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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Latest Research Publications
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Specialist Journals
Breast Cancer in Pregnancy
Breast Cancer Screening
Familial Breast Cancer
Male Breast Cancer
Paget's Disease of the Breast

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).

Pengelly S, Lambert AW, Khan M, Groome J
Breast lumps in service women.
J R Nav Med Serv. 2014; 100(2):174-8 [PubMed] Related Publications
INTRODUCTION: Breast cancer is uncommon in a young population but it does occur. 80% of breast cancer occurs after 50 yrs of age. This article uses current guidelines and evidence to advise military medical staff on how best to investigate and manage serving-age women presenting with breast symptoms. Male breast changes will be dealt with in a future article.
DIFFERENTIAL DIAGNOSIS: Young females presenting with breast lumps are unlikely to have cancer. In order of frequency the causes are likely to be benign breast change; fibroadenoma; abscesses in 20-30 year olds; cysts in 30-40 year olds, and lastly cancer. The UK sees 48,000 new cases of breast cancer in women every year; breast cancer can also occur in men but is very rare.
DIAGNOSIS AND MANAGEMENT: Management in the deployed, primary and secondary care settings are described. It may be reasonable in young women to wait and see if a lump resolves after the patient's next menstrual cycle before referring the patient. Once referred, current guidelines recommend that all patients are seen by a breast surgeon within two weeks. Within this group, a subgroup of patients with 'red-flag' lumps is identified who need to be referred urgently. The remaining patients have lumps that can be considered non-urgent: however, hospitals will still endeavour to see these patients within two weeks..
CONCLUSIONS: Breast cancer is more difficult to diagnose in the younger patient. In primary care, breast lumps are still simple to manage if the points in this article are followed. Anxious patients can be reassured that cancer is unlikely. However, cancer in this young age group is associated with worse outcomes than breast cancer in older patients.

Cinocca S, Rosini F, Asioli S, et al.
Cytological features of nipple adenoma in scraping smears.
Pathologica. 2014; 106(2):41-4 [PubMed] Related Publications
INTRODUCTION: Nipple adenoma (NA) is a benign epithelial lesion of the breast that can clinically simulate Paget's disease or invasive ductal carcinoma. Therefore, correct pre-operative diagnosis is important for appropriate management.
METHODS: Cytological samples may be obtained by different methods such as fine needle aspiration, nipple discharge or nipple scraping. Herein, the cytological features of three cases of NA are described in which samples were derived from nipple scraping.
RESULTS: In all three cases, patients were adult females presenting with a sub-areolar nodule, showing skin ulceration in 2 of 3 cases. The nipple scraping cytological smears were characterised by a bloody background with epithelial cells arranged in clusters or singularly, showing an irregular nuclei profile. These features could simulate a malignant process. However, at higher magnification, fine nuclear chromatin with inconspicuous nucleoli and presence of myoepithelial cells were helpful to exclude malignancy.
DISCUSSION: NA may present "worrisome" cytological features on smears derived from nipple scraping. Therefore, knowledge of the cytological spectrum of this lesion is important to avoid misdiagnosis.

Magro G, Longo FR, Salvatorelli L, et al.
Lipomatous myofibroblastoma of the breast: case report with diagnostic and histogenetic considerations.
Pathologica. 2014; 106(2):36-40 [PubMed] Related Publications
We report rare case of myofibroblastoma (MFB) of the breast comprised predominantly of a mature fatty component, representing approximately 70% of the entire tumour area. This tumour, designated "lipomatous MFB", should be interpreted as the morphological result of an unbalanced bidirectional differentiation of the precursor mammary stromal cell, with the adipocytic component overwhelming the fibroblastic/myofibroblastic one. Lipomatous MFB is a rare variant of mammary MFB, which can mimic malignancy because of the close juxtaposition of fibroblasts/myofibroblasts with mature adipocytes, resulting in a finger-like infiltrative growth pattern of the former towards the latter. Histogenetic considerations and differential diagnostic problems with other bland-looking spindle cell tumours containing infiltrating fat are provided.

Zhang Q, Wang J, He H, et al.
Trametenolic acid B reverses multidrug resistance in breast cancer cells through regulating the expression level of P-glycoprotein.
Phytother Res. 2014; 28(7):1037-44 [PubMed] Related Publications
Trametenolic acid B (TAB) is the main active composition of Trametes lactinea (Berk.) Pat which possesses antitumor activities. There was no report its antitumor effect through regulating P-glycoprotein (P-gp) so far, due toP-gp over expression is one of the most important mechanisms contributing to the multiple drug resistance phenotype. The present aim was to investigate the effects of TAB on P-gp in multidrug-resistant cells;Paclitaxel-resistant cell line MDA-MB-231/Taxol was established by stepwise exposure for 10 months.MDA-MB-231 cells and MDA-MB-231/Taxol cells were treated with TAB, and their growth was evaluated using MTT assays. Paclitaxel accumulation in the cells was analyzed by high performance liquid chromatogram(HPLC). The activity of P-gp was detected by intracellular accumulation of rhodamine 123 (Rho123), and the protein expression of P-gp was evaluated using western blot. Results indicated that the IC50 of MDA-MB-231/Taxol to paclitaxel (Taxol) was 33 times higher than that of nature MDA-MB-231. TAB increased the intracellular concentration of Taxol and inhibited the activity of P-gp and suppressed the expression of P-gp in MDA-MB-231/Taxol cells. Our present results showed that TAB could reverse Taxol resistance in MDA-MB-231/Taxol cells,mainly inhibiting the activity of P-gp and down-regulating the expression level of P-gp, and then enhancing the accumulation of chemotherapy agents.

