Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Outcome of minimally invasive procedures for early breast cancer(College of Surgeons of Sri Lanka, 2015) Atulugama, N.S.; Bandaranayake, B.M.V.C.; de Silva, G.K.S.; Ariyapala, K.S.K.; Ediriweera, E.P.D.S.INTRODUCTION: Worldwide incidence of stage I breast cancer is around 41%. For primary breast lesions management trend has changed from mastectomy to breast conservation (BCS) and for axillary staging from routine nodal dissection (ALND) to Sentinel Lymph node Biopsy (SLNB) in clinically negative axillae. In many studies it has been proven that this paradigm shift has brought increase patient satisfaction with less morbidity and with same oncological outcome. MATERIAL AND METHODS: Patients with early breast cancer and clinically negative axillae were prospectively analysed in a single unit from January 2013. They were offered breast conservation or mastectomy (on patient's request) with SLNB. We used Isolated Methylene Blue technique (IMBT) for SLNB. All patients followed up for 2 years with standard surveillance protocol and data comprising of pre-op evaluation, surgical data, histological details and surveillance were recorded in a database. RESULTS: Total number of patients included were 253. BCS was offered for 157 (62.05%) patients. Ninety five (60.5%) had Primary closure, 49(31.2%) had Volume displacements and 15 (9%) had Volume replacements. Twenty eight patients needed re-surgery immediately due to inadequate margins and 14 ended up in mastectomy. Out of mastectomy patients 6 had TRAM and 4 had LD immediate reconstructions. Median age for BCS 53yrs and mastectomy 54yrs. Only 3 patients had axillary recurrences but no breast recurrences during the study period. CONCLUSIONS: BCS and SLNB with IMBT can be offered for early breast cancer patients with non-inferior oncological outcome compared to standard treatment of mastectomy and axillary clearance.Item Serum ferritin in newly diagnosed breast cancer and apparently healthy individuals(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Akalanka, H.M.K.; Ekanayake, S.; Samarasinghe, K.BACKGROUND: Iron is an essential element for the cell proliferation and is primarily stored in human body in the form of ferritin. Iron metabolism is influenced by oestrogen and interactions between iron and oestrogen is thought to synergistically promote breast cancer (BC). OBJECTIVES: To assess serum ferittin concentrations of BC patients and healthy females. METHODS: Newly diagnosed BC patients (n=150) and apparently healthy females (n=75) who consented to be on the study were enrolled. Serum ferritin concentration was assessed using enzyme immunoassay method using mini vidas immune analyser. RESULTS: Median serum ferritin concentrations (IQR) of pre (n=58) and postmenopausal (n=92) BC patients were 32.32 (37.84) ng/ml and 64.33 (27.18) ng/ml respectively. Postmenopausal BC patients had significantly high (p<0.05) serum ferritin concentrations compared to premenopausal BC patients. Apparently healthy pre (n=35) and postmenopausal (n=40) women had median values of 26.06(28.09) ng/ml and 45.00(51.24) ng/ml respectively the difference of which was statistically significant (p<0.05). A significant difference in serum ferritin concentration was not observed among premenopausal BC women and apparently healthy women (p>0.05). However, postmenopausal BC women had significant high levels of serum ferritin compared to postmenopausal healthy women (0<0.05). The postmenopausal ferritin concentrations among BC and normal women studied via ROC curve showed 70% (p=0.000, CI 0.62-0.79) of area under the curve with ferritin cutoff value of 58 ng/mL with 60% sensitivity and 75% specificity. Among postmenopausal BC and healthy women, 56.5% and 29% had ferritin levels above this cutoff value respectively and postmenopausal women having ferritin levels above the cutoff had 3times (OR=3.1, 95%CI 1.6-5.9) risk of having breast cancer. CONCLUSIONS: Elevated serum ferritin concentration in postmenopausal women is associated with breast cancer risk but not in premenopausal women.Item Nottingham grade 2 breast cancer; is it a true prognostic category?