BackgroundTrastuzumab emtansine (T-DM1) is indicated for HER2-positive early breast cancer with residual invasive disease after neoadjuvant chemotherapy (NAC). However, the extent of benefit T-DM1 will provide over trastuzumab plus pertuzumab (HP) in patients with microscopic residual invasive disease after NAC remains unclear.MethodsData of patients with HER2-positive breast cancer who were treated with HER2-targeted therapy as NAC and completed HP or T-DM1 as adjuvant therapy from October 2018 to October 2022 were retrospectively extracted from the institutional database. Invasive disease-free survival (IDFS), overall survival (OS), and safety were analyzed.ResultsOf the 110 patients, 61 achieved pCR (55.4%), and 49 had residual invasive disease. Of the 49 patients, 29 received HP, and 20 received T-DM1 as adjuvant therapy. The proportion of ypT1aN0 was 31.0% (n = 9/29) in the HP group and 45.0% (n = 9/20) in the T-DM1 group. The 3-year IDFS and OS were 96.6% and 95.0%, and 96.6% and 100% in the HP and T-DM1 groups, respectively. The 3-year IDFS and OS of patients with ypT1aN0 were 100% in both groups. The most common adverse events of any grade in the T-DM1 group were aspartate aminotransferase increased (90%) and alanine aminotransferase increased (85%) aminotransferase and platelet count decreased (70%).ConclusionThe 3-year IDFS and OS of patients with ypT1aN0 disease who received HP or T-DM1 as adjuvant therapy were comparable.
BackgroundAkt1, a crucial component of the PI3K/Akt signaling pathway, mediates a plethora of cancer-related processes such as cell growth, proliferation, survival, apoptosis and invasion. So, the pathogenesis of various types of cancer may be attributed to single nucleotide polymorphisms (SNPs) in the AKT1 gene. Here, we aimed to investigate whether AKT1 rs1130214, rs1130233 and rs2494732 SNPs are associated with an increased risk of breast cancer (BC).Material and methodsA total of 100 women diagnosed with BC and 100 healthy controls were included. The AKT1 SNPs were genotyped using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and amplification refractory mutation system PCR (ARMS-PCR) methods. Using logistic regression analysis, the genotypic and allelic associations between AKT1 SNPs and BC development were determined under co-dominant, dominant, and recessive inheritance models. Genotype combination and haplotype analysis were also performed to assess the combined effect of the AKT1 SNPs on the risk of BC. We used RNAsnp online server to predict the effect of rs1130233 SNP on local RNA secondary structure.ResultsThe rs1130233 SNP was observed to be significantly associated with predisposition to BC under recessive inheritance model (p < 0.05). The rs1130233 T allele confers risk of developing BC (OR: 1.877; 95% CI: 1.242-2.837; p = 0.003). For rs1130214/rs2494732 and rs1130233/rs2494732, AA/TC and CC/TC combined genotypes were found to be independently associated with reduced risk of BC, respectively. We also found that individuals with the CTC haplotype have an increased risk of BC (p < 0.05).ConclusionOur results highlight that AKT1 rs1130233 SNP is significantly associated with a higher risk of BC. Furthermore, the CTC haplotype can be utilized to identify individuals with a genetic susceptibility to BC.
Circulating tumor cells (CTCs) are cancerous cells that detach from the tumor and circulate in the bloodstream, resulting in metastasis by invading and colonizing new organs. These cells, however, pose a great significance from the clinical perspective as they can be used for the detection and prognosis of cancer. Traditionally used cancer diagnosis treatments are invasive and cannot detect tumor heterogeneity. CTCs, on the other hand, can be recovered through various non-invasive techniques such as liquid biopsies. Further, they can potentially aid in accurate diagnosis and prognosis, real-time monitoring of the body's therapeutic response, and in providing personalized therapy. Hence, CTCs can conceivably help in reducing breast cancer-related mortality. Numerous techniques have been developed for the accurate detection and capture of CTCs. However, there is still much scope for improvement before CTCs can be used in clinical settings. In this review, we discuss about CTC characteristics and their role in breast cancer. The clinical significance of CTCs in breast cancer is elaborated. Further, various technologies developed and the ongoing trials for CTC detection are reviewed. Potential for improvement in currently employed methods and future research expectations are also discussed.
