ekspresi mRNA Mammaglobin penderita kanker payudara - USU ...

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Gillanders, W.E. (2005): Clinical translation of a Mammaglobin-A DNA vaccine ..... data/keterangan dari Ibu/Saudari bersifat rahasia, tidak diketahui orang lain.
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American Cancer Society (2010): Breast Cancer Facts and Figures 2009-2010. http://www.cancer.org/acs/groups/content/@nho/documents/document /f861009final90809pdf.pdf Antoine, C., Leibens, F., Carly, B., Pastijn, A. and Rozenberg, S. (2004): Influence of HRT on prognostic factors for breast cancer: a systematic review after the women's health initiative trial. Hum. Reprod., 19: 741-56. Armstrong, K., Eisen, A., and Weber, B. (2000): Assessing the risk of breast cancer. New Engl. J. Med., 342: 564-71. Autier, P. (2002): A breast cancer screening program operating in a liberal health care system: the Luxembourg Mammography Program, 1992-1997. Int. J. Cancer, 97: 828-32. Axilbund, J.E., Gross, A.L., Visvanathan, K. ( 2011): Chapter 5 in Early diagnosis and treatment of cancer Series: Breast Cancer. Jacobs L. and Finlayson C.A (Ed) Saunders Elsevier: pp 71-88. Backus, J., Laughlin, T., Wang, Y., Belly, R., Robert, W., Baden, J., Min, C. J., Mannie, A., Tafra, L., Atkins, D. and Verbanac, K.M. (2005): Identification and characterization of optimal gene expression markers for detection of breast cancer metastasis. Journal of Molecular Diagnostics, 7:327–336. Bae J.W., Choi K.H., Kim H.G., Park S.H. (2000): The detection of circulating breast cancer cells in peripheral blood by Reverse Transcriptase-Polymerase Chain Reaction. J. Korean Med Sci, 15: 194-8. Bernstein J.L., Godbold J.H., Raptis G., Watson M.A., Levinson B., Aaronson S.A., Fleming T.P.(2005): Identification of Mammaglobin as a Novel Serum Marker for Breast Cancer. Clin Cancer Res, 11:6528-6535 Bitisik, O., Saip, P., Saglam, S., Derin, D. And Dalay, N. (2009): Mammaglobin and maspin transcripts in blood may reflect disease progression and the effect of therapy in breast cancer. Genetics and Molecular Research 9(1): 97-106 Brekelmans, C.T., Seynaeve C., Bartels, C.C., Verhoog, L.C., Van Den, O.A., Obdeijn, I.M. and Klijin, J.G. (2001): Effectiveness of breast cancer surveillance in

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BRCA 1/2 gene mutation carriers and women with high familial risk. J. Clin. Oncol., 19: 924-30. Canda, M.S., Gury, M., Erbayraktar, R.S., Acar, F. and Canda, T. (2004): Association of invasive breast Carcinoma and Glioblastoma multiforme: a case report with histological and immunohistochemical features. Turk. J. Med. Sci., 34: 131-135. Carter, D., Dillon, D.C., Reynolds, L.D., Retter, M.W., Fanger , G., Molesh, D.A., Sleath, P.R., McNeill, P.D., Vedvick, T.S., Reed, S.G., Persing, D.H. and Houghton, R.L.( 2003): Serum antibodies to lipophilin-B detected in late stage breast cancer patients. Clin. Cancer Res., 9:749-754. Cerveira, N., Torres, L., Rocha, P., Bizarro, S., Pereira, D., Abreu, J., Teixeira, M.R. and Castedo, S. (2004): Highly sensitive detection of the MGB1 transcript (mammaglobin) in the peripheral blood of breast cancer patients. Int. J. Cancer, 108: 592–595. Collado, M., Landt, O., Barragán, E., Lass, U., Cervera, J., Sanz, M. A. And Bolufer, P. (2004): Locked nucleic acid-enhanced detection of 1100delC*CHEK2 germ-line mutation in Spanish patients with hematologic malignancies. Clin. Chem., 50: 2201 - 2204. Connor, E. and Stuenkel, C.A. (2001): Hormone replacement therapy (HRT)-risks and benefits. Int. J. Epidemiol., 30: 423-6. Corradini, P., Voena, C., Astolfi, M., Dell´Oro, S., Pilotti, S., Arrigoni, G., Bregni, M., Pileri, A. and Gianni, A.M. (2001): Maspin and mammaglobin genes are specific markers for RT-PCR detection of minimal residual disease in patients with breast cancer. Ann. Oncol., 12: 1693–1698. Cristofanilli, M., Hayes, D.F., Budd, G. T., Ellis, M.J., Stopeck, A., Reuben, J.M., Doyle, G.V., Matera, J., Allard, W.J., Miller, M. C., Fritsche, H.A., Hortobagyi, G.N. and Terstappen, L.W.M.M. (2005): Circulating Tumor Cells: A novel prognostic factor for newly diagnosed metastatic breast cancer. Journal of Clinical Oncology, 23(7): 1420-1430. De Jong, M.M., Nolte, I. M., te Meerman, G.J., Van Der Graaf, W.T., Oosterwikjk, J.C., Kleibeuker, J.H., Schaapveld M. and De Vries E. G. (2002): Genes other than BRCA1 and BRCA2 involved in breast cancer susceptibility, J. Med. Genet., 39: 225-42.

