Breast Cancer
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Breast cancer is the most common type of cancer among women, the risk of breast cancer increases with age, it is most common after the age of 50. Each breast has 15- 20 sections (lobes), each of which has many smaller sections (lobules). The lobes and lobules are connected by thin tubes (ducts). The most frequent type of breast cancer is that starting in the ducts (ductal cancer), other types include cancer beginning in the lobes or lobules (lobular carcinoma), less common is Inflammatory breast cancer which causes the breast to be red, and swollen. The incidence of breast cancer has been increasing in Western countries, the rate of increase has been faster in younger women, however, the cause of most breast cancers remains unknown. World-wide about 794,000 women are diagnosed with breast cancer each year.

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Information Patients and the Public (42 links)


Information for Health Professionals / Researchers (15 links)

See also: Molecular Biology of Breast Cancer

Breast Cancer Organisations (11 links)

See also: National Cancer Organisations

Specialist Journals (12 links)

See also: Oncology Journals

Latest Research Publications

This list of publications is regularly updated (Source: PubMed).

Moore HC, Unger JM, Phillips KA, et al.
Goserelin for ovarian protection during breast-cancer adjuvant chemotherapy.
N Engl J Med. 2015; 372(10):923-32 [PubMed] Related Publications
BACKGROUND: Ovarian failure is a common toxic effect of chemotherapy. Studies of the use of gonadotropin-releasing hormone (GnRH) agonists to protect ovarian function have shown mixed results and lack data on pregnancy outcomes.
METHODS: We randomly assigned 257 premenopausal women with operable hormone-receptor-negative breast cancer to receive standard chemotherapy with the GnRH agonist goserelin (goserelin group) or standard chemotherapy without goserelin (chemotherapy-alone group). The primary study end point was the rate of ovarian failure at 2 years, with ovarian failure defined as the absence of menses in the preceding 6 months and levels of follicle-stimulating hormone (FSH) in the postmenopausal range. Rates were compared with the use of conditional logistic regression. Secondary end points included pregnancy outcomes and disease-free and overall survival.
RESULTS: At baseline, 218 patients were eligible and could be evaluated. Among 135 with complete primary end-point data, the ovarian failure rate was 8% in the goserelin group and 22% in the chemotherapy-alone group (odds ratio, 0.30; 95% confidence interval [CI], 0.09 to 0.97; two-sided P=0.04). Owing to missing primary end-point data, sensitivity analyses were performed, and the results were consistent with the main findings. Missing data did not differ according to treatment group or according to the stratification factors of age and planned chemotherapy regimen. Among the 218 patients who could be evaluated, pregnancy occurred in more women in the goserelin group than in the chemotherapy-alone group (21% vs. 11%, P=0.03); women in the goserelin group also had improved disease-free survival (P=0.04) and overall survival (P=0.05).
CONCLUSIONS: Although missing data weaken interpretation of the findings, administration of goserelin with chemotherapy appeared to protect against ovarian failure, reducing the risk of early menopause and improving prospects for fertility. (Funded by the National Cancer Institute and others; POEMS/S0230 ClinicalTrials.gov number, NCT00068601.).


Swain SM, Baselga J, Kim SB, et al.
Pertuzumab, trastuzumab, and docetaxel in HER2-positive metastatic breast cancer.
N Engl J Med. 2015; 372(8):724-34 [PubMed] Related Publications
BACKGROUND: In patients with metastatic breast cancer that is positive for human epidermal growth factor receptor 2 (HER2), progression-free survival was significantly improved after first-line therapy with pertuzumab, trastuzumab, and docetaxel, as compared with placebo, trastuzumab, and docetaxel. Overall survival was significantly improved with pertuzumab in an interim analysis without the median being reached. We report final prespecified overall survival results with a median follow-up of 50 months.
METHODS: We randomly assigned patients with metastatic breast cancer who had not received previous chemotherapy or anti-HER2 therapy for their metastatic disease to receive the pertuzumab combination or the placebo combination. The secondary end points of overall survival, investigator-assessed progression-free survival, independently assessed duration of response, and safety are reported. Sensitivity analyses were adjusted for patients who crossed over from placebo to pertuzumab after the interim analysis.
RESULTS: The median overall survival was 56.5 months (95% confidence interval [CI], 49.3 to not reached) in the group receiving the pertuzumab combination, as compared with 40.8 months (95% CI, 35.8 to 48.3) in the group receiving the placebo combination (hazard ratio favoring the pertuzumab group, 0.68; 95% CI, 0.56 to 0.84; P<0.001), a difference of 15.7 months. This analysis was not adjusted for crossover to the pertuzumab group and is therefore conservative. Results of sensitivity analyses after adjustment for crossover were consistent. Median progression-free survival as assessed by investigators improved by 6.3 months in the pertuzumab group (hazard ratio, 0.68; 95% CI, 0.58 to 0.80). Pertuzumab extended the median duration of response by 7.7 months, as independently assessed. Most adverse events occurred during the administration of docetaxel in the two groups, with long-term cardiac safety maintained.
CONCLUSIONS: In patients with HER2-positive metastatic breast cancer, the addition of pertuzumab to trastuzumab and docetaxel, as compared with the addition of placebo, significantly improved the median overall survival to 56.5 months and extended the results of previous analyses showing the efficacy of this drug combination. (Funded by F. Hoffmann-La Roche and Genentech; CLEOPATRA ClinicalTrials.gov number, NCT00567190.).

Related: Docetaxel Trastuzumab (Herceptin)


Weigelt B, Eberle C, Cowell CF, et al.
Metaplastic breast carcinoma: more than a special type.
Nat Rev Cancer. 2014; 14(3):147-8 [PubMed] Related Publications
Metaplastic breast carcinoma (MBC) is a special histological type of invasive breast cancer. MBC is a descriptive and operational term for a heterogeneous collection of tumours with distinct histologies, clinical behaviours and potentially responses to therapy.


