Archives of Breast Cancer
Year:2018 | Volume:5 | Issue:3|Papers Count:9

Bad news is “ any news that adversely and seriously affects an individual’ s view of his or her future, ” 1 and talking about one’ s cancer diagnosis is one of them. Delivering bad news is a complex, necessary communication skill that should be effectively learned, especially by oncologists. Giving bad news has two key parts: transferring information to patients and responding to patients’ emotional reactions...

Background: To systematically review the performance of scintimammography compared with mammography in detecting breast lesions. Methods: A literature search was performed in PubMed and ScienceDirect databases with “ scintimammography AND breast lesions, ” “ mammography AND breast lesions, ” “ diagnostic value, ” and “ accuracy” as keywords to identify all related studies published in English from January 1, 2000, to August 1, 2017. Twenty-five studies, with a total of 4094 patients with clinically suspicious breast lesions, were included in the final analysis to assess the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of scintimammography vs. mammography in detecting breast lesions. Results: The sensitivity and specificity of mammography were 75. 82 ± 10. 53 (95% confidence interval [CI], 50-84) and 59. 58 ± 22. 79 (95% CI, 20-91. 4), respectively. The PPV and NPV of mammography were 75. 60 ± 2. 21 (95% CI, 42-93) and 61. 62 ± 1. 67 (95% CI, 39. 1-86), respectively. The sensitivity of scintimammography was 86. 64 ± 8. 84 (95% CI, 58. 3-100), and the specificity was 83. 42 ± 10. 74 (95% CI, 60-100). The PPV and NPV of scintimammography were 82. 10 ± 11. 65 (95% CI, 58-98. 30) and 81. 02 ± 17. 00 (95% CI, 45-100), respectively. Conclusions: Although mammography has a high sensitivity in the examination of older patients with fatty breast tissue, it is less reliable in detecting breast lesions in young and premenopausal patients with dense breasts. Diagnostic accuracy of scintimammography, as a functional imaging modality, is not affected by breast density, contrary to mammography. Therefore, scintimammography can improve the specificity of mammography.

Background: Phyllodes tumors (PTs) are a small group of fibroepithelial breast lesions, which are classified as benign, borderline, or malignant. Traditionally, a margin of 1 cm has been suggested as the standard of care for all groups of PTs. According to new studies and recent updates, the recurrence rate of benign PT is low and not associated with the surgical margin status. There is still a controversy for PT surgical margin. Case Presentation: A woman with the primary diagnosis of fibroadenoma in core needle biopsy underwent surgery. The pathology report showed benign PT and margins about 1 mm in some areas. This case was presented in the weekly breast multidisciplinary team session of the Department of Breast Surgery, Tehran University of Medical Sciences. Question: The question was whether re-excision was necessary to achieve the safe surgical margin. Conclusion: In accordance with the latest published evidence, the members of the panel decided to accept the margin, informed the patient about the risk of recurrence, and recommended close follow-up.

Background: Breast cancer diagnosis always causes a great deal of stress and results in significant changes in the patient’ s routine life, which— apart from physical injuries— can lead to loss of social functioning and increased risk of mental disorders. Psychological resilience may be a protective factor in dealing with stressful clinical situations. The present study aimed at investigating the effect of acceptance and commitment group therapy on the quality of life and resilience of women with breast cancer. Methods: This study had a quasi-experimental, pre-post intervention design with a control group. Twenty women with breast cancer (stages I or II) were randomly assigned to an intervention or a control group. The intervention consisted of eight weekly sessions of acceptance and commitment group therapy. Follow-up evaluations were carried out two months after the intervention. The Quality of Life Questionnaire-Core 30 (QLQ-C30), Quality of Life Questionnaire-Breast Cancer (QLQ-BR23), and the Connor-Davidson Resilience Scale (CD-RISC) were used in this study. Results: Sixteen patients completed the study. Compared with the control group, significant improvements were observed in the total and subscale scores on QLQ-C30 (partial η 2 = 0. 40), QLQ-BR23 (partial η 2 = 0. 73), and CD-RISC scores (partial η 2 = 0. 94) and (P < 0. 01) in the intervention group. Conclusion: Acceptance and commitment program appears to be an effective therapeutic intervention for improving quality of life and resilience of breast cancer patients. Therefore, we suggest that this intervention be provided along with medical treatments to improve quality of life and resilience of breast cancer patients.

Background: Breast cancer is the most common cause of cancer-related death in women worldwide. Novel genetic markers for breast cancer susceptibility have been identified in population-based studies. The aim of this study was to examine the association of two single-nucleotide polymorphisms (SNPs) of FGFR2 (rs1219648) and TOX3 (rs8051542) with the risk of breast cancer in Iranian women. Methods: Breast cancer patients (n = 126) and healthy controls (n = 160) were genotyped for SNPs in FGFR2 (rs1219648) and TOX3 (rs8051542) using the tetraprimer amplification refractory mutation system-polymerase chain reaction (ARMS-PCR). Also, immunohistochemical tests for human epidermal growth factor receptor-2, estrogen receptor, and progesterone receptor were carried out on breast tumor tissues. Results: TOX3 (rs8051542) CC (OR = 1. 24; 95% CI, 0. 72-0. 214; P < 0. 001) and FGFR2 (rs1219648) GG (OR = 62. 0; 95% CI, 23. 63-162. 66; χ 2 =132. 775; P < 0. 001) polymorphism was significantly associated with breast cancer. The association was also significant between breast cancer risk and TOX3 (rs8051542) TC and FGFR2 (rs1219648) AG variants. Conclusion: Our findings suggested that genetic variants of FGFR2 (rs1219648 AG) and TOX3 (rs8051542 TC) can be potential candidate biomarkers for breast cancer risk.