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De la Hoya, M., Gutiérrez-Enríquez, S., Velasco, E., Osorio, A., de Abajo, A.S., Vega, A., Salazar, R., Esteban, E., Llort, G., Gonzalez-Sarmiento, R., Carracedo, A., Benítez, J., Miner, C., Díez, O., Díaz-Rubio, E. and Caldes, T. (2006): Genomic Rearrangements at the BRCA1 Locus in Spanish families with breast ovarian cancer . Clin. Chem., 52: 1480-1485 Duffy, M.J. (2005): Predictive markers in breast and other cancers. Clin. Chem., 51: 494–503. Duffy, M.J. (2006): Serum tumor markers in breast cancer: Are they of clinical value? Clin. Chem., 52: 345-51. Elahi, M., Norat, T., Goudable, J. and Riboli, E. (2004):Biomarkers of dietary fat intake and the risk of breast cancer: A meta-analysis. Int. J. Cancer, 111: 584-91. Elmore, J.G., Miglioretti, D.L. and Carney, P.A. (2005): Does practice make perfect when interpreting mammography? part II. J. Natl. Cancer Inst., 95:250-2. El-Sharkawy S.L., El-Aal W.S.A., El-Shaer M.A.M., Abbas N.F., Youssef, M.F.(2007): Mammaglobin: A novel tumor marker for breast cancer,Turkish Journal of Cancer 37 (3) : 89-97. Ergul E. and Sazci A.(2001): Molecular Genetics of Breast Cancer. Turk J Med Sci 31: 1-14 Frazier, A.L., Ryan, C.T., Rockett, H., Willett, W.C. and Colditz, G.A. (2003): Adolescent diet and risk of breast cancer. Breast Cancer Res., 5: R59-R64. Gasco, M., Shami, S. and Crook, T. (2002): The p53 pathway in breast cancer. Breast Cancer Res., 4: 70-76. Giard, R.W.M. and Hermans, J. (1992): The value of aspiration cytology of the breast. Cancer, 69: 2104-2110. Gillanders, W.E. (2005): Clinical translation of a Mammaglobin-A DNA vaccine for Breast Cancer Therapy. Ph.D. Thesis, Washington University School of Medicine. Giordano, S.H. (2005): A review of the diagnosis and management of male breast cancer. Oncologist, 10: 471-9. Grebenchtchikov, N., Brinkman, A., van Broekhoven, S. P.J., de Jong, D., GeurtsMoespot, A. , Span, P. N., Peters, H. A., Portengen, H. , Foekens, J.A., Sweep, C.G.J.

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(Fred) and Dorssers, L.C.J. (2004): Development of an ELISA for measurement of BCAR1 protein in human breast cancer tissue . Clinical Chemistry, 50:1356-1363. Grünewald, Gunsilius, E., expression: a comparison to 1077.

