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Greece

Cancer Statistics
Population in 2012: 11.4m
People newly diagnosed with cancer (excluding NMSC) / yr: 41,000
Age-standardised rate, incidence per 100,000 people/yr: 163.0
Risk of getting cancer before age 75:16.0%
People dying from cancer /yr: 28,500
Data from IARC GlobalCan (2012)
Greece: Cancer Organisations and Resources
Greece: Cancer Journals
Latest Research Publications from Greece

Greece: Cancer Organisations and Resources (5 links)


Greece: Cancer Journals (3 links)

See also: Oncology Journals

Latest Research Publications from Greece

Vaidakis D, Moustaki I, Zervas I, et al.
Knowledge of Greek adolescents on human papilloma virus (HPV) and vaccination: A national epidemiologic study.
Medicine (Baltimore). 2017; 96(1):e5287 [PubMed] Free Access to Full Article Related Publications
The aim of the present study was to identify the sexual behavior, attitudes, beliefs, and knowledge on sexually transmitted infections (STIs) focused on human papilloma virus (HPV) in the Greek adolescent population. The participants were 4547 adolescents, a representative sample for Greek territory with a mean age of 17 years. After written permission from Greek ministry of education each student completed a questionnaire with 36 questions. The fields covered were demographic characteristics, sexual life data, and basic knowledge on HPV. In the present study, 43% and 75% of the participants knew about HPV or cervical cancer, while more than 6 out of 10 did not know the association between the 2. More than 60% of the participants could not answer correctly neither about HPV infection and cervical cancer frequency in sexually active women, nor about protection methods against HPV and cervical cancer. This study shows that the low vaccination coverage of the Greek population may be due to lack of information and awareness of the adolescents and their parents. It is our duty to increase our efforts in order to better educate the population and vaccinate the population as early as possible in their reproductive years.

Kwan HY, Chao X, Su T, et al.
The anticancer and antiobesity effects of Mediterranean diet.
Crit Rev Food Sci Nutr. 2017; 57(1):82-94 [PubMed] Related Publications
Cancers have been the leading cause of death worldwide and the prevalence of obesity is also increasing in these few decades. Interestingly, there is a direct association between cancer and obesity. Each year, more than 90,000 cancer deaths are caused by obesity or overweight. The dietary pattern in Crete, referred as the traditional Mediterranean diet, is believed to confer Crete people the low mortality rates from cancers. Nevertheless, the antiobesity effect of the Mediterranean diet is less studied. Given the causal relationship between obesity and cancer, the antiobesity effect of traditional Mediterranean diet might contribute to its anticancer effects. In this regard, we will critically review the anticancer and antiobesity effects of this diet and its dietary factors. The possible mechanisms underlying these effects will also be discussed.

Panousis D, Kontogianni P, Ntasiou P, et al.
Clinical characteristics and management of a Greek female patient cohort with breast ductal carcinoma in situ.
J BUON. 2016 Jul-Aug; 21(4):809-817 [PubMed] Related Publications
PURPOSE: The purpose of this retrospective single-centre study was to examine the histopathological characteristics of breast ductal carcinoma in situ (DCIS) lesions in a cohort of Greek female patients and describe our experience regarding the clinical management of the disease.
METHODS: The medical records from 1995 up to mid-2014 were scanned in order to trace DCIS cases. One hundred and seventy two patients (6.8% of all breast cancer cases) were diagnosed with pure DCIS and no invasive components; 32.0% underwent a second surgery, mainly due to first surgery positive margins.
RESULTS: Age at first surgery ranged from 27 to 79 years (mean±SD 50±11) and median tumor size was 10mm (interquartile range/IQR7equals;12mm). Comedo necrosis (CN) was identified in 28.5% of the cases. The detection of CN was significantly associated with older age at diagnosis, larger tumor size and lower probability of highly differentiated tumors. Radiotherapy (RT) and hormonotherapy (HT) were applied to 44.8% and 63.4% of the patients, respectively.
CONCLUSIONS: We implemented international practices (surgery, radiotherapy and prophylactic hormonal therapy) to patients diagnosed with DCIS and have observed only two relapses. It is our belief that DCIS requires a multidisciplinary approach and patient-tailored therapy which can potentially contribute to minimization of the local recurrence risk.

Chrysagi A, Kaparos G, Vrekoussis T, et al.
Prevalence of HPV genotypes in cervical adenocarcinoma: a study in Greek women.
J BUON. 2016 May-Jun; 21(3):666-72 [PubMed] Related Publications
PURPOSE: To study the prevalence of human papillomavirus (HPV) genotypes among cervical adenocarcinomas in Greek women.
METHODS: The study group comprised 78 adenocarcinoma cases (20 in situ and 58 invasive). HPV DNA was amplified using polymerase chain reaction (PCR) and HPV genotypes were identified by reverse hybridization.
RESULTS: There was a high prevalence of HPV infection both for in situ (95%) or invasive (94.83%) adenocarcinomas, comprising also cancers of unusual morphology. HPV 16 was the commonest strain (N=57, 73.08%) followed by HPV 18 (N=28, 35.90%). Interestingly, 13 cases (16.67%) were also HPV 52 positive (as co-infection with HPV 16 or 18). All other strains with the exception of HPV 66 were found only as co-infections. No significant age difference was noted in terms of any HPV strain positivity.
CONCLUSIONS: HPV DNA was found in the large majority of cervical adenocarcinomas. As opposed to other studies, HPV 52 was the third most commonly encountered strain after HPV 16 and HPV 18. The above findings would probably be of help in decision making concerning vaccination policy for the prevention of HPV infection in Greece.

