Introduction Breast cancer (BC) is the most prevalent cancer among women globally, and breast self-examination (BSE) is a simple and cost-effective examination for early detection and diagnosis of BC. This study aimed to assess the levels of knowledge, attitude, practice, and perception of susceptibility to risk of BC BSE among female students in higher learning institutions. Methods This was an analytical cross-sectional study that included 309 female students from various higher learning institutions in Dodoma city, Tanzania. An interviewer-administered and semi-structured questionnaire was used for the collection of the required data. Binary logistic regression was used to assess the factors associated with adequate knowledge, positive attitude, and good practice toward BSE among study participants. Statistical significance was considered at p < 0.05. Results The majority, 67.6% (209/309) of the students, were aged between 18 and 23 years with a mean age of 23.1 ± 3.3 years. Of all the study participants, 22.5% (41/182), 52.8% (163/309), and 42.4% (131/309) had good practice, adequate knowledge, and positive attitude on BSE, respectively. High-family income (aOR = 2.02, 95% = 1.28–7.63, p = 0.013), history of BC in the family (aOR = 3.92, 95% CI = 3.89–11.76, p = 0.017), previous training on BSE (aOR = 3.34, 95% CI = 1.16–9.65, p = 0.038), positive attitude toward BSE (aOR = 3.87, 95% CI = 3.27–5.88, p = 0.001), and having adequate knowledge of BSE (aOR = 1.19, 95% CI = 1.12–2.72, p = 0.043) were the predictors of BSE practice. Conclusion The level of BSE practice among participants in this study was quite. Inadequate knowledge, not having a positive attitude, and not being aware of BSE among participants contributed to the low level of BSE practice. Intensive breast health awareness campaigns are needed to raise awareness and increase the level of knowledge toward BSE practice.
Introduction Minimizing the risk of breast cancer-related lymphedema (BCRL) through specific strategies has been crucial to the development of new integrative surgical approaches, such as the axillary reverse mapping (ARM) technique. By mapping and preserving the arm lymphatic drainage, its application was expected to minimize the risk of BCRL. There are still many controversies regarding its systemic use, oncological safety and the tracer to be used. Methods The aim of this systematic review was to identify randomized controlled trials (RCTs) using the ARM technique and to investigate whether there is a significant reduction in the incidence of BCRL. Articles were searched using PubMed, Cochrane Library and EMBASE. Key words included “axillary reverse mapping”, “breast cancer”, “lymphedema”. Results Six studies with 1826 patients were included in our analysis: 867 patients in the study arm received ARM + axillary lymph node dissection (ALND), and 959 patients in the control arm received ALND alone. The incidence in the study arm was 8.2% (67/822) compared to 23.1% (214/928) in the control arm among patients who completed follow-up. Conclusions The use of the ARM technique appears to reduce the incidence of BCRL. However, its surgical indications, its oncological safety in terms of preserving the identified lymph nodes, the standardization of the method and its learning curve remain to be clarified.
Invasive lobular carcinoma (ILC) is characterized by a distinct metastatic pattern and a greater propensity for dissemination to unusual anatomical sites, including the gastrointestinal tract. These metastases may present with nonspecific findings and can mimic benign conditions, particularly when the primary tumor was diagnosed decades earlier. We report the case of a 76-year-old woman with a history of breast cancer treated 34 years earlier, who presented with altered bowel habits and hematochezia. Colonoscopy revealed two small flat colonic polyps, which were removed endoscopically. Histopathological examination demonstrated infiltration of the lamina propria by carcinoma. Immunohistochemical analysis showed positivity for cytokeratins, GATA3, estrogen receptors, mammaglobin and TRPS1, supporting a breast origin. Subsequent breast imaging and biopsy confirmed invasive lobular carcinoma. Staging studies did not reveal further metastatic involvement beyond the colonic metastasis. This case highlights the importance of considering metastatic disease in the differential diagnosis of colonic polyps in patients with a history of invasive lobular carcinoma, even after a prolonged disease-free interval, and underscores the key role of histological evaluation and immunohistochemistry in establishing the correct diagnosis.
