gene and protein levels. The mTOR signaling is significantly upregulated in TIBC compared with SDBC, suggesting an enhanced aggressiveness of TIBC. Besides, CP may also represent novel immunohistochemical marker helpful in distinguishing between TIBC and SDBC. Further studies with larger sets of patients are guaranteed to verify these findings associated with TIBC. 5 TIBC samples where compared with 5 SDBC

Project description:BackgroundIn Morocco, of the estimated 29,000 people living with HIV in 2011, only 20% were aware of their HIV status. More than half of diagnoses were at the AIDS stage. We assumed that people who were unaware of their infection had contacts with the healthcare system for HIV indicators that might prompt the healthcare provider to offer a test. The aim was to assess missed opportunities for HIV testing in patients newly diagnosed with HIV who accessed care in Morocco.MethodsA cross-sectional study was conducted in 2012-2013 in six Moroccan HIV centers. Participants were aged ≥18, and had sought care within 6 months after their HIV diagnosis. A standardized questionnaire administered during a face-to-face interview collected the patient's characteristics at HIV diagnosis, HIV testing and medical history. Contacts with care and the occurrence of clinical conditions were assessed during the 3 years prior to HIV diagnosis. Over this period, we assessed whether healthcare providers had offered HIV testing to patients with HIV-related clinical or behavioral conditions.ResultsWe enrolled 650 newly HIV-diagnosed patients (median age: 35, women: 55%, heterosexuals: 81%, diagnosed with AIDS or CD4 < 200 cells/mm3: 63%). During the 3 years prior to the HIV diagnosis, 71% (n = 463) of participants had ≥1 contact with the healthcare system. Of 323 people with HIV-related clinical conditions, 22% did not seek care for them and 9% sought care and were offered an HIV test by a healthcare provider. The remaining 69% were not offered a test and were considered as missed opportunities for HIV testing. Of men who have sex with men, 83% did not address their sexual behavior with their healthcare provider, 11% were not offered HIV testing, while 6% were offered HIV testing after reporting their sexual behavior to their provider.ConclusionsAmong people who actually sought care during the period of probable infection, many opportunities for HIV testing, based on at-risk behaviors or clinical signs, were missed. This highlights the need to improve the recognition of HIV clinical indicators by physicians, further expand community-based HIV testing by lay providers, and implement self-testing to increase accessibility and privacy.

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Survival among women diagnosed with screen-detected or interval breast cancer classified as true, minimal signs, or missed through an informed radiological review.

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