Akbar M, Akbar K, Naveed D
Frequency and correlation of molecular subtypes of breast cancer with clinicopathological features.
J Ayub Med Coll Abbottabad. 2014 Jul-Sep; 26(3):290-3 [PubMed] Related Publications
BACKGROUND: Traditional clinicopathological classification of breast cancer has limitations as tumours with similar clinical and histological features behave differently regarding outcome and responsiveness to chemo/immunotherapy. The objectives of the study were to determine the frequency of different molecular subtypes of breast cancer based on immunohistochemical staining and to find the correlation of each subtype with clinicopathological features.
METHODS: Sixty patients with histologically diagnosed invasive ductal carcinoma were enrolled in this cross sectional study. Immunohistological staining of the tumour samples and based on receptor status tumours were classified in four subtypes, Luminal A, Luminal B, HER2/neu oncogene amplification subtype and Tripple negative subtype. Clinical features, stage of disease at presentation and histopathological grade of the tumours was also recoded in each subtype. Prevalence of each subtype was calculated and correlation with clinical and pathological features was determined.
RESULTS: Mean age of tli`S patients was 47.55 years. Protective role of breast feeding was not confirmed in this study as 58 (96.67%) patients breast fed their children. Only two (3.33%) patients gave family history of breast cancer in the study. Thirty three (55%) patients had grade 2 tumours, 26 (43.33%) had grade 3 tumours while only one patient had grade 1 tumour. HER2/neu amplification subtype was the most common molecular subclass in the study, comprising 30% of all the patients. Ten patients (16.67%) in this study belonged to triple negative group. Triple negative disease was found in younger women with mean age of 40-60 years.
CONCLUSION: Breast cancer particularly triple negative disease was found in younger age group and patients usually present in advanced stage of their disease.HER2fneu positive breast cancer was the most common subtype in this study.


Koonce SL, Mclaughlin SA, Eck DL, et al.
Breast cancer recurrence in patients receiving epidural and paravertebral anesthesia: a retrospective, case-control study.
Middle East J Anaesthesiol. 2014; 22(6):567-71 [PubMed] Related Publications
PURPOSE: Studies have suggested an association between the use of regional paravertebral or epidural anesthesia and a reduction in tumor recurrence following breast cancer surgery. To examine this relationship we performed a retrospective case-control study of patients undergoing breast cancer surgery receiving regional, regional and general, or general anesthesia.
METHODS: A retrospective chart review was performed of patients undergoing surgery for stage 0 to III breast cancer. Patients identified as receiving regional anesthesia were then matched for age, stage, estrogen receptor (ER) status, progesterone receptor status, and HER-2 expression with patients who received no regional anesthesia. Univariate (Pearson's χ2 test and odds ratio) and multivariate logistic analyses with backward stepwise regression were performed to determine factors associated with cancer recurrence.
RESULTS: Between 1998 and 2007, 816 women underwent surgery for stage 0-III breast cancer at our institution. Forty-five patients developed tumors. Univariate analysis showed the use of regional anesthesia trended towards reduced cancer recurrence, but it did not achieve statistical significance (p = 0.06). Higher recurrence rates were associated with ER positive status (p = 0.003) and higher tumor stage (p < 0.0001). Age and HER-2 status were not associated with increased cancer recurrence (both p > 0.11). Multivariate analysis confirmed ER status and stage as independently influential (p = 0.002 and p < 0.0001 respectively).
CONCLUSION: Although we found a trend towards reduced breast cancer recurrence with the use of regional anesthesia, univariate analysis did not reach statistical significance.


Milojkovic N, Homsi S
Polymethylmethacrylate pulmonary embolism as a complication of percutaneous vertebroplasty in cancer patients.
J Ark Med Soc. 2014; 111(7):140-2 [PubMed] Related Publications
Percutaneous vertebroplasty is frequently used in the treatment of vertebral body fractures due to osteoporosis, vertebral body metastasis, or myeloma. Acrylic cement of polymethylmethacrylate injected into the vertebral body can leak into the paravertebral venous system and reach the pulmonary artery via the azygos vein leading to a cement pulmonary embolism. We are presenting a case of a 78 year old woman who was found to have polymethylmethacrylate pulmonary embolism as a result of vertebroplasty used for vertebral collapse from metastatic breast cancer. The appearance of new intrapulmonary artery tubular opaque density on CXR performed post procedure is highly suggestive of the diagnosis. In this case, we are exploring the importance of clinical and radiographic correlations, as well as evaluation of the hemodynamic and perfusion effect of the cement pulmonary embolism as essential steps in the management of this condition.


Babić I, Trstenjak VH
Mammography Screening--how persistent should we be in the recommendations?
Coll Antropol. 2014; 38 Suppl 2:207-9 [PubMed] Related Publications
55 year old women came to me as her family doctor, seeking advice on mammography screening. She rather wouldn't do it because she feels well, is a bit afraid of radiation and thinks it's not important, since she doesn't have individual risk. Having in mind newly emerging evidence about the questionable value of the screening, especially in women without any risks, I was in dilemma what to recommend. Therefore, we did a limited literature search. Systematic reviews are questioning effectiveness of mammography as screening method, evidences show limited effect on reducing mortality and the burden of overdiagnosis and overtreatmnent. Professional recommendations vary from country to country. Overall impression is that many questions remain open and, until better method of screening is found, the decisions about breast cancer screening should be strongly individualized, according to the patients risks. We openly discussed it, she decided to postpone mammography for a while.