Background Breast cancer remains one of the most prevalent malignancies worldwide, with survival rates varying considerably across different regions and populations. This systematic review aims to provide a comprehensive descriptive synthesis of breast cancer survival rates globally, focusing on 1-, 3-, 5-, and 10-year survival outcomes. Methods A systematic search was performed across international databases, including Scopus, Web of Science, PubMed, ScienceDirect, and Google Scholar, covering studies published from 2005 to January 2023. Observational cohort studies reporting survival rates in women with primary invasive breast cancer were included. Two independent reviewers screened articles, extracted data, and assessed methodological quality using the STROBE checklist. Descriptive summaries (means, medians, ranges) were calculated for survival rates across studies. Results A total of 74 studies comprising 159,965 breast cancer patients were included. The mean 5-year survival rate across 36 studies was 67.4% (range: 34.0–91.0%). The lowest reported 5-year survival was 34.0% (Tunisia), and the highest was 91.0% (Egypt). Higher survival rates were consistently observed in developed countries (mean: 72.5%) compared to developing countries (mean: 58.3%). By age, 5-year survival was 74.0% for women <39 years, 76.0% for ages 40–64 years, and 58.0% for ages ≥65 years. By disease stage, survival ranged from 90.0% (stage I) to 37.0% (stage IV). Temporal analysis showed improvement in 5-year survival from 63.0% (studies published 2005–2010) to 72.0% (studies published after 2010). Factors associated with better survival included early stage, ER-positive status, younger age (40–64 years), and surgical treatment. Conclusion Breast cancer survival rates vary substantially by geographic region, disease stage, age, and tumor characteristics. While survival has improved over time, particularly in high-income regions, persistent disparities remain. These findings emphasize the need for targeted interventions, including early detection programs, improved access to adjuvant therapies, and standardized data collection for cancer registries, especially in low- and middle-income countries.
Introduction Synovial sarcoma is a rare malignant mesenchymal tumor, accounting for 5–10% of soft tissue sarcomas. Primary breast involvement is extremely uncommon, with very few cases reported. Case presentation A 37-year-old female presented with a progressively enlarging mass in the left breast over two years, with accelerated growth during pregnancy. Imaging revealed a BI-RADS 4C lesion. Core needle biopsy suggested a low-grade mesenchymal tumor. The patient underwent a total mastectomy, and final histopathology confirmed biphasic synovial sarcoma with negative margins. Seven months later, she developed local recurrence involving the chest wall and axillary region. She received chemotherapy with ifosfamide and docetaxel, followed by radiotherapy using IMRT/VMAT techniques. After two years of follow-up, she remains free of disease. Discussion Diagnosis is based on histopathological and immunohistochemical findings. Surgical resection is the mainstay of treatment, although recurrence is frequent and the role of adjuvant therapy remains controversial. Conclusion This case highlights the importance of multidisciplinary management in rare breast sarcomas.
Objective: To evaluate factors associated with overall survival (OS) and disease-free survival (DFS) in patients with node-positive breast cancer treated with neoadjuvant chemotherapy followed by axillary lymph node dissection. Methods: A retrospective cohort study was conducted, including patients treated between January 2017 and December 2023. Clinical, therapeutic, and oncologic variables were collected. Survival outcomes were estimated using the Kaplan-Meier method, and factors associated with OS and DFS were assessed using Cox proportional hazards regres sion models. Results: A total of 353 patients were included, with a mean age of 55 years, 58.4% were postmenopausal. The most fre-quent molecular subtype was luminal B (51.6%), and most patients underwent simple mastectomy (62.3%). A com-plete pathological nodal response (ypN0) was observed in 32.3% of cases. The 10-year OS rate was 86% (95% CI: 84.2-89.7%), and the 10-ycar DFS rate was 88.8% (95% CI: 87.8-90.2%). Factors independently associated with worse OS included age (HR: 1.05; p = 0.001 ), triple-negative subtype (HR: 3.11; p = 0.002 ), and number of involved lymph nodes (HR: 1.19 per additional node; p <= 0.0001 ). DFS was significantly associated with histologic subtype, extent of nedal involvement, and Ki-67 index. Conclusion: At a leading breast surgery referral center in Colombia, overall survival among patients with node-positive breast cancer treated with neoadjuvant therapy followed by axillary lymph node dissection was comparable to globally reported outcomes. Locoregional recurrence was independent of the axillary surgical approach, while tumor biology and nodal disease burden were the main determinants of prognosis.
