Female breast cancer remains a major health concern due to its rising incidence and mortality rates around the world. Recent statistical trends have shown a significant increase in its prevalence, accounting for 11.7% of all cancer cases worldwide (1). In Pakistan, female breast cancer incidence is the highest among all other malignancies, with a total of 25,928 cases reported nationally in 2020 (2).
There are numerous risk factors for breast cancer: old age, family history of breast and reproductive tract malignancies, early menarche, nulliparity, late menopause, high-fat diet, alcohol consumption etc. (3). A study conducted in 2017 identified vitamin D deficiency (VDD) as a possible risk factor for breast cancer (4). In 2020, the results of a case-control study conducted in Karachi, Pakistan, revealed that women with low serum VDD <20ng/ml were at a greater risk of developing breast cancer compared to patients with sufficient serum vitamin D >30ng/ml (5).
Historically, Pakistani women are prone to developing VDD despite abundant sun light due to Pakistan’s subtropical climate. The primary reason behind this paradox can be associated with the low air quality index in many of the major cities of the country. The high population density and closely-built infrastructure also act as barriers towards adequate sun exposure for Pakistani women. Furthermore, distorted beauty ideals that discourage women from going out in the sun are deeply rooted in South Asian culture. The cosmetics industry plays a huge role in reinforcing this notion through advertisements that glorify fair-skinned women. There is also a lack of awareness regarding balanced diets among women, especially from lower socio-economic backgrounds.
The possible correlation of VDD with female breast cancer has amplified the need for awareness programmes to educate the female population regarding the importance of vitamin D. Women-centric NGOs and healthcare organisations spreading awareness regarding breast cancer should emphasize VDD as its underlying cause and encourage them to spend more time outdoors and to include vitamin D supplements in their diet. Electronic media can also play a pivotal role in propagating this information. Lastly, the government’s ongoing food fortification programme against VDD and other nutritional deficiencies should be accelerated and strictly monitored to ensure its proper implementation and success.
With female breast cancer increasing at an unprecedented rate, the government must take effective measures to minimize the risk of breast cancer in vitamin D deficient females.
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Background: Distal trans-radial access (dTRA) is a novel technique of arterial cannulation in coronary interventions. The comparative efficacy of dTRA and conventional trans-radial access (TRA) in attenuating periprocedural complications is unknown. Methods: Embase and PubMed/MEDLINE were searched from their inception until June 25, 2022, for randomized clinical trials. Outcomes included were radial artery occlusion (RAO), radial artery spasm, hemostasis time, access time, unsuccessful cannulation, crossover rate, and early discharge after transradial stenting of coronary arteries (EASY) type I-III hematomas. Statistical analysis was conducted using the random effects model to derive risk ratios (RRs) and mean differences (MDs) with their corresponding 95% confidence intervals (CIs). Results: A total of 6 randomized clinical trials comprising 3240 patients were included. Subjects were predominantly male (73%) and had a mean age of 66 years. The dTRA group had a lower risk of RAO [RR 0.43 (95% CI, 0.26-0.69); P = 0.0005; I 2 = 0%] and had a shorter hemostasis time [MD −22.85 min (95% CI, −39.06 to −6.65); P = 0.006; I 2 = 99%]. The dTRA group had a higher crossover rate [RR 3.04 (95% CI, 1.88-4.91); P = 0.00001; I 2 = 56%] and a longer access time [MD 0.68 min (95% CI, 0.17-1.18); P = 0.009; I 2 = 99%]. The TRA group had a lower rate of unsuccessful cannulation [RR 0.81 (95% CI, 0.70-0.95); P = 0.01; I 2 = 92%]. There was no significant difference between the groups for radial artery spasm and EASY type I-III hematomas. Conclusion: dTRA is a safe alternative to conventional TRA for coronary interventions with a lower risk of RAO. Future trials are required to further compare both approaches.
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