K., Haun, M., Urbanek ,M., Fliegl, M., Mueller-Holzner, E., Dünser, M., Marth, C. and Gastl, G. (2000): Mammaglobin gene superior marker of breast cancer cells in peripheral blood in epidermal-growth-factor and cytokeratin-19. Lab. Invest., 80: 1071–

Guadagni, F., Ferroni, P., Carlini, S., Mariotti, S., Spila, A., Aloe, S., D´Alessandro, R., Carone, M.D., Cicchetti, A., Riccoiotti, A., Venturo, I., Perri, P., Filippo, F. D., Cognetti, F., Botti, C. and Roselli, M. (2001): A reevaluation of carcinoembryonic antigen (CEA) as a serum marker for breast cancer. Clin. Cancer Res., 7: 1257- 2362. Harbeck, N., Kates, R.E., Look, M.P., Gelder, M.M., Klijn, J.G.M. and Kruger, A. (2002): Enhanced benefit from adjuvant chemotherapy in breast cancer patients classified high-risk according to urokinase-type plasminogen activator (uPA) and plasminogen activator inhibitor type 1 (N = 3424). Cancer Res., 62: 4617–4622. Harris L., Fritsche H., Mennel R., Norton L., Ravdin P., Taube S., Somerfield M.R., Hayes D.F.,and Bast Jr R.C.(2007): American Society of Clinical Oncology 2007 Update of Recommendations for the Use of Tumor Marker in Breast Cancer. J. of Clin. Onc. 25(33): 5287-5312. Hellström, L., Goodman, G., Pullman, J., Yang, Y. and Hellström, K. E. (2001): Overepreesion oh HER-2 in ovarian carcinoma. Cancer Research, 61: 2420-2423 Henry, N.L. and Hayes, D.F. (2006): Uses and abuses of tumor markers in the diagnosis monitoring and treatment of primary and metastatic breast cancer. Oncologist, 11(6)541-52. Jemal, A.; Siegel, R.; Ward, E.; Murray, T.; Xu, J. And Thun, M. J. (2007): Cancer statistics, 2007. CA Cancer J. Clin., 57:43-66. Jones G. (1999): CA 15-3. SydPath. [email protected] Koga, T., Horio, Y., Mitsudomi, T., Takahashi, T. and Yatabe, Y. (2004): Identification of MGB1 as a marker in the differential diagnosis of lung tumors in patients with a history of breast cancer by analysis of publicly available SAGE data. J. Mol. Diagn, 6(2): 90-95.

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Lacroix M.(2006): Significance, detection and markers disseminated breast cancer cells. Endocrine-Related Cancer, 13: 1033–1067. Lee I.M., Cook N.R., Rexrode K.M. and Buring J.E. (2001): Lifetime physical activity and risk of breast cancer. British Journal of Cancer., 85(7), 962–965 Loman, N., Bladström, A. Johannsson, O., Borg, A. And Olsson, H. (2003): Cancer incidence in relatives of a population- based set of cases of early- onset breast cancer with a known BRCA1 and BRCA2 mutation status. Breast Cancer Res., 5: R175- R186. Margolese R.G., Fisher B., Hortobagyi G.N. and Bloomer W.D.(2003): Chapter 118 Neoplasms of the Breast: Cancer Medicine, 6th Edition" McTieranan, A., Rajan, K.B., Tworoger, S.S., Irwin, M., Bernstein, L., Baumgartner, R., Gilliland, F., Stanczyk, F.Z., Yasui, Y. and Ballard-Barbash, R. (2003): Adiposity and sex hormones in postmenopausal breast cancer survivors. Journal of Clinical Oncology, 21: 1961-6. Mikhitarian, K., Martin, R.H., Ruppel, M. B., W.E. Gillanders, W.E., Hoda, R., Schutte, D.H., Callahan, K., Mitas, M. and Cole, D.J. (2008): Detection of mammaglobin mRNA in peripheral blood is associated with high grade breast cancer: Interim results of a prospective cohort study. BMC. Cancer, 8:55. Miksicek, R.J., Myal, Y., Watson, P.H., Walker, C., Murpohy,L.C. and Leygue, E. (2002): Identification of a novel breast-and salivary gland-specific, Mucin-like gene strongly expressed in normal and tumor human mammary epithelium. Cancer Res., 62: 2736-2740. Molina, R., Barak, V., van Dalen, A., Duffy, M.J., Einarsson, R. and Gion, M. (2005): Tumor markers in breast cancer: European Group of Tumor Markers (EGTM) recommendations. Tumor Biol., 26: 281–293. Notani, P.N.(2001): Global variation in cancer incidence and mortality. Current science, Vol. 81, No. 5 Núñez-Villar, M.J., Martinez-Arribas, F., Pollan, M., Lucas, A.R., Sánchez, J., Tejerina, A. and Schneider, J. (2003): Elevated mammaglobin (h-MAM) expression in breast cancer is associated with clinical and biological features defining a less aggressive tumor phenotype. Breast Cancer Res.,5(3): R65-70.