Gmajnić R, Beganović A, Pribić S, et al.
Breast cancer detection: role of family physicians.
Coll Antropol. 2014; 38 Suppl 2:191-4 [PubMed] Related Publications
Croatia started implementing the national programs for early breast cancer detection in 2006, early detection of colon cancer and early detection of cervical cancer. A possible way to improve the adherence of the women to the screening on breast cancer could be by transferring the responsibility for the program implementation from the public health institutes to family physicians. The Project: "Model of early cancer detection integrated in a practice of family physician", was carried out by the Department of Family Medicine of the Osijek University School of Medicine. The results have shown that responsiveness of women invited to do preventive mammography was significantly higher in the experimental than in the control group. The central role of FM in the implementation of preventive programmes has already been recognized in many countries as an advantage from the organizational aspects and by means of decreased expenditure, compared to the vertical programmes with strict formal control centered to the public institutions.


Cornejo-Moreno BA, Uribe-Escamilla D, Salamanca-Gómez F
Breast cancer genes: looking for BRACA's lost brother.
Isr Med Assoc J. 2014; 16(12):787-92 [PubMed] Related Publications
Breast cancer, specifically mammary carcinoma, is the most common cause of death from cancer in women worldwide, with a lifetime risk of one in nine, and its prevalence is increasing. It represents around 30% of all cancer in females and approximately 40,000 deaths in the United States per year. Important advances have been made in detection and treatment, but a significant number of breast cancers are still detected late. This summary of its epidemiology and history, the molecular aspects of detection and the main implicated genes emphasizes the etiology and heterogeneity of the disease. It is still not clear whether the remaining cases of breast cancer negative to BRCA are due to mutations in another high penetrance gene or to unknown factors yet to be discovered.

Related: BRCA1 BRCA2


Lewis S, Bloom J, Rice J, et al.
Using teams to implement personalized health care across a multi-site breast cancer network.
Adv Health Care Manag. 2014; 16:71-94 [PubMed] Related Publications
PURPOSE: This study sought to identify the organizational factors associated with team and network effectiveness of the Athena Breast Health Network, a multi-site collaboration between five University of California health systems.
DESIGN/METHODOLOGY/APPROACH: Providers, managers, and support staff completed self-administered surveys over three years. Statistical analyses at the network and medical center levels tested hypotheses regarding the correlates of effective teams and perceived network effectiveness over time.
FINDINGS: Perceived team effectiveness was positively correlated with group culture and environments which support collaboration, negatively correlated with hierarchical culture, and negatively associated with professional tenure at year two. As measured by increasing team effectiveness scores over time and Athena's potential impact on patient care, perceived network effectiveness was positively associated with team effectiveness.
RESEARCH LIMITATIONS/IMPLICATIONS: Results do not allow us to conclude that a certain type of culture "causes" team effectiveness or that team effectiveness "causes" greater perceptions of progress over time. Subsequent studies should examine these variables simultaneously. Further research is needed to examine the role of payment incentives, internal reward systems, the use of electronic health records, public disclosure of performance data, and depth of leadership within each organization and within the network overall.
PRACTICAL IMPLICATIONS: - Focusing on group affiliation and participation may improve team member perceptions regarding effectiveness and impact on patient care.
ORIGINALITY/VALUE: Relatively little is known about the adaptive processes that occur within inter-organizational networks to achieve desired goals, and particularly the roles played by multi-disciplinary interprofessional teams. We studied a network comprising multiple campuses actively involved in better understanding, preventing, and treating a complex disease.


Morgan PD, Tyler I, Fogel J, Barnett K
African American women share 'real talk' stories about fatigue related to breast cancer treatment.
ABNF J. 2014; 25(4):116-22 [PubMed] Related Publications
Fatigue is the most common side effect experienced by women undergoing treatment for breast cancer. The fatigue experience of African American (AA) women who undergo breast cancer treatment has been understudied. The purpose of this qualitative exploratory study is to share stories of 10 AA women who experienced fatigue related to breast cancer treatment. AA women provided real talk descriptors of fatigue. Women expressed how physicians were supportive of their exercising to manage their fatigue. However, many women describe the medications prescribed for fatigue as not very helpful or even making them feel worse. Women shared use of complementary treatment approaches and that their physicians approved of such complementary treatment use. All the participants described how they relied on prayer for their spiritual strength to deal with the overwhelming effects of fatigue on their daily lives. An understanding by health care practitioners of the fatigue and coping experiences related to breast cancer among AA women can provide better ways for health care practitioners to treat and help their AA patients address fatigue symptoms.


Imtiaz S, Siddiqui N
Vitamin-D status at breast cancer diagnosis: correlation with social and environmental factors and dietary intake.
J Ayub Med Coll Abbottabad. 2014 Apr-Jun; 26(2):186-90 [PubMed] Related Publications
BACKGROUND: Serum levels of vitamin-D are low in breast cancer patients. Vitamin-D levels have inverse correlations with postmenopausal state, obesity, poor sun exposure and low intake of vitamin-D rich diet. The objective of this study was to quantify levels of vitamin-D in serum to determine the degree of vitamin-D deficiency in breast cancer patients compared with age matched controls and to observe the association between serum 25-OH vitamin-D levels and personal and social parameters, BMI, amount of sun exposure and dietary intake.
METHODS: In this cross-sectional analytical study all newly diagnosed breast cancer female patients were recruited into the study over a period of 6 months. Age matched healthy females were also recruited as a control group. Personal and social data was documented on to a pro forma. Sun exposure was determined by mid-day exposure to direct sunlight. Serum 25-OHD levels were studied by ELISA technique on the blood samples. The dietary information was collected by recall over the last 1 year.
RESULTS: Vitamin-D deficiency was found in 99% breast cancer females and 90% in healthy females. Mean serum vitamin-D level was 9.6 ± 5 ng/ml and 15.2 ± 10 ng/ml for cases and control group respectively. All breast cancer and 95% healthy females with BMI > 30 were found to be vitamin-D deficient. Menopausal state, parity, parda (veil) observation, area of living and sun exposure did not affect vitamin-D status in either group. Egg, fish and cheese intake revealed correlation with vitamin-D deficiency. Forty percent healthy females were found to have deficient serum vitamin-D levels despite being on supplement.
CONCLUSION: Vitamin-D deficiency was highly prevalent among breast cancer females. Serum 25 OHD levels exhibited an inverse correlation with high body mass index and vitamin-D rich diet.


