Objective: High-mobility group (HMG) protein families are critical regulators of chromatin structure and gene expression in breast cancer. This study systematically evaluates their expression patterns, genetic interactions, and clinical relevance. Materials and Methods: Expression profiles of HMG proteins were analyzed using mRNA data from gene expression profiling interactive analysis 2. We performed protein-level validation using the Human Protein Atlas. Prognostic significance was assessed through survival analysis, while genetic alterations were mapped using cBioPortal. Pathway enrichment and protein-protein interactions were explored with EnrichR and Search Tool for the retrieval of interacting genes/proteins, respectively. Associations with p53 mutation status were investigated using University of Alabama at Birmingham Cancer Data Analysis Portal. Results: HMGA1 emerged as a central driver in triple-negative breast cancer (TNBC), forming a transcriptional complex with FOXM1 that activated VEGFA-mediated angiogenesis, which correlated withwas associated with poor patient survival. In contrast, HMGA2 overexpression was paradoxically associated with favorable outcomes despite promoting tumor angiogenesis. HMGB1 regulation was linked to genomic instability and metastasis, yet it showed potential protective effects in survival analyses. HMGB2 independently predicts poor prognosis in large tumors, and HMGB3 correlates with aggressive progression. HMGB4, though expressed at low levels, is associated with improved survival in early-stage patients. HMGN1 and HMGN4 promoted tumor growth, while HMGN2 suppressed proliferation and induced apoptosis, highlighting its therapeutic potential. Conclusion: HMG proteins exhibit context-dependent roles in breast cancer, with HMGA1, HMGB2-3, and HMGN1/4 driving tumors, while HMGA2, HMGB1, HMGB4, and HMGN2 show protective or paradoxical effects. These findings position HMG proteins as both biomarkers and therapeutic targets, particularly HMGA1 in TNBC angiogenesis and HMGN2 in the induction of apoptosis.
Objective: Breast cancer is the most common malignancy among women in Dubai, yet the economic burden of its treatment remains understudied. This study aimed to estimate the direct medical costs of breast cancer care in Dubai in 2024 and to examine variations by encounter type, comorbidity burden, and provider setting. Materials and Methods: A retrospective cross-sectional analysis of insurance claims was conducted for January-December 2024. Breast cancer cases were identified using International Classification of Diseases, 10th revision, clinical modification codes, and comorbidity burden was assessed using the Charlson comorbidity index (CCI). Costs were analyzed by encounter type (outpatient, inpatient, day case) and by provider setting (clinic/center versus hospital). A Tweedie generalized linear model was applied to evaluate the effect of comorbidities and service characteristics on costs. Results: A total of 8,967 patients (mean age 51.8 years) with 81,248 claims were identified. Outpatient visits constituted 86% of encounters and accounted for 81% of total expenditure (USD 48.7M). Inpatient admissions accounted for 6% of encounters and had the highest mean cost per patient (USD 10,808). The total expenditure was USD 60.0M. Costs increased significantly with comorbidity severity: patients with CCI ≥5 incurred 6.4-fold higher costs compared to those without comorbidities (p<0.0001). Hospital-based care increased costs by 16%, and pharmacy claims contributed an additional 31% to expenditures. Conclusion: Breast cancer treatment in Dubai imposes a substantial economic burden, largely driven by outpatient services, hospital-based care, and medication costs. Comorbidity significantly increases expenditures. These findings highlight the importance of integrated, risk-stratified care pathways and sustainable strategies to optimize resource allocation for breast cancer management in the United Arab Emirates.
