Abstract The reasons for the recently observed increase in the incidence of breast cancer in the Indian population are not clearly understood, but thought to be largely explained by westernization of lifestyles and changes in reproductive behavior, which characterize exposure to hormones. Our aim is to review the reproductive risk factors and comorbidities and evaluate the association between molecular subtypes of breast cancer. A hospital-based analytical case-control study was conducted among the breast cancer cases with controls in a multispecialty teaching hospital for a period of one year. Totally, 130 subjects were recruited and an interview was conducted using a structured questionnaire to obtain demographic and risk factor data, including tissue marker status (ER, PR and HER-2) obtained from case files. Data were analyzed with SPSS-20 version. Results: The highest age group reported in this study was 51- 60 years which has a 3.8 times increased risk compared to other age and the age group of 31- 40 have a decrease risk of 0.33. In this study, the percentage of post menopause (68%) and mothers not breastfeeding (10%) was higher in cases compared to controls and a noted increase in the risk of breast cancer with odds ratio (OR) of 2.745 (p= <0.0001) and 9.08 (p=0.01) respectively. Duration of breastfeeding showed significantly (p=<0.0001)) moderate positive correlation (r=0.549, 0.457, 0.418 and 0.636) for luminal A, luminal B, HER+, and triple negative respectively. This study found that all the reproductive risk factors do not have correlation with a molecular subtype of breast cancer except breastfeeding. Post menopause and breastfeeding were common factors associated with all people and could be modifiable to prevent the occurrence of breast cancer through lifestyle changes.

ABSTRACT Introduction: Drug-Drug interactions (DDI) may cause considerable adverse drug reactions and potentially lead to an increased or decreased clinical effect of a given drug and increases the cost of management. Cancer patients are at high risk of such DDIs because they commonly receive a high number of drugs concomitantly, including other cytotoxic agents, hormonal agents, targeted agents, and supportive care agents among medication prescribed to treat comorbidities, especially for elderly patients. The objective of this study is to evaluate the incidence of comorbidities and the role of clinical pharmacist in preventing DDIs in a group of cancer patients. Materials and Methods: A prospective - observational study was conducted in a multispecialty hospital for a period of 8 months among 100 cancer inpatients of oncology department. DDIs were analyzed using Medscape Drug Interaction checker. Results: In this study, 65 DDIs were identified from 100 patients. Of all DDIs, 33.85% were major, 60% were moderate, and 6.15% were minor DDIs. Clinically significant (55.38 %) DDIs were reported and 69.44% of those were accepted and modified accordingly. Furthermore, we observed 50.77% of DDIs between co administered drugs. Elderly people (48%) have more co-morbidity such as diabetes (30%) and hypertension (17.81%). Conclusion: This study concluded that DDIs are very common in cancer patients, particularly people with more co morbidities and using multiple medicines. Clinical pharmacist and physicians must work together to extend the practice of preventing DDIs on individual patient management to improve their quality of life.

RESUMEN Introducción: Las interacciones medicamentosas (DDI) pueden causar reacciones adversas considerables a los medicamentos y, potencialmente, pueden provocar un aumento o disminución del efecto clínico de un medicamento dado y aumentan los costos de administración. Los pacientes con cáncer tienen un alto riesgo de tales interacciones porque comúnmente reciben una gran cantidad de medicamentos concomitantes, incluidos otros agentes citotóxicos, agentes hormonales, agentes dirigidos y agentes de atención de apoyo entre los medicamentos prescritos para tratar las comorbilidades, especialmente en pacientes ancianos. El objetivo de este estudio es evaluar la incidencia de comorbilidades y el papel del farmacéutico clínico en la prevención de interacciones entre medicamentos en un grupo de pacientes con cáncer. Materiales y métodos: se realizó un estudio prospectivo - observacional en un hospital de múltiples especialidades durante un período de 8 meses entre 100 pacientes hospitalizados con cáncer del departamento de oncología. Las interacciones de fármaco y fármaco se analizaron utilizando el comprobador de interacción de medicamentos de Medscape. Resultados: En este estudio, se identificaron 65 interacciones de 100 pacientes. De todas las interacciones entre medicamentos, 33,85% fueron mayores, 60% fueron moderadas y 6,15% fueron interacciones menores. Se informaron interacciones clínicamente significativas (55,38%) y el 69,44% de ellas se aceptaron y modificaron en consecuencia. Además, observamos el 50,77% de las interacciones entre los fármacos coadministrados. Las personas mayores (48%) tienen más comorbilidad, como diabetes (30%) e hipertensión (17,81%). Conclusión: este estudio concluyó que las interacciones entre medicamentos son muy comunes en pacientes con cáncer, especialmente en personas con más comorbilidades y que usan múltiples medicamentos. El farmacéutico clínico y los médicos deben trabajar juntos para ampliar la práctica de prevención de interacciones entre medicamentos en el manejo individual del paciente para mejorar su calidad de vida.