Introduction and objective: Breast-related symptoms during lactation are challenging. This study aims to describe the relationship between breast symptoms during lactation and ultrasound findings. Achieving an accurate diagnosis allows for optimal treatment (defining the need for drainage and antibiotic use), improved clinical outcomes, and a higher likelihood of continuing breastfeeding. Materials and methods: A retrospective study including women who presented to the emergency department of Clinica de La Mujer between January 2021 and January 2023. Eligible patients were pregnant, lactating, or had weaned within the previous 6 months, presenting with breast symptoms, general malaise, or fever of unknown origin, who underwent emergency ultrasound evaluation with sonographic evidence of fluid collections. Results: A total of 45 patients were included. Pain was present in 93%, a palpable mass in 62%, fever in 22%, 20% required drainage, and 11% required hospitalization. No clinical findings were significantly associated with specific ultrasonographic diagnoses; however, patients with abscesses showed a greater need for drainage. Ultrasound classified lesions as galactoceles (44%), phlegmons (28%), and abscesses (26%). Forty-six percent were receiving antimicrobial therapy at diagnosis, which was associated with the presence of an abscess. Twenty percent required drainage (10/45 ). Conclusions: Pain and mass sensation were the most frequent symptoms; however, no significant clinical differences were identified between types of fluid collections. The prevalence of abscesses (26%) was higher than previously reported in the literature. Notably, 46% of patients with mastitis who sought emergency care due to refractory symptoms were already receiving antibiotic therapy. A high proportion of abscesses were managed surgically, suggesting that alternative therapeutic strategies should be considered.
Introduction Adenoid cystic carcinoma (ACC) of the breast is an exceedingly rare malignancy, accounting for only 0.1–1% of all breast cancers. Despite being triple-negative, it follows an indolent clinical course and has a favorable prognosis. Case presentation We report the case of a 63-year-old female who presented with a palpable nodule in the right breast. Imaging studies were nonspecific. Core needle biopsy showed features of ACC, confirmed post-surgically. The patient underwent breast-conserving surgery with negative margins, a sentinel lymph node biopsy, which was negative, and adjuvant radiotherapy. Systemic therapy was not administered, given the low-risk nature of the tumor. Conclusion This case highlights the importance of including ACC in the differential diagnosis of breast masses and suggests a tailored, conservative therapeutic approach due to its distinct biological behavior.
Caspase-3 is a leading executioner of apoptosis and a central intersection of intrinsic and extrinsic death pathways of cancer cells. Breast cancer (BC) remains the most commonly diagnosed malignancy in women worldwide and the leading cause of cancer-related death, with metastasis being the primary operator of death. Notably, upraised caspase-3 expression is associated with adverse clinical outcomes, including lymph node metastasis and distant repetition, challenging its traditional interpretation as a potent marker of apoptosis. In contrast, caspase-8, an initiator of extrinsic apoptotic pathways, has shown limited prognostic significance in breast cancer despite its clear role in other malignancies. Moreover, the interaction of apoptotic signaling with cell cycle machinery - particularly through cyclin-dependent kinase 2 (CDK2) - adds additional complexity, as CDK2 can directly phosphorylate and inactivate caspase-3, thereby inhibiting apoptosis while promoting proliferation and invasion. It has been proposed that end tumor cells undergoing caspase-3 stimulation can release pro-growth factors that promote the proliferation of surviving cancer cells, a phenomenon sometimes referred to as the “phoenix rise” pathway. This review critically synthesizes the actual knowledge of caspase-3 and caspase-8 in BC, explores their non-apoptotic functions in invasion and metastasis, integrates comparative insights from canine mammary tumor (CMT), and details the CDK2-caspase-3 mechanism as a novel mechanistic link between cell cycle dysregulation, apoptotic resistance, and metastatic progression that is important for biomarker improvement and targeted therapy.
