Archives of Breast Cancer
Year:2022 | Volume:9 | Issue:2|Papers Count:15

Breast cancer has now overrun lung cancer as the world’, s most commonly diagnosed cancer, based on the latest estimates released by the International Agency for Research on Cancer. 1 To prevent an estimated 2. 5 million deaths per annum, it is crucial to focus on increasing public awareness for risk reduction and early diagnosis, especially in the regions with increasing rates and unequitable resources.

Background: Health literacy (HL) is an individual’, s ability to interpret and effectively utilize health information. Low HL has been associated with poorer treatment adherence. The effect of HL on treatment adherence is important to understand when survival is closely tied with treatment, such as in breast cancer (BC). The aim of our review was to examine the influence of HL on treatment adherence in BC patients. Methods: A scoping review was conducted according to the Joanna Briggs Institute methodological framework. A comprehensive search was performed using 5 electronic databases to map the available literature. Studies were included that assessed BC patients’,HL with a validated instrument and associated this with treatment adherence. Results: Our review initially yielded 1404 studies. Of these, 9 studies (n=2468) met our inclusion criteria. Five studies (n=1478, 60%) found no association between HL and treatment adherence. Of the 3 studies (n=1175) focused on breast surgery decision-making, 2 studies (n=915, 77. 8%) reported a positive association between HL and the decision to partake in reconstruction. In contrast, 3 (n=936) of 5 (n=1147) studies examining adjuvant therapy demonstrated that treatment decisions were not affected by HL. Conclusion: Although it is difficult to determine the relationship between HL and treatment adherence from the contrasting results of the available literature, HL may have a greater impact on surgical decision-making as compared to the receipt of adjuvant therapy. Additional research is required to better characterize the effects of HL on treatment adherence, including surgical decision-making.

Background: NCCN guidelines recommend surgical excision for patients with atypical ductal hyperplasia (ADH) on percutaneous biopsy. Improved imaging and biopsy techniques have lower contemporary upgrade rates, challenging standard practice. We sought to identify low-risk features of ADH to define patients who may benefit from active monitoring over surgical excision. Methods: A retrospective analysis identified 87 stereotactic biopsies diagnosing ADH undergoing surgical excision at a single institution from 01/2008 to 10/2015. Imaging was reviewed for lesion size and residual calcifications. Biopsy slides were reviewed for ADH features. Categorical variables were analyzed using Chi-square and Fisher’, s exact tests,continuous variables with T-and Wilcoxon tests. Logistic regression model was used to determine the association between the number of low-risk features present and odds of upgrade. Results: Upgrade was identified in 13 cases (14. 9%,11 ductal carcinoma in situ and 2 invasive breast cancer). Low-risk imaging features included imaging size <1cm (P=0. 004) and >50% removed by biopsy (P=0. 03). The only significant low-risk pathologic feature was the lack of micropapillary features (P=0. 10). Focal ADH (1-2 foci, P=0. 12) was felt to be clinically significant. Those with the lowest risk of upgrade (0%) had all 4 low-risk features (n=17, 20%). When comparing biopsies that differed by one low-risk feature, the biopsy with one less low-risk feature present had 129% increase in odds of upgrade (exact OR=2. 29, 95% CI 1. 35, 4. 15, P=0. 001). Conclusion: Overall upgrade rate was low in this contemporary cohort. Patients at lowest risk for upgrade had all 4 low-risk features and could be safely offered active monitoring over surgical excision.

Background: Distress and adrenal balance of breast cancer survivors (BCS) are key elements of their psychophysical health, and increasing evidence has shown both physical exercise and the natural environment are effective for their modulation. The aim of the study was to evaluate the acute effects of the environment and type of light intensity workouts, on distress, salivary cortisol and dehydroepiandrosterone sulfate (DHEA-S) in BCS. Methods: Twenty-four BCS participated in six different workouts, each with the same duration and intensity. Three of them were conducted in natural environments –,walking (Wnature), canoeing with assistance (Cnature) and a mix of myofascial and yoga exercises (MYnature). The others were conducted in an urban environment, namely walking (Wurban), or an indoor environment, namely mobilisation and light upper body exercises (MCgym) and a mix of myofascial and yoga exercises (MYgym). Before and after each workout, the Distress Thermometer was completed and saliva was collected. Results: Workouts practised in natural environments elicited a higher reduction in cortisol and the cortisol to DHEA-S ratio and a greater DHEA-S increase compared with workouts practised in urban and indoor environments. Overall, Cnature and MYnature were the best activities,among those practised in urban and indoor environments, MYgym elicited the best results. Distress was not acutely reduced after Wurban and MCgym. Conclusion: Natural environments seem to provide the best management of distress, cortisol, DHEA-S and their balance when working out at light intensities. The simultaneous presence of forests and rivers seems to be the key element of the observed results.

