مقاله شماره ۲۰
#Urology
#Oncology
عنوان:
Short-Term ADT Combined With Radiotherapy as Salvage Treatment After Radical Prostatectomy
سایتیشن:
Carrie et al.
مجله:
The Lancet Oncology
نوع مطالعه
randomised trial
تاریخ انتشار:
16, oct, 2018
چکیده:
BACKGROUND
Radiotherapy is the standard salvage treatment after radical prostatectomy. To date, the role of androgen deprivation therapy has not been formally shown. In this follow-up study, we aimed to update the results of the GETUG-AFU 16 trial, which assessed the efficacy of radiotherapy plus androgen suppression versus radiotherapy alone.
METHODS
GETUG-AFU 16 was an open-label, multicentre, phase 3, randomised, controlled trial that enrolled men (aged ≥18 years) with Eastern Cooperative Oncology Group performance status of 0 or 1, with histologically confirmed adenocarcinoma of the prostate (but no previous androgen suppression or pelvic radiotherapy), stage pT2, T3, or T4a (bladder neck involvement only) and pN0 or pNx according to the tumour, node, metastasis (TNM) staging system, whose prostate-specific antigen (PSA) concentration increased from 0·1 ng/mL to between 0·2 ng/mL and 2·0 ng/mL after radical prostatectomy, without evidence of clinical disease. Patients were assigned through central randomisation (1:1) to short-term androgen suppression (subcutaneous injection of 10·8 mg goserelin on the first day of irradiation and 3 months later) plus radiotherapy (3D conformal radiotherapy or intensity modulated radiotherapy of 66 Gy in 33 fractions, 5 days a week for 7 weeks) or radiotherapy alone. Randomisation was stratified using a permuted block method (block sizes of two and four) according to investigational site, radiotherapy modality, and prognosis. The primary endpoint was progression-free survival in the intention-to-treat population. This post-hoc one-shot data collection done 4 years after last data cutoff included patients who were alive at the time of the primary analysis and updated long-term patient status by including dates for first local progression, metastatic disease diagnosis, or death (if any of these had occurred) or the date of the last tumour evaluation or last PSA measurement. Survival at 120 months was reported. Late serious adverse effects were assessed. This trial is registered on ClinicalTrials.gov, NCT00423475.
FINDINGS
Between Oct 19, 2006, and March 30, 2010, 743 patients were randomly assigned, 374 to radiotherapy alone and 369 to radiotherapy plus goserelin. At the time of data cutoff (March 12, 2019), the median follow-up was 112 months (IQR 102-123). The 120-month progression-free survival was 64% (95% CI 58-69) for patients treated with radiotherapy plus goserelin and 49% (43-54) for patients treated with radiotherapy alone (hazard ratio 0·54, 0·43-0·68; stratified log-rank test p<0·0001). Two cases of secondary cancer occurred since the primary analysis, but were not considered to be treatment related. No treatment-related deaths occurred.
INTERPRETATION
The 120-month progression-free survival confirmed the results from the primary analysis. Salvage radiotherapy combined with short-term androgen suppression significantly reduced risk of biochemical or clinical progression and death compared with salvage radiotherapy alone. The results of the GETUG-AFU 16 trial confirm the efficacy of androgen suppression plus radiotherapy as salvage treatment in patients with increasing PSA concentration after radical prostatectomy for prostate cancer.
DOI: https://doi.org/10.1016/S1470-2045(19)30486-3
🔎 @Meditorha
#Urology
#Oncology
عنوان:
Short-Term ADT Combined With Radiotherapy as Salvage Treatment After Radical Prostatectomy
سایتیشن:
Carrie et al.
مجله:
The Lancet Oncology
نوع مطالعه
randomised trial
تاریخ انتشار:
16, oct, 2018
چکیده:
BACKGROUND
Radiotherapy is the standard salvage treatment after radical prostatectomy. To date, the role of androgen deprivation therapy has not been formally shown. In this follow-up study, we aimed to update the results of the GETUG-AFU 16 trial, which assessed the efficacy of radiotherapy plus androgen suppression versus radiotherapy alone.