(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Peiris, H.H.; Mudduwa, L.K.B.; Thalagala, N.I.; Jayatilake, K.A.P.W.BACKGROUND: Nottingham grade (NG) is a well-recognized prognostic factor derived by adding scores (1-3) given for three histological features of breast cancer (BC). NG is assigned according to the final score (NG1=score 3-5, NG2=score 6-7, NG3=score 8-9) where NG1 has the best and NG3 has the worst prognosis. OBJECTIVE: To assess whether the NG2 entails only patients with a similar prognosis. METHODS: Data were collected from all NG2 BC patients who had sought the services of our unit from 2006 to 2012. Grading was done by a single investigator. Patients were divided into two groups according to the score assigned in grading (6 and 7) and followed up with a mean follow-up time of 45 (SD=23) months. Clinico-pathological features were compared using chi-square test. Kaplan-Meier model with log-rank test was used for survival analysis. RESULTS: The study included 352 NG2 BC patients (score 6=195; score 7=157) with a mean age of 52 (SD=11) years. Majority of the patients with score 6 had ER/PR positive tumours (p=0.007 and 0.029) whereas score 7 patients had Her 2 positive tumours (p=0.002). There was a significant survival difference between the patients who had scores 6 and 7 (breast cancer specific survival p=0.007; recurrence free survival p=0.019). There was no survival difference between the patients with NG1 and score 6 and NG3 and score 7 (p>0.05). CONCLUSIONS: NG2 comprises two subsets of patients with a significant survival difference. Their prognosis is more in line with the preceding/subsequent grade than the same grade, probably due to the difference in ER/PR and Her 2 expression.Item Quality of breast cancer early detection services in the well women clinics in the district of Gampaha(Sri Lanka Medical Association, 2012) Vithana, P.V.S.C.; Ariyarathne, M.A.Y.; Jayawardena, P.L.AIMS: To evaluate selected aspects of breast cancer early detection services implemented through well woman clinics (WWCs) in the Gampaha District. METHODS: Clinical breast-examination(CBE) coverage of target age group women(TGW) of 35-59 years was assessed in all the WWCs in Gampaha district from 2003-2007. Quality assessment of breast cancer early detection services was done using Lot Quality Assurance Sampling. The lot size and threshold value computed were twenty and six clinics respectively. Checklists were used in assessing coverage, physical facilities and clinic activities. Client-satisfaction on WWC services was assessed among 200 TGW attending 20 WWCs using an interviewer-administered questionnaires. RESULTS: CBE coverage in the Gampaha district increased from 1.1% (3389/318711) to 2.2% (7248/326271) from 2003-2007. With regard to physical facilities, the number of clinics that were rated substandard varied between 7-18 (35% - 90%). Adequacy in relation to notice boards, stationery, furniture and linen, and cleanliness outside premises and toilets were identified as substandard. With regard to services, punctuality of staff arrival and in commencement of clinics, provision of healtheducation, availability of supervision and CBE and breast self-examination (BSE) services were observed as substandard in 7-20 clinics (35%-100%). Median satisfaction score among TGW was 45.2% (IQR: 38.7 - 54.8%). Only 11% had a score of >70%; the threshold for satisfaction. CONCLUSIONS: Coverage of breast cancer early detection service in the Gampaha district in 2007,11 years after commencing WWC services, was still very low (2.2%). All 20 clinics were substandard for overallCBEand BSE services.Item Effectiveness of an educational intervention on early detection of breast cancer in the district of Gampaha(Sri Lanka Medical Association, 2012) Vithana, P.V.S.C.; Ariyarathne, M.A.Y.; Jayawardena, P.L.INTRODUCTION AND AIMS: To assess the effectiveness of an educational intervention on improving knowledge, attitudes and practices (KAP) on early detection of breast cancer among Public Health Midwives (PHMs) and target group women (TGW) in the district of Gampaha. METHODS: A community-based intervention was conducted in Gampaha district using two Medical Officer of Health areas selected by random sampling as intervention (IA) and control (CA). The study participants were all PHMs in IA (n=38) and CA (n=47J and 260 TGW from each area. PHMs who were exposed to the educational intervention first, conducted the same among the TGW. For PHMs, post-intervention survey was conducted at one and six months and for TGW at six months after intervention. RESULTS: The overall median scores for KAP