Related: Paclitaxel

Bergmann A, da Costa Leite Ferreira MG, de Aguiar SS, et al.
Physiotherapy in upper limb lymphedema after breast cancer treatment: a randomized study.
Lymphology. 2014; 47(2):82-91 [PubMed] Related Publications
Our aim was to compare the responses of physical treatment with or without manual lymphatic drainage (MLD) in lymphedema after breast cancer treatment in a Brazilian population. This was a controlled clinical trial with lymphedema secondary to breast cancer treatment patients that were randomized into either: Group 1 consisting of MLD, skin care, bandaging and remedial exercises; or Group 2 using skin care, bandaging and remedial exercises. Sixty-six patients were randomized and 9 were excluded during the first phase, resulting in a total of 57 patients eligible for analyzes with 28 in Group 1 and 29 in Group 2. The first phase of treatment had an average duration of 24 days (+/- 12.38) and final volume excess average (VE) between limbs was 494.51 ml, corresponding to 29.18% of the initial volume. Volume reduction was highly significant, independent of the intervention (p < 0.001), and both treatments led to an average of percentage volume excess reduction (PVER) of 15.02%. Patients with incomplete range of motion and lymphatic-related fibrotic tissues showed a statistically significant reduction in the percentage of volume excess (p = 0.010; p = 0.009). The presence of arm paresthesia was associated with the lowest therapeutic response (p = 0.024). Both treatment groups demonstrated absolute and relative reductions of excess limb volume, and the addition of MLD did not significantly increase the therapeutic response in women with lymphedema after breast cancer.

Johansson K, Klernäs P, Weibull A, Mattsson S
A home-based weight lifting program for patients with arm lymphedema following breast cancer treatment: a pilot and feasibility study.
Lymphology. 2014; 47(2):51-64 [PubMed] Related Publications
It is well documented that resistance exercise can be performed by patients with breast cancer-related arm lymphedema. The aim of this pilot study was to evaluate the feasibility and safety of a 12-week self-administered weight lifting program for arm and shoulder, and its influence on arm lymphedema status, upper extremity muscle strength, and disability. Twenty-three patients with breast cancer-related arm lymphedema performed the program 3 times/week. The weight resistance levels were individually adjusted for shoulder flexion and adduction, and elbow extension and flexion corresponding to a repetition range of 8-12 repetition maximum. A log book was used to evaluate adherence to the program, wearing of compression sleeve and perceived exertion. Measurements were performed before a 2-week control period without intervention, and before and after intervention, and with arm volume measurements every fortnight to check for adverse events. Results revealed no significant changes during the control period. Adherence to the intervention program was excellent, and two adverse events were registered during the first weeks. After intervention, an increase of shoulder and arm strength (measured by an isometric muscle strength device) was found in all exercises (p = 0.001-0.003). A reduction of excess volume was shown, in ml (p = 0.03) and percentage (p = 0.005), measured by water displacement method. A tendency towards reduction (p = 0.07) of fat tissue in the upper arm (n = 10) in both arms was found measured by MRI. In this pilot study, we concluded that a home-based weight-lifting program performed by patients with breast cancer-related arm lymphedema is feasible and safe providing that the program includes regular follow-up for safety.

Ay AA, Kutun S, Cetin A
Lymphoedema after mastectomy for breast cancer: importance of supportive care.
S Afr J Surg. 2014; 52(2):41-4 [PubMed] Related Publications
BACKGROUND: Lymphoedema resulting from axillary lymph node dissection remains a challenging complication after modified radical mastectomy.
OBJECTIVE: To examine the effects of supportive therapy such as rehabilitation and medical and physical treatment on the development of lymphoedema, in an attempt to establish non-surgical ways to help prevent or reduce it.
METHODS: Patients (N=5 064) who underwent breast cancer surgery in the Department of General Surgery, Ankara Oncology Research and Training Hospital, Turkey, between 1995 and 2010 were included. Data were collected by retrospectively examining all the patients' files and the pre- and postoperative breast cancer follow-up forms.
RESULTS: Of the patients in the study, 19.9% developed lymphoedema. It was significantly less common in patients who participated in physiotherapy than in those who did not, and it was more common in patients with a body mass index (BMI, kg/m²) between 30 and 34.9 than in patients with lower BMIs. Postoperative axillary radiotherapy did not affect the occurrence of lymphoedema.
CONCLUSION: It is clear that the most successful method to reduce the impact of lymphoedema is to prevent it. We believe that educating patients about the risk factors for developing lymphoedema and referring them to postoperative physical therapy and rehabilitation clinics are the most important ways to avoid this distressing condition.