Background: Breast cancer is the most life-threatening cancer in women all over the world. Considering the detrimental side effects of standard chemo drugs, plant-based drugs can be used effectively. This work aims to investigate the effect of herbal extracts mediated by electrical pulses on breast cancer cell lines. Methods: Three different samples were chosen (Turmeric, Pepper, Neem), shade dried, and extracted using the soxhlet method, with ethanol as a solvent. These extracts were used as an anticancer drug against three breast cancer cell lines (MCF-10A, MCF-7, MDA-MB-231). Further, BTX ECM830 electroporator was used to generate electrical pulses of different parameters to enhance the uptake of extracts into the cancer cells. Realtime MT Assay was used to obtain the viability of breast cancer cell lines. A comparative study was conducted to assess the effect of each treatment on different breast cancer cell lines. Results: Treatments were more susceptive to cancerous cell lines than normal cells. Low intensity, high duration electrical pulses with herbal extracts showed a higher cytotoxic effect than other treatments. A notable increase in cell death was observed in combination treatments compared to single treatments. The lowest viability of 4% was obtained for synergetic treatment of electrical pulses and herbal extract. Conclusion: In the current study, we found for the first time that herbal extracts in combination with electrical pulses exhibited strong anticancer activity against breast cancer cell lines. This promising treatment can be used efficiently to treat breast cancer without any side effects

Background: Breast cancer is one of the most prevalent cancers in women in Iran and many other countries around the world. This cancer is the most critical cause of malignancy-related mortality in women. Early detection of breast cancer through mammographic screening of breast cancer greatly increases the chance of a successful treatment. This study aimed to explore the obstacles to mammographic screening of breast cancer in women. Methods: This cross-sectional study was carried out among 812 women over the age of 40 who had not undergone mammographic screening or had undergone it irregularly from three selected clinics in Zahedan in 2017. To this end, the researchers used a questionnaire which consisted of 17 questions to examine the barriers to mammographic screening of breast cancer. Results: The results of this study showed that the most common barriers to this test were the following: not having the symptoms of breast cancer (62. 7%),mammography being performed by male staff (57. 5%),the absence of this test as a priority and necessity of life (57. 2%),examination being sufficient by a physician or healthcare providers for diagnosis of breast cancer (55. 8%),and the embarrassment of getting naked during mammography (51. 5%). Conclusion: Concerning the findings of this study, it has to be suggested first that mammography in the healthcare system should be performed by female staff. Second, health volunteers and local mass media, including provincial radio and television networks, can also play a major role in transferring educational materials to this target group.

Background: Non-mammary metastasis to the breast poses a diagnostic challenge for the pathologists especially when no prior history of non-mammary malignancy is provided. Since non-mammary metastasis is not a very common occurrence, there is a chance that it can be easily missed especially with overlapping morphology and unknown prior history of any malignancy. Methods: In total, 40 patients matching our inclusion criteria were identified through hospital information system in a 10-year period. Confirmatory stains were used to confirm the diagnosis. Results: The most common primary malignancy site was gastrointestinal tract comprising 35% of the metastasis. This was followed by small cell carcinomas (17. 5%). In addition, in 72. 5% of the patients, there was a known history of primary malignancy but only in 18 (45%) of the cases, the clinicians mentioned it on the biopsy request form. For the remaining cases (27. 5%), the clinician was contacted after the verification of the report and was asked to evaluate the possibility of metastasis from the known primary site. Conclusion: Identifying the non-mammary metastasis is important at the time of initial diagnosis as it can prevent the patient from extensive surgery, which might not be needed, if it is not a primary breast tumor. Provision of prior history and use of immunohistochemical stains can aid in timely and accurate diagnosis.

Background: The participation of patients in treatment and nursing decision-making has been advocated by many medical staff. This is not only to attach importance to the wishes of patients, but also to the needs of social development. The purpose of this research was to investigate the attitudes of Chinese breast cancer medical staff towards the implementation of breast cancer decision-making aids. Methods: A cross-sectional study was conducted among 420 doctors and nurses in the Department of Breast Surgery. We used a questionnaire designed by investigators. Data was collected from February 2021 to September 2021. IBM SPSS Version 22 was used to analyze the collected data. Results: Overall, 420 valid questionnaires were returned from 220 doctors and 200 nurses. Response rate was 85. 19%. The results showed that 77. 14% of the medical staff supported the promotion of breast cancer decision-making aids, and 85. 71%（, 360/420）, agreed that patients should be the main participants in high-quality clinical decision-making. Also, 95. 24%（, 400/420）, believed that patients should know the reasons for making treatment decisions, and agreed that the positive effects of patient decision-making aids were positively correlated with high education (reducation=0. 317, P=0. 001). There were statistically significant differences in the attitudes of medical staff with different working years (X2=9. 432, P=0. 024), educational background (X2=42. 918, P<0. 001) and shared decision education (X2=11. 932, P=0. 008) on whether to promote decision-making aids. Conclusion: At this stage, breast medical staff have a positive attitude towards using breast cancer decision aids for joint decision-making.