METHODS
GETUG-AFU 16 was an open-label, multicentre, phase 3, randomised, controlled trial that enrolled men (aged ≥18 years) with Eastern Cooperative Oncology Group performance status of 0 or 1, with histologically confirmed adenocarcinoma of the prostate (but no previous androgen suppression or pelvic radiotherapy), stage pT2, T3, or T4a (bladder neck involvement only) and pN0 or pNx according to the tumour, node, metastasis (TNM) staging system, whose prostate-specific antigen (PSA) concentration increased from 0·1 ng/mL to between 0·2 ng/mL and 2·0 ng/mL after radical prostatectomy, without evidence of clinical disease. Patients were assigned through central randomisation (1:1) to short-term androgen suppression (subcutaneous injection of 10·8 mg goserelin on the first day of irradiation and 3 months later) plus radiotherapy (3D conformal radiotherapy or intensity modulated radiotherapy of 66 Gy in 33 fractions, 5 days a week for 7 weeks) or radiotherapy alone. Randomisation was stratified using a permuted block method (block sizes of two and four) according to investigational site, radiotherapy modality, and prognosis. The primary endpoint was progression-free survival in the intention-to-treat population. This post-hoc one-shot data collection done 4 years after last data cutoff included patients who were alive at the time of the primary analysis and updated long-term patient status by including dates for first local progression, metastatic disease diagnosis, or death (if any of these had occurred) or the date of the last tumour evaluation or last PSA measurement. Survival at 120 months was reported. Late serious adverse effects were assessed. This trial is registered on ClinicalTrials.gov, NCT00423475.
FINDINGS
Between Oct 19, 2006, and March 30, 2010, 743 patients were randomly assigned, 374 to radiotherapy alone and 369 to radiotherapy plus goserelin. At the time of data cutoff (March 12, 2019), the median follow-up was 112 months (IQR 102-123). The 120-month progression-free survival was 64% (95% CI 58-69) for patients treated with radiotherapy plus goserelin and 49% (43-54) for patients treated with radiotherapy alone (hazard ratio 0·54, 0·43-0·68; stratified log-rank test p<0·0001). Two cases of secondary cancer occurred since the primary analysis, but were not considered to be treatment related. No treatment-related deaths occurred.
INTERPRETATION
The 120-month progression-free survival confirmed the results from the primary analysis. Salvage radiotherapy combined with short-term androgen suppression significantly reduced risk of biochemical or clinical progression and death compared with salvage radiotherapy alone. The results of the GETUG-AFU 16 trial confirm the efficacy of androgen suppression plus radiotherapy as salvage treatment in patients with increasing PSA concentration after radical prostatectomy for prostate cancer.
DOI: https://doi.org/10.1016/S1470-2045(19)30486-3
🔎 @Meditorha
مقاله شماره ۲۸
#Oncology
#Gynecology
عنوان:
Secondary Surgical Cytoreduction for Recurrent Ovarian Cancer
مجله:
The New England Journal of Medicine
تاریخ انتشار:
Nov, 2019
سایتیشن:
Coleman et al.
چکیده:
BACKGROUND
Secondary surgical cytoreduction in women with platinum-sensitive, recurrent epithelial ovarian, primary peritoneal, or fallopian-tube ("ovarian") cancer is widely practiced but has not been evaluated in phase 3 investigation.
METHODS
We randomly assigned patients with recurrent ovarian cancer who had received one previous therapy, had an interval during which no platinum-based chemotherapy was used (platinum-free interval) of 6 months or more, and had investigator-determined resectable disease (to no macroscopic residual disease) to undergo secondary surgical cytoreduction and then receive platinum-based chemotherapy or to receive platinum-based chemotherapy alone. Adjuvant chemotherapy (paclitaxel-carboplatin or gemcitabine-carboplatin) and use of bevacizumab were at the discretion of the investigator. The primary end point was overall survival.
RESULTS
A total of 485 patients underwent randomization, 240 to secondary cytoreduction before chemotherapy and 245 to chemotherapy alone. The median follow-up was 48.1 months. Complete gross resection was achieved in 67% of the patients assigned to surgery who underwent the procedure. Platinum-based chemotherapy with bevacizumab followed by bevacizumab maintenance was administered to 84% of the patients overall and was equally distributed between the two groups. The hazard ratio for death (surgery vs. no surgery) was 1.29 (95% confidence interval [CI], 0.97 to 1.72; P = 0.08), which corresponded to a median overall survival of 50.6 months and 64.7 months, respectively. Adjustment for platinum-free interval and chemotherapy choice did not alter the effect. The hazard ratio for disease progression or death (surgery vs. no surgery) was 0.82 (95% CI, 0.66 to 1.01; median progression-free survival, 18.9 months and 16.2 months, respectively). Surgical morbidity at 30 days was 9%; 1 patient (0.4%) died from postoperative complications. Patient-reported quality of life decreased significantly after surgery but did not differ significantly between the two groups after recovery.