Primary synovial sarcoma of the breast is an extremely rare malignancy, representing less than 1% of breast tumors. Its clinical presentation can mimic other spindle cell neoplasms, including dermatofibrosarcoma protuberans (DFSP), making diagnosis challenging. We report the case of a 60-year-old postmenopausal woman presenting with a firm, mobile 10 cm mass in the upper outer quadrant of the left breast, classified on imaging as breast ımaging reporting and data System 4. A core needle biopsy initially suggested DFSP because of strong CD34 positivity. A simple mastectomy revealed a highly cellular, spindle-cell tumor arranged in fascicles, forming a characteristic whorled pattern. Immunohistochemistry showed CD34 negativity, transducin-like enhancer of split 1 positivity, B-cell lymphoma 2 positivity, and focal epithelial membrane antigen positivity. Molecular analysis confirmed SYT-SSX1 fusion, establishing the diagnosis of monophasic synovial sarcoma. Surgical margins were negative, and one-year follow-up showed that the patient remained disease-free. This case highlights the importance of immunohistochemistry and molecular testing for accurate diagnosis and appropriate management.
Triple-negative breast cancer (TNBC) lacks estrogen and progesterone receptors, and estrogen receptor/progesterone receptor/human epidermal growth factor receptor 2 expression, and is associated with early relapse, visceral metastasis, and limited targeted options. High-throughput profiling supports TNBC as a collection of molecularly distinct diseases with exploitable vulnerabilities across DNA-damage response, cell-cycle control, receptor tyrosine kinase signaling, metabolism, and anti-tumor immunity. Clinically, immune checkpoint blockade has shifted standards of care in selected settings, and biomarker enrichment is increasingly central to trial design. In parallel, DNA repair-directed approaches, including poly(ADP-ribose) polymerase inhibitors in BRCA1/2-mutant and homologous recombination-deficient tumors, are being extended through rational combinations that intensify replication stress (e.g., ataxia telangiectasia and Rad3-related protein, WEE1, or checkpoint kinase 1 inhibition) to deepen responses and delay resistance. Additional candidate targets, including androgen receptor-driven disease biology, epidermal growth factor receptor, fibroblast growth factor receptor, vascular endothelial growth factor receptor signaling, and emerging antibody-drug conjugate antigens highlight the importance of matching therapy to subtype and tumor microenvironment context. Metabolic reprogramming (glycolysis, fatty-acid oxidation/synthesis, and amino-acid use) intersects with therapy resistance and may provide complementary combination opportunities. In this study, we synthesize recent advances in actionable TNBC pathways, summarize key preclinical and clinical evidence, and propose a pragmatic framework for biomarker-led combinations that integrate DNA repair, cell-cycle, metabolic, and immune vulnerabilities.
Self-injection of non-medical substances, such as mineral or baby oil, into the breast for augmentation is an unsafe practice and can lead to serious complications. Chronic granulomatous inflammation and fat necrosis may develop, and the imaging findings may mimic breast cancer, creating diagnostic and therapeutic challenges. We present the case of an 18-year-old woman who developed bilateral breast pain and masses after self-injection of baby oil. We highlight the radiological and histopathological features and remind clinicians to consider foreign-body granulomatous reactions in the differential diagnosis of suspicious breast lesions.
Objective: Mastectomy with immediate reconstruction is a primary surgical treatment for breast cancer. While both synthetic meshes and biological grafts are used in these procedures, their comparative effectiveness requires further investigation. This study evaluates the use of polytetrafluoroethylene (PTFE) mesh versus allogeneic dura mater (DM) in direct-to-implant breast reconstruction for reinforcing the inframammary fold (IMF) and stabilizing the implant. Materials and Methods: A prospective, randomized, open-label trial enrolled 116 patients (192 breasts) who underwent subcutaneous or skin-sparing mastectomies or subtotal radical resections, all followed by immediate subpectoral implant-based reconstruction. Participants were randomized to receive either a PTFE mesh (60 patients; 96 breasts) or a DM graft (56 patients; 96 breasts) for implant support. Outcomes were assessed through radiological imaging for complications, anthropometric measurements for IMF and implant stability, and the breast evaluation questionnaire version 2.0© (reconstruction module) for quality of life. Results: The PTFE group demonstrated a lower rate of major complications (3 vs. 7, respectively), while minor complications were comparable (23 vs. 28, respectively). Anthropometric analysis demonstrated that PTFE mesh provided superior stabilization of the IMF and the implant position postoperatively. Quality of life scores were comparable between the two groups. Conclusion: The use of PTFE mesh in immediate subpectoral breast reconstruction provides reliable anti-gravitational stabilization of the IMF and implant, and is associated with a favorable complication profile and high patient-reported quality of life.