Kemp ML, Andronikou S, Lucas S, Rubin G
Is routine biopsy of sonographically benign breast lesions in black African women under 40 years of age recommended?
S Afr J Surg. 2014; 52(2):36-40 [PubMed] Related Publications
INTRODUCTION: Breast lesions that appear benign on ultrasound examination continue to be biopsied, and no relevant data from Africa exist.
OBJECTIVE: To determine the histological spectrum of sonographically benign lesions measuring >3 cm in women in Johannesburg, South Africa, by age and population group, and establish associations between the histological findings and the size of the lesion and the patient's HIV status and family history.
METHODS: Biopsy results of breast masses that appeared benign on ultrasound were reviewed and the prevalence of histological subtypes was determined according to HIV status and family history. The Kruskal-Wallis test and separate logistic regression analysis were used for determining associations with size.
RESULTS: Sixty-eight of a total of 13 112 patients seen over a 3.5-year-period were included;. There were 73 lesions, of which 65 (89.0%) were benign and 8 (11.0%) malignant. The most common lesions were fibroadenomas (60.3%) and breast carcinomas (6.8%). Size did not predict malignancy (p=0.22). Family history and HIV status were not significant.
CONCLUSION: A high proportion (11.0%) of lesions that appeared benign on ultrasound were malignant. The size of the lesion did not correlate with histological subtype or malignancy. Further research, including training of ultrasonographers in using the Breast Imaging Reporting and Data System (BIRADS) ultrasound lexicon, standardisation of technique with assistance from established users and possibly double reading for a period, is needed to determine whether there is a true high prevalence of malignancy in sonographically benign breast lesions in our community.

Gandini S, Gnagnarella P, Serrano D, et al.
Vitamin D receptor polymorphisms and cancer.
Adv Exp Med Biol. 2014; 810:69-105 [PubMed] Related Publications
It was suggested that vitamin D levels influence cancer development. The vitamin D receptor (VDR) is a crucial mediator for the cellular effects of vitamin D. In fact It has been hypothesized that polymorphisms in the VDR gene affect cancer risk and the relevance of VDR gene restriction fragment length polymorphisms for various types of cancer has been investigated by a great number of studies. However, results from previous studies on the association of VDR polymorphisms with different cancer types are somewhat contradictory, and the role of VDR in the etiology of cancer is still equivocal. We have performed a systematic review of the literature to analyze the relevance of more VDR polymorphisms (Fok1, Bsm1, Taq1, Apa1, and Cdx2) for individual malignancies, including cancer of the skin (melanoma and nonmelanoma skin cancer), ovarian cancer, renal cell carcinoma, bladder cancer, non-Hodgkin lymphoma, leukemia, thyroid carcinoma, esophageal adenocarcinoma, hepatocellular carcinoma, sarcoma, head and neck and oral squamous cell carcinoma. Up to June 2012, we identified 79 independent studies for a total of 52427 cases and 62225 controls. Significant associations with VDR polymorphisms have been reported for prostate (Fok1, Bsm1, Taq1), breast (Fok1, Bsm1, Apa1), colon-rectum (Fok1, Bsm1, Taq1) and skin cancer (Fok1, Bsm1, Taq1). Very few studies reported risk estimates for the other cancer sites. Conflicting data have been reported for most malignancies and at present it is still not possible to make any definitive statements about the importance of the VDR genotype for cancer risk. It seems probable that interactions with other factors such as calcium and vitamin D intake, 25(OH)D plasma levels and UV radiation exposure play a decisive role in cancer risk. To conclude, there is some indication that VDR polymorphisms may modulate the risk of some cancer sites and in future studies VDR genetic variation should be integrated also with prediagnostic indicator of vitamin D status.

Related: Colorectal (Bowel) Cancer Polymorphisms Prostate Cancer Skin Cancer

Grant WB
Solar ultraviolet irradiance and cancer incidence and mortality.
Adv Exp Med Biol. 2014; 810:52-68 [PubMed] Related Publications
The solar ultraviolet-B (UVB)/vitamin D/cancer hypothesis was proposed by the brothers Cedric and Frank Garland in 1980. In 2002, the list was increased to 15 types of cancer using data in the 1999 version of the atlas of cancer mortality rates in the United States. Ecological studies of cancer incidence and/or mortality rates with respect to indices of solar UVB doses have also been reported for Australia, China, France, Japan, and Spain with largely similar findings. In addition, several studies using nonmelanoma skin cancer as the index of solar UVB dose have found reduced internal cancer incidence and/or mortality rates, especially in sunny countries. A study of cancer incidence with respect to 54 categories of occupation in five Nordic countries, using lip cancer less lung cancer as the UVB index, found this index inversely correlated with 14 types of internal cancers for males and four for females. Observational studies with respect to UVB doses and serum 25-hydroxyvitamin D [25(OH)D] concentrations also support the hypothesis. Hill's criteria for causality in a biological system to assess whether solar UVB and vitamin D can be considered causal in reducing risk of cancer. The primary criteria for this analysis include strength of association, consistent findings in different populations, biological gradient, plausibility (e.g., mechanisms), and experimental verification (e.g., randomized controlled trials). The totality of evidence is judged to satisfy the criteria very well for breast and colorectal cancer, and moderately well for several other types of cancer.

