Background Around 70% of breast cancers (BCs) are estrogen receptor-α (ERα)-positive. Adjuvant endocrine therapy is used to reduce estrogen levels and inhibit signal transduction through the ER. The anti-estrogen drugs that are most commonly used in endocrine therapy belong to the selective ER modulator (SERM) class and include tamoxifen. Although it has been used for three decades in cases of early-stage and ERα-positive BC, resistance to tamoxifen is a common problem. microRNAs (miRNAs) have a potential role in demonstrating BC resistance to tamoxifen therapy. Hence, there is a need to investigate the expression of miRNA-221 (miR-221) in luminal-subtype BC patients receiving tamoxifen therapy. Methods This case-control study investigated luminal-subtype BC patients who had undergone endocrine therapy for at least 1 year. The case group comprised patients with local or metastatic recurrence, and the control group comprised patients without local or metastatic recurrence. Results There was a significant difference in miR-221 expression ( p = 0.005) between the case and control groups. There were no significant differences between the groups that were positive and negative for the progesterone receptor (PR) ( p = 0.25), had high and low marker of proliferation Ki-67 levels ( p = 0.60), were positive and negative for lymphovascular invasion ( p = 0.14), and had stage 2 and stage 3 cancer ( p = 0.25). Conclusion miR-221 expression was higher in tamoxifen-resistant BC cases. miR-221 is a potential biomarker of tamoxifen resistance.

Introduction: The high mortality rate in breast cancer (BC) patients is generally due to metastases resistant to systemic therapy. Two causes of systemic therapy resistance in BC patients are circulating miRNAs-221 and miR-222, leading to improved BC cell proliferation, survival, and reduced cell apoptosis. This study investigated the miRNA expression changes associated with cancer cell resistance to tamoxifen therapy and is expected to be clinically meaningful before providing endocrine therapy to luminal-type BC patients who express them. Methods: This case–control research included individuals with the luminal subtype of BC who had received tamoxifen medication for around one year. Furthermore, the case group contained 15 individuals with local recurrence or metastases, while the control group comprised 19 patients without local recurrence or metastases. Plasma miR-221/222 quantification was performed with real-time PCR using transcript-specific primers. Results: A significant difference was found in circulating miR-221 expression between cases and controls (P=0.005) but not in miR-222 expression (P=0.070). There were no significant differences between miR-221/222 expression, progesterone receptor, Ki67 protein levels, lymphovascular invasion, and stage. However, receiver operator characteristic curve analyses showed miR-221/222 expressions predictive of tamoxifen resistance (P=0.030) with a sensitivity of 60.00 and a specificity of 83.33%. Conclusion: The use of circulating miR-221/222 expression can predict relapse as well as resistance to tamoxifen treatment in BC patients, and their testing is recommended for luminal subtype BC patients who will undergo tamoxifen therapy to determine their risk of tamoxifen resistance early, increasing treatment effectiveness.

The Breast Unit in the University Malaya Medical Centre (UMMC) was set up in 1993 to cater for the increasing number of women presenting with breast complaints. The surgeon plays a central role in the coordination of the multidisciplinary team which consists of the breast surgeon, pathologist, radiologist, oncologist, plastic surgeon, physiotherapist, psychooncologist, as well as the specialist breast care nurse. The unit provides a comprehensive patient care yrogramme, with diagnostic services (triple assessment comprising clinical evaluation, radiological assessment and biopsy), breast screening services (clinical breast examination ana mammography / adjunct ultrasound), oncological services and palliative care services. Throughout the course of the treatment and post-treatment, emphasis is placed on supportive and emotional care of the patient and her relatives. Teaching and training of undergraduate and postgraduate students form part of the functions of this unit, and clinical and basic research is actively carried out. It has been shown that patients treated in a multidisciplinary breast unit have a better overall outcome: however in low and middle income countries, the development of such units are hampered but lack of manpower and resources. In UMMC, with the institution of treatment protocols and guidelines, it is hoped that survival of patients treated in this multidisciplinary unit will progressively improve.Key words : breast cancer, multidisciplinary breast unit, comprehensive breast care

BACKGROUND: The prevalence of metabolic syndrome (MetS) in USA and Makassar are 22% and 23.7%. The prevalence of Non Alcoholic Steatosis Hepatosis (NASH) in MetS has not been reported. Study in Non-alcoholic Fatty Liver Disease (NAFLD) is 25–90 % in obesity patients. In NASH, there is accumulation of lipid in hepatocyte (raised free fatty acid level), raised stress oxidative (decreased total antioxidant status), raised of inflammation process (decreased adiponectin) and hepatic fibrotic process (raised TGF β1). The aim of this study is to investigate the correlation of free fatty acid, total antioxidant status, adiponectin and TGF-β1 with the occurrence of NASH.METHODS: This was a case control study in man aged ≥30 years old. Metabolic syndrome (MetS) was defined by IDF categories. NASH was defined as fatty liver plus raised type IV collagen level ≥140 ng/ml and Alanine Transferase (ALT) level 1.5x upper normal limit.RESULT: The samples consisted of 8 MetS subjects, 11 MetS subjects with fatty liver and 2 MetS subjects with suspect NASH. Low level of adiponectin and high level free fatty acid led to progression from Fatty Liver (FL) to NASH. Level of total antioxidant and Level of TGF-β1 were relatively steady in NASH.CONCLUSION: The level of Free Fatty acid in subjects with MetS-FL was higher than in subjects with MetS, but was lower than in subjects with MetS-NASH. No difference in total antioxidants status level was observed among all groups. Level of adiponectin decreased in subjects with MetS-FL and MetS-NASH compared with subjects with MetS only. The level of TGF-β1 increased in subjects with MetS-FL more than in subjects with MetS only, and was steady low in subjects with MetS-NASH.KEYWORDS: metabolic syndrome, NASH, free fatty acid, total antioxidant status, adiponectin, transforming growth factor β1

The Breast Unit in the University Malaya Medical Centre (UMMC) was set up in 1993 to cater for the increasing number of women presenting with breast complaints. The surgeon plays a central role in the coordination of the multidisciplinary team which consists of the breast surgeon, pathologist, radiologist, oncologist, plastic surgeon, physiotherapist, psychooncologist, as well as the specialist breast care nurse. The unit provides a comprehensive patient care yrogramme, with diagnostic services (triple assessment comprising clinical evaluation, radiological assessment and biopsy), breast screening services (clinical breast examination ana mammography / adjunct ultrasound), oncological services and palliative care services. Throughout the course of the treatment and post-treatment, emphasis is placed on supportive and emotional care of the patient and her relatives. Teaching and training of undergraduate and postgraduate students form part of the functions of this unit, and clinical and basic research is actively carried out. It has been shown that patients treated in a multidisciplinary breast unit have a better overall outcome: however in low and middle income countries, the development of such units are hampered but lack of manpower and resources. In UMMC, with the institution of treatment protocols and guidelines, it is hoped that survival of patients treated in this multidisciplinary unit will progressively improve.Key words : breast cancer, multidisciplinary breast unit, comprehensive breast care