Altay C, Balci P, Altay S, et al.
Diffusion-weighted MR imaging: role in the differential diagnosis of breast lesions.
JBR-BTR. 2014 Jul-Aug; 97(4):211-6 [PubMed] Related Publications
PURPOSE: To evaluate the diagnostic value of magnetic resonance diffusion-weighted imaging (DWI) using apparent diffusion coefficient (ADC) values to the characterization of breast lesions and differentiation of benign and malignant lesions.
MATERIALS AND METHODS: Thirty-seven women (mean age, 38 years) with 37 enrolled in the study. DWI and ADC maps in the axial plane were obtained using a 1.5 Tesla MRI device. Mean ADC measurements were calculated among cysts, normal fibroglandular tissue, benign lesions and malignant lesions were evaluated.
RESULTS: Out of 37 women, 4 had normally breast MRI findings. The diagnosis of remaining 33 patients with 37 breast lesions were as follows; malign lesions (n = 23), benign lesions (n = 10) and simple breast cyst (n = 4). The ADC values were as follows (in units of 10(-3) mm2/s): Normal fibroglandular tissue (range: 1.39-2.06; mean: 1.61 ± 0.23), benign breast lesions (range: 1.09-1.76; mean: 1.47 ± 0.25), cyts (range: 2.27-2.46, mean: 2.37 ± 0.07) and malignant breast lesions (range: 0.78-1.26, mean: 0.96 ± 0.25). The mean ADC obtained from malignant breast lesions was statistically different from that observed in benign solid lesions (p < < 0.01) and normal fibroglandular breast tissue (p < 0.01). Furthermore, the mean ADC values of benign breast lesions was not statistically different from cyst (p ≥ 0.01) and normal fibroglandular breast tissue (p ≥ 0.01). A ADC value of 1.1 x 10(-3) mm'/s as a treshold value provided differantiation for malign and benign lesions, with a sensitivity of 91.3% and a specificity of 85.7% compared with conventional breast MRI values.
CONCLUSION: DWI with quantitative ADC measurements is a reliable tool for differentiation of benign and malignant breast lesions.


Huyskens J, Geniets C
Granular cell tumor in the breast mimicking breast carcinoma.
JBR-BTR. 2014 Sep-Oct; 97(5):289-90 [PubMed] Related Publications
Granular cell tumor is also known as a granular cell myoblastoma, Abrikossoff's tumor, granular cell nerve sheath tumor or granular cell scwhannoma. It is a rare soft-tissue mass that can develop in any soft tissue. Most commonly it appears in the tongue (40%), the oral cavity or in the subcutaneous tissue. In rare occasions it is reported as a breast mass, mimicking a carcinoma. Not only clinically, but also on mammography, ultrasonography and macroscopically. Diagnosis can only be made on histology, emphasizing once again the importance of a thorough pre-operative multi-disciplinary assessment. We describe a case in which a woman presents herself with a palpable nodule in the breast in which clinical investigation, mammography and especially sonography indicated the presence of a malignancy. Only after we conducted a core biopsy for pre-operative histological investigation, we could make the diagnosis of a granular cell tumor, preventing an unnecessary mastectomy. The patient refused however local excision and was followed up with mammography and sonography.


Ishizuna K, Ninomiya J, Ogawa T, et al.
Effectiveness and safety of tegafur-gimeracil-oteracil potassium (TS-1) for metastatic breast cancer: a single-center retrospective study.
Gan To Kagaku Ryoho. 2014; 41(13):2577-82 [PubMed] Related Publications
BACKGROUND: Tegafur-gimeracil-oteracil potassium (TS-1)is a drug that is used mainly as a third-line treatment or beyond for metastatic breast cancer(MBC). However, there is still insufficient evidence on its clinical effectiveness, and there are very few reports on clinical research using TS-1 up front. In this report, we examined the effectiveness and safety of TS-1 therapy for MBC.
PATIENTS AND METHODS: The subjects were 46 patients with MBC who were treated with TS-1 between January 2005 and January 2013. These patients were retrospectively examined.
RESULTS: The objective response rate to TS-1 therapy was 30.4%, clinical benefit rate (CBR)was 50.0%, and the median time to treatment failure was 10.7 months. When examined by site, the CBR was high locally (46.2%), in the lymph nodes (40.7%), in the bone (42.9%), and in the lungs and pleura (44.8%). However it was low in the liver(30.0%). The relationship was examined between clinicopathological factors and the effectiveness of TS-1 therapy. The objective response rate (ORR) was significantly higher for patients with disease-free interval (DFI) of 2 years or more (p=0.039), TS-1 therapy used as third-line treatment or earlier (p=0.022), negative HER2 status (p=0.020), and no history of capecitabine (CAP)therapy (p=0.049). The CBR was significantly higher for patients with no visceral metastasis (p=0.032), TS-1 used as third-line treatment or earlier (p=0.019), negative HER2 status (p= 0.045), no history of CAP therapy (p=0.006), and no history of tegafur-uracil/doxifluridine therapy (p=0.031). Multivariate analysis showed that DFI of 2 years or more (p=0.035, odds ratio:0.104)was an independent predictor of effectiveness assessed by ORR. There were only 4 patients in whom the treatment was discontinued due to adverse event, and TS-1 was generally well tolerated.
CONCLUSION: TS-1 was highly effective and well tolerated by patients with MBC. Its up-front use might enable the maintenance of satisfactory QOL and the enhancement of its clinical effectiveness.