Background: The present study aimed to investigate breast cancer trend, incidence, and mortality among Iranian women and was one of the first provincial and population-based studies to investigate breast cancer changes during 14 years in the largest province of Iran, Kerman. Methods: This was a population-based longitudinal study. Information about women diagnosed with breast cancer from 2001 to 2014 was obtained from the Cancer Registry of Kerman University of Medical Sciences. Independent-samples t test, one-way analysis of variance, linear regression, time series graphs, and fitted line plots were performed using SPSS 22 and Minitab 17. Results: A total of 2771 women were diagnosed with breast cancer in Kerman province from 2001 to 2014. The mean age of female patients was 49. 52± 12. 88 years. The total incidence rate was 13. 5 per 100, 000 women and there was an increasing trend for incidence and age at diagnosis. Also, 254 women died from breast cancer during these 14 years and the mean mortality age was 54. 16± 14. 33 years. There was also an increasing trend for mortality and age of death. Conclusion: There is an increasing trend for incidence and mortality from breast cancer in Kerman province and this requires interventions such as appropriate screening programs. Also, enabling physicians and increasing patient awareness to identify breast cancer symptoms is necessary.

Background: Making prognosis and identifying the patients at higher risk of mortality are important issues in breast cancer (BC) treatment. The aim of this study was to stratify BC case receiving mastectomy into prognostic risk categories using the Nottingham Prognostic Index (NPI). Methods: This was a retrospective review from January 2002 to December 2014. Results: Approximately 35% of all BCs diagnosed in our institution had undergone mastectomy. The mean age was 51. 9 years. The mean size of the primary breast tumor was 5. 8 cm and showed significant association with the histologic grade (P = 0. 001), nodal involvement (P < 0. 001), positive tumor margins (P = 0. 027), and the cancer stage (P < 0. 001). Based on the NPI sores, 1. 5% of the cases would have an excellent prognosis, 10. 8% a good prognosis, 55. 8% a moderate prognosis, and 31. 9% a poor prognosis. Conclusion: The current study found that 87. 7% of the women with breast had moderate to poor prognosis at the time of diagnosis. Patients are found to present late when the disease is advanced.

Background: Occult primary breast cancer is a presentation of breast cancer involving lymph nodes without an identified primary tumor within the breast. Mastectomy with axillary node dissection has been the traditional management. However, reported oncologic outcomes with mastectomy have been similar to those with breast conserving therapy (axillary surgery and radiotherapy). With the increased sensitivity of MRI and its routine use in the workup of occult breast cancer, the role of mastectomy for occult breast cancer is now even less clear. We report our institutional experienc of neoadjuvant chemotherapy followed by axillary surgery and radiotherapy for women with occult breast cancer. Methods: We conducted a retrospective review of women diagnosed with isolated metastatic adenocarcinoma to the axilla histologically consistent with breast adenocarcinoma without evidence of a primary breast tumor. Medical records were analyzed to gather pertinent information regarding diagnostic workup, treatment, recurrence, and survival. Results: We identified seven patients treated in our institution between 2012 and 2017 who met the criteria for primary occult breast cancer. The median age at diagnosis was 63 years old (range 42-71). Subtypes by immunohistochemistry (IHC) were HER-2 positive (3 pts), triple negative (2 pts), and hormone receptor positive/HER-2 negative (2 pts). All patients received neoadjuvant chemotherapy and axillary surgery without mastectomy followed by adjuvant radiotherapy to the breast and regional nodes. Hormone receptor positive patients received adjuvant endocrine therapy. At a median follow-up of 3. 5 years, all patients were alive with no local or regional recurrence of disease while one patient developed distant metastases. Conclusion: A multimodality approach with neoadjuvant chemotherapy can lead to high rates of breast conservation in women with primary occult breast cancer. This approach appears to be oncologically safe.

Background: Breast cancer metastases to the central nervous system are more commonly multiple intracranial lesions. Rarely, in the case of single extradural metastasis, it is clinically and radiologically challenging and important to differentiate other solitary extradural masses such as meningioma. Moreover, according to the literature, it seems that there is a relationship between breast cancer and meningioma. Case Presentation: We report a 54-year-old female presenting with a sudden onset of headache and seizure whose MRI showed an extra-axial intracranial mass in her brain. The patient underwent operative removal of the tumor with the clinical and radiologic diagnosis of meningioma. The pathological finding was suspected to be breast cancer metastasis. Future evaluation of her breast showed tissue distortion in the left breast and the pathologic diagnosis of the breast lesion was invasive ductal carcinoma. In a follow-up CT scan, there were multiple liver and lung metastases. Conclusion: It is crucial for physicians with various specialties to be aware of different possibilities in the setting of a single extra-axial brain mass.