الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Breast cancer (BC) is a leading cause of death worldwide, and ranks as the fifth cause of death among all forms of cancers, which is the second most common cancer globally next to lung cancer (BC) is the top cancer in women both in the developed and the developing world.
The study was conducted to fulfill the following general Objectives:
1-To investigate the role of genetics ,hormonal and cultural factors contributing to the risk of (BC) in Egyptian women less than 50 years.
Specific Objectives:
4. To examine the genetic polymorphism in the low penetrance gene involved in estrogen biosynthesis and metabolism (CYP17andCYP19genes) in Egyptian women under 50years and their role in determining (BC) risk in this population.
5. To investigate the relation between serum (E2) level, (OT) level and age of diagnosis of (BC).
6. To explore the association between age of start of regular sexual activity (which is culturally determined) and between (BC) risk in young women.
A Hospital based case-control study was carried out (103 cases and 208 control) over a period of 36 months from 2012 to 2015 of out patient clinic of Clinical Oncology Department of (DOC) and EL-Mahmoudia clinic for nutrition .
Data was collected from the patients and their control through an interwiewing questionnaire that included:
• Personal and demographic data including name ,age ,sex.
• Socio- demographic data including Education and occupation.
• Data about genetic ,hormonal and cultural determinants of (BC) or protective, risk factors such as: age of diagnosis , high level of (E2) , low of (OT) level, high level of (A1 & A2), ( positive family history of (BC), low emotional support and low emotional satisfaction , estradiol level ,early age at menarche ,late age at first pregnancy, null parity and late age at menopause .
Review of medical records for each patient and control to obtain information about
A-Laboratory investigation
The sample of cases and control were investigated for genetic polymorphism in the low penetrance gene involved in (E2) biosynthesis and metabolism (CYP17and CYP19 genes)
• Testing for the (CYP17) gene polymorphisms (A1/A1- (A1/A2) and (A2/A2) genotype).
• (CYP19) testing for (TTTA)n repeat at intron4
• Serum estradiol
• Serum estrone
• Plasma oxytocin levels (POT).
- ER 2-PR 3- (HER2)
B- plain x-ray of breast
- Breast U/S
- Breast Mammogram
III-A statistical analysis phase
The results of the study could be summarized in the following items
• Age ranged from 24 to 49 years old. Mean age was 40.56 ± 6.65 years among cases; versus 38.39 ± 7.18 years among control group.
• The study reveals that the age of diagnosis was ranged from 31.0 - 49.0 by a mean ± SD of 37.79±7.32 and a median 39.0.
• Regarding the education level, 73.8% of cases were illiterate versus 38.5% of the controls. On the other hand, 4.9% of (BC) cases had university degree compared to 10.1% of the controls.
• The professional represent 2.9% of (BC) cases in comparison with 30.3% in controls. Most of females in this study were house wives either cases 87.4% or controls. 65.5%.
• Hormonal replacement (OCPs) ranged from54.4 %in (BC) cases compared to5.8% in control with a significant difference, (2=95.239, P= 0.000*) .
• The study shows that 32 (31.1%) had positive family history of (BC) compared to 20(9.6%) in control group. The difference between two groups was statistically significant 2=22.768*,p=0.001*.
• The study shows that 3.9% of (BC) cases were current smokers compared to1.0% among controls with a statistical significant differences(2 = 12.346 P=0.001)
• The practice of exercise had a protective effect on (BC) formation.OR=(0.341),(P=0.000).
• CYP17 ranged from71.8% in (BC) and (95.7%) in controls with a significant difference. (2=36.467, P= 0.001)
• CYP17(A1/A2) ranged from 35.9% in (BC) cases,52.4% in control.The difference between the two groups was astatistically significant 2=38.135*,p=0.001*
• Saturated fats intake was 32% in (BC) cases and 7.2% in control . The difference between two groups was a statistically significant(2=32.533*,p=0.000)
• CYP19 ranged from 159-194 with Mean± SD(174.54 ±8.01)in (BC) and 151-187 with Mean± SD (169.12±7.23) in controls .The difference between the two groups was a statistically significant T=5.808,p=0.001*.
• High sexual activity frequency was 5.1%in (BC) and 5.3% in control. difference between the two groups was astatistically significant (2=19.439*,p=0.001). -The study showed that high emotional satisfaction was 27.3% in (BC) cases ,47.6% in control. The difference between two groups was a statistically significant 2=18.866*, p=0.001.
- Logestic regression analysis shows that t (HT)- (OCPs), ( positive family history of (BC),smoking, saturated fats, CYP17(A1/A2 vs ND) , low emotional satisfaction, low sex satisfaction,(CYP19) and age were significant risk factors for (BC) formation, while Physical exercises ,Vitamine (D) and high sexual activity frequency have a protective effects on (BC) formation.
6.2 Conclusion
It should be based on the results of the study .It can be concluded that significant pridector of (BC) among Egyptian Women under 50 years were Hormonal Treatment (HT), (OCPs), ( positive family history of (BC), low physical activity, saturated fat , (CYP17)(A1/A2 Vs ND), low emotional satisfaction, low sex satisfaction ,(CYP19) and age(31-49 years).For applicability of the model for clinical prediction of (BC) risk among Egyptian Women under 50 years,the final model score was transformed into a simple point score integer with a mean score 15.
6.3 Recommendation
1- Increase public awareness about (BC) through mass media and news paper and of communication about hormonal therapy. smoking, overweight,. Breast feeding , sedentary life style, alcohol, daturated fat,exposure to radiation and chemicals
2- Strengthening Public Health education and health promotion program for prevention of (BC). The educational message should cover the following items:
- Dietary modification (unsaturated fat : Olive oil, increase fruits and vegetables 5 serving / day 400 g/day).
- Maintain health body weight.18.5-24.8 kg/m2
- Keep sleep for 8 hours per day.
- Physical exercise for walking for 30 min daily and encourage breast feeding. -Smoking cessation.
1. Increase public awareness about (BC) through communication of mass media and news paper about overweight, women in hormonal therapy, important of smoking. Cessation , breast feed, sedentary life style, alcohol, exposure to radiation and chemicals.
2. Strengthening the national program for screening for high risk women ( obese women and null- Para women or women on HT,with positive family history.
3. . Educational materials are written handouts, booklets ,posters, leaflet should be available at health clinic to provide patients with necessary information regarding (BC) and its preventions. The health Care workers (HCWs) roles:
- Help to performing early screening test .
- Refer patients to appropriate investigation. Health care provider should be aware of possible side effects especially (HRT) , (OCPS) For longer than 3 years .Health education that should be given preventive treatment that provide clear instruction verbal and written to the patient emphasize in long nature of treatment of (BC).
- It is recommended the presence of dietitian in the health care facilities to provide planning for dietary meals and dietary education of the Patients
- Encourage (BSE)and( CBE) for early detection of any abnormality of breast .-for all women with trible negative (BC) younger than 60 years tested for BRCA1/2 Gene mutation in genetic counseling for high risk female with positive family history
4- School health education programs are critically opportunities for facilitating healthy life style to all school students at all sex for prevention of (BC).
5- Improving and strengthen the announcement of hotline for (BC) care.
6- Further studies and future researches about appropriate strategies for prevention different setting of (MOH&P).
A- Conduct a genetic study for testing (TTTA)n repeat at intron4 on alarge scale of population will require sequencing for genetic testing .
B- Encouraging a clinical trials to examine (OT) role in prevention of (BC) in alarge scale population in order to probability of manufacturing (OT) therapy against (BC).