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Oakley, K.L., Going, J.J. (1995): Specimen slice radiography of cancer in breast conserving excisions. J.Clin. Pathol 48:1028-30 O'Brien, N., Maguire, T.M., O'Donovan, N., Lynch, N., Hill, A. D.K., McDermott, E., O’Higgins, N. and Duffy, M.J.(2002): Mammaglobin A: a promising marker for breast cancer. Clin. Chem., 48(8): 1362-1364. Passebosc-Faure, K., Li, G., Lambert, C., Cottier, M., Gentil-Perret, A., Fournel, P.; Pérol, M. and Genin, C. (2005): Evaluation of a panel of molecular markers for the diagnosis of malignant serous effusions. Clin. Cancer Res.,11(19). Perkins G.L., Slater E.D., Sanders G.K., Prichard J.G.(2007): Serum Tumor Markers. American Family Physician, 68 (6): 1075-82. Peto, J. (2002): Breast cnacer susceptibility: A new look at an old model.,Cancer Cell, 1: 411-2. Poschl, G. and Seitz, H.K. (2004): Alcohol and cancer. Alcohol, 39: 155-65. Raina, V., Bhutani, M., Bedi, R., Sharma, A., Deo, S.V., Shukla, N.K., Mohanti, B.K. and Rat, G.K. (2005): Clinical features and prognostic factors of early breast cancer at a major cancer center in North India. Indian J. Cancer, 42: 40-5. Raynor, M., Stephenson, S.A., Walsh, D.C.A., Pittman, K.B. and Dobrovic, A. (2002): Optimization of the RTPCR detection of immunomagnetically enriched carcinoma cells. Cancer, 2:14-21. Roncella, S., Ferro, P., Bacigalupo, B., Pronzato, P., Tognoni, A., Falco, E., et al (2005): Human mammoglobin m-RNA is a reliable molecular marker for detecting occult breast cancer cells in peripheral blood. J. Exp. Clin. Cancer Res., 24.2 Roncella, S., Ferro, P., Bacigalupo,B., Dessanti, P., Giannico A., Gorji, N., et al (2006): Relationship between Human Mammaglobin mRNA Expression in Breast Cancer Tissue and Clinico-Pathology features of the Tumor. J. Exp. Clin. Cancer Res., 25.1 Ross, J.S., Fletcher, J.A., Linette, G.P., Clark, E., Ayers, M. And Symmans, W.F. (2003): The HER-2/neu and protein in breast cancer 2003: biomarker and target of therapy. Oncologist, 8: 307–325.