Objective: BRCA1/2 pathogenic variant carriers face a high risk of breast cancer, making early detection vital for minimizing systemic treatments. Contrast-enhanced magnetic resonance imaging (MRI) outperforms mammography and ultrasound in detecting lesions that are often missed, particularly in individuals with BRCA1 or BRCA2 variants. However, the effectiveness of MRI-guided biopsy remains unclear. Thus, the aim was to evaluate the effectiveness of MRI-guided biopsy in detecting malignancy among BRCA1/2 pathogenic variant carriers with MRI-only-detected breast lesions and compare these findings with those in non-carriers and assess lesion characteristics and diagnostic yield. Materials and Methods: We retrospectively analyzed. We compared the effectiveness of MRI-guided biopsy for BRCA1/2 pathogenic variant carriers with MRI-only-detected lesions with that of non-carriers between April 2018 and December 2022. We examined the clinicopathological characteristics and MRI findings of the BRCA1/2 carriers. Results: A total of 130 lesions from 126 patients were reviewed. The BRCA1/2 mutation group had a significantly higher incidence of category 3 lesions on MRI. Invasive carcinoma was more prevalent among BRCA1/2 carriers, and non-carriers predominantly presented with ductal carcinoma in situ. MRI-guided biopsy identified malignant tumors in 30.1% of lesions. The positive predictive values were 42.9% for BRCA1/2 carriers and 28.6% for non-carriers. Conclusion: MRI-guided biopsy was effective in detecting early-stage invasive carcinoma in BRCA1/2 carriers, highlighting its role in tailored surveillance strategies. For new lesions categorized as breast imaging reporting and data system 3 on MRI, biopsy should be considered, particularly for BRCA1/2 carriers. Prospective studies are needed to validate these findings and assess long-term clinical outcomes to inform personalized management approaches for high-risk populations.
The breast constitutes an essential component of a woman’s identity, body image, and self-esteem. The objective of this article is to present a rare case of breast skin pathology and to examine its differential diagnosis. A fifty-year-old woman consulted our department for a burning sensation in her right breast in combination with a rash involving the nipple-areola complex. The patient received treatment for evolving bacterial mastitis; however, a zosteriform vesicular rash subsequently developed over the right scapular region. The diagnosis of varicella zoster virus infection was confirmed, and oral medication was adjusted to antivirals, resulting in progressive reduction of the rash. To the best of our knowledge, reports on herpes zoster involving the nipple are scarce in the literature. This article presents such an atypical manifestation, underscoring the importance of including herpes zoster in the differential diagnosis of nipple-areolar complex lesions, and provides a brief review of the relevant literature.
Objective:Developing nations with resource limited settings see a higher proportion of presentation at advanced stages of breast cancer compared to developed nations because of poor public awareness and lack of screening guidelines. This study aimed to assess the impact of a video-based teaching module on breast cancer awareness and self-examination among literate women in a developing country. Materials and Methods:This quasi-experimental, community-based, intervention study was conducted among literate women of a metropolitan city in a developing country, to evaluate the impact of a video-based teaching module on breast cancer awareness and self-examination. Female school teachers over 25 years old with virtual platform access were included. Simple random sampling was used to select participant schools. The target sample size was 103 based on a reference study. An educational video and questionnaires were validated through expert and volunteer feedback, followed by baseline and follow-up surveys at 6 weeks and 10 weeks after intervention. The Friedman test for overall change in scores and Wilcoxon signed-rank test were used for pairwise comparison between time points. Results:The survey was completed by 181 participants. Mean (standard deviation) age was 41.79 (9.20) years. Median (interquartile range) cumulative score for the knowledge domain was 18 (14-21), 24 (19-32) and 25 (20-33) at baseline, 6 weeks and 10 weeks respectively with significant differences between each of these time points (p<0.001). There was a significant increase in the number of participants with a median score of 3 at 6 and 10 weeks compared to baseline in the attitude domain after intervention. The proportion of study participants with a score of ≥3 points in the practices domain increased from 22% (40/181) at baseline to 41.2% (74/181) at 6 weeks and 49.1% (89/181) at 10 weeks of educational intervention. Conclusion:A video-based educational intervention may enhance breast cancer knowledge, attitudes, and self-examination practices in educated women with access to electronic media. This may contribute to early breast cancer detection in resource-constrained settings with limited screening options.