Introduction: The connection between human parvovirus B19 (B19V) infection and various illnesses has been established; however, its impact on cancer patients remains poorly understood. This study assesses the psychological and immunological impacts of B19V infection in breast cancer patients. Healthy controls (BH) and breast cancer patients before chemotherapy (BB) and after chemotherapy (BA) were recruited. Methods: B19V antibodies and B19V DNA were evaluated for B19V infection. Socio-demographics, psychological status, and cytokine levels were evaluated using SAS 9.4 for all statistical analyses. Results: The BA group displayed higher anxiety and depression scores on both the Hospital Anxiety and Depression Scale (HADS) (p = 0.008) and the Patient Health Questionnaire (PHQ) (p = 0.001). Those positive for B19V-IgG among BA individuals showed higher PHQ sums (p = 0.028) and lower Fact-sums (p = 0.039). In BH, TNF-alpha levels were significantly lower in B19V IgG + subjects (p = 0.018). Overall, breast cancer patients (BB + BA) had higher PHQ scores; however, B19V infection was associated with lower PHQ scores (p = 0.0363 for B19V IgG). Conclusions: The impact of B19V infection on cognitive function and depression prognosis in breast cancer patients suggests potential consequences.
Introduction: Breast cancer remains the most common neoplasm in women worldwide. Nodal status is a key prognostic factor; therefore, sentinel lymph node biopsy (SLNB) has been established as the gold standard, reducing the need for invasive procedures such as axillary lymphadenectomy. Artificial intelligence (AI) is emerging as a tool that could potentially predict sentinel lymph node positivity and support surgical decision-making. Methods: A retrospective cross-sectional observational study was conducted, including 541 patients diagnosed with early invasive breast cancer between 2019 and 2023 at Clinica Universitaria Colombia. Undersampling was applied to balance the dataset. A machine learning and deep learning model was trained using the AIPRIL AI platform. Model performance was evaluated using recall, specificity, accuracy, AUC-ROC, and F1 Score. Results: The selected model was the ridge classifier, which showed an accuracy of 70.28%, precision of 96.46%, recall of 72.02%, specificity of 14%, AUC of 0.49, and F1 score of 82.46%. Variable importance analysis identified initial clinical stage (42.6%), histological grade (22%), and estrogen receptor status (20.4%) as the main predictors. Conclusions: Our model demonstrated good ability to identify positive sentinel lymph node cases, with high accuracy and recall, although with limitations in specificity and AUC. These findings enabled the identification of relevant variables and the acquisition of methodological experience for future research. Furthermore, there is a need to incorporate additional clinically relevant variables to improve the model's performance.
Introduction: Breast-conserving surgery (BCS) is an oncologically safe treatment for early-stage breast cancer. However, moderate to large defects may compromise esthetic outcomes. Immediate reconstruction using perforator flaps allows restoration of breast contour without affecting oncologic safety. Objective: To describe clinical outcomes and esthetic results of immediate breast reconstruction using perforator flaps following BCS. Methods: A retrospective descriptive study was conducted at two oncological centers in Guayaquil, Ecuador, between May 2022 and January 2024. Clinical, pathological, surgical, and esthetic variables were analyzed. Results: Nineteen patients underwent immediate reconstruction with perforator flaps. The mean age was 58.6 +/- 15.0 years. Adjuvant radiotherapy was administered in 18 patients (94.7%). The most frequent tumor location was the upper outer quadrant (78.9%). Postoperative complications occurred in 2 patients (10.5%). Esthetic outcomes were excellent in 42.1%, good in 31.6%, and fair in 26.3%. No local recurrences were observed during follow-up. Conclusions: Immediate breast reconstruction with perforator flaps is a safe and effective technique with low morbidity and favorable esthetic outcomes following BCS.
Introduction: Breast cancer remains a major global health concern, with incidence, risk factors, and diagnostic challenges differing across regions. In Latin America, further research is needed to clarify the influence of hormonal contraceptives on specific molecular subtypes. Objective: To assess the association between hormonal contraceptive use and molecular subtypes of breast cancer among patients treated at a specialized oncology center in Lima, Peru. Methods: A cross-sectional study was conducted at the Instituto Nacional de Enfermedades Neopl & aacute;sicas (INEN) between 2024 and 2025, including 269 women with histologically confirmed breast cancer who had undergone surgery. Data were obtained through structured interviews and a review of medical records. Associations between hormonal contraceptive use and clinical, reproductive, histopathological variables, and molecular subtypes were analyzed using Poisson regression to estimate unadjusted and adjusted prevalence ratios. Results: Luminal subtypes accounted for 62.8% of cases, with Luminal B being the most common (48.7%). Overall, 53.5% of participants reported hormonal contraceptive use for 2-8.5 years, predominantly combined estrogen-progestin formulations (63.1%). No statistically significant association was found between hormonal contraceptive use and molecular subtypes. Conclusion: No significant association was identified between hormonal contraceptive use and breast cancer molecular subtypes, although several clinical, reproductive and histopathological factors were significantly associated with luminal and non-luminal subtypes.