Related: Tegafur-uracil


Warren LE, Punglia RS, Wong JS, Bellon JR
Management of the regional lymph nodes following breast-conservation therapy for early-stage breast cancer: an evolving paradigm.
Int J Radiat Oncol Biol Phys. 2014; 90(4):772-7 [PubMed] Related Publications
Radiation therapy to the breast following breast conservation surgery has been the standard of care since randomized trials demonstrated equivalent survival compared to mastectomy and improved local control and survival compared to breast conservation surgery alone. Recent controversies regarding adjuvant radiation therapy have included the potential role of additional radiation to the regional lymph nodes. This review summarizes the evolution of regional nodal management focusing on 2 topics: first, the changing paradigm with regard to surgical evaluation of the axilla; second, the role for regional lymph node irradiation and optimal design of treatment fields. Contemporary data reaffirm prior studies showing that complete axillary dissection may not provide additional benefit relative to sentinel lymph node biopsy in select patient populations. Preliminary data also suggest that directed nodal radiation therapy to the supraclavicular and internal mammary lymph nodes may prove beneficial; publication of several studies are awaited to confirm these results and to help define subgroups with the greatest likelihood of benefit.


Hindley A, Zain Z, Wood L, et al.
Mometasone furoate cream reduces acute radiation dermatitis in patients receiving breast radiation therapy: results of a randomized trial.
Int J Radiat Oncol Biol Phys. 2014; 90(4):748-55 [PubMed] Related Publications
PURPOSE: We wanted to confirm the benefit of mometasone furoate (MF) in preventing acute radiation reactions, as shown in a previous study (Boström et al, Radiother Oncol 2001;59:257-265).
METHODS AND MATERIALS: The study was a double-blind comparison of MF with D (Diprobase), administered daily from the start of radiation therapy for 5 weeks in patients receiving breast radiation therapy, 40 Gy in 2.67-Gy fractions daily over 3 weeks. The primary endpoint was mean modified Radiation Therapy Oncology Group (RTOG) score.
RESULTS: Mean RTOG scores were significantly less for MF than for D (P=.046). Maximum RTOG and mean erythema scores were significantly less for MF than for D (P=.018 and P=.012, respectively). The Dermatology Life Quality Index (DLQI) score was significantly less for MF than for D at weeks 4 and 5 when corrected for Hospital Anxiety and Depression (HAD) questionnaire scores.
CONCLUSIONS: MF cream significantly reduces radiation dermatitis when applied to the breast during and after radiation therapy. For the first time, we have shown a significantly beneficial effect on quality of life using a validated instrument (DLQI), for a topical steroid cream. We believe that application of this cream should be the standard of care where radiation dermatitis is expected.


Iqbal J, Ginsburg O, Rochon PA, et al.
Differences in breast cancer stage at diagnosis and cancer-specific survival by race and ethnicity in the United States.
JAMA. 2015; 313(2):165-73 [PubMed] Related Publications
IMPORTANCE: Women with early-stage breast cancers are expected to have excellent survival rates. It is important to identify factors that predict diagnosis of early-stage breast cancers.
OBJECTIVE: To determine the proportion of breast cancers that were identified at an early stage (stage I) in different racial/ethnic groups and whether ethnic differences may be better explained by early detection or by intrinsic biological differences in tumor aggressiveness.
DESIGN, SETTING, AND PARTICIPANTS: Observational study of women diagnosed with invasive breast cancer from 2004 to 2011 who were identified in the Surveillance, Epidemiology, and End Results (SEER) 18 registries database (N = 452,215). For each of 8 racial/ethnic groups, biological aggressiveness (triple-negative cancers, lymph node metastases, and distant metastases) of small-sized tumors of 2.0 cm or less was estimated. The odds ratio (OR) for being diagnosed at stage I compared with a later stage and the hazard ratio (HR) for death from stage I breast cancer by racial/ethnic group were determined. The date of final follow-up was December 31, 2011.
MAIN OUTCOMES AND MEASURES: Breast cancer stage at diagnosis and 7-year breast cancer-specific survival, adjusted for age at diagnosis, income, and estrogen receptor status.
RESULTS: Of 373,563 women with invasive breast cancer, 268,675 (71.9%) were non-Hispanic white; 34,928 (9.4%), Hispanic white; 38,751 (10.4%), black; 25,211 (6.7%), Asian; and 5998 (1.6%), other ethnicities. Mean follow-up time was 40.6 months (median, 38 months). Compared with non-Hispanic white women diagnosed with stage I breast cancer (50.8%), Japanese women (56.1%) were more likely to be diagnosed (OR, 1.23 [95% CI, 1.15-1.31], P < .001) and black women (37.0%) were less likely to be diagnosed (OR, 0.65 [95% CI, 0.64-0.67], P < .001). Actuarial risk of death from stage I breast cancer at 7 years was higher among black women (6.2%) than non-Hispanic white women (3.0%) (HR, 1.57 [95% CI, 1.40-1.75]; P < .001), and lower among South Asian women (1.7%) (HR, 0.48 [95% CI, 0.20-1.15]; P = .10). Black women were more likely to die of breast cancer with small-sized tumors (9.0%) than non-Hispanic white women (4.6%) (HR, 1.96 [95% CI, 1.82-2.12]; P < .001); the difference remained after adjustment for income and estrogen receptor status (HR, 1.56 [95% CI, 1.45-1.69]; P < .001).
CONCLUSIONS AND RELEVANCE: Among US women diagnosed with invasive breast cancer, the likelihood of diagnosis at an early stage, and survival after stage I diagnosis, varied by race and ethnicity. Much of the difference could be statistically accounted for by intrinsic biological differences such as lymph node metastasis, distant metastasis, and triple-negative behavior of tumors.