CONCLUSIONS
In this trial involving patients with platinum-sensitive, recurrent ovarian cancer, secondary surgical cytoreduction followed by chemotherapy did not result in longer overall survival than chemotherapy alone.
DOI: https://www.nejm.org/doi/10.1056/NEJMoa1902626
توضیحات:
The authors of this multinational, randomized, phase III clinical trial compared outcomes of secondary surgical cytoreduction followed by platinum-based chemotherapy versus platinum-based chemotherapy alone in 485 women with resectable, platinum-sensitive, recurrent ovarian cancer. The median overall survival was 50.6 months following surgery compared with 64.7 months without surgery. The hazard ratio for death was 1.29 with surgery compared with platinum-based chemotherapy alone (P=.08). Surgery was not associated with improved outcomes even when comparing only 67% of surgical patients who achieved complete gross resection with the chemotherapy-alone cohort.
🔎 @Meditorha
#Oncology
#Gynecology
عنوان:
Secondary Surgical Cytoreduction for Recurrent Ovarian Cancer
مجله:
The New England Journal of Medicine
تاریخ انتشار:
Nov, 2019
سایتیشن:
Coleman et al.
چکیده:
BACKGROUND
Secondary surgical cytoreduction in women with platinum-sensitive, recurrent epithelial ovarian, primary peritoneal, or fallopian-tube ("ovarian") cancer is widely practiced but has not been evaluated in phase 3 investigation.
METHODS
We randomly assigned patients with recurrent ovarian cancer who had received one previous therapy, had an interval during which no platinum-based chemotherapy was used (platinum-free interval) of 6 months or more, and had investigator-determined resectable disease (to no macroscopic residual disease) to undergo secondary surgical cytoreduction and then receive platinum-based chemotherapy or to receive platinum-based chemotherapy alone. Adjuvant chemotherapy (paclitaxel-carboplatin or gemcitabine-carboplatin) and use of bevacizumab were at the discretion of the investigator. The primary end point was overall survival.
RESULTS
A total of 485 patients underwent randomization, 240 to secondary cytoreduction before chemotherapy and 245 to chemotherapy alone. The median follow-up was 48.1 months. Complete gross resection was achieved in 67% of the patients assigned to surgery who underwent the procedure. Platinum-based chemotherapy with bevacizumab followed by bevacizumab maintenance was administered to 84% of the patients overall and was equally distributed between the two groups. The hazard ratio for death (surgery vs. no surgery) was 1.29 (95% confidence interval [CI], 0.97 to 1.72; P = 0.08), which corresponded to a median overall survival of 50.6 months and 64.7 months, respectively. Adjustment for platinum-free interval and chemotherapy choice did not alter the effect. The hazard ratio for disease progression or death (surgery vs. no surgery) was 0.82 (95% CI, 0.66 to 1.01; median progression-free survival, 18.9 months and 16.2 months, respectively). Surgical morbidity at 30 days was 9%; 1 patient (0.4%) died from postoperative complications. Patient-reported quality of life decreased significantly after surgery but did not differ significantly between the two groups after recovery.
CONCLUSIONS
In this trial involving patients with platinum-sensitive, recurrent ovarian cancer, secondary surgical cytoreduction followed by chemotherapy did not result in longer overall survival than chemotherapy alone.
DOI: https://www.nejm.org/doi/10.1056/NEJMoa1902626
توضیحات:
The authors of this multinational, randomized, phase III clinical trial compared outcomes of secondary surgical cytoreduction followed by platinum-based chemotherapy versus platinum-based chemotherapy alone in 485 women with resectable, platinum-sensitive, recurrent ovarian cancer. The median overall survival was 50.6 months following surgery compared with 64.7 months without surgery. The hazard ratio for death was 1.29 with surgery compared with platinum-based chemotherapy alone (P=.08). Surgery was not associated with improved outcomes even when comparing only 67% of surgical patients who achieved complete gross resection with the chemotherapy-alone cohort.