Juvenile giant fibroadenoma (GFA) is defined as a benign tumor larger than 5 cm, 500 grams, and/or involving at least 80% of the breast. It typically occurs in young patients and causes breast deformity and asymmetry. Surgical treatment involves resection of the tumor (enucleation), rearrangement of the skin envelope, and repositioning of the nipple-areola complex. However, the expected re-expansion of the breast following tumor removal, often managed through periareolar approaches, can be unpredictable and prolonged in certain cases. For this reason, oncoplastic surgery techniques have been developed, which allow for immediate partial reconstruction and are now among the available therapeutic options. This report describes three cases in which an oncoplastic approach was used for the treatment of GFA.
Objective: To evaluate the feasibility of using deep learning models applied to digital breast tomosynthesis (DBT) images for non-invasive prediction of breast cancer biomarkers, including estrogen receptor (ER), progesterone receptor (PR), human epithelial growth factor receptor 2 (HER2), Ki-67 proliferation index, and triple-negative breast cancer (TNBC). Materials and Methods: In this retrospective study, patients with histopathologically-confirmed, invasive breast cancer were included. Furthermore, all included patients had complete, immunohistochemically-assessed biomarker data available. For each case, a representative DBT slice showing the tumor was selected and preprocessed using histogram equalization. Two pretrained convolutional neural networks (VGG19 and ResNet50) were fine-tuned for binary classification of each biomarker. Model performance was evaluated using accuracy, area under the curve (AUC), F1 score, and Matthews correlation coefficient. Results: The study sample included 43 anonymized female patients. Deep learning models achieved strong predictive performance for ER (AUC = 0.81) and TNBC (AUC = 0.93). HER2 (AUC = 0.74) and Ki-67 index (AUC = 0.70) were predicted with moderate accuracy. PR results varied, with VGG19 reaching AUC = 0.76 while ResNet50 performed poorly (AUC = 0.24). Conclusion: Deep learning models applied to DBT images enabled non-invasive prediction of some key breast cancer biomarkers, especially ER status and TNBC type. This approach may function as a virtual biopsy to complement histopathology, guide biopsy targeting, and support treatment planning. Although preliminary, the findings highlight the potential of artificial intelligence-enhanced DBT assessment and warrant validation in larger, multi-center prospective studies.
Objective: Minimally invasive nipple-sparing mastectomy (NSM), performed via endoscopic or robotic-assisted approaches, has been developed to improve cosmetic and psychosocial outcomes without compromising oncologic safety. While international experience is growing, data from low-and middle-income countries remain limited. Materials and Methods: We conducted a retrospective case series of five consecutive patients (six breasts) who underwent minimally invasive NSM between January 2024 and June 2025 in an Indian center. Three patients underwent conventional endoscopic NSM and two underwent robotic-assisted NSM (one unilateral and one bilateral). Data collected included demographic and genetic status, tumor biology, operative details, reconstruction method, perioperative complications, pathology, and short-term follow-up. Primary endpoints were feasibility and safety; secondary endpoints were margin status, early oncologic outcomes, and cosmetic satisfaction. Results: All procedures were completed successfully without conversion to open surgery. Median (range) operative time was 210 (180-300) minutes, with robotic procedures requiring longer duration. No intraoperative complications, nipple-areolar necrosis, or implant losses were observed. Two patients developed minor seromas that resolved with aspiration. Pathological margins were negative in all cases. At a median follow-up of six (4-18) months, all patients were alive, disease-free, and reported good-to-excellent cosmetic satisfaction. Conclusion: Our early experience demonstrates that both endoscopic and robotic-assisted NSM are feasible and safe in carefully selected patients, providing satisfactory oncologic and esthetic outcomes. However, these results should be interpreted with caution due to the very small sample size, short follow-up, and absence of a comparator group. Larger prospective multicenter studies with long-term outcomes are required to confirm oncologic safety and define the role of minimally invasive NSM India.