IntroductionMyeloid sarcoma is a high-grade hematological malignancy that rarely occurs in the breast as the tumor is generally seen in the ribs, sternum, and orbital bones. We report a case of isolated myeloid sarcoma presenting as a breast mass and reviewed the literature to raise awareness of this disease.Case presentationA 20-year-old girl presented with a painless mass located in the upper outer quadrant of the left breast. The patient underwent a bilateral breast US revealing a central retroareolar large hypoechoic solid mass about 55 × 33 mm. A core needle biopsy was performed leading to the suspicion of non-Hodgkin lymphoma. The patient was planned to start CHOP protocol till the final confirmatory pathologic results. She received 4 cycles with a partial response. A new biopsy from the breast mass and IHC revealed the diagnosis of myeloid sarcoma. Bone marrow examination was normocellular with no abnormal deposits. She received 4 cycles HD Cytarabine with a PET CT revealing a complete response. She is prepared for bone marrow transplantation.ConclusionBeing rare, breast myeloid sarcoma is often misinterpreted as NHL or lobular breast cancer. Oncologists must remain aware of this condition because it frequently co-occurs with or follows AML.
Nipple discharge is a common and problematic symptom reported by many women seeking evaluation in primary care practices, surgery clinics, and breast radiology facilities. Discharge has been cited as the second to third most commonly reported breast symptom, next to palpable lumps and tenderness.1-3 Numerous groups have discussed management strategies regarding nipple discharge, and there has been a significant evolution away from surgical intervention. For the radiologist, nipple discharge can be a dilemma for many reasons. For academic medical centers with the availability of a network of clinical breast care personnel, subspecialty trained breast radiologists, and breast surgeons, a comprehensive evaluation and management strategy is more realistic. In the community setting, managing a patient with nipple discharge can be challenging due to limited time and resources. Fortunately, the vast majority of patients presenting with nipple discharge can be appropriately triaged with a thorough history and physical exam. For those requiring imaging, mammography and ultrasound are widely available for initial work-up. Magnetic Resonance Imaging (MRI) has also become more commonplace in recent years and has become an important tool in the evaluation process of nipple discharge. Ductography, which is decreasing in popularity, may continue to play a specific role in managing nipple discharge; however, the availability of skilled practitioners may be limited. Our aim in this review is to discuss features that differentiate physiologic from pathologic nipple discharge, provide a literature summary to guide imaging recommendations, and introduce a flow chart as an overview for step-by-step management.
Machine learning (ML) models are cost-effective tools that can establish a prognosis by considering clinical, genomic, and histological data from breast cancer patients. In this study, we evaluate the performance of 12 ML models in predicting the overall survival of breast cancer patients from “The Cancer Genome Atlas-Breast Cancer” database at 60 months of follow-up. The models evaluated were Logistic Regression (LR), Ridge Classifier (RC), Least Absolute Shrinkage and Selection Operator (LASSO), K-Nearest Neighbors (KNN), Naive Bayes (NB), Linear Discriminant Analysis (LDA), Decision Tree (DT), Multilayer Perceptron (MP), Stochastic Gradient Descent (SGD), Support Vector Machine (SVM), Random Forest (RF), and XGBoost (XGB). The most accurate models were NB (86.76%) and SGD (85.29%). The models with the highest sensitivity were SGD (93.75%), MP (91.67%), and NB (89.89%), while the models with the highest specificity were KNN (95.0%), DT (90.0%), and LASSO (85.0%). The models with the highest area under the ROC curve were LDA (90.83%), LASSO (90.1%), and LR (89.79%). The most relevant variables were “Previous Diagnosis of Cancer,” “Presence of Tumor,” “Ancillary Therapy,” and “Histology.” Our findings demonstrate that AI tools for predicting patient outcomes are a viable option when expensive prognostic genomic tools are not available. According to our results, NB and LASSO show promising performance in predicting the prognosis of breast cancer patients. Further studies with data from developing countries are needed to improve the performance of these tools.
Paget disease (PD) of the breast is a rare malignancy of the nipple-areola region that is almost always associated with an underlying in situ or invasive carcinoma. It can affect both women and men. It is more commonly seen in postmenopausal women. Clinical features may be the only sign of cancer during the initial presentation, making a diagnosis challenging. Early changes in PD include itching, scaling, and erythema of the nipple that can mimic other benign conditions, such as eczema. Histologically, it is characterized by an intraepidermal proliferation of malignant glandular epithelial cells in the nipple-areolar region. Imaging plays an important role in evaluating the extent of involvement and in deciding patient management. This article will provide an overview of the clinical features, histopathology, associated imaging findings, and management of PD.