Related: Colorectal (Bowel) Cancer Lung Cancer Skin Cancer

Shui I, Giovannucci E
Vitamin D status and cancer incidence and mortality.
Adv Exp Med Biol. 2014; 810:33-51 [PubMed] Related Publications
The role of vitamin D in cancer incidence and mortality has been investigated using several approaches, including using sun exposure as a proxy for vitamin D status, assessing vitamin D intake from food and supplements, using a predicted score to estimate vitamin D status, and directly measuring circulating 25(OH)D. A variety of complementary study designs have been implemented with various strengths and limitations. Although definitive randomized control trial data are lacking, there is strong evidence for a protective relationship of vitamin D and colorectal cancer incidence. Evidence for other cancers is not as consistent. More recently, large pooling projects have begun to investigate rarer cancers, studies have investigated common variation and expression of vitamin D-related genes and their relationships to cancer, and evidence has emerged on the role of vitamin D in cancer survival. Further study is needed to answer important questions that remain about the most affected cancer sites, the timing of vitamin D exposure in relation cancer etiology duringthe life span (e.g., adolescence or adulthood), the dose-response/optimal levels required for the most benefit, and which stages of carcinogenesis (e.g., incidence or progression) are most relevant.

Related: Colorectal (Bowel) Cancer Prostate Cancer

Ordóñez Mena JM, Brenner H
Vitamin D and cancer: an overview on epidemiological studies.
Adv Exp Med Biol. 2014; 810:17-32 [PubMed] Related Publications
In recent years, a rapidly increasing number of studies have investigated the relationship of vitamin D with total cancer and site-specific cancer obtaining diverse findings. In this chapter we provide an overview of epidemiological studies of vitamin D intake, 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D serum levels and vitamin D associated polymorphisms in relation to total and site-specific cancer risk. Overall, epidemiological evidence for total cancer is inconclusive. However, a large number of studies support a relationship of vitamin D with colorectal cancer and to a lesser extent with breast cancer. Findings are inconsistent for other cancers including all other gastrointestinal cancers and prostate cancer. Different vitamin D associated polymorphisms were found to be significantly associated to colorectal, breast and prostate cancer risk.

Related: Colorectal (Bowel) Cancer Polymorphisms Prostate Cancer

Boughey JC, McCall LM, Ballman KV, et al.
Tumor biology correlates with rates of breast-conserving surgery and pathologic complete response after neoadjuvant chemotherapy for breast cancer: findings from the ACOSOG Z1071 (Alliance) Prospective Multicenter Clinical Trial.
Ann Surg. 2014; 260(4):608-14; discussion 614-6 [PubMed] Article available free on PMC after 01/10/2015 Related Publications
OBJECTIVE: To determine the impact of tumor biology on rates of breast-conserving surgery and pathologic complete response (pCR) after neoadjuvant chemotherapy.
BACKGROUND: The impact of tumor biology on the rate of breast-conserving surgery after neoadjuvant chemotherapy has not been well studied.
METHODS: We used data from ACOSOG Z1071, a prospective, multicenter study assessing sentinel lymph node surgery after neoadjuvant chemotherapy in patients presenting with node-positive breast cancer from 2009 through 2011, to determine rates of breast-conserving surgery and pCR after chemotherapy by approximated biologic subtype.
RESULTS: Of the 756 patients enrolled on Z1071, 694 had findings available from pathologic review of breast and axillary specimens from surgery after chemotherapy. Approximated subtype was triple-negative in 170 (24.5%), human epidermal growth factor receptor 2 (HER2)-positive in 207 (29.8%), and hormone-receptor-positive, HER2-negative in 317 (45.7%) patients. Patient age, clinical tumor and nodal stage at presentation did not differ across subtypes. Rates of breast-conserving surgery were significantly higher in patients with triple-negative (46.8%) and HER2-positive tumors (43.0%) than in those with hormone-receptor-positive, HER2-negative tumors (34.5%) (P = 0.019). Rates of pCR in both the breast and axilla were 38.2% in triple-negative, 45.4% in HER2-positive, and 11.4% in hormone-receptor-positive, HER2-negative disease (P < 0.0001). Rates of pCR in the breast only and the axilla only exhibited similar differences across tumor subtypes.
CONCLUSIONS: Patients with triple-negative and HER2-positive breast cancers have the highest rates of breast-conserving surgery and pCR after neoadjuvant chemotherapy. Patients with these subtypes are most likely to be candidates for less invasive surgical approaches after chemotherapy.

Morgan K
Radiotherapy-induced skin reactions: prevention and cure.
Br J Nurs. 2014 Sep 11-24; 23(16):S24, S26-32 [PubMed] Related Publications
This article describes the prophylactic use of Mepitel Film in three breast-cancer patients undergoing adjuvant radiotherapy. Each patient had significant risk factors for developing severe radiotherapy-induced skin reactions. This article details the experience encountered by these patients through their treatment courses, with observations by the review radiographers responsible for the care and support of these patients during their radiotherapy and the patients themselves. The film was found to be easy to use by the clinical team and resulted in a significant reduction in adverse side effects to the skin, with an associated improvement in patient satisfaction. There was found to be a financial benefit with the use of Mepitel Film when compared to the foam dressings often required for wound management if the patients had suffered moist desquamation.

Sawyer A
Complementary exercise and quality of life in patients with breast cancer.
Br J Nurs. 2014 Sep 11-24; 23(16):S18, S20, S22-3 [PubMed] Related Publications
AIM: This literature review will investigate whether complementary exercise interventions can improve quality of life (QoL) for breast cancer patients at all stages of treatment, receiving a variety of cancer therapies.
METHOD: A systematic literature review of academic primary research will be conducted. All relevant evidence found will be analysed and appraised to answer the research question. The term 'complementary' is defined as 'exercises that are additional to the breast-cancer treatment, and specifically not alternative treatments'. The complementary exercise therapies will consider physical movement in all forms.
FINDINGS: Themes were derived from four assessment domains of QoL: social, physical, functional and psychological wellbeing. Every study showed improved overall QoL and six of the nine studies reviewed showed improved overall QoL to statistical significance. According to theme, statistically significant improvements were recorded in two out of nine studies for social wellbeing; five out of nine for psychological wellbeing; four out of nine for physical wellbeing; and none out of six for functional wellbeing.
CONCLUSION: Complementary exercise does improve QoL, but the improvement was statistically significant in two-thirds of the research findings. This proportion is not deemed strong enough as evidence to influence future practice, so further research is recommended.