Kakava K, Karelas I, Koutrafouris I, et al.
Relationship between ABO blood groups and head and neck cancer among Greek patients.
J BUON. 2016 May-Jun; 21(3):594-6 [PubMed] Related Publications
PURPOSE: We examined the association of ABO blood groups with the different types of head and neck cancers.
METHODS: 195 diagnosed cases and 801 controls were selected from a Greek tertiary cancer center. Information regarding type of head and neck cancer and ABO blood group was collected and registered.
RESULTS: The O blood group was found to be most prevalent followed by A, B and AB among the controls, whereas blood group A followed by O, B and AB was most prevalent among cancer patients. The difference among the distribution between the cases and controls was statistically significant in blood group A (p<0.05), whereas blood group A had 1.52-fold higher risk of developing head and neck cancer compared to people of other blood groups.
CONCLUSIONS: Blood group A was found to be a potential risk factor for the development of head and neck cancers.

Fragkioudaki S, Mavragani CP, Moutsopoulos HM
Predicting the risk for lymphoma development in Sjogren syndrome: An easy tool for clinical use.
Medicine (Baltimore). 2016; 95(25):e3766 [PubMed] Free Access to Full Article Related Publications
The heightened risk of non-Hodgkin lymphoma (NHL) development in primary Sjogren syndrome (SS) is well established. Several adverse clinical and laboratory predictors have been described. In the current work, we aimed to formulate a predictive score for NHL development, based on clinical, serological, and histopathological findings at the time of SS diagnosis. In the present case-control study of 381 primary SS patients and 92 primary SS patients with concomitant NHL, clinical, serological, and histopathological variables at the time of SS diagnosis were retrospectively recorded. For the identification of predictors for NHL development univariate and multivariate models were constructed. Salivary gland enlargement (SGE), lymphadenopathy, Raynaud phenomenon, anti-Ro/SSA or/and anti-La/SSB autoantibodies, rheumatoid factor (RF) positivity, monoclonal gammopathy, and C4 hypocomplementemia were shown to be independent predictors for NHL development. On the basis of the number of independent risk factors identified, a predictive risk score for NHL development was formulated. Thus, patients presenting with ≤2 risk factors had a 3.8% probability of NHL development, those with 3 to 6 risk factors 39.9% (OR (95%CI): 16.6 [6.5-42.5], P < 0.05), while in the presence of all 7 risk factors the corresponding probability reached 100% (OR [95%CI]: 210.0 [10.0-4412.9], P < 0.0001). In conclusion, an easy to use diagnostic scoring tool for NHL development in the context of SS is presented. This model is highly significant for the design of early therapeutic interventions in high risk SS patients for NHL development.

Anninos P, Anastasiadis P, Adamopoulos A, Kotini A
Biomagnetic activity and non linear analysis in obstetrics and gynecology in a Greek population.
Clin Exp Obstet Gynecol. 2016; 43(3):406-8 [PubMed] Related Publications
This article reports the application of non-linear analysis to biomagnetic signals recorded from fetal growth restriction, fetal brain activity, ovarian lesions, breast lesions, umbilical arteries, uterine myomas, and uterine arteries in a Greek population. The results were correlated with clinical findings. The biomagnetic measurements and the application of non-linear analysis are promising procedures in Obstetrics and Gynecology.

Ponti G, Manfredini M, Ruini C
Wall paintings facies and their possible genetic correlates in the ancient Pompeii: A bio-anthropologic message from the past?
Gene. 2016; 589(2):151-6 [PubMed] Related Publications
The figurative arts and precisely the ancient Pompeian wall paintings portraits can provide an additional source of information in supplementing bio-anthropological studies. There are several genetic diseases with a wide spectrum of congenital bone stigmata in association to distinctive facial features. Gorlin-Goltz syndrome, also named nevoid basal cell carcinoma syndrome, is an autosomal dominant syndrome characterized by unusual skeletal changes, such as macrocephaly, facial asymmetry, hypertelorism, frontal and parietal bossing caused by germline mutations of the gene PTCH1. The Gorlin syndrome, clinically defined in 1963, existed during Dynastic Egyptian times, as revealed by a spectrum of skeletal findings compatible with the syndrome in mummies dating back to three thousand years ago and, most likely, in the ancient population of Pompeii. In the present research, we discuss the potential relationship between Pompeian wall paintings portrait and the cranio-metric bone changes revealed among the Pompeian skull collections assuming that the ancient portraits can constitute an important tool that should be strictly integrated with osteologic and biomolecular data in order to argue a syndromic diagnosis in ancient population.

Isaakidou A, Gazouli M, Aravantinos G, et al.
Prediction of response to combination chemotherapy with irinotecan in Greek patients with metastatic colorectal cancer.
J Cancer Res Ther. 2016 Jan-Mar; 12(1):193-7 [PubMed] Related Publications
BACKGROUND: The aim of our study was to analyze the possible relationships between treatment efficacy, and germinal gene polymorphisms linked to the irinotecan in combination with bevasizumab or panitumumab and capecitabine or 5-FU that has been routinely used in our practice, in the management of metastatic colorectal cancer (CRC).
MATERIALS AND METHODS: Ninety-four Greek with histologically proven metastatic CRC were included in the study. Treatment was administered until disease progression or unacceptable toxicity, for a maximum of eight cycles. Patients were stratified into stable disease. (SD) and progressive disease. (PD). Associations between clinical data, KRAS, UGT1A1. (UGT1A1*28) and DPD (IVS14+1 G. > A) polymorphisms, and toxicity were analyzed.
RESULTS: Fifty-eight (61.70%) patients were characterized with SD disease and 36 (38.30%) with PD. There were not statistical significant differences between carriers of KRAS mutated alleles between SD and PD groups. No significant difference was found between response rates and toxicity and DPD or UGT1A1 genotypes. Our results suggested that determination of DPD or UGT1A1 genotypes could not be useful for predicting severe toxicity of irinotecan in our population.
CONCLUSIONS: The clinical significance of the findings requires replication in larger populations. Furthermore, as 5.FU and irinotecan metabolism is complex, numerous genes in addition to DPD and UGT1A1 should be investigated.