🔎 @Meditorha
New England Journal of Medicine
Secondary Surgical Cytoreduction for Recurrent Ovarian Cancer | NEJM
Original Article from The New England Journal of Medicine — Secondary Surgical Cytoreduction for Recurrent Ovarian Cancer
مقاله شماره ۳۰
#Gynecology
#Oncology
عنوان:
Supplemental MRI Screening for Women With Extremely Dense Breast Tissue
مجله:
The New England Journal of Medicine
نوع مطالعه:
RCT
تاریخ انتشار:
Nov, 2019
سایتیشن:
Bakker et al.
چکیده:
BACKGROUND
Extremely dense breast tissue is a risk factor for breast cancer and limits the detection of cancer with mammography. Data are needed on the use of supplemental magnetic resonance imaging (MRI) to improve early detection and reduce interval breast cancers in such patients.
METHODS
In this multicenter, randomized, controlled trial in the Netherlands, we assigned 40,373 women between the ages of 50 and 75 years with extremely dense breast tissue and normal results on screening mammography to a group that was invited to undergo supplemental MRI or to a group that received mammography screening only. The groups were assigned in a 1:4 ratio, with 8061 in the MRI-invitation group and 32,312 in the mammography-only group. The primary outcome was the between-group difference in the incidence of interval cancers during a 2-year screening period.
RESULTS
The interval-cancer rate was 2.5 per 1000 screenings in the MRI-invitation group and 5.0 per 1000 screenings in the mammography-only group, for a difference of 2.5 per 1000 screenings (95% confidence interval [CI], 1.0 to 3.7; P<0.001). Of the women who were invited to undergo MRI, 59% accepted the invitation. Of the 20 interval cancers that were diagnosed in the MRI-invitation group, 4 were diagnosed in the women who actually underwent MRI (0.8 per 1000 screenings) and 16 in those who did not accept the invitation (4.9 per 1000 screenings). The MRI cancer-detection rate among the women who actually underwent MRI screening was 16.5 per 1000 screenings (95% CI, 13.3 to 20.5). The positive predictive value was 17.4% (95% CI, 14.2 to 21.2) for recall for additional testing and 26.3% (95% CI, 21.7 to 31.6) for biopsy. The false positive rate was 79.8 per 1000 screenings. Among the women who underwent MRI, 0.1% had either an adverse event or a serious adverse event during or immediately after the screening.
CONCLUSIONS
The use of supplemental MRI screening in women with extremely dense breast tissue and normal results on mammography resulted in the diagnosis of significantly fewer interval cancers than mammography alone during a 2-year screening period.
DOI: https://www.nejm.org/doi/full/10.1056/NEJMoa1903986
توضیحات مهم:
✅ در این مطالعه، ۴۰۳۷۳ زن در محدودع سنی ۵۰ تا ۷۵ سال با بافت پستان extremely dense و نتایج غربالگری نرمال ماموگرافی بصورت رندوم به دو گروه supplemental MRI و فقط ماموگرافی تقسیم شدند.
✔️ The interval cancer rate was significantly lower in the MRI-invitation group compared with the mammography-only group.
✔️ Among the 20 interval cancers diagnosed in the MRI-invitation group, 4 were diagnosed in women who underwent MRI and 16 were diagnosed in those who did not accept the invitation.
✔️Among the women who underwent MRI screening, the cancer-detection rate was 16.5 per 1000 screenings.
✔️ The positive predictive value was 17.4% for recall for additional testing and 26.3% for biopsy, whereas the false-positive rate was 79.8 per 1000 screenings.
✔️✔️ نتایج این مطالعه نشان می دهد که supplemental MRI در زنان با بافت پستان extremely dense و ماموگرافی نرمال منجر به تشخیص کمتر قابل توجهی از کنسرهای interval در مقایسه با ماموگرافی به تنهایی می شود.
🔎 @Meditorha
#Gynecology
#Oncology
عنوان:
Supplemental MRI Screening for Women With Extremely Dense Breast Tissue
مجله:
The New England Journal of Medicine
نوع مطالعه:
RCT
تاریخ انتشار:
Nov, 2019
سایتیشن:
Bakker et al.
چکیده:
BACKGROUND
Extremely dense breast tissue is a risk factor for breast cancer and limits the detection of cancer with mammography. Data are needed on the use of supplemental magnetic resonance imaging (MRI) to improve early detection and reduce interval breast cancers in such patients.