Glackin M, Gregg T
Screening-detected non-symptomatic breast cancer: a case history.
Br J Nurs. 2014 Sep 11-24; 23(16):S40-7 [PubMed] Related Publications
Alice is a 65 year-old woman who was recalled for further investigations following a routine screening mammogram, which showed a 25 mm mass in her left breast. This case history will report on the further investigations and surgery required to manage this infiltrating ductal carcinoma. The histopathology report will be analysed to provide a rationale for future treatment with radiotherapy, and Alice's expected prognosis will be presented using the Nottingham Prognostic Index. Alice's psychological support needs will identified and the appropriate interventions will be discussed with a particular focus on Alice's history of depression. The supportive and educational role of the breast care nurse and the multidisciplinary team will be highlighted throughout the study.

Related: Cancer Screening and Early Detection

Sedloev T
Prognostic factors and indices in the complex treatment of ductal carcinoma in situ of the breast--review.
Khirurgiia (Sofiia). 2014; (1):23-33 [PubMed] Related Publications
The ductal carcinoma in situ (DCIS) is the most rapidly growing subgroup in the family of the cancerous diseases of breast. The unclarified biology and pathogenesis of the DCIS result in uncertainty in the therapeutic measures, which leads to major variations in its treatment on a global scale. Contrary to the consensus reached for the complex therapeutic measures in the invasive carcinomas of the breast, the therapeutic strategy for the DCIS keeps on giving rise to lively discussions. The application of conservative surgery preserved the total survival rate achieved in patients with DCIS of the breast, however the high frequency of the local relapses remains an essential problem. The presented review of references aims attempting examinations of the following items: the studies on the therapeutic measures, and the application of prognostic systems for risk assessment of a relapse, which leads to individual approach in the choice of the most suitable combination of the therapeutic methods for patients with DCIS of the breast.

Wong J, Xu B, Yeung HN, et al.
Age disparity in palliative radiation therapy among patients with advanced cancer.
Int J Radiat Oncol Biol Phys. 2014; 90(1):224-30 [PubMed] Article available free on PMC after 01/09/2015 Related Publications
PURPOSE/OBJECTIVE: Palliative radiation therapy represents an important treatment option among patients with advanced cancer, although research shows decreased use among older patients. This study evaluated age-related patterns of palliative radiation use among an elderly Medicare population.
METHODS AND MATERIALS: We identified 63,221 patients with metastatic lung, breast, prostate, or colorectal cancer diagnosed between 2000 and 2007 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Receipt of palliative radiation therapy was extracted from Medicare claims. Multivariate Poisson regression analysis determined residual age-related disparity in the receipt of palliative radiation therapy after controlling for confounding covariates including age-related differences in patient and demographic covariates, length of life, and patient preferences for aggressive cancer therapy.
RESULTS: The use of radiation decreased steadily with increasing patient age. Forty-two percent of patients aged 66 to 69 received palliative radiation therapy. Rates of palliative radiation decreased to 38%, 32%, 24%, and 14% among patients aged 70 to 74, 75 to 79, 80 to 84, and over 85, respectively. Multivariate analysis found that confounding covariates attenuated these findings, although the decreased relative rate of palliative radiation therapy among the elderly remained clinically and statistically significant. On multivariate analysis, compared to patients 66 to 69 years old, those aged 70 to 74, 75 to 79, 80 to 84, and over 85 had a 7%, 15%, 25%, and 44% decreased rate of receiving palliative radiation, respectively (all P<.0001).
CONCLUSIONS: Age disparity with palliative radiation therapy exists among older cancer patients. Further research should strive to identify barriers to palliative radiation among the elderly, and extra effort should be made to give older patients the opportunity to receive this quality of life-enhancing treatment at the end of life.

Related: Colorectal (Bowel) Cancer Lung Cancer Prostate Cancer USA

Teo K, Brunton VG
The role and therapeutic potential of the autotaxin-lysophosphatidate signalling axis in breast cancer.
Biochem J. 2014; 463(1):157-65 [PubMed] Related Publications
ATX (autotaxin) is a secreted lysophospholipase capable of catalysing the formation of the bioactive lipid mediator LPA (lysophosphatidate) from LPC (lysophosphatidylcholine). The ATX-LPA signalling axis plays an important role in both normal physiology and disease pathogenesis, including cancer. In a number of different human cancers, expression of ATX and the G-protein-coupled LPARs (lysophosphatidic acid receptors) have been shown to be elevated and their activation regulates many processes central to tumorigenesis, including proliferation, invasion, migration and angiogenesis. The present review provides an overview of the ATX-LPA signalling axis and collates current knowledge regarding its specific role in breast cancer. The potential manipulation of this pathway to facilitate diagnosis and treatment is also discussed.

