title: Does Alternative and Traditional WASAM (Local cautery) Therapy Facilitate an Early and More Extensive Locoregional Metastasis of Breast Cancer?
abstract: BACKGROUND
  A large heterogeneous group of unproven remedies exist to treat cancer in both developed and developing countries. Some of these remedies often do more harm than good to the patients. The traditional medicine is the sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures. The traditional medicine in Oman is based on herbal treatment and skin treatment (massage, Cupping and skin burn "cautery" treatment-known as Wasam or Kaiy). WASAM (local cautery) is widely practiced in Oman for treating cancer. The loco-regional spread of breast cancer depends on numerous factors like tumour size, grade, receptor status, Ki67, Lympho vascular invasion, location of tumour within the breast, multifocal tumour, depth of tumour from skin, and status of local/regional lymphatic drainage.
  
  
  OBJECTIVE
  The objective of study was to analyze the frequency of loco-regional spread in female breast cancer patients who received Wasam therapy.
  
  
  METHODS
  It is a retrospective analysis of female breast cancer cases diagnosed between 2008-2014 at the Department of Surgery and National Oncology Center, the Royal hospital who were treated with Wasam therapy. Breast cancer patients' data were retrieved and reviewed from Electronic medical record system (EMR AL-SHIFA). The tumour (T) stage and Nodal (N) status were analyzed in all patients. The data of patients who received Wasam was compared with those who did not receive it as controls.
  
  
  RESULTS
  A total of 532 cases were diagnosed to have breast cancer during the study period, of which 464 were included in this analysis. Out of these 74 have Wasam and 390 were in control group not receiving any Wasam therapy. No Wasam patient had N0 status while more than one third of the control group was N0. About 15.9% (74/464) had Wasam therapy. It was found that 6.7%, 67.6% and 25.7% had one, 2-5 and more than 5 scars of Wasam therapy respectively. These patients underwent surgery (either mastectomy or breast conserving) with pathologic analysis of tumour and axillary lymph nodes (sentinel nodes, sampling or clearance). Approximately 50% of tumours were less than T2 stage. All 74 patients (100%) who received Wasam therapy showed axillary lymph node metastasis (N1 to N3), irrespective of their T stage (size of tumour). Further analysis is under way of these cases to look into additional risk factors like tumour grade, ER, PR, Her-2, Ki67, LVI, and location of these tumours within the breast.
  
  
  CONCLUSIONS
  The tumour size (T stage) is an important predictor of locoregional spread. Published data suggest the frequency of axillary nodal metastasis are as: T1a 4.2%, T1b 7.4%, T1c 15.8%, T2 28.7% and T3 26.2%. The Grade I, II, and III have 22.1%, 51.6%, and 26.3% chances of axillary LN metastasis. ER+ve tumours have 38.9% and ER-ve tumours have 8.4% frequency of metastasis to axillary LNs. The data from our study suggest that the Wasam cases have higher and early loco-regional spread of breast cancer (100% vs. 19.2% in T1, 100% vs. 50% in T2, and 100% vs. 90% in T3). The Wasam therapy can set in local inflammation or infection. This can cause increased local temperature and oedema. This may well facilitate lymph angiogenesis and dilatation of existing channels.
mesh_terms: D001365:Axilla; D001943:Breast Neoplasms / Q000628:therapy*; D005260:Female; D006801:Humans; D008198:Lymph Nodes; D008207:Lymphatic Metastasis; D008519:Medicine, Traditional / Q000009:adverse effects* / Q000379:methods*; D009367:Neoplasm Staging; D009850:Oman; D012189:Retrospective Studies