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Silva, A.L., Tome, M.J., Correia, A.E., and Passos-Coelho, J.L. (2002): Human mammaglobin RT-PCR assay for detection of occult breast cancer cells in hematopoietic products. Ann. Oncol., 13: 442–429. Singletary, S.E., Greene, F.L., Sobin, L.H. (2003): Classification of Isolated Tumor Cells Clarification of the 6th Edition of the American Joint on Cancer Staging Manual. American Cancer Society. Singletary, S. E. and Connolly, J.L. (2006): Breast Cancer Staging: Working with the sixth edition of the AJCC Cancer Staging Manual. CA Cancer J. Clin., 56:37-47. Sjödin, A. (2005): Human Secretoglobins in Normal and Neoplastic Cells and Tissues. Medical dissertation, University of Umeå, Sweden. Slamon, D.J., Leyland-Jones, B., Shak, S., Fuchs, H., Paton, V. and Bajamonde, A. (2001): Use of chemotherapy plus a monoclonal antibody against HER- 2 for metastatic breast cancer that overexpress HER-2. N. Engl. J. Med., 344:783–92. Smigal, C., Jemal, A., Ward, E., Cokkinides, V., Smith, R., Howe, H. L. And Thun, M. (2006): Trends in breast cancer by race and ethnicity: Update 2006. CA Cancer J.Clin., 56:168-183. Span, P.N., Waanders, E., Manders, P., Heuvel, J., Foekens, J.A., Waston, M.A. and Sweep, F. (2004): Mammaglobin is associated with low-grade, steroid receptorpositive breast tumors from postmenopausal patients, and has independent prognostic value for relapse free survival time. J. Clin. Oncol., 22(4): 691-698. Stewart, S.L., King, J.B., Thompson, T.D., Friedman, C and Wingo, P.A. (2004) : Cancer mortality surveillance United States, 1990-2000. Morbidity and mortality WeeklyReport, 53: 1-108. Terry, P.D. and Rohan, T.E. (2002): Cigarette smoking and the risk of breast cancer in women. Cancer Epidem., 11: 953-971. Tjindarbumi D and Mangunkusumo R.(2002): Cancer in Indonesia, Present and Future. Jpn J. Clin. Oncol; 32(Supplement 1)S17-S21 Tryggevadottir, L., Olafsdottir, E.J., Gudlaugsdottir, S., Jonasson, J.G. and Tulinius, H. (2003): BRCA2 mutation carriers, reproductive factors and breast cancer risk. BreastCancer Res., 5: R121-R128.

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Ursin, G., Bernstein, L., Lord, S., Karim, J.R., Deapen, D., Press, M.F., Daling, J.R., Norman, S.A., Liff, J.M. and Marchbanks, P.A. (2005): Reproductive factors and subtypes of breast cancer defined by hormone receptor and histology. Br. J. Cancer, 93: 364-71. Watson, M.A. and Fleming, T.P. (1996): Mammaglobin, a mammary-specific member of the uteroglobin gene family, is overexpressed in human breast cancer. Cancer Res., 56(4): 860-865. Watson, M.A., Darrow, C., Zimonjic, D.B., Popescu, N.C. and Fleming, T.P. (1998): Structure and transcriptional regulation of the human mammaglobin gene, a breast cancer associated member of the uteroglobin gene family localized to chromosome 11q13. Oncogene, 16(6): 817-824. Watson, M.A., Dintzis, S., Darrow, C.M., Voss, L.E., Pipersio, J., Jensen, R. and Fleming, T.P. (1999): Mammaglobin expression in primary, metastatic, and occult breast cancer. Cancer Res., 59(13): 3028-3031. Winchester D.P. (1992): Physical Examination of the Breast. Cancer Supplement, Volume 69, No. 7 Wood, W.C., Muss, H.B., Solin, L.J., Olopade, O.I. (2005): Malignant Tumors of the breast Cancer. In: Principles and Practice of Oncology.7th Ed, V.T. DeVita, S. Hellman, S.A. Rosenberg(Eds). Philadelphia, Lippincott Williams & Wilkins, pp: 1415-77 Woodward, W.A., Strom, E.A., Tucker, S.L., McNeese, M.D., Perkins, G.H., Schechter, N.R., Singletary, S.E., Theriault, R.L., Hortobagyi, G.N., Hunt, K.K. and Thomas A. Buchholz (2003): Changes in the 2003 American Joint Committee on Cancer Staging for Breast Cancer Dramatically Affect Stage-Specific Survival. Journal of Clinical Oncology, 21 (17): 3244-3248 Wrensch, M.,Chew, T., Farren, G., Barlow, J., Belli, F., Clarke, C., Erdmann, C.A., Lee, M., Moghadassi, M., Peskin-Mentzer, R., Quesenberry Jr, C.P., SoudersMason, V., Spence, L., Suzuki, M. and Gould, M. (2003): Risk factors for breast cancer in a population with high incidence rates. Breast Cancer Research, 5 (4) Zach, O., Kasparu, H., Krieger, O., Hehenwarter, W., Girschikofsky, M. and Lutz, D. (1999): Detection of circulating mammary carcinoma cells in the peripheral blood of breast cancer patients via a nested reverse transcriptase polymerase chain reaction assay for mammaglobin mRNA. J. Clin. Oncol., 17: 2015–2019.