Background: Women with breast cancer suffer high levels of stress due to their disease-induced emotional, cognitive, behavioral and physical problems which increase their metacognitive beliefs, death anxiety, and rumination, disrupting the treatment process and exerting a negative impact. The present study aimed to investigate the effectiveness of positive thinking training in perceived stress, metacognitive beliefs, and death anxiety in women with breast cancer in Ahvaz in 2019. Methods: This was a quasi-experimental study with a pretest-posttest control group design. Statistical population consisted of all women with breast cancer visiting Shafa Health Center of Ahvaz in 2019, among whom 30 women were selected as the sample using convenience sampling. Cancer patients were randomly divided into intervention (n=15) and control (n=15) groups. The research instruments included the Perceived Stress Scale, the Metacognitions Questionnaire (MCQ-30), and the Scale of Death Anxiety (SDA). Univariate and multivariate analyses of covariance were used to analyze data. Results: Results suggested that positive thinking training reduced perceived stress, metacognitive beliefs and death anxiety in women with breast cancer in the intervention group compared with those in the control group (P<0. 001). Conclusion: The results showed that positive thinking training was effective in reducing perceived stress, metacognitive beliefs, and death anxiety in women with breast cancer.

Background: Granular cell tumors (GrCTs) are rare neoplasms derived from Schwann cells and can affect any part of the body. They are histologically categorized into benign (most common), atypical, or malignant (<2%) subtypes. Methods: A retrospective review of pathology-proven GrCTs at a tertiary hospital was done from 4/1/2014 to 3/31/2021. The patient age, gender, location of the tumor, and imaging findings were reviewed. Results: A total of 18 patients with GrCTs were found over a period of 7 years. The sites of involvement ranged from the tongue to the heel. The most common site of occurrence was the esophagus. There were 2 cases of recurrences and 2 cases of multicentric GrCTs. In our study, we did not have atypical or malignant GrCTs. Conclusion: Granular cell tumors are uncommon and primarily published as case reports and case series. Our seven-year review provides a comprehensive synopsis of this tumor in the breast and rest of the body. Their clinical and imaging features are non-characteristic, but histopathologic features with immunohistochemistry are diagnostic. Complete surgical excision with negative margins is the accepted standard of care. A global overview of this tumor will allow physicians to provide their patients with a better understanding of their diagnosis and prognosis.

Background: Metastasis in tumor draining lymph nodes (TDLNs) is correlated with poor prognosis in breast cancers. It is associated with local immune suppression, which can be partly due to the higher expression of check point inhibitors in immune cells. The morphological manifestation of the underlying immunomodulation of TDLNs has been less investigated. Here, we present the histomorphological changes and PD1 expression pattern in metastatic and non-metastatic TDLNs in breast cancer patients. Methods: A total of 248 metastatic or non-metastatic TDLNs from 50 breast carcinoma samples were examined histologically and for PD1 expression in the present study. We assessed the immune response in these TDLNs as per histomorphological patterns on H&E stained slides, categorizing them into lymphocyte predominance, germinal center predominance and an un-stimulated pattern. Anti-PD1 immunohistochemistry was performed on all lymph nodes. The results were analyzed using SPSS version 23 and P value <0. 05 was considered to be significant. Results: The lymph node metastasis in breast carcinoma was significantly higher at younger age, patients with higher tumor grade and lympho-vascular invasion in the primary tumor. The metastatic lymph nodes showed significantly higher densities of germinal centers with abnormal shapes, as compared to non-metastatic ones. There was significantly higher expression of PD1 in the immune cells of metastatic TDLNs. Conclusion: The identification of PD1 immunohistochemical profile along with histological changes of TDLNs should therefore be considered as a possible prognostic and predictive marker for lymph node metastasis. The patients with higher densities of germinal center with abnormal shape and increased PD1 expression should benefit from immune-check point inhibitor therapy.