Breast Cancer is the leading form of cancer found in women and a major cause of increased mortality rates among them. However, manual diagnosis of the disease is time-consuming and often limited by the availability of screening systems. Thus, there is a pressing need for an automatic diagnosis system that can quickly detect cancer in its early stages. Data mining and machine learning techniques have emerged as valuable tools in developing such a system. In this study we investigated the performance of several machine learning models on the Wisconsin Breast Cancer (original) dataset with a particular emphasis on finding which models perform the best for breast cancer diagnosis. The study also explores the contrast between the proposed ANN methodology and conventional machine learning techniques. The comparison between the methods employed in the current study and those utilized in earlier research on the Wisconsin Breast Cancer dataset is also compared. The findings of this study are in line with those of previous studies which also highlighted the efficacy of SVM, Decision Tree, CART, ANN, and ELM ANN for breast cancer detection. Several classifiers achieved high accuracy, precision and F1 scores for benign and malignant tumours, respectively. It is also found that models with hyperparameter adjustment performed better than those without and boosting methods like as XGBoost, Adaboost, and Gradient Boost consistently performed well across benign and malignant tumours. The study emphasizes the significance of hyperparameter tuning and the efficacy of boosting algorithms in addressing the complexity and nonlinearity of data. Using the Wisconsin Breast Cancer (original) dataset, a detailed summary of the current status of research on breast cancer diagnosis is provided.
Primary angiosarcoma (PAS) of the breast is an extremely uncommon variant of breast malignancies. Highly aggressiveness and dismal prognosis characterize this endothelial neoplasm. We report here an unusual case of PAS of the breast occurring in a 46-year-old woman associated with concurrent bilateral invasive ductal carcinoma and ovarian metastases.
INTRODUCTION:Alopecia is one of the main adverse events of chemotherapy in breast cancer. However, its impact is often ignored and underestimated by clinicians. Our aim was to evaluate the quality of life of breast cancer patients with chemotherapy induced alopecia. METHODS:We conducted a prospective study including 72 breast cancer patients who developed alopecia on or after stopping chemotherapy in the last 6 months. Clinical information and characteristics of alopecia were assessed using a self-prepared questionnaire. DLQI score was used to evaluate patients' quality of life. RESULTS:We interviewed a total of 72 women with a mean age of 53.5 ± 6 years. Alopecia appeared soon after the first course in 62.5%. All patients actively tried to hide induced hair fall (either by a hat in 6.9% or by a headscarf in 93.1%). Quality of life was impacted in 97.2% of patients with a median DLQI score of 6.5. Women who did not underwent mastectomy were significantly more bothered by hair loss than those who had radical surgery (78.1% vs 55%, p = 0.04). Working status was a significant predictor factor of a bad quality of life due to alopecia (100% in working women vs 58.3% in homemaker or retired patients, p = 0.006). CONCLUSION:Chemotherapy induced alopecia had a negative impact on quality of life of patients with breast cancer, especially in working women and those who did not have radical surgery. Prior wearing of headscarves did not impact significantly the DLQI score.
BACKGROUND:The management of mastodynia plays a central role in improving women quality of life. Despite its high occurrence, specific therapeutic guidelines for mastalgia are still lacking. Available therapies include unspecific anti-inflammatories, even though they may often expose to undesirable effects and low compliance. OBJECTIVE:The aim of this study was to highlight the efficacy of the topical application of combined natural molecules including Boswellia serrata, Betaine and myo-Inositol in improving cyclic mastalgia. METHODS:In this retrospective pilot clinical study, patients with cyclic mastalgia applied a specific breast gel for three months. The severity of the pain was measured through the Visual Analogue Score (VAS) in the treated group compared to untreated one. Treated patients also filled in a questionnaire evaluating acceptance and safety of the breast gel. RESULTS:This pilot clinical study demonstrated for the first time the efficacy of the topical application of a breast gel based on Betaine, Boswellia serrata, and myo-Inositol in improving cyclic mastodynia. The completed questionnaires also revealed high levels of acceptance, as both safety and compliance. CONCLUSIONS:Besides confirming the positive effects of these natural molecules in the management of conditions affecting breast physiology - so far evaluated as oral supplementation - the obtained results pave the way for further studies supporting the use of such molecules as a tailored medical device in the management of breast pain, thus also opening toward a combined oral and topical approach.