METHODS
In this multicenter, randomized, controlled trial in the Netherlands, we assigned 40,373 women between the ages of 50 and 75 years with extremely dense breast tissue and normal results on screening mammography to a group that was invited to undergo supplemental MRI or to a group that received mammography screening only. The groups were assigned in a 1:4 ratio, with 8061 in the MRI-invitation group and 32,312 in the mammography-only group. The primary outcome was the between-group difference in the incidence of interval cancers during a 2-year screening period.
RESULTS
The interval-cancer rate was 2.5 per 1000 screenings in the MRI-invitation group and 5.0 per 1000 screenings in the mammography-only group, for a difference of 2.5 per 1000 screenings (95% confidence interval [CI], 1.0 to 3.7; P<0.001). Of the women who were invited to undergo MRI, 59% accepted the invitation. Of the 20 interval cancers that were diagnosed in the MRI-invitation group, 4 were diagnosed in the women who actually underwent MRI (0.8 per 1000 screenings) and 16 in those who did not accept the invitation (4.9 per 1000 screenings). The MRI cancer-detection rate among the women who actually underwent MRI screening was 16.5 per 1000 screenings (95% CI, 13.3 to 20.5). The positive predictive value was 17.4% (95% CI, 14.2 to 21.2) for recall for additional testing and 26.3% (95% CI, 21.7 to 31.6) for biopsy. The false positive rate was 79.8 per 1000 screenings. Among the women who underwent MRI, 0.1% had either an adverse event or a serious adverse event during or immediately after the screening.
CONCLUSIONS
The use of supplemental MRI screening in women with extremely dense breast tissue and normal results on mammography resulted in the diagnosis of significantly fewer interval cancers than mammography alone during a 2-year screening period.
DOI: https://www.nejm.org/doi/full/10.1056/NEJMoa1903986
توضیحات مهم:
✅ در این مطالعه، ۴۰۳۷۳ زن در محدودع سنی ۵۰ تا ۷۵ سال با بافت پستان extremely dense و نتایج غربالگری نرمال ماموگرافی بصورت رندوم به دو گروه supplemental MRI و فقط ماموگرافی تقسیم شدند.
✔️ The interval cancer rate was significantly lower in the MRI-invitation group compared with the mammography-only group.
✔️ Among the 20 interval cancers diagnosed in the MRI-invitation group, 4 were diagnosed in women who underwent MRI and 16 were diagnosed in those who did not accept the invitation.
✔️Among the women who underwent MRI screening, the cancer-detection rate was 16.5 per 1000 screenings.
✔️ The positive predictive value was 17.4% for recall for additional testing and 26.3% for biopsy, whereas the false-positive rate was 79.8 per 1000 screenings.
✔️✔️ نتایج این مطالعه نشان می دهد که supplemental MRI در زنان با بافت پستان extremely dense و ماموگرافی نرمال منجر به تشخیص کمتر قابل توجهی از کنسرهای interval در مقایسه با ماموگرافی به تنهایی می شود.
🔎 @Meditorha
New England Journal of Medicine
Supplemental MRI Screening for Women with Extremely Dense Breast Tissue | NEJM
Original Article from The New England Journal of Medicine — Supplemental MRI Screening for Women with Extremely Dense Breast Tissue
مقاله شماره ۳۸
#Oncology
#BreastCancer
#Epidemiology
عنوان:
Risk factors for breast cancer among young women in southern iran
مجله:
IJC ( International Journal of Cancer)
نوع مطالعه:
Case_control study
تاریخ انتشار:
Nov, 09, 2010
سایتیشن:
Ghiasvand et al.
چکیده:
Age standardized incidence rates of breast cancer in developed countries is nearly threefold higher than in developing countries. Iran has had one of the lowest incidence rates for breast cancer in the world, but during the last four decades increasing incidence rates of breast cancer made it the most prevalent cancer in Iranian women. After adjustment for age, Iranian young women are at relatively higher risk of breast cancer than their counterparts in developed countries. The purpose of this study was to investigate some established risk factors of breast cancer in Iranian young women. A hospital‐based case control study comprising 521 women with histologically confirmed, incident breast cancer and 521 controls frequency‐matched by age and province of residence was conducted. Logistic regression performed to investigate associations of reproductive and anthropometric factors with breast cancer risk. In multivariate analysis, family history [odds ratio (OR): 1.61; 95% confidence interval (CI): 1.07–2.42], oral contraceptives (OC) usage (OR: 1.52; 95% CI: 1.11–2.08), low parity (OR parity ≥ 3 vs. 1–2: 0.33; 95% CI: 0.23–0.49), employment (OR: 1.83; 95% CI: 1.05–3.23) and shorter period of breast feeding (OR ≥ 37 months vs. < 37: 0.61; 95% CI: 0.44–0.84) were related to a higher risk of breast cancer in young women. This was the first study focusing on risk factors of breast cancer in Iranian young women. The trend of decreasing parity and shortened duration of breast feeding along with OC usage might partly explain the rapid rising of breast cancer incidence in Iranian young women.