Related: USA


Cescon DW, Gorrini C, Mak TW
Breaking up is hard to do: PI3K isoforms on the rebound.
Cancer Cell. 2015; 27(1):5-7 [PubMed] Related Publications
In this issue of Cancer Cell, Schwartz and colleagues and Costa and colleagues demonstrate that inhibition of PI3Kα or PI3Kβ in cancer cells with hyperactivated PI3Kα or PI3Kβ, respectively, activates the other isoform, leading to a "rebound" of the PI3K activity through different compensation mechanisms.

Related: Cancer Prevention and Risk Reduction PTEN


Ursaru M, Jari I, Popescu R, et al.
Multifactorial analysis of local and lymph node recurrences after conservative or radical surgery for stage 0-II breast cancer.
Rev Med Chir Soc Med Nat Iasi. 2014 Oct-Dec; 118(4):1062-7 [PubMed] Related Publications
AIM: Multifactorial analysis of local and lymph node recurrences in stage 0-II breast cancer treated by conservative or radical surgery.
MATERIAL AND METHODS: In the interval January 1, 2005-July 31, 2013, 477 breast cancer patients were assessed by imaging techniques at the Radiology Clinic of Iasi "Sf. Spiridon" Hospital and Radiology Service of the Iasi Regional Cancer Institute. Of these 229 (48%) patients underwent conservative surgery and 248 (52%) patients radical surgery.
RESULTS: Local recurrences were 2.8 times more frequent in conservatively vs. radically treated patients, and lymph node recurrences 2 times more frequent in patients treated conservatively. Breast tumors larger than 3 cm in diameter were at higher risk for local and distant recurrence in lymph nodes.
CONCLUSIONS: Assessment in patients with local and lymph nodes recurrences of the relative risk for developing other types of recurrences (bone, pleuro pulmonary, liver, brain metastases) indicated that these are a risk factor for other types of recurrences, influencing the prognosis of patients. Local recurrences showed a higher relative risk for other types of recurrences than nodal recurrences.


Jari I, Ursaru M, Gheorghe L, et al.
Computerized calculation of breast density: our experience from Arcadia Medical Imaging Center.
Rev Med Chir Soc Med Nat Iasi. 2014 Oct-Dec; 118(4):979-85 [PubMed] Related Publications
THE AIM OF THIS STUDY: To implement a spatial fuzzy C-means algorithm for image segmentation and breast tissue density quantification and compare it with BI-RADS breast density classes determined by radiologists.
MATERIAL AND METHODS: The analysis was based on 206 mammograms performed in 111 women with various breast abnormalities. Digitized mammographic films were independently double read by radiologists certified in breast diagnosis, followed by consensus with arbitration agreement (radiological ground truth). Reporting was done using the BI-RADS mammography lexicon. Using an algorithm based on a combination of spatial fuzzy C-means clustering and binary thresholding, percent mammographic density was computed in digitized mammograms. The BI-RADS breast density readings were compared with percent breast density measurements determined by computer algorithm.
RESULTS: The algorithm was found to match the BI-RADS density classification in 90% of the cases, with an excellent agreement (kappa = 0.88) between the radiological ground truth versus the algorithm breast tissue density estimates.
CONCLUSIONS: Our study proposed an algorithm that can be applied both to digitized and digital mammograms, which proved to be effective in breast density estimates. The method can accurately determine the percentage density removing the human observer variability. The proposed method showed an excellent agreement with radiological ground truth.


Lucas DJ, Sabino J, Shriver CD, et al.
Doing more: trends in breast cancer surgery, 2005 to 2011.
Am Surg. 2015; 81(1):74-80 [PubMed] Related Publications
An increasing number of women may be choosing mastectomy over breast-conserving surgery for breast cancer as well as undergoing more bilateral resection, immediate reconstruction, and prophylactic operations. Women who had breast cancer operations between 2005 and 2011 were selected from the National Surgical Quality Improvement Program database. Annual trends were explored using robust Poisson multivariable regression as were predictors for mastectomy versus breast-conserving surgery. A total of 85,401 women were identified. Mastectomy increased from 2005 to 2011, starting at 40 per cent in 2005 and peaking at 51 per cent in 2008 (P < 0.001). Bilateral resection, immediate reconstruction, and prophylactic mastectomy also increased (all P < 0.001). Independent predictors of mastectomy included young age, Asian race, invasive cancer (vs carcinoma in situ), bilateral resection, axillary dissection, higher American Society of Anesthesiologists class, and lower body mass index (all P < 0.001). There was an increase in mastectomy, bilateral resection, immediate reconstruction, and prophylactic mastectomy from 2005 to 2011.

Related: USA


Sue GR, Chagpar AB
Predictors of recurrence in patients diagnosed with ductal carcinoma in situ.
Am Surg. 2015; 81(1):48-51 [PubMed] Related Publications
Although patients diagnosed with ductal carcinoma In Situ (DCIS) enjoy a favorable prognosis, recurrence after definitive management does occur in a subset of these patients. Factors influencing the development of recurrence remain poorly understood. A retrospective chart review of 205 consecutive patients who presented to an academic breast center with DCIS from 2000 to 2003 was conducted under an Institutional Review Board-approved protocol. With a median follow-up of 8.5 years, 14 (6.8%) of the 205 patients who presented with DCIS between 2000 and 2003 had a recurrence of their DCIS. The median age of all patients at the time of diagnosis of their initial DCIS was 55.5 years (range, 35.8 to 88.9 years). Patients who experienced tumor recurrence were more likely to have Grade 3 DCIS on initial diagnosis compared with patients without recurrence (72.7 vs 35.4%, P = 0.032). The odds ratio of tumor recurrence for high-grade compared with low-grade DCIS was 4.39. Patient age, race, tumor size, tumor histologic subtype, or histopathologic features was not associated with recurrence. Patients with high-grade DCIS are more likely to recur than patients with low-grade DCIS, and this seems to be more predictive of recurrence than other clinicopathologic markers.