Objective:This study examined body composition changes during neoadjuvant chemotherapy (NACT) for breast cancer and aimed to identify clinical parameters associated with skeletal muscle loss. Materials and Methods:We retrospectively analyzed women with stage I-III breast cancer who received NACT. Skeletal muscle and subcutaneous fat areas at the third lumbar vertebra were quantified on computed tomography and normalized for height to calculate the skeletal muscle index (SMI, cm²/m²) and subcutaneous fat index (SFI, cm²/m²). Pre- and post-NACT values were compared, and the prevalence of low skeletal muscle mass (LSMM, SMI <38.5 cm²/m²) and sarcopenic obesity (body mass index ≥30 kg/m² with LSMM) was determined. Multivariable linear regression assessed independent predictors of post-NACT SMI. Results:A total of 177 patients (mean age 51.0±10.7 years; 24% with diabetes) were included. Mean SMI declined significantly after NACT (43.1±7.4 to 41.4±7.1 cm²/m²; mean change -1.7±3.1, p<0.001). SFI also decreased (132.9±59.2 to 123.5±55.1 cm²/m²; mean change -9.5±27.0, p<0.001). The prevalence of LSMM increased from 27.7% to 37.3% (p = 0.003), and sarcopenic obesity from 8.5% to 12.4%. Patients with diabetes experienced greater muscle loss than those without diabetes (-2.7 vs. -1.4 cm²/m²). Diabetes mellitus was the only independent predictor of post-NACT SMI decline (β = -1.42, p = 0.013), while age and chemotherapy regimen were not significant. Conclusion:NACT is associated with significant reductions in skeletal muscle and subcutaneous fat, together with increased rates of LSMM. Diabetes mellitus independently predicted lower post-treatment SMI.
Breast cancer is the most frequently diagnosed malignancy among women worldwide, and significant progress in systemic therapy, surgical techniques, and radiotherapy has contributed to improved clinical outcomes. However, many clinical scenarios encountered in daily practice are not fully addressed by randomized trials, leaving persistent areas of uncertainty in the management of early-stage breast cancer. To meet these challenges, the multidisciplinary panel at Research Institute of Senology, Acıbadem University developed consensus-driven recommendations for clinical scenarios that are encountered in daily practice. Herein, we aim to reflect both current evidence and institutional practice, and to provide practical guidance in areas where uncertainty persists. As breast cancer treatment continues to evolve, updates will be required to integrate emerging data and refine individualized patient care.