Related: Signal Transduction

Haber KM, Seagle BL, Drew B, et al.
Genetic counseling for hereditary breast and gynecologic cancer syndromes at a community hospital.
Conn Med. 2014; 78(7):417-20 [PubMed] Related Publications
Genetic screening and testing has been shown to be medically and emotionally beneficial for patients with a personal history or strong family history of breast, ovarian, and/or colorectal cancer. Gynecologic oncologists increasingly utilize genetic screening to modify their care and treatment plans of patients and their offspring based on inherited susceptibility to cancer. The U.S. Preventive Services Task Force (USPSTF) developed specific criteria that consider the medical, psychosocial, and ethical ramifications of genetic counseling of high-risk individuals. Genetic counseling and screening, along with early intervention, is of benefit to women with family histories suggestive of harboring breast cancer antigen (BRCA) mutations. The Western Connecticut Health Network (WCHN) Hereditary Cancer and Genetic Counseling Program provides a comprehensive cancer risk assessment and offers genetic screening as appropriate. This report describes trends in patient referrals, intake, results of genetic testing, and an expansion of services in a community-based genetic counseling program.

Related: Gynacological Cancers

Kuroda N, Fujishima N, Hayes MM, et al.
Encapsulated papillary carcinoma, apocrine type, of the breast.
Malays J Pathol. 2014; 36(2):139-43 [PubMed] Related Publications
The apocrine type of encapsulated papillary carcinoma (ECP-A), of the breast is a rare neoplasm and there are only eight cases reported to date. Herein, we report the ninth case. A 68-year-old Japanese woman presented with a left breast mass. The cytoplasm of the tumour cells showed positive immunostaining for GCDFP-15. Myoepithelial cells were absent within the papillary structures and at the periphery of the lesion. The clinical course of the patient was uneventful 11 months after surgery. We postulate that EPC-A belongs to the molecular apocrine type of breast carcinoma.

Chen BQ, Parmar MP, Gartshore K
Supporting women with advanced breast cancer: the impact of altered functional status on their social roles.
Can Oncol Nurs J. 2014; 24(3):194-203 [PubMed] Related Publications
Despite early detection of breast cancer and the progress of treatment modalities, metastasis-specific symptoms continue to impact women's functional status and daily living. The aim of this study was to explore the experience of altered functional status and social roles of women with advanced breast cancer. Using qualitative descriptive methodology, semi-structured interviews were conducted with 10 women diagnosed with advanced breast cancer and altered functional status attending a tertiary care cancer centre. Results illustrated the adaptive experience of women living with their illness as they reshaped their social roles to fit with their altered functional status and advanced disease. These findings highlight the opportunity for supportive care nursing interventions to facilitate the behavioural and cognitive transitions that are experienced by women with advanced breast cancer and altered functional status. These results may have implications for women with other advanced chronic diseases, though more research is required.

Related: Canada

Lanfranchi A
Normal breast physiology: the reasons hormonal contraceptives and induced abortion increase breast-cancer risk.
Issues Law Med. 2014; 29(1):135-46 [PubMed] Related Publications
A woman gains protection from breast cancer by completing a full-term pregnancy. In utero, her offspring produce hormones that mature 85 percent of the mother's breast tissue into cancer-resistant breast tissue. If the pregnancy ends through an induced abortion or a premature birth before thirty-two weeks, the mother's breasts will have only partially matured, retaining even more cancer-susceptible breast tissue than when the pregnancy began. This increased amount of immature breast tissue will leave the mother with more sites for cancer initiation, thereby increasing her risk of breast cancer. Hormonal contraceptives increase breast-cancer risk by their proliferative effect on breast tissue and their direct carcinogenic effects on DNA. Hormonal contraceptives include estrogen-progestin combination drugs prescribed in any manner of delivery: orally, transdermally, vaginally, or intrauterine. This article provides the detailed physiology and data that elucidate the mechanisms through which induced abortion and hormonal contraceptives increase breast-cancer risk.

Lanfranchi AE, Fagan P
Breast cancer and induced abortion: a comprehensive review of breast development and pathophysiology, the epidemiologic literature, and proposal for creation of databanks to elucidate all breast cancer risk factors.
Issues Law Med. 2014; 29(1):3-133 [PubMed] Related Publications
This article synthesizes breast developmental biology and pathophysiology which cause induced abortion to be a risk for breast cancer with the extant epidemiologic studies that differentiate induced and spontaneous abortions. These studies are rigorously statistically analyzed. It also outlines a proposal for the establishment of much-needed data banks that will be able to supply gold-standard prospective data for all breast cancer risks. We recommend collecting longitudinal data though the use of National Accreditation Program for Breast Centers (NAPBC)-approved mammography centers, which can also be linked to a corresponding tissue bank. The data is greatly needed to control the cost of mass mammography screening by identifying those women who are at higher risk of breast cancer and in need of regular or early screening. It is the authors' hope that through this rigorously referenced review, analysis, and proposal that medical science will be advanced and both medical professionals and the lay public will understand the risks contributing to the continued epidemic of breast cancer both here and abroad.