Makatsoris T, Tsamandas AC, Strimpakos A, et al.
HER Family Protein Expression in a Greek Population with Gastric Cancer. A Retrospective Hellenic Cooperative Oncology Group Study.
Anticancer Res. 2016; 36(4):1581-90 [PubMed] Related Publications
BACKGROUND: Gastric cancer is a relatively common malignancy. Recently, the presence of the human epidermal growth factor receptor 2 (HER2) was identified as a molecular target in a proportion of patients who benefited from the addition of appropriate anti-HER2 treatments. Our study explored the clinical and prognostic role of known HER family members, human epidermal growth factor receptor 1 (EGFR or HER1), HER2, HER3 and HER4.
PATIENTS AND METHODS: Formalin-fixed paraffin-embedded (FFPE) tumor tissue samples from 249 gastric cancer patients were studied by immunohistochemistry for protein expression of EGFR, HER2, HER3 and HER4.
RESULTS: Of the 249 evaluable patients, 32 did not have complete data of treatment details and/or follow-up and were excluded from the survival analyses. Of the 217 patients with complete treatment and follow-up data, 178 were operated and treated for early disease (group 1), while 39 for advanced disease (group 2). The frequency of positive EGFR, HER2, HER3 and HER4 protein expression in all patients was 17.5%, 11.8%, 14.8% and 32.9%, respectively. There were no differences in protein expression of any of the markers between the two groups. There were, however, statistically significant associations between HER4 and all other HER family members, as well as between HER2 and HER3 expression. Of note, EGFR-positive membranous protein expression was significantly associated with the presence of lymphovascular invasion (p=0.027) and HER3 and HER4 negative cytoplasmic protein expression with well/moderately-differentiated tumors (p=0.030 and p=0.014, respectively). None of the HER family members were of prognostic value for OS in univariate analysis.
CONCLUSION: The present study confirmed the known protein expression frequencies of HER family members in gastric cancer in a Greek population. Several associations were observed among the HER family members and between clinicopathological characteristics and HER family members. Further research is needed on their exact prognostic role, as well as their therapeutic targeting.

Laios K, Karamanou M, Chatziioannou A, et al.
Views on ocular cancer in Arabo-Islamic medicine and the leading influence of the ancient Greek medicine.
J BUON. 2016 Jan-Feb; 21(1):276-8 [PubMed] Related Publications
In the ophthalmological treatises of the medieval Arabo-Islamic physicians such as al-Mawsili (9th-10th century), al-Kahhal (ca. 940-1010), Haly Abbas (10th century) and al Sadili (14th century) we may find references about ocular cancer, focusing on eyelid tumors and cancerous ulcers of the cornea. These references are similar to the analogous ones of ancient Greek physicians as these are preserved in the medical texts of the most famous Byzantine doctors, indicating the influence of ancient Greek medicine in the Arabo-Islamic one.

Chrysanthakopoulos NA
Correlation between periodontal disease indices and lung cancer in Greek adults: a case-control study.
Exp Oncol. 2016; 38(1):49-53 [PubMed] Related Publications
AIM: The aim of the present case-control study was to examine the possible associations between periodontal disease indices and the risk of lung cancer development in a sample of Greek out-patients referred to a medical and a dental private practice.
MATERIALS AND METHODS: A total of 200 individuals were interviewed and underwent an oral clinical examination, and 64 of them were suffered from several histological types of lung cancer. The estimation of the possible associations between lung cancer as a dependent variable and periodontal disease indices as independent ones was carried out by using a multiple regression analysis model.
RESULTS: Probing pocket depth (odds ratio (OR) = 2.72, 95% confidence interval (CI) 1.05-7.06), clinical attachment loss (OR = 3.51, 95% CI 1.30-9.47) bleeding on probing (OR = 1.93, 95% CI 0.98-3.81) were significantly associated with the risk of developing lung cancer. Smoking (OR = 2.49, 95% CI 1.20-5.17) was significantly associated with the mentioned risk, whereas it was consisted as a confounder regarding the estimated associations between moderate/severe clinical attachment loss and presence of bleeding on probing with the risk of developing lung cancer.
CONCLUSION: Probing pocket depth as an index for periodontal disease severity was statistically significantly associated with the risk of developing lung cancer.

Kypreou KP, Stefanaki I, Antonopoulou K, et al.
Prediction of Melanoma Risk in a Southern European Population Based on a Weighted Genetic Risk Score.
J Invest Dermatol. 2016; 136(3):690-5 [PubMed] Related Publications
Many single nucleotide polymorphisms (SNPs) have been described as putative risk factors for melanoma. The aim of our study was to validate the most prominent genetic risk loci in an independent Greek melanoma case-control dataset and to assess their cumulative effect solely or combined with established phenotypic risk factors on individualized risk prediction. We genotyped 59 SNPs in 800 patients and 800 controls and tested their association with melanoma using logistic regression analyses. We constructed a weighted genetic risk score (GRSGWS) based on SNPs that showed genome-wide significant (GWS) association with melanoma in previous studies and assessed their impact on risk prediction. Fifteen independent SNPs from 12 loci were significantly associated with melanoma (P < 0.05). Risk score analysis yielded an odds ratio of 1.36 per standard deviation increase of the GRSGWS (P = 1.1 × 10(-7)). Individuals in the highest 20% of the GRSGWS had a 1.88-fold increase in melanoma risk compared with those in the middle quintile. By adding the GRSGWS to a phenotypic risk model, the C-statistic increased from 0.764 to 0.775 (P = 0.007). In summary, the GRSGWS is associated with melanoma risk and achieves a modest improvement in risk prediction when added to a phenotypic risk model.

