International Journal of Cancer Management
Year:2018 | Volume:11 | Issue:12|Papers Count:7

Background: Assessment of efficacy of preoperative magnetic resonance imaging (pMRI) is important to improve the diagnosis and treatment results in patients with breast cancer (BC). Objectives: We designed this study to determine the role of pMRI in surgical planning for patients suffering from BC. Methods: We, cross sectionally, observed 98 women with BC referring to an educational hospital in Tehran from January 2014 to December 2015. Data pertaining age, pathological type of BC, preoperative imaging findings, and surgical planning were gathered. The frequency of plan alteration was determined according to pMRI findings and analyzed, using appropriate statistical analyses (descriptive statistics, independent t-test, Chi-square, and Fisher’ s exact tests). Results: Initial surgical plan of 23 patients (23. 47%) was changed. Pathological diagnosis of BC (P = 0. 460), size of lesion (P = 0. 696), laterality (P = 0. 139), and lymph node involvement (P = 0. 094) did not seem to alter the surgical plan. On the contrary, younger age (P = 0. 049), more lesions (P = 0. 002), pMRI enhancement curve washout pattern (P = 0. 020), and multifocality (P < 0. 001) of lesions in pMRI seemed to change surgical treatment plan. Yet, neither ultrasonography nor mammography findings did alter the plan (P > 0. 050). Conclusions: pMRI findings, including multiple lesions and multifocal involvement showing enhancement pattern suggestive for malignancy, may change surgical planning in about a quarter of women suffering from BC, particularly the younger ones, but MRI is not mere criterion for determining and usage of it should be limited to necessary subjects because when it is done without strict parameters, it will cause over diagnosis and over treatment.

Context: Pelvic masses are a prevalent cause for referral to gynecologic oncology departments to evaluate the possibility of benign or malignant conditions. Pelvic mass often was found in pelvic examinations among females with ovarian. Tumor markers are advantageous biomarker in tumor diagnosis. Evidence Acquisition: We performed a computerized search in Medline/PubMed databases and Google Scholar with key words: "Cancer antigen 125 (CA125), Human epididymis protein 4 (HE4), risk of ovarian malignancy algorithm (ROMA), Risk of malignancy index (RMI), and Pelvic mass". Results: The usage of tumor marker CA125 alone is associated with serious limitations like low sensitivity for early or stage I disease and lack of specificity especially in pre-menopausal women. Serum HE4 is a good biomarker for discriminating ovarian cancer from benign pelvic disease, but could be affected by several factors including pregnancy, age, and smoking. ROMA has a high sensitivity, specificity, and negative predictive value to predict the presence of ovarian cancer in women with a pelvic mass. RMI could differentiate between benign and malignant pelvic masses, but RMI expression was higher in women with 55 years or more. Conclusions: According to the results of this study, combination of these biomarkers or at least 2 or 3 biomarkers are suggested for early stage diagnosis of pelvic mass with high sensitivity and specificity.

Background: Despite using various chemotropic drugs, the therapy strategies of cervical cancer are not satisfactory. Researchers tended to examine anti-proliferative effects of different botanical components such as crocin on several cancers. Objectives: We investigated the anti-cancer mechanisms of crocin and epirubicin combination on cancer cervical cells to use fewer toxic components. Methods: By MTT, Hoechst staining and flowcytometry techniques, cell proliferation inhibitory, and apoptosis induction effects of crocin and epirubisin combination on a cervical cancer cell line (OV2008) were determined. Then, alteration expression of the Bax, Bcl2, and P21 genes were also investigated through real-time polymerase chain reaction (real-time PCR). Results: The MTT results showed that crocin and epirubicin stopped proliferation of OV2008 cells. These substances had a simple additive effect after 72 hours treatment. The Hoechst staining illustrated that apoptosis significantly increased after combination therapy. The results of the cell cycle analysis showed that the percentage of dead cells was increased compared to the control group. Also, the number of cells, introduced in all of cell cycle phases, was changed, too. Moreover, real-Time PCR results showed that epiburicin 3. 75 µ m/mL and crocin 2000 µ m/mL led to Bax and P21 up-regulated and Bcl2 down-regulated. Conclusions: Crocin can be used in companion with fewer dose of chemotropic drugs to get better results in cancer therapy and can be more effective on the reduction of drug resistance due to target the main regulators of apoptosis. Nonetheless, more surveys are needed to enlighten their molecular mechanisms.

Background: Breast cancer screening can prevent cancer deaths. Fatalism and fear perceptions of women on breast cancer screening were considered in a few studies. Objectives: The present study was conducted to determine the health beliefs, fears, and fatalism of Muslim Turkish women with regard to breast cancer screening. Methods: The study was designed as cross-sectional study and conducted in the "Quran Courses" being taught under the administration of the Turkish Directorate of Religious Affairs in a city in Turkey. Women from the participants of 23 Quran courses in the city were included in the sample group on the basis of simple random sampling. The sample group consisted of 339 women aged above 40 years. Data collected by personal information form, the Breast Cancer Fear Scale, the Breast Cancer Fatalism Scale, and the Health Belief Model Scale. We were calculated the data with percentage, mean, standard deviation, One-way ANOVA and t test. Before the study was conducted, the necessary permissions were received from the Ethics Committee, the relevant institution, and the individuals involved. Results: A significant relationship was determined between the educational levels of women and their degree of fatalism regarding breast cancer (t = 2. 229, P = 0. 027) as well as a familial history of breast cancer and their BSE self-efficacy perception (t =-2. 311, P = 0. 027). No significant statistical difference was determined between the socio-demographic characteristics of age, employment and marital status and respondents' health beliefs, fear, and fatalism. Conclusions: As a result of the study, regular BSE, CBE, and mammography rates were estimated at 5. 3%, 9. 7%, and 9. 4%, respectively and no significant relationship was determined between the screening behaviors of women and their degree of fear and fatalism.