Kurian AW, Lichtensztajn DY, Keegan TH, et al.
Use of and mortality after bilateral mastectomy compared with other surgical treatments for breast cancer in California, 1998-2011.
JAMA. 2014; 312(9):902-14 [PubMed] Related Publications
IMPORTANCE: Bilateral mastectomy is increasingly used to treat unilateral breast cancer. Because it may have medical and psychosocial complications, a better understanding of its use and outcomes is essential to optimizing cancer care.
OBJECTIVE: To compare use of and mortality after bilateral mastectomy, breast-conserving therapy with radiation, and unilateral mastectomy.
DESIGN, SETTING, AND PARTICIPANTS: Observational cohort study within the population-based California Cancer Registry; participants were women diagnosed with stages 0-III unilateral breast cancer in California from 1998 through 2011, with median follow-up of 89.1 months.
MAIN OUTCOMES AND MEASURES: Factors associated with surgery use (from polytomous logistic regression); overall and breast cancer-specific mortality (from propensity score weighting and Cox proportional hazards analysis).
RESULTS: Among 189,734 patients, the rate of bilateral mastectomy increased from 2.0% (95% CI, 1.7%-2.2%) in 1998 to 12.3% (95% CI, 11.8%-12.9%) in 2011, an annual increase of 14.3% (95% CI, 13.1%-15.5%); among women younger than 40 years, the rate increased from 3.6% (95% CI, 2.3%-5.0%) in 1998 to 33% (95% CI, 29.8%-36.5%) in 2011. Bilateral mastectomy was more often used by non-Hispanic white women, those with private insurance, and those who received care at a National Cancer Institute (NCI)-designated cancer center (8.6% [95% CI, 8.1%-9.2%] among NCI cancer center patients vs 6.0% [95% CI, 5.9%-6.1%] among non-NCI cancer center patients; odds ratio [OR], 1.13 [95% CI, 1.04-1.22]); in contrast, unilateral mastectomy was more often used by racial/ethnic minorities (Filipina, 52.8% [95% CI, 51.6%-54.0%]; OR, 2.00 [95% CI, 1.90-2.11] and Hispanic, 45.6% [95% CI, 45.0%-46.2%]; OR, 1.16 [95% CI, 1.13-1.20] vs non-Hispanic white, 35.2% [95% CI, 34.9%-35.5%]) and those with public/Medicaid insurance (48.4% [95% CI, 47.8%-48.9%]; OR, 1.08 [95% CI, 1.05-1.11] vs private insurance, 36.6% [95% CI, 36.3%-36.8%]). Compared with breast-conserving surgery with radiation (10-year mortality, 16.8% [95% CI, 16.6%-17.1%]), unilateral mastectomy was associated with higher all-cause mortality (hazard ratio [HR], 1.35 [95% CI, 1.32-1.39]; 10-year mortality, 20.1% [95% CI, 19.9%-20.4%]). There was no significant mortality difference compared with bilateral mastectomy (HR, 1.02 [95% CI, 0.94-1.11]; 10-year mortality, 18.8% [95% CI, 18.6%-19.0%]). Propensity analysis showed similar results.
CONCLUSIONS AND RELEVANCE: Use of bilateral mastectomy increased significantly throughout California from 1998 through 2011 and was not associated with lower mortality than that achieved with breast-conserving surgery plus radiation. Unilateral mastectomy was associated with higher mortality than were the other 2 surgical options.

Conway-Phillips R, Janusek L
Influence of sense of coherence, spirituality, social support and health perception on breast cancer screening motivation and behaviors in African American women.
ABNF J. 2014; 25(3):72-9 [PubMed] Related Publications
Despite formidable barriers, some African American women (AAW) engage in breast cancer screening (BCS) behaviors. Understanding individual characteristics that allow AAW to overcome barriers to BCS is critical to reduce breast cancer mortality among AAW. A salutogenic model of health was used to evaluate the influence of sense of coherence, social support, spirituality and health perception on BCS motivation and behaviors in AAW, and to determine differences in these factors in AAW who participate in free BCS programs compared to AAW who do not. Findings revealed that greater levels of spirituality were significantly associated with greater motivation to practice BCS. Further, women who utilized free BCS programs reported significantly greater rates of both performing and of intent to perform breast self examinations (BSE) in the future, obtaining clinical breast exams and mammograms. Findings can inform the development of culturally specific programs to improve the utilization of BCS programs by AAW.

Related: Cancer Screening and Early Detection

Saleh F, Raghupathy R, Asfar S, et al.
Analysis of the effect of the active compound of green tea (EGCG) on the proliferation of peripheral blood mononuclear cells.
BMC Complement Altern Med. 2014; 14:322 [PubMed] Article available free on PMC after 01/09/2015 Related Publications
BACKGROUND: Cancer immunotherapy requires proper manipulation of the immune system, lymphocytes in particular, in order to identify and destroy the cancer cells as non-self. In this study we investigated the effect of the flavonoid present in green tea, namely epigallocatechin-3-gallate (EGCG), on the proliferation of, and IFN-γ production by, peripheral blood mononuclear cells (PBMC) from breast cancer patients stimulated with a mitogen, anti-CD3 and the common breast cancer peptides Her-2/neu, and p53.
METHODS: Blood samples were collected from 25 patients with breast cancer at the Kuwait Cancer Control Centre (KCCC). The patients were newly diagnosed, and had not undergone any treatment or surgery at the time of sample collection. The control group consisted of 25 healthy women age-matched (±5 years) to the patients. PBMC were isolated from the patients and controls, and were cultured separately with the mitogen PHA, anti-CD3 antibodies, and Her-2/neu and p53 in the presence or absence of standardized doses of EGCG. The degree of proliferation and interferon-γ [IFN-γ) release were then analyzed.
RESULTS: EGCG significantly suppressed the proliferation of PBMC in response to stimulation separately with (i) the mitogen, (ii) anti-CD3, and (iii) the cancer antigen peptides. IFN-γ production was also significantly suppressed by EGCG in vitro.
CONCLUSIONS: EGCG appears to have an immunosuppressive effect on the proliferation of PBMC, indicating that EGCG is worth exploring for immunomodulatory effects in autoimmune diseases and tissue transplantation.