Tofas P, Skiada A, Angelopoulou M, et al.
Carbapenemase-producing Klebsiella pneumoniae bloodstream infections in neutropenic patients with haematological malignancies or aplastic anaemia: Analysis of 50 cases.
Int J Antimicrob Agents. 2016; 47(4):335-9 [PubMed] Related Publications
Carbapenemase-producing Klebsiella pneumoniae (CP-Kp) are currently among the most important nosocomial pathogens in many geographic regions. A retrospective study was conducted between 2010 and 2014 in four hospitals located in a high-prevalence area (Athens, Greece) to describe the clinical features, treatment and outcomes of neutropenic patients with haematological diseases complicated with CP-Kp bloodstream infections. A total of 50 patients were identified, including 48 with haematological malignancies and 2 with aplastic anaemia. All patients had neutropenia (<500 cells/mm(3)), of whom 40 had <100 neutrophils/mm(3). The probable source of bacteraemia was identified in 9 patients; in the remaining 41 patients the bacteraemia was considered primary. For definitive treatment, 30 patients received combination therapy (two or more active drugs), 10 received monotherapy (one active drug) and 4 received therapy with no active drug; the remaining 6 patients died within 48 h after the onset of bacteraemia. The 14-day all-cause mortality rate was 50%, 38% and 33% for those who received one, two or three active drugs respectively. In the Cox proportional hazards model, unresolved neutropenia [hazard ratio (HR)=19.28, 95% confidence interval (CI) 2.31-160.69; P=0.006], septic shock (HR=3.04, 95% CI 1.06-8.78; P=0.04) and treatment with one active drug (HR for monotherapy versus combination therapy=3.95, 95% CI 1.23-12.65; P=0.02) were independent predictors of death, whilst combination therapy was associated with lower mortality. These findings may assist physicians in making treatment decisions for neutropenic patients with CP-Kp infections.

Apalla Z, Lallas A, Sotiriou E, et al.
Farmers develop more aggressive histologic subtypes of basal cell carcinoma. Experience from a Tertiary Hospital in Northern Greece.
J Eur Acad Dermatol Venereol. 2016; 30 Suppl 3:17-20 [PubMed] Related Publications
BACKGROUND: Ultraviolet radiation plays an important role in the pathogenesis of non-melanoma skin cancer. Outdoor workers, including farmers, experience higher exposure levels compared to the general population. Available literature data suggest that occupational ultraviolet exposure represents an independent risk factor for squamous cell carcinoma; whereas for basal cell carcinoma (BCC) this association still remains unclarified.
OBJECTIVES: To analyse the epidemiological, clinical and histological data of patients diagnosed with BCC, and correlate them with outdoor occupation in farmers.
METHODS: Individuals with histologically diagnosed BCCs, between September 2013 and September 2015, were included in the study. Their medical data, including epidemiological, clinical and histological characteristics, were recorded and analysed in conjunction with the occupation. Farmers were identified based on their specific public health insurance.
RESULTS: Three hundred and forty patients, with 542 BCCs were included in the study. One hundred and twenty (35.3%) were farmers. Mean age of farmers was lower than non-farmers (66.0 ± 9.1 years vs. 75 ± 6.6 years, Mann-Whitney U-test, P < 0.001). Farmers had a sixfold higher probability for exhibiting photodamaged skin (OR = 6.02, 95% CI: 3.66-9.90, P < 0.001). Farmer workers were more likely to exhibit infiltrative or morpheaform BCC, but less likely to develop superficial BCC.
CONCLUSION: Our results indicate a higher risk of earlier development of more aggressive histological subtypes of BCCs in farmers. Photodamage was also more common in this group. Primary and secondary prevention strategies focusing on outdoor workers, including farmers, are mandatory.

Petrou A, Moris D, Kountourakis P, et al.
The ALPPS procedure as a novel "liver-first" approach in treating liver metastases of colon cancer: the first experience in Greek Cypriot area.
World J Surg Oncol. 2016; 14:67 [PubMed] Free Access to Full Article Related Publications
BACKGROUND: Despite recent advances in multimodality and multidisciplinary treatment of colorectal liver metastases, many patients suffer from extensive bilobar disease, which prevents the performance of a single procedure due to an insufficient future liver remnant (FLR). We present a novel indication for associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) as a "liver-first" approach when inadequate FLR was faced preoperatively, in a patient with extensive bilobar liver metastatic disease of colon cancer origin.
CASE PRESENTATION: A 51-year-old lady was referred to our center due to a stage IV colon cancer with extensive bilobar liver disease and synchronous colon obstruction. During the multidisciplinary tumor board, it was recommended to proceed first in a palliative loop colostomy (at the level of transverse colon) operation and afterwards to offer her palliative chemotherapy. After seven cycles of chemotherapy, the patient was re-evaluated by CT scans that revealed an excellent response (>30%), but the metastatic liver disease was still considered inoperable. Moreover, with the completion of 12 cycles, the indicated restaging process showed further response. Subsequent to a thorough review by the multidisciplinary team, it was decided to proceed to the ALPPS procedure as a feasible means to perform extensive or bilobar liver resections, combined with a decreased risk of tumor progression in the interim.
CONCLUSIONS: All in all, ALPPS can offer a feasible but surgically demanding liver-first approach with satisfactory short-term results in selected patients. Larger studies are mandatory to evaluate short- and long-term results of the procedure on survival, morbidity, and mortality.

