Quality of life, Biomarkers, and Involvement of Ghrelin in Women with Breast Cancer

Abstract

Breast cancer (BC) is the most common and most lethal cancer among women worldwide. More than a million and a half are diagnosed every year with more than 600,000 deaths among women worldwide. It is estimated than 1 in every 7 women will develop breast cancer in their life time. It is a major public health concern with high economic cost as well. BC is a multidimensional construct. Several dimensions of this construct have never been examined before in the United Arab Emirates (UAE). This study investigated major facets of the Quality of life (QOL) among women with BC in the UAE, compared it with a sample of age matched healthy group of women without any neoplastic background, changes in serum biomarkers of women with BC and to detect the impact of the disease on these biomarkers at the beginning of the disease before treatment started and then again 12 months later following treatment for the cancer and the role of ghrelin hormone in BC and depression at a tissue level and at serum level.

In order to examine QOL with its all dimensions among women with BC, an epidemiological case-control study was conducted recruiting a sample of 300 women, 155 women with BC and 145 age-matched healthy women without any neoplastic background as a control group. This was carried out by using a series of standardized psychometric tools in addition to conducting a psychiatric diagnostic interview. Moreover, blood biomarker results were reviewed retrospectively for cases and controls at the beginning and then 12 months following treatment for BC. In relation to the histopathological characteristics and treatment modalities for BC, all pathology, medical and oncology data for 155 women with BC was retrieved from the computer system and analyzed retrospectively. Finally, in relation to ghrelin hormone, all mammary morphological types, normal, benign and malignant were examined with immunohistochemistry for the expression of ghrelin and its functioning receptor (GHS-R1a). Serum of the same women, whose mammary tissue sections were examined by IHC, was tested for ghrelin serum level to find out its link to BC and depression. This was carried out by Enzyme-Linked Immunosorbent Assay (ELISA).

The results have demonstrated that women with BC had poor QOL in comparison to the control group. They had poor view of their body image and sexuality and moreover physical disability rate was high. They also tended to suppress negative emotions to a great extent. Anxiety symptoms were also high. Major depressive disorders and post traumatic disorders were lower among women with BC compared to healthy controls. Several risk factors turned to be linked to BC. These included age, having night shift work, hypertension, diabetes mellitus, oral contraceptive pills, hormonal replacement therapy and not breast feeding. In terms of significant traumatic life events, the Arabic version of the CESC English scale showed to have high validity and reliability among women with BC in the UAE. The results also showed that the levels of several serum haematological and biochemical markers seemed to be abnormal among women with BC compared to healthy control. These included elevated levels of platelet, basophils, liver enzymes, lactate dehydrogenase and tumour serum markers. On the other hand, they were low levels of serum magnesium, C-reactive protein and creatinine. Analysis of histopathological characteristics indicated that the aggressive biological nature of the disease was at the late stage and presentation to medical services for treatment. Clinically, women with BC seemed to have all treatment modalities for BC with high rate of mastectomy and axillary clearance. Regarding ghrelin hormone and it relation to BC, the results showed that malignant mammary tissues had an exclusive and differential immune-reactivity to ghrelin hormone, whereas its receptor, the GHS-R1a, was immune-reactive all mammary tissue morphological types. In addition, more metastasis to the lymph nodes was significantly correlated with more immune-reactivity to ghrelin receptor. The results for gene expression for pro-ghrelin, ghrelin and its receptors were inconclusive

It is concluded that breast cancer is the most common cancer among women in the UAE. It attacks women at an earlier age than their counterparts in the West. More attention should to be allocated to the QOL and the unmet psychosocial needs of women with BC. This in turn would improve compliance to treatment and prognosis as well. It is also recommended that awareness campaigns and early screening should be applied for early detection of the disease to prevent late presentation to the medical services and other complications.