توضیحات مهم:
نویسندگان در این مطالعه به بررسی ریسک فاکتورهای سرطان سینه در زنان جوان جنوب ایران پرداخته اند.
در این مطالعه مورد_شاهدی ۵۲۱ مورد تایید شده سرطان سینه توسط پاتولوژی و ۵۲۱ شاهد بررسی شدند.
نتایج حاکی از آن بود که سابقه ی فامیلی ، مصرف ocp ، نا برابری اجتماعی و کوتاه بودن زمان شیردهی با ریسک بالاتری از سرطان سینه همراه بودند.
در این مطالعه علت افزایش سرطان سینه در زنان جوان ایرانی در دهه های اخیر را مصرف ocp ، طول شیردهی کم و نابرابری در نظر گرفت.
Pdf 👉🏻 https://onlinelibrary.wiley.com/doi/full/10.1002/ijc.25748
🔎 @Meditorha
#Oncology
#BreastCancer
#Epidemiology
عنوان:
Risk factors for breast cancer among young women in southern iran
مجله:
IJC ( International Journal of Cancer)
نوع مطالعه:
Case_control study
تاریخ انتشار:
Nov, 09, 2010
سایتیشن:
Ghiasvand et al.
چکیده:
Age standardized incidence rates of breast cancer in developed countries is nearly threefold higher than in developing countries. Iran has had one of the lowest incidence rates for breast cancer in the world, but during the last four decades increasing incidence rates of breast cancer made it the most prevalent cancer in Iranian women. After adjustment for age, Iranian young women are at relatively higher risk of breast cancer than their counterparts in developed countries. The purpose of this study was to investigate some established risk factors of breast cancer in Iranian young women. A hospital‐based case control study comprising 521 women with histologically confirmed, incident breast cancer and 521 controls frequency‐matched by age and province of residence was conducted. Logistic regression performed to investigate associations of reproductive and anthropometric factors with breast cancer risk. In multivariate analysis, family history [odds ratio (OR): 1.61; 95% confidence interval (CI): 1.07–2.42], oral contraceptives (OC) usage (OR: 1.52; 95% CI: 1.11–2.08), low parity (OR parity ≥ 3 vs. 1–2: 0.33; 95% CI: 0.23–0.49), employment (OR: 1.83; 95% CI: 1.05–3.23) and shorter period of breast feeding (OR ≥ 37 months vs. < 37: 0.61; 95% CI: 0.44–0.84) were related to a higher risk of breast cancer in young women. This was the first study focusing on risk factors of breast cancer in Iranian young women. The trend of decreasing parity and shortened duration of breast feeding along with OC usage might partly explain the rapid rising of breast cancer incidence in Iranian young women.
توضیحات مهم:
نویسندگان در این مطالعه به بررسی ریسک فاکتورهای سرطان سینه در زنان جوان جنوب ایران پرداخته اند.
در این مطالعه مورد_شاهدی ۵۲۱ مورد تایید شده سرطان سینه توسط پاتولوژی و ۵۲۱ شاهد بررسی شدند.
نتایج حاکی از آن بود که سابقه ی فامیلی ، مصرف ocp ، نا برابری اجتماعی و کوتاه بودن زمان شیردهی با ریسک بالاتری از سرطان سینه همراه بودند.
در این مطالعه علت افزایش سرطان سینه در زنان جوان ایرانی در دهه های اخیر را مصرف ocp ، طول شیردهی کم و نابرابری در نظر گرفت.
Pdf 👉🏻 https://onlinelibrary.wiley.com/doi/full/10.1002/ijc.25748
🔎 @Meditorha
Wiley Online Library
Risk factors for breast cancer among young women in southern Iran
Age standardized incidence rates of breast cancer in developed countries is nearly threefold higher than in developing countries. Iran has had one of the lowest incidence rates for breast cancer in t...