Sun X, Luo S, He Y, et al.
Screening of the miRNAs related to breast cancer and identification of its target genes.
Eur J Gynaecol Oncol. 2014; 35(6):696-700 [PubMed] Related Publications
OBJECTIVE: To predict and verify the target genes of the miRNAs related to breast cancer beginning from the miRNA expression profile of human breast cancer.
MATERIALS AND METHODS: The total RNA was extracted from cancer tissues and the corresponding paracancerous tissues of eight breast cancer patients, and then miRNAs were separated. Human breast cancer cell line MDA-MB-231 and the normal mammary epithelial cell line HBL-100 were cultured, and the total RNA was extracted, respectively, with separation of miRNAs. The gene chip technology was used to analyze and detect the miRNAs differentially expressed in tissues and cancer cells. The miRNA expression profile of human breast cancer was obtained through chip scanning and data analysis.
RESULTS: Through dual-luciferase method, it was verified that PDCD4 and PDCD10 were real target genes of miR-21 and miR-200c, respectively.
CONCLUSION: miR-21 and miR-200c are related miRNAs to breast cancer, and they are associated with the occurrence and development of breast cancer.

Related: MicroRNAs microRNA mir-21 PDCD10 PDCD4


Tolaney SM, Barry WT, Dang CT, et al.
Adjuvant paclitaxel and trastuzumab for node-negative, HER2-positive breast cancer.
N Engl J Med. 2015; 372(2):134-41 [PubMed] Free Access to Full Article Related Publications
BACKGROUND: No single standard treatment exists for patients with small, node-negative, human epidermal growth factor receptor type 2 (HER2)-positive breast cancers, because most of these patients have been ineligible for the pivotal trials of adjuvant trastuzumab.
METHODS: We performed an uncontrolled, single-group, multicenter, investigator-initiated study of adjuvant paclitaxel and trastuzumab in 406 patients with tumors measuring up to 3 cm in greatest dimension. Patients received weekly treatment with paclitaxel and trastuzumab for 12 weeks, followed by 9 months of trastuzumab monotherapy. The primary end point was survival free from invasive disease.
RESULTS: The median follow-up period was 4.0 years. The 3-year rate of survival free from invasive disease was 98.7% (95% confidence interval [CI], 97.6 to 99.8). Among the 12 relapses seen, 2 were due to distant metastatic breast cancer. Excluding contralateral HER2-negative breast cancers and nonbreast cancers, 7 disease-specific events were noted. A total of 13 patients (3.2%; 95% CI, 1.7 to 5.4) reported at least one episode of grade 3 neuropathy, and 2 had symptomatic congestive heart failure (0.5%; 95% CI, 0.1 to 1.8), both of whom had normalization of the left ventricular ejection fraction after discontinuation of trastuzumab. A total of 13 patients had significant asymptomatic declines in ejection fraction (3.2%; 95% CI, 1.7 to 5.4), as defined by the study, but 11 of these patients were able to resume trastuzumab therapy after a brief interruption.
CONCLUSIONS: Among women with predominantly stage I HER2-positive breast cancer, treatment with adjuvant paclitaxel plus trastuzumab was associated with a risk of early recurrence of about 2%; 6% of patients withdrew from the study because of protocol-specified adverse events. (Funded by Genentech; ClinicalTrials.gov number, NCT00542451.).

Related: Paclitaxel Trastuzumab (Herceptin)


Chang C, Goel HL, Gao H, et al.
A laminin 511 matrix is regulated by TAZ and functions as the ligand for the α6Bβ1 integrin to sustain breast cancer stem cells.
Genes Dev. 2015; 29(1):1-6 [PubMed] Article available free on PMC after 01/07/2015 Related Publications
Understanding how the extracellular matrix impacts the function of cancer stem cells (CSCs) is a significant but poorly understood problem. We report that breast CSCs produce a laminin (LM) 511 matrix that promotes self-renewal and tumor initiation by engaging the α6Bβ1 integrin and activating the Hippo transducer TAZ. Although TAZ is important for the function of breast CSCs, the mechanism is unknown. We observed that TAZ regulates the transcription of the α5 subunit of LM511 and the formation of a LM511 matrix. These data establish a positive feedback loop involving TAZ and LM511 that contributes to stemness in breast cancer.


Aboutorabi A, Hadian M, Ghaderi H, et al.
Cost-effectiveness analysis of trastuzumab in the adjuvant treatment for early breast cancer.
Glob J Health Sci. 2015; 7(1):98-106 [PubMed] Related Publications
BACKGROUND: Evidence from randomized controlled trials (RCTs) has shown a significant survival advantage of trastuzumab. Although extant work in developed countries examined economic evaluation of trastuzumab in adjuvant treatment for early breast cancer based on the 1-year treatment, there is uncertainty about cost-effectiveness of trastuzumab in the Adjuvant Treatment of early breast cancer in developing countries. This study aimed to estimate cost-effectiveness of adjuvant trastuzumab therapy compared to AC-T regimen in early breast cancer in Iran.
METHODS: A cost-effectiveness analysis was performed using a Markov model to estimate outcomes and costs over a 20-year time period using a cohort of women with HER2 positive early breast cancer, treated with or without 12 months trastuzumab adjuvant chemotherapy. Transition probabilities were derived mainly from the BCIRG006 trial. Costs were estimated from the perspective of the Iranian health care system. Both costs and outcomes were discounted by 3%. One-way sensitivity analysis was undertaken to assess the associated uncertainties in the expected output measures.
RESULTS: On the basis of BCIRG006 trial, our model showed that adjuvant trastuzumab treatment in early breast cancer, yield 0.87 quality-adjusted life-years (QALY) compared with AC-T regimen. Adjuvant trastuzumab treatment yielded an incremental cost-effectiveness ratio (ICER) of US$ 51302 per QALY.
CONCLUSION: By using threshold of 3 times GDP per capita, as per World Health Organization (WHO) recommendation, 12 months trastuzumab adjuvant chemotherapy is not a cost-effective therapy for patients with HER2-positive breast cancer in Iran.