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Zehentner, B. K., Persing, D. H., Deme, A., Toure, P., Hawes, S. E., Brooks, L., Feng, Q., Hayes, D. C., Critichlow, C. W., Houghton, R. L.and Kiviatet, N. B. (2004): Mammaglobin as a Novel Breast Cancer Biomarker: Multigene Reverse Transcription-PCR Assay and Sandwich ELISA. Clinical Chemistry, 2069–2076. Zhang, S.M., Manson, J.E., Rexrode, K.M., Cook, N.R., Buring, J.E. and Lee, I.M. (2007): Use of oral conjugated estrogen alone and risk of breast cancer. Am. J. Epidemiol.,165(5):524-529.

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Lampiran 1. PENJELASAN MENGENAI PENELITIAN: LEMBAR PENJELASAN KEPADA CALON SUBJEK PENELITIAN Selamat pagi/siang Ibu/Saudari sekalian Nama saya dr. Surjadi Rimbun dan akan melakukan penelitian dengan judul: Ekspresi m-RNA mammaglobin pada wanita penderitaa kanker payudara dengan metastase di Kotamadya medan. Penelitian ini bertujuan untuk mengetahui Ekspresi m-RNA mammaglobin. Dengan diketahuinya ekspresi m-RNA mammaglobin maka diharapkan akan dapat menambah modalitas terapi terhadap kanker payudara. Jika Ibu/Saudari bersedia mengikuti penelitian ini maka akan dilakukan pemeriksaan terhadap Ibu/Saudari dengan cara melakukan wawancara, pengambilan darah vena daerah cubiti/ siku untuk diperiksa di laboratorium.Kami sangat mengharapkan keikut sertaan Ibu/Saudari dalam penelitian ini, karena selain bermanfaat untuk diri sendiri, juga bermanfaat untuk orang lain. Selama penelitian ini, Ibu/Saudari tidak dibebankan biaya apapun. Semua data/keterangan dari Ibu/Saudari bersifat rahasia, tidak diketahui orang lain. Apabila keberatan, Ibu/Saudari bebas untuk menolak mengikuti penelitian ini, tanpa khawatir akan mengurangi pelayanan yang kami berikan. Jika sudah mengerti dan bersedia mengikuti penelitian ini maka Ibu/saudari dapat mengisi lembar persetujuan. Pemeriksaan yang akan dilakukan diatas pada lazimnya tidak akan menimbulkan hal yang berbahaya bagi Ibu/Saudari sekalian, Namun bila terjadi hal-hal yang tidak diinginkan yang disebabkan oleh perlakuan penelitian ini, maka Ibu/Saudari dapat menghubungi saya. Nama

: dr. Surjadi Rimbun

Alamat kantor : Jl. Krakatau 57-C Medan (telp-HP 0616614923-0811632515) Demikian penjelasan ini saya sampaikan, kiranya hasil dari penelitian ini bermanfaat bagi kita semua. Medan, Oktober 2012...... Peneliti,

(dr. Surjadi Rimbun)

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Lampiran 2. LEMBAR PERSETUJUAN SETELAH PENJELASAN (INFORMED CONSENT)

Saya yang bertanda tangan dibawah ini: Nama

:

Umur

:

Jenis kelamin

:

Alamat

:

No.Telp./ HP

:

Setelah mempelajari dan mendapatkan penjelasan yang sejelas-jelasnya mengenai penelitian yang berjudul Ekspresi m-RNA mammaglobin pada wanita penderita Kanker payudara dengan metastase di Kotamadya Medan, dan setelah mengetahui dan menyadari sepenuhnya risiko yang mungkin terjadi, dengan ini saya menyatakan bahwa saya bersedia dengan sukarela menjadi subjek penelitian tersebut dan patuh akan ketentuan-ketentuan yang dibuat peneliti. Jika sewaktu-waktu ingin berhenti, saya berhak untuk tidak melanjutkan mengikuti penelitian ini tanpa ada sanksi apapun.

Yang menyatakan

(

Saksi

)

(

)

Peneliti

(Dr. Surjadi Rimbun)

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Lampiran 3. Kuesioner subjek DATA SUBJEK INISIAL SUBJEK : ░░░░░░░░ Nama : ...................................................................... Jenis kelamin : P Umur : ....... tahun ; Tanggal lahir : .......................... Pekerjaan : ……………………………………………….. Alamat : ......................................................................... Telp. : ............................ HP : .................................. Tempat/ tgl : Medan,/ .............. .......................................... 1. Apakah Ibu/saudari sekarang ini sedang menderita penyakit kanker payudara?  YA  TIDAK 2.

Jika YA,apakah Ibu/saudari sedang dalam masa pengobatan kanker payudara?  TIDAK  YA Jika YA, apa jenis pengobatan yang sedang berjalan sekarang?  Operasi  Radiasi  Kemoterapi

3. Jika TIDAK, apakah Ibu/saudari sudah selesai menjalani terapi lebih dari 5 tahun?  YA  TIDAK 4. Jika TIDAK, apakah ini kanker yang kambuh kembali menurut dokter yang merawat Ibu/ saudari?  YA  TIDAK 5. Apakah Ibu/saudari selama masa pengobatan, rutin menjalani pemeriksaan darah?  YA  TIDAK Jika YA, pemeriksaan darah rutin apa yang pernah atau sedang dijalani? …………………………………………………………………………………… ….................................................................................................................. .........................................................................................................................

6. Apakah dokter yang merawat pernah memberitahukan keadaan penyakit kanker payudara Ibu/ saudari?

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 YA

 TIDAK

7. Jika YA, apakah Ibu/ saudari tahu tentang stadium penyakit kanker payudara?  TIDAK  YA

8. Apakah juga Ibu/ saudari tahu tentang stadium penyakit kanker payudara yang sedang/ pernah diderita?  YA  TIDAK 9. Stadium penyakit kanker payudara adalah : (beri tanda  pada bagian yang dirasa benar, jawaban boleh lebih dari satu)  Stadium dini adalah bila kanker hanya mengenai salah satu payudara  Stadium dini adalah bila kanker masih dapat diobati  Stadium terdiri dari I sampai IV  Stadium lanjut adalah bila kanker telah menyebar ke organ lain (metastase)  Stadium lanjut sama dengan stadium IV

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Lampiran 4. Data Klinis dan histopatologi serta hasil imaging penderita kanker payudara DATA SUBJEK INISIAL SUBJEK : ░░░░░░░░ Nama : …. ............................................................. Jenis kelamin : P Umur : ....…. tahun ; Tanggal lahir : ...................... …. Pekerjaan : ………………………………………………... Alamat : ......................................................................... . Telp. : ............................ HP : ............................... .... Tempat/ tgl : Medan,/ ...................................................... .... No. Med Rekod : .......................................................................... 1.

Diagnosa klinis ……………………………………………………......

:

2.

Hasil :………………………………………………………….

Histopatologi

3.

Hasil Foto :………………………………………………………….

X-Ray

4.

Hasil :………………………………………………………….

USG

5.

Hasil :…………………………………………………………..

CT-Scan

6.

Hasil MRI/PET :…………………………………………………………..

CT

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Universitas Sumatera Utara