Nikou GC, Pazaitou-Panayiotou K, Dimitroulopoulos D, et al.
Results of a prospective multicenter neuroendocrine tumor registry reporting on clinicopathologic characteristics of Greek patients.
BMC Endocr Disord. 2016; 16:8 [PubMed] Free Access to Full Article Related Publications
BACKGROUND: The rare incidence of neuroendocrine neoplasms (NENs) has contributed to a paucity of large epidemiologic studies of patients with this condition. We investigated the occurrence and clinicopathologic features of NENs in Greece.
METHODS: Between October 2010 and November 2012 we collected data on 246 newly diagnosed patients from a broad-based multi-institutional registry that comprises eight academic and hospital sites in Greece. The WHO 2010 pathologic classification and the 7th AJCC Staging system was applied in all cases.
RESULTS: Of all patients 94 % had a sporadic and 6 % a multiple endocrine neoplasia tumor; 63.4 % were gastroenteropancreatic-(GEP)-NENs, 17.9 % Head & Neck NENs, 9.8 % NENs of Unknown Primary, 6.5 % Lung NENs and 2.4 % Pheochromocytomas. Gastric and pancreatic NENs were the most common primary sites. Poorly differentiated neuroendocrine carcinomas (NEC) were 9.3 %, all sporadic. Fifteen percent of patients were asymptomatic at presentation, 24 % had a first symptom of the disease related to endocrine syndrome and 61 % had symptoms related to locally advanced or metastatic disease. Metastatic disease was established in 25 % of tumors most frequently in the GEP NEN group. Findings are presented according to Ki-67 distribution. MRI had a higher diagnostic positive yield than Octreoscan. Somatostatin analogs, lanreotide and octreotide acetate, were prescribed at 38.5 & 61.5 % of NEN patients respectively and were found to be equally effective at providing symptomatic relief.
CONCLUSIONS: This is to our knowledge the first study of a Greek tumor registry and one of the few European Registries providing information regarding clinicopathologic characteristics and therapies in patients with neuroendocrine tumors of various origin sites, beyond GEP NENs.

Ponti G, Pellacani G, Tomasi A, et al.
Skeletal stigmata as keys to access to the composite and ancient Gorlin-Goltz syndrome history: The Egypt, Pompeii and Herculaneum lessons.
Gene. 2016; 589(2):104-11 [PubMed] Related Publications
There are several genetic diseases with a wide spectrum of congenital bone stigmata in association to cutaneous and visceral benign and malignant neoplasms. Gorlin-Goltz syndrome, also named nevoid basal cell carcinoma syndrome, is an autosomal dominant systemic disease with almost complete penetrance and high intra-familial phenotypic variability, caused by germline mutations of the gene PTCH1. The syndrome is characterized by unusual skeletal changes and high predisposition to the development of multiple basal cell carcinomas, odontogenic keratocysts tumors and other visceral tumors. The Gorlin syndrome, clinically defined as distinct syndrome in 1963, existed during Dynastic Egyptian times, as revealed by a costellation of skeletal findings compatible with the syndrome in mummies dating back to 3000years ago and, most likely, in the ancient population of Pompeii. These paleogenetic and historical evidences, together with the clinical and biomolecular modern evidences, confirm the quite benign behavior of the syndrome and the critical value of the multiple and synchronous skeletal anomalies in the recognition of these rare and complex genetic disease.

Antoniadis D, Lavrentiadis G, Papadopoulos VN, et al.
The Validity of the Distress Thermometer in Greek Colon Cancer Patients.
Acta Chir Belg. 2015 Nov-Dec; 115(6):387-92 [PubMed] Related Publications
BACKGROUND: Although screening for distress is a crucial part of psycho-social care for cancer patients, there has not been a validation study for this purpose in Greece. The purpose of this study was to evaluate for the first time the psychometric properties of the Greek translation of the Distress Thermometer (DT) and Problem List (PL) in Greek colorectal cancer patients (CRC).
METHODS: Participants were 84 CRC inpatients of the 1st Surgical Propedeutic Department of the Aristotle University of Thessaloniki with a mean age of 70.8±9.5 years. Participants completed the DT, PL and the Hospital Anxiety and -Depression Scale (HADS).
RESULTS: The Cronbach's alpha coefficient in the DT was 0.795. Patients' mean score in the DT was 5.7±2.74, while the mean number of the reported problems in the PL was 18.85±5.50 and the mean total score of the HADS was 15.61±6.95. ROC-analysis supported that a cut-off score of 7 gives the optimal sensitivity and specificity for the DT.
CONCLUSION: The index sample has manifested high levels of distress, which correspond to high need for support and improvement of the patient-provider relationship. This is probably a difficult task, since the Greek healthcare system has minimal experience of providing psycho-oncology care. The present study has indicated that the DT can be reliably used in the Greek clinical setting. Future studies, along with state provision, are essential in order to offer Greek cancer patients state-of-the-art and comprehensive care.