INTRODUCTION: Breast cancer is the most common cancer in women worldwide and is a significant threat to public health. This study aims to conduct a systematic review of the relationship between hormonal contraceptive use and breast cancer incidence. METHODS: The search was conducted using Google Scholar, Proquest, Pubmed and one Indonesian database, Garuda, using English and Indonesian keywords. The inclusion criteria in this study were the publication year of the last five years, namely 2019–2023, English and Indonesian language, case-control observational research, using the Indonesian population, and full-text access. RESULTS: A total of 165 studies were obtained from the Google Scholar database, including 104 studies. The overall multivariate analysis revealed that there was a statistically significant association of hormonal contraception with the incidence of breast cancer with OR values in the range of 2–6. CONCLUSIONS: The findings of this systematic study suggest that the use of hormones can contribute to hormonal imbalances that further increase breast cell proliferation and disrupt gene expression, resulting in uncontrolled cell development/cancer. In addition, the findings recommend increasing the number of studies on this topic to obtain more adequate and possibly more diverse information.
AIM: To retrospectively study the therapeutic modalities of primary breast sarcomas in view of the data of a local Tunisian experience. METHODS: It is a monocentric, descriptive, retrospective study including 13 cases of primary breast sarcoma treated over a period of 25 years (1995–2020) in the oncological radiotherapy department of a university hospital in Sousse, Tunisia. RESULTS: In our study, 13 cases of non-metastatic breast sarcomas that has been identified, divided into ten cases of phyllodes sarcomas and three cases of non-phyllodes sarcomas. Surgically, all our patients had a mastectomy. Among them, seven underwent a lymph node procedure: five underwent axillary lymph node dissection, and two others had primary axillary lymph node biopsy. For the adjuvant treatment, all the patients included in our study received radiotherapy and seven received chemotherapy. Local recurrence occurred on the operative scar in one patient after completion of radiation therapy. Metastatic relapse was described in five patients. The time to onset of metastases varied between two months and five years. Nevertheless, a complete remission was noted in 6 patients with a follow-up varying from four years to 20 years. Two patients were lost to follow-up. CONCLUSION: Breast sarcomas remain a very rare entity of aggressive tumors. The therapeutic approach is poorly codified. For this reason, the therapeutic decision should always be discussed in a multidisciplinary assessment.
OBJECTIVE: We aim to evaluate the indication and use of genomic signatures in breast cancer patients and outcomes who in patients undergoing adjuvant chemotherapy or not. METHODS: This is a retrospective study of breast cancer patients managed in a private oncology clinic in Teresina, from November 2014 to February 2021. All patients with an indication of genomic signature were included. Clinical and pathological variables, use of genomic signatures, treatment and follow-up were obtained. The nomogram to predict Oncotype DX results (University of Tennessee Medical Center) was also calculated. Clinical risk calculation was based on MINDACT, using the modified version of Adjuvant Online. The genetic signatures performed were: the Oncotype, MammaPrint and EndoPredict. RESULTS: Fifty (50) female patients were included in the study. The mean age of the participants was 57.1 years. Among the patients receiving a genomic signature (26–52.0%), there was a change in treatment in 8 (30.7%) cases. Chemotherapy was indicated in four patients, It was contraindicated in another four patients. Treatment changed in 30.7% of the tested patients. Chemotherapy was indicated for those who would not receive it before. It was contraindicated in patients who would previously undergo chemotherapy.
Efficient treatment of cancer has been a subject of research by scientists for many years. Current treatments for cancer, such as radiotherapy, chemotherapy and surgery have been used in traditional combination therapy, but they have major setbacks like non-specificity, non-responsiveness in certain cancer types towards treatment, tumor recurrence, etc. Epidemiological data has shown that breast cancer accounts for 14% of cancer cases occurring in Indian women. In recent years, scientists have started to focus on the use of natural compounds like lectins obtained from various sources to counter the side effects of traditional therapy. Lectins like Sambucus nigra Agglutinin, Maackia amurensis lectin, Okra lectins, Haliclona caerulea lectin, Sclerotium rolfsii lectin, etc., have been discovered to have both diagnostic and therapeutic potential for breast cancer patients. Lectins have been found to have inhibitory effects on various cancer cell activities such as neo-angiogenesis, causing cell cycle arrest at the G1 phase, and inducing apoptosis. The major idea behind the use of lectins in cancer diagnostics and therapeutics is their capability to bind to glycosylated proteins that are expressed on the cell surface. This review focuses on an exploration of the roles of post-translational modification in cancer cells, especially glycosylation, and the potential of lectins in cancer diagnosis and therapeutics.