Background: Breast cancer is considered a major health problem and the most common cancer among females in both developed and non-developed countries. Early diagnosis of breast cancer decreases morbidities and mortalities. This study attempts to explore the accuracy measures of a digital mammography unit in the diagnosis of breast cancer and compare the mammography results with the final histopathology results. Methods: The study was designed as a cross-sectional prospective hospital base in which mammography examination was used for patients. Then, U/S was performed as a complementary study. All the mammography and U/S reports were reviewed and compared with the histopathology results. Six indicators were used to measure the accuracy of the mammography system using their formulas. SPSS program was used to examine the correlation between imaging results and histopathological findings and to draw the area under the receiver operating characteristic curve (AUC). Confidence interval was considered at 95% and margin of error at 5%. Results: Sensitivity, Specificity, PPV, NPV, accuracy and the area under the ROC curve of mammography alone were 94. 9%, 66. 7%, 90%, 66. 7%, 0. 771 and increased to 100%, 76. 9%, 90. 3%, 100%, 92. 7%, 0. 917, respectively when Ultrasound was used as a complementary to mammography. A statistically significant moderate correlation was shown between the results of mammography alone and histopathology results (Spearman correlation= 0. 527, P-value<0. 01), and a statistically significant strong correlation between mammography combined with ultrasound, and histopathology results (Spearman correlation=0. 882, P-value<0. 01). Conclusion: Mammography is an important tool to detect breast cancer. Mammography when combined with Ultrasound yields a very significant improvement in sensitivity and specificity for diagnosing different breast lesions.

Background: Fibroadenoma is the second most common tumour in the breast (after carcinoma) and is the most common tumour in women younger than 30 years. Multiple fibroadenomas (more than five lesions in one breast) are very uncommon and are considered disease. Familial bilateral multiple fibroadenoma is an exceedingly rare presentation with only one such case described earlier in medical literature where three siblings had multiple bilateral breast fibroadenomas. We report a case series of familial fibroadenomas present in four siblings, along with one case presenting with bilateral multiple fibroadenoma, which is first in the medical literature. Case Presentation: Fine needle Aspiration were suggestive of bilateral multiple fibroadenoma. Upon surgery, 10 fibroadenomas were removed from the right breast and 9 fibroadenomas were removed from the left breast. Histopathological examination was consistent with fibroadenoma with myxomatous change. Conclusion: Familial fibroadenoma of the breast is an exceedingly rare presentation of a very common tumour. This was the first reported case of 4 siblings having familial fibroadenoma. Further studies are required to investigate the familial nature of this disorder.

Background: Breast fibromatosis is a rare, locally infiltrative lesion without metastatic potential that arises from either stromal fibroblasts or myofibroblasts of the breast or the pectoral fascia, extending into the breast, with its cytological and histological features only rarely been described. Case Presentation: A 58-year-old woman, with no past medical/surgical or family history, was diagnosed on regular mammographic and ultrasound examination with a nodular tumor density, in the upper inner part of her right breast. There were no calcifications or apparent lymph nodes in the right axilla. The woman underwent FNA and US-guided biopsy and final resection biopsy under hook marking. We reviewed the cytological findings of fibromatosis of the breast, as they presented in FNAC aspirates of a non-palpable mammographic finding and the histological findings in both preoperative core-needle biopsy and excision specimen. The final diagnosis was of fibromatosis of the breast. No further actions were taken. The woman is well, without recurrence, more than four years afterwards. Conclusion: The diagnosis in the presented patient can make the pathologists more acquainted with the cytological and pathologic features of a rare tumor entity and the clinicians with a rare breast lesion, which can mimic malignancy both clinically and radiologically. The diagnosis of fibromatosis of the breast is more reliable in excision specimens. Nevertheless, cytology can be an invaluable adjunct to histology, pre-operatively, as it can exclude cancer and help in the preoperative planning.

Background: Nipple-sparing mastectomy (NSM) has become widely adopted owing to its oncologic safety, aesthetic results and psychological benefits. Lack of sensation on the Nipple-areola complex (NAC) after reconstruction remains a common complaint that has been scarcely researched in the alloplastic reconstruction population. The aim of this report is to present a nipple neurotization technique suitable for patients undergoing implant-based breast reconstruction. Case Presentation: A 42-year-old female with ductal breast carcinoma underwent periareolar NSM with implant-based reconstruction and complained about lack of tactile sensation on mastectomy flaps and NAC. A year after the reconstruction surgery, she underwent late NAC neurotization by bridging the 4th intercostal nerve to the undersurface of the areola using a 15cm sural nerve autograft. Recovery of protective and pressure sensation was seen six months later over the NAC. Conclusion: This case confirms that late neurotization in alloplastic reconstruction by bridging the areolar dermis to a donor intercostal nerve provides sensory recovery at the NAC.