Vranken MJ, Lisman JA, Mantel-Teeuwisse AK, et al.
Barriers to access to opioid medicines: a review of national legislation and regulations of 11 central and eastern European countries.
Lancet Oncol. 2016; 17(1):e13-22 [PubMed] Related Publications
Control measures designed to prevent the misuse of opioid medicines can often unintentionally restrict legitimate medical use, leaving patients with cancer in pain. This study aimed to develop and validate an assessment instrument based on WHO policy guidelines to systematically identify legal and regulatory barriers to opioid access in 11 European countries (Bulgaria, Cyprus, Estonia, Greece, Hungary, Latvia, Lithuania, Serbia, Slovakia, Slovenia, and Turkey) as part of the Access to Opioid Medication in Europe project. Relevant legislation and regulations were independently assessed by three reviewers and potential barriers were identified within nine categories including prescribing, penalties, and others. Potential barriers were identified in all countries, ranging from 22 potential barriers (Cyprus) to 128 potential barriers (Lithuania). The total number of barriers in a single category varied from one (Slovenia, usage category) to 49 (Greece, prescribing category). Differences, such as prescription validity, varied within one category, ranging from 5 days (Hungary) to 13 weeks (Cyprus). The results of this Review should give rise to a national review and revision of provisions that impede access to opioids, disproportionate to their (intended) benefit in preventing misuse, in these 11 European countries.

Alamanou GD, Balokas AS, Fotos VN, et al.
Information needs of cancer patients: Validation of the Greek Cassileth's Information Styles Questionnaire.
Eur J Oncol Nurs. 2016; 20:49-57 [PubMed] Related Publications
PURPOSE: The aim of this study was to validate the translated in Greek Cassileth's Information Styles Questionnaire (ISQ).
METHODS: It was a cross-sectional study. The sample consisted of one hundred and nine adult patients diagnosed with cancer, attending the oncology outpatient department (outpatients) or being hospitalized (inpatients), from January 2013 to September 2013, in one general hospital in Athens. Two instruments were used: The Control Preference Scale (CPS), an assessment tool to measure decision-making preferences of cancer patients and ISQ to assess the information needs of patients. Exploratory factor analysis (EFA) was carried out to evaluate construct validity of the ISQ. The internal consistency of subscales was analyzed with Cronbach's alpha and the association of demographics and clinical variables with the ISQ was explored using linear regression analysis.
RESULTS: Sixty one (56%) patients were males. The mean age was 65.5 (SD = 11.9) years. Two dimensions of the ISQ were revealed. Cronbach's alpha was 0.92 for "Disease and treatment" dimension (12 of 17 items of the questionnaire) and 0.89 for "Psychological" dimension (5 of 17 items of the questionnaire). Statistical analysis showed that the patients' preferred decision making roles were associated with the ISQ dimensions. Also, age, sex, diagnosis, educational level and the existence of metastasis were associated with the score of "Disease and treatment" dimension. All the scales of ISQ, exceeded the minimum reliability standard of 0.70.
CONCLUSIONS: The results showed that the Greek ISQ is a reliable and valid tool for identifying the information needs of cancer patients.

Kyrkou G, Trakakis E, Attilakos A, et al.
Metabolic syndrome in Greek women with polycystic ovary syndrome: prevalence, characteristics and associations with body mass index. A prospective controlled study.
Arch Gynecol Obstet. 2016; 293(4):915-23 [PubMed] Related Publications
PURPOSE: The aim of this study was to estimate the prevalence, to evaluate the characteristics of the metabolic syndrome (MetS) in Greek women with polycystic ovary syndrome (PCOS) and to investigate the correlation of MetS with body mass index (BMI).
METHODS: In a prospective controlled study, 230 Greek female patients with PCOS and 155 age-matched healthy controls were enrolled. Diagnosis of PCOS was based on the revised criteria of Rotterdam. Both groups were examined for MetS. Diagnosis of MetS was based on the revised criteria of International Diabetes Federation (IDF).
RESULTS: The prevalence of the MetS was 12.6 %, nearly sevenfold higher than the controls. Elevated fasting plasma glucose (7.0 vs. 1.9 %) and elevated triglycerides (10.4 vs. 3.2 %) were more frequent in the PCOS cohort (p < 0.05). Women with PCOS presented statistically higher BMI in comparison with the controls (p < 0.001). Subsequently, the prevalence of MetS was estimated in three groups: normal, overweight and obese subdivided according to BMI. The latter two groups showed significant differences compared with the healthy controls (24.5 vs. 8.8 %, p = 0.050).
CONCLUSION: In conclusion, this study showed high prevalence of MetS and increased BMI in Greek PCOS women. In addition, it demonstrated the higher prevalence of MetS in obese PCOS women in comparison with the controls. These results are placing them at increased risk for cardiovascular disease and diabetes in the future and underline the necessity of periodic screening, appropriate diet and exercise program.

Sifaki-Pistolla D, Karageorgos SA, Koulentaki M, et al.
Geoepidemiology of hepatocellular carcinoma in the island of Crete, Greece. A possible role of pesticides.
Liver Int. 2016; 36(4):588-94 [PubMed] Related Publications
BACKGROUND & AIMS: Geoepidemiological data of hepatocellular carcinoma (HCC) are lacking. Crete has a genetically homogeneous population and is suitable for studies to identify a possible contribution of environmental factors in HCC.
METHODS: Databases for HCC (316 cases), hepatitis B virus (HBV) (633) and hepatitis C virus (HCV) (392), constructed over the past 20 years in our Unit, were used. Data included place of birth and place of residence for the last 15 years. Hellenic Statistical Authority provided population statistics from 1980 to 2014. Time-spatial methods were applied in Gis-ArcMap 10 software. Spatial autocorrelation tests (Moran's index) detected differences between the spatial distribution to place of residence. Spatial density maps were created. Kriging Interpolation was applied, to produce prediction maps of HCC.
RESULTS: Hepatitis C virus appears in areas of high prevalence while HBV is uniformly distributed. HCC is more prevalent in Eastern Crete. A spatial autocorrelation between HCC and either HCV (Moran's I = 0.88, P < 0.001) or HBV (I = 0.84, P < 0.02) was found as expected. However, there is a discrepancy in the South East of Crete, where a higher prevalence of HCC than expected was observed. This is an area where extensive use of pesticides in large green houses is practiced.
CONCLUSIONS: Hepatocellular carcinoma is associated with the dispersion of HCV and HBVs. In an area with widespread use of pesticides, a higher than expected spatial distribution of HCC was detected.