Related: Trastuzumab (Herceptin)


Obaidi J, Musallam E, Al-Ghzawi HM, et al.
Vitamin D and its relationship with breast cancer: an evidence based practice paper.
Glob J Health Sci. 2015; 7(1):261-6 [PubMed] Related Publications
BACKGROUND: In oncology research fields, vitamin D has emerged as the most fruitful issue. The previous decade witnessed intensive efforts in connecting vitamin D with risk reduction and progression of various epithelial cancers, especially, breast cancer.
PURPOSE: To evaluate the relationship between vitamin D levels and breast cancer.
METHOD: A comprehensive search of several electronic databases was conducted in Pub Med, MEDLINE, CINAHL, in addition to, web search engine "Google" for abstracts, in order to determine the relationship between vitamin D and breast cancer.
RESULTS: It was found that an increased serum level of vitamin D is associated with decreased risk of breast cancer.
CONCLUSION: It was concluded that vitamin D plays a significant role in protection of breast cancer.


Win AK, Reece JC, Ryan S
Family history and risk of endometrial cancer: a systematic review and meta-analysis.
Obstet Gynecol. 2015; 125(1):89-98 [PubMed] Related Publications
OBJECTIVE: To obtain precise estimates of endometrial cancer risk associated with a family history of endometrial cancer or cancers at other sites.
DATA SOURCES: For the systematic review, we used PubMed to search for all relevant studies on family history and endometrial cancer that were published before December 2013. Medical Subject Heading terms "endometrial neoplasm" and "uterine neoplasm" were used in combination with one of the key phrases "family history," "first-degree," "familial risk," "aggregation," or "relatedness."
METHODS OF STUDY SELECTION: Studies were included if they were case-control or cohort studies that investigated the association between a family history of cancer specified to site and endometrial cancer. Studies were excluded if they were review or editorial articles or not translated into English or did not define family history clearly or used spouses as control participants.
TABULATION, INTEGRATION, AND RESULTS: We included 16 studies containing 3,871 women as cases and 49,475 women as controls from 10 case-control studies and 33,510 women as cases from six cohort studies. We conducted meta-analyses to estimate the pooled relative risk (95% confidence interval [CI]) of endometrial cancer associated with a first-degree family history of endometrial, colorectal, breast, ovarian, and cervical cancer to be: 1.82 (1.65-1.98), 1.17 (1.03-1.31), 0.96 (0.88-1.04), 1.13 (0.85-1.41), and 1.19 (0.83-1.55), respectively. We estimated cumulative risk of endometrial cancer to age 70 years to be 3.1% (95% CI 2.8-3.4) for women with a first-degree relative with endometrial cancer and the population-attributable risk to be 3.5% (95% CI 2.8-4.2).
CONCLUSION: Women with a first-degree family history of endometrial cancer or colorectal cancer have a higher risk of developing endometrial cancer than those without a family history. This study is likely to be of clinical relevance to inform women of their risk of endometrial cancer.

Related: Colorectal (Bowel) Cancer Endometrial (Uterus) Cancer Endometrial Cancer Ovarian Cancer Cervical Cancer


Kotepui M, Piwkham D, Chupeerach C, et al.
Epidemiology and histopathology of benign breast diseases and breast cancer in southern Thailand.
Eur J Gynaecol Oncol. 2014; 35(6):670-5 [PubMed] Related Publications
BACKGROUND: Most palpable breast masses and lesions are benign; less than 30% of women with palpable masses have a diagnosis of cancer.
MATERIALS AND METHODS: The aim of this study was to describe the epidemiological and pathological characteristics of benign breast disease (BBD) and breast cancer (BC) among women who underwent a breast biopsy in the Department of Pathology, Hatyai Hospital, Songkhla, Thailand from January 2003 to December 2011.
RESULTS: Of the 2,532 biopsy reports of breast reviewed, there were 1,846 (72.9%) women with BBD and 686 (27.1%) women with BC. The most common form of breast disease diagnosed was fibroadenoma, followed by BC and fibrocystic change. BBD occurred in women under 40 years of age whereas BC occurred in women over 40 years of age (p < 0.001, OR = 8.629, 95% CI = 6.939 - 10.729). Fibroadenoma occurred in women less than 40 years of age while BC occurred in women over 40 years of age (p < 0.001, OR = 23.906, 95%CI = 18.359 - 31.129). Fibrocystic change occurred in patients less than 40 years of age while BC commonly occurred in patients 40 years of age and over (p < 0.001, OR = 3.865, 95% CI = 2.993 - 4.991).
CONCLUSION: The overall incidence of BBD and BC has increased over the past nine years. It is important for pathologists and oncologists to recognise BBD especially fibroadenoma and fibrocystic change to assess a patient's risk of developing BC and to establish the most appropriate treatment for each case. Moreover, continued vigilance, and mammographic screening should be established for early diagnosis of BC.

Related: Thailand


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