Introduction: Breast plasmacytoma is an exceptionally rare presentation of plasma cell neoplasia and may closely resemble primary breast carcinoma. This case is notable for describing a solitary breast plasmacytoma arising more than 15 years after allogeneic stem-cell transplantation for multiple myeloma (MM), later followed by a marrow-only relapse despite persistently negative Positron Emission Tomography-Computed Tomography (PET-CT). It adds to the literature by illustrating the challenges of differentiating true solitary disease from late extramedullary recurrence and the limitations of imaging during early relapse. Case report: A 61-year-old woman with remote MM in long-term remission presented with an incidental right breast mass. Mammography and MRI demonstrated a solitary suspicious lesion. Core biopsy revealed monoclonal plasma cell infiltration with lambda light-chain restriction, confirming breast plasmacytoma. Systemic staging showed < 10% plasma cells in bone marrow, negative serum and urine immunofixation, and no additional lesions on PET-CT, supporting the diagnosis of solitary extramedullary plasmacytoma. The patient underwent definitive radiotherapy (46 Gy) with partial radiological response. During follow-up, rising IgG and free lambda light chains indicated renewed clonal activity, preceding radiologic abnormalities. Despite persistently negative PET-CT, bone marrow reassessment showed relapse with 12% clonal plasma cells. She was treated with VRd chemotherapy followed by donor lymphocyte infusion and remains clinically stable. Conclusion: This case reinforces that solitary breast plasmacytoma requires thorough systemic assessment and long-term follow-up. Biochemical markers may anticipate relapse earlier than imaging, underscoring their critical role in surveillance of patients with previous MM.
Orbital tumors comprise a wide range of primary and secondary entities, with metastases representing a minority. Breast cancer is the most common primary tumor associated with orbital metastases in women, while involvement of the lacrimal gland is extremely rare. Accurate diagnosis of orbital masses requires an integrated approach, including radiological techniques and histopathological confirmation. This article presents the case of a 60-year-old woman with a rapidly progressive orbital mass. Imaging studies and histopathological evaluation were consistent with metastatic invasive lobular carcinoma of the breast. Chemotherapy was initiated, requiring escalation through five treatment lines. The patient died 17 months after diagnosis. This case highlights the importance of considering metastatic disease in the differential diagnosis of orbital tumors.
Introduction: In this study, we present our learning curve with E-NSM through a single port and insufflation with immediate prepectoral implant-based breast reconstruction (SPIE-NSM + IPBR) as a surgical option for minimally invasive mastectomy. Methods: We reviewed medical records of patients undergoing SPIE-NSM + IPBR between February 2024 and June 2025, all performed by a single surgeon at one institution, to assess the learning curve for feasibility, safety, and reproducibility. Results: Twenty-nine procedures were performed on 29 patients, with a mean surgical time of 128.7 +/- 35.2 min for SPIE-NSM and 172.3 +/- 30.5 min for the complete SPIE-NSM + IPBR. CUSUM analysis showed significant improvement from case 13 onward in both scenarios. Comparing the initial group (cases 1-13) with the final group (cases 14-29), a significant decrease was observed in the mean endoscopic mastectomy time (143.5 +/- 37.8 min vs. 116.6 +/- 28.5 min; p = 0.037) and in the mean mastectomy plus reconstruction time (184.7 +/- 33.2 min vs. 162.2 +/- 24.7 min; p = 0.046). No conversions to open surgery were recorded. Final histopathological showed no affected margins. The median hospital stay was 1 day (IQR: 1-1.5). One major complication (Clavien-Dindo IIIa; 3.5%) occurred. No implant loss or recurrence was observed during a median follow-up of 6.7 months. Conclusions: Our study confirms that SPIE-NSM with IPBR is a feasible and safe alternative, potentially applicable in any hospital, as it relies on standard laparoscopic instruments that enable more patients to benefit from minimally invasive mastectomy. An acceptable learning curve is required.