Tsoucalas G, Karamanou M, Sgantzos M, et al.
Uterine cancer in the writings of ancient Greek physicians.
J BUON. 2015 Sep-Oct; 20(5):1382-5 [PubMed] Related Publications
In this article, we present the views on uterine cancer of the ancient Greek physicians. We emphasize on uterine's cancer aetiology according to the dominant in antiquity humoural theory, on its surgical treatment suggested by Soranus of Ephesus, and in the vivid description provided by Aretaeus of Cappadocia. During that period, uterine cancer was considered as an incurable and painful malignancy and its approach was mainly palliative.

Koutrouli N, Anagnostopoulos F, Tsikkinis A, et al.
Psychometric properties of the Greek version of the Social Constraints Scale in a sample of women with breast cancer.
Women Health. 2016; 56(4):413-27 [PubMed] Related Publications
This study evaluated the psychometric properties of the Greek version of the Social Constraints Scale, developed in English by Lepore and Ituarte (1999). The scale was culturally adapted in Greek and was then administered, along with measures of psychological distress and intrusions, to a sample of 202 women with breast cancer, recruited from July 2012 to October 2013. Although the scale has usually been treated as a unidimensional measure, exploratory factor analysis revealed three underlying factors in the Greek Social Constraints Scale: unsupportive behaviors, avoidant behaviors, and suggestions for pretense and distraction. The three-factor solution explained 55% of the total variance. Subscale reliability was satisfactory (Cronbach's alpha coefficients ranging from 0.77 to 0.88). All subscales were significantly related to intrusions and psychological distress. Thus, the Greek Social Constraints Scale is a reliable and valid multidimensional instrument. The results of the present study show that, among all kinds of social constraints, unsupportive behaviors are the most highly correlated with distress, while distraction/pretense is most correlated with intrusiveness. Findings suggested that health professionals should aim to educate both the patient to claim her right to express feelings and thoughts and her social network to adopt disclosure-facilitating behaviors to compensate for intrusiveness and distress.

Manoli E, Kouras A, Karagkiozidou O, et al.
Polycyclic aromatic hydrocarbons (PAHs) at traffic and urban background sites of northern Greece: source apportionment of ambient PAH levels and PAH-induced lung cancer risk.
Environ Sci Pollut Res Int. 2016; 23(4):3556-68 [PubMed] Related Publications
Thirteen particle-phase PAHs, including nine >4-ring congeners [Benz[a]anthracene (BaAn), Chrysene (Chry), Benzo[b]fluoranthene (BbF), Benzo[k]fluoranthene (BkF), Benzo[e]pyrene (BeP), Benzo[a]pyrene (BaP), Dibenzo[a,h]anthracene (dBaAn), Benzo[g,h,i]perylene (BghiPe), Indeno(1,2,3-c,d)pyrene (IP)], listed by IARC (International Agency for Research on Cancer) as class 1, class 2A, and 2B carcinogens, plus four ≤ 4-ring congeners [Phenanthrene (Ph), Anthracene (An), Fluoranthene (Fl), Pyrene (Py)], were concurrently measured in inhalable and respirable particle fractions (PM10 and PM2.5) at a heavy-traffic and an urban background site in Thessaloniki, northern Greece, during the warm and the cold period of the year. Carcinogenic and mutagenic potencies of the PAH-bearing particles were calculated, and the inhalation cancer risk (ICR) for local population was estimated. Finally, Chemical Mass Balance (CMB) modeling was employed for the source apportionment of ambient PAH levels and the estimated lung cancer risk. Resulted inhalation cancer risk during winter was found to be equivalent in the city center and the urban background area suggesting that residential wood burning may offset the benefits from minor traffic emissions.

Bamias A, Peroukidis S, Stamatopoulou S, et al.
Utilization of Systemic Chemotherapy in Advanced Urothelial Cancer: A Retrospective Collaborative Study by the Hellenic Genitourinary Cancer Group (HGUCG).
Clin Genitourin Cancer. 2016; 14(2):e153-9 [PubMed] Related Publications
BACKGROUND: Advanced urothelial cancer (AUCa) is associated with poor long-term survival. Two major concerns are related to nonexposure to cisplatin-based chemotherapy and poor outcome after relapse. Our purpose was to record patterns of practice in AUCa in Greece, focusing on first-line treatment and management of relapsed disease.
METHODS: Patients with AUCa treated from 2011 to 2013 were included in the analysis. Fitness for cisplatin was assessed by recently established criteria.
RESULTS: Of 327 patients treated with first-line chemotherapy, 179 (55%) did not receive cisplatin. Criteria for unfitness for cisplatin were: Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≥ 2, 21%; creatinine clearance ≤ 60 mL/min, 55%; hearing impairment, 8%; neuropathy, 1%; and cardiac failure, 5%. Forty-six patients (27%) did not fulfill any criterion for unfitness for cisplatin. The main reasons for these deviations were comorbidities (28%) and advanced age (32%). Seventy-four (68%) of 109 patients who experienced a relapse received second-line chemotherapy. The most frequent reason for not offering second-line chemotherapy was poor PS or limited life expectancy (66%).
CONCLUSION: In line with international data, approximately 50% of Greek patients with AUCa do not receive cisplatin-based chemotherapy, although 27% of them were suitable for such treatment. In addition, about one third of patients with relapse did not receive second-line chemotherapy because of poor PS or short life expectancy. Enforcing criteria for fitness for cisplatin and earlier diagnosis of relapse represent 2 targets for improvement in current treatment practice for AUCa.