Soran A, Kanbour-Shakir A, Bas O, Bonaventura M
A tattoo pigmented node and breast cancer.
Bratisl Lek Listy. 2014; 115(5):311-2 [PubMed] Related Publications
Over the last decade, the axillary SLNB has replaced routine ALND for clinical staging in early breast cancer. Studies describe a potential pitfall in the identification of a true sentinel node during surgery due to lymph node pigmentation secondary to migration of tattoo dye. These pigmented “pseudo-sentinel” nodes, if located superficially in the axilla, may mimic the blue sentinel node on visual inspection, therefore missing the true sentinel node and potentially understaging the patient. Here, we present a case report of a breast cancer patient with a tattoo and discuss the importance of tattoo pigment in the LN (Fig. 1, Ref. 8).

Zemanova M, Rauova K, Boljesikova E, et al.
Analysis of radiation-induced angiosarcoma of the breast.
Bratisl Lek Listy. 2014; 115(5):307-10 [PubMed] Related Publications
Breast angiosarcoma may occur de novo, or as a complication of radiation therapy, or chronic lymphedema secondary to axillary lymph node dissection for mammary carcinoma. Both primary and secondary angiosarcomas may present with bruise like skin discoloration, which may delay the diagnosis. Imaging findings are nonspecific. In case of high-grade tumours, MRI may be used effectively to determine lesion extent by showing rapid enhancement, nevertheless earliest possible diagnostics is crucial therefore any symptoms of angiosarcoma have to be carefully analysed. The case analysed here reports on results of 44-year old premenopausal woman who was treated for a T1N1M0 invasive ductal carcinoma. After a biopsy diagnosis of carcinoma, the patient underwent quadrantectomy with axillary lymph node dissection. She received partial 4 cycles of chemotherapy with adriamycin and cyclophosphamide, followed by radiation treatment. Thereafter, a standard postoperative radiotherapy was applied at our institution four months after chemotherapy (TD 46 Gy in 23 fractions followed by a 10 Gy electron boost to the tumour bed). Adjuvant chemotherapy was finished six months after operation, followed by tamoxifen. Follow up: no further complications were detected during regular check-ups. However, 12-years later, patient reported significant changes at breast region which was exposed to radiation during treatment of original tumour. In this article, we describe the clinical presentation, imaging and pathological findings of secondary angiosarcoma of the breast after radiotherapy (Fig. 2, Ref. 26).

Thittai AK, Xia R
An analysis of the segmentation threshold used in axial-shear strain elastography.
Ultrasonics. 2015; 55:58-64 [PubMed] Article available free on PMC after 01/01/2016 Related Publications
Axial-shear strain elastography was introduced recently to image the tumor-host tissue boundary bonding characteristics. The image depicting the axial-shear strain distribution in a tissue under axial compression was termed as an axial-shear strain elastogram (ASSE). It has been demonstrated through simulation, tissue-mimicking phantom experiments, and retrospective analysis of in vivo breast lesion data that metrics quantifying the pattern of axial-shear strain distribution on ASSE can be used as features for identifying the lesion boundary condition as loosely-bonded or firmly-bonded. Consequently, features from ASSE have been shown to have potential in non-invasive breast lesion classification into benign versus malignant. Although there appears to be a broad concurrence in the results reported by different groups, important details pertaining to the appropriate segmentation threshold needed for - (1) displaying the ASSE as a color-overlay on top of corresponding Axial Strain Elastogram (ASE) and/or sonogram for feature visualization and (2) ASSE feature extraction are not yet fully addressed. In this study, we utilize ASSE from tissue mimicking phantom (with loosely-bonded and firmly-bonded inclusions) experiments and freehand - acquired in vivo breast lesion data (7 benign and 9 malignant) to analyze the effect of segmentation threshold on ASSE feature value, specifically, the "fill-in" feature that was introduced recently. We varied the segmentation threshold from 20% to 70% (of the maximum ASSE value) for each frame of the acquisition cine-loop of every data and computed the number of ASSE pixels within the lesion that was greater than or equal to this threshold value. If at least 40% of the pixels within the lesion area crossed this segmentation threshold, the ASSE frame was considered to demonstrate a "fill-in" that would indicate a loosely-bonded lesion boundary condition (suggestive of a benign lesion). Otherwise, the ASSE frame was considered not to demonstrate a "fill-in" indicating a firmly-bonded lesion boundary condition (suggestive of a malignant lesion). The results demonstrate that in the case of in vivo breast lesion data the appropriate range for the segmentation threshold value seems to be 40-60%. It was noted that for a segmentation threshold within this range (for example, at 50%) all of the analyzed breast lesion cases can be correctly classified into benign and malignant, based on the percentage number of frames within the acquisition cine-loop that demonstrate a "fill-in".

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