respectively were as follows: PHMs: Pre-intervention: IA: 58%[IQR: 53- 69%), 90%(IQR: 70-100%) and 62%(IQR: 57-70%). CA: 64%(IQR: 56-69%), 90%{IQR: 70-90%) and 62%( IQR: 50-77%). Post-intervention; six months IA: 93% (IQR: 91-93%), 100%(IQR: 90-100%), and 81%(IQR: 77-89%). CA: 67%(IQR: 58- 71%), 90%(IQR: 90-100%), and 62%( IQR: 58-73%). TGW: Pre-intervention: IA: 54%(IQR: 46-59%), 50%(IQR: 41-59%), and 0%(IQR: 0-20%). CA: 54%(IQR: 44- 59%), 50%(IQR: 36-59%), and 0%( IQR: 0-20%). Post-intervention: six months IA: 77%(IQR: 72-82%), 68%(IQR: 59- 76 %) and 40%(IQR: 20-60%). CA: 54%(1QR: 46- 59%), 50%(IQR: 36-64%), and 0%( IQR: 0-20%). All the post-intervention scores of PHMs and TGW in the IA were significantly higher in comparison to CA (p<0.001). CONCLUSIONS: This planned educational intervention had a significant impact on improving KAP of PHMs and TGW in the Gampaha districtItem Qualitative assessment of breast cancer early detection services provided through well woman clinics in the district of Gampaha in Sri Lanka(Asian Pacific Organization for Cancer Prevention, 2013) Vithana, P.V.; Hemachandra, N.N.; Ariyaratne, M.; Jayawardana, P.BACKGROUND: Breast cancer is the most common cancer diagnosed among women in Sri Lanka. Early detection can lead to reduction in morbidity and mortality. The objective here was to identify perceptions of public health midwives (PHMs) on the importance of early detection of breast cancer and deficiencies of and suggestions on improving existing breast cancer early detection services provided through Well Woman Clinics. MATERIALS AND METHODS: A qualitative study using four focus group discussions (FGDs) were conducted among 38 PHMs in the Gampaha district in Sri Lanka and the meetings were audio-recorded, transcribed and analyzed using constant comparison and identifying themes and categories. RESULTS: All the PHMs had a firm realization on the need of breast cancer early detection. The four FGDs among PHMs revealed non-availability of guidelines, inadequacy of training, lack of skills and material to provide health education, inability to provide privacy during clinical examination, shortage of stationery, lack of community awareness and motivation. The suggestions for the improvements of the programme identified in FGDs were capacity building of PHMs, making availability of guidelines, rescheduling clinics, improving the supervision, strengthening the monitoring, improving coordination between clinical and preventive sectors, and improving community awareness. CONCLUSIONS: Results of the FGDs can provide useful information on components to be improved in breast cancer early detection services. Study recommendations were training programmes at basic and post basic levels on a regular basis and supervision for the sustainance of the breast cancer early detection program.Item Educational intervention on breast cancer early detection: effectiveness among target group women in the district of Gampaha, Sri Lanka(Asian Pacific Organization for Cancer Prevention, 2015) Vithana, P.C.; Ariyaratne, M.; Jayawardana, P.PURPOSE: The present study concerns the effectiveness of an educational intervention for improving knowledge, attitudes and practices (KAP) of breast cancer early detection among target group women (TGW) in the district of Gampaha, Sri Lanka. MATERIALS AND METHODS: The study was a community-based intervention. Two medical officer of health areas in Gampaha district were selected using random sampling as intervention (IA) and control (CA). Public health midwives (PHMs) in the IA were exposed to the educational intervention first, conducted the same among the TGW through PHMs. KAP was assessed using an interviewer- administrated questionnaire among 260 TGW from each area selected using cluster sampling before and six months after the intervention. RESULTS: The overall median scores for KAP among TGW in IG increased significantly from pre intervention level of 54% (IQR: 46-59%), 50% (IQR: 41-59%), and 0% (IQR: 0-20%) to post intervention level of 77% (IQR: 72-82%), 68% (IQR: 59- 76 %) and 40% (IQR: 20-60%) respectively. In CG, overall median scores for KAP remained almost the same at pre intervention 54% (IQR:44-59%), 50% (IQR:36-59%) and 0% (IQR: 0-20%) and post intervention 54% (IQR:46-59%), 50% (IQR:36-64%) and 0% (IQR: 0-20%) respectively. CONCLUSIONS: The educational intervention was found to be effective.