Objective: Idiopathic granulomatous mastitis (IGM) is a rare inflammatory breast condition lacking standardized treatment and with unpredictable outcomes. To address these issues, using clinical and ultrasound findings from an initial subset, we created the Pittsburgh Classification to stratify severity and developed a corresponding treatment algorithm for IGM, then evaluated its effectiveness in a larger cohort of IGM patients. Materials and Methods: This retrospective multicenter study reviewed clinical and sonographic findings and outcomes of women with biopsy-proven IGM treated at multiple breast centers between 2020 and 2025. The Pittsburgh clinical classification ranges from Type 1 (minimal skin irritation) to Type 5 (widespread involvement); ultrasound classification spans Type A (localized mass ≤2 cm) to Type D (diffuse disease). Treatments were assessed utilizing the Pittsburgh algorithm, with responses classified as full response (CR), near-complete response (nCR), or no response (NR). Chi-square tests assessed associations (p<0.05). Results: Of 522 patients included (mean age 37.0±8.8 years), 86.4% (n = 451) received algorithm-concordant treatment, achieving CR in 68.7% (n = 310), nCR in 35.3% (n = 159) and NR in 11.8% (n = 53). Among these, 65.4% (295/451) of patients with CR were concordant with the Pittsburgh treatment algorithm, whereas 13.6% (n = 71) patients received discordant treatments, with a significantly lower CR rate of 21.1% (15/71) (p<0.001). Multifocal disease was significantly more prevalent in NR (83.0%, 44/53) and nCR (70.4%; 112/159) patients compared to CR (20.6%; 64/310) (p<0.001), although lesion-based response rates were similar (CR 56.8%, nCR 57.0%, NR 56.6%). Regarding concordance with treatment algorithm, clinical Type 4 IGM was more prevalent in NR (67.9%; 36/53) and nCR (72.9%, 116/159), whereas in clinical Type 1 IGM, NR, nCR, and CR were 1.8% (1/53), 4.4% (7/159), and 30.6% (95/310), respectively (p<0.001). Surgery at presentation was preferred in 16.9% (n = 88) of patients, with 6% (n = 30) requiring subsequent surgical treatments to treat residual disease. Conclusion: Concordance with the proposed IGM treatment algorithm based on clinical and ultrasound findings resulted in significantly higher CR rates. Multiple foci and stratified clinical types correlated with outcomes. Prospective global research is needed to validate these findings.
Objective: Breast lesions of uncertain malignant potential (B3) pose a diagnostic and management challenge. Surgical excision (SE) has traditionally been the standard for definitive diagnosis, but it may represent overtreatment. Percutaneous vacuum-assisted excision (VAE) offers a minimally invasive alternative. This study aimed to evaluate the safety and efficacy of VAE compared with SE for the management of B3 breast lesions, with the aim of reducing overtreatment. Materials and Methods: This retrospective single-center study included 64 patients with histologically confirmed B3 lesions diagnosed by tomosynthesis-guided vacuum-assisted breast biopsy between January 2018 and January 2024. Patients were managed by SE, VAE, or imaging follow-up, based on multidisciplinary team recommendations. Imaging characteristics, histopathology, upgrade rates, and follow-up outcomes were analyzed. Results: Most lesions presented as microcalcifications (92%). The most common histological subtypes were atypical intraductal epithelial proliferation (37.5%) and lobular neoplasia (25%). SE was performed in 26 patients (40%), VAE in 22 (34%), and 16 (25%) underwent follow-up. Malignant upgrades occurred in 8 of 26 SE-treated lesions (30.8%), predominantly atypical intraductal epithelial proliferation, while no upgrades were observed in the VAE group (p = 0.007). Mean follow-up was longer for SE (42 months) than VAE (21 months, p = 0.036). One SE patient developed invasive carcinoma at 48 months; no malignant progression occurred after VAE. Conclusion: VAE is a safe, minimally invasive and effective alternative to SE for carefully selected B3 lesions, particularly those without atypia and with imaging-pathology concordance, potentially reducing overtreatment. Multidisciplinary evaluation remains essential.
Objective: Multidisciplinary teams (MDTs) are essential for optimizing breast cancer treatment, yet the role of general-purpose artificial intelligence (AI), such as ChatGPT, in supporting these teams remains underexplored. This study compared ChatGPT versions 3.5 and 4 with a hospital-based MDT in making treatment and follow-up recommendations, using St. Gallen, European Society for Medical Oncology, National Comprehensive Cancer Network, and American Society of Clinical Oncology guidelines as a reference. Materials and Methods: A retrospective analysis of 100 consecutive breast cancer patients diagnosed between January 2023 and January 2024 at a training hospital in İstanbul, Türkiye, was conducted. The MDT provided consensus-based recommendations, while anonymized patient data were processed by ChatGPT using English prompts based on guideline summaries. Two experienced breast surgeons independently rated recommendation appropriateness on a five-point scale post-treatment, focusing on clinical outcomes, with agreement assessed using weighted Cohen’s kappa across cancer stage, molecular subtype, and proliferation index. Results: ChatGPT-4 (with a knowledge cut-off of March 2023) demonstrated substantial agreement with the MDT for primary treatments (weighted κ = 0.712), whereas ChatGPT-3.5 showed moderate agreement (κ = 0.600). Agreement for additional recommendations, such as genetic counseling, was lower (GPT-4: κ = 0.398; GPT-3.5: κ = 0.302), with better performance in early-stage and less aggressive subtypes compared to advanced or aggressive cases. Discrepancies were noted in complex or aggressive cases. Conclusion: The study suggests ChatGPT, particularly version 4, may serve as a supportive tool for breast cancer teams, especially in early-stage cases, though clinical expertise remains vital for complex scenarios, warranting further research to refine AI integration.