Introduction Breast cancer is the most common malignancy in women worldwide, with risk factors including obesity, late parity, and breast density. Obesity is associated with higher breast density, which not only increases the risk of breast cancer but also reduces the sensitivity of mammographic screening. This study aims to evaluate the relationship between BMI and breast density to identify potential predictors of increased breast cancer risk. Methods This was an epidemiological, analytical, cross-sectional study. A total of 282 patients aged 40 to 65 years undergoing mammographic screening were included. Patients were divided into two cohorts based on BMI: normal BMI (< 25 kg/m(2)) and overweight/obesity (>= 25 kg/m(2)). Breast density was classified according to the BI-RADS fifth edition. Data analysis was performed using IBM SPSS version 28, applying the Chi-square test, Kruskal-Wallis test, and logistic regression analysis to determine the associations between variables (p < 0.05). Results Obesity was significantly associated with extremely dense breasts (p < 0.001). Additionally, late parity (> 25 years) and alcohol consumption were identified as associated variables with high breast density (OR: 9.82, 95% CI: 1.08-89.06, p = 0.042 and OR: 4.60, 95% CI: 1.18-17.95, p = 0.028, respectively). Breast density was inversely correlated with age, with younger women exhibiting higher breast density (p < 0.001). Conclusion Obesity, late parity, and alcohol consumption are significantly associated variables of extremely dense breasts, which may increase breast cancer risk. These findings highlight the need for targeted screening strategies and preventive interventions for women with high BMI and other risk factors. Further research in larger, diverse populations is recommended to strengthen these associations and inform public health policies.
Achieving microscopically negative margins (R0) remains one of the main challenges in breast-conserving surgery (BCS), directly influencing local control, cosmetic outcome, and the need for re-excision. Despite advances in localization techniques such as seed placement and intraoperative pathology, incomplete resections still occur in up to 20% of cases. Recent technological developments now offer the opportunity to redefine margin assessment through multimodal intraoperative molecular imaging, artificial intelligence (AI), and mixed reality (AR/VR) visualization. Preoperative imaging – spanning magnetic resonance imaging (MRI), ultrasound, and combined positron-emission tomography (PET) / computed tomography (CT) – provides functional information that guides personalized surgical planning. AI-based segmentation and radiomics enable integration of these datasets into three-dimensional models for accurate tumor mapping and prediction of disease spread. Intraoperatively, radioguided surgery (RGS), intraoperative ultrasound, and fluorescence or gamma systems offer real-time navigation, while label-free techniques such as Raman spectroscopy, impedance analysis, and hyperspectral imaging add biochemical insight at the resection margin. AR/VR tools further enhance spatial orientation by fusing preoperative and intraoperative data into interactive 3D environments. After excision, specimen imaging with micro-CT, Cerenkov luminescence, and high-resolution PET/CT provides immediate verification of margin status. Emerging AI algorithms can interpret these multimodal images in real time, supporting rapid intraoperative decision-making. Together, these innovations define a continuum of planning, navigation, and verification that progressively reduces uncertainty around surgical margins. The convergence of molecular imaging, digital visualization, and AI marks a decisive step toward consistently R0, biologically informed, and truly personalized breast-conserving surgery.
Unde venis et quo vadis (“Where do you come from and where are you going?”) reflects the evolution of axillary management in breast cancer, transitioning from radical procedures with high morbidity to more conservative, evidence-based, and risk-adapted approaches. For decades, axillary lymph node dissection (ALND) was performed for staging and locoregional control, but its complications, particularly lymphedema, prompted the search for less invasive strategies. Sentinel lymph node biopsy (SLNB) emerged as a key advance in clinically node-negative (cN0) patients, enabling omission of ALND when SLNB was negative. The current focus is on assessing therapeutic response in node-positive patients treated with neoadjuvant systemic therapy (NST) to tailor subsequent surgery. In this context, techniques such as targeted axillary dissection (TAD) and the MARI protocol have emerged, combining pre-NST node marking with radioguided localization. Additionally, the incorporation of 18F-FDG PET/CT has enhanced initial staging, response assessment, and surgical planning. The integration of PET imaging, radioguided surgery and individualized risk evaluation enables safe, personalized surgical de-escalation. This approach maintains oncologic control while reducing morbidity. This review synthesizes current evidence on the management of the positive axilla and highlights the central role of nuclear medicine in the new paradigm of precision breast cancer surgery.