Katodritou E, Terpos E, Kastritis E, et al.
Lack of survival improvement with novel anti-myeloma agents for patients with multiple myeloma and central nervous system involvement: the Greek Myeloma Study Group experience.
Ann Hematol. 2015; 94(12):2033-42 [PubMed] Related Publications
Involvement of the central nervous system (CNS) is a rare complication of multiple myeloma (MM). Herein, we have described the incidence, characteristics, prognostic factors for post CNS-MM survival, and outcome of CNS-MM and explored the efficacy of novel agents (NA) (thalidomide, bortezomib, lenalidomide) in this setting. Between 2000 and 2013, 31 (0.9 %) out of 3408 newly diagnosed symptomatic MM patients, consecutively diagnosed and treated during the same period in 12 Greek centers, developed CNS-MM (M/F 15/16, median age 59 years, range 20-96 years; newly diagnosed/relapsed-refractory 2/29; median time to CNS-MM diagnosis 29 months). Clinical and laboratory characteristics were retrospectively recorded. Twenty-six percent of patients had circulating plasma cells (PCs) or plasma cell leukemia (PCL) at CNS-MM and 39 % had skull-derived plasmacytomas, suggesting hematological and contiguous spread. Treatment for CNS-MM was offered in 29/31 patients and 11/29 responded (NA 18/29, additional radiotherapy 9/28, intrathecal chemotherapy 13/29). The median post CNS-MM survival was 3 months (95 % CI 1.9-4.1) and did not differ between patients treated with NA and/or radiotherapy vs. others. In the multivariate analysis, prior treatment of MM with NA, extramedullary disease (EMD) during MM course (i.e., plasmacytomas, circulating PCs, or documented PCL) and abnormally high LDH at MM diagnosis were independent prognostic factors, whereas treatment of CNS-MM with NA did not predict for post CNS-MM survival. Despite the relatively limited number of patients due to the rarity of CNS-MM, our results suggest that NA do not seem to improve post CNS-MM survival. Patients with EMD display shortened post CNS-MM survival and should be followed thoroughly.

Triantafyllidou O, Vlachos IS, Apostolou P, et al.
Epidemiological and clinicopathological characteristics of BRCA-positive and BRCA-negative breast cancer patients in Greece.
J BUON. 2015 Jul-Aug; 20(4):978-84 [PubMed] Related Publications
PURPOSE: BRCA mutation carriers can benefit from targeted clinical interventions. On the other hand, families with evident aggregation of breast cancer (BC) cases and a BRCA-negative genetic test can still be considered as of elevated risk, since the underlying genetic factor remains unidentified. In the present study, we compared clinical and demographic characteristics between BRCA1 mutation carriers (BRCA1mut) and non-carriers (non-BRCA1) in a Greek group of BC patients (n=321).
METHODS: Data were collected and analyzed from 321 women with BC, with 131 patients screened for pathogenic mutations in the high-penetrant genes BRCA1 and BRCA2. Collected data included demographics, pedigrees, tumor histopathology and immunohistochemistry findings.
RESULTS: In BRCA1mut patients, their mothers and grand- mothers were diagnosed at a younger age compared to non-BRCA1-carriers. Additionally, BRCA1mut patients were diagnosed with mainly estrogen receptor (ER) negative (p<0.001), Her-2 negative (p<0.05) and triple negative (p<0.01) tumors. The youngest generation was diagnosed with familial breast cancer (FBC) 9.7 years earlier than their mothers (p<0.001). Age at BC diagnosis negatively correlated with the nuclear grade of breast tumors (r=-0.3, p<0.05). Among parous individuals, the number of full-term pregnancies significantly correlated with the age at BC onset (r=0.19, p<0.05).
CONCLUSION: Despite their similarities, FBC cases with identified BRCA1 mutations exhibit a clearly distinct profile. We have identified an anticipation effect in FBC patients, with significantly reduced age at diagnosis in younger generations. Increased parity seems to prevent early BC onset. This is the first study comparing clinical and demographic characteristics of FBC BRCA1mut and non-carriers in a Greek cohort.

Zavos G, Moris D, Kostakis ID, et al.
De Novo Visceral Malignancies in Renal Transplant Recipients: A Single Center Experience of 2054 Recipients for More Than 30 Years.
Exp Clin Transplant. 2015; 13(4):313-8 [PubMed] Related Publications
OBJECTIVES: We report the incidence and pattern of malignancies in renal transplant recipients from our department.
MATERIALS AND METHODS: Between March 1983 and August 2013, the records of 2054 renal transplant recipients from our department were retrospectively reviewed with regard to type of neoplasm, age, gender, interval between the transplant and the diagnosis of malignancy, immunosuppressive regimens, graft functional status, and rejection episodes.
RESULTS: Among the 2054 renal transplant recipients, visceral malignancies developed in 74 patients (3.6%). The mean age at transplant was 43.9 years, and the mean age at death was 61.9 years. Sixty-eight patients (91.9%) died with a functioning graft. Fifty-four (73%) died during follow-up. The mean time from transplant to malignancy was 96.4 months, and from malignancy to death was 27.5 months. No difference regarding the type of immunosuppression, the type of donor, or the interval between transplant and malignancy was detected when we compared cancers.
CONCLUSIONS: Malignancies after a renal transplant display aggressive behavior and occur more frequently several years after the transplant, but they also may occur earlier. The type of immunosuppression, the type of donor, or the interval between transplant and malignancy do not differ significantly among cancers.

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