Context: Triple negative breast cancers (TNBC) constitute about 15% of breast neoplasms. In contrast to estrogen receptor (ER) or human epidermal growth factor receptor (HER2) positive breast cancers, which respond to hormonal therapy (such as tamoxifen) or anti-HER2 therapy (such as trastuzumab), respectively, the main standard therapy in either early or late stage TNBC is chemotherapy. Therefore, it is necessary to find new treatment modalities for TNBC patients. We searched the literature to find published studies on immunotherapy in triple negative breast cancer and the putative biomarkers of response to these treatments. Evidence Acquisition: We searched PubMed, Scopus, and Web of Science Core Collection with these keywords: "Triple negative breast cancer, Immunotherapy, Resistance, Response, Programmed cell death 1 receptor, CTLA-4, Tumor mutation burden, and Immune signature". Results: TNBC is considered a heterogeneous neoplasm with regard to molecular aberrations. Analysis of genomic expression profile of TNBC has delineated 4 subtypes. TNBC tumors show high genetic instability. Tumor infiltrating lymphocytes (TILs) are detected more in TNBCs, compared to other breast cancer types. It has been shown that the amount of CD8 positive T cells in TNBCs is an independent predictor of overall survival. Up to now, two immunotherapy strategies have been used in clinical trials of TNBC, including immune checkpoint blockers and therapeutic cancer vaccines. Tumor programmed cell death ligand 1 (PDL1) expression is the most widely used immunotherapy biomarker. Tumor mutation burden (TMB) can be a promising biomarker of response to immunotherapy. The more somatic mutations a cancer cell has, the more neoantigens it probably produces. Analysis of TMB can give an estimate of tumor mutation load. Increased somatic mutation load has also been observed in tumors with impaired mismatch repair (MMR). Conclusions: As TNBC is regarded a heterogeneous disease, the discovery of biomarkers of response to immunotherapy will increase the likelihood of response to these therapies. Further in-depth investigations are needed to find novel biomarkers of response to these immunotherapies for the better management of patients with TNBC.

Background: Sentinel lymph node dissection after neoadjuvant chemotherapy is of questionable accuracy. Objectives: In this study, accuracy and feasibility of sentinel lymph node biopsy in patients with breast cancer presented with clinically positive axillary nodes were evaluated. Methods: We conducted a cross sectional study on patients with breast cancer treated at Milad Hospital of Tehran, Iran from June 2014 to February 2015. Clinically node positive patients (proven by biopsy), who became clinically node-negative by ultrasonography and physical examination following neoadjuvant chemotherapy and had been dissected up to 3 lymph nodes according to sentinel lymph node pattern, were included in the study. We used a 2 × 2 contingency table to analyze the feasibility of sentinel lymph node biopsy (sensitivity, specificity, false negative ratio, and accuracy). STATA statistical software (version 13. 0, StataCorp LP, Texas, USA) was used for statistical analysis. Results: Among 52 patients, who entered the study, 47 patients had been dissected up to 3 lymph nodes according to sentinel lymph node pattern. We achieved a sensitivity of 100% (16/16), false-negative rate of 0% (0/21), a negative predictive value of 100% (26/26), and an overall accuracy of 89. 4%. Conclusions: Sentinel lymph node dissection seems to be feasible and accurate in clinically lymph node positive patients with breast cancer, who achieve a clinically negative node status by ultrasonography and physical examination, following neoadjuvant chemotherapy.

Background: Individuals with breast cancer may experience multiple types of recurrence and a terminal event during their life. Follow-up may be interrupted for several reasons, including patients lost to follow-up or end of a study. Death is considered as a dependent terminal event. Objectives: The main objective was to model the dependency between (locoregional and metastaticrelapses and death in breast cancer patients. Methods: This retrospective cohort study was conducted in Cancer Research Center, Shahid Beheshti University of Medical Sciences on 342 patients with BC. Patients were followed up to 20 years from January 1996 until February 2015. This study considers the analysis of diseases recurrence and survival for joint modeling of three correlated evens: Local recurrence, metastasis, and death. The aims are to detect the effects of relapses on death and the correlation between local and distant recurrences. We propose a joint frailty model for multiple recurrent events with a terminal event. Results: According to all obtained results of the fitted models, the risk of local and metastatic relapses or death increased for women with positive lymph node (N+) or for women with a grade higher than I. Also, it was found that if the association between these 3 times to events are not taken into account, we may lose a significant association. The variable HR+ was significantly correlated with the hazards of two types of recurrences, and death for both reduced and proposed models (P < 0. 05). Conclusions: We concluded that the risk of locoregional recurrences is correlated with the risk of metastatic and the risk of metastatic relapse is also correlated with death. In this special setting, it can be difficult to get an independence between locoregional and distant recurrences. Also, these results should be considered with caution, with the few number of recurrences.