Idiopathic granulomatous mastitis (IGM) is a rare, benign, and chronic inflammatory breast disease of uncertain etiology. It often mimics infectious mastitis and inflammatory breast cancer in both clinical and radiologic presentations, leading to diagnostic and therapeutic challenges. This review aims to provide a comprehensive summary of the current literature regarding the etiology, pathogenesis, clinical manifestations, diagnostic strategies, and treatment options for IGM. A narrative review was conducted using an extensive search of the PubMed database, focusing on articles that discuss various aspects of IGM, including its potential autoimmune, hormonal, and infectious origins, as well as current diagnostic and management approaches. IGM most commonly affects women of reproductive age, often within a few years postpartum. Histologically, it is characterized by non-caseating granulomatous inflammation centered on breast lobules. Although corticosteroids are widely used as the first-line therapy, treatment regimens vary significantly across centers, and relapse is not uncommon. Immunosuppressive agents, such as methotrexate, have shown promising results in steroid-resistant cases. Surgical interventions are generally reserved for refractory cases because of the risk of recurrence and unfavourable cosmetic outcomes. The role of infectious agents, particularly Corynebacterium kroppenstedtii, remains controversial, and distinguishing between idiopathic and infectious GM is crucial for management. IGM is a multifactorial and clinically heterogeneous condition requiring individualized, multidisciplinary management. There remains a need for further prospective studies and consensus guidelines to optimize diagnosis and treatment, especially in recurrent or refractory cases.
Objective:Mastectomy rates are increasing in young patients despite few data supporting improved outcomes. We investigated the association between surgical approach and survival in young patients with breast cancer. Materials and Methods:Retrospective review identified women ≤40 years old with operable, non-metastatic invasive breast cancer treated between 2010-2019. Cox proportional hazard analyses, stratified by hormone receptor and human epidermal growth factor receptor 2 (HER2) status, identified factors associated with increased risk of recurrence and death. Results:Of 588 patients, 65% underwent mastectomy and 35% breast conserving surgery (BCS). Median follow-up was 5.9 years. Overall recurrence and mortality rates were 15% and 12%, respectively. On multivariable analysis, black race [hazard ratio (HR), 2.14 (1.26-3.61), p = 0.005], lymphovascular space invasion (LVSI) [HR, 1.98 (1.17-3.36), p = 0.01], and extranodal extension [HR, 2.12 (1.09-4.12), p = 0.03] were associated with increased risk of death. Stage III disease [HR, 2.06 (1.05-4.03), p = 0.04] and LVSI [HR, 2.18 (1.43-3.32), p<0.001] were associated with increased risk of recurrence. Increasing age decreased the risk of death [HR, 0.94 (0.88-0.99), p = 0.02] and recurrence [HR, 0.95 (0.90-0.99), p = 0.02]. Mastectomy versus BCS did not impact recurrence [HR, 1.18 (0.73-1.92), p = 0.51] or overall survival (OS) [HR, 0.86 (0.46-1.58), p = 0.62] in the entire cohort. BCS was associated with increased risk of recurrence in the hormone receptor-/HER2+ subtype [HR, 9.06 (1.03-80.00), p = 0.047] but did not affect survival. Conclusion:OS does not differ by surgery type in young patients with breast cancer. Future research should focus on racial disparities in breast cancer care.