Phyllodes tumor is an uncommon breast neoplasm that is present in variable sizes. Giant phyllodes are those larger than 10 cm in diameter. Clinically, giant phyllodes tumors present as a visible, rapidly growing mass distorting the breast contour. Such tumors with large size and rapid growth rate suggest a phyllode diagnosis of fibroadenoma. Planning a standard treatment strategy for these tumors is quite challenging. While adequate surgical excision with tumor-free resection margins is the standard of care for most giant phyllodes cases, borderline and malignant giant phyllodes tumors might require wider resections given their high recurrence rates. Some authors described total mastectomy as the treatment option for giant borderline and malignant phyllodes to obtain wide, clear margins. Between March 2022 and September 2023, our surgical oncology department presented and operated on three cases of giant phyllodes. They underwent a nipple-sparing mastectomy and immediate breast reconstruction using pre-pectoral silicone implants. We think that with such a procedure, we can benefit from the wide, safe margins of mastectomy that have been proven to decrease local recurrence rates while considering the aesthetic outcome.
BACKGROUND:Neuro-Behcet's disease (NBD) is a variant of Behcet's disease (BD). To our knowledge, there have been no previous reports on concurrent NBD in breast cancer patients undergoing chemotherapy. CASE PRESENTATION:Our patient had a history of BD and was asymptomatic. She was diagnosed with human epidermal growth factor receptor 2-positive breast cancer by core needle biopsy and was administered neoadjuvant chemotherapy. After four courses, in addition to the aggravation of the existing adverse events, headache, fever, dysarthria, and muscle weakness in the upper left and lower extremities appeared. On admission, she was diagnosed with acute NBD, and steroid therapy was initiated. After her symptoms improved gradually, she was discharged. Then, she underwent mastectomy and axillary lymph node dissection for breast cancer. Trastuzumab and pertuzumab plus tamoxifen were administered postoperatively. Two years postoperatively, no recurrence of breast cancer and NBD was noted. CONCLUSION:When chemotherapy is administered to breast cancer patients with a history of BD, it is necessary to select chemotherapy with as few adverse events as possible and to continue with treatment while paying attention to the risk of NBD.
INTRODUCTION: Housewives are a population at high risk of breast cancer due to repeated or chronic exposure to stress. Prevention in a simple yet evidence-based manner is needed. METHODS: This study is a narrative review of the potential of massage as breast cancer prevention through stress and immune system mechanisms. RESULTS: Massage is able to prevent chronic stress through improved sleep and fatigue and lower stress levels. Prevention of chronic stress will maximize the function of cells that eliminate cancer cells, such as B cells, T cells, and natural killer (NK) cells, and improve the balance of Foxp3 Tregulator cells. Partnered delivery massage will bring effective benefits for stress reduction. CONCLUSIONS: Massage can provide indirect prevention of breast cancer, and partnered delivery massage can be a good choice to reduce stress.
INTRODUCTION: Indonesian civilization extensively uses traditional medicine to cure illnesses and preserve health. The lack of knowledge on the security and efficacy of medicinal plants is still a significant concern. Although the precise chemicals responsible for this impact are unknown, ginger is a common medicinal plant in Southeast Asia that may have anticancer qualities. METHOD: Using data from Dudedocking, a machine-learning model was created to predict possible breast anticancer chemicals from ginger. The model was used to forecast substances that block KIT and MAPK2 proteins, essential elements in breast cancer. RESULT: Beta-carotene, 5-Hydroxy-74′-dimethoxyflavone, [12]-Shogaol, Isogingerenone B, curcumin, Trans-[10]-Shogaol, Gingerenone A, Dihydrocurcumin, and demethoxycurcumin were all superior to the reference ligand for MAPK2, according to molecular docking studies. Lycopene, [8]-Shogaol, [6]-Shogaol, and [1]-Paradol exhibited low toxicity and no Lipinski violations, but beta carotene had toxic predictions and Lipinski violations. It was anticipated that all three substances would have anticarcinogenic qualities. CONCLUSION: Overall, this study shows the value of machine learning in drug development and offers insightful information on possible anticancer chemicals from ginger.
INTRODUCTION: Breast self-examination (BSE) is an important tool for early detection of breast cancer and can contribute to increased awareness and familiarity with breast tissue. This study aimed to review factors that influenced BSE in preventing breast cancer. METHODS: In the initial stage of searching for journal articles, 186 journals were obtained, then screening was carried out within a time span of 2019–2024 and using Indonesian and English 54 journals. Of the 12 journals reviewed, the results showed that 4 journals reviewed had conducted pre and post-BSE practices, and 8 journal reviews conducted BSE practices conducted by students and health workers. RESULTS: Several factors play an important role in implementing BSE, namely age, knowledge, history of exposure to information, family history, ethnicity, and attitude. Overall, the study shows that the need to create awareness and educate women, especially rural women, on the importance of BSE as a preventive measure for breast cancer is paramount. CONCLUSIONS: Factors influencing the implementation of BSE can be a barrier or an enhancement in breast cancer prevention.
