Archives of Breast Cancer
Year:2018 | Volume:5 | Issue:4|Papers Count:7

One of the most significant findings of the 1990s was the discovery of the BRCA gene mutation, which was a major advancement in the prevention of breast cancer. Since the BRCA breakthrough, screening for breast cancer susceptibility genes has become of great interest to high-risk patients and their family members. 1, 2 BRCA1 and BRCA2 are two major genes responsible for about 5% to 10% of all breast cancer cases and 10% to 18% of ovarian cancer cases. Carriers of BRCA1/2 mutation could have an elevated risk of 69% to 72% for breast cancer compared with the average-risk women (12%)...

Background: Although iatrogenic displacement of epithelial cells after breast instrumentation is a well-documented phenomenon, it is usually underdiagnosed. Misinterpretation of this issue results in overtreatment of patients in some instances. Additionally, the hazard of tumor seeding and dissemination after needling is a concern to both clinicians and patients. Both issues are addressed in this narrative review. Methods: We searched PubMed for abstracts of English-language publications using keywords “ needle track/tract” and “ displaced epithelium/epithelial displacement/iatrogenic displacement, ” which resulted in 439 records restricted to human subjects. We read all the abstracts and selected 27 manuscripts with the most relevance. Results: There are some histopathologic features that can be useful in differentiating between epithelial displacement and real invasion/metastasis. The risk of seeding or metastasis after needling is shown to be trivial. Factors militating against the growth of dislodged cells are also discussed. Conclusion: Epithelial displacement is an important issue in breast pathology that should be considered in every patient with a history of breast instrumentation.

Background: Fibroadenoma is a common benign breast disorder in young women which has a low risk of malignant transformation. Most fibroadenomas present as a single mass, but the presence of multiple fibroadenomas can be seen in 15– 20% of patients, with average number of 3– 4 masses in one breast. In different studies and reports, various treatment modalities-including observation and follow up, surgery, radiofrequency ablation, etc-have been proposed, though the best management for these patients are not determined yet. Case presentation: We present the case of 33-year-old female with history of multiple bilateral benign breast lesions with a presumptive diagnosis of fibroadenomas. She had three previous surgical excisions in the past 14 years. Her case was presented to a breast MDT meeting to obtain a recommendation on appropriate management. Question: The proposed a question in MDT concerned the best and most appropriate management plan for the patient; Does she require further surgical excisions? And if not, how should she be followed? Conclusion: After reviewing past medical history, physical examination, and all documents regarding the patient, MDT members recommended that the patient should be managed with close follow up with physical examination and ultrasound every 6 months. The necessity of further surgical intervention would be determined according to any new findings.

Background: Breast surgery for women newly diagnosed with breast cancer is associated with poor postoperative quality of life (QOL). The aim of this study was to determine the effectiveness of a programmed discharge planning in improving overall QOL and its physical, emotional, social, and spiritual domains. Method: In this quasi-experimental study, we evaluated the newly diagnosed breast cancer women undergoing breast-conserving therapy in two groups, an experimental group (n = 35) and a control group (n = 34). The experimental group received programmed discharge planning at the time of hospital admission until six weeks after discharge. The control group received routine hospital care. Participants completed the QOL questionnaires before and after the intervention. The data were analyzed using the independent-samples t test, Fisher exact test, and Mann-Whitney U. Results: Before the intervention, there were no significant differences between the control and experimental groups in overall QOL or its physical, emotional, social, and spiritual domains. The data analysis after intervention showed significant improvement in QOL in the experimental group as compared with the control group. The changes in the scores of various domains of QOL were statistically significant (P < 0. 01). Conclusion: This study emphasizes that programmed discharge planning is useful for improving QOL after breast-conserving surgery. Our finding could be applied to breast cancer patients with radiation therapy or chemotherapy.

Background: Breast cancer is considered a chronic disease owing to the increases in survival rate. Thus, better body image and patient satisfaction with the surgery have become more important factors to be considered when choosing the surgical approach. The aim of this study was to compare body image and patient satisfaction following three different approaches. Methods: We evaluated 183 consecutive patients who had undergone three different surgeries including breast-conserving surgery (BCS), mastectomy, or mastectomy followed by reconstruction (M-R). Body image was evaluated using the BICI questionnaire, and patient satisfaction was rated using a multiple-choice question and a scale ranging from 1 to 10. Results: A significantly better body image was observed in the M-R and BCS groups compared with mastectomy (P = 0. 02). In body image subscale analysis, social functioning scores were higher in the M-R and BCS groups than in the mastectomy group (P = 0. 01), but no differences were obtained between surgery groups in appearance dissatisfaction subscale. Patients were more satisfied with BCS than the other two surgeries (P = 0. 008). Conclusion: Based on the results of this study, it could be proposed that both oncoplastic BCS and implant reconstruction could provide patients with acceptable body image, while BCS could bring about better satisfaction with the surgery. Reconstruction may be an alternative for the patients to improve body image and satisfaction when BCS is not applicable.

Background: Patient participation in medical decisions is essential and requires sufficient knowledge and awareness. Thus, the aim of this study was to investigate the relationship between health literacy and the participation of breast cancer patients in their medical decisions in Shiraz, Iran. Methods: This was a descriptive-analytical study conducted on 196 women with breast cancer in 2016-2017. Data were collected using the standardized Health Literacy for Iranian Adults (HELIA) and the Decisional Conflict Scale. The data were analyzed using descriptive statistics and inferential methods (t test, Pearson correlation, ANOVA, and Kruskal-Wallis) on SPSS 21. Results: The mean age of participants was 46. 7 years. Their health literacy was inadequate (18. 7) and their decisional conflict was average (51. 79). There was also an inverse and significant relationship between health literacy and decisional conflict (P < 0. 001, r =-0. 81) Conclusion: Increasing health literacy could reduce decisional conflict. It requires training individuals be able to access credible and reliable sources of information. This training can be provided through doctors, treatment staff, and public and social media.

Background: Warfarin induced breast necrosis is a rare complication of oral anticoagulant therapy. Although it can be related to protein C, S, and antithrombin III deficiency; the pathogenesis of necrosis is still unknown. Case presentation: We report a case of a 38-year-old woman with extensive left breast necrosis after receiving warfarin for treatment of deep vein thrombosis. Simple mastectomy was performed and the wound was closed secondarily with an abdominal advancement flap. Rivaroxaban was prescribed after discontinuation of warfarin. Conclusion: Although breast necrosis following warfarin usage is uncommon, it should be considered in women presenting with breast symptoms after initiation of warfarin. Early diagnosis and appropriate management are essential